neoplasm
abnormal formation of tissue such as tumor or growth
benign
non cancerous tumor cells that grow locally and can not metastasis to other parts of the body
there is a capsule
if it impinges other organs causing damage to the surrounding body parts
Why would we remove a benign tumor
malignant
cancerous tumor cells that invade neighboring tissues
enter the lymph nodes and blood vessels that cause metastasis
there is no capsule and can grow very rapidly
mutation
disruption in the DNA that causes abnormal cellular proliferation
protogenes
normal genes that controls cellular growth and differentiation
it tells us what type of cell it needs to be
oncogenes
causes unrestricted growth
implicated by abnormal cell proliferation or mutation
tumor suppressor gene
regulates growth
tells the cell when to stop dividing
this will allow the tumor to flourish and grow more rapidly bc there is nothing telling the cell to stop
what happens when the antioncogene is knocked out or inactivated?
G0 phase
outside the cell cycle
when the cell is not dividing
usually long
G1 phase
when the cell has active metabolism
S phase
where the DNA is replicated or synthesized
G2 phase
when the cell is preparing for mitosis
M phase
cell divides
after G1 and G2 phase
Where are the checkpoints?
allow the cell to repair itself in case there is a mutation
What do the checkpoints do?
M phase
what is the most sensitive phase for radiation?
not all cells are in the same phase at the same time when the tissue is growing...some of the cells in different phases can repair itself
why do we need multiple treatments?
random mutation, genetic mutation passed down through generations
external: exposure to carcinogens
what are the 3 main causes of mutations
chemical: alcohol tobacco, vinyl chloride
physical: asbestos, wood dust
viruses: Hep B, HPV, T-cells
Radiation: ionizing radiation,UV rays
what are the common carcinogens
anatomical origin, cell origin, biological behavior
What are tumors classified as
carcinoma
malignant tumor that is located in the epithelial tissue
sarcoma
malignant tumor that is located in the meschymeal or connective tissue
squamous cell
carcinoma that is exposed to air
adenocarcinoma
carcinoma in the ductal or glandular site no air exposure
bengin
can only be well differentiated
carcinoma in situ
pre invasive tumor
usually a lesion
is on the most outer surface and does not invade the basement membrane
Change in bowel and bladder habits
A sore that doesn't heal
Unusual bleeding from any internal or external site
Thickening/lump in breast or other area
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
Unexpla
acronym of warning signs
slowed but continuous growth
rapid proliferation is followed by
Histology or Morphology
the study of the microscopic structures of the tissue
the cell organ
tells us what type of cell we are referring to
1. breast/prostate
2. lung
3. colon or rectal
what are the most common cancers
Sarcoma: mesenchymal cells or connective tissue
carcinomas: epithelial tissue
lymphoma: mesenchymal cells of the blood and lymphatics
histology of sarcoma, leukemia, lymphoma and carcinomas
1. may directly invade organs that are close
2. lymphatic
3.blood
4.implantation
5. venus plexus
6. biological factors
6 ways metastasis can occur
cancer
a malignant tumor or neoplasm
cancer incidence
the amount of new cases estimated to be diagnosed with cancer per 100,000 people
cancer mortality
number of deaths per 100k people
3
1 out of ___ get cancer
2nd
cancer is the ___ leading death
1. prostate/breast
2. lung
3. colon/rectal
top 3 incidence cancers
1. lung
2. breast/prostate
3. colon/rectal
top 3 mortality cancers
want the incidence rate to be furthest from the mortality rate
what is the goal
people with cancer could die with unrelated issues
why is it hard to find the true mortality rate
bc they have earlier diagnoses and detection through PAS and mammograms
also better treatments
why is breast and prostate easier to treat?
person place time
What are the factors for incidence and mortality rates
age
gender
race
occupation
genetic makeup
occupation
ethnicity
socioeconomic status
lifestyle
level of education
what are the person characteristics
population density
lifestyle
culture
access to health care
environmental contaminants
health practices
place characteristics
survival rate
the reciprocal of cancer mortality
varies with person, place and time characteristics
Etilogy
the study of the cause of the disease
epidemiology
the study of the disease incidence
american cancer society
american college of surgeon commissioners on cancer
SEER
tumor registries
name information sources
to collect data and conduct research on the trends of cancer
also learn to how eliminate cancer, better treatments, and decrease the incidence
why do we have information sources
Pap Smear
scraping of the cervix and exam the cells
can detect HPV or malignancies
help avoid getting cervical cancer
fecal occult blood test
help to detect colon or rectal cancer
Colonoscopy
removes posible pollos in the colon
will help avoid getting colon cancer in the future
mammogram
help in finding the earliest stages of breast cancer
can lead to a biopsy
PSA
test done for early detection of prostate cancer
increase amount can be a sign of having prostate cancer
signs and symptoms
help to detect where the tumor may be
good detector for diagnosis
screening tests
done for early detection of cancer
found of through diagnostic exams
- type of tumor
- location of tumor
- presence of spread to distant sites
- lymph node involvement
- distance the tumor has invaded normal tissue
what are the work up components and how are they found out?
