Cancer Fundamentals Flashcards

1
Q

What is a Proto-oncogene?

A

A type of gene that causes cancer when mutated: Proto-oncogenes promote (initiate) and regulate cell division and differentiation; when mutated proto-oncogenes become mutated (oncogenes) this enables a cell to divide without regulation. Proto-oncogene often mutated into oncogenes by suffering a single nucleotide point mutation (ie RAS).

EXAMPLES:
EGFR (receptor)
RAS/KRAS (signaling)

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2
Q

What is a tumor suppressor gene?

A

A type of gene that can cause cancer when mutated: A tumor suppressor gene normally controls (interrupts) cell growth and division. When mutated, tumor suppressor genes may no longer retain the ability to control cell growth and division, leading to uncontrolled growth/cancer.

EXAMPLES:
TP53 (prevents replication of damaged DNA and induces apoptosis)
BRCA1, BRCA2 (Repairs damaged DNA), RB (stops DNA replication)

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3
Q

What is a “DNA repair gene?

A

A type of gene that can cause cancer when mutated: A gene involved in DNA repair. When altered, DNA repair genes are unable to repair DNA and cells tend to accumulate DNA damage such as additional mutations and chromosomal changes (duplications or deletions) which may cause the cells to become cancerous.

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4
Q

What is cancer?

A

Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body

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5
Q

What are some differences between cancer cells and normal cells?

A

grow in the absence of signals telling them to grow. Normal cells only grow when they receive such signals.

ignore signals that normally tell cells to stop dividing or to die (a process known as programmed cell death, or apoptosis).

invade into nearby areas and spread to other areas of the body. Normal cells stop growing when they encounter other cells, and most normal cells do not move around the body.

tell blood vessels to grow toward tumors. These blood vessels supply tumors with oxygen and nutrients and remove waste products from tumors.

hide from the immune system. The immune system normally eliminates damaged or abnormal cells.

trick the immune system into helping cancer cells stay alive and grow. For instance, some cancer cells convince immune cells to protect the tumor instead of attacking it.

accumulate multiple changes in their chromosomes, such as duplications and deletions of chromosome parts. Some cancer cells have double the normal number of chromosomes.

rely on different kinds of nutrients than normal cells. In addition, some cancer cells make energy from nutrients in a different way than most normal cells. This lets cancer cells grow more quickly.

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6
Q

How does cancer develop:

Is cancer a genetic disease?

What happens to the DNA?

What happens to cell growth/division?

A

Cancer is a genetic disease—that is, it is caused by changes to the DNA sequence (genes) that control the way our cells function, especially how they grow and divide.

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7
Q

What is metastatic cancer?

A

A cancer that has spread from the place where it first formed to another place in the body is called metastatic cancer. The process by which cancer cells spread to other parts of the body is called metastasis.

Metastatic cancer has the same name and the same type of cancer cells as the original, or primary, cancer. For example, breast cancer that forms a metastatic tumor in the lung is metastatic breast cancer, not lung cancer.

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8
Q

Under a microscope, do metastatic cancer cells generally look the same as cells of the original cancer?

A

Yes! Moreover, metastatic cancer cells and cells of the original cancer usually have some molecular features in common, such as the presence of specific chromosome changes.

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9
Q

Is Hyperplasia cancer?

A

No. Hyperplasia occurs when cells within a tissue multiply faster than normal and extra cells build up. However, the cells and the way the tissue is organized still look normal under a microscope. Hyperplasia can be caused by several factors or conditions, including chronic irritation.

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10
Q

Is Dysplasia cancer?

Compare to hyperplasia, especially how do the cells/tissue look?

List one example of dysplasia.

A

No.

Dysplasia is a more advanced condition than hyperplasia. In dysplasia, there is also a buildup of extra cells. But the cells look abnormal and there are changes in how the tissue is organized. In general, the more abnormal the cells and tissue look, the greater the chance that cancer will form. Some types of dysplasia may need to be monitored or treated, but others do not.

An example of dysplasia is an abnormal mole (called a dysplastic nevus) that forms on the skin. A dysplastic nevus can turn into melanoma, although most do not.

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11
Q

Is Carcinoma in situ cancer?

A

No. Carcinoma in situ is an even more advanced condition (compared to Hyperplasia and Dysplasia). Although it is sometimes called stage 0 cancer, it is not cancer because the abnormal cells do not invade nearby tissue the way that cancer cells do. But because some carcinomas in situ may become cancer, they are usually treated.

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12
Q

What is a Carcinoma?

What shape are the cells when viewed under a microscope?

True or false:
Carcinomas are the least common type of cancer.

A

Carcinomas are formed by epithelial cells, which are the cells that cover the inside and outside surfaces of the body (derived from the embryonic ectoderm). There are many types of epithelial cells/carcinomas.

The cells have a column-like shape when viewed under a microscope.

FALSE
Carcinomas are the MOST common type of cancer.

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13
Q

What are 4 different types of Carcinoma?

A

Carcinomas that begin in different epithelial cell types have specific names:
Adenocarcinoma
Basal cell carcinoma
Squamous cell carcinoma
Transitional cell carcinoma

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14
Q

What is Adenocarcinoma?

A

Carcinomas (the most common type of cancer) that begin in different epithelial cell types have specific names:

Adenocarcinoma is a cancer that forms in epithelial cells that produce fluids or mucus. Tissues with this type of epithelial cell are sometimes called glandular tissues. Most cancers of the breast, colon, and prostate are adenocarcinomas

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15
Q

What is Basal cell carcinoma?

A

Carcinomas (the most common type of cancer) that begin in different epithelial cell types have specific names:

Basal cell carcinoma is a cancer that begins in the lower or basal (base) layer of the epidermis, which is a person’s outer layer of skin.

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16
Q

What is Squamous cell carcinoma?

A

Carcinomas (the most common type of cancer) that begin in different epithelial cell types have specific names:

Squamous cell carcinoma is a cancer that forms in squamous cells, which are epithelial cells that lie just beneath the outer surface of the skin. Squamous cells also line many other organs, including the stomach, intestines, lungs, bladder, and kidneys. Squamous cells look flat, like fish scales, when viewed under a microscope. Squamous cell carcinomas are sometimes called epidermoid carcinomas.

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17
Q

What is Transitional cell carcinoma?

A

Carcinomas (the most common type of cancer) that begin in different epithelial cell types have specific names:

Transitional cell carcinoma is a cancer that forms in a type of epithelial tissue called transitional epithelium, or urothelium. This tissue, which is made up of many layers of epithelial cells that can get bigger and smaller, is found in the linings of the bladder, ureters, and part of the kidneys (renal pelvis), and a few other organs. Some cancers of the bladder, ureters, and kidneys are transitional cell carcinomas.

