cellular regulation exemplars

Cancer

a group of diseases characterized by uncontrolled + unregulated cell growth

Defect in proliferation + differentiation

-proliferation: may produce more than 2 cells at a time of division

-differentiation: cells function differently, make abnormal proteins or hormones

Cancer promotion + progression

-promotion: reversible risk factors like smoking, alcohol use, obesity

-progression: tumor growth, metastasis (spread), angiogenesis

Cancer diagnostic testing

-imaging: X-ray, CT, MRI, US, PET

-cytology studies (study of cells)

-endoscopic exams (colonoscopy)

-bone marrow exams

-blood labs: CBC, CMP, tumor markers, PSA (prostate specific antigen)

-biopsy (risk infection)

Stages of cancer 0-2

-stage 0: cancer in situ (cells present but no spread/invasion)

-stage 1: cancer is small + not spreading to tissues/organs

-stage 2: cancer is growing + spreading, but not far

Stages of cancer 3 and 4

-stage 3: cancer has spread extensively into nearby tissues/lymph nodes, but still not too distant/far

-stage 4: cancer has spread to distant parts of the body from where it originated

TNM classification (staging)

-Tumor size and invasiveness (T)

-spread to lymph Nodes (N)

-presence or absence of Metastasis (M)

Cancer primary + secondary prevention

-Primary: smoking, sun exposure, physical activity, healthy diet, prophylactic surgery

-Secondary: screening (mammogram), treatment goals (cure, control, palliation), personalized cancer medicine

Cancer management

-surgery: prevention, reconstruction, diagnosis, etc.

-chemotherapy: systemic chemical therapy, IV/PO, acts against all rapidly dividing cells, works against spreading but may damage healthy cells

-radiation: local treatment, potential damage to healthy tissue, precautions around others

Chemo + radiation side effects

cardiovascular, fatigue, GI effects, kidney + liver toxicity, bone marrow suppression (anemia, leukopenia, thrombocytopenia), integumentary (alopecia/skin damage), nervous system, lung damage

Targeted + biologic + hormonal therapy

-targeted: more precise treatment w reduced side effects

-biologic: boosts the immune system to fight cancer

-hormonal: treat certain cancers responsive to hormones

Nutrition complication - cancer

-malnutrition: encourage soft, non-irritating, high-protein, high-calorie foods, supplements, eat through the day

-altered taste, cancer cachexia (tissue wasting)

Infection complication - cancer

-ulceration + necrosis from tumor

-tumor compressing vital organs

-neutropenia from cancer treatment

call provider for 100.4 T or higher, infection rapidly fatal if neutropenic

Leukemia

group of cancers affecting blood + blood-forming tissues of bone marrow, lymph system, and spleen

Causes of leukemia

-loss of regulation in cell division

-dysfunctional WBCs

-genetic + environmental factors

Clinical manifestations - leukemia

-abnormalities of RBCs + platelets (anemia, thrombocytopenia)

-accumulation of abnormal WBCs in organs

Diagnostic testing - leukemia

-blood + bone marrow examination

-lumbar puncture

-PET/CT scan

Hodgkin lymphoma

a specific type of lymphoma characterized by Reed-Sternberg cells proliferate in lymph nodes (giant, multi-nucleated abnormal cells)

Cellular origin - Hodgkin lymphoma

B lymphocytes

True or false: Hodgkin's pattern is orderly/predictable

TRUE

Causes of hodgkin lymphoma

-epstein barr virus

-genetics

-exposure to occupational toxins

-giant multi-nucleated cells in lymph nodes

-travel to other parts of the body

What is Epstein-Barr virus

a very common herpes virus that infects most people around the world during their lifetime

Clinical manifestations - hodgkin lymphoma

-enlargement of lymph nodes (moveable/non-tender)

-weight loss, fatigue, weakness, fever, night sweats

-anemia

-hepatomegaly (enlarged liver), splenomegaly (enlarged spleen)

Diagnostic tests + management - hodgkin lymphoma

-diagnostics: blood analysis, lymph node biopsy, bone marrow exam, radiologic studies

-management: chemotherapy, hematopoietic stem cell transplant

Non-hodgkin lymphoma

a group of cancers of the lymphatic system caused by abnormal, uncontrolled growth of lymphocytes (usually B cells or T cells)

Cellular origin - Non hodgkin lymphoma

B lymphocytes (85%)

T/natural killer lymphocytes (15%)

Causes of non-hodgkin lymphoma

-viruses + bacteria + chemicals

-chromosomal abnormalities

-lymphocytes arrested in various stages of development

Clinical manifestations - non-hodgkin lymphoma

-painless lymph node enlargement

-usually widespread disease at time of symptoms

-depends on where it's present: GI symptoms, hepatomegaly, neurologic symptoms

Diagnostic tests + management - non-hodgkin lymphoma

-diagnostic: blood studies, MRI, LP/bone marrow biopsy, endoscopy

-management: chemo, radiation, biotherapy, pathotherapy, topical therapy

What is the difference between Hodgkins and Non-Hodgkins?

-HODGKINS: HAS Reed-Sternberg cells + is predictable COMMON

-NON HODGKINS: DOES NOT have Reed-Sternberg cells +

can spread more unpredictably UNCOMMON

Burkitt lymphoma

the most aggressive type of non-hodgkin lymphoma cause by abnormal B lymphocytes multiplying radidly

Anemia

deficiency in number of RBCs, quality/quantity of hemoglobin, and/or volume of packed RBCs

Causes of anemia

-decrease RBC production (deficient nutrients)

-blood loss (acute or chronic)

-increased RBC destruction (sickle cell)

Iron deficiency anemia

when the body doesn't have enough iron to make enough hemoglobin

Causes of iron deficiency anemia

-inadequate iron intake (increased need-pregnant/menstral)

-malabsorption (iron absorbed in duodenum-GI surgery)

-blood loss/iron loss (GI bleed, gastritis, peptic ulcer, cancer)

Clinical manifestations - iron deficiency anemia

pallor, palpitations, increased HR, fatigue, weight loss, cold intolerance, dizziness, lightheaded, dyspnea/increased RR, black stool (melena), glossitis (inflam tongue), cheilitis (imflam/cracking of the lips)

Diagnostic tests - iron deficiency anemia

-CBC (RBCs, Hgb, Hct, MCV, MCH, Reticulocytes-young RBCs)

-Iron studies (serum iron, ferritin-stores iron, trasnferrin-transports iron)

-Endoscopy/colonoscopy

Management - iron deficiency anemia

-replace iron: FERROUS SULFATE (take 1 hr before meals, take w vitamin C, sit upright x 30 mins, black stool/constipation)

-iron rich foods (lean meats, legumes, dark green leafy veggies whole + enriched grains)

-RBC transfusion + monitor labs/symptoms

Thalassemia

disorder where the body does NOT produce enough hemoglobin and RBCs

Causes - Thalassemia

-autosomal recessive gene (from parent)

-beta + alpha forms

-minor + major forms

Clinical manifestations - Thalassemia

-minor (asymptomatic)

-major (life threatening)

-growth problems, anemia symptoms + jaundice

-lung disease, cardiac/endocrine problems

Pernicious anemia

anemia caused by vitamin B12 deficiency from lack of intrinsic factor (protein made by the stomach

Causes - pernicious anemia

-autoimmune

-GI surgery