Coexisting-exam 4 Cancer

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Cancer pathogenesis

Initiation‐ DNA mutation
Promotion‐ rapid division->tumor
Progression‐ aggressive growth & metastases

Progression of cancer

Normal, dysplasia, in situ neoplasm, invasive neoplasm

____ contributes to cancer risk

Obesity

Cancer treatment

Chemo, surgical excision (debulking), radiation

Radical resection

Surrounding structures sacrificed, goal is cure

Debulking

Reduction of tumor load, structure preserved, goal is palliation

What does radiation induce?

Vasculitis & cell killing mutations in rapidly dividing tissues (tumors)

What does radiation produce?

Scarring & adhesions in surrounding tissues

Traditional chemo

Alkylating agents, antimetabolites, abx, nitrosureas, enzymes, plant alkaloids

Toxicity effects of alkylating agents

Bone marrow suppression, pulmonary, renal

Toxicity effects of antimetabolites

Bone marrow suppression, hepatic, renal

Toxicity effects of plant alkaloids

Bone marrow suppression, peripheral & autonomic nervous system

Toxicity effects of abx

Bone marrow suppression, stomatitis, bleomycin=pulmonary, daunorubicin=cardiac

Toxicity effects of nitrosureas

Bone marrow suppression

Toxicity effects of L-asparaginase

Hepatic failure

S/S of paraneoplastic syndromes

Fever‐ tumor necrosis, inflammation, production/release of endogenous pyrogens
Anorexia/wt loss‐ physiologic/psychologic
Hematologic derangements‐ anemia, pancytopenia, DVT, DIC
Neuromuscular abnormalities‐ myasthenic syndrome
Ectopic Hormones
Hypercalcemia‐ bone mets, PTH production
Tumor Lysis Syndrome‐ urate, K+, PO4‐

Paraneoplastic syndromes: adrenal insufficiency

Metastatic replacement of gland

Paraneoplastic syndromes: Renal Dysfunction‐

Antigen/antibody complexes, ureteral obstruction, hyperuricemia

Paraneoplastic syndromes: Respiratory‐

Bleomycin (interstitial pneumonitis)

Ectopic hormone production: Corticotropin (ACTH)‐

small cell (lung), medullary thyroid, thymoma, carcinoid, non‐beta islet cell
(pancreas)->Cushing syndrome

Ectopic hormone production: ADH‐

small cell (lung), pancreas, lymphomas, (pain)->SIADH

Ectopic hormone production: Parathormone‐

renal, squamous (lung), pancreas, ovary-> hyperparathyroidism

Ectopic hormone production: Thyrocalcitonin‐

Medullary (thyroid)->hypocalcemia

Ectopic hormone production: Gonadotropin‐

large cell (lung), ovary, adrenal-> gynecomastia, precocious puberty

Ectopic hormone production: MSH‐

small cell (lung)-> hyperpigmentation

Ectopic hormone production: Thyrotropin‐

Choriocarcinoma, testicular (embryonal)

Ectopic hormone production: Insulin‐

retroperitoneal tumors->hypoglycemia

Cardiac complications of paraneoplastic syndromes

Doxorubicin & daunorubicin, effusion/tamponade (metastatic invasion)
SVC compression

Neuro complications w/ paraneoplastic syndromes

SC compression
Increased ICP

What is the #1 cause of cancer death?

Lung ca

Lung cancer

15% 5-yr survival
Often advanced stage by time of diagnosis

Lung ca: squamous cell‐

Bronchial (central), slow growing, ↑ Ca (PTH & bone mets)

Lung ca: adenocarcinoma‐

Peripheral, pleural invasion, hypercoagulability

Lung ca: small cell

Central, lymphatic invasion, early
metastasis, SIADH, Eaton‐ Lambert, cushing syndrome

Lung ca: large cell

Peripheral, early mets (brain mets), gynecomastia, galactorrhea (gonadotropin production)

What is the 2nd leading cause of cancer death?

Colorectal

Colorectal ca

99% adenocarcinoma, lymphatic mets, adenocarcinoma, bowel prep->fluid loss, transfusion ↓s survival, radiated abd->blood loss (adhesions & neovascularization)

What is the 2nd leading cause of cancer death in men?

Prostate

Diagnosis and treatment of prostate ca

PSA
TURP, HDR, cryotherapy, radical prostatectomy (DaVinci), hormone therapy, chemo

Stats for breast ca

12.6% lifetime risk
3.6% risk of death
70% cure rate

Treatment for breast ca

Axillary dissection
Tamoxifen & raloxifen
Chemo
Radiation

What are the effects of isosulfan blue (a dye used during axillary dissection)?

Decreases SpO2 by pulse-ox

Risk associated w/ axillary dissection

Lymphedema

SE and risks associated w/ tamoxifen & raloxifen

Menopausal symptoms
↑d risk of DVT

Effects of chemo

Bone marrow suppression, cardiac toxicity

Effects of radiation

Plexopathy, cardiac pneumonitis/pulm fibrosis

Risk associated w/ thyroid ca

Recurrent laryngeal nerve injury & hypoparathyroidism
Airway eval

Causes of esophageal ca

ETOH, smoking

What is the 4th most common cause of cancer death?

Pancreatic

Surgical procedures for treatment of pancreatic ca

Whipple-pancreatoduodenectomy
Total pancreatectomy

Effects of total pancreatectomy

DM, malabsorption, 10% 5 yr survival

Palliative procedures for pancreatic ca

Biliary diversion, radiation/chemo, celiac plexus block

Multiple myeloma

Bone ca
Single clone plasma cells
Immunoglobulins secreting

S/S of multiple myeloma

Pathologic fractures, hypercalcemia, bone marrow suppression, renal failure (Bence-Jones protein), coagulopathy, neuropathy, infection

Other forms of bone ca

Osteosarcoma, Ewing's sarcoma, chondrosarcoma

Ewing's sarcoma

Neuroectodermal tumor, teenagers

Lymphoma

Hodgkin's-EBV
NHL

Leukemia

Lymphogenous or myelogenous
Acute lymphoblastic
Chronic lymphocytic
Adult T-cell
Acute & chronic myeloid

Treatment for lymphoma/leukemia

Chemo, bone marrow transplant

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