Neoplasia An abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that
of normal tissues and persists in the same excessive manner after the cessation of the
stimuli which evoked the change
Malignant:• Rapid increase in size• Local invasion• Loss of differentiation of cells• Anaplasia and dysplasia• Metastasis
Clinical Features
• Malignant tumour may manifest itself in four ways:1. Effects of primary tumour2. Effects of secondary deposits3. General effects of malignant disease4. Paraneoplastic syndromes – remote effects of
hormones or other tumour-cell products e.g. ACTH, PTH in lung cancer
Tumour Markers
• Blood chemicals produced by malignant cells• Biochemical indicators of the presence of a
tumour• Cell surface antigens• Cytoplasmic proteins• Enzymes • Hormones
Significance:
• Screening• Diagnosis• Prognostic indicator• May indicate malignant change in a benign
condition• Postoperative monitoring – fall, recurrence
Treatment
• Curative– Ablate the disease completely– Removal of primary and secondary
• Palliative – measures taken to ease the symptoms
CURATIVE:
• Surgery• Radiotherapy – seminoma, lymphoma, SCC• Cytotoxic chemotherapy – lymphoma • Combination
PALLIATIVE:
1. Surgery2. Radiotherapy 3. Hormone therapy4. Cytotoxic chemotherapy5. Drugs6. Nerve blocks
• Radiotherapy– Indicated for localized irremovable disease– Localized secondary deposits in bone– Inoperable lymph node deposits
• Cytotoxic chemotherapy– Damage dividing cells – normal and abnormal– Curative– Adjuvant– Neoadjuvant– Palliative
• Nerve blocks– With phenol or alcohol– Celiac plexus – pancreatic, gastric, hepatic cancer– Subcostal – rib metastasis
Prognosis depends on:
1. Extent of spread2. Microscopic appearance3. Anatomical situation4. General condition of the patient
1. Extent of spread - STAGING
• Clinical examination• At operation• Excised specimen• TNM classification– Tumour – size, degree of invasion– Node – regional, distant– Metastasis – presence or absence
2. Microscopic appearance
• Degree of histologic differentiation• Well-differentiated – good prognosis• Un-differentiated – bad prognosis
3. Anatomical situation
• Site may preclude a tumour’s adequate removal
• E.g. – Lower esophagus– Behind aortic arch– Frontal lobe– Brain stem