Tumor markers
Substance (antigens) that is detectable on the surface of a tumor cell
Tumor markers
Released from normal cells in response to presence of a tumor
Tumor markers
Some of the most useful __________ have been HcG, PSA, and Calcitonin
Tumor markers
Have limited values in screening tests because of differing levels in benign and early cancer states
Tumor markers
Widely used in clients with wide spread cancer to gauge the course of disease
Tumor markers
Levels are increased with rampant disease and decreased with abatement (control)
Tumor markers
Also known as cell surface antigens
Tumor markers
diagnosis of cancer is made by the presence of antigens expressed on the surface of tumor cells or substances released by normal cells in response to the presence of a tumor
HcG
Human chronic gonadotropin/useful tumor marker
PSA
Prostate specific antigen/useful tumor marker
Calcitonin
Used in identification of thyroid tumors/ useful tumor marker
Neoplasia
New growth that is uncoordinated
Neoplasia
A disorder of cell proliferation and differentiation
Neoplasia
Cells that grow without waiting for signals from the body that new tissue is needed
Neoplasia
Cells that ignore signals to stop dividing
Neoplasia
Cells that often do not mature normally (differentiate) to do the "job" the tissue is supposed to do
Neoplasia
Cells that do not die off (apoptosis) to keep the number of cells constant
Normal Cell division
The number of cells produced equals the number of cells that die (homeostasis)
Normal Cell division
The total number of cells in the body remains constant
Normal Cell division
Each cell follows a normal pattern of growth and reproduction controlled by the cells DNA
Normal Cell division
If the DNA is altered in the parent cell it will pass the mutation to the daughter cell.
Changes in cellular DNA
_______________can cause dysfunction, alter the cell structure, and lead to early cell death
Changes in cellular DNA
_____________can be caused by exposure to chemicals, viruses, environmental hazards, or radiation
Changes in cellular DNA
It is also possible for DNA to spontaneously mutate and cause _______________
Cellular proliferation and differentiation
Is necessary for tissue growth and repair
Proliferation
Tissues that are able to gain new or replacement cell by cell division is experiencing ___________
Proliferation
An example of __________ is, bleeding stimulates cell formation in bone marrow.
Differentiation
Proliferating cells transformed into different and more specialized cells are undergoing _________________
Differentiation
Cells can no longer perform cell division after it has gone completely through _______________
Differentiation
The process of specialization. Where new cells acquire the structure and function of the cells they replace.
Differentiation
The process by which cells are transformed into different more specialized cell types as they proliferate.
Characteristics of cancer cells
Cells have poor cellular differentiation which increases the growth rate
Characteristics of cancer cells
Cells have membrane changes such as decreased contact inhibition and decreased cohesiveness
Characteristics of cancer cells
Cell surface has antigens (tumor markers)
Decreased contact inhibition
Cells do not stop dividing when they come in contact with each other
Decreased cohesiveness
Malignant cells have __________. This is why they spread so easy. (they are able to break away from each other and get into the blood stream).
Growth factors
___________ attach to receptor proteins- which often work by affecting G proteinswhich turn on enzymes (proteins) which make second messengers which go down inside the cell and make it divide.
Growth factors
Cells divide only when they are told to do so by __________
Growth factors
Cause stable cells to enter the cell cycle and divide
Cell(s)
All ______ create proteins based on its genes... such as growth factor receptors
Cell(s)
Any ____ can mutate
Growth factor receptors
Ready the cell to respond to growth factors from another cell
Growth factor receptors
Growth factors bind to __________ and simulate cell division
M Phase
Mitotic Phase
Mitotic Phase
Includes Prophase, Metaphase, Anaphase, Telephase
G1 Phase
First growth phase
G1 Phase
Phase includes growth and normal metabolic roles
S Phase
Synthesis Phase
S Phase
Includes interphase
S Phase
Phase where DNA is replicated
G2 Phase
Second growth phase
G2 Phase
Phase includes growth and preparation for mitosis
Benign tumors
When differentiated, "working" cells mutate, they form differentiated "working" tumors, known as
