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Questions and Answers
What is the average doubling time for a solid tumor?
What is the average doubling time for a solid tumor?
Which of the following factors is NOT considered a carcinogenic factor?
Which of the following factors is NOT considered a carcinogenic factor?
How does the growth fraction of a tumor influence its volume increase?
How does the growth fraction of a tumor influence its volume increase?
At which point is a tumor typically considered clinically undetectable?
At which point is a tumor typically considered clinically undetectable?
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What is the major route through which tumors commonly spread?
What is the major route through which tumors commonly spread?
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Which characteristics are commonly associated with malignant tumors?
Which characteristics are commonly associated with malignant tumors?
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What is the primary difference between benign and malignant tumors?
What is the primary difference between benign and malignant tumors?
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What role do risk factors play in the carcinogenesis stages?
What role do risk factors play in the carcinogenesis stages?
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Which of the following is NOT typically a warning sign of cancer?
Which of the following is NOT typically a warning sign of cancer?
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In terms of cancer screening and detection, which method is specifically recommended for lung cancer in individuals aged 40 and older?
In terms of cancer screening and detection, which method is specifically recommended for lung cancer in individuals aged 40 and older?
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What characteristic is primarily associated with malignant tumors compared to benign tumors?
What characteristic is primarily associated with malignant tumors compared to benign tumors?
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During which stage of carcinogenesis does the unregulated growth of previously initiated cells occur?
During which stage of carcinogenesis does the unregulated growth of previously initiated cells occur?
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Which of the following is NOT a characteristic of cancer cells?
Which of the following is NOT a characteristic of cancer cells?
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Which of the following cells shows loss of contact inhibition, a common characteristic of cancer cells?
Which of the following cells shows loss of contact inhibition, a common characteristic of cancer cells?
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Which tumor type originates from adipose tissue?
Which tumor type originates from adipose tissue?
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What does the presence of tumor-specific antigens indicate?
What does the presence of tumor-specific antigens indicate?
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Which of the following is a common characteristic of benign tumors?
Which of the following is a common characteristic of benign tumors?
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Which of the following tumor types is derived from bone cells?
Which of the following tumor types is derived from bone cells?
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What is a hallmark of cancer that indicates its ability to spread to other organs?
What is a hallmark of cancer that indicates its ability to spread to other organs?
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Which term describes the abnormal increase in the size of cells?
Which term describes the abnormal increase in the size of cells?
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What is the primary function of tumor suppressor genes?
What is the primary function of tumor suppressor genes?
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Which of the following characteristics makes cancer cells more aggressive?
Which of the following characteristics makes cancer cells more aggressive?
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What is the significance of angiogenesis in tumor growth?
What is the significance of angiogenesis in tumor growth?
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Which process leads to alterations in genes that regulate apoptosis in cancer cells?
Which process leads to alterations in genes that regulate apoptosis in cancer cells?
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Study Notes
Oncology Overview
- Oncology is the study and treatment of tumors.
- Tumors are neoplasms, abnormal growths of cells.
- Benign tumors are not cancerous.
- Malignant tumors are cancerous, known as cancer.
Tumor Types
- Benign tumors are well-differentiated, slow-growing, usually cohesive, and do not invade or infiltrate surrounding tissues. Their structure typically resembles the tissue of origin.
- Malignant tumors are variably differentiated, growing erratically, often infiltrating, and may be rapid. They often have abnormal mitotic figures and structure.
- They can metastasize (spread to other parts of the body).
Theories of Cancer Development
- Cellular differentiation theory outlines benign growth patterns and precancerous changes like hypertrophy, hyperplasia, metaplasia, dysplasia, and anaplasia.
- Failure of the immune response theory points to a key role of the immune system in preventing cancer cell growth, with examples like Kaposi's sarcoma in HIV/AIDS patients.
Tumor Terminology
- A suffix "-OMA" is commonly used in benign tumor names (e.g., fibroma, lipoma, osteoma).
- Malignant tumors are often categorized by the cell type of origin.
Classification of Human Tumors
- Tumors are classified based on their cell tissue of origin (mesenchymal, epithelial, internal organs, germ cells).
- Examples include: mesenchymal tumors (fibroma, liposarcoma); epithelial tumors (adenomas, carcinomas); liver cell adenoma, carcinoma and germ cell tumors (teratoma, embryonal carcinoma).
Carcinogenesis
- Initiation is exposure to carcinogens (e.g., chemicals, radiation, viruses).
- Promotion is the action of the carcinogen, causing unregulated growth in pre-existing cells (reversible).
- Progression - tumor cells gain malignant characteristics.
Characteristics of Cancer Cells
- Altered cell differentiation, appearance (pleomorphism, abnormal nuclei/multiple nuclei, abnormal chromosome number/arrangement), and metabolism.
- Production of surface enzymes for invasion and metastasis.
- Increased anaerobic glycolysis.
- Inappropriately secrete hormones, creating a paraneoplastic syndrome.
- Tumor-specific antigens, signaling the immune system to recognize these cells as foreign.
- Loss of normal control mechanisms to stop cell proliferation and contact inhibition.
- Cells are less genetically stable, leading to increasing malignant mutations.
Tumor Growth
- Cells cycle through different phases (G1, S, G2, M, Go).
- Cell cycle time is the length of time required for one cell division to the next, and is influenced by time spent in the Go phase.
- Doubling time is the time a tumor takes to double in size (usually 2 months for solid tumors).
