Cancer Flashcards
Radiation plexopathy
Upper trunk Dose related Numbness and parasthesia Insidious and self limiting Ct loss of planes but no focal lesions Edema
Emg
Myokimic discharges
CAancer plexopathy
10 times more common than radiation plexopathy
Pain
Slow onset
Lower
Trunk c8-t1
Ct w focal lesions
Horners syndrome
What is the most common nonmalignant neuro tumor?
Meningioma, which arise from the arachnoid (cap) Cells of the arachnoid villi. They’re usually benign and are cured by surgical resection. They may present with focal seizures, weakness, a favorite or increased ICP.
Most common cause of spinal metastases are
Breast, lung, prostate
What are the most common kinds of spinal tumors?
90% of spinal cord compression resulting from cancer comes from extra medullary sources. That includes epidural, intradural and leptomeningeal disease. Intramedullary spinal cord compression is seen in less than 5% of spinal cord tumors and includes gliomas, ependymomas, and astrocytomas
What is the earliest presentation of neoplastic spinal cord compromise?
Pain
What is trismus?
Trismus is the condition seen as a sequela of radiation therapy in head and neck cancer. It is the inability to open the mouth fully as a result of spasm in the masseter and lateral pterygoid muscles. In addition radiation therapy can affect the surrounding local connective tissue which contributes to spasm.
What causes Trismus?
Radiation-induced ectopic activity in the trigeminal nerve leads to neuropathic pain, weakness, spasm of the masseter muscle.
Lymphedema is most commonly associated with which cancers?
Breast, pelvic, and head and neck
Describe the grading of lymphedema
Grade one is pitting Edema which is partially reversible with elevation.
- Grade 2 is non-pitting edema which is not reduce by elevation is characterized by fibrosis beginning.
- grade 3 swelling of involved extremity described as length of static elephantiasis. Cartilage like.
- grade 4 elephantiasis is enormous swelling of the involved area. Tissue is fibrotic and unresponsive to therapeutic intervention.
What nerve is frequently damaged in axillary lymph node dissection in breast cancer?
Intercostobrachial nerve is the lateral cutaneous nerve of the second thoracic nerve root.
It provides innervation to the medial, posterior portion of the arm and axilla and the lateral portion of the chest wall. It is affected by axillary lymph node dissection and presents with absent or abnormal sensation or neuropathic pain
What is the most common sight of vertebral metastases?
Body most commonly in the thoracic spine
What is the best diagnostic tool for detecting spinal metastases?
MRI has sensitivity of 83% to 93% and specificity and 90% to 97%
How do bisphosphonate work?
Inhibit osteoclastic bone resorption
Do bone scans show lytic lesions?
No they only show new bone formation. 50% of lesions in bonescans turn out to be cancer. Further imaging is required for a positive bone scan.
What kind of lesions are formed in multiple myeloma?
Lytic, therefore will not show up on a bone scan.
Other lytic lesions come from non-small cell lung cancer, renal cancer, melanoma, thyroid, and non-Hodgkin’s lymphoma
How does radiation plexitis present?
- Gradual /delayed
- usually with numbness and paresthesias.
- It must be differentiated from tumor recurrence which can cause Brachial
- An MRI of the brachioplexus with contrast can rule out axillary reoccurrence of breast cancer.
- Electrodiagnostic testing can help differentiate brachioplexopathy from other neurologic condition typical findings include myokymia on needle electric.
What Cara chemotherapeutic agents can cause hearing loss?
Platinum based agents like cisplatinin.
The spine is considered unstable when tumor is involved in….
The spine is unstable when there’s two or more column involvement or if the middle column is involved.
What is the best way to treat an unstable metastatic lesion of the spine?
Surgical fixation. Lesions that measure more than two thirds of the cortex and those that present with functional pain are at greater chance of pathologic fracture.
What is the highest risk for pathologic fracture?
Functional Pain is a greater risk than weight-bearing versus nonweightbearing and lytic vs blastic
