Arbuda/Tumors, Shakya tantra
ARBUDA (TUMOURS)
Development of arbuda:
(Su.Sam.Ni 11/13)
Aggravated dosa, accumulate, vitiate mamsa etc and lead to the development of a rounded, fixed, large, deep rooted, slow growing, non-inflammatory swelling associated with mild pain. Such a swelling is termed arbuda.
Classification
(1) Vataja arbuda (4) Raktaja
(2) Pittaja (5) Mémsaja
(3) 'Kaphaja. (6) Medoja arbuda
The symptoms produced in each of these variety are similar to those produced in various granthi roga.
Raktarbuda-
The vitiated, aggravated dosa in turn Vitiate rakta and then localise in the vessels. By narrowing their passages and obstructing the flow of blood, the dosa cause the development of a rapidly growing swelling, covered with fleshy sprouts and which readily bleeds on touch etc. This is termed raktarbuda.
This condition is incurable. Owing to continuous haemorrhage the person suffers from anaemia etc.
Mamsarbuda:
The tissues at the area of trauma, gets vitiated, leading to the formation of a painless, hard (stone-like), fixed, swelling having a colour similar to the surrounding skin. This incurable mamsarbuda is said to manifest geneially in those who consume meat constantly and excessively.
Even though some of these arbuda are curable, if they are continuously exudating, situated over vital structures and deeply fixed (involves substantial amount of tissues), are to be considered as incurable.
Adhyarbuda- Tumour growing over previously manifested one, is termed adhyarbuda.
Dvirarbuda- Tumours which manifest either simultaneously or after sometime after the manifestation of a primary tumours is defined as dvirarbuda. (Secondary)
Neoplasia-
'Neoplasia' literally means new growths, but all new growths would not be defined under ”neoplasia”. Only when cells lose control and regulation over replication and then result in an abnormal mass of tissue, the word ”neoplasm” is used.
Therefore "neoplasm" is defined as ”a mass of tissue formed as a result of abnormal, excessive, uncoordinated, autonomous and purposeless proliferation of cells".
The study of neoplasm is termed "oncology".
Neoplasm{ Benign, Malignant
Benign neoplasms- The neoplasms which are slow growing and localised, without causing much discomfort to the host are defined as beingn.
Malignant neoplasms- These neoplasms spread very fast throughout the body and may finally lead to the death of the host.
The word "cancer" is generally used for malignant neoplasms.
Nomenclature- Tumors are named based on their parenchymal components ("parenchyma” is composed mainly of proliferating tumour cells).
Suffix- 'oma' is added to denote benign tumours
Suffix- 'sarcoma' is added to denote malignant tumours.
Classification-
SN.Tissue of origin | Benign | Malignant
1. Squamous epithelium Squamous cell Squamous cell carcinoma
2. Glandular epithelium Adenoma Adenocarcinoma
3 Hepatocytes Liver cell Adenoma Hepatoma
4 Adipoisie tissue Lipoma Liposarcoma
5 Adult fibrous tissu Fibroma Fibrosarcoma
6. Cartilage Chondroma Chondrosarcoma
7 Bone Osteoma Osteosarcoma
8 Smooth muscle leiomyoma Leiomyosarcoma
9 Skeletal muscle Rhabdomyoma Rhabdomyosarcoma
10. Blood vessels Haemangioma Angiosarcoma
11.lymph vessels lymphangioma lymphangiosarcoma
12 Nerve cells Ganglioneuroma Neuroblastoma
Characteristic features of tumours-
(i) Malignant tumour cells have increased mitotic rate (compared to normal cells) and slower death rates.
(ii) Clinically, benign tumours are slow growing and generally asymptomatic.
(iii) Clinically, malignant tumours grow rapidly, ulcerate on the surface, invade locally into deeper tissue, spread to distant sites (termed metastasis) and may produce systemic features like anorexia, anaemia, weight loss etc.
(iv) Benign tumours are generally spherical or ovoid, encapsulated or well-circumscribed, freely moveable, firm and uniform.
(v) Malignant tumours are generally irregular, poorly-circumscribed and extend into adjacent tissues and secondary changes like haemorrhage, infection and ulceration are common.
