Neoplasia Flashcards
Tumour vs cancer
Tumour is a group of abnormal cells that form a mass or growth (not always cancer)
Cancer is a disease where abnormal cells uncontrollably divide, often forming a tumour, characterised by remission and relapse
Benign tumour
Noncancerous tumours that are surrounded by a capsule, grow slowly and remain localised (non-invasive), have normal structure
Malignant tumour
Cancerous, have abnormal heterogenous cell and tissue structure, grow rapidly and can metastasise, not enclosed in a capsule
Carcinoma vs adenocarcinoma
Carcinoma: cancer of the epithelium
Adenocarcinoma: specifically from glandular epithelium
Oncogenes
Tumour suppressor genes
Caretaker genes
Autonomy
Anaplasia
Angiogenesis
Oncogenes: promote tumour growth by increasing proliferation
TSG: limit cancer development by inhibiting proliferation (p53)
Caretaker genes: repair damaged DNA
Autonomy: ability of cells to avoid cell controls such as apoptosis
Anaplasia: loss of normal cell functioning
Angiogenesis: formation of new blood vessels, tumour stimulates this to grow and meet metabolic needs
The last 3 are characteristic of metastasis
Role of chronic inflammation in cancer development
- Inflammatory cells release cytokines and growth factors that stimulate cell proliferation and vascular growth (angiogenesis factors)
Role of viral infection in cancer development
+ HPV development
- Chronic infection by viruses such as hepatitis B or C & HPV increases risk of liver & cervical cancer
- HPV virus inserts DNA into cervical cells and produces oncogenes
Carcinogens
Environmental agents that have carcinogenic properties
Environmental factors that increase risk of cancer
- Smoking
- Diet
- Obesity - insulin resistance relates to pathogenesis of cancer due to increased FA circulation from adipose tissue
- Alcohol
- Occupational hazards
- UV
Tumour cell markers
What are they, types, use, issues
- Substances produced by cancer cells that are detectable in the blood, spinal fluid or urine
- Hormones, enzymes, genes, antigen (e.g. prostate specific antigen PSA)
- Used to screen for high risk, diagnose, and follow clinical course
- Problem: also produced by non-cancerous tissues
How cancer is evaluated
- X-ray. CT, MRI
- Biopsy esp sentinel node biopsies
Cancer staging
TNM system
* T: tumour size
* N: involvement of LNs
* M: degree of metastasis
Clinical manifestations of cancer
Symptoms are due to tumour pressing on organs, treatment, and inflammatory cytokines acting on the CNS and PNS
* Pain (obstruction, destruction and inflammation)
* Anaemia (reduced RBC, iron malabsorption and haemorrhaging)
* Fatigue
* Cachexia & anorexia
* Infection, thrombocytopenia & anaemia (cancer & treatment suppresses bone marrow production of RBCs, WBC and platelets)
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Cancer treatments
Chemotherapy: non-selective cytotoxic drugs that target cell growth and replication
Combination therapy: use of multiple therapies which serve different functions. and to avoid drug resistance
Adjuvant therapy: the use of drugs after initial treatment, such as surgery, when there is minimal cancer remaining but risk of metastasis
Neoadjuvant: early use before surgery/radiation to decrease size
Hormonal: drugs that interact with hormone receptors in hormone-dependent tumours
Immunotherapy: using the immune system to kill cancer and avoid destroying healthy tissue (tumour specific vaccines for melanoma, monoclonal antibodies in non-hodgkins lymphoma)
Radiation: use of ionising radiation to damage cancer cells without damaging normal structures, making them more vulnerable to other treatments
Surgery: complete removal. debulking or palliative
Therapeutic index
Effective dose needed to kill cancer cells compared to the dose that would be harmful to normal cells (usually very low)
