Pathological Conditions in Oncology

Pathology Definition

the sicence of the causes and effects of diseases, especially the branch of medicine that deals with examing the histlogy for diagnostic purposes

Three overlapping risk factors for cancer and chronic conditions

1. alcohol

2. smoking

3. obesity

what percent of body is water

60%

• ICF = 66%

• ECF = 33%

What is tissue

a collection of cells and their ecm working together to perform a shared function

what is an organ

a strucutre made up of a group of tissues, working together to perform a specific function

what is interstital matrix

The interstitial matrix is the extracellular matrix that exists between tissues, providing structural and biochemical support to surrounding cells.

what is interstital matrix

made up of fibroblasts, which produce collagen and other components

• water as well

is there more filtration on the arterial or venous end of capillaries

more filtration due to higher hydrostatic pressure

why is there more absorption on the venous ends

There is more absorption on the venous end of capillaries due to lower hydrostatic pressure and and increased colloid proteins pulling water back into the vessels

what is exudate

inflammation causes cytokines to be released, resulting in increased vascular permeability, leading to the accumulation of fluid, proteins, and cells in tissues.

what is transudate

decreased concentration of protein in blood results in fluid leaking out of the vessels into the interstitial space with low protein content.

• no proteins released

6 causes of abnormal fluid retention

1. increased vascular permeability

2. inreased hydrostatic pressure

3. decreased protein synthesis

4. increased protein loss

5. lymphatic obstruction

6. sodium retention

What is ascites

A pathological condition characterized by the accumulation of excess fluid in the abdominal cavity, often due to liver disease, heart failure, or malignancies.

most common cause of ascites

liver cirrhosis

what is cirrhosis

chronic liver disease that results in excessive liver scarring and destruction of hepatocytes

• liver has only 1 repair pathway - fibrosis - leading to loss of liver function and complications such as portal hypertension and liver failure.

three symptoms of cirrhosis

1. jaundice

2. ascites

3. splenomegaly

what is esophageal varices (symptom of cirrhosis)

Enlarged veins in the esophagus that occur due to increased pressure in the portal vein, often leading to bleeding.

three leading causes of cirrhosis

1. viral (Hep B and C)

2. Alcohol/metabolic

3. Autoimmune

what cancer are patients with cirrhosis at an increased risk at?

Liver cancer (hepatocellular carcinoma)

• more fibrosis repair = increase risk of hepatocytes becoming cancerous

why does cirrhosis limit the interventional approaches to cancer treatment

the liver is important in the metabolism and pharmacokinetics of many drugs

• cirrhosis livers have less efficacy to convert drugs and activate them

best treatment for hepatocellular carcinoma

liver transplant: get rid of cancer and potential cirrhosis

hepatic venous outflow obstruction

any condition that impairs the blood flow through the liver or from the liver to the heart

how does HVOO cause ascites

increased in hydrostatic pressure in the hepatic veins leads to fluid accumulation in the abdominal cavity.

Veno-occlusive disease of the liver

liver sinusoidal endothelial cells canbe damaged, leading to venous obstruction and hepatic dysfunction.

Budd-Chiari Syndrome

a condition caused by obstruction of hepatic venous outflow due to thrombosis or compression, often resulting in liver dysfunction and portal hypertension.

• hepatocyte death may occur

What is pleural effusion

Pleural effusion is the accumulation of fluid in the pleural space

simple pleural effusion

accumulation of fluid

complicated pleural effusion (empyema)

accumulation of infected fluid in the pleural spaces

Serofibrinous Pleuritis

the inflammation of the pleura

• most common causes are infection and autoimmine disorders

two ways serofibrinous pleuritis is associated with cancer

metastatic involvement of the pleura can cause pleuritis

radiation therapy for tumors of the lung and mediasteinum can cause pleuritis

Pericardial Effusion

the abnormal build up of fluid in the pericardial sac around the heart

Radiation-related pericarditis

inflammation of the pericardium due to radiation therapy, often manifesting as pericardial effusion

• acute manifestation of radiation injury

what can rapid accumulation of pericardial effusion result in?

cardiac tamponade: fluid compressing the heart

Edema

abnormal buildup of fluid in the tissue and interstitium

three categories of edema

1. subcutaneous

2. pulmonary

3. brain edema

localized subcutatenous edema

edema secondary to surgical procedures or RT that disrupt draining lymphatics

• the more nodes removed = more edema

what lymph node procedure minimizes lymphedema

Sentinel lymph node biopsy

Hydrocephalus

A condition characterized by an accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain, leading to increased intracranial pressure and potential brain damage.

two types of cancer that can cause hydrocephalus

1. brain tumors/metastasis

2. leptomeninges

radiation leukocephalopathy

damage to the brain's white matter caused by radiation therapy, leading to symptoms like memory loss, confusion, and difficulty walking.

• also causes hydrocephalus

late effect

what is the underlying pathogenesis of coronary and cerebral vascular diseases

atherosclerosis

what is atherosclerosis

buildup of fatty deposits (plaque) inside arteries, which can narrow them and reduce blood flow.

what are athersclerotic plaques susceptible to?

1. rupture/ulceration

   • exposes thrombogenic substances and leads to thromosis

2. atheroembolism

   • plaqure rupture can lead to debris causing microemboli

3. aneurysm

what is an aneurysm

bulge or ballooning in a blood vessel wall caused by weakness, which can rupture and lead to serious bleeding.

