Malignant disease

Published on 05/05/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

Print this page

This article have been viewed 1003 times

9 Malignant disease

Questions

What is the meaning of ‘opsoclonus’ and does it always indicate malignancy?

Does a greatly elevated lactate dehydrogenase (LDH) denote malignancy?

Does a normal erythrocyte sedimentation rate (ESR) exclude malignancy in a patient complaining of feeling easily fatigued?

Why is folic acid supplementation given just after the day of methotrexate administration? Can we give them simultaneously on the same day?

Is hydroxyurea useful in the treatment of chronic myeloid leukaemia?

What is the treatment of choice of mucosa-associated lymphoid tissue (MALT) lymphoma? Is the eradication of Helicobacter pylori enough? Does the positivity of CD2 rule out MALT lymphoma?

Stage IIE Hodgkin’s lymphoma is the ‘involvement of one or more lymph node regions plus an extralymphatic site’ and that stage IV is the ‘involvement of one or more extralymphatic organs with or without lymph node involvement’. What is the difference? Is ‘site’ different from ‘organ’ and, if so, what is ‘site’?

1. What is Hodgkin’s lymphoma?

2. What is the difference between Hodgkin’s and non-Hodgkin’s lymphoma?

Why is serum calcium elevated in patients suffering from lymphoma?

In a patient with suspected multiple myeloma, with pains in the back ribs, is the skull still the most sensitive site to observe bony lesions?

Please explain why the incidence of ovarian cancer (surface epithelial type)/carcinoma is low in women who take the oral contraceptive pill and who have undergone tubal ligation, compared with the general population?

What is the treatment of Kaposi’s sarcoma?

How effective is a paracetamol and codeine phosphate combination in cancer pain therapy and ordinary pain therapy, and what is the difference in using them in cancer pain therapy?

What is meant by co-analgesic drugs in palliative care?

Is trastuzumab useful in all patients with metastatic breast cancer?

I have heard that Imatinib is useful in stromal cell tumours. Can you explain the mechanism?

Does monoclonal gammopathy of unknown significance (MGUS) progress to multiple myeloma?

Why do some cancers particularly metastase to bone?

What is the difference between lead time bias and length time bias.

Could lymphocytosis (lymphocytes: 4.4×10⁹/L, representing 56% of total lymphocytic count) and not accompanied by any other haematological or systemic symptoms or signs except for mild weight loss (5–10% previous body weight) some 12 years ago, with no progression until now, be chronic lymphocytic leukaemia?

What is the sensitivity of a prostate-specific antigen (PSA) in detecting prostatic carcinoma?

Opsoclonus is characteristic of the paraneoplastic syndrome. It describes rapid, chaotic, conjugate, spontaneous eye movements that distort ocular fixation. It is associated with ataxia and other brain stem disturbances.

It can do but a high LDH also occurs with haemolysis, liver disease and myocardial infarction.

No; the ESR will usually be raised but this is by no means invariable.

Folinic acid, not folic acid, is used to counteract the folate antagonist action of methotrexate and should be given 24 hours after the methotrexate and not at the same time.

No. Imatinib is first line therapy.

Low-grade gastric MALT lymphomas restricted to the mucosa or submucosa are often treated successfully by H. pylori eradication but others require surgery and chemotherapy. Try eradication therapy initially.

CD2 is associated with T and natural killer (NK) cells; MALT lymphomas are B cell lymphomas.

‘Site’ and ‘organ’ mean the same most of the time. Sometimes, however, the site is clear (e.g. a mass in the epigastrium) without it being very obvious which organ is involved.

Lymphomas are divided histologically into:

• Hodgkin’s lymphoma: characteristically has Sternberg-Reed cells, together with a mixture of lymphocytes and histiocytes.

• Non-Hodgkin’s lymphoma: does not have Sternberg-Reed cells but does have lymphoid tissue of various types depending on the type of lymphoma (see K&C 7e, Table 9.20, p. 480).

Further reading

Jaffe ES et al (eds) (2001) WHO Classification of Tumours. Pathology and Genetics of Tumours of Haemopoietic and Lymphoid Tissues. Lyon: IARC Press.

Some lymphomas secrete 1,25-dihydroxycholecalciferol, which will raise the serum calcium level.

No; an X-ray of the area of pain, e.g. the spine, would be the best test but a full skeletal survey, which would of course include the skull, is usually carried out in a patient suspected of having myeloma.

The “Incessant ovulation theory” suggests that continuous ovulation in a nulliparous woman is associated with high frequency of malignant change. Ovulation is reduced by oral contraceptive treatment and is incomplete with tubal ligation, perhaps explaining the reduced frequency of ovarian cancer in these patients.

Treatment of Kaposi’s sarcoma depends very much on the site. Many do not need treatment but some need surgical treatment and others chemotherapy. This lesion is now much less common in patients with IDS since the introduction of highly active antiretroviral therapy.

Paracetamol and codeine phosphate as a combination at an adequate dosage is sometimes helpful in pain control. It is important that the drugs are given regularly. They can be useful in cancer pain when this is mild, making opiates unnecessary.

These are drugs used in addition to opioids. Examples include NSAIDs, which are used with an opioid for bone pain, and anticonvulsant drugs, e.g. gabapentin, carbamazepine and pregabalin for neuropathic pain.

No. It is only useful in patients who overexpress HER2 receptors. It is now being used in patients following surgery for early breast cancer, and in patients with metastatic disease. Trastuzumab is a member of the epidermal growth factor family.

Stromal tumour cells have a mutation in the proto-oncogene, which leads to activation and cell surface expression of the tyrosine kinase KIT (CD117). Imatinib is a tyrosine kinase inhibitor and is also used in chronic myeloid leukaemia.

Yes. Patients with a serum monoclonal protein concentration of >1.5g/dL that is IgA or IgM, and an abnormal serum free light chain ratio (k: chains), are the most likely to develop multiple myeloma.

Bone is a frequent site of metastasis due to its high blood flow. Tumour cells also produce adhesins that bind them to marrow stromal cells. Bone also contains growth factors, e.g. tumour growth factor beta (TGFβ).

In ‘lead’ time bias, the diagnosis is made early, e.g. by screening so that ‘survival time’ appears longer. Death still occurs at the same time from the genesis of the cancer.

With ‘length’ time bias, a greater number of slowly growing tumours are detected when screening asymptomatic individuals.

Yes; chronic lymphocytic leukaemia can have a good prognosis (see K&C 7e, Table 9.15, p. 474). Lymphocytosis only has a median survival of > 10 years.

Using a cut-off level of 4 mg/mL, the sensitivity is 70–80% and specificity 60–70%.

Related

1000 Questions and Answers from Kumar _ Clarks Clinical Medicine