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By
Prof. J.T. Anim
Department of Pathology
Lecture V
Topics
Effect of neoplasm on host
Effect of host on neoplasm
Tumour immunity
Spontaneous regression of malignant
tumours
Effect of Neoplasm on Host
Local effects
Mechanical pressure
Destruction of tissue (pressure/aggressive invasion)
Haemorrhage +/- ulceration
Infection
Systemic effects
Fever - TNFα, IL-1 (tumour cells, macrophages)
Cachexia (anorexia, malabsorption, anaerobic metabolism
of neoplasm, cytokines eg. TNFα = cachexin, IL-6)
Effect on immune system (immunosuppression due to
tumour itself or treatment; autoimmunity – non-organ
specific)
Effect of Neoplasm on Host
Systemic effects Contd.
Haematological effects
Anaemia – iron deficiency, nutritional, excess Rbc
destruction (AIHA)(HD, lymphomas, thymoma), MAHA (ca
stomach, pancreas, colon, lung, breast), decreased
erythropoietin, sideroblastic, red cell aplasia (thymoma)
Increased red cell production – ectopic EPO (renal cell
carcinoma, cerebellar haemangioblastoma, uterine
fibroleiomyoma, liver carcinoma, ovarian carcinoma, lung
carcinoma)
Effects on platelets and clotting – thrombocytopaenia
(immune-mediated destruction); intravascular coagulation
(prostate, bronchus, stomach, breast), migratory
thrombophlebitis (carcinoma of bronchus, pancreas,
stomach, female genitalia, breast – mucin producing
tumours)
Effect of Neoplasm on Host
Systemic effects contd
Cutaneous manifestations
Acanthosis nigricans – 75% adenocarcinoma
Dermatomyositis – 15% malignancy
Exfoliative dermatitis – lymphomas & leukaemias
Erythema gyratum repens – carcinoma of bronchus
Pigmentation – carcinomatosis
Pruritis – lymphomas & some carcinomas
Herpes zoster – Hodgkin’s and other lymphomas
Acquired ichthyosis – lymphomas
Necrolytic migratory erythema - glucagonoma
Effect of Neoplasm on Host
Neuromuscular effects
Myopathy – carcinomas & lymphomas
Myasthenic syndrome – oat cell carcinoma of bronchus,
thymoma
Mixed neuropathy (sensory and motor)
Ca bronchus, stomach, breast, lymphoma, myeloma
Sensory neuropathy – carcinoma of bronchus
Autonomic neuropathy
Dementia or psychosis
Cerebellar degeneration – ca bronchus, ovary, lymphoma
Brain stem degeneration
PMLE (papova virus) – rarely, lymphoma
Effect of Neoplasm on Host
Systemic effects contd
Endocrine effects
Appropriate hormone production
Ectopic/inappropriate hormone production