_______ _______.
Benign tumors
Contains cells that look like normal tissue cells
Benign tumors
May perform the normal function of the tissue (like secreting hormones, however, could lead to over secretion)
Benign tumors
Usually encapsulated (has boundaries)
Benign tumors
Growth rate is generally slow
Benign tumors
Dose not metastasize
Benign tumors
Produces death to host by encroachment of vital organs/tissues
Benign tumors
Usually does not invade neighboring tissues
Benign tumors
When being named, they usually end in OMA
Benign tumors
Cause more local symptoms, non-cancerous
Benign tumors
Well differentiated
Benign tumors
Capable of causing damage to nearby organs by compressing them
Malignant tumors
When undifferentiated, rapidly dividing cells mutate, they form rapidly dividing tumors known as, _________ ________.
Malignant tumors
Contains cells that do not look like normal adult cells
Malignant tumors
These cells divide rapidly, so tumors grow quickly, cells also mutate faster and change type
Malignant tumors
The tumor does not have clear boundaries and sends "legs" out into surrounding tissue
Malignant tumors
Do not perform the normal functions of the organ/tissue cells
Malignant tumors
May secrete hormones associated with other tissues
Malignant tumors
Can compress and/or destroy the surrounding tissue
Malignant tumors
Cause more wide spread systemic symptoms and can cause death
Malignant tumors
When named usually end in carcinoma
Malignant tumors
Tumor has poor differentiation
Malignant tumors
Infiltrates tissues, tumor has no boundaries
Malignant tumors
Growth is usually rapid
Malignant tumors
Tumor eventually metastasizes
Malignant tumors
Tumor produces death to the host by producing vital organ dysfunction (necrosis and ischemia) or death by organ failure
Cancer
Means "crab" due to _______ cells having crablike legs
Cancer
Distribution of disease is across a life span (at all ages) but is responsible for more deaths in the 3-15 year old range than any other disease.
Cancer
Survival rates are improving
Cancer
__________ is not a single disease, but can appear in almost any organ
Cancer
A cure for _________ is dependent on type of cancer and the extent of the disease at diagnosis
Cancer
________ Cells are uncontrolled and poorly differentiated
Cancer
2nd leading cause of mortality in the US
Oncogenesis
The genetic mechanism where normal cells are transformed into cancer cells. (Beginning of cancer) Malignant tumors
Tumor cell transformation
Cell goes through three phases. Initiation, promotion and progression
Initiation
During cell transformation the initial mutation occurs
Promotion
During cell transformation the mutated cells are simulated to divide
Progression
During cell transformation tumor cells compete with each other and develop more mutations which make them more aggressive.
Types of oncogenes
Viral oncogenes, cellular oncogenes, and proto-oncogenes
Viral oncogenes
A virus that can produce cancer by entering a host cell and becoming part of the cell's DNA structure
Viral oncogenes
Types of ______________are HPV, EBV, HBV, and HTLV-1
Viral oncogenes
15% of all cancers
HPV
Human papilloma virus
EBV
Epstein-barr virus
HBV
Hepatitis B virus
HTLV-1
Human T-cell leukemia virus
Cellular Oncogene
A normal gene that, when mutated can cause cancer to develop
Proto-Oncogene
A normal protein that codes for normal proteins used in cell division
Proto-Oncogene
Codes for growth factors, and growth factor receptors
Proto-Oncogene
Codes for G proteins, and enzymes that produce 2nd messengers
Proto-Oncogene
Codes for genes that turns the production of coded proteins on and off
Contact inhibition
Is the cessation of growth after a cell comes in contact with another cell, blocking its synthesis of DNA, RNA, and proteins
Cohesiveness
Normal cell walls help support each other when they come in contact with each other by sticking together.
Mutated Proto-oncogenes
Still code for proteins needed for cell division, however the proteins may not work properly and may be produced in excess.
Mutated Proto-oncogenes
____________ are capable of producing too much of a protein, or an abnormal protein
Mutated Proto-oncogenes
___________are capable of producing proteins that turns on all by themselves
Mutated Proto-oncogenes
___________ are capable of producing proteins that are made when not needed
Mutated Proto-oncogenes
_____________are capable of producing a protein that cannot turn cell division off
Mutated Proto-oncogenes
______________are capable of producing a protein that should have been made by a different cell
Cancer risk factors
Genetic predisposition combined with environmental hazards and life style may promote the development of some cancers.
