Effects of neoplasia on host

1. NEOPLASIA
Dr. Sobia Khalid

2. Effects of TUMOR on the HOST
 Location anatomic ENCROACHMENT
 HORMONE production
 Bleeding, Infection
 ACUTE symptoms, e.g., rupture, infarction
 METASTASES

3. CACHEXIA
 Reduced diet: Fat loss>Muscle
loss
 Cachexia: Fat lost + Muscle loss
 TNF
 IL-1
 PIF (Proteolysis Inducing Factor)

4. PARA-Neoplastic Syndromes
Endocrine
 Nerve/Muscle, e.g., myasthenia w. lung
ca.
 Skin: e.g., acanthosis nigricans,
dermatomyositis
 Bone/Joint/Soft tissue: HPOA
(Hypertrophic Pulmonary
OsteoArthropathy)
 Vascular: Trousseau, Endocarditis
 Hematologic: Anemias
 Renal: e.g., Nephrotic Syndrome

5. ENDOCRINE
Cushing syndrome Small cell carcinoma of lung ACTH or ACTH-like substance
Pancreatic carcinoma
Neural tumors
Syndrome of inappropriate
antidiuretic hormone
secretion
Small cell carcinoma of lung;
intracranial neoplasms
Antidiuretic hormone or atrial
natriuretic hormones
Hypercalcemia Squamous cell carcinoma of lung
Parathyroid hormone-related protein
(PTHRP), TGF-α, TNF, IL-1
Breast carcinoma
Renal carcinoma
Adult T-cell leukemia/lymphoma
Ovarian carcinoma
Hypoglycemia Fibrosarcoma Insulin or insulin-like substance
Other mesenchymal sarcomas
Hepatocellular carcinoma
Carcinoid syndrome Bronchial adenoma (carcinoid) Serotonin, bradykinin
Pancreatic carcinoma
Gastric carcinoma
Polycythemia Renal carcinoma Erythropoietin
Cerebellar hemangioma
Hepatocellular carcinoma

6. GRADING/STAGING
GRADING: HOW
“DIFFERENTIATED” ARE
THE CELLS?
STAGING: HOW MUCH
ANATOMIC EXTENSION?
Which one of the above do
you think is more important?

7. GRADING
 Degree of differentiation of the tumor cells.
 Number of mitoses
 Architectural features

9. Examples
 Gleason grading system is for prostatic
carcinoma.

10. STAGING
 Size of the primary lesion,
 Its extent of spread to regional lymph nodes,
 the presence or absence of blood- borne
metastases. currently i

11. EXAMPLES
 Ann Arbor staging is the staging system for
Hodgkins lymphoma

12. MAJOR STAGING SYSTEM
 American Joint Committee on Cancer Staging
 This system uses a classification called the
TNM system—
 T for primary tumor
 N for regional lymph node involvement
 M for metastases

13. GENERAL PRINCIPLES
 The primary lesion is characterized as T1 to
T4 based on increasing size.
 T0 is used to indicate an in situ lesion.
 N0 would mean no nodal involvement,
whereas N1 to N3 would denote involvement
of an increasing number and range of nodes.
 M0 signifies no distant metastases, whereas
M1 or sometimes M2 indicates the presence of
metastases and some judgment as to their
number.

14. WELL?
MODERATE?
POOR?
GRADING for Squamous Cell
Carcinoma

19. ADENOCARCINOMA GRADING
Let’s have some FUN!

24. LAB DIAGNOSIS
 BIOPSY
 CYTOLOGY: (exfoliative)
 CYTOLOGY: (FNA, Fine Needle
Aspirate)

25. IMMUNOHISTOCHEMISTRY
Categorization of
undifferentiated tumors
Leukemias/Lymphomas
Site of origin
Receptors, e.g., ER, PR

26. TUMOR MARKERS
 HORMONES: (Paraneoplastic Syndromes)
 “ONCO”FETAL: AFP, CEA
 ISOENZYMES: PAP, NSE
 PROTEINS: PSA, PSMA
 GLYCOPROTEINS: CA-125, CA-19-5, CA-15-3
 MOLECULAR: p53, RAS
NOTE: These SAME substances which can be
measured in the blood, also can be stained by
immunochemical methods in tissue

27. MICRO-ARRAYS
THOUSANDS of genes identified
from tumors give the cells their own
identity and FINGERPRINT and may
give important prognostic
information as well as guidelines for
therapy. Some say this may replace
standard histopathologic
identifications of tumors.
What do you think?