Cancer Diagnosis, Management, and Prevention: Diagnosis part

Question 1

A lump in the breast may be benign or malignant, but what is far more concerning for malignancy?

Answer 1

Skin invasion

Question 2

Because our thoracic, abdominal, and pelvic cavities offer abundant room for tumors to grow without being detected what may be a key clinical presentation?

Answer 2

Obstruction

Question 3

What may be an indication of airway obstruction?

Answer 3

Stridor

Question 4

Lung carcinoma growing in what direction can cause airway obstruction?

What may happen to downstream lung tissue?

Answer 4

1) Endobronchial direction

2) Collapse

Question 5

What causes superior vena cava syndrome?

Answer 5

Obstruction of the SVC by lung cancer

Question 6

What are clinical symptoms of SVC syndrome?

Answer 6

1) Venous distension of neck and chest wall

2) Facial and Upper arm edema

Question 7

What clinical test can exaggerate the facial edema and plethora caused by SVC syndrome?

How is this test performed?

Answer 7

1) Pemberton’s sign

2) Arms are raised above the head

Question 8

Why are spinal cord compressions a true oncologic emergency?

Answer 8

May cause permanent paralysis

Question 9

What do tumors require to grow?

Answer 9

Angiogenesis

Question 10

While a hepatic adenoma is benign, what can make it fatal?

Answer 10

Hemorrhages into the liver and bleeds extensively to form a subcapsular hematoma

Question 11

If a post-menopausal female states that they began menstruating again, what should be number one in your differential diagnosis?

Answer 11

Uterine cancer

Question 12

What is the most common tumor in the kidney?

Why is painless hematuria a common clinical sign with this cancer?

Answer 12

1) Renal cell carcinoma

2) It is extremely vascularized and bleeds very easy

Question 13

Abrupt hemorrhages can lead to rapid enlargement of a tumor or compartment and cause what in patients?

Answer 13

Pain

Question 14

Chronic bleeding from a tumor can lead to?

Answer 14

Iron-deficiency anemia

Question 15

What procedure do you run on a man 40 years or older presenting with iron deficiency anemia?

Answer 15

Colonoscopy

Question 16

What spaces are very easily irritated by tumor cells?

Answer 16

Peritoneum and pleural spaces

Question 17

What clinical sign can ovarian carcinomas cause?

What about for lung carcinomas?

Answer 17

1) Malignant ascites

2) Pleural effusions

Question 18

Palpable and/or visible mass, Obstructive signs/symptoms, and Hemorrhage can all be detected by?

Answer 18

History taking

Question 19

Palpable and/or visible mass, Indications of invasion, Compression, and Effusions can all be detected by?

Answer 19

Physical examination

Question 20

Hemorrhages and Effusions can be detected by?

Answer 20

Lab testing

Question 21

What can all features of malignancy be detected by?

Answer 21

Radiography

Question 22

What cancer marker is used to diagnose ovarian cancer?

Answer 22

CA-125

Question 23

What is the sentinel LN?

Answer 23

The first LN hit during lymphatic metastasis

Question 24

What is the typical route of metastasis for sarcomas?

Answer 24

Hematogenous

Question 25

What is the typical route of metastasis for carcinomas?

Answer 25

Lymphatic but also hematogenous for more advanced carcinomas

Question 26

When breast carcinoma is suspected what should be done to aid in possible detection?

Answer 26

Palpating the lymph nodes in the breast, especially the Axillary LNs

Question 27

When lung carcinoma is suspected what should be done to aid in possible detection?

Answer 27

Use of radiology for possible hilar and mediastinal lymph node involvement

Question 28

Sentinel node biopsies and LN dissections are used for?

Answer 28

Breast carcinomas and melanomas

Question 29

When checking for metastasis in endometrial carcinomas, what should be done?

Answer 29

LN dissection due to carcinomas spreading via lymphatics

Question 30

Sarcomas spread to what organs most commonly?

Answer 30

Lung and Liver

Question 31

What carcinoma tumor is the exception to the rule because it likes to spread hematogenously?

