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Flashcards in Clinical Manifestations of Cancer Deck (46):
1

1. Tumor growth can compress and erode what?
2. Tissue ulceration and necrosis: What are signs of this? 2

3. Cancer can produce what? 2

4. Tissue damaged by cancer heals how?

1. blood vessels
2.
-Blood in the stool can be an early warning sign of colorectal cancer
-Painless hematuria may be the only sign of bladder cancer

3. Cancer can produce
-tissue destroying toxins and
-enzymes

4. Tissue damaged by cancer does not heal properly

2

Effects on the normal tissue secondary to cancer
1. Mass of an abdominal tumor can cause a what?

2. Development of what in the lungs and mediastinum? 3

1. bowel obstruction

2. Effusions
-Pleural,
-pericardial or
-peritoneal spaces

3

1. Pleural effusion think what cancers? 2

2. Peritoneal fluid think what cancer? 1

1. lung cancer or lymphoma

2. ovarian cancer

4

Anorexia
Due to decreased caloric intake
from what?
6

1. physical obstruction of the gastrointestinal tract
2. Pain
3. Depression
4. Constipation
5. Malabsorption
6. Debility or the side effects of treatment such as opiates, radiotherapy, or chemotherapy

5

1. Weight loss is primarily from the what?

2. Protein loss is equally divided among what? 2

3. This causes a decreased what?

1. fat stores then muscle

2. skeletal muscle and visceral proteins

3. liver mass

6

Cachexia
1. What is it?
2. Can be secondary to what?
3. Tumors consume large amounts of _______ and increase ________ formation

4. Further abnormalities in _____ and _______ metabolism

5. ________ proteins are preserved and the liver recycles the nutrients and _________ occurs

1. Involuntary loss of at least 5% body mass
-Not just related to decreased food intake
2. Secondary to a hypermetabolic state and altered nutrient metabolism


3. glucose, lactate
4. fat and protein

5. Visceral, hepatomegaly

7

Whats the different between Cachexia and Anorexia?

-Anorexia- decreased caloric intake but an increase can reverse it. Liver shrinks
-Chachexia- cant be reversed. Liver enlarges

8

Cancer anorexia-cachexia syndrome
1. Common manifesation of ________ tumors except for breat cancer?

2. More common in what populations? 2

3. Weight loss from what? 2

4. _____ or ________ nutritional supplementation does not reverse cachexia

1. solid

2.
children
older adults

3. fat and skeletal muscle


4. Oral or parenteral

9

Cancer anorexia-cachexia syndrome
1. Involuntary loss of what?
2. Shorter median ______?
3. Do not respond well to what?
4. Have more problems with what?

1. Involuntary loss of 5% of body weight
2. Shorter median survival
3. Do not respond as well to chemotherapy
4. Have more problems with toxicity

10

Fatigue
1. Can be secondary to what?
2. Cancer fatigue is characterized by what? 3
3. Not relieved by what?
4. How long can it last?
5. Causes are?

1. Secondary to
-the cancer or
-it’s treatment

2. Cancer fatigue is characterized by
-tiredness,
-weakness and
-lack of energy

3. Not relieved by sleep or rest like that of normal healthy persons

4. Fatigue can precede diagnosis and can last months after cancer treatment

5. Cause is likely multifactorial

11

Fatigue can be categorized into what categories? 2

central or peripheral

12

1. Peripheral fatigue occurs where?

2. What is the PP behind this? 2

1. occurs in the neuromuscular junctions and muscles

1. Inability of the peripheral neuromuscular apparatus to perform a task in response to stimulus
2. Lack of ATP and build up of lactic acid

13

1. Central fatigue arises where?
2. What do they have difficulty initiating?
3. May be secondary to what?

1. Central fatigue arises in the CNS
2. Difficulty in initiating or maintaining voluntary activities
3. May be secondary to dysregulation of serotonin and proinflammatory cytokines

14

1. Cancer patients report poor ______ quality


2. Sometimes secondary to what? 2

sleep: Trouble falling asleep, staying asleep, nighttime awakenings and restless sleep

1. to pain or
2. side effects of treatment such as nausea and vomiting

15

Anemia
1. May be related to what? 4
2. Often treated with what? 2
3. Malignancies can decrease RBC production by? 4

1. May be related to
-blood loss,
-hemolysis,
-impaired RBC production or
-treatment effects

2. Often treated with
-Epogen but
-may require transfusion

3. Malignancies can decrease RBC production by
-Nutritional deficiencies
-Bone marrow failure
-Blunted EPO response
-Inflammatory cytokines produced by tumors decrease EPO production

16

Fever
1. Most common malignancies that present with fever? 5

1. Lymphoma (esp. Non-Hodgkin's)
2. Leukemia
3. Renal cell (20% present with fever)
4. Hepatocellular carcinoma
5. Atrial myxomas (Uncommon tumor type- Up to 30% present with fever)

17

1. Paraneoplastic syndromes are defined as?

2. Caused by?

3. Most common in these cancers? 3

1. Collections of symptoms that result from substances produced by the tumor and occur remotely from the tumor itself

2. Caused by abnormal increases in hormones secondary to the effects of the cancer cells

3. Most common in these cancers
-Lung
-Breast
-Hematologic

18

Paraneoplastic Syndromes
1. May be what manifestation?

