Chapter 10

6. Infection= the most significant cause of _____ and ___ in cancer patients

complications and death

Tobacco Use -Secondhand smoke is associated with ____

-modestly increased risk of lung cancer

Tobacco Use -The chemicals that are in tobacco are _____ -They are absorbed from the _____ into the ____ and distributed by the ____ to _____ -They are ___ by the ____ and ____ by the ____ -they are present in the _____ of smokers

-mutagens -lungs, blood, blood, all organs of the body -detoxified by the liver, cleared by the kidneys -urine

3. Cachexia Weight loss: -Occurs in a cancer patient despite ___ -May be due to ____ -Comes at the expense of _____ which is ___, causing the ____

-normal or even increased food intake -increased metabolic activity of the tumor itself -normal tissue, sacrificed, wasting seen in cancer patients

Causes of Cancer 3. Viruses -Viruses that cause cancer are called_____ There are 2 ways in which viruses can cause cancer: 1. _____: -viruses ______ -that causes _____ -example: ____, or called____ 2. _____: -viruses cause ____, which results in ___ -____ involves ____ -____ are at higher risk of ____

-oncogenic viruses 1. The direct way: -Viruses invade the host cells and insert their genetic material into the cell's DNA -That causes the cell to transform into a cancer cell -human papilloma virus, e.g. cervical cancer 2. The indirect way: -tissue damage, healing -healing, actively dividing cells -Actively dividing cells, higher risk of mutation

1. Pain -Early stages of cancer are not usually associated with ____ -There are exceptions (____,____) -Pain occurs in 60-80% of _____ (_____) -Pain is ____, it is a result of interaction of ____,_____ and ___ -it is affected by ___,____,___,___ and ___ -_____ is the first priority with end-stage cancer

-pain -(bone cancer, brain cancer) -late stages of cancer (terminally ill patients) -subjective, interaction of physiological, psychological, and cultural factors -fear, anxiety, fatigue, sleep loss, and overall physical deterioration -pain control

Cancer Risk Factors -Personal behaviors (4) -Environmental risk factors (5)

1. Tobacco use 2. Diet 3. Alcohol 4. Sexual behaviors 1. Air pollution 2. Occupation 3. Ultraviolet radiation 4. Ionizing radiation 5. Hormones

Diet and decreased risk of cancer: -Fiber in food (remnants ____): high fiber intake is associated with _____ -selenium, which is a ______, is associated with _____ THE GOOD NEWS -Vitamins ____,___, and ___ are _____ (which ____ free radicals) -Omega 3 fatty acids (fish oil) are associated with ____ -A diet rich in fruits and vegetables is associated with ____

-(plant cell wall not digested by humans): decreased risk of colon cancer -cofactor in enzymes that destroy free radicals, decreased risk of colon cancer -E,C,A antioxidants (decrease) -a decrease in the number and size of tumors -a decreased rate of colon cancer

Ionizing Radiation Observations of the Hiroshima and Nagasaki atomic bomb: Leukemias in adults in children: -in adults, a latent period of ____ after exposure -In children under 15, a latent period of ___ -Increased frequencies of ____" (cancers of _______,____, or the ____) -especially ___ and ____ -but also increased frequencies of ___,____,___,___ and ___ -Children conceived after the exposure of their parents to the atomic bomb have shown ____

-20 years -6-7 years -"solid tumors" (body tissues other than blood, bone marrow, or the lymphatic system) -thyroid and breast cancers -lung, stomach, colon, esophagus, and urinary tract cancers -NO increase in any cancer thus far

Environmental Risk Factors Air pollution -A person inhales about ____ of air per day -Thus, even _____ of the air will result in _____ -Living _____ is a recognized cancer risk factor because ______ -Most studies demonstrated association between _____ and ____

-20,000 liters -modest contamination of the air, inhalation of high doses of pollutants -close to industries, industrial emission include heavy metals and hydrocarbons -increased rate of lung cancer and industrial emissions

