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Lewis 16 Cancer

Lewis Chapter 16 Cancer

What are the two major cellular dysfunctions in cancer? Proliferation (growth) and Differentiation (specialization)
Cancer is a group of over 200 diseases characterized by what? uncontrolled/unregulated growth of cells
People over what age account for 76% of diagnosed cancers? Over 55
What has happened to the incidence rates of cancer since 1992? They have remained stable
Name 4 cancers that have declined largely due to prevention efforts. Colorectal, lung, oral, and pharyngeal
Name two kinds of cancer that are on the rise. Hodgkin’s Lymphoma and skin cancers
Why has melanoma been on the rise? Due to genetic predisposition and sun exposure
Is the incidence rate of cancer higher in men or women? Men
How does cancer rate as cause of death? second most common after heart disease
What is the leading cause of death in people under 85 years of age? Cancer
What group has the highest incidence and death rates of cancer? African Americans
What is the 5-year survival rate? 65%
What do we mean when we say predetermined stem cell? That stem cells of a particular tissue will become functioning cells of that tissue type
How is the proliferation of cells normally controlled? An intracellular mechanism determines when cellular proliferation is necessary. Usually it balances out with cellular degeneration.
What is contact inhibition and what does it have to do with cancer? Normal cells respect the boundaries and territories of the cells surrounding them. Cancer cells have no regard for boundaries.
How are cancer cells grown in culture characterized? loss of contact inhibition
How does the rate of proliferation compare in different tissues? Some like hair follicles, bone marrow and epithelial lining of GI are rapid and some like myocardium and cartilage are slow to stop
What is dynamic equilibrium mean in regards to cells? that as cells die, cells are generated so that a balance is maintained.
What do cancer cells think of dynamic equilibrium? They think it’s a rule that just doesn’t apply to them
If it is a misconception that cancer cells grow faster than regular cells then how do we explain the rapid growth of a cancer tumor? Regular cells follow rules of contact inhibition and dynamic equilibrium so that times of growth are regulated. Cancer cells don’t follow the rules so that 1 becomes 2 becomes 4 and so on…
What is the stem cell theory in a nutshell? Stem cells that have lost the ability to control proliferation due to some mutation/damage to DNA are the target/origin of cancer development.
What are the 3 ways a stem cell might handle mutation? 1. Apoptosis 2. Self repair 3.Pass mutation to daughter cells=cancer
Stem cell theory almost explains everything but cannot explain what? Malignant stem cells can differentiate to form normal tissue cells
How does cellular differentiation usually work? All cells start out as a fertilized egg so they all have the potential initially to be any kind of tissue. As they differentiate that potential is repressed so that they become a functional cell of a particular tissue type.
Cells are not supposed to dedifferentiate. What is dedifferentiate? Reverting back to an undifferentiated state
What are the two types of genes that can be affected by mutations? Protooncogenes and Tumor Suppressor Genes
What are Protooncogenes? Normal cellular genes that are important regulators of normal cellular processes
What are normal cellular genes that are important in regulation of normal cellular processes called? Protooncogenes
Protooncogenes _______ ______ and Tumor Suppressor Genes ________ ______. Promote growth, Suppress Growth
Mutated Protooncogenes function as _________. Oncogenes (tumor-inducing genes).
What is the function of Protooncogenes that is analogous to a lock? Protooncogenes act like the lock that keep cells in their mature differentiated states.
What kind of things can “unlock” protooncogenes and what is the result? Carcinogens, oncongencic viruses, resulting in genetic alterations and mutations
What is the nature of “unlocked” oncogenes? All the potential the cell had in the embryonic state are again expressed
Some cells produce proteins characteristic of the embryonic and fetal stages of life. Name a couple. carcinoembryonic antigen (CEA) and alpha-fetoprotein (FP)
What is the function of tumor suppressor genes? to regulate cell growth
What happens when mutations alter tumor suppressor genes? They lose their ability to suppress tumor growth
What are BRCA-1 and BRCA-2 and what do they have to do with ovarian and breast cancer? They are tumor suppressor genes and if altered increase a person’s risk of ovarian and breast cancers.
What is APC? another tumor suppressing gene
What could alterations in the APC gene increase a person’s risk for? familial adenomatous polyposis which is a precursor for colorectal cancer.
Bladder, breast, colorectal, esophageal, liver, lung, and ovarian cancer have been linked to alterations in what tumor suppressor gene? P53
What is the difference between benign and malignant neoplasms? Benign: well differentiated, encapsulated, slight vascularity, similar to parent cells. Malignant: rarely encapsulated, poorly differentiated to undiferentiated, metastasis, plenty of vasculature, infiltrative and expansive.
