Detection Diagnosis Malignancy Flashcards
Where can tumors grow without being detected?
Thoracic abdominal and pelvic cavities
What is Superior vena cava syndrome?
Venous distension of neck and chest wall Facial edema and plethora Upper arm edema
How do you exaggerate SVC syndrome?
Pemberton’s sign, raise the arms above the head
What might an abdominal or pelvic tumor obstruct?
SBO ureters leading to hydrobnephrosis BIliary system Blood and lymph vesssels
What is a true oncologic emergency?
Compression of the spinal cord
What is indicated if a post menopausal women is bleeding again?
Could be ovarian cancer as tumors can hemorrhage
What could painless hematuria inidicate?
Tumors in bladder or kidney
What is the significance of a benign hepatic adenoma bleeding?
The liver expands as it fills with blood and causes acute pain in the RUQ. This is life threatening
Transudative fluid?
low protein low cellular
Exudative fluid?
High protein high cell count
What is canalicular metastatic sprerad?
travels along a pre existing duct or lumen
What is transcoelomic metastatic spread?
Invasive spread through serosa
What type of cancer typically spreads through lymphatic metastasis?
Carcinomas
How do sarcomas typically metastasize?
via hematogenous metastasis
When you cannot palpate the lymph nodes with a suspicion of lung carcinoma, as you can for suspected breast cancer, what do you do?
Evaluate the hilar and mediastinal lymph nodes with radiology
What type of cancer needs lymph node staging?
Carcinomas
What manifestation of metastatic cancer might you ID before a patient knows they have cancer?
-
Fatigue/weight loss:
- Extreme fatigue may indicate mets
-
Bone/Back pain
- osseous metastasis
-
HA/cognitive dysfunction/local neuro signs
- brain mets
-
Obstruction/compression
- spinal cord compression
- lymph node metastasis causing obstruction
Virchow node?
- Supraclavicular lymphadenopathy left sided
- Associated with carcinoma especially in older adults
- ANY thoracic or abdominal carcinoma can be responsibe
Why can virchows node indicate any abdominal or thoracic cancer?
3 quarters of the bodys lymp goes through the thoracic duct into the subclavian vein which is the site where virchows node is seen
Primary vs Metastatic tumor?
Primary
- Solitary lesion
- no other cancer diagnosis
- Doesn’t show up at sites usual for mets such as liver or adrenals
Metastatic:
- Multiple lesions
- Hx of other cancers
- locations more typical for mets
Sister Mary Josephs nodule?
Typically Indicitave of ovarian cancer
In a patientt with prior diagnosis of cancer how shoud clinical or radiographic surveillance be approached to anticipate development of metastasis?
- Recurrence of cancer will typically be metastatic so knowing the regional lymph node drainiage is important
- Radiographic imaging depends on the specific person and cancer but is important
- Serum tumor markers are important to check as well
What is a paraneoplastic syndrome?
- Production of other hormones outside of the normal regulation by the tumor OR if the tumor evokes elaboration of other factors
68 yo male with 50 pack year smoking history presenting to the ED with acute mental status change.
- Calcium is elevated 14.8 (8-11)
- PTH is low 5 (12-68)
what causes hypercalceimic/hypophosphatemic state if it isn’t PTH driven?
- PTH-rp due to Humoral hypercalcemia of malignancy
- Excess PTHrP results in bone resporption and distal tubular calcium reabsorption
- Doesn’t affect vitamin D path adn intestinal absorption of Ca
- Squamous carciniomas of any sites are likely as well as breast, GI and GU
What cancer is most common to be assoc with PTH-rP?
Lung squamous cell carcinoma
52 yo women 60 pack yr smoking history, cc for increasing lethargy and weakness
- drowsy irritable
- normal BP and Euvolemic
- Very low plasma sodium
- Low serum osmolality
- Urine osmalality increased
Diagnosed with SIADH, what is causing this? What cancer is most assoc with this?
- SIADH caused by mass in the lungs secreting ADH to retain free water rather than excrete it in urine
- causes hyponatremia resulting in altered mental status
- Small cell lung cancer
What other cancers are assoc with SIADH?
- GI carcinoma
- GU and ovarian Carcinoma
- Lung (small cell and squamous cell)
Jack Thatcher 48 yo man with new onset htn.
- low serum potassium
- 8lb weight loss 2 months
- muscle weakness
- Morning cortisol high
- ACTH very high
What is wrong?
Find out later he has significant smoking history and you get a cxr.
Cxr shows a mass. What could be happening?
- Cortisol and ACTH are both elevated and this indicates it’s likely driven by ACTH, this is causing Cushing Syndrome
- typical cushing’s is something wrong with pituitary
- primary adrenal low CTH high cortisol
- Ectopic ACTH is high and cortisol
- Ectopic production doesn’t cause the moon facies and centripetal obesity
- Small cell neuroendocrine carcinoma secreting ACTH
Jack Thatcher the 48 yo man with small cell neuroendocrine carcinoma is now having issues after his diagnosis with his legs to weak to go out and mouth is too dry to enjoy food.
What is happening?
- Lambert-Eaton Myasthenic Syndrome: mediated by abs to voltage gated calcium channels at NMJ
- look for anti VGCC abs
- proximal mm weakness improves with repetitive motion/stimulation
- Assoc with small cell carcinomas
