Cancer Detection, Prevention, and Treatment Flashcards Preview

Heme/Lymph Exam 1 (EH) > Cancer Detection, Prevention, and Treatment > Flashcards

Flashcards in Cancer Detection, Prevention, and Treatment Deck (42)
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1

Ways to detect a tumor based on sensation

Breast Cancer: annual physical exam, monthly breast exam

Soft tissue sarcomas: may present with mass

2

Does a mass alone tell you something is cancer?

Nope

 Skin invasion overlying a mass is far more concerning for malignancy, though

3

What are some clues that a mass could be causing obstruction?

Lung Carcinoma: endobronchial growth, causes stridor, collapsed lung, and SVCS (below) 

Superior Vena Cava Syndrome: venous distension of neck, chest wall, facial edema and plethora, upper arm edema (Pemberton's sign) 

Abdominal and pelvic tumors: can compress GI, bladder, biliary system, vessels

4

A tumor around the spinal cord can cause what sort of sudden emergency?

Spinal cord compression 

may cause permanent paralysis or worse 

5

What are some examples of hemorrhage in tumors? 

Hemorrhage can be a presenting sign in teh following 

post-menopausal bleeding (always concerning for uterine cancer, do biopsy)

Less specific concerns: hematuria, hematochezia, hematemesis, hemoptysis 

6

What are some ways that hemorrhaging tumors can manifest (besides seeing it) 

 

rapid enlargement of a tumor or compartment from the blood with significant associated pain 

chronic bleeding leading to iron-deficient anemia 

7

What are some reasons that tumors cause irritation?

peritoneum and pleural spaces are easily irritated by tumor cells 

can cause ascites (ovarian carcinoma)

can cause malignant pleural effusions (tumor irritating pleura) 

8

What are some approaches we can take as physicians to detect tumors? 

History: 

palpable/visible mass (pt will tell you about)

obstructive signs/sx

hemorrhage (pt will tell you) 

Exam:

palpable/visible mass

indications of invasion

compression

effusions

Labs: 

hemorrage

effusions

cancer markers 

Rad: 

all of the above 

9

Case Study: 

62 y/o f pt with increasing fatigue, abdominal weight gain, increased gas/constipation 

Exam: ascites, adnexal mass 

Orders: Ca125 elevated, full body imaging, biopsy with surgery and removal of tumor 

Dx: Ovarian Cancer

10

How to stage cancer 

T: Tumor size/invasion 

N: lymph Node metastasis 

M: other Metastasis/other considerations 

11

Different types of metastatic spread: 

Lymphatic:

Hematogenous:

Transcoelomic: 

Canalicular:

 

travels through lymph (typical of carcinomas)

travels through blood (typical of sarcomas, advanced carcinomas)

punches through serosa 

travels through duct/lumen

12

How does understanding the spread of cancers impact clinical care? 

helps us know where to look for metastasis (check LN palpably or with rad.)

what types of sx of metastasis to look for 

if a previous cancer diagnosis, how to order radiology in anticipation for metastasis 

13

Sentinel biopsies and LN dissections are done in which cancers? 

Endometrial carcinoma spreads via lymph, where do you check for metastasis?'

Myometrial sarcoma would metastasize where?

Breast carcinoma and melanoma 

 

LN! 

Blood and can go to lungs and liver (common for sarcomas)

14

Carcinomas need to be staged by looking at what? 

 

What is the one exception?

LN

 

Renal cell carcinoma (spreads hematogenously, even though it's a carcinoma) 

15

What are some general metastatic cancer symptoms we should beware of?

fatigue, weight loss

bone pain/back pain

headache/neuropsych sx

obstruction/compression 

16

What is the Sister Mary Joseph nodule?

 

What is the Virchow node?

umbilical metastasis, typically from ovarian cancer 

 

Supraclavicular LAD, typically left sided, associated with thoracic/abdominal carcinoma due to drainage of thoracic duct into subclavian vein in the supraclavicular region 

17

What is the difference between a primary and metastatic tumor?

primary: 

solitary, no other cancer dx, unusual met location, typical demographic 

metastatic: 

multiple, history of other cancer, location typical for mets, unusual demographic 

18

What kind of surveillance should be done in a pt with a prior diagnosis of cancer or in anticipation of metastasis?

depends on the cancer! 

checking regional LN is most important, using radiology as appropriate

can use serum cancer markers as well 

Ovarian:Ca125

Myeloma: B2 microglobulin 

Medullary thyroid: Calcitonin

19

What does a late metastasis from a sarcoma present like?

lung metastasis from sarcoma can arise a decade later and pt's may not even remember that they had a primary sarcoma (like a uterine leiomyosarcoma) 

(it actually happens a lot that people forget diagnoses, esp if they were relatively easy, minor to treat) 

20

What does late metastasis from breast cancer present like? 

metastasis from breast carcinomas can arise decades later 

back pain decades after definitive breast cancer can indicate osseous metastsis to the spine 

21

What is the definition of paraneoplastic syndrome? 

tumor secretes a substance (PTH-rP, ACTH)

tumor evokes eleboration of other factors (autoantibodies, cytokines)

22

Case Study:

68 yo m, smoker with acute AMS 

exam: drowsy, confused, Ca elevated, Phos low, PTH low, PTH-rP is elevated

Dx: Humoral Hypercalcemia of Malignancy from squamous carcinomas of any site, likely lung in this case due to hx of smoking

Sx mediated by PTH-rP secretion from tumor

CT shows right hilar lung mass 

23

Case Study

52 yo f, smoker, c/o lethargy and weakness 

Exam: drowsy, irritable, normal BP, euvolemic, Na low, Osm low, urine Osm elevated 

secretion of ADH signals renal receptors to retain free water, diluting serum osm and causing AMS 

Dx: SIADH most often from small neuroendocrine carcinoma but can be from lung, GI and GU/ovarian carcinomas 

Hers is from lung due to smoking history 

24

Case Study 

48 yo m, new onset HTN

 

Exam: low K, weight loss, muscle weakness

morning serum cortisol elevated

ACTH elevated

Dx: Cushing syndrome due to small cell carcinoma and ectopic ACTH

often neuroendocrine tumors, but can be lung, bronchial, pancreatic islet, medullary thyroid, or pheochromocytoma 

25

What is Eaton-Lambert Myasthenic syndrome?

often associated with small cell malignancy

assx with muscle weakness and dry mouth 

dz is mediated by antibodies to voltage gated Ca channels 

Dx via antibody and nerve stimulation testing 

26

When is surgery for malignancy not indicated

metastatic disease removes the advantage of surgery 

 

leukemia/lymphoma can't really be surgical excised

 

systemic therapy can be so effective that surgery isn't needed

 

27

Types of radiation therapy

external beam radiation

intensity-modulated radiotherapy 

brachytherapy

systemic radionucleotides 

28

How does external beam radiation work?

 

How does brachytherapy work?

linear accelerator delivers direct radiation beams to affected site

 

very localized high-dose therapy delivered continuously for a prolonged time through implanted devices 

29

What is an example of systemic radionucleotides?

I131 is used for thyroid cancer and noncancerous thyroid diseases 

the metabolism of iodine by neoplastic thyroid cells results in cellular ingestion of the killing radionucleotide

30

When do you use radiation therapy?

it is part of adjuvant and neoadjuvant therapy 

Use when surgery is contraindicated 

Use for palliative care (prevent spinal cord compression, ENT carcinoma to prevent suffocation, pelvic side wall to prevent pain)