Chapter 24 Clinical effects and management of neoplasia
Clinical effects
Benign neoplasms
Benign neoplasms usually present because of the local effects of the tumour, with any systemic symptoms linked to the production of a specific chemical such as a hormone by the tumour cells (Table 3.24.1). The clinical effects of benign neoplasms are very dependent upon the site and size of the tumour. Small benign neoplasms are often asymptomatic and only discovered incidentally. However, those occurring at critical sites may cause serious disease or death. Hormone-producing benign tumours most commonly arise within endocrine organs and usually present due to the clinical effects of excess hormone production.
Table 3.24.1 CLINICAL PRESENTATION OF BENIGN NEOPLASMS
| Tumour feature | Example | Clinical symptom |
|---|---|---|
| Asymptomatic | Renal oncocytoma | Asymptomatic |
| Pressure on local structures | Pituitary adenomaOsteoma | Tunnel visionPain |
| Obstruction of lumen | Ampullary adenoma | Obstructive jaundice |
| Haemorrhage | Colorectal adenomaHepatic adenoma | Rectal bleedingSevere intra-abdominal haemorrhage |
| Hormone production | Pituitary adenomaAdrenocortical adenoma | AcromegalyCushing’s disease, Cushing’s syndrome |
| Malignant transformation | Colorectal adenoma | Colorectal carcinoma |
Malignant neoplasms
Malignant neoplasms may present with similar local effects to those of benign neoplasms. However, malignant neoplasms also possess the ability to invade rather than compress local tissues and this commonly results in their local effects becoming more serious than a benign tumour of the same size occurring at the same site. Malignant neoplasms may, therefore, cause extensive disease locally as well as at a distance through spreading. Figure 3.24.1 shows examples of the problems that can occur depending on the area affected. Adherence, fistula formation, strictures and perforations can all occur in addition to compression.
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