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Flashcards in Clinical Manifestations of CA Deck (20):
1

How might CA effect tissue integrity?

Tumor growth can compress and erode blood vessels.

tissue ulceration and necrosis (blood in stool, painless hematuria)

CA can produce tissue destroying toxins and enzymes

Mass of an abdominal tumor can cause a bowel obstruction

Development of effusions:
-pleural, pericardial, or peritoneal spaces (think lung CA, lymphoma, or ovarian CA.)

2

Anorexia:
-cause
-wt loss from what stores?
-can protein loss be restored?
-liver size?

Cause: decreased caloric intake from:
--physical obstruction of GI tract
--pain
--depression
--constipation
--malabsorption
--debility (opiates, radiotherapy, or chemotherapy)

Weight loss is primarily from the fat stores then muscle.

Protein loss is equally divided among the skeletal muscle and visceral proteins. (w/ cachexia protein supplementation connot reverse wt loss.)

Liver: shrinks.

3

Cachexia:
-what is this?
-cause
-can protein loss be restored?
-liver size?

What: involuntary loss of at least 5% of body mass, not just related to decreased food intake.

Cause: 2ndry to a hypermetabolic state and altered nutrient metabolism. Tumors consume large amounts of glucose and increase lactate formation (tumor isnt good at delivering oxygen to itself)

Caloric and protein supplementation cannot reverse wt loss in cachexia.

Liver enlarges in cachexia.

4

Fatigue:
-characterized by?
-relief with sleep or rest?
-types, describe each.

Characterized by tiredness, weakness, and lack of energy

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

Peripheral fatigue; occurs in the NMJ and muscles. lack ATP and build up of lactic acid.

Central fatigue: arises in the CNS, difficulty in initiating or maintaining voluntary activities, may be 2ndry to dysregulation of serotonin and proinflamm cytokines.

*CA pts dont sleep well.

5

Anemia:
-cause
-tx
-BBW

Cause:
-may be related to blood loss, hemolysis, impaired RBC production or tx effects. Malignancies can decrease RBC production.

Tx: epogen but may require transfusion

BBW: those treated with Epogen for anemia associated with CA have increased mortality rate.

6

Fever:
-MC malignancies that present with fever?

Lymphoma, leukemia, renal cell, hepatocellular carcinoma

7

Paraneoplastic syndromes
-what is this?
-cause
-MC in what cancers?

What: collection of sx that result from substances (hormones, peptides, cytokines) produced by the tumor and occur remotely from the tumor itself.
*immune cross-reactivity between malignant and normal tissues.

Cause by abnormal increases in hormones 2ndry to the effects of the CA cells.

MC in lung(SCLC)*, breast, hematologic, breast cancer

8

What are the endocrine paraneoplastic syndromes?

-SIADH
-Hypercalcemia
-cushing syndrome
-hypoglycemia

9

SIADH:
-what is this?
-associated CA
-signs and sx

What: tumor cell production of ADH leading to increased free water absorption. failure of negative feedback system that regulates the release of ADH.

Associated CA: small cell lung CA*

Signs and Sx:
-hyponatremia
-increased urine osmolality with decreased urine output
-decreased serum osmolality

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

10

Hypercalcemia:
-associated CA
-sx
-cause

Associated CA: breast*, Multiple myeloma*, renal cell, squamous cell (lung*), lymphoma, ovarian, endometrial.

Sx:
-Altered mental status, weakness, ataxia, lethargy, hypertonia, renal failure, nausea, vomiting, hypertension, bradycardia

Cause:
-secretion of PTH-rP (most commonly squamous cell cancers of the lung) (80% of the time)**

-osteolytic activity at sites of skeletal mets

-tumor secretion of Vit D

-Ectopic tumor secretion of PTH.

11

Cushing Syndrome
-associated CA
-sx
-lab findings

Associated CA:
-small cell lung CA or bronchial carcinoid
-thymoma, medullary thyroid CA, GI, pancreatic, adrenal, or ovarian.

Sx:
-muscle weakness, peripheral edema, HTN, wt gain, centripetal fat distribution

Lab findings:
-hypokalemia
-elevated baseline serum cortisol
-normal to elevated midnight serum ACTH
-not suppressed with dexamethasone.

12

Hypoglycemia
-associated cancers
-sx

Associated Tumors
-Insulin-producing islet cell tumors
-non-islet cell tumors

Sx
-recurrent or constant hypoglycemia

13

What are the Paraneuoplastic neurologic syndromes?

cause?
Tx
Prognosis

Limbic encephalitis: SCLC

Paraneoplastic cerebellar degeneration: SCLC

Lambert-eaton syndrome: SCLC (reverse myasthenia gravis; weakness of the limbs)

Myasthenia Graivs: thymoma (begins with eye muscle weakness)

Autonomic neuropathy: SCLC

Subacute (peripheral) sensory neuropathy: SCLC

SCLC = smalll cell lung cancer.

Cause: immune cross reactivity between tumor cells and the nervous system.

Tx: immunosuppressive therapy

Prognosis:
-cause permanent damage, tx of primary tumor doesnt always result in neurologic improvement

14

Dermatologic and Rheumatologic syndromes:
-name one and describe it.

Acathosis nigricans: darkening of skin, raised discoloration seen with DM, adenocarcinoma*, lung, breast, and ovarian CA.

15

Hematologic syndromes:
-what are these??
-sx

eosinophilia
granulocytosis
pure red cell aplasia
thrombocytosis

Sx: rarely symptomatic.

16

Eosinophilia:
-associated malignancies

Associated malignancies:
-lymphomas and leukemias
-paraneoplastic eosinophilis associated with Lung, GI, and gynecologic CA.

17

Granulocytosis (Neutrophilia)
-WBC range
-associated CA

WBC range: 12-30 x 10^9 /L but can go as high as 50 x 10^9

Associated CA: lung (large cell), GI, brain, breast, renal, gynecologic

18

Pure Red CEll aplasia
-mc associated with which CA?
-may be caused by?

Associated with THYMOMA

Caused by leukemia, lymphoma, myelodysplastic syndrome(BM becomes scar tissue).

19

Thrombocytosis
-platelet count?
-cause
-associated CA
-sx

Platelet count greater than 400 x 10 ^9/L

Cause; tumor production of IL-6

Associated CA: GI, lung. breast, gyn, lymphoma, renal cell, prostate, mesothelioma, glioblastoma, head, and neck CA

usually asymptomatic

20

What are the most common paraneoplastic syndromes?

SIADH
-SCLC

Cushings Syndrome
-SCLC, bronchial carcinoid

Hypercalcemia
-breast, MM, lung