What are the stages of the orderly development of cancer? Initiation, Promotion, and Progression
What event precipitates initiation? the cell’s DNA is mutated due to an error in DNA replication or exposure to a chemical, radiation, or viral agent
What is characteristic of an initiated cell? It has the potential for developing into a clone of neoplastic cells
Why don’t all initiated cells turn into tumors? Tumor development requires replication of the initiated cell. As long as it does not replicate it is not a tumor cell. Some self-destruct (Apoptosis).
Is initiation reversible? Nope
Many ________ are detoxified by protective enzymes and excreted. Carcinogens
Carcinogenic effects in the stage of initiation are characterized as being what? Irreversible and additive
Carcinogens are available in three convenient forms. What are they? Viral, Chemical, and Radiation
Radiologists and uranium miners have a higher incidence of what kind of cancer? Bone Cancer
UV radiation is linked to what kind of cancer? Melanoma
Burkitt’s Lymphoma has been associated with the presence of what virus? Epstein-Barr (EPV)
What virus is associated with Kaposi sarcoma? HIV
Based on current info. ____ % of cancer is based on a strong genetic link. 10%
What stage of cancer development is characterized by the reversible proliferation of the altered cells? Promotion
What happens to the likelihood of additional mutation as the population of altered cells increase? Increases too
Give some examples of promoting factors. Smoking, Dietary Fat, Obesity, Alcohol Consumption
What is the big difference between initiation and promotion stages of cancer development? The activity of promoting factors is reversible.
What is a complete carcinogen? A carcinogen capable of initiating and promoting cancer. Cigarette smoke is a complete carcinogen.
What is the period between the initial genetic alteration and clinical evidence of cancer is called what? the latent period
What two stages of cancer development take place during the latent period? initiation and promotion
What accounts for the huge variation in the length of the latent period? the mitotic rate of the tissue of origin.
Approximately how many cancer cells would be in a 1cm tumor? 1 billion
What stage in cancer development is characterized by increased growth rate of the tumor, invasiveness, and spread of the cancer to distant sites (metastasis)? Progression
What are the characteristics of progression? Increased growth rate of the tumor, increased invasiveness, metastasis.
What is tumor angiogenesis? The process of the formation of blood vessels within the tumor
How does metalloproteinase enzymes facilitate metastasis? They destroy basement membrane of the tumor and of lymph and blood vessels, muscles, nerves, and most epithelial boundaries.
Describe the steps involved in hematogenous metastasis. Primary tumor cells use metalloproteinase enzymes to get into blood vessels and travel through the body. They adhere to a small blood vessels somewhere else in the body and penetrate through to a new home.
Why don’t most tumor cells that are trying to find a new home by hematogenous metastasis make it? Destroyed by the turbulence of blood flow or cells of the immune system.
What can protect tumor cells from destruction in the blood vessels? clumping together with platelets and fibrin
Define skip metastasis. The tumor cells my skip the closest lymph nodes and travel to more distant lymph nodes.
___________ is critical to the supply of nutrients and removal of wastes to the tumor. Vascularization
Why do our immune cells have a harder time recognizing cancer cells as non-self? Because they originate from normal human cells
What are antigens on malignant cancer cells called? Tumor Associated Antigens (TAAs)
What is immunologic surveillance? The immune system’s response to TAAs
What kind of cells are thought to play a dominant role in resisting tumor growth? Cytotoxic T cells
T cells release cytokines. What do Cytokines do? Call in the troops: t-cells, natural killer cells, B cells, and macrophages
Name two cytokines produced by T cells. interleukin-2 (IL-2) and Y-interferon
What kind of cells are able to lyse tumor cells spontaneously without prior sensitization? Natural Killer cells
How are CEA’s used to determine the success of cancer treatment? A pre-treatment titer for CEA is compared to post treatment titer. If the titer is the same or rises it is an indication that the cancer is still thriving or spreading.