Treatment of Cancer 2. Radiation -Causes ______ which may be ____ -Rapidly deciding cells are more ___ -The goal is to ____ without _____, becoming more ____ (____)

-DNA damage, lethal to irradiated cells -radio-sensitive -eradicate cancer cells, damaging normal tissue, precise (cyber-knife)

Ultraviolet Radiation 2. Squamous cell carcinoma: -found more commonly in ____ -The tumors are ______, mostly around the __,___, and ____

-men who work outdoors -distributed over areas that are exposed to the sun; head, neck, and upper extremities

Treatment of Cancer 5. Biological therapy b. Gene therapy: -Experimental: currently_____ -General definition: _____ -This can be accomplished by (3) -These genes are introduced via _____

-being researched -the transfer of new genetic material into a cell for therapeutic benefit 1. replacing or inactivating a dysfunctional gene 2. Replacing or adding a functional gene 3. Inserting a gene into a cell to make it function normally -engineered viruses

Personal Behaviors Alcohol -Alcohol consumption has been linked to ____ and ____ Alcohol may: (3) -The interaction of alcohol and smoke increases the risk of _____, because the alcohol acts as a ____ -Individuals who both smoke and drink alcohol have increased risk of cancers of the _____,_____,____ and _____

-breast and colorectal cancer 1. decrease the liver's ability to rid the body of carcinogens 2. Impair the immune system 3. Interfere with membrane permeability in breast tissue -malignant tumors, solvent for the carcinogens in smoke -mouth, pharynx-larynx, esophagus and liver

Environmental agents that cause cancer are called _____ -Carcinogens cause cancer by _____ -Evidence for exposure to carcinogens come from ____ and __

-carcinogens -increasing the frequency of mutations in somatic cells -laboratory and epidemiological studies

Ionizing Radiation -Ionizing radiation inhibits ____ and addicts ____ 1. Cells of the ____ and ____ (____) are rapidly dividing cells -suppression of _____ can cause _____ to ____, affecting the ____ 2. Even low doses of radiation can severely affect the ____ because ____

-cell division, mostly rapidly dividing cells 1. lymphoid tissue and bone marrow (stem cells) -stem cell division, granulocytes to disappear, immune system -developing fetus, cell division is very rapid

Treatment of Cancer 3. Chemotherapy -There are several classes of _____ -New chemotherapies are ____ -In general, these are ______, whether ____ or ____ -Chemotherapy drugs work against _____ and _____ e.g they inhibit synthesis of ___,___ or ___ -In the past, ________ was used, but tumors _____ -Currently, ______ is used in an attempt to reduce ____ and allow for ______

-chemotherapeutic agents -constantly invented -cytotoxic agents for all cells, malignant or normal -cellular metabolism controlling growth and replication, DNA, RNA, or protein -single-agent chemotherapy, developed drug resistance -combination chemotherapy, drug resistance, smaller dose intensity (smaller dose for each drug)

Treatment of Cancer 3) Monoclonal antibodies -Produced by ____ -Specific for a ___bind only to ____ and induce an _____ 4. Conjugated antibodies -Antibodies to which either ____ (____) or _____ (____) are attached (____) -the therapy is then delivered to _____

-clones of a single immune cell -particular antigen, specific cancer cells, immune response against the target cancer cells only -radioisotopes (radiation) or toxins (chemotherapy) are attached (in the lab) -only the specific cancer cells

Treatment of Cancer 5. Biological therapy -Experimental: _____ Includes (2) -Goal: to provide ______, e.g to _____ without ____ -Strategy: development of _____ -these are _____ -they are substances that _____ and can ____ -Examples (4)

-currently being research 1. immunotherapy 2. gene therapy -specific cancer therapy, damage cancer cells, damaging normal cells -biologic response modifiers(BRM) -substances that change the interaction between the immune system and cancer cells by enhancing the immune function -occur naturally in the body, be made in the lab -cytokines, lymphokines, vaccines, antibodies

