Cancer Genetics: Wound Vocabulary

• Module 2 focuses on Cancer and Genetics

Wound Vocabulary

• Abrasion refers to an injury caused by rubbing or scraping, with the loss of the skin's superficial layer.
• Angiogenesis defines the process of forming new blood vessels, which occurs in the granulation phase of wound repair or when cancer cells stimulate blood vessel growth.
• Approximation refers to the state when wound edges are touching, this is important for healing, and applies to wounds healing by first or third intention.
• Avulsion is a wound resulting from tissue being torn away in a large piece and need healing by secondary intention.
• Cellulitis is an inflammation or infection, characterized by redness, pain, heat, and edema (S.H.A.R.P).
• Debridement involves removing devitalized or dead tissue as well as foreign material from the wound bed to support healing and reduce infection risk.
• Dehiscence refers to the splitting open of a surgical wound and requires closure via suture.
• Erythema is redness of skin, caused by vasodilatation related to inflammation, infection, or injury.
• Exudate is fluid from wounds, and it can be clear (serous), sanguineous (bloody), or purulent (pus).
• Granulation Tissue fills wounds with scar tissue, which is red or pink and has a lumpy appearance and is necessary for healing.
• Ischemia means a deficiency of blood supply to an area of tissue or an organ.
• Laceration refers to a wound that is produced by the tearing or cutting of the skin.
• Maceration is a softening, whitish look to the intact skin that surrounds wounds caused by excessive moisture, and happens when exudate is poorly managed or briefs are not changed routinely.
• Necrotic Tissue is dead tissue that is usually black or brown and hard or leathery, and it must be removed for the wound to heal due to infection risk.
• Purulent contains or forms pus and is characterized as an opaque white, green, or yellow exudate.

Healing by Intention

• Primary Intention has wound margins brought together by sutures, steri-strips, glue, Band-Aids, or surgical staples and heals with minimal scaring or infection, which is common in incisions, cuts, and puncture wounds.
• Secondary Intention: the tissue requires margins to contract, and then fills-in, resulting in a large scar, and may lead to high risks of infection from larger wounds with loss of tissue and contamination.
• Tertiary Intention: Wound margins either separate after being closed or are intentionally left open to allow infection drainage, then brought together after granulation tissue appears, highly contaminated wounds benefit from this.

Factors Affecting Wound Healing

• Nutritional Status
• Blood Flow/02 delivery
• Impaired Inflammatory/Immune Response
• Infection
• Wound Separation
• Foreign Bodies

What is Cancer?

• Cancer develops from a healthy cell.

Benign vs Malignant Growths

• Benign characteristics: well differentiated, stays together in the tissue, encapsulated growth pattern, generally slow growth rate, movable, and does not metastasize.
• Malignant characteristics:poor differentiation, breaks apart easily, infiltrates surrounding tissues, typically rapid growth rate, fixed in surrounding tissues and metastasizes in other tissues.

Cancer Cell Characteristics

• Differentiation: Tumors lose differentiation features over time.
• Contact Inhibition: Cancer cells grow rampantly despite contact with other cells.
• Cohesiveness: Malignant cells lack cohesiveness causing the cells to shed and spread.
• Anchorage Independence: Cancer cells can move freely (and therefore metastasize).
• Faulty Cell-to-Cell Communication: Cancer cells do not get the message to stop growing.
• Antigen Expression: Cancer cells express a number of cell surface molecules or antigens that are immunologically identified as foreign
• Enzymes: Most cancers synthesize and secrete enzymes that break down proteins involved in insuring intracellular organization and cell to cell cohesion.

Tumor Nomenclature

• Sentinel node: the initial lymph node to which the primary tumor drains.
• Benign tumors: usually are named by adding the suffix -oma.
• Malignant tumors of epithelial origin: usually are named by adding the suffix -carcinoma.
• Malignant tumors of mesenchymal: tumors are called sarcomas. Anaplasia means without form.

Oncogenes

• Oncogenesis refers to the genetic mechanism whereby normal cells are transformed into cancer cells. Genetic predisposition combined with environmental risk factors promotes cancer development.
• Oncogene occurs when a mutated gene now has the potential to cause cancer.
• Proto-oncogene: normal gene with a “genetic weakness" that makes it more susceptible to being converted into an oncogene.
• Cellular oncogenes: cancer characteristics coded on the host's inherited genes.
• Viral oncogenes: viruses can cause cancer by transmitting their DNA or RNA into host cells which damages the cell's genes.
• Mutated Anti-oncogene: leads to under production of cancer-preventing cells.
• Host Factors: Heredity; hormones; faulty immunologic mechanisms; obesity, smoking, alcohol
• Environmental Factors: Chemicals, radiation (including sun), pollution, food, molds, tanning beds
• Mutation of oncogenes by viruses can be linked to cancer formation by: Human Papilloma Virus (HPV), Epstein Barr Virus (EBV), Hepatitis B and C virus, and Kaposi sarcoma herpesvirus (AIDS related), and Human T-cell Lymphotropic Virus Type 1 (HTLV-1) retrovirus

Methods of Metastasis

• Direct extension is when a tumor cells spreads to tissues adjacent to the primary tumor, sending projections into the surrounding tissue to spread to the nearest cells.
• Seeding: the tumor cells slough off from primary tumor and develop into more tumors.
• Circulation happens through the blood and/or lymph, leading to a secondary tumor developing in a site distant from the primary tumor.

