Week 1

Question 1

Cancer

Answer 1

Cancer is a disease that is characterised by the uncontrolled growth and spread of abnormal cells. Cancer cells are derived from normal cells that have undergone neoplastic transformation ie. An irreversible process leading to the transformation of a healthy cell into a cancer cell

Question 2

GAP 1: POST MITOTIC / PRE SYNTHESIS PHASE

Answer 2

● Lasts from 18 – 30 hours
● Time from the end of mitosis to DNA synthesis
● Primarily a stage of ‘readiness,’ in which cells start to make enzymes for DNA synthesis and prepare for entry into the S phase.

Question 3

SYNTHESIS (S)

Answer 3

● Lasts 7 – 20 hours
● Proteins containing DNA are copied
● Synthesis of DNA leads to doubling of the total amount (DNA is replicated)
● Normal cell reproduction is dependant upon orderly synthesis of genetic material
● Cells are most vulnerable to damage during the S phase

Question 4

GAP 2 (G2) POST SYNTHETIC / PRE MITOTIC PHASE :

Answer 4

● 2nd gap period. Lasts from 2 – 10 hours
● Errors in replication are corrected
● Specialised proteins and RNA are synthesised
● Cells are basically awaiting entry into the mitotic phase

Question 5

Go (RESTING) PHASE

Answer 5

● There is an additional phase in the cell cycle. Some cells do not enter the G1 pool, but enter the Go state, where they become temporarily or permanently quiescent.
● In the Go, cells are not active in the cell cycle
● Lasts from a few hours to a few years
● Since at any given time, only 15-30% of cells are cycling, the Go cells are the largest population

Question 5

Mitosis (M)

Answer 5

● Lasts 30 minutes to 2 hours
● Cell division occurs
● Duplication of the DNA MUST be complete before cells enter the mitotic phase
4 subphases :
○ Prophase *
○ Metaphase *
○ Anaphase *
○ Telophase *

Question 6

Proliferative Growth Patterns

Answer 6

● A common feature of all cancers is the loss of cellular proliferation ie. cancer cells are not subject to the usual restriction on cell growth and proliferation imposed by the host
● Normal cells acquire certain specialized characteristics of their tissue of origin – ie.. DIFFERENTIATION
● Well differentiated – tumour cells reproduce these features well – ie.. Breast cells
● Poorly differentiated – tumour cells reproduce these features poorly– ie.. Difficult to tell the cell of origin
● Undifferentiated – cannot tell – no maturation

Question 7

Tumour growth

Answer 7

● From a single cell, cancer may take months/years to become detectable
● DOUBLING TIME is the time a tumour takes to double its size
● Solid tumour is usually palpable at approx 30 doublings
● Death from cancer usually occurs at around 40 doublings

Question 8

ONCOGENES

Answer 8

Oncogenes are mutated forms of proto-oncogenes, normal growth-promoting genes in cells. When activated by mutations, they cause excessive production of growth factors, leading to tumorigenesis.

Question 9

MEDIATORS OF CELL GROWTH

Answer 9

● PDGF - Platelet-derived growth factor is one of the numerous proteins that regulate cell growth and division
● Epidermal Growth Factor (EGF) is a protein with 53 amino acid residues and three disulfide bonds, crucial for cell growth and proliferation, specifically HERreceptor2.
● TGF – Transforming Growth Factor plays crucial roles in tissue development, cell differentiation, and embryonic development, as well as numerous other signaling pathways.
● VEGF - Vascular endothelial growth factor is an important signal protein involved in angiogenesis.

Question 10

TUMOUR SUPPRESSOR GENES

Answer 10

Tumor suppressor genes, such as the p53 gene, play a crucial role in controlling cell growth. Mutations in these genes can lead to uncontrolled growth, as cells lose their switch off, allowing uncontrolled growth. The p53 gene, which normally halts the cell cycle, can be mutated, causing abnormal cell growth.

Question 11

Apoptosis : Programmed cell death

Answer 11

● Maintenance of healthy tissues and organs is dependant upon the proper balance of cell division with apoptosis.
● Apoptosis is regulated by different gene products : One of the most well characterized proteins that directs cells to ‘suicide’ at the proper time is the product coded by the tumour suppressor gene, P53

Question 12

Carcinogen

Answer 12

A substance capable of causing cancer in living tissue

Question 13

Cancer Staging

Answer 13

Accurate staging provides guidance in the selection of cancer treatment that will be most effective for the patient. This enables:
● Prognostic information
● Informs clinicians of the benefit of treatment and the risk of recurrence
● Inclusion, exclusion and stratification criteria for patients to enter clinical trials
● International collaborative cancer research by following global disease outcomes

Question 14

Staging Systems

Answer 14

Include the following information
● Location of Tumour
● Type of Cells (such as germ cells or adenocarcinoma)
● Tumour Grade (how abnormal cells look compared to normal cells)
● Measurement of tumour size
● Lymph node spread of tumour cells
● Metastatic spread to other sites

Question 15

TNM

Answer 15

T (Tumour ) - Size and Extent of Primary Tumour
N (Nodes) - Number of nearby lymph nodes that contain cancer/cells
M (Metastasis) - Spread to other sites and organs

Question 16

The Metastatic Cascade

Answer 16

1.Tumour initiation
2.Progression
3.Proliferation
4.Angiogenesis
5.Invasion / Intravasation
6.Extravasation
7.Colony Formation
8.Evasion of host defenses

Question 17

Clinical Distress

Answer 17

Multiple studies have shown that clinical distress is related to :
* Disease status
* Treatment tolerance
* Symptom intensity
* Symptom intensity and frequency
* Lifestyle effects of symptom intensity and frequency
* Quality of life

Question 18

Psychosocial Problems

Answer 18

Psychosocial care for patients and their families should begin at the time of their diagnosis, continue through treatment, and extend through survivorship or (for many) bereavement

Question 19

Supportive Care

Answer 19

embraces the full range of issues that emerge for an individual as the impact of cancer and treatment are felt and the person tries to deal with the situation

Question 20

Risk Factors and Assessment of Psychosocial Distress

Answer 20

Certain risk factors in patients and their families increase the likelihood of heightened emotional distress and protracted recovery adjustment in patients with cancer. Lancaster and Nattress (2005) and the CPG summary guide (2005), identify some of these factors which include the following:
* Being very old or very young
* Being single, separated, divorced or widowed
* Being female
* Having children younger than 21 years
* Those with poor marital functioning

Question 21

Planning and Delivery of Treatment

Answer 21

The approach to cancer care involves a person-centered, system-wide, and team-based approach, focusing on healthcare professionals’ responsibility for supportive care. It involves developing the workforce, maintaining quality care through evidence-based protocols, and population-based planning to identify needs and gaps in existing services.

Question 22

Barriers to the Delivery of Psychosocial Care

Answer 22

Psychosocial services are crucial for improving patient outcomes, but they are often not widely available due to barriers such as geographic access, lack of health insurance, stigma, miscommunication, failure to implement guidelines, inexperience with assessment, poor coordination, lack of familiarity with community resources, and limited quality assurance systems.