(vi) Differentiation- Differentiation is defined as the extent of morphological and functional resemblance of parenchymal tumour cells to corresponding normal cells.
If the changes in morphology and functions of tumour cells in comparission to normal cells is minimal, it is called "well-differentiated". Eg Most benign tumours.
If there is poor structural or functional resemblance of tumour cells with corressponding normal cells, it is called ‘poorly differentiated or "undifferentiated" tumour.
Note- Benign tumours form well circumscribed masses, that push aside the neighbouring structures as they expand. They do not infiltrate or invade into surrounding tissue.
Malignant tumours, as they expand, invade, infiltrate and destroy the surrounding tissue; beside having distant metastases.
Metastasis (Distant spread):
Benign tumours do not metastasise, whereas all malignant tumours (with few exceptions) metastasise. Generally larger, more rapidly-growing tumours, show greater tendency to metastasise.
(a) Lymphatic spread- Malignant cells easily invade the walls of lymphatics and form continous growths in lymphatic channels or malignant cells maty detach to form tumour emboli which maybe carried along with' lymph to regional lymph nodes and then far ahead. Therefore, regional lymph nodes get infiltrated resulting in regional nodal metastasis.
Important Note-
Virchow's lymph Node- This is a nodal metastasis into supraclavicular lymph nodes from cancers of abdominal organs eg cancer of stomach, colon, gallbladder, testis etc.
(b) Haematogenous spread - Sarcomas and generally all carcinomas metastasise by this route. Systemic veins drain blood into venae cavae from limbs, head and neck and pelvis. Therefore, cancers of these sites often metastasise into lungs.
Portal vein draws blood from spleen, pancreas and intestine into liver. Therefore carcinoma of spleen etc metastasis easily into liver.
(c) Cancers may also spread via CSF, along epitheluim lined surfaces etc.
Staging- Generally TNM system is followed
T- Primary tumour size
N- Lymph node involvement
M- Distant metastasis
Details of this TNM system of staging has been explained under the chapter of breast carcinoma. (Students can kindly refer PART- A Chapter No. 7)
Clinical Aspects-
Maiignant tumours (in comparision to benign tumours) produce many local as well as generalised features in the patient.
1. Local effects-
(a) Compression- Tumours because of their critical position (and many times owing to their size) may produce varied compressive features.
(i) For Eg- Tumours at Ampulla of vater may lead to biliary obstruction.
Tumour of head of pancreas may lead to biliary stasis.
(ii) Mechanical obstructionIntestinal obstruction due to nedplasia of the gut.
(iii) May easily undergo ulceration, haemorrhage, have superadded bacterial infections or may undergo torsion (Eg ovarian tumours etc).
(2) Cachexia - In advanced stages of cancer, patient present with anorexia and wasting; which may be secondary to increased nutritional demands of the tumour or due to haemorrhage, secondary infections, malabsorption, anxiety etc.
(3) Fever - of unexplained origin can be a presenting feature in certain malignancies viz Hodgkin's disease, osteogenic sarcoma etc.
(4) Some of the conditions viz hypercalcaemia, polycythaemia, hypoglycaemia, peripheral neuropathy, hypertrophnc osteoarthmpathy, malabsorption of various dietary components etc are produced, which cannot be explained to be either due to local or distant spread of the neoplasia.
Management-
The management of cancer is possible only by a multispeciality team of doctors. However surgery remains the definitive treatment, and the only chance of cure for most solid tumours.
Surgery has a great role in the management of tumours esp., in solid tumours. It helps in diagnosis, excision of the primary disease, removal of metastatic deposits, palliation, reconstruction etc.
Generally, diagnosis is confirmed before any surgical procedure is carried out. But many times surgery is required (viz explorative laprotomy) in intra-abdominal tumours etc to diagnose and stage the neoplastic growth.
Radical surgery for cure of malignancy, involves removal of the primary tumour, along with a rim of surrounding healthy tissue and the regional lymph nodes. This cures the primary lesion and reduces the chances of metastasis through lymphatics.
When due to secondary deposits into various organs, certain discomforting symptoms are produced, surgical removal of metastasised lesion, plays an important role in ensuring a longer and a quality life span.
