Tumor Lysis Syndrome
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Definition Simultaneous death of many cancer cells produces release to blood of enormous quantities of products of their destruction.
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When? May particularly occur during initial phase of treatment of pts. w/ large chemosensitive tumors
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Symptoms Hyperphosphatemia
Hyperuricemia
Hyperkalemia (life-threatening: cardiac arrhytmias)
Hypocalcemia secondary to formation of calcium phosphate: tetany, mental agitation, seizures
Acute renal failure
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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
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Management: • Forced diuresis 3 L/m2 PWE + furosemide
• Allopurinol to fight hyperuricemia (protein degradation).
• Novel agent: rasburicase
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Hypercalcemia - Clinical Symptoms
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) |
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Local Radiotherapy
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Teleradiotherapy tumor irradiated from a distant (usually ~ 1m) source
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Brachytherapy irradiation source is placed @ direct vicinity of irradiated tissue
(aka. Curietherapy)
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Brachytherapy
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Contact or intracavital irradiation Installation of radiation source into cavity or through a natural route
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Interstitial irradiation Insertion of the radioactive source interstitially
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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
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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.
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Teleradiotherapy
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Conventional orthovolt (125-500 kV)
-can only be used for palliative tx. of superficially located metastases
--> practically not used these days
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Megavolt telecobaltotherapy, photons & electrons from linear accelerator, neutrons from either neutron generator or cyclotrone
--> energy: 4 - 20 MeV
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Renal Ca. - Clinical Presentation
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 |
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Pancreatic cancer
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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
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Clinical Features Pain
Obstructive Jaundice
Weight loss
Anorexia
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Risk Factors • Cigarette Smoking, Obesity, Non-hereditary Chronic Pancreatitis
• Environmental Factors (diet, coffee), prev. partial gastrectomy / cholecystectomy & H. pylori
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Physical Findings` (+) Courvoisier’s sign
• Palpable, nontender gallbladder
(+) Virchow’s Node
Advanced Disease
• Abdominal Mass, Hepatomegaly, Splenomegaly, Ascitis
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Diagnostic Procedures Ultrasound
CT Scan
ERCP
Endoscopic US
MRCP
FDG-PET*
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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
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Treatment Symptom management
Endoscopic biliary / duodenal stenting
Intestinal bypass surgery
Deoxycytidine analogue Gemcitabine
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*Excluding occult distal metastasis
BI-RADS
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 |
Breast Imaging Reporting and Database System score.
- Scoring syst. used by radiologists describe mammogram results
- Most efficient tool to help detect breast cancer, esp. at its earliest stage
*Table taken from UCSF Department of Radiology & Biomed. Imaging
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