Detection Diagnosis Malignancy

Question 1

Where can tumors grow without being detected?

Answer 1

Thoracic abdominal and pelvic cavities

Question 2

What is Superior vena cava syndrome?

Answer 2

Venous distension of neck and chest wall Facial edema and plethora Upper arm edema

Question 3

How do you exaggerate SVC syndrome?

Answer 3

Pemberton’s sign, raise the arms above the head

Question 4

What might an abdominal or pelvic tumor obstruct?

Answer 4

SBO ureters leading to hydrobnephrosis BIliary system Blood and lymph vesssels

Question 5

What is a true oncologic emergency?

Answer 5

Compression of the spinal cord

Question 6

What is indicated if a post menopausal women is bleeding again?

Answer 6

Could be ovarian cancer as tumors can hemorrhage

Question 7

What could painless hematuria inidicate?

Answer 7

Tumors in bladder or kidney

Question 8

What is the significance of a benign hepatic adenoma bleeding?

Answer 8

The liver expands as it fills with blood and causes acute pain in the RUQ. This is life threatening

Question 9

Transudative fluid?

Answer 9

low protein low cellular

Question 10

Exudative fluid?

Answer 10

High protein high cell count

Question 11

What is canalicular metastatic sprerad?

Answer 11

travels along a pre existing duct or lumen

Question 12

What is transcoelomic metastatic spread?

Answer 12

Invasive spread through serosa

Question 13

What type of cancer typically spreads through lymphatic metastasis?

Answer 13

Carcinomas

Question 14

How do sarcomas typically metastasize?

Answer 14

via hematogenous metastasis

Question 15

When you cannot palpate the lymph nodes with a suspicion of lung carcinoma, as you can for suspected breast cancer, what do you do?

Answer 15

Evaluate the hilar and mediastinal lymph nodes with radiology

Question 16

What type of cancer needs lymph node staging?

Answer 16

Carcinomas

Question 17

What manifestation of metastatic cancer might you ID before a patient knows they have cancer?

Answer 17

• 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

Question 18

Virchow node?

Answer 18

• Supraclavicular lymphadenopathy left sided
• Associated with carcinoma especially in older adults
• ANY thoracic or abdominal carcinoma can be responsibe

Question 19

Why can virchows node indicate any abdominal or thoracic cancer?

Answer 19

3 quarters of the bodys lymp goes through the thoracic duct into the subclavian vein which is the site where virchows node is seen

Question 20

Primary vs Metastatic tumor?

Answer 20

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

Question 21

Sister Mary Josephs nodule?

Answer 21

Typically Indicitave of ovarian cancer

Question 22

In a patientt with prior diagnosis of cancer how shoud clinical or radiographic surveillance be approached to anticipate development of metastasis?

Answer 22

• 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

Question 23

What is a paraneoplastic syndrome?

Answer 23

• Production of other hormones outside of the normal regulation by the tumor OR if the tumor evokes elaboration of other factors

Question 24

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?

Answer 24

• 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

Question 25

What cancer is most common to be assoc with PTH-rP?

Answer 25

Lung squamous cell carcinoma

Question 26

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?

Answer 26

• 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

Question 27

What other cancers are assoc with SIADH?

Answer 27

• GI carcinoma
• GU and ovarian Carcinoma
• Lung (small cell and squamous cell)

Question 28

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?

Answer 28

• 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

Question 29

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?

Answer 29

• 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