Oncology: Paraneoplastic Syndrome Flashcards
(39 cards)
What is the difference between paraneoplastic syndromes vs systemic effects of cancer?
- Paraneoplastic are a consequence of cancer but no due to the location of cancer cells
- Systemic effects are consequential to the location of tumour cells
How does paraneoplastic syndrome affect the GI?
- Cancer cachexia and anorexia
- Gastroduodenal ulceration
- Protein losing enteropathy
How does paraneoplastic syndrome affect the GI?
- Cancer cachexia and anorexia
- Gastroduodenal ulceration
- Protein losing enteropathy
What causes cancer cachexia and anorexia?
What are the clinical signs and treatment?
- Anaerobic respiration due glucose utilisation and tumoural hypoxia- increased lactate, altered insulin sensitivity
- Altered metabolism- cancer cytokines/inflammation
- Poor appetite in some patients
CS: weight loss, reduced fat mass, lean muscle mass
Treatment: maintain caloric intake, omega 3
How can cancer cause gastroduodenal ulceration?
GI tumours can cause gastric or duodenal ulceration
Some tumours produce hormones/metabolites which may increase gastric acid
How can GI cancer cause PLE?
Diffuse GI lesions allow protein loss
What are the mechanisms of paraneoplastic haematological effects?
- Loss
- Reduced production
- Destruction
Cytoses
Coagulation disorders
How can cancers cause acute/chronic blood loss anaemia?
Acute:
* if no haematemesis or melena- splenic
* TP drops before PCV
Chronic
* GI or oral lesions
* CS: lethargy, pallor
* Poorly regenerative microcytic hypochromic anaemia due to iron deficiency
How can cancer cause reduced production cytopenias?
Anaemia of chronic inflammatory disease
* Disordered iron storage
* Shortened RBC life span
Myelophthisis- crowding in bone marrow from tumour or suppressive cytokines
* Non-regen normochromic normocytic anaemia
* Diagnosis- bone marrow aspirate
Hyperoestrogenism
testicular tumours- sertoli cell
* Neutrophilia progressing to pancytopenia due to bone marrow hypoplasia
How can cancer cause destruction cytopenias?
Paraneoplastic immune mediated anaemia/thrombocytopenia
* Secondary to lymphoproliferative tumours and occasionally other tumours
* Must exclude lymphoproliferative disease
Microangiopathic anaemia
* Systemic effect
* Fibrin networks
* Schistocytes
How can cancer cause destruction cytopenias?
Paraneoplastic immune mediated anaemia/thrombocytopenia
* Secondary to lymphoproliferative tumours and occasionally other tumours
* Must exclude lymphoproliferative disease
Microangiopathic anaemia
* Systemic effect
* Fibrin networks
* Schistocytes
What of the following is not a cause of schistocytosis?
1. DIC
2. IMHA
3. Metastatic carcinoma
4. Haemangiosarcoma
5. Lipoma
5) Lipoma
What paraneoplastic cytoses can occur?
Erythrocytosis
* Renal tumours- increased EPO
* lymphoma, nasal fibrosarcoma, transmissible vereneal, hepatic
* CS: PUPD, neurological, seizures
* Tx- phlebotomy, removal, hydroxyurea
Neutrophilia
* Tumour induced or immune response to tumour
Eosinophilia
* T cell Lymphoma
* Mast cell
- Why can cancers cause mono-clonal gammopathies?
- What are the CS?
- How is it diagnosed?
- How is it treated?
- Excess production of single immunoglobulin by tumour cells
- Hyperviscosity of blood- renal failure, ocular
- Electrophoresis
- Plasmapheresis
- Why can cancers cause mono-clonal gammopathies?
- What are the CS?
- How is it diagnosed?
- How is it treated?
- Excess production of single immunoglobulin by tumour cells
- Hyperviscosity of blood- renal failure, ocular
- Electrophoresis
- Plasmapheresis
How can tumours affect coagulation?
DIC
* Altered consumptive coagulation
* Thromboembolism
* Elevated APTT, PT, FDPs, D dimers
Mainly in association with carcinoma and Haemangiosarcoma
What endocrine effects can tumours have?
- Hypercalcaemia
- Hypoglycaemia
- Ectopic ACTH syndrome
- Hyperoestrogenisms
ACTH controls the production of cortisol
What are the clinical signs of hypercalcaemia?
- PUPD
- Dehydration
- GI signs
- Weakness
- Muscle fasiculations
- Calcification of soft tissues
- Arrythmias
- Death
How is hypercalcaemia managed in an emergency?
- Rehydrate with saline- 3-4x maintenance
- Consider furosemide
- Consider bisphosphates
- Consider salmon calcitonin
- Consider prednisolone
Removal of inciting lesion
How should hypercalcaemia be worked up?
- Assess tCa and ica
- Rectal exam- anal gland tumours
- Assess and aspirate LNs
- Check history for diet/toxins
- Imaging of thorax/abdomen
- PTH/PTHrp/Vitamin D
- Bone marrow biopsy
- Consider ACTH stimulation test
What is the most common cause of monoclonal gammopathies?
- Myeloma
- Leukaemia
- Lymphoma
- What is the most common cancer with insulinoma?
- What are the clinical signs of hypoglycaemia?
- How is it managed?
- What are the non-neoplastic differentials?
- Paranasal sinus
- Weakness, disorientation, seizures, coma, death
- IV glucose, CRI glucose, medical managment- prednisolone, diazoxie, oceotide, removal of tumour
- Sepsis, starvation, liver dysfunction, hypoadrenocorticism, lab error
- What location of tumours is associated with ectopic ACTH syndrome?
- How is it diagnosed and managed?
- Lung tumours
- Hyperadrenocortisism tests- exision of lesion
What neoplasms can cause neurological signs?
- Systemic effects- neurological mass
- Paraneoplasttic- myasthenia gravis, peripheral neuropathy
