Neoplasia Lecture Slides PDF

NEOPLASIA NURS B310 University of South Carolina Beaufort DR Clinton Butler, MD 3 February 2025  STUDENT OUTCOMES Outline the characteristics of tumor cells. Differentiate between benign and malignant tumors. Identify local and systemic clinical manifestat...

NEOPLASIA NURS B310 University of South Carolina Beaufort DR Clinton Butler, MD 3 February 2025  STUDENT OUTCOMES Outline the characteristics of tumor cells. Differentiate between benign and malignant tumors. Identify local and systemic clinical manifestations of neoplasia. Explain the mechanisms of cancer spread. Compare the different screening and diagnostic mechanisms for cancer. What is a sentinel node? Differentiate among the three types of cancer treatment (curative, control, and palliative). Explain the two basic methods of classifying cancers based on grading and staging.  COMPONENTS OF TISSUE RENEWAL AND REPAIR Cell Proliferation Process of cell division Inherent adaptive mechanism for replacing body cells Cell Differentiation Process of specialization New cells acquire the structure and function of cells they replace Apoptosis A form of programmed cell death to eliminate unwanted cells  Genes that Control Cell Growth and Replication Protooncogenes Tumor suppressor genes Genes that control programmed cell death or apoptosis Genes that regulate repair of damaged DNA  CHARACTERISTICS OF CANCER Neoplasms exhibit autonomy and anaplasia. Autonomy refers to the unregulated proliferation of the neoplasm. Anaplasia refers to the loss of cell differentiation and therefore the loss of cell function. The greater the degree of anaplasia the more aggressive, or malignant, the tumor will be. Neoplasms exhibit several other distinct characteristics: Loss of cell-to-cell communication = which allows further unrestricted growth of tumor cells Increased energy expenditure = which deprives unaffected cells of nutrients Increased motility and loss of cohesion/adhesion = which promotes movement to other locations Rapid angiogenesis (development of new blood vessels) = which provides extensive blood flow to the tumor cells Substance secretion = which alters the metabolism and degrades neighboring unaffected cells Presence of foreign antigens on the cancer cell surface = which can trigger the immune response  Characteristics of Benign Neoplasms A slow, progressive rate of growth that may come to a standstill or regress An expansive manner of growth Inability to metastasize to distant sites Composed of well-differentiated cells that resemble the cells of the tissue of origin  Characteristics of Malignant Neoplasms Tend to grow rapidly and spread widely Have the potential to kill regardless of their original location Tend to compress blood vessels and outgrow their blood supply, causing ischemia and tissue necrosis Rob normal tissues of essential nutrients Liberate enzymes and toxins that destroy tumor tissue and normal tissue  Factors Differentiating Benign and Malignant Neoplasms Cell characteristics Manner of growth Rate of growth Potential for metastasizing or spreading Tendency to cause tissue damage Capacity to cause death  METHODS BY WHICH CANCER SPREADS Local Spread Direct extension and seeding Metastatic spread through the blood or lymph pathways  FACTORS AFFECTING TUMOR GROWTH The number of cells that are actively dividing or moving through the cell cycle The duration of the cell cycle The number of cells that are being lost compared with the number of new cells being produced Growth fraction, which is the ratio of dividing cells to resting cells in a tissue mass Doubling time, which is the length of time it takes for the total mass of cells in a tumor to double  HOST AND ENVIRONMENTAL FACTORS LEADING TO CANCER Heredity Hormones Carcinogens Chemical Radiation Oncogenic viruses Immunologic mechanisms  CANCER CLASSIFICATIONS vs. GRADING Tumor staging, I through IV. The higher the numeric stage, the greater the tumor size and the more extensive the tumor spread. (Asset provided by Anatomical Chart Company.)  Stage 0: The disease is only in the ducts or lobules of the breast. It has not spread to the surrounding tissue. It is also called noninvasive cancer. Stage I: The disease is invasive. Cancer cells are now in normal breast tissue. There are 2 types: Stage IA: The tumor is small. It has not spread to the lymph node. Stage IB: The tumor is in the lymph nodes and may also be in the breast tissue. It is less than 2 cm in size. Stage II describes invasive breast cancer. There are 2 types: Stage IIA: A tumor may not be found in the breast or there is a tumor that is 2cm or smaller in the breast, but cancer cells have spread to at least 1 to 3 lymph nodes. Or Stage IIA may show a 2 to 5 cm tumor in the breast without spread to the axillary lymph nodes. Stage IIB: The tumor is 2 to 5 cm and the disease has spread to 1 to 3 axillary lymph nodes. Or the tumor is larger than 5 cm but has not spread to the axillary lymph nodes. Stage III describes invasive breast cancer. There are 3 types: Stage IIIA: The tumor of any size has spread to 4 to 9 lymph nodes. Or the tumor is larger than 5cm and only has spread to 1- 3 lymph nodes. Stage IIIB: The tumor may be any size and the disease has spread to the chest wall. It may cause swelling of the breast and may be in up to 9 lymph nodes. Inflammatory breast cancer is considered Stage IIIB. Stage IIIC: The tumor may be any size with spread to 10 or https://www.facs.org/for-patients/the-day-of-your-surgery/breast-cancer- more lymph nodes. surgery/breast-cancer-types/breast-cancer-staging Stage IV (metastatic): The tumor can be any size and the disease has spread to other organs and tissues, such as the bones, lungs, brain, liver, distant lymph nodes, or chest wall.  