Unit 3_Oncology Flashcards by Danielle Pieri

What is uncontrolled cell proliferation and spread of abnormal cells?

Cancer

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Why are cancer rates declining?

Prevention and detection of new cancers and recurrent cancer
Surveillance/monitoring for cancer spread, recurrence, or second cancers
Intervention for consequences of cancer and its treatment
Coordination of care between specialists and primary care providers to ensure that all the survivor’s health needs are met

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What are lifestyle risk factors of cancer?

Tobacco
Diet/nutrition
Alcohol
Obesity

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What percentage of cancers are linked to heredity as most are largely preventable?

~5-10%

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What is the median age of primary cancer diagnosis for all races/genders?

~66 years old

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What lifestyle risk factor is linked to 90% of lung cancers?

Smoking

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What lifestyle risk factor is linked to 1/3 of cancer mortality?

Dietary causes

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The incidence of different types of cancer varies ______.

geographically

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What are people living in rural areas less likely to do?

Use preventive screening services or to exercise regularly

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What is an environmental risk factor of cancer?

War-time exposure

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What links between biobehavioral and psychologic factors and the progression (but not necessarily the initiation) of cancer?

stress, depression, and social isolation

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What is the process by which normal cells undergo physical and structural changes as they develop to form tissues?
- Different physiological functions

Mutation –> differentiation is altered and malignant?
- Malignant cells
- Can occur during mitosis (depending on the cell type), exposure to chemicals, viruses, radiation, etc.

Differentiation

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What is the increased number of cells in tissue –> increased tissue mass?
- Can be normal physiological function –> wound healing, callus forming.

Hyperplasia

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What is the increase in cell mass due to tumor formation?

Neoplastic hyperplasia

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What is the disorganization of cells in which an adult cell varies from its normal size, shape, or organization?
- May reverse itself or lead to cancer
- Often caused by chronic irritation

Dysplasia

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What is early dysplasia?
- One cell type was replaced by another

Reversible and benign but still an abnormal change
Examples:
- Columnar epithelium of respiratory tract –> squamous epithelium
- Barrett’s esophagus: The squamous epithelium of the esophagus is replaced by the glandular epithelium of the stomach

Metaplasia

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What are “neoplasms”?

Abnormal new growth of tissues that serves no functional purpose and may harm the host organism
- Competes for blood supply and nutrients
- Doesn’t respond to normal body function

Primary tumors: normally local to the given structure

Secondary: cells have metastasized from another part of body

Classified as benign or malignant

Tumors

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What is the following known as:
Tumor: size of primary tumor (0-4)

Node: regional lymph node involvement (0-4)

Metastasis: zero if no metastasis; 1 if metastases are present

Tumor-Node-Metastasis (TNM) Staging

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As part of Tumor-Node-Metastasis (TNM) Staging, what is known as the primary tumor cannot be assessed?

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As part of Tumor-Node-Metastasis (TNM) Staging, what is known as no evidence of primary tumor?

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As part of Tumor-Node-Metastasis (TNM) Staging, what is known as carcinoma in the situ (confined site of origin)?

TIS

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As part of Tumor-Node-Metastasis (TNM) Staging, what is known as progressive increase in tumor size and involvement locally?

T1, T2, T3, T4

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As part of Tumor-Node-Metastasis (TNM) Staging, what is known as the nodes cannot be assessed?

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As part of Tumor-Node-Metastasis (TNM) Staging, what is known as no metastasis to regional lymph nodes?

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As part of Tumor-Node-Metastasis (TNM) Staging, what is known as increasing degrees of involvement of regional lymph nodes?

N1, N2, N3

As part of Tumor-Node-Metastasis (TNM) Staging, what is known as presence of distant metastasis cannot be assessed?

As part of Tumor-Node-Metastasis (TNM) Staging, what is known as no distant metastasis?

As part of Tumor-Node-Metastasis (TNM) Staging, what is known as distant metastasis?

What can prognosis/treatment of cancer depend on?

Cell type Tissue of origin Degree of differentiation Anatomic site Benign/malignant

What is the following known as? Stage 0: carcinoma in situ (premalignant, preinvasive) Stage I: Early stage, cancer localized to primary organ Stage II: Increased risk of regional spread because of tumor size/grade Stage III: local cancer has spread regionally but may not be disseminated to distant regions Stage IV: cancer has spread and disseminated to distant sites

Cancer summary staging (number)

What cancer stage is carcinoma in situ (premalignant, preinvasive)?

Stage 0

What cancer stage is early stage, cancer localized to primary organ?

Stage I

What cancer stage is increased risk of regional spread because of tumor size/grade?

Stage II

What cancer stage is local cancer has spread regionally but may not be disseminated to distant regions?

Stage III

What cancer stage is when cancer has spread and disseminated to distant sites?

Stage IV

What are cancer-causing genes? These genes transform normal cells into malignant cells, independently or incorporated with a virus.

Oncogenes

What type of genes are the “brakes” to the “stuck accelerator” of the activated oncogene?

Tumor suppressor genes

What is the process by which a normal cell undergoes malignant transformation?

Carcinogenesis

How do we know cancer is linked to the immune system?

