CANCER: Lecture – Flashcards

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Compare difference between benign and malignant tumors
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1) Benign: Grow slowly/ Well-defined capsule/ Well-differentiated/ Low mitotic index/ Does not metastasize 2) Malignant: Grow rapidly/ Not encapsulated/ Poorly differentiated/ high mitotic index/ Metastasis
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Benin tumors named according to the tissue from which they arise and include the suffix "_ _ _"
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"oma" Lipoma -fat Giloma - brain Leiomyoma -soft tissue Chondroma - cartilage
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Define adenocarcinoma
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Cancer that begins in cells that line certain internal organs and that have gland-like (secretory) properties.
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Cancers of lymphatic tissues are called?
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lymphomas
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Cancers of blood-forming cells are called?
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leukemias
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Define sarcomas
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Sarcomas are cancers that develop from connective tissues in the body, such as muscles, fat, bones, membranes that line the joints, or blood vessels. There are many types of sarcomas.
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Describe rhabdomyosarcoma
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Rhabdomyosarcoma (RMS) is a cancer made up of cells that normally develop into skeletal muscles. The body has 3 main types of muscles: Skeletal (voluntary) muscles are muscles that we control to move parts of our body.
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Cancinoma in situ (CIS)
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epithelial tumors of glandular or epithelial origin that have NOT broken through the basement membrane or invaded the surrounding stroma.
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Describe carcinoma
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1) A carcinoma is any malignant cancer that arises from epithelial cells. 2) Carcinomas invade surrounding tissues and organs and may metastasize, or spread, to lymph nodes and other sites.
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How are malignant tumors named?
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Malignant tumors named according to tissues from which they arise.
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Cancinoma in situ (CIS)
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1) epithelial tumors of glandular or epithelial origin that have NOT broken through the basement membrane or invaded the surrounding stroma. 2) is a pre-malignant condition, in which some cytological signs of malignancy are present, but there is no histological evidence of invasion through the epithelial basement membrane.
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What are Tumor Markers?
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1) Substances produced by cancer cells or that are found on plasma cell membranes, in the blood, CSF or urine. 2) examples are: Hormones/ Genes/ Antigens/ Antibodies
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What are Tumor Markers used for?
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1) Screen and identify individuals at high risk for cancer 2) Diagnose specific types of tumors 3) Observe clinical course of cancer 4) Problems with tumor markers: false positive and negatives.
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What are the differences between Hodgkins Lymphoma and Non-Hodgkins Lymphoma?
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1) Hodgkins lymphoma - characterized by Reed- Sternberg cells * nodular lymphocyte Symptom: Fever, weight loss, night sweats, pruritus - (itching) 2) Non-hodgkin lymphoma - generic term for a diverse group of lymphomas 3) New classification based on cell type T,B, NK 4) Non-hodgin lymphomas are linked to chromosome translocations, viral, and bacterial infections, environmental agents, immunodeficiencyes and autoimmune disorders
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What is Burkitt Lymphoma?
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1) *Most common type of non-Hodgkin lymphoma in children. 2) Very fast growing tumor of the jaw and facial bones. 3) Epstein-Barr virus is found in nasopharyngeal secretions of patients
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What is Multiple Myeloma?
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1) Malignant proliferation of plasma cells 2) Infiltrate bone marrow and aggregate into tumor masses in skeletal system 3) M-proteins 4) Bence Jones protein 5) Hypercalcemia, renal failure, bone lesions
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4 types of cancer cells
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1. squamous cells 2. leukaemias = cancers from blood cells 3. lymphamas = cacners of lymphatic systems 4. basal cells = skin cancer
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neoplasm (define)
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1. tumor 2. "new growth"
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6 characteristics of BENIGN
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1. slow growth 2. well-defined capsule 3. not invasive 4. well differentiated 5. low mitotic index 6. do not metastasize
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6 characteristics of MALIGNANT
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1. rapid growth 2. not encapsulated 3. invasive 4. poorly differentiated 5. high mitotic index 6. can spread distantly (metastasis)
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4 types of benign tumors
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1. Lipoma = fat cells 2. Glioma = brain cells (glial cells) 3. Leiomyoma = soft tissues (uterus) 4. Chrondroma = cartilage
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Lymphomas (define)
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cancers of lymphatic tissue
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Leukemias (define)
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cancers of blood-forming cells
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Carcinoma In Situ (CIS)
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Preinvasive epithelial malignant tumors of glandular or epithelial origin that have not broken through the basement membrane or invaded the surrounding stroma.
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Adenocarcinoma (define)
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a cancer originating in glandular tissue = epithelial tissues includes: skin, glands and other tissue that lines the cavities and organs of the body.
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Rhabdomyosarcomas (define)
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1. cancer made up of cells that normally develop into skeletal muscles 2. malignant connective tissue tumors
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sarcomas (define)
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Sarcomas are cancers that develop from connective tissues in the body, such as muscles, fat, bones, membranes that line the joints, or blood vessels.
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Lymphomas (define)
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1. are cancers of the white blood cells called lymphocytes, part of the body's immune system. 2. In lymphoma, the lymphocytes morph into a cancer cell and accumulate in the lymph nodes and lymphatic system, where they crowd out normal lymphocytes. 3. there are two main types (1) Hodgkin's lymphoma and (2) Non-Hodgkin's lymphoma.
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Hodgkin's lymphoma
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1. a specific type of cell called a Reed-Sternberg cell is present in the bloodstream and lymph nodes 2. Reed-Sternberg are large cells with two nuclei easily visible under a microscope.
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Non-Hodgkin's lymphoma
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1. does not contain Reed-Sternberg 2. have a variety of different cancer cells that have different characteristics 3. difficult to identify and cure
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4 main types of leukemia
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1. Acute lymphoblastic leukemia, or ALL. 2. Acute myelogenous leukemia, or AML. 3.Chronic lymphocytic leukemia, or CLL. 4. Chronic myelogenous leukemia, or CML.
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Leukemia
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1. cancer of the blood cells 2. starts in the bone marrow, the soft tissue inside most bones (where blood cells are made) 3. in leukemia, the bone marrow starts to make a lot of abnormal WBC, called leukemia cells-which don't do the work of normal white blood cells, they grow faster than normal cells, and they don't stop growing when they should. 4. Over time, leukemia cells can crowd out the normal blood cells- leading to serious anemia, bleeding, and infections. 5. Leukemia cells can also spread to the lymph nodes or other organs and cause swelling or pain.
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What test is used to diagnose leukemia?
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Lumbar puncture
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Immunohistochemistry (IHC)
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1. process of detecting antigens (e.g., proteins) in cells of a tissue section by exploiting the principle of antibodies binding specifically to antigens in biological tissues 2. Immunohistochemical staining is widely used in the diagnosis of abnormal cells such as those found in cancerous tumors
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Tumor markers (6 facts)
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1. substances produced by cancer cells or found on plasma cell membranes, in blood, CSF or urine 2. these substances (biological markers) can be hormones/ enzymes/ genes/ antigen/ or antibodies 3. used to diagnose specific types of tumors 4. observe clinical course of the cancer 5. identify individuals at high risk for cancer 6. problem: false positives and negatives
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Hepatitis B & C viruses ties to Cancer (4 facts)
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1. characterized by permanent inflammatory processes that predispose to liver cancer and in particular hepatocellular carcinoma (HCC). 2. healthy liver, inflammatory processes stimulate growth and repair and restore normal liver architecture. However, if liver inflammation becomes chronic, regeneration in the liver is disrupted and lead to formation of excessive scar tissue, termed fibrosis. 3. long-term, exacerbation of fibrosis leads to cirrhosis, at cirrhotic stages, liver damage is often irreversible/difficult to treat. Cirrhosis leads frequently to death from liver failure or to HCC. 4. HCC is the first cause of death in cirrhotic patients, and is a tumor with poor prognosis, ranking third in terms of death by cancer.
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Implication of viruses and cancer (5 types)
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1. Hepatitis B and C viruses 2. Epstein-Barr virus (EBV) 3. Kaposi sarcoma herpesvirus (KSHV) 4. Human papillomavirus (HPV) 5. Human T cell leukemia-lymphma virus (HTLV)
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Hepatitis B and C viruses and cancer (5 facts)
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1. EBV was the first human virus to be directly implicated in carcinogenesis 2. EBV uses its viral proteins, the actions of which mimic several growth factors, transcription factors, and antiapoptotic factors, to usurp control of the cellular pathways that regulate diverse homeostatic cellular functions. 3. most humans coexist with virus without serious sequelae, but a small proportion will develop tumors. 4. EBV has been implicated in the pathogenesis of Burkitt's lymphoma, Hodgkin's disease, non-Hodgkin's lymphoma, nasopharyngeal carcinoma, and lymphomas, as well as leiomyosarcomas arising in immunocompromised individuals. 5. This virus has also been associated with epithelial malignancies arising in the gastric region and the breast, although some of this work remains in dispute.
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What are the staging-based presence of metastasis?
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Stage I - NO metatasis Stage II - Local invasion Stage III - Spread to regional structures Stage IV - Distance metastasis (i.e. lungs to brain)
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Identify the T,N,M from the World Health Organization's TNM system.
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T = tumor N = node M = distance of metastasis
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World Health Organization's TNM system, T [identify different levels]
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T = tumor [# indicates size of tumor] T0 = breast free of tumor T1 = lesion < 2cm T2 = lesion 2-5 cm T3 = skin/chest wall involved by invasion
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World Health Organization's TNM system, N [identify different levels]
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N = lymph node involvement [# indicates no. of nodes] N0 = no axillary nodes N1 = mobile nodes N2 = fixed nodes
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World Health Organization's TNM system, M [identify different levels]
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M = extent of distant metastases M0 = no metastases M1 = demonstrable metastases M2 = suspected (questionable) metastases
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Does cancer cause pain?
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1. little or no pain associated with early stages of malignancy 2. pain influenced by fear, anxiety, sleep loss, overall physical deterioration 3. mechanisms: pressure/ obstruction/ invasion of sensitive structures/ stretching of visceral surfaces/ tissue destruction/ inflammation
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Bacterial cause of cancer?
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Helicobacter pylori 1. peptic ulcer disease 2. stomach carcinoma 3. mucuous-asociated lymphoid tissue lymphomas
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Viral cause of cancer? [name 5]
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1. Hepatitis B and C viruses 2. Epstein-Bar virus (EBV) 3. Kaposi sarcoma herpesvirus (KSHV) 4. Human papillomavirus (HPV) 5. Human T cell elukemia-lymphoma virus (HTLV)
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Basic ways tumor spreads. [3]
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1. direct invasion of continuous organs [known as "local spread"] 2. metastases to distant organs [by way of lymphatic and blood systems] 3. by way of implantation or inoculation [accidentally through cancer surgery, malignant cells may actually drip from needle or instrument]
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Syndrome of cachexia?
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1. near end stage clinical manifestation of cancer [refuse to eat] 2. most severe form of malnutrition/ present in 80% of cancer pt. at death 3. includes: anorexia, early satiety, wt. loss, anemia, asthenia, taste alterations, altered protein-lipid-carbohydrate metabolism.
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sarcomas vs. carcinomas
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1) Sarcoma [CHILDREN]: cancer of connective tissue or supportive tissues, inside of bones - Diagnosed during growth 2) Carcinomas [ADULTS]: cancer of epithelial origin such as breasts, colon, pancreas, skin, lung which spreads to bone - Diagnosed peak growth periods
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Describe childhood cancer
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1) Most originate from the mesodermal germ layer - layer gives rise to connective tissue, bone, cartilage, muscle, blood, blood vessels, gonads, kidneys, and the lymphatic system 2) Most sarcomas vs. carcinomas in adults 3) Fast growing and without early signs 4) Most common childhood cancers are leukemias, sarcomas, and embryonic tumors 5) These are embryonic tumors - Originate during intrauterine life/ Immature embryonic tissue unable to mature or differentiate into fully developed cells 6) Diagnosed early in life
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Leukemia in children
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1) Most common malignancy in children 2) Children with Down syndrome have a 10 to 20 times greater risk for developing
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Sarcoma
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1) Bone tumors - affects the long bones 2) Osteosarcoma and Ewing sarcoma = cancer mainly affects children and adolescents and usually develops in the arms, legs, ribs, spinal column, and pelvis. (during developmental stages)
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Neuroblastoma in children
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1) cancer that starts in young nerve cells called neuroblasts- the neuroblasts never mature. Instead, they divide and grow into tumors. 2) tumors start in the nerves of the adrenal glands. These glands sit on top of the kidneys and release hormones that control the sympathetic nervous system. 3) But these tumors can begin in any part of the body. The chest, neck, pelvis and spinal cord are other common places for them.
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Wilms tumor in children
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1) form of childhood kidney cancer 2) A missing iris of the eye (aniridia) is a birth defect that is sometimes associated with Wilms tumor. = "cats eyes"
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rhabdomyosarcoma in children
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1) a cancerous (malignant) tumor of the muscles that are attached to the bones. It can occur in many places in the body. 2) is the most common soft tissue sarcoma in children.
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retinoblastoma in children
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1) Retinoblastoma is a malignant tumor composed of retinoblasts (immature baby cells) in the retina. These cells form the nerve tissues (rods and cones) at the back of the eye. Their job is to form images. The images are then transmitted by the optic nerve to the area of the brain responsible for sight. 2) "cats eyes"
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What are some environmental factors to childhood cancer?
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1) Prenatal exposure = drugs and ionizing radiation 2) Childhood exposure = drugs, secondhand smoke, ionizing radiation, viruses/ Anabolic androgenic steroids, cytotoxic agents, immunosuppressive agents, Epstein-Barr virus, and AIDS
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Describe Epstein-Bar Virus (EBV)
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1) herpesvirus family 2) also termed "mon" for infectious mononucleosis 3) associated with fever, sore throat, swollen lymph noeds, enlarged spleen 4) may cause cancers such as certain lymphomas and nasopharyngeal cancer
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Prognosis with childhood cancer
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1) > 70% of children cured 2) Survival rates higher in children under 15 years 3) Younger are more likely to be enrolled in clinical trials 4) Survivors have increased risk of cancer later in life 5) Residual and long-term effects of treatment 6) Psychologic sequelae
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***ID cancer treatment with chemotherapy - 3 categories***
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1) INDUCTOIN: chemotherapy given to induce remission, first line of treatment 2) ADJUVANT: treatment given in addition to the primary or to the initial treatment 3) NEOADJUVANT: chemotherapy given to prior to surgical procedure in attempt to shrink the cancer so that the surgical procedure may not be as extensive
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ID 3 types of cancer treatment discussed
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1) ionizing radiation: targets cancer cells 2) surgery: debulking/ palliative/ biopsy 3) Hormone therapy
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Describe ionizing radiation cancer treatment
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1) Eradicate cancer without excessive toxicity 2) Avoid damage to normal structures 3) Ionizing radiation damages the cancer cell's DNA 4) side effects: affects bone marrows (decrease RBC/Platelets/WBC)/ 15min on table for 5 days for 6 wks/ peeling skin, lose hair
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What is palliative surgery for cancer treatment?
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1) operation performed on an incurable cancer 2) surgery in not intended to cure only to prolong life 3) surgery used to assuage pain or dysfunction
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Describe chemotherapy
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1) Use of nonselective cytotoxic drugs that target vital cellular machinery or metabolic pathways critical to both malignant and normal cell growth and replication 2) Goal: Eliminate enough tumor cells so the body's defense can eradicate any remaining cells
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ID clinical manifestations of cancer (7 facts)
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1) decrease pain 2) fatigue 3) cachexia 4) anemia 5) leukopenia and thrombocytopenia 6) infection 7) paraneoplastic syndrome
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decrease pain
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1) cancer clinical manifestation 2) Little or no pain is associated with early stages of malignancy 3) Influenced by fear, anxiety, sleep loss, fatigue, and overall physical deterioration 4) Mechanisms: Pressure/ Obstruction/ Invasion of sensitive structures/ Stretching of visceral surfaces/ Tissue destruction/ Inflammation
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fatigue
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1) cancer clinical manifestation 2) Subjective clinical manifestation 3) Tiredness, weakness, lack of energy, exhaustion, lethargy, inability to concentrate, depression, sleepiness, boredom, and lack of motivation
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cachexia
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1) cancer clinical manifestation 2) Most severe form of malnutrition, present in 80% of cancer patients at death 3) Includes anorexia, early satiety, weight loss, anemia, asthenia, taste alterations, and altered protein, lipid, and carbohydrate metabolism
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anemia
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1) cancer clinical manifestation 2) A decrease of hemoglobin in the blood (less iron/less oxygen) 3) Mechanisms: Chronic bleeding resulting in iron deficiency/ Severe malnutrition/ Medical therapies/ Malignancy in blood-forming organs
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leukopenia and thrombocytopenia
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1) cancer clinical manifestation 2) Direct tumor invasion to the bone marrow causes leukopenia and thrombocytopenia 3) Chemotherapy drugs are toxic to the bone marrow 4) Leukopenia: decrease in WBC will increase infection 5) Thrombocytopenia: decrease in platelet count (<50,000) will increase infection
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infection
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1) cancer clinical manifestation 2) Risk increases when the absolute neutrophil and lymphocyte counts fall
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paraneoplastic syndrome
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1) cancer clinical manifestation 2) Symptom complexes that cannot be explained by the local or distant spread of the tumor or by the effects of hormones released by the tissue from which the tumor arose 3) disease or symptom due to the presence of cancer but is not due to the local presence of the cancer cell
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Metastasis of cancer
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1) Spread of cancer from a primary site of origin to a distant site Steps: ---Direct or continuous extension ---Penetration into lymphatics, blood vessels, or body cavities ---Transport into lymph or blood ---Transport to secondary sites ---Entry and growth in secondary sites
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Distant metastases of cancer
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1) Metastasis often occurs in the first capillary bed encountered by circulating cells 2) Organ tropism = Preferential growth of cancerous cells in certain organs 3) Growth factors, chemokines, hormones, tissue-selective homing receptors, and chemotactic factors
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Characteristic of how tumors spread
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1) Direct invasion of contiguous organs-known as local spread 2) Metastases to distant organs- by way of lymphatics and blood 3) Metastases by way of implantation - accidentally when a biopsy is done-malignant cell actually drip form a needle or instrument 4) Requires great efficiency 5) Usually occurs late
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How cancer "local spread" by invasion
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1) Cellular multiplication- by mitotic rate vs. cellular death rate 2) Mechanical pressure 3) Release of lytic enzymes 4) Decreased cell-to-cell adhesion 5) Increased motility: Intravasation or Extravasation
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Three-Step theory of invasion
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1) Tumor cell attachment = Fibronectin and laminin 2) Degradation or dissolution of the matrix = Enzymes 3) Locomotion into the matrix = Invadopodia (pseudopodia)
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ID proto-oncogenes and tumor-suppressor genes
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1) Proto-oncogenes: Normal genes that direct protein synthesis and cellular growth - become an oncogene due to mutations or increased expression- code for "go" signals 2) Oncogenes: Mutant genes - when mutated or expressed at high levels, helps turn a normal cell into a tumor cell. 3) Tumor-suppressor genes: Encode proteins that in their normal state negatively regulate proliferation [aka -anti-oncogenes] - code for "stop" signals
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Describe mutation of normal genes (7 facts)
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1) Point mutations = Changes in 1 or a few nucleotide base pairs 2) Chromosome translocation = A piece on one chromosome is transferred to another 3) Gene amplification = Duplication of a small piece of chromosome over and over which increased expression of an oncogene 4) Mutation of tumor-suppressor genes = Allows unregulated cellular growth 5) Loss of heterozygosity = Both chromosome copies of a gene are inactivated 6) Gene silencing = Whole regions of chromosomes are shut off while the same regions in other cells remain active 7) Chromosome instability = Increase in malignant cells Results in chromosome loss, loss of heterozygosity, and chromosome amplification
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