2. When a patient without a known cancer presents with one of the “typical” paraneoplastic syndromes, a diagnosis of________must be ruled out

1. May be the first or most prominent manifestation

2. Cancer

19

1. Mechanisms of paraneoplastic syndromes?

2. Tumor secretion of?

1. Immune cross-reactivity between malignant and normal tissues

2. Tumor secretion of
-Hormones
-Peptides
-Cytokines

20

Paraneoplastic syndromes: Which symtpoms can it affect? 5

1. Endocrine
2. Neurologic
3. Hematologic
4. Dermatologic
5. Rheumatologic

21

Endocrine syndromes?
4

1. SIADH
2. Hypercalcemia
3. Cushing syndrome
4. Hypoglycemia

22

1. What is SIADH is what?
2. MOA?
3. Associated cancers? (most important to remember)
4. Describe the failure of the negatice feedback system that regulates the release of ADH?

1. Syndrome of inappropriate antidiuretic hormone

2. Secondary to tumor cell production of ADH (Increased free water reabsorption)

3. Small cell lung cancer (10-45% of patients)*****
-Mesothelioma, bladder, urethral, endometrial, prostate, oropharyngeal, thymoma, lymphoma, Ewing sarcoma, brain, GI, breast, adrenal

4. ADH production continues despite a decrease in serum osmolality resulting in water retention and dilutional hyponatremia

23

Signs and symptoms of SIADH
3

Clinical manifestations?

1. Hyponatremia
2. Increased urine osmolality with decreased urine output
3. Decreased serum osolality

-gait disturbances, falls, HA, nausea, fatigue, muscle cramps, anorexia, confusion, lethargy, seizures, respiratory depression, coma

24

Hypercalcemia
-Associated cancers?
(most common? 3)





-Breast,
-multiple myeloma,
-squamous cell cancers (esp. lung)

renal cell, lymphoma, ovarian, endometrial

25

Symptoms of Hypercalcemia?
8

1. Altered mental status,
2. weakness, ataxia, lethargy,
3. hypertonia,
4. renal failure,
5. nausea, vomiting,
6. hypertension,
7. bradycardia

26

Hypercalcemia in cancer may be secondary to one of the following:

1. Secretion of parathyroid hormone related protein by tumor cells (80% of cases)


2. From osteolytic activity at sites of skeletal metastases (second most common cause)


3. Tumor secretion of Vitamin D
4. Ectopic tumor secretion of PTH

27

Hypercalcemia:
Secretion of parathyroid hormone related protein by tumor cells (80% of cases): MOst commonly from what cancers?

From osteolytic activity at sites of skeletal metastases (second most common cause): Most commonly from what cancers? 3

--Most commonly from squamous cell cancers (esp. lung)


-Breast cancer,
-multiple myeloma,
-lymphomas

28

Cushing syndrome
Associated cancers? (two most common?)
8

50-60% from
1. Small cell lung cancer or
2. bronchial carcinoid

3. Thymoma,
4. medullary thyroid cancer,
5. GI,
6. pancreatic,
7. adrenal,
8. ovarian

29

Cushing syndrome syptoms? 5

Lab findings? 4

Symptoms
1. Muscle weakness,
2. peripheral edema,
3. HTN,
4. weight gain,
5. centripetal fat distribution

Lab findings
1. Hypokalemia
2. Elevated baseline serum cortisol
3. Normal to elevated midnight serum ACTH
4. Not suppressed with dexamethasone

30

Hypoglycemia
Associated cancers? 2

Symtpoms?

Rare to be tumor associated
Associated cancers
1. Insulin-producing islet cell tumors
2. Non-islet cell tumors
Tumor cell production of IGF-2 or insulin

Symptoms
1. Recurrent or constant hypoglycemia

31

Paraneoplastic neurologic syndromes
1. Immune cross-reactivity between what?
2. Cause what kind of damage?
3. Treatmentof the primary tumor does what?
4. Mainstay treatment?
5. Are detected before cancer is diagnosed in what percent of cases?

