PATHOPHYSIOLOGIC BASIS OF MALIGNANT NEOPLASM

Predisposing Factors/Etiologic Factors

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Cellular Aberrations
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Ca Cell Proliferation Malignant cells produce Anorexia and cachexia
⮚ Disrupt normal cell enzymes, hormones and Syndrome
growth and interfere other substances ⮚ Tissue wasting
with tissue function (Paraneoplastic Syndrome) ⮚ Severe weight loss
⮚ Pressure ⮚ Anemia ⮚ Severe debilitation
⮚ Obstruction ⮚ Hypercalcemia
⮚ Pain ⮚ Disseminated
⮚ Effusion intravascular
⮚ Ulceration coagulation (DIC)
⮚ Vascular thrombosis,
embolus,
thrombophlebitis

⮚ Proliferation of Ca cells
✔ Pressure - due to increase in size of neoplastic growth.
✔ Obstruction - as tumor continues to grow, hollow organs and vessels become
compressed and obstructed.
E.g. esophagus, bronchi, ureters, bowel, blood vessels lymphatic system.
✔ Pain
Due to:
✧ Pressure on nerve endings
✧ Distention of organs/vessels
✧ Lack of O2 to tissues and organs
✧ Release of pain mediators by the tumor
✧ Late sign of Ca
⮚ Effusion
✔ When lymphatic flow is obstructed, there may be effusion in serous cavities.
✔ Effusion into the pleural cavity: pleural effusion; effusion into the abdominal
cavity: ascites
⮚ Ulceration and Necrosis
✔ Result as the tumor erodes blood vessels and pressure on tissue causes
ischemia → tissue damage and bleeding → infection
⮚ Vascular thrombosis, embolus, thrombophlebitis
✔ Tumors tend to produce abnormal coagulation factors that cause increased
clotting (pulmonary emboli → life threatening)
⮚ Paraneoplastic Syndrome - malignant cells produce enzymes, hormones and other
substances.
✔ Anemia
✧ Ca cells produce chemicals that interfere with rbc production
✧ Iron uptake is greater in the tumor than that deposited in the liver.
✧ Blood loss may result from bleeding
✔ Hypercalcemia
 ✧ Tumors of the bone, squamous cell lung Ca, Ca of the breast produce a
parathyroid - like hormone that increases or accelerates bone breakdown
and release of calcium.
✧ Also results from metastasis to the bones.
✧ Enhanced by immobilization and dehydration.
✔ Dessiminated Intravascular Coagulation (DIC)
✧ More likely to occur in Ca of the lungs, pancreas, stomach, prostate.
✧ Precipitated by the release of tissue thromboplastin or endothelial injury.
⮚ Anorexia - Cachexia Syndrome
✔ The final outcome of unrestrained Ca cell growth.
✔ Malignant neoplasms deprive normal cells nutrition.
✔ Tumors produce alteration in enzyme system necessary for normal
metabolism → stored fat is lost, tissues lose nitrogen (negative Nitrogen
balance)
✔ Tumors revert to anaerobic metabolism → consume glucose, deplete
glycogen stores in the liver and convert glucose to lactate.
✔ Protein depletion, serum albumin levels decrease.
✔ Tumors take up Na, water retention masks malnutrition and is not
immediately reflected as weight loss.
✔ Ca cells produce anorexigenic substances that act in the satiety center of the
hypothalamus, causing anorexia.
✔ Taste sensation diminishes or becomes altered and the individual may have
aversion to eating, particularly meat.