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58 Cards in this Set
- Front
- Back
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Which 5 cancers account for 55% of all cancers?
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Which 5 cancers account for 55% of all cancers?
1. Lung 2. Prostate 3. Breast 4. Colon 5. Rectum |
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TMN staging
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TMN staging:
Tumor Nodes Mets |
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Breast ca metastasizes where?
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Breast Ca metastasizes where?
Lung Liver Brain Bone New dx - every 3 mos do CXR, liver enzymes & alk phos |
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2nd most common malignancy but #1 cause of ca deaths
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2nd most common malignancy but #1 cause of ca deaths:
Lung cancer |
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80% of lung ca are what kind?
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80% of lung cancers are NSCLC.
Non-small cell lung cancer. • Squamous cell carcinoma (SCC) • Adenocarcinoma • Large cell carcinoma |
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Squamous cell carcinoma (SCC)
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Squamous Cell Carcinoma (SCC):
• Tends to originate in central bronchi • Metastasizes to regional lymph nodes • Early mets, aggressive clinical course • Assume micromets at presentation • “Squamous” means “scaly” |
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Squamous cell Ca sx
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Squamous cell ca sx:
▫ New cough, or change in chronic cough ▫ Dyspnea, hemoptysis, anorexia, weight loss ▫ Muscle weakness, chest pain ▫ Enlarging nodule or mass; persistent infiltrate, atelectasis, or pleural effusion on CXR or CT scan ▫ Brain mets → headache, N/V, seizures, altered mental status ▫ Peripheral tumors are less likely to produce early sx |
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BOARD QUESTION:
What is Horner’s syndrome? |
Horner’s syndrome:
Is 2° lesion in the sympathetic nervous system, especially the cervical chain or central pathways → • Ptosis • Meiosis • Absence of sweating • Receding eyeball Per lecture: invasion of sympathetic innervations from superior sulcus tumors (Pancoast tumors) |
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Lung ca 1-yr survival rate
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Lung ca 1-yr survival rate is ~ 40%
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Sx of locally advanced SCC
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Sx of locally advanced SCC:
▫ Chest pain from direct chest wall invasion ▫ Horner’s syndrome ▫ Hoarseness 2° pressure on left laryngeal nerve ▫ Superior vena cava syndrome (tumor compression) ▫ Elevated hemidiaphragm 2° pressure on phrenic nerve |
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Sx of locally advanced SCC
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Sx of locally advanced SCC:
▫ Chest pain from direct chest wall invasion ▫ Horner’s syndrome ▫ Hoarseness 2° pressure on left laryngeal nerve ▫ Superior vena cava syndrome (tumor compression) ▫ Elevated hemidiaphragm 2° pressure on phrenic nerve |
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Paraneoplastic Syndrome
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Paraneoplastic syndrome:
A co-morbid condition due to the indirect–remote or 'biologic' effects of malignancy, which may be the first sign of a neoplasm or its recurrence. PSS occur in > 15% of CASs PSS are 2° hormones, growth factors, biological response modifiers, and other as-yet unidentified factors, and may regress with treatment of the primary tumor. |
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Hematologic neoplastic syndrome
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Hematologic neoplastic syndrome
• Leukemoid reaction • Reactive eosinophilia • Peripheral 'cytoses or 'cytopenias • Hemolysis • DIC • Thromboembolism • Thrombophlebitis migrans |
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Metabolic neoplastic syndrome
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Metabolic neoplastic syndrome
• Lactic acidosis • Hypertrophic pulmonary osteoarthropathy • Hyperamylasemia • Hyperlipidemia |
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Neuromuscular neoplastic syndrome
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Neuromuscular neoplastic syndrome
• Peripheral neuropathy • Myopathy • CNS • Spinal cord degeneration • Inflammation |
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Renal neoplastic syndrome
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Renal neoplastic syndrome
• Nephrotic syndrome • Uric acid nephropathy |
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Skin neoplastic syndrome
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Skin neoplastic syndrome:
• Bullous mucocutaneous lesions • Acquired ichthyosis • Acanthosis nigricans • Dermatomyositis |
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BOARD QUESTION
SCC produces what? |
Squamous cell carcinoma →
• Parathyroid-like hormone → • Hypercalcemia → • Hypertrophic pulm osteoartropathy & clubbing |
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What is a PET scan?
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Positron Emission Tomography (PET) a nuclear medicine imaging method similar to computed tomography, except that the image shows the tissue concentration of a positron-emitting radioisotope
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What does a PET scan do?
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A PET scan “looks for activity & division of cells” (more sensitive and specific for mediastinal lymph node involvement- preop staging of potentially resectable NSCLC)
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How many people with colon ca have a family hx?
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How many people with colon ca have a family hx?
25% |
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Colon ca risk factors
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Colon ca risk factors:
▫ Age >50 ▫ Hx: adenomatous polyps, colon cancer, IBD or ovarian/uterine/breast Ca. ▫ Family history of polyps or colon cancer ▫ Smoking, ETOH, ↑fat, ↑calorie, ↓fiber diets, red meat, obesity and sedentary lifestyle |
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BOARD QUESTION
What can maybe prevent colon ca recurrence? |
What can maybe prevent colon ca recurrence?
