ATUMOR ATLAS

Endocrine system

Adrenal gland

NEUROBLASTOMA

DATA FORM FOR CANCER CLASSIFICATION - NEUROBLASTOMA

HISTOPATHOLOGIC TYPE

Sympathicoblastoma , Sympathicogonioma , Malignant ganglioneuroma , Gangliosympathicoblastma , Ganglioneuroma

Thyroid gland

DATA FORM FOR CANCER CLASSIFICATION - THYROID GLAND

HISTOPATHOLOGIC TYPE

Papillary carcinoma (including those with follicular foci) , Follicular carcinoma , Medullary carcinoma , Undifferentiated (anaplastic) carcinoma

RISK FACTORS, ENDOCRINE ORGANS

Thyroid gland

Exposure to radiation

Multiple endocrine neoplasia

Medullary carcinoma of thyroid

Hyperparathyroidism

Pheochromocytoma

Parathyroid gland

Exposure to radiation

Familial factors

Multiple endocrine neoplasia (MEN) syndrome (type I and type II: Sipple's syndrome) Hyperparathyroidism

Pancreatic islet cell tumor

Pituitary adenoma

Pheochromocytoma

Medullary carcinoma of thyroid

Adrenal gland

Low serum potassium level

Low serum chloride level

Low total eosinophils

Lymphopenia

Low plasma level of ACTH

Increase plasma cortisol level

Increased urinary free cortisol

Elevated plasma aldosterone level

Low plasma renin level

C.T. scan

M.R.I

Pheochromocytoma

MEN type II syndrome ( Sipple's syndrome )

Pheochromocytoma

Hyperparathyroidism

Medullary carcinoma of thyroid

Recklinghausen's neurofibromatosis

Griffith's syndrome

Pheochromocytoma

Neurofibroma

Duodenal somatostatinoma

Von Hippel Lindau's syndrome

Cerebellar, medullary, spinal hemangioblastomas

Pheochromocytoma

Retinal angioma

CLINICAL FEATURES

Parathyroid Adenoma

Early findings:

Hypercalcemia , Polyuria , Polydipsia , Anorexia , Nausea , Vomitting , Constipation , Muscle weakness , Confusion , Depression , Lethargy

Late findings:

Nephrolithiasis , Nephrocalcinosis , Hypertension , Bone pain , Bone cysts , Arthralgias , Osteitis fibrosa cystica , Pathologic fractures , Band keratopathy

Functioning and non-functioning adrenal cortex tumors

Palpable abdominal mass , Abdominal pain , Cushing's syndrome (Increased cortisol secretion) , Cutaneous striae (purple) , Easy bruisability , Deposition of adipose tissue in face (Moon facies) , Deposition of adipose tissue in interscapular area (Buffalo hump) , Deposition of adipose tissue in mesenteric bed (Truncal obesity) , Osteoporosis , Diabetes mellitus , Hypertension , Obesity , Emotional changes , Irritability , Depression , Psychosis , Confusion , Conn's syndrome (Increased aldosterone secretion) , Hypertension , Headaches , Muscle weakness due to hypokalaemia , Easy fatigue , Polyuria , Polydipsia , Increased androgen secretion , Hirsutism , Oligomenorrhea , Virilization

Pheochromocytoma

Hypertension , Paroxysms or crises , Headache , Profuse sweating , Palpitations , Apprehension , Pain in the chest or abdomen , Nausea , Vomitting , Flushing , Tachycardia ,Weight loss , Fever , Sipple's syndrome (MEN II syndrome) , Medullary carcinoma of thyroid , Hyperthyroidism

Neuroblastoma

Palpable abdominal mass , Firm to hard , Irregular Non-tender Dumbbell tumors Neuurological signs , Bone pain , Respiratory distress , Massive hepatomegaly

LABORATORY TESTS, THYROID CARCINOMA

Elevated serum calcium level (Sipple's syndrome)

Elevated serum calcitonin level (Medullary carcinoma)

Elevated serum

CEA level Thyroid hormone assays

Ultrasound

Scintigraphy after radioisotope administration (low uptake)

Radioiodine scan (cold lesion)

Fine needle aspiration cytology

Aspiration biopsy

Chest X ray for detection of pulmonary metastases

C.T. scan of neck

Bone scan for detection of bony metastases

LABORATORY TESTS, PARATHYROID CARCINOMA

Elevated serum level of calcium Low serum phosphate level

Elevated serum chloride level

Elevated serum parathyroid hormone (PTH)

Elevated serum alkaline phosphatase

Elevated serum creatinine level Blood urea nitrogen

Serum protein electrophoretic pattern

Bone studies

Radiography of bones (osteopenia)

Osteitis fibrosa cystica found on X rays (rare)

X ray of skull (ground glass appearance)

Ultrasound

C.T. scan of neck

Thallium 201 technetium - 99m subtraction scan

M.R.I.

LABORATORY TESTS, CARCINOMA OF ADRENAL GLAND CORTEX

Low serum potassium level

Low serum chloride level

Low total eosinophils

Lymphopenia

Low plasma level of ACTH

Increase plasma cortisol level

Increased urinary free cortisol

Elevated plasma aldosterone level

Low plasma renin level

C.T. scan

M.R.I

LABORATORY TESTS, PHEOCRHOMOCYTOMA

Elevated blood glucose level

Polycythemia

Elevated plasma epinephrine & nor-epinephrine levels

Elevated urinary catecholamines, metanephrine & vanillyl mandelic acid (VMA)

Plain X ray abdomen

C.T scan

M.R.I .(characteristic bright lesion on T2 weighted imaging)

A TUMOR ATLAS

Breast



RISK FACTORS, BREAST CANCER


Female sex, Advanced age ,Previous history of breast cancer, Family history ,Nulliparity Benign breast disease ( Multiple papillomatosis ), Early menarche Late menopause ,Irradiation ,Obesity Alcohol ,

Contraceptive pill & hormone replacement therapy



Duct cell carcinoma of breast

Early disease:
Palpable mass, Breast pain Nipple discharge ,Ulceration, Skin dimpling, Edema ,Erythema Axillary mass Scaling of the nipple (Paget's disease)


Advanced disease:
Fixation of the mass to the chest wall , Axillary lymphadenopathy , Edema of the arm, Breast enlargement , Ulceration , Supraclavicular lymphadenopathy ,Back pain Bone pain, Jaundice and Weight loss



Detects tissue asymmetry, abnormal masses, microcalcifications, and skin thickening



Radiologic procedures:



Chest X- rays may show pulmonary metastases

CT scans of liver & brain may show systemic metastases

Radionuclide bone scanning may show metastatic lesions



Fine needle aspiration cytology:



An out patient procedure

Immediate results

Relatively atraumatic

Can not differentiate between in-situ & invasive carcinoma

Can distinguish ductal from lobular carcinoma



Core biopsy:



An out patient procedure performed under local anesthesia

In-situ disease can be differentiated from invasive disease

A greater appraisal of the grade & type of tumor is possible



Open surgical biopsy:
Requires hospital admission.

Usually done under general anesthesia

A definitive method for the diagnosis of disease



Ultrasound:
Differentiates cystic from solid lesions

Is not diagnostic of malignancy




Other laboratory tests:


Consistently elevated erythrocyte sedimentation rate

Elevated serum alkaline phosphatase

Hypercalcemia