CA detection Flashcards
Possible physical findings associated with tumors
sensation of a mass; invasion of skin, blood, and/or nerves; obstruction of GI, airway, blood/lymph vessels; spinal cord compression
Stridor is indicative of…
an airway obstruction
Sxs of superior vena cava syndrome
venous distension of neck, venous distension of chest wall, facial edema and plethora, upper arm edema
Pemberton’s sign
exaggeration of findings when arms are raised above the head
Post-menopausal female “menstruating again” may indicate…
uterine cancer
Hemorrhage in tumors may cause what side effects besides seeing blood in body fluid
pain, iron-deficiency anemia
Important things to consider in history-taking for CA detection
palpable and/or visible mass, obstructive signs/symptoms, hemorrhage
Important things to consider in physical examination for CA detection
palpable mass, indications of invasion, compression, effusions
Biomarker for adenexal mass
CA-125
Three components of cancer staging
tumor size/invasion, lymph node metastasis, distant metastases
Four routes of metastatic spread
lymphatic, hematogenous, transcoelomic, canalicular
First LN tumor cells travel to as they metastasize
sentinel
At time of diagnosis, where should you look for possible metastasis?
lymph nodes (may require radiographic eval)
Most common route of sarcoma metastasis
hematogenous
Most common route of carcinoma metastasis
lymphatic
What manifestation of metastatic cancer might you identify before a patient has a known cancer diagnosis?
fatigue/weight loss, bone or back pain, HA/localizing neuro signs, obstruction or compression
Sister Mary Joseph nodule
umbilical metastasis from ovarian carcinoma
Virchow node
supraclavicular lymphadenopathy (typically L sided), often associated with thoracic abdominal carcinoma
Indicators of a primary tumor
solitary, no other cancer diagnosis, location unusual for mets, typical demographic
Indicators of a metastatic tumor
multiple, history of other CA, location more typical for mets, unusual
Myeloma tumor marker
B2 microglobulin
Medullary thyroid carcinoma tumor marker
calcitonin
Back pain decades after “definitive” breast cancer therapy may be indicative of…
osseous metastasis to the spine
Paraneoplastic syndrome
tumor secretes substances that evokes the elaboration of other factors and produces a physiologic response
Mass effects
airway obstruction, invasion and rupture of vessels, SVC syndrome, spinal cord compression
Humoral hypercalcemia of malignancy lab values
elevated Ca, low phosphorus, low PTH
What can cause a hypercalcemic/hypophosphatemic state if it isn’t PTH driven?
PTH-rP
CAs associated with high PTHrP levels
squamous carcinomas, cancer of the breast, GI and GU tracts
Symptoms associated with high PTHrP levels
mental status changes due to high Ca levels, muscle weakness, polyuria, renal insufficiency
Symptoms associated with SIADH
increasing lethargy and weakness, nausea, vomiting, HA, confusion
SIADH lab values
low plasma sodium, low serum osmolality, high urine osmolality
Secretion of ADH/AVP causes…
retention of free water, diluted serum and mental status changes
CA most commonly associated with SIADH
small cell neuroendocrine carcinoma; may also be associated with GI/GU carcinomas and lung
Cushing syndrome sxs
hypertension, unintentional weight loss, muscle weakness, metabolic alkalosis, hypokalemia
Cushing syndrome lab levels
high cortisol, high ACTH
Second most common paraneoplastic syndrome in small cell neuroendocrine carcinoma
Cushing syndrome
CA associated with Cushing syndrome (paraneoplastic)
lung, bronchial carcinoid tumors, pancreatic islet tumors, medullary thyroid carcinoma, pheochromocytoma
Eaton-Lambert myasthenic syndrome pathology
mediated by antibodies to voltage-gated Ca channels
Local therapy candidates
sarcomas, non-melanoma skin cancer, in situ carcinomas
Adjuvant therapy process
Surgery followed by chemo and/or radiation therapy
Neoadjuvant therapy process
Chemo and/or radiation therapy followed by surgery, more chemo and/or radiation
For what types of diseases would surgery not be indicated?
metastatic diseases and leukemia/lymphoma
Mechanisms of radiation therapy
external beam radiation, intensity modulated radiotherapy, brachytherapy, systemic radionucleotides
External beam radiation
linear accelerator delivering direct radiation beams to affected sites
Brachytherapy
very localized high-dose therapy delivered continuously for a prolonged time through implanted devices
Systemic radionucleotides
specifically useful for thyroid cancers and diseases, metabolism of iodine results in ingestion of radionucleotide by cells
When may radiation therapy be considered?
part of adjuvant or neoadjuvant therapy, contraindication of surgery, palliation
Possible targets of systemic CA therapy
receptor status (growth factor or hormone stimulation), antigens or receptor targets
CAR-T therapy
chimeric antigen receptor therapy, t cells manipulated to express a binding domain for a specific tumor-associated antigen
Indication for stem cell transplantation
therapy that involves ablation of bone marrow such as hematopoietic neoplasms, advanced solid tumors that need a high dose of cytotoxic chemotherapy
Types of stem cell transplantation
allogenic, syngeneic, autologous
Disadvantages of CA-125 test
not specific for malignant ovarian tumors
Options for prostate cancer screenings
prostate-specific ag test, digital rectal exam
Disadvantages of PSA and DRE for prostate CA screen
PSA elevation may be due to benign or inflammatory conditions, DRE identifies a tumor after it has become advanced
How often should a woman get a pap smear?
every 3 years
Advantages of Pap smear
effective tool that identifies pre-cancerous lesions before invasive CA even arises
Breast CA screening pros/cons
management changes year to year and by recommending body, harms may outweigh benefits, CA may be over diagnosed, mammography should be done 50-75 biennially
Breast self-exam
allows familiarity with subtle changes, can be started at an early age, frequency of every month, check axilla and skin changes, avoid checking prior to or during menstrual cycles
Testing guidelines for BRCA-1/-2 testing
family history of breast or ovarian cancer in multiple relatives, relatives diagnosed at a young age, or in a male relative; personal diagnosis before age 45
BRCA positive prophylactic therapy options
double mastectomy, bilateral salpingo-oopherectomy, hormone therapy, increased screening and self exam
Options for colon carcinoma screening
fecal immunochemical test, high-sensitivity guaiac-based fecal occult blood test, fecal DNA test, colonoscopy
Who should have a low-dose annual CT for lung carcinoma screening?
current smokers, 30-pack-year history of smoking, those who quit smoking in the last 15 years
Ovarian CA prevention
prophylactic salpingectomy/oopherectomy
