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AB&SS2 > C 2.2: Primary Malignant Neoplastic Diseases > Flashcards

C 2.2: Primary Malignant Neoplastic Diseases Flashcards

1
Q

what are malignant neoplasms

2 different origins

A

cancerous growths

epithelial
connective tissue

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2
Q

name for malignant neoplasms that have epithelial origin

A

carcinoma

or more commonly : adenocarcinoma

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3
Q

name for malignant neoplasms that have connective tissue origin

A

sarcoma

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4
Q

malignant neoplasms of which origin are most common

A

epithelial

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5
Q

what are 3 routes of spread for metastatic cancer

A

blood
lymphatics
direct invasion (cancer is in direct contact w/ another organ, facilitating spread)

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6
Q

proven causes of malignant neoplasms

A

exposure to carcinogens and radiation

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7
Q

risk factors for malignant neoplasms

A

viruses (HPV, Hep B and C)
family Hx
environment
hormones (HRT)

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8
Q

list some US signs that would be suspicious of malignancy

A 
hypoechoic halo
hypo, solid liver mass
multiple liver masses
high velocity signs/arterial waveform in a mass
hypervascular
lymphadenopathy
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9
Q

describe Hepatocellular carcinoma

what are its 3 forms

A

most common primary tumor of the liver occurring in the 6th decade of life

  1. focal solitary
  2. focal multiple
  3. diffuse infiltration
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10
Q

is HCC more common in W or M

A

Men

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11
Q

risk factors for HCC

A

alcoholic cirrhosis
Hep B and C
toxic metabolites (chronic exposure to chemicals)
metabolic disorders

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12
Q

which risk factor of HCC is the most common cause of the disease in the west

A

alcoholic cirrhosis

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13
Q

another name for HCC

A

hepatoma

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14
Q

HCC is specifically associated w/ which metabolic disorder

A

GSD - glycogen storage disease

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15
Q

symptoms of HCC

A

RUQ pain
weight loss
ascites
hepatomegally (= 15.5cm is norm, 17cm upper limit)

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16
Q

is weight loss in older patients always worrisome

A

yes

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17
Q

the disruption of the production of which protein produced by the liver may cause ascites?

A

albumin - controls osmotic balance

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18
Q

US appearance of HCC

A

often hypo w/ an anechoic halo
<5 cm
high velocity signal w/ doppler
portal/hepatic venous invasion

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19
Q

w/ HCC, is portal or hepatic vein invasion more common

A

portal

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20
Q

which lab values will be elevated w/ HCC

A

ALP AST ALT

and AFP

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21
Q

what % of patients w/ HCC will have increased AFP values

A

70%

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22
Q

3 benign abnormalities that cant be distinguished from the hyperechoic presentation of HCC

A

hemangioma
adenoma
lipoma

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23
Q

describe a hemangiosarcoma of the liver

what age grp does it typically effect

A

rare aggressive cancer w/ rapid spread

60-80yrs

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24
Q

hemangiosarcomas of the liver are associated w/ which risk factors

A

arsenic
thorotrast (old xray contrast)
PVC exposure (polyvinyl chloride)

