Detection And Diagnosis Of Malignancy - Dr. Pence

Question 1

Signs of malignancy

Answer 1

1. Invasion seen on the skin
2. Obstruction : in cavities inside the body can cause an obstruction like SI or ureter or bronchus obstruction
3. Compression : medical emergency, pressing spinal cord (paresthesia, back pain, saddle anesthesia loss of bladder and bowl function)**
4. Hemorrhage

Question 2

Superior Vena Cava Syndrome

Answer 2

A type of obstruction form tumor that is compressing against the SVC = Backup of blood to subclavian, brachiocephalic, jugular veins

1. Vein distention on neck and chest wall
2. Facial edema
3. Upper arm edema
4. POSITIVE PEMBRETON’S SIGN

Question 3

Pembertons sign

Answer 3

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

Question 4

Hydronephrosis

Answer 4

Tumor is the ureter

Question 5

Tumor compressing the spinal cord how to TX

Answer 5

Steroids can shrink it initially

Then radiation or surgery

Question 6

Hemorrhage from tumors can happen most commonly in what

Answer 6

Uterine cancers

Question 7

Hemorrhage in tumors

Answer 7

Post- menopause bleeding again
Blood in stool
Blood in urine
Blood in vomit or spit

Question 8

Hemorrhage from tumors SX

Answer 8

Usually painful and blood in something coming out from body

Question 9

Hemorrhage from tumors can be mistaken as what

Answer 9

IDA from chronic bleeding

Question 10

Pleural effusion

Answer 10

Fluid in the pleural cavity of lung

Can happen from tumor in lung due to causing irritation

Question 11

Ovarian carcinoma SX you usually see

Answer 11

Pleural effusion in the body cavity

And ASCITES

Question 12

How to tell if fluid in the pleural or peritoneal cavity I’d transudative or exudative

Answer 12

Use the throacentesis and paracentesis to remove it = both diagnostic and theraputic

Question 13

First thing to order to see if a person has a tumor

Answer 13

A CT scan

Question 14

Cancer staging

Answer 14

T
N
M

Question 15

Transcoelomic spread

Answer 15

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

Question 16

Canalicular spread

Answer 16

Traveling a duct like bile duct, ureter

Question 17

How to know what the sentinel node is

Answer 17

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

Question 18

SX that can point to cancer before it gets too out of hand

Answer 18

1. B sx - fever weightloss, night sweats,
2. Back pain or Bone pain
3. Headaches (neuro signs)
4. Obstruction/compression (can hear stridor)

Question 19

Sister Mary Joseph nodule

Answer 19

Umbilical cancer usually from ovarian cancer

Question 20

Virchow node

Answer 20

SUPRACLAVICULAR LN is prominent (all abd or thoracic organs drain here)- from Left side and lower right side of body

Question 21

Primary vs Metastatic

Primary

Answer 21

1. Only one lesion
2. No other cancer dx
3. Unusual in Mets locations (unusual places)
4. Demographic involved

Question 22

Primary vs Metastatic

Metastatic

Answer 22

1. Many lesions
2. History of other cancer
3. Mets are common (unusual place like liver, adrenal glands)
4. No demographic involved

Question 23

What do you do after you have dx someone with cancer

Answer 23

1. Follow up for any recurrence which is usually metastatic
2. Drain LNs
3. CT scan
4. Tumor markers in serum

Question 24

Marker for ovarian cancer

Answer 24

CA 125

Question 25

Myeloma marker

Answer 25

B2 microglobulin

Question 26

Medullary thyroid carcinoma marker

Answer 26

Calcitonin

Question 27

Mass effect from tumor

Answer 27

Sx alongside cancer

1. Airway obstruction
2. Invasion and rupture of vessels - hemorrhage
3. SVC syndrome
4. Spinal cord compression

Question 28

Paraneoplastic syndrome

Answer 28

What is produced from the tumor

1. PTHrp or ACTH secreted
2. Autoantibodies and cytokines made

Question 29

CASE 1 : 68yo male with 50 pack year history
Acute mental status

Elevated CA
PTH low

Answer 29

PTH-rP (PTH related protein ) = structurally similar to PTH causing hypercalcemia

Question 30

PTHrp

Answer 30

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

Question 31

CASE 2 : 52 yo woman with 60 pack-year smoking
Increased lethargy and weakness

LOW Na+
Low serum osmolarity
High urine osmolarity

Answer 31

= 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

Question 32

CASE 3 : 48 yo male new onset HTN (160/90)
LOW P
Weight loss
Muscle weakness

Answer 32

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

Question 33

Cushing syndrome or Primary Adrenal disease causes what

Answer 33

HTN, hypokalemia 
\+ Centropetal obesity 
\+ Moon facies 
\+ easy bruising 
More chronic 
(Ectopic source does not do this)

Question 34

Ectopic ACTH SX

Answer 34

HTN
hypokalemia 
Metabolic alkalosis 
Muscle wasting 
More acute

Question 35

Other cancers that present with ectopic ACTH

Answer 35

Lung
Bronchial 
Pancreatic 
Medullary thyroid 
Phenochromocytoma (adrenal gland)

Question 36

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

Answer 36

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