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59 terms

Coexisting-exam 4 Cancer

STUDY
PLAY
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