Paraneoplastic Syndromes and random stuff at end of lecture Flashcards
Name the endocrinopathies
Cushings Hypercalcemia SIADH Hypoglycemia Polycythemia
Paraneoplastic Cushings
*DX: Increased ACTH AND POMC
mostly from small cell lung cancer
see HTN and decreased serum K (more than other cushings)
Paraneoplastic Hypercalcemia
*Most common paraneoplastic and VERY life-threatening metabolic disorder in cancer patients
Typically lung cancer (or breast)
Tumor makes PTHRP which acts like PTH and activates osteolysis so get increased Calcium, decreased PTH and increased PTHRP
Symptoms = weakness, confusion, lethargy, constipation
Paraneoplastic SIADH
Seen with small cell lung cancer or intracranial cancer
Causes hyponatremia from all the water reabsorption
**Cerebral edema it causes can be lethal
Paraneoplastic Hypoglycemia
Typically from Soft Tissue Sarcomas and Hepatocellular carcinomas that make insulin-like proteins
Paraneoplastic Polycythemia
EPO made from tumors of breast or lungs
*Clotting and thrombosis can occur
Name the other, non-endocrine, paraneoplastic syndromes
Hypertrophic Osteoarthropathy Acanthosis Nigricans Neuromyopathic syndrome DIC Non-bacterial thrombotic endocarditis Trouseau Syndrome
Paraneoplastic Hypertrophic Osteoarthropathy
Lung Cancer
TRIAD Presentation: 1) new bone formation in long bones and bones of fingers 2) arthritis of adjacent joints and 3) Clubbing of fingers
Paraneoplastic Anathosis Nigricans
NEW presentation (can be benign from previous)
Gray/black patches of hyperkeratosis present in certain skin areas
Increased EGF production by Lung or Gastric Tumors
Paraneoplastic Neumyopathic syndrome
Tumor antigens are similar to nerves and so body makes anti-nerve cell antibodies leading to peripheral neuropathy, corticocerebellar lesions, polymyopathy, and EATON LAMBERT
Eaton Lambert = Myasthenic syndrome and suspect if no thymoma or autoimmune disease
Paraneoplastic Vascular - DIC
- APL = large promyelocytes with increased granules and granule contents induce coagulation cascade
- Prostate cancer with increased mucins to activate cascade
Paraneoplastic Vascular - NBTE
Non-Bact Thrombotic Endocarditis
Fibrinous deposits/vegetations on heart valves from pro-coagulation effects that can be bad and send emboli to the brain
Paraneoplasti Vascular - Trousseau Syndrome
migratory superficial thrombophlebitis with migratory crops of tender nodules in veins
From Deep-seeded cancers - Pancreas or Lung
make increased mucins to activate clotting
Tumor Markers
not for diagnostics (can support diagnostics) but used in association with cancer and can be used to follow treatment
PSA
Prostate cancer marker and for Screening!
CEA
colon and pancreas marker (along with CA19-9)
CA19-9
Colon and pancreas marker (along with CEA)
AFP
Liver and Testes marker
remember Alcohol For Penis
CA-125
Ovarian cancer marker
HCG
Testicular cancer marker
FML4-ALK
Fusion marker of genes in lung cancer
(+) predictive with ALK inhibitor Crisotinib
V600E of BRAF
Molecular marker in Melanoma
+Predictor for BRAF inhibitor
EGFR
+predictive molecular marker for Erlotinib
RAS
Negative prognostic marker
negative predictive marker for treatment of colon cancer with Cetuximab
Crisotinib
treatment for FML4-ALK fusion gene in lung cancer
ALK inhibitor
Erlotinib
Antibody to treat EGFR cancers
