Pathophysiology and Pharmacology of Cancer Flashcards
What is cancer?
- Cancer is a genetic disorder at cellular level
- Chronic disease
- Uncontrolled proliferation of cells
Cancer
- Abnormal cells are not killed
- Abnormal cells divide/replicate
- Grow beyond normal tissue
Causes of cancer?
- genetic
- environmental
- behavioural
Caused by:
- Genetic: 10% of cancers
- Oncogenes trigger cancer characteristics
Abnormal genes, promote cell proliferation (BRCA1,
BRCA2)- Tumour-suppressor genes suppress oncogenes Encode proteins that in their normal state negatively regulate proliferation. deletion or mutation -> inactive -> allow tumour to grow
- Environmental factors: exposure to radiation/toxins
- Behavioural factors: diet, smoking, low exercise
describe the process of carcinogenesis
- initiation phase
- promotion phase
- progression phase
initiation phase:
the cell is exposed to the initiating factor/carcinogen
normal call -> DNA changes
promotion:
abnormal cell growth is promoted
- > failure of DNA repair -> genetic mutations ->
1) activation of growth-promoting oncogenes
2) inactivation of tumour suppressor genes
3) alterations in genes that regulate apoptosis - > unreguated cell prolifertion / decreased cell apoptosis
- > clonal expansion
progression:
cellular changes become irreversible and demonstrate malignant behaviour
-> tumour progression -> malignant neoplasm -> invasion and metastisis
Discuss the development of cancer on a cellular level
normal call -> genetic changes -> DNA becomes abnormal -> cell avoids apoptosis -> continued cel replication -> angiogenesis - > tumour growth -> tumour cells break away -> metastisis
Name the 2 types of tumour
Malignant (Neoplasm) - metastasis to surrounding tissue, not self-limiting
Benign - don’t spread or reoccur
describe some differences between the 2 types of tumours
Benign
Grow slowly, Well-defined capsule, Not invasive, Well-differentiated, Do not metastasise
Malignant
Grow rapidly, Not encapsulated, Invasive, Poorly differentiated, Can spread distantly (metastasis)
__________ must occur in order for a tumour to enlarge
Angiogenesis must occur in order for a tumour to enlarge
formation of new blood vessels
Primary tumour
A tumour that grows within a specific organ
common sites of metestesis
brain/CSF, lungs, liver, kidneys, bones, adrenal glands
Pharmaceutical therapy for cancer
Antineoplastic Drugs
- Cytotoxic drugs (Chemotherapy)
- Hormonal drugs
- Immunotherapy drugs
Cytotoxic drugs (Chemotherapy) Cell cycle has 5 phases: - \_\_\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_\_\_\_\_\_\_\_\_ Cytotoxic drugs interfere in one or more phases
Cell cycle has 5 phases:
- Presynthesis gap phase
- DNA synthesis phase
- Premitotic phase
- Mitosis Phase
- Resting Phase
Cytotoxic drugs interfere in one or more phases
chemotherapy side effects
- Alopecia (damage to follicle cells)
- Impaired bone marrow production of blood cells (myelosuppression)
- Infertility
describe Hormonal drugs
Tumours that can be stimulated by hormones
- Breast, Prostate, Ovaries
Impact on hormone production = cancer cell death
Can be achieved by:
Blocking hormone production
Fooling signal pathway
Blocking hormone receptors
Describe Immunotherapy drugs
Biological treatment to manipulate immune system
Immune system works more effectively
- Tag and destroy
Different types
- Adoptive cell transfer (T cell)
- Cytokines (cell Protiens)
- Vaccines
- Monoclonal antibodies
Used in combination with cytotoxic treatments
grading of tumour
- Grade I—Cells differ slightly from normal cells (mild dysplasia) and are well differentiated (low grade).
- Grade II—Cells are more abnormal (moderate dysplasia) and moderately differentiated (intermediate grade).
- Grade III—Cells are very abnormal (severe dysplasia) and poorly differentiated (high grade).
- Grade IV—Cells are immature and primitive (anaplasia) and undifferentiated; cell of origin is difficult to determine (high grade).
- Grade X—Grade cannot be assessed.
how do immunotherapy drugs work?
Tags the cell as a foreign cell which allows the body’s immune system to identify the cell, identify it as dangerous and destroy it.
Creates more antigens on the surface of the cancer cell which triggers the immune system’s response of destroying the cell.
What are the different types of immunotherapy drugs
Adoptive cell transfer (T cell)
Cytokines (cell Proteins)
Vaccines
Monoclonal antibodies -contain antibodies that bind to specific antigens on the cancer cell.