Sometimes when the metastases is widespread, palliative removal of the primary lesion, may sometimes improve the quality of life.
Reconstructive surgery, after excision of the primary lesion and secondary metastatic deposits, ensures return of normal physiology or improves the cosmetic appeal of the region.
RADIOTHERAPY
Radiotherapy in the form of X-rays or gamma rays with an energy less than 1.1O 6V, has certain avantages viz.
(a) Deep seated tumours canbe treated
(b) Secondary electrons generated by the interaction of the high-energy beam with the skin are projected forwards so that the radiations dose is greater subcutaneously, minimising skiri reactions
(c) Absorption of radiation is similar in all tissues
Radiotherapy is associated with a certain disadvantage viz inevitable damage to surrounding tissue. The most sensitive tissues are bone marrow, gonads, eye, mucosa of gastro-intestinal tract, skin, lung tissue, kidney, liver, bone etc.
CHEMOTHERAPY
Advent of never drugs, is widening the scope of chemotherapy.
(1) There are certain chemotherapeutic drugs like cycIophosphamide, nitrogen mustard etc which bind to proteins of DNA and inhibit or restrict their functions.
(2) Drugs like 5-fluorouracil, methotrexate etc induce cell death or prevent replication of cells.
(3) Vincristine, vinblastin etc help in arresting cells in mitosis.
(4) Adriamycin, bleomycin etc also prevent replication, by binding to DNA.
Chemotherapy is most successful in the treatment of haematological malignancies like lymphoma, leukemia etc. Ovarian cancers, breast carcinoma, prostate carcinoma, testicular cancers etc also respond well to chemotherapy.
Oesophageal, pancreatic and squamous'cell carcinoma of lungs are marginally responsive or un-responsive to chemotherapy.
Chemotherapy rather thari being used alone, when used as adjuvant therapy along with surgery etc, produces better sucess rates.
Complications-
Toxicity is the main limiting factor for chemotherapy. Nausea, vomitting, alopecia, leucopenia,-thrombo-cytopenia, infertity etc are some of the common complications.
Development of arbuda:
(Su.Sam.Ni 11/13)
Aggravated dosa, accumulate, vitiate mamsa etc and lead to the development of a rounded, fixed, large, deep rooted, slow growing, non-inflammatory swelling associated with mild pain. Such a swelling is termed arbuda.
Classification
(1) Vataja arbuda (4) Raktaja
(2) Pittaja (5) Mémsaja
(3) 'Kaphaja. (6) Medoja arbuda
The symptoms produced in each of these variety are similar to those produced in various granthi roga.
Raktarbuda-
The vitiated, aggravated dosa in turn Vitiate rakta and then localise in the vessels. By narrowing their passages and obstructing the flow of blood, the dosa cause the development of a rapidly growing swelling, covered with fleshy sprouts and which readily bleeds on touch etc. This is termed raktarbuda.
This condition is incurable. Owing to continuous haemorrhage the person suffers from anaemia etc.
Mamsarbuda:
The tissues at the area of trauma, gets vitiated, leading to the formation of a painless, hard (stone-like), fixed, swelling having a colour similar to the surrounding skin. This incurable mamsarbuda is said to manifest geneially in those who consume meat constantly and excessively.
Even though some of these arbuda are curable, if they are continuously exudating, situated over vital structures and deeply fixed (involves substantial amount of tissues), are to be considered as incurable.
Adhyarbuda- Tumour growing over previously manifested one, is termed adhyarbuda.
Dvirarbuda- Tumours which manifest either simultaneously or after sometime after the manifestation of a primary tumours is defined as dvirarbuda. (Secondary)
Neoplasia-
'Neoplasia' literally means new growths, but all new growths would not be defined under ”neoplasia”. Only when cells lose control and regulation over replication and then result in an abnormal mass of tissue, the word ”neoplasm” is used.
Therefore "neoplasm" is defined as ”a mass of tissue formed as a result of abnormal, excessive, uncoordinated, autonomous and purposeless proliferation of cells".
The study of neoplasm is termed "oncology".