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18
Q

What is a Sarcoma?

A

Sarcomas are cancers that originate from the embryonic mesoderm (middle layer). Sarcomas form in bone and soft tissues including: muscle, fat, blood vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments).

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19
Q

What are some types of Sarcomas?

What is the most common?

A

Sarcomas are cancers, originating from the mesoderm, that form in bone and soft tissues, including muscle, fat, blood vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments.

Osteosarcoma is the most common - bone cancer.

The most common types of soft tissue sarcoma are:
leiomyosarcoma - smooth muscle
Kaposi sarcoma - skin, mucous membranes that line the GI tract, blood vessels, lymph nodes, and other organs
malignant fibrous histiocytoma
liposarcoma and
dermatofibrosarcoma protuberans.

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20
Q

What is an Osteosarcoma?

A

Sarcomas are cancers, originating from the mesoderm, that form in Bone and soft tissues, including muscle, fat, blood vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments.

Osteosarcoma is the most common Sarcoma. Osteosarcoma is cancer of bone.

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21
Q

What is an Leiomyosarcoma (LMS)?

A

Sarcomas are cancers, originating from the mesoderm, that form in bone and soft tissues, including muscle, fat, blood vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments.

Leiomyosarcoma is a soft tissue sarcoma, a rare type of cancer that grows in the smooth muscles. A malignant (cancer) tumor of smooth muscle cells that can arise almost anywhere in the body, but is most common in the uterus, abdomen, or pelvis.

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22
Q

What is Kaposi sarcoma?

A

Sarcomas are cancers, originating from the mesoderm, that form in bone and soft tissues, including muscle, fat, blood vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments.

Kaposi sarcoma (KS) is a type of cancer that forms in the lining of blood vessels and lymph vessels. The cancer forms growths of cells, called lesions, on the skin. The lesions often form on the face, arms and legs. The lesions may look pink, red, purple or brown.

Lesions also can appear on the genitals or in the mouth. In severe Kaposi sarcoma, lesions can be in the digestive tract and lungs.

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23
Q

What is malignant fibrous histiocytoma?

A

Sarcomas are cancers, originating from the mesoderm, that form in bone and soft tissues, including muscle, fat, blood vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments.

Malignant fibrous histiocytoma is a type of cancer that usually forms in the soft tissue, but it may also form in bone. It can occur anywhere in the body, but it usually occurs in the legs (especially the thighs), arms, or back of the abdomen. It may also occur in a part of the body where a patient received radiation therapy in the past. Malignant fibrous histiocytomas often grow quickly and spread to other parts of the body, including the lungs. They usually occur in older adults, and they may sometimes occur as a second cancer in patients who had retinoblastoma. Also called malignant fibrous cytoma and undifferentiated pleomorphic sarcoma.

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24
Q

What is a Liposarcoma?

A

Sarcomas are cancers, originating from the mesoderm, that form in bone and soft tissues, including muscle, fat, blood vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments.

Liposarcomas are the most common subtype of soft tissue sarcomas, accounting for at least 20% of all sarcomas in adults. Liposarcomas arise from the precursor lipoblasts of the adipocytes (i.e. fat cells) in adipose (i.e. fat) tissues. A rare type of cancer that begins in fat cells. It usually forms in the layer of fat just under the skin or in the deep soft tissues of the legs (especially in the thigh or back of the knee) or in the abdomen. It may also form in other parts of the body. Most liposarcomas are painless and tend to grow slowly, but some may grow quickly and spread to nearby tissue or to other parts of the body. Liposarcomas usually occur in adults, and are rare in children and adolescents. They are a type of soft tissue sarcoma.

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25
Q

What is dermatofibrosarcoma protuberans?

A

Sarcomas are cancers, originating from the mesoderm, that form in bone and soft tissues, including muscle, fat, blood vessels, lymph vessels, and fibrous tissue (such as tendons and ligaments.

Dermatofibrosarcoma protuberans is a type of tumor that begins as a hard nodule and grows slowly. These tumors are usually found in the dermis (the inner layer of the two main layers of tissue that make up the skin) of the limbs or trunk of the body. They can grow into surrounding tissue but do not spread to other parts of the body. These tumors are related to giant cell fibroblastomas.

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26
Q

What is Leukemia?

A

Leukemia are cancers that begin in the blood-forming tissue of the bone marrow. These cancers do not form solid tumors. Instead, large numbers of abnormal white blood cells (leukemia cells and leukemic blast cells) build up in the blood and bone marrow, crowding out normal blood cells.

Leukemia occurs most often in adults older than 55, but it is also the most common cancer in children younger than 15.

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27
Q

What are 4 common types of Leukemia?

A

Leukemia is a broad term for cancers of the blood cells that begin in the bone marrow. The type of leukemia depends on the type of blood cell that becomes cancer and whether it grows quickly or slowly.

There are four common types of leukemia, which are grouped based on how quickly the disease gets worse (acute or chronic) and on the type of blood cell the cancer starts in (lymphoblastic or myeloid). Acute forms of leukemia grow quickly and chronic forms grow more slowly.

Acute lymphocytic leukemia (ALL) is the most common kind of leukemia. It usually occurs in young children but can also occur in adults. It’s sometimes called acute lymphoblastic leukemia.

Acute Myelogenous Leukemia (AML) is the most common kind of aggressive leukemia in adults. It can also affect children. This type of leukemia starts in the myeloid cells of the bone marrow and can spread quickly into the blood.

Chronic lymphocytic leukemia (CLL) is the most common type of slow-growing leukemia. It usually affects older adults. CLL starts in the lymphoid (white blood) cells of the bone marrow and progresses slowly. A person with CLL may feel fine for several years before experiencing symptoms or seeking treatment. But it can eventually enter the blood and spread to other parts of the body.

Chronic myelogenous (CML) leukemia usually affects adults. It’s sometimes called chronic myeloid leukemia. This type of leukemia starts in the myeloid cells of the bone marrow. It grows slowly, so symptoms may not start for months or years. CML can eventually spread to the blood and other parts of the body.

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28
Q

What is Acute lymphocytic leukemia (ALL), one of the 4 most common types of Leukemia?

A

Leukemia is a broad term for cancers of the blood cells that begin in the bone marrow. The type of leukemia depends on the type of blood cell that becomes cancer and whether it grows quickly or slowly.

