class 5 cancer Flashcards
1
Q
Cell Death -2 major ways
A
Apoptosis
* Necrosis
2
Q
Foundational Concept:
Apoptosis
A
- Normal process to remove injured or
worn-out cells - Can be a normal physiologic process or a
result of a pathologic process - “Cell Suicide” – involves controlled cell
destruction and normal cell deletion and
renewal (ie) RBC’s - Process does not elicit an inflammatory
response
3
Q
Necrosis
A
- Cell death in an organ or tissue that is still
part of the living person - Interferes with cell replacement and tissue
regeneration - Pathologic form of cell death, unregulated
and injurious - Liquefaction necrosis
- Coagulation necrosis (Grey firm mass)
- Caseous necrosis (Cheesy material)
- Produces an inflammatory response
- An overgrowth of infectious agents can
create a decreased blood flow
4
Q
Gangrene
A
- A considerable mass of tissue undergoes
necrosis - Dry or moist (wet) gangrene
- Gas gangrene (Closteridium bacteria
invades)
5
Q
Angiogenesis
A
Is the formation of new blood vessels
6
Q
Angiogenesis-how is to connected to cancer
A
To divide rapidly and indefinitely tumor
cells need adequate supply of nutrients
- Cancer cells control angiogenesis and
establish their own blood supply - Solid tumors need to create a new
capillary network to “feed” themselves - Serves as a route for metastases (spread)
7
Q
Cell Proliferation
A
- Process of cell division (cell reproduction)
- Adaptive mechanism for replacing body
cells when old ones die
8
Q
cell proliferation- how it connects to cancer
A
…Cancer cells fail
to respond to the normal cues controlling
cellular reproduction. Instead, they
typically go through the cell cycle at an
increased rate and frequency. They have no contact inhibition
9
Q
Cell Differentiation
A
- Process where proliferating cells are transformed
into different and more specialized cell types - Determines what a cell looks like, how it will
function, and how long it will live - (ie) red blood cells live 120 day
10
Q
what cells cant reproduce and why
A
cardiac and neuron cells because they are fully differentiated
11
Q
Neoplasia
A
- Defects in these two processes, cell
proliferation and cell differentiation
underlie the nature of neoplasia - New growth = Neoplasm
12
Q
Anaplasia
A
- Lack of cell differentiation, occurs in
cancerous tissue - Causes a cancer cell to lose its ability to
perform previous functions and bears
little resemblance to its tissue origin - Highly anaplastic cells usually indicate a
particularly aggressive tumor
13
Q
What is a benign tumor? and how do they cause harm
A
A non-cancerous growth that does not invade nearby tissues or spread to other parts of the body.
Rarely causes death
Causes harm by putting pressure on the
surrounding tissues
14
Q
What are common characteristics of benign tumors?
A
Slow-growing, well-defined, encapsulated, non-invasive, and non-metastatic.
15
Q
What is a malignant tumor?
A
A cancerous growth that can invade nearby tissues and spread to other parts of the body. Less well-differentiated cells- anaplastic
16
Q
What are the characteristics of malignant tumors?
A
invasive growth, potential for metastasis, irregular shape, rapid growth, and diverse cell types.
17
Q
Name the four main types of malignant tumors.
A
Carcinomas, sarcomas, lymphomas, and leukemias.
18
Q
What is a carcinoma?
A
A malignant tumor that arises from epithelial cells, such as breast or lung cancer.
19
Q
What are sarcomas?
A
Cancers that originate from connective tissues like bones, muscles, and fat.
20
Q
Oncogenes
A
An oncogene is a gene that has the potential to cause cancer. In tumor cells, they are often mutated and/or
expressed at high levels. Problem when turned”on”
21
Q
Tumor suppressor genes
A
genes in the body that help regulate cell growth and division, prevent excessive cell proliferation, and repair DNA.
When these genes function properly, they act as “brakes” on the cell cycle, ensuring that cells do not grow uncontrollably. If these genes are mutated or inactivated, it can lead to cancer.
22
Q
Repair or mutator genes
A
These genes help correct errors that can occur during DNA replication or as a result of environmental factors like radiation and chemicals. When these genes are mutated or malfunctioning, the ability of cells to repair DNA is compromised, leading to an increased risk of cancer.