Personal Behaviors: Tobacco use: -Both ____ and ____ support the conclusion that cigarette smoke is ____ -Smoking contributes to 30% of all _____ -By late middle age, lung cancer is is 10 times greater in ____ than ____ -_____ kills more than 430,000 a year in the US and 3 million a year worldwide

-epidemiologic and experimental data; carcinogenic -cancer-related deaths -10 times greater, cigarette smokers than in nonsmokers -smoking

2. Fatigue -Fatigue is the most ____ -Mechanisms are ___ Possibilities: (5)

-frequently reported symptom of both cancer and its treatment (radiation, chemotherapy) -poorly understood 1. Biochemical changes secondary to the cancer itself 2. Psychosocial factors (such as depression) 3. Sleep disturbances 4. Nutritional status 5. Level of activity

Treatment of Cancer b. Gene therapy -Gene therapy that is employed specifically for the treatment of cancer attempts to: -decrease ____ -increase ______ -help _____ -kill ___

-growth rate of cancer cells by inserting genes for growth suppression -the death rate of cancer cells by replacing and/or inserting genes that cause apoptosis -the immune system identify cancer cells by injecting them with engineered viruses;; for tumor cells that do not possess Tumor Specific Antigens (TAA) -cancer cells by injecting immune cells with genes that make specific cytokines or antibodies to boost the immune system (immunotherapy)

4. Anemia -low _____ -Mechanisms that may cause anemia in cancer patients (4) -Administration of _____, a drug which _____ is sometimes but not always successful

-hemoglobin concentrations in the blood 1. Severe malnutrition 2. Chronic bleeding (resulting in iron deficiency) 3. Malignancy of the bone marrow (blood-cell forming organ) 4. Side effects of medical therapies (radiation and chemotherapy), which cause destruction of rapidly growing cells (RBC & WBC) -erythropoietin, stimulates the production of erythrocytes

Treatment of Cancer a. Immunotherapy 1. Cytokines: a. Interferons (α,β,γ): -Improve ______ -Slow ____ or ____ -Stimulate ____, ___ and ____ b. Interleukins (1,2,12): stimulate _____ (___) that can ____ c. Colony-stimulating factors -Stimulate ______ (the source of _____) to ___ and ___ to _____ (____ and ____)

-immune system function against cancer cells -down the growth of cancer cells or promote their development into cells with more normal behavior -macrophages, Tc, and NK cells b. immune cells (NK), destroy cancer cells -bone marrow stem cells (all blood cells), divide and develop, combat the damage to fast growing cells caused by current cancer treatment (radiation and chemotherapy)

Air Pollution -_____ pollution in general is worse than _____ pollution -The two main indoor pollutants are: (2) -Active or passive (second hand) smoking causes the _____ and thus ___ -radon is a _______ -it gives rise to _____ that are _____ -about 10% of _____ are attributed to ____

-indoor, outdoor 1. cigarette smoke 2. Radon gas -formation of free radicals, DNA damage -radioactive gas that is present in soil or trapped in houses -radioactive decay products, carcinogenic to humans -lung cancer cases, radon pollution in houses

Causes of Cancer -Only when the genetic changes occur in reproductive cells, they are ____ (______) -Example: ____ -_____ are found in individuals with this cancer -The inherited mutations are carried in ____ -Thus, they are present in ____ -example _____ and ____

-inherited (passed from generation to generation) -inherited breast cancer -cancer-causing genes -the DNA of reproductive cells -all the offspring's body cells -BRCA1 and BRCA2 mutation

Causes of Cancer -Cancer risk depends on interaction between _____ and ____ -At the level of the cell, cancer is ____ because _____, and ____ are ____ -However, most of the genetic changes that cause cancer occur in ____, not in the _____ -Thus, these genetic changes (events) are not _____ -They are ____, but they are not ___

-inherited and environmental factors -genetic, the primary basis of cancer is mutations, mutations are genetic events -somatic cells, reproductive cells -transmitted to future generations -genetic events, inherited

