Cancers Flashcards
Squamous cell lung cancer
PTH-like hormone secretion
Hypertrophic pulmonary osteoarthropathy-long bone pain
Cavitation on CXR
Treatment: surgery and radiation (sugery does not work with metastases)
Adenocarcinoma of the lung
Hypertrophic pulmonary osteoarthorpathy-long bone pain
Peripheral-pleural involvement
Associated with pulmonary scars/fibrosis
Diagnosing Lung Cancer
Obtain: CXR, CT scan, tissue biopsy (determines histologic type)
Always perform a biopsy for intrathoracic lymphadenopathy (specificity is 60%)
CXR-not screening-most important
Stability of an abnormality over a 2 year period is benign
CT scan of chest-useful for staging
Local and distant metastases
nodules less than 1 cm or low probability of being malignant
Cytologic examination of sputum
Central tumors-may still need further tests
PET-distant metastases
nodules greater than 1 cm
Broncoscopy-central tumors
malignancy suspicion intermediate
Risk of surgery is high
Needle biopsy-can also do peripheraal lesions
Invasive-only selected patients
malignancy suspicion intermediate
Risk of surgery is high
resection-malignancy suspicion is high
mediastinoscopy-advanced disease
Small Cell lung Cancer
SIADH
Ectopic ACTH
Eaton Lambert syndrome
Treatment: Chemo plus radiation
If extensive: just chemo with prophylactic radation
Treatment of CRC
Surgery is only curative treatment
CEA level obtained before surgery-check every 3-6 months
Annual CT scan of abdomen/pelvis and CXR for up to 5 years
Colonscopy at year 1 and every 3 years after that
Hepatocellular adenoma
History of contraceptie use, female sex, and anabolic steroid use
Can lead to hemoperinoteum and hemorrhage
Little malignant potential
Diagnosis: CT scan, ultrasound, or hepatic arteriography (most accurate but invasive)
Treatment: discontinue oral contraceptives
Surgically resect tumors >5 cm that do not regress after discontinuing oral contraceptives
Cavernous hemagioma
Most common type of benign liver tumor
Symptoms: RUQ pain or mass
Complications: hemorrhage, obstructive jaundice, coagulopathy, CHF secondary to AV shunt, gastric outlet obstruction
Diagnose: ultrasound or CT scan with IV contrast
Biopsy contraindicated due to risk of rupture
Most do not require treatment
Focal nodular hyperplasia
Tumor (no malignant potential) in women of reproductive age
No association with oral contraceptives
Hepatomegaly may be present
Treatment is not necessary
Hepatocellular carcinoma
Two types:
Nonfibrolamellar-hep B/C and cirrhosis—poor prognosis
Fibrolamellar-adolescents
Risks: cirrhosis, aflatoxin, vinyl chlroide, thorotrast, AAT deficiency, hemochromo, wilsons, schisto, hepatic adenoma, cigarette, glycogen storage disease
Clinical: abdominal pain (hepatomegaly), portal HTN, ascites, jaundice, splenomegaly
Paraneoplastic: erythrocytosis, thrombocytosis, hypercalcemia, carcinoid, hypertrophic pulmonary osteodystrophy, hypoglycemia, high cholesterol
Diagnosis: liver biopsy-definitive diagnosis
Labs: hepatitis panel, LFTs, coagulation tests
Ultrasound, CT scan (abdomen chest and pelvis), MRI and MRA for surgery
AFP elevation-mointoring response to therapy
Treatment: liver resection
Liver transplantation
Carcinoma of gallbladder
adenocarcinomas
Associated with gallstones
Surgery: cholecystectomy (can be with wedge resection of liver and lymph node dissection)
Low prognosis
Cholangriocarcinoma
Tumor of intrahepatic or extrahepatic bile ducts
Most are adenocarcinomas
Poor prognosis
Risk: primary sclerosis cholangitis
Ulcerative colitis, choledochal cysts, and Clornochis sinensis
Diagnosis: Cholangioraphy (PTC or ERCP)
Stent can be placed to relieve biliary obstruction
Choledochal cysts
Cystic dilatations of biliary tree
Complications: cholangiocarcinoma, hepaic absces, rucurrent cholangitis/pancreatitis, biliary obstruction, cirrhosis, portal HTN
Diagnosis: ultrasound, ERCP is definitive
Treatment: surgery
Pancreatic cancer
Risks: cigarette smoking, chronic pancreatitis, diabetes, heavy alcohol use, benzidine, and b-napthylamine
Prognosis is poor
Migratory thrombophelbtis, courvoisiers sign (palpable gallbladder)
Diagnosis:
ERCP most sensitive
CT preferred
Markers: CA 19-9, CEA
Treatment: whipple procdure only hope for cure
ERCP or PTC with stent placement across the obstruction for palliation
Esophageal Cancer
Squamous cell risks: alcohol and tobacco use, nitrosamines, betel nuts, hot food/tea, HPV, achalasia, Plummer Vinson, caustic ingestion, and nasopharyngeal carcinoma
Adenocarcinoma risks: GERD and Barrett’s esophagus
Prognosis is poor
Diagnosis: Barium swallow: evaluation of dysphagia
Upper endoscopy with biopsy and brush cytology is definitive diagnosis
Transesophageal ultrasound determines depth of tumor
Full metastatic workup: bone scan, CT scan, CXR
Treatment: palliation
Esophagectomy curative if not spread to local nodes
Chemotherapy plus radiation before surgery have been shown to prolong survival
Gastric Cancer
Adenocarcinomas
Risks: atrophic gastritis, H. pylori, pernicious anemia, blood type A, high intake of perserved foods/smoked fish
diagnosis: endoscopy with multiple biopsies can complement with barium sereis
Abdominal CT scan for metastases
Fecal occult blood test
Treatment: surgical resection with wide (5cm) margins with extended lymph node dissection
Chemotherapy may be appropriate
