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Flashcards in Disorders of Growth Deck (32)
1

NEOPLASM

"A NEOPLASM is an abnormal mass of tissue, the growth of which exceeds and is unco-ordinated with that of normal tissues, and which persists in the same excessive manner after cessation of the stimuli which evoked the change."
- Sir Rupert Willis, 1960

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NEOPLASIA

NEOPLASIA is the process by which a neoplasm is formed.

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TUMOUR

TUMOUR literally means swelling, but conventionally is used as a synonym for neoplasm

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BEHAVIOUR of Tumours

A benign tumour grows by expansion, displacing adjacent tissue
A malignant tumour grows by infiltration of local tissues, and spreads to other parts of the body
Primary tumour
original malignant tumour
Secondary tumours
"offspring" of a primary malignant tumour

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SPREAD OF MALIGNANT TUMOURS

Local - direct invasion
Distant – metastasis

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ROUTES OF METASTASIS

lymphatics
blood
transcoelomic
along epithelial-lined spaces
within epithelium

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METASTASIS VIA LYMPHATICS

tumour may directly invade lymphatics
tumour emboli filtered out, then grow, in lymph nodes
typical of epithelial malignancy

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METASTASIS VIA BLOOD

tumour may invade blood vessels
emboli filtered out by capillary beds, eg liver, lung
typical of stromal malignancy and later stages of epithelial malignancy

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METASTASIS VIA TRANSCOELOMIC SPREAD

peritoneal, pleural

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METASTASIS VIA EPITHELIAL-LINED SPACES

bronchiolo-alveolar carcinoma of lung

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METASTASIS WITHIN EPITHELIUM

Paget's disease of nipple, vulva and anus

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PARTICULAR SITES OF METASTASES - LIVER

liver: GIT carcinomas, GUS, bronchus, breast

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PARTICULAR SITES OF METASTASES - LUNG

lungs: sarcoma; carcinoma of thyroid, breast, kidney, bronchus, etc.

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PARTICULAR SITES OF METASTASES - BONE

bone: carcinoma of breast, thyroid, bronchus, prostate, uterus

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PARTICULAR SITES OF METASTASES - BRAIN

brain: carcinoma of bronchus

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PARTICULAR SITES OF METASTASES - ENDOCRINES

endocrines: carcinoma of bronchus often goes to adrenals

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PARTICULAR SITES OF METASTASES - SKIN

skin: malignant melanoma; clear cell carcinoma of kidney

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BENIGN EPITHELIAL TUMOURS

Adenoma
Papilloma
Cystadenoma
Polyp - a mass attached to a surface, which may or may not be a neoplasm

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MALIGNANT TUMOURS

Cancer - any malignant tumour
Carcinoma - a malignant tumour of epithelial tissue
Sarcoma - a malignant tumour of stromal tissue

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MESENCHYMAL TUMOURS

are named according to the cell type, with a suffix
-oma if benign
-sarcoma if malignant

e.g. lipoma and liposarcoma

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LEUKAEMIA

neoplastic proliferation of haemopoietic stem cells
neoplastic cells spill over into the blood stream
all regarded as malignant

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LYMPHOMA

malignant proliferation of cells of lymphoid tissue
Two types
Hodgkin's disease
mixture of cells, including Reed-Sternberg cells
non-Hodgkin's lymphoma
lacks the cellular mixture of Hodgkin's disease

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TERATOMA

arises from "totipotential" cells, producing tissues representing all three germ cell layers
ovary (usually benign)
testes (usually malignant)
midline (sequestered primitive cells)

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PRECURSORS OF MALIGNANCY

PREMALIGNANT CONDITIONS
lesions with an increased risk of the development of invasive tumour
can be non-neoplastic or neoplastic

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PREMALIGNANT CONDITIONS NON-NEOPLASTIC

chronic inflammation
varicose leg ulcers can lead to skin cancer
cirrhosis of the liver
hepatocellular carcinoma
chronic ulcerative colitis
adenocarcinoma of the large intestine
xeroderma pigmentosum
squamous cell carcinoma of the skin

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PREMALIGNANT CONDITIONS NEOPLASTIC

familial polyposis coli
autosomal dominant
1000s of large intestinal adenomas
carcinoma inevitable
intra-epithelial neoplasia:
nuclear changes of carcinoma, without breaching basement membrane - "dysplasia" or "carcinoma-in-situ" - important in uterine cervix, vulva, bronchus, etc.

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TUMOUR GRADING

an assessment of the degree of differentiation of a tumour
correlates with how aggressive the tumour behaves
only relevant for malignant tumours
usually define 3 or 4 grades

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TUMOUR STAGING

based on three main features
size of primary tumour
extent of lymph node disease
any blood-borne metastasis
sometimes quoted as "TNM"
The TNM system
T = size of tumour (T1 to T4)
N = extent of lymph node involvement (N0 to N3)
M = distant metastasis (M0 to M1)
criteria different for each tumour
better prediction of outcome than grade, for most tumours

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THE EFFECTS OF TUMOURS

displacement or destruction of normal structures
excess “normal” function
paraneoplastic phenomena

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EFFECTS OF BENIGN TUMOURS

Mechanical pressure

Obstruction

Ulceration

Infection

Rupture of cystic neoplasm

Hormone production

Malignant change

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EFFECTS OF MALIGNANT TUMOURS

All the physical effects of benign tumours
Tissue destruction

Haemorrhage
any cancer breaching a vessel wall
Secondary infection
bacterial invasion of necrotic tumour
Cachexia
severe weight loss
increased metabolic rate
tissue necrosis factor
Pain
Anaemia
haemorrhage
bone marrow replacement
haemolysis
Paraneoplastic syndromes

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PARANEOPLASTIC SYNDROMES

Ectopic hormone production
carcinoma of bronchus may cause Cushing's syndrome, inappropriate ADH secretion, secretion of PTH analogue
fibrosarcoma can produce hypoglycaemia
renal carcinoma can release erythropoetin
Peripheral neuropathy, cerebellar degeneration, myopathy
Thrombophlebitis migrans
carcinoma of bronchus (5%) and pancreas (30%)
Acanthosis nigricans
caused by epidermal growth factor analogue
Nephrotic syndrome
proteinuria, hypoalbuminaemia, generalised oedema
complexes of tumour antigen and host antibody deposited in glomerulus
Finger clubbing
Hypertrophic pulmonary osteoarthropathy
Non-bacterial thrombotic endocarditis