Cancer Biology Basics

Cellular Aberrations

• Cellular aberrations are deviations from normal cellular functions.

What is Cell Cycle?

• The cell cycle is the life cycle of a cell.
• It is a series of ordered events, involving cell growth and development, culminating in the formation of two new daughter cells.
• The cell cycle is not a linear pathway.

Cell Cycle Checkpoints

• The cell cycle checkpoints monitor and control the cell cycle.
• G1-to-S checkpoint: Checks for cell size, nutrients/growth factors, and DNA damage.
• G2-to-M checkpoint: Checks for cell size and DNA replication.
• Metaphase checkpoint: Checks for chromosome spindle attachment.

Normal Cell Growth: The Cell Cycle

• Oncogenes promote cell division and growth.
• Tumor suppressor genes regulate cell division and repair DNA damage to prevent cancerous changes.

Essential Cellular Functions

• Mutagens, carcinogens, viruses, and irradiation can lead to cancer via genetic predisposition.
• This impacts normal cellular functions.
• Normal cellular functions are transformed to cellular oncogene, leading to an altered cellular function, which results in a "spontaneous" neoplasm.

Carcinogenesis

• A three-step process:
  • Initiation: Initiators (carcinogens) alter the genetic structure of DNA.
  • Promotion: Repeated exposure to promoting agents causes expression of abnormal or mutated genetic information.
  • Progression: Altered cells exhibit increased malignant behavior, leading to invasion and metastasis.

Oncology

• Oncology is the branch of medicine that studies, detects, treats, and manages cancer and neoplasia.

Root Words

• Neo-: New
• Plasia-: Growth
• Plasm-: Substance
• Trophy-: Size
• Oma-: Tumor
• Statis-: Location

A- Ana- Hyper- Meta- Dys-

• A-: None
• Ana-: Lack
• Hyper-: Excessive
• Meta-: Change
• Dys-: Bad, deranged

Care of Patients with Cancer

• Cancer is a disease that begins when an abnormal cell is transformed by a genetic mutation of cellular DNA.
• The cell forms a clone and proliferates abnormally.
• Cells acquire invasive characteristics and change surrounding tissues. Cells access lymph and blood vessels to spread to other body areas.

Care of Patients with Cancer-Cellular Origin

• Carcinoma: originates in epithelial tissue.
  • Adenocarcinoma: originates in glandular tissue (breast, prostate)
  • Sarcoma: originates in fat, muscle, blood vessels, nerves, bones

Care of Patients with Cancer-Warning Signs

• Change in bowel or bladder habits
• A lesion that does not heal
• Unusual bleeding or discharge
• Thickening or lump formation
• Indigestion or difficulty swallowing
• Obvious changes in wart or mole
• Nagging cough or persistent hoarseness
• Unplained anemia
• Sudden loss of weight

Other Definitions and Characteristics of Cancer

• Benign Neoplasm: Slow-growing, localized, encapsulated, and not cancerous.
• Malignant Neoplasm: Aggressive, invades and destroys tissues, characteristic of cancer.
• Metastasis: Cells travel through the blood or lymphatic system to another tissue/organ forming a secondary tumor.

Tumor Grading

• Examined the tumor through biopsy under a microscope to determine the grade of the cancer.
• Increasing abnormality increases the grade, from 1 to 4.

Cancer Staging

• Classification of the extent of disease (TNM system):
  • Tumor (T): Size and extent of primary tumor.
  • Node (N): Regional lymph node involvement.
  • Metastasis (M): Distant metastasis.

Numerical Staging System for Cancer

• Stage 0: Cancer in-situ (limited to surface cells); Stage 1: Cancer limited to the origin tissue, evidence of growth; Stage 2: Limited local spread of cancerous cells; Stage 3; Extensive local and regional spread; Stage 4: Distant metastasis

Pathophysiology of Cancer

• Cancer cells differ from normal cells in size, structure, function, and growth rate.
• Control of growth is absent in cancer cells; this uncontrolled growth destroys surrounding tissues/organs via the cardiovascular and lymphatic systems, interfering with vital organs/functions.
• Primary sites of cancer metastasis are the bone, lymph nodes, liver, lungs, and brain.

Breast Cancer

• Classified as invasive when it penetrates the tissue surrounding the mammary duct and grows in an irregular pattern. Metastasis occurs via lymph nodes. Common sites for metastasis: bone, lungs, brain, liver and skin. Diagnosis via breast biopsy/needle aspiration/surgical removal of the tumor.

Major Prognostic Factors for Breast Cancer

• Invasive carcinoma vs in-situ disease
• Distant metastases
• Lymph node metastases
• Tumor size
• Locally advanced disease

Cancer Staging (Breast Cancer)

• Stage indicators (e.g., 0, I, II, III, IV) refer to primary tumor size, lymph node involvement, and the presence or absence of distant metastases and provide a survival rate and prognosis percentage.

Carcinoma of the Breast-Findings

• Presence of lump
• Nipple inversion
• Breast discharges
• Changes in skin - "peau d'orange"
• Diagnostics: mammography, UTZ, MRI (possibly) biopsy

Interventions

• Nonsurgical: Chemotherapy, radiation therapy, hormonal manipulation
• Surgical: Lumpectomy, partial or segmental mastectomy, total mastectomy, modified radical mastectomy, radical mastectomy

Monitoring and Managing Potential Complications

• Lymphedema: Occurs after axillary surgery.
• Hematoma Formation: Following mastectomy or breast conservation.
• Infection

Nursing Interventions

• Monitor for adverse effects of radiation and chemotherapy.
• Provide psychological support.
• Involve the patient in planning and treatment.
• Describing surgical procedures to alleviate fear.
• Prepare for chemotherapy effects (alopecia, fatigue), administer antiemetics.
• Administer I.V. fluids and hyperalimentation as indicated.
• Help patient identify support persons.
• Suggest psychological interventions for anxiety/depression/sexual problems.
• Teach cancer-screening procedures.

