1.3c Neoplastic Flashcards
Cancer what is it?
Group of complex diseases
Can affect any body tissue
Occurs when normal cells mutate into abnormal cells with uncontrolled growth
Chronic disease with acute episodes
Oncology
- Study of cancer
- Derived from Greek oncoma, meaning “bulk”
Oncologists
Oncology nurse
Neoplasms what is it?
Neoplasm
-Mass of new tissue that grows independently of its surrounding structures and has no physiologic purpose
-Used interchangeably with “tumor”
Benign neoplasms
what is it?
Local Cohesive Well defied borders Pushes other tissue out of the way Slow growth Encapsulated Easily removed Usually dos not recur
Malignant neoplasms
what is it
Invasive Non-cohesive Does not stop at tissue borderers Invades and destroys surrounding tissues Rapid growth Metastasized to distant sites Not always easy to remove Can recur
Characteristics of Malignant Cells
Loss of regulation of the rate of mitosis
Loss of specialization and differentiation
Loss of contact inhibition
Progressive acquisition of a cancerous phenotype
Irreversibility
Altered cell structure
Simplified metabolic activities
Transplantability (metastasis)
Ability to promote its own survival
Risk Factors for Cancer
1 of 3
Genetics and heredity
- Recurring patterns of cancer within a family a risk factor for heredity, not necessarily genetic
- Familial cancers generally occur during old age.
Age
- Associated with aging
- Hormonal changes
Gender
- Breast, thyroid cancer in women
- Prostate, bladder cancer in men
Poverty
-Higher risk due to lack of insurance and access to care
Stress
-Risk if continuous and unmanaged
Risk Factors for Cancer
2 of 3
Diet
-High in red meat, saturated fat
Occupation
-Standards to protect workers from hazardous substances may not be strict enough
Infection
-Hepatitis B, C, HPV
Obesity
- Hormone-dependent cancers
- Breast, colon, endometrium, kidney, adenocarcinoma of esophagus
Sun exposure
- Ozone layer thinning
- Older adults with decreased pigment are more at risk, regardless of skin color.
Risk Factors for Cancer
3 of 3
Tobacco use
- Most preventable cause of death
- Lung cancer
- Secondhand smoke (SHS)
Alcohol use
Recreational drug use
- Promotes unhealthy lifestyle
- Marijuana demonstrative, but not implicated
Cellular Differentiation
Hyperplasia
-Increase in number, density of normal cells
Metaplasia
- Change in normal pattern of differentiation
- Cell types not normally found in that location of the body
Dysplasia
-Loss of DNA control over differentiation occurring in response to adverse conditions
Anaplasia
-Regression of a cell to immature or undifferentiated cell type
These types often reverse after irrigating factor is eliminated.
Theories of Carcinogenesis
Cell mutation
Cell mutation
Carcinogens cause mutations in cellular DNA and transform normal cells into cancer cells.
Three stages
-Initiation stage: initial incident that caused the damage (sunburn, radiation exposure), cells then become defective
- Promotion stage: occurs over many years, repeated exposure (sun)
- Progression stage: inherited changes in the cell causing cancer
Theories of Carcinogenesis
Oncogense
Oncogense: abnormal genes
- Promote cell proliferation
- Capable of triggering cancerous characteristics
- Proto-oncogenes: normal genes
- –Normal genes that promote growth and repair
Known Carcinogen Groups
Two groups
Two groups
Genotoxic
-Directly alter DNA and cause mutations.
Promoter substances
-Cause other adverse biologic effects (secondary physiological effects), hormone imbalance, chronic lung damage
Known Carcinogens
Viruses
Weaken immunologic defenses against neoplasms
HIV, hepatitis B, HPV
Known Carcinogens
Drugs and hormones
Impair immune function
Estrogen-containing contraceptive pills implicated in breast cancer but reduce ovarian cancer.
Known Carcinogens
Chemical agents
Chemical agents
Both genotoxic and promotional
Natural substances in the body
-Bile acids from a high-fat diet
Some foods: sugar substitutes, nitrate preservatives
Known Carcinogens
Physical agents
Physical agents
Excessive exposure to radiation
Radon
Tumor Invasion
Invasion
Qualities of aggressive tumors to facilitate invasion
- Ability to cause pressure atrophy
- Ability to disrupt basement membrane
- Motility
- Response to chemical signals from adjacent tissues. Chemotaxis: move around and respond to chemical responses
Tumor Metastasis
Metastasis
- Occurs by means of one or more mechanisms or spread by way of body cavities
- Blood- or lymph-borne metastasis
- Metastatic lesions
- Cells escape detection by immune system.
Most common metastasis sites: lymph nodes, liver, lungs, bones, brain
Physiologic and Psychologic Effects of Cancer
- Functional
- Infection
- Blood
- Malaise or fatigue
- Anorexia, nausea, vomiting
- Pain
- Grief, Fear, Punishment, Isolation, Disturbed Body Image and Sexual Dysfunction
Diagnosis of Cancer
X-ray imaging Computed Tomography Magnetic Resonance Imaging Ultrasonography Tissue samples through biopsy Collections of secretions Simple screening procedures Tumor markers
Classification
Tissue origin?
