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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
Q

US appearance of Hemangiosarcoma

A

large

mixed echogenicity

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26
Q

another name for hemangiosarcoma

A

angiosarcoma

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27
Q

describe an epitheloid hemangioendothelioma of the liver

US appearance

A

rare, malignant, vascular tumor

multiple hypo masses
you will see an indentation of the hepatic capsule that is located directly over the lesion

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28
Q

describe a hepatoblastoma

what age grp does it effect

A

most common primary liver malignancy in children
often poor prognosis

< 5 yrs

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29
Q

hepatoblastomas are associated w/ which syndrome

A

Beckwith-Wiedermann syndrome - over growth syndrome

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30
Q

what does the term ‘blast’ refer to

A

germ cells

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31
Q

what lab value will be elevated w/ a hepatoblastoma

A

AFP

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32
Q

US appearance of a hepatoblastoma

A

single, solid, large

mixed echogenicity, poorly defined walls, calcium deposits

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33
Q

describe lymphoma in general terms

A

primary malignant neoplasm of the lymphatic syst

can be nodal or extranodal (anywhere in lymph tissue)

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34
Q

are conditions w/ painless presentations usually more of less worrisome

A

more

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35
Q

2 types of lymphoma

A

hodgkin’s

non-hodgkin’s

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36
Q

describe hodgkin’s lymphoma
prognosis?

which age group does it more commonly effect

A

type of lymphoma that typically effects a younger age grp (15-40 yrs)… spread to other organs but good prognosis

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37
Q

symptoms of hodgkin’s lymphoma

A

fever, weight loss, anemia
painless enlargement of lymph nodes in clavicle and neck area
para-AO lymphadenopathy

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38
Q

does hodgkin’s lymphoma effect M or W more

A

M

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39
Q

what % of people w/ hodgkin’s lymphoma have para-AO lymphadenopathy

A

25%

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40
Q

describe non-hodgkin’s lymphoma

which age group does it more commonly effect

A

type of lymphoma arising from lymphoid tissue, specifically T and B cells

typically effects a older age grp (65-74 yrs)

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41
Q

symptoms of non-hodgkin’s lymphoma

A

fever, weight loss, night sweats
painless enlargement of lymph nodes in neck area or axillary
para-AO lymphadenopathy
mets to liver and spleen

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42
Q

what % of people w/ non-hodgkin’s lymphoma have para-AO lymphadenopathy

A

50%

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43
Q

US appearance of hodgkin’s and non-hodgkin’s

A
  • 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
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44
Q

what are organ and vessel displacement is specific to hodgkin’s and non-hodgkin’s

A

floating AO - Ao pushed anteriorly
sandwich - SMA displaced anteriorly
silhouette/mentle sign - enlarged nodes surrounding AO and IVC

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45
Q

describe a hemangiosarcoma of the spleen

where does it often spread

A

rare primary tumor of spleen, often there is mets to the liver

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46
Q

US appearance of a hemangiosarcoma of the spleen

A

similar to cavernous hemangioma in the spleen

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47
Q

hemangiosarcomas of the spleen are associated w/ which condition

A

anemia (70%)

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48
Q

What does puritus mean

A

Itchy skin

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49
Q

Another term for GB carcinoma

Is it associated w/ stones

A

Adenocarcinoma

Yes

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50
Q

When does adenocarcinoma of the GB usually present

A

6-7th decade of life

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51
Q

Signs and symptoms of adenocarcinoma of the GB

A

Similar to chronic cholecystitis (RUQ pain and intolerance to fatty foods)

Jaundice and pruritus in late stages

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52
Q

Where is it common for adenocarcinoma of the GB to spread

A

Lymph nodes and liver

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53
Q

US appearance of adenocarcinoma of the GB

A
  • Polyp w/ irregular borders or mass
  • Thickening of GB wall (focal or diffuse)
  • maybe be invading the liver
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54
Q

Describe a cholangiocarcinoma

What age does it usually occur

A

a slow growing adenocarcinoma of the bile ducts

50-60 yrs

55
Q

Risk factors for cholangiocarcinoma

A
  • Chronic biliary stasis and inflammation

- Patient Hx of choledochal cyst or caroli’s

56
Q

Clinical presentation of cholangiocarcinoma

Which lab values will be increased

A

Vague/insidious
Jaundice/pruritis
Elevated serum bilirubin and ALP

57
Q

3 forms of cholangiocarcinom

A

Intrahepatic
Distal (region of CBD)
Hilar or Klatskins

58
Q

Which type of cholangiocarcinoma is most common

A

Hilar / Klatkins

59
Q

Describe Hilar / Klatkins cholangiocarcinoma

Where do it often occur (location)

