lewis ch 15 (cancer) Flashcards
what are the 2 major dysfunctions present in the process of cancer development
proliferation
differentiation
what rate do cancer cells multiply at
the same as the rate of the location they originated from
sometimes cancer cells produce more than 2 cells
through mitosis. 1 x 2 x 4 x 8 x 16
pyramid effect
which are more malignant: undifferentiated cancer cells or differentiated cancer cells
undifferentiated cancer cells
alterations in these tumor suppressor genes cause increased incidence in breast & ovarian cancers
BRCA 1 and 2
what is the process of the development of cancer
- -initiation–
1) carcinogen invades target cell
2) altered cell: dysfunction in differentiation and proliferation
3) cancer cell - -promotion–
4) proliferation - -progression–
5) evidence of clinical disease
6) evidence of regional spread and metastasis
Cancer-causing agents capable of producing
cell alterations
carcinogens
examples of carcinogens (5)
- poor diet
- radiation
- environmental toxins
- viruses, bacteria, parasites
- chemicals in tobacco goods
first stage of development of cancer, mutation of cell’s genetic structure
initiation
second stage of development of cancer, characterized by reversible proliferation of altered cells
promotion
what are some examples of reversible proliferation activities
- obesity
- smoking
- alcohol use
- dietary fat
the amount of time in the
initiation and promotion stage. The cancer is
not yet clinically evident.
latent period
third stage of development of cancer, characterized by increased growth of tumor, invasiveness, and metastasis
progression
what are the main sites of metastasis (6)
- brain
- CSF
- bones
- lung
- liver
- adrenals
what is it called when the primary tumor develops its own blood supply
tumor angiogenesis
what is the role of lymphocytes in response to tumor associated antigens
check cell surface
antigens and detect and
destroy abnormal cells
what is the role of cytotoxic T cells in response to tumor associated antigens
Kill tumor cells directly, Produce cytokines
what is the role of NK cells and macrophages in response to tumor associated antigens
lyse tumor cells
what is the role of B cells in response to tumor associated antigens
make antibodies that bind to tumor cells
what are some characteristics of benign tumors
- encapsulated
- differentiated
- normal cell characteristics
- slight vascularity
what are some characteristics of malignant tumors
- not encapsulated
- poorly differentiated
- abnormal cells
- moderate to marked vascularity
what are four things tumors can be classified by
- anatomic site
- anatomic extent (TNM classification)
- histology
- extent of disease
3 anatomic sites tumors can be classified by
- carcinoma: skin and glands, mucous membranes
- sarcoma: CT, bone, muscle, fat
- lymphoma and leukemia: blood
what are the three parameters that classify anatomic extent (TNM classification)
T: tumor size and invasiveness
N: spread to lymph nodes
M: metastasis
what does T^0 mean
no evidence of primary tumor
what does T^is mean
carcinoma in situ
what does T^1-4 mean
ascending degrees of increase in tumor size and involvement
what does T^x mean
tumor cannot be found or measured
what does N^0 mean
no evidence of disease in lymph nodes
what does N^1-4 mean
ascending degrees of nodal involvement
what does N^x mean
regional lymph nodes unable to be assessed
what does M^0 mean
no evidence of distant metastases
what does M^1-4 mean
ascending degrees of metastatic involvement including distant nodes
what does M^x mean
cannot be determined
staging done at completion of diagnostic workup to
guide effective treatment selection (Bone and liver scans, ultrasonography, CT, MRI, PET scans)
clinical staging
staging determined by surgical excision, exploration,
and/or lymph node sampling
surgical staging
what does clinical stage 0 mean
Cancer in situ (localized cancer
cells that show no tendency to invade
or metastasize)
what does clinical stage 1 mean
Tumor limited to tissue of origin;
localized tumor growth
what does clinical stage 2 mean
Limited local spread
what does clinical stage 3 mean
Extensive local and regional
spread
what does clinical stage 4 mean
metastasis
7 warning signs of cancer (CAUTION)
C: change in bladder/bowel habits A: a sore that won't heal U: unusual bleeding or discharge T: thickening or lump I: indigestion or trouble swallowing O: obvious change in wart or mole N: nagging cough or hoarseness
3 goals of cancer treatment
- cure
- control
- palliative
Study of genomic variation associated
with drug responses
pharmacogenomics
Use of chemicals given as a systemic
therapy for cancer, used for solid tumors and hematologic cancers
antineoplastic therapy (chemo)
methods of admin for chemo (3)
- oral
- IM
- IV (most common)
type of chemo: Delivery of drug directly into
tumor site, higher concentrations of drug can
be delivered with less systemic
toxicity
regional chemo
what normal cells are most affected by chemotherapy
- bone marrow stem cells
- epithelial cells in GI tract
- hair
- neutrophils
- ova/testes
One of the oldest nonsurgical
methods of cancer treatment, emission of energy
from a source and travels through
space or some material
radiation
Implantation or insertion of radioactive
materials into or close to tumor, minimal exposure to healthy tissue
internal radiation
common side effects of radiation therapy (6)
- bone marrow suppression
- fatigue
- GI problems
- integumentary and mucosal reactions
- pulmonary effects
- reproductive effects
type of cancer treatment: Boost or manipulate the immune system and create an
environment not conducive for cancer cells to grow, attacks cancer cells directly
immunotherapy
type of cancer treatment: Interferes with cancer growth by targeting specific cell receptors and pathways that
are important in tumor growth, does less damage to normal cells
targeted therapy
side effects with immunotherapy and targeted therapy (8)
- flulike symptoms (pretreat with acetaminophen)
- anorexia/weight loss
- fatigue, weakness
- nausea/vomiting
- photosensitivity
- hepatotoxicity
- tachycardia
- orthostatic hypotension
two examples of hormone therapy used to treat cancer
- sex hormones
- corticosteroids
supportive med for cancer treatment for anemia
erythropoietin (epoetin alfa)
supportive med for cancer treatment for neutropenia
granulocyte colony-stimulating factor (filgrastim)
supportive med for cancer treatment for myeloid cell recovery after bone marrow transplant
Granulocyte-macrophage colony-stimulating factor
sargramostim
supportive med for cancer treatment for thrombocytopenia
interleukin 11 platelet growth factor (oprelvekin)
allogeneic donor
matched donor
syngeneic donor
identical twin
autologous donor
patients own stem cells
problems associated with cancer and chemotherapy
- nutritional (malnutrition, altered taste sensation, cancer cachexia)
- infection
- oncologic emergency
- cancer pain
oncologic emergency: obstructive:
-Intense, localized, and persistent back pain with vertebral tenderness.
- Motor weakness, sensory paresthesia and loss.
- Autonomic dysfunction (e.g., change in bowel or bladder function).
spinal cord compression
oncologic emergency: obstructive:
• Facial edema, periorbital edema.
- Distention of veins of head, neck, and chest.
- Headache, seizures.
- Mediastinal mass on chest x-ray.
superior vena cava syndrome
oncologic emergency: obstructive:
• Signs of hypovolemia: hypotension, tachycardia, low central venous pressure, decreased urine output.
third space syndrome
oncologic emergency: metabolic:
• Serum calcium higher than 12mg/dL (3mmol/L) often produces symptoms.
- Apathy, depression, fatigue, muscle weakness, ECG changes, polyuria and nocturia, anorexia, nausea, vomiting.
- High calcium elevations can be life threatening.
- Chronic hypercalcemia can result in nephrocalcinosis and irreversible renal failure.
hypercalcemia
oncologic emergency: metabolic:
• Water retention and hyponatremia (hypotonic hyponatremia) .
• Weight gain without edema, weakness, anorexia, nausea, vomiting, personality changes, seizures, oliguria, decrease in reflexes, coma.
syndrome of inappropriate antidiuretic hormone
oncologic emergency: metabolic:
• Hallmark signs: hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia.
- Weakness, muscle cramps, diarrhea, nausea, vomiting.
- Occurs within 24–48 hr after starting chemotherapy.
- May last 5–7 days.
- Metabolic abnormalities and concentrated uric acid (which crystallizes in distal tubules of kidneys) can lead to acute kidney injury.
tumor lysis syndrome
oncologic emergency: infiltrative:
• Heavy feeling over chest, shortness of breath, tachycardia, cough, dysphagia, hiccups, hoarseness.
- Nausea, vomiting, excessive perspiration.
- Decreased level of consciousness, distant or muted heart sounds.
- Extreme anxiety.
cardiac tamponade
oncologic emergency: infiltrative:
• Bleeding: ranges from minor oozing to spurting of blood in the case of a “blowout” of artery.
carotid artery rupture
