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PNP #2 > ONCOLOGY > Flashcards

ONCOLOGY Flashcards

1
Q

Differentiation

A

Each cell types differentiates and carries out particular functions.
The structure reflects the function of the tissue.

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2
Q

Mitosis

A

Part of the cell cycle

Requires genetic control—DNA and RNA

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3
Q

Mutation

A

If DNA in parent cell is altered and passed on, offspring cells will carry the mutation

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4
Q

Apoptosis

A

Programmed cell death

Controlled by genetic elements

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5
Q

Neoplasm or tumor

A

 Cellular growth that no longer responds to normal genetic controls
 Cell continues to reproduce, without need for them to reproduce
 Deprives other cells of nutrition
 Neoplasms may consist of atypical or immature cells.
 Characteristics of each tumor depend on:
• Type of cell from which the tumor arises
• Unique structure and growth pattern

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6
Q

Defect in Cellular Proliferation

A

 Most human tissues contain predetermined, undifferentiated stem cells.
 Predetermined stem cells give rise to mature cells of the type of tissue where they reside.
 All cells are controlled by an intracellular mechanism that determines proliferation.
 Cancer cells grown in culture are characterized by loss of contact inhibition.
 Grow on top of one another and on top of or between normal cells
 Cancer cells respond differently from normal cells to intracellular signals regulating equilibrium.
 Divide indiscriminately
 Stem cell theory
 Loss of intracellular control of proliferation results from mutation of stem cells.
 DNA is substituted or permanently rearranged.
 Once mutated
 Cells can die from damage or by initiating programmed cellular suicide (apoptosis).
 Can recognize damage and repair itself
 Surviving mutated cells have potential to become malignant.
 Two types of genes that can be affected by mutation are
1.Proto-oncogenes
 Regulate normal cellular processes such as promoting growth
2.Tumour suppressor genes
 Suppress growth of tumours
 Function to regulate cell growth

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7
Q

Nomenclature

A

 Benign tumors have tissue name plus the suffix -oma (e.g., adenoma)
 Malignant tumors (cancers) have the tissue name plus the suffix -carcinoma (e.g., adenocarcinoma)
 Tumors of connective tissue are usually termed sarcomas and are often malignant.
 Several malignant tumors have unique names:
 Hodgkin’s disease
 Wilms’ tumor
 Leukemia

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8
Q

Benign tumors

A

Usually differentiated cells that reproduce at a higher rate than normal
Encapsulated
Tissue damage
This is a result of compression of adjacent structures.
It can be life-threatening in the brain.

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9
Q

Malignant tumors

A

Undifferentiated, nonfunctional cells
Rapid reproduction—abnormal mitotic figures
Infiltrate or spread into surrounding tissue
Spread to distant sites

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10
Q

Malignant Tumors: Cancer

A

 Lack control of mitosis and do not undergo apoptosis
 No normal organization or differentiation
 No contact inhibition
 Abnormal cell membranes
 Altered surface antigens
 Do not adhere to each other
–Often break loose from mass
–Invade other tissues and may spread to distant sites

 Mass compresses blood vessels.
—Leads to necrosis and inflammation around tumor
 Tumor cells may secrete enzymes or hormones.
–Break down of proteins and cells
–Systemic effects, such as altered calcium levels
 Inflammation and loss of normal cells
–Lead to progressive reduction in organ integrity and function
 Angiogenesis
–Some tumor cells secrete growth factors.
• Stimulate the development of new capillaries in the tumor

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11
Q

Carcinogenesis

A

 Process whereby normal cells are transformed into cancer cells
 Process varies greatly with respect to time
 Cancer is thought to be a multifactorial disease because of :
–Environmental effects
–Change in gene expression (heredity)
–Infection in some cases (e.g., cervical and hepatic cancers)
 Some cancers have well-established risk factors.

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12
Q

Development of Cancer

A

Likely to be multifactorial

Origin of cancer may be:
Genetic
Chemical
Environmental
Viral or immunological
From causes not yet identified
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13
Q

Development of Cancer (Cont.): initiation

A

 Mutation of cell’s genetic structure
• From inherited mutation (an error during DNA replication)
• From exposure to a chemical, radiation, or viral agent
 Mutated cell has the potential to develop into clone of neoplastic cells
 Once initiated, mutation is irreversible.
 Not all mutated cells form a tumour.
 Mutated cells become tumours only when they establish the ability to self-replicate and grow.

