Lymphatic, first site
usually for carcinoma; however,
big time exception.
Two of them, I just talked
to you about one.
[0:00:11,2] are cancers,
what kind of cancer?
Is it a carcinoma?
Or is it a sarcoma?
It’s a carcinoma.
And what structure did I just
give you there from metastasis?
Did I give you lymphatics?
Or did I give you portal vein?
I give you portal vein.
Read this statement.
Carcinoma, rule of thumb pathology,
but there’s some major exceptions:
– third leading cause of death in a man,
third leading cause of death
from cancer in a female.
What about renal cell carcinoma?
Especially left side.
you invade, invade, invade
and as you do so,
you will then enter the renal vein.
What’s renal cancer?
It’s a carcinoma.
So from henceforth, you start
thinking of carcinomas as such.
You start thinking about carcinoma
as being it’s spread that it would choose
as far as the most convenient
method of spreading.
Sometimes it might be lymphatic,
sometimes it could be hematogenous.
Hematogenous tends to be more sarcomas.
Carcinomas, if they get
through the lymph node,
into efferent, then it will then become
hematogenous in general, keep that in mind.
You take a look at this liver.
This is not cirrhosis.
How many nodules do you find?
Many, many, many, many?
As far as you’re concerned,
multiple nodules on an organ.
And if you know for a fact that
it’s cancer, it means metastasis.
So where most likely did the metastasis
to the liver take place in this picture?
Most likely colorectal cancer.
So probably one through the lymphatics,
went into the portal vein
and then invaded hematogenously
to the liver.
What does seeding mean to you?
Seeding means a cancer
on the surface of an organ.
Let me give you a couple of surfaces
that you want to pay attention to:
How does this work?
For example, as a family,
And we’ll take a look at later;
ovarian tumors, the most common set of
family or the family of ovarian cancers
that’s most common
is not germ cell tumor,
it’s surface-derived ovarian tumor.
You’ve heard of serous
that is the most common
malignant ovarian tumor.
Guess what family belongs to:
So, what type of spread would surface-derived
cancers then take or choose?
Seeding, what does seeding mean?
Literally, the cancer on the surface.
I’m going to give you another one.
What is the only cause of
mesothelioma in the United States?
What if your patient was a roofer?
The only cause of mesothelioma
in the United States is asbestos exposure.
isn’t the pleura on surface?
What do you think is the most common
cause of brain cancer especially adults?
It’s astrocytoma, a glioma known as
I gave you three major cancers just now.
Ovarian tumors, serous cystadenocarcinoma,
mesothelioma, and glioblastoma multiforme.
the spread of these cancers because they’re
more likely on the surface of that organ
would then seed into the adjacent structures.
If it’s the ovary, it might
then seed into the peritoneum.
Pleura, we talk about seeding there,
and particularly glioblastoma multiforme,
it might then seed,
Or the glioma may then seed
into the cerebrospinal fluid.
Three major different types of metastasis:
lymphatic, hematogenous and seeding.
And I have given you
specific behavioral characteristics.
Our topic is bone metastasis.
How important is this?
The vertebrae would be
the most common site
and the way that it would
spread to the bone would be
a particular type of plexus known as
your Batson paravertebral plexus.
I’ll give you an example.
Here’s your patient.
72 years of age, and comes in
for a physical examination,
upon digital rectal examination,
you feel a gritty, gritty prostate.
What does gritty feel like?
You find that there is increase in PSA.
And in addition,
you find increase in Alk Phos,
Tell me about prognosis of your patient.
What’s going on?
The gritty type of palpation
that you felt on the prostate
and increase in PSA would then mean
prostate cancer as far as you are concerned.
I gave you no symptoms otherwise, did I?
I didn’t give you increased frequency,
I didn’t give you inadequate voiding,
I gave you prostate cancer.
Usually on the peripheral portion
of the prostate.
Next, I gave you alk phos.
What does that mean?
The prostate cancer now spread
and metastasize through
the Batson paravertebral plexus
to the vertebrae giving alk phos.
what does that mean to you?
Good. Bone growth.
So there was deposition of bone.
If there’s deposition of bone
taking place with the metastasis,
this type of spread would be more opaque
or would there be destruction
of the bone resulting in lucency.
Osteoblastic, B – blastic, will build bone,
more bone that you find,
take a look at the x-ray,
its called “hot bone”.
A hot bone to you means that there
is increase opacity of that bone
due to increased osteoblastic activity.
Increase in alk phos.
Are we clear about
how you should be using alk phos
in a setting of metastasis
to the bone which is your topic.
On the other side,
we have osteolytic.
Whenever you think about osteolytic,
take a look at the skull here.
It looks like bullets have
actually gone through the skull.
And What I mean by that is punched
out lesions, lytic punched out lesions.
One, there is such damage
taking place to the skull
then you’ll find there to be hypercalcemia
and this will be a different topic in
which we will go through and [0:06:56,4],
known as multiple myeloma.
This does not necessarily
bone metastasis. Right?
So this will be multiple myeloma.
Where the metastasis comes
in to play would be on the left,
where you find the patient
with prostate cancer
and then osteoblastic
activity of the vertebrae.
The vertebrae would be the most
common site as for as bone metastasis.
If it’s osteoblastic,
increased alk phos.
If it’s osteolytic,
then you would expect there to be
destruction of bone would only mean
the calcium starts depositing or
being released into circulation
guaranteed your patient has hypercalcemia
and with the lytic bone lesion,
you expect there to be