systemic effects of neoplasia

Paraneoplastic vs systemic effects

P- consequence of having cancer

S- consequence of location of cancer

GI effects examples

Cancer Cachexia, anorexia

Gastroduodenal ulcers

PLE

GI effects - cachexia + anorexia causes

Hypoxia → Anaerobic resp → lactate, alter insulin sensitivity

Cytokines + inlf → alter metabolism

AL

GI effects - Cachexia + anorexia CS

WL, dec fat, m loss

GI effects - Cachexia + anorexia tx

Maintain caloric intake (inc fat, dec carb diet)

Omega 3 PUFA

GI effects - gastroduodenal ulcers effects

Bleeding → anemia

Melaena

Haematoemesis

Rupture

GI effects - gastroduodenal ulcers Cause

Hormones / metabolites (histamine, gastrin)→ inc gastric acid → ulcers

GI effects - PLE effects

Ascites

Dec clotting factors + binding proteins

GI effects - PLE commonly seen with what tumour

GI lymphoma

GI effects - gastroduodenal ulcers Common with which tumours + why

MCT → inc histamine

Gastrinoma → inc gastrin

Mechanisms of haematological effects

Cytosis

Monoclonal gammopathies

Coagulation disorders

Blood loss anaemia chronic vs acute CS + haematology

A- TP dec before PCV, shock CS

C- leth, pallor, inc platelets

Blood loss anaemia causes of acute

GI = haematemesis, melaena

Splenic

Blood loss anaemia Causes of chronic

GI, oral

Blood loss anaemia Chronic blood smear appearance (iron deficiency)

Regen microcytic hypochromic anaemia

Reduced production cytopaenia causes + blood smear appearance

Poor iron storage, dec RBC life span

Mild/mod normochromic normocytic non regen anaemia

Reduced production cytopaenia - myelophthisis def

Crowding out of stem cells in BM by tumour cells (some produce suppressive cytokines)

Reduced production cytopaenia - Causes of myelophthisis

WBC tumours - lymphoma, leukaemia, multiple myeloma, histiocytic sarcoma, MCT

Reduced production cytopaenia - Myelophthisis dx

Neutropenia → thrombocytopenia → anaemia

Non regen normochromic normocytic anaemia

BM aspirate

Reduced production cytopaenia - Hyperoestrogenism causes

Testicular tumours (Sertoli cells)

Reduced production cytopaenia - Hyperoestrogenism Dx + CS

Neutrophilia → pancytopaenia

F, symmetrical alopecia, pendulous prepuce, hyperpigmentation, penile atrophy, gynecomastia, prostatic metaplasia

Reduced production cytopaenia - Hyperoestrogenism Tx

Castrate

Destruction cytopenias - causes

Lymphoproliferative tumours → Immune mediated anaemia + thrombocytopenia

RBC shearing in fibrin networks → Systemic microangiopathic anaemia, schistocytes

Paraneoplastic cytoses- erythrocytosis causes, CS, tx

Renal tumour (inc EPO), lymphoma, nasal fibrosarcoma, TVT, hep tumour

PUPD, neuro, seizure

Phlebotomy, remove cause, hydroxyurea

Paraneoplastic cytoses- neutrophilia cause

Tumour induced, immune response to tumour

Paraneoplastic cytoses- eosinophilia causes

T cell lymphoma, MCT → IL-5

Monoclonal gammopathies - CS + why

Hyper viscosity → neuro, coma, CV

Dec immune function, renal failure, coagulopathies, ocular disorders

Monoclonal gammopathies - Dx

Electrophoresis of serum + urine

Monoclonal gammopathies - Tx

Plasmapheresis

DIC - dx

Inc APTT, PT, FDP, D dimer, schistocytes

Dec fibrinogen, platelets

DIC - casue

Carcinoma, HSA

Common endocrine issues

HyperCa

Hypoglycaemia

Ectopic ACTH syndrome

Hyperoestrogenism

Hypercalcaemia - causes

Inc PTH/ PTHrP (thyroid carcinoma)

Bone lysis

Hypercalcaemia - CS

PUPD, dehydration, AL, V, weak, m fasciculations, calcify soft tissue, arrhythmia, death

Hypercalcaemia - Initial management + why (then remove cause)