23
Q
3 main types of carcinogens
A
- chemical carcinogen
- physical carcinogen (radiation)
- infectious pathogen (viral)
24
Q
2 Types of Cancer
A
- Solid Tumors
- Confined to a specific tissue or organ
- Able to metastasize to another site
- Hematologic Cancer (systemic)
- Involves blood-forming cells that are
naturally located in blood and lymph
systems - Disseminated from the beginning
24
3 ways Cancer is Spread
* Direct invasion and extension (into
surrounding tissue)
* Seeding (into body cavity)
* Lymphatics and vasculature carry cancer
cells from one part of the body to
another(metastases)
24
impairment or decline in the
surveillance capacity of the immune
system, 3 factors
* Immunosuppressant drugs
* Immunodeficiency disease
* Aging immune system
25
Steps of Metastasis
Break loose from primary tumor
Invade the extracellular matrix
Gain access to a blood vessel (or
lymph)
Survive its’ passage in the bloodstream
Emerge from the bloodstream (or
lymph) at a favorable location
Invade the surrounding tissue & grow
25
Clinical Manifestations of cancer
* Anemia
* Compress and erode blood vessels resulting in ulceration (losing blood)
* Pain (palpable mass)
* Invades and compresses adjacent tissue
(crowding, crushing, obstruction)
* Loss of function
* Variable depends on site
-immunocompromised gets sores in mouth that are very painful
-extreme fatigue
26
Cachexia
* Weight loss and wasting of body fat due to:
* N/V, mouth sores, altered taste
* Depression or pain
* Loss of appetite (anorexia)
* Leads to weight loss and malnutrition
* Tissue necrosing factor hormone
-takes away muscle mass and fat stores
26
fatigue in cancer patients cause
* The increased metabolic demands of dividing cells
* Toxic response to chemo
* Emotional drain
* Often is anemic
*Takes nutrients from other cells
27
What are paraneoplastic syndromes?
Disorders triggered by cancer that are not directly caused by the tumor itself, often due to immune responses or substances produced by the tumor.
28
How do paraneoplastic syndromes arise?
They can arise from hormones or substances produced by the tumor or from the immune system's reaction to the cancer.
29
Diagnostic tests
* History and physical examination
* Imaging studies
* Biopsy and cytology studies
* Tumor markers and other blood, urine or
tissue tests
30
What are tumor cell markers?
Substances produced by cancer cells or by the body in response to cancer, found in blood, urine, or tissues.
Can help identify the type of tumor, monitor
its progression, and identify people at
high risk for this type of tumor
31
Stage & Grade of cancer
used to determine the best
treatment protocol for an individual.
32
Stage (TMN Classification System)
T- location and size of primary tumour; extent to which cells
have spread to neighboring tissues/structures {T 1-4}
* N- extent to which tumour cells have spread to lymph nodes
* M- extent to which distant metastases are present
33
what is grade of cancer
Describes degree of differentiation of cells and rate of
mitosis of cells
34
Staging of Solid Tumours (1-4)
*Stage 1: no lymph involvement, no mets and tumors are
less than 2 cm in size
*Stage 2: local lymph involvement, no mets and tumors are
less than 5 cm in size
*Stage 3: nodal involvement, no mets, tumors are over 5
cm
*Stage 4: nodal involvement, mets, tumors can be greater
than 5 cm.
35
Grading scale 1-4
Grade 1
* Cells well-differentiated
* Grade 2
* Cells moderately differentiated
* Grade 3
* Cells poorly differentiated
* Grade 4
* Cells are un-differentiated (de-differentiated)
36
2 main classifications of lung cancer
Non-Small Cell Lung Cancer (NSCLC)
This is the most common type of lung cancer, accounting for about 85% of all cases.
Includes squamous cell, adenocarcinomas, and large cell carcinomas
Small Cell Lung Cancer (SCLC)
This type accounts for about 15% of lung cancer cases and is more aggressive than NSCLC. It tends to grow and spread rapidly.
