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SBL (Skin, Blood, Lymph) Exam 1 and 2 > Lecture 7: Cancer Detection, Treatment, and Prevention > Flashcards

Lecture 7: Cancer Detection, Treatment, and Prevention Flashcards

1
Q

What are 3 problems that masses can cause?

A
  • invasion of adjacent structures, obstruction of passageways (GI/airways), and compression (spinal cord)
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2
Q

What does a mass tell you about malignancy?

A

NOTHING

  • though invasion of the skin (for example) is a BIG concern for potential malignancy
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3
Q

How would a lung carcinoma cause airway obstruction?

A

by growing endobronchially

  • could cause downstream tissue to collapse and/or airway stridor
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4
Q

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?

A
  • 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
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5
Q

What is a hematological issue regarding tumors?

A

HEMORRHAGE

  • even benign tumors can be fatal if they hemorrhage
  • should consider tumors if we see hematuria, hematochezia (stool), hematemsis (vomit), or hemotpysis (cough)
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6
Q

What kind of cancer should we consider in older female patients who seem to be “menstruating again”?

A

UTERINE CANCER

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7
Q

What is the most common renal tumor in adults?

A

Renal Cell Carcinoma

  • extremely vascular and bleeds A LOT
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8
Q

What can abrupt and chronic tumor hemorrhaging lead to?

A

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)

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9
Q

Ovarian Carcinomas and tissue irritation

A

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

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10
Q

What is an adnexal mass?

A
  • lump of tissue near the uterus, ovaries, fallopian tubes, or the connecting tissues
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11
Q

What is a common tumor marker for ovarian cancer?

A

CA-125

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12
Q

What is the step-wise process for dealing with pts suspected of having cancer?

A
  1. vague symptomatology
  2. phyiscal examination
  3. laboratory testing
  4. radiographic evaluation
  5. surgery –> DEFINITIVE DIAGNOSIS and treatment
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13
Q

What are the 3 components of cancer staging?

A
  1. T (tumor size/invasion) - ranked 1-4
  2. N (degree of lymph node involvement) - ranked 0-2
  3. M (distant metastases) - ranked 0-2
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14
Q

What are the 4 types of metastatic spread and which one is the most common?

A
  1. lymphatic - MOST COMMON
    • typical spread of CARCINOMAS
  2. hematogenous
    • typical spread of SARCOMAS (or adv. carcinomas)
  3. transcoelomic
    • punches through membrane, seeding cavity nearby
  4. canalicular - travels through pre-existing lumen/duct
    • ex: bile duct/sub-arachnoid space
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15
Q

What are the 4 most likely sites for hematogenous metastasis to spread?

A

Lung, Liver, Brain, Bone

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16
Q

What is a consideration for checking lymph nodes in a suspected case of breast cancer vs lung carcinoma?

A

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

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17
Q

What are Sentinel Node Biopsies? What are two common cancers this practice is used in?

A
  • 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
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18
Q

What organ is a myometrial leiomyosarcoma likely to metastasize to?

A

LUNGS

  • LIVER is also very common
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19
Q

What is an example of a carcinoma that does not require lymph node staging?

A

Renal Cell Carcinoma

  • it is hematogenously spread (think lungs, liver, brain, bone)
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20
Q

Why is fatigue/weight loss a symptom of metastatic cancer?

A

extreme fatigue caused by the extreme burden of having the tumor

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21
Q

What is Sister Mary Joseph nodule and what kind of cancer is it typically a sign of?

A
  • large, round, red umbilical mass caused by metastasis of ovarian carcinomas
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22
Q

What is a Virchow Node and what is typically responsible for it?

A
  • a supraclavicular lymphadenopathy (usually LEFT-SIDED) often associated with carcinomas in older adults
  • seen in ANY thoracic/abdominal/pelvic carcinomas
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23
Q

What are clues to determining if a tumor is Primary vs Metastatic?

A

Primary - solitary, no other cancer diagnosis, unusual met location, typical pt. demographic

Metastatic - multiple tumors, history of cancer, typical mets location, unusual

24
Q

Why are tumor recurrences typically metastatic in nature?

A
  • the primary tumor site initially got the most treatment, but other sites might not have received enough to eliminate their cancer cells completely
25
Q

What are common serum tumor markers of:

  1. ovarian cancer
  2. myeloma
  3. medullary thyroid carcinoma
A
  1. CA-125
  2. B2 microglobulin
  3. calcitonin
26
Q

What are clues to determining if a tumor is Primary vs Metastatic?

A

Primary - solitary, no other cancer diagnosis, unusual met location, typical pt. demographic

Metastatic - multiple tumors, history of cancer, typical mets location, unusual

27
Q

Why are tumor recurrences typically metastatic in nature?

A
  • the primary tumor site initially got the most treatment, but other sites might not have received enough to eliminate their cancer cells completely
28
Q

What are common serum tumor markers of:

  1. ovarian cancer
  2. myeloma
  3. medullary thyroid carcinoma
A
  1. CA-125
  2. B2 microglobulin
  3. calcitonin
29
Q

What are two common features of patients suffering from late metastasis from breast cancer?

