Tumor Lysis SyndromeDefinition 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 |
Hypercalcemia - Clinical SymptomsPts. 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) |
| | Local RadiotherapyTeleradiotherapy tumor irradiated from a distant (usually ~ 1m) source | Brachytherapy irradiation source is placed @ direct vicinity of irradiated tissue (aka. Curietherapy) |
BrachytherapyContact 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. |
TeleradiotherapyConventional 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 |
Renal Ca. - Clinical PresentationTypical 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 |
| | Pancreatic cancerNotes 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 |
*Excluding occult distal metastasis
BI-RADS0 (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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