CLINICAL MANIFESTATIONS OF CANCER Tissue Integrity Compressed and eroded blood vessels; ulceration and necrosis; frank bleeding and hemorrhage Cancer Cachexia Weight loss and wasting of body fat and muscle tissue; profound weakness, anorexia, and anemia Paraneoplastic Syndromes Inappropriate hormone release, circulating hematopoietic, neurological, and dermatological factors  DIAGNOSTIC MEASURES FOR CANCER DETECTION Lab tests Screening for early detection Pap smear Observation Biopsy Cytologic studies and tissue biopsy Palpation Endoscopic examinations Ultrasound Laboratory tests X-ray studies, MRI CT and PET Tumor markers Staging and grading of tumors  Goals of Cancer Treatment Curative Control Palliative Supplemental Slides  CANCER TREATMENT MODALITIES Surgery Chemotherapy Radiation Direct DNA-interacting Indirect DNA-interacting Hormonal therapy Cell cycle–specific Targeted therapy Cell cycle–nonspecific Biotherapy Immunotherapy Biologic response  Stem Cells Definition Reserve cells that remain quiescent until there is a need for cell replenishment. When a stem cell divides, one daughter cell retains the stem cell characteristics, and the other daughter cell becomes a progenitor cell that proceeds through to terminal differentiation. Self-renewal Potency  Cancer Cell Differentiation Cancer cells are characterized by two main features: - abnormal and rapid proliferation and - loss of differentiation. The term anaplasia describes the loss of cell differentiation in cancerous tissue The cytologic/histologic grading of tumors is based on the degree of differentiation and the number of proliferating cells. The closer the tumor cells resemble comparable normal tissue cells, both morphologically and functionally, the lower the grade. Scale ranging from grades I to IV, grade I neoplasms are well differentiated, and grade IV are poorly differentiated and display marked anaplasia..  Oncologic Emergencies Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Hypercalcemia Superior Vena Cava Syndrome Hematologic Disorders (anemia, DIC) Sepsis Tumor Lysis Syndrome  Stem Cell Transplantation Bone marrow transplantation (BMT) Peripheral blood stem cell transplantation (PBSCT) Two treatment approaches for individuals with leukemias, certain solid tumors, and other cancers previously thought to be incurable  Radiation’s Beneficial Effects Radiation therapy uses high-energy particles or waves to destroy or damage cancer cells. The absorption of energy from radiation in tissue leads to the ionization of molecules or creation of free radicals. Radiation can also produce effects indirectly by interacting with water (which makes up approximately 80% of a cell’s volume) to produce free radicals, which damage cell structures. Radiation can interrupt the cell cycle process, kill cells, or damage DNA in the cells. Radiation must produce double-stranded breaks in DNA to kill a cell, owing to the high capacity of cells for repairing single-stranded breaks https://www.cancercenter.com/community/blog/2020/03/video-how-does-radiation-therapy- work  Adverse Effects of Radiation Therapy Unfortunately radiation therapy negatively affects normal tissue that is rapidly proliferative similar to malignant cells. Tissues within the treatment fields that are most frequently affected are the skin, the mucosal lining of the gastrointestinal tract, and the bone marrow.  Chemotherapy Direct and Indirect DNA-Interacting Agents Direct DNA-interacting agents include the alkylating agents, antitumor antibiotics, and topoisomerase inhibitors. As a class, the alkylating agents exert their cytotoxic effects by transferring their alkyl group to many cellular constituents. Indirect DNA-interacting agents include the antimetabolites and mitotic spindle inhibitors. The antimetabolites (folic acid antagonists and purine and pyrimidine antagonists) interrupt the biochemical pathways relating to nucleotide and nucleic acid synthesis.  Chemotherapy Cell Cycle Drugs Drugs that are cell cycle specific exert their action during a specific phase of the cell cycle. Drugs that are cell cycle nonspecific exert their effects throughout all phases of the cell cycle.  Biotherapy Biotherapy involves the use of immunotherapy and biologic response modifiers as a means of changing the person’s own immune response to cancer. The major mechanisms by which biotherapy exerts its effects are modifications of host responses or tumor cell biology.  Targeted Therapy Targeted cancer therapy uses drugs that selectively attack malignant cells without causing harm to normal cells. It focuses on altered molecules and signaling pathways that allow cancer cells to grow and spread in an uncontrolled manner. Targeted therapies include small molecules that block specific enzymes and growth factors involved in cancer cell growth.