Lecture 7: Cancer Detection, Treatment, and Prevention Flashcards
What are 3 problems that masses can cause?
- invasion of adjacent structures, obstruction of passageways (GI/airways), and compression (spinal cord)
What does a mass tell you about malignancy?
NOTHING
- though invasion of the skin (for example) is a BIG concern for potential malignancy
How would a lung carcinoma cause airway obstruction?
by growing endobronchially
- could cause downstream tissue to collapse and/or airway stridor
What is Superior Vena Cava Syndrome and what are 3 common findings of it? What is a sign to detect potential Superior Vena Cava Syndrome?
- obstruction of the superior vena cava causes:
venous distension of neck and chest wall, with facial edema and plethora (pinkness of face), and upper arm edema
- Pemberton’s Sign: above findings become exaggerated when arms are raised above the pts head
What is a hematological issue regarding tumors?
HEMORRHAGE
- even benign tumors can be fatal if they hemorrhage
- should consider tumors if we see hematuria, hematochezia (stool), hematemsis (vomit), or hemotpysis (cough)
What kind of cancer should we consider in older female patients who seem to be “menstruating again”?
UTERINE CANCER
What is the most common renal tumor in adults?
Renal Cell Carcinoma
- extremely vascular and bleeds A LOT
What can abrupt and chronic tumor hemorrhaging lead to?
Abrupt - rapid enlargement of a tumor or compartment, leading to increased PAIN
Chronic - can lead to iron-deficiency anemia, meaning we should get a colonoscopy ordered to check for tumors (especially in order individuals)
Ovarian Carcinomas and tissue irritation
ovarian carcinomas can irritate the peritoneum around the mass, causing inflammation
- inflammed tissue causes fluid leakage into the peritoneal cavity that can lead to MALIGNANT ASCITES
can also see malignant pleural effusions
What is an adnexal mass?
- lump of tissue near the uterus, ovaries, fallopian tubes, or the connecting tissues
What is a common tumor marker for ovarian cancer?
CA-125
What is the step-wise process for dealing with pts suspected of having cancer?
- vague symptomatology
- phyiscal examination
- laboratory testing
- radiographic evaluation
- surgery –> DEFINITIVE DIAGNOSIS and treatment
What are the 3 components of cancer staging?
- T (tumor size/invasion) - ranked 1-4
- N (degree of lymph node involvement) - ranked 0-2
- M (distant metastases) - ranked 0-2
What are the 4 types of metastatic spread and which one is the most common?
- lymphatic - MOST COMMON
- typical spread of CARCINOMAS
- hematogenous
- typical spread of SARCOMAS (or adv. carcinomas)
- transcoelomic
- punches through membrane, seeding cavity nearby
- canalicular - travels through pre-existing lumen/duct
- ex: bile duct/sub-arachnoid space
What are the 4 most likely sites for hematogenous metastasis to spread?
Lung, Liver, Brain, Bone
What is a consideration for checking lymph nodes in a suspected case of breast cancer vs lung carcinoma?
Breast - check the axillary and supraclavicular LNs close to the breast
Lung - no easy access for physical examination of hilar and mediastinal LNs –> USE RADIOGRAPHIC EVALS
What are Sentinel Node Biopsies? What are two common cancers this practice is used in?
- used to determine staging of potential cancer
- radioactive dye administered that is taken up by the tumor; can be tracked by probe to see if sentinel nodes are involved
- EX: breast carcinoma and melanoma
What organ is a myometrial leiomyosarcoma likely to metastasize to?
LUNGS
- LIVER is also very common
What is an example of a carcinoma that does not require lymph node staging?
Renal Cell Carcinoma
- it is hematogenously spread (think lungs, liver, brain, bone)
Why is fatigue/weight loss a symptom of metastatic cancer?
extreme fatigue caused by the extreme burden of having the tumor
What is Sister Mary Joseph nodule and what kind of cancer is it typically a sign of?
- large, round, red umbilical mass caused by metastasis of ovarian carcinomas
What is a Virchow Node and what is typically responsible for it?
- a supraclavicular lymphadenopathy (usually LEFT-SIDED) often associated with carcinomas in older adults
- seen in ANY thoracic/abdominal/pelvic carcinomas
What are clues to determining if a tumor is Primary vs Metastatic?
Primary - solitary, no other cancer diagnosis, unusual met location, typical pt. demographic
Metastatic - multiple tumors, history of cancer, typical mets location, unusual
Why are tumor recurrences typically metastatic in nature?
- the primary tumor site initially got the most treatment, but other sites might not have received enough to eliminate their cancer cells completely
What are common serum tumor markers of:
- ovarian cancer
- myeloma
- medullary thyroid carcinoma
- CA-125
- B2 microglobulin
- calcitonin
What are clues to determining if a tumor is Primary vs Metastatic?
Primary - solitary, no other cancer diagnosis, unusual met location, typical pt. demographic
Metastatic - multiple tumors, history of cancer, typical mets location, unusual
Why are tumor recurrences typically metastatic in nature?
- the primary tumor site initially got the most treatment, but other sites might not have received enough to eliminate their cancer cells completely
What are common serum tumor markers of:
- ovarian cancer
- myeloma
- medullary thyroid carcinoma
- CA-125
- B2 microglobulin
- calcitonin
What are two common features of patients suffering from late metastasis from breast cancer?
