Exam 2: Neoplasms Flashcards
1
Q
Define neoplasia:
A
uncoordinated/unregulated growth due to lack of regulatory mechanisms
2
Q
What is the #1 cancer in the world?
A
skin cancer
3
Q
What is the #1 cancer COD for men and women?
A
lung cancer
4
Q
76% of cancer cases are diagnosed after the age of:
A
55
5
Q
What is the cancer 5 year survival rate?
A
65%
6
Q
Cancer is the ______ COD in the USA
A
second
7
Q
Who are cancer rates higher in?
A
males
8
Q
Cancer incidence & mortality rates are highest in:
A
blacks
9
Q
The survival rate for cancer is dependent on?
A
○ Poverty ○ Access to care ○ Poor health when diagnosed ○ Comorbidities ○ Differences in cell/tumor biology ○ Type of cancer ○ Staging at diagnosis ○ Treatment available
10
Q
What is invasive growth?
A
When cancer cells are able to grow into different/adjacent tissues (Normal cells cannot do this (bladder cells can’t extend into the pelvic wall)
11
Q
What occurs during cell proliferation?
A
○ Tissues acquire new cells through mitosis
○ Increase in the number of cells as a result of cell division
12
Q
What occurs during cell differentiation?
A
○ Proliferating cells are transformed to specialized cells. They have a specific function (ex: hepatic cells, muscle cells, etc.)
13
Q
What is cell apoptosis?
A
○ Normal programmed cell death that is used to eliminate old, damaged, excess cells
14
Q
What is neoplasm?
A
An increase in neoplastic cells due to uncontrolled proliferation w/ invasion into surround tissues (they avoid the apoptosis process and continue to grow, divide, and live)
15
Q
The most common cancer sites for males and cancer related death are:
A
- prostate
- lung
- colorectal
16
Q
The most common cancer sites for women and cancer related death are:
A
- breast
- lung
- colorectal
17
Q
These cells are referred to as reserve cells and remain incompletely differentiated throughout their lifetime (dormant until an appropriate stimuli causes them to proliferate)
A
stem cells
18
Q
What are 2 important features of stem cells?
A
○ Self-renewal
○ Potency
19
Q
What is meant by stem cell self renewal?
A
stem cell can undergo various mitotic division while remaining undifferentiated
20
Q
What is meant by stem cell potency?
A
the varying ability of stem cells to differentiate into specialized cell types
21
Q
Stem cells can treat cancer and are typically used in what conditions:
A
- spinal cord injuries to help the neurons regenerate
- diabetes
- parkinson’s
- muscular dystrophy
22
Q
Describe some characteristics of cancer cells:
A
- they have lost the need for growth factors
- they can divide with no limit (crowding out normal cells)
- they can continue to divide with DNA damage
23
Q
The action of a drug is exerted in a:
A
specific phase of the cell cycle
24
Q
What stage of the cell cycle does Methotrexate interfere?
A
with DNA synthesis (G1)
25
The cell cycle nonspecific phase:
○ Exert drug effect on all phases of the cell cycle
| ○ Can act in the Resting State, DNA synthesis, or during mitosis
26
During combination chemo, combination of the cell cycle is:
Specific & Nonspecific (ex: ABVD used to treat Hodgkin's Lymphomas)
27
Benign tumors can grow:
by expansion w/o invading other tissue and is encapsulated (well differentiated)
28
Malignant tumors can grow:
by invasion and infiltrates surrounding tissue
29
Which tumors have the ability to expand by metastasis?
malignant tumors
▪ they access the blood, lymph, etc. to spread to other parts of the body
▪ they retain the characteristics of the original cell site (lung cells will have same cell characteristics as ovarian cells when they spread)
30
These cells are well differentiated cells and represent normal cells of that organ
benign
31
These cells are poorly differentiated (less time to grow):
malignant
32
What is the rate of growth for benign tumors?
▪ Progressive/slow
| ▪ Can regress and stop growing altogether
33
What is the rate of growth for malignant tumors?
▪ Depends on the level of differentiating
| ▪ The more undifferentiated the cells are, the quicker it grows
34
What is the mode of growth for benign cells?
▪ Don't invade.
▪ Grow by expansion
▪ Usually encapsulated or contained
35
What is the mode of growth for malignant cells?
▪ Invade other tissues, lymph & blood
36
What is metaplasia?
chronic irritation or injury that causes a change in the type of adult cells in that tissue (ex: smoker's squamous cell epithelium results in changes in the types of cells of the esophagus)
37
Barret's esophagus is at an increased r/f:
cancer
38
What is dysplasia?
alteration in the adult cell size, shape, organization, and number of cells (cervical cancer - PAP smears)
39
What are the 6 hallmarks of cancer?
1. self-sufficiency in growth signals
2. insensitivity to anti-growth signals
3. evading apoptosis
4. limitless replication potential
5. sustained angiogenesis
6. tissue evasion and metastasis
40
During the in situ stage of cancer, what is occurring?
