Cancers final deck: paraneoplastics, psommomas, mets

Question 1

What paraneoplastic syndrome is caused by calcitriol (1,25 OH D3)? What is the effect and which cancers casue this?

Answer 1

causes hypercalcemia

caused by hodgkin lymphoma and some non-hodgkin lymphomas

Question 2

What paraneoplastic syndromes are casued by ACTH

Answer 2

Cushing syndrome

seen with small cell lung CA

Question 3

What paraneoplastic syndrome is casued by ADH?

Answer 3

SIADH

seen with small cell lunc CA and intracranial neoplasms

Question 4

What paramneoplastic syndrome is casued by antibodies against presymaptic Ca channels at the NMJ?

Answer 4

Lambert-Eaton myasthenic syndrome. seen with small cell lung cancer

Question 5

What paraneoplastic syndrome is caused by EPO secrection?

Answer 5

polycythemia

seen with renal cell carcinoma, thymoma, hemangioblastoma, HCC, leiomyoma, pheochromocytoma

Question 6

What paraneoplastic syndrome is caused by PTHrP

Answer 6

parathyroid hormone (locally active, has fewer checks than normal PTH)
cuases hypercalcemia.  seen with squamous cell lung carcinoma, renal cell carcionma and breast CA

Question 7

When do you see psommoma bodies?

Answer 7

PSaMMoma:
1. papillary carcinoma of the thyroid/papillary renal cell carcionoma
2. serous papillary cystadenocarcionma of the ovar
3. meningioma
4. malignant mesothelioma
(among a couple of others)

Question 8

I have a metastasis in the brain. What are the likely primary tumors?

Answer 8

lung > breast > GU (then osteosarcoma > melanoma > GI)

commonly seen as multiple well-circumscribed tumors at gray/white matter junction

Question 9

I have mets in the liver. Where is the primary tumor?

Answer 9

colon&raquo_space; stomach > pancreas.

Question 10

What organs are the most common sites of mets?

Answer 10

after lymph nodes, liver and lung

Question 11

I have mets in the bone. Where is the primary tumor?

Answer 11

prostate/breast > lung > thyroid

remember that bone mets are MUCH more common than primary bone tumors and have a predilection for the axial skeleton.

Question 12

What should I know about the kinds of bone lesions associated wiht prostate mets?

Answer 12

prostate mets usually cause blastic lesions. the cancer activates osteoblasts, which build excess bone, causing bone sclerosis. However, the bone structure is abnormal, so even though it is very hard, it is also more susceptible to breaking. Bone lesions can be a cause of significant pain in cancer

Question 13

What should I know about the kinds of bone lesions associated with breast mets?

Answer 13

breast mets to the bone can be blastic- activating osteoblasts, or lytic- activating osteoclasts. Both lesions weaken bone and cause pain.

Question 14

paraneoplastic cerebellar degeneration

Answer 14

seen with cancers of the lung, breast, ovary, uterus, and lymphoma. antibodies against the tumor end up cross reacting with neurons in the cerebellum.

Question 15

I have mets in the bone. Where is the primary tumor?

Answer 15

prostate/breast > lung > thyroid

remember that bone mets are MUCH more common than primary bone tumors and have a predilection for the axial skeleton.