Tumour behaviour

An understanding of tumour biology is essential to the planning of surgical treatment for cancer.

The behaviour of solid tumours is diverse and the implications for surgery are often paradoxical. The three principal methods of spread are:

♦ Direct infiltration

Most cancers disseminate by all three methods, although one method of spread may be predominant. Breast and colorectal cancer exhibit both blood and lymphatic spread whereas cancers arising in the upper gastrointestinal tract and the upper airways metastasize via the lymphatics. Even cancers arising from the same cell type behave differently—papillary and follicular tumours of the thyroid give rise to lymphatic and haematogenous metastases respectively. Different surgical approaches will be required depending on tumour type.

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