Clinical aspects of neoplasia

DR ALIYA ZAMAN
 Local and Hormonal Effects

Location of tumor is important

Neoplasms in the gut can cause obstruction.
A small (1 cm) pituitary adenoma, can compress and
destroy the surrounding structures .
Cancers arising within or metastatic to an endocrine gland
can cause
1. endocrine insufficiency by destroying the gland
2. clinical problems by producing hormones.
A benign beta-cell adenoma of the pancreatic islets less
than 1 cm in diameter may produce sufficient insulin to
cause fatal hypoglycemia.
 The erosive and destructive growth of cancers

 Skin and mucosa------ulcerations, secondary

infections, and bleeding.

 Neoplasms of the gut ------------ Melena (blood in

the stool)

 urinary tract ------------ hematuria

 Cancer Cachexia

In cancer patient progressive loss of body fat and

lean body mass accompanied by profound weakness,
anorexia, and anemia, referred to as cachexia.

Cancer cachexia is associated with:

• Equal loss of both fat and lean muscle
• Elevated basal metabolic rate
• Evidence of systemic inflammation
TNFα (originally known as cachectin) is a leading cause

Humoral factors released from tumor cells such as

proteolysis inducing factor have been implicated in the loss
of muscle mass

Decreased secretion of host anabolic hormones

 An altered host metabolic response with abnormalities in

protein, lipid, and carbohydrate metabolism
 Paraneoplastic Syndromes

A paraneoplastic syndrome is a set of signs and

symptoms that occur in people with a cancerous
tumor.
 They develop when a malignant tumor releases a
substance (hormone/protein) which affects a certain
body system or when the body’s immune system

 Releases a substance (antibody) meant to kill the

tumor but also damages healthy body cells
(autoimmune response).
These occur in about 10% of persons with cancer.
Despite their relative infrequency, paraneoplastic
syndromes are important to recognize, for several
reasons:
1. They may be the earliest manifestation of an occult
neoplasm.
2. In affected patients they can cause significant
clinical problems and may even be lethal.
3. They may mimic metastatic disease and therefore
confound treatment.
The types of cancer most likely to cause paraneoplastic
syndromes are:
Breast
Gastric (stomach)
Leukemia
Lymphoma
Lung, especially small cell lung cancer
Ovarian
Pancreatic
Renal (kidney)
 SYMPTOMS

Symptoms of paraneoplastic syndromes vary

depending on the organ systems affected.

 In more than half of cases, the symptoms appear

before a person receives a cancer diagnosis.

 These syndromes' symptoms may include fever, loss

of appetite and weight, and night sweats.
Several humoral factors have been associated with
paraneoplastic hypercalcemia of malignancy.
 The most important, parathyroid hormone-related
protein (PTHRP), is a molecule related to, but distinct
from, parathyroid hormone (PTH).
The most common lung neoplasm associated with
hypercalcemia is squamous cell carcinoma.
In addition to PTHRP, several other factors, such as IL-
1, TGF-α, TNF, and dihydroxyvitamin D, have also been
causally implicated in the hypercalcemia of malignancy.
Acanthosis nigricans is a disorder characterized by
grayblack patches of thickened, hyperkeratotic skin
with a velvety appearance.

 In addition, in about 50% of the cases, particularly

in those over age 40, the appearance of such lesions
is associated with some form of cancer.
Hypertrophic osteoarthropathy is encountered in 1%
to 10% of patients with lung carcinoma
This disorder is characterized by
(1) periosteal new bone formation, primarily at the
distal ends of long bones, metatarsals, metacarpals,
and proximal phalanges
(2) arthritis of the adjacent joints
 (3) clubbing of the digits
Migratory thrombophlebitis (Trousseau syndrome)
may be encountered in association with deep-seated
cancers, most often carcinomas of the pancreas or
lung.
Disseminated intravascular coagulation may
complicate a diversity of clinical disorders
 it is most commonly associated with acute
promyelocytic leukemia and prostatic adenocarcinoma.
Nonbacterial thrombotic endocarditis
Bland, small, nonbacterial fibrinous
vegetations sometimes form on the cardiac valve
leaflets (more often on left-sided valves), particularly in
individuals with advanced mucin-secreting
adenocarcinomas.
Endocrine syndromes, which can cause:
 High blood pressure
 Weakness
 Weight gain
Neurologic syndromes, with symptoms such as:
 Dizziness
 Double vision
 Reduced reflexes, sensation, or coordination
 Speech difficulty
Weakness Skin syndromes, which may produce:
 Flushing (redness)
 Itching
 Benign (non-cancerous) skin growths