Small, round, to oval cells
Highly malignant (brain mets common)
37
Metaplasia
Replacement of one cell type with another cell type –one that can better endure the stressor or change
38
early stages of lung cancer
- cough/chronic cough
-dyspnea (SOB)
-hemoptysis (cough blood)
-chest and shoulder pain
- recurring temp
-recurring resp. infections/ always having a cold
39
late stages lung cancer
-bone pain/spinal cord compression
-chest pain/tightness
-dysphasia
-head and neck edema
-blurred vision and headache
-weakness, anorexia, weight loss, cachexia
-pleural effusion
-liver metastasised
40
why does hoarseness happen with lung ca
involvement of
the laryngeal
nerve
41
why does dysphasia happen with lung ca
because of
compression of
the esophagus
42
Diagnostic Tests for lung cancer
CXR
* CT Scans
* MRI
* Sputum cytology
* Fibreoptic bronchoscopy
* Transthoracic fine needle aspiration
43
colorectal cancers also known as
adenocarcinomas
44
Manifestations (Ca of Colon)
* Bleeding
* (occult or frank blood in the stool; highly
significant early symptom)
* Change in bowel habits
* Diarrhea, constipation
* Sense of urgency
* Feeling of incomplete emptying of the bowel
* Anemia
* Anorexia
* Weight loss
* Pain is a late symptom
45
Staging of Ca of Colon
I: Limited to invasion of the
mucosal & submucosal layer of the
colon
*II: Involves the entire wall of the
bowel without lymph node
involvement
*III: Invasion of the serosal layer &
regional lymph node involvement
*IV: Far-advanced metastases
46
Diagnosis of colon cancer
* Stool for occult blood
* (if 50 years of age or older
every 1-2 yrs)
* Digital rectal exam
* Barium enema
* Sigmoidscopy
* Colonoscopy (when + screening test)
* Carcinoembryonic antigen (CEA)
* If increased risk screen earlier and more often
47
Treatment of colon ca
* Prevention
* Increasing roughage (fruits, veges, & grains to
increase bulk; decrease fat, & provide
antioxidants
* Surgical removal
* ONLY RECOGNIZED Rx
* Preoperative radiation
* Post op chemo may be used
* Radiation & chemo also used as palliative
treatment methods
48
Pancreatic Cancer risk factors and side effects
* Risk factors
* Smoking (major risk factor)
* Pancreatitis and dietary factors
* Adenocarcinoma—most common form
* Arises from the epithelial cells in the ducts
* Symptoms
* Pain
* Jaundice
* Weight loss
* Usually far-advanced when diagnosed and most have metastasized
49
Hepatocellular Carcinoma risk factors and symptoms
- the most common type of primary liver cancer and typically arises in the context of chronic liver disease, such as cirrhosis.
* Risk Factors
* Chronic hepatitis
* Cirrhosis
* Long term exposure to hepatocarcinogens
* Symptoms
* Insidious onset
* Weakness, anorexia, fatigue, vomiting
* Bloating, Fullness, Dull, aching abdominal pain
* Ascites, Jaundice, Hepatomegaly
* Portal hypertension and splenomegaly are common
* Elevated Liver enzymes and Alpha-fetoprotein (AFP)
50
Treatment of Advanced
Cancer
* Often it is palliative
* Surgery
* When localized or as a palliative
treatment
* Radiation/Chemo
* PAIN Control - IMPORTANT
51
blood cancer effects what
Blood cancer can affect blood, bone
marrow and lymph nodes. People with
blood cancer have abnormal production
of blood cells, particularly white blood
cells
52
what 2 paths does leukemia effect
myeloid or lymphoid
53
hematopoietic stem
cells
type of stem cell responsible for the formation of blood cells. They are found primarily in the bone marrow and play a crucial role in the body’s hematopoiesis, the process by which blood cells are produced.
54
what causes bone marrow failure
Immature, nonfunctional, cancerous stem cells proliferate to the point where normal stem cells are replaced with them = crowding of bone marrow with leukemic cells = bone marrow failure
55
Pathogenesis - Leukemia (how it develops)
* Leukemic cells interfere with the maturation of normal bone marrow cells: immature WBCs, suppressed production of erythrocytes (RBC’s) & platelets
* Leukemic cells proliferate in the bone marrow, circulate the blood, and infiltrate the spleen, lymph nodes and other tissues
* Disseminated from the onset: A diffuse cancer, no localized solid mass
56
Classification of Leukemia
According to their predominant cell type
(lymphocytic or myelocytic)
AND
Whether the condition is acute (immature cells) or chronic (more differentiated cells)
57
acute leukemia
A type of cancer characterized by the rapid proliferation of immature myeloblasts or lymphoblasts; therefore the cells are not developing into mature cells.
