Clinical Manifestation of Cancer Flashcards
Cancer effect on tissue integrity
Tumor growth compresses and erodes blood vessels
Tissue ulceration & necrosis -> blood in stool/urine
Cancer produces tissue-destroying toxins and enzymes
-Tissue destroyed by cancer doesn’t heal properly
Normal tissue effects secondary to cancer
Bowel obstruction from abdominal tumor/mass
Effusion of pleural/pericardial/peritoneal space with accumulation of fluid in serous layer buildup
Pleural and peritoneal effusions common cancer causes
Pleural: think lung cancer, lymphoma, breast cancer
Peritoneal: ovarian, colorectal, stomach, pancreatic cancer
Anorexia
Weight loss due to decreased caloric intake
Primarily fat store lost w/ protein loss equal between skeletal and visceral proteins
Liver shrinks
Cachexia
Involuntary weight loss 5% mass secondary to hypermetabolic state and altered nutrient metabolism
Tumors consume glucose under anaerobic metabolism -> get build up of lactate
Liver enlarged due to visceral protein accumulation
To Tx cachexia, you have to Tx the tumor
Cachexia is a poor prognosis factor
Fatigue
Peripheral: in neuromuscular junction and muscles
-Neuromuscular apparatus fails to perform - ATP deficit w/ lactic acid buildup
Central: arises in CNS
- Difficult initiating/maintaining voluntary activities
- secondary to serotonin and proinflammatory cytokine dysregulation
Cancer pts also report poor sleep quality
Anemia
Blood loss, hemolysis, impaired rbc production
-nutritional deficit, BM failure, blunted EPO response/production
Tx: Epogen or transfusion
-BBW: increased mortality in cancer patients - complications or decreased clearance rate
Fever
Common with lymphoma (HL), leukemia, renal cell, hepatocellular carcinoma
Atrial myxomas - while rare, often present w/ fever
Paraneoplastic Syndromes
Symptoms caused by substance produced by tumor or abnormal hormone increase in response to cancer cells
Most common w/ lung, breast, hematologic cancer
Often a 1st symptoms - always r/o CA w/ paraneoplastic syndrome
Effects endocrine, neuro, heme, derm, and rheumatologic systems
SIADH
Small cell lung cancer most common
ADH increases free water absorption - get water retention and dilutional hyponatremia
Sx: gait disturbances, falls, HA, fatigue, seizure, respiratory depression, confusion
Hypercalcemia
One of the most common paraneoplastic syndromes
MM, bony metastasis
Secondary to PTHrP (80% - SCLC), or osteolytic activity (breast, MM, lymphoma), Vitamin D secretion, or ectopic PTH secretion from tumor
Sx: AMS, weak, ataxia, lethargy, ovarian, endometrial cancer
Cushing’s Syndrome
Small cell lung cancer or bronchogenic carcinoid
Get hypokalemia, elevated cortisol w/ no response to dexamethasone (tumor), elevated abnormal ACTH
Sx: muscle weakness, peripheral edema, HTN, wt. gain, centripetal fat distribution
Hypoglycemia
Rare tumor association
Usually insulin-producing islet cell tumor or non-islet cell tumor
Sx: recurrent or constant hypoglycemia
Paraneoplastic Neurological Syndromes
Immune cross-reactivity between tumor and nervous system causes permanent damage
Tx is immunosuppressive therapy - tumor Tx doesn’t resolve neurological impairment
Lymphoma, MM, SCLC
Paraneoplastic Neurological Syndrome manifestations
SCLC causes limbic encephalitis, paraneoplastic cerebellar degeneration, autonomic neuropathy, subacute sensory neuropathy
-Thymoma = myasthenia gravis w/ central presentation (eye weakness)
Lambert-Eaton Syndrome is reverse of MG w/ peripheral weakness of limbs
Acanthosis Nigricans
Dark, velvety patches in skin folds
Adenocarcinoma (GI most commonly, or hematologic cancers
Hematologic syndromes and common causative cancers
Eosinophilia - tumor releases growth factor
-Lymphoma, leukemia or paraneoplastic lung/GI/GYN
Granulocytosis - solid tumors, commonly large cell lung cancer
Pure Red Cell aplasia - Thymoma
Thrombocytosis - tumor-produced cytokine IL-6
-Cancer, infection, splenectomy, blood loss/iron deficiency
Most common paraneoplastic syndromes and associated tumors
SIADH - SCLC
Cushings - SCLC/Bronchogenic cancer
Hypercalcemia - MM, bony metastases
