Manifestations of Cancer Flashcards
1
Q
How is tissue integrity lost during cancer growth?
A
- tumor growth can compress and erode blood vessels
- tissue ulceration and necrosis:
blood in stool can be early warning sign of colorectal cancer
painless hematuria may be only sign of bladder cancer - cancer can produce tissue destroying toxins and enzymes: tissue damaged by cancer doesn’t heal properly
2
Q
How can tumor growth effect normal tissue?
A
- massof an abdominal tumor can cause a bowel obstruction
- development of effusions:
pleural, pericardial, or peritoneal spaces:
pleural effusion think lung cancer or lymphoma, peritoneal fluid think ovarian cancer
3
Q
Why does anorexia occur secondary to cancer?
A
- due to decreased caloric intake:
physical obstruction of GI tract
pain
depression
constipation
malabsorption
debility or side effects of tx such as opiates, radiotherapy, or chemotherapy - wt loss is primarily from fat stores then muscle
- protein loss is equally divided among skeletal muscle and visceral proteins: will have decreased liver mass
- this is reversible with protein and calor supp
4
Q
Why does cachexia occur secondary to cancer?
A
- involuntary loss of at least 5% of body mass
- not just related to decreased food intake
- secondary to hypermetabolic state and altered nutrient metabolism created by cancer
- tumors consume large amts of glucose and increase lactate formation
- further abnormalities in fat and protein metabolism
- visceral proteins are preserved and liver recycles nutrients and hepatomegaly occurs
- only way to reverse this is tx of cancer
5
Q
What is cancer anorexia-cachexia syndrome?
A
- common manifestation of solid tumors except breast cancer
- more common in kids and older adults
- wt lost from fat and skeletal muscle
- oral or parenteral nutritional supp. doesn’t reverse cachexia
- involuntary loss of 5% of body wt:
shorter median survival, doesn’t respond as well to chemo, have problems with toxicity
6
Q
How is fatigue secondary to cancer?
A
- can be secondary to cancer or it’s tx
- 1/3 of pts present with fatigue
- cancer fatigue is characterized by tiredness, weakness, and lack of energy
- not relieved by sleep or rest like that of normal health persons
- fatigue can preced dx and can last months after cancer tx
- cause is likely mulitfactorial
7
Q
How can fatigue be categorized?
A
- central or peripheral
- peripheral fatigue occurs in neuromuscular jxns and muscles:
inability of peripheral neuromuscular appartatus to perform a task in response to stimulus.
lack of ATP and build up of lactic acid - leads to decreased firing at neuromuscular jxns (abs eating away at jxns) - central fatigue: arises in CNS
difficulty in initiating or maintaining voluntary activities.
May be secondary to dysregulation of serotonin and proinflammatory cytokines
(have a lot of pain - can’t sleep)
8
Q
Poor sleep secondary to cancer?
A
- trouble falling asleep, staying asleep, nighttime awakenings and restless sleep
- sometimes secondary to pain or SEs of tx such as nausea and vomiting
9
Q
How does anemia occur secondary to cancer?
A
- may be related to blood loss, hemolysis, impaired RBC production, or tx effects
- often tx with epogen but may require a transfusion
malignancies can decrease RBC production by:
- nutritional deficiences
- bone marrow failure
- blunted EPO response
- inflammatory cytokines produced by tumors decrease EPO production
10
Q
Most common malignancies to present with a fever?
A
- lymphoma (Non-hodgkin’s)
- leukemia
- renal cell (20% present with fever)
- hepatocellular carcinoma
- atrial myxomas: uncommon tumor type but MC primary heart tumor: up to 30% present with fever
11
Q
When will these sxs of cancer present?
A
- may present b/f cancer is dx or may be signs of advanced disease
- careful eval of pts with these presenting complaints may uncover occult malignancies
12
Q
What are paraneoplastic syndromes? Cause? Most common in what cancers? Mechanisms?
A
- collection of sxs that result from substances produced by the tumor and occur remotely from the tumor itself
- caused by abnormal increases in hormones secondary to effects of the cancer cells
- MC cancers that these occur:
lung
breast
hematologic - affects up to 8% of pts with cancer
- Mechanism: immune x-reactivity b/t malignant and normal tissues
- tumor secretion of:
hormones
peptides
cytokines
13
Q
When do paraneoplastic syndromes manifest?
A
- may be the first or most prominent manifestation
- when a pt w/o a known cancer presents with one of the typical paraneoplastic syndromes, a dx of cancer must be ruled out
14
Q
What systems can paraneoplastic syndromes affect?
A
- endocrine
- neuro
- heme
- derm
- rheum
15
Q
Endocrine paraneoplastic syndromes?
A
- SIADH
- hypercalcemia
- cushing syndrome
- hypoglycemia
16
Q
Cause of SIADH?
A
- secondary to tumor cell production of ADH
- this leads to increased free water reabsorption
- failure of negative feedback system that regulates the release of ADH - ADH production continues despite a decrease in serum osmolality resulting in water retention and dilutional hyponatremia
17
Q
Assoc cancers - SIADH?
A
- small cell lung cancer (10-45% of pts)
- mesothelioma, bladder, urethral, endometrial, prostate, oropharyngeal, thymoma, lymphoma, ewing sarcoma, brain, GI, breast, adrenal
18
Q
Signs and sxs of SIADH? Clinical manifestations?
A
- hyponatremia
- increased urine osmolality with decreased urine output
- decreased serum osmolality
- manifestations:
gait disturbances, falls, HA, nausea, fatigue, muscle cramps, anorexia, confusion, lethargy, seizures, respiratory depression, coma
19
Q
Assoc cancers - manifest with hypercalcemia?