3 modifiable factors for atherosclerosis

hyperlipidedemia, hypertension, smoking

3 non-modifiabe factors for atherosclerosis

genetic abnormalities, family history, age, being male

Stroke (CVA)

happens when blood flow to part of the brain is blocked or a vessel bursts, causing brain cell damage.

two general types of strokes

1. hemorragic stroke

   • a weakened blood vessel in the brain bursts, causing bleeding and damage to brain tissue.

2. ischemic stroke

   • a blood clot or blockage cuts off blood flow to part of the brain, leading to brain cell death.

hemmorage = burst

ischemic = block

thrombotic vs. embolic ischemic strokes

• thrombotic: blood clot develops from blood vessels inside brain

• embolic: blood clot/plaque debris develops elsewhere in the body and travels to brain

Signs/Symptoms of a stroke

BE FAST

• balance loss

• eyesight changes

• face drooping

• arm weakness

• speech difficulty

• time to call 911

Transient Ischemic Attacks

are brief episodes of stroke-like symptoms caused by temporary blockage of blood flow to the brain, usually resolving within minutes to hours without lasting damage.

• often warning sign for major stroke

what type of strokes do cancers mostly cause

ischemic strokes

4 reasons cancer can induce a stroke (two are tx related)

1. cancer is a hypercoaguable state

   • tumors try isolate themselves from immune system, throw out coaguable factors

2. direct vessel compression from a tumor

3. vasculopathy from irradiation

4. chemotherapy association

   • cisplatin, thalidomide

myocardial infarction

happens when blood flow to coronary vessels of heart are blocked, causing necrosis to the heart muscle.

signs/symptoms of myocardial infarction

chest pain, shortness of breath, sweating, nausea, and pain radiating to the jaw or arm.

why is it important to keep the heart out of the radiation treatment field

RT can induce damage to coronary arteries that accelerate development of atherosclerosis

Pulmonary Embolism

a sudden blockage in a lung artery, usually caused by a blood clot that traveled from the legs (deep vein thrombosis).

symptoms of PE

include shortness of breath, chest pain, cough, and rapid heart rate.

why is PE risk increased in cancer patients

• cancer is prothrombotic state: blood is more prone to clote

• patients may less active, DVT will throw clots

Virchow’s triad of thrombosis

1. hypercoagubility of blood

2. vessel wall injury

3. stasis of blood

fracture

loss of bone integrity resulting from mechanical injury and/or diminished bone strength

pathologic fracture

bone weakened by an underlying disease process (such as a neoplasm)

what is more common: bone metastasis or bone neoplasms

Bone metastasis is more common than primary bone neoplasms, as most bone lesions result from cancer that has spread from other parts of the body.

• prostate, breast, thyroid, lung

osteolytic metastasis

a type of bone metastasis characterized by the destruction of bone tissue due to the invasion of cancer cells

• increased PTH induces osteoclasts to break down bone

• often seen in breast cancer

osteoblastic metastasis

deposition of new abnormal bone growth

• often seen in prostate cancer.

osteoporosis

a condition characterized by weakened bones and increased risk of fractures due to loss of bone density.

major causes of osteoporosis

include aging, hormonal changes, and nutritional deficiencies.

cancer therapies that increase osteoporosis in patients

Selective estrogen receptor modulators and androgen deprivation therapy

COPD

(Chronic Obstructive Pulmonary Disease) is a progressive lung disease that causes breathing difficulties due to airflow obstruction.

• most commonyl caused by smoking

COPD impact on cancer

can lead to increased risk of lung cancer due to compromised lung function and inflammation.

• also have worse outcomes: surgical resection of lung cancer requires having sufficient lung reserve in remaining lung

pneumothorax

is a condition where air leaks into the space between the lungs and chest wall, causing lung collapse (atelectasis). It can occur spontaneously or due to injury.

primary spontaneous pneumothorax

spontaneous distruption of pleural lining, often seen in younger patients

secondary pneumothorax

underlying lung disease that disrupts pleural surface

• TB, emphysema, pleural cancer, etc

Tension Pneumothorax

is a life-threatening condition where air accumulates in the pleural space, leading to increased pressure that collapses the lung and shifts mediastinal structures. This requires immediate medical intervention to decompress the pleural cavity.

• non collapsed lung is impacted, can’t transfer oxygen

Pneumonia

an infection that inflames the air sacs in one or both lungs, which may fill with fluid or pus, causing difficulty in breathing.

lung defence mechanisms

cough

alveolar macrophages

mucociliar elevator

pneumonitis

inflammation of lung tissue, often due to infection, allergens, or chemicals, that can lead to similar symptoms as pneumonia, including cough, fever, and difficulty breathing.

pneumonia vs. pneumonitis

pneumonia = inflammation caused by infection

pneumonitis = inflammation caused by allergens, chemicals or other irritants.

radiation pneumonitis

inflammation of lung tissue resulting from radiation therapy, often occurring in cancer patients, characterized by cough, fever, and shortness of breath.

chronic radiation pneumonitis is called

pulmonary fibrosis

Stridor

a high-pitched wheezing sound caused by an obstruction in the upper airway.

causes of stridor

airway obstruction, infections, tumor in upper airway, foreign bodies

Chondroradionecrosis

death of condrocytes due to radiation therapy to neck

• cartilage death = potential airway collapse

rare late complication

GI obstruction

a blockage that prevents the normal passage of contents through the gastrointestinal tract, which can lead to symptoms like vomiting, abdominal pain, and distension.

Two types of tumor causes of GI obstruction

intraluminal or extrinsic (mesentery growth) tumors

• GI or GYN origin

other causes of GI obstruction

herniation

adhesions

volvulus

intussception

why do opiods cause GI obstruction

decreased GI motility since peristalsis is inhibited