Cancer Student (2) PDF

CANCER COLORADO CHRISTIAN UNIVERSITY BIO 345 ELLEN HUANG RN MS Copyright © 2017, Elsevier Inc. All rights r 2 eserved. CANCER Diseases in which abnormal cells divide without control and are able to invade other tissues Copyright © 2017, El...

CANCER COLORADO CHRISTIAN UNIVERSITY BIO 345 ELLEN HUANG RN MS Copyright © 2017, Elsevier Inc. All rights r 2 eserved. CANCER Diseases in which abnormal cells divide without control and are able to invade other tissues Copyright © 2017, Elsevier Inc. All rights r 3 eserved. BENIGN VS. MALIGNANT Benign TUMORS Malignant Grow slowly Grow rapidly Well-defined capsule Not encapsulated Not invasive Invasive Well differentiated Poorly differentiated Low mitotic index High mitotic index Do not metastasize Can spread distantly (metastasis) Copyright © 2017, Elsevier Inc. All rights r 4 eserved. Copyright © 2017, Elsevier Inc. All rights r 5 eserved. CLASSIFICATION AND NOMENCLATURE (CONT.) Carcinoma in situ (CIS) – Pre-cancer – Preinvasive epithelial malignant tumors of glandular or epithelial origin that have not broken through the basement membrane or invaded the surrounding stroma Copyright © 2017, Elsevier Inc. All rights r 6 eserved.  HALLMARKS OF CANCER Sustained proliferative signaling Evading growth suppression Genomic instability Replicative immortality Inducing angiogenesis Reprogramming energy metabolism Resistance to apoptotic cell death Tumor promoting inflammation Avoiding immune destruction Activating invasion & metastasis INFLAMMATION AND CANCER Chronic inflammation is an important factor in the development of cancer Helicobacter pylori – Chronic inflammation associated with: Peptic ulcer disease Stomach carcinoma Mucosa-associated lymphoid tissue lymphomas Copyright © 2017, Elsevier Inc. All rights r 8 eserved. VIRUSES AND CANCER Hepatitis B and C viruses Epstein-Barr virus (EBV) Kaposi sarcoma herpesvirus (KSHV) Human papillomavirus (HPV) Human T-cell leukemia-lymphoma virus (HTLV) Copyright © 2017, Elsevier Inc. All rights r 9 eserved. METASTASIS Spread of cancer from a primary site of origin to a distant site Anatomic patterns of lymph and venous flow determine how cancer spreads – Breast cancer bones – Lymphomas spleen – Colon cancer liver – Liver cancer  lungs Copyright © 2017, Elsevier Inc. All rights r 10 eserved. CLINICAL MANIFESTATIONS: *pain is what the patient says it is PAIN – Little or no pain is associated with early stages of malignancy – Mechanisms: Pressure Obstruction Invasion of sensitive structures Stretching of visceral surfaces Tissue destruction Inflammation/Infection Copyright © 2017, Elsevier Inc. All rights r 11 eserved. CLINICAL MANIFESTATIONS: FATIGUE – Most frequently reported symptom – Due to loss of muscle function Metabolic products of cancer treatment Circulating cytokines (TNF, interleukin-1) Copyright © 2017, Elsevier Inc. All rights r 12 eserved. CLINICAL MANIFESTATIONS: CACHEXIA Includes: – taste alterations – Anorexia – altered protein, lipid, – early satiety and carbohydrate – weight loss metabolism – Anemia – Asthenia Copyright © 2017, Elsevier Inc. All rights r 13 eserved. CLINICAL MANIFESTATIONS: ANEMIA A decrease of hemoglobin in the blood – Normal hemoglobin level = 15 – 20% of cancer patients have hemoglobin concentrations < 9 Copyright © 2017, Elsevier Inc. All rights r 14 eserved. CLINICAL MANIFESTATIONS (CONT.) Leukopenia and thrombocytopenia – Direct tumor invasion to the bone marrow causes leukopenia and thrombocytopenia – Chemotherapy drugs are toxic to the bone marrow Infection – Risk increases when the absolute neutrophil and lymphocyte counts fall Copyright © 2017, Elsevier Inc. All rights r 15 eserved. CLINICAL MANIFESTATIONS (CONT.) Gastrointestinal manifestations – Oral ulcers – Malabsorption – Diarrhea – Risk for infection – Therapy-induced nausea Hair and skin manifestations – Alopecia from chemotherapy Usually temporary – Skin breakdown and dryness Copyright © 2017, Elsevier Inc. All rights r 16 eserved. STAGING Microscopic analysis for staging—based on presence of metastasis – Stage I: No metastasis – Stage II: Local invasion – Stage III: Spread to regional structures (such as lymph nodes) – Stage IV: Distant metastasis (ex. Liverlung; prostatebone) Copyright © 2017, Elsevier Inc. All rights r 17 eserved. TNM SYSTEM Copyright © 2017, Elsevier Inc. All rights r 18 eserved. GRADING OF CANCER An indication of how abnormal the cancer cells appear under the microscope TUMOR MARKERS Tumor cell markers (biologic markers) are substances produced by cancer cells that are found on or in tumor cells, in the blood, CSF, or urine Tumor markers are used to: – Screen and identify individuals at high risk for cancer – Diagnose specific types of tumors – Observe clinical course of cancer – Problem: false positives and negatives Copyright © 2017, Elsevier Inc. All rights r 20 eserved. CANCER TREATMENT Surgery – To prevent cancer (colon polyps) – Biopsy for diagnosis and staging – Lymph node sampling – Palliative surgery Radiation – Goals Eradicate cancer without excessive toxicity Copyright © 2017, Elsevier Inc. All rights r 21 eserved. CHEMOTHERAPY Induction chemotherapy – For shrinkage or disappearance of tumors Adjuvant chemotherapy – Eliminate micrometastasis after surgery Neoadjuvant therapy – Given before localized treatment to shrink tumor Copyright © 2017, Elsevier Inc. All rights r 22 eserved. CANCER TREATMENT Targeted disruption – Used in combination with chemotherapy Copyright © 2017, Elsevier Inc. All rights r 23 eserved. TOBACCO *most important cause of cancer Causes cancer in more than 15 organs Copyright © 2017, Elsevier Inc. All rights r 25 eserved. PHYSICAL ACTIVITY Reduces cancer risk (breast, colon, other) – Decreases insulin and insulin-like growth factors – Decreases obesity – Decreases inflammatory mediators and free radicals – Increases gut motility Reduces length of time bowel lining is exposed to potential mutagens – Decreases levels of circulating sex hormones & metabolic hormones Copyright © 2017, Elsevier Inc. All rights r 26 eserved. DIET & NUTRITION Dietary components can be activated into carcinogens or can prevent cancer Copyright © 2017, Elsevier Inc. All rights r 27 eserved. XENOBIOTICS Toxic, mutagenic, and carcinogenic chemicals in food Copyright © 2017, Elsevier Inc. All rights r 28 eserved. OBESITY Correlates with the body mass index (BMI) Chronic inflammation Hormones from adipose tissue Copyright © 2017, Elsevier Inc. All rights r 29 eserved. ALCOHOL CONSUMPTION Genetic factors involved No “safe limit” of intake Copyright © 2017, Elsevier Inc. All rights r 30 eserved. IONIZING RADIATION Emission from x-rays, radioisotopes, radon, and other radioactive sources Exposure causes cell death, gene mutations, and chromosome aberrations Copyright © 2017, Elsevier Inc. All rights r 31 eserved.  RADIATION-INDUCED Targeted CANCER effects: damage cancer cell’s DNA Nontargeted effects: –Genomic instability –Bystander effects Copyright © 2017, Elsevier Inc. All rights r 32 eserved. ULTRAVIOLET RADIATION Principal source is sunlight Causes: – basal cell carcinoma – squamous cell carcinoma – melanoma– most lethal form of skin cancer Copyright © 2017, Elsevier Inc. All rights r 33 eserved. ELECTROMAGNETIC RADIATION (EMR) Non-ionizing, low-frequency radiation Microwaves, radar, cell phones, and power frequency radiation associated with electricity and radio waves, fluorescent lights, computers, and other electric equipment May or may not be carcinogenic Copyright © 2017, Elsevier Inc. All rights r 34 eserved.  AIR POLLUTION Particles and liquid droplets made up of acids, organic chemicals, metal, and dust particles Carcinogenic and causes lung cancer High proportion of mutagenic agents Primary particles Secondary particles Copyright © 2017, Elsevier Inc. All rights r 35 eserved. AIR POLLUTION (CONT.) Copyright © 2017, Elsevier Inc. All rights r 36 eserved.  CHEMICAL AND OCCUPATIONAL HAZARDS Present in air, soil, water, household products, toys, workplaces, and homes Substantial number of occupational carcinogenic agents Copyright © 2017, Elsevier Inc. All rights r 37 eserved.