Lewis Chapter 16 Cancer
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| What are the two major cellular dysfunctions in cancer? | Proliferation (growth) and Differentiation (specialization)
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| Cancer is a group of over 200 diseases characterized by what? | uncontrolled/unregulated growth of cells
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| People over what age account for 76% of diagnosed cancers? | Over 55
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| What has happened to the incidence rates of cancer since 1992? | They have remained stable
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| Name 4 cancers that have declined largely due to prevention efforts. | Colorectal, lung, oral, and pharyngeal
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| Name two kinds of cancer that are on the rise. | Hodgkin’s Lymphoma and skin cancers
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| Why has melanoma been on the rise? | Due to genetic predisposition and sun exposure
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| Is the incidence rate of cancer higher in men or women? | Men
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| How does cancer rate as cause of death? | second most common after heart disease
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| What is the leading cause of death in people under 85 years of age? | Cancer
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| What group has the highest incidence and death rates of cancer? | African Americans
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| What is the 5-year survival rate? | 65%
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| 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
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| How is the proliferation of cells normally controlled? | An intracellular mechanism determines when cellular proliferation is necessary. Usually it balances out with cellular degeneration.
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| 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.
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| How are cancer cells grown in culture characterized? | loss of contact inhibition
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| 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
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| What is dynamic equilibrium mean in regards to cells? | that as cells die, cells are generated so that a balance is maintained.
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| What do cancer cells think of dynamic equilibrium? | They think it’s a rule that just doesn’t apply to them
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| 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…
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| 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.
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| What are the 3 ways a stem cell might handle mutation? | 1. Apoptosis 2. Self repair 3.Pass mutation to daughter cells=cancer
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| Stem cell theory almost explains everything but cannot explain what? | Malignant stem cells can differentiate to form normal tissue cells
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| 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.
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| Cells are not supposed to dedifferentiate. What is dedifferentiate? | Reverting back to an undifferentiated state
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| What are the two types of genes that can be affected by mutations? | Protooncogenes and Tumor Suppressor Genes
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| What are Protooncogenes? | Normal cellular genes that are important regulators of normal cellular processes
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| What are normal cellular genes that are important in regulation of normal cellular processes called? | Protooncogenes
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| Protooncogenes _______ ______ and Tumor Suppressor Genes ________ ______. | Promote growth, Suppress Growth
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| Mutated Protooncogenes function as _________. | Oncogenes (tumor-inducing genes).
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| 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.
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| What kind of things can “unlock” protooncogenes and what is the result? | Carcinogens, oncongencic viruses, resulting in genetic alterations and mutations
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| What is the nature of “unlocked” oncogenes? | All the potential the cell had in the embryonic state are again expressed
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| Some cells produce proteins characteristic of the embryonic and fetal stages of life. Name a couple. | carcinoembryonic antigen (CEA) and alpha-fetoprotein (FP)
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| What is the function of tumor suppressor genes? | to regulate cell growth
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| What happens when mutations alter tumor suppressor genes? | They lose their ability to suppress tumor growth
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| 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.
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| What is APC? | another tumor suppressing gene
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| What could alterations in the APC gene increase a person’s risk for? | familial adenomatous polyposis which is a precursor for colorectal cancer.
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| Bladder, breast, colorectal, esophageal, liver, lung, and ovarian cancer have been linked to alterations in what tumor suppressor gene? | P53
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| 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.
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| What are the stages of the orderly development of cancer? | Initiation, Promotion, and Progression
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| 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
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| What is characteristic of an initiated cell? | It has the potential for developing into a clone of neoplastic cells
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| 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).
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| Is initiation reversible? | Nope
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| Many ________ are detoxified by protective enzymes and excreted. | Carcinogens
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| Carcinogenic effects in the stage of initiation are characterized as being what? | Irreversible and additive
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| Carcinogens are available in three convenient forms. What are they? | Viral, Chemical, and Radiation
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| Radiologists and uranium miners have a higher incidence of what kind of cancer? | Bone Cancer
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| UV radiation is linked to what kind of cancer? | Melanoma
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| Burkitt’s Lymphoma has been associated with the presence of what virus? | Epstein-Barr (EPV)
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| What virus is associated with Kaposi sarcoma? | HIV
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| Based on current info. ____ % of cancer is based on a strong genetic link. | 10%
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| What stage of cancer development is characterized by the reversible proliferation of the altered cells? | Promotion
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| What happens to the likelihood of additional mutation as the population of altered cells increase? | Increases too
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| Give some examples of promoting factors. | Smoking, Dietary Fat, Obesity, Alcohol Consumption
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| What is the big difference between initiation and promotion stages of cancer development? | The activity of promoting factors is reversible.
