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CAN > The lymphatic system > Flashcards

The lymphatic system Flashcards

1
Q

What is the lymphatic system made up of?

A

Blind ending capillaries and lymph nodes which return lymph to the venous system.

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2
Q

Do the capillaries have valves? How fast is the flow?

A

Yes but retrograde flow can still occur. Fluid travels slowly through the 15-75 micrometre capillaries

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3
Q

What does the superficial system drain and where to?

A

Skin
Mucus membrane
Serous linings of cavities
Drains in parallel with veins.

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4
Q

What does the superficial system drain an where to?

A

Drains organs in parallel with arteries to the para-aortic nodes

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5
Q

Where does all the system drain to?

A

Superficial joins deep and drain into cysterna chyli and thoracic duct which joins the SCV.

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6
Q

How much fluid travels through the system a day?

A

8L.day at a low pressure

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7
Q

What does the cysterna chyli drain?

A

Lower limbs, R+L lumbar and intestinal trunks

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8
Q

What drains into the Left thoracic duct?

A

Cysterna chyli, L intercostal, L bronchomediastinal, L subclavian and L jugular drainage

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9
Q

Where does the left thoracic duct ultimately drain to?

A

L SCV

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10
Q

What does the R thoracic duct drain?

A

R subclavian, jugular trunk, bronchomediastinal nodes into the R SCV.

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11
Q

What imaging method is used to view the lymphatic system?

A

Lymphangiogram

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12
Q

Where do the posterior intercostal vessels lie?

A

Posterior to the diaphragm

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13
Q

What is the issue with benign tumours?

A

They do not metastasise but the cause pressure on local structures

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14
Q

What can tumours erode through?

A

Membranes and compartments into cavities

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15
Q

What are the characteristics of a benign tumour?

A

Small, well differentiated and demarcated, slow growing, non-invasive and non-metastasising

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16
Q

What are the characteristics of a malignant tumour?

A

Large, Poorly differentiated and demarcated, rapidly growing, haemorrhage, necrosis, locally invasive and metastasising.

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17
Q

How can cancer spread?

A
  • Locally through direct extension into adjacent tissues and cavities.
  • Lymphatic spread through vessels and nodes in a predictable manner.
  • Haematogenous spread, particularly through veins.
  • Metastatic cascade
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18
Q

Why do secondary tumours have some appearance of the primary tumour?

A

Cells have memory

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19
Q

What causes a primary tumour in the neurocranium?

A

CT and glial cells.

Can’t get a primary cancer of neurons in the brain

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20
Q

How does local spread occur?

A

Penetration into natural space through BM. Associate with SEEDING in cavities.

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21
Q

Which is the most common cavity for seeding?

A

Peritoneal due to large size, large volume of epithelial tissue and good blood supply.

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22
Q

What results from seeding in the peritoneal cavity?

A

Omental cake appearance on CT

ASCITES as increased fluid in cavity, causing discomfort from the raised pressure.

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23
Q

What is seeding?

A

The spread of cancer cells to neighbouring tissues and their subsequent growth as a malignancy, usually caused by a biopsy.

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24
Q

How do ovarian cancer pts present?

A

Unmovable weight gain and hard abdomen.

25
Q

What are the implications of lung cancer on local structures?

A

Cause veins to collapse = CV symptoms

Compress sympathetic chain, SCV and SVC

26
Q

Why does lung cancer grow well?

A

High O2 and can easily invade the spongy lung tissue

27
Q

Why does a tumour of the maxillary sinus grow fast?

A

Due to the space and O2 supply. Affects young males most.

28
Q

Where will a tumour of the maxillary sinus spread to and what will this cause?

A

Paranasal sinuses = blocked nose
Alveolar bone = toothache
Orbit = double vision (spreads by fracturing the orbit floor that lies above maxillary sinus)

29
Q

What does pressure on the Recurrent laryngeal nerve cause?

A

Vocal cord paralysis affecting voice and breathing

30
Q

Why might clubbing arise from a tumour on the right side of the midline of the thorax?

