METASTASIS

METASTASIS- AN INTRODUCTION
Cancer may remain locally invasive or may spread to non adjuvant areas Tumors growing in or penetrating body cavities may shed cells or emboli and seed the surface of other organs patterns of metastasis can be partially explained by circulatory pattern and affinity for certain malignant cells to bind

DEFINITION
Spread

of cancer cells from primary tumor to distant sites by direct spread or through lympahtic & blood circulation

LYMPHATIC SPREAD
Lymph and blood are the key mechanism of spread of cancer cells Lymphatic spread is most common mechanism of Metastasis Tumor emboli enter the lymph channels by interstitial fluid Malignant cells also may penetrate lymphatic vessels by invasion

CONTD
Malignant cells either lodge in the lymph nodes or pass between the lymphatic and venous circulation Tumor in areas of body with rapid and extensive lymphatic circulation are high risk for metastasis Breast tumors frequently metastasize in this manner through axillary, clavicular and thoracic lymph channel

HEMATOGENOUS SPREAD
Hematogenous spread is the dissemination of malignant cells via blood stream Is directly related to the vascularity of the tumor Few malignant cells can survive the turbulance of arterial circulation,insufficient oxygenation or destruction by bodys immune system Structure of most arteries and arterioles is far too secure to permit malignant invasion

CONTD

Malignant cells that do survive are able to attach to endothelium Endothelium retracts,allowing malignant cells to enter the basement membrane Secrete lysomal enzyme which destroy surrounding body tissues allowing implantation

ANGIOGENESIS
Is the growth of new capillaries from the host tissue by the release of growth factor & enzyme Proteins rapidly stimulate formation of new blood vessels Helps malignant cells obtain the necessary nutrient and oxygen Large tumor emboli that trapped in the microcirculation of distant sites may further metastasize to other sites

TRANSPLANTATION

Mechanical carriage of fragments of tumor cells by surgical instruments during operation or the use of needles during diagnostic procedures

SIGNS AND SYMPTOMS

Symptoms of metastasis varies with location of the tumors Initially, nearby lymph nodes are struck early Lungs, bones, liver, and brain are the most common metastasis locations from solid tumors

Lymph nodes: lymphadenopathy Lungs: cough, hemoptysis and dyspnea Liver: hepatomegaly and jaundice Bones: bone pain, fracture of affected bones Brain: neurological symptoms such as headaches, seizures, and vertigo Although advanced cancer may cause pain, it is often not the first symptom. Some patients, however, don't show any symptoms.

MAJOR CATAGORIES OF TUMOR

Neoplasms are classified according to the tissue from which they arise beside benign or malignant Name for neoplasms end in the suffix-oma means tumor Suffix is usually attatched to a term for the parent tissue of neoplasm More than one parent tissue also enters into the formationof neoplasm

PURPOSES OF CATAGORIES OF TUMOUR

To identify which organ (or tissue) they arouse from To determine the histologic type To identify the type of tumor

CLASSIFICATION OF TUMOR - BY TISSUE OF ORIGIN

Tissue of origin Bengin Malignant

1.Connective tissue
Embryonic fibrous tissue Fibrous tissue Adipose tissue Myxoma Fibroma Lipoma Myxosarcoma Fibrosarcoma Liposarcoma

Cartilage Bone

Chondroma Osteoma

Chondrosarcoma Osteogenic sarcoma

Tissue of origin

Bengin

Malignant

2. Endothelium
Blood vessels Hemangioma Hemangio endothelioma Kapsis sarcoma Hemangio sarcoma Lymphangio sarcoma Lymphangio endothelioma Multiple myeloma Ewigs sarcoma Leukemia

Lymph vessels

Lymphgioma

Bone marrow

Tissue of origin Lymphoid tissue

Bengin

Malignant Malignant lymphoma Lymphosarcoma Reticulum cell sarcoma

Ganglion cells Gial cells Meninges

Ganglioneuroma Glioma Meningioma

Neuroblastoma Glioblastoma Malignant meningioma

Tissue of origin

Bengin

Malignant

3. Epithelium
Skin & mucous membrane Papilloma Squamous cell Carcinoma Basal cell carcinoma

Glands

Adenoma Cystadenoma
Nevus

Adenocarcinoma Cystadeno carcinoma

Malignant melanoma

Pigmented cells

4. Muscle tissue
Smooth muscle Striated muscle Leiomyoma Rhabdomyoma Leiomyo sarcoma Rhabdomyo sarcoma

Tissue of origin

Bengin Dermoid cyst

Malignant Embryonal carcinoma Enbryonal sarcoma Teratocarcinoma

5. Gonads

6. Nerve tissue
Nerve fibres and sheaths Neuroma Neurinoma Neurilomama Neurofibroma Neurogenic sarcoma

Neurofibro sarcoma

HISTOLOGIC ANALYTIC CLASSIFICATION

The histologic grading of appearance of the cells and the degree of differentiation are evaluated Four grades are used

Grade 1
Cells differ slightly from normal cells(mild displasis) well differentiated

Grade 2
Cells are more abnormal(moderate displasis) moderately differentiated

Grade 3
Cells are very abnormal (severe dysplasia) poorly differentiated

Grade 4
Cells are immature and primitive(anaplaxia) undifferentiated Cell of origin difficult to determined

EXTENT OF DISEASE CLASSIFICATION

extent of disease classification is often called staging Staging determines the extent of disease process of cancer by stages

Stage 0
Cancer in situ Defined as a neoplasm of epithelial tissues that remains confined to the site of origin

Stage I
Tumour linked to tissue of origin Localized tumor growth

Stage II

Limited local spread

Stage III

Extensive local and regional spread

Stage IV

Metastatis

This type of classification is used as a basis for staging in cancer of cervix and Hodkings disease

TNM CLASSIFICATION SYSTEM

Represents the standardization of the clinic staging of cancer Used to determine the extent of disease process of cancer according to three parameters

T- Tumour size N- Lymph node M- Metastasis

Then a number is added to each of these letters to indicate the size and spread staging of tumor become more important when deciding an appropriate treatment Used in cancer of breast

Tumor

Tx Primary tumor cannot be accessed T0 no evidence of primary tumor Ts - carcinoma in situ T1, T2,T3,T4 increasing size and local extent of primary tumor

Nodes

Nx regional lymph cannot be assessed N0 no regional lymph node metastasis N1a, N2a,N3a increasing involvement of regional lymph node

Metastasis
Mx distant metastasis cannot be assessed M0 no distant metastasis M1 distant metastasis