More Quick Notes - Diseases and Such
|
Definition
Simultaneous death of many cancer cells produces release to blood of enormous quantities of products of their destruction.
|
|
When?
May particularly occur during initial phase of treatment of pts. w/ large chemosensitive tumors
|
|
Symptoms
Hyperphosphatemia
Hyperuricemia Hyperkalemia (life-threatening: cardiac arrhytmias) Hypocalcemia secondary to formation of calcium phosphate: tetany, mental agitation, seizures Acute renal failure |
|
Diagnosis
Based on development of
-increased lvl. of serum uric acid (8mg%) , phosphate (4,5 mg%) , and potassium (6mg%) -decreased levels of serum calcium (7mg%) -increased serum creatinine (1,5 x upper normal limit) -cardiac arrhythmias or death, seizures |
|
Management:
• Forced diuresis 3 L/m2 PWE + furosemide
• Allopurinol to fight hyperuricemia (protein degradation). • Novel agent: rasburicase |
|
Pts. w/ Ca. conc. b/w 10.5 & 12 mg/dl usually asymptomatic
|
Clinical manifestations appear w/ higher lvls.
|
|
Renal
|
polyuria
nephrolithiasis (chronic HC) |
|
GI
|
anorexia
nausea vomiting constipation pancreatitis |
|
Neuro-psych
|
weakness
fatigue confusion stupor coma |
|
CV
|
shortened QT interval on ECG
bradyarrhythmias heart block cardiac arrest |
|
Ocular
|
band keratopathy (chronic HC)
|
|
Teleradiotherapy
tumor irradiated from a distant (usually ~ 1m) source
|
|
Brachytherapy
irradiation source is placed @ direct vicinity of irradiated tissue
(aka. Curietherapy) |
|
Contact or intracavital irradiation
Installation of radiation source into cavity or through a natural route
|
|
Interstitial irradiation
Insertion of the radioactive source interstitially
|
|
LDR (low-dose-rate)
Currently, most freq. = Cesium 137
--> dose rate: 1 cGy/min Intracavital: most freq. cervical ca. Interstitial: oral cavity ca. , pharyngeal ca. , prostate ca. , sarcoma |
|
HDR (high-dose-rate)
Currently, most freq. = Iridiuim 192
--> dose rate: 100 cGy/min Intracavital: vaginal ca. , oesophageal ca. , lung ca. , sarcoma Interstitial: prostate ca. |
|
Conventional
orthovolt (125-500 kV)
-can only be used for palliative tx. of superficially located metastases --> practically not used these days |
|
Megavolt
telecobaltotherapy, photons & electrons from linear accelerator, neutrons from either neutron generator or cyclotrone
--> energy: 4 - 20 MeV |
|
Typical Triad
|
hematuria
abd. pain flank / abd. mass (palpable tumor) |
|
Less freq.
|
fever
weight loss anemia varicocele (abn. enlargement of pampiniform venous plexus) PARANEOPLASTIC SYNDROMES: --> erythrocytosis --> hypercalcemia --> nonmetastatic hepatic dysfunc. (Stauffer's synd.) --> acquired dysfibrinogenemia |
|
Notes
Freq. site = Head of pancreas
No screening test available 5-year survival < 5% Median age of diag. = 72 y/o Peak incidence - 65-84 y/o Males > Females |
|
Clinical Features
Pain
Obstructive Jaundice Weight loss Anorexia |
|
Risk Factors
• Cigarette Smoking, Obesity, Non-hereditary Chronic Pancreatitis
• Environmental Factors (diet, coffee), prev. partial gastrectomy / cholecystectomy & H. pylori |
|
Physical Findings`
(+) Courvoisier’s sign
• Palpable, nontender gallbladder (+) Virchow’s Node Advanced Disease • Abdominal Mass, Hepatomegaly, Splenomegaly, Ascitis |
|
Diagnostic Procedures
Ultrasound
CT Scan ERCP Endoscopic US MRCP FDG-PET* |
|
CA 19-9 (Serum Marker)
• 80-90% sensitivity & specificity
• Suggestive of diag. pancreatic ca. • Prognostic impilcations – Very high levels w/ inoperable disease • Serial evaluation useful for monitoring response to tx. • Detecting recurrence in pts. w/ completely resected tumors |
|
Treatment
Symptom management
Endoscopic biliary / duodenal stenting Intestinal bypass surgery Deoxycytidine analogue Gemcitabine |
|
0 (incomplete)
|
Recommend add. imaging --> mammogram / targeted US
|
|
1 (negative)
|
Routine breast MR screening if cumulative lifetime risk ≥ 20%
|
|
2 (benign)
|
Routine breast MR screening if cumulative lifetime risk ≥ 20%
|
|
3 (prob. benign)
|
Short-interval (6 mth) follow-up
|
|
4 (suspicious)
|
Tissue diagnosis
|
|
5 (highly suggestive of malignancy)
|
Tissue diagnosis
|
|
6 (known biopsy-proven malignancy)
|
Surgical excision when clinically appropriate
|
No comments yet.
Cheatography n. The art of mapping complex subjects into clear, instantly navigable reference guides.