diagnostic exams
radiologic, laboratory, EKG , endoscopic testings
Radiologic exams
x-rays, PET scans, MRI scans, CT scans
laboratory testing
bone marrow tests
WBC
important for lymphoma patients
EKG
done for heart
endoscopic
sticking a tube inside the body to see what is going on inside
ex.colonoscopy
biopsy
what is done to give us the histology of the tumor
primary prevention
intervening before someone gets cancer
healthy habits, avoidance of risks, pap smears, colonoscopy
quit bad habits
secondary prevention
early detection of the disease
very early clinical disease as possible
screening tests (mammogram, PSA)
tertiary prevention
preventing future damage
rehabilitating the residual damage that has already been done
risk
defined as the potential to develop untwined consequences of an event- the probability of injury or death
risk factor
an element of personal behavior, genetic makeup or exposure to a known cancer causing agent that increases a persons chances of developing a particular form of cancer
relative risk
a ratio of probability of developing cancer among a group having particular characteristic or risk factor to the probability of developing cancer among a similar group without the characteristic or risk factor
lung
cigarette smoking, radiation exposure, secondhand smoke
skin
excessive exposure to sun, fear complexion, occupational exposure (farmers, landscapers,
breast
increasing age
personal/family history
high-fat diet (more hormones are produced)
early menarche/late menopause (more hormonal exposure)
colon/rectum
personal/family history
high fat/low fiber diet
history of ulcerative colitis
over age of 50
prostate
african american man
increasing age
family history
uterus/endometrial
estrogen replacement therapy
easy menarche/late menopause
age over 50
oral
tobacco use
excessive alcohol use
estrogen replacement therapy
treatments to control certain levels that increase risk of endometrial cancer
HPV
increase risk to cervix CA and H/N CA
general health assessment
past and present assessments
self report questionnaire
gives the doctor data
nutritional assessment
weight change percentage
detecting anorexia and cachexia
cachexia
malnutrition
- less than 70 calories a day
- more than 5 lb weight loss in 2 months
- wanting to increase appetite and gain weight
- physician advises weight gain
what are the signs of anorexia/cachexia
- nutritional counseling
- appetite stimulants
- enteral/parenteral nutrition
how to manage weight changes?
systemic assessment
fatigue
karonofsky scale
pain assessment
psychosocial assessment
Karnofsky scale
excellent tool for measuring pain behavior and estimate physical activity
diet and exercise
find and correct etiology
what helps fatigue
sudden and abrupt...wave of fatigue
usually right after treatment
the body works extra hard because the cells are trying to repair themselves
how is fatigue established in radiation
ECOG performance status
measures how well they do/take care of themselves
fatigue can be a huge factor
location
character (constant or pulsing)
temporary factors (onset, duration)
palliative
intensity
what makes up a pain assessment
pain rating scale
how they measure intensity
psychosocial factors
financial worries, loss of independence, family issues, isolation, fear of death
quality of life
extent to which ones usual or expected physical, emotional and social well-being are affected by a medial condition or its treatment
QOL index
functional living index
FACT scale (questionnaire validation measure)
how is it QOL measured
it affects how we treat the patient
based on their attitude rather then age
why is QOL important
ti see if there are hematological complications related to underlying disease or treatment
why do we look at blood
myleosuppression
decrease in bone marrow (platelets, WBC, RBC)
commonly due to radiation
anemia
decrease in RBC count
decrease o2 carrying capacity
leukopenia
decrease in WBC
causes increase risk to infections
thrombocytopenia
decrease in platelets
can cause risk to bleeding out
can't form clots
lab orders
UA, stool analysis, BC, CBC
CC or chief compliant
in patients own words
HPI
define the present illness (pt) any related PMH
PMH
med, hospitalizations, surgeries, current/past medical problems
FHx
cancer in the family
Soc Hx
martial status, employment, ETOH, smoking, street drugs, street drugs, education
ROS or review of systems
general, skin, HEENT, Resp, CV, GI, GYN
helps to see if there is chance that the cancer has spread some place
blood pressure
respiratory rate
temperature
O2 sat
pulse
what are the 5 vital signs
respiratory per pediatrics
20-30
pulse per adults
60-100
breathe per adults
12-20
diastolic
60-80
95-100%
pulse oximeter
what is the O2 sat and measured with what
manual sphingtometer
what do u measure BP
erythema
redness of the skin
common in the breast and folds of the skin
the two surfaces rub together and gives more scattering/dosage to that area
why common in the folds?