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25
US appearance of Hemangiosarcoma
large | mixed echogenicity
26
another name for hemangiosarcoma
angiosarcoma
27
describe an epitheloid hemangioendothelioma of the liver US appearance
rare, malignant, vascular tumor multiple hypo masses you will see an indentation of the hepatic capsule that is located directly over the lesion
28
describe a hepatoblastoma what age grp does it effect
most common primary liver malignancy in children often poor prognosis < 5 yrs
29
hepatoblastomas are associated w/ which syndrome
Beckwith-Wiedermann syndrome - over growth syndrome
30
what does the term 'blast' refer to
germ cells
31
what lab value will be elevated w/ a hepatoblastoma
AFP
32
US appearance of a hepatoblastoma
single, solid, large | mixed echogenicity, poorly defined walls, calcium deposits
33
describe lymphoma in general terms
primary malignant neoplasm of the lymphatic syst can be nodal or extranodal (anywhere in lymph tissue)
34
are conditions w/ painless presentations usually more of less worrisome
more
35
2 types of lymphoma
hodgkin's | non-hodgkin's
36
describe hodgkin's lymphoma prognosis? which age group does it more commonly effect
type of lymphoma that typically effects a younger age grp (15-40 yrs)... spread to other organs but good prognosis
37
symptoms of hodgkin's lymphoma
fever, weight loss, anemia painless enlargement of lymph nodes in clavicle and neck area para-AO lymphadenopathy
38
does hodgkin's lymphoma effect M or W more
M
39
what % of people w/ hodgkin's lymphoma have para-AO lymphadenopathy
25%
40
describe non-hodgkin's lymphoma which age group does it more commonly effect
type of lymphoma arising from lymphoid tissue, specifically T and B cells typically effects a older age grp (65-74 yrs)
41
symptoms of non-hodgkin's lymphoma
fever, weight loss, night sweats painless enlargement of lymph nodes in neck area or axillary para-AO lymphadenopathy mets to liver and spleen
42
what % of people w/ non-hodgkin's lymphoma have para-AO lymphadenopathy
50%
43
US appearance of hodgkin's and non-hodgkin's
- anechoic, hypo, solid, homo masses seen anterior and posterior to the AO/IVC, may be perceived as poor transmission - lobulated or scalloped - splenomagaly - hydro - nodes compressing ureters - organ and vessel displacement
44
what are organ and vessel displacement is specific to hodgkin's and non-hodgkin's
floating AO - Ao pushed anteriorly sandwich - SMA displaced anteriorly silhouette/mentle sign - enlarged nodes surrounding AO and IVC
45
describe a hemangiosarcoma of the spleen where does it often spread
rare primary tumor of spleen, often there is mets to the liver
46
US appearance of a hemangiosarcoma of the spleen
similar to cavernous hemangioma in the spleen
47
hemangiosarcomas of the spleen are associated w/ which condition
anemia (70%)
48
What does puritus mean
Itchy skin
49
Another term for GB carcinoma | Is it associated w/ stones
Adenocarcinoma Yes
50
When does adenocarcinoma of the GB usually present
6-7th decade of life
51
Signs and symptoms of adenocarcinoma of the GB
Similar to chronic cholecystitis (RUQ pain and intolerance to fatty foods) Jaundice and pruritus in late stages
52
Where is it common for adenocarcinoma of the GB to spread
Lymph nodes and liver
53
US appearance of adenocarcinoma of the GB
- Polyp w/ irregular borders or mass - Thickening of GB wall (focal or diffuse) - maybe be invading the liver
54
Describe a cholangiocarcinoma What age does it usually occur
a slow growing adenocarcinoma of the bile ducts 50-60 yrs
55
Risk factors for cholangiocarcinoma
- Chronic biliary stasis and inflammation | - Patient Hx of choledochal cyst or caroli’s
56
Clinical presentation of cholangiocarcinoma Which lab values will be increased
Vague/insidious Jaundice/pruritis Elevated serum bilirubin and ALP
57
3 forms of cholangiocarcinom
Intrahepatic Distal (region of CBD) Hilar or Klatskins
58
Which type of cholangiocarcinoma is most common
Hilar / Klatkins
59
Describe Hilar / Klatkins cholangiocarcinoma Where do it often occur (location)
Most common cholangiocarcinoma At the bifurcation of R and L CHD
60
US appearance of Hilar / Klatkins cholangiocarcinoma
