Clinical Manifestations Flashcards
Cancer associated with blood in the stool
Colorectal CA
Cancer associated with painless hematuria
Bladder CA
How can cancer effect the normal tissue?
Bowel obstruction (abdominal tumor) Development of effusions
What cancers primarily lead to a pleural effusion?
Lung CA
Lymphoma
Breast CA
What cancers primarily lead to peritoneal effusions?
Ovarian
Colorectal
Stomach
Pancreatic
What is anorexia due to in cancer?
Decreased caloric intake due to decreased desire of food
Reasons for Anorexia in Cancer
Physical obstruction of GI tract Pain Depression Constipation Malabsorption Debility or SE of treatment
Where is weight loss typically from in anorexia?
Fat stores
Then muscle
Liver Size in Anorexia
Decreased
Define Cachexia
Involuntary loss of at least 5% body mass
Secondary to hyper metabolic state & altered nutrient metabolism
Why cachexia in cancer?
Tumor consume large amounts of glucose & increase lactate formation
Abnormalities in fat & protein metabolism
Liver Size in Cachexia
Increased- hepatomegaly
Cancer Anorexia-Cachexia Syndrome
Common in solid tumors
Decreased appetite & increase metabolism
More common in young and old
What does cachexia lead to with the weight loss?
Shorter median survival
Do no respond well to chemotherapy
More problems with toxicity
Characterization of Cancer Fatigue
Tiredness
Weakness
Lack of energy
Not relieved by sleep
Peripheral Fatigue
Inability of peripheral neuromuscular apparatus to perform a task in response to stimulus
Anaerobic metabolism
Central Fatigue
Difficulty in initiating or maintaining voluntary activities
Secondary to dysregulation of serotonin & pro-inflammatory cytokines
Why poor sleep quality in cancer patients?
Trouble falling asleep Staying asleep Nighttime awakenings Restless sleep Secondary to pain or SE of treatment (N/V)
Anemia in Cancer
Blood loss
Hemolysis
Impaired RBC production
Treatment effects
How do malignancies decrease RBC production?
Nutritional deficiencies
Bone marrow failure
Blunted EPO response
Inflammatory cytokines produce by tumors decrease EPO production
Common Malignancies that Present with a Fever
Non-Hodgkin's Lymphoma Leukemia Renal cell Hepatocellular carcinoma Atrial myxomas
Define Paraneoplastic Syndromes
Collections of symptoms that result from substances produced by the tumor & occur remotely from eh tumor itself
Paraneoplastic Syndromes Cause
Abnormal increases in hormones secondary to the effects of the cancer cells
Paraneoplastic Syndromes Common in What Cancers
Lung
Breast
Hematologic
Mechanisms of Paraneoplastic Syndromes
Immune cross-reactivity between malignant & normal tissues
Tumor secretes hormones, peptides, cytokines
What systems can paraneoplastic syndromes affect?
Endocrine Neurologic Hematologic Dermatologic Rheumatologic
Paraneoplastic Endocrine Syndromes
SIADH
Hypercalcmia
Cushing syndrome
Hypoglycemia
SIADH
Increased free water reabsorption
Failure of the negative feed back system that regulates the release of ADH
What does SIADH cause?
Dilutional hyponatremia
Associated Cancers with SIADH
Small cell lung CA Mesothelioma Bladder Urethral Endometrial Prostate Oropharyngeal Thymoma Lymphoma Ewing sarcoma Brain GI Breast Adrenal
Signs/Symptoms of SIADH
Hyponatremia
Increase urine osmolality with decreased urine output
Decreased serum osmolality
Clinical Manifestations of SIADH
Gait disturbances Falls HA Nausea Fatigue Muscle cramps Anorexia Confusion Lethargy Seizures Respiratory depression Coma
Associated Cancers with Hypercalcemia
Breast Multiple myeloma Renal cell SCC Lymphoma Ovarian Endometrial
Symptoms of Hypercalcemia
Altered mental status Weakness Ataxia Lethargy Hypertonia Renal failure N/V HTN Bradycardia
Hypercalcemia is due to
Secretion of PTH related protein
Osteolytic activity
Tumor secretion of Vitamin D
Ectopic secretion of PTH
Most Common Cancer with Hypercalcemia due to PTH Related Protein Secretion
SCC (esp. lung)
Cancers Common with Hypercalcemia due to Osteolytic Activity
Breast
Multiple myeloma
Lymphomas
What is high in Cushing Syndrome?
