Clinical Manifestations Flashcards by Alicia Daum

Cancer associated with blood in the stool

Colorectal CA

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Cancer associated with painless hematuria

Bladder CA

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How can cancer effect the normal tissue?

Bowel obstruction (abdominal tumor)
Development of effusions

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What cancers primarily lead to a pleural effusion?

Lung CA
Lymphoma
Breast CA

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What cancers primarily lead to peritoneal effusions?

Ovarian
Colorectal
Stomach
Pancreatic

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What is anorexia due to in cancer?

Decreased caloric intake due to decreased desire of food

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Reasons for Anorexia in Cancer

Physical obstruction of GI tract
Pain
Depression
Constipation
Malabsorption
Debility or SE of treatment

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Where is weight loss typically from in anorexia?

Fat stores

Then muscle

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Liver Size in Anorexia

Decreased

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Define Cachexia

Involuntary loss of at least 5% body mass

Secondary to hyper metabolic state & altered nutrient metabolism

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Why cachexia in cancer?

Tumor consume large amounts of glucose & increase lactate formation
Abnormalities in fat & protein metabolism

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Liver Size in Cachexia

Increased- hepatomegaly

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Cancer Anorexia-Cachexia Syndrome

Common in solid tumors
Decreased appetite & increase metabolism
More common in young and old

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What does cachexia lead to with the weight loss?

Shorter median survival
Do no respond well to chemotherapy
More problems with toxicity

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Characterization of Cancer Fatigue

Tiredness
Weakness
Lack of energy
Not relieved by sleep

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Peripheral Fatigue

Inability of peripheral neuromuscular apparatus to perform a task in response to stimulus
Anaerobic metabolism

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Central Fatigue

Difficulty in initiating or maintaining voluntary activities

Secondary to dysregulation of serotonin & pro-inflammatory cytokines

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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)

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Anemia in Cancer

Blood loss
Hemolysis
Impaired RBC production
Treatment effects

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How do malignancies decrease RBC production?

Nutritional deficiencies
Bone marrow failure
Blunted EPO response
Inflammatory cytokines produce by tumors decrease EPO production

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Common Malignancies that Present with a Fever

Non-Hodgkin's Lymphoma
Leukemia
Renal cell
Hepatocellular carcinoma
Atrial myxomas

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Define Paraneoplastic Syndromes

Collections of symptoms that result from substances produced by the tumor & occur remotely from eh tumor itself

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Paraneoplastic Syndromes Cause

Abnormal increases in hormones secondary to the effects of the cancer cells

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Paraneoplastic Syndromes Common in What Cancers

Lung
Breast
Hematologic

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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