Outline 9 Cancer Flashcards
Incidence is what?
how many NEW cases in a given period of time (usually a year)
Prevalence is what?
How many people are LIVING WITH the disease within a specific period of time
Cancer on the VF tends to be what color?
white
What is the incidence and prevalence of cancer?
Incidence – roughly 1,200,000 new cases of cancer/yr.
Prevalence - roughly 8 million survivors
Roughly 600,000 people die of cancer each year
Which cancer kills more than any other form of cancer?
Lung cancer
What percentage of men and women are diagnosed with some form of cancer
Almost ½ of all men (46%) and 38% of women will be diagnosed with some form of cancer.
Chances of death from cancer are 24% for men and 20% for women.
What is the incidence and prevalence for laryngeal cancer?
Incidence of laryngeal cancer roughly 12,000/yr.
-Laryngeal cancer is less than 2% of all cancers diagnosed each year, but it is 25% of all head and neck cancers.
Incidence of laryngectomies total roughly 5-7,000/yr.
Prevalence - roughly 60,000
What is the ratio of gender with laryngectomy ?
more men than women by 4:1 (used to be 10:1 but women are catching up in a lot of areas – heart attacks, incarceration, the good things.
what is the average age of diagnosis ?
63 yrs. old (lots of retired men)
What is the survival rate or laryngeal cancer?
there are other health issues that come with and elderly population made up of smokers
• Survival rate is generally good, for a few years.
• Become your patients for a few years, and then they die.
What is normal cell division?
there is division, gap 1, a synthesis period (DNA replicates), gap 2
What happens in gap 1 ?
we’re not sure but it’s most effective if you were to interfere with a cell BUT we don’t know what happens during gap periods
lasts a minimum of 2 hours
What happens in gap 2?
we’re not sure what happens
lasts a minimum of 10 hours
The fastest cell can divide in how many hours?..why is that important?
12 hours
-Important if you have a really fast-growing cancer (point is that it may not take that much time for cancer to get serious)
what is the normal cell death?
In any 24-hour period, roughly 3 billion cells die off and are replaced!
Planned cell death is called ?
Apoptosis
meaning “to drop off” in Greek
What is apoptosis?
cell death
when a cell stops getting communication from other cells around it, it dies
The process of keeping cells from wandering off and living where they shouldn’t
What is Metastasis?
when a cell wanders off and starts duplicating, instead of dying
Where to cancer cells tend to metastisize?
in certain places; likely to end up in the same place across people
where does Laryngeal cancer mestasisize ?
grows through the structures next to it
- Spreads to brain and/or lungs (usually lungs)
- Also will metastasize to the skin around it (more locally than other cancers)
- Will grow through the fascia of the spinal column, the tongue, jaw
Since it is laryngeal cancer it metasizes much more locally than other cancers. Why is this problematic?
it will get into the lymph nodes of the neck, which are connected to the other lymph nodes in your body and spread everywhere
One of the largest concentrations of lymph nodes in your body are in your neck, and when cancer enters the lymph nodes, it spreads to other lymph nodes which are all over your body.
Necrosis is
cell death due to damage or disease
What happens as a result to necrosis?
There will be rapid cell replacement; cells around injured cells kick into overdrive
Shortened Gap 1 period (G1) to replace the damaged cells (but the fastest a cell can replicate itself is always 12 hours)
What is cancer?
abnormal cell life; occurs when there is damage to a cell’s suicide program
A cancer cell has a genetic defect, and reproduces other cells exactly like itself that also have that same genetic defects
How FAST a cancer cell reproduces depends on what?
on the kind of cell it was in the first place
- Kidney and prostate cancer come from very slow reproducing cells, and thus are slow-growing cancers
- A rapid reproducer is blood: really short time for some blood cancers from diagnosis to death; sometimes just a matter of a few days
What are the 4 cases when cancer occurs?
