Cancer- Chapter 40

Cancerous neoplasm

abnormal mass of cells

abnormal growth, appearance, and function of cells

Second leading cause of death

age is the primary risk factor

types of sporadic and inherited genetic alterations

defective tumor suppressor genes

mutated proto-oncogenes

tumor suppressor genes

guard against cancer

protooncogenes

control normal growth

oncogenes allow

unrestrained cell division

cell cycle stages

G0, G1, G2, S, and M

Checkpoints within the cycle

repair, recycling, or apoptosis if needed

what doesn’t stop at checkpoints

cancer cells

cancer cells will disregard

growth inhibition signals

Immunocompetence

immune system should destroy abnormal cells

declines with age

cancer genetics

mutations

TP53 problem

oncogene

Mutations may be

hereditary or sporadic- such as carcinogenic exposure

TP53 is a tumor suppressor gene

control apoptosis

guardian of the genome

Proto-oncogene

regulates a cell’s movement though the cell cycle

can mutate and become oncogenes

Some viruses are oncogenic such as

HPV

Epstein- Barr virus

Hepatitis C and B

3 stages of carcinogenesis

Initiation

Promotion

Progression

Initiation stage

alteration in a gene or genes

Promotion

pre-neoplastic cells accumulate, process can be altered by chemo preventative agents

Progression

phase between a premalignant lesion and the development of invasive cancer

Metastasis

movement of cancer cells from primary location to distant site

Tumor angiogenesis

secrete VEGF and give them the ability to make blood vessels

Neoplasia

“New growth”, uncontrolled abnormal growth 

Benign

Well-differentiated, remain localized, not invasive.

Malignant

On scale of well differentiated to poor. Invasive, destructive to surrounding tissue.

Adenoma

Benign tumor in glandular tissue/organ

Lipomas

derived from fat cells

Hemangioma

collection of blood vessels in the skin or internal organ

Osteoma

benign tumor of bone

Nevi

non-cancerous moles on the skin

myomas

muscle tumor

carcinoma

malignant epithelial cells

adenocacinoma

cancer of the glandular or ductal tissue

sarcoma

Cancerous changes in mesenchymal cells: connective tissue, cartilage, and bone

Leukemia

Cancerous changes in leukocytes/blood cells

Lymphoma

cancerous lymphocytes in lymph tissue

Benign tumors

Well-differentiated, remain localized, cohesive, and well-demarcated from surrounding tissue

Malignant tumors

Poorly differentiated, Invasive and destructive to surrounding

Cells easily metastasize

Anaplasia

total cellular disorganization

abnormal appearance

Grading of tumors

based on the level of differentiation

1 is well differentiated

3 is poorly differentiation

TNM is also a way to

stage

TNM letters stand for

Tumor size

N is for lymph node involvement

Metastasis

What are the common sites for metastasis

liver

bone

an lungs

TNM x or 0

x- cannot be measured

0- cannot be found

Paraneoplastic syndrome

unexpected pathology provoked by the presence of cancer

ex. hormone-like substances secreted

often, paraneoplastic manifestations are the

first sign of cancer

Cancer cachexia

progressive loss of body fat and lean body mass

The bog red flag of cancer cachexia

unintentional weight loss

Assessment to look out for

general complaints such as fatigue and unintentional weight loss

palpate lymph nodes

Tools for diagnosis

screening tests for specific cancers

MRI

CT scan

tumor markers

Carcinoembryonic antigen (CEA)

Colon and Rectal

Alpha - fetoprotein (AFP)

liver

CA- 125

ovarian and uterine

PSA

prostate

Treatments

surgery- highest cancer cure rate

Radiation- destroy tumor cells

Chemotherapy- cytotoxic drugs destroys cells

Side effects of chemo

dry mouth

anorexia

nausea

vomiting

alopecia

bone marrow suppression

Immunotherapy

another type of treatment

enhance the body’s immune response to cancer

Lung cancer primary risk

cigarette smoking

most common form of lung cancer

non-small cell lung cancer (NSCLC)

it is slow growing

cigarette pack years

how many years smoking X cigarette packs a day

Signs and symptoms of lung cancer

cough

hemoptysis (blood in sputum)

unintentional weight loss

wheeze

stridor

Lung cancer tumor

may cause obstructive accumulation of secretions, productive cough

leads to incorrect diagnosis

what can lead to a diagnosis of lung cancer

paraneoplastic syndrome- like secretion of ACTH and ADH

increase number of stage means

increase for spread and more likely for a poor outcome

leading cause of cancer-related death in both men and women throughout the world

lung cancer

Surgery treatments for lung cancer

Wedge resection

Lobectomy

Wedge resection for lung cancer

remove part of the lung

Lobectomy for lung cancer

removes the entire lobe

most common

pharmacological treatments for lung cancer

tyrosine kinase inhibitors

2nd most common cancer in the US

breast cancer

the genes associated with breast cancer

BRCA1 and BRCA2

Breast cancer risk factors

family history

BRCA1 and BRCA2

most common type of breast cancer

epithelial cell tumors lining ducts or lobules

Receptors associated with breast cancer production

Estrogen receptor positive (ER-positive)

Human epidermal growth factor receptor 2 (HER2)

Breast cancer signs and symptoms

singular, nontender firm mass

swelling in one breast

nipple or skin retraction

peau d’orange

paget’s disease of the breast

adherence to the skin or chest wall

Breast cancer diagnosis

mammogram

ultrasound

biopsy

ductogram

PET scan

histological exam of lymph nodes

what would a mammogram look for

calcifications

biopsy test samples for breast cancer

estrogen/progesterone receptor test

HER2

oncotype assay

Breast cancer treatment

Surgery

radiation

chemotherapy

immunological agents

adjuvant therapies

adjuvant therapies for breast cancer

selective estrogen receptor modulators

aromatase inhibitors

bisphosphonates

selective estrogen receptor modulators

tamoxifen

raloxifene

aromatase inhibitors

anastazole

this will block aromatase, an enzyme responsible for converting steroid hormones into estrogens

Bisphosphonates

Zolendric acid

• inhibit osteoclast function

5th leading cause of cancer death in women in the US

ovarian cancer

what contributes to a late diagnosis of ovarian cancer

diffuse symptoms

diffuse symptoms of ovarian cancer

lower abdominal pain

increase abdominal size

bloating

ovarian cancer tumors

germ cell

epithelial

stromal

Germ cell

cells that develop to ova

epithelial

outer epithelial surface cells of ovary

Stromal

tissue that secretes hormones

most forms of ovarian cancer

epithelial

ovarian cancer risk factors

family history

BRCA1 and BRCA2 genes

What cancer antigen do they look for with ovarian cancer

cancer antigen-125 (CA-125)

ovarian cancer diagnosis

CA-125

transvaginal ultrasound

laparotomy

cytological analysis of ascites fluid

biopsy of the tumor and lymph nodes

ovarian cancer treatment

surgical resection of tumor

often total hysterectomy

chemotherapy

chemo for ovarian cancer

several cycles often needed

platinum and paclitaxel

epithelial growth factor inhibitors

tyrosine-kinase inhibitors

chemotherapy works to reduce __________ of cancer cells

mitosis

two categories of recurrent ovarian cancer

Platinum-sensitive- relapse more than 6 months after

Platinum-resistant- relapse earlier than 6 months

Cervical cancer biopsy

see dysplasia called cervical intraepithelial neoplasia

CIN stages

1- mild

2- moderate

3- severe dysplasia