Effects of Malignant Tumors

1. Effects of Malignant Tumors

2. Tumors produce ill effects by different ways: 1. Mechanical pressureand obstruction: They are more pronounced and complete than in benign tumors. 2. Destruction of the tissue: Malignant tumors and their metastasis infiltrate and destroy vital structures. 3. Hemorrhage: Carcinoma of the surface epithelium usually ulcerates and bleeds.

3. 4. Secondary infection: • All ulcerative cancers undergo secondary bacterial infection, and this aggravates the clinical condition. • Obstruction also is complicated by infection. • Bronchopneumonia due to aspiration of course food and infected saliva is the commonest cause of death in cancer mouth.

4. 5. Starvation: • Direct nutritional effect due to failure of food intake in cases of cancer mouth, esophagus and stomach. • In cancer colon it is due to diarrhea and severe malabsorption syndrome. 6. Pain: In advanced cancer pain may be severe leading to anxiety and insomnia.

5. 7. Hematological disorders: • Anemia is common due to hemorrhage, malabsorption and bone marrow replacement. • Neutrophilleucocytosis is found in progressive cancers and sometimes eosinophilia. 8. Cachexia: Weakness and anemia (due to secretion of interleukin (IL-1) and tumor necrosis factor (TNF) probably by macrophages within the tumor).

6. 9. Immunological effects: • There is little impairment in immune response except in cases of lymphoma, multiple myeloma, leukemia. 10. Amyloidosis: • It is a common feature in Hodgkin's disease, multiple myeloma, renal cell carcinoma and medullary carcinoma of thyroid.

7. 11. Nephrotic syndrome: with IgG, IgM deposits on the glomerular basement membrane. 12. Carcinomatous syndromes or para-malignant syndromes: • A variety of syndromes is association with neoplasms which are not explained in terms of infiltration either by the primary tumor or its metastasis. • It is first described in relation to bronchogenic carcinoma.

8. This includes: A. Neuropathic effect: • Cancers lung, stomach, breast and ovary may be accompanied by progressive destruction of neurons in the C.N.S. • It leads to a clinical picture of “corticocerebellar degeneration”, “peripheral neuritis” or “encephalomyelitis”.

9. B. Myopathic effect: • Oat cell lung carcinoma, breast and colon carcinoma may produce “myopathy” involving the limb girdles and the proximal limb muscles. C. Dermatological effects: • A wide spread skin lesion is the first presentation of internal neoplasm. e.g: “acanthosisnigricans” in which profuse, black, warty lesions develop in the axillae, goins in case of adenocarcinoma of the stomach, pancreas, and lung.

10. D. “Thrombo phlebitis migrans”: • It occurs commonly in cases of deep seated cancer e.g. pancreas, lung, stomach. • This is characterized by transient venous inflammation followed by thrombosis which migrates from one area of the body to another. E. Afibrinogenemia: • It is a bleeding syndrome due to fibrinolysis rarely occurs in visceral cancer.

11. F. Pulmonary osteoarthropathy: • This is seen in bronchogenic carcinoma, mesothelioma of pleura, chronic suppurative lung diseases (bronchiectasis, lung abscess empyema). • There is marked finger clubbing with pain and swelling of the wrists and ankles, sometimes it simulates rheumatoid arthritis.

12. G.Hormonal effect: • These come into 2 categories: • Tumors of endocrine tissue secreting their own hormones. • Tumors of non endocrine origin producing a hormonal effect by the inappropriate secretion of a hormone or hormone like substances.

13. CAUSES OF DEATH IN MALIGNANT TUMOURS • A combination of the following factors causes patient death: I. Anemia: Caused by: • Metastasis in bone marrow. • Ulceration and bleeding of the tumor. • Hemolysis induced by autoimmune mechanism. • Folic acid deficiency as it is utilized by the tumor • Hypoferremia of unknown cause.

