DR SHWE SIN

FMHS
It is the effects of neoplasms
on the patients
Tumor-Host interactions are
a two way street
Any tumor even benign one
may cause morbidity and
mortality


Because of:
1. Location and impingement on adjacent
structures (site and size)
2. Functional activity such as hormone
synthesis or the development of
paraneoplastic syndromes
3. Bleeding and infections
4. Symptoms results from rupture or
infarction
5. Cachexia or wasting
I. Local effects:
1) Location- impingement and obstruction
2) Bleeding, ulceration, secondary
infection
3) Infarction (due to torsion)
4) Functional activity (hormone
production)
II. Cachexia
III. Paraneoplastic syndromes

Location is important: Impingement and
obstruction on adjacent structures
e.g - A small (1 cm) pituitary adenoma can
compress and destroy the surrounding normal
gland
- A 0.5 cm leiomyoma in the wall of
renal artery may lead to renal ischemia
- A small carcinoma within common bile
duct may induce fatal biliary tract
obstruction

A tumor may ulcerate leading to
bleeding or secondary infection
Benign or malignant neoplasms
that protrude into gut lumen
may cause intussusception ,
obstruction or infarction
Hormone production is also important:
- Adenomas and carcinomas arising in the b-
cells of the islets of the pancreas can
produce fatal hyperinsulinism
- Some adenomas and carcinomas of adrenal
cortex elaborate corticosteroids that affect
the patients
- Hormonal activity is more likely in benign
tumor than carcinoma
Cancer patients suffer
progressive loss of body fat and
lean body mass
Accompanied by profound
weakness, anorexia, wasting
and anaemia
cachexia
Due to action of cytokines produced by
tumor and the host (e.g TNF)
suppresses appetite and inhibit release
of free fatty acids
Calorie expenditure remains high and
basal metabolic rate is increased
Other: protein-mobilizing factor called
proteolysis-inducing factor play some
role
Also attributed by grief and anxiety
There is no satisfactory treatment

Symptom complex
That cannot be readily explained by local or
distant spread
By elaboration of hormones indigenous to the
tissue of origin paraneoplastic syndromes
Appear 10- 15 % of patients
May be - earliest manifestation
- represent significant
clinical problems
- lethal
- mimic metastatic
disease
The most common syndromes are:
- hypercalcemia (e.g breast cancers)
- Cushing syndrome (e.g lung cancers)
- nonbacterial thrombotic endocarditis (e.g
haematologic malignancies)
Hypercalcemia due to synthesis of
parathyroid hormone-related protein (PTHrP)
by tumor cells
Cushing syndrome- due to ectopic
production of ACTH or ACH-like polypeptides
by cancer cells
Nonbacterial thrombotic endocarditis -
Substances that can cause hypercoagulability

GRADING:
Necessary
Histologic estimate of malignancy of a
tumor
For making accurate prognosis and for
treatment protocols
Criteria depends on- degree of
differentiation, nuclear pleomorphism
and hyperchromasia & number of mitoses
Classified as grade I, II, III or IV
Or Well, Moderate and Poorly
differentiated
STAGING:
It is clinical estimate of extent of tumor spread
Staging is determined by surgical exploration
or imaging
Two methods of staging are currently used: the
TMN system and the AJCC system
Based on :
1. Tumor size (T) T0 to T4
2. local and regional lymph node spread (N) N0
to N3
3. distant metastasis (M) M0 to M1/M2
Staging has greater clinical value than grading
Biopsy and histology
Cytology (Fine needle aspiration
cytology FNAC)
Immunohistohistochemistry (IHC)
and Immunocytochemistry
Flow cytometry
Tumor Markers (e.g CEA)
Molecular diagnosis (e.g PCR)
Biopsy is the tissue specimen made available for
histological diagnosis
Biopsy & histology is the most important method
of tumor diagnosis
Provides definitive diagnosis (Gold standard)
The specimen must be adequate, representative
and properly preserved
Several sampling are available:
- excisional, incisional, punch, wedge, cone and
fine-needle aspiration biopsy
Routine stain- Haematoxylin and Eosin (H&E)

Fine-needle aspiration of tumors (FNAC &
FNAB)- is widely used
Next best to histology
Involves aspiration of cells from mass,
followed by cytologic examination of the
smear (? Dysplasia or anaplasia)
Can apply in readily palpable lesions
affecting breast, thyroid, lymph nodes and
salivary glands
Can also apply in deeper structures (liver,
pancreas and pelvic lymph nodes) by using
Modern imaging techniques (USG, CT scan)
Robbins Basic Pathology, 8
th
Edition