5 most common cancers (men)
prostate, colorectal, melanoma, lung, head and neck
5 most common cancers (women)
breast, colorectal, melanoma, lung, uterus,
Diagnosis of cancer
Imaging techniques - CT, MRI, Ultrasound Biopsy - FNB for breast Blood tests (Tumour Cell Markers) - PSA (Prostate Cancer) - CA 15-3 (Breast Cancer)
cancer is then stages using the TNM system
What is screening
Testing of an asymptomatic population
Why is screening important?
The primary tumour often doesn’t cause symptoms unless it is putting pressure on other organs
Large research project in Australia – significantly fewer deaths in people diagnosed from screening
Breast cancer diagnosis through BreastScreen Australia = 69% lower risk of dying
Cervical cancer diagnosis through Screening = 87% lower risk of dying
Bowel cancer diagnosis through Screening = 59% lower risk of dying
name and describe the Clinical manifestations of cancer
Pain:
Pain is more evident in the later stages of malignancy – there can be little pain associated with the early stages.
The level of pain experienced can be due to the physical deterioration, the tumour pressing on organs, and worsen due to fear, anxiety, sleep loss and fatigue.
Infection
The risk increases when neutrophils and lymphocyte counts fall. Patients become neutropenic – low neutrophil count and at an increased risk of infection.
Due to tumour invasion of the bone marrow, leukemias of the blood forming cells, and chemotherapy drugs that are toxic to the cells.
Anaemia A decrease of haemoglobin in the blood Caused by: - Chronic bleeding = iron deficiency, - medical therapies - malignancy in blood-forming organs - suppression of the bone marrow by disease or treatment,
Fatigue - Can be debilitating and difficult to measure
Causes:
- Sleep disturbance,
- biochemical changes from circulating cytokines
secondary to disease and treatment
- psychosocial factors, level of activity
- nutritional status
- anaemia
Cachexia:
Most severe form of malnutrition
Can lose 80% of adipose and skeletal muscle mass
Breast Cancer – Symptoms
Breast Mass or thickening A lump in the underarm or above the collarbone Skin rash near the nipple area Dimpling in an area of the breast Nipple discharge Burning, stinging or pricking sensation
Breast Cancer – Diagnosis
Diagnosis:
Breast examination
Mammogram
Fine needle biopsy
Breast Cancer – Treatment
Treatment:
Lumpectomy
Mastectomy
Radiation
Chemotherapy
Breast Cancer – Nursing care (hospital)
- Psychological support for the patient and family
- Pre & post op care
-Psychological support for the patient and family- Altered body image
- Personal fear/Anxiety
- Pain relief – Medications, heat packs, alternative
therapies - Education
- Medications
- Side effects
Breast Cancer – Nursing care (community)
- Post op care
- Psychological support for the patient and family
- Pain relief – Medications, heat packs, alternative
therapies - Wound care
- Education
- Medications
- Side effects
- Lymphatic drainage massage
- Handwashing & wound care
- Counselling/Support services
Prostate Cancer – Symptoms
name 5
- Can be asymptomatic in the early stages
- Symptoms dependent on size of malignancy
- Can include urgency, frequency, hesitancy, dysuria and - nocturia
- Haematuria, blood in the ejaculate
- Erectile dysfunction
- Bone pain
- Nerve pain
- Fatigue
- Weight loss
Prostate cancer treatment
Surgery
- TURP (trans urethral resection of prostate)
- Radical Prostatectomy
Radiation therapy
Hormonal therapy
- Focuses on reducing Androgen as prostate cancer cells are androgen dependent and may die if deprived of androgen.
Prostate cancer nursing care (hospital)
Pre & Post op care – TURP, Prostatectomy
Health education
Psychological support
- Distorted body image
- Erectile dysfunction
Incontinence assessment
- Promote pelvic floor exercises
- Liaise with physiotherapist or continence specialist
Catheter Care
Pain management
Prostate cancer nursing care (community)
Health promotion – Nurses can increase public awareness, early diagnosis saves lives
Post op care
Psychological support
- Distorted body image
- Erectile dysfunction
Incontinence care
- Catheter Care
Pain management
Counselling
UTI/Post op Infection care
Name at least 2 types of lung cell cancer tumours
Small cell carcinoma
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Symptoms of lung cancer?
Chronic cough,
haemoptysis,
wheezing,
SOB
Dull, aching or pleuritic chest pain due to the tumour growing
Hoarseness/dysphagia due to the tumour pressing on the trachea or oesophagus
Treatment for lung cancer?
Surgery
- Wedge resection
- Lobectomy
- Pneumonectomy
Chemotherapy & Radiotherapy
Palliative care
Lung cancer nursing care (hospital)
Pre & Post op care – Lobectomy
Nutritional support
Health education/promotion
Psychological support
Pain management
Palliative Care
End of Life Care