14. II. Malnutrition: • Tumors of the alimentary tract interfere with food intake, digestion and absorption. III. Renal failure: • Caused by tumors of the genito-urinary system and rectum due to urinary tract obstruction. IV. Obstructive jaundice and hepatic failure: • Caused by tumors of the liver, biliary tract and pancreas.

15. V. Increased intra-cranial tension and pressure on vital centers: • Caused by intra-cranial tumors. VI. Chronic toxemia: • Due to secondary bacterial infection in ulcerated tumors. VII. Malignant cachexia: • State of general weakness and wasting induced by toxic effect of the necrotic tumor cells, malnutrition, anemia, bacterial toxins and functional failure of different organs.

16. PROGNOSIS IN MALIGNANT TUMOURS • Prognosis of malignant tumors depends on: • Type of the tumor: • Certain malignant tumors are more aggressive than others e.g. malignant melanoma has a poor prognosis than squamous cells carcinoma. • Tumor site: • Tumors in internal & vital organs are more dangerous than tumors in superficial organs & skin.

17. Age of the patient: • Tumors of young age are worse in prognosis because of the rapid growth, spread and recurrence. • Tumor stage: • The extent of spread and the presence or absence of metastasis is the most important factors in prognosis. • Tumor grade: • Histological grading: Well differentiated tumors are usually of better prognosis.

18. Host immune responses: • Cellular immunity is believed to play as the defense mechanism against tumors through cytotoxic T cells and activated macrophages. • Tumor radiosensitivity: • According to the response of tumors to radiation, they are divided into 3 groups: • Radiosensitive as lymphoma • Radioresponsive as breast carcinoma • Radioresistant as sarcomas

19. Clinical staging of carcinoma: I. According to the size and degree of spread carcinomas are classified into: • Stage 0: Tumor of microscopic size. • Stage I: Tumor confined to the organ of origin. • Stage II: Local spread not interfering with surgical removal. • Stage III: Fixation to the surrounding structures. • Stage IV: Distant metastasis.

20. II. T.N.M. system: • T for the tumor size and local spread. • N regional lymph node affection. • M for distant metastasis. • Each estimated by 0, 1, 2, 3, 4 degrees.

21. LABORATORY DIAGNOSIS OF CANCER • Biopsy: • Determine the presence or absence of tumor, its histological classification, degree of cellular differentiation, extension of the tumor and presence or absence of metastasis in the draining lymph nodes. • The specimen has to be selected properly and preserved in a fixative medium as 10% formalin to give a reliable diagnosis. • Paraffin sections stained by H&E are prepared and examined. • Sometimes frozen sections are done on fresh biopsy material

22. Fine needle aspiration: • Aspiration of cells and fluids from tumor masses e.g. breast, thyroid and lymph node. • The aspirated cells are smeared, stained and examined. • Cytologic smears: • Microscopic study of dysplastic and malignant cell in smears prepared from body fluids and secretions and stained by Papanicolaou stain. • The procedure is used in diagnosis of cervical, uterine, bronchial, bladder and gastric carcinomas ... etc.

23. Immunocytochemistry: • For detection of tumor markers by monoclonal antibody. Examples: (a) Carcinoembryonic antigen (CEA): Detected in particularly adenocarcinomas of the gastrointestinal tract. (b) Cytokeratin in epithelial tumors. (c) Prostate specific antigen in prostatic carcinoma. (d) S100 protein in neurogenic and melanocytic.

24. Tumor markers: • Tumor-derived or tumor-associated molecules that can be detected in blood or other body fluids. • They are used to confirm diagnosis and determine the response to therapy. Examples: (a) Carcinoembryonic antigen in G.I.T. and breast carcinoma. (b) Alpha-fetoprotein in hepatic carcinomas. (c) Prostatic acid phosphatase in prostatic carcinoma. • Flow cytometry: • Measurement of the DNA content of tumor cells by flow cytometry.