chapter 4: Cancer

A benign tumor that projects from an epithelial surface is usually called a ___________________

30%

Mutations inherited from parent to child account for

5-10% of all cancers.

Tumor

A mass of abnormal cells that develops when cancerous cells divide and grow uncontrollably.

Secondary tumor

A term that is used to describe either a new primary cancer or a metastasis.

he American Cancer Society uses the acronym CAUTION to remind individuals of some of the signs of cancer:

Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing Obvious change in a wart or mole Nagging cough or hoarseness

Both normal and cancer cell

DNA is damaged during radiation therapy. Radiation can be administered in several ways.

DNA repair genes instruct a cell to repair damaged

DNA. Cancer may occur when mutation makes the cell unable to correct DNA damage or unable to commit suicide.

At least one-third of all cancers are preventable. Reduce the risk of developing cancer by making healthy lifestyle choices:

Don't use tobacco. Tobacco use is the single greatest avoidable risk factor for cancer mortality worldwide, causing an estimated 22% of cancer deaths per year. • Maintain a healthy weight and be physically active. Maintaining a healthy weight may lower your risk for various cancers. Physi- cal activity will help you control your weight and might lower your risk of cancer. • Eat a healthy diet. Eat plenty of fruits and vegetables and limit fat intake. • Limit alcohol consumption. If you choose to drink alcohol, do so in moderation—a maxi- mum of one drink per day for women or two drinks per day for men. • Protect your skin from UV rays. Avoid mid- day sun, use sunscreen, wear protective clothing, and avoid tanning beds. • Get immunized. Get vaccinated against hepatitis B and the human papillomavirus. • Avoid risky behaviors. Practice safe sex. Don't share needles. • Get recommended cancer screenings. Screening increases the chances of detect- ing certain cancers early, when they are most likely to be curable

Hepatomegaly

Enlarged liver.

Dysphagia

Esophageal disease manifests itself as dysphagia, difficult or painful swallowing.

Mutations inherited from parent to child account for 25% of all cancer

False

biopsy

In most cases a biopsy must be done for a cancer diagnosis. A small tissue sample is removed and the sample is viewed under a microscope. The size and shape of the cells, size and shape of the cell's nucleus, and arrangement of the cells are evaluated.

Malignant

Malignant tumors are life-threatening, grow rapidly, invade surrounding tissue, and may metastasize to other parts of the body through the blood or lymph. Malignant tumors have a crab-like appearance and an irregular surface (Figure 4-1 ). Under a microscope the cells of a malignant tumor do not resemble cells of their origin and do not have a uniform appearance (Figure 4-2 ). Malignant tumors are not encapsulated, making excision more difficult, and tend to reoccur.

leading Sites of Cancer Deaths Worldwide, 2012

Men Lung and bronchus Liver Stomach Colon and rectum Prostate Esophagus Women Breast Lung and bronchus Colon and rectum Cervix Stomach Liver

leading Sites of New Cases of Cancer Worldwide, 2012

Men Lung and bronchus Prostate Colon and rectum Stomach Liver Esophagus Women Breast Colon and rectum Lung and bronchus Cervix Stomach Uterus

leading Sites of Cancer Deaths in the United States, 2013

Men Lung and bronchus, Prostate,Colon and rectum Pancreas,Liver and intrahepatic bile duct, Leukemia Women Lung and bronchus ,Breast ,Colon and rectum, Pancreas,Ovary,Leukemia

leading Sites of New Cases of Cancer in the United States, 2013

Men Prostate Lung and bronchus Colon and rectum Urinary bladder Melanoma Kidney and renal pelvis Women Breast Lung and bronchus Colon and rectum Uterine Thyroid Non-Hodgkin's lymphoma

Mortality

Mortality is the number of deaths that occur among people with a certain disease. Even if a disease causes very few deaths, it is still important to monitor the presence of that dis- ease. Illness causes lost days of work and school, leads to disability, incurs medical expenses, and can have a big impact on the economy.