Acute lymphocytic leukemia (ALL) is the most common kind of leukemia. It usually occurs in young children but can also occur in adults. It’s sometimes called acute lymphoblastic leukemia.

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29
Q

What is Acute Myelogenous Leukemia (AML), one of the 4 most common types of Leukemia?

A

Leukemia is a broad term for cancers of the blood cells that begin in the bone marrow. The type of leukemia depends on the type of blood cell that becomes cancer and whether it grows quickly or slowly.

Acute Myelogenous Leukemia (AML) is the most common kind of aggressive leukemia in adults. It can also affect children. This type of leukemia starts in the myeloid cells of the bone marrow and can spread quickly into the blood.

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30
Q

What is Chronic lymphocytic leukemia (CLL), one of the 4 most common types of Leukemia?

A

Leukemia is a broad term for cancers of the blood cells that begin in the bone marrow. The type of leukemia depends on the type of blood cell that becomes cancer and whether it grows quickly or slowly.

Chronic lymphocytic leukemia (CLL) is the most common type of slow-growing leukemia. It usually affects older adults. CLL starts in the lymphoid (white blood) cells of the bone marrow and progresses slowly. A person with CLL may feel fine for several years before experiencing symptoms or seeking treatment. But it can eventually enter the blood and spread to other parts of the body.

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31
Q

What is Chronic myelogenous leukemia (CML), one of the 4 most common types of Leukemia?

A

Leukemia is a broad term for cancers of the blood cells that begin in the bone marrow. The type of leukemia depends on the type of blood cell that becomes cancer and whether it grows quickly or slowly.

Chronic myelogenous leukemia (CML) usually affects adults. It’s sometimes called chronic myeloid leukemia. This type of leukemia starts in the myeloid cells of the bone marrow. It grows slowly, so symptoms may not start for months or years. CML can eventually spread to the blood and other parts of the body.

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32
Q

What is Lymphoma?

A

Lymphoma is cancer that begins in lymphocytes (T cells or B cells). These are disease-fighting white blood cells that are part of the immune system. In lymphoma, abnormal lymphocytes build up in lymph nodes and lymph vessels, as well as in other organs of the body.

There are two main types of lymphoma:

Hodgkin lymphoma – People with this disease have abnormal lymphocytes that are called Reed-Sternberg cells. These cells usually form from B cells.

Non-Hodgkin lymphoma – This is a large group of cancers that start in lymphocytes. The cancers can grow quickly or slowly and can form from B cells or T cells.

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33
Q

What are some Key Differences Between Leukemia, Lymphoma, and Myeloma?

A

Leukemia is the most prevalent of “The Big Three”. Leukemia starts in a person’s blood forming tissue (bone marrow) and will cause an overproduction of abnormal white blood cells which will eventually travel into the bloodstream.

Leukemia is broken down into two types, chronic and acute. Chronic leukemia tends to be the less severe of the two, progresses at a slower pace, and inhibits the development of healthy blood stem cells. Acute leukemia progresses rapidly and prevents healthy blood stem cells from being able to mature as necessary. Symptoms of acute leukemia appear earlier than chronic leukemia, and are often more severe.
—————
Lymphoma is the cancer of the lymphatic system, (the body’s germ fighting system). The lymphatic system includes lymph nodes, spleen, the thymus gland and bone marrow. With lymphoma, Lymphocytes (B and T cells) develop a genetic mutation. This mutation causes the cells to rapidly multiply and survive in the lymphatic system causing the lymph nodes, the spleen, and liver to swell.

The two most common forms:
Hodgkins- usually form from B-cells, typically begins in the upper portion of the body’s lymph nodes, characterized by the presence of Reed-Sternberg cells.
Non-Hodgkin’s (most common form), can form from B or T cells, will arise in lymph nodes anywhere in the body, are characterized by the absence of Reed-Sternberg cells.
—————
Myeloma, is the overproduction of abnormal plasma cells in bone marrow, these cells remain in the bone marrow and do not travel to the bloodstream. Plasma cells are responsible for the production of antibodies. The two most common forms of myeloma are multiple myeloma (located at multiple sites in the body at the time of diagnosis) and Plasmacytoma myeloma (located in one area of the body, most often in the bones, skin, muscles or lungs).

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34
Q

What are the two main types of Lymphoma?

A

Hodgkin lymphoma – People with this disease have abnormal lymphocytes that are called Reed-Sternberg cells. These cells usually form from B cells.

Non-Hodgkin lymphoma – This is a large group of cancers that start in lymphocytes. The cancers can grow quickly or slowly and can form from B cells or T cells.

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35
Q

What is Melanoma?

A

Melanoma is cancer that begins in cells that become melanocytes, which are specialized cells that make melanin (the pigment that gives skin its color). Most melanomas form on the skin, but melanomas can also form in other pigmented tissues, such as the eye.

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36
Q

What are Brain and Spinal Cord Tumors, how are they named?

A

There are different types of brain and spinal cord tumors. These tumors are named based on the type of cell in which they formed and where the tumor first formed in the central nervous system. For example, an astrocytic tumor begins in star-shaped brain cells called astrocytes, which help keep nerve cells healthy. Brain tumors can be benign (not cancer) or malignant (cancer).

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37
Q

What are the main types of skin cancer?

A

squamous cell carcinoma, basal cell carcinoma, and melanoma. Melanoma is much less common than the other types but much more likely to invade nearby tissue and spread to other parts of the body. Most deaths from skin cancer are caused by melanoma.

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38
Q

What is a germ cell tumor? What are some of the types? Can germ cell tumors be either benign or malignant?

A

Germ cell tumors are a type of tumor that begins in the cells that give rise to sperm or eggs. These tumors can occur almost anywhere in the body and can be either benign or malignant.

Central Nervous System, Childhood Extracranial Germ Cell Tumor,
Childhood Extragonadal Germ Cell Tumor
Ovarian Germ Cell Tumor
Testicular Cancer

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39
Q

What are Neuroendocrine Tumors?

Are these tumors always malignant?

Name some examples (7)

A

Neuroendocrine Tumors form from cells that release hormones into the blood in response to a signal from the nervous system. Neuroendocrine tumors may make higher-than-normal amounts of hormones, which can cause many different symptoms.

These tumors may be benign (not cancer) or malignant (cancer).

Some examples of neuroendocrine tumors are:
1. carcinoid tumors
2. islet cell tumors
3. medullary thyroid cancer
4. pheochromocytomas
5. neuroendocrine carcinoma of the skin (Merkel cell cancer)
6. small cell lung cancer
7. large cell neuroendocrine carcinoma (a rare type of lung cancer

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40
Q

What are Carcinoid tumors?

