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Path - Prognosis of Neoplasms (i) (dysplasia (sites... (cervical dysplasia…
Path - Prognosis of Neoplasms (i)
carcinoma in situ
no invasion beyond epithelium/basement membrane
no access to blood/lymphatic vessels - no met potential
(but capable if not excised @ this stage)
all layers of epithelium show neoplastic effects/features
some cancers curable @ this stage (no chemo required)
dysplasia
neoplastic change in epithelium showing some features of malignancy but does NOT involve full thickness of epithelium
early manifestation of malignancy
graded: mild, moderate, severe
dyskaryosis = dysplasia in cytological preparations
can become neoplasia in situ, which then can become invasive carcinoma (continuum)
DYSPLASIA IS NEOPLASTIC, requires surgery usually
sites...
cervical dysplasia = intraepithelial neoplasia
screening NB
graded 1 (mild) - 3 (severe)
gastric
colonic (screening effective)
skin actinic keratosis
bronchus (rare)
Barrett's oesophagus (intestinal metaplasia which increases dysplasia risk)
Haematological effects of malignancy
Anaemia
megaloblastic
DNA synthesis interfered with (cytotoxic drugs)
structurally abnormal RBCs
Haemolytic
RBCs destroyed by immune system
Hypoplastic
BM failure (haematopoietic cell destruction)
can be due to tumour infiltration/chemo/radiotherpay
Fe deficient = most common (due to blood loss)
DVT (hypercoag)
tumour activates clotting factors, platelets, endothelial cells + inhibits fibrinolysis
polycythaemia
rare
increased Hb due to increased RBCs
e.g. in renal cell carcinoma increased erythropoietin produced
PR bleeding
distal = bright red
caecum + up = mixed with stool
melena, black, tar-like
Non-metastatic effects of malignancy
mets not evident in site of symptoms
ectopic hormone production (hormone produced by cells that aren't meant to produce it)
small cell lung carcinoma - ACTH - Cushing's
excess ADH
testicular cancer - oestrogen - gynaecomastia
squamous cell lung carcinoma - PTH - hypercalcaemia (clinical emergency, can also be cause by bone damage from mets releasing Ca2+ into blood)
insulinoma - insulin - hypoglycaemia
Paraneoplastic syndrome
can't be explained by mets or hormones
peripheral neuropathy
myopathy
dermatomyositis
PUO + night sweats
cerebellar degeneration
possible reasons: microscopic tumour or immune-mediated (most likely ck-induced, e.g. anti-cerebellar antibodies
Malignant Melanoma
malignancy of melanocytes
new black nodule or ABCDE change in mole (asymmetry, bleeding/border irregular, colour, diameter, elevation/evolution
aetiology = sunlight
Assessing prognosis...
Clarke's level of invasion
not used as much
level of invasion into different parts of dermis
Breslow thickness
thickness of invasion into skin
greater than 2mm = v poor prognosis
<0.76mm = 98% cure rate
many sites (skin, anal margin, eye)