To reduce your risk of cancer, look no farther than your fridge. Aim for five to nine daily servings of all kinds of fruits and vegetables—especially these superstars:

O Cruciferous vegetables such as broccoli, cauliflower, and cabbage O Beans O Berries O Tomatoes O Green leafy vegetables such as spinach and kale O Grapes O Garli

Grading

Part of cancer diagnosis is the grading and stag- ing of the cancer. Grading is helpful in making a prognosis of the disease. Malignant tumors are generally graded on a scale of one to four The higher the number the higher the degree of abnormality. Prostate, breast, and kidney cancer are graded by unique grading scales that reflect the characteristics of cells within these organs. Malignant tumors are staged to develop a treatment plan and to help predict the prognosis of the disease. Staging is classifying a tumor based on its size and the extent of its spread.

Common Prefixes Used to Name Tumors

Prefix Cell or Tissue of Origin adeno- gland angio- vessels (type not specified) chondro- cartilage fibro- fibrous tissue hemangio- blood vessels lymphangio- lymph vessels lipo- fat myo- muscle neuro- nerve osteo- bone

Staging

Staging is classifying a tumor based on its size and the extent of its spread. In the TNM staging system (Table 4-7 ): • T stands for tumor; it is based on the size of the original (primary) tumor and whether it has grown into nearby tissues. • N stands for node; it tells whether the cancer has spread to the nearby lymph nodes. • M stands for metastasis; it tells whether the cancer has spread to distant parts of the body.

Histology

Study of cells

metastasize

These abnormal cells infiltrate normal body tissue and in some cases spread or metastasize.

____________________ is the single greatest avoidable risk factor for cancer mortality worldwide

Tobacco use

Some viruses are carcinogens.

True

The most important risk factor for cancer is tobacco use.

True

Under a microscope the cells of a benign tumor resemble cells of their origin and have a uniform appearance.

True

____________________ are chemicals made by tumor cells that can be detected in blood.

Tumor markers

Benign

Tumors may be benign (not cancer) or malignant (cancer).

Jaundice

Yellow-orange discoloration of the skin, tissues, and the whites of the eyes caused when bilirubin (an orange pigment) accumulates in the plasma.

Dysuria

a sense of urinary urgency, and dysuria, a painful, burning sensation during urination.

Which of the following genes are not responsible for the cell division processes

a. cyclins

What type of cancer treatment uses high- energy rays to damage DNA of cells interfering with cell division and growth

a. radiation therapy

Ascites

abnormal accumulation of fluid in the abdomen A characteristic symptom of cirrhosis is distention of the abdomen caused by the accumulation of fluid in the peritoneal cavity. This fluid is called ascites and develops as a result of liver failure. The pressure within the obstructed veins forces plasma into the abdominal cavity. This fluid often must be drained.

Most other benign tumors are named by

adding the suffix oma to the prefix that designates the cell or tissue of origin For example, a benign tumor arising from fat tissue is called a lipoma.

____________________ uses medications that target rapidly dividing cells and therefore kill cancer cells and some normal cell

adenocarcinoma

Approximately 1,660,290 new can- cer cases are expected to be diagnosed in the United States in 2013. In 2013, about 580,350 Americans are expected to die of cancer ,

almost 1,600 people per day There were an estimated 14.1 million cancer cases diagnosed worldwide in 2012 The number of cancer cases diagnosed world- wide will continue to increase to an estimated 24 million by 2035. Cancer is the leading cause of death worldwide; in 2012 cancer killed 8.2 million people.

Monoclonal antibodies are synthetic

antibodies that are designed to bind to a specific antigen on a cancer cell.