NSAIDs • Low dose ASA and • COX inhibitor, ie, celcoxib 400 mg/d |
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Left colon ca sx
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Left colon ca: obstructive symptoms:
• colicky abdominal pain • change in bowel habits |
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Rectal ca sx
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Rectal Ca sx:
• Tenesmus • Urgency • Recurrent hematochezia |
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Where do colorectal mets go?
hint: LLL |
Colorectal mets:
• Lung • Liver • Local nodes |
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Where do cervical mets go?
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Where do cervical mets go?
• Bladder • Rectum |
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Cervical ca tx
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Cervical ca tx:
• depends on the degree and extent of CIN(cervical intra- epithelial neoplasia) • Cauterization or cryosurgery. • CO2 laser. • Loop excision. • Conization of the cervix. • Hysterectomy • Radiation • Very difficult chemo tx with lots of AE: Chemotherapy/radiation-sensitizing cisplatin, etc |
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Ovarian ca
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Ovarian Ca:
• Early dx & tx does not seem to affect outcome. • Ultrasound (pelvic and transvaginal) – adnexal mass, ascites + CT of the Chest/Abd/Pelvis • Laparotomy may see “Peritoneal studding,” which means has spread to abd cavity. • Mets grow locally – bladder, kidney, abd wall. • CA-125 is specific for ovarian cancer |
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Uterine ca risk factors
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Uterine ca risk factors:
• Chronic estrogen exposure (unopposed, ie premarin without provera) • Obesity • Nulliparity/early menarche/ late menopause • Diabetes • Polycystic Ovaries • Extended use of tamoxifen • Hereditary nonpolyposis colorectal cancer • In utero DES exposure (clear cell) |
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Esophageal ca 5-yr survival rate
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Esophageal 5-yr survival rate is < 15%
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Stomach ca is usually what kind?
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Stomach Ca is usually an adenocarcinoma.
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Stomach ca worse prognosis if -
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Stomach ca has a worse prognosis if –
• It is diffuse • There is signet ring formation of path report • It is proximal (as opposed to distal) |
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Stomach ca risk factors
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Stomach ca risk factors:
• Chronic H. pylori • Pernicious anemia • History of partial gastric resection > 15 yrs ago • Hypochlorhydria and atrophic gastritis • Blood group A |
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Signs of stomach ca mets
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Stomach ca mets if:
▫ Left supraclavicular node (Virchow’s node-intraabdominal disease) Left supraclavicular node – do scan of chest/abd/pelvis ▫ Umbilical nodule (Sister Mary Joseph nodule) ▫ Rigid rectal shelf (Blumer’s shelf) ▫ Ovarian metastases (Krukenberg tumor) ▫ Hepatomegaly |
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Pancreatic ca statistics
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Pancreatic ca statistics:
• Tenth most common malignancy • Less than 5% of patients will live 5 years • Incidence is in the 7th and 8th decade • Very poor prognosis |
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Pancreatic ca risk factors
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Pancreatic ca statistics:
• Tenth most common malignancy • Less than 5% of patients will live 5 years • Incidence is in the 7th and 8th decade • Very poor prognosis |
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Pancreatic ca risk factors
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Pancreatic ca risk factors:
▫ Smoking ▫ Age ▫ Obesity ▫ Prior abdominal radiation ▫ Occupational exposure to organic solvents ▫ Coffee and excess alcohol ▫ Diabetes, maybe ▫ Chronic pancreatitis ▫ Familial predisposition (5-8%) |
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Pancreatic ca sx
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Pancreatic ca sx:
▫ Painless jaundice (obstructive) ▫ Epigastric or LUQ pain (lesion in tail) - sitting up and leaning forward may relieve pain ▫ Diarrhea due to maldigestion (steatorrhea in the absence of jaundice is uncommon) ▫ Nausea/anorexia ▫ Painful, enlarged gallbladder ▫ Occult blood in stools (ampulla of vater cancer) ▫ Elevated CA 19-9 ▫ Pain – depends on where lesion is located ▫ RUQ pain |
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Multiple Myeloma
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Multiple Myeloma
• malignancy of plasma cells o bone destruction o paraprotein formation o “Your bone marrow is being replaced.” • Renal failure “Light chain” component • Median age at dx 68-70 yrs |
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Acute Lymphoblastic Leukemia
ALL |
Acute Lymphoblastic Leukemia
Ages 3-7. 2nd peak age 60. Sick for days or weeks before dx Fatigue, fever, infxn, gum hypertrophy, bone pain Bleeding, purpura, arm petichia, pnumocystis carnii Hepatosplenomegaly & ↑supraclavicular lymph node WBC <500 Blast count >200,000 Curable in kids. Poor prognosis as an adult Chemo, autology tx |
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ALL memory hints
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ALL = ALL ages. (Ages 3-5 with 2nd peak ~ age 60)