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| What is a complete carcinogen? | A carcinogen capable of initiating and promoting cancer. Cigarette smoke is a complete carcinogen.
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| What is the period between the initial genetic alteration and clinical evidence of cancer is called what? | the latent period
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| What two stages of cancer development take place during the latent period? | initiation and promotion
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| What accounts for the huge variation in the length of the latent period? | the mitotic rate of the tissue of origin.
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| Approximately how many cancer cells would be in a 1cm tumor? | 1 billion
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| 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
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| What are the characteristics of progression? | Increased growth rate of the tumor, increased invasiveness, metastasis.
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| What is tumor angiogenesis? | The process of the formation of blood vessels within the tumor
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| 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.
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| 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.
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| 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.
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| What can protect tumor cells from destruction in the blood vessels? | clumping together with platelets and fibrin
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| Define skip metastasis. | The tumor cells my skip the closest lymph nodes and travel to more distant lymph nodes.
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| ___________ is critical to the supply of nutrients and removal of wastes to the tumor. | Vascularization
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| Why do our immune cells have a harder time recognizing cancer cells as non-self? | Because they originate from normal human cells
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| What are antigens on malignant cancer cells called? | Tumor Associated Antigens (TAAs)
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| What is immunologic surveillance? | The immune system’s response to TAAs
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| What kind of cells are thought to play a dominant role in resisting tumor growth? | Cytotoxic T cells
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| T cells release cytokines. What do Cytokines do? | Call in the troops: t-cells, natural killer cells, B cells, and macrophages
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| Name two cytokines produced by T cells. | interleukin-2 (IL-2) and Y-interferon
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| What kind of cells are able to lyse tumor cells spontaneously without prior sensitization? | Natural Killer cells
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| 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.
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| 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
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| How long is CEA normal in the fetal gut, liver, and pancreas? | It is there for the first three months then disappears
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| What kind of antigen is produced by normal fetal liver cells and malignant liver cells? | alpha fetoprotein
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| What kind of cancer does AFP have diagnostic value for? | hepatocellular cancer
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| How are tumors classified? | by anatomic site, histology (grading), and extent of disease (staging)
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| How are tumors identified by anatomic classification? | by tissue of origin, anatomic site, and behavior- benign or malignant
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| What do carcinomas originate from? | From embryonic ectoderm and endoderm
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| What kind of tissues originate from ectoderm? | skin and glands
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| What kind of tissues originate form endoderm? | Mucous membrane linings of the respiratory tract, GI tract and genitourinary tract
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| What kind of tissues originate from mesoderm? | connective tissue, muscle, bone, and fate
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| Sarcomas originate from embryonic ________. | Mesoderm
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| What kind of classification system classifies cancers based on the amount differentiation or undifferentiation of the cells? | Histologic Classification
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| In the histologic classification system more differentiation is a better or worse prognosis? | better
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| Grade I | well differentiated cells
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| Grade II | moderately differentiated cells
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| Grade III | poorly differentiated cells
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| Grade IV | undifferentiated cells (Cell of origin is difficult to determine)
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| What grade would cells that resemble the tissue of origin be? | Grade I
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| What grade would cancer cells that are difficult to determine their cell of origin? | Grade IV
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| Cells differ slightly from normal cells and are well differentiated | Grade 1
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| Cells more abnormal and moderately differentiated | Grade 2
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| Cells very abnormal and poorly differentiated | Grade 3
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| Cells are immature and primitive and undifferentiated. Cell of origin is difficult to determine. | Grade 4
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| What classification system is based on the extent of the disease rather than cell appearance? | Staging
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| Cancer in situ (In Place) | Stage 0
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| Tumor limited to the tissue of origin: localized tumor growth | Stage 1
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| Limited local spread | Stage II
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| Extensive local and regional spread | Stage III
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| Metastasis | Stage IV
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| What classification system is based on the extent of the disease based on three parameters? | TNM
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| T | Tumor size and invasiveness
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| N | Spread to lymph nodes
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| M | Metastasis
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| 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.
