Clinical Manifestations of Cancer Flashcards
- Tumor growth can compress and erode what?
- Tissue ulceration and necrosis: What are signs of this? 2
- Cancer can produce what? 2
- Tissue damaged by cancer heals how?
- blood vessels
- Blood in the stool can be an early warning sign of colorectal cancer
- Painless hematuria may be the only sign of bladder cancer
- Cancer can produce
- tissue destroying toxins and
- enzymes - Tissue damaged by cancer does not heal properly
Effects on the normal tissue secondary to cancer
1. Mass of an abdominal tumor can cause a what?
- Development of what in the lungs and mediastinum? 3
- bowel obstruction
- Effusions
- Pleural,
- pericardial or
- peritoneal spaces
- Pleural effusion think what cancers? 2
2. Peritoneal fluid think what cancer? 1
- lung cancer or lymphoma
2. ovarian cancer
Anorexia
Due to decreased caloric intake
from what?
6
- physical obstruction of the gastrointestinal tract
- Pain
- Depression
- Constipation
- Malabsorption
- Debility or the side effects of treatment such as opiates, radiotherapy, or chemotherapy
- Weight loss is primarily from the what?
- Protein loss is equally divided among what? 2
- This causes a decreased what?
- fat stores then muscle
- skeletal muscle and visceral proteins
- liver mass
Cachexia
- What is it?
- Can be secondary to what?
- Tumors consume large amounts of _______ and increase ________ formation
- Further abnormalities in _____ and _______ metabolism
- ________ proteins are preserved and the liver recycles the nutrients and _________ occurs
- Involuntary loss of at least 5% body mass
- Not just related to decreased food intake - Secondary to a hypermetabolic state and altered nutrient metabolism
- glucose, lactate
- fat and protein
- Visceral, hepatomegaly
Whats the different between Cachexia and Anorexia?
- Anorexia- decreased caloric intake but an increase can reverse it. Liver shrinks
- Chachexia- cant be reversed. Liver enlarges
Cancer anorexia-cachexia syndrome
1. Common manifesation of ________ tumors except for breat cancer?
- More common in what populations? 2
- Weight loss from what? 2
- _____ or ________ nutritional supplementation does not reverse cachexia
- solid
- children
older adults - fat and skeletal muscle
- Oral or parenteral
Cancer anorexia-cachexia syndrome
- Involuntary loss of what?
- Shorter median ______?
- Do not respond well to what?
- Have more problems with what?
- Involuntary loss of 5% of body weight
- Shorter median survival
- Do not respond as well to chemotherapy
- Have more problems with toxicity
Fatigue
- Can be secondary to what?
- Cancer fatigue is characterized by what? 3
- Not relieved by what?
- How long can it last?
- Causes are?
- Secondary to
- the cancer or
- it’s treatment - Cancer fatigue is characterized by
- tiredness,
- weakness and
- lack of energy - Not relieved by sleep or rest like that of normal healthy persons
- Fatigue can precede diagnosis and can last months after cancer treatment
- Cause is likely multifactorial
Fatigue can be categorized into what categories? 2
central or peripheral
- Peripheral fatigue occurs where?
2. What is the PP behind this? 2
- occurs in the neuromuscular junctions and muscles
- Inability of the peripheral neuromuscular apparatus to perform a task in response to stimulus
- Lack of ATP and build up of lactic acid
- Central fatigue arises where?
- What do they have difficulty initiating?
- May be secondary to what?
- Central fatigue arises in the CNS
- Difficulty in initiating or maintaining voluntary activities
- May be secondary to dysregulation of serotonin and proinflammatory cytokines
- Cancer patients report poor ______ quality
2. Sometimes secondary to what? 2
sleep: Trouble falling asleep, staying asleep, nighttime awakenings and restless sleep
- to pain or
- side effects of treatment such as nausea and vomiting
Anemia
- May be related to what? 4
- Often treated with what? 2
- Malignancies can decrease RBC production by? 4
- May be related to
- blood loss,
- hemolysis,
- impaired RBC production or
- treatment effects - Often treated with
- Epogen but
- may require transfusion - Malignancies can decrease RBC production by
- Nutritional deficiencies
- Bone marrow failure
- Blunted EPO response
- Inflammatory cytokines produced by tumors decrease EPO production
Fever
1. Most common malignancies that present with fever? 5
- Lymphoma (esp. Non-Hodgkin’s)
- Leukemia
- Renal cell (20% present with fever)
- Hepatocellular carcinoma
- Atrial myxomas (Uncommon tumor type- Up to 30% present with fever)
- Paraneoplastic syndromes are defined as?
