Week 1-3 Flashcards
1
Q
Cancer Care Continuum
A
- Framework used in oncology since 1970s
- Describes various stages of cancer care
2
Q
Geographic Distribution
A
- Highest rates in eastern & central Canada
- Highest region is AB
- Males in NS
- Females in NFLD & Lab
3
Q
Statistics
A
- Leading cause of death in Canada
- Lung cancer highest deaths
4
Q
Implications
A
- New drug treatments targeting specific changes in cancer cella
- Extended life expectancy results in increased cancer rates
- Increasing treatment to older persons
- Inpatient treatments from other settings
5
Q
CCO
A
- Established by ON gov in 1995
- Mandate to improve cancer services
- Part of ON health since 2019
- Comprehensive agency coordinate provincial screening, treating, research
6
Q
Regional Cancer Centres
A
- Under cancer care ON
- Meet goals of ON cancer plan
- 14 regional centres
- LHSC SW regional cancer program
7
Q
Paediatric Oncology Group of Ontario (POGO)
A
- Coordinates with ministry of health Ontario
- Diagnosis at Ontario’s 5 hospitals with specialized programs
- Satellite site program with community hospitals
- Interlink Program - coordinates patient/family
8
Q
What is Cancer
A
- Cells lose normal growth regulation
- Genetic mutations in cell DNA
- Abnormal growth
- Results from many cell abnormalities
9
Q
Monoclonal Disease
A
From a single cell
10
Q
Cell Cycle
A
- G0 cells inactive
- G1&2 cell growth/energy building
- S DNA replication
- M DNA splits/duplication
11
Q
Cell Cycle Key Points
A
- Controlled by proteins (cyclins) & enzymes (CDKs)
- Checkpoints to ensure safe/accurate cell division
12
Q
Clonality
A
One cell leads to the proliferation of many malignant cells
13
Q
Autonomy
A
Growth is resistant to normal regulation
14
Q
Anaplasia
A
Cell differentiation is less/not at all coordinated
15
Q
Metastasis
A
Malignant cells disseminate & grow discontinuously to other parts of the body
16
Q
Differences from Normal Cells
A
- Lack of control
- Growth inhibition
- Differentiation
- Metastatic spread
- Angiogenesis
- Cell surface changes
17
Q
Differentiation
A
Cancer cells don’t fully mature to specialized cells less effective
18
Q
Angiogenesis
A
Establishes its own blood supply creates route for metastatic spread
19
Q
Benign & Malignant Tumours
A
- Abnormal cell growth with a loss of normal cell regulation
- Benign is slow growing with no invasion to other tissue – can become malignant
- Only malignant cells able to spread and invade other cells
20
Q
Neoplasm & Tumour
A
- Refer to the abnormal and unregulated growth of tissues
- Can be benign or malignant
21
Q
Oncogenes
A
- Produce proteins that accelerate cell division
- If mutated, cell division accelerated incorrectly
22
Q
Tumour Suppressor Genes (TSGs)
A
- Provide the negative feedback in cell division by blocking growth signals
- If mutated, this capability is lost and cell division is unstoppable
23
Q
Apoptosis
A
- Protective mechanism – stops damaged DNA
- Programmed cell death – self-destruction
- In cancer cells over 50% missing this protective mechanism ⇨ increased risk of developing cancer
24
Q
Immortal Growth
A
- Cells have a finite number of times to divide
- Telomeres shorten and cell can no longer divide
- Some cancer cells produce an enzyme that extends life of telomeres increasing cell division indefinitely
25
Tumour Heterogeneity
Different cell populations in a single tumour increases the difficulty in treatment as some cells could be resistant than if all cells the same (homogeneity)
26
Carcinogens
Substances that alter normal cellular genetics causing malignancy
27
Carcinogenic Categories
- Chemicals (cigarette smoke)
- Radiation (UV from sun)
- Viruses (Hep B, HPV)
- Bacteria (little linkage to cancer)
28
Genetic Mutations
- Damaging radiation
- Exposure to carcinogens
- Failure in DNA regulation functions
- Hormones – breast, prostate, ovary, endometrium, testes, thyroid, bone
- Family history
29
Dysplasia
- Cells different from other tissue
- Graded: mild, moderate, severe
- Premalignant changes
- Basement membrane must break to form malignancy
- Abnormal cell growth is reversible
30
Carcinoma in Situ
High grade dysplasia with potential to progress to invasive cancer
31
Carcinoma
- Epithelial tissue
- Adenocarcinoma
- Squamous cell carcinoma
32
Sarcoma
- Connective tissue
- Bone, cartilage
33
Leukemia
- Bone marrow
- Myeloid
- Lymphoid
34
Lymphoma
Lymphatic system
35
Myeloma
Plasma cells in bone marrow
36
Routes of Spread
- Blood and lymphatic circulation
- Directly along tissues into other areas – peritoneal cavity from colon cancer spread
- CNS
37
Metastatic Spread
- Anatomical proximity
- Blood circulation
- Changes in cancer cell surfaces
38
TMN System
T - size of tumour
N - absence/presence of regional lymph nodes
M - absence/presence of distant metastases
39
Impacts on Immune System
- Diet
- Stress
- Age
- Exercise
- Smoking
- Alcohol
- Insufficient sleep
40
Primary Prevention
- Health promotion to reduce risk
- Modifiable risk factors
- Lifestyle considerations
41
Secondary Prevention
- Screening for early detection – BSE, pap smears, PSA blood tests, genetic testing
- CCO cancer screening programs
42
Tertiary Prevention
Monitoring/preventing recurrence of primary cancer /secondary malignancies from initial treatment in survivors
43
Reducing Cancer Risk
- Avoid tobacco use
- Maintain a healthy body weight
- Healthy diet - including fruits and vegetables
- Regular physical activity
- Avoiding/reducing alcohol intake
- Vaccination against HPV and hepatitis B
- Avoid ultraviolet radiation
- Reducing exposure to air pollution
44
Most Preventable Cancer
Cervical
45
High Sensitivity
Majority with cancer test +
46
High Specificity
Majority without cancer test -
47
Criteria for Screening Tests
- The cancer should be a serious and common occurrence
- Should be detectable at an early stage
Improved treatability if detected earlier
- Screening test should be acceptable – for whom?
- Inexpensive
- Evidence that screening reduces mortality
- Health services should be available
- Risks should be less than benefits
48
Screening Principles
- Identifies asymptomatic persons with elevated risk of cancer
- Further diagnostic testing offered
- Earlier identification of disease
- Earlier diagnosis & treatment
- Decrease mortality
49
CCO Programs
- OBSP (breast)
- OCSP (cervical)
- CCC (colon)
- Lung cancer pilot program
50
Screening Information
- Risks
- Benefits
- Purpose of screening
- Potential for false positive and false negative results
- Follow up plans
51
Screening Uptake
- Overall high
- Disadvantaged groups under-represented = greater risk of developing cancer
52
Disadvantaged Groups
- Older women
- Ethnic minorities
- Low income
53
Nursing Role Prevention & Screening
- Tertiary prevention & rehab
- Influences of health-promoting behaviours
- Education
- Access to care
- Income
- Cultural