58
Hallmark of acute leukemia
the presence of blast cells (immature
cells)
59
What is chronic leukemia?
A type of cancer characterized by the slow accumulation of relatively mature but dysfunctional blood cells in the blood and bone marrow.
60
Acute Lymphocytic Leukemia (ALL)
Most common cancer in children & adults
61
Acute Myleocytic Leukemia (AML)
Mainly seen in adults (but also in children
& young adults) and Those with Down’s Syndrome
62
Chronic (mainly affects adults, insidious onset) both types
Chronic Myleocytic Leukemia (CML)
Chronic Lymphocytic Leukemia (CLL)
63
pancytopenia
a condition where you have low levels of red blood cells, white blood cells, and platelets, leading to fatigue, infections, and bleeding issues. It can be caused by problems in the bone marrow, destruction of cells, nutritional deficiencies, or infections.
can be acquired or inherited
chemo sensitive
64
Manifestations – Acute Leukemia –AML & ALL
* Abrupt onset
* Anemia (Decrease erthrocytes)
* Weakness, fatigue, pallor
* Thrombocytopenia (reduced platelets)
* Easy bruising
* Increased number of nonfunctional WBC’s (risk of infection)
* Fever, Night sweats, Weight loss
* Bone pain (due to bone marrow expansion)
* CNS involvement (HA, N&V, seizures, coma)
* Lymphadenopathy, splenomegaly, hepatomegaly – due to infiltration of leukemic cells
65
chronic leukemia
* Patients present more insidiously
* If a patient presents at a “routine check up” it is much more likely to be chronic leukemia
* Less likely to present with pancytopenia;
often asymptomatic
* Less chemo sensitive
* Best initial test is a full blood count
* WBC high (immature and non-functional)
* Look at the white blood cell differential
* Smudge cells in CLL on smear
66
CML manifestations
no symptoms early on, symptoms
similar to the acute form but S&S less severe (anemia, thrombocytopenia, fatigue,
weakness, splenomegaly, bone pain, increase diaphoresis & heat intolerance, (+) for Philadelphia chromosome
67
CLL manifestations
– no symptoms early on; fatigue
anorexia, lymphadenopathy, splenomegaly,
hepatomegaly, anemia, thrombocytopenia,
fever, weight loss, lymphocytosis (increase
in lymphocytes is the Hallmark symptom;
but they are incompetent lymphocytes
68
Diagnostic tests leukemia
* Complete Blood Count (CBC)
* Most leukemia WBC are high
* Hct, Hgb, plt are low
* CT scan shows collection of leukemic cells outside the blood or bone marrow (ie) infiltrates in the meningial tissue
* Bone marrow biopsy for blasts or abnormal levels of
lymphocytes
69
LAD = Lymphadenopathy
swelling of lymph nodes
70
Local large node (LAD) is a sign of
draining infection
71
Treatment - Leukemia
* Chemotherapy – is used PRIOR to Bone Marrow Transplant
* Radiation – localized (ie. spleen or lymph nodes), cranial, total body
* BMT – remove/destroy pt BM replace with donor stem cells
* Antibiotic therapy to treat infections
72
Lymphoma, what is it and where does it start
Malignant neoplasms of cells native to
lymphoid tissue and spleen
* Like the leukemias, lymphomas are derived from WBCs mainly the lymphocytes and lymph tissues
* Usually start in lymph nodes but can infiltrate lymphoid tissue
* Spread to spleen, liver, bone marrow
* Does produce a mass lesion or solid tumor
usually in lymph node
73
2 Types Lymphoma
Hodgkins Lymphoma (HL)
Non-Hodgkins Lymphoma (NHL)
74
Hodgkins Disease hallmark for diagnosis
presence of reed Sternberg cells
75
Hodgkins Disease -
Manifestations
Arises in a single node and spreads to other
nodes (cervical and mediastinal mostly)
* Usually starts with a large painless mass in the neck, above the diaphragm (lymphadenopathy)
* Feeling ill: pruritis, fever, night sweats chills, anorexia, cachexia, unexplained weight loss, fatigue, lethargy, anemia, impaired immune function, increase incidence of infection (leukocytosis); enlarged spleen and liver may also be detected
76
Non-Hodgkins Lymphoma
(NHL)- Manifestations
* More common than Hodgkins Lymphoma
* Multicentric in origin
* Sporadic spread through lymphatics & vascular system
* S&S similar to those of Hodgkins
* Increased susceptibility to infections
* Reed-sternberg cell is ABSENT
77
Lymphoma
Treatment
Active surveillance, chemo, radiation,
bone marrow transplant, immunotherapy
78
What is multiple myeloma?