- Caused by?
- Most common in these cancers? 3
- Collections of symptoms that result from substances produced by the tumor and occur remotely from the tumor itself
- Caused by abnormal increases in hormones secondary to the effects of the cancer cells
- Most common in these cancers
- Lung
- Breast
- Hematologic
Paraneoplastic Syndromes
1. May be what manifestation?
- When a patient without a known cancer presents with one of the “typical” paraneoplastic syndromes, a diagnosis of________must be ruled out
- May be the first or most prominent manifestation
2. Cancer
- Mechanisms of paraneoplastic syndromes?
2. Tumor secretion of?
- Immune cross-reactivity between malignant and normal tissues
- Tumor secretion of
- Hormones
- Peptides
- Cytokines
Paraneoplastic syndromes: Which symtpoms can it affect? 5
- Endocrine
- Neurologic
- Hematologic
- Dermatologic
- Rheumatologic
Endocrine syndromes?
4
- SIADH
- Hypercalcemia
- Cushing syndrome
- Hypoglycemia
- What is SIADH is what?
- MOA?
- Associated cancers? (most important to remember)
- Describe the failure of the negatice feedback system that regulates the release of ADH?
- Syndrome of inappropriate antidiuretic hormone
- Secondary to tumor cell production of ADH (Increased free water reabsorption)
- Small cell lung cancer (10-45% of patients)*****
- Mesothelioma, bladder, urethral, endometrial, prostate, oropharyngeal, thymoma, lymphoma, Ewing sarcoma, brain, GI, breast, adrenal - ADH production continues despite a decrease in serum osmolality resulting in water retention and dilutional hyponatremia
Signs and symptoms of SIADH
3
Clinical manifestations?
- Hyponatremia
- Increased urine osmolality with decreased urine output
- Decreased serum osolality
-gait disturbances, falls, HA, nausea, fatigue, muscle cramps, anorexia, confusion, lethargy, seizures, respiratory depression, coma
Hypercalcemia
-Associated cancers?
(most common? 3)
- Breast,
- multiple myeloma,
- squamous cell cancers (esp. lung)
renal cell, lymphoma, ovarian, endometrial
Symptoms of Hypercalcemia?
8
- Altered mental status,
- weakness, ataxia, lethargy,
- hypertonia,
- renal failure,
- nausea, vomiting,
- hypertension,
- bradycardia
Hypercalcemia in cancer may be secondary to one of the following:
- Secretion of parathyroid hormone related protein by tumor cells (80% of cases)
- From osteolytic activity at sites of skeletal metastases (second most common cause)
- Tumor secretion of Vitamin D
- Ectopic tumor secretion of PTH
Hypercalcemia:
Secretion of parathyroid hormone related protein by tumor cells (80% of cases): MOst commonly from what cancers?
From osteolytic activity at sites of skeletal metastases (second most common cause): Most commonly from what cancers? 3
–Most commonly from squamous cell cancers (esp. lung)
- Breast cancer,
- multiple myeloma,
- lymphomas
Cushing syndrome
Associated cancers? (two most common?)
8
50-60% from
- Small cell lung cancer or
- bronchial carcinoid
- Thymoma,
- medullary thyroid cancer,
- GI,
- pancreatic,
- adrenal,
- ovarian
Cushing syndrome syptoms? 5
Lab findings? 4
Symptoms
- Muscle weakness,
- peripheral edema,
- HTN,
- weight gain,
- centripetal fat distribution
Lab findings
- Hypokalemia
- Elevated baseline serum cortisol
- Normal to elevated midnight serum ACTH
- Not suppressed with dexamethasone
Hypoglycemia
Associated cancers? 2
Symtpoms?
Rare to be tumor associated Associated cancers 1. Insulin-producing islet cell tumors 2. Non-islet cell tumors Tumor cell production of IGF-2 or insulin
Symptoms
1. Recurrent or constant hypoglycemia
Paraneoplastic neurologic syndromes
- Immune cross-reactivity between what?
- Cause what kind of damage?
- Treatmentof the primary tumor does what?
- Mainstay treatment?
- Are detected before cancer is diagnosed in what percent of cases?