- A tumor is clinically undetectable until it reaches a volume of 1cm³ (1 billion cells).
- Growth fraction is the ratio of dividing cells to all cells.
Carcinogenic Factors
- Heredity.
- Hormonal factors.
- Bacteria and parasites.
- Oncogenic viruses.
- Immune deficiency.
- Environmental factors.
- Chemicals.
- Radiation.
Route of Spread
- Lymphatics.
- Blood vessels (hematogenous).
- Direct seeding into surrounding tissues.
Most Common Cancer in the Philippines
- WHO reports nearly 10 million cancer deaths globally in 2020.
- Common cancers: breast, lung, colon and rectum, and prostate.
- In 2018, 141,021 cancer cases and 86,337 related deaths were reported. Cancer incidence and mortality rates vary. The Philippines data reflects specific proportions of common cancers.
Diagnostic Tests
- Tumor markers (PSA, S-100, thyroglobulin, CA 15-3/CA 27-29, CEA/CA 19-9, CA 125, HCG, AFP, B2M, Chromogranin A).
- Diagnostic imaging (X-ray, mammography, CT scan, ultrasound, nuclear medicine, Positron Emission Tomography (PET), lymphoscintigraphy, MRI)
- Biopsy (fine-needle aspiration, core needle, incisional, excisional biopsy, frozen section).
- Endoscopy (diagnostic and therapeutic purposes for bronchial or G.I. cancer).
Staging of Cancer
- Process for describing the extent and spread from origin.
- TNM staging system.
- T (tumor size)
- N (node involvement)
- M (metastasis)
- Staging (Stages 0-4) represents increasing spread and size of a tumor.
Grading of Cancer
- Gradation classifies tumors by their degree of differentiation (Grade 1-3).
- Low-grade tumors are less aggressive, high-grade tumors more aggressive.
Modalities of Treatment
- Surgery.
- Chemotherapy.
- Radiation therapy.
- Biotherapy.
- Stem cell therapy.
Surgical Oncology
- Defined as a branch of surgery focusing on the surgical management of malignant neoplasms.
- Procedures for preventing cancer in high-risk patients, diagnosing primary or metastatic malignancies, and primary/secondary treatment of malignancies.
- Surgical procedures involving removal of tissue for diagnosis and therapy.
- Palliative (symptom relief) care can be a key aspect.
- Nursing roles cover risk factor identification and surgical procedure support. These includes preoperative, intraoperative, and postoperative care.
- Principles of oncology are based in surgery, oncology, nursing, and medicine, but methods and priorities may change.
- Prevention and identification of risk factors (age and specific risks, survival and quality-adjusted curves of preventive therapies, routine screening with clinical exams).
- Other factors (hereditary potential, comorbidities, cancer debilitation, paraneoplastic syndromes).
- Different types of surgery (diagnostic, preventative, curative, palliative, reconstructive).
- Diagnostic surgical procedures (biopsy, e.g., fine needle aspiration, core needle, incisional, excisional, frozen section, endoscopy.)
Chemotherapy
- Definition: the use of cytotoxic drugs to treat cancer.
- Function: killing tumor cells by interfering with cellular functions and their replication.
- Systemic treatment (vs. localized treatment).
- Goals include cure, control (stopping growth/spread), or palliation (symptom relief).
- Cell cycle generation has distinct phases (G1, S, G2, M, Go).
- Chemotherapy agent types include adjuvant, neoadjuvant, primary therapy, induction, and combination therapies, and myeloablative therapies.
- Drug classification (cell cycle specific or non-specific).
Routes of Administration
- Oral (most convenient, needs patient compliance, often taken with meals).
- Subcutaneous/Intramuscular (injections into muscle, rotation of injection sites).
- Intravenous (IV) (most common, direct vein injection, bolus or infusion). Peripheral or central access including percutaneous-line devices (PICC line, port-a-cath, Hickman catheter)
- Intra-thecal/intra-ventricular (directly into cerebrospinal fluid; often for leukemia, lymphoma).
- Intra-arterial (catheter placement in an artery of the tumor location).
- Intra-cavitary (into body cavities via chest tubes or catheters, e.g. bladder cancer).
- Topical (for surface areas).
Safe Administration of Chemo Drugs
- Chemo drugs are dangerous.
- No contact with chemo drugs.
- Pregnant should not receive chemo.
- Specialized preparation area, personal protective equipment like gowns, gloves, masks, and eye protection required.
- Labeling and disposal of drugs into puncture-resistant containers are vital safety steps.
Management of Chemotherapy Spills
- Immediate cleanup by protected personnel (training is necessary).
- Identifying the spill site and warning others to avoid contamination.
Common Side Effects of Chemotherapy
- Nausea/Vomiting
- Alopecia (hair loss)
- Stomatitis (mouth sores)
- Anorexia (loss of appetite)
- Anemia
- Neutropenia
- Thrombocytopenia
- Vesicant Extravasation (leak into tissues)
- Flare (allergic reaction)
- Phlebitis (inflammation of a vein)
- Anaphylaxis (severe allergic reaction).
Management of Chemotherapy-induced Side Effects & Adverse Reactions
- Methods for managing symptoms (e.g., oral hygiene, hydration, positioning, antiemetics, nutrition, blood checks, supportive care).
Specific Toxicities of Chemotherapy
- Specific reactions to chemo drugs including types of toxicity, causes, and management.
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