Cancer risk factors
Heredity, hormonal factors and immunologic mechanisms have been linked to cancer.
Genetic predispositions
Heredity, hormones and immunologic mechanisms
Environmental hazards
Chemical carcinogens, radiation, oncogenic viruses
Chemical carcinogens
Air pollution and occupational hazards
Radiation
Includes both Ionizing and non-ionizing ___________
Radiation
Risk is determined on intensity and length of exposure
Lifestyle risks
Include diet, tobacco use, and sexual behaviors
Diet
A person can predispose themself to develop cancer with a __________ high in fat and low in fiber. Also, if nitrate consumption is increased.
Diet
Types of cancers caused by ____________ are stomach cancer and colon cancer
Diet
1/3 of cancer causes are related to ___________
Tobacco
A person can predispose themselves to develop cancer with the use of ________________. (primary and secondary and oral use is a risk factor).
Tobacco
Types of cancers caused by _____________ are lung cancer and oral cancer
Tobacco
1/3 of all cancer cases
Sexual behaviors
A person can predispose themselves to develop cancer with their _________________, by engaging in coitus prior to 18 yrs. Old, by having more than 2 sexual partners in a life time, or by having a partner with multiple partners.
Sexual behaviors
Types of cancers caused with poor _______________ are cervical cancers and testicular cancers.
Immunosuppression
Allows tumor cells to go undetected until they are established and difficult to eliminate
Immunosuppression
allows for successful spreading of tumors because the tumor is able to escape the hosts immune defenses
Grow up
Normally after a cell has divided, it becomes either a permanent or a stable cell. These cells stop reproducing and get to work for the body.
Grow up
Cells are called differentiated because they look different form one another, you can tell a spleen cell from a skin cell.
Tumor immunobiology
Includes both tumor surveillance hypothesis and immune surveillance escape mechanisms
Tumor surveillance hypothesis
The ability of the immune system to recognize and react to antigens produced by cancerous tumors as it would any other foreign antigen
Immune surveillance escape mechanisms
The ability of cancer cells to avoid or resist the host's immune response
Mechanisms of cancer spread
Lack of a well-defined border makes complete excision difficult if not impossible
Mechanisms of cancer spread
Methods of spread are direct extension, seeding, and metastasis
Direct extension
Cancer spreads to tissues adjacent to primary tumor
Direct extension
Malignant tumors grow rampantly by filtration and invasion of surrounding tissues.
Seeding
Tumor cells are shed from primary tumor and develop into more tumors
Seeding
Erosion of cancer cells into body cavities
Metastasis
Tumor cells travel through the blood and or lymph vessels and develop in a site distant form the primary tumor.
Metastasis
Metastatic cells have enzymatic qualities that enable them to breakdown a cells matrix and invade surrounding tissues through the blood stream
Tumor growth
Depends on how many cells that are actively engaged in proliferation, the duration of cell cycle, and number of cells lost vs. number of cells produced
Process of tumor spread
Attachment, dissolution and locomotion
Attachment
The tumor cell attaches to the basement membrane of the tissue affected
Dissolution
The tumor cell secretes substances to break down the cell membrane
Locomotion
The tumor cell moves (using pseudopods) into the tissue
Grading
Is according to histological (cellular) characteristics
Grading
diagnosis is made by the ____________ being governed by the histologic or cellular characteristics.
Grading
For an example, the surgeon would rather remove and the histologist would determine the level of differentiation of the cells.
