Enter text here

Enter text here

1. Problems in host d/t

   • 1. Location/impingement
   • 2. Functional activity
   • 3. Bleeding and infection
   • 4. Produce enzymes and metabolic toxins
   • 5. Rupture/infarction
   • 6. Cachexia
   • 7. Pain

2. Effects on host

   • 1. Bleed/discharge – unusual
   • 2. Bowel movement – change
   • 3. Wart/mole – change
   • 4. Wound – not healing
   • 5. Weight loss – unexplained
   • 6. Anaemia or low Hb
   • 7. Fatigue – persistent
   • 8. Cough/hoarse – persistent for no reason
   • 9. Solid lump – painless/fixed

3. Local effects

   • Pain
     • Not usually early sign, depends on location and size of tumour
     • D/t – P on sensory nerve
     • Stretch of visceral capsule
     • Inflammation
     • Infection
     • Ischaemia
     • Bleeding
   • Obstruction
     • Tu can compress duct/structure/passage
       • From external, inside or around structure
     • Tu can obstruct duct/tubes
       • Digestive tract
       • Blood and lymph
       • Nerves
   • Necrosis/ulceration
     • Esp GIT/oral where normal flora becomes opportunistic – host resistance to infection is decreased

4. Systemic effects

   • Hormone production
     • Usually with benign, well differentiated tu in endocrine organ
     • eg. beta cells in pancreas > release insulin > hyperinsulinaemia > ± fatal
     • eg. adrenal cortex > release aldosterone > Na retention > hypertension + hyperkalaemia
   • Paraneoplastic syndrome
     • Signs and symptoms experienced d/t humoral/immune substances released d/t presence of tu
     • Neural PNS– affects neurological functioning
     • Haematological PNS – blood clotting
     • Endochrine PNS – hormone levels
     • May indicate – occult neoplasm, mimic metastases
     • Complicates diagnosis and treatment
     • 1. Hypercalcaemia – synthesis of parathyroid hormone/breakdown of bone
     • 2. Cushing syndrome – Ectopic production of ACTH (usually lung ca)
     • 3. Inc prod of pro-coagulants – > venous thrombosis > non-bacterial thrombotic endocarditis
     • 4. Inappropriate ADH secretion
     • 5. Lambert-eaton myasthenic syndrome – proximal muscle weakness with NO improvement with anti-cholinergic drugs
     • 6. 1 tu causing multiple syndromes – eg. broncogenic ca secreting ADH, ACTH, PTH, HCG, serotonin etc
   • Bleeding
     • Tu erodes vessel/causes ulceration
     • Bonemarrow depression= Dec in clotting
     • Chronic bleeding in GIT – occult bleed presenting with anaemia
   • Cancer-anorexia-cachexia
     • Common with most solid tu (≠ breast ca)
     • Multifactorial
       • Anorexia – d/t tu/hypothamus stimulation/treatment
       • Fatigue and Stress
       • Changes in protein and carb metabolism
       • Cachectic factors – prod by macrophage in response to tu > Inc weakness and fatigue, Inc tissue vreakdown > anaemia
       • Anaemia – d/t anorexia ,chronic bleeding, bonemarrow depression > Dec O2 > fatigue/poor healing