LEC 10: Cancer Care Flashcards
Cancer
Uncontrolled and unregulated growth of cells
Risk Factors for Cancer
- Obesity, inactivity, unhealthy eating, excessive sun exposure, smoking
- Chemical, radiation, viruses, genetic susceptibility
What are types of occupations that are risk factors for cancer?
- Pilots
- X-ray technicians
- Working in nuclear plants
What viruses are risk factors for cancer?
- HPV
- HIV
- Hepatitis B and C
What are the two major process that contribute to cancer cells?
- Cell proliferation
2. Cell differentiation
Normal Cell Growth
- Cell growth
- Normal cell growth = Cells stay in a state of equilibrium during cell growth
- Normal cells respect boundaries of other cells
- Immature cells become mature cells
- Normally, the differentiated cell is stable and does not differentiate
Defects in Cell Proliferation
- Cancer cells do not respect boundaries of other cells
- Cancer cells are generated at the same rate as the cells of the tissue from which they arise
- Cancer cell division is haphazard
Defects in Cell Differentiation
- Cancer cells do not look and behave like mature cells
- Cancer cells revert to an immature cell and can look abnormal
- Proto-oncogens become oncogenes and tumour suppressor genes become inactive
Proto-Oncogenes
Promote cell growth and keep cell in the locked in mature state
Tumor Suppressor Genes
Inhibit cancer cell growth
Health Bodies
- In healthy bodies, we want proto-oncogenes and tumour suppressor genes BUT when there is a glitch in our systems simething triggers proto-oncogenes into oncogenes which let cells to differentiate (become immature)
- Oncogenes are bad - When there is a glitch in our systems, tumour suppressor genes become inactive and are not able to prevent cancer cells from growing
What are the 3 stages to cancer cell development?
- Initiation
- Mutation on cell’s genetic structure - Promotion
- Reversible growth of altered cells - Progression
- Increased growth, invasion, and metastasis of the cancer
What are the 3 things than can happen in the initiation phase?
- A cell can die if it is altered
- A cell can try and repair itself
- A cell can replicate as an altered cell
How big dose a cancer cell need to be in order to be directed by an MRI?
The growth or mass needs to be 0.5cm
- 1cm tumour = to 1 billion cancer cells
What is the role of the immune system in cancer cell recognition and destruction?
- Immune system distinguished between normal and abnormal cells
- Cancer cells can be perceived as abnormal (non-self) cells and destroyed OR
- Because cancer cells are mutated from normal cells- they can be perceived as ‘self-cells’ and response by immune system can be inadequate
Benign Tumour
Cells grow only locally and cannot spread by invasion or metastasis
-Not cancer
Malignant Cells
Invade neighbouring tissues, enter blood vessels, and metastasize to different sites
- Cancer
Metastasis
Movement of the cancer to another location
- There is different affinities depending on the cancers
Diagnostic Tests
- Cytology studies
- Blood-work
- Colonoscopy studies
- Radioisotope scans
- Assays for oncofetal antigens or genetic markers
- Bone marrow examiantion
- Biopsy
What are the 3 ways tumours are classified?
- Anatomical site (location)
- Histological analysis (grading)
- Extent of disease (staging)
What are the 4 anatomical sites that cancers can be described as?
- Carcinomas
- Sarcomas
- Lymphomas
- Leukemias
Carcinomas
Cancer of external or internal body surfaces
- Lungs, brast, colon
Sarcomas
Cancer of supporting tissues
- Bone, cartilage, fat, muscle
Lymphomas
Cancer of the lymph nodes
Leukemias
Cancer within the bone marrow and blood stream
Histological Analysis (Grading)
How abnormal the cell looks under a microscope and how quickly the tumour is likely to grow and spread
Grade I
- Cells differ slightly than normal cells
- Well differentiated
Grade II
- Cells more abnormal
- Moderately differentiated
Grade III
- Cells very abnormal
- Poorly differentiated
Grade IV
- Cells immature an dprimitive
- Undifferentiated
Extent of Disease (Staging)
Description of the extent of disease rather than on cell appearance
Stage 0: Cancer is instu
Stage I: Tumour limited to the tissue origin
Stage II: Limited local spread
Stage III: Extensive local and regional spread
Stage IV: Metastasis: has spread to the rest of the body
TNM Classification
Primary Tumour Size (T)
- T0: No evidence of primary tumour
- TIS: Carcinoma instu
- T 1-4: Ascending degrees of increase in tumour size and involvement
Involvement of Regional Lymph Nodes (N)
- N0: No evidence of primary tumour
- N 1-4: Ascending degrees of lymph node involvement
- Nx: Regional lymph nodes unable to be assessed clinically
Distant Metastases (M)
- M0: No evidence of distant metastases
- M1-4: Ascending degrees of metastatic involvement including distant nodes
Tumor Makers
- Substances produced by tumour cells, or other cells of the body, in response to cancer
- Can be found in the blood, urine, tumour tissue, or other tissues
- Different tumour markers are found in different types of cancers
- May be measured before treatment to help physicians plan appropriate therapy
What are the goals of care for cancer patients?
- Cure: eradicate the cancer
- Control: Can’t be completely removed, but are responsive cancer therapies
- Palliation: Relief or control of symptoms and optimization of quality of life
What are the 2 treatment options?
- Surgical therapy
- Cure and control; supportive and palliative procedures; rehabilitation - Chemotherapy
- Drug therapy
- Cure, control, and palliation - Radiation therapy
- High dose of radiation
- Cure, control, and palliation
*Can be used singularly or on combination; usually used in combination
Pain in the Patient with Cancer
- Causes of pain
- Tumours, medical procedures, treatments - Types of pain
- Based on the part of the body affected - Treating pain
- Non-opioids, adjuvants, opioids
Cancer Pain Relief Ladder
a. Non-opioids and/or adjuvant
- Pain persisting or increasing; move up
- Acetaminophen, NSAIDs, acetylsalicylic acid
b. Opioids for mild to moderate pain and/or non-opioids, adjuvant
- Pain persisting or increasing; move up
- Codeine, morphine
c. Opioids for moderate to severe pain and/or non-opioids, adjuvant
- Freedom from pain
- Morphine, hydromorphone, fentanyl
Psychosocial Care
- Establish therapeutic relationship
- Assess patient and family needs for counselling and referrals
- Actively listen to patient and family
- Offer strategies to enhance coping
- Provide information and answer questions
- Collaborate with patient and family to establish goals
- Maintain hope
- Consider spiritual aspects of care
- Encourage patent and family participation in care