*CBD is norm *Dilated intrahepatic ducts solid mass at liver hilum Bulging of ducts
61
Describe an adenocarcinoma of the panc Risk factors for panc adenocarcinoma
Typically effects panc head Most common malignancy of the panc Smoking, alcohol and diabetes
62
In what age group does adenocarcinoma of the panc usually occur
60-80 years
63
What’s the prognosis of adenocarcinoma of the panc
Poor
64
What lab value will be elevated with adenocarcinoma of the panc
Lipase
65
Clinical presentation of adenocarcinoma of the panc
Painless jaundice Nausea and vomiting Changes in stool due to obstruction (bile not entering duodenum)
66
Direct signs of adenocarcinoma of the panc on US
>2cm Hypo variable echoexture
67
Indirect signs of adenocarcinoma of the panc on US
Dilated panc duct, and bile ducts Double duct sign Dilated GB (courvoisier’s GB)
68
What is a courvoisier’s GB
Dilated GB that creates palpable mass
69
In what age group does a cystic neoplasm of the panc usually occur
Middle age to older age group
70
2 types of cystic neoplasms of the panc
1. Microscystic (serous cystadenoma) | 2. Macroscystic (mucinous cystadenoma)
71
Describe a Microscystic (serous cytadenoma) of the panc Where does it often occur in the panc
Benign, occurs more often in the panc head
72
US appearance of the Microscystic (serous cytadenoma)
Many small cysts <2 cm | Can appear solid and echogenic due to multiple cysts
73
Describe a Macroscystic (mucinous cytadenoma) of the panc
Uncommon Malignant, often in a panc tail
74
US appearance of Macroscystic (mucinous cytadenoma)
Larger cystic areas (>2cm) | Unilocular or multiocular
75
what are the advantages of CT and angiography over US
better at assessing vascularity and extent/size
76
whats a norm wall thickness of the GI tract when distended and non distended
distended: 3 mm non distended: 5 mm
77
US pattern of thickened gut
target appearance of pseudo kidney hypo rim (represents thick gut wall) w/ hyper center (residual lumen)
78
how will the GI wall look w/ benign conditions that cause thickening
long segment involved symmetrical thickening individual layers are still seen
79
how will the GI wall look w/ malignant conditions that cause thickening
short segment involved asymmetrical thickening destruction of layers
80
causes of increased peristalsis
obstrution and inflammation
81
causes of decreased peristalsis
paralytic ileus and end stage obstruction
82
will obstructed and inflamed bowel be compressible
no
83
can lymphadenopathy and hyperemia be seen in both benign and malignant conditions of the GI
yes
84
clinical presentation of GI primary malignant neoplasm
pain anemia palpable mass blood in stool
85
what is the most common malignant tumor of GI tract
adenocarcinoma
86
is an adenocarcinoma of the GI tract occurs in the sm. bowel, which area will likely be effected increased risk of this w/ which disease
ileum crohns
87
is adenocarcinoma of the colon common 2 presentations in the colon
yes polypoid (more often in cecum and AC) or annular (descending and sigmoid)
88
does the annular form of adenocarcinoma in the colon cause obstruction
yes
89
US appearance of adenocarcinoma of the GI what else should you look for in the abdoment
large, hypo mass thick gut wall w/ characteristic signs look for nodes and mets
90
describe lymphoma of the GI tract What age group does it effect
can be primary or mets.... if primary will be non-hodgkins most common GI tumor in children <10
91
US appearance of lymphoma of the GI tract
hypo, solid nodules target lesion involves mesenteric nodes
92
all primary malignant tumors of the urinary tract are more common in which gender
men
93
describe RCC what age grp does it most often effect
an adenocarcinoma that is the most common malignant renal tumor in adults 50-70
94
clinical presentation of RCC
``` flank pain gross hematuria palpable mass hypertension weight loss ```
95
RCC is associated w/ which 2 conditions
tuberous sclerosis | hippel-lindau
96
what is hippel-lindau
inherited disease where people form both benign and malignant tumors in their body
97
what other areas of the body should you check w/ RCC
``` IVC for tumor invasion (causes leg edema) renal veins para AO lymph nodes contralateral kidney testes for varicose veins ```
