Detection And Diagnosis Of Malignancy - Dr. Pence Flashcards
Signs of malignancy
- Invasion seen on the skin
- Obstruction : in cavities inside the body can cause an obstruction like SI or ureter or bronchus obstruction
- Compression : medical emergency, pressing spinal cord (paresthesia, back pain, saddle anesthesia loss of bladder and bowl function)**
- Hemorrhage
Superior Vena Cava Syndrome
A type of obstruction form tumor that is compressing against the SVC = Backup of blood to subclavian, brachiocephalic, jugular veins
- Vein distention on neck and chest wall
- Facial edema
- Upper arm edema
- POSITIVE PEMBRETON’S SIGN
Pembertons sign
You raise the pt are above head and it turns face bright red
= from back up of blood into veins form the SVC being obstructed
Hydronephrosis
Tumor is the ureter
Tumor compressing the spinal cord how to TX
Steroids can shrink it initially
Then radiation or surgery
Hemorrhage from tumors can happen most commonly in what
Uterine cancers
Hemorrhage in tumors
Post- menopause bleeding again
Blood in stool
Blood in urine
Blood in vomit or spit
Hemorrhage from tumors SX
Usually painful and blood in something coming out from body
Hemorrhage from tumors can be mistaken as what
IDA from chronic bleeding
Pleural effusion
Fluid in the pleural cavity of lung
Can happen from tumor in lung due to causing irritation
Ovarian carcinoma SX you usually see
Pleural effusion in the body cavity
And ASCITES
How to tell if fluid in the pleural or peritoneal cavity I’d transudative or exudative
Use the throacentesis and paracentesis to remove it = both diagnostic and theraputic
First thing to order to see if a person has a tumor
A CT scan
Cancer staging
T
N
M
Transcoelomic spread
Tumor invades through the organ in the the peritoneum and floats freely in there able to attach to any other organ
Most common in ovarian cancer
Canalicular spread
Traveling a duct like bile duct, ureter
How to know what the sentinel node is
Inject dye to tumor and first LN with dye to it is the one and that one is removed in surgery and send it for biopsy so you know if it it metastatic
SX that can point to cancer before it gets too out of hand
- B sx - fever weightloss, night sweats,
- Back pain or Bone pain
- Headaches (neuro signs)
- Obstruction/compression (can hear stridor)
Sister Mary Joseph nodule
Umbilical cancer usually from ovarian cancer
Virchow node
SUPRACLAVICULAR LN is prominent (all abd or thoracic organs drain here)- from Left side and lower right side of body
Primary vs Metastatic
Primary
- Only one lesion
- No other cancer dx
- Unusual in Mets locations (unusual places)
- Demographic involved
Primary vs Metastatic
Metastatic
- Many lesions
- History of other cancer
- Mets are common (unusual place like liver, adrenal glands)
- No demographic involved
What do you do after you have dx someone with cancer
- Follow up for any recurrence which is usually metastatic
- Drain LNs
- CT scan
- Tumor markers in serum
Marker for ovarian cancer
CA 125
Myeloma marker
B2 microglobulin
Medullary thyroid carcinoma marker
Calcitonin
Mass effect from tumor
Sx alongside cancer
- Airway obstruction
- Invasion and rupture of vessels - hemorrhage
- SVC syndrome
- Spinal cord compression
Paraneoplastic syndrome
What is produced from the tumor
- PTHrp or ACTH secreted
- Autoantibodies and cytokines made
CASE 1 : 68yo male with 50 pack year history
Acute mental status
Elevated CA
PTH low
PTH-rP (PTH related protein ) = structurally similar to PTH causing hypercalcemia
PTHrp
Usually in squamous carcinomas any place of body (breast, lung, GI, GU)
= bone resorption
= calcium reabsorption in distal tubules
= NO effect of Vit D in GI
CASE 2 : 52 yo woman with 60 pack-year smoking
Increased lethargy and weakness
LOW Na+
Low serum osmolarity
High urine osmolarity
= SIADH (syndrome of inappropriate ADH)
= mass in lung that promotes ADH
Can be Small Cell Neuroendocrine carcinoma (very aggressive and associated with many paraneoplastic syndromes), GI, ovarian, GU carcinomas also possible
CASE 3 : 48 yo male new onset HTN (160/90)
LOW P
Weight loss
Muscle weakness
Tumor causing ACTH to be release causing a lot of cortisol and that causes excretion of P
(Tumor in lung either making PCTH too much hormone like CRH or ACTH)
1. Cushing syndrome (high adrenocorticohormone) = PP tumor
2. Primary adrenal disease
3. Ectopic source
Cushing syndrome or Primary Adrenal disease causes what
HTN, hypokalemia \+ Centropetal obesity \+ Moon facies \+ easy bruising More chronic (Ectopic source does not do this)
Ectopic ACTH SX
HTN hypokalemia Metabolic alkalosis Muscle wasting More acute
Other cancers that present with ectopic ACTH
Lung Bronchial Pancreatic Medullary thyroid Phenochromocytoma (adrenal gland)
Pt with lung cancer rousing PCTH comes back with dry mouth can eat his lamb and weak legs What is this called What is this How to screen or it Usually seen when
Lambert- Eaton Myasthenic Syndrome (LEMS)
Abs——> Voltage gated Ca+2 channels =
Proximal muscle weakness and improves with repetitive motion and stimulation
**screen for anti-VGCC Abs + nerve stimulation test
** commonly seen in small cell lung cancer
