Lecture 50 - Paraneoplasms and Presentations of Cancer Flashcards
what are the local Effects on Tumors and Host ?
○ Destruction of normal tissue by tumor
○ Space occupying effect of the tumor
Tumor Erosion of mucosa, vessel, skin, nerves (bleeding, secondary infection, perineural invasion)
what are the “general” Effect on Tumors and Host ?
○ Cachexia – Progressive loss of body fat and lean body/muscle mass
Profound weakness, anorexia, anemia
○ Hormonal Effects - -
when should you suspect cachexia?
Involuntary weight loss of > 10 % of premorbid weight
What are the different kinds of hormonal effects a malignancy can induce?
Tumor of Endocrine tissue which normally produces a hormone
vs
paraneoplastic Syndrome – hormones/ being produced by a malignant tissue that does not normally produce those hormones
what are the different categories of Paraneoplastic Syndromes?
Endocrinopathies
Osseous Tissue syndromes
Dermatologic
Neuromyopathies
vascular/coagulopathies
Endocrinopathies
Paraneoplastic Cushing Syndrome-
Hypercalcemia
Syndrome of Inappropriate ADH secretion (SIADH)
Hypoglycemia
Polycythemia
Paraneoplastic Cushing Syndrome-
what is it?
what type of tumor most commonly causes it ?
Symptoms?
tumor producing ACTH, leading to adrenal production of Cortisol
50% produced by Lung tumors
Symptoms: Cushings – truncal obesity, fat pad, easy bruising, fatigue, depression, etc
Paraneoplastic Hypercalcemia
- Significance?
- cause?
- type of tumor?
- Clinical Presentation:
- lab findings:
– most common incidence and most life threatening
- Lung cancer (that has not metastisized to the bone) that produced PTH or PTH RP leading to “leakage” of calcium from the bone
Symptoms: Confusions, weakness, lethargy, constipation
Labs: Hypercalcemia + Low/normal Serum PTH; elevated PTHRP
Paraneoplasm: Syndrome of Inappropriate ADH secretion (SIADH)
- what is it?
- type of tumor
- lab findings;
- clinical effects? potential cause of death?
Secretion of ectopic ADH
Small Cell Carcinoma of the Lung, intracranial tumors
Labs: Hyponatremia
Clinical :cerebral edema (death); seizures
Paraneoplastic Hypoglycemia
- cause
- type of tumor
Paraneoplastic Polycythemia
- cause
Hypoglycemia: ectopic tumor secretes insulin like substance
- soft tissue sarcomas, hepatocellular carcinoma
Polycythemia:
Erythropoietin secreted by tumors; can cause thrombosis
Osteopathic Paraneoplastic ○ Hypertrophic Osteoarthropathy
- type of tumor
- Triad of symptoms
1-10% of patients with lung cancer
– New periosteal bone formation
– Arthritis of adjacent joints
- new onset clubbing of the fingers (in persons without emphysema)
Dermatologic Paraneoplasm:
- Ancanthosis Nigricans
- what is it?
- benign causes?
- malignant causes?
Gray/Black patches of verrucous hyperkeratosis, usually in the skin folds due to production of epitdermal growth factors
Benign causes: Diabetes
Malignant causes: Epidermal growth factors by Lung, gastric tumors
Paraneoplastic Neuromyopathies –
Presenations?
Causes?
Peripheral Neuropathies, cortical cerebellar damage
- Eaton Lambert Syndrome (auto-antibodies produced against tumor antigen which cross react with calcium channels)
Paraneoplastic - Vascular/Coagulopathies
- DIC (cause, and type of cancer)
NBTE (what is it?)
Trousseau Syndrome - (what is it; types/stage of cancer that causes it?)
DIC –
cancers: APL, Prostate cancer
Cause: Mucin with pro-coagulant effect
NBTE
- Non bacterial thrombotic endocarditis (non bacterial vegetations on the cardiac leaflets which can prduce emboli)
caused by advanced cancers
Trousseau Syndrome -- Advanced cancers (pancreas and lung); secrete mucins which activate the coagulation cascade leading to migratory (sequential) thrombophlebitis
Ancillary Tests of Pathology:
IHC as diagnositic test –
Uses – finding the tissue of origin in met, finding micro mets
Finding an unknown primary