98
US appearance of RCC
variable echogenicity hypo rim increased blood flow
99
another name for RCC
hypernephroma
100
describe a nephroblastoma what age does it present
most common malignant renal tumor in children 3-4 yrs
101
another name for nephroblastoma
Wilm's tumor
102
nephroblastoma are associated w/ which conditions
Beckwidth wiedemann
103
clinical presentation of nephroblastoma
``` fever hematuria hypertension palpable mass anemia ```
104
US appearance of nephroblastoma
large, well defined, solid, unilateral variable echotexture lymphadenopathy and mets
105
describe a transitional cell carcinoma (TCC) of the kidney
arises from the epithelial lining of the collecting system (eg calyces, renal pelvis, ureters, bladder)
106
what other pediatric tumor could a nephroblastoma be confused with and why
neuroblastoma, due to its location
107
clinical presentation of TCC
gross or microscopic hematuria
108
3 DDX for TCC in the renal pelvis
blood clot fungal balls sloughed papilla (point of pyramid)
109
US appearance of TCC in the renal sinus
ill defined, hypo mass
110
US appearance of TCC in the bladder which areas does it commonly effect
non-mobile mass or thickened wall (blood clot would be mobile) commonly effect the trigone, lateral and posterior walls
111
symptoms for TCC of the bladder
painless hematuria frequency dyuria suprapubic pain
112
2 procedure need to diagnose TCC of the bladder
cystoscopy and biopsy
113
US appearance of TCC in the ureters
hydro above the solid mass
114
describe squamous cell carcinoma (bladder) its associated w/ which conditions
rare, aggressive bladder cancer w/ distal mets chronic UTIS, stones and strictures
115
clinical presentation and US appearance of squamous cell carcinoma (bladder)
same as TCC
116
describe an adenocarcinoma of the prostate which zone does it commonly effect
most commonly diagnosed cancer in men peripheral zone, then spreads towards the capsule
117
at what age does adenocarcinoma of the prostate usually occur risk factors
>50 age, fatty diet, family Hx
118
4 steps for evaluating adenocarcinoma of the prostate
DRE, PSA, TRUS, biopsy
119
signs and symptoms of adenocarcinoma of the prostate
``` asymp. may have bone pain weakness weight loss PSA elevated ```
120
US appearance of adenocarcinoma of the prostate
if sm: hypo if lrg: variable prostate losses smooth contour
121
treatment for adenocarcinoma of the prostate
monitor cryotherapy radiation (brachytherapy or external beam) radical prostatectomy (gold standard, risk for nerve damage)
122
describe a cortical cancer of the adrenal
rare, often an adenoma, in cortical region | can be hyperfunctioning or nonfunctioning
123
are cortical cancers usually hyperfunctioning or nonfunctioning in males and females
M: non-func. F: function.
124
4 clinical presentations of excessive hormone production by the adrenals
cushings syndrome (+ cortisol) Conns disease (+ aldosterone) viralization/feminization precocious puberty
125
US appearance of cortical cancer of the adrenal
well define, solid mass variable echogenicity/echotexture regional and nodal mets
126
echotexture tendencies of hyper and non-functioning cortical cancers of the adrenal
hyper: homo non: hetero
127
describe a neuroblastoma what age grp does it effect
highly malignant tumor arising from adrenal medulla found in children 4-5 yrs
128
clinical presentation of a neuroblastoma
palpable mass weight loss failure to thrive very irritable
129
US appearance of a neuroblastoma
solid, hetero, poorly defined calcifications renal displacement mets to liver and around great vessels
130
are malignant neoplasms of the peritoneum rare
yes
131
US appearance of mesothelioma of the peritoneum
omental caking/thickening peritoneal thickeneing ascites
132
a mesothelioma of the peritoneum is associated w/ exposure to what materials what age group and gender does it effect
asbestos middle aged men
133
describe lymphoma of the peritoneum US appearance
non-hodgkin's type hypo mass along the peritoneum
134
lymphoma of the peritoneum is associate w/ which condition
AIDS

AB&SS2 (9 decks)

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