NaCl fluids → calciuresis

Furosemide → calciuresis

Bisphosphonates → osteoclasts stop

Prednisolone (in lymphoproliferative dz)

Hypercalcaemia - What to check if diagnosed

Assess total + ionised

Assess phosphate

Rectal exam for anal gland tumours

LN FNA, BM biopsy

Imaging

ACTH stim

Hypercalcaemia - What should PTH be normally for negative feedback cycle

Decreased

Hypoglycaemia - common tunour

Insulinoma, hep carcinoma, smooth m tumour

Hypoglycaemia - CS

Weak, disorientation, seizure, coma

Hypoglycaemia - Management

IV glucose → CRI glucose

Prednisolone (inc glucose), diazoxide (dec insulin), octreotide (somatostatin)

Remove tumour

Ectopic ACTH syndrome - common tumour cause

Lung

Ectopic ACTH syndrome -Dx

Hyperadrenocorticism tests with tumour (not adrenal)

Ectopic ACTH syndrome -Tx

Remove tumour

Neuro issues - paraneoplastic examples

Myaesthenia gravis

Peripheral neuropathy

Myaesthenia gravis - CS

Weak, ex int, dysphagia, Megaoesophagus, regurg

Myaesthenia gravis - Dx

ACHr ab + tumour

Myaesthenia gravis - Tx

Remove tumour

Immunosupp

Peripheral neuropathy - histo

Demyelination, myelin globulation, axonal degeneration

Peripheral neuropathy - Common tumours

Lung, insulinoma, lymphoma, MCT, thyroid adenocarcinoma, melanoma

Cutaneous paraneoplastic examples

•Alopecia and Malassezzia associated dermatitis

•Pancreatic associated panniculitis

•Superficial necrolytic dermatitis (SND)

•Paraneoplastic immune mediated disease – Pemphigus and Erythema multiforme

•Feline Thymoma-Associated Exfoliative Dermatitis (FTAED)

•Cutaneous flushing

Nodular dermatofibrosis

Feline paraneoplastic alopecia - CS

Symmetrical Alopecia (ven abd, limbs → general)

Non pruritic

Glistening skin

Footpad crusting + scale

Malassezia dermatitis (greasy brown)

Pancreatic panniculitis - def

Infl + hydrolysis of adipose in panc infl + Neo (enzymes)

Superficial necrolytic dermatitis/ necrolytic migratory erythema/ hepatocutaneous syndrome - cause

Hep dz, panc Neo → aa deficiency

Superficial necrolytic dermatitis - Cs

Footpad hyperkeratosis (erythema, crust, hyperkeratosis, fissures)

Crusting dermatitis (alopeica, ulcers, crusts) at junctions + feet

Leth, AL, DM

Paraneoplastic Pemphigus - def

Autoimmune ulceration of mucosa + mucocutaenous junctions

Paraneoplastic Pemphigus - Tumour causes

Lymphoma, Thymoma, splenic sarcoma, thymus mass

Paraneoplastic Pemphigus - Cutaneous gross

Vesicles

Ulcers

Bilateral symmetrical

Feline Thymoma associated exfoliative dermatitis animals

Older cats

Feline Thymoma associated exfoliative dermatitis gross

Non pruritic exfoliative dermatitis

Alopecia

Keratosis sebaceous accumulations in digits, claws, ears

Crusting

Ulcers

Cutaneous flushing def

Release of vasoactive substances from tumours (pheochromocytoma, lung, MCT) → skin colour changes

Nodular dermatophytosis def + animals

Nodules of collagen out nevi on limbs, head, trunk

Middle Aged German Shepherd (bilateral renal cysts, adenocarcinoma)

Hypertrophic osteopathy - def + causes + CS

Palisading periosteal proliferation along long bones

Pul tumours

Shifting lame, swell, oedema, warm limbs

Hypertrophic osteopathy - Dx + Tx

CS, rx

Remove cause, pred, analgesia, Bisphosphonates 4

Pyrexia - cause

Infl cytokines

Lymphoma, renal cancer, hep tumour

Pyrexia - Tx

Remove tumour, nsaid, paracetamol

Common CV issues

Tumour exudate/ bleeding → effusion → tachypnoea, dyspnoea, RCHF, collapse, pulsus paradoxus, electrical changes