A

Most common cholangiocarcinoma

At the bifurcation of R and L CHD

60
Q

US appearance of Hilar / Klatkins cholangiocarcinoma

A

*CBD is norm
*Dilated intrahepatic ducts
solid mass at liver hilum
Bulging of ducts

61
Q

Describe an adenocarcinoma of the panc

Risk factors for panc adenocarcinoma

A

Typically effects panc head
Most common malignancy of the panc

Smoking, alcohol and diabetes

62
Q

In what age group does adenocarcinoma of the panc usually occur

A

60-80 years

63
Q

What’s the prognosis of adenocarcinoma of the panc

A

Poor

64
Q

What lab value will be elevated with adenocarcinoma of the panc

A

Lipase

65
Q

Clinical presentation of adenocarcinoma of the panc

A

Painless jaundice
Nausea and vomiting
Changes in stool due to obstruction (bile not entering duodenum)

66
Q

Direct signs of adenocarcinoma of the panc on US

A

> 2cm
Hypo
variable echoexture

67
Q

Indirect signs of adenocarcinoma of the panc on US

A

Dilated panc duct, and bile ducts
Double duct sign
Dilated GB (courvoisier’s GB)

68
Q

What is a courvoisier’s GB

A

Dilated GB that creates palpable mass

69
Q

In what age group does a cystic neoplasm of the panc usually occur

A

Middle age to older age group

70
Q

2 types of cystic neoplasms of the panc

A
  1. Microscystic (serous cystadenoma)

2. Macroscystic (mucinous cystadenoma)

71
Q

Describe a Microscystic (serous cytadenoma) of the panc

Where does it often occur in the panc

A

Benign, occurs more often in the panc head

72
Q

US appearance of the Microscystic (serous cytadenoma)

A

Many small cysts <2 cm

Can appear solid and echogenic due to multiple cysts

73
Q

Describe a Macroscystic (mucinous cytadenoma) of the panc

A

Uncommon

Malignant, often in a panc tail

74
Q

US appearance of Macroscystic (mucinous cytadenoma)

A

Larger cystic areas (>2cm)

Unilocular or multiocular

75
Q

what are the advantages of CT and angiography over US

A

better at assessing vascularity and extent/size

76
Q

whats a norm wall thickness of the GI tract when distended and non distended

A

distended: 3 mm

non distended: 5 mm

77
Q

US pattern of thickened gut

A

target appearance of pseudo kidney

hypo rim (represents thick gut wall) w/ hyper center (residual lumen)

78
Q

how will the GI wall look w/ benign conditions that cause thickening

A

long segment involved
symmetrical thickening
individual layers are still seen

79
Q

how will the GI wall look w/ malignant conditions that cause thickening

A

short segment involved
asymmetrical thickening
destruction of layers

80
Q

causes of increased peristalsis

A

obstrution and inflammation

81
Q

causes of decreased peristalsis

A

paralytic ileus and end stage obstruction

82
Q

will obstructed and inflamed bowel be compressible

A

no

83
Q

can lymphadenopathy and hyperemia be seen in both benign and malignant conditions of the GI

A

yes

84
Q

clinical presentation of GI primary malignant neoplasm

A

pain
anemia
palpable mass
blood in stool

85
Q

what is the most common malignant tumor of GI tract

A

adenocarcinoma

86
Q

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

A

ileum

crohns

87
Q

is adenocarcinoma of the colon common

2 presentations in the colon

A

yes

polypoid (more often in cecum and AC)
or
annular (descending and sigmoid)

88
Q

does the annular form of adenocarcinoma in the colon cause obstruction

A

yes

89
Q

US appearance of adenocarcinoma of the GI

what else should you look for in the abdoment

A

large, hypo mass
thick gut wall w/ characteristic signs

look for nodes and mets

90
Q

describe lymphoma of the GI tract

What age group does it effect

A

can be primary or mets…. if primary will be non-hodgkins

most common GI tumor in children <10

91
Q

US appearance of lymphoma of the GI tract

A

hypo, solid nodules
target lesion
involves mesenteric nodes

92
Q

all primary malignant tumors of the urinary tract are more common in which gender

A

men

93
Q

describe RCC

what age grp does it most often effect

A

an adenocarcinoma that is the most common malignant renal tumor in adults

50-70

94
Q

clinical presentation of RCC

A 
flank pain
gross hematuria
palpable mass
hypertension
weight loss
95
Q

RCC is associated w/ which 2 conditions

A

tuberous sclerosis

hippel-lindau

96
Q

what is hippel-lindau

A

inherited disease where people form both benign and malignant tumors in their body

97
Q

what other areas of the body should you check w/ RCC

A 
IVC for tumor invasion (causes leg edema)
renal veins
para AO lymph nodes
contralateral kidney
testes for varicose veins
98
Q

