Neoplasia V Flashcards
Mass effect of tumours?
Local problems because of size; compression of adjacent structures that is anatomically dependent:
Blocking of blood vessels, airways, bile ducts, oesophagus, etc
In the brain - any mass effect is bad due to limited space (brain compression even with benign growth)
Advantage of compression?
Some tumours are not near other structures and can become large without notice - late presentation, e.g: tail of pancreas and ovarian cancer (older women also tend to put on weight so less notice)
Early presentation symptoms of different cancers?
Vocal chord - change in voice occurs early
Skin cancers - can beseen
Breast cancer - self-examination can lead to them being found early
Testicular cancer - self-examination
Loss of function as a warning?
Organ can no longer perform its normal function - useful sign, inc. hoarseness, jaundice (blocked bile ducts)
Different tumours have different effects depending on where and what they are
Presentation of colon cancer?
Blood in stool tends to be late
Perforation (hole) - major problem
Lung cancer presentation?
Decreased area of healthy lung and decreased O2 consumption
Often a late occurrence, often with large and multiple tumours
Patients with lung cancer tend to have PRE-EXISTING LUNG DISEASE (e.g: COPD in smokers) - may not take much to further reduce lung function
Infection, secondary to obstruction - like stagnant water
Lung cancer precautions with infection?
Older smoker getting better with antibiotics after pneumonia - must do X-ray 6 months later
Presentation of bladder and kidney cancers?
Obstruction can lead to being unable to drain urine
Backwards pressure
Kidney stops functioning - buildup of toxins and abnormal electrolyte balance
Can get renal failure, so drug dose must be lowered as little/no excretion
Describe brain cancers
No such thing as “benign” in brain
Pressure increase can affect functions like maintenance of heart rate, breathing
Can cause seizures
Weight loss in cancer?
AKA cachexia - tumours divide frequently and are very metabolically active
Tumours can also produce all sorts of molecules that result in increased metabolism throughout the body, mainly Tissue Necrosis Factor (TNF) - body consumes “itself”
What is infiltration?
Direct invasion of other structures/organs
Can result in fistula and sinuses - connection between wrong structures
Signs of infiltration?
Nerves affected - e.g: phrenic nerve innervates the diaphragm (C3, 4 AND 5 KEEPS THE DIAPHRAGM ALIVE)
Loss of function
Motor problems - dysphagia, diaphragm breathing
Sensory - pain (late sign)/loss of sensation
Others - autonomic function
Heterogenous appearance of some tumours?
Due to haemorrhage within tumours - sign of malignancy
Blood vessels in cancer?
Metastasis via blood means that cancer has infiltrated blood vessels
Larger vessels are a problem (often a cause of sudden death in patients with known cancer): Cannot operate on tumours wrapped around the carotid artery or bowel cancers wrapped around the abdominal aorta
Irradiating large vessels causes an inflammatory response, due to damage to “self” cells and scarring occurs (obstruction of vessel)
Irradiating
Bone marrow tumours?
Cause lack of production of wbcs, platelets and rbcs
Folate in cancer?
Folate (folic acid) is needed for cell division - tumours use up a lot and less is available for other cells
Meaning of paraneoplastic?
Tumours can produce HORMONES - changes are not directly related to the tumour and are often unusual
Can result in electrolyte disturbances (high Ca, low Na)
Osteoarthropathy - big fingers (lung cancer can cause this even from a distant site)
Unusual neurological symptoms
Paraneoplastic syndromes?
Skin rash - common with often unknown causes
Fever - MOST COMMON SYMPTOM associated with tumourss; related to abnormal production of endogenous “pyrogens”
Pyrexia of Unknown Origin (PUO) - no a diagnosis (night sweats); lots of causes but cannot miss cancer
Immune response to cancer?
Tumours express proteins that are not normally expressed - can stimulate and immune response
Often tumours that stimulate a strong immune response have a good prognosis
Cancer evasion of immune system?
Many tumours have developed complex mechanisms of evading the immune system, e.g: HPV is good at evading the immune system
Cancer patients are at risk of infection (due to cancer and due to prescribed drugs) - not an uncommon cause of death in cancer patients
Can get UNUSUAL INFECTIONS - reactivation of chicken pox (shingles)
Metastases in lung?
Can lead to loss of function
Bone metastases?
Can cause pathological fractures (bone replaced with soft tissue) - light injuries can cause fractures
Calcium metabolism - high Ca levels (arrhythmia)
Kidney problems
Palliative care description?
Aimed at reducing symptoms and making passing on as comfortable and dignified as possible