This is early stage cancer where the neoplasm is confined to the original site and hasn't spread to surrounding tissue/organs (malignant cells haven't crossed basement membrane )
41
What treatment options are available during the in situ stage of cancer?
- surgical removal (with very low chance of reoccurring)
| * cervical in situ cancer = 100% survival rate
42
What is carcinogenesis?
process by which carcinogens cause normal cells to become cancer cells
43
Carcinogens can be:
- chemical
- physical
- biological
44
Colon cancer can be caused by diets high in:
fats
45
Diets high in nitrates results in:
high incidence of cancer
46
What are the phases of carcinogens?
- initiation
- promotion
- transformation
- progression
47
What occurs during the initiation stage of carcinogenesis?
▪ Carcinogen is introduced to the tissues
| ▪ Produces change in the genome of the normal cell
48
What occurs during the promotion stage of carcinogenesis?
▪ Induction of unregulated/accelerated growth in cells that have already been
initiated by growth factors or chemicals
▪ Reversible if you remove the carcinogens
49
What occurs during the transformation stage of carcinogenesis?
▪ Cell changes to a non-normal cell
▪ Escapes normal control mechanisms
▪ Increase in growth
▪ Changes in the cell membrane/surface
50
What occurs during the progression stage of carcinogenesis?
▪ Cells acquire malignant phenotypes
▪ Can promote cell proliferation
▪ i.e. can lead to metastasis
51
What is angiogenesis?
Where a tumor is causing new vessels to be produced to allow tumor to grow (making of new blood vessels)
52
In Control of Cell Replication, cancer cells:
have to ability to grow indefinitely (mitosis)
53
What gene is activated in DNA damaged genes to initiate apoptosis?
TP53 gene
54
What is proto-oncogenes?
○ Normal genes that become cancerous if they are MUTATED (they encode for growth factors)
55
How can proto-oncogenes cancer genes be mutated?
▪ Chromosomal Translocations
| ▪ Gene Amplifications
56
What occurs during chromosomal translocations and what are some examples?
□ Genes move from one chromosome to another
- Burkitt Lymphoma
- Chronic Myelogenous Leukemia
57
What occurs during gene amplifications and what are some examples?
Multiple copies of genes enhance gene expression which can increase cell
proliferation
- ex: breast cancer
58
What is the patho of cancer?
- Genetic damages causes cells to mutate
- Cell's revert from a differentiated state to an undifferentiated state
- Proliferation of cells is continuous (Proliferation = time it takes for the tumor to double in size)
59
What particular genes are involved in breast cancer?
BRACA 1 and BRACA 2
60
What hormone may contribute to the development of breast, ovary and endometrium cancer?
estrogen
61
Testosterone may cause what type of cancer?
- prostate
| - testicular
62
Kaposi sarcoma is associated with which condition?
AIDS and is considered a marker for undiagnosed HIV
63
Who is cancer more common in and why?
elderly due to decreased immune system
64
What does immunotherapy do?
heightens the persons immune response (can be given with chemo)
65
What are the anatomic classifications of cancer?
- carcinomas
- sarcomas
- adenocarcinomas
66
The carcinomas classification:
Originate in epithelial or mucosal tissues
| Ex: Basal Cell Carcinoma (skin cancer
67
The sarcomas classification:
Originate in bone, muscle, or nerve
| Ex: Osteogenic sarcoma (bone cancer
68
The adenocarcinomas classification:
▪ Adeno = Glands
| Ex: Lymphoma, melanoma, etc.
69
What is required to determine the histologic class of cancer?
a microscopic exam
70
What is examined during a microscopic exam?
- the level of differentiation
- rate of mitosis
- number of normal cells
71
This grade has mild dysplasia and differs very little from normal cells:
grade 1
72
This grade has immature cells (rapid, unregulated growth) and the cell origin is difficult to determine:
grade 4
73
25% of the time, lung cancer is __________
ASYMPTOMATIC
74
What are the s/sx of lung cancer?
```
○ Difficulty breathing
○ Wheezing breath sounds
○ Hoarseness
○ Chest pain, back pain, shoulder radiating pain
▪ "Cancer" Pain usually
occurs in the later stages of
cancer
```
75
What are some early warning signs of cancer?
- Unusual bleeding/discharge
- Un-healing lesions
- Change in bowel habits
- Nagging cough / hoarseness
- Lumps
- Changes in moles/lesions
- Dysphagia
76
What is the purpose of staging cancer?
helps determine how far it's spread (how large the tumor is), the prognosis and treatment plan
77
In this stage (the very earliest stage) cancer is completely curable if removed
Carcinoma In Situ
78
What does the TMN method stand for?
tumor, lymph nodes, metastases
79
The "T" in TMN is staging of the:
- the size of the tumor (in cm)
| - 0-3 (3 is the worst meaning the tumor is so large, it has spread out of the organ tissues)
80
The "N" in TMN is staging of the:
▪ Regional lymph node involvement (cancer normally metastasizes into the nearest lymph nodes within the same region/compartment)
81
Breast cancer can spread to:
axillary lymphs
82
What is the rating for "N" in TMN?