A type of cancer that affects plasma cells in the bone marrow, leading to the production of abnormal antibodies.
79
What are the common symptoms of multiple myeloma?
Bone pain, fractures, fatigue, frequent infections, hypercalcemia, ANEMIA, weight loss, weakness
80
multiple myeloma hallmark for diagnosis
(+) Bence Jones Proteins in urine
81
Radiation
used to
* Destroy tumor cells,
* Shrink the tumor
* Palliation
However kills all cells not just cancer cells
82
Surgery
used for
* Diagnosis & staging
* Tumor removal
* Palliation
83
Hormonal agents
Meds used to alter hormonal
environment of cancer cells negatively.
Used for tumors who are using hormones to grow
84
Biotherapy
Altering one’s immune response to
cancer
Immunotherapy & Biologic response
modifiers (ie. interferon)
85
CAM and nutritional treatment
CAM includes a variety of health care practices, products, and systems that are not part of standard medical care. This can include herbal remedies, acupuncture, yoga, meditation, and more
86
Three Primary Goals:
Cure
* Permanent removal of cancer cells
* Early detection: small, localized
Control
* Preventing growth and spread of tumor
* Cure is no longer possible: tumour has
metastasized
Palliate
* Pain and symptom management
* Advanced stages
* Chemotherapy may still be used to
reduce the size of tumours
87
what is Chemoprophylaxis
* Taking a drug to prevent cancer
* Example: Tamoxifen
88
what is Radiation + Chemotherapy
* Most successful
* Fewest adverse effects
89
Adjuvant chemotherapy
* Antineoplastic drugs given AFTER
surgery or radiation
90
Neoadjuvant chemotherapy
* Antineoplastic drugs given BEFORE
surgery or radiation
91
Degree and severity of toxic effects
related to cancer treatment is affected
by:
Age
Nutritional status
Prior cancer drug treatment or
radiation therapy
92
Antineoplastic agents
drugs used to treat cancer by inhibiting the growth and proliferation of cancer cells. They work through various mechanisms and are categorized based on their action and chemical structure.
affect cells that
are undergoing rapid mitosis, thus
healthy cells that undergo mitosis are
also affected.
93
Myelosuppression
suppression of bone marrow activity
94
Antineoplastic agents effects on
healthy cells that undergo mitosis.
Ø Reduced production of RBC's,
WBC's and platelets
Ø Myelosuppression: suppression of
bone marrow activity
Ø Cell counts must recover so the
patient can receive chemotherapy
again.
95
what is nadir
The lowest blood count
following chemotherapy
Nadir time is 7-11 days after
chemo
Varies- depending on the
drug
High risk for bleeding and infection
96
The most reliable indicator of an
infection in cancer patients is
presence of fever:
febrile neutropenia
97
low platelets increase risk for
Because platelets are
involved in the process of
coagulation, risk of bruising and
bleeding increases when counts fall
below the normal range
98
Common signs often associated with
thrombocytopenia
include joint, soft
tissue or mucocutaneous bleeding,
retinal haemorrhage, petechiae,
ecchymoses, or skin necrosis
99
why are RBCs less effected by cancer treatment
Red blood cells (RBCs), or
erythrocytes, are least affected
by cancer drugs because their
average circulating life span is
considerably longer than that of
neutrophils or platelets (approximately
120 days)
100
contributing factors that lead to anemia
chronic disease, chronic blood loss,
inadequate nutrition, tumor invasion
into bone marrow, prior treatment.
