Neoplasia Part 5, UTHSC Fall 2022 D2 Pathology

Neoplasia Part 5, UTHSC Fall 2022 D2 Pathology What are the Clinical Aspects of Neoplasia? - Local and hormonal effects - Cancer cachexia - Paraneoplastic syndromes - Grading and staging Local and Hormonal Effects of neoplasia - Location as a critical determinant of the clinical effects of both benign and malignant tumors - Bleeding and infection if tumor ulcerates through adjacent surfaces - Impingement on adjacent structures, example: pituitary adenoma can compress and destroy the surrounding normal gland → hypopituitarism - Neoplasms in the gut may cause obstruction. - Pancreatic cancer can obstruct bile ducts → jaundice Cancer Cachexia - Progressive loss of body fat and lean body mass,"wasting" - Profound weakness, anorexia, anemia - Elevated basal metabolic rate - Evidence of systemic inflammation - The mechanisms not fully understood. - Role of TNF-alpha in cachexia Paraneoplastic Syndromes Some signs and symptoms in patients with cancer which cannot be explained by tumor spread or release of hormones that are indigenous to the tumor "cell of origin". how often are Paraneoplastic Syndromes seen in people with cancer? 10% of the time why are Paraneoplastic Syndromes important? They may be the earliest manifestation of an occult neoplasm. T/F In affected patients, Paraneoplastic Syndromes can cause significant clinicalproblems and may even be lethal True how can Paraneoplastic Syndromes confound treatment? They may mimic metastatic disease what causes Disseminated intravascular coagulation (DIC) and what are the major underlying cancers that could be the cause? - Tumor products that activate clotting - Leukemia, Prostatic carcinoma what causes Cushing syndrome (endocrinopathies) and what are the major underlying cancers that could be the cause? - ACTH or ACTH-like substance - Small cell carcinoma of lung, pancreatic carcinoma, neural tumors what causes Paraneoplastic autoimmune multiorgan syndrome (PAMS) (Paraneoplastic pemphigus) and what are the major underlying cancers that could be the cause? - Cross reactivity of epithelial antigens (such as desmosomal structures) with anti-tumor antibodies - Chronic myelocytic leukemia (CML), Lymphoma what causes Acanthosis nigricans and what are the major underlying cancers that could be the cause? - Immunologic; secretion of epidermal growth factor - Gastric carcinoma, Lung carcinoma, Uterine carcinoma What is Grading And Staging used for? Methods to quantify the probable clinical aggressiveness of a given neoplasm for making an accurate prognosis (Benign/Malignant) tumors, usually well-differentiated Benign (Benign/Malignant) tumors, showing cellular atypia and wider spectrum of differentiation Malignant What is the Spectrum of differentiation from most to least differentiated? 1. Well differentiated 2. Moderately differentiated 3. Poorly differentiated 4. Undifferentiated (Anaplastic) Grading A morphologic assessment determined by cytological appearance: based on the degree of differentiation of the tumor cells T/F A correlation between histologic appearance and biologic behavior is extremely accurate False, it is less than perfect Staging A quantification of the size of the tumor and the extent of spread to regional lymph nodes, and the presence or absence of distant metastases. Determined by surgical exploration or imaging Grading is a (clinical/histopathologic) evaluation histopathologic Staging is a (clinical/histopathologic) evaluation clinical TNM system A quantification of the size of the tumor and the extent of metastatic spread. Each person's treatment is guided by the stage of their disease T in the TNM system size and invasiveness of the primary tumor N in the TNM system lymph node involvement M in TNM system metastasis to distant organs TNM staging and prognosis example using oral cancer 5-year survival rate Stage I: 85%