Benign?
Malignant?
Epithelium
Benign: papilloma
Malignant: carcinoma
Melanocytes
Benign: melanoma
Malignant: malignant melanoma
Adipose tissue
Benign: lipoma
Malignant: lipocarcinoma
Neural tissue
Benign: ganglioneuroma
Malignant: neuroblastoma
Bone tissue
Benign: osteoma
Malignant: osteosarcoma
Granulocytes
Benign: granulocytosis
Malignant: leukemia
Grading of tumors
Grading
- Evaluates amount of differentiation (matured, most like parent cell) of cell and estimated growth rate
- Classification is on grade scale of 1 (least malignant) to 4 (aggressively malignant)
Staging of tumors
Staging
- Classifies solid tumors
- Refers to the relative size of the tumor and extent of the disease
-T N M classification system is used internationally.
T (tumor)= tumor size, depth of invasion, and surface spread
N (nodes)= presence and extent of lymph node involvement
M (metastasis)= presence or absence of metastasis
Cytologic Examination
Specimens are collected by:
- Exfoliation from an epithelial surface
- Aspiration of fluid from body cavities or blood
- Needle aspirations of solid tumors
Tumor Marker
Protein molecule detectable in serum or other bodily fluids
Examples include antigens, hormones, proteins, and enzymes.
Categories
- Derived from the tumor itself
- Associated with host (immune) response to tumor
Imaging
Routine x-ray imaging
-Method of choice for breast, lung, and bone
Computed tomography (C T) -Visualization of cross sections of anatomy, reveals subtle differences in tissue densities
Magnetic Resonance Imaging (M R I)
-For screening and follow-up of cranial and head and neck tumors
Nuclear imaging
- Special scanner in conjunction with ingestion or injection of specific radioactive isotopes
- Used for possible bone or organ metastases
- Positron emission tomography (PET)
- Single photon emission computed tomography (SPE CT)
Ultrasonography
-Measures sound waves bouncing off body structures
Direct Visualization
Allows visual identification of organs within the limits of the scope
Invasive, but does not require use of radiography
Sigmoidoscopy
Cystoscopy: urethra/bladder
Endoscopy: GI
Bronchoscopy: lungs
Laboratory Tests
Used in conjunction with other diagnostic tests
Rule out other pathologic conditions
Rule out nutritional disorders
Blood, urine, sputum samples
Support During Diagnosis
Coping mechanisms
- Denial
- Intellectualization
Anxiety and stress from waiting for results
Goals of Cancer Treatment
Goals:
Eliminate the tumor or malignant cells
Prevent metastasis
Reduce cellular growth and the tumor burden
Promote functional abilities
Provide pain relief to those whose disease has not responded to treatment
Surgical Cancer Treatment
Surgery
Prophylactic surgery: elective breast removal
Diagnostic surgery: biopsy
Primary treatment
-Removes entire tumor and involved surrounding tissue, lymph nodes
Intraoperative radiation therapy: targeted radiation during surgery, helps to preserve healthy tissue
Palliation
- Reduces bulk of tumor
- Allows involved organs to function as long as possible
Reconstruction, rehabilitation
-More desirable functional, cosmetic effect after curative or radical surgery
Pharmacological Cancer Treatment
Chemotherapy
Chemotherapy
Using cytotoxic medications to cure liquid and solid cancers
Decrease tumor size, adjunctive to surgery or radiation therapy
Prevent or treat suspected metastases
In conjunction with biotherapy
Pharmacological Cancer Treatment
Classes of chemotherapy drugs
Classes of chemotherapy drugs
- Cell cycle specific: target specific dividing cells
- Cell cycle nonspecific: target cells in all phases of cycle
- Most common way is based on pharmacologic properties of the agent
Pharmacological Cancer Treatment
Alkylating agents
Chemotherapy
Alkylating agents
- Create defects in the tumor DNA
- Not phase-specific
- prevents cell replication
- hard on kidneys, bladder damage
Pharmacological Cancer Treatment
Antimetabolites
Antimetabolites
- Interfere with nucleic acid synthesis
- Phase-specific (S)
- cell cycle specific
Pharmacological Cancer Treatment
Antitumor antibiotics
Antitumor antibiotics
- Disrupt D N A replication and R N A transcription; create free radicals
- Not phase-specific
- cell cycle nonspecific
- toxic effect, cardiac muscle damage
Pharmacological Cancer Treatment
Mitotic inhibitors
Mitotic inhibitors
- Prevent cell division in the M phase
- Include plant alkaloids and taxoids
- cell cycle specific
Pharmacological Cancer Treatment
Hormones and hormone antagonists
Chemotherapy
Hormones and hormone antagonists
- Corticosteroids alter cellular function and growth
- Phase specific (G1) cell cycle specific
- Suppress MNA, alters function and growth
Effects of Chemotherapy
Effects of chemotherapeutic drugs
Tissues affected by cytoxic drugs
- Mucous membranes
- Hair cells
- Bone marrow depression affecting most blood cells
- Organs such as heart, lungs, bladder, kidneys
- Reproductive organs
Administration of Chemotherapy
Chemotherapy
Preparation and administration
- Wear gloves, a mask, gown
- Take care when handling excretory products of patients undergoing chemotherapy
- Teach patients to dispose of body fluids safely
- Administration
- –Orally, intramuscularly, intravenous infusion
- –Direct injection into intraperitoneal or intrapleural body cavities
- Vascular access devices (VADs)
Management of Patients Receiving Chemotherapy
Assessment and monitoring of toxic effects or side effects of drugs
Organ toxicities reported immediately
Teach how to care for access sites and dispose of used equipment, excretions
Teach to increase fluid intake, get rest, identify major complications, know when to call for physician, limit exposure to other people
Management of Patients Receiving Chemotherapy
Psychologic issues
Psychologic issues
Need to plan activities around chemotherapy
Weight loss
Alopecia
Feelings of powerlessness, depression
Radiation Therapy
what is it
Consists of delivering ionizing radiations of gamma and x-rays
Used to kill the tumor, reduce its size, decrease pain, or relieve obstruction
External radiation (teletherapy) -Relatively uniform dosage from a source at a distance from the patient
Internal radiation (brachytherapy)
- Given inside the body
- Radioactive material is placed directly into or adjacent to the tumor.
Can be dangerous for those living with, taking care of, treating patient
Decision to use made by risk-benefit analysis
Biotherapy
Modifies the biologic processes that result in malignant cells
Enhances the patient’s own immune response
Currently used for both hematological and solid malignancies
Biotherapy
Applications
Applications
Detection screening in high-risk groups
Differential diagnosis and classification of tumor cells
Monitoring the course of the disease
Active therapies to halt or limit the disease
Other Cancer Treatment
Bone marrow
Stem cell
Bone marrow and peripheral blood stem cell transplantations
B M T
-Treatment to stimulate nonfunctioning marrow or to replace marrow
P B S C T
-Process of removing circulating stem cells from peripheral blood through apheresis (the removal of blood plasma from the body by the withdrawal of blood) and returning these cells to patient after chemotherapy
Complementary Therapies
Botanical agents Nutritional supplements Dietary regimens Mind-body modalities Energy healing Spiritual approaches Miscellaneous therapies
Anxiety
Assess the patient’s level of anxiety
Establish a therapeutic relationship
Encourage patient to express feelings
Review coping strategies
Identify community resources
- Hotlines
- Support groups
Provide specific information about disease
Provide calm environment
Disturbed Body Image
Discuss meaning of loss or change
Observe and evaluate interaction with others
Allow denial but do not participate
Assist the patient and others in coping with changes in appearance
Teach patient or others to participate in care of the afflicted body area
Teach strategies for minimizing physical changes
Teach about alopecia
Grieving
Use therapeutic communication skills
Answer questions about illness and prognosis honestly
Encourage your patient to:
- Make final arrangements
- Participate in activities as long as possible
Early detection of cancer
Breast CA, when to get screened?
Women ages 40-45: should have the choice to start annual breast cancer screening with mammograms if they wish to do so
Women age 45-54: should get mammograms every year
Women ages 55+: should switch to mammograms q 2 years or can continue yearly screening. Screening should continue as long as a woman is in good health and is expected to live 10+ years
All women: should be familiar with the known benefits, limitations and potential harms linked to breast cancer screening
**Know your own breasts!
Early detection of cancer
Colon/rectal cancer and polyps, when to screen?
Men and Women age 45: sensitive testing which looks at the stool or with an exam that looks by visual exam
Continuing regular exams through age 75
Age 76-85: talk with provider about continuing screening is right for you
Age 85+: screening no longer needed
Early detection of cancer
Cervical cancer, when to screen?
Age 25: screening should begin
Age 25-65: should get primary HPV test done every 5 years. If primary HPV test is not available, a co-test (HPV and PAP test) done every 5 years or a Pap test done every 3 years
Age 65+: who have had regular cervical cancer testing in the past 10 years with normal results should not be tested
Cervix removed: not related to cervical cancer or serious pre-cancer should not be tested
Vaccinated against HPV: still follow the screening recommendations
Early detection of cancer
Endometrial cancer
Recommended at the time of menopause
Report any unexpected vaginal bleeding/spotting
History of endometrial cancer: yearly biopsy
Early detection of cancer
Lung cancer
Recommended yearly lung cancer for people at higher risk who meet the following:
Age 55-74 who are in fairly good health
AND
Currently smoke or have quit smoking in the past 15 years
AND
30 pack a year smoking history (1 pack per day/year)
Early detection of cancer
Prostate cancer
Starting at age 50 men should talk to provider about pros and cons of testing
African American or have a father/brother who had prostate cancer before age 65 should talk with provider
