Clinical Features of Tumors

1

• Clinical Features of Tumors
• ? Morbidity Mortality
• All masses ?must be evaluated (Biopsy)
• Effects on host
• Location and impingement on adjacent structures
• Functional Activity e.g., Hormone synthesis
• Bleeding and secondary infections when they
  ulcerate through adjacent natural surfaces ? GIT
• Initiation of acute symptoms caused by either
  rupture or infarction
• Cancer Cachexia WASTING
• ? loss of body fat and lean body mass profound
  
• weakness, anorexia, and anemia
• ? Wasting syndrome (soluble cytokines -TNF-1)
• ?anorexia is a common
• Paraneoplastic Syndromes
• ? Table 7-12 in text book ( must KNOW)!
• ? Hormonal, neurological, hematological
  disturbances
• ? not directly related to invasion by primary
  tumor or its metastases
• ? 10 of patients with malignant disease

2

• Clinical Features of Tumors
• Paraneoplastic Syndromes
• Most of them are produced by - small cell
  carcinoma of the lung
• 1. MC syndrome Hypercalcemia (by squamous cell
  ca. of Lung)
• 2. Endocrinopathies Cushing syndrome ( MC)
  (?ACTH production)
• by small cell carcinoma of the lung
• 3. Neuromyopathies
• ? Peripheral neuropathies
• ? Cortical -Cerebellar degeneration
• ? A myasthenia - like ( Lambert Eaton)
  syndrome
• 4. Acanthosis Nigricans
• Characteristics
• Gray-black patches of verrucous hyperkeratosis on
  the SKIN
• Over 40YRS. - 50 develop Cancer
• Underlying cancer
• Gastric Carcinoma
• Lung Carcinoma
• Uterine Carcinoma
• Causal Mechanism

3

• Clinical Features of Tumors
• Paraneoplastic Syndromes
• 5. Hypertropic osteoarthropathy
• Characteristics
• Periosteal new bone formation distal ends of
  long bones
• Arthritis
• Clubbing of digits
• Cause
• unknown.
• Vascular and hematological
• Nonbacterial Thrombotic endocarditis
• Acute DIC (MC- AML-M3 and Prostatic ca.)
• Migratory thrombophlebitis - TROUSSEAUS SYNDROME
• Pancreatic, Bronchogenic carcinomas
• Causal Mechanism
• Tumor Products (Mucins that activate clotting)

4

• Clinical Features of Tumors
• Staging Grading of Tumors
• Basis of Grading
• Degree of tumor cell differentiation and number
  of mitoses within the tumor
• to judge the extent to which the tumor cells
  resemble or fail to resemble their normal
  counterparts
• GRADING I-IV
• GRADE I well-differentiated (looks ALMOST like
  parent tissue)
• GRADE II moderately differentiated
• GRADE III poorly differentiated
• GRADE IV undifferentiated (almost impossible
  to tell where primary neoplasm originated)
• Basis of STAGING
• 1. UICC (Union Internationale Contre Cancer -
  TNM)
• Tumor size
• Lymph Nodes involvement
• Metastases
• 2. AJC (American Joint Committee)
• Divides all cancers into stages 0-IV

5

• Which is most important for Clinical Prognosis of
  Tumors?

Staging
6

• Lab Diagnosis of Neoplasms
• Fine Needle Aspiration Cytology (FNAC)
• Biopsy
• Immunochemistry
• Cytogenetic Analysis (Karyotyping)
• FISH (fluorescent in situ hybridization)
• Chromosome Painting
• Spectral Karyotyping
• Recombinant DNA Technology
• PCR Assays
• Southern, Northern and Western blots

7
Cytology (Pap) SmearsDiagnosis of cervix
carcinoma
Abnormal smear
Normal smear
pleomorphic, Hyper-chromatic nuclei
large, flattened squamous cells
no malignant cells
Malignant cells
8
Pap Smear
9
IMMUNOCHEMISTRY( IHC)Cytokeratin

• Dark brown staining of keratin
• Positive Epithelial
• Negative Mesenchymal