Grading
The tumor cells would be categorized as grade 1-4, with the most poorly differentiated cells grade 4
Grading
This method is used to determine tumor size and lymph node involvement
Staging
Is the definition of the extent of the disease by category
Staging
In _____________ T= primary tumor
Staging
In _____________ N = Node involvement
Staging
diagnosis is made by the classification of cancers by ____________ them according to the clinical spread of the disease
Staging
In ____________ M = Metastatic spread
Staging
For an example, the surgeon would classify a tumor as a "ToNoMo" if there was no evidence of a tumor (To), no node involvement (No), and no metastasis (Mo)
Diagnostic methods
PAP test, biopsy, staging, grading and by the presence of tumor markers
PAP test
diagnosis is made through microscopic cytology
Biopsy
diagnosis is made by removal of tissue for microscopic study
Successful spread of a tumor is dependent on
The tissue invaded is compatible to the tumor cell type
Successful spread of a tumor is dependent on
The tumor being able to escape the hosts immune system
Successful spread of a tumor is dependent on
The tumor being able to access a blood supply (via angiogenesis)
Clinical manifestations of cancer
Tissue integrity, pain, cachexia, paraneoplastic syndroms, blood dyscrasias, and infection
Tissue integrity
Tissues involved with cancer are friable (easily broken) and hemorrhagic.
Tissue integrity
Cancer disrupts _______________by creating obstruction, pain from tissue erosion and compression, ulceration, and necrosis
Pain
Is caused by pressure/stretching, obstruction, and invasion of tissues by tumor
Pain
There is usually little or no ____________ in early stages, but is manifested in late stages.
Pain
_____________ management is of major concern in cancer treatment
Cancer Cachexia
wasting" syndrome related to malnutrition and increased BMR from growing tumor(s)
Cancer Cachexia
Is identified with wasting of body fat and muscle tissue
Cancer Cachexia
Can become exacerbated (made worse) by cancer therapies
Blood dyscrasias
include Anemia, Leukopenia, and Thrombocytopenia
Anemia
is caused from bleeding, malnutrition, and cancer treatments (especially radiation therapy)
Anemia
is a condition in which the body does not have enough healthy red blood cells (red blood cells provide oxygen to the body tissues)
Leukopenia
is caused from bone cancers or cancer treatments
Leukopenia
is a condition where there is a decrease in WBC, which causes a decrease in disease fighting cells that are circulation in the blood stream
Thromnocytopenia
is caused from bone cancers or cancer treatment
Thromnocytopenia
is a condition is which your blood has a lower than normal number of blood cells called fragments called platelets.
Platelets
are also called thrombocytes.
Platelets
travel through you blood vessels and stick together (clot) to stop bleeding that may happen if a blood vessel is damaged.
Infection
most significant cause of mortality
Infection
risk of __________ is increased due to malnutrition and blood dyscrasias
Paraneoplastic syndrome
is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells.
Paraneoplastic syndrome
These phenomena are mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by an immune response against the tumor.
Paraneoplastic syndrome
an example, some cancers heighten the body's ability for hypercoaguability and venous thrombosis
dyscrasias
means disease or disorder
cancer treatment goals
Curative, adjuvant (or control), and palliative
Curative
the goal is to have the cancer eliminated from the body
Adjuvant (or control)
the goal is that treatment will prolong the individuals life by slowing the growth and or prevent the spread of cancer.
Palliative
the goal is that treatment will provide comfort to the individual with terminal (life expectancy < 6 months) cancer
Cancer treatment types
chemotherapy, radiation, surgery, immunotherapy, and BRM's (biologic response modifiers)
Chemotherapy
has evolved as one of the major systemic treatment modalities.
Chemotherapy
enables drugs to reach the site of the tumor
Chemotherapy
there are different classifications of ___________________ based on the drugs mechanism of action
Chemotherapy
in _____________ multiple drugs may be used or may be used with other therapies
Chemotherapy
_______________ has adverse reactions such as nausea, vomiting, diarrhea, bone marrow suppression, and secondary malignancies
Radiation
Primary method of treatment (postoprative and preoprative)
Radiation
may be used with chemo or chemo-surgery treatment
Radiation
when coupled with palliative treatments it reduces symptoms for a person with advanced cancer
Radiation
ionizing ____________ may be used externally or internally ( implants)
Radiation
most effective treatment for rapidly growing, poorly differentiated tumor cells
Radiation
_____________has adverse reactions such skin problems, mucous membranes, bone marrow suppression, and alopecia
Surgery
is used for diagnosis, staging of cancer, and tumor removal
Surgery
is a component of adjuvant therapy with chemo or radiation therapy
Surgery
May be used curative, adjuvant or palliative care
Surgery
May assist with "TNM" identification
Immunotherapy
immune system identifies and destroys cancer cells without damaging normal cells with the use of biological response modifiers
Immunotherapy
also known as biotherapy
Colony stimulation factors
stimulates bone marrow to increase cell production to restore what is lost through cancer therapy
Colony stimulation factors
They do not directly affect tumors but through their role in stimulating blood cells they can be helpful as support of the person's immune system during cancer treatment.
