Malignancy Flashcards
Which hormones are secreted by small cell carcinoma of the bronchus and what syndrome does this result in (3)
. ACTH and precursors: Cushing syndrome
. Vasopressin: dilution hyponatraemia
. HCg: gynaeaccomastia
Which hormones are secreted by carcinoid tumours and what syndrome does this result in (4)
• ACTH (peptide): Cushing syndrome
• Vasopressin: dilution hyponatreMia
• vasoactive amines eg serotonin (synth from tryptophan therefore tryptophan deficiency, so can’t make proteins and nicotinic acid → pellagra like skin lesions due to nicotinic acid deficiency)
• histamine and kinins
Which hormones are secreted by squamous cell carcinoma of the bronchus and what syndrome does this result in
Pthrp (parathyroid hormone related peptide ): hypercalcaemia of malignancy
Which hormones are secreted by renal cell carcinoma and what syndrome does this result in
Pthrp: hypercalcaemia
Name 4 tumours that increase ADH concentration
• Small cell carcinomas of the bronchus
• carcinoid tumours
• breast cancer, pancreatic adenocarcinomas
How does hypercalcaemia of malignancy happen (3)
• Mostly pthrp
Osteoclast activation:
• osteoclast activating cytokines eg il1, TNF beta by the haematological tumours eg myeloma
• prostaglandins produced by tumours Met’s in bone
Name metabolic complications of malignancy (6)
• Cushings (common)
• siadh (common)
• hyper Ca of malignancy (common)
• kidney disease acute/chronic: due to urinary tract obstruction, hyper Ca, direct infiltration eg lymphoma, Bence Jones proteinuria in myeloma, antibiotics, cytotoxic drugs, turnour lysis syndrome
• hyper K, hyper uricaemia, hyper p, hypo Ca = TLS and cytotoxic drugs
• hypo mg (often with hypok): cytotoxic drugs eg cisplatin for ovarian cancer, renal loss with amphotericin for fungalinfections
What are carcinoid tumours
Gaptroenteropancreatic neuroendocrine tumours that arise from neuroendocrince cells from embryological gut
Mostly found in appendix and ileocecal
Low grade malignancy
Most secretory ones are bronchial
Name 3 screening and diagnostic tests for carcinoid tumours
• Usually 24 hour urine 5-hydroxyindoleacetic acid 5-hiaa (metabolite of 5-ht)
• chromogranin A = more sensitive
. Whole blood serotonin: if suspect bronchial carcinoid but normal 5-hiaa secretion
Which is the only tumour marker that canbe used for screening, diagnosis, prognosis, treat monitor and recurrence follow up
Chorionic gonadotrophin: marker for choriocarcinoma
What does high AFP indicate (3)
• Normal pregnancy (made by yolk sac, fetal liver and gut)
• hepatocellular carcinomas: (>450 diagnose but not , specific,can be raised in cirrhosis ), monitor response treatment
• testicular germ cell tumours: prognosis, staging and monitoring for non-seminomatous germ cell tumours
What does high CEA (carcinoembryonic antigen) indicate (3)
• Elevated in 50% of patients with colorectal cancer (can’t use for screening or monitoring because not specific or sensitive enough)
• Other malignancies: pancreatic , breast, lung
• Non malignant: liver disease, pancreatitis, IBD, heavy smokers
What does high HCG indicate (4)
. Normal placenta, highest at week 8
‘ abnormal trophoblastic tissue
• tumour secreting hormone ectopically
• secreted by 50% of testicular nsgcts (measure with AFP after treatment)
• choriocarcinoma (malignant proliferation of chorionic villi that may develop from hydatidiform mole, potentially malignant proliferation placenta) = very sensitive ! For diagnosis, monitoring treatment , follow up
What should assays for hCG as tumour marker measure
Both:
• intact hCG (alpha and beta subunit)
• free total beta hCG (specific to hCG, seminomas for eg produce a significant proportion)
(Alpha subunit identical to that of lh, FSH, tsh )