What speed of growth?

Where are they typically found (what two tissues most common)

What syndrome can they cause, and how?

A

Carcinoid tumors are a type of neuroendocrine tumor. They are slow-growing tumors that are usually found in the gastrointestinal system (most often in the rectum and small intestine). Carcinoid tumors may spread to the liver or other sites in the body, and they may secrete substances such as serotonin or prostaglandins, causing carcinoid syndrome.

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41
Q

What is carcinoid syndrome?

A

A combination of symptoms caused by the release of serotonin and other substances from carcinoid tumors of the gastrointestinal tract. Symptoms may include flushing of the face, flat angiomas (small collections of dilated blood vessels) of the skin, diarrhea, bronchial spasms, rapid pulse, and sudden drops in blood pressure.

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42
Q

Define incidence.

A

new cases

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43
Q

Define prevalence.

A

All existing cases

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44
Q

Define mortality.

A

Deaths

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45
Q

Define survival

A

How long people survive after diagnosis

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46
Q

Define morbidity

A

Cancer-related health complications

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47
Q

Define survivorship

A

Survival beyond cancer treatment (including quality of life)

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48
Q

Define financial toxicity

A

Financial toxicity describes problems a cancer patient has related to the cost of treatment.

KEY POINTS
Several studies show that cancer patients and survivors are more likely to have financial toxicity than are people without cancer.
The level of financial toxicity you may have will depend on several factors in your household.
Cancer treatment can affect your ability to work and pay your bills.
Your age, race, income, and whether you have a job can affect your risk of financial toxicity.

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49
Q

Cancer disparities (sometimes called cancer health disparities) are differences in cancer measures/outcomes/metrics such as 9 listed):

A
  1. incidence (new cases)
  2. prevalence (all existing cases)
  3. mortality (deaths)
  4. survival (how long people survive after diagnosis)
  5. morbidity (cancer-related health complications)
  6. survivorship (including quality of life after cancer treatment)
  7. financial burden of cancer or related health conditions
  8. screening rates
  9. stage at diagnosis
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50
Q

Define Carcinogenesis

A

Process by which a normal cell develops into a cancer cell

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51
Q

Define somatic mutation theory

-> 3 features related to genetics, cellular origins, irreversibility)

Is this the predominant model?

A

The predominant cancer model
1. Cancer is a disease of genetic variants
2. Cancer arises from a single somatic cell
3. Initiation and carcinogenesis are irreversible

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52
Q

What are three characteristics of cancer STEM CELLS described by the: Cancer Stem Cell model (how are they different from OTHER CANCER cells):

A

Tumors are heterogeneous.
Cancer stem cells have special characteristics within the tumor:

Only Cancer stem cells can:
1. become a new tumor
2. go into resting phase (resistance to treatment thereby surviving treatment)
3. move back into active phase (causing relapse)

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53
Q

Define two hit hypothesis

A

According to a “two-hit” model, dominantly inherited predisposition to cancer entails a germline mutation, while tumorigenesis requires a second, somatic, mutation. Non-hereditary cancer of the same type requires the same two hits, but both are somatic.

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54
Q

Define Hanahan and Weinberg’s model of cellular events to produce Malignancy (6 steps related to: (1) cell signaling; (2) growth suppressors; (3) immortality; (4) invasion/metastasis; (5) angiogenesis and (6) cell death)

A

(1) sustaining proliferative signaling; (2) evading growth suppressors; (3) enabling replicative immortality; (4) activating invasion and metastasis; (5) inducing angiogenesis and (6) resisting cell death.

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55
Q

Describe the cell cycle

A

Cell cycle is the name we give the process through which cells replicate and make two new cells. Cell cycle has different stages called G1, S, G2, and M. G1 is the stage where the cell is preparing to divide. To do this, it then moves into the S phase where the cell copies all the DNA. So, S stands for DNA synthesis. After the DNA is copied and there’s a complete extra set of all the genetic material, the cell moves into the G2 stage, where it organizes and condenses the genetic material, or starts to condense the genetic material, and prepares to divide. The next stage is M. M stands for mitosis. This is where the cell actually partitions the two copies of the genetic material into the two daughter cells. After M phase completes, cell division occurs and two cells are left, and the cell cycle can begin again.

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56
Q

List the 4 conceptual stages of Carcinogenesis.

What step begins malignancy?

A

Carcinogenesis can be divided conceptually into four steps:

  1. tumor initiation - irreversible change (variant) passed to daughter cells (ie UV, tobacco)
  2. tumor promotion - accelerated cancer formation (ie obesity, high estrogen levels)
  3. tumor progression - malignant conversion occurs
  4. Metastasis
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57
Q

Name 5 Key tumor characteristics

A
  1. Uncontrolled cell division,
  2. loss of contact inhibition
  3. Apoptosis avoidance
  4. Angiogenesis
  5. Ability to invade surrounding tissues and metastasize
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58
Q

Name 6 causes of Carcinogenesis?

A
  1. Chronic inflammation
  2. Virus exposure
  3. Bacterial exposure (Helicobacter pylori)
  4. High-fat diet and obesity
  5. Additives (food dyes, artificial flavors/preservatives)
  6. Pharmaceutical exposure (ie chemotherapy)
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59
Q

Name 8 differences between cancer cells and normal cells

A
  1. Grow in absence of signaling
  2. Ignore signaling to stop dividing or apoptosis
  3. Invade nearby areas and spread
  4. Attract angiogenesis
  5. Hide from immune system
  6. Trick immune system to aid survival
  7. Accumulate multiple genetic changes
  8. Utilize different kinds of nutrients
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60
Q

True or False:
Most cancer deaths are caused by Metastasis

A

True

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61
Q

What are the 6 primary types of cancer histological categories?

A

Carcinoma
Sarcoma
Myeloma
Leukemia
Lymphoma
Mixed Types

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62
Q

What is a Carcinoma?

Carcinomas account for what % of all cancer cases?

A

Carcinoma refers to a malignant neoplasm of epithelial origin or cancer of the internal or external lining of the body.

Carcinomas, malignancies of epithelial tissue, account for 80 to 90 percent of all cancer cases.

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63
Q

What Percentage of all cancer cases do Carcinomas (epithelial origin) account for?

A

Carcinomas, malignancies of epithelial tissue, account for 80 to 90 percent of all cancer cases.

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64
Q

What are the two major subtypes of adenocarcinoma?