- can occur decades later
- pt. has back pain after “definitive” breast cancer therapy (due to osseous metastasis to the spine)
What are 4 common cancers that cause Humoral Hypercalcemia of Malignancy (HHM)?
- inc. in PTHrP (parathyroid hormone-related protein)
- squamous carcinomas (any site), and cancers of breast/gastrointestinal/genitourinary tracts
What are three common signs that should make you think about SIADH as an option?
- heavy smoker, drowsy/confused, dilute blood/concentrated urine
What are the 3 causes of Cushing’s Syndrome?
- Cushings Disease - pituitary tumor inc. ACTH/cort
- Primary Adrenal Disease - adrenal tumor inc. cort
- Ectopic ACTH - tumor inc. ACTH/cort
What cancer is SIADH seen the most in? What are 3 other cancers that can cause it?
- most common paraneoplastic syndrome in small cell neuroendocrine carcinoma of the LUNG
- also seen in gastrointestinal, genitourinary, and ovarian carcinomas
What are three common signs that should make you think about SIADH as an option?
- heavy smoker, drowsy/confused, dilute blood/concentrated urine
What are the 3 causes of Cushing’s Syndrome?
- Cushings Disease - pituitary tumor inc. ACTH/cort
- Primary Adrenal Disease - adrenal tumor inc. cort
- Ectopic ACTH - tumor inc. ACTH/cort
What are 4 common signs that should make you think Cushing’s Syndrome?
heavy smoker, hypertension, hypokalemia (low potassium), weight loss (ectopic only)
What cancer is Cushing’s Syndrome the 2nd most common paraneoplastic syndrome of?
small cell neuroendocrine carcinoma
What are 5 other tumors associated with ectopic ACTH secretion? (LBPMP)
- lung (squamous, adenocarcinoma, small cell)
- bronchial carcinoid tumors
- pancreatic islet tumors
- medullary thyroid carcinoma
- pheochromocytoma
What are 4 common signs that should make you think Cushing’s Syndrome?
heavy smoker, hypertension, hypokalemia (low potassium), weight loss (ectopic only)
What is Eaton-Lambert Mysasthenic Syndrome and what malignancy is it commonly associated with? How is it diagnosed?
mediated by Abs to voltage-gated calcium channels
- anti-VGCC Abs
- often seen with small cell neuroendocrine carcinoma
Diagnosis w/antibodies and nerve stimulation testing
What are 3 common cancers that can be surgically removed effectively?
sarcomas, non-melanoma skin cancer, in-situ carcinomas (before invasion)
What is Adjuvant Therapy?
- start with surgical removal to “cytoreduce” or get the most mass out that you can
- provide radiation and systemic therapy after surgery
What is Neoadjuvant Therapy?
- start with chemo/radiation to cytoreduce mass, then surgically remove as much as possible, and then use more chemo/radiation
- in cases where surgery is not as effective upfront
What is Brachytherapy?
- very localized high-dose therapy delivered continuously for a prolonged time through implant devices
- common use in prostate cancer
What are Systemic Radionucleotides?
- iodine 131 used for thyroid cancer and other thyroid diseases
- metabolism of radioactive iodine by neoplastic thyroid cells causes cellular ingestion of the killing radionucleotide
What is Intensity Modulated Radiotherapy (IMT)?
- also called Cyberknife
- basically create a 3D area of radiation therapy that allows other vital tissues to be protected
“custom fit”
When is Stem Cell Transplant indicated and what are 3 common transplant methods?
- used when bone marrow is destroyed (hematopoietic neoplasms, high dose cytotoxic chemotherapy for solid tumors)
- Allogeneic (someone else), Syngeneic (identical twin), and Autologous (from yourself)
How can Ovarian Cancer be screened and prevented?
- NO effective screening (CA-125 is not specific for malignant ovarian tumors)
- high risk pts can have bilateral ovary/fallopian tube removal (prophylactic salpingectomy/oophorectomy
What are two common screening methods to check for Prostate Cancer and what problems are associated with them?
- serum prostate-specific antigen testing
- serum testing inc. in many benign/inflam states
- digital rectal exam
- typically ID’s tumors AFTER they are advanced
What is the most effective screening/prevention tool for Cervical Cancer?
PAP SMEAR
- do every 3 years as long as normal w/o prior history
- add HPV DNA test at age 30 and onward
Why are Pap Smears so important for screening? What vaccine should be had by pts?
- cervical cancer is hard to treat
- can identify precancerous lesions that can be excised or removed before cancer even arises
- get HPV vaccine –> eliminates conditions caused by HPV strains
What are 4 tips pts should know for doing self breast exams?
- check the AXILLA
- look for skin changes
- avoid checking prior to/during menstrual cycle
- find a system that helps you to do it
self check once a month
What are 3 options pts who are BRCA positive have for breast cancer prevention?
- Prophylactic surgery
- double mastectomy, bilateral sapingo-oophorectomy
- hormone therapy (prophylactically)
- inc. screenings and self exams
How can Endometrial Cancer be screened/prevented?
counsel women at menopause to report any vaginal bleeding
What options are available for colon carcinoma screening? (4)
- from ages 45-75
- fecal immunochemical test (annual), guaiac-based fecal occult blood test (annual), fecal DNA test (3 yrs), colonoscopy (10 yrs)
- colonoscopy can check for precancerous polyps and remove them before they invade
What are options for Lung Carcinoma prevention and screening?
P: STOP FUCKING SMOKING
S: low dose CT (current smokers, 30 pk yr, quitters in past 15 yrs)
