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Flashcards in Clinical Manifestations Deck (63)
1

Cancer associated with blood in the stool

Colorectal CA

2

Cancer associated with painless hematuria

Bladder CA

3

How can cancer effect the normal tissue?

Bowel obstruction (abdominal tumor)
Development of effusions

4

What cancers primarily lead to a pleural effusion?

Lung CA
Lymphoma
Breast CA

5

What cancers primarily lead to peritoneal effusions?

Ovarian
Colorectal
Stomach
Pancreatic

6

What is anorexia due to in cancer?

Decreased caloric intake due to decreased desire of food

7

Reasons for Anorexia in Cancer

Physical obstruction of GI tract
Pain
Depression
Constipation
Malabsorption
Debility or SE of treatment

8

Where is weight loss typically from in anorexia?

Fat stores
Then muscle

9

Liver Size in Anorexia

Decreased

10

Define Cachexia

Involuntary loss of at least 5% body mass
Secondary to hyper metabolic state & altered nutrient metabolism

11

Why cachexia in cancer?

Tumor consume large amounts of glucose & increase lactate formation
Abnormalities in fat & protein metabolism

12

Liver Size in Cachexia

Increased- hepatomegaly

13

Cancer Anorexia-Cachexia Syndrome

Common in solid tumors
Decreased appetite & increase metabolism
More common in young and old

14

What does cachexia lead to with the weight loss?

Shorter median survival
Do no respond well to chemotherapy
More problems with toxicity

15

Characterization of Cancer Fatigue

Tiredness
Weakness
Lack of energy
Not relieved by sleep

16

Peripheral Fatigue

Inability of peripheral neuromuscular apparatus to perform a task in response to stimulus
Anaerobic metabolism

17

Central Fatigue

Difficulty in initiating or maintaining voluntary activities
Secondary to dysregulation of serotonin & pro-inflammatory cytokines

18

Why poor sleep quality in cancer patients?

Trouble falling asleep
Staying asleep
Nighttime awakenings
Restless sleep
Secondary to pain or SE of treatment (N/V)

19

Anemia in Cancer

Blood loss
Hemolysis
Impaired RBC production
Treatment effects

20

How do malignancies decrease RBC production?

Nutritional deficiencies
Bone marrow failure
Blunted EPO response
Inflammatory cytokines produce by tumors decrease EPO production

21

Common Malignancies that Present with a Fever

Non-Hodgkin's Lymphoma
Leukemia
Renal cell
Hepatocellular carcinoma
Atrial myxomas

22

Define Paraneoplastic Syndromes

Collections of symptoms that result from substances produced by the tumor & occur remotely from eh tumor itself

23

Paraneoplastic Syndromes Cause

Abnormal increases in hormones secondary to the effects of the cancer cells

24

Paraneoplastic Syndromes Common in What Cancers

Lung
Breast
Hematologic

25

Mechanisms of Paraneoplastic Syndromes

Immune cross-reactivity between malignant & normal tissues
Tumor secretes hormones, peptides, cytokines

26

What systems can paraneoplastic syndromes affect?

Endocrine
Neurologic
Hematologic
Dermatologic
Rheumatologic

27

Paraneoplastic Endocrine Syndromes

SIADH
Hypercalcmia
Cushing syndrome
Hypoglycemia

28

SIADH

Increased free water reabsorption
Failure of the negative feed back system that regulates the release of ADH

29

What does SIADH cause?

Dilutional hyponatremia

30

Associated Cancers with SIADH

Small cell lung CA
Mesothelioma
Bladder
Urethral
Endometrial
Prostate
Oropharyngeal
Thymoma
Lymphoma
Ewing sarcoma
Brain
GI
Breast
Adrenal

31

Signs/Symptoms of SIADH

Hyponatremia
Increase urine osmolality with decreased urine output
Decreased serum osmolality

32

Clinical Manifestations of SIADH

Gait disturbances
Falls
HA
Nausea
Fatigue
Muscle cramps
Anorexia
Confusion
Lethargy
Seizures
Respiratory depression
Coma

33

Associated Cancers with Hypercalcemia

Breast
Multiple myeloma
Renal cell
SCC
Lymphoma
Ovarian
Endometrial

34

Symptoms of Hypercalcemia

Altered mental status
Weakness
Ataxia
Lethargy
Hypertonia
Renal failure
N/V
HTN
Bradycardia

35

Hypercalcemia is due to

Secretion of PTH related protein
Osteolytic activity
Tumor secretion of Vitamin D
Ectopic secretion of PTH

36

Most Common Cancer with Hypercalcemia due to PTH Related Protein Secretion

SCC (esp. lung)

37

Cancers Common with Hypercalcemia due to Osteolytic Activity

Breast
Multiple myeloma
Lymphomas

38

What is high in Cushing Syndrome?