A

Carcinomas are divided into two major subtypes:

Adenocarcinoma, which develops in an organ or gland. Generally occur in mucus membranes and are first seen as a thickened plaque-like white mucosa. They often spread easily through the soft tissue.

Squamous cell carcinoma, which originates in the squamous epithelium. Occur in many areas of the body.

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65
Q

True or False:
Most carcinomas affect organs or glands capable of secretion, such as the breasts, which produce milk, or the lungs, which secrete mucus, or colon or prostate or bladder.

A

True

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66
Q

What is a sarcoma?

What do s the most common sarcoma, where does it develop?

A

Sarcoma refers to cancer that originates in supportive and connective tissues such as bones, tendons, cartilage, muscle, and fat.

Generally occurring in young adults, the most common sarcoma often develops as a painful mass on the bone. Sarcoma tumors usually resemble the tissue in which they grow.

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67
Q

Name some examples of Sarcomas (11 listed)

A

Osteosarcoma or osteogenic sarcoma (bone)

Chondrosarcoma (cartilage)

Leiomyosarcoma (smooth muscle)

Rhabdomyosarcoma (skeletal muscle)

Mesothelial sarcoma or mesothelioma (membranous lining of body cavities)

Fibrosarcoma (fibrous tissue)

Angiosarcoma or hemangioendothelioma (blood vessels)

Liposarcoma (adipose tissue)

Glioma or astrocytoma (neurogenic connective tissue found in the brain)

Myxosarcoma (primitive embryonic connective tissue)

Mesenchymous or mixed mesodermal tumor (mixed connective tissue types)

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68
Q

What tissue does Osteosarcoma (or osteogenic sarcoma) originate from?

A

Bone

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69
Q

What tissue does Chondrosarcoma originate from?

A

Cartillage

70
Q

What tissue does Leiomyosarcoma originate from?

A

smooth muscle

71
Q

What tissue does Rhabdomyosarcoma originate from?

A

skeletal muscle

72
Q

What tissue does mesothelial sarcoma or mesothelioma originate from?

A

membranous lining of body cavities

73
Q

What tissue does Fibrosarcoma originate from?

A

fibrous tissue

74
Q

What tissue does angiosarcoma or hemangioendothelioma originate from?

A

blood vessels

75
Q

What tissue does Liposarcoma originate from?

A

adipose tissue

76
Q

What tissue does Glioma or astrocytoma originate from?

A

neurogenic connective tissue found in the brain

77
Q

What tissue does Myxosarcoma originate from?

A

primitive embryonic CONNECTIVE tissue

78
Q

What tissue does Mesenchymous or mixed mesodermal tumor originate from?

A

mixed CONNECTIVE tissue types

79
Q

What is Myeloma?

A

Myeloma is cancer that originates in the plasma cells of bone marrow. The plasma cells produce some of the proteins found in blood.

Myeloma can also form a solid tumor called a solitary plasmacytoma rather than infect your entire bone marrow. These tumors are often treated with radiation therapy.

80
Q

What is Leukemia? Name some examples.

A

Leukemias (“liquid cancers” or “blood cancers”) are cancers of the bone marrow (the site of blood cell production). The word leukemia means “white blood” in Greek. The disease is often associated with the overproduction of immature white blood cells. These immature white blood cells do not perform as well as they should, therefore the patient is often prone to infection. Leukemia also affects red blood cells and can cause poor blood clotting and fatigue due to anemia.

Examples of leukemia include:

Myelogenous or granulocytic leukemia (malignancy of the myeloid and granulocytic white blood cell series)

Lymphatic, lymphocytic, or lymphoblastic leukemia (malignancy of the lymphoid and lymphocytic blood cell series)

Polycythemia vera or erythremia (malignancy of various blood cell products, but with red cells predominating)

81
Q

What is Myelogenous or granulocytic leukemia Leukemia?

A

malignancy of the myeloid and granulocytic white blood cell series

82
Q

What is Lymphatic, lymphocytic, or lymphoblastic Leukemia?

A

malignancy of the lymphoid and lymphocytic blood cell series

83
Q

What is Polycythemia vera or erythremia Leukemia?

A

malignancy of various blood cell products, but with red cells predominating

84
Q

Where do Lymphomas develop?

A

Lymphomas develop in the glands or nodes of the lymphatic system, a network of vessels, nodes, and organs (specifically the spleen, tonsils, and thymus) that purify bodily fluids and produce infection-fighting white blood cells, or lymphocytes. Unlike the leukemias which are sometimes called “liquid cancers,” lymphomas are “solid cancers.” Lymphomas may also occur in specific organs such as the stomach, breast or brain. These lymphomas are referred to as extranodal lymphomas.

The lymphomas are subclassified into two categories:

Hodgkin lymphoma (presence of Reed-Sternberg cells)

Non-Hodgkin lymphoma (absence of Reed-Sternberg cells)

85
Q

What is the Ectoderm?

A

The outermost of the three cell layers in a developing embryo; the origin of epidermal tissues such as the skin, nails, hair, nervous system, and external sense organs.

Epithelial tissue arises from the ectoderm and the endoderm; therefore, carcinomas can arise from either the ectoderm or the endoderm.

86
Q

True or False
Epithelial tissue only arises from the ectoderm not the endoderm.

A

False.
Epithelial tissue arises from the ectoderm AND the endoderm; therefore, carcinomas can arise from either the ectoderm or the endoderm.

87
Q

Epithelial tissue derived from ectoderm is generally what type of epithelium?

A

squamous epithelium

88
Q

Epithelial tissue derived from endoderm is generally what type of epithelium?

A

glandular epithelium

89
Q

What are some of the body tissues derived from the third or middle primary germ layer known as the Mesoderm.

A

Muscles
Fibrous tissue
Bone and cartilage
Fat or adipose tissue
Blood and lymph vessels
Blood cells

90
Q

What is the Endoderm? What are examples of tissue that arise from Endoderm?

A

The endoderm is the innermost layer of the three primary germ layers of the embryon. The glandular epithelium arises from the innermost layer.

Adenocarcinomas arise from tissues derived from the endoderm.

Examples of the tissue that arise from the endoderm layer include:

epithelium of pharynx, auditory tube, larynx, trachea, bronchi, lungs, the digestive tract, liver, pancreas, bladder, urethra, tonsils, thyroid, parathyroid, thymus, breast, prostate.

91
Q

Adenocarcinomas arise from what embryonic germ layer?

A

endoderm

92
Q

Epithelial tissues derived from ectoderm is generally what type of epithelium?

