Neoplasms Flashcards
Define cancer
A disease of genomic alterations
A neoplasm is characterized by
uncontrolled growth of anaplastic cells that tend to invade surrounding tissue & metastasize to distant sites
How does cancer arise?
from mutations in a cell’s gene, genomic instability, &/or inflammation
Define neoplasia
New growth or tumor
Solid tumors
Carcinoma
Adenocarcinoma
Sarcoma
Carcinoma
Originates in epithelial tissue
Adenocarcinoma
Originates in glandular tissue
lung cancer → small cell
Colon cancer → adenocarcinoma of colon
Sarcoma
Originates in connective or supportive tissue
i.e. osteosarcoma
How can hematologic malignancies be described?
As liquid or blood cancers
List examples of hematologic malignancies
Leukemia → AML; CML; ALL; CLL
Lymphoma → hodgkin’s/ non-hodgkin’s
Multiple myeloma
Myelodysplastic syndrome
Physical carcinogens
Ionizing radiation
Ultraviolet radiation from sunlight
Chemical carcinogens
Abestos
Arsenic
Benzene
Insecticides
Tobacco smoke
Viral/ bacterial carcinogens
HPV
HIV
Retroviruses
H. pylori
Cancer causes:
Host factors
Genetics
Obesity
Aging
Lifestyle
Cancer causes:
Environmental factors
Pollution
Smoking
Alcohol
Poor nutrition
Occupational exposure
Normal cell growth (8)
Well differentiated
Controlled, slow growth
Uniform shape
Cellular communication
Monolayered
Encapsulated
Cell cohesiveness
Mortal (Apoptosis)
Malignant cell growth (8)
Poorly differentiated
Abnormal appearance
Lack of cohesiveness
Uncontrolled growth
Multilayered
Loss of cellular communication
Invasive, capable of spreading
Immortal (avoid apoptosis)
Characteristics that increase the development of malignancies (6)
Genomic instability
Tumor-promoting inflammation
Unlocking phenotypic plasticity
Non-mutational epigenetic reprogramming
Polymorphic microbiomes
Senescent cells
Mutations in regulatory cells:
Proto-oncogene
Genes that code for proteins involved in normal cell growth
→ when mutated, enable cancer cells to grow uncontrollably = oncogene
Mutations in regulatory cells:
Tumor suppressor gene
Gene that codes protein products that inhibit cellular division, repair damaged DNA, & promote apoptosis
What happens when tumor suppressor genes are altered?
These genes become inactivated & allow uncontrolled proliferation
List examples of tumor suppressor genes
BRCA1 & BRCA2
Mutations in regulatory cells:
DNA repair genes
Allow cells to repair DNA damage
5 pathways → active at different stages of cell cycle
What can happen if DNA repair genes don’t correct?
Leads to a mutation that can lead to cancer formation
i.e with BRCA1 & 2
Mutations in regulatory cells:
Epigenetic changes
Changes in genetic expression rather than DNA sequence that can affect efficacy of DNA repair genes
→ tells genes when to turn on or off
Mutations in regulatory cells:
Chromosome translocation
Occurs when one piece of a chromosome moves to another chromosome
Chromosome translocation is a genetic alteration that activates an ______
oncogene
Give an example of chromosome translocation
The BCR gene on chromosome 9 is fused to the ABL gene on chromosome 22
Mutations in regulatory cells:
Genetic instability
defective mechanisms that lead to increased rate of genetic alterations
Genetic instability is the clonal evolution of _____ _____
tumor cells
Classic sign of cancer
Mutations in regulatory cells:
Inflammation
enhances the process of carcinogens
Characteristics of cancer cells:
Pleomorphism
cells in various shapes & sizes
Characteristics of cancer cells:
Hyperchromatism
nuclear chromatin more pronounced with staining
Characteristics of cancer cells:
Polymorphism
Nucleus enlarges & variable in shape
Abnormal chromosome arrangements:
Translocation
exchange of chromosomal material
Abnormal chromosome arrangements:
Deletions
Loss of chromosome segment
Abnormal chromosome arrangements:
Amplification
Increase number of copies of a DNA sequence
Abnormal chromosome arrangements:
Aneuploidy
Abnormal number (extra or missing) of chromosomes
Characteristics of benign cells (6)
Well-differentiated
Controlled growth
Uniform shape
Cell cohesiveness
Contact inhibition
Mortal (apoptosis)
Characteristics of malignant cells (7)
Poorly differentiated
Abnormal appearance
Uncontrolled proliferation
Accelerated use of nutrients
Loss of contact inhibition
Invasive
Immortal (avoids apoptosis)
What does cellular differentiation & grading refer to?
the extent cancer cells resemble normal cells, both in structure & maturity
Grading = degree of differentiation (scale)
Grade 1 → well differentiated (low grade)
Grade 2 → moderate differentiated/ intermediate grade
Grade 3 → poorly differentiated / high grade
Grade 4 → undifferentiated / unable to tell where the cell came from
Define anaplasia
Lack of differentiation
What is metastasis and how does it spread?
