Detection and Diagnosis of Malignancy (Part 1 of 3)

Question 1

What could a tumor lead to? (4)

Answer 1

sensation of a mass, invasion of adjacent structures, obstruction, and compression

Question 2

what is important to remember about sensation of a mass?

Answer 2

a local mass does not tell you whether it is malignant or benign

Question 3

what is important to remember about skin invasion?

Answer 3

a lump in the breast may be benign or malignant, but skin invasion is far more concerning for malignancy

Question 4

where does obstruction usually occur?

Answer 4

centrally–> our thoracic, abdominal, and pelvic cavities offer abundant room for tumors to grow without being detected

Question 5

a tumor causing a lung obstruction can lead to what?

Answer 5

airway obstruction leading to stridor and downstream lung tissue may collapse

Question 6

what is superior vena cava syndrome?

Answer 6

when a cancer/malignancy is compressing the superior vena cava and with that compression you get a back up of blood flow to the brachiocephalic vein, jugular vein, and subclavian vein

Question 7

what is the presentation of superior vena cava syndrome?

Answer 7

venous distension of the neck, venous distension of the chest wall, facial edema and plethora, and upper arm edema

Question 8

what is Pemberton’s sign?

Answer 8

when signs of superior vena cava syndrome are exaggerated when the arms are raised above the head

Question 9

abdominal and pelvic tumors may obstruct what leading to what?

Answer 9

GI tract–> SBO; ureters–> hydronephrosis; biliary system, blood/lymph vessels

Question 10

what are 4 common malignancies responsible for obstruction?

Answer 10

ovarian tumors, lymphomas, intestinal tumors, and pancreatic tumors

Question 11

how can tumors cause compression?

Answer 11

compression of the spinal cord–> a true oncologic emergency

Question 12

how does spinal cord compression typically present?

Answer 12

bilateral paresthesias and weakness of the LEs with cauda equina syndrome

Question 13

what does it mean to say hemorrhage in tumors?

Answer 13

hemorrhage can be a presenting sign- if a post menopausal female present with “menstruating again” - this is NOT NORMAL- think uterine cancer

Question 14

apart from seeing blood in bodily fluids, bleeding tumors may cause other clinical findings such as what?

Answer 14

abrupt hemorrhage can lead to rapid enlargement of a tumor or compartment–> significant PAIN; chronic bleeding can lead to iron deficiency anemia

Question 15

the peritoneum and pleural space are very easily irritated by tumor cells- how do they respond?

Answer 15

these spaces collect fluid leading to pleural effusions or ascites

Question 16

the differential list is large for either a pleural effusion or ascites; what is very important to remember here?

Answer 16

History is KEY

Question 17

how should you approach diagnosing a pleural effusion or ascites?

Answer 17

find out whether it is transudative or exudative

Question 18

what are thoracentesis and paracentesis used for?

Answer 18

both therapeutic and diagnostic advantages

Question 19

how can history taking lead to detection of tumors?

Answer 19

palpable or visible mass? obstructive signs/symptoms? hx of hemorrhage/bleeding?

Question 20

how can physical examination lead to detection of tumors?

Answer 20

palpable or visible mass, indications of invasion, compression, effusions

Question 21

how can laboratory testing lead to detection of tumors?

Answer 21

hemorrhage and effusions and don’t forget cancer markers