A

squamous epithelium

93
Q

Epithelial tissue derived from endoderm is generally what type of epithelium?

A

glandular epithelium

94
Q

What are some of the tissues derived from the middle primary germ layer known as the Mesoderm?

A

Muscles
Fibrous tissue
Bone and cartilage
Fat or adipose tissue
Blood and lymph vessels
Blood cells

95
Q

What are the two major Carcinoma subtypes?

A

Adenocarcinoma, which develops in an organ or gland. Generally occur in the mucous membranes.

Squamous cell carcinoma, which originates in the squamous epithelium. Generally occur in many areas of the body.

96
Q

Tumor Grading:
Gx through G4 Definitions

A

Gx - undetermined
G1 - Well differentiated (low grade)
G2 - Moderately differentiated (intermediate grade)
G3 - poorly differentiated (high grade)
G4 - Undifferentiated (high grade)

97
Q

TNM Staging

A

Most common staging system
T- Tumor size
N - Node involvement
M - Metastasis

98
Q

What does “prognostic stage groups” mean?

A

Merger between anatomical stage (Grade + TNM) with genomic profiles and molecular targets. Utilizes a more personalized approach. May explain why an early-stage cancer has a poor prognosis.

99
Q

What is the Innate immune response?

A

Occurs naturally and uses phagocytic cells that release inflammatory mediators and natural killer (NK) cells.

Nonspecific process
Natural immunity

100
Q

What is Acquired or adaptive immune response?

What are three types?

A

involves antigen-specific B and T lymphocytes in response to specific antigens or foreign proteins. Has memory, allows improved consecutive response to the same antigen (AKA anamnesis).

Three types:
1. Humoral (antibody)-mediated
2. Cell-mediated
3. Regulatory T cells

101
Q

What is Humoral (antibody)-mediated
immune response?

A

Mediated b antibodies, secreted by plasma cells or transformed B lymphocytes following exposure to an antigen. Destroy the antigen/cell upon binding

102
Q

What is Cell-Mediated immune response?

A

Mediated by the T lymphocytes that can either induce cell death (when cells express antigens) or activate cells used in innate processes.

103
Q

Which cells within the immune system dampen the immune response to prevent attacks of health tissues (autoimmune disease)?

A

Regulatory T cells (formerly suppressor T cells)

104
Q

Which cells participate in the Innate immune system?

A

Myeloid Lineage:

Myeloid progenitor differentiates into:
Neutrophils
Mast cell
Basophils
Eosinophil
Monocyte (differentiates into: Macrophage & Dendritic cell)

105
Q

Which cells participate in the Adaptive immune system?

A

Lymphoid Lineage:

Lymphoid progenitor differentiates into

Natural killer cell (innate immunity)
B cell progenitor (which differentiates into Plasma cell and Memory B cell)
T cell progenitory (which differentiates into Memory T cell, Cytotoxic T cell, Helper T Cell)

106
Q

What is hematopoiesis?

A

The process that a pluripotent stem cell differentiates ito peripherial blood cell lines.

107
Q

Myeloid blood cell line will differentiate into:

A

Red blood cells
Platelets
White blood cells (innate immunity)

108
Q

Lymphoid blood cell line will differentiate into:

A

Lymphocytes (B cell, T cell, Plasma cell, and NK cell)

109
Q

What are some granulocytes?

A

Basophils
Eosinophils
Neutrophils

110
Q

What are some Agranulocytes?

A

B cells
T cells
Monocytes (macrophage pre-cursor)

111
Q

Describe T cells

A

Differentiate from Lymphoid progenitor.
Mature in the thymus gland.
Job: Kill infected cells and communicate to other immune system players

Helper T cells communicate with other cells by stimulating production of T cells, B cells, or phagocytes.

Killer T cells attack foreign antigens (particularly viruses)

112
Q

Describe B cells

A

Derived from a lymphoid progenitor.
Secrete antibodies in respons to foreign antigens. Each B cell makes ONLY one antibody. B cells can develop into plasma cells which make LOTS of antibodies.

113
Q

Describe Natural Killer (NK cells)

A

Derived from a Lymphoid progenitor though part of the innate immune system. Can attack any type of foreign antigen through production of strong chemicals that bind to the foreign antigen.

114
Q

What are some goals of the Complement System within Innate immunity?

A

Trigger an inflammatory response:
swelling, redness, pain which will flood the area with immune system cells to further attack/clean up.

115
Q

What are two types of Immune response within Adaptive Immunity?

A

Humoral response (B-cells)

Cell-mediated response (T cell - inkluding killer T cells)

116
Q

What are Immunoglobulins produced by B cells?

A

Antibodies: Immunoglobulins - 2x heavy chains, 2x light chains of amino acids

117
Q

What are the different types of antibodies: Immunoglobulins and where is each found?

A

IgA - body fluids (tears/saliva)
IgE - lungs, skin, and mucuous membranes (also involved in allergic/hypersensitivity reactions)
IgG - blood, lymphactis, CSF (activates complement system & key player in humeral immunity)
IgM - blood and lymph fluid (largest and first responders to antigen)
IgD - role not well understood, may have some antibody function for penicillin, diptheria, and insulin.

118
Q

What are some important Cell Mediators in the Immune response?

A

Soluble mediators (receptors)

  1. Antibodies (serum glycoproteins (AKA immunoglobulins) specific to an antigen.
  2. Cytokines (polypeptides, ie interleukins, interferons, TNF, CSF) mediate a cellular response (anti- or pro- inflammatory) which can cross the BBB
  3. Prostaglandins, which mediate inflammation
119
Q

What are TSA and TAA that have been a focus in immunotherapy and targeted therapy?

A

TSA - Tumor-Specific Antigen (only found on tumor cells)

TAA - Tumor-Associated Antigen (found mostly on tumor cells, also found on healthy cells in lower volumes) EXAMPLE= HER2 targeted by Trastuzumab.

120
Q

What is Immunoediting and what are the 3 steps involved?

A

The evolution of a tumor cell that allows escape from the immune system.
1. Elimination (highly immunogenic tumors are destroyed, though low immunogenic tumors survive/escape.
2. Equilibrium: the immune stystem ignores the cancer cells with low immunogenicity.
3. Escape: ignored cancer cells grow/divide

121
Q

What are 7 types of immunotherapy?