Environmental Risk Factors 1. Basal cell carcinoma -Commonly occurs in individuals with ____,___ and ____, who tend to ___ -mostly in skin areas that ____

-light complexions, light eyes, fair hair, get sun burn rather than tan -receive the greatest sun exposure

Treatment of Cancer 3. Hair and skin -Hair ____ (not caused by _____) -Skin ____ and _____, increased risk of _____ and ____ 4. Reproductive tract -Gametes are ____ -Effects are ____ and ___ -_______ -Decreased _____ for both men and women

-loss (all chemo agents) -dryness and breakdown, wounds and infections -rapidly growing cells -dose-dependent and age-dependent -premature menopause -fertility

Examples of Pain -Pain can be directly related to ___ or as a result of ____ Examples: 1. Bone metastasis causes pain due to: (3) -Bone pain may be referred ____ and manifested as ____ for example 2. Abdominal pain is often caused by ____ -Tumors that _____ cause pain (____ is often needed to obtain ___) -Liver cancer ____, resulting in a _____ 3. Tumors_____ create pain -___ have very little space to grow between the ____ and the ___ without ____ -Peripheral tumors may ____

-malignancy, related problems 1. -irritation of the outer layer of the bone (periosteum) -pressure in the bone cavity -pathologic fractures -away from the bone, back pain 2. severe stretching from tumor invasion of hollow organs -obstruct and distend the bowel (surgery, relief of pain) -stretches the liver, dull pain over the right upper abdominal quadrant 3. Compressing nerves -brain tumors, brain and the skull, compressing blood vessels and nerve endings -compress peripheral nerves and nerve endings (the sensory receptor for pain)

Ultraviolet Radiation 3. Melanoma -Melanoma= a ______ -melanocytes are found in the _____ and contain a ____ (____) -Tumors are correlated with ____ -Specifically, to episodes of ____, ____, at a ____ -The most _____ type of cancer

-malignant pigmented mole -basal cell layer, pigment (melanin) -the amount of exposure to the sun -severe, blistering sunburn, young age -aggressive

3. Cachexia -is a form of _____ associated with cancer, resulting in ___,____, and ___ -Cachexia results in: (2) -Cachexia is a syndrome which includes both ___ and ___

-malnutrition; wasting, emancipation, and decreased quality of life 1. changes in appearance including sunken eyes, cheeks, and temporal areas, sharp nose 2. Dry and rough skin -anorexia and weight loss

Diet -_____ and ____ are a controversy -Saccharin: ______ (yes in ____) -Nitrites: -____ -a reaction that creates carcinogens may occur when ____ -_____ food may also produce carcinogens Salt: -Countries in East Asia, where people ingest large quantities of salted and preserved fish, have higher rates of ____ than in the USA

-preservatives and additives -no relationship in humans (mice) -preservatives in fish and meat cause stomach cancer in experimental animals -foods preserved with nitrites are cooked -smoking -Stomach cancer

Treatment of Cancer 1. GI tract -GI tract has ______to ____ and ___ the _____ -symptoms: (7) -Treatment: ____, and ____ 2. Bone marrow -____,___ and _____ are rapidly growing cells -_____ causes fatigue -Treatment: _____ -Leukcytopenia causes _______; Treatment: _______ -Reduced platelets causes ____; Treatment: _____

-rapidly growing cells, produce and repair, barrier of epithelial mucosa -diarrhea, malabsorption, ulcers, infections, nausea, vomiting, reduced appetite -anti-nausea drugs, supplemental nutrition -RBC, WBC, and platelets -Anemia -RBC transfusion and erythropoietin -immune suppression; cytokines to stimulate WBC production -bleeding; platelet transfusion and thrombopoiten

Treatment of Cancer 2. Vaccines: -Encourage the immune system to _____ -Produce ____ for ____ Therapeutic vaccines: - are given to people _____; they are designed to (3) Prophylactic vaccines: -Are given to _____; they are designed to (2)

