[Gen. surg] tumours from SIMS Lahore

TUMOURS

What is a tumour?

Overgrowth of cells

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

Classification

• Benign

• Malignant– Primary– secondary

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

Diagnosis

• History• Examination• Special investigations• Histopathology

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

• Surgery– Curative resection– Bypass

• Radiotherapy– Indicated for localized irremovable disease– Localized secondary deposits in bone– Inoperable lymph node deposits

• Hormone therapy– Breast cancer– Prostate cancer

• Cytotoxic chemotherapy– Damage dividing cells – normal and abnormal– Curative– Adjuvant– Neoadjuvant– Palliative

• Drugs– Pain relief – NSAIDS, opiates– Hypnotics– Anti-emetics

• Nerve blocks– With phenol or alcohol– Celiac plexus – pancreatic, gastric, hepatic cancer– Subcostal – rib metastasis

PROGNOSIS

is a medical term for predicting the likely outcome of one's current standing.

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

4. General condition

• Poor general health• Co-morbidities e.g. congestive cardiac failure

Screening

Detection of disease in an asymptomatic population

EXAMPLES:• Mammography• Pap smear• PSA level• Colonoscopy