Cancer Cells releasing hormones, hormone-like substances, or polypeptides tha act on Target Tissues in the local area or are released in circulation to act on organ sites DISTANT from the tumor.

***PNS may the the first clinical Manifestation of a tumor***

T/F

PNS can cause greater morbidity than the cancer itself?

1. Infiltration and destruction of normal tissue
2. Obstruction of Hollow organs
3. Circulatory Disturbances
4. Local bleeding (hemopthysis, melena, hematuria)

Weight Loss and metabolic alterations that occur DESPITE ADEQUATE nutritional intake

*Incidence in veterinary cancer patients esteimated to be <25%*

• Some instances can be attributed directly to the growth or spread of the neoplasm or to therapy
• Others, cachexia results from production of cytokines (IL-1, IL-6, TNF, IF-γ)by host tissues in response to cancer

• Insulin Resistance
• Glucose Intolerance
• Increased Gluconeogenesis
• Increased Cori cycle activity
• Increased Fatty acid metabolism
• Hyperlipidemia
• Increased Protein turnover
• Increased skeletal muscle catabolism

1. Treatment of the underlying tumor(best approach)
2. Total Parenteral Nutrition

T/F:

The way to detect a Protein-Losing Enteropathy in the veterinary cancer patient is to detect α-1-Antitripsin in stools.

FALSE

*detection of the alpha-1-antitripsin in stools is the way to detect a PLE in humans but hasn't been extensively evaluated in veterinary medicine***

Mast Cell Tumor (degranulation of mast cell->excess release of histamine->bind to H2 receptors->Increase gastric acid production->mucosal damage or ulceration)

***Gastrinomas are also associated with PNS-GI ulceration***

T/F:

Lymphoma is the most common cause of HM (Hypercalcemia of Malignancy).

TRUE

***most common cause of hypercalcemia in dogs and cats is cancer (2/3 dogs, 1/3 cats)***

Multifactorial:

1. Release of osteoclast-activating factor (multiple myeloma)
2. Bone destruction by neoplastic cells (bone tumors)
3. Secretion of humoral factor (PTH, PTHrp) by neoplastic cells (lymphoma, Anal Sac Apocrine Gland Adenocarcinomas)

1. R/O Lipemia and Hemolysis
2. Interpret the total calcium in relation to the level of serum albumin (Adjusted Calcium (mg/dl)=[calcium (mg/d)-albumin (g/dl)]+3.5)

T/F:

Renal function impairment is insignificant in Hypercalcemia of Malignancy and if present is usually the last sign exhibited

FALSE

***Renal Function impairment is the first manifestation of HM***

• Mild hypercaclemia, minimal clinical signs: Rehydrate patient and correct underlying neoplasm
• Moderate Hypercalcemia and clinical signs:  Rehydrate as above, furosemide, glucocorticoids
• Severe Hypercalcemia and clinical signs:  As above plus consider bisphosphates and calcitonin for refractory cases

T/F:

Insulinoma is the most common cause of hypoglycemia in dogs and the neoplasm most associated with hypoglycemia in cats.

Islet Cell Tumors

• excessive insulin produced be the tumor