It’s the spread of cancer cells from original site
→ spreads via bloodstream or lymphatic system
Symptoms of metastatic disease
SOB
Pain
Headache
Seizures
Site of metastasis for melanoma
Brain, lung
Site of metastasis for lung cancer
Brain, bone, liver
Site of metastasis for colon cancer
Liver, lung, brain
Site of metastasis for prostate cancer
Bone, lung
Site of metastasis for breast cancer
Bone, lung, liver, brain
List the sequential process of metastasis
Transformation → angiogenesis → motility & invasion (cap, venules, lymph vessels) → multi-cell aggregates (lymphs, PLTs) → embolism & circulation → arrest in capillary beds → extravasation into organ parenchyma → response to microenvironment → tumor cell proliferation & angiogenesis → metastases → metastasis of metastases
List the clinical manifestations of cancer (10)
Anorexia/ Cachexia
Bleeding
Immunosuppression
Infections
Weight loss
Fatigue
Pain
Sleep disorders
Paraneoplastic syndromes
What are paraneoplastic syndromes?
They are caused by cancers & may be a presenting sign
List examples of paraneoplastic syndromes
SIADH
Cushing’s
Hypercalcemia
venous thrombosis
List the 4 goals of cancer therapy
Prevention
Cure
Control
Palliation
List 6 different treatments of cancer
Surgery
Radiation therapy
Chemotherapy
Hormones
Targeted therapy/ biotherapy
Immunotherapy
Tx of cancer:
Surgery
Directly removes the tumor &/or affected lymph nodes
With surgery pathologic specimens are examined for?
Clear margins
What are some adverse effects to surgery as a cancer Tx?
inability to remove all the tumor
bleeding
infection
What kind of therapy is chemotherapy?
Systemic therapy
Some cells are cell-cycle specific and others are non-specific
Chemotherapy interrupts
Tumor growth & kills tumor cells
Toxicities & adverse effects of chemotherapy
Based on their effect on particular cells
Common side effects of chemo
N/V
Alopecia
Immunosuppression
Increased risk of infection/ bleeding
Chemotherapy drugs are often administered
in combination w/ one or more agents &/or other Tx modalities
Radiation therapy
Uses focused ionizing radiation to damage DNA & prevent further growth of tumor
Internal radiation
Implanted into or near the tumor in small capsules or other containers
External radiation
Aimed at tumor from outside the body
Side effects of radiation therapy
Skin redness
irritation
ulceration
fibrosis
atrophy
Biotherapy:
Use of natural & manufactured substances derived from the body to:
- Stimulate or restore the ability of immune system
- Uses Ab to fight cancer
- Change or modify the relationship between the cancer & host
Biotherapy uses targeted therapy that:
- blocks a specific receptor
- attaches to a specific receptor to assist the immune system to kill the cancer
- carries chemotherapy or a radioisotope into the cell
Immunotherapy helps …
effector cells in the body to become activated &/or enhance results in targeted cancer cell death
Treatment approaches (4)
- neoadjuvant therapy
- adjuvant therapy
- conditioning / preparative therapy
- immunosuppression
Neoadjuvant therapy
Use of one or more Tx modalities before the primary therapy
Goal is to shrink tumor size
Adjuvant therapy
Follows the primary modality
Goal is to target minimal disease or micrometastasis
Conditioning or preparative therapy
Goal is to empty marrow space before transplant or to eliminate residual disease
Immunosuppression
To blunt immune response
Nursing management for cancer Tx/ care:
Interprofessional approach
Patient education!!
Issue of adherence
Monitoring of labs
Sx management
Nursing management:
Sx management includes
Use of common terminology criteria for adverse events grading system (CTCAE)
CTCAE:
Granulocytopenia
Grade 1 → 1,500-3,000/μL
Grade 2 → 1,000-1,499/μL
Grade 3 → 500-999/μL
Grade 4 → < 500/μL
Grade 5 → N/A
CTCAE:
Thrombocytopenia
Grade 1 → 100,000-150,000/μL
Grade 2 → 50,000-99,000/μL
Grade 3 → 25,000-49,000/μL
Grade 4 → < 25,000/μL
Grade 5 → N/A
CTCAE:
Anorexia
Grade 1 → coaxing/ dietary change needed
Grade 2 → oral intake altered < 3 days, no sig weight loss
Grade 3 → 3-5 day duration, tube feeding
Grade 4 → life threatening, > 5 day duration
Grade 5 → death
CTCAE:
Diarrhea
Grade 1 → > 2 stools per day over baseline
Grade 2 → 2-6 stools over baseline, IV or SC fluids < 24 hrs
Grade 3 → > 6 stools, incontinence, IV fluids & hospitalization > 24 hrs
grade 4 → life threatening, hemodynamic collapse
grade 5 → death
CTCAE:
Vomiting
Grade 1 → < 3 episodes in 24 hrs
Grade 2 → 3-5 episodes in 24 hrs, fluids for < 24 hrs
Grade 3 → > 5 episodes/ day or > 4 day duration
Grade 4 → life threatening, hemodynamic collapse
Grade 5 → death
Question:
Which of the following genes, when mutated is NOT implicated in the development of neoplasms?
A) Carcinogens
B) tumor suppressor gene
C) oncogenes
D) mutator genes
A) Carcinogens
Question:
Which of the following is a characteristic of benign neoplasms?
A) high undifferentiated
B) invasive
C) destructive
D cell overproliferation
D cell overproliferation
Question:
As a public health nurse, which intervention would have the greatest impact on reducing cancer rates?
A) smoking cessation programs
B) routine genetic testing
C) distributing sunscreen each summer
D) eliminating unnecessary radiation
A) smoking cessation programs
Question:
Identify 4 goals of cancer Tx (SATA)
A) cure
B) control
C) Decrease side effects of Tx
D) palliation
E) prevention
F) research into new Tx
A) cure
B) control
D) palliation
E) prevention
