Clin Med Exam 3

tumor (neoplasm)

uncontrolled cell proliferation

radiation

- targeted therapy that kills cancer cells or slows growth by damaging cancer's DNA

- effect takes weeks/months

external beam radiation

treats all cancers

1 multiple choice option

internal beam radiation

treats cancers of the head/neck, breast, cervix, prostate, eye, and thyroid

1 multiple choice option

chemotherapy

- limits proliferation by attenuating cell growth

- inhibit DNA/RNA synthesis and function

- inhibit cell divison (mitosis)

benign neoplasms

- looks similar to normal tissue

- tends to grow slowly

- possible secondary problems (e.g. impingement)

clinical presentation of bone tumors

- pain not attributable to position

- night pain

- pathologic fracture

- presence of a mass

- swelling, fever, unexplained weight loss

diagnosis of bone tumors can happen by using

- imaging

- biosy

- labs

- staging/grading

what labs do we look of for dx of bone tumors

- ESR

- CBC

- calcium

- phosphorus

- alkaline phosphatase

treatment strategies for bone tumors

- resection

- chemotherapy

- radiation

- stem cell transplant

- gene-based therapies

complete/wide/en bloc resection for bone tumor

tumor + surrounding tissue removed

1 multiple choice option

marginal resection for bone tumor

most, but not all, of tumor is removed

1 multiple choice option

osteochondroma

- cartilage-capped bony spur/outgrowth on bone surface

- usually occurs at end of long-bone growth plates, interfering with joint function

- most commonly form at shoulder or knee

benign neoplasms medical terminolgy

- oma

1 multiple choice option

malignant neoplasms medical terminology

- sarcoma

1 multiple choice option

osteochondroma symptoms

- a hard, immobile, detectable mass that is painless

- loss of joint ROM

- soreness of the adjacent muscles

- limb length discrepancies

- pressure or irritation with exercise

- possibility for changes in blood flow

treatment for osteochondroma

excision if pt is experiencing neurovascular compromise

osteoid osteoma

benign skeletal neoplasm consisting of a nidus of osteoid tissue in the cortex

osteoid osteoma symptoms

- pain at night

- pain with activity

- pain relieved with NSAIDs

- can affect bone growth in individuals with open growth plates

osteoid osteoma treatment

- pain control (NSAIDs)

- excision if growing and/or interfering with active lifestyle

osteoblastoma

- benign, but larger than osteoid osteoma and likely to grow

- usually in the vertebral column or long bones along diaphysis

osteoblastoma symptoms

- pain for several months

- pain less likely to be relieved with NSAIDs

- possible scoliosis

- nerve root impingment

osteoblastoma treatment

- curettage (scraping)

- wide excision margin (because of high recurrence)

- reconstruction or implants may be necessary depending on extent of bone/joint tissue resection

enchrondroma

- cartilage cyst found in bone marrow, often found incidentally

- usually found in metacarpals/metatarsals but also found in humerus and femur

enchrondroma symptoms

- mostly asymptomatic

- possible fractures of the affected bone

- enlargment of affected finger

enchrondroma treatment

- observation

- curettage considered in bone health is compromised

chondroblastoma

- slow growing tumor usually at epiphyseal plate, usually femur/tibia/humerus

- benign, but locally aggressive and usually must be excised

chondroblastoma symptoms

- localized pain

- limited joint motion

- swelling at end of long bones

- tenderness at end of long bones

hemangioma

- growth of endothelial cells that line blood vessels

- may involve skin, showing up in neonates

- some involve vertebral bodies

giant cell tumor of bone

- 6th most common bone tumor (rare)

- wide age distribution

- historically considered benign

- center of the epiphysis of long bones

- develop slowly

giant cell tumor symptoms

- mild pain that progresses with tumor growth

- limited range of motion (proximity to the joint space)

- swelling (large growth)

