Podcast
Questions and Answers
What is the most common site of metastasis in carcinomas of thyroid, breast, lung, prostate, and kidney?
What is the most common site of metastasis in carcinomas of thyroid, breast, lung, prostate, and kidney?
Which of the following effects is NOT associated with bone metastases?
Which of the following effects is NOT associated with bone metastases?
What is the term for the spread of malignant cells through body cavities, such as the peritoneal or pleural cavity?
What is the term for the spread of malignant cells through body cavities, such as the peritoneal or pleural cavity?
Which type of spread is associated with bilateral ovarian metastases in females?
Which type of spread is associated with bilateral ovarian metastases in females?
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What is the microscopic appearance of metastases?
What is the microscopic appearance of metastases?
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Which of the following organs is an uncommon site for metastases?
Which of the following organs is an uncommon site for metastases?
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What is the term for the spread of malignant cells through the blood stream?
What is the term for the spread of malignant cells through the blood stream?
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What is the type of spread responsible for the formation of metastatic peritoneal/omental nodules accompanied by hemorrhagic ascites?
What is the type of spread responsible for the formation of metastatic peritoneal/omental nodules accompanied by hemorrhagic ascites?
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What is the primary mechanism of distant spread in carcinomas?
What is the primary mechanism of distant spread in carcinomas?
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What is the result of lymph node capsule infiltration during lymphatic spread?
What is the result of lymph node capsule infiltration during lymphatic spread?
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What is the fate of most tumor emboli in the circulation?
What is the fate of most tumor emboli in the circulation?
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What is the mechanism of direct spread in malignant tumors?
What is the mechanism of direct spread in malignant tumors?
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What is the result of tumor cells spreading to a surface such as skin or mucosa?
What is the result of tumor cells spreading to a surface such as skin or mucosa?
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What is the route of spread of tumor cells from one hollow organ to another adjacent one?
What is the route of spread of tumor cells from one hollow organ to another adjacent one?
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Which of the following is a characteristic of lymphatic permeation?
Which of the following is a characteristic of lymphatic permeation?
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What is the term for the spread of tumor cells from one node to another through efferent lymphatics?
What is the term for the spread of tumor cells from one node to another through efferent lymphatics?
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Which type of tumor is more likely to reach the circulation by direct invasion of blood vessels within the tumor?
Which type of tumor is more likely to reach the circulation by direct invasion of blood vessels within the tumor?
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What is the term for the final stage of tumor metastasis, where tumor cells settle in a new site and proliferate?
What is the term for the final stage of tumor metastasis, where tumor cells settle in a new site and proliferate?
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What is the usual route for malignant cells to reach the venous circulation in case of carcinoma?
What is the usual route for malignant cells to reach the venous circulation in case of carcinoma?
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Which of the following organs is NOT a common site for metastases from tumors of organs drained by the systemic veins?
Which of the following organs is NOT a common site for metastases from tumors of organs drained by the systemic veins?
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Which route is responsible for metastases in brain, spinal cord, and vertebrae without causing lung metastases?
Which route is responsible for metastases in brain, spinal cord, and vertebrae without causing lung metastases?
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What is the characteristic of the blood vessels formed in tumors due to the release of tumor-derived angiogenesis factor?
What is the characteristic of the blood vessels formed in tumors due to the release of tumor-derived angiogenesis factor?
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Which of the following statements is TRUE about tumor metastases?
Which of the following statements is TRUE about tumor metastases?
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Which of the following is a common site for metastases from tumors of the pelvic organs?
Which of the following is a common site for metastases from tumors of the pelvic organs?
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Study Notes
Metastasis and Spread of Cancer
- Metastases can occur in various organs, with the most common sites being the liver, lungs, bones, and brain.
Hematogenous (Blood) Spread
- Metastases can appear as scattered round nodules of variable sizes.
- Bone metastasis is common in carcinomas of the thyroid, breast, lung, prostate, and kidney, and develops in vascular bone sites.
- Bone metastases are commonly osteolytic, but can be osteosclerotic in cases of prostate cancer.
Effects of Bone Metastases
- Pathological fracture
- Severe pain
- Bone marrow destruction leading to pancytopenia (significant reduction in the number of almost all blood cells)
Spread Through Body Cavities (Transcoelomic Spread)
- Trans-peritoneal spread can occur from carcinomas of the stomach, colon, and pancreas, leading to metastatic peritoneal/omental nodules accompanied by hemorrhagic ascites.
- Krukenberg tumors can occur in females, where carcinoma of the stomach (or colon) is associated with bilateral ovarian metastases.
Other Methods of Spread
- Transluminal implantation: malignant cells can detach from transitional carcinoma of the renal pelvis and become implanted in the mucosa of the urinary bladder.
- Lymphatic permeation: malignant cells can grow inside the lumen of lymphatics, causing marked lymphatic obstruction and lymphatic edema.
Pattern of Blood Spread
- Malignant cells can reach the venous circulation through the thoracic duct (after lymphatic spread) or by direct invasion of blood vessels within the tumor.
- Tumors are richly vascularized due to the release of tumor-derived angiogenesis factor, leading to the formation of feeding vessels derived from the host.
Course of Tumor Emboli
- Emboli derived from primary tumors of organs drained by systemic veins can cause lung metastases.
- Emboli derived from tumors of the lungs (whether primary or metastatic) can cause metastases in different organs such as the liver, bones, etc.
- Emboli derived from tumors of organs drained by the portal vein can cause liver metastases.
Degradation
- Proteolytic enzymes, such as IV collagenase and cathepsin D, can degrade basement membrane and connective tissue, allowing for invasion.
Migration
- Tumor-derived cytokines (mobility factors) can mediate migration of tumor cells.
Vascular Dissemination and Homing of Tumor Cells
- Tumor cells can cross the vascular basement membrane and adhere to platelets, which affords them some protection from host immune cells.
- The surviving tumor cell emboli can get impacted in small vessels, leading to adherence to the endothelium, crossing the basement membrane, and finally settling in the new site (homing), where they can proliferate and form metastatic deposits.
Routes of Spread
- Local (Direct) Spread: Malignant cells can spread in all directions along lines of least resistance, with some structures like cartilage, periosteum, and elastic tissue delaying direct spread.
- Distant Spread (Metastasis): Occurs through lymphatic or hematogenous spread, with lymphatic spread occurring more commonly with carcinomas than sarcomas.
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Description
This quiz covers the pathology of organ metastases, including the most common sites of metastases, gross and microscopic pictures, and specific types of metastases such as bone metastasis.