Neoplasm{ Benign, Malignant
Benign neoplasms- The neoplasms which are slow growing and localised, without causing much discomfort to the host are defined as beingn.
Malignant neoplasms- These neoplasms spread very fast throughout the body and may finally lead to the death of the host.
The word "cancer" is generally used for malignant neoplasms.
Nomenclature- Tumors are named based on their parenchymal components ("parenchyma” is composed mainly of proliferating tumour cells).
Suffix- 'oma' is added to denote benign tumours
Suffix- 'sarcoma' is added to denote malignant tumours.
Classification-
SN.Tissue of origin | Benign | Malignant
1. Squamous epithelium Squamous cell Squamous cell carcinoma
2. Glandular epithelium Adenoma Adenocarcinoma
3 Hepatocytes Liver cell Adenoma Hepatoma
4 Adipoisie tissue Lipoma Liposarcoma
5 Adult fibrous tissu Fibroma Fibrosarcoma
6. Cartilage Chondroma Chondrosarcoma
7 Bone Osteoma Osteosarcoma
8 Smooth muscle leiomyoma Leiomyosarcoma
9 Skeletal muscle Rhabdomyoma Rhabdomyosarcoma
10. Blood vessels Haemangioma Angiosarcoma
11.lymph vessels lymphangioma lymphangiosarcoma
12 Nerve cells Ganglioneuroma Neuroblastoma
Characteristic features of tumours-
(i) Malignant tumour cells have increased mitotic rate (compared to normal cells) and slower death rates.
(ii) Clinically, benign tumours are slow growing and generally asymptomatic.
(iii) Clinically, malignant tumours grow rapidly, ulcerate on the surface, invade locally into deeper tissue, spread to distant sites (termed metastasis) and may produce systemic features like anorexia, anaemia, weight loss etc.
(iv) Benign tumours are generally spherical or ovoid, encapsulated or well-circumscribed, freely moveable, firm and uniform.
(v) Malignant tumours are generally irregular, poorly-circumscribed and extend into adjacent tissues and secondary changes like haemorrhage, infection and ulceration are common.
(vi) Differentiation- Differentiation is defined as the extent of morphological and functional resemblance of parenchymal tumour cells to corresponding normal cells.
If the changes in morphology and functions of tumour cells in comparission to normal cells is minimal, it is called "well-differentiated". Eg Most benign tumours.
If there is poor structural or functional resemblance of tumour cells with corressponding normal cells, it is called ‘poorly differentiated or "undifferentiated" tumour.
Note- Benign tumours form well circumscribed masses, that push aside the neighbouring structures as they expand. They do not infiltrate or invade into surrounding tissue.
Malignant tumours, as they expand, invade, infiltrate and destroy the surrounding tissue; beside having distant metastases.
Metastasis (Distant spread):
Benign tumours do not metastasise, whereas all malignant tumours (with few exceptions) metastasise. Generally larger, more rapidly-growing tumours, show greater tendency to metastasise.
(a) Lymphatic spread- Malignant cells easily invade the walls of lymphatics and form continous growths in lymphatic channels or malignant cells maty detach to form tumour emboli which maybe carried along with' lymph to regional lymph nodes and then far ahead. Therefore, regional lymph nodes get infiltrated resulting in regional nodal metastasis.
Important Note-
Virchow's lymph Node- This is a nodal metastasis into supraclavicular lymph nodes from cancers of abdominal organs eg cancer of stomach, colon, gallbladder, testis etc.
(b) Haematogenous spread - Sarcomas and generally all carcinomas metastasise by this route. Systemic veins drain blood into venae cavae from limbs, head and neck and pelvis. Therefore, cancers of these sites often metastasise into lungs.
Portal vein draws blood from spleen, pancreas and intestine into liver. Therefore carcinoma of spleen etc metastasis easily into liver.
(c) Cancers may also spread via CSF, along epitheluim lined surfaces etc.
Staging- Generally TNM system is followed
T- Primary tumour size
N- Lymph node involvement
M- Distant metastasis
Details of this TNM system of staging has been explained under the chapter of breast carcinoma. (Students can kindly refer PART- A Chapter No. 7)
Clinical Aspects-
Maiignant tumours (in comparision to benign tumours) produce many local as well as generalised features in the patient.