Aldosterone
Cortisol
Associated Cancers with Cushing Syndrome
Small cell lung CA Bronchial carcinoid Thymoma Medullary thyroid CA GI Pancreatic Adrenal Ovarian
Symptoms of Cushing Syndrome
Muscle weakness Peripheral edema HTN Weight gain Centripetal fat distribution
Lab Findings with Cushing’s Syndrome
Hypokalemia
Elevated baseline serum cortisol
Normal to elevated midnight serum ACTH
Not suppressed with dexamethasone
Associated Cancers with Hypoglycemia
Insulin-producing islet cell tumors
Non-islet cell tumors: IGF-2 or insulin
Immune Cross-Reactivity Issues
Permanent damage
Treatment of primary tumor doesn’t always result in neurologic improvement
Treatment is immunosuppressive therapy
Neurologic Syndromes
Limbic encephalitis Paraneoplastic cerebellar degeneration Lambert-Eaton Syndrome Myasthenia graves Autonomic neuropathy Subacute (peripheral) sensory neuroapthy
Cancers Associated with Limbic Encephalitis
Small cell lung cancer
Testicular germ cell
Breast
Cancer Associated with Paraneoplastic Cerebellar Degeneration
Small cell lung cancer
Cancer Associated with Lambert-Eaton Syndrome
Small cell lung cancer
Cancer Associated with Myasthenia Gravis
Thymoma
Cancer Associated with Small Cell Lung Cancer
Autonomic neuropathy
Cancers Associated with Subacute (peripheral) Sensory Neuropathy
Small cell lung cancer
Other lung cancers
What is the most common of the neurologic paraneoplastic syndromes?
Lambert-Eaton myasthenic syndrome
What does myasthenia graves present with?
Eye muscle weakness
Dermatologic & Rheumatologic Syndromes
Acanthosis nigricans Pemphigus Extramammary paget Ichthyosis Dermatomyositis Erythroderma Hypertrophic osteoarthropathy Leukocytoclastic vasculitis Polymyalgia rheumatica Sweet syndrome (acute febrile neutrophilic dermatosis)
Cancers Associated with Acanthosis Nigricans
Adenocarcinomas: gastric carcinoma, lung, breast, ovarian
Hematologic cancers
Types of Hematologic Paraneoplastic Syndromes
Eosinophilia
Granulocytosis
Pure red cell aplasia
Thrombocytosis
Define Eosinophilia
Tumor production of eosinophil growth factors
Associated Malignancies with Eosinophilia
Lymphomas Leukemias Lung CA GI CA Gynecologic CA
Cancers Associated with Granulocytosis (Neutrolphilia)
Lung CA (large cell) GI CA Brain CA Breast CA Renal CA Gynecologic CA
Cancers Associated with Pure Red Cell Aplasia
Thymoma (most common)
Leukemia
Lymphoma
Myelodysplastic Syndrome
Associated Cancers with Thrombocytosis
GI Lung Breast GYN Lymphoma Renal cell Prostate Mesothelioma Glioblastoma H&N CA
Commonly Associated Conditions with Thrombocytosis
Infection
Post-splenectomy
Acute blood loss
Iron deficiency
Malignancies Most Common with Paraneoplastic Syndromes
Small cell lung cancer
Breast
GYN tumors
Hematologic malignancies
Top 3 Paraneoplastic Syndromes
SIADH
Cushing Syndrome
Hypercalcemia