Suicide genes control

apoptosis (programmed cell death) and tell the cell to kill itself if something goes wrong,

What scanning type of radiography creates a three-dimensional picture of the inside of the body with an x-ray machine

b. CT

. The N in the TNM malignant tumor staging stands for ____________________

b. node

The result of uncontrolled cell division is an abnormal growth of cells or a tumor (neoplasm). Tumors may be

benign (not cancer) or malignant (cancer). Some cancers do not form solid tumors. These include leukemia (cancer of the blood), most types of lymphoma (cancer of the lymphatic system), and myeloma (cancer of the bone marrow).

Normal rapidly dividing cells include

blood cells, bone marrow cells, cells of hair follicles, and cells lining the digestive tract. Damage to these cells causes the common side effects of anemia, hair loss, nau- sea, vomiting, and diarrhea. The side effects of chemotherapy are temporary and can often be treated.

Hematuria

blood in the urine; if present in large enough quantities, urine may be bright red or reddish brown

Osteosarcoma is a malignant tumor of the ____________________.

bone

Which of the following is not a general sign or symptom of cancer

c. hemorrhage

Which of the following is a known risk factor for cancer

c. infection with certain viruses

A carcinoma could arise in all the following except ____________________

c. muscle

In addition to genetics, lifestyle and environmental factors contribute to c

cancer

The progress of a cancer depends on the particular type of

cancer and its location. Without treatment, cancer usually results in death. The ultimate causes of death in cancer patients include secondary infection, organ failure, hemorrhage, and undetermined factors.

If a patient has signs and symptoms of cancer, or if a screening test result suggests cancer, a doctor must determine if

cancer is the cause. There is no single test that can accurately diagnose cancer. Diagnosis of cancer may include a complete per- sonal and family medical history, physical exam, blood tests, diagnostic imaging, and biopsy.

Part of cancer diagnosis is the grading and staging of the

cancer. Grading is helpful in making a prognosis of the disease.

Mutations can be caused by ____________________, which are cancer - causing agents or substances.

carcinogens

Mutations can be caused by

carcinogens, or cancer-causing agents or substances. Examples of carcinogens include particular viruses or bacteria, certain chemicals, and radiation.

Other mono- clonal antibodies carry

carry drugs or radioactive isotopes directly to cancer cells.

About half of cancer patients receive

chemotherapy treatment. Chemotherapy is used to treat many kinds of cancer, and many different chemotherapy drugs are used today.

Blood tests are used to measure the number of blood cells in

circulation and the levels of chemicals, enzymes, proteins, and waste products that are normally found in the blood. The levels of some chemicals normally found in the blood may be either too high or too low as a result of the cancer. Tumor markers are chemicals made by tumor cells that can be detected in blood. Tumor markers are also produced by some normal cells in the body and levels may be significantly elevated in noncancerous conditions. This limits the potential for tumor marker tests to help in diagnosing cancer. Examples of tumor markers include prostate-specific antigen for prostate cancer and cancer antigen 125 for ovarian cancer.

Carcinomas are more

common, grow slower, and metastasize primarily through the lymph.

The body is made up of trillions of living cells. These cells grow and divide in a

controlled way to produce more cells. When you are young, cells divide faster to allow you to grow.

Benign tumors ____________________.

d. all of the above

A benign tumor arising from fat tissue is called a(n) ___________________

d. lipoma

Some monoclonal antibodies attach to the cancer cell and signal the immune system to

destroy the cancer cell.

In the United States one-half of all men and one-third of all women will develop

develop cancer during their lifetimes. Cancer is the second most common cause of death in the United States, exceeded only by heart dis- ease, accounting for nearly one of every four deaths.

In most cases a biopsy must be done for a cancer

diagnosis. A small tissue sample is removed and the sample is viewed under a microscope. The size and shape of the cells, size and shape of the cell's nucleus, and arrangement of the cells are evaluated.

The side effects of radiation therapy depend on the

dose, type of radiation received, and part of the body treated. Common side effects include hair loss and skin irritation at the treatment site and fatigue. Most side effects are temporary and disappear over time once treatment has ended.

