Midterm Flashcards
What are the most common types of cancer in Canada?
Lung, Breast, Colorectal and prostate cancer
Who’s most commonly affected?
People 50 years and older
1 in 2 Canadians expected to develop cancer during their lifetime
What is cancer?
Disease of the cell, it is a abnormal growth resulting from uncontrolled proliferation
what is a neoplasm?
abnormal growth of cells that divide more than they should. Can be malignant or benign.
Cancer biology
abnormal cell is transformed by the genetic mutation of its DNA. There are two major dysfunctions present during the process of cancer- defective cellular proliferation (the growth) and defective cellular differentiation (undifferentiation occurs).
What is cellular differentiation?
process where an unspecialized cell acquires traits that allows it to perform specialized functions. Normally a orderly process, but in cancer this process may be reversed
How can cells mutate?
Exogenous sources- pesticides, radiation, viruses, carcinogens
How does inflammation cause cancer?
Active inflammation predisposes a person to cancer. By stimulating a wound-healing response that includes proliferation and new blood vessel growth.
what are the susceptible organs that may cause chronic inflammation?
Gastrointestinal (GI) tract, pancreas
Thyroid gland
Prostate, urinary bladder
Pleura, skin
What is carcinogenesis?
Process whereby N cells are transformed into cancer cells
what are causes of cancer?
chemical carcinogens: mutagens and chemical carcinogenesis and their metabolism
Physical carcinogenesis: Radiation, UV radiation
Infectious pathogens: Human T cell leukemia, DNA virus, HPV, Epstein Barr Virus, Hep B virus
Benign Tumor?
Named according to the tissues from which they arise.
Lipoma- Fat
Neurofibroma- Nerve tumor
Leiomyoma- Smooth muscle
Malignant tumors?
Are also named according to the tissues from which they arise.
Malignant epithelial tumors: Carcinomas
Ducts or glands: Adenocarcinomas
Malignant connective tissue tumors: Sarcomas
Cancers of lymphatic tissue: Lymphomas
Cancers of blood-forming cells: Leukemias
What does in situ mean ?
Have not broken through the basement membrane or invaded the surrounding stroma.
What are the three prognosis of carcinoma in situ?
Can remain stable for a long time.
Can progress to invasive and metastatic cancers.
Can regress and disappear.
What is the other word for DCIS?
Intraductal carcinomaorstage 0 breast cancer. DCIS is a non-invasive or pre-invasive breast cancer. This means the cells that line the ducts have changed to cancer cells but they have not spread through the walls of the ducts into the nearby breast tissue
Cancer invasion and metastasis
Cancer cells secrete protease.
Proteases digest the extracellular matrix & basement membranes.
- Create pathways through which cells can move.
Metastatic cells must be able to withstand the physiologic stresses of travel in the blood and lymphatic circulation.
Metastatic cells must then survive in a new environment.
what is metastasis?
Is the spread of cancer cells from the site of the original tumor to distant tissues & organs thru the body. Is a complex process that requires cells to have many new abilities.
1. Spread
2. Survive
3. Proliferate in distant locations
4. Destination must be receptive to growth of cancer
What is invasion?
Local spread!!
Is a prerequisite for metastasis (the first step in the metastatic process).
Cancer often spreads first to regional lymph nodes thru the lymphatic system & then to distant organs thru the bloodstream.
Invasion then requires the cancer attach to specific receptors & survive in the specific environment.
Pathways that cancer may spread?
Through dissemination, and occurs thru 3 pathways.
Direct seeding of body cavities or surfaces
Occurs when a malignant neoplasm penetrates into an “open field” (i.e. peritoneal cavity, pleural space)
Often seen with ovarian cancer
Lymphatic spread
Dissemination of carcinomas by lymphatic system
Most common pathway for initial carcinoma spread
Typically involves lymphatic vessels located at the tumor margins Ex: Breast, Lung
Hematogenous spread
Dissemination by arteries and veins
Typical of sarcomas, but is also seen with carcinomas
Most often involves the lungs and liver
How are tumor classifications beneficial?
Communicate the status of the Ca to members of the health care team,
Assist in determining the most effective treatment plan,
Evaluate the treatment plan,
Predict prognosis,
Compare like groups for statistical purposes.
Staging means what?
extent of disease
Grading means what?
anatomic site and histology
Histologic classification
The appearance of abnormal cells & degree of differentiation are evaluated pathologically.
For many tumor types, four grades are used to evaluate abnormal cells based on the degree to which the cells resemble the tissue of origin.
Tumors that are poorly differentiated (undifferentiated) have a worse prognosis than those that are closer in appearance to
the N tissue
Grade 1
Cells differ slightly from N cells (mild dysplasia) and are well differentiated.
Grade 2
Cells are more abnormal (moderate dysplasia) and moderately differentiated.
Grade 3
Cells are very abnormal (severe dysplasia) and poorly differentiated.
Grade 4
Cells are immature and primitive (anaplasia) and undifferentiated; cell of origin is difficult to determine.