What antigen is found on normal cells from the fetal gut, liver, and pancreas as well as cancer cells derived from the GI tract? CEA = Carcinoembryonic Antigen
How long is CEA normal in the fetal gut, liver, and pancreas? It is there for the first three months then disappears
What kind of antigen is produced by normal fetal liver cells and malignant liver cells? alpha fetoprotein
What kind of cancer does AFP have diagnostic value for? hepatocellular cancer
How are tumors classified? by anatomic site, histology (grading), and extent of disease (staging)
How are tumors identified by anatomic classification? by tissue of origin, anatomic site, and behavior- benign or malignant
What do carcinomas originate from? From embryonic ectoderm and endoderm
What kind of tissues originate from ectoderm? skin and glands
What kind of tissues originate form endoderm? Mucous membrane linings of the respiratory tract, GI tract and genitourinary tract
What kind of tissues originate from mesoderm? connective tissue, muscle, bone, and fate
Sarcomas originate from embryonic ________. Mesoderm
What kind of classification system classifies cancers based on the amount differentiation or undifferentiation of the cells? Histologic Classification
In the histologic classification system more differentiation is a better or worse prognosis? better
Grade I well differentiated cells
Grade II moderately differentiated cells
Grade III poorly differentiated cells
Grade IV undifferentiated cells (Cell of origin is difficult to determine)
What grade would cells that resemble the tissue of origin be? Grade I
What grade would cancer cells that are difficult to determine their cell of origin? Grade IV
Cells differ slightly from normal cells and are well differentiated Grade 1
Cells more abnormal and moderately differentiated Grade 2
Cells very abnormal and poorly differentiated Grade 3
Cells are immature and primitive and undifferentiated. Cell of origin is difficult to determine. Grade 4
What classification system is based on the extent of the disease rather than cell appearance? Staging
Cancer in situ (In Place) Stage 0
Tumor limited to the tissue of origin: localized tumor growth Stage 1
Limited local spread Stage II
Extensive local and regional spread Stage III
Metastasis Stage IV
What classification system is based on the extent of the disease based on three parameters? TNM
T Tumor size and invasiveness
N Spread to lymph nodes
M Metastasis
What are 3 things we can offer our patients to ease the fear and anxiety associated with a diagnosis of cancer? Give clear explanations. Give written information. Actively listen to the patient’s concerns.
What scale describes patient performance in terms of functionality on a percentage basis? Darnofsky Functional Performance Scale
What procedure is the only definitive measure for diagnosing cancer? Biopsy
Who does the histologic examination and determines if the tissue is benign or malignant? Pathologist
Name several kinds of Biopsies that may be performed. needle/aspiration, incisional, or excisional,
What are the goals of cancer treatment? Cure, Control, or palliation
What are the factors that determine the therapeutic approach? Tumor cell type, location, and size and the systemic extent of the disease.
What factors directly related to the patient’s status determine the therapeutic approach? Physiologic status (comorbidities), psychologic status, and personal desires.
What have the American Society of Clinical Oncologist (ASCO) and the National Comprehensive Cancer Network (NCCN) created that may be useful to our patients with cancer? Evidence-based cancer treatment guidelines.
Where can we find information from ASCO and NCCN? www.asco.org or www.nccn.org
What kind of therapies might be included in treatment when cure is the goal? Local therapies alone (e.g. surgery or radiation) or in combination with or without periods of adjunctive systemic therapy.
Generally speaking how does the risk of recurrence change over time? Risk are highest for recurrence after treatment and decrease with the passage of time.
The qualifications for considering a patient cured vary according to what? Mitotic rate of the cancer, a cancer with a fast mitotic rate is considered cured if it doesn’t show up again in 2 years; whereas a slow growing cancer may need 20 years to be considered cancer free.
What is the goal of treatment for cancers that cannot be eradicated but respond to treatment? control
What is the goal of palliative treatment of cancer? Relief or control of symptoms and the maintenance of a satisfactory quality of life
Name the four treatment modalities for cancer. surgery, radiation therapy, chemotherapy, and biologic and targeted therapy
What factors determine treatment modality? cell type, location and size of tumor, extent of disease, Physiologic and psychologic status, Expressed needs and desires
What is the advantage and disadvantage of multimodal treatment? Multimodal treatment is more effective against the cancer due to the use of more than on mechanism, yet it also means more adverse effects for the patient.
What kind of treatment/surgery is performed when a tumor cannot be removed (involvement in a vital organ)? Debulking or cytoreductive procedures are used to reduce tumor size and increase the likelihood of the success of radiation or chemotherapy.
What is the use of chemicals as systemic therapy for cancer? Chemotherapy
What is the goal of chemotherapy? To reduce the number of malignant cancer cells in the primary tumor and metastatic sites.
Who should be involved in the preparation and administration of antineoplastic agents? Only those personnel specifically trained in chemotherapy handling techniques
Name several factors that determine cancer response to chemotherapy. Mitotic rate, size of tumor, age of tumor, location of tumor, presence of resistant tumor cells
What are common side effects of radiation and chemotherapy? Bone marrow suppression, Fatigue, GI disturbances, Integumentary and mucosal reactions, GI disturbances, Pulmonary and cardiovascular , reproductive effects
Does chemotherapy or radiation have a greater effect on bone marrow suppression? Chemotherapy because its systemic
Why does bone marrow suppression make our patients feel extremely fatigued and put them at higher risk for infection and hemorrhage? Because bone marrow makes red blood cells, white blood cells, and platelets.
