Clinical Manifestations of CA Flashcards
How might CA effect tissue integrity?
Tumor growth can compress and erode blood vessels.
tissue ulceration and necrosis (blood in stool, painless hematuria)
CA can produce tissue destroying toxins and enzymes
Mass of an abdominal tumor can cause a bowel obstruction
Development of effusions:
-pleural, pericardial, or peritoneal spaces (think lung CA, lymphoma, or ovarian CA.)
Anorexia:
- cause
- wt loss from what stores?
- can protein loss be restored?
- liver size?
Cause: decreased caloric intake from:
- -physical obstruction of GI tract
- -pain
- -depression
- -constipation
- -malabsorption
- -debility (opiates, radiotherapy, or chemotherapy)
Weight loss is primarily from the fat stores then muscle.
Protein loss is equally divided among the skeletal muscle and visceral proteins. (w/ cachexia protein supplementation connot reverse wt loss.)
Liver: shrinks.
Cachexia:
- what is this?
- cause
- can protein loss be restored?
- liver size?
What: involuntary loss of at least 5% of body mass, not just related to decreased food intake.
Cause: 2ndry to a hypermetabolic state and altered nutrient metabolism. Tumors consume large amounts of glucose and increase lactate formation (tumor isnt good at delivering oxygen to itself)
Caloric and protein supplementation cannot reverse wt loss in cachexia.
Liver enlarges in cachexia.
Fatigue:
- characterized by?
- relief with sleep or rest?
- types, describe each.
Characterized by tiredness, weakness, and lack of energy
not relieved by sleep or rest like that of normal healthy persons.
Peripheral fatigue; occurs in the NMJ and muscles. lack ATP and build up of lactic acid.
Central fatigue: arises in the CNS, difficulty in initiating or maintaining voluntary activities, may be 2ndry to dysregulation of serotonin and proinflamm cytokines.
*CA pts dont sleep well.
Anemia:
- cause
- tx
- BBW
Cause:
-may be related to blood loss, hemolysis, impaired RBC production or tx effects. Malignancies can decrease RBC production.
Tx: epogen but may require transfusion
BBW: those treated with Epogen for anemia associated with CA have increased mortality rate.
Fever:
-MC malignancies that present with fever?
Lymphoma, leukemia, renal cell, hepatocellular carcinoma
Paraneoplastic syndromes
- what is this?
- cause
- MC in what cancers?
What: collection of sx that result from substances (hormones, peptides, cytokines) produced by the tumor and occur remotely from the tumor itself.
*immune cross-reactivity between malignant and normal tissues.
Cause by abnormal increases in hormones 2ndry to the effects of the CA cells.
MC in lung(SCLC)*, breast, hematologic, breast cancer
What are the endocrine paraneoplastic syndromes?
- SIADH
- Hypercalcemia
- cushing syndrome
- hypoglycemia
SIADH:
- what is this?
- associated CA
- signs and sx
What: tumor cell production of ADH leading to increased free water absorption. failure of negative feedback system that regulates the release of ADH.
Associated CA: small cell lung CA*
Signs and Sx:
- hyponatremia
- increased urine osmolality with decreased urine output
- decreased serum osmolality
-seizures, gait disturbances, falls, HA, nausea, fatigue, muscle cramps, anorexia, confusion, lethargy, resp depression, coma
Hypercalcemia:
- associated CA
- sx
- cause
Associated CA: breast, Multiple myeloma, renal cell, squamous cell (lung*), lymphoma, ovarian, endometrial.
Sx:
-Altered mental status, weakness, ataxia, lethargy, hypertonia, renal failure, nausea, vomiting, hypertension, bradycardia
Cause:
-secretion of PTH-rP (most commonly squamous cell cancers of the lung) (80% of the time)**
- osteolytic activity at sites of skeletal mets
- tumor secretion of Vit D
- Ectopic tumor secretion of PTH.
Cushing Syndrome
- associated CA
- sx
- lab findings
Associated CA:
- small cell lung CA or bronchial carcinoid
- thymoma, medullary thyroid CA, GI, pancreatic, adrenal, or ovarian.
Sx:
-muscle weakness, peripheral edema, HTN, wt gain, centripetal fat distribution
Lab findings:
- hypokalemia
- elevated baseline serum cortisol
- normal to elevated midnight serum ACTH
- not suppressed with dexamethasone.
Hypoglycemia
- associated cancers
- sx
Associated Tumors
- Insulin-producing islet cell tumors
- non-islet cell tumors
Sx
-recurrent or constant hypoglycemia
What are the Paraneuoplastic neurologic syndromes?
cause?
Tx
Prognosis
Limbic encephalitis: SCLC
Paraneoplastic cerebellar degeneration: SCLC
Lambert-eaton syndrome: SCLC (reverse myasthenia gravis; weakness of the limbs)
Myasthenia Graivs: thymoma (begins with eye muscle weakness)
Autonomic neuropathy: SCLC
Subacute (peripheral) sensory neuropathy: SCLC
SCLC = smalll cell lung cancer.
Cause: immune cross reactivity between tumor cells and the nervous system.
Tx: immunosuppressive therapy
Prognosis:
-cause permanent damage, tx of primary tumor doesnt always result in neurologic improvement
Dermatologic and Rheumatologic syndromes:
-name one and describe it.
Acathosis nigricans: darkening of skin, raised discoloration seen with DM, adenocarcinoma*, lung, breast, and ovarian CA.
Hematologic syndromes:
- what are these??
- sx
eosinophilia
granulocytosis
pure red cell aplasia
thrombocytosis
Sx: rarely symptomatic.