1. higher incidence of cancer after immunosuppression or in immunodeficiency 2. infiltration of tumors by lymphocytes and macrophages 3. lymphocyte proliferation in response to tumors 4. regression of metastases after ablation of the primary tumor, and 5. immune-mediated spontaneous regression of human tumors (especially in malignant melanoma, but also in neuroblastoma and other tumors)

How may the immune system respond?

- May be associated with tumor inhibition but not elimination. - recognition of tumor antigens by the immune system may result in tolerance rather than activation of a response. - Healthy individuals get tumors --> antitumor immunity is often insufficient and easily overwhelmed by a rapidly proliferating malignancy

What occurs when major immune responses elicited against tumors involve both innate and adaptive immunity? - NK cells and macrophages that directly kill cancer cells without any previous exposure to the tumor. - Complement-dependent cytotoxicity against tumor cells. Opsonization --> lysosomal contents to destroy the cancer cell. Adaptive immune responses against tumors include specific cytotoxic CD8+ T cells (cytotoxic T lymphocytes) that recognize tumor antigens and lyse tumor cells. - These cells are the major immunologic barrier against tumors.

Immune response against tumors

What are the following? 1. Loss of immunogenicity. - Tumors can mutate antigenic peptides so that they cannot be loaded onto the class I MHC and be presented to CD8+ T cells. - Cytotoxic T cell cannot make good contact with the tumor cell and undergo the remaining steps of triggering its killing mechanism. 2. Antigenic modulation refers to the loss of a surface antigen. - Tumor antigens are internalized or downregulated so that antibodies cannot bind. 3. Induction of immune suppression - Tumors produce a variety of suppressive factors that inhibit NK and T cells directly

Tumor evasion strategies

What are steps for metastasis?

A. Transformation/proliferation B. Angiogenesis - Creation of new blood vessels C. Intravasation - Invasion of blood vessel D. Arrest/adherence - Stick to blood vessel wall E. Extravasation - Exit the blood vessel F. Tumor cell proliferation

What are the following known as? For rapidly growing tumors, millions of tumor cells are shed into the vascular system each day. - Most eliminated - Lots of cells --> some survive to form metastases The major challenge in treating cancer is not eradicating the primary tumor because surgery or radiation is effective in these early cases. - Eradicating metastases is the key factor to cancer cure. Blood vessels from preexisting vessels grow into the tumor (angiogenesis) - Crucial to tissue growth, repair, and maintenance.

Mechanisms of metastases

What typically contain much of the cellular structure of the original tissues?

Metastases

What are the most important predictors of recurrent cancer?

The stage at the time of initial therapy and histologic findings

What biopsy consists of making an incision and removing a portion of the abnormal tissue?

An incisional biopsy or open biopsy

What biopsy consists of making an incision to excise all gross, abnormal tissue that is either visually apparent or identified using a needle placed to localize the lesion?

excisional biopsy (sometimes referred to as lumpectomy)

What may be found in the blood during cancer diagnostics of tumor biomarkers?

Substances produced and secreted by tumor cells

What are used more frequently rather than just individual tumor marker evaluations?

Test panels

What is used most often in combination with other therapies?

Surgery

What require additional treatment (Chemo-radiation)?

Micro metastases

What are two goals of irradiation therapy?

1. destroy the dividing cancer cells by destroying hydrogen bonds between DNA strands within the cancer cells 2. limit damage to resting normal cells

What may be used preoperatively to shrink a tumor, making it operable, while preventing further spread of the disease during surgery? After the surgical wound heals, postoperative doses prevent residual cancer cells from multiplying or metastasizing.

Irradiation therapy

How do chemotherapy agents kill cancer cells by affecting DNA synthesis/function?

- Bind to DNA and prevent replication - Bind to DNA: distort structure - Block cell growth - Inhibit enzymes responsible for DNA structure - Disrupt mitosis - Direct cancer cell death

After chemotherapy treatment, what are destroyed and what may develop?

sensitive cells are destroyed resistant cells may develop

Improved survival rates occur with screening and early detection/treatment, especially for cancers that have a _____ effective treatment.

highly

What is cancer prognosis influenced by?

- type of cancer; - stage and grade of disease at diagnosis - availability of effective treatment - response to treatment; - factors related to lifestyle such as smoking, alcohol consumption, diet, nutrition, and exercise

The prognosis is _____ for anyone with advanced, disseminated cancer

poor

Many people considered “cured” are left with physical _________ and movement _________ that interfere with their daily lives.

limitations dysfunctions

What are some socioeconomic differences in prognosis of cancer?

Limited access to health care, little or no insurance, lack of a primary health care provider, limited knowledge of the benefits of early diagnosis and treatment, and greater exposure to carcinogens.

In terminally ill individuals, rates of change are more important indicators of _________than absolute measures.

survival

What are the following? - Lack of provider awareness of rehab benefits. - Absence of standardized referral pathways. Limited integration of rehab into oncology treatment plans.

Major Barriers to Rehabilitation Utilization

What are the following? - Exercise Therapy: 150 min/week of moderate-intensity activity improves fatigue, mobility, and overall function. - Lymphedema Management: Manual drainage, compression therapy, and exercise to reduce swelling & improve circulation. - Pain & Neuropathy Management: PT/OT interventions, manual therapy, and strength training. - Cognitive & Vocational Rehabilitation: Addressing chemo-induced brain fog and return-to-work challenges.

Key Rehabilitation Strategies for Cancer Survivors