- pathologic fracture

giant cell tumor treatment

- removal of tumor

- high recurrence rate may be due to bleeding at surgical site with reseeding (of tumor cells) in the area

malignant neoplasms can spread by

- local invasion

- blood

low-grade malignant tumors

- chordoma

- chondrosarcoma

high-grade malignant tumros

- osteosarcoma

- ewing's sarcoma

sarcomas

- develop in connective and supportive tissue

- tumors of bone, cartilage, synovium

primary bone tumors in childhood

- No. 1 is Osteosarcoma

- No. 2 is Ewing's Sarcoma

primary bone tumors in adulthood

chondrosarcoma

two types of pathogenesis of bone tumors

- osteoblastic

- osteolytic

osteoblastic

- neoplastic cells produce osteoid

- known as tumor bone or neoplastic bone

osteolytic

neoplastic cells incite local osteoclastic resorption of bone

chordoma

- develop from notochord

- slow-growing, locally aggressive

- treatment involves resection, often after chemo

- poor long-term prognosis

osteosarcoma

- most common primary malignant bone tumor

- develops in the metaphysis

- mainly osteoblastic

- extremely malignant

- radiation resistant

manifestations of osteosarcoma

- continuous pain that increases quickly (period of weeks)

- early metastasis to lungs

treatment for osteosarcoma

- excision with pre and/or post-op chemo

- expandable prostheses (in children)

- rotationplasty

chondrosarcoma

- relatively slow growing tumor of cartilage

- pelvic and shoulder girdles

- men in their 40s to 60s

- surgical intervention

chondrosarcoma treatment

- chemo & radiation NOT effective

- complete resection a high priority

Ewing's Sarcoma

- non-osteogenic primary tumor

- seen in bone (diaphysis) or soft tissue

- 2nd most common in children

- favors long tubular bones

- early metastasis to the lung

pathogenesis of Ewing's

- soft tumor with hemorrhagic necrosis caused by rapid tumor growth

- medullary cavity is affected

- bone marrow is infiltrated

- "onion skin" appearance on x-ray (periosteum is elevated)

diagnosis in Ewing's

- radiograph of involved bone

- CT, MRI, bone scan

- sedimentation rate

- x-ray of chest

- local pain (the usual C/C) may be attributed to injury

- fever possible in young children

treatment & outcome for Ewing's

- local tumors responsive to high-dose radiation

- metastases require aggressive combination therapy

- selective surgeries like amputation and limb-sparing surgeries

- 5 year survival

signs/symptoms of multiple myeloma

- calcium (elevated)

- renal failure

- anemia

- bone lesions

multiple myeloma treatment

- treatable, but not curable

- remission with medication

- radiation to decrease bone pain

common complications for multiple myeloma

- hypercalcemia

- headache

- vision changes

- radicular pain

- neuropathy

- loss of bowel and bladder control

- paraplegia

all secondary bone tumors are metastatic

true

1 multiple choice option

of all bone neoplasms, secondary metastatic tumors are the most common

true

1 multiple choice option

metastatic tumors of bone sources are

- prostate

- breast

- lung

- kidney

- thyroid

- GI

primary symptom of metastatic tumors of bone

pain

initial diagnosis for spinal metastasis

- radiography

- neurological exam

presenting symptoms for spinal metastasis

- weakness

- sensory loss

- bowel and bladder sphincter disturbance

treatment for spinal metastasis

radiotherapy

prognosis of spinal metastasis

- if paralyzed prior to radiation, patient will very likely remain non-ambulatory

- if ambulatory at start of radiation, 80% will be able to continue to walk

- because metastasis represents loss of containment, cure is not possible

radiofrequency ablation

- fast, cheap

- subject to energy dispersal

- relatively poor visualizing

microwave ablation

- quick

- control over dosing may be limited

cryoablation

- great control

- less dangerous for nearby neuro tissue

- expensive, time-consuming

high-intensity focused ultrasound

- no skin compromise

- great control, great visualization

- expensive and not applicable for all tumors

prostate pathology symptoms

- weak or interrupted flow of urine

- nocturia

- trouble starting flow of urine

- trouble emptying bladder

- pain while urinating

- blood in urine or semen

- LBP/pelvic pain

prostatitis

any condition that causes inflammation of the prostate gland

signs and symptoms of prostatitis

- prostatic discharge

- burning

- increased frequency of urination and possible reduction in sexual potency

- LBP

- nagging sacral ache with radiation down the involved leg if the seminal vesicle is involved

acute prostatitis treatment

- antibiotics

- muscle relaxants

- biofeedback for pelvic floor relaxation

prostate cancer

malignant cells form small islands of cancer confined to the prostate

risk factors for prostate cancer

- age > 50

- 2-3x more likely if a man's brother or father has been diagnosed

- Cadmium exposure (e.g. through manufacturing jobs)