1. Local effects-
(a) Compression- Tumours because of their critical position (and many times owing to their size) may produce varied compressive features.
(i) For Eg- Tumours at Ampulla of vater may lead to biliary obstruction.
Tumour of head of pancreas may lead to biliary stasis.
(ii) Mechanical obstructionIntestinal obstruction due to nedplasia of the gut.
(iii) May easily undergo ulceration, haemorrhage, have superadded bacterial infections or may undergo torsion (Eg ovarian tumours etc).
(2) Cachexia - In advanced stages of cancer, patient present with anorexia and wasting; which may be secondary to increased nutritional demands of the tumour or due to haemorrhage, secondary infections, malabsorption, anxiety etc.
(3) Fever - of unexplained origin can be a presenting feature in certain malignancies viz Hodgkin's disease, osteogenic sarcoma etc.
(4) Some of the conditions viz hypercalcaemia, polycythaemia, hypoglycaemia, peripheral neuropathy, hypertrophnc osteoarthmpathy, malabsorption of various dietary components etc are produced, which cannot be explained to be either due to local or distant spread of the neoplasia.
Management-
The management of cancer is possible only by a multispeciality team of doctors. However surgery remains the definitive treatment, and the only chance of cure for most solid tumours.
Surgery has a great role in the management of tumours esp., in solid tumours. It helps in diagnosis, excision of the primary disease, removal of metastatic deposits, palliation, reconstruction etc.
Generally, diagnosis is confirmed before any surgical procedure is carried out. But many times surgery is required (viz explorative laprotomy) in intra-abdominal tumours etc to diagnose and stage the neoplastic growth.
Radical surgery for cure of malignancy, involves removal of the primary tumour, along with a rim of surrounding healthy tissue and the regional lymph nodes. This cures the primary lesion and reduces the chances of metastasis through lymphatics.
When due to secondary deposits into various organs, certain discomforting symptoms are produced, surgical removal of metastasised lesion, plays an important role in ensuring a longer and a quality life span.
Sometimes when the metastases is widespread, palliative removal of the primary lesion, may sometimes improve the quality of life.
Reconstructive surgery, after excision of the primary lesion and secondary metastatic deposits, ensures return of normal physiology or improves the cosmetic appeal of the region.
RADIOTHERAPY
Radiotherapy in the form of X-rays or gamma rays with an energy less than 1.1O 6V, has certain avantages viz.
(a) Deep seated tumours canbe treated
(b) Secondary electrons generated by the interaction of the high-energy beam with the skin are projected forwards so that the radiations dose is greater subcutaneously, minimising skiri reactions
(c) Absorption of radiation is similar in all tissues
Radiotherapy is associated with a certain disadvantage viz inevitable damage to surrounding tissue. The most sensitive tissues are bone marrow, gonads, eye, mucosa of gastro-intestinal tract, skin, lung tissue, kidney, liver, bone etc.
CHEMOTHERAPY
Advent of never drugs, is widening the scope of chemotherapy.
(1) There are certain chemotherapeutic drugs like cycIophosphamide, nitrogen mustard etc which bind to proteins of DNA and inhibit or restrict their functions.
(2) Drugs like 5-fluorouracil, methotrexate etc induce cell death or prevent replication of cells.
(3) Vincristine, vinblastin etc help in arresting cells in mitosis.
(4) Adriamycin, bleomycin etc also prevent replication, by binding to DNA.
Chemotherapy is most successful in the treatment of haematological malignancies like lymphoma, leukemia etc. Ovarian cancers, breast carcinoma, prostate carcinoma, testicular cancers etc also respond well to chemotherapy.
Oesophageal, pancreatic and squamous'cell carcinoma of lungs are marginally responsive or un-responsive to chemotherapy.
Chemotherapy rather thari being used alone, when used as adjuvant therapy along with surgery etc, produces better sucess rates.
Complications-
Toxicity is the main limiting factor for chemotherapy. Nausea, vomitting, alopecia, leucopenia,-thrombo-cytopenia, infertity etc are some of the common complications.
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