What conditions are caused by the effects of chemotherapy and radiation on the hematologic system? Anemia, Leukopenia, and Thrombocytpenia
When do patients typically experience Nadir? About 7-10 days after the initiation of therapy
Which WBC is most affected by Chemotherapy? Neutrophils
At what level of thrombocytopenia does risk of serious bleeding become apparent? Risk of serious bleeding is generally not apparent until the platelet count falls below 50,000/microliter.
What is the persistent subjective sense of tiredness associated with cancer and its treatment that interferes with our patient’s day to day functioning? Fatigue
The highly proliferative cells of the mucosal lining are replaced how often? every 2-6 days
The ___________ __________ one of the most sensitive tissues to radiation and chemotherapy. Intestinal mucosa
What are GI disturbances with chemotherapy and radiation related to? stimulation of the vomiting center, desquamation of the GI lining, and Direct damage to GI
What are the adverse effect of chemotherapy and radiation to the GI system? N&V, constipation, diarrhea, mucositis, anorexia
How do GI effects affect our patient? Our patient’s nutritional and hydration status is at risk as well as their sense of well – being
What measures can we take to assist our patient’s with anticipatory nausea and vomiting? prophylactic anti-emetic and anti-anxiety medication 1 hr before tx , a light non-irritating meal before may help
What do we monitor our patients with N&V for? dehydration, I&0, metabolic alkalosis
What causes “radiation caries” and how can we help our patient’s prevent it? diminished saliva with meticulous mouth care
What kind of food will our patient’s having chemotherapy and radiation need? small frequent meals of non irritating, high protein and high calorie foods, supplements like Ensure and frequent fluid intake
Define cachexia. Weight loss, wasting of muscle, loss of appetite, and general debility that can occur during a chronic disease
Erythema may develop after 1-24 hours after a single treatment of radiation. What is it? Eythema is an acute response followed by dry desquamation.
What happen with radiation induced desquamation if the cellular sloughing is faster than the ability of the new epidermal cells to replace dead cells? A wet desquamation occurs with exposure of the dermis and weeping of serous fluid
What is HSCT? hematopoetic stem cell transplant
Where does marrow come from when the transplantation is allogeneic? Stem cells are acquired from a donor whose marrow has been matched by HLA. Often the donor is a relative or someone found through a national bone marrow registry.
What is it called when stem cells are taken from one identical twin and transplanted to the other? Syngeneic transplantation
Where do autologous stem cells come from? From the patient
Give two reasons for the nurse to suggest the need for nutritional supplements to the health care provider. As soon as 5% of weight is lost or if the patient is has the potential for protein and calorie malnutrition
What should be monitored in regards to our patients nutritional needs? Albumin and prealbumin levels, I&O, weight
Give some examples of high protein/biologic foods. double strength milk, milk shake, eggnog, cottage cheese, tuna, fish, chicken, pork, beef
Give some examples of high-calorie foods. ice cream, mayonnaise, butter, sour cream, peanut butter, whipped cream, corn oil, jelly, honey
What is superior vena cava syndrome? the obstruction of the superior vena cava by a tumor or thrombosis.
What are the clinical manifestations of superior vena cava syndrome? facial edema, periorbital edema, distention of veins of the head, neck, and chest, headache, and seizures. There may be a mediastinal mass visible on x-ray
What is spinal cord compression? a neurologic emergency caused by the presence of a malignant tumor in the epidural space of the spinal cord
What is third space syndrome? the fluid from the vascular space shifts to interstitial space resulting in hypovolemia, hypotension, tachycardia, low central venous pressure, decreased urine output
What kind of cancer is responsible for the most deaths? Lung and bronchus cancer
Which type of cancer has the fastest rising incidence rate in the US? Melanoma
What is doubling time? The amount of time required for a tumor to double in size
What is the pyramid effect? the proliferation of tumor cells where one becomes two becomes four becomes eight and so on
What kind of mature cells are differentiated from mesoderm? Muscles, bone, connective tissue
What kind of mature cells are differentiated from endoderm? trachea, lungs, epithelium
What kind of mature cells are differentiated from ectoderm? Brain, Skin, Glands
List several promoting factors. Obesity, dietary fat, cigarette smoking, and alcohol consumption
Where does colon cancer like to spread to? The liver
What are the most frequent sites of metastasis? lungs, brain, bone, liver, and adrenal glands