SPREAD OF TUMOURS AND EFFECTS

TUMOURS MAY BE ASYMPTOMATIC (E.G. EARLY Ca CERVIX, Ca BREAST AND

Ca PROSTATE
- IF SYMPTOMATIC, EFFECTS VARIED
A. LOCAL EFFECTS
- TUMOURS OCCUPY SPACE AND EFFECTS MAY BE SERIOUS E.G. IN BRAIN
- EXPANSILE GROWTH MAY CAUSE OBSTRUCTION OF ADJACENT STRUCTURES
OR OCCLUDE LUMEN E.G. OESOPHAGUS, BRONCHUS
- LOCAL INFILTRATIVE GROWTH MAY CAUSE DESTRUCTION OR LOSS OF
FUNCTION
- VASCULAR EFFECTS INCLUDE BLEEDING E.G. PITUITARY OR THYROID GLAND
WITH DRAMATIC CLINICAL EFFECTS. HAEMORRHAGE FROM TUMOUR SURFACE
MAY CAUSE IRON DEFICIENCY ANAEMIA
B. DISTURBANCES IN BLOOD COAGULATION
- BLOOD FLOW IN TUMOURS OFTEN ERRATIC AND ENDOTHELIUM OFTEN
ABNORMAL AND PRONE TO INJURY
- SOME TUMOURS PRODUCE THROMBOPLASTIN WITH THROMBOSIS ENSUING
E.G. MIGRATORY THROMBOPHLEBITIS E.G. PANCREATIC CARCINOMA AND
RENAL VEIN THROMBOSIS IN RENAL CELL CARCINOMA
- IMMOBILITY AND SURGERY CONTRIBUTE TO THROMBOTIC TENDENCY
- TUMOUR PRODUCTS MAY CONTINUOUSLY ACTIVATE COAGULATION SYSTEM.
DEPLETION OF COMPONENTS CAUSE DIC
- THROMBOCYTOPAEMIA IN LEUKAEMIAS DUE TO DISTURBED MEGAKARYOCYTE
MATURATION IN BONE MARROW CAUSES SPONTANEOUS BLEEDING
C. METASTATIC EFFECTS
- COMMONEST CAUSE OF CANCE DEATHS AFTER TREATMENT
- METASTATIC SITES INCLUDE LYMPH NODES, LUNG, BONE MARROW, BRAIN AND
LIVER, BONE
- EFFECTS SAME AS THOSE OF PRIMARY TUMOUR E.G. HAEMORRHAGIC
EFFUSIONS IN PLEURAL AND PERICARDIAL SPACES, BONE FRACTURE ETC.
D. NON-METASTATIC SYSTEMIC EFFECTS
- EFFECTS THAT ARE NOT PREDICTABLE OR OBVIOUSLY RELATED TO THE
PHYSICAL PRESENCE OF TUMOUR AT A PRIMARY OR METASTATIC SITE
CACHEXIA:
- WT LOSS DUE TO LOSS OF FAT AND CATABOLISM OF MUSCLE PROTEIN FAR IN
EXCESS OF THE DEGREE PREDICTED OR THE BASIS OF TUMOUR SIZE ALONE.
- RELATED TO SECRETION OF INTERLEUKIN I (IL-I) AND TUMOUR NECROSIS
FACTOR (TNF)
ENDOCRINE EFFECTS
- TUMOUR CELLS SECRETE PEPTIDE HORMONES E.G. ACTH BY SMALL CELL
LUNG CARCINOMAS WITH K+ LOSS AND CUSHINGOID STATE PTH BY
SQUAMOUS CELL CARCINOMA OF LUNG
NEUROLOGICAL EFFECTS
- INCOMPLETELY UNDERSTOOD
- RELATED TO SELECTIVE DEATH OF NEURONS E.G. ATAXIA DUE TO LOSS OF
PURKINJE CELLS
- EFFECTS BOTH MOTOR AND SENSORY
DERMATOLOGICAL
- DERMATOMYOSITIS (VASCULITIS OF SKIN AND MUSCLE)
- ACANTHOSIS NIGRICANS (SKIN TAGS IN AXILLAE AND GROINS WITH SKIN
PIGMENTATION)
TUMOUR PROGRESSION
- DESCRIBES STEPWISE ACQUISITION OF MORE AGGRESSIVE PROPERTIES BY A
TUMOUR DURING GROWTH
- BENIGN TUMOURS MAY BECOME MALIGNANT
- INTRAEPITHELIAL NEOPLASIA (E.G. CINIII) BECOMING INVASIVE
- TUMOURS INITIALLY SENSITIVE TO DRUGS BECOMING RESISTANT
- CHRONIC LEUKAEMIAS BECOMING ACUTE AND RAPIDLY PROGRESSIVE
- PHENOMENON IS A MANIFESTATION OF THE FACT THAT TUMOURS CONSIST OF
GENETICALLY UNSTABLE PROLIFERATING CELLS
- SUBPOPULATIONS OF CELLS WITH NEW PROPERTIES ARE CONSTANTLY
GENERATED AND IF THEY POSSESS GROWTH ADVANTAGE, THEY QUICKLY
ADOPT A LEADING ROLE IN DEFINING THE TUMOUR’S CHARACTER