A

Pressure on SVC impairs return to R atrium and causes congested neck veins

31
Q

How does cancer spread through lymphatics?

A

Tumours have no lymphatic drainage so rely on adjacent systems. Can skip nodes due to occlusion or venous-lymph anastomoses.

32
Q

Why is the predictable pattern of lymphatic spread important?

A

Determines prognosis, treatment and what needs removing

33
Q

Why are regional nodes important?

A

They can act as barriers to destroy the malignant cells via immunological responses

34
Q

What happens when an immunological response takes place in a node?

A

Localised hyperplasia

35
Q

What does an enlarged node signify?

A

Hard and hurts = infection

Dense and painless - malignant

36
Q

What is the sentinel node?

A

The first node in a regional basin to be involved in the spread. A biopsy of this node helps to predict spread.

37
Q

How does a) breast b) melanoma and c) colon cancer spread through the lymphatic system?

A

a) Breast = superficial with veins
b) Melanoma = superficial with veins
c) Colon = Deep

38
Q

What increased a males risk of breast cancer?

A

Gynaecomastia and use of steroids

39
Q

Where is the breast located?

A

It is a modified sweat gland that lies within the superficial fascia over pectoralis major, ribs 2-6 and cooper’s ligaments.

40
Q

What anatomical relations is it important to consider in breast cancer?

A

Near midline
Has an axillary tail
The centre of the breast is midclavicular

41
Q

Which women are more at risk of breast cancer?

A

Nullipara women. Glands are small until lactation and surrounded by fat and CT.
More aggressive in younger women than postmenopausal

42
Q

What is the lateral blood supply of the breast?

A

Axillary A and V

43
Q

What is the medial blood supply to the breast?

A

Internal thoracic A and V / Mammary A

Intercostal branches

44
Q

What is the lymphatic drainage of the breast?

A

Follows veins

45
Q

Where does breast cancer spread and metastasis to?

A

Axilla, abdomen, bone and contralateral breast. Spreads locally through thoracic wall

46
Q

What may result from surgical removal of breast cancer?

A

Surgical oedema if the lymphatic drainage is removed

47
Q

Why is haematogenous spread more common in veins?

A

The walls are thinner and so more easily invaded.

48
Q

Which veins allow easy access to arterioles?

A

Pulmonary veins

49
Q

What type of drainage does the liver receive?

A

Portal drainage = access to capillary beds. Liver metastasis common

50
Q

How does lung cancer spread through vessels?

A

Easy access into the thin walled arterioles

51
Q

Where does the vertebral column drain to?

A

Paravertebral venous plexus

52
Q

Where does the colon drain to?

A

Ascending and transverse via SMV and transverse and descending and sigmoig via IMV to the liver via PORTAL drainage.

53
Q

How does prostate cancer spread?

A

Via paravertebral veins to sacrum, vertebrae, pelvis

54
Q

Which cancers commonly metastasise in bone?

A

Prostate, breast, lung and thyroid

55
Q

How does bone metastasis present?

A

Pain
Increased blood calcium
Spinal cord compression as spreads to spine
Causes pathological fractures

56
Q

Where do brain metastasis occur?

A

Access is limited by BBB but can spreead to meninges, parenchyma, cerebrum, brainstem, cerebellum. Metastasis are more common than primary brain tumours.

57
Q

Where does lung cancer spread to? How does this present?

A

Mediastinum and hilar = CV symptoms present first and then pleural effusion which will then cause respiratory symptoms

58
Q

What are the three main types of intervention?

A
  • Radiotherapy = Irradiate tumour and minimises damage to normal tissue. Damages skin superficial to tumour with a 3rd degree burn.
  • Chemotherapy = cytotoxic, hormonal, immunotherapy. Administered via veins but need to be fit and healthy for chemo
  • Surgery to relieve symptomology of compression and to remove lymph nodes. May be curative but risk of returning if micro cells left behind.

CAN (16 decks)

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