Metastasis

• Breast and Lung cancers spread to the same specific locations

Cancer Staging

• Staging describes the severity of a cancer and how much it has spread, and is important to help doctors plan treatment, estimate prognosis, and for health care providers to communicate info.
• Different staging systems are used for different types of cancer.
• TNM system is based on the size of the primary tumor, the amount of spread to nearby lymph nodes, and the presence of metastasis to other parts of the body.
• TX: Primary tumor cannot be evaluated
• TO: No evidence of primary tumor
• Tis: Carcinoma in situ
• T1, T2, T3, T4: Size and/or extent of the primary tumor
• NX: Regional lymph nodes cannot be evaluated
• NO: No regional lymph node involvement
• N1, N2, N3: Degree of regional lymph node involvement
• MX: Distant metastasis cannot be evaluated
• MO: No distant metastasis
• M1: Distant metastasis is present
• Summary staging groups cancer location into five main categories of in situ, localized, regional, and distant/metastatic location for the spread of the tumor.

Tumor Grading

• Tumor grade is how abnormal the tumor cells and the tumor tissue look under a microscope to estimate how quickly a tumor is likely to grow and spread.
• “Well-differentiated.” Tumors usually grow and spread at a slower rate. Tumors are "undifferentiated" or "poorly differentiated and have abnormal-looking cells and are likely to have metastasis.
• GX: Grade cannot be assessed (undetermined grade)
• Grade I: Well differentiated, least aggressive
• Grade II: Moderately differentiated
• Grade III: Poorly differentiated
• Grade IV: Very poorly differentiated, more likely to progress quickly, highly malignant.

Cancer Signs and Symptoms

• Fatigue is the reported symptom.
• Pain from pressure/stretching, obstruction, and invasion of tissues by tumor.
• Blood dyscrasias are blood component disorders, which are either caused by the primary tumor or bone marrow damage from cancer treatments.
  • Anemia is a Low red blood cell count caused by bleeding, malnutrition
  • Leukopenia is a low white blood cell count: risk for infection
  • Thrombocytopenia is a low platelet count, and is a bleeding disorder leadings to anemia.
• Infection is a significant cause of mortality of cancer patients.
• Cachexia is a "Wasting" syndrome related to malnutrition due to increased basal metabolic rate caused by growing tumors.

Goals of Cancer Treatment

• Curative treatment aims for complete elimination of cancer from the individual.
• Control: Cancer that cannot be cured can be managed as a chronic disease.
• Palliative: Treatment is given only to relieve symptoms and suffering caused by cancer for comfort.
• Adjuvant Therapy: is given in addition to the primary treatment to ensure the cancer is eradicated.

Types of Cancer Treatments

• Chemotherapy: the drugs kill all fast-growing cells whether they are cancerous or not that targets tumors because they are composed of fast-growing cells.
• Adverse reactions occur in the G.I. Tract causing nausea/vomiting/diarrhea, Bone Marrow Suppression reducing the blood components, and Alopecia.
• Radiotherapy: Ionizing radiation is effective for rapidly growing, poorly differentiated tumor cells to reduce the size of a tumor and provide comfort. Adverse reactions include Skin burns, Bone marrow suppression, and Alopecia.
• Surgery: Can be curative to assist with staging and identification.
• Biotherapy: Medications stimulate the Immune system to identify and destroy cancer cells without damaging surrounding normal cells. BRM medications can either enhance or suppress the appropriate action needed to kill the tumor cells effectively and minimize risk to other cells..

Immunotherapy

• High specificity for antigens to cause less damage with memory cells giving long protection
• The negative side effects are similar to chemotherapy and radiotherapy.

Types of BRMS

• Monoclonal Antibodies (-Mab drugs), Interleukin-2, and Alpha Interferon.
• Monoclonal Antibodies can make the cancer cell more visible to the immune system or block growth signals, or stop new blood vessels from forming.

Adult vs Pediatric Cancers

• Most pediatric cancers tend to be diagnosed during peak growth times with genetic causes
• The less than 1% of pediatric cancers are found accidentally, tolerate treatment but long term consequences, and are very responsive to chemo.
• Greater than 99% of adults cancers are from environmental factors are are diagnosed easier and intolerant to treatment.

Teratogens

• Teratogens are chemical, biological, or physical factors that might cause an abnormal development of a fetus.
• The period between three to eight weeks of pregnancy is considered to be the most critical for embryo development.
• Examples of TERATOGENS are Diseases, Drugs/chemicals include alcohol, tobacco, marijuana, cocaine, methamphetamine, heroin, and Environmental factors
• Fetal Alcohol Syndrome has no known safe amount of alcohol consumption during pregnancy and can cause, developmental delays, physical defects, Seizures during withdrawal, behavioral issues, and intellectual impairments. T. O. R. C. H. includes, Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections are most common infections associated with congenital anomalies.

Epigenetics

• Epigenetics are modifications of DNA, without changing the underlying sequence, that control gene expression.
• The epigenetic changes can cause issues and be inherited through multiple generations.
• Common epigenetic issues are DNA methylation and Mice whose agouti gene is more prone to develop diabetes and cancer.