1) The cell suicide program (apoptosis) is damaged
2) When a cell does not receive signal from the cells around it
3) When a cell wanders off and does not suicide, and the body’s immune system defense does NOT hunt down the wandering cell and kill it.
4) Override
What happens when a cell wanders off and does not suicide?
oThese wandering cells begin to grow where they shouldn’t
oThis is loss of error control.
-All of us probably get cancer 100 times a day; cells wander off without committing suicide, but our body’s immune system takes care of those cells to get rid of them.
What happens in override?
a cell’s duplication has created a defective gene that overrides the suicide program
•If the suicide program has switched off, a genetic defect has overridden the “switch on: die,” so a cell switches on, lives forever, duplicates itself to more cells that have the override gene and those cells live forever.
•Neurons are supposed to have an override gene, because “the neuron lives as long as the moron” (HAHA)
What five (general) things can cause cancer?
- Inheritance
- Chemicals
- Carcinogens
- Viruses
- Radiation
how can inheritance cause cancer?
genetic function – you can inherit a bad error-control program, a tendency to get cancer (e.g., breast cancer, skin cancer, colon cancer)
how can chemicals cause cancer?
teratogens mess with cell function – smoke (tobacco esp.), carcinogens (alcohol, fungi, gasoline, lead), dyes containing formaldehyde, dioxins from food containing pesticides, viruses (e.g., HPV 100% of the time will cause cancer), etc…
how can radiation cause cancer?
messes with genetic programs, literally fries genes
T/F We do not know what the mechanism is that alters the genetic blueprint
True
What are the risk factors for laryngeal cancer?
1.Smoke, particularly tobacco smoke
-Being exposed to smoke from being a firefighter, using a wood-burning stove, smoking, etc…
2.Alcohol; smoke and alcohol together are very potent
-Both go right past the larynx
3.Poor nutrition
4.GERD (acid reflux)
•High correlation with esophageal and laryngeal cancers
•By extension, bulimia (although the heart usually gives out first)
What are symptoms of glottic cancer?
1.Hoarseness (first signs)
2.Persistent cough
•Most laryngeal cancers begin on the vocal folds
•Incidence of subglottic cancer is low; most happens at the level of the glottis)
Symptoms of supraglottic cancer: above glottis – the pharynx, nasopharynx, and orophynx
- Prolonged sore throat; feeling of lump in the throat that hurts
- Dysphagia
- Prolonged sore throat; feeling of lump in the throat that hurts
- Persistent throat pain
- Persistent ear pain
- Dyspnea/stridor; rough, difficult breathing
- Unexplained weight loss (cancer in general)
What does TNM stand for?
T – Tumor (size of tumor and tissue that it encompasses)
N – Nodes (in laryngeal & pharyngeal cancer you can also think of it as neck)
•Cancer has travelled to the nodes; how much of the neck tissue is effected
•Lymph nodes are a super highway; the cancer has metastasized
M – Metastasis: cancer has spread to distant sites – laryngeal cancer will travel up to brain, down to lungs
Explain how the size of the tumor develops
A large tumor crowds out the cells that should be in that area, and surrounds other cells (cancer cells can grow around the healthy cells that are supposed to be there – not necessarily a solid ball of cancer cells)
Explain Tx, T1, T2, T3, T4
Tx: a tumor has been identified but has not yet been assessed
T1: a tumor is in situ (on site); confined, small, appears to be sitting on the structure surface (T1 on vocal folds looks like a mole and the folds are still able to move)
T2: larger but still confined; on the vocal folds, the bump appears to be a little bit larger; may or may not yet affect the movement of the folds
T3: More tissue is involved; movement of the vocal folds is impaired; into muscle tissue, potentially into cartilage
T4: Sizable tumor; the larynx may appear to be immobal (accompanied by dysphagia, breathing problems, etc…)
n for node involvement–explain N0, Nx, N1, N2, N3
N0 – no lymph node involvement
Nx – in the nodes, but difficult to assess how many nodes are involved (it’s spread but you can’t assess it)
N1 – Cancer has spread to the ipsilateral side of the lymph nodes in the neck (1 or 2 nodes only)
N2 – Ipsilateral, BUT larger number and larger tumor in the lymph nodes
N3 – Bilateral spreading to the lymph nodes (both sides of neck)
M for metastasis is localized to the neck
M0 – none; no spreading (first look in lungs, then brain)
Mx – Likely metastasis but cannot assess it.