-recognize cancer cells -memory cells, extended protection -after cancer is diagnosed 1. Treat and eradicate existing cancer 2. Prevent cancer from recurring 3. Destroy cancer cells not killed by prior treatments -healthy individuals before cancer developed 1. Prevent the development of cancer 2. Stimulate the immune system to attack cancer-causing viruses

Tobacco Use -Low-tar cigarettes do not _____ because ____ -Cigarette smoke is more _____ than ____ or _____ -Alkaline smoke is more ____ and less ____ -Nicotine absorption rates in the blood are ____ Thus: -Cigarette smokers have ____ and ______ -while pipe and cigar smokers have ____

-reduce the risk of lung cancer, the greatest risk is the inhalation of tobacco smoke -acidic, pipe or cigar smoke -irritating, readily inhaled into the lungs -decreased for more alkaline smoke -higher rates of lung and liver cancer -more frequent oral cancers

Treatment of Cancer 4. Hormonal therapy: -Mostly for ___ -Mechanism of action involves _____ or _____ -Commonly used hormonal agents: (5)

-reproductive cancers -plasma membrane receptor blockage or activation to regulate intercellular signaling for growth and proliferation 1. Estrogens: fro endometrial cancer and prostate cancer 2. Anti-estrogens: for breast cancer 3. Androgens: for breast cancer 4. Anti-androgens: for prostate cancer 5. Corticosteroids: for leukemias and lymphomas

Environmental Risk Factors Hormones -The hormones that are associated with cancer are usually _____ (____), including ____,____,and ____ -These hormones facilitate _____ -Estrogen causes ____ -testosterone causes _____ -The cancers related to the sex hormones are: ___,____,____,____ and ____ cancers -Research indicates that hormones serve as ______ but not as ____ -In other words: they do not _____, but rather they _____

-sex hormones (sex steroids), estrogen, progesterone, and testosterone -target tissue growth -proliferation of breast and endometrial cells -proliferation of testes and prostate gland -breast, ovary, testicular, and prostate -promoters of carcinogenesis, primary carcinogens -do not initiate the formation of cancer, contribute to it

Tobacco Use -Forms of ____ have increased "Dipping snuff" (chewing tobacco):the tobacco is ____ -Nicotine is then _____ -Oral cancer occurs____ among snuff dippers compared to people who do not use tobacco

-smokeless tobacco -placed between the cheek and gum -directly absorbed through the oral tissue -more frequently

2. Fatigue -is a _____ -Described by cancer patients as (9)

-subjective clinical symptom 1. Tiredness 2. Weakness 3. Lack of energy 4. Exhaustion 5. Lethargy 6. Depression 7. Lack of motivation 8. Inability to concentrate 9. Decreased mental status

Environmental Risk Factors Ionizing radiation -is radiation ______ -Exposure to ____ such as ____, ____, and ____ -There is a relationship between the ____ and ____ -Radiation can cause ____, either ____ or by ____

-that is strong enough to cause molecules to lose atoms and thus become ions -radioactive sources, x-rays, radioisotopes, atomic bomb -amount of exposure and the development of cancer -mutations in the DNA, directly, creating free radicals

3. Cachexia -Anorexia= ____ -The loss of appetite in cancer patients may be due to (4) -Anorexia leads to ___ resulting in: (3)

-the general symptom of decreased appetite 1. Pain 2. Depression 3. Alteration of taste 4. Medical treatment of cancer: chemotherapy and radiotherapy -protein malnutrition 1. Prolonged and gradual wasting of muscle mass 2. Diminished immune competence 3. overall physical deterioration

Personal Behaviors Diet: -In humans, _____ correlates with cancer -High consumption of dietary fat is linked to _______: ___,___,___,___ (and __) -Polyunsaturated fats found in vegetable oils promote cancer in animals because they ______ -Animals are fed_____, which may affect ______ (____ and ____) -Women have a much higher incidence of _____ than men -____ has been suggested as the main single determinant in causing hormonal dependent cancers - Obesity in women has been associated with _____ because ___