 Carcinogens may be:

  1. Chemical
  2. Radiation
  3. Viral

 Carcinogens can be:

  1. Detoxified (by protective enzymes)
  2. Harmlessly excreted

 Cells damaged by carcinogens may:

  1. Self-repair
  2. Die
  3. Replicate into daughter cells with same genetic alteration
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14
Q

Development of Cancer

1. Chemical carcinogens

A
  • -Long latency period makes identification of carcinogens difficult.
  • -Animal studies may not apply to humans.
  • -Certain drugs have been identified as carcinogens.
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15
Q

Development of Cancer

2.Radiation

A
  • -Ionizing radiation can cause cancer in almost any human tissue.
  • -Dose of radiation needed to cause cancer is unknown.
  • –Ultraviolet radiation is associated with melanoma and squamous and basal cell carcinoma.
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16
Q

Development of Cancer (Cont.)

3. viral carcinogens

A

ie. Epstein-Barr virus (EBV)= Burkitt’s lymphoma

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17
Q

Development of Cancer (Cont.)

PROMOTION

A 
	Process leads to tumor development
	Activities of promotion are reversible:
•	Obesity
•	Smoking
•	Alcohol
•	Dietary fat
•	Hormones
•	environmental chemicals
	Cause further changes in DNA
	Less differentiation and increased rate of mitosis and/or lack of apoptosis
	Dysplasia or anaplasia may be evident.
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18
Q

Development of Cancer (Cont.)

LATENT PERIOD

A
  • -May range from 1 to 40 years
  • -Length of latent period associated with mitotic rate of tissue of origin and environmental factors
  • -For disease to be clinically evident, tumour must reach a critical mass that can be detected.
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19
Q

Development of Cancer (Cont.)

PROGRESSION

A 
	Characterized by 
•	Increased growth rate of tumour
•	Invasiveness
•	Metastasis
	Most frequent sites of metastasis are lungs, brain, bone, liver, and adrenal glands.

 Metastasis process begins with rapid growth of primary tumour
• Develops its own blood supply
—-Critical for survival and growth of tumour
• Tumour angiogenesis is formation of blood vessels within tumour
• Certain segments of primary tumour can detach and invade surrounding tissues
• Detached cells can invade lymph nodes and vascular vessels to travel to distant sites.
• Most mobile tumour cells do not survive.
• Surviving tumour cells must create an environment conducive to growth and development.

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20
Q

Immunity and Cancer Risk

A

—Cell-mediated immunity recognizes some tumor cells and destroys them.

—Immunization for cervical cancer and hepatitis is recommended to reduce cancer risk from infection.

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21
Q

Risk Factors

A

 Genetic factors
–Oncogenes that regulate all growth
 Viruses
–Oncoviruses alter host cell’s DNA.
 Radiation
–Ultraviolet rays, X-rays and gamma rays, Radioactive isotopes, Risk is increased with higher cumulative dosage.
 Chemicals (check health and safety information)
–Organic solvents, Asbestos, Heavy metals, Formaldehyde, Chemotherapy agents
 Biological factors
–Chronic irritation and inflammation, Age, Diet,, Hormones

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22
Q

Risk Reduction

A

Limit UV exposure from sun or tanning booths.
Regular medical and dental examinations

Self-examination

Diet:

  • Increased fiber content
  • Reduced fats
  • Five to ten servings of fresh fruits and vegetable daily. These foods contain antioxidants, which reduce changes in DNA.
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23
Q

Warning Signs of Cancer

A
  • anemia
  • change in bowel movements
  • a sore that does not heal
  • weight loss
  • cough
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24
Q

Local Effects of Tumors

A

—-Pain
 May be absent until very late stages
 Occurs when tumor is well advanced
 Severity depends on the type of tumor

—-Obstruction
 Occurs wen tumor compresses a duct or passageway
 Blood supply or lymphatic flow may be restricted
 Digestive tract
 Airflow in bronchi

——Tissue necrosis and ulceration
 May lead to bleeding or infection around the tumor