Side effects of cancer treatment
Targets rapidly dividing healthy cells
GI: ulcers, malabsorption, diarrhoea, vomiting (use centrally acting serotonin antagonists such as odansetron)
Bone marrow: anaemia, bleeding, neutropenia & immune weakness
Hair loss & skin breadown
Infertility & premature menopause
Top cancers of greatest significance in Australia
Breast (most common in women, often younger)
Prostate (most common in men)
Colorectal (most common in older age)
Lung (highest mortality rate)
Melanoma (least common skin cancer but most aggressive, most common in teenagers)
Childhood: leukemia most common
Colorectal cancer
Risks, types of tumours, symptoms, diagnosis
Risks: genes, environment, polyps
Tumours: R) large and bulky, L) small, button like masses
Symptoms: pain, bleeding, change in bowel habits
Diagnosis: faceal occult, colonoscopy
Aetiology of lung cancer
- Smoking
- Hydrocarbons, arsenic, airpolution
- Genetics and gender differences
Pathophysiology of lung cancer
- Accumulations of mutations in epithelial cells by carcinogens, inflammation, genetics
- Disruption in mucosal lining eventually erodes the basal membrane
- Continued tumour development by epidermal GF, that is slow (8-10 years for 1 cm)
Lung cancer classification (list)
Based on histology
* squamous cell carcinoma
* Adenocarcinoma
* Small cell carcinoma (SCLC)
* Large cell carcinoma
SS, adeno and large are categorised as non-smal cell carcinoma (NSCLC)
Squamous cell carcinoma (NSCLC)
- Slow growing, usually doesnt metastasise
- Centrally located (symptoms are cough and haemoptysis)
- Surgical resection + adjuvant therapy and radiation
Adeocarcinoma (NSCLC)
- Moderate growing
- Most common in non-smokers
- Peripherally located, assymptomatic until widespread metastasis
- Surgical resection, doesnt respond well to chemo
Large-cell (undifferentiated) carcinoma (NSCLC)
- Rapid growth, highly metastatic via blood and lymph
- Cells are anaplastic and from bronchi
- Surgery usually not possible due to metastasis, radiosensitive but recurs
Small-cell lung cancer (SCLC)
- Very rapid, most malignant, typically the brain
- Causes endocrine disturbances
- Chemo and radiation used but poor prognosis and usually palliative treatment
Routes and locations of lung cancer metastasis
Route: direct extension, blood, lymph
Location: brain, liver, bones, LN, adrenals
Neoplastic syndrome
Description, cause, symptoms, type of lung cancer associated
- Set of signs and symptoms that occur in an individual with a cancerous tumour, due to signalling molecules (cytokines) and immune system (SCLC)
- Symptoms: hypercalcaemia, SIADH, adrenal hypersecretion, haematological and neurological disorders
Manifestations of lung cancer + late stage
- Pneumonitis (inflammation without infection)
- Haemoptysis
- Dyspnoea, wheezing, persistant cough
- Chest pain
Late stage
* Anorexia, fatigue, N/V
* Dysphagia, diaphragm paralysis, SVC obstruction, hoarseness
Lung cancer staging
NSCLC: TNM staging
SCLC: limited and extensive
Diagnostic studies in lung cancer
- Scans: x-ray, CT (differentiate between NSCLC and SCLC), bone scans etc, MRI, PET
- Sputum cytology (detect exfoliant cells from tumour)
- FNA, lung biopsy
- Pleural fluid analysis
- FBC
- ABGs to detect respiratory failure
- Lunction tests (spirometry, FEV, forced vital capacity)
Lung cancer treatment
- Surgery: early stage NSCLC
- Radiaion: curative, adjuvant or alliative
- Stereotactic body radiotherapy: high dose to tumour
- Chemo: primary for SCLC and non-resectable, or adjuvant to surgery in NSCLC
- Biological and targetted
Nursing management
- Effective airway, breathing, oxygenation
- Pain & symptom management
- Monitor side effects
- Education: stressors, support, smoking cessation