Tumor Vaccines
vaccines would be used following a cancer diagnosis to prevent recurrence, get the body to reject tumor lumps and to prevent metastasis
Tumor Vaccines
vaccines are used after someone has cancer
Immunotherapy advantages
Immunotherapy has a high specificity for antigens
Immunotherapy advantages
Immunotherapy creates immune memory cells that give long protection
BRM's (Biologic Response Modifiers)
substances that are able to trigger the immune system to indirectly affect tumors
BRM's (Biologic Response Modifiers)
These include cytokines such as interferon's and interleukins
BRM's (Biologic Response Modifiers)
This strategy involves giving larger amounts of these substances by injection or infusion in the hope of stimulating the cells of the immune system to act more effectively.
BRM's (Biologic Response Modifiers)
Mobilizes the patient's immune system to fight cancer
BRM's (Biologic Response Modifiers)
Have direct cytotoxic effects
BRM's (Biologic Response Modifiers)
Initiate/augment the hosts tumor-immune rejection
BRM's (Biologic Response Modifiers)
Increases cancers susceptibility to the immune system
BRM types
cytokines, monoclonal antibodies, and hematopoietic growth factors
Monoclonal antibodies
These antibodies can be useful in fighting diseases because they can be designed specifically to only target a certain antigen, such as one that is found on cancer cells.
Monoclonal antibodies
A major advantage of these drugs is that because they are so specific, they may have only mild side effects, unlike some other cancer treatments
hematopoietic growth factors
are a group of substances with the ability to support hematopoietic (blood cell) colony formation in vitro
hematopoietic growth factors
This group of substances includes erythropoietin, interleukin-3 and colony-stimulating factors (CSFs).
hematopoietic growth factors
used to promote bone marrow proliferation in aplastic anemia, following cytotoxic chemotherapy, or following a bone marrow transplant
cytokines
regulate the innate immune system: natural killer (NK) cells, macrophages, and neutrophils. They also regulate the adaptive immune system, the T and B cell immune responses
cytokines
messengers of the immune system
etiology
the study of causes of a disease
Pediatric cancers
are usually found by accident
Pediatric cancers
patients are usually tolerant to treatment
Pediatric cancers
patients have long term side effects
Pediatric cancers
Most tend to be diagnosed during peak growth times
Pediatric cancers
cancer is often overlooked because common childhood disease signs and symptoms are often similar to those of cancer
Pediatric cancers
cancer is less prevalent in children and is not expected on routine examinations
Pediatric cancers
most involve the hematopoietic system, connective tissue, nervous system, or nervous tissue
Pediatric cancers
Leukemia's account for 1/3 of childhood cancers
Pediatric cancers
Embryonic tumors(usually diagnosed before 5) are very rare
Pediatric cancer incidence
second leading cause of death by disease in children 1-14 years of age
Pediatric cancer incidence
80% of cancers have metastasized at time of diagnosis
Pediatric cancer incidence
1% of all cancer cases are children
Pediatric cancer incidence
Patient is usually predisposed
Pediatric cancer incidence
genetic causes are greater than environmental causes
Pediatric cancer incidence
few cancers can be prevented
long term side effects
altered sex cells
long term side effects
neurologic dysfunction
long term side effects
impaired growth
long term side effects
high risk of second malignancies
Adult cancers
99% of all cancer cases are adults
Adult cancers
environmental causes are high
Adult cancers
80% can be prevented
Adult cancers
detection of cancer is during routine/screening exams
Adult cancers
usually intolerant to treatment
Adult cancers
less responsive to treatment