cancer mets

Question 1

68 y.o. man admitted as an emergency

1 year ago, lung resection for CA

done well since but for the past months, has had back pain and for the last 3 days, unable to walk because of weakness and numbness in both legs

you consider that he may have a 2˚ deposit in his spine.

(a) what other functional disturbance is likely to be present on enquiry?

Answer 1

loss of bowel and/or bladder control

Question 2

(b) your clinical examination suggest presence of an UMN lesion.

list 4 features that would suggest this was the case.

Answer 2

1. hypertonia
2. hyperreflexia
3. +ve Babinski’s sign
4. muscle mass maintained

Question 3

an MRI confirms your Dx with a 2˚ deposit in the body of the 11th dorsal vertebrae. radiologist contacts you to point out there is pressure from this lesion on the thoracic spinal cord.

(c) suggest 3 urgent rx that should be considered to help the sx of leg weakness.

Answer 3

emergency - immediate rx <24 h

1. steroids
2. radiotherapy
3. surgery

Question 4

(d) further ix show raised serum calcium level.

give 2 possible explanations for this finding.

Answer 4

1. Lung CA producing PTH-like hormone causing hypercalcaemia (usually SCC) = paraneoplastic syndrome
2. break down of bone spine

^{other paraneoplastic syndromes:}

• ^{ectopic ACTH causing Cushing’s}
• ^{SIADH (usually SCC)}

Question 5

(e) name 2 pathological types for this lung CA deposits in the spine

Answer 5

1. adenocarcinoma
2. small cell bronchial carcinoma

large cell anaplastic

SCC