Clinical presentation of cancer general Flashcards by Hannah Nolan

Metastatic effects presnetation

Circulatory invasion
Organomegaly
Metastasis
Effusions

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Direct effects of cancer

Mass - pressure, pain, often palaple
Obstruction of a conduit (blockage)
Ulceration serosl or mucosal surface, perforation

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Non metastatic effects of cancer

Temperature rise
Weight loss unintentional
Paraneoplastic effects

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Cancer spread

Blood
Lymph
Transcoloemic - through abdomen

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What is virchows node associated with

Upper 1/3 GI tract - middle and distal oeophagus or stomach

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Supraclavicular lymphadenopathy cacners

Breast
Lung
Oesophagus
Stomach
THink thorax!

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What does invasion of the skin in a tumour mean

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Pectoral muscle attachment

one nipple higher than the other when raise ar

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Area of breast and likely lymph node involvement

Lateral = axillary
Superior - SCL lymph nodes
Inferior - internal mamillary lymph nodes
Outer = multiple

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What is carcinoid syndrome

Excess 5HT/serotonin causing flushing, diarrhoea and bronchospasm
Urine measurement - 5HIAA - use lab
Marker for intervetion
Liver mets

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What need to examine if positive para aortic lymph nodes

Testes or ovaries - blood supply drains to these lymph nodes

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Is JVP pulsatile in SVC

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What is achalasia

Rats tail at gastro oesophageal junction
Likely to aspirate to RHS chest

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Direct and metastatic effects cancer

Compression - nerve symptoms
Direct invasion
Effusion
Ascites
Orgna involvement

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Charcteristic level of tumor causing horners syndrome

T1 - NSCLC

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What is absent in horners syndrome if lesion distal to carotid bifurcationa nd why

Anhydrosis
After this point the nerve supplies the skin

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What innervation do you lose in horners syndrome

Sympathetic innervation
Unopposed constriction of pupil
Drooping

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What is important if spinal cord compression above C5

No innervation to phrenic nerve -> respiratory failure as no innervation of resp mucles

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Involvementof spinal cord compression

MRI investigate
70% thoracic
15% lumbar
5% sacral - cauda equina - LMN
10% cervical

What level of spine differentiates cauda equina vs spinal cord compression

L2
Spinal cord = UMN signs bilateral
Cauda equina = LMN bilateral signs

What skin change is characteristic of peutz jegher syndrome

Peri oral freckles eg on lips

Karposis sarcoma

Skin, resp, GI
HIV +
HHV 8 ass

what can cause polycythaemia in cancer

Tumours producing EPO -> excess RBC

Dermal features of dermatomyositis

Heliotropic rash - pinky discolouration peri orbitally
Gottrens patches - over extensor tendons in hands

Why is dermatomyositis important

40% of patients have a malignancy

Types of paraneoplastic syndrome

SIADH Ectopic ACTH Hypercalcemia HPOA skin manifestations

Pronathism

Lower jaw protrudes eg acromegaly

Cushings syndrome causes

Cushings disease - pituitary adenoma Exogenous steroids Adrenal adenoma Ectopic ACTH - SCLC

thickening of areolar disc hat is it

Gynaecomastia

What cancer can cause myasthenia gravis

SCLC -> lambert eaton syndrome

Why can some paraneoplastic syndromes persist after cancer cured

If tehyre an immune response eg AI - antibody production persisits

Complications of chemotherapy

Neutropenic sepsis Anaemia - bone marrwo supression VTE neuropathy

Complications of radiotherapy

PNeumonitis Toxicity to normal tissue eg spinal cord Secondary malignancy Reduced exercise tolerance

Hypertrophy vs hyperplasia

Hypertrophy = increased size of cells Hyperplasia - increase number of cells

Metaplasia vs dysplasia

Metaplasia - replacement of one type of tissue by another, can revert Dysplasia - architectual and cytological change - pre malignant

Carcingoens

Cigarettes Vinyl chloride - PVC plastic Aflatoxin N-hydroxylated metaboites of azo dyes - textile industry Alkyldiazonium ions from nitrosamines - textile

Carcinogenesis steps

Initiation - fail to repair DNA damage Promtor - repeatled contact with cells Progression

Why does smojing increase the risk of bladder cancer

Processed by kidney and excreted - sit in the bladder

Lung cancer gendered

Male decreasing deaths Female increasing deaths

Where does mesothelioma arise from

Surface serosal cells of pleural peritoneal and peridcardial cavities

Presentation of mesothelioma

SOB - feeling of suffocating - loss of plasticity of pleural membranes, lung can't expand

What are young females <20 more at risk of with non hodgkins lymphoma treatment

Radiotherapy to chest while breast cells still developing -> breast cancer later in life

Viruses causing cancer

Retrovirsus - HTLV1, II, III, HIV-2 Herpes viruses - HSV 1, 2, VZV CMV, HHV-6, HHV-7 EBV, HHV-8 (KS, PEL, castleman) Hepatitis - HBV, HCV - (HCC cause) Papillomarviruses HPV 16,18,31,45 HPV 6,11 (condylomata)

Bacterial infections increasing caner risk

H.pylori - gastric cancer, gastric lymphoma, Mycobacterium TB Helminths Schistosoma haematobium - bladder cancer Schistosoma japonicum - colorectal hepatocellular, lymphoreticular cancers Clonorchis sinensis -> cholagniocarcinoma Make into separate cards?

Factors genetic disposition of factor

Family clustering of specific types of cancer Cases occuring in v young individuals Ass between different tumour types Multiplicity of cancer eg bilateral breast cancer