A
  1. Monoclonal antibodies (rituximab or trastuzumab)
  2. Cytokines, proteins created by WBC (interlukins, hematopoetic growth factor)
  3. Vaccines, cancer antigens that elicit an immune response
  4. Checkpoint Inhibitors (protens that allow the T cells to mount a stronger immune response (nivolumab and ipilimumab)
  5. Tumor-infiltrating lymphocytes (TILs), patient’s own TILs growing in culture, activated, and then reinfused
  6. Chimeric antigen receptor-T cell (CAR-T) therapy: Patient’s own T cells are genetically modified to express a specific T cell receptor on the surface of the cancer cells.
  7. Gene therapy - introduction of DNA/RNA into the body through a vector
122
Q

Definition of Genomics

A

The study of the complete set of DNA (including all of its genes) within a person or organism

123
Q

Defintion of Genetics

A

The study of genes and heredity

124
Q

Define Penetrance

A

The # of individuals with a genetic variant that will present with a specific disease.
Further characterized as High or Low.

125
Q

Define Autosomal dominant

A

Only one copy of the variant gene is needed to display the quality or disease.

126
Q

Define Autosomal recessive

A

Two copies of a variant gene are inherited and needed to display the quality or disease.

127
Q

What are some features of heritable cancers in the individual?

A

In the individual patient:
Multiple primary tumors in the same organ.
Multiple primary tumors in different organs.
Bilateral primary tumors in paired organs.
Multifocality within a single organ (e.g., multiple tumors in the same breast, all of which have risen from one original tumor).
Younger-than-usual age at tumor diagnosis.
Tumors with rare histology.
Tumors occurring in the sex not usually affected (e.g., breast cancer in men).
Tumors associated with other genetic traits.
Tumors associated with congenital defects.
Tumors associated with an inherited precursor lesion.
Tumors associated with another rare disease.
Tumors associated with cutaneous lesions known to be related to cancer susceptibility disorders (e.g., the genodermatoses).

128
Q

What are some features of a heritable cancer in the family?

A

One first-degree relative with the same or a related tumor and one of the individual features listed.
Two or more first-degree relatives with tumors of the same site.
Two or more first-degree relatives with tumor types belonging to a known familial cancer syndrome.
Two or more first-degree relatives with rare tumors.
Three or more relatives in two generations with tumors of the same site or etiologically related sites.

129
Q

What is pharmacogenomics?

A

The study of how genetics and genomics influences treatment options

130
Q

What is GINA and when was it established?

A

The federal Genetic Information Nondiscrimination Act, established in 2008, provides protection related to:

  1. Analysis of DNA and RNA.
  2. Cancer screening testing (ie. breast and ovarian cancer, hereditary nonpolyposis colorectal cancer and familial cutaneous malignant melanoma).
  3. Genetic testing for other disease (ie. Huntington’s, cystic fibrosis) and sicle cell anemia screening.
131
Q

What does GINA do?

A

This federal law: Genetic Information Nondiscrimination Act (passed in 2008) protects U.S. citizens with an inherited disorder from being treated unjustly because of their genetic makeup.

132
Q

What are some key protections that GINA provides?

A

Genetic Information Nondiscrimination Act (passed in 2008) protecs U.S. citizens by:

  1. Insurers cannot adjust premiums based on a person’s genetic information.
  2. Insurers cannot mandate genetic testing for individuals.
  3. Employers cannot hire, fire, or change job assignments based on a person’s genetic information.
133
Q

What are some GINA limitations?

A

Employer have access to some information that may include individual genetic testing details for special situations including:

Certifying requirements for FMLA

Monitoring the biologic effects of substances

134
Q

What two items does GINA NOT prohibit?

A

Medical underwriting for current health status

Mandate coverage for testing or treatment

135
Q

What four U.S. populations are NOT protected by GINA

A
  1. US military (health through Tricare)
  2. Those receiving care through Veterans Affairs
  3. The Indian Health Service
  4. Federal employees with the Federal Employee Benefit Plan

The above policies have their own policies preventing discriminiation

136
Q

What % of the population may have a personal or family health history indicative of a hereitary cancer syndrome?

A

As much as 10%

137
Q

In what ways can Cost be an issue with Genetic Testing,?

A

Genetic testing costs can be significant.

Most insurers WILL cover part or all of the testing costs, though there are often strict eligibility criteria established by insurance companies, and these costs will differ between plans.

Individuals should be aware of financial costs prior to obtaining Genetic Testing.

138
Q

In what way can Genetic Counseling be an issue with Genetic Testing,?

A

Genetic counseling may be a time-intensive process to ensure that the individualized, complete education is understood by the person looking for information and/or screening.

139
Q

What is of the utmost importance when with obtaining Genetic Testing?

A

Obtaining informed consent, with a clear understanding of risks and benefits.

140
Q

In regards to Genetics & Genetics testing, what are four Roles for a General Oncology Nurse?

A
  1. Perform risk assessments (including personal, medical, occupational, environmental, and family history) using established risk assessmetn tools
  2. Refer families with a genetic predisposition to a genetic healthcare professional
  3. Assist to implement recommendations prescribed by the genetic professional
  4. Provide psychosocial support and encouragement for patients and families pursuing genetic testing.
141
Q

In regards to Genetics & Genetics testing, what are six Roles for an Advance Practice Nurse?

A
  1. Perform risk assessments and identify factors that suggest a hereditary predisposition
  2. Initiate data collection for a three-generation pedigree
  3. Answer general questions about genetics
  4. Refer at-risk familites to a genetic healthcare professional
  5. Provide psychosocial support
  6. Assist with evaluating and monitoring the impact of genetic testing and recommended screening and preventative measures.
142
Q

In regards to Genetics & Genetics testing, what are ten Roles for an Advance Practice Nurse with Subspecialy in Genetics?

A
  1. Conduct in-depth assessment of family history
  2. Construct pedigrees with cancers verified thorugh medical records and death certificates
  3. Assess patient’s risk of having a specific mutation, and evaluate eligible/appropriate genetic testing
  4. Provide genetic counseling, including pre-and post-testing counseling PRN
  5. Provid info. to ensure informed consent regarding the strengths, risks, and limitations of testing
  6. Conduct physical assessments from a genetics perspective
  7. Coordinate follow-up care based on genetics testing results
  8. Assess and develop strategies to facilitate coping with any adverse psychological consequences of a diagnosis of a hereditary cancer syndrome
  9. Identify other family members who might benefit from genetic testing
  10. Assist with enrolling families with unusual syndromes in research studies
143
Q

What are eight elements indicating Heriditary Predisposition for developing cancer?