-total dietary fat -reproductive cancers: endometrial, breast, ovarian, prostate (and rectal) -increase the production of free radicals -hormones, humans who eat them (organic beef and chicken) -hormone-dependent cancers -diet -hormonal dependent cancer, the most potent estrogen is converted in adipose tissue

Treatment of Cancer Side effects of current cancer treatment: -At times the side effects of treatment are _____ and greatly affect ____ -It is due to the _____ -Systems and organs with rapidly growing cells are affected including: (4)

-worse than the cancer itself, quality of life -nonspecific nature of treatment which targets rapidly growing cells 1. GI tract 2. Bone marrow 3. Hair and skin 4. Reproductive tract

Other cancer contributing factors: 1. ______ -the incidence of cancer ______ -the ______ may not be _____ 2. _______: -____ are at higher risk for many cancers, with the exception of: ______ (____,___,____), ____, and ____ 3. _____ -______

1. Aging -increases at a rapid rate with age for most cancer -aging immune system, potent enough to detect and destroy cancer cells in some aging individuals 2. Gender -males: female reproductive cancers (breast, uterine, ovarian), thyroid cancer, and colon cancer 3. Viruses -oncogenic viruses

Treatment of Cancer 5. Biological therapy Biological response modifiers (BRM) may have the following actions: 1. ______ -using _____ such as ____,___ and _____ cells to ______ 2. _______: -using agents such as ____,____ and _____ to _____ 3. _______: -Using substances such as ____,____, and _____ to ____

1. Direct cytotoxic effect on cancer cells: -effector cells, macrophages, Tc, and NK; recognize cancer cell antigens 2. Improvement of the immune rejection response against tumors: -cytokines, lymphokines, antibodies, recognize and fight cancer cell antigens 3. Modification of cancer cell susceptibility to lytic effects of the immune system -interferons, interleukins, and colony-stimulating factors, weaken cancer cells

3. Cachexia As a syndrome, cachexia also includes: 1. ______ -a ________ -____ may be responsible 2. _______ -Altered carbohydrate metabolism causes a _____ with ____,___ and ___ -Proteins and lipids are converted to ____ (____) to ____ 3. _____ (____) 4. _____ (____)

1. Early satiety -sense of being full after ingesting a small amount of food -tumor metabolites 2. Altered protein, lipid and carbohydrate metabolism -syndrome similar to diabetes, increases in blood sugar, insulin, and insulin resistance -glucose (glyuconeogenesis), meet energy needs 3. Asthenia (marked weakness) 4. Anemia (low hemoglobin levels in the blood)

Causes of Cancer Evidence for exposure to carcinogens: 1. _______ -In experimental animals, ____ -_____ may be a problem -Examples: (2) 2. _______:______ -the relationship between life-style and cancer is ________ Examples: -Breast cancer is ______ but _____ -Colon cancer is ______ but ____ -Most people who develop ____ have been exposed to ______; risk may be ____ or ____(_____)

1. Laboratory studies are conducted in live animals or in vitro; -many agents cause cancer -dosage 1. Certain chemicals cause certain types of cancer (saccharin caused bladder cancer in rats) 2. Cigarette smoke causes lung cancer 2. Epidemiological studies: comparison of populations with different life-styles -not absolutely clear -prevalent in American & Northern European women, but rare in developing countries -rare in Japan but Japanese immigrants to the US have increased colon cancer incidence -inhaling asbestos particles, occupational or secondary (family members)

Tobacco Use -Cigarette smoking increases the incidence of many cancers: (9) Smoking is also a direct cause of (6)

1. Oral cavity 2. lung 3. larynx 4. liver 5. kidney 6. bladder 7. esophagus 8. pancreas 9. certain blood cells (such as myeloid leukemia) 1. Ischemic heart disease 2. Aortic aneurysm 3. Stroke 4. Chronic obstructive lung disease 5. Pneumonia 6. Cirrhosis of liver