dry desquamation
flaky, dry skin
moist dequamation
very are, new looking skin
necrosis
dead skin
there is full damage
acute side effects
occurs during the treatment
what we look out for
late side effects
occur after the treatment
can develop months after
radiation: skin, loss of hair
cancer: vomiting, confusion, not walking well, pain
side effect of radiation vs side effect of cancer
radio dermatitis
can see changes in the skin texture, very scale like
tecabgiectasia
spider looking in the area of the skin
alopecia
loss of hair
occurs at 2000 cGy
only specific to the area of radiation
permeant lose at 4000
- cataracts
- lossing cognitive ability
some late side effects when treating brain
diarrhea
bone marrow decrease
mucositis
acute side effects
mucositis
sickening of white mucus
stroma
dry mouth
lahermittes
around the cervical spine
bending the neck causes an electric shock down the shoulders and body
otoscope
measures hearing
direct laryngoscope
checking mouth and throat
stethoscope
checking the chest, lungs and heart
pulse per pediatrics
70-120
systolic
80-120
staging
made at initial diagnosis
size and extent of the tumor
aids in prognosis
AJCC
the biggest staging classification
everything but lymphoma
gleasons score
for prostate cancer
get both this and a AJCC stage
duke staging
colon/rectal staging
Ann Arbor staging
lymphoma staging
FIGO
GYN
cervix and uterus staging
clinical and pathologic
what are the two types of classification
clinical
based on evidence before primary treatment
based on only diagnosis exams
can be helpful in starting treatment
pathologic
based on evidence before and after primary treatment
need a resection of the tumor and exam of the lymph node involvement
lumpectomy
reception of the primary tumor
pathologic has tissue involvement
main difference between pathologic and clinical
TNM
what is the staging system
T
size and extent of the primary tumor
N
lymph node involvement
sees how many
can be done through a dye test
M
metastasis or not
can be found based on signs/symptoms
PET and CT scans confirm
determine the path report, treatment choice and field size
what is an important aspect of staging
axillary lymph nodes
where does the breast spread to
pelvic lymph nodes
where cervix spread to
Tis
carcinoma in situ
increasing in size
extends into other tissue
T1 --> T4
during clinical stage
when do u see Nx
N0
when there are no lymph nodes present
increasing lymph node involvement
N1-->N3
M0
when there is no metastasis
M1
distant metastasis
grading
information on the aggressiveness and degree of differentiation
rate of growth
less differentiated
the faster the growth the _____ the cell becomes
differentiation
how much the cell looks like the original
undifferentiated
least amount of differentiation
can't tell what it is suppose to be originally
G1
well differentiated
slight anaplasia
cells are uniformed and shows rare or no mitotic figures
g2
moderately differentiated
variations and occasional mitotic figures
moderate anaplasia
G3
poorly differentiated
disorderly pattern with many mitotic figures
less structural similarity
marked anaplasia
G4
undifferentiated
does not look like the original cell
mostly anaplastic
may not know the primary
Pleomorphism
structure is totally different from original
not its normal self
gleason score
grading system for prostate
0-10
take the largest and second largest area of the tumor and give each a score
individual can go up to 5
2-4 well differentiated
5-6 moderately
7 poorly
8-10 undifferentiated
how is the gleason score calculated
direct invasion
tumor spreads and destroys other organs
ex. skin cancer to small bones
lung from lobe to lobe
lymphatic system
cells break off of the tumor and go into the _____ and lodge into the nodes
blood stream
some cells will go off into the ____ as it takes nutrients
seeding
cells can drop off in the abdomen and lodge to start growing
they float to wherever they want
venus plexus
direct blood supply goes to the spinal bodies
common metastasis from prostate cancer
biological factors
factors we can not totally understand
ex. breast cancer spreading to the eye
radical
goal is to cure the patient
give it everything we got
can give it enough dose of radiation that can destroy the tumor
can be surgery, chemo, or radiation
palliative
goal is to relieve the pain rather than cure
prolong their life and reduce their pain
chemotherapy
cytoxic drugs or agents are administered orally, through injection, through pecfesuin, and topically
systemic treatment
systemic
travels throughout most of the entire body
cell cycle specific
agents that work on different phases of the cell
radio sensitizers
agents that work into the cells causing them to make the cells sensitive to radiation
radio protectors
agents where the normal cells uptake this drug and will be more resistant to radiation
adjuvant
given after primary treatment
secondary treatment
neo adijuvant
PRIOR to treatment
want the affect prior to the primary treatment
reduce the size
primary
main treatment
combination
different agents together
more than one treatment radiation, chemo, surgery
radiation therapy
use of high energy ionizing radiation to kill cancer cells
locally treat primary and regional lymph nodes
diagnosis (biopsy)
staging (exploratory laparotomy)
treatment
palliation
surgery aids in
free radicals
ionizing radiation causes a chemical reaction in the cells and create molecules called