1 . tumor cells and the nervous system

2. Cause permanent damage
3. Treatment of the primary tumor doesn’t always result in neurologic improvement
4. Mainstay of treatment is immunosuppressive therapy
5. Are detected before cancer is diagnosed in 80% of cases

32

Paraneoplastic neurologic syndromes

Associated malignancies? 2

1. Up to 5% of patients with small cell lung cancer
2. Up to 10% of patients with lymphoma or multiple myeloma

33

Neurologic syndromes
1. Limbic encephalitis 3

2. Paraneoplastic cerebellar degeneration

3. Lambert-Eaton syndrome

4. Myasthenia Gravis

5. Autonomic neuropathy

6. Subacute (peripheral) sensory neuropathy 2

1.
SCLC*,
testicular germ cell,
breast

2. SCLC

3. SCLC

4. Thymoma

5. SCLC

6. SCLC and other lung cancers

34

Neurologic paraneoplastic syndromes
1. Rare except for _____________myasthenic syndrome
3% of all people with SCLC
2. AKA?
3. presents as?

Myasthenia gravis
4. 15% of all people with what?
5. Presents with what?

1. Lambert-Eaton
2. reverse myasthenia gravis
3. Weakness of the limbs

4. thymoma
5. eye muscle weakness

35

Dematologic and Rheumatologic syndromes
10

1. Acanthosis nigricans
2. Pemphigus
3. Extramammary Paget
4. Ichthyosis
5. Dermatomyositis
6. Erythroderma
7. Hypertrophic osteoarthropathy
8. Leukocytoclastic vasculitis
9. Polymyalgia rheumatica
10. Sweet syndrome (acute febrile neutrophilic dermatosis)

36

1. What is Acanthosis nigricans?
2. Most commonly associated with what? (most common) 4
3. Can also be associated with what cancer?

1. Darkening of the skin around the creases
2. Most commonly associated with adenocarcinoma
-GI tract (most common)
(Gastric carcinoma)
Other adenocarcinomas
-Lung,
-breast,
-ovarian

3. Also can be associated with hematologic cancers

37

Hematologic syndromes4

1. Eosinophilia
2. Granulocytosis
3. Pure red cell aplasia
4. Thrombocytosis

38

Paraneoplastic hematologic syndromes
1. Presents how?
2. Usually detected how?
3. Usually seen in what kind of disease?

1. Rarely symptomatic
2. Usually detected after a cancer diagnosis
3. Usually seen with advanced disease

39

Eosinophilia
1. MOA?
2. Associated malignancies?
2 most common
3 others

1. Tumor production of eosinophil growth factors
2. Associated malignancies
-Lymphomas and
-leukemia's

Paraneoplastic eosinophilia associated with
-Lung,
-GI and
-gynecologic cancers

40

Granulocytosis (neutrophilia)
1. Occurs in approximately ____% of pts with solid tumors
2. WBC ranges from _____ x 109/L
3. But can go as high as ___ x 109/L

4. Associated cancers? (most common? 1)
6
Mechanism poorly understood

1. 15
2. 12-30
3. 50
4. Lung cancer (mostly large cell),

GI, brain, breast, renal, gynecologic cancers

41

Pure red cell aplasia
1. Most commonly associated with what?
2. Can also be caused by? 3

1. Most commonly associated with thymoma
2. May be caused by
-leukemia,
-lymphoma,
-myelodysplastic syndrome

42

Thrombocytosis
1. 35% of patients with a platelet count > ______x 109/L have a malignancy
2. From tumor production of __________?

3. Associated cancers?

4. Other commonly associated conditions? 4

5. Usually present how?

1. 400

2. cytokine IL-6

3. GI, lung, breast, gyn, lymphoma, renal cell, prostate, mesothelioma, glioblastoma, head and neck cancer

4.
-Infection,
-post splenectomy,
-acute blood loss,
-iron deficiency

5. asymptomatic

43

Malignancies most commonly associated with paraneoplastic syndromes
4***********

1. Small cell lung cancer
(most common overall)
2. Breast cancer
3. Gynecologic tumors
4. Hematologic malignancies

44

3 most common paraneoplastic syndromes

1. SIADH

2. Cushing syndrome

3. Hypercalcemia

45

What causes the following:
1. SIADH?
2. Cushing syndrome?
3. Hypercalcemia? 2

1. Increased ADH production

2. Increased ACTH production

3.
-PTH related protein
-Multiple myeloma or bony metastases

46

Recognition of a paraneoplastic syndrome may aid in early diagnosis of cancer
-Most likely the ___________ paraneoplastic syndromes as they present early in the course of cancer

neurologic