A
  1. Cancer a a young age
  2. More than one primary cancer in one person
  3. Evidence of autosomal dominant inheritance (2(+) generations affected both M & F)
  4. Bilateral cancer in any paired organ
  5. Any pattern of cancer associated with a known cancer syndrome
  6. Cancer occuring more frequently in a family than expected by chance in the absence of known environmental and lifestyle risk factors
  7. Multifocal cancers in an organ
  8. A cluster of the same cancer in close relatives
144
Q

What is autosomal dominant inheritance?

A

Two or more generations

145
Q

What is absolute risk?

A

the Chance that a person will develop a disease within a preiod of time, often expressed as a percentage.

Applies to a population rather than an individual

146
Q

What is Relative risk?

A

Compares risk between people who have a particular risk factor and another group that does not have the same risk factor. Both types of risks are considered when providing education in terms of screening and/or lifestyle modification

147
Q

What are the three types of Genetic Testing results?

A

Positive (predisposition, increased risk)

Negative (no risk elevation)

Indeterminate significance

148
Q

If Genetics Testing reveals Positive findings (predisposition, increased risk), what are additional items discussed

A

Follow-up screening

lifestyle modification

prevention strategies

-> results may have implications for others in the family

149
Q
A
150
Q

List 7 examples of neuroendocrine tumors, tumors that form from cells that secrete hormone based on signals from the nervous system.

A

Seven examples of neuroendocrine tumors are:
1. carcinoid tumors
2. islet cell tumors
3. medullary thyroid cancer
4. pheochromocytomas
5. neuroendocrine carcinoma of the skin (Merkel cell cancer)
6. small cell lung cancer
7. large cell neuroendocrine carcinoma (a rare type of lung cancer

151
Q

Tumor Marker
CA125
Useful to detect which type of cancer

A

CA125
Useful for ovarian cancer diagnosis and monitoring in conjunction with other testing

152
Q

Tumor Marker
Alpha-Fetoprotein or AFP

A

Alpha-Fetoprotein or AFP Informative for distinguishing between various types of germ cell tumors, especially when used together with measurement of B-Human chorionic gonadotrophin (B-hCG)

153
Q

Tumor Marker
Carcinoembryonic antigen (CEA)

A

Carcinoembryonic antigen (CEA) Can be elevated in
- colorectal
- breast
- lung
however, elevated levels are not tumor specific but can still be of prognostic or monitoring value

154
Q

Tumor Marker
Tissue estrogen and progesterone receptors

A

Tissue estrogen and progesterone receptors
Have prognostic utility for the treatment of breast
cancer, as test-positive individuals are responsive to antiestrogen therapies

155
Q

Tumor Marker
Tissue HER-2/neu

A

Tissue HER-2/neu
Useful in assessment of breast cancer patients for possible treatment with Herceptin

156
Q

Name Tumor Markers for Prostate cancer

A

PSA
Prostate acid phosphatase

157
Q

Name Tumor Markers for Breast cancer

A

CA15-3
CA27.29
HER-2/neu (if taking Herceptin)

158
Q

Name Tumor Markers for Ovarian cancer

A

CA125

159
Q

Name Tumor Markers for Pancreatic cancer

A

CA19-9

160
Q

Name Tumor Markers for Colorectal cancer

A

CEA
CEA = also some limited utility for monitoring breast and lung cancers

161
Q

Name Tumor Markers for
Nonseminomatous testicular cancer

A

AFP (Alpha-Fetoprotein)

162
Q

Name Tumor Markers for
Thyroid cancer

A

Thyroglobulin (contraindicated if the individual has autoantibodies)

163
Q

Lung cancer

What rank for cancer diagnosis? (ie 1st, 5th, etc)

What rank for cancer death?

Compare incidence/death rate:
M vs F
- Caucasian
- African American
- Hispanic

A

Lung cancer:

  • 2nd leading cancer diagnosis
  • 1st leading cause of cancer death

MEN (2016)
- African Americans had the highest incidence (68.1 per 100,000) and death rate (55.3 per
100,000) for lung cancer
- Caucasians second highest in both categories (58.8 and 47.1 per 100,000, respectively).

WOMEN (2016)
- Caucasians had the highest incidence rate (49.6 per 100,000) and death rate (33.2 per 100,000)
- African Americans second in both categories (42.1 and 29.8 per 100,000, respectively).

HISPANIC (2016)
Both sexes had the lowest incidence and death rates

164
Q

Nonanalgesic adjuvant drugs may be useful in supplementing pain control.

Name 3x Anticonvulsants commonly used to supplement pain control.

What TYPE of pain are anticonvulsants best used to aid?

A

Anticonvulsants:
- gabapentin (Neurontin)
- phenytoin (Dilantin)
- carbamazepine (Tegretol)

May have activity in neuropathic pain such as brachial or lumbosacral plexopathies or chemotherapy-induced neuropathies

165
Q

Nonanalgesic adjuvant drugs may be useful in supplementing pain control.

Name 2 Antidepressants commonly
used adjuvants

A

Antidepressants:
- amitriptyline (Elavil)
- nortriptyline (Pamelor)

Commonly used nonanalgesic pain adjuvants.

166
Q

Nonanalgesic adjuvant drugs may be useful in supplementing pain control.

Name 1x NMDA (N-methyl-d-aspartate) antagonist with use for neuropathic pain

A

NMDA (N-methyl-d-aspartate) antagonist:
- Ketamine

Use for neuropathic pain

167
Q

Name a synthetic opiate
where its use is discouraged in oncology patients.

Why is its use discouraged?s

A

Meperidine (Demerol) = a synthetic opiate where its use is discouraged in oncology patients.

Discouraged because its metabolite normeperidine may accumulate and cause CNS toxicity

168
Q

Name 3x neurotransmitters released by tissue damage (contributing to perception of pain)

A

Bradykinin
Substance P
Prostaglandin

169
Q

Opiates: What is drug tolerance?

Is tolerance addiction?

A

Tolerance = a state in which the dose must be increased to achieve a good clinical results. All opiate drugs continuously taken will lead to tolerance.

No: tolerance is not addiction.

170
Q

Opiates: What is drug dependence?

Name 5x physical symptoms of withdrawal

Is dependence addiction?

A

Drug dependence is common in long-term opioid therapy; it is
characterized by physical withdrawal syndrome on immediate cessation of the drug or the administration of
an antagonist.

Rapid withdrawal may lead to:
1. exacerbation of pain
2. shivering
3. nausea and vomiting
4. muscle spasms
5. host of unpleasant physical effects.

No: dependence is not addiction.

171
Q
A

True addiction implies the repetitive use of opioids to satisfy
a psychic craving, a drug-centered lifestyle, and continued use despite physical and socioeconomic harm