101
symptoms of anemia
Pale, cool skin
Tachycardia (to contradict low RBC)
Chest pain
Headaches
Fatigue
May be attributed to other hematologic
effects, GI effects, anxiety and depression
Weakness
Low hemoglobin
Lack of oxygen
102
neurologic effects of chemo in CNS
Unsteadiness when walking
Muscle control/balance
Weakness/Overall lack of strength
Behavior changes
Confusion
Agitation
Dizziness
Seizures
103
neurologic effects of chemo in PNS
Peripheral Neuropathy
Muscle weakness
Peripheral neuritis
Incontinence
Erectile Dysfunction
104
Cranial Nerve Damage
Tinnitus
Vision changes Blurred vision
Double vision
Loss of vision Vincristine toxicity may present as blindness and must be reported promptly.
Weakness of face, tongue, neck or
shoulder
Slurred speech
Difficulty expressing oneself
Difficulty swallowing
Changes in taste or smell
105
Chemotherapy – Induced Peripheral
Neuropathy (CIPN):
CIPN refers to nerve damage caused by chemotherapy, affecting peripheral nerves, which can lead to sensory, motor, or autonomic dysfunction.
Must prevent thermal injury and falls
106
Antiemetics
work best when
given continuously rather than as
needed and should be administered
30 – 60 minutes before initiation of
chemotherapy to be effective.
107
Mucositis
Inflammation of the GI mucosa
Consequences of mucositis:
Painful ulcerations in the mouth and
esophagus
Difficulty eating or swallowing
GI bleeding
Intestinal infections
Severe diarrhea
Thrush
108
Anorexia
Major loss of appetite and aversion to
food
Usually due to nausea, vomiting, and/or
mucositis
May be the result of direct effects from
the tumor itself or from associated
psychological changes such as anxiety
and depression
109
Some chemotherapy drugs damage
the intestinal lining, causing what
inhibiting the reabsorption of fluids and producing
loose stools
110
Some chemotherapy drugs decrease
motility of the GI tract, resulting in
greater absorption of fluids, which
leads to constipation
111
how chemo effects cardiovascular
Some chemotherapy drugs can be
toxic to the heart
Patient will need to be monitored with
ECG
Patients need regular assessment for
signs of heart failure
Cardioprotective measures:
A cardioprotective drug (dexrazoxane) is
administered just prior to doxorubicin
infusion to prevent permanent heart damage
112
some chemo drugs cause what in the lungs, and treatments
Some chemotherapy drugs are known
for causing pneumonitis (lung
inflammation).
Management:
Pulse oximetry
Routine respiratory status
assessments
Regular chest auscultation
Chest X-rays, sometimes 2-3 times
per week to assess for lung changes
113
chemo effects on urinary system and management
Considerable nephrotoxicity with some
antineoplastics.
Kidney failure may occur if dosage limit
exceeded
Management:
Monitor intake and output closely
Diuretics as needed
Check urine for RBC's
Maintain good hydration throughout treatment
Consider administering a drug to prevent
hemorrhagic cystitis
Hyperuricemia
Most frequently associated with chemotherapy for lymphomas and leukemias due to rapid cell kill.
114
Signs of hyperuricemia
Nausea, vomiting, decreased urine out (oliguria)
115
Primary hyperuricemia:
Increased production of uric acid from
dietary purines
Overproduction and undersecretion of uric acid
116
Secondary hyperuricemia
If large numbers of cancer cells die rapidly,
they release significant amounts of uric
acid into the bloodstream, which the
kidneys are unable to eliminate quickly
enough.
Uric acid crystals deposited in the renal
tubules can lead to renal failure
117
What can occur if antineoplastics extravasate or infiltrate from an injection site?
Severe tissue and nerve damage, local infection, and even loss of a limb.
118
What is extravasation in the context of antineoplastics?
The leakage of a drug from a blood vessel into the surrounding tissue.
119
What are the potential consequences of extravasation of vesicants?
Serious tissue injury, nerve damage, local infection, and limb loss.
120
Management
of
Extravasation
Stop the infusion immediately
Leave the cannula in place to enable
aspiration of infiltrated drug and
administration of antidote through the
cannula
Elevate limb to reduce swelling
Do not apply pressure
Follow institutional protocols regarding
further interventions (most interventions
involve hot/cold compresses).
121
other effects of chemo
Fatigue
Common complaint, difficult to determine
cause
Allopecia
Hair loss usually begins within 1-2 weeks
of the first treatment and regrowth may
take 3-5 months after the last treatment
Development of secondary cancer
Usually, many years after the first
Children have 10-20 times greater risk
for developing a secondary malignancy
122
