EFFECTS OF TUMOUR ON THE HOST

LOCATION,

SIZE,

LOCAL INVASION,

FUNCTIONAL ACTIVITY ( HORMONE )

BLEEDING = Meleana, Hematuria. SECONDARY INFECTION - ULCERATION,

TUMOURS PRODUCE:- Morbidity and mortality,

- All masses require anatomic evaluation

ACUTE SYMPTOMS:

= RUPTURE

= INFARCTION

CANCER CACHEXIA:

… Loss of body fat

… Weakness

… Anorexia

… Anemia;

• TNF

• IL - 1,

• IFN -gamma

? others

Clinical features of tumours

“Symptom complexes in cancer-bearing

patients that cannot readily be explained,

either by the local or distant spread of the

tumor or by the elaboration of hormones

indigenous to the tissue are known as

paraneoplastic syndromes”.

10 % of patients with cancer

May be an early manifestation of occult neoplasm,

May be significant clinical problems,

May mimic metastatic disease;

PARANEOPLASTIC SYNDROMES:

Paraneoplastic syndromes

Syndrome Mechanism Example

Cushing's Syndrome ACTH-like substance Lung (oat cell)

carcinoma

HypercalcemiaParathormone-like

substance

Lung (squamous cell)

carcinoma

HyponatremiaInappropriate ADH

secretion

Lung (oat cell)

carcinoma

PolycythemiaErythropoietin-like

substance Renal cell carcinoma

Trousseau's

SyndromeHypercoagulable state Various carcinomas

Hypoglycemia Insulin-like substance Various carcinomas

and sarcomas

Carcinoid Syndrome5-hydroxy-indoleacetic

acid (5-HIAA)

Metastatic malignant

carcinoid tumors

"T" score is based upon the tumor size.

"N" score indicates the extent of lymph node

involvement.

"M" score indicates whether distant

metastases are present.

Degree of Differentiation,

Grade - I : Well differentiated ( > 75% ),

Grade - II : Moderately ( 50 - 75%),

Grade - III : Poorly ( 25 - 50%),

Grade - IV : Anaplastic ( < 25%)

Grading:

HISTOPATHOLOGY:

Clinical data - Important,

FNAC: Fine Needle Aspiration Cytology

Biopsy Adequate,

Excision Representative,

Properly preserved

Frozen Section

Diagnosis of Cancer

SCCN

O

R

M

A

L

Mild Dysplasia

SCC in situ

Adequate ………..Representative Biopsy

2. CYTOLOGIC METHOD:

Fine Needle Aspiration Cytology ( FNAC )

… Breast, Thyroid gland, Lymph nodes,

… Deeper tissues - Imaging assistance,

Exfoliative Cytology:

… Pap Smear ( Papanicolaou )

- Vaginal Smear = Carcinoma Cervix,

… Body fluids - Pleural fluid, Ascitic

fluid, Sputum, Bronchial washings….etc.

Diagnosis of Cancer

M

A

M

M

O

G

R

A

M

Diagnosis Of Undifferentiated Malignant Tumours,

Categorization Of Leukemias & Lymphomas,

Detection Of Site Of Origin In Metastatic Tumours,

Detection Of Molecules Of Prognostic Significance

( E.g., ER, PR)

Cytokeratine +ve

Vimentine +ve

1. Hormones:… HCG - Trophoblastic tumours,

… Calcitonin - Medullary carcinoma

of thyroid gland,

4. Tumour Markers:( Biochemical Indicators of Tumours)

2. Oncofetal Antigens:

… Alpha - fetoprotein -

= Hepatocellular carcinoma,

= Testicular tumours;

4. Tumour Markers:( Biochemical Indicators of Tumours)

3. Isoenzymes:

* Prostatic acid phosphatase -

--- Carcinoma prostate,

* Neuron specific enolase -

--- Neuroblastoma,

--- Carcinoma lung,

4. Tumour Markers:( Biochemical Indicators of Tumours)

4. Specific Proteins:

* Immunoglobulins -

--- Multiple myeloma,

* Prostate specific antigen

--- Carcinoma prostate,

4. Tumour Markers:( Biochemical Indicators of Tumours)

5. Glycoproteins:

* Ca - 125 - Ovarian tumours,

* Ca - 19-9 - Tumours of colon,

pancreas,

* Ca - 15-3 - Carcinoma Breast;

Tumour Markers: ( contd …)

Surgery Recurrence

Clinical

presentation

Time [ months ]Asymptomatic

Symptomatic

if untreated

Blood concentration of tumour marker