9/26a Cancer (Biomedical Sciences) Flashcards
Define Neoplasm
Tumor, new tissue growth
-spectrum of disease characterized by abnormal growth of cells resulting in distorted tissue architecture
Classification of cancer systems
Benign vs malignant
Tissue of origin
Anatomic location
Define Dysplastic
abnormal cells that are not cancerous - often precursor to cancerous lesions
different kinds of dysplastic cells
- 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
Define in situ
neoplasm that has not invaded adjacent structures
- ex: breast cancer
- Isolated!!
Define malignant
cancerous, abnormal cells
- capable of invasion and local/distant spread (metastasis)
- fast growing
- invasive, infiltrative
- anaplastic, undifferentiated, and/or immature cells
- NOT NORMAL CELLS
Define benign
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
Classifying cancer
Epithelial Tissue (skin glands, GI/GU, reproductive)
-Benign: adenoma
-Malignant: carcinoma
Connective Tissue (bone, fat, muscle, cartilage)
-Bengin: tissue type + “-oma” - lipoma
-Malignant: Sarcoma
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:
lipoma squamous cell carcinoma basal cell carcinoma breast adenocarcinoma osteoma Osteosarcoma
Epidemiology and pathophysiology of cancer
- approximately 40% of americans will be diagnosed with cancer in their lifetime
- Males most common: prostate, lung, colorectal
- Females most common: breast, lung, colorectal - second most common cause of death in US, though decreasing
why are cancer survival rates increasing?
Prevention, Detection, and Treatment
Why is health poor even after survival of cancer?
- there are emotional considerations
- significantly less likely for people to return to work in comparison with other disorders
how are physical therapists and healthcare providers to help cancer patients after survival
help them become more functional in society
how does cell growth and maturation occur?
throughout embryogenesis, growth, tissue repair, and remodeling
what are necessary components of healthy cell growth?
- recognize DNA damage or errors in replication
- activate checkpoints to stop further/unnecessary replication
- implement corrective measures or induce apoptosis
what are reasons for loss of control of cell growth?
- 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
Normal cell growth cycle
mitosis > 2 homologous pairs > G1 cell growth > oncogenes > tumor suppressor genes > synthesis > DNA repair genes > G2
–Need good cell repair processes
Loss of normal growth control
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
Tumor suppressor genes (most common)
first checkpoint in cell growth - stops and gives negative FB to cell growth
oncogenes
give positive FB to cell growth
Viruses that introduce foreign genetic material
HPV (most common/well known), Herpes virus, t-cell leukemia virus all introduce cancerous material to the host cell
Overactication of ras pathway leads to:
another factor that leads to uncontrolled proliferation in cell growth
abnormal signaling
- hormone receptors (estrogen) - hormone replacemet for menopause increases the rate for certain cancers (uteran and breast)
- 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
Neoplasia hallmarks of cancer
- Proliferation (ability and speed + uncontrolled)
- invasion of nearby tissues and structures through the basement membrane
- metastatic potential primarily through angiogenesis through BVs
Common sites of metastasis
Bone, liver, brain, lungs and sometimes adrenal glands
Cancer risk factors
- 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
Diagnosing cancer
- screening - the more up to date, the better
- genetic testing
- diagnostic imaging (often incidental)
- clinical manifestations/symptoms and systemic effects
- ultimately need biopsy for tissue sample to confirm
Cancer Screening Guideliens
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
Signs and symptoms concerning for cancer
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
Grading and staging cancer
-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
when do PTs get involved with cancer patients?
- Curative Intent: 5 year disease free survival
- Palliative: improve symptom burden and quality of life
- Hospice Care: expected survival <6 months, focus on QOL
Role of PT in cancer treatment?
- Prevention/Improved QOL: anti-inflammatory benefits of physical activity/exercise; promotion of a healthy lifestyle
- Functional Status - ability to receive treatment; cardiovascular, metabolic and immune function
- Anti-inflammatory benefits: improved survival in physically active patients
ECOG - eastern cooperative oncology group
Used for treatment, patients must be 0-2 to be candidates for chemotherapy
ECOG 4 - often consider hospice care
Treatment-associated comorbidities
Post-operative deconditioning and mobility
Cancer-related fatigue
Chemotherapy-related cognitive impairment
Lymphedema
Radiation Fibrosis
when to refer a patient to ER
sudden change, unstable, shortness of breath, muscle pain weakness, worsening of mental status