The clinical manifestations of cancer include (6)

1. Pain 2. Fatigue 3. Cachexia 4. Anemia 5. Leukopenia and thrombocytopenia 6. Infection

1. Pain Physiological mechanisms that cause pain in cancer patients are: (6) ** nerve endings are the ____

1. Pressure 2. Invasion of a sensitive structure (bone) 3. Stretching of visceral surfaces 4. Obstruction (blood, bowel) ------1-4 are due to mechanical activation of nerve endings---- 5. Tissue destruction 6. Inflammation ----4-6 are due to chemical activation of nerve endings **sensory receptor for pain

Cancer treatment (6)

1. Surgery 2. Radiation 3. Chemotherapy 4. Hormones 5. a combination of any of the above ----1-5= current therapies---- 6. Biological therapy -immunotherapy -gene therapy ---6 is experimental therapies---

Skin Cancer Signs of malignant skin cancer (4)

1. Symmetry/asymmetry 2. Border (even vs. uneven edges) 3. Color (one shade vs. more than one shade) 4. Diameter (smaller than 1/4 inch vs. larger than a 1/4 inch)

Environmental Risk Factors Ultraviolet radiation -Sunlight can cause certain types of skin cancer (3) -Basal cells are in the ____, they ____ -Squamous cells are ______ (they are ____)

1. basal cell carcinoma 2. squamous cell carcinoma 3. melanoma -deepest layer of the epidermis, constantly germinate -more superficial in the epidermis than basal cells (mature basal cells that are pushed up)

Treatment of Cancer 1. Surgery: the objectives are ____ and ____ a. diagnosis: to determine ___ and ____ - ________ -cancer first metastasizes to the _____ -sentinel nodes: _____ -how? _______ b. Treatment: ______ ( and ____) -pre-invasive or pre-malignant tumor= _____ -curative= _____ -Debulking surgery= _______ -Palliative surgery= _____

1. diagnosis and treatment a. staging and treatment needs -biopsy of a tumor and the adjacent lymph nodes -sentinel nodes -lymph nodes that are the first to receive drainage from a given region -radioactive dye (tracer) injection for sentinel node identification b. removal of tumor and lymph nodes -when a tumor has not spread beyond the limits of surgical excision (skin, cervix) -tumor is removed with a margin of normal tissue -most but not all of the tumor can be removed, for increased success of chemotherapy & radiation -for symptoms relief when cure is not possible

Personal Behaviors Sexual behavior -The risk of developing cancer is related to (3) -The possible mechanism is a _____ (_____) ______ -It causes _____ and _____ -Other sub-strains of human papillomavirus are associated with cancers of the ___,____, and ___

1. the age of first sexual intercourse 2. the number of sexual partners 3. sexually transmitted infections -virus (human papillomavirus), transmitted between sexual partners -abnormal pap smear and cervical dysplasia -penis, vulva, anus

5. Leukopenia & Thrombocytopenia Leukopenia= _____ -compromises ___ and causes ___ Thrombocytopenia= ____ -compromises ____ and may result in ____ -Leukopenia and thrombocytopenia may be caused by: (2)

decrease in the number of leukocyte (blood count) -immune function; increased infections decrease in the number of platelets -blood clotting, hemorrhage 1. Tumor invasion of the bone marrow 2. Chemotherapy and radiotherapy are toxic to the bone marrow and its rapidly growing cells (RBC, WBC, thrombocytes)

Environmental Risk Factors Occupation -There are cancers that are associated with ______ examples (3)

occupational hazards 1. Underground miners that are exposed to radon gas are at risk of increased lung cancer rates whether or not they smoke 2. Asbestos may cause as many as 5% of all lung cancers 3. Manufacture workers for plants producing dyes, rubber, paint, and glue, are linked to cancers of the bladder and to leukemia