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25
Systemic Effects of Malignant Tumors
 Weight loss and cachexia (ca-KeK-Sia): Anorexia, fatigue, pain, stress. Increased demands on the body from tumor cells  Anemia: Caused by blood loss at tumor site,Nutritional deficits may reduce hemoglobin synthesis.  Severe fatigue: Caused by inflammatory changes, cachexia, anemia, Stress of treatment schedule, Psychological factors  Effusions : Inflammation causes fluid buildup in body cavities.  Infections: Occur frequently as resistance declines  Bleeding: Tumor cells may erode the blood vessels.  Paraneoplastic syndrome: Associated with certain tumor types, Tumor cells release substances that affect neurological function and may have hormonal effects.
26
Diagnostic Tests
--Routine screening Essential for early detection Following treatment to detect any further tumors --Self-examination Early detection if done consistently Breast, testicular, and skin examinations are important. --Blood tests Measure blood cell levels during treatment May detect tumor markers (e.g., PSA test) --Radiographic, ultrasound, MRI, CT --Methods of visualizing changes in tissues or organs --Cytological tests require biopsy or cell sample Histological and cytological examinations to determine degree of differentiation and tumor type May be tested for growth promoter sensitivities, (e.g., estrogen-dependent tumors) Most dependable confirmation of malignancy
27
Spread of Malignant Tumors | INVASION
Local spread Tumor cells grow into adjacent tissues Example: Uterine carcinoma invades the vagina
28
Spread of Malignant Tumors | METASTASIS
Spread to distant sites Via blood or lymph or other body fluids Example: Carcinoma of the colon spreads to the liver.
29
Staging Cancer
Essential to standardize comparative studies of treatments and outcomes Used to estimate prognosis Most common system used is the TMN system: - -Size of primary tumor (T) - -Involvement of regional lymph nodes (N) - -Spread (metastasis) of tumor (M)
30
Treatment
Depends on specific cancer - Surgery, chemotherapy, immunotherapy, radiation - Combination of the above
31
Surgery
 Removal of tumor and surrounding tissue  May be done with laparoscope and several small incisions ---Minimizes tissue damage ---Improves recovery time  Removal of adequate surrounding tissue may result in changes in function.  Radiofrequency ablation (RFA) ---Alternative surgery for small single tumors in solid or fluid-filled organs, but not the lungs
32
Radiation Therapy
 May be used alone or combined with other therapies  Causes mutations or alterations in target DNA  Most effective in rapidly dividing cells  Some types of cancers are radioresistant.  May be used as an adjuvant therapy prior to surgery to shrink tumor
33
``` Radiation Therapy (Cont’d) METHODS OF ADMIN ```
 External sources—cobalt machine • Radiation for a short time to specific site in the body • Requires multiple treatments  Internal Insertion of radioactive material at the tumor site • Treat specific cancers (e.g., cervical or oral tumors).  Instill radioisotope in a solution into a body cavity. • Monitor to ensure that there is no leakage • Radioisotopes may be given by injection for specific tumors.
34
Adverse Effects of Radiation
 Bone marrow depression - Decreased leukocytes—increase risk of infection - Decreased erythrocytes—fatigue, tissue breakdown - Decreased platelets—excessive bleeding  Epithelial cell damage -Damage to blood vessels and skin, hair loss  Infertility -Caused by abdominal radiation  Nonspecific fatigue and lethargy -Can lead to mental depression
35
Chemotherapy
 Antineoplastic drugs  Can be used alone or in combination with surgery or radiation ```  Usually combination of two to four drugs -Given at periodic intervals -Classifications include: • Antimitotics • Antimetabolites • Alkylating agents • Antibiotics -Drugs interfere with protein synthesis and/or DNA replication. ```
36
Adverse Effects of Chemotherapy
---Bone marrow depression  Limiting factor with chemotherapy  Blood test taken before each treatment  Nadir is point of lowest cell count—different points in cycle ---Nausea  May occur prior to, during, or shortly after treatment  Antiemetic drugs helpful for decreasing nausea ---Epithelial cell damage  Occurs easily  Hair loss  Breakdown of skin and mucosa ``` ----Damage to specific areas  With some antineoplastic drugs  Fibrosis in the lungs  Damage to myocardial cells  Kidney damage ```
