Chapter 7

The nurse has provided an educational session with a 56-year-old man newly diagnosed with a benign tumor of the colon. The nurse knows that the patient needs further teaching when he makes which remark?

"This tumor I have, will I die from it?"

List the factors used to describe benign and malignant neoplasm

-Cell characteristics -Rate of growth -Manner of growth - Capacity to invade and metastasize to other parts of the body -Potential for causing death

Not all cells in the body can reenter the cell cycle, but some will do so continuously. In terms of regeneration and differentiation, which types of cells will or will not reenter the cell cycle?

-The well-differentiated neurons and cells of skeletal and cardiac muscle that rarely divide and reproduce -The progenitor or parent cells that continue to divide and reproduce, such as blood cells, skin cells, and liver cells - The undifferentiated stem cells that can be triggered to enter the cell cycle and produce large numbers of progenitor cells when the need arises

tumors usually are named by adding the suffix __________ to the parenchymal tissue type from which the growth originated

-oma

Tumor cells must double _______ times before there will be a palpable mass.

30

An 8-year-old boy has been diagnosed with acute lymphocytic leukemia (ALL). His treatment plan includes placement of an implanted central venous catheter and multiple administrations of chemotherapy. The client says, "NO! I don't want to be stuck with needles all the time." A. What would the nurse tell the client to decrease his anxiety? B. How would the nurse explain the way chemotherapy works to the boy's parents?

A. "To make it better for you, the doctor is going to put a tube just under your skin that the nurses can put your medication in, so they won't have to stick you in the hands and arms so many times. You will still get stuck by a needle, but it will not be as painful as trying to start an IV in your arms." B. Since the client's cancer is found in his blood and bone marrow, surgery can't be use to cure it. Chemotherapy is the primary treatment for most hematologic and some solid tumors. Chemotherapy is a systemic treatment that enables drugs to reach the site of the tumors as well as other distant sites.

Tumor markers are used for screening, establishing prognosis, monitoring treatment, and detecting recurrent disease. Which serum tumor markers have been proven to be among the most useful in clinical practice?

Alpha-fetoprotein and human chorionic gonadotropin

---- is a common side effect of many cancers. It is related to blood loss, hemolysis, impaired red cell production, or treatment effects

Anemia

---- do not usually cause death unless the location interferes with a vital organ's function

Benign tumors

List some of the common methods used for diagnosing cancer.

Blood tests for tumor markers, cytologic studies and tissue biopsy, endoscopic examinations, ultrasound, x-ray studies, MRI, computed tomography, and positron emission tomography

Compare and contrast benign tumors and malignant tumors

Both benign and malignant tumors have lost the ability to suppress growth. As a result, the tumor cells begin to proliferate. Benign tumors are composed of well-differentiated cells and are confined to the area of tissue origin. In contrast, malignant tumors are composed of less differentiated cells that will reenter circulation and establish secondary tumors in another region of the body.

A woman diagnosed with breast cancer asks her nurse how a malignant tumor in her breast could spread to other parts of her body. The nurse answers that a malignant neoplasm is made of up less well-differentiated cells that have which of the following abilities?

Break loose Enter the circulatory or lymphatic system Form secondary malignant tumors at other sites

The nurse in the oncology unit has just admitted a patient with metastatic cancer. The patient asks how cancer moves from one place to another in the body. What would the nurse answer?

Cancer cells enter the body's lymph system and thereby spread to other parts of the body

Explain how a diminished immune system may play a role in carcinogenesis.

Cancer cells express abnormal cell surface proteins. With a compromised immune system, these abnormalities are missed and allowed to persist in the body

Cancer cells differ from normal cells in many ways. They have lost the ability to accurately communicate with other cells, and they do not have to be anchored to other cells to survive. How else are they different from other cells?

Cancer cells have an unlimited life span Cancer cells have lost contact inhibition Cancer cells are termed genetically unstable

Childhood cancers are often diagnosed late in the disease process because the signs and symptoms mimic other childhood diseases. However, with huge strides in treatment methods more and more children survive childhood cancer. These survivors face the uncertainty of what the life-saving treatment they received during their childhood may produce what late effects?

Cardiomyopathy and pulmonary fibrosis Cognitive dysfunction and hormonal dysfunction Impaired growth and second malignancies

Epigenetic effects

Changes in gene expression without DNA mutation

What is paraneoplastic syndrome?

Characterized by manifestations in sites that are not affected by the disease. Most commonly, manifestations are caused by the elaboration of hormones by cancer cells and