- lack of exercise

pathogenesis of prostate cancer

- likely involves endocrine system

- tumors originate on periphery of prostate

- metastasis via lymphatic system & possibly other routes

signs and symptoms of prostate cancer

- dull, vague, diffuse ache localized to the lower lumbar spine or upper sacral regions

- urinary symptoms only after the tumor has grown to sufficient size to compromise the urethra

treatments for prostate cancer

- transurethral resection of the prostate (TURP)

- radical prostatectomy

- retropubic prostatectomy

- perineal prostatectomy

- radiation therapy

- hormone therapy

- chemotherapy

radical prostatectomy

remove prostate and seminal vesicles (lymph nodes)

surgical complications for prostate cancer

- incontinence (bowel and bladder)

- impotence

- inguinal hernia (first 2 years following surgery)

brachytherapy of the prostate

radiation oncology procedure where radioactive "seeds" are placed directly within or near a tumor in the prostate to destroy malignant cells

ochiectomy

removal of testicles

hormone therapy for prostate cancer

- orchiectomy

- luteinizing hormone (stops testosterone)

- anti-androgens (blocks testosterone)

testicular cancer

- germ cell tumor

- common in men 15-35 y/o

- cancer in the testicles

risk factors for testicular cancer

- 15-35 year old men

- white

- economically developed and/or western nation

- family Hx

cryptochidism

undescended testes

signs and symptoms for testicular cancer

- testicular enlargment + pain, swelling and/or harness

- ache in the abdomen or scrotum

- back/groin pain (where psoas invasion is present)

- back pain is the most common chief complaint

testicular cancer treatment

- chemotherpay

- organ sparing surgery (1st option)

testicular cancer prognosis

good, but chemo complications is an issue

testicular torsion

- twisted spermatic cord

- possibly associated with trauma or exertion

- acute scrotal pain, possibly intermittent

- causes ischemic testicular injury

- a surgical emergency (4-8 hour therapeutic window)

endometriosis

endometrial tissue located outside the uterus

endometriosis risk factors

women in their 20's and 30's

endometriosis symptoms

- pain in sacrum below L5/S1, possibly lateralized

- pain begins in the premenstrual stage and merges with menstrual pain

uterine fibroid

benign fibroid tumor on inner or outer uterine surface

uterine fibroid risk factors

- women ages 35-45

- african-american descent

- women who have never been pregnant

- family Hx

signs and symptoms for uterine fibroid

- heavy menstrual bleeding

- bleeding after intercourse

- bleeding between menstrual periods

- frequent urination

- abdominal swelling

- low back pain during intercourse or menstrual periods

- fatigue

- constipation

- repeated miscarriages

pelvic inflammatory disease (PID)

- spectrum of infections of the female genital tract to involve the endometrium and/or fallopian tubes

- commonly associated with gonorrhea and chlamydia

risk factors for PID

- sexually active women younger than 25 years of age

- gonorrhea, chlamydia

- intrauterine procedures

- presence of endocervical infection

- use of an IUD

signs and symptoms of PID

- bilateral lower abdominal pain

- vaginal discharge

- low back pain

- irregular vaginal bleeding

- fever, nausea, vomiting

salpingitis

- infection and inflammation of the oviducts

- term is used interchangeable with PID

risk factors for salpingitis

- retrograde menstrual flow and opening of the cervix during menstruation is theorized to facilitate infection

- surgical procedures that break the cervical barrier

- bacterial infections

- gonorrhea

- chlamyida

signs and symptoms for salpingiits

- diffuse lower abdominal ache

- purulent vaginal discharge

- abnormal vaginal bleeding

- right upper quadrant pain

- low back pain

ectopic pregnancy

- fertilized egg implants outside the uterus

- most often in the fallopian tube, but ovary, cervix, and abdomen are also possible