▪ N = 0 (0 lymph nodes involved)
▪ N 1 = few nodes are involved
▪ N 2 = systemic (multiple nodes are involved)
83
What is the ranking for "M" in TMN?
▪ Absent or present
▪ M 0 = no metastasis
▪ M 1 = metastasis to one organs
▪ M 2 = metastases are everywhere (different organs are effected)
84
A low grade cancer cell indicates:
slow, progressive, less aggressive
85
A high grade cancer cell indicates:
rapid growth, poorly differentiated
86
Why do nurses need to know stage and grade of cancer cells?
▪ To know their pain per pt subjective data
▪ Stage and Grade affects the Rx plan (VERY RIGID and SPECIFIC and INDIVIDUALIZED per pt)
▪ Need to have psychological implementations to comfort them
87
What are the risk factors for cancer?
- Heredity
- Hormonal Factors
- Immunologic factors
- Environmental/Chemical
Carcinogens
> Oncogenic Viruses (HPV =
cervical cancer)
> Smoking and secondhand
smoke
> Lifestyle factors
> UV radiation
> Occupational carcinogens
88
What dietary factors are implicated in cancer?
▪ Foods fried in used oil (multiple times)
▪ Nitrates in smoked/cured meats
▪ Fatty red meats
▪ Low fiber intake
▪ High fat diets (associated with colon cancer)
89
Tobacco contains both:
- pro-carcinogens (interfere w/ cell regulatory controls)
- promoters (change
the genetic expression)
90
What cancers are associated with smoking?
- Lung
- Laryngeal
- Head/neck cancer
- Pancreas
- Uterine
- Cervical
- Bladder
* smoking is related to 30% of all cancer deaths/87% of lung cancer deaths
91
What are the s/sx of most solid tumors?
- anemia
- anorexia & cachexia (muscle wasting)
- fatigue and sleep disorders
- compression/obstruction of tissues/organs
- pain (not an early symptom, normally associated with late stages of cancer)
- psychosocial integrity & QOL
92
In anemia of cancer patients, what is occurring?
○ Decreased RBC level
○ Tumors is drawing up normal amount of blood and making the body anemic
○ Bone marrow suppression
93
How is cancer diagnosed?
- Biopsy, XR, CT, endoscopies
| - Tumor markers
94
What are tumor markers?
Sampled via blood test that targets antigens expressed on the surface of tumor cells (or substances released from normal cells when tumor cells are present)
95
When are tumor markers used?
▪ Screening
▪ Establishing prognosis
▪ Monitor/evaluating treatment plan effectiveness
▪ Detecting recurrent disease
96
What is carcinoembryonic antigen (CEA)?
▪ Source of embryonic tissue of the gut and pancreas that is used in suspected Colorectal, Pancreas, Stomach cancers
97
What is the marker for ovarian cancer and produced by ovarian cells?
CA-125
98
What is PSA?
▪ Prostate Specific Antigen (Produced by epithelial cells of prostate) and is a marker for prostate cancer and should be UNDETECTABLE
99
What are some treatment options for cancer?
- surgery
- radiation
- chemo
100
This is the oldest RX for cancer and can be used to diagnosis, stage, remove tumors or palliative
surgery
101
what is the first choice treatment for solid tumors?
surgery
102
What occurs during raditaion?
rapidly proliferating and poorly differentiated cells are killed off by radiation (doesn’t affect normal tissues)
103
What is the side effects of radiation?
- PRIMARY = fatigue
- bone marrow suppression causing anemia (this also decreases neutrophils causing neutropenia which places pt at risk for infection)
- xerostomia (dry mouth)
- hair loss
- skin burns (do not use lotion on these area. can cause severe damage to the skin when combine w/radiation)
104
What is one thing you should NOT do when caring for a patient who gets radiation?
wash off radiation lines
105
Which cancer treatment method is most effective against rapid proliferating cells?
chemo (specific/nonspecific/combo therapy)
106
What are some s/sx of chemo?
- anorexia, N/V, alopecia
| - bone marrow suppression
107
Why does hair fall out during chemo?
chemo targets rapidly dividing cells, therefore the hair is prevented from growing (hair is rapidly dividing)
108
Bone marrow suppression makes the pt more susceptible to:
- infection
- anemia
- hemorrhage
109
What are the 4 major classes of cancer drugs?
○ Cytotoxic agents (kill cells directly)
○ Hormones & Hormone antagonists (breast & prostate cancers)
○ Biological response modifiers
○ Targeted drugs (bind to specific molecules)
110
Chemo only applies to:
cytotoxic agents
111
These drugs kill cancerous cells or reduce the number of cells
Chemotherapeutic Drugs
112
What is combination therapy?
2-3 different drugs resulting in a more effective treatment option
113
What are the protocols of Chemotherapeutic Drugs?
○ Predesigned schedule of treatment plans
| ○ Very strict and individualized schedule of treatments
114
What are stomatitis?
sores in the mouth
115
What is a sentinel node?
initial lymph node the tumor has spread to