Answer 31

Renal cell carcinoma

Question 32

In a patient with possible cancer, what general symptom may indicate metastasis?

Answer 32

Extreme fatigue

Question 33

What symptom may indicate Osseous metastasis?

Answer 33

Bone pain/back pain

Question 34

What symptom may indicate Brain metastasis?

Answer 34

Headaches, cognitive dysfunction, and neurological signs

Question 35

What symptom may indicate Spinal cord metastasis? What symptom may indicate Lymph node metastasis?

Answer 35

1) Compression | 2) Obstruction

Question 36

A Sister Mary Joseph nodule indicates metastasis in what location? Typically from what cancer?

Answer 36

1) Umbilicus | 2) Ovarian carcinoma

Question 37

What is a Virchow node? What is it often associated with, especially in older adults?

Answer 37

1) Supraclavicular lymphadenopathy (classically left-sided) | 2) Any thoracic or abdominal carcinoma

Question 38

The recurrences of cancer are typically in what form?

Answer 38

Metastatic

Question 39

ꞵ2 microglobulin is the cancer marker for? Calcitonin is the cancer marker for?

Answer 39

1) Myeloma | 2) Medullary thyroid carcinoma

Question 40

What late metastasis can arise a decade later?

Answer 40

1) Lung metastasis from sarcoma | 2) Breast carcinoma

Question 41

In a patient with late lung metastasis from sarcoma they may not have even remembered that they had a primary tumor such as?

Answer 41

Uterine leiomyosarcoma

Question 42

In a patient with late breast carcinoma metastasis what symptom would they have after breast cancer therapy? This is due to?

Answer 42

1) Back pain | 2) Osseous metastases to spine

Question 43

What is paraneoplastic syndrome?

Answer 43

1) Tumor that secretes substances such as ACTH | 2) Tumor that evokes elaboration of other factors such as cytokines

Question 44

What pertinent lab values would be seen in Humoral hypercalcemia of malignancy?

Answer 44

1) High calcium 2) Low phosphorus 3) Low PTH

Question 45

What can cause a hypercalcemic/hypophosphatemic state of Humoral hypercalcemia of malignancy if it isn’t PTH-driven? What symptom is often seen in these cases?

Answer 45

1) Parathyroid hormone-related protein (PTH-rP) | 2) Mental status changes

Question 46

PTH-rP mediated hypercalcemia is seen in what type of cancers? In what sites?

Answer 46

1) Squamous carcinomas | 2) Lung, breast, GI, GU

Question 47

What pertinent lab values would be seen in Syndrome of Inappropriate ADH secretion (SIADH)?

Answer 47

1) High Urine osmolality 2) Low Plasma sodium 3) Low Serum osmolality

Question 48

What is SIADH mediated by?

Answer 48

Arginine Vasopressin (AVP)/Antidiuretic Hormone

Question 49

The secretion of ADH/AVP by the tumor, signals renal receptors to? How does this cause mental status changes seen in SIADH?

Answer 49

1) Retain free water rather than excreting it in urine | 2) Free water dilutes the serum

Question 50

SIADH is the most common paraneoplastic syndrome in what cancer?

Answer 50

Small cell neuroendocrine carcinoma

Question 51

What pertinent lab values would be seen in Cushing's syndrome?

Answer 51

1) High cortisol 2) High ACTH 3) Low serum potassium

Question 52

What symptoms would be seen in Cushing's syndrome from someone with ectopic ACTH secretion?

Answer 52

1) HTN 2) Weight loss 3) Muscle weakness

Question 53

What is the 2nd most common paraneoplastic syndrome in small cell neuroendocrine carcinoma?

Answer 53

Cushing's syndrome

Question 54

What are common symptoms of Eaton-Lambert myasthenic syndrome?

Answer 54

1) Dry mouth | 2) Weakness in legs

Question 55

Eaton-Lambert myasthenic syndrome is mediated typically by? How is it diagnosed?

Answer 55

1) Antibodies to Voltage-gated Calcium Channels | 2) Antibodies and nerve stimulation testing