Click here to load reader

Surgical Oncology

  • View
    1.252

  • Download
    5

Embed Size (px)

Text of Surgical Oncology

  • 1.SURGICAL ONCOLOGY James Taclin C. Banez, MD, FPSGS, FPCS, DPBS, DPSA

2.

  • Study of neoplastic diseases:
    • ONCOS = tumor LOGOS = study
  • Neoplasm :
    • Altered cell population characterized by an excessive, non-useful proliferation of cells that are unresponsive to normal control mechanisms and to organizing influences of adjacent tissue.

3. Neoplasm:

  • Malignant:
    • Cancer cells that exhibit uncontrolled proliferation and impair the function of normal organs by local tissue invasion and metastatic spread to distant anatomic sites.
  • Benign:
    • Composed of normal appearing cells that do not invade locally or metastasize to other sites

4. EPIDEMIOLOGY:

  • Overall cancer death rates shows slow steady increase
  • Lower death rates during past 50yrs:
    • Stomach
    • Uterus
  • Increase death rates:
    • Lung
    • Pancreas

5. EPIDEMIOLOGY:

  • Cancerincidencebysites and sex:

Male Female Lung 20% Breast 27% Prostate 20% Colon & Rectum 16% Colon & Rectum 14% Lung 11% Urinary 10% Uterus 10% Leukemia & Lymphoma 8% Leukemia & Lymphoma 7% Skin, pancreas and oral 3-4% Skin, pancreas and oral 3-4% 6. EPIDEMIOLOGY:

  • Cancerdeathbysites and sex:

Male Female Lung 36% Lung 20% Colon & Rectum 11% Breast 18% Prostate 10% Colon & Rectum 14% Leukemia & Lymphoma 9% Leukemia & Lymphoma 9% Pancreas & Urinary 5% each Pancreas & Ovary 5% Urinary & Uterus 4% each 7.

  • The most significant 5 yrs survival rates are achieved in patients w/ cancer ofskin, thyroid, cervix, uterusandbladder ; w/ the lowest survival w/pancreatic cancer
  • Females tend to have a greater number of 5yrs survival w/ cancer of any given primary site than males, reason (?)
      • 5 yr survival female= 50%
      • 5 yr survival male= 31%

8. ETIOLOGY:

  • Chemical carcinogens :
    • Hydrocarbons from coal tar = skin, larynx & bronchial CA
    • Aromatic amines = urinary tract CA
    • Benzene = leukemia
    • Asbestos = mesothelioma
  • Physical carcinogens:
    • Ionizing radiations = bone cancer
      • Multiple x-rays = skin/thyroid CA
    • Atomic bomb (Japan) = leukemia

9. ETIOLOGY:

  • Mechanical (chronic irritation):
    • Marjolins ulcer = burn scar cancer
  • Infection:
    • Parasitic:
      • Schistosomas Liver & bladder CA
    • Viruses:
      • Hepatitis B hepatocellular CA
      • Epstein-Barr virus Burkitts lymphoma
      • Herpes simplex virus 2 cervical CA
      • Aids

10. ETIOLOGY:

  • Geographic factors:
    • Inc. CA of stomach Scandinavian,
    • Iceland and Japan
    • Inc. CA of liver South & West Africa
    • Inc. CA of Nasopharynx China
    • Inc. CA of urinary bladder Egypt
    • Dec. CA of colon Black/Africa
    • Dec. CA prostate / breast Japan
    • Dec. CA of uterine/cervix Israel/Jewish
    • Dec. CA of skin Blacks
  • customs & environmentplays an important role in the development of CA.
  • migration of populations usually causes a shift towards the patterns of cancer incidence of the host country

11. ETIOLOGY:

  • Precancerous conditions:
    • Leucoplakia
    • Actinic keratosis
    • Polyps of colon & rectum
    • Neurofibromas
    • Dysplasia of cervix, bronchial
    • Chronic ulcerative colitis
  • Hereditary factors:
    • Familial polyposis colonic CA
    • Breast CA 2-3x in daughters and in younger age

12. ETIOLOGY:

  • Oncogenes & Growth Factors:
    • RNA tumor viruses cause:
      • Carcinomas
      • Sarcoma
      • Leukemia
      • Lymphomas
    • Retrovirus have an enzyme that alters genomic RNA resulting to abnormal growth and differentiation of the cell.
  • Multi-factorial:
    • Lung / breast CA

13. CANCER BIOLOGY

  • Morphologic changes:
    • Rise from a single cell
    • Revert to more primitive cell types
    • Normal orderly tissue patterns are lost or replaced by the random pilling up of malignant cells w/o definite pattern
    • High index of mitoses
    • Invasion of adjacent structures

14. CANCER BIOLOGY

  • Biochemical changes:
    • Changes in DNA, RNA and chemical architecture results to LOSS of CONTACT INHIBITION to proliferation and intercellular adhesiveness
    • Reversion of normal cellular biochemistry to that of the embryonal cells that produces EMBRYONAL subs. (CEA, alpha fetoprotein)

15. CANCER BIOLOGY

  • Biochemical changes:
    • Also produced biologically active subs. Normally produced by the cells. (hyperparathyroidism); also that are not normally produced by the cells of origin (bronchogenic CA=ACTH)
  • Growth rates of neoplasm:
    • Doubling time is doubled
    • Takes 30 doubling time to produce 1cm nodule

16. CANCER BIOLOGY

  • Effector mechanism in tumor immunity:
    • Host provides a number of effector mechs. that destroys the tumor:
      • Tumor-antigen-specific antibodies
      • Mononuclear phagocytes
      • Natural killer cells
      • Cytotoxic T lymphocytes
      • Neutrophils
      • K cells

17. CANCER BIOLOGY

  • Effector mechanism in tumor immunity:
    • Tumor Necrosis Factor (TNF):
      • Cytokines produced by monocytes, machrophage, endothelial cells, large granular lymphocytes and neutrophils
      • Properties:
        • Direct cytotoxicity for certain cells
        • Stimulation of procoagulant activity by vascular endothelial cells
        • Induction of fever by direct effect on the hypothalamic thermoregulatory center

18. CANCER PATHOLOGY

  • Classification of Neoplasm:
    • Carcinoma arising from epithelial cells
    • Sarcoma arise from connective tissue and cells of mesenchymal origin (fibrous, muscular, fatty, vascular & skeletal).

19. CANCER PATHOLOGY

  • Grading of malignancy:
    • Brodersclassified carcinoma into 4 grades according to:
      • Degree of differentiation
      • Appearance of cells, their nuclei and the number of mitotic figures
    • Grade I least malignant
    • Grade IV most malignant

20. CANCER PATHOLOGY

    • Carcinoma in Situ:
      • Has cytologic characteristic of malignant tumors but w/ no detectable invasion into the surrounding tissue or infiltration into deeper cell layers

21. ROUTES OF SPREAD:

  • Metastasis may entirely dominate the clinical picture, while the primary tumor remains latent and asymptomatic
    • Direct ex

Search related