Oncology Etiology

Question 1

Spinal Cord Compression

Answer 1

Cancers that cause spinal cord compression most commonly metastasize to the vertebral bodies, resulting in physical damage to the spinal cord from edema, hemorrhage, and pressure-induced ischemia to the vasculature of the spinal cord.
Persistent compression can result in irreversible changes to the myelin sheaths resulting in permanent neurologic impairment.

Question 1

Neutropenic Fever

Answer 1

Infectious agents may be viral, fungal or bacterial
Viral – CMV, HSV, VZV (varicella)
Bacterial – Staph, Strep. Enterococcus, H. flu, E. coli, Klebsiella, Pseudomonas
Fungal – Candida or Aspergillosis

Sites of infection: include central venous access catheter, skin, mouth, sinuses, chest or lung, abdomen, perianal region, and CNS

Question 2

Hypercalcemia mechanism

Answer 2

Hypercalcemia is caused by one of three mechanisms:

**Systemic effects of tumor-released proteins

Direct osteolysis of bone by tumor

Increased absorption of calcium due to increased active metabolite of Vitamin D**

MC cause is cancer secreting PTH

Patho- This activates the parathyroid hormone receptor, stimulating osteoclastic activity and promoting renal reabsorption of calcium

Question 3

Hypercalcemia stats

Answer 3

• Cancer secreting PTH is usually a marker of advanced cancer, with median survival ranging from 1 to 3 months. remember there’s other mechanisms for high calcium
• Affects 20-30% of all cancer patients at some point
• MC myeloma, breast, NSCLC lung

LARP + Breasts - Hypercalcemia
Doesn’t include myeloma for some reason

Question 4

Tumor Lysis Syndrome

Answer 4

: massive release of cellular material including nucleic acids, proteins, phosphorus, and potassium.

Question 5

Effusions

Answer 5

-may be the initial finding in a patient with cancer

-Pleural, pericardial, or peritoneal space

-may also appear during the course of disease

-MC serous surface with tumor

-Pleural and pericardial effusions MC by lung and breast cancers

Malignant ascites associated with ovarian, colorectal, stomach, and pancreatic cancers.

For cardiac tamponade - The rate of accumulation and distensibility of the sac determine the degree of hemodynamic instability

Question 6

SVC Syndrome

Answer 6

The result of direct obstruction of the superior vena cava by malignancies such as compression of the vessel wall by right upper lobe tumors or thymoma and/or mediastinal lymphadenopathy
The most common malignancy that causes SVCS is bronchogenic carcinoma

Question 7

Thromboembolic Event

Answer 7

Several factors make patients with cancer more susceptible to thromboembolic events, including DVT and PE
Malignancy causes a hypercoagulable state
Neoplastic cells and chemotherapy can cause intimal injury
Obstructive tumors cause venous stasis