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What does the stroma provide?

- mechanical support
- intercellular signalling
- nutrition


What is a desmoplastic reaction?

Fibrous stroma formation due to induction of connective tissue fibroblast proliferation by growth factors from the tumour cells


What does the stroma contain? (in a desmoplastic reaction)

- cancer-associated fibroblasts
- myofibroblasts (see puckering of skin)
- blood vessels (blood to tumour)
- lymphatics


What are the clinical complications of tumours dependent on?

- location
- cell of origin
- behaviour


In what general classifications can effects of tumours be?

- local
- metabolic
- due to metastases


What are some LOCAL complications of tumours?

- compression
- destruction


Compression is a local complication of tumours. Describe this

Displacement of adjacent tissue

- benign eg. pituitary adenomas obliterate adjacent functioning pituitary tissue leading to hypopituitarism


Destruction is a local complication of tumours. Describe this


Rapidly fatal is vital structures are invaded e.g. artery

Mucosal surfaces - ulceration eg. GI - anaemia


Describe tumour type-specific METABOLIC complications of tumours?

- well differentiated endocrine tumours can retain functional properties
- autonomous
- number of cells exceeds normal organ
- eg. thyrotoxicosis in thyroid adenoma
- if inappropriate (paraneoplastic) eg. ACTH/ADH in small cells lung cancer


Give some non-specific METABOLIC complications of tumours

- cachexia
- warburg effect
- neuropathies
- myopathies
- venous thrombosis


What is cachexia?

Profound weight-loss despite apparently adequate nutrition

Tumour-derived humoral effects that interfere with protein metabolism


What is the Warburg effect?

Produces energy by high rate of glycolysis with fermentation of lactic acid

Used in imagine - PET scanning (FDG uptake)

Observation seen in most cancer cells