The majority of cancers are the result of acquired mutations that are due to

environmental and lifestyles factors and therefore are largely preventable. More than 50% of all cancers involve an acquired mutation in the tumor suppressor gene

Malignant tumors of

epithelial origin are named with the prefix that designates the cell or tissue of origin followed by the term carcinoma. For example, an adenocarcinoma is a malignant tumor of a gland. These tumors are found in the breast, colon, liver, lung, prostate, skin, and stomach.

Neoplasm

ew cells form when the body does not need them. The result of uncontrolled cell division is an abnormal growth of cells or a tumor (neoplasm). Tumors may be benign (not cancer) or malignant (cancer). Some cancers do not form solid tumors. These include leukemia (cancer of the blood), most types of lymphoma (cancer of the lymphatic system), and myeloma (cancer of the bone marrow).

At least half of all cancers are preventable.

false

Benign tumors invade surrounding tissues.

false

Carcinogenesis

formation of cancer

oncogenes

genes that cause cancer by blocking the normal controls on cell reproduction Oncogenes tell cells when to divide and tumor suppressor genes tell cells when not to divide.

The etiology of cancer puzzles researchers today nearly as much as it did 100 years ago. Cancer is partially explained by

genetics; however, life- style and environmental factors also contribute to cancer.

Radiation therapy uses

high-energy rays to damage DNA of cells, interfering with cell division and growth.

Nonspecific immunotherapies stimulate the

immune system in a very general way.

Immunotherapy stimulates and strengthens the

immune system so it can recognize and kill cancer cells.

Mutation in the four genes that are responsible for the cell division process can be

inherited or acquired.

Metrorrhagia

is bleeding between menstrual periods or extreme irregularity of the menstrual cycle.

During external radiation therapy, the radiation comes from a la

large machine outside the body that aims the beams at precise points on the body to destroy as few normal cells as possible

Malignant tumors are

life-threatening, grow rapidly, invade surrounding tissue, and may metastasize to other parts of the body through the blood or lymph. Malignant tumors have a crab-like appearance and an irregular surface . Under a microscope the cells of a malignant tumor do not resemble cells of their origin and do not have a uniform appearance . Malignant tumors are not encapsulated, making excision more difficult, and tend to reoccur.

Benign tumors are not

life-threatening, grow slowly, and remain localized. A benign tumor may grow and enlarge in the area but will not invade surrounding tissue or metastasize to other parts of the body through blood or lymph. Benign tumors have a smooth surface and are symmetrical. Under a microscope the cells of a benign tumor resemble cells of their origin and have a uniform appearance. Benign tumors are encapsulated (covered with a capsule-like mate- rial), which makes removal (excision) easier. Benign tumors rarely reoccur after removal.

The signs and symptoms of cancer will depend on the

location of the tumor, its size, and how much it affects the organs or tissues in the area. If a cancer has metastasized, signs or symptoms may appear in different parts of the body.

Cancer is not just one disease; there are

many different types of cancer. Cancer affects the young and old and involves nearly every tissue or organ in the body.

The immune system should recognize and destroy these

mutated cells, so cancer may also indicate a failure of the immune system.

Some cancers, such as breast cancer and prostate cancer, need

need hormones to grow. Surgery may be used to remove the source of the hormone (ovaries, testes). Hormone therapy medications can suppress hormone synthesis or block the action of hormones.

Surgery and radiation therapy are considered

ocal treatments; chemotherapy is a systemic treatment.

The treatment plan for cancer depends mainly on the

of cancer and the stage of the disease. The patient's age and general health may also be considered. Most treatment plans include sur- gery, radiation therapy, or chemotherapy, or a combination of these. Some treatment plans may include hormone therapy or immunotherapy.

Four types of genes are responsible for the cell division process:

oncogenes, tumor suppressor genes, suicide genes, and DNA repair genes.

Malignant tumors are generally graded on a scale of

one to four The higher the number the higher the degree of abnormality. Prostate, breast, and kidney cancer are graded by unique grading scales that reflect the characteristics of cells within these organs.