Clinical staging
Classifying the extent and spread of disease is termed staging.
Is completed after the diagnostic workup and determines the treatment options.
Stage 0
Cancer in situ
Stage 1
Tumor limited to the tissue of origin; localized tumor growth
Stage 2
Limited local spread
Stage 3
Extensive local and regional spread
Stage 4
Metastasis
What is TNM?
Tumor size and invasiveness (T),
Presence or absence of regional spread to the lymph nodes (N),
Metastasis to distant organ sites (M).
What is screening used for?
Prevention and no symptoms
What is diagnostics used for?
People who have symptoms
Prevention & Detection of Cancer
We have a prominent role in the prevention and detection of cancer.
Elimination of modifiable predisposing risk factors reduces the incidence of cancer and may favorably affect survival of patients who have cancer.
An important aspect of nursing care is to educate the public about cancer prevention and early detection.
Lung cancer screening
For adults aged 55-74 years with at least a 30 pack-year* smoking history who currently smoke or quit less than 15 years ago, we recommend annual screening with LDCT (low dose CT scan) up to three consecutive times.
-pack year = amount smoked x how many years
Breast cancer screening
Recommend mammography screening for asymptomatic women at least 40 years of
age. Individuals born as female in Nova Scotia, aged 40-49, are recommended to have annual screening mammography. Individuals born as female in Nova Scotia, aged 50-74, are recommended to have screening mammography at two year intervals. Individuals born as female 50-74 can also be recommended to return on an annual basis if they:
o have a strong family history of breast cancer (mother, sister, daughter, father,
brother, son),
o are currently on HRT or
o the radiologist has recommended returning sooner.
Cervical cancer screening
Sexually active individuals born with a cervix* should start having a Pap test at the age of 25. Once these individuals begin having Pap tests, they should have them every 3 years.
Individuals with a cervix who become sexually active* for the first time after the age of
25 should have a Pap test within three years of the time that they became sexually
active.
Individuals born with a cervix who have been TREATED (by LEEP, laser, cryotherapy,
cone, hysterectomy) for cervical dysplasia or have a history of cancer of the cervix
should receive annual screening for life.
When can you stop getting paps ?
after age 60 and you have three negatives q 3 years.
Colorectal cancer screening
Fecal Immunochemical Test (FIT)- All healthy people aged 50-74, with no family history of colon cancer, should be screened every two years.
Higher Risk Individual: Colonoscopy at age 40 or 10 years earlier than youngest affected relative
(whichever comes first) (for persons with a first-degree relative with CRC or
adenoma diagnosed <60 OR two or more second-degree relatives with CRC or
adenoma <60). A repeat colonoscopy is recommended every 5 years for these
individuals
AAA Screening
We recommend one-time screening ultrasonography for all individuals age 65–80 years but females with a hx of smoking or cardiovascular disease.
We suggest one-time screening ultrasonography after 55 years of age for all first-degree
relatives of patients with AAA.
Preventative measures
Self-examination:
Early detection if done consistently
Breast, testicular, and skin examinations
Routine screening:
Essential for early detection
Following treatment to detect any further tumors
Disease monitoring:
Status of disease at diagnosis
Progression of disease
Alpha fetoprotein (AFP)
Tumor marker for liver cancer
CA-125
Ovarian tumor marker
CA 15-3 / CA27.29
Breast tumor markers
3 Goals of care
Cure
Control
Palliation
BRCA gene
In selected high-risk diseases, surgery plays a role in prevention of cancer.
Women with BRCA1/2 mutations have a significantly increased risk of breast and ovarian cancer: Prophylactic mastectomy or bilateral salpingo-oophorectomy or both.
Chemotherapy
Eradicates enough tumor cells to enable the body’s natural defenses to eradicate the remaining cells.
Can be a single-agent or combination chemotherapy.
Induction chemotherapy: Causes shrinkage or the disappearance of tumors.
Adjuvant chemotherapy
Administered after the surgical excision with a goal of eliminating micro metastases.
Neoadjuvant chemotherapy
Administered before localized (surgical or radiation) treatment.
Radiation Therapy
Used to kill Ca cells while minimizing the damage to normal structures
Ionizing radiation
Damages cells by imparting enough ionizing radiation to cause molecular damage to the DNA.
Causes irreversible damage to normal cells.
Lifetime radiation dose
Brachytherapy
Internal radiation
What diet is a risk factor for cancer?
High in red meat and increase ETOH intake
Effects of Malignant Tumors
Weight loss & cachexia (severe tissue wasting):
R/t inc. metabolic demand, altered carbohydrate and protein metabolism, cachectic factors
Anemia:
R/t chronic bleeding, bone marrow depression, anorexia, dec food intake
Bleeding:
R/t Erosion of blood vessels, tissue ulceration
Infections:
R/t bone marrow depression, impaired immune response
Paraneoplastic Syndromes:
R/t release of substances by tumor cells that affect neurological function, blood clotting, hormonal effects
Hyper-coagulation:
Effusions:
Inflammation causing fluid buildup in body cavities.