Breast Self-Examination (BSE)

• Perform 7-10 days after menses or on a specific day of the month.

Lung Cancer

• Lung cancer is abnormal cell growth in lung tissue, resulting in a tumor.
• Lung cancer may be primary (develops in the lung) or secondary (spreads from another part of the body).
• Major categories include small cell and non-small cell lung cancers.
• Risk factors include repetitive exposure to inhaled irritants (e.g., cigarette smoke, air pollution).

Risk Factors for Lung Cancer

• Exposure to inhaled irritants (e.g., cigarette smoke, air pollution)
• Benzopyrenes
• Hydrocarbons

Types of Lung Cancer

• Small cell (oat cell) and Non-small cell (Adenocarcinoma/Squamous cell/Large cell)

Care of Patients with Cancer of the Liver

• Liver cancer starts in liver cells (hepatocytes).
• Types include hepatocellular carcinoma (most common), and intrahepatic cholangiocarcinoma/hepatoblastoma (less common).
• Risk factors for liver cancer: chronic infection of Hepatitis B/C; liver cirrhosis; inherited liver/hemochromatosis, Wilson's disease; diabetes; exposure to aflatoxins; excessive alcohol consumption.
• Liver cancer often undetected until spread within the pelvis/abdomen.
• Treatments: Surgery, chemotherapy.

Care of Patients with Cancer of the Stomach

• Stomach cancer typically begins in mucus-producing cells (adenocarcinoma).
• Predominantly found in the stomach's lower part of the swallowing tube (gastroesophageal junction).
• Risk Factors: Diet high in salted/smoked foods, low in fruits/veggies, family history of stomach cancer, infection w/Helicobacter pylori, long-term stomach inflammation, pernicious anemia, smoking, stomach polyps.
• Stages of Stomach Cancer: -Stage 1: Tumor is restricted to the top layer of tissue -Stage 2: Cancer spread to deeper muscle or involves more lymph nodes -Stage 3: Cancer may have grown through all the layers -Stage 4: Cancer that has spread to other parts of the body

Care of Patients with Cancer of the Colon

• Cancer starts in the large intestine (colon).
• Cancer typically occurs in older adults
• Risk factors for colon cancer: Age, African-American race, inflammatory intestinal conditions, inherited syndromes, family history of colon cancer, low-fiber/high-fat diet, diabetes, obesity, smoking, alcohol use, radiation.
• Stages of colon cancer (e.g., A, B, C, D).
• Types of colon cancer include adenocarcinoma (most common).

Care of Patients with Cancer of the Ovaries

• Begins in the ovaries (egg-producing cells).
• Often undetected until it has spread to the pelvis/abdomen.
• Treatment: Surgery, Chemotherapy.
• Risk Factors: Older age, inherited gene mutations (BRCA1/2, Lynch syndrome), family history of ovarian cancer, estrogen hormone replacement therapy (high doses), age when menstruation started, menopause.
• Types of Ovarian Cancer:
• Epithelial tumors: 90% of ovarian cancers; begin int he thin layer of tissue covering the outside of the ovaries.
• Stromal tumors: 7% of ovarian cancers: Begin in the ovarian tissue that contains hormone-producing cells.
• Germ cell tumors: Rare ovarian cancers, begin in the egg-producing cells.

## Leukemias

• Neoplastic proliferation of white blood cells (WBCs) in the blood or bone marrow. Characterized by rapid, continuous turnover of cells leading to an increased level of WBCs in circulation.
• Acute leukemias: Abrupt onset within weeks/months, rapidly progressing; common in young children, adults.
• Chronic leukemias: Evolving over many months/years, slowly progressing, common in older patients.

Acute Myeloid Leukemia (AML)

• Results from defects (mutations) in stem cells differentiating into myeloid cells.
• Commonly diagnosed in adults (60 years).
• High mortality rates. Treatments include induction therapy, and supportive therapies.

Chronic Myeloid Leukemia (CML)

• Mutation in myeloid stem cells.
• A section of DNA is missing from chromosome 22 and translocated onto chromosome 9, on the BCR (chromosome 22) and ABL gene (chromosome 9).
• Symptoms include enlarged spleen, fatigue, anorexia (loss of appetite), weight loss.
• Treatment: Imatinib mesylate (Tyrosine-kinase-inhibitor), and supportive therapies.

Acute Lymphoblastic Leukemia (ALL)

• Uncontrolled proliferation of immature lymphoid cells (lymphoblasts).
• Common in children (4 years of age). Adults less commonly affected.
• Treatments: Chemotherapy.

Chronic Lymphoid Leukemia (CLL)

• Common malignancy in older adults (60+ years of age). CLL arises from a malignant clone of B lymphocytes.
• Diagnosis is often made incidentally.
• Symptoms include lymphadenopathy, splenomegaly, infection, and unintentional weight loss.
• Treatments: Chemotherapy, monoclonal antibodies

Test your knowledge on the fundamental characteristics of malignant cells and the roles of genes in cancer development. This quiz covers essential concepts such as tumor suppressor genes and the process of cancer metastasis. Perfect for students studying cancer biology or related fields.