Aldosterone
Cortisol

39

Associated Cancers with Cushing Syndrome

Small cell lung CA
Bronchial carcinoid
Thymoma
Medullary thyroid CA
GI
Pancreatic
Adrenal
Ovarian

40

Symptoms of Cushing Syndrome

Muscle weakness
Peripheral edema
HTN
Weight gain
Centripetal fat distribution

41

Lab Findings with Cushing's Syndrome

Hypokalemia
Elevated baseline serum cortisol
Normal to elevated midnight serum ACTH
Not suppressed with dexamethasone

42

Associated Cancers with Hypoglycemia

Insulin-producing islet cell tumors
Non-islet cell tumors: IGF-2 or insulin

43

Immune Cross-Reactivity Issues

Permanent damage
Treatment of primary tumor doesn't always result in neurologic improvement
Treatment is immunosuppressive therapy

44

Neurologic Syndromes

Limbic encephalitis
Paraneoplastic cerebellar degeneration
Lambert-Eaton Syndrome
Myasthenia graves
Autonomic neuropathy
Subacute (peripheral) sensory neuroapthy

45

Cancers Associated with Limbic Encephalitis

Small cell lung cancer
Testicular germ cell
Breast

46

Cancer Associated with Paraneoplastic Cerebellar Degeneration

Small cell lung cancer

47

Cancer Associated with Lambert-Eaton Syndrome

Small cell lung cancer

48

Cancer Associated with Myasthenia Gravis

Thymoma

49

Cancer Associated with Small Cell Lung Cancer

Autonomic neuropathy

50

Cancers Associated with Subacute (peripheral) Sensory Neuropathy

Small cell lung cancer
Other lung cancers

51

What is the most common of the neurologic paraneoplastic syndromes?

Lambert-Eaton myasthenic syndrome

52

What does myasthenia graves present with?

Eye muscle weakness

53

Dermatologic & Rheumatologic Syndromes

Acanthosis nigricans
Pemphigus
Extramammary paget
Ichthyosis
Dermatomyositis
Erythroderma
Hypertrophic osteoarthropathy
Leukocytoclastic vasculitis
Polymyalgia rheumatica
Sweet syndrome (acute febrile neutrophilic dermatosis)

54

Cancers Associated with Acanthosis Nigricans

Adenocarcinomas: gastric carcinoma, lung, breast, ovarian
Hematologic cancers

55

Types of Hematologic Paraneoplastic Syndromes

Eosinophilia
Granulocytosis
Pure red cell aplasia
Thrombocytosis

56

Define Eosinophilia

Tumor production of eosinophil growth factors

57

Associated Malignancies with Eosinophilia

Lymphomas
Leukemias
Lung CA
GI CA
Gynecologic CA

58

Cancers Associated with Granulocytosis (Neutrolphilia)

Lung CA (large cell)
GI CA
Brain CA
Breast CA
Renal CA
Gynecologic CA

59

Cancers Associated with Pure Red Cell Aplasia

Thymoma (most common)
Leukemia
Lymphoma
Myelodysplastic Syndrome

60

Associated Cancers with Thrombocytosis

GI
Lung
Breast
GYN
Lymphoma
Renal cell
Prostate
Mesothelioma
Glioblastoma
H&N CA

61

Commonly Associated Conditions with Thrombocytosis

Infection
Post-splenectomy
Acute blood loss
Iron deficiency

62

Malignancies Most Common with Paraneoplastic Syndromes

Small cell lung cancer
Breast
GYN tumors
Hematologic malignancies

63

Top 3 Paraneoplastic Syndromes

SIADH
Cushing Syndrome
Hypercalcemia