37
Other Drugs
 Blocking agents: Act to block receptors for growth promoters on cancer cells  Biological response modifiers (BRMs): Augment the natural immune response  Angiogenesis inhibitors: Inhibit the stimulus for growth of blood vessels  Analgesics: Prescribed to alleviate pain AND May be used in high dosages
38
Nutrition
Patients with advanced cancer are often malnourished. ``` Contributing factors: Change in taste sensation Anorexia Vomiting and/or diarrhea from treatments Sore mouth or loss of teeth Pain and fatigue Malabsorption caused by inflammation in the digestive tract ```
39
Complementary Therapies
``` --May include: Massage Meditation Counseling Exercise Therapeutic touch Research-based evidence has not been published for: Raw food macrobiotic diet Use of insulin and glucose with chemotherapy ``` --Health care workers need to be aware of these different types of therapies to advise patients.
40
Prognosis
--Cancer-free state generally defined as 5-year survival without recurrence --Some cancers such as childhood leukemias can be considered cured after a 10-year, cancer-free period. --Remission—no clinical signs of cancer Client may experience several remissions --Life expectancy and death rates for specific cancers vary.
41
Examples of Malignant Tumors
--Skin cancer  Visible, easily diagnosed and treated  Excellent prognosis, with exception of malignant melanoma --Ovarian cancer  Poor prognosis because of hidden nature of cancer  High mortality rates --Brain tumors  Both benign or malignant tumors are life-threatening because of compression of brain tissue.  Primary tumor usually fatal; thus, no metastasis
42
Cancer Incidence
Most common in men - Prostate cancer - Lung cancer - Colorectal cancer Most common in women - Breast cancer - Lung cancer - Colorectal cancer
43
Lung Cancer
 About 90% of cases are related to smoking.  Bronchogenic carcinoma -Most common type of primary malignant lung tumor -Arises from bronchial epithelium  Squamous cell carcinoma -Usually develops from epithelial lining of a bronchus  Adenocarcinomas and bronchoalveolar cell carcinomas -Usually found on periphery of lung
44
Lung tumor effects
 Obstruction of airflow into a bronchus • Causes abnormal breath sounds and dyspnea  Inflammation and bleeding surrounding the tumor • Cough, hemoptysis, and secondary infections  Pleural effusion, hemothorax, pneumothorax  Paraneoplastic syndrome - altered immune response to a neoplasm • Occurs wen tumor cell secretes hormones or hormone-like substances  Usual systemic effects of cancer
45
Early signs OF LUNG CANCER
``` Persistent productive cough Detection on radiograph Hemoptysis Pleural involvement Chest pain Hoarseness, facial or arm edema, headache, dysphagia, or atelectasis ``` Systemic signs --Weight loss, anemia, fatigue Paraneoplastic syndrome - -Indicated by signs of an endocrine disorder - -Related to the specific hormone secreted Signs of metastases - -Bone pain - -Cognitive deficits, motor deficits
46
LUNG CANCER DIAGNOSTIC TESTS AND TREATMENT
``` Diagnostic tests: Specialized helical CT scans and MRI Chest radiography Bronchoscopy Biopsy and mediastinoscopy ``` Treatment: Surgical resection or lobectomy Chemotherapy and radiation Photodynamic therapy
47
Colorectal Cancer
```  Most malignancies develop from adenomatous polyps.  Early diagnosis is essential.  Cancer occurs primarily in persons older than 50 years.  Risk factors -Familial multiple polyposis -Long-term ulcerative colitis -Genetic factors -Environmental factors • Diet low in fiber ```
48
COLORECTAL CANCER SIGNS AND SYMPTOMS
Initial signs depend largely on the location of the growth. ``` General signs: Change in bowel habits Alternating diarrhea and constipation Bleeding Fatigue, weight loss, anemia ```
49
COLORECTAL TREATMENT
Surgical removal with radiation and/or chemotherapy
50
Carcinoma of the breast | MALIGNANT CANCER