1 . tumor cells and the nervous system
- Cause permanent damage
- Treatment of the primary tumor doesn’t always result in neurologic improvement
- Mainstay of treatment is immunosuppressive therapy
- Are detected before cancer is diagnosed in 80% of cases
Paraneoplastic neurologic syndromes
Associated malignancies? 2
- Up to 5% of patients with small cell lung cancer
2. Up to 10% of patients with lymphoma or multiple myeloma
Neurologic syndromes
1. Limbic encephalitis 3
- Paraneoplastic cerebellar degeneration
- Lambert-Eaton syndrome
- Myasthenia Gravis
- Autonomic neuropathy
- Subacute (peripheral) sensory neuropathy 2
- SCLC*,
testicular germ cell,
breast - SCLC
- SCLC
- Thymoma
- SCLC
- SCLC and other lung cancers
Neurologic paraneoplastic syndromes 1. Rare except for \_\_\_\_\_\_\_\_\_\_\_\_\_myasthenic syndrome 3% of all people with SCLC 2. AKA? 3. presents as?
Myasthenia gravis
- 15% of all people with what?
- Presents with what?
- Lambert-Eaton
- reverse myasthenia gravis
- Weakness of the limbs
- thymoma
- eye muscle weakness
Dematologic and Rheumatologic syndromes
10
- Acanthosis nigricans
- Pemphigus
- Extramammary Paget
- Ichthyosis
- Dermatomyositis
- Erythroderma
- Hypertrophic osteoarthropathy
- Leukocytoclastic vasculitis
- Polymyalgia rheumatica
- Sweet syndrome (acute febrile neutrophilic dermatosis)
- What is Acanthosis nigricans?
- Most commonly associated with what? (most common) 4
- Can also be associated with what cancer?
- Darkening of the skin around the creases
- Most commonly associated with adenocarcinoma
-GI tract (most common)
(Gastric carcinoma)
Other adenocarcinomas
-Lung,
-breast,
-ovarian - Also can be associated with hematologic cancers
Hematologic syndromes4
- Eosinophilia
- Granulocytosis
- Pure red cell aplasia
- Thrombocytosis
Paraneoplastic hematologic syndromes
- Presents how?
- Usually detected how?
- Usually seen in what kind of disease?
- Rarely symptomatic
- Usually detected after a cancer diagnosis
- Usually seen with advanced disease
Eosinophilia 1. MOA? 2. Associated malignancies? 2 most common 3 others
- Tumor production of eosinophil growth factors
- Associated malignancies
- Lymphomas and
- leukemia’s
Paraneoplastic eosinophilia associated with
- Lung,
- GI and
- gynecologic cancers
Granulocytosis (neutrophilia)
- Occurs in approximately ____% of pts with solid tumors
- WBC ranges from _____ x 109/L
- But can go as high as ___ x 109/L
- Associated cancers? (most common? 1)
6
Mechanism poorly understood
- 15
- 12-30
- 50
- Lung cancer (mostly large cell),
GI, brain, breast, renal, gynecologic cancers
Pure red cell aplasia
- Most commonly associated with what?
- Can also be caused by? 3
- Most commonly associated with thymoma
- May be caused by
- leukemia,
- lymphoma,
- myelodysplastic syndrome
Thrombocytosis
- 35% of patients with a platelet count > ______x 109/L have a malignancy
- From tumor production of __________?
- Associated cancers?
- Other commonly associated conditions? 4
- Usually present how?
- 400
- cytokine IL-6
- GI, lung, breast, gyn, lymphoma, renal cell, prostate, mesothelioma, glioblastoma, head and neck cancer
- Infection,
- post splenectomy,
- acute blood loss,
- iron deficiency
- asymptomatic
Malignancies most commonly associated with paraneoplastic syndromes
4***
1. Small cell lung cancer (most common overall) 2. Breast cancer 3. Gynecologic tumors 4. Hematologic malignancies
3 most common paraneoplastic syndromes
- SIADH
- Cushing syndrome
- Hypercalcemia
What causes the following:
- SIADH?
- Cushing syndrome?
- Hypercalcemia? 2
- Increased ADH production
- Increased ACTH production
- PTH related protein
- Multiple myeloma or bony metastases
Recognition of a paraneoplastic syndrome may aid in early diagnosis of cancer
-Most likely the ___________ paraneoplastic syndromes as they present early in the course of cancer
neurologic
