Identifying Types of Tumor - NCLEX-PN

Medullary carcinoma of the thyroid originates from the parafollicular cells (c cells). Elevated levels of calcitonin in these patients cause diarrhea, which is the most common clinical symptom. Papillary carcinoma, follicular carcinoma, and anaplastic carcinoma are not associated with any significant elevation in calcitonin levels.

Hematuria, flank pain, and an abdominal mass are all signs of renal cell carcinoma, an adenocarcinoma originating in the proximal proximal tubule of the kidney.

Mesothelioma is a form of lung cancer associated with asbestos exposure, Ewing's sarcoma is a type of bone cancer common in children and adolescents, and Hodgkin's lymphoma is a cancer that originates in the lymphocytes of the blood.

Hepatocellular carcinoma accounts for approximately 75% of all primary liver cancers.

Cholangiocarcinoma and hepatoblastoma are rare forms of liver cancer, and a teratoma is a tumor that contains normal-appearing tissues from multiple germ layers, which can appear in multiple locations in the body.

Breast, lung, kidney, and prostate cancers make up approximately 80% of metastases to bone. Stomach cancer can metastasize to bone, but it does so only rarely.

Kaposi sarcoma presents with red, purple, brown, or black papular lesions on the extremities, back, face, mouth, and genitalia. It is caused by human herpes virus 8 (HHV8) and is typically seen in immunocompromised patients.

Neither Burkitt lymphoma nor pancreatic cancer typically present with any associated skin lesions, while melanomas tend to be singular lesions.

Multiple myeloma, also known as plasma cell myeloma or Kahler's disease, presents with lytic bone lesions, blood count abnormalities, elevated blood calcium, and an abnormal paraprotein antibodies which can cause damage to kidneys.

Osteosarcoma, while located in the bone, tends to present with a mass visible on imaging. Gastric and ovarian cancer are not associated with any changes in bone (unless due to metastasis).

EBV infection is common in Burkitt lymphoma. In malaria-endemic areas, it is thought that the cancer is actually caused by chronic malarial infection increasing a person's susceptibility to chronic EBV infection. The same is assumed about HIV co-infection with EBV in the United States.

None of the other infections listed are associated with Burkitt lymphoma.

90% of medulloblastomas are in pediatric patients. It is the tumor type in 14.5% of primary brain malignancies of childhood and adolescence. Glioblastoma is the most common type of brain tumor in adults and accounts for 52% of all primary brain tumors. Meningiomas are also fairly common in adult populations, accounting for 34% of primary brain tumors. Juvenile pilocytic astrocytoma is a brain tumor of childhood but only accounts for 2% of cases.

Actinic keratosis occasionally develops into squamous cell carcinoma and is generally removed prophylactically. Actinic keratosis is not associated with development of any of the other skin cancer types listed.

Small cell carcinoma (also called oat cell cancer) makes up 15% of lung cancers and almost always presents in patients with a history of cigarette smoking.

Adenocarcinoma is the most common type of lung cancer in patients who have never smoked. Mesothelioma is most commonly caused by asbestos exposure, while bronchial carcinoids are often of unknown etiology.

Paget's disease of the breast will often present as itchy, scaling, cracked, red lesions around the nipple. The other conditions mentioned are all forms of breast cancer, but all of them originate in tissues deeper to the breast and will generally present without a visible rash, though some skin changes such as redness or dimpling may occur.

A fibroma is considered a benign fibrous tissue tumor. The other tumor types are all malignant.

The most common soft tissue tumor in children is rhabdomyosarcoma. This generally presents on the face, neck, or extremities, with nearly one-third of cases presenting with orbital involvement. 90% of all cases of rhabdomyosarcoma are seen in children, most often seen in children under 10 years of age. Leiomyosarcoma, epithelioid sarcoma, and desmoid tumors are all relatively rare soft tissue tumors of childhood.