A
  • can occur decades later

- pt. has back pain after “definitive” breast cancer therapy (due to osseous metastasis to the spine)

30
Q

What are 4 common cancers that cause Humoral Hypercalcemia of Malignancy (HHM)?

A
  • inc. in PTHrP (parathyroid hormone-related protein)

- squamous carcinomas (any site), and cancers of breast/gastrointestinal/genitourinary tracts

31
Q

What are three common signs that should make you think about SIADH as an option?

A
  • heavy smoker, drowsy/confused, dilute blood/concentrated urine
32
Q

What are the 3 causes of Cushing’s Syndrome?

A
  1. Cushings Disease - pituitary tumor inc. ACTH/cort
  2. Primary Adrenal Disease - adrenal tumor inc. cort
  3. Ectopic ACTH - tumor inc. ACTH/cort
33
Q

What cancer is SIADH seen the most in? What are 3 other cancers that can cause it?

A
  • most common paraneoplastic syndrome in small cell neuroendocrine carcinoma of the LUNG
  • also seen in gastrointestinal, genitourinary, and ovarian carcinomas
34
Q

What are three common signs that should make you think about SIADH as an option?

A
  • heavy smoker, drowsy/confused, dilute blood/concentrated urine
35
Q

What are the 3 causes of Cushing’s Syndrome?

A
  1. Cushings Disease - pituitary tumor inc. ACTH/cort
  2. Primary Adrenal Disease - adrenal tumor inc. cort
  3. Ectopic ACTH - tumor inc. ACTH/cort
36
Q

What are 4 common signs that should make you think Cushing’s Syndrome?

A

heavy smoker, hypertension, hypokalemia (low potassium), weight loss (ectopic only)

37
Q

What cancer is Cushing’s Syndrome the 2nd most common paraneoplastic syndrome of?

A

small cell neuroendocrine carcinoma

38
Q

What are 5 other tumors associated with ectopic ACTH secretion? (LBPMP)

A
  1. lung (squamous, adenocarcinoma, small cell)
  2. bronchial carcinoid tumors
  3. pancreatic islet tumors
  4. medullary thyroid carcinoma
  5. pheochromocytoma
39
Q

What are 4 common signs that should make you think Cushing’s Syndrome?

A

heavy smoker, hypertension, hypokalemia (low potassium), weight loss (ectopic only)

40
Q

What is Eaton-Lambert Mysasthenic Syndrome and what malignancy is it commonly associated with? How is it diagnosed?

A

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

41
Q

What are 3 common cancers that can be surgically removed effectively?

A

sarcomas, non-melanoma skin cancer, in-situ carcinomas (before invasion)

42
Q

What is Adjuvant Therapy?

A
  • start with surgical removal to “cytoreduce” or get the most mass out that you can
  • provide radiation and systemic therapy after surgery
43
Q

What is Neoadjuvant Therapy?

A
  • 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
44
Q

What is Brachytherapy?

A
  • very localized high-dose therapy delivered continuously for a prolonged time through implant devices
  • common use in prostate cancer
45
Q

What are Systemic Radionucleotides?

A
  • 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
46
Q

What is Intensity Modulated Radiotherapy (IMT)?

A
  • also called Cyberknife
  • basically create a 3D area of radiation therapy that allows other vital tissues to be protected

“custom fit”

47
Q

When is Stem Cell Transplant indicated and what are 3 common transplant methods?

A
  • 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)
48
Q

How can Ovarian Cancer be screened and prevented?

A
  • 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
49
Q

What are two common screening methods to check for Prostate Cancer and what problems are associated with them?

A
  1. serum prostate-specific antigen testing
    • serum testing inc. in many benign/inflam states
  2. digital rectal exam
    • typically ID’s tumors AFTER they are advanced
50
Q

What is the most effective screening/prevention tool for Cervical Cancer?

A

PAP SMEAR

  • do every 3 years as long as normal w/o prior history
  • add HPV DNA test at age 30 and onward
51
Q

Why are Pap Smears so important for screening? What vaccine should be had by pts?

A
  • 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
52
Q

What are 4 tips pts should know for doing self breast exams?

A
  1. check the AXILLA
  2. look for skin changes
  3. avoid checking prior to/during menstrual cycle
  4. find a system that helps you to do it

self check once a month

53
Q

What are 3 options pts who are BRCA positive have for breast cancer prevention?

A
  1. Prophylactic surgery
    • double mastectomy, bilateral sapingo-oophorectomy
  2. hormone therapy (prophylactically)
  3. inc. screenings and self exams
54
Q

How can Endometrial Cancer be screened/prevented?

A

counsel women at menopause to report any vaginal bleeding

55
Q

What options are available for colon carcinoma screening? (4)

A
  • 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
56
Q

What are options for Lung Carcinoma prevention and screening?

A

P: STOP FUCKING SMOKING

S: low dose CT (current smokers, 30 pk yr, quitters in past 15 yrs)

SBL (Skin, Blood, Lymph) Exam 1 and 2 (22 decks)

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