Primary tumor

original tumor; the source of metastasis T stands for tumor; it is based on the size of the original (primary) tumor and whether it has grown into nearby tissues.

During internal radiation therapy, the radiation is

placed inside the body in specific tissue to destroy as few normal cells as possible.

A benign tumor that projects from an epithelial surface is usually called a p

polyp

A malignant tumor of a gland is called an ____________________.

polyp

Malignant tumors are staged to develop a treatment plan and to help

predict the prognosis of the disease. Staging is classifying a tumor based on its size and the extent of its spread.

About half of all people with cancer receive

radiation therapy as part of their cancer treatment; radiation therapy is used to treat just about every type of cancer.

Chemotherapy uses medications that target

rapidly dividing cells and, therefore, kills cancer cells and some normal cells.

If possible, malignant tumors are

removed via surgery. The tumor and some surrounding tissue are removed. Removing surrounding tissue may help prevent the tumor from recurring. Nearby lymph nodes may also be removed to determine if cancer cells have entered the lymphatic sys- tem. Even with surgical removal, the possibility that malignant cells have been left behind may have to be addressed.

Cancer is the ____________________ most common cause of death in the United States.

second

Morbidity

the incidence of disease. Morbidity is the number of cases of a disease in a population.

Malignant tumors of the supportive tissue are named with

the prefix that designates the cell or tissue of origin followed by the term sarcoma.For example, an osteosarcoma is a malignant tumor of bone. These tumors are found in muscle, bone, and cartilage. Sarcomas are less common, grow faster, and metastasize primarily through the blood.

When cancer is found early, treatment may be more likely to work. But decisions about how to treat older adults may depend more on their general health and

their quality of life than on their actual age. The presence of other health problems and the medications they are taking for these can also affect which cancer treatments they will receive. On the other hand, older adults who are generally healthy do as well with most treatments, including chemotherapy, as their younger counterparts.

Benign tumors rarely reoccur after removal.

true

In the United States half of all men will develop cancer in their lifetimes.

true

The majority of cancers are the result of acquired mutations.

true

There is no single test that can accurately diagnose cancer.

ture

Cancer is characterized by ____________________ growth of abnormal cells in the body

uncontrolled

Oncogenes tell cells when to divide and tumor suppressor genes tell cells when not to divide. Mutations that inhibit the function of oncogenes and tumor suppressor genes cause

uncontrolled cell division that may result in cancer.

The mechanism of all cancers is

uncontrolled cell division, which is the result of alterations (mutation) in genes (pieces of DNA) that play a role in the cell division process.

Cancer is characterized by

uncontrolled growth of abnormal cells in the body. These abnormal cells infiltrate normal body tissue and in some cases spread or metastasize.

Once you are an adult, most cells divide only to replace worn- out or dying cells or to repair injuries. Some- times cell division becomes

uncontrolled; cells do not die when they should and new cells form when the body does not need them.

The skin frequently serves as a marker for

underlying internal diseases. Having any of these signs and symptoms does not mean that you have cancer; many other things cause these signs and symptoms, too. Specific cancers have additional signs and symptoms, which will be included in later discussions of specific body systems.

In a grade 4 tumor, the tumor cells look

very abnormal

General signs and symptoms of cancer include

weight loss, fever, fatigue, pain, and skin changes (hyperpigmentation, jaun- dice, erythema, pruritis, excessive hair growth). Unexplained weight loss may be a result of cancer cells competing for nutrients, often at the expense of normal cells' growth and metabolism. Fever is often a systemic response to infection; however, fever is also a common sign of leukemia and lymphoma. Fatigue may be the result of the cancer's effect on the body or the body's response to the cancer. Pain can result from the malignant tumor putting pressure on nerves, bones, or organs.

Inherited mutations in the tumor suppressor BRCA1 or BRCA2 genes increases a

woman's risk of developing hereditary breast or ovarian cancers.

Research shows that certain risk factors increase the chance that a person will develop cancer.

