Clinical Features of Neoplasm
1) Effects according to tumor location:
Any tumor, benign or malignant may
cause morbidity and mortality. Location of the tumor is of critical importance
in both benign and malignant tumors eg A small pituitary adenoma (benign) can
compress and destroy surrounding normal gland and give rise to hypopituitarism
a small carcinoma within common bile duct (malignant) may induce fatal biliary
tract obstruction .
2) Hormone production:
Hormone production is increased in
both benign (mostly) and malignant tumors arising in endocrine glands eg
Tumors of pancreas produce increased
causing amount of insulin hyperinsulinism. Tumors of adrenal cortex excessive
corticosteroids
3. Clogging:
It may be caused in a hollow viscus
by tumor. in the lumen or pressing on the wall from outside eg Intestinal
obstruction.
Biliary tract causing obstructive
jaundice.
Urinary tract causing
hydronephrosis. Bronchus-pulmonary collapse.
Portal vein ascites and varices.
4) Irritation of serous membrane
Deposition of tumor on serous membrane results in the form of inflammatory
exudate.
5 Tine destruction:
Progressive
destruction of time may produce a lot of function perforation or hemorrhage.
6 Infection may superimpose the ulcerated
7) Fever: Certain to produce fever directly and some indirectly due to infection
8) Anemia:
It may be due to prolonged
malnutrition. recurrent blood loss, and long-lasting infection producing marrow
depression
9) Malignant cachexia:
The progressive
weakness and lows of weight in the presence of malignant tumor is called
malignant cachexia. It may be induced by the toxin produced by the tumor or by
malnutrition, hemorrhage, ulceration, pain, insomnia and bacterial infection.
10) Paraneoplastic syndromes:
This
is a collective term for disorders arising from metabolic effects of cancer on
the tissues remote from the tumor eg endocrine, hematologic or neuromuscular
disorders, OR The symptom complexes other than cachexia that appear in patients
with cancer and that cannot be readily explained either by: Local or distant
spread of tumor or by:
Elaboration of hormones indigenous
to the tissue of origin of the tumor, are referred to paraneoplastic syndromes
( ie there seems no relation between cancer and these symptoms)
Diagnosis Of Tumor (Investigations)
1) Screening:
The tests performed on asymptomatic
individual to detect tumor in very early stage is called screening.
Unfortunately screening methods do not exist for most types of cancers.
Following are the screening tests that can detect the tumor in early stage.
Cervical smear:
Annual cervical
smears in all sexually active women is recommended. Dysplastic epithelium can
be detected and treated to prevent development of cervical cancer.
Mammography:
Self-examination of
breasts monthly to detect small lump is recommended. Mammography to detect
pre-clinical breast cancer is suggested every 2 or 3 years.
Sigmoidoscopy:
People aged 50 and above are
suggested to undergo sigmoidoscopy to detect early colon cancer or
pre-cancerous adenomas of colon and rectum.
2) Cytological examination:
Cytological examination of cell is a
useful and accurate method of diagnosing cancer. Samples for cytological
examination may be obtained by a variety of techniques such as:
Exfoliated cells may be identified
in samples of sputum, urine, CSF and body fluids. Malignant cells may be found
in blood and bone marrow
Brushing or scraping of epithelium
or of a lesion that has been visualized by endoscopy may be performed to obtain
cells for examination
Fine-needle aspiration
3) Histological examination:
This is the definitive method of
establishing the diagnosis of a neoplasm. The test is based on examination of
the entire neoplasm removed at surgery (excisional biopsy) or incisional biopsy
or with a large bore cutting needle.
Histologic examination reveals
benign or malignant type of neoplasm, grade of malignancy, and degree of
invasion.
4) Serological examination (tumor
markers)
5) Radiographic examination:
Xays , CT and MRI scans are helpful
in the diagnosis of tumors. As a general rule, radiographic findings suggestive
of cancer must be confirmed by either cytological or histological examination.
Treatment:
Surgery Radiation therapy.
Chemotherapy (anti-cancer drugs).
Radiosensitivity of tumors
Radiotherapy is an important mode of
therapy as a curative and palliative treatment. Tumors differ widely in their
reaction to radiotherapy.
Radio sensitivity of tumors depend
on:
Degree of mitotic activity:
Therefore rapidly dividing (labile)
cells more respond to radiotherapy eg tumors of bone marrow, intestinal
epithelium, and gonads. Slow dividing (stable) cells respond less as compared
to labile cells while the non-dividing (permanent) cells of neurons are
radioresistant).
Degree of differentiation:
Undifferentiated tumors more respond than well differentiated.
Hormone dependence of tumors
Induction of tumor by hormones
1) High estrogen level
2) Anabolic steroids
3) Endometrial carcinoma Breast
carcinoma Liver cell carcinoma
Hormonal dependent tumors Many
tumors that are not caused by hormones are dependent on hormones for optimal
growth. The cells of such tumors have receptors on their cell membrane for
hormonal binding. When the tumor is deprived of the hormone. Its growth becomes
slow.
Prostate cancer This cancer is
almost always dependent on androgen. Removal of both tests or the
administration of estrogen frequently results in dramatic - though temporary -
regression of prostate cancer.
Breast cancer This cancer is
frequently dependent on estrogen and less frequently on progesterone. Hormone
dependence correlates strongly with the presence of estrogen and progesterone
receptors on the cell membrane.
Thyroid cancer
They are dependent on thyroid
stimulating hormone (TSH). Administration of thyroid hormone suppresses TSH
secretion and therefore regresses thyroid cancer.
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