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| What scale describes patient performance in terms of functionality on a percentage basis? | Darnofsky Functional Performance Scale
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| What procedure is the only definitive measure for diagnosing cancer? | Biopsy
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| Who does the histologic examination and determines if the tissue is benign or malignant? | Pathologist
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| Name several kinds of Biopsies that may be performed. | needle/aspiration, incisional, or excisional,
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| What are the goals of cancer treatment? | Cure, Control, or palliation
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| What are the factors that determine the therapeutic approach? | Tumor cell type, location, and size and the systemic extent of the disease.
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| What factors directly related to the patient’s status determine the therapeutic approach? | Physiologic status (comorbidities), psychologic status, and personal desires.
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| 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.
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| Where can we find information from ASCO and NCCN? | www.asco.org or www.nccn.org
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| 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.
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| 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.
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| 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.
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| What is the goal of treatment for cancers that cannot be eradicated but respond to treatment? | control
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| What is the goal of palliative treatment of cancer? | Relief or control of symptoms and the maintenance of a satisfactory quality of life
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| Name the four treatment modalities for cancer. | surgery, radiation therapy, chemotherapy, and biologic and targeted therapy
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| What factors determine treatment modality? | cell type, location and size of tumor, extent of disease, Physiologic and psychologic status, Expressed needs and desires
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| 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.
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| 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.
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| What is the use of chemicals as systemic therapy for cancer? | Chemotherapy
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| What is the goal of chemotherapy? | To reduce the number of malignant cancer cells in the primary tumor and metastatic sites.
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| Who should be involved in the preparation and administration of antineoplastic agents? | Only those personnel specifically trained in chemotherapy handling techniques
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| 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
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| 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
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| Does chemotherapy or radiation have a greater effect on bone marrow suppression? | Chemotherapy because its systemic
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| 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.
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| What conditions are caused by the effects of chemotherapy and radiation on the hematologic system? | Anemia, Leukopenia, and Thrombocytpenia
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| When do patients typically experience Nadir? | About 7-10 days after the initiation of therapy
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| Which WBC is most affected by Chemotherapy? | Neutrophils
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| 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.
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| 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
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| The highly proliferative cells of the mucosal lining are replaced how often? | every 2-6 days
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| The ___________ __________ one of the most sensitive tissues to radiation and chemotherapy. | Intestinal mucosa
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| 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
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| What are the adverse effect of chemotherapy and radiation to the GI system? | N&V, constipation, diarrhea, mucositis, anorexia
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| 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
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| 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
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| What do we monitor our patients with N&V for? | dehydration, I&0, metabolic alkalosis
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| What causes “radiation caries” and how can we help our patient’s prevent it? | diminished saliva with meticulous mouth care
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| 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
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| Define cachexia. | Weight loss, wasting of muscle, loss of appetite, and general debility that can occur during a chronic disease
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| 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.
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| 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
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| What is HSCT? | hematopoetic stem cell transplant
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| 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.
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| What is it called when stem cells are taken from one identical twin and transplanted to the other? | Syngeneic transplantation
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| Where do autologous stem cells come from? | From the patient
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| 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
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| What should be monitored in regards to our patients nutritional needs? | Albumin and prealbumin levels, I&O, weight
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| Give some examples of high protein/biologic foods. | double strength milk, milk shake, eggnog, cottage cheese, tuna, fish, chicken, pork, beef
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| Give some examples of high-calorie foods. | ice cream, mayonnaise, butter, sour cream, peanut butter, whipped cream, corn oil, jelly, honey
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| What is superior vena cava syndrome? | the obstruction of the superior vena cava by a tumor or thrombosis.
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| 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
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| What is spinal cord compression? | a neurologic emergency caused by the presence of a malignant tumor in the epidural space of the spinal cord
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| 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
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| What kind of cancer is responsible for the most deaths? | Lung and bronchus cancer
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| Which type of cancer has the fastest rising incidence rate in the US? | Melanoma
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| What is doubling time? | The amount of time required for a tumor to double in size
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| What is the pyramid effect? | the proliferation of tumor cells where one becomes two becomes four becomes eight and so on
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| What kind of mature cells are differentiated from mesoderm? | Muscles, bone, connective tissue
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| What kind of mature cells are differentiated from endoderm? | trachea, lungs, epithelium
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| What kind of mature cells are differentiated from ectoderm? | Brain, Skin, Glands
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| List several promoting factors. | Obesity, dietary fat, cigarette smoking, and alcohol consumption
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| Where does colon cancer like to spread to? | The liver
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| What are the most frequent sites of metastasis? | lungs, brain, bone, liver, and adrenal glands
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