Thyroid solitary nodule
Detection on physical exam=>1 cm in diameter
Malignancy: nodule is fixed during swallowing, unusually firm, irregularity of nodule, solitary nodule, history of radiation therapy, history of rapid development, vocal cord paralysis, cervical adenopathy, elevated calcitonin, family history
Diagnosis: fine needle aspiration is initial evaluation (reliable except follicular)
FNA benign=observation and repeat FNA
FNA malignant: surgery
Thyroid scan: with indeterminate FNA or low TSH
Cold=decreased uptake of radionucletide iodine
warm=normal
Hot= increased uptake
Cold=surgery
Hot=close observation and periodic thyroid studies
US: differentiates solid from cystic (solid=malignant)
larger than 4 cm are not malignant
Papillary thyroid cancer
Risk: history of radiation to head/neck in childhood
Cervical lymphadenopathy
Positive iodine uptake
Treatment: lobectomy with isthmusectomy
Total thyroidectomy if tumor is >3 cm, bilateral, advanced or distant metastases are present
TSH suppression therapy
Radioiodine therapy for larger tumors
Follicular carcinoma of thyroid
Avidly absorbs iodine
Can have distant metastases
Associated with iodine defieciency
Tumor extension through the tumor capsule-diagnose via tissue sample
Hurthle cell carcinoma subset: abundant cytoplasm, tightly packed mitochondria, oval nuclei with prominent nucloli-radioiodine resistant
Treatment: total thyroidectomy with postoperative iodine ablation
Medullary carcinoma of thyroid
Associated with MEN II (screen for pheochromocytoma)
Arises from parafollicular C cells-produces calcitonin
Treatment: total thyroidectomy,
Modified radical neck dissection when lymph node involvement
Anaplastic carcinoma of thyroid
Elderly
Highly malignant
Arises from long standing follicular or papillary thyroid carcinoma
Grim prognosis due to invasion of adjacent organs
Treatment: chemotherapy and radiation
Pallliative care
Craniopharyngioma
Tumors of suprasellar region arising from embryologic remnants of Rathke’s pouch
Pituitary adenoma is most common
Bitemporal hemianopsia may be present
Headaches, papilledema and changes in mentation
hyperprolactinemia,, diabetes insipidus, panhypopituitarism
Diagnosis: brain MRI
Treatment: surgical excision with our without radiation therapy
Insulinomas
Associated with MEN I
Clinical: sympathetic activation: diaphoresis, palpitations, tremors, high BP, anxiety
Neuroglycopenic symptoms: HA, visual disturbances, confusion, seizures, coma
Diagnosis: 72 hour fast
patient becomes hypoglycemic (normal patients insulin will decrease) insulin levels will be too high
C peptide also elevated
Treatment: surgical resection
Zollinger-Ellison syndrome
High gastrin secreting tumor in pancreatic islet cells
Associated with MEN I
Complications: GI hemorrhage, GI perforation, gastric outleet/obstruction/stricture, metastatic disease (liver)
Clinical: peptic ulcers, diarrhea, weight loss, abdominal pain
Diagnosis: secretin injection (normally inhibits gastrin) gastrin will increase after secretin
Gastrin >1000
Treatment: PPIs
expoloration for possible curative resection
Glucagnoma
Clinical: necrotizing migatory erythema, glossitis, stomatitis, diabetes, and hyperglycemia
Low amino acid levels and high glucagon
Treatment: surgery
Somatostatinoma
Poor progonosis
Clinical: gallstones diabetes and steatorrhea
VIPoma
Clinical: watery diarrhea-dehydration, hypokalemia, acidosis
achlorhydria
Hyperglycemia and hypercalcemia
Treatment: surgery
Treatment and risks of prostate cancer
Risks: age (most important), african american, high fat diet, positive family history, exposure to herbicides and pesticides
Prostectomy if life expectancy more than 10 years
locally invasive: radiation therapy plus androgen deprivation
Metastatic disease: reduce testosterone
Orchiectomy, antiandrogens, leuprolide, GnRH antagonists (Degarelix)
Renal Cell carcinoma
Risks: cigarettes, phenacetin analgesics, ADKD, chronic dialysis, exposure to heavy met, hypertension
paraneoplastic syndromes: EPO, PTH like hormone, renin, cortisol, or gonadotropins
Diagnosis: renal ultrasound
Abdominal CT if ultrasound shows mass
Treatment: radical nephrectomy (kidney, adrenal, gertoas fascia and nodal tissue along renal hilum)
Bladder Cancer
Risks: cigarette smoking (major), aniline dyes, azo dyes, long term cyclophosphamide
Diagnosis: urinalysis and urine culture to rule out infection Urine cytology-to detect malignant cells IVP Cystoscopy and biopsy (definitive test) Chest radiograph and CT for staging
Treatment: Stage 0: not invasion-intravesical chemo
Stage A: lamina propria invasion-transuretrhal resection of bladder tumor-recurs so frequent cystoscopy
stage B (muscle invasion) and C (perivescular fat invasion): radical cystecomy and removal of prostate/ureterus/ovaries/anterior vagina and urinary diversion
Stage D: metastasis-radical cystecomy and systemic chemo
testicular cancer diagnosis and treatment
Diagnosis: testicular mass on physical exam
Testicular ultrasound initial test
B-HCG high in choriocarcinoma
AFP increased in embryonal tumors
CT scan and chest radiograph for staging
Treatment: remove surgically
Perform CT scan of chest, abdomen and pelvis for staging
perform HCG and AFP for comparison
Seminoma: also radiation
non seminoma: retroperitoneal lymph node dissection with or without chemo