A
- breast, MM, renal cell, squamous cell cancers (esp lung), lymphoma, ovarian, endometrial
- this is one of MC paraneoplastic syndromes
20
Q
Sxs of hypercalcemia?
A
- altered mental status
- weakness
- ataxia
- lethargy
- hypertonia
- renal failure
- N/V
- HTN
- bradycardia
21
Q
Hypercalcemia in cancer may be secondary to what?
A
- secretion of PTH-RP by tumor cells (80% of cases): most commonly from squamous cell cancers (esp lung)
- from osteolytic activity at sites of skeletal mets (2nd MC cause): breast cancer, MM, lymphomas
- tumor secretion of Vit D
- ectopic tumor secretion of PTH
22
Q
How commonly is cushing syndrome a paraneoplastic syndrome?
Assoc cancers?
A
- 5-10%
- 50-60% from small cell lung cancer or bronchial carcinoid
- thymoma, medullary thyroid cancer, GI, pancreatic, adrenal, ovarian
23
Q
Sxs of cushing syndrome?
lab findings?
A
- muscle weakness, peripheral edema, HTN, wt gain, centripetal fat distribution
-lab findings:
hypokalemia**
elev. baseline serum cortisol
normal to elev. midnight serum ACTH
not suppressed with dexamethasone
24
Q
How common is hypoglycemia as paraneoplastic syndrome? Assoc cancers? Sxs?
A
- rare to be tumor assoc
- assoc cancers:
insulin producing islet cell tumors
non-iselt cell tumors: tumor cell production of IGF-2 or insulin - sxs:
recurrent or constant hypoglycemia
25
How do paraneoplastic neuro syndromes occur?
| Tx? When are these dx?
- immune cross-reactivity b/t tumor cells and nervous system:
cause permanent damage
- tx of primary tumor doesn't always result in neuro improvement
- mainstay of tx: immunosuprressive therapy
- are detected b/f cancer is dx in 80% of cases
26
How common are paraneoplastic neuro syndromes?
| Assoc malignancies?
- affects less than 1% of cancer pts overall (rare)
- assoc malignancies:
up to 5% of pts with small cell lung cancer
up to 10% of pts with lymphoma or MM
27
What are the neuro syndromes and what cancer are they MC found in?
- limbic encephalitis:
SCLC*, testicular germ cell, breast
- paraneoplastic cerebellar degeneration: SCLC
- lambert-eaton syndrome: SCLC
- Myasthenia Gravis: thymoma
- autonomic neuropathy: SCLC
- subacute (peripheral) sensory neuropathy: SCLC and other lung cancers
28
Diff b/t Lambert-eaton myasthenic syndrome and Myastehnia gravis?
- Lambert-eaton: 3% of people with SCLC, reverse myasthenia gravis (presents peripherally), weakness of limbs
- myasthenia gravis: presents more centrally, 15% of people with thymoma, presents with eye muscle weakness
29
Derm and Rheum syndromes?
- acanthosis nigricans
- pemphigus
- extramammary paget
- ichthyosis
- dermatomyositis
- erythroderma
- hypertrophic osteoarthropathy
- leukocytoclastic vasculitis
- polymyalgia rheumatica
- sweet syndrome (acute febrile neutrophilic dermatosis)
30
Acanthosis nigricans is assoc with what cancers?
- MC assoc with adenocarcinoma: GI tract MC (gastric carcinoma)
- other adenocarcinomas: lung, breast, ovarian
- also can be assoc with heme cancers
31
Heme syndromes?
- eosinophilia
- granulocytosis
- pure red cell aplasia
- thrombocytosis
32
When are paraneoplastic heme syndromes detected?
- usually detected after cancer dx
| - usually seen with advanced disease
33
What is Eosinophilia? Assoc malignancies?
- tumor production of eosinophil growth factors
- assoc malignancies:
lymphomas and leukemias
paraneoplastic eosinophilia assoc with:
lung, GI, and Gyn cancers
34
How common is granulocytosis (neutrophilia)?
| Occurs in what cancers?
- occurs approx 15% of pts with solid tumors
- WBC ranges from 12000-30000 (can go as high as 50000) - generally is really high!
- assoc cancers:
lung cancer (mostly large cell), GI, brain, breast, renal, gyn cancers
- mechanism is poorly understood
35
Pure red cell aplasia is assoc with what cancers?
- MC assoc with thymoma
| - may be caused by leukemia, lymphoma, myelodysplastic syndrome
36
How often is thrombocytosis assoc with a malignancy? Cause?
| Assoc cancers? Other conditions?
- 35% of pts with platelet ct of greater than 400,000 have a malignancy
- from tumor production of cytokine IL-6
- assoc cancers:
GI, lung, breast, gyn, lymphoma, renal cell, prostate, mesothelioma, gliobastoma, head and neck cancer
- other commonly assoc conditions:
infection, post splenectory, acute blood loss, iron deficiency
- usually asx
37
3 most common paraneoplastic syndromes?
- SIADH (increased ADH prod)
- cushing syndrome (increased ACTH production)
- hypercalcemia (PTH-RP): MM or bony mets
38
What malignancies are most commonly assoc with paraneoplastic syndromes?
- SCLC (MC overall)
- breast cancer
- gyn tumors
- hematologic malignancies
39
What may help aid in early dx of cancer?
- recognition of paraneoplastic syndrome
| - most likely the neuro paraneoplastic syndromes - they present early in course of cancer
