Early diagnosis in neoplasic diseases

Epidemiology 

10 million new cases each year  6 million deaths  Increasing trend

Case 1 
Male, 55 yrs, smoker (1 pack/day),
± thoracic pain of great intensity, invalidating cough ± EKG normal ± Lab: ESR 60mm/h ± Chest Xray: acute pneumonia 

Evolution: after 10 days vesicular eruption on left intercostal space corresponding to pair VII intercostal nerves, persistent cough

Case 1 
Diagnosis:
± Zona zoster intercostal 

Clinic: persistent cough  Investigations:
± Bronchoscopy: bronchopulmonary tumor

Case 2 
Male, 36years, non-smoker non± Violent thoracic pain, predominently at night, resistant to usual analgetics ± Clinic: systolic murmur at base of heart ± Rx standard: discreet widening of upper mediastinum ± ECO cardiogram: normal ± Biologic: normal 

Evolution: persistence of pain that requires opiates

Case 2. 
CT: policyclic tumor in upper mediastinum with paratracheal and paraaortic extension  DG: Malignant non-Hodgkin limfoma non Treatment: radiotherapy, chemotherapy specific therapy (oncology)

Case 3 
Male, 48 yrs,alcoholic
± Clinic: bilateral lumbar pain, T>37grd C ± Lab: ESR 30mm/h ± Abdominal US: renal microlitiasis 

Evolution: persistence of pain, prolonged fever, purple skin rash

Case 3 
Further investigations:
± Uroculture: sterile ± Hemoculture: sterile ± Abdominal CT: pancreas tail tumor 

Diagnosis:
± Neoplasm of pancreas 

Treatment: surgery

Paraneoplasic syndromes 
Signs and symptoms associated to specific neoplasms, without connexion to local invasion  Frequency: 7 - 10% (30 - 50% !)  Cancer type: pulmonary, breast, colon, ovary, pancreas  Cause: polipeptides secreted by neoplasic cells

Paraneoplasic syndromes 

   

Endocrinological Neurological Hematological Dermatological Osteoarthritis

ENDOCRINE PARANEOPLASIC SYNDROMES 
     
HIPERCALCEMIA -PARATHORMONe Cushing SYNDROME Hypertiroidism Hyponatremia - ADH HypergonadotrophynemiaHypergonadotrophynemia- FSH and LH Hypoglycemia TREATMENT: specific for tumor+ Minocyclin, Ciproheptadine, Corticosteroids

MUSCULAR and DERMATOLOGIC

PARANEOPLASIC SYNDROMES
Dermatomyositis and polimyositis  Patients > 50, pulmonary neoplasms  Pain, motor deficits, atrophies, edema of muscles+ (SLE)  EMG  Biopsy ±inflamation, necrosis skin rash

Acanthosis nigricans  Patients >30, digestiv neoplasms  papiloma with blackish pigmentation of skin (inguinal, axilary, neck, submammary areas) Pruritus DhuringDhuring-Brocq bulous dermatosis 

Degenerative and inflamatory lesions of central or peripheric nervous system: Acute/subacute polineuropathies, encephalitis, myelopathies, cerebelous atrophies  Eaton Lambert syndrome  Asociated to tumors of thorax  IMMUNE MECHANISM: inadequate acetilcholine in presinaptic terminations  Clinic: myastenic syndrome: muscular pain, pareshtesias, diminished reflexes  Treatment : guanidine, corticosteroids, plasmaferesis

NEUROLOGIC PARANEOPLASIC SYNDROMES

OSTEOARTICULAR PARANEOPLASIC SYNDROMES 
Hypertrophic pneumic osteoarthropathy  in pulmonary tumors, mesothelioma, pulmonary metastasis  chronic poliarthritis of knees, fists, elbows, clubbing, acromegaly  Carpian channel syndrome (plasmocitoma)

VASCULAR, HEMATOLOGIC and RENAL

PARANEOPLASIC SYNDROMES
VASCULAR  ENDOCARDITIS  TROMBOFLEBITIS MIGRANS
(tumors of pancreas, bronchiae)

HEMATOLOGIC  HEMOLITIC ANEMIA (leukemias)  TROMBOCYTOPENIC PURPURA  IDC (glandular neoplasms) RENAL  NEFRITIS

Primary prevention 

Environmental factors identification and management

Primary prevention 

Life style  Environmental factors

UICC recommendations 

Varied and well-balanced diet wellAvoid uniform diet, repeating of same meal. Take drugs with caution on long term use Avoid dietary excesses, especially lipids Avoid alcohol excess 



UICC recommendations (II) 
   
Give up smoking Secure daily provision of optimal amounts of vitamins A, C, E Include vegetal fibers Avoid excess of salt, smoked food and give up the habit of ingesting hot liquids Avoid burned food and excess of fried food

UICC recommendations (III) 
   
Avoid fermented food which is not intentionally thus prepared Avoid excessive sun exposure Avoid physical and mental fatigue Practice physical exercises and sports Use showers and bathes frequently

Secondary Prevention 

Identification and modification of signs and symptoms which suggest cancer

Screening 
Uterine cervix  Mammography  Colo-rectal cancer Colo-

Chemoprophylaxy 
Estrogen receptors modulators ± tamoxifen  Nonsteroidal anti-inflammatory drugs anti Calcium  Glucocorticoids  Retinoids

Tertiary prevention 
Identification and modification of psychological, social, economical and physical consequences

Tertiary prevention 
  
Physical rehabilitation Psychical rehabilitation Social and professional reintegration Patients care in terminal phases

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