To answer this question, it is essential to 1) identify the correct definition of acute conditions versus chronic conditions and 2) identify the age groups that experience acute leukemia versus chronic leukemia. Acute conditions such as acute leukemias have rapid onsets, while chronic conditions such as chronic leukemias have gradual onsets. Acute leukemias are more common among children and young adults, while chronic conditions are more common among adults aged 25 to 60.

Wilm's tumor, also known as nephroblastoma, is a rare type of malignant tumor that occurs primarily in children. These tumors tend to be unilateral, and will present as an abdominal mass with abdominal pain or tenderness, nausea and vomiting, and fever. 20% of cases will also present with hematuria.

The proper intervention for a lesion on the nose should include complete excision of the lesion to send for biopsy to discover the extent and type of skin lesion. It may require additional treatment in the form of topical chemotherapy drugs or further surgery depending on the pathological findings. Wide excision to fascia may be reserved for more invasive skin cancers such as malgnant melanoma after an initial biopsy has been performed. Lesions that have been present for longer than 6 months should be biopsied as a general rule, although some practitioners may biopsy sooner with increased suspicion of omnious looking lesions.

The Philadelphia chromosome is associated with chronic myelogenous leukemia.

The correct answer is "Medullary thyroid cancer, pheochromocytoma, parathyroid adenoma," as these are the cancers most commonly associated with MEN2A (Multiple Endocrine Neoplasia) Syndrome, a familial cancer syndrome that predisposes to development of numerous cancers in patients generally at younger ages that would be expected. One should have an index of suspicion for such a familial cancer syndrome when evaluating a patient with a new cancer who has a family history of similar cancers that are known to be associated with familial cancer syndromes.

Medullary thyroid cancer, pheochromocytoma, and mucosal adenomas are seen in patients with MEN2B Syndrome, not MEN2A.

Medullary thyroid cancer, parathyroid adenoma, and islet cell tumors of the pancreas are not seen together in a particular cancer syndrome. Parathyroid adenomas, islet cell tumors of the pancreas, and pituitary adenomas are seen in patients with MEN1 Syndrome though.

Medullary thyroid cancer, colorectal cancer, uterine cancer, and gastric cancer are not seen together in a particular cancer syndrome. Colorectal cancer, uterine cancer, and gastric cancer are known to be associated with Lynch Syndrome, also known as Hereditary Non-Polyposis Colorectal Cancer Syndrome though.

Medullary thyroid cancer, head and neck cancer, esophageal cancer, and anal cancer are not seen together in a particular cancer syndrome. Head and neck cancer, esophageal cancer (squamous cell carcinoma), and anal cancer are all known to be associated with alcohol and tobacco use among other risk factors.

The most likely diagnosis in this patient is pheochromocytoma. A pheochromocytoma is a rare neuroendocrine neoplasm that arises within the chromaffin cells of the adrenal medulla. Pheochromocytomas can secrete norepinephrine and/or epinephrine, which can lead to symptoms of sympathetic activation. Patients with pheochromocytomas may experience palpitations, hypertension, headaches, fatigue, flushing, sweating, nausea, anxiety, and flank pain, among other symptoms. The workup for pheochromocytoma includes 24-hour urine catecholamines and metanephrines, as these would be elevated in a patient with a pheochromocytoma.

For the patient in this vignette, he/she complains of a number of symptoms that are consistent with a pheochromocytoma, and the elevated 24-hour urine catecholamines and metanephrines has a high sensitivity and specificity for pheochromocytoma, so this is the most likely diagnosis.

Panic attacks and generalized anxiety disorder may present with similar symptoms to a pheochromocytoma, but would not account for the elevated urine catecholamines and metanephrines.

Amphetamine abuse and cocaine abuse may present with some similar symptoms to a pheochromocytoma, but would not account account for the elevated urine catecholamines and metanephrines, and also would have appeared in the urine drug screen. The urine drug screen in this patient was within normal limits.