You get ALL bloody: purpura, arm petichia. Liver, spleen & supraclavicular nodes ALL enlarge. BLAST count is BLASTED out of sight (>200,000) Happens to little kids (ages 3-5). Little # WBC (<500). Age 5, < 500 WBC. |
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Acute Myeloid Leukemia
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Acute Myeloid Leukemia
“AUER ROD IS ALL YOU NEED TO KNOW” Incidence rises after age 40. Median age 60. Risk factor: Benzene exposure Fatigue, bruising, bleeding, fever, infxn, DIC High WBC → poor prognosis Hyperleukocytosis → hepatosplenomegaly Chemo to cure, tx |
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AML memory hints
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AML = AUER RODS
A = AUER RODS M = MIDDLE-AGED L = LIMITS LIFE SPAN (poor prognosis) AUER = hour AML = AUERs (hours) of My Life are Limited (poor pronosis) AML = And Many Leukocytes (high WBC) AML = And Middle-aged Lovers DIC = disseminated intravascular coag And My Loopy Poodle is Pregnant AML, Poor Prognosis |
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Chronic Lymphocytic Leukemia
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Chronic Lymphocytic Leukemia
AGE 65. AN INDOLENT DZ. “Don’t lift, don’t get hit. Belly pain → rupt spleen” Weakness, fever, wt loss, night sweats Lymphadenophathy, bleeding, infxn Hypogammaglobulinemia in 50%. WBC 20,000+ Accumulation of long-lived small lymphocytes Allogenic tx if std tx fails |
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CLL memory hints
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CLL = Chronic, lazy leukemia (an indolent disease)
CLL = Can't Lift Leukemia "Don't lift, don't get hit." --- could rupture spleen CLL = aCcumlation of Long-Lived small lymphocytes CLL = Consistenly Large # of Lymphocytes (WBC 20,000+) Leukocytosis with left shift. |
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Chronic Myelogenous Leukemia
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Chronic Myelogenous Leukemia
PHILADELPHIA CHROMOSOME Age 67 (rarely under age 35) Fatigue, night sweats, fever, splenomegaly, ↑WBC Overproduction of myeloid cells Leukocytosis with left ship Tx = Gleevax. Allogenic tx cures 80% |
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CML memory hints
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CML = CaMeL
old, hot, sweaty CaMeLs turning left in Philadelphia old ~ age 67 (rarely <35) Philadelphia chromosome Fatigue, nite sweats, fever Camel hump = enlarged spleen Leukocytosis with left shift. |
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Hodgkins Lymphoma
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Hodgkins Lymphoma
REED-STERNBERG CELLS Peak in 20’s & again in 40’s Drenching nite sweats, fever, pruritis Painful lymphadenopathy EBV-like risk factor Malignant clonal B-cell Bad tx, but 95% cure |
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Hodgkins Lymphoma memory hints
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HL = Hodgkins Lymphoma
REED-STERNBERG CELLS HL = HeLL REally STERN church is itching to condemn sinners to HeLL. You must go 2 (20) church 4 (40) salvation. (Peaks age 20 & again age 40) The STERN church is full of hot sweaty itchy 20 & 40-yr olds. Fever Drenching nite sweats Pruritis HL = HeLp. Chemo can HeLp 95% of people. (95% cure rate) |
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Non-Hodgkins Lymphoma
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Non-Hodgkins Lymphoma
90% OF ALL LYMPHOMAS Drenching nite sweats, fever and/or wt loss Viral connection – EBV? Pesticides, herbicides, autoimmune dz, prior chemo Hypogammaglobulinemia PET scan to monitor dz Surg, rad, chemo, tx |
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Non-Hodgkins Lymphoma memory hints
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You do NOT want NON-Hodgkins (Hodgkins has 95% cure rate, NON-Hodgkins does NOT.)
Non = Ninety % of all lymphomas. did NOT use protective gear (pesticide or herbicide exposure, autoimmune dz, chem) NOT much gamma globulin left (Hypogammaglobulinemia) |
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SCC (Squamous Cell Cancer) memory hints
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SCc = SCaly
SCc = SCary (assume mets at presentation) SCc = Scary Cough (tends to originate in central bronchi) |
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BOARD QUESTION: what is Horner's syndrome?
Horner's syndrome memory hint |
Ross & Beth Horner's eyes are funny: lid lag, small pupils,eyeballs receding)
Beth teaches 1st grade- she has small (little) pupils. |
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Signs of stomach cancer mets
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Stomach ca mets if:
▫ Left supraclavicular node (Virchow’s node-intraabdominal disease) Left supraclavicular node – do scan of chest/abd/pelvis |
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Virchow's node memory hint
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virCHOW
CHOW as in food CHOW as in stomach |
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Multiple Myeloma
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Multiple Myeloma
• malignancy of plasma cells o bone destruction o paraprotein formation o “Your bone marrow is being replaced.” • Renal failure “Light chain” component • Median age at dx 68-70 yrs |
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Multiple Myeloma memory hints
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Multiple Myeloma = MM
MM = the M's are chained together MM - renal failure with light chains MM = Mystery Marrow ("your bone marrow is being replace") MM = Mini-Management (supportive cares, rad for bone pain) 5-year survival rate ~ 35%. |
