Paraneoplastic

Question 1

• Disorders that accompany benign or malignant

diseases but are not directly related to mass effects or invasion

Answer 1

PARANEOPLASTIC SYNDROME:

ENDOCRINE/HEMATOLOGIC

Question 2

Tumors of neuroendocrine origin, such as small
cell lung carcinoma (SCLC) and carcinoids,
produce a wide array of ____ and are
common causes of paraneoplastic syndromes.

Answer 2

peptide hormones

Question 3

(expression of a hormone from its normal
tissue of origin)
o For example, ACTH of the pituitary

Answer 3

eutopic

Question 4

hormone production from an atypical 
tissue source
-For example, the squamous lung CA
o Conveys abnormal physiology 
associated with neoplastic hormone 
production
o Not fully understood

Answer 4

Ectopic

Question 5

is often 
characterized by abnormal regulation of 
hormone production (e.g., defective 
feedback control) and peptide 
processing.

Answer 5

Ectopic

Question 6

• Occurs in up to 20% of patients with cancer.
• Most common in cancers of lung, head and neck,
skin, esophagus, breast, genitourinary, multiple
myeloma, lymphomas
• PTHrP production probably cause osteolysis and
hypercalcemia

Answer 6

HUMORAL HYPERCALCEMIA OF MALIGNANCY (HMM)

Question 7

Another cause of HHM is excess production of

Answer 7

1,25- dihydroxyvitamin D

Question 8

o Structurally related to PTH and binds to the
PTH receptor, explaining the similar
biochemical features of HHM and
hyperparathyroidism
o Plays a key role in skeletal development and
regulates cellular proliferation and
differentiation in other tissues, including skin,
bone marrow, breast, and hair follicles

Answer 8

PTHrP

Question 9

HMM is stimulated by:

Answer 9

• Hedgehog pathways
• Gli transcription factors
• TGF-ß
• Ras oncogene
• Loss of p53

Question 10

HMM clinical manifestations:

Answer 10

Hypercalcemia, fatigue, mental status changes, dehydration, symptoms of nephrolithiasis

Question 11

is the initial presenting

feature of malignancy

Answer 11

Hypercalcemic
o With a Calcium level of >3.5 mmol/L
(>14 mg/dL)

Question 12

HMM: Elevated _________ confirms the diagnosis

Answer 12

PTHrP

Question 13

HMM treatment: Oral phosphorous (250 mg po 3-4x daily) until
serum phosphorus _____

Answer 13

> 1mmol/L (>3 mg/dL)

Question 14

Saline rehydration to dilute serum calcium and

promote _______

Answer 14

calciuresis

Question 15

Used for acute management of life thereatening hypercalcemia

Answer 15

Furosemide (loop diuretic)

Question 16

Used for chronic management of life thereatening hypercalcemia

Answer 16

Bisphosphonates used for chronic treatment;
o Pamidronate 30-90 mg IV
o Zolendronate 4-8 mg IV
o Etidronate 7.5 mg/kg/day po for 3-7 days

Question 17

o 2-8 U/kg sc every 12 hrs)

o Severe hypercalcemia

Answer 17

Calcitonin

Question 18

for patients with;
o Lymphoma
o Multiple myeloma
o Leukemia

Answer 18

Glucocorticoids (prednisone 40-100 mg po in 4

divided doses)

Question 19

Tumor-Association SIADH compensatory mechanisms:

Answer 19

decreased thirst,
suppression of aldosterone, production of atrial
natriuretic peptide

Question 20

Examples of tumors causing SIADH are

Answer 20

Small Cell

Lung CA and carcinoids (most common)

Question 21

SIADH clinical manifestations

Answer 21

• Asymptomatic
• Hyponatremia
• Weakness, lethargy, nausea, 
confusion, depressed mental status, seizures
• Suppressed thirst mechanism

Question 22

SIADH DIAGNOSIS

Answer 22

• Hyponatremia
• Decreased serum osmolality
• Normal or increased urine osmolality

Question 23

o Inhibit vasopressin action along the renal
distal tubule
o Slow onset of action (1-2 weeks)

Answer 23

Demeclocycline (150-300 mg 3-4x daily)

Question 24

Hypertonic saline (3%) or NSS plus furosemide for 
severe hyponatremia (< 115 meq) - treatment for:\_\_\_\_

Answer 24

SIADH

Question 25

• Slow Na correction (0.5-1 meq/L per hr) | o to prevent_________

Answer 25

central pontine | myelinolysis

Question 26

• 10-20% of cases • Neuroendocrine tumors • Increased expression of the proopiomelanocortin (POMC) gene.

