F00574 003 f005
First mutation
First mutation Normal
/_ epittielium — — Basal lamina
- Blood vessel
- Connective tissue
- Lymphatic
Initial proliferation
Smali adenoma
Further mutation
Inherited oracquired gain of oncogene Loss of tumour suppressor gene
Further mutation; subset selected for rapid growth
Further mutation ->invasion or metastasis
Ł
Lymphatic spread -
Blood spread -
Carcinoma
Ectopic growth factor production and autostimulation
Local invasion through basal lamina
t Angiogenesis to support tumour growth
Failed apoptosis {e.g. p53 mutation)
/
Breakdown of connective tissue via tumour production of e.g. collagenase
tissue metalloproteinases Loss of celi adhesion molecules e.g. E-cadherin
© Elsevier. Boon et al.: Davidson's Principles and Practice of Mediclne 20e - www.studentconsult.com
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