LEC 10: Cancer Care

Question 1

Cancer

Answer 1

Uncontrolled and unregulated growth of cells

Question 2

Risk Factors for Cancer

Answer 2

• Obesity, inactivity, unhealthy eating, excessive sun exposure, smoking
• Chemical, radiation, viruses, genetic susceptibility

Question 3

What are types of occupations that are risk factors for cancer?

Answer 3

• Pilots
• X-ray technicians
• Working in nuclear plants

Question 4

What viruses are risk factors for cancer?

Answer 4

• HPV
• HIV
• Hepatitis B and C

Question 5

What are the two major process that contribute to cancer cells?

Answer 5

1. Cell proliferation

2. Cell differentiation

Question 6

Normal Cell Growth

Answer 6

• 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

Question 7

Defects in Cell Proliferation

Answer 7

• 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

Question 8

Defects in Cell Differentiation

Answer 8

• 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

Question 9

Proto-Oncogenes

Answer 9

Promote cell growth and keep cell in the locked in mature state

Question 10

Tumor Suppressor Genes

Answer 10

Inhibit cancer cell growth

Question 11

Health Bodies

Answer 11

1. 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
2. When there is a glitch in our systems, tumour suppressor genes become inactive and are not able to prevent cancer cells from growing

Question 12

What are the 3 stages to cancer cell development?

Answer 12

1. Initiation
   - Mutation on cell’s genetic structure
2. Promotion
   - Reversible growth of altered cells
3. Progression
   - Increased growth, invasion, and metastasis of the cancer

Question 13

What are the 3 things than can happen in the initiation phase?

Answer 13

1. A cell can die if it is altered
2. A cell can try and repair itself
3. A cell can replicate as an altered cell

Question 14

How big dose a cancer cell need to be in order to be directed by an MRI?

Answer 14

The growth or mass needs to be 0.5cm

- 1cm tumour = to 1 billion cancer cells

Question 15

What is the role of the immune system in cancer cell recognition and destruction?

Answer 15

• 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

Question 16

Benign Tumour

Answer 16

Cells grow only locally and cannot spread by invasion or metastasis
-Not cancer

Question 17

Malignant Cells

Answer 17

Invade neighbouring tissues, enter blood vessels, and metastasize to different sites
- Cancer

Question 18

Metastasis

Answer 18

Movement of the cancer to another location

- There is different affinities depending on the cancers

Question 19

Diagnostic Tests

Answer 19

• Cytology studies
• Blood-work
• Colonoscopy studies
• Radioisotope scans
• Assays for oncofetal antigens or genetic markers
• Bone marrow examiantion
• Biopsy

Question 20

What are the 3 ways tumours are classified?

Answer 20

1. Anatomical site (location)
2. Histological analysis (grading)
3. Extent of disease (staging)

Question 21

What are the 4 anatomical sites that cancers can be described as?

Answer 21

1. Carcinomas
2. Sarcomas
3. Lymphomas
4. Leukemias

Question 22

Carcinomas

Answer 22

Cancer of external or internal body surfaces

- Lungs, brast, colon

Question 23

Sarcomas

Answer 23

Cancer of supporting tissues

- Bone, cartilage, fat, muscle

Question 24

Lymphomas

Answer 24

Cancer of the lymph nodes

Question 25

Leukemias

Answer 25

Cancer within the bone marrow and blood stream

Question 26

Histological Analysis (Grading)

Answer 26

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

Question 27

Extent of Disease (Staging)

Answer 27

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

Question 28

TNM Classification

Answer 28

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

Question 29

Tumor Makers

Answer 29

- 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

Question 30

What are the goals of care for cancer patients?

Answer 30

- 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

Question 31

What are the 2 treatment options?

Answer 31

1. Surgical therapy - Cure and control; supportive and palliative procedures; rehabilitation 2. Chemotherapy - Drug therapy - Cure, control, and palliation 3. Radiation therapy - High dose of radiation - Cure, control, and palliation *Can be used singularly or on combination; usually used in combination

Question 32

Pain in the Patient with Cancer

Answer 32

1. Causes of pain - Tumours, medical procedures, treatments 2. Types of pain - Based on the part of the body affected 3. Treating pain - Non-opioids, adjuvants, opioids

Question 33

Cancer Pain Relief Ladder

Answer 33

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

Question 34

Psychosocial Care

Answer 34

- 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