US appearance of RCC

A

variable echogenicity
hypo rim
increased blood flow

99
Q

another name for RCC

A

hypernephroma

100
Q

describe a nephroblastoma

what age does it present

A

most common malignant renal tumor in children

3-4 yrs

101
Q

another name for nephroblastoma

A

Wilm’s tumor

102
Q

nephroblastoma are associated w/ which conditions

A

Beckwidth wiedemann

103
Q

clinical presentation of nephroblastoma

A 
fever
hematuria
hypertension
palpable mass
anemia
104
Q

US appearance of nephroblastoma

A

large, well defined, solid, unilateral
variable echotexture
lymphadenopathy and mets

105
Q

describe a transitional cell carcinoma (TCC) of the kidney

A

arises from the epithelial lining of the collecting system (eg calyces, renal pelvis, ureters, bladder)

106
Q

what other pediatric tumor could a nephroblastoma be confused with and why

A

neuroblastoma, due to its location

107
Q

clinical presentation of TCC

A

gross or microscopic hematuria

108
Q

3 DDX for TCC in the renal pelvis

A

blood clot
fungal balls
sloughed papilla (point of pyramid)

109
Q

US appearance of TCC in the renal sinus

A

ill defined, hypo mass

110
Q

US appearance of TCC in the bladder

which areas does it commonly effect

A

non-mobile mass or thickened wall (blood clot would be mobile)

commonly effect the trigone, lateral and posterior walls

111
Q

symptoms for TCC of the bladder

A

painless hematuria
frequency
dyuria
suprapubic pain

112
Q

2 procedure need to diagnose TCC of the bladder

A

cystoscopy and biopsy

113
Q

US appearance of TCC in the ureters

A

hydro above the solid mass

114
Q

describe squamous cell carcinoma (bladder)

its associated w/ which conditions

A

rare, aggressive bladder cancer w/ distal mets

chronic UTIS, stones and strictures

115
Q

clinical presentation and US appearance of squamous cell carcinoma (bladder)

A

same as TCC

116
Q

describe an adenocarcinoma of the prostate

which zone does it commonly effect

A

most commonly diagnosed cancer in men

peripheral zone, then spreads towards the capsule

117
Q

at what age does adenocarcinoma of the prostate usually occur

risk factors

A

> 50

age, fatty diet, family Hx

118
Q

4 steps for evaluating adenocarcinoma of the prostate

A

DRE, PSA, TRUS, biopsy

119
Q

signs and symptoms of adenocarcinoma of the prostate

A 
asymp.
may have bone pain
weakness
weight loss
 PSA elevated
120
Q

US appearance of adenocarcinoma of the prostate

A

if sm: hypo

if lrg: variable

prostate losses smooth contour

121
Q

treatment for adenocarcinoma of the prostate

A

monitor
cryotherapy
radiation (brachytherapy or external beam)
radical prostatectomy (gold standard, risk for nerve damage)

122
Q

describe a cortical cancer of the adrenal

A

rare, often an adenoma, in cortical region

can be hyperfunctioning or nonfunctioning

123
Q

are cortical cancers usually hyperfunctioning or nonfunctioning in males and females

A

M: non-func.
F: function.

124
Q

4 clinical presentations of excessive hormone production by the adrenals

A

cushings syndrome (+ cortisol)
Conns disease (+ aldosterone)
viralization/feminization
precocious puberty

125
Q

US appearance of cortical cancer of the adrenal

A

well define, solid mass
variable echogenicity/echotexture
regional and nodal mets

126
Q

echotexture tendencies of hyper and non-functioning cortical cancers of the adrenal

A

hyper: homo
non: hetero

127
Q

describe a neuroblastoma

what age grp does it effect

A

highly malignant tumor arising from adrenal medulla

found in children 4-5 yrs

128
Q

clinical presentation of a neuroblastoma

A

palpable mass
weight loss
failure to thrive
very irritable

129
Q

US appearance of a neuroblastoma

A

solid, hetero, poorly defined
calcifications
renal displacement
mets to liver and around great vessels

130
Q

are malignant neoplasms of the peritoneum rare

A

yes

131
Q

US appearance of mesothelioma of the peritoneum

A

omental caking/thickening
peritoneal thickeneing
ascites

132
Q

a mesothelioma of the peritoneum is associated w/ exposure to what materials

what age group and gender does it effect

A

asbestos

middle aged men

133
Q

describe lymphoma of the peritoneum

US appearance

A

non-hodgkin’s type

hypo mass along the peritoneum

134
Q

lymphoma of the peritoneum is associate w/ which condition

A

AIDS

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