Answer 26

Cushing’s Syndrome

Question 27

is the most | common cause of ectopic ACTH

Answer 27

Small Cell Lung CA (>50%)

Question 28

Cushing's syndrome clinical manifestations:

Answer 28

-Less marked weight gain (centripetal fat distribution) • Fluid retention, hypertension, hypokalemia, metabolic alkalosis, glucose intolerance, steroid psychosis • Increased skin pigmentation • Marked skin fragility, easy bruising (due to increased glucocorticoids) • Severe hypokalemia • Depression or personality changes • Diabetes mellitus • Poor wound healing • Opportunistic infections (P. carinii, mycotic)

Question 29

Cushing's syndrome diagnosis: Urine free cortisol levels

Answer 29

> 2-4x normal

Question 30

Cushing's syndrome diagnosis: Plasma ACTH level

Answer 30

> 22 pmol/L (> 100pg/mL)

Question 31

High dose ______ (8mg per orem) suppresses 8:00 am serum cortisol (50% decrease from baseline) in 80% of pituitary ACTH-producing adenomas

Answer 31

dexamethasone

Question 32

CUSHING SYNDROME TREATMENTS:

Answer 32

``` KMMG • Ketoconazole (200-400 mg bid po) • Metyrapone (250-500 mg q 6 hrs) • Mitotane 3-6 g po in 4 divided doses • Glucocorticoids (to avoid adrenal insufficiency ```

Question 33

Hmm calcium level

Answer 33

>3.5mmol (14md/dL)

Question 34

Tumor-induced hypoglycemia:excess production of IGF-II

Answer 34

* Mesenchymal tumors * Hemangiopericytomas * Hepatocellular tumors * Adrenal carcinomas

Question 35

Erythrocytosis

Answer 35

Renal CA, hepatocarcinoma, cerebellar hemangioblastomas

Question 36

granulocytosis

Answer 36

Lung Ca, GIT ca, Ovarian ca

Question 37

Thrombocytosis

Answer 37

Lung CA, git, breast, ovarian CA

Question 38

The most significant risk factor for cancer overall is

Answer 38

AGE (2/3 over 65 y.o)

Question 39

NINE MODIFIABLE RISK FACTORS FOR | MORE THAN ONE-THIRD OF CANCERS WORLDWIDE

Answer 39

1. Smoking 2. Alcohol consumption 3. Obesity 4. Physical inactivity 5. Low fruit and vegetable consumption 6. Unsafe sex 7. Air pollution 8. Indoor smoke from household fuels 9. Contaminated injections – HIV

Question 40

The first priority in patient management after the diagnosis of cancer is established and shared with the patient

Answer 40

staging

Question 41

is an anatomically based system that categorizes the tumor on the basis of the size of the primary tumor lesion, the presence of nodal involvement, and the presence of metastatic disease

Answer 41

TNM classification (most widely used)

Question 42

are the ones with bad prognosis, tumor has involved other organs.

Answer 42

T3, N2, N3, M1

Question 43

second major determinant of treatment outcome is | the

Answer 43

physiologic reserve of the patient

Question 44

Instead, | surrogate markers for physiologic reserve are used, such as

Answer 44

the patient’s age or Karnofsky performance status or Eastern Cooperative Oncology Group (ECOG) performance status.

Question 45

Older patients and those with a Karnofsky performance status ___ or ECOG __ have a poor prognosis unless the poor performance is a reversible consequence of the tumor.

Answer 45

<70, ≥3

Question 46

chemotherapy or | chemotherapy plus radiation therapy delivered before the use of definitive surgical treatment

Answer 46

Neo adjvant therapy

Question 47

The most common side effects of treatment are:

Answer 47

o nausea and vomiting o febrile neutropenia o Myelosuppression

Question 48

Delayed emesis tx

Answer 48

cisplatin