CLINICAL FEATURES OF NEOPLASIA BY : DR(MRS)B.J.THANENTHIRAN(MBBS)

Effects of tumor on host Direct effects due to primary tumors. Effects due to metastasis. Effects due to paraneoplastic syndromes.

Effects are Mechanical pressure & obstruction. Destruction of tissue infiltrate & destroy vital organs. Haemorrhage. Secondary infections.

Haematological disorders. Anaemia. Neutrophil leucocytosis. Eosinophilia. Pain, anxiety & insomnia. Immunological effects. Hodgkins depress cell mediated immunity. Multiple myeloma suppress immunoglobulins. Amyloidosis. Nephrotic syndrome.

Cancer cachexia – wasting syndrome. progressive loss of body fat & lean body mass, accompanied by profound weakness, anorexia & anaemia. Origin of cancer cachexia is multifactorial. Anorexia Reduced food intake due to abnormalities of taste & in the central control of appetite. Malabsorption. Liver involvement. High calorie expenditure due to increased basal metabolic rate. Infection.

Paraneoplastic syndromes Symptom complexes other than cachexia Occurs in patients with cancer Cannot be explained by local / distant spread of tumor or by the elaboration of hormones indigenous to the tissues of origin of the tumor. They may represent the earliest manifestation of an occult neoplasm. They may mimic metabolic lesions. They may represent significant clinical problems & may be lethal.

Grading & staging of tumor Grading – Based on the cytological differentiation of tumor cells & the number of mitosis within the tumor. Grade I Grade II Increasing anaplasia Grade III Grade IV Criteria for individual grades vary with each form of neoplasia.

Size of the primary lesion T(tumor) Staging – Depends on Size of the primary lesion T(tumor) Spread to regional lymph nodes N(nodes) Presence/absence of metastasis M(mets) With increasing size of the tumor T1 < T2 < T3 < T4 Progressively advancing nodal involvement N0 < N1 < N2 < N3 Absence or presence of metastasis M0 / M1 Compared to grading, staging has greater clinical values.

Laboratory diagnosis of cancer Morphological methods Biochemical assays Molecular diagnosis Molecular profiling of tumors

Morphological methods Sampling by Excision Biopsy FNAC Cytological smears

Immunocytochemistry Immunohistochemistry Flow cytometry

Biochemical assays Measuring enzymes, hormones & other tumor markers in blood. These assays contribute to finding cases & are useful in determining the effectiveness of therapy. Eg – PSA, CEA

Molecular profiling of tumors Molecular diagnosis PCR ( Polymerase Chain Reaction) FISH ( Fluorescent insitu hybridization) Molecular profiling of tumors DNA micro assay analysis

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