 Incidence increases after age 20 years • Most cases in women between ages 50 and 69 years  Most tumors are unilateral  Earlier onset associated with more aggressive growth  Different types • Most arise from ductal epithelial cells  Metastasis occurs via lymph nodes early in the course of the disease.  Presence of estrogen or progesterone receptors on tumor cells influences treatment
51
Carcinoma of the Breast | Predisposing factors
```  First-degree relative with the disease  Strong genetic predisposition (BRCA1 and BRCA2)  Longer and higher exposure to estrogen  Nulliparous or late first pregnancy  Lack of exercise  Smoking  High-fat diet  Radiation therapy to the chest  Cancer of the uterus, ovaries, or pancreas ```
52
Carcinoma of the Breast (Cont.) SIGNS AND SYMPTOMS
 Change on mammogram  Initial sign—single, small, hard, painless nodule  Later—distortion of breast tissue, dimpled skin, discharge from nipple  Ultrasound or needle biopsy confirms diagnosis.
53
CARCINOMA OF THE BREAST | Course of breast cancer
```  Metastasis occurs by the time the tumor is 1 to 2 cm in diameter.  Axillary lymph node involvement  Secondary tumors in: • Bone • Lung • Brain • Liver ```
54
Carcinoma of the Breast (Cont.) | TREATMENT
- -Surgery may be a lumpectomy or removal of the breast. - -Lymph nodes may be removed, depending on the stage of the disease. - -Tissue biopsy will determine the presence of specific growth factors to design drug treatment and chemotherapy. - -Radiation therapy may be done before or after surgery.
55
Carcinoma of the Breast | STAGING
Staging is based on the TMN system and the presence of receptors for specific growth accelerators in the tumor.
56
Carcinoma of the Cervix
 Most cases of cervical cancer are caused by human papillomavirus (HPV) infection, a sexually transmitted virus.  Vaccines now exist against the causative strains of HPV.  Routine Pap smears of cervical cells are important in identifying early, treatable stages of the disease: -By age 20 years or in the year that sexual intercourse begins -At intervals, as advised by health care worker
57
Carcinoma of the Cervix (Cont.) | COURSE OF DISEASE
 Early dysplasia of cells; abnormal cells showing less differentiation  In situ tumor is located on the mucosal surface.  Invasion to submucosa  Invasion and spread to adjacent organs  Late metastasis
58
Carcinoma of the Cervix (Cont.) | RISK FACTORS
Age < 40 years Strongly linked to HPV viral infection (STD) Multiple partners Sexual intercourse beginning in early teenage years Smoking History of prior STDs
59
LEEP -
(loop electrosurgical excision procedure) — removes abnormal tissue by cutting it away using a thin wire loop that carries an electrical current.
60
The Leukemias
 Group of neoplastic disorders involving white blood cells  Uncontrolled WBC production in bone or lymph nodes  Other hemopoietic tissues are reduced.  One or more types of leukocytes are undifferentiated, immature, and nonfunctional.  Large numbers released into general circulation  Infiltrate lymph nodes, spleen, liver, brain, other organs
61
Acute leukemias (ALL and AML)
High proportion of immature nonfunctional cells in bone marrow and peripheral circulation Onset usually abrupt , marked signs of complications Occurs primarily in children and younger adults
62
Chronic leukemias (CLL and CML)
Higher proportion of mature cells Insidious onset Mild signs and better prognosis Common in older adults
63
Signs and Symptoms of Acute Leukemia
```  Usual signs at onset -Frequent or uncontrolled infections -Petechiae and purpura -Signs of anemia  Severe and steady bone pain  Weight loss, fatigue, possible fever  Enlarged lymph nodes, spleen, liver  Headache, visual disturbances, drowsiness, vomiting ```
64
``` The Leukemias (Cont.) Diagnostic tests ```
 Peripheral blood smears • Immature leukocytes and altered numbers of WBCs • Numbers of RBCs and platelets decreased • Bone marrow biopsy for confirmation
65
``` The Leukemias (Cont.) Treatment ```
Chemotherapy ALL in young children responds well to drugs Biological therapy (interferon) May be used to stimulate the immune system
66
Complications of Leukemia
```  Opportunistic infections, including pneumonia  Sepsis  Congestive heart failure  Hemorrhage  Liver failure  Renal failure  CNS depression and coma ```

PNP #2 (10 decks)

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