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Path - The Acquisition + Handling of Tissue from Neoplasms for Pathology…
Path - The Acquisition + Handling of Tissue from Neoplasms for Pathology Evaluation (ii)
Mets
direct into adjacent tissue
vascular (tumour embolisation)
most common sites: liver, lung, brain, bone, nodes
transcoelomic - across a body cavity (e.g. peritoneal, pleural, pericardial, subarachnoid space)
perineural (surrounding a N)
along natural passages
assessed in staging
lympatic
lymphadenopathy = swollen nodes, most common (e.g. stomach cancer swells supraclav node - virchow's node)
lymphangitis carcinomatosis (infiltration + obstruction of pul lymphatics by tumour - seen on x-ray)
peau d'orange (dilated dermal lymphatics in breast, can't drain as filled with tumour - pitted appearance)
lymphedema (obstruction of lymphatics anywhere in body but mainly limbs)
facilitated by...
collagenases (degrade basement membrane)
low tumour cell-cell adhesion (easier embolisation)
high tumour-endothelium adhesion (readily stick to vessel walls)
angiogenesis (increased VEGF, can be treated with anti-VEGF drugs)
clinical effects
lymphadenopathy
jaundice
bone pain/fractures without trauma
cerebral stroke
anorexia
lassitude
cachexia
Krukenberg tumour
mucin producing ovarian cancer that mets transperotineally to GIT
Commonest neoplasms that met to bone
breast
prostate
thyroid
renal
Tx of Malignant Neoplasms
surgery
radio
! carcinogen
SEs = necrosis, fibrosis, secondary malignancy (e.g. breast carcinoma a few years after having radio to mediastinum)
chemo
! carcinogen
SEs = BM damage, extreme immunosuppression, secondary malignancy
growth R blockers
e.g. tamoxifen
oestrogen R blocker
80% of breast cancers respond (determined by immunohistochemistry)
e.g. Herceptin/trastuzumab
Her2 (member of EGF tyrosine kinase family, amplified in 20-30% of breast cancers) R blocker
monoclonal antibody that binds + blocks R
small molecules inhibitors (targeted tx)
block cellular pathways (e.g. phosphorylation, which is aberrant/excessive in malignancy, resulting in excess cell prolif)
e.g. imatinib/geevec (tyrosine kinase inhibitor)
anti-angiogenic agents
immunotherapy
stim immune response (e.g. BCG, checkpoint inhibitors)
inhibit cells that inhibit immune response
MDMs
pathologist
surgeon
oncologist
radiotherapist
radiologist
cancer care nurses
case presented + discussed, tx planned