M1 – There is most definitely metastasis
T/F Metastasis of laryngeal cancer most commonly goes down to the lungs, but can go up to the brain.
True
What is carcinoma?
occurs in the cells that line the surfaces of the body; e.g., digestive tract (laryngeal cancer)
•Laryngeal cancer typically begins as squamous cell carcinoma
What is sarcoma?
it arises in connective tissues; tendons, muscles, and bones
What is lymphoma?
arises in the lymph nodes
What is leukemia?
blood cancer and the blood-forming systems such as bone marrow
Tumors must be about ____ to be detectable.
1 gram
May take a tumor ______ to get to be 1 gram
4-5 years
Leukoplakia
cellular change on surface of vocal folds, appears as extra white tissue patches with purplish/reddish edges; is precancerous (remember that vocal folds are supposed to be white)
A tumor causes the larynx structures
Causes the larynx structures to become stiff, no vibration, and no mobility in the vocal folds.
If the vocal folds are still vibrating, the cancer is STILL superficial and has not gone through the skin into the muscle & bone
T/F Laryngeal cancer does respond to chemotherapy
FALSE it does NOT
this is used as a last resort
How does radiation therapy work on laryngeal cancer?
saturating a tumor with high amounts of radiation
oCatches rapidly dividing cells in very delicate phases; will hopefully kill rapidly dividing cells before it kills normal cells (cancerous tissue has a high percentage of rapidly dividing cells)
What are the side affects of radiation therapy?
Side Effects: Hair loss, immune compromised, infertility, anemia, and being sick to your stomach are common side-effects of radiation
•Hair cells, digestive system lining, and blood cells are rapidly dividing cells.
•Radiated tissue becomes STIFF, so radiation of the larynx causes it to become stiff – eating, talking, swallowing become issues
How long does radiation treatment last?
Typically lasts 5 – 8 weeks with the patient receiving 50 – 80 Grays (Gys) total
What are grays?
oGrays are units of radiation measurement
oIf you receive more than 80 grays, the radiation is more likely to cause more cancer rather than fixing it.
What does it mean if I say “he received one gy” ?
1 gy is a specific dose of ionizing radiation; ionizing radiation dose (atomic level)
what is rad?
another measurement of radiation
100 Rads = ______ Gray.
1 gray
Radiation affects the ability to produce _______ voice
alarygeal voice
What are some other considerations for laryngeal cancer?
- Type of tissue and its response
- Maximum dosage before the tissue breaks down
- Things not noted in books or mentioned by medical professionals:
- General effects
- Speech/esophageal effects
- May even affect electrolarynx speech, but not usually.
What are some things not noted in books or mentioned by medical professionals?
-The spine is irradiated when receiving radiation for laryngeal cancer
oCan affect lower motor neurons, can result in ipsilateral paresis
-Catarracts – higher occurance
-Blood pressure – carotid artery can become stiff
What are some general effects of radiation?
- Causes xerostomia (dry mouth)
- dysphagia
- decreased tissue compliance (stiffness)
What is a last resort?
Chemotherapy
VEGF stands for?
Vascular Endothelial Growth Factors
Angiogenesis
The creation of new blood vesicles
We are all exposed to about ______ a year?
2 miliSieverts
T/F Cancers in the larynx tend to start superficially
True, • On the surface tissue of the vocal folds themselves
If the VF are still vibrating then the cancer has remained superficial but what two things should we be looking at?
- VF stretch and compression to be symmetrical
* Equal movement
