Cancer Care

What is cancer?

Uncontrolled growth of abnormal cells in the body that can invade other tissues.

Can cancer be genetic? Hereditary?

Genetic: Yes

Hereditary: Not always, less common

Benign vs Malignant tumors

Benign: Non-cancerous tumors that don’t spread to other tissues.

Malignant: Cancerous and can invade surrounding tissue or metastasize to other organs/ tissues

How does cancer develop

Initiation: Carcinogen/UV

• Irreversible genetic mutation in stem cell/progenitor cell

Promotion: Tumor promoter/ UV

• Clonal expansion of initiated cells within generalized hyperplasia

• Outgrowth of pre-malignant tumors = papillomas

Progression: 

• Malignant conversion to invasive carcinoma

• Metastasis

What are carcinogens that influence the initiation phase of cancer development

Group 1: Carcinogenic to humans

• Smoking, exposure to solar radiation, alcoholic beverages, and processed meats

Group 2A: Probably carcinogenic to humans

• Emissions from high temp, frying, steroids, exposures working in hairdressing, red meat

Group 2B: Possibly carcinogenic to humans

• Coffee, gasoline & exhaust, welding fumes, pickled veggies

Group 3: Carcinogenicity not classifiable

• Tea, static, magnetic fields, fluorescent lighting, polyethene

Group 4: Probably not carcinogenic

• Caprolactam, use in the manufacture of synthetic fibers. 

What makes the promotion phase of cancer development worse

Alcohol, tobacco, diet

What is immunologic surveillance

• Some cancer cells present altered cell-surface antigens: TAAS (tumor associated antigens)

• Constant monitoring of normal tissues by NK cells, cytotoxic T cells, macrophages, and B cells

• Cancer cells may go unnoticed because they arise from normal human cells (immunologic escape)

What can cause cancer to progress faster

• Additional genetic alterations

• Inflammation and oxidative stress

What is cancer cachexia

Wasting syndrome that results in weakness and involuntary weight loss

What is metastasis? Where are the most common sites?

Spread of cancer to a distant site.

Most common sites: Liver, bone, lungs

Some cancers have an affinity for specific tissue:

• Colon → liver

• Breast → bones

What does CAUTION stand for in the 7 warning signs of cancer

C: Change in bowel/bladder habits

A: A sore that does not heal

U: Unusual bleeding or discharge

T: Thickening or lump

I: Indigestion or difficulty swallowing

O: Obvious change in wart or mole

N: Nagging cough or hoarseness

Diagnostic studies

• Computed tomography (CT) scan

• Magnetic resonance imaging (MRI) scan

• Breast MRI

• X-rays and other radiographic tests

• Mammography

• Nuclear medicine scans

• Ultrasound

What is a PET scan (Positron Emission Tomography)

Imaging test that uses a small amount of radioactive material (radiotracer) to visualize how tissues and organs are functioning.

Define these types of cancer: Carcinoma, sarcoma, lymphoma, glioma, and leukemia

Carcinoma: epithelial tissue that line or cover internal organs (breast, prostate, colon, stomach, lung)

Sarcoma: connective or supportive tissue (bone, cartilage, fat, muscle, blood vessels)

Lymphoma: lymphatic system

Glioma: Nerve cells

Leukemia: blood-forming tissue (bone marrow)

What is histological classification

Grading of tumor- appearance of cells and degree of differentiation

What are the different grades of histologic classification

Grade I: Low grade

• Well differentiated (closer to appearance to the normal tissue of origin)

Grade II: Intermediate grade

Grade III: High grade

Grade IV: High grade

• Poorly differentiated (undifferentiated)

Grade X: Cannot be graded

What does TNM stand for and what does it measure (breast cancer)

Measures the extent of disease classification.

LN= lymph nodes

IM= internal mammary

T: Tumor size

• T1: Tumor size <2 cm

• T2: Tumor size 2-5 cm

• T3: Tumor size >5 cm

• T4: Tumor extends to skin or chest wall

N: Lymph nodes

• N0: No lymph node metastasis

• N1: Metastasis to ipsilateral, movable, axillary LN’s

• N2: Metastasis to ipsilateral fixed axillary, or IM LN’s

• N3: Metastasis to infraclavicular/ supraclavicular LN or to axillary and IM LN’s

M: Metastasis

• M0: No distant metastasis

• M1: Distant metastasis

Define clinical staging 0-4 with breast cancer

0: Abnormal cells in lining of the ducts or secretions of the breast. Results in increased risk of developing breast cancer in both breasts. 100% survival rate

1: Cancer in the breast tissue, tumor < 1 inch across. 98% survival rate

2: Cancer in the breast tissue, tumor < 2 inches across. Cancer may also spread to auxiliary lymph nodes. 88% survival rate.

3: Tumor is larger than 2 inches across with excessive spread to auxiliary or nearby lymph nodes. Possible dimpling, inflammation, or change in color of the skin. 53% survival rate.

4: Spread of cancer beyond the immediate region of the breast. 16% survival rate.

What are the breast cancer screening guidelines for women with average risk

Age 40: Talk with doctor about when to begin screening, women should have the opportunity to begin screening if they choose.

Age 45: Being yearly mammograms.

Age 55: Transition to mammograms to every other year or continue with annual.

Age 55+: Continue regular mammograms if you’re in good health

Is there a standard or routine screening for prostate cancer? What are the tests for prostate cancer?

No, there is no standard or routing screening test.

Tests include:

• Digital rectal exam

• Prostate-specific antigen test

• Prostate cancer gene 3 (PCA3) RNA

When do colorectal cancer screenings start for both men and women

Begins at age 50, continues to at least age 75

What tests find polyps and colorectal cancers

• Flexible sigmoidoscopy q 5 yrs

• Colonoscopy q 10 yrs

• CT colonography q 5 yrs

• Double contrast barium enema q 5 yrs

What tests mainly find colorectal cancer

• FOBT yearly: guaiac (gFOBT) and immunochemical tests (or FIT)

• Stool DNA tests (q 3 yrs)

What are the screening guidelines for cervical cancer

<21: No screening recommended

21-29: Cytology (pap smear) every 3 years. Abnormal pap may be followed up with HPV testing

30-65: Cytology + HPV testing every 5 years or cytology every 3 years

>65: No cervical cancer screening required if woman has had regular screening in the previous 10 years and no serous precancers in the last 20 years or continue testing if an abnormality was found in the last 20 years

What are the ABCDEs of screening for skin cancer

A: Asymmetry

B: Border

C: Color

D:Diameter

E: Evolving

What are standard therapies for cancer treatment

• Surgery

• Chemotherapy

• Radiation

• Biologic response modifiers

• Hematopoietic stem cell transplant

• Watchful waiting