Functional anatomy of cancer

Anatomical basis of cancer assessment( Vascular supply, lymphatic drainage and anatomical relationships)

By Dr. Abdul Waheed Ansari

Chairperson & Prof. Anatomy, RAKCOMS. RAKMHSU.

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Learning outcomes of the topic

• Functional anatomy of oral cavity cancers.

• Functional anatomy of liver cancers.

• Functional anatomy of breast cancer.

• Functional anatomy of prostate cancer, cervical cancer, colon and rectum cancers.

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Functional anatomy of oral cavity cancers

• Oral cavity has roof, floor, posterior wall, lateral walls and oral fissure.

• Roof of oral cavity is formed by hard and soft palate.

• Floor of mouth has tongue.• Posterior wall has adenoid tissue as member of

Waldeyer’s ring.• The palatine tonsils are located between the

pillars of tonsil.• Laterally vestibule of the mouth.

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The boundaries of oral cavity

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Cancer may arise from tongue

• Tongue is a mucomuscular organ. It has root, tip, dorsum of tongue and lateral margins.

• The mucus membrane is divided embryo logically into anterior 2/3rd

and posterior 1/3rd with the help of sulcus terminalis.

• Embryo logically the anterior 2/3rd of tongue develops from 2 lateral lingual swellings; the posterior 1/3rd develops from median lingual swelling and hypobranchial eminence.

• The nerve supply comes from the first, second and third pharyngeal arches-trigeminal, facial and glossopharyngeal nerves.

• The musculature of tongue develops from occipital myotomes. The nerve supply is by XII cranial nerve-hypoglossal nerve.

• The blood supply to tongue comes from lingual artery, a branch from external carotid artery.

• The venous drainage is by lingual veins. Cancer of tongue may spread through these veins and drain into internal jugular vein.

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Squamous cell carcinoma of the tongue in a 32 year-old chronic smoker.

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The lymphatic drainage of tongue

• 1. Tip of tongue is drained by sub mental group of lymph nodes.

• 2. Anterior 2/3rd of tongue lateral border drains into ipsilateral submandibular group of lymph nodes.

• 3. Anterior 2/3rd of tongue centrally drains into submandibular nodes on both sides.

• 4. Posterior 1/3rd of tongue drains into upper deep cervical lymph nodes.

• 5. Final nodes to be involved are Juguloomohyoid and deep cervical

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Tongue cancers

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The embryology of tongue

• The tongue develops from two

swellings:-

• Two lateral mesenchymal

swellings called the lateral lingual

swellings.

• Another small median elevation

named tuberculum impar

develops from the endoderm of

the pharynx at the region just

posterior to the lateral lingual

swellings.

• By the rapid growth of the lingual

swellings, they grow backward to

cover the tuberculum impar and

also grow forward and medially to

fuse with each other and give rise

to the anterior 2/3 of the tongue.

• The posterior 1/3 of the

tongue has a median end of

the 2nd 3rd and 4th branchial

arches at the region of the

hypobranchial eminence,

copula of His proliferates

rapidly.

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Functional anatomy of

liver cancers

• Liver is the largest organ in

our body. It lies under the

right and left domes of

diaphragm. It is covered with

peritoneum.

• Liver is connected with

neighboring organs with

peritoneal folds.

• The visceral surface of liver

has hilum, porta hepatis,

where blood vessels and

ducts enter and leave the

liver.

• The gall bladder lies under

the visceral surface.

• It stores bile and concentrate the bile and on

contraction and hormonal effects pumps

the bile into the second part of duodenum

through the hepatopancreatic duct.

• Liver receives blood supply through two

sources, venous blood and arterial blood.

• Hepatic artery brings oxygenated blood to

the liver where as portal vein brings the

blood from the intestines and spleen

where the blood is enriched with absorbed

nutrients.

• Portal vein is formed by the union of

superior mesenteric vein joining the

splenic vein.

• Cancers arising from the gut enters the

liver through this route and spreads to liver

as metastasis or secondary.

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Normal human liver

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Liver visceral surface

• LHL=left hepatic lobe

• RHL=right hepatic lobe

• QL=quadrate lobe

• CL=caudate lobe

• PV=portal vein

• FL=falciform ligament

• RL=round ligament of liver-Ligamentum teres

• GB=gall bladder

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Portal vein

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Porto systemic anastomoses

• In cases of obstruction to the flow of blood through liver these sites will open up and may cause, hepatic encephalopathy.

• During cirrhosis of liver or cancers of liver these portocaval anastomoses opens up and can damage the brain.

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Functional anatomy of breast

• The human breast lies in the superficial fascia of pectoral region.

• It extends vertically from 2-6 intercostal spaces.

• Transversely from breast bone to midaxillary line, as axillary tail of Spence.

• It has nipple and areola and glandular tissue along with fat embedded with in the glandular tissue.

• The arterial supply comes from branches of axillary artery and internal mammary artery.

• The lymphatic drains into pectoral group of lymph nodes and finally in to other axillary groups of lymph nodes.

• Cancers from breast are more common in the outer upper quadrants of breast.

• The cancer from breast can reach the thoracic cavity via lymphatic's passing through the internal mammary vessels.

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BREAST ANATOMY

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BREAST CANCER QUADRANTS

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Normal mammogram and breast cancer

Functional anatomy of pelvic organs

• Cervix, rectum, colon, anal canal

and prostate are the commonest

organs involved in spread of

cancer from pelvic cavity to other

regions including brain and back

bone.

• The pelvic veins communicates

with the sacral veins and

vertebral veins.

• Through vertebral plexus of veins

the pelvic veins are connected

with the cranial veins and any

infection or cancer can spread

through this route to brain and

spinal cord.

• The cervical cancer is the commonest cancer in female person.

• The cervix is the lower part of uterus.

• The lymphatic drainage from cervix is to:-Paracervical, sacral group and internal iliac groups of lymph nodes .

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Cervix anatomy

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Rectum and anal canal anatomy

• Rectum and anal canal are the terminal part of digestive system.

• Rectum and anal canal lies in the pelvic cavity.

• The blood supply to rectum and anal canal is by inferior rectal, middle rectal and superior rectal vessels.

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The lymphatic drains in to the following groups of lymph nodes

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The prostate anatomy

• The prostate gland is found within the pelvic area: below the bladder and in front of the rectum.

• The size of the prostate gland is often compared to that of a walnut.

• A normal healthy prostate gland is usually 3-5cms in width.

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The prostate cancer spreads to back bone

• This photo shows prostate cancer which is metastatic and has spread to the bone and joints.

• The cancer is shown as lesions (white marks) within the red bone marrow.

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Metastatic Prostate Cancer In The Spine

• This photo shows metastatic prostate cancer which has spread to the spine.

• The arrow and surrounding white area marks the vertebrate of the spine which has been affected by cancer.

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Prostate cancer spreads to the cranial bones

• In this image, prostate cancer has spread (metastasized) away from the primary area of the prostate gland.

• It has caused lesions (damage) to the skull cap.

• The skull and other areas of bone are often affected by metastatic prostate cancer.

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References

• http://www.dartmouth.edu/~humananatomy/part_6/chapter_32.html

• http://www.whathealth.com/prostatecancer/photo-7.html

• http://quizlet.com/22227043/srwk1-thursday-flash-cards/

• http://www.ghorayeb.com/TongueCancer.html

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