Patho (U1.6): Neoplasia

neoplasm aka tumor

cellular growth under abnormal growth conditions leading to excess mitosis depriving other cells of nutrients

benign (encapsulated) tumors: characteristics

well-differentiated

benign (encapsulated) tumors: rate of growth

progressive and slow

benign (encapsulated) tumors: mode of growth

encapsulated within origin tissue

benign (encapsulated) tumors: metastasis

no metastasis

benign (encapsulated) tumors: death

does not cause death unless it disrupts vital body functions

malignant (cancerous) tumor: characteristics

undifferentiated with atypical structure

malignant (cancerous) tumor: rate of growth

the more undifferentiated, the more rapid

malignant (cancerous) tumor: mode of growth

invasion of surrounding tissue

malignant (cancerous) tumor: metastasis

gain access to blood and lymph channels to metastize to other areas

malignant (cancerous) tumor: death

causes death unless treated

lipoma

benign fat tissue tumor

leiomyoma

benign smooth muscle tumor

papilloma

benign epithelial tissue tumor

carcinoma

malignant epithelial tumors

sarcomas

malignant connective tissue tumorly

lymphoma

malignant lympatic tissue tumor

angiogenesis

cancer cell secretes growth factors that stimulate development of new capillaries in tumors to acquire blood supply

malignant transformation

transformation of normal cells to cancerous cells

proto-oncogenes

normal genes coding for normal cells

oncogenes

mutated proto-oncogenes that code for cancerous cells and promote proliferation

anti-oncogenes (tumor suppressor)

prevent proliferation of cancerous cells and maintain genomic stability

burkitt lymphoma

myc proto-oncogenes that code for growth proteins are trabnslocated from chromsome 8 to 14

chronic myelogenous leukemia

translocation of chromosome 9 to 22 creating oncogene and increased proliferation

carcinogenesis

carcinogenic agents that cause normal cells to become cancerous

intitation stage of carcinogenesis

exposure to carcinogen causing alterations in DNA

promotion stage in carcinogenesis

proliferation of cells triggered by excess growth factors and chemicals

is the promotion stage of carcinogenesis reversible

yes, if promotor substance is removed

progression stage of carcinogenesis

tumor cells become malignant

carcinogens

cancer-causing agents

direct-reacting carcinogens

directly bind to DNA and cause mutations

indirect-reacting carcinogens or procarcinogens or intiatiors

active after metabolite binds to DNA, causing mutations

oncoviruses

parasites that insert genome into host cell to produce new viral particles

what are the 4 DNA viruses in humans

HPV, EBV, KSHV/HHv8, HBV

local effects of clinical manifestations of cancer

cancer disrupts tissue, compresses blood vessels (leads to ulcerations, necrosis, bleeding), and destroys tissue (inflammation, pain)

systemic effects of clinical manifestations of cancer

in advanced stages and causes cancer cachexia (progressive weight loss, loss of muscles, weakness, anorexia, anemia, effusion)

paraneoplastic syndrome

caused by ectopic hormone production or immune mechanisms. it isn’t directly related to tumor invasion

metastasis

spread of cancer cells from orignial site to distant tissues/organs

invasion stage of metastasis

local spread of cancer. if cancer survives the environment, it will lead to metastasis

epithelial-mesenchymal transition (EMT) stage of metastasis

epithelial cell acquires mesenchymal features by losing polarity and adhesion to basement membrane while increasing migratory capacity (secrete protease that breaks cell membranes), increase resistance to apoptosis, and dedifferentiation

lymphatic metastasis

earliest detectable epithelial cancer through sentinel lymph node biopsy

1st destination of lymphatic metastasis?

regional lymph nodes

hematologic metastasis

advanced cancer metastizes throught blood

1st destination of hematologic metastasis?

organs with rich blood flow

stage 1 cancer

tumor confined to orignial spots

stage 2 cancer

tumor is locally invasive

stage 3 cancer

tumor advanced to regional structure

stage 4 cancer

tumor spread to distant sites

T0

organ has no tumor

Tis

pre-invasive cancer

T1

lesion smaller than 2 cm

T2

lesion bigger than 2cm

N0

no lymph nodes involved

N1

regional lymph nodes involved

N2

distant lymph nodes involved

M0

no metastasis but possible microscopic metastasis

M1

distant metastasis

what does T2NlM0 mean and what stage cancer would this be

tumor is bigger than 2 cm, regional lymph nodes are involved, and no metastasis. this would be stage 3 cancer

tumor grade

how closely tumor cells resemble normal tissue (degree of differentiation)

low-grade tumors

well differentiated with slower growth but still malignant but prognosis is better

high-grade tumor

undifferentiated with fast growth

tumor markers

substances produced by tumor cells that are secreted into body fluids. used to screen for risk of cancer and diagnose types of tumors

tumor markers for liver or germ tumors

AFP in blood

tumor markers for prostate tumor

PSA antigens

tumor marker for ovarian tumor

CA-125

cancer treatment surgeries

must achieve margins. tumor should be completely removed along with surrounding healthy tissue

colectomy

remove colon to prevent cancer

prophylactic masectomy

remove breast to prevent cancer

external beam radiation therapy

killing cancer cells through radiation. machine

brachytherapy

radiation placed insde body near tumor

chemotherapy

cytotoxic durgs kill cancer cells

induction therapy

shrinkage of tumors through chemotherapy

adjuvant therapy

chemotherapy after surgery to eliminate micrometastases

neoadjuvant therapy

chemotherapy given before localized treatment

cancer-free state

5-year survival without recurrence

A nurse is explaining the development of cancer to

a client. A mutation gives one cell a selective

advantage over neighboring cells. Which outcome

should the nurse expect?

increased resistance to apoptosis and increased proliferation

A 70-year-old client has a tumor containing cells

that closely resemble the normal cells of the tissue

from which the tumor originated. The tumor is

growing slowly and remains localized. How should

the nurse interpret these findings?

tumor is likely benign and well differentiated

A client has a tumor containing cells with multiple

additional mutations that allow the cells to grow

more rapidly, resist apoptosis, and invade

surrounding tissues. Which stage of

carcinogenesis does this finding represent?

Progression

A client asks the nurse about the difference

between a carcinogen and a tumor promoter.

Which response by the nurse is correct?

a promoter stimulates the growth or porliferation of previously altered cells while a carcinogen intiates or contributes to cellular changes that lead to cancer

A 68-year-old client with an advanced malignant

tumor asks the nurse how EMT contributes to

cancer progression. Which characteristics are

associated with EMT?

increased cellular motility, loss of epithelial characteristics, increased ability to invade surrounding tissues, increased potential for metastasis

The nurse is reviewing the routes of cancer

metastasis with a student nurse. Which

statements about lymphatic metastasis are

correct?

earliest detectable routes of epithelial cancer, regional lymph nodes are first destination, breast cancer spreads first to axillary lymph nodes, sentinel lymph node biopsy can detect

A 62-year-old client is diagnosed with

carcinoma in situ of the cervix. The client asks

why the condition has not yet been classified as

invasive cancer. Which response by the nurse

is most accurate?

the abnormal cells have not cross the basement membrane

A 64-year-old client has a large localized breast

tumor. The healthcare provider prescribes

chemotherapy before surgery to reduce the size

of the tumor and make surgical removal easier.

Which type of chemotherapy is being used?

neoadjuvant chemotherapy