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CANCER
Week 3: Ch. 12-14
Objectives:
Define cancer and discuss methods for naming and classifying tumors
Describe characteristics of the cancer cell and the mechanism involved in metastasis
Cancer refers to a
BENIGN
benign)
GROW RAPIDLY
NOT ENCAPSULATED
NOT INVASIVE
INVASIVE
WELL DIFFERENTIATED
POORLY DIFFERENTIATED
Benign tumors
DO NOT METASTASIZE
CAN SPREAD DISTANTLY
o Include the suffix
(METASTASIS)
o Can be life
cause bleeding, erodes through vessel)
o Can progress to cancer
o Examples:
oma
threatening (grow too big,
Malignant tumors
o Carcinomas arise from epithelial tissue
o Adenocarcinomas arise from glandular or ductal epithelium
MALIGNANT
CHARACTERISTICS OF CANCER CELLS How they proliferate/survive; behave differently from normal cells
Week 3
Autonomy Cancer cells gain independence from normal cellular controls (part of transformation process)
HeLa cells
CANCER STEM CELLS
Biological markers
Screen and identify individuals at high risk for certain types of cancer
Observe clinical course of cancer (Ex: would expect dec CEA levels after tx of colon CA)
ETIOLOGY
Carcinogens
o Injury to cell with exposure
o Latent period
Chemical
o Asbestos
o Cigarettes
Radiation
o X-rays
o UV light
o Nuclear radiation
Infection
o Chronic inflammation
o Chronic suppression/stimulation of immune system
Week 3
Germ-line
Acquired
o
CA is disease of aging
o Genetic mutations occur over time
o 4 to 7 mutations lead to CA
o
Overview:
o Detachment and invasion
o Survival and spread in circulation
o Selective adherence
o Escape from circulation
o
Week 3
o
o
o
o
O
PAIN
o
o
o
o
FATIGUE
o Subjective clinical manifestation
o Tiredness, weakness, lack of energy, exhaustion, lethargy, inability to concentrate, depression, sleepiness,
boredom, and lack of motivation
o Suggested causes:
Sleep disturbance, biochemical changes from circulating cytokines, secondary to disease and
treatment, psychosocial factors, level of activity, nutritional status, and environmental factors
o
CACHEXIA
o Most severe form of malnutrition
o Present in 80% of cancer patients at death
o Includes:
Anorexia
Early satiety
Weight loss
Anemia
Asthenia
Taste alterations
Chronic bleeding resulting in iron deficiency, severe malnutrition, medical therapies, or malignancy
in blood forming organs
Week 3
O TREATMENT CHEMOTHERAPY
Began with mustard gas in WWII
Now extensive cancer chemo cocktails
Targets vulnerability of cancer cells
Usually given in combinations
Toxic to normal AND abnormal cells
o
O
O
O
O
O
O
O
O
O
O CHEMOTHERAPY
O
O
CLASSIFICATION: (based on what it does)
Cell cycle-phase specific
o Antimetabolites
o Plant Alkaloids
o
Cell cycle nonspecific
o Alkylating Agents
o Antitumor antibiotics
o
Hormones
o
O
TYPES:
Induction chemotherapy
o 1st chemotherapy agent given
o Accepted as best treatment
o Often given in toxic doses
Neoadjuvant
o Given PRIOR to other treatments
o Ex To shrink tumor prior to surgery
Adjuvant
o Given AFTER primary treatment (i.e. surgery) of cancer
o Lowers risk of recurrence
Salvage
o Trying to buy the pt some time; no cure
o
o
C: Cytoxan (cyclophosphamide)
Week 3
Surgery
o Biopsy and lymph node sampling
Sentinel nodes
o Debulking surgery (part but not all)
o Palliative surgery (buying time)
o
Theoretically, antitumor responses can selectively eliminate cancer cells while sparing normal cells
O
Pain
Week 3
Fatigue
Cachexia
Anemia
Leukopenia and thrombocytopenia
Infection
o
O ONCOLOGIC EMERGENCIES (LIFE-THREATENING)
Metabolic
o Disseminated Intravascular Coagulation (DIC)
o Thrombocytopenia
o Sepsis/Septic Shock (d/t immunosuppression)
o Tumor Lysis Syndrome
o Hypercalcemia
o Syndrome of Inappropriate Antidiuretic Hormone (SIADH) (hypoNa+)
o Anaphylaxis
o
Structural
o Increased ICP
o Spinal Cord Compression (paralysis symptoms)
o Superior Vena Cava Compression
o Cardiac Tamponade
o Malignant Pleural Effusions
o
O CHILDHOOD CANCERS
Most common childhood cancers are leukemias, sarcomas, and embryonic tumors
o Embryonic tumors:
Immature embryonic tissue unable to mature or differentiate into fully developed cells
o
CHILDHOOD VS ADULT CANCERS
O
o
CHILDHOOD
ADULT
<1% of cancers
>99% of cancers
Involves tissue
Involves organs
Nonepithelial and
mesenchimal
Carcinomas
Short latency
Week 3
Ecogenetic involvement
80% preventable
Detection usually
accidental
80% metastasized at
diagnosis (Fast growing!)
Local or regional at
diagnosis
Responsive to treatment
Less responsive to
treatment
o
o ETIOLOGY (pediatric cancers)
Multifactorial
o Genetic
o Environmental
o Prenatal exposures
o Childhood exposures
o
Genetic factors
o Oncogenes
Ex: Anabolic androgenic steroids, cytotoxic agents, immunosuppressive agents, Epstein-Barr virus
o
O PROGNOSIS GOOD!!
Psychologic ramifications