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What is cancer?
disease of unregulated cell growth, division, and differentiation
What does angiogenesis mean?
formation of new blood supply
What are some mechanisms that cancer is spread?
rapid growth, dec cellular adhesion, inc motility, angiogenesis
What does carcinoma affect?
epithelial tissue
What does adenocarcinoma affect?
glandular epithelial tissue
what does sarcoma affect?
connective tissue
What does glioma affect?
CNS glial cells
What does neuroblastoma affect?
neurons (and Brenna’s brother apparently)
what does lymphoma affect?
lymphocytes
What is knudson hypothesis?
cancer is the result of accumulated mutations to a cell’s DNA (takes multiple “hits” to DNA for malignancy to develop, not just one)
What is carcinogenesis?
development of cancer depends on accumulation of genetic modifications (activation of proto-oncogenes or inhibition of tumor suppressor genes)
What are proto-oncogenes?
genes that stimulate cell proliferation
What are tumor suppressor genes?
genes that keep proliferation in tact
What is the most common cancer in men?
prostate
What is the most common cancer in women?
breast
What are the 2nd and 3rd most common cancers in both sexes?
lung and colorectal
How did the incidence disparity b/t males and female change from the early 90s?
it significantly narrowed
What combined strategy contributed to the decrease in death rate and increased 5 year survival rate?
prevention (reduction in smoking), early detection, improved treatment
There have been notable improvements in survival for most cancer types due to ____
earlier detection and/or advances in tx
What is the 2nd most common cause of death in the US? (heart disease is 1st)
cancer
What is the leading cause of death for both sexes?
lung cancer
What is the second cause of death in women?
breast cancer
What is the 2nd cause of death in men?
prostate cancer
What is the 3rd cause of death in both sexes?
colon and rectal cancer
What is the most common, preventable cause of cancer?
tobacco
carcinogen pathophysiology
exposure to carcinogens —> covalent bonds form b/t carcinogens and DNA —> accumulation of permanent mutations in critical genes
What type of radiation has deep penetrating power and breaks DNA?
ionizing radiation
What type of radiation has little penetrating power and damages pyrimidines, interfering w/ replication?
nonionizing radiation
What is ionizing radiation used for?
used to sterilize drugs, vaccines, and some f foods including fruits. spinach, lettuce, and meat
What is nonionizing radiation used for?
used to sterilize air, water, and solid surfaces
What are examples of ionizing radiation?
gamma rays, xrays, cathode rays
What are examples of non ionizing radiation?
UV rays
What happens when tumor suppressor genes are deleted or mutated?
growth proceeds unchecked
What activates oncogenes resulting uncontrolled cellular proliferation?
a mutational change in the gene
what are homologs of normal cellular genes that participate in cell growth pathways and cell cycle regulation?
oncogenes (humans normally carry some, but they are usually kept in check)
What are examples of viral oncogenes?
EBV- burkitt and hodgkin lymphoma
HPV- cervical, head, and neck cancers
Hep B- hepatocellular carcinoma
How do viral oncogenes cause cancer?
some viruses carry an oncogene and incorporate it into human DNA when the virus infects the cell and sometimes turns on a human oncogene
(all oncogenic viruses have ability to stimulate unlimited cell growth)
What are the most important ways for nonsmokers to reduce cancer risk?
maintain healthy weight, regular physical activity, and healthy diet
How many drinks of alcohol per day would substantially increase risk for cancer?
2
What is the most commonly used system for staging at the initial diagnosis?
T- tumor location, size, level of invasion
N- presence or absence of nodal metastases
M- presence or absence of metastases
What determines the treatment and outcomes of cancer?
staging
What is clinical staging?
based on physical examination, imaging tests, and biopsies of affected areas
What is pathologic staging?
can only be determined from individual pt’s who have had surgery to remove a tumor or explore the results of both clinical staging with surgical results
What is the staging system for Hodgkins and non-hodgkins lymphoma?
Ann Arbor
What is the staging system for multiple myeloma?
international staging system (ISS)
What staging is used for prostate cancer?
Gleason score grades aggressiveness of cancer cells (2-10)
add scores from 2 areas w/ the most cancer cells
What are many solid tumors graded on?
proliferative indices
what is molecular testing useful for?
determining both prognosis and treatment
What are paraneoplastic effects of a tumor?
remote effects that are not related to the direct invasion, obstruction or metastasis
sx usually due to aberrant hormonal or metabolic effects
How are paraneoplastic syndromes divided?
by the system they affect (endocrine, hematologic, neurologic, neuromuscular, mucocutaneous)
What are paraneoplastic endocrine syndromes?
the tumor tissue itself secretes the hormone that produces the syndrome (ectopic hormone production)
believed to result from activation of oncogenes in the tumor that are usually suppressed in normal tissue
What are ectopic hormones?
pro-hormones of higher molecular weight than those secreted by normal, differentiated endocrine cell
What are paraneoplastic neurologic syndromes?
immunologic response is directed against shared antigens that are ectopically expressed by the tumor, but otherwise predominantly expressed by the nervous system
antibodies detected in serum and CSF fluid in most pts
Why are paraneoplastic syndromes clinically important?
may provide early clues to the presence of some cancers or the metabolic or toxic effects of the syndrome may create a more urgent situation than the cancer itself (once the tumor resolves, the syndrome resolves as well)
What is Sweet’s Syndrome associated with?
leukemia