Warning signs of cancer
C: Change in bowel or bladder habits
A: A sore that does not heal
U: Unusual bleeding or discharge
T: Thickening or lump in the breast or elsewhere
I: Indigestion or difficulty swallowing
O: Obvious changes in warts or moles
N: Nagging cough or hoarseness
Cancer in children
Mutated DNA in cells that occur most often early in life
Second leading cause of death in children < 15 years
Advances in treatment have increased survival
Often difficult to detect
Osteosarcoma
Osteosarcoma is the most common bone cancer in children.
Osteosarcomas grow on the outside of bones where Ewing sarcoma grow on bone tissues.
Usually found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur.
The peak age of incidence is between 10 and 25 years.
Symptoms in early stage are often attributed to extremity injury or normal growing pains.’
-Swelling near a bone
-Bone or joint pain
-Bone injury or bone break for no clear reason
Treatment may include surgical resection (limb salvage procedure) to save a limb or remove affected tissue, or amputation.
Chemotherapy is used to treat the cancer and may be used before and after surgery.
Colon cancer
Colorectal cancer includes two types of cancers: cancer of the colon (large intestine or bowel) referred to as colon cancer, and cancer of the rectum (the end portion of the large intestine) or rectal cancer. Both types of cancer have many features in common, so they are collectively called colorectal cancer.
Risk factors that increase the chance of developing colorectal cancer include:
a family history of colorectal cancer inherited syndromes
benign polyps a personal history of colorectal cancer
inflammatory bowel disease, such as ulcerative colitis
Signs and symptoms of colorectal cancer
A change in your bowel habits.(obstruction, pencil stools, constipation, diarrhea)
Blood in your stool, either apparent (visible) or occult (hidden).
Pain in your lower abdomen or pelvis.
Anemia (low iron in your blood)
Feeling very tired
Nausea or vomiting
Weight loss and weakness
Diagnosis for Colorectal CA
General physical examincluding a digital rectal examination (a doctor or nurse practitioner puts their finger in your bum to examine you).
Lab and blood tests
Testing of stool samplefor occult (hidden) blood.
Colonoscopy: Scope that looks at entire bowel
Biopsy of colon or rectal tissue:A doctor removes a small portion of the colon or rectum to examine under a microscope. This is the most accurate test of all, but because it involves cutting the body, the other tests are usually done first.
CT (computed tomography) scan of abdomen and pelvis:to see the tumor and if the cancer has spread
Melanoma
Melanoma is the most aggressive of all skin cancers
The leading cause of melanoma is (UV) radiation from the sun or artificial sources(tanning beds, sunlamps)
ABCDE
Asymmetry
Border
Color
Diameter
Evolution
Superficial spread melanoma (SSM)
May start from an existing mole (dysplastic nevus).
Nodular melanoma (NM)
A nodule appears, usually not related to an existing mole.
Lentigo maligna melanoma (LMM)
Less common.
Most commonly appears on the sun-exposed faces of the elderly.
Acral lentiginous melanoma
Occurs on the palms or the soles of the feet or under the nail
Accounts for the majority of malignant melanomas for dark-skinned people but for only a small percentage of all melanomas for light-skinned people.
Benign Brain tumors
Predominantly benign tumour of the meninges occurring at both cranial and spinal sites.
Produces symptoms from local mass effect due to compression of neural structures or may present with seizure.
Diagnosis confirmed by the characteristic appearance on magnetic resonance imaging (MRI) with and without contrast enhancement.
Asymptomatic lesions may be followed up with serial observation.
Treatment of symptomatic meningioma is usually surgical resection, although, in some cases, local radiotherapy is used as primary treatment.
Radiation therapy considered as adjuvant treatment for grade III meningiomas and in some cases grade II lesions.
Frontal lobe
Personality, movement, sense of smell
Parietal lobe
identification of objects, sense of pain and touch, body navigation, spatial position
Occipital
Vision
Cerebellum
Balance
Pons
Control of eye and face movement
Temporal lobe
Memory, speech, musical rhythm
Meningioma – RISK FACTORS
Family history
Headaches
Neurological Deficits
Seizure
Radiotherapy
Investigations:
MRI – definitive diagnosis
CT Scan – may not be as cut and dry but more accessible
Asymptomatic lesions may be monitored by serial observation. The majority of incidental meningiomas show minimal growth; thus, they may be observed without surgical intervention unless specific symptoms appear of the tumor demonstrating growth.
The treatment of meningiomas is generally considered surgical. An open surgical approach is usually indicated.
FOLLOW UP & MONITORING
All meningiomas should have a 6 month MRI follow-up after diagnosis then annually
After 5 years, the interval can be doubled
In those patients who have not had treatment of their meningioma, any change in headache pattern or development of new or progressive neurological symptoms should prompt a return for evaluation of the tumor.
In patients with seizure presentation, maintenance of anticonvulsant therapy may be required,