• Age. The most important risk factor for can- cer is growing older. About 77% of all can- cers are diagnosed in persons 55 years of age and older. • Tobacco use. Tobacco use is strongly linked to an increased risk for many types of can- cer. Cigarette smoking causes about 30% of all cancer deaths in the United States. • Infections. Certain infections increase the risk for some types of cancer: ➢ Human papillomavirus increases the risk for cancers of the cervix, penis, vagina, anus, and vulva. ➢ Hepatitis B and hepatitis C viruses increase the risk for liver cancer. ➢ Epstein-Barr virus increases the risk for lymphoma and nasopharynx cancer. ➢ Human herpesvirus 8 has been found in nearly all tumors in patients with Kaposi sarcoma. ➢ Human T-lymphotrophic virus-1 has been linked to adult T-cell leukemia. ➢ Helicobacter pylori increases the risk for gastric cancer. • Radiation. Being exposed to radiation is a known cause of cancer. There are two main types of radiation linked with an increased risk for cancer: ➢ Ultraviolet (UV) radiation from sunlight is the main cause of nonmelanoma skin cancers. ➢ Ionizing radiation, including medical radiation (x-rays, CT scans, fluoroscopy, nuclear medicine scans), and radon gas in our homes. Ionizing radiation causes leukemia, thyroid cancer, and breast cancer. • Immunosuppressive medications. If a cell has a mutation and is abnormal the immune system should recognize and kill abnormal cells. Both nonspecific and spe- cific immunity are involved in the elimi- nation of abnormal cells. Natural killer cells, part of nonspecific immunity, secrete chemicals that cause pores to form in the membrane of abnormal cells, leading to cell death. Cytotoxic T cells, part of specific immunity, are also involved in the elimina- tion of abnormal cells. Immunosuppressive medications decrease immune function and therefore increase the risk for development of cancer.

A variety of methods are available to view internal organs, to screen for cancer, and to detect tumors.

• Radiography is the use of x-rays to form a still or moving picture of the inside of the body. A mammogram is an x-ray photo- graph of the breast. Potentially malignant tumors show up on a mammogram as small white areas (Figure 4-4 ). • Computed tomography (CT) is a scanning type of radiography that creates a three- dimensional picture of the inside of the body with an x-ray machine (Figure 4-5 ). A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes a contrast medium (a special dye) is injected into a patient's vein to provide better detail. • Magnetic resonance imaging (MRI) is a type of scanning that uses a magnetic field, not x-rays, to induce tissues to emit radio waves. Different tissues can be dis- tinguished because each emits different signals. With MRI, tumors can then be visualized on a computer screen in cross sections similar to those produced in CT scanning (Figure 4-6 ). A contrast medium may be injected into a patient's vein to create a clearer picture. • During ultrasonography, high-frequency sound waves are reflected off internal tissues to produce an image called a sonogram. Ultrasound does not involve radiation, is easy to use, and is inexpensive

the TNM staging system

• T stands for tumor; it is based on the size of the original (primary) tumor and whether it has grown into nearby tissues. • N stands for node; it tells whether the can- cer has spread to the nearby lymph nodes. • M stands for metastasis; it tells whether the cancer has spread to distant parts of the body. ------------------------------------------------------ T (Tumor): -TX Tumor can't be measured -TO No evidence of primary tumor -Tis Cancer cells are only growing in the most superficial layer of tissue, without growing into deeper tissues. This may also be called in situ cancer. -T1-4 Describe the tumor size and/or amount of spread into nearby structures. The higher the T number, the larger the tumor and/or the more it has grown into nearby tissues. N (nodes): -NX Nearby lymph nodes cannot be evaluated -NO Nearby lymph nodes do not contain cancer -N1-3 Describe the size, location, and/or the number of lymph nodes involved. The higher the N number, the more lymph nodes there are that contain cancer. M (metastasis): -MX Metastasis cannot be evaluated -MO No distant metastasis was found -M1 Distant metastases were found