9/26a Cancer (Biomedical Sciences)

Question 1

Define Neoplasm

Answer 1

Tumor, new tissue growth

-spectrum of disease characterized by abnormal growth of cells resulting in distorted tissue architecture

Question 2

Classification of cancer systems

Answer 2

Benign vs malignant
Tissue of origin
Anatomic location

Question 3

Define Dysplastic

Answer 3

abnormal cells that are not cancerous - often precursor to cancerous lesions

Question 4

different kinds of dysplastic cells

Answer 4

• precursor cancer stage
• Skin - dysplastic nevi = moles
• monitor for progression/growth
• can be seen on pap-smears and colonoscopies
• don’t typically cause cancer until there are greater than 1 billion of those cells

Question 5

Define in situ

Answer 5

neoplasm that has not invaded adjacent structures

• ex: breast cancer
• Isolated!!

Question 6

Define malignant

Answer 6

cancerous, abnormal cells

• capable of invasion and local/distant spread (metastasis)
• fast growing
• invasive, infiltrative
• anaplastic, undifferentiated, and/or immature cells
• NOT NORMAL CELLS

Question 7

Define benign

Answer 7

non-cancerous, normal cells, organized and localized

• non-invasive
• does not spread
• slow growing
• encapsulated
• well-differentiated cells
• not harmless, BUT you may have a benign tumor in the brain and if it gets larger you will still have the neurologic deficits if the tumor is pushing on the brain
• NORMAL CELLS

Question 8

Classifying cancer

Answer 8

Epithelial Tissue (skin glands, GI/GU, reproductive)
-Benign: adenoma
-Malignant: carcinoma
Connective Tissue (bone, fat, muscle, cartilage)
-Bengin: tissue type + “-oma” - lipoma
-Malignant: Sarcoma

Question 9

Benign tumor of fat cells: 
Malignant tumor of squamous cells: 
Malignant tumor of basal cells:
Malignant tumor of breast glandular cells: 
Benign tumor of bone: 
Malignant tumor of bone:

Answer 9

lipoma
squamous cell carcinoma
basal cell carcinoma
breast adenocarcinoma
osteoma
Osteosarcoma

Question 10

Epidemiology and pathophysiology of cancer

Answer 10

1. approximately 40% of americans will be diagnosed with cancer in their lifetime
   - Males most common: prostate, lung, colorectal
   - Females most common: breast, lung, colorectal
2. second most common cause of death in US, though decreasing

Question 11

why are cancer survival rates increasing?

Answer 11

Prevention, Detection, and Treatment

Question 12

Why is health poor even after survival of cancer?

Answer 12

• there are emotional considerations

- significantly less likely for people to return to work in comparison with other disorders

Question 13

how are physical therapists and healthcare providers to help cancer patients after survival

Answer 13

help them become more functional in society

Question 14

how does cell growth and maturation occur?

Answer 14

throughout embryogenesis, growth, tissue repair, and remodeling

Question 15

what are necessary components of healthy cell growth?

Answer 15

• recognize DNA damage or errors in replication
• activate checkpoints to stop further/unnecessary replication
• implement corrective measures or induce apoptosis

Question 16

what are reasons for loss of control of cell growth?

Answer 16

• genetic: hereditary predisposition (inactivation of tumor suppressor gene - stops and gives negative FB to cell or overactivation of oncogenes)
• epigenetic: chronic inflammation from environmental situations (poor diet, inactivity, hormones)
• abnormal signaling: RAS pathway, positive and negative FB that is signaling uncontrolled cell proliferation

Question 17

Normal cell growth cycle

Answer 17

mitosis > 2 homologous pairs > G1 cell growth > oncogenes > tumor suppressor genes > synthesis > DNA repair genes > G2

–Need good cell repair processes

Question 18

Loss of normal growth control

Answer 18

Inactivation > normal cell growth > cell damage/no repair > cell suicide or apoptosis
Overactivation > cancer cell division > first mutation > second mutation > third mutation > fourth mutation > uncontrolled growth

Question 19

Tumor suppressor genes (most common)

Answer 19

first checkpoint in cell growth - stops and gives negative FB to cell growth

Question 20

oncogenes

Answer 20

give positive FB to cell growth

Question 21

Viruses that introduce foreign genetic material

Answer 21

HPV (most common/well known), Herpes virus, t-cell leukemia virus all introduce cancerous material to the host cell

Question 22

Overactication of ras pathway leads to:

Answer 22

another factor that leads to uncontrolled proliferation in cell growth

Question 23

abnormal signaling

Answer 23

1. hormone receptors (estrogen) - hormone replacemet for menopause increases the rate for certain cancers (uteran and breast)
2. angiogenesis (VEGF) - vascular endothelial growth factor, collection of new tumor cells are becoming vascularized. Most common route of spreading is through tumors in the blood stream that spread to distant sites

Question 24

Neoplasia hallmarks of cancer

Answer 24

1. Proliferation (ability and speed + uncontrolled)
2. invasion of nearby tissues and structures through the basement membrane
3. metastatic potential primarily through angiogenesis through BVs

Question 25

Common sites of metastasis

Answer 25

Bone, liver, brain, lungs and sometimes adrenal glands

Question 26

Cancer risk factors

Answer 26

- tobacco (most common) - When a healthcare provider talks to a patient about smoking, they are around 10-20% successful in helping them quit - Nutrition - not eating enough fruits and veggies - physical activity - living a sedentary life, direct relationship between exercise and physical activity - alcohol - excess sun exposure - weight - genetics - environmental exposure - viruses/prior infections - immunocompromised state

Question 27

Diagnosing cancer

Answer 27

1. screening - the more up to date, the better 2. genetic testing 3. diagnostic imaging (often incidental) 4. clinical manifestations/symptoms and systemic effects 5. ultimately need biopsy for tissue sample to confirm

Question 28

Cancer Screening Guideliens

Answer 28

Colorectal - colonoscopy starting at age 50 Breast - mammogram starting at age 40-50 cervical - pap smear starting at age 21 prostate - PSA test + rectal exam starting at age 50, but no longer recommended bc of USA preventative task force lung - low dose CT starting at age 55 for those with >30 pack year smoking history

Question 29

Signs and symptoms concerning for cancer

Answer 29

``` Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump (in breast or elsewhere) Inability to swallow food easily Obvious change in a wart or mole Nagging cough or hoarseness ```

Question 30

Grading and staging cancer

Answer 30

-higher the grade, the more abnormal the cells were -staging - TNM: TUmor, Number of lymph nodes affected, Metastasis Stage I: small, local tumor; Stage IV: widespread metastatic disease

Question 31

when do PTs get involved with cancer patients?

Answer 31

- Curative Intent: 5 year disease free survival - Palliative: improve symptom burden and quality of life - Hospice Care: expected survival <6 months, focus on QOL

Question 32

Role of PT in cancer treatment?

Answer 32

1. Prevention/Improved QOL: anti-inflammatory benefits of physical activity/exercise; promotion of a healthy lifestyle 2. Functional Status - ability to receive treatment; cardiovascular, metabolic and immune function 3. Anti-inflammatory benefits: improved survival in physically active patients

Question 33

ECOG - eastern cooperative oncology group

Answer 33

Used for treatment, patients must be 0-2 to be candidates for chemotherapy ECOG 4 - often consider hospice care

Question 34

Treatment-associated comorbidities

Answer 34

Post-operative deconditioning and mobility Cancer-related fatigue Chemotherapy-related cognitive impairment Lymphedema Radiation Fibrosis

Question 35

when to refer a patient to ER

Answer 35

sudden change, unstable, shortness of breath, muscle pain weakness, worsening of mental status