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Cancer > Paraneoplastic syndromes > Flashcards

Paraneoplastic syndromes Flashcards

1
Q

Paraneoplastic syndromes three physiological causes

A

Tumour production of substances directly or indirectly cause distant symptoms
Depletetion normal substances -> paraneoplastic manifestation
Host response to tumour that results -> syndrome (auto-immunological)

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2
Q

Range of paraneoplastic syndroems

A

Endocrinologic
Haematologic
Gastrointestinal
Renal
Cutaneous
Neurologic

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3
Q

What causes cushings paraneoplastic syndroem

A

ACTH release - ACTH
Precursors - MSH, b-lipotroin, endorphins, encephalins
-> cushings syndrome

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4
Q

Cancer types causing ectopic ACTH

A

SCLC
NSCLC
Pancreatic
Thymic
Carcinoid tumours
Phaechromocytoma
Medullary carcinoma of thyroid

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5
Q

Presentation of ectopic ACTH syndrome

A

Rapid onset
Marked weakbess secondary to proximal myopatjy
Hyper-pigmentation
Metabolic disturbance eg hyperglycaemia, hypokalaemic alkalosis

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6
Q

Diagnosis of ectopic ACTH

A

Clinical features - hyperpigmentation, myopahty, hypokalaemia, metabolic alkalosis, high 24hr urinary cortisol, high plasma ACTH/precursors, no response to high dose dex suppression or corticotropin releasing homrone stimulation

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7
Q

treatment for ectopic ACTH syndrome

A

Specific anti-tumour treatment
Decrease cortisol secretion surgically - bilateral adrenalectomy
efically - ocreotide, ketoconazole, aminogluthethamide

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8
Q

Most common endocrine paraneoplastic syndrome

A

Innapropriate Anti diuretic hormone - aginine vasopressin

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9
Q

Causes of innappropriate SIADH secretion

A

CNS - infections, vasculitis, stroke, head injury, tumours, Guillain Barre syndrome, acute intermittent prophyria, psychological stress

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10
Q

Causes of innapropriate secretion drugs

A

Drugs - vincristine, cyclophosphamide, morphine, chlorpropramide, thiazides, clofibrate, carbamazepine, cisplatin

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11
Q

Pulmonary causes of innapropriate anitdieuresis

A

Pulmonary - infections, tumours, positive pressure ventialtion, pneumothorax, asthma, CF,

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12
Q

Cancers causng innapropriate antidiuresis

A

SCLC, pancreatic, prostate, NHL, HD

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13
Q

Presentation of innappropriate antidiuresis

A

CNS toxicity = fatigue, headaches, progress altered mental state, confusion and seizures
Often asymptomatic
Exclde CNS disease, pulmonary disease, drug induced

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14
Q

Treatment for inappropriate antidiuresis

A

Fluid restriction (0.5-1.0L/day)
Democlocycline

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15
Q

Lab criteria for SIADH

A

Hyponatremia Na<130mmol/L
Serum hypo-osmolarity <275 mosm/kg
Urinary osmolarity>serum
Urinary sodium >25 mmol/L
Non suppressed ADH

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16
Q

What tumours can secrete gonadotrophins

A

Pituitary tumours
Gestational trophoblastic tumours
Germ cell tumours
Hepatoblastomas in children and lung tumours

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17
Q

Investigaitons for gynaecomastia in a male

A

Testicular exam
CXR/CT scans

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18
Q

Exxtragonadal tumurs secreting beta hCG

A

Lung
Adrenal
Hepatoma
GI tract tumours
Genitourinary tumours

19
Q

What type of cancers cell wise more likey -> hypercalcemia

A

Squamous cell -> PTH-rP

20
Q

What is hypercalcemia in breast cancer most commonly from

A

Bone mets
Rarely from PTH-rP

21
Q

Presentation of hypercalcemia

A

NAUSEA
Polyuria
Polydipsia
Dehydration
Cardiac arrhythmias
Constipation

22
Q

Diagnosis of hypercalcemia

A

Serum coorected calcium >2.7 mmol/L
Serum chloride low
Hypercaluria
High urinary phosphate
Low or undetectable palasma PTH hormone

23
Q

When is peak effect of IV bisphophonate in calcium

A

Severeal days after given

24
Q

What is a encephalomyopathy

A

Petivascular inflammation and selective neuronal degeneration at several levels of nervous system

25
Q

What sites can encephalomyopathies affect

A

Limbic system
Brainstem and spinal cord
Loss of neurons in amygdala, hippocampus and insular cortex gliosis
Lymphocyte cuffing of blood vessels
Microglial nodules

26
Q

What cancers cause ecephalomyopathies

A

75% - SCLC
Breast, ovary, NHL

27
Q

Presentation of encephalomyopathies

A

Slow, subacute onset
Progressive
Loss of short term memory
hallucinations
Fit/seizure
Personality changes

28
Q

Diangosis of encephalomyopathies

A

CSF - raised protein/IgG level, pelocytosis
Serum: anti-Hu antibody
MRI

29
Q

Treatment for encepahlomyopathies

A

Anti-tumour theraoy

30
Q

Prognosis of encephalomyopathies

A

Can persist after cancer treated
due to anitbodies still present in immune system

31
Q

Ovarian cancer encepahlomyopathy symptoms

A

Anti-Hu antibodies attack cerebellum
Ataxic gait - may be in wheel chair

32
Q

What is lambert eaton myasthenic syndrome

A

Disorder of NMJ
Reduced pre-synaptic calcium dependent acetylcholine release
60% of patients with LEMS have cancer

33
Q

Cancers causing LEMS

A

SCLC - 60-70%
Breast, thymus, GIT cacners

34
Q

Presenation of LEMS

A

Proximal muscle weakness
Sparing of bulbar muscles (unlike Myasthenia gravis)
30% dysphagia

35
Q

Diagnosis of LEMS

A

EMG - normal condction velocity
Low amplitude compund mucel action potential nears normal after exercise

36
Q

Treatment for LEMS

A

Treat cancer
Corticosteroids
PLasma exchange - high resposne rate
Cholinesterase inhibitors usually ineffective

37
Q

Cancers ass w dermatomyositis

A

NSCLC, SCLC, breat, ovary, GIT cancers

38
Q

Presentation of dermatomyosutus

A

Proximal myopathy
SKin changes
Cardiopulmonary conditions, arthralgias, retinopathy

39
Q

Diagnosis of dermatomyosits/polymyositis

A

Serum: high CK, LDH, aldolase
Muscle biopsy - mysotisia and inflammatory degeneration
EMG - fibrillation, insertion irritability, short polyphasic motor units

40
Q

Treatment for dermatomyositis

A

Search for and treat tumoru - 40% have cancer
Corticosteroids
Azathioprine
Inconsistent course often independent of tumour

41
Q

Waht cancer can acanthosis nigricans be ass with

A

Distal third oesophagus or stomach
Teenagers - insulin resistance

42
Q

What is erythema giratum repens

A

Seen w cervical cancer and bowel ccancer

43
Q

Haematological manifestiations in cancer

A

Erythrocytosis - EPO
Anaemia
Granulocytosis/granulocytopenia
Thrombocytpsis/thromboxytopenia
Thrombophlebitis
Coagulopathies and diseeminated IV coagulation
Nonbacterial thrombotic endocarditis

44
Q
A

Cancer (22 decks)

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