Clin Med 1 Cancer 2

Key features of malignancy

Rapid growth, local invasion, and metastasis

Rapid growth consist of

Needing more nutrients, Angiogenesis, compression of surrounding tissue

What does needing more nutrients consist of ?

Weight loss, malnutrition, despite adequate diet

Cycle of local invasion

Enzyme release from tumor, tissue destruction, and grow into the surrounding tissues

Metastasis

The spreading from primary site to other locations

What percentage of people when diagnosed have clincally detectable metasis?

30%

What percentage of people have an occult metastasis (found through biopsy or imaging, don't know primary area)?

30-40%

Hematogenous metastasis

Angiogenesis, invades the blood vessel walls, deposit into the capillary beds

Most common metastasis sites

Brain and CSF, lungs, liver, adrenals, bone

Symptoms of cancer

Local effects, unexplained weight loss, musclular weakness, anorexia, and anemia and coagulation disorders

Different types of cancer pain

Pressure on or displacement of nerves, Bone destruction, Local infiltration and inflammation, Obstruction of hollow organs, Interference with blood supply -> hypoxia, Non-mechanical pain

Paraneoplastic syndromes?

Complexes that cannot be explained by local or distant spread, Hormone-like substances are secreted by tumors, still unexplained

What percentage of all cancer patients have paraneoplastic syndromes?

10-20%

Paraneoplastic syndrome examples?

Hypercalcemia, Anorexia, Fever, Cushing's syndrome, Tumors have been found to secrete serotonin, prostaglandins, catecholamines

Cushing's syndrome?

excessive cortisol production

Ancillary testing for cancer

Blood tests, Cytology (biopsy), Imaging, Surgery

Cancers that can be found in the blood

Leukemia, Prostate, Ovarian, Colon

Imaging that can be used for cancers

Conventional x-rays - mammograms, CT, MRI, Nuclear medicine - bone scans, SPECT, and PET

Find tumors in imaging

Large overgrowths on bones, If radioactive tracers, the cancer will be red

Prognosis for cancer

Dependent on the type of cancer, growth fraction/rate, degree of spread

How many cancer patients are cured?

1 in 3

What can we use for prognosis?

Staging and grading

What does staging consist of?

T - size of tumor

N - spread in lymph nodes

M - metastasis

How does tumor staging work?

0-3

0 being no tumor

3 being large tumor

How does node staging work?

0-2

0 no spread

1 local nodes affected

2 distant nodes affected

How does metastasis staging work?

0-x

0 no metastasis

1 place

x unknown/multiple

normal breast tissue look like

Circular with a clear inner nucleus

Differentiated breast cancer look like

Architecture is altered, cells are not as circular, have some small dark spots in tissue

Poorly differentiated breast cancer look like

Cells are jagged, large dark spots, no nucleus

Treatments for cancer

Surgery, Radiation therapy, Chemotherapy, Bone marrow transplant, Biologic response modifiers, Palliative care

Side effects of treatment (primarily chemo+radiation)

Nausea, Hair loss, Mouth sores, Bone marrow supression

Bone marrow suppression consist of

Immunosuppression, Anemia, Coagulation dysfunction

Practical implications of cancer?

Screening - making sure patient does not have cancer, Exercise - sedentary lifestyle is not good for patient, Oncology specialty

Winningham contraindication to aerobic exercise?

Platelet - under 50k - risk for bleeding, Hemoglobin - fatigue and hypoxia under 10, WBC count - infection risk and added exercise and immunity

Modalities and cancer contraindications?

Thermal (heat) - radiation therapy, Ultrasound, Electric and thermal