Neoplasm (cancer) – Flashcards
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What is neoplasm?
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Any new or abnormal cellular growth, specifically one that is uncontrolled and progressive, refers to benign and malignant tumors
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What is a tumor?
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And abnormal mass of tissue that results when cells divide more than they should or do not die when they should, can be benign or malignant
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What does benign mean?
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Growth of cells is steady, slow, usually can find, treatable, not fatal but can cause problems. They do not spread to any other part of the body.
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What is malignant?
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Cells can invade and destroy nearby tissue and spread to other parts of the body; resistant to treatment and frequently fatal. Also called cancerous.
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What is carcinoma?
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Malignant tumor originating in epithelial tissue, like skin or linings of internal organs.
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What are examples of carcinoma?
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Breast, colon, skin, and the liver cancers.
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What is sarcoma?
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Malignant tumor originating in connective tissue
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What are examples of sarcoma cancer's?
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Bone, muscle, adipose, hematopietic, lymphoid
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What is metastasis?
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The spread of cancer from one part of the body to another
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What is cancer?
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Disorder of cell growth and regulation, no limits for cellular replication, production of cells that serve no purpose.
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What is the epidemiology of cancer? (How deadly is it in America?)
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Second leading cause of death
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What is a carcinogen?
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Substance which causes cancer
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What is carcinogenesis?
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Multi step process in which normal cells are transformed into cancer cells
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What are examples of chemical carcinogens?
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- Cigarette smoke - Pesticides - Certain food additives - Polycyclic hydrocarbons - Asbestos - aflatoxin b1
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What kind of cancers can cigarette smoke cause?
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All cancers
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What percentage of cancers are caused by cigarette smoke?
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30%
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Which kinds of food additives are cancerous?
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Nitrites which are found in sausages and processed meats
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What are Polycyclic hydrocarbons?
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Describes many chemicals including the ones produced when charring of protein foods
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What is aflatoxin b1?
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A toxin produced by mold that may grow and grains and not stored and warm, humid environments
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How does radiation cause cancer?
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It damages DNA beyond repair
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What are sources of radiation that are known to be carcinogenic?
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- X-rays - UV light - Radioactive material - Atomic waste
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Is stress a risk factor for cancer?
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Yes. It can influence the immune system or hormonal system
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How does inflammation increased risk for cancer?
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The inflammatory response produces cytokines, which result in chemicals in the immune response that encourage cell proliferation (multiplication) and suppress apoptosis (Cell death)
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Can cancer because by genetics?
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A small percentage of cancers are considered hereditary. However all cancers involved genetics to a certain degree, because they are the result of damage to genes.
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Which nutritional factors are thought to increase the risk of cancer?
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- Protein - Dietary fat - Calories - Alcohol
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Which nutritional factors are thought to decrease the risk of cancer?
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- Antioxidants - Soy - Phytochemicals (plant chemicals)
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According to epidemiological research the nutritional factors that increase risk of cancer are:
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- Red meat -saturated fat, trans fat - Alcohol - Obesity - Food preparation (cured, blackend, or smoked meat)
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According to Epidemiological research, which nutrition factors decrease risk of cancer?
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- Fruits and vegetables - Whole grains, fiber - Vitamin D - Physical activity
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Why do cruciferous vegetables decrease risk of cancer?
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Because they contain glucosinolates
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What are glucosinolates?
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Chemicals found in cruciferous vegetables that break down into biologically active compounds that may have anti-cancer affects
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What are examples of cruciferous vegetables?
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- Cabbage - Cauliflower - Broccoli - Bok choy - Brussels sprouts
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What does the American Cancer Society recommend for a screening of breast cancer?
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Women over 40 should get an annual mammogram
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What does the American Cancer Society recommend for screening of cervical cancer?
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For women over 21 get a PAP and pelvic exam every three years
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What is the American Cancer Society recommend for a screening of colorectal cancer?
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Men over 50 get a colonoscopy every 10 years
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What does the American Cancer Society recommend for a screening of prostate cancer?
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Men over 50 receive a blood test, frequency depends on levels
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What is chemoprevention?
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Cancer chemoprevention is the use of natural, synthetic (made in a laboratory), or biologic (from a living source) substances to reverse, suppress, or prevent the development of cancer
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What are substance thought to be chemopreventive?
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- carotenoids (orange colored produce) - resveratrol (red wine) - quercetin (flavanoid) - catechins (black and green tea) - diallyldisulfide (garlic) - thymoquinone (black cumin) - various spices
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How does normal cell growth work?
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cycling cells divide continuously by copying their DNA exactly and then splitting into 2 daughter cells with genetic controls for cell division and growth.
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What do oncogenes do?
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stimulate growth
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What do tumor suppressor genes do?
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suppress cell growth
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What are telomeres?
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pieces of chromosomes that become shorter after each cell division; when the telomere shortens to a specific length the cell will stop dividing
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How does cancer cell growth work?
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they reproduce at an uncontrolled rate, and become autonomous from normal signals, and may secrete their own growth factor. An enzyme is secreted that destroys the telomere.
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What are the steps of carcinogenisis?
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initiation, promotion, and progression
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What is initiation?
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mutation in DNA that is theorized to be irreversible
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What is promotion?
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alteration of genetic expression in cell causing increased expression of a gene with critical mutation and increased cell proliferation.
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What is progression?
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further mutations from genetic instability during promotion and recruitment of inflammatory immune cells to the tumor.
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Neoplasm growth rate is determined by:
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- characteristics of host (age, gender, ect) - original cell type (rate of proliferation) - blood supply - growth locally or metastasize
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What is proliferation?
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reproduction rate
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What are three ways to diagnose cancer?
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- biochemical - tumor imaging techniques - invasive techniques
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How can biomarkers be used to diagnose cancer?
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used for early cancer detection by looking for certain proteins and antigens in the blood
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What are examples of tumor imaging techniques?
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MRI, CT, ultrasound, PET, mammogram, bone scans
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What are examples of invasive techniques for diagnosing cancer?
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biopsy, cytological aspiration, laparoscopy
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What is a biopsy?
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Some tissue is removed to test for cancer but result is not definitive.
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What is a cytological aspiration?
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Cell specimens are removed to test for cancer.
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How are tumors classified?
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by stage 0 being the least serious and IV being the most serious
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What determines which stage a cancer is in?
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- depth, surface spread, and tumor size - are lymph nodes affected - has the tumor metastasized
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Where do carcinomas cancers originate?
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epithelial tissue
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Where do sarcomas cancers originate?
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connective tissue
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Where do lymphomas cancers originate?
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lymphatic system
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Where do gliomas cancers originate?
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glial cells of CNS
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Where do leukemias cancers originate?
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bone marrow
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What is cachexia?
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involuntary weight loss, tissue wasting, inability to perform daily activities, and metabolic alterations. Frequently present in cancer patients
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What are the three phases of cachexia?
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1. precachexia 2. moderate cachexia 3. advanced cachexia
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What are the abnormalities in carbohydrate metabolism that occur with cancer?
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insulin resistance, increased glucose synthesis, increased gluconeogenesis, increased Cori cycle activity, decreased glucose tolerance. All of these result in higher glucose in the blood
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What are abnormalities in protein metabolism that occur with cancer?
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depletion of lean body mass due to protein catabolism and decreased protein synthesis.
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What are the abnormalities in lipid metabolism that occur with cancer?
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increased lipid metabolism, decreased lipogenesis, decreased activity of lipoprotein lipase, and increased lipolysis. These result in higher fat in the blood
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What causes cancer patients to decrease food intake?
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- anorexia of malignanacy (pain with eating, taste changes) - anorexia of therapy - malabsorption
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What is primary surgery?
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when surgery is the only treatment
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What is adjuvant surgery?
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surgery is used as treatment in addition to the initial treatment
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What is combination surgery?
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surgery, then chemotherapy and/or radiation
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What is salvage surgery?
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extensive surgery after less extensive surgery
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What is palliative surgery?
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surgery used to relieve disease and/or treatment related symptoms (not used to treat cancer, just symptoms)
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How does surgery of the head and neck affect nutrition and weight?
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most people experience malnutrition and weight loss.
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What does surgery of the head and neck increase risks of (in relation to nutrition?)
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difficulty chewing and swallowing, dysgeusia (impairment of taste), xerostomia (dry mouth), alterations in small, and difficulty speaking
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What should happen if a person with a head and neck surgery is expected to have a long rehab?
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gastrostomy or jejunostomy placed (feeding tube that goes directly into the stomach or small intestine)
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What are the risk factors for esophageal cancer?
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smoking, alcohol abuse, barrett's esophagus (chronic heartburn), diet low in fruits and vegis
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What is the prognosis typically for someone diagnosed with esophageal cancer?
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poor due to late diagnosis.
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What can commonly develop in people who have esophageal cancer?
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cachexia
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What is needed in people with esophageal cancer due to slow recovery of oral intake?
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feeding tube
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What is the main risk factor for gastric cancer?
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repeated infection with H. pylori
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What is the 5-year survival rate for gastric cancer?
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less than 25%
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What does partial of full gastrectomy increase risk for? (removal of the stomach and intestines)
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vit B12 deficiency and decreased calcium and iron absorption
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What are potential complications for gastric surgery?
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dumping syndrome, delayed gastric emptying, early satiety, nausea, vomiting
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What are risk factors for colorectal cancers? (can also be called colon cancer or cancer of the large intestine)
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family history, lack of physical activity, obesity, smoking, history of IBD (irritable bowel disease)
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How is colon caner treated?
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clostomy or ileostomy (removal of parts of the large intestine)
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What can surgery on the large intestine cause?
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electrolyte and fluid loss
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What are the symptoms of pancreatic cancer?
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- weight loss and anorexia - malabsorption and steatorrhea (fat in stool) - hyperglycemia - delayed gastric emptying - delayed gastric emptying
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What is chemotherapy?
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medications that interrupt different stages of cell cycle replication that are most lethal to cells under continual replication
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How is chemo best used?
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in combination with other therapies
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What cells are most susceptible to chemotherapy?
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Those that reproduce at a rapid rate: cells of the bone marrow, epithelial lining of digestive tract, cells of hair follicles
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What are common side effects of chemotherapy that are due to toxicity of rapidly dividing cells?
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- neutropenia (low WBC) - thrombocytopenia (low platlets) - anemia (low RBC) - diarrhea - mucositis (inflammation of mucus membrane) - alopecia (hair loss) - cardiotoxicity, neurotoxicity, nephrotoxicity
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What are other common side effects of chemotherapy?
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- pain when you eat hot or cold foods - dry mouth - altered tastes - decreased appetite - nausea and vomiting - painful swallowing - skin problems - increased bleeding time - fatigue - chemobrain (forgetfulness)
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How does radiation work to treat cancer?
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damages body tissue and disrupts DNA reproductions
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Which cells are most susceptible to radiation?
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continuously proliferation cells
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How is radiation different than chemotherapy?
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the toxicity is localized to the region being irradiated
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How and how long is radiation administered?
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internally or externally 5 days a week for 4-6 week
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What symptoms can radiation have on the head/neck area?
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altered taste, smell (lasting several months), mouth pain, xerostomia (dry mouth), peridontal disease (gums)
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What symptoms can radiation have on the esophagus and lung area?
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esophagitis (inflammation), dysphagia, nausea, motor dysfunctions (hard to open jaw)
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What symptoms can radiation have on the stomach area?
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higher doses can cause bleeding, vomiting, and weight loss
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What symptoms can radiation have on the intestinal area?
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decreased mucosal lining and villi, nausea, vomiting, anorexia, steatorrhea, diarrhea, inflammation, ulcers, enteritis
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What is hematopoietic stem cell transplantation?
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the transplantation of hematopoietic stem cells usually dericed from bone marrow, peripheral blood, or umbilibal cord blood
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What is a major complication of hematopoietic stem cell transplantation?
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graft vs host disease, associated with long-term medical problems including immunosuppression, organ dysfunction and infections
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What are biological response modifiers?
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immunotherapy or biological response modifiers that boosts the body's own immune system to eradicate cancer cells (new approach)
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What is the primary goal of nutrition therapy in cancer patients?
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prevent malnutrition
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What is the caloric recommendation for a sedentary cancer patient?
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25-30 kcal/kg
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What is the caloric recommendation for a stressed cancer patient?
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30-35+ kcal/kg
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What are the protein needs for a cancer patient?
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1.0-1.5 g/kg
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What are the protein needs for a stressed cancer patient?
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1.5-2.5 g/kg
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How should you time meals with a cancer patient?
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mornings may be when food is best tolerated and small frequent meals
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How can you address the problem of nausea and vomiting?
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- avoid trigger odors - eat small frequent meals low in fat - clear liquid diet after therapy - anti-emetic medication
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How can you address the problem of early satiety?
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- small, frequent meals - avoid beverages with meals - use medications to increase gastric emptying
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How can you address the problem of mucositis?
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pain medication and encourage liquids and soft foods
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How can you address the problem of diarrhea?
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- encourage rehyration fluids (gatorade, perialyte) - take antidiarrheal medicaiton
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How can you address the problem of dysgeusia?
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avoid metal utensils and meats are often not tolerated
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How can you address the problem of xerostomia (dry mouth)?
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- artificial saliva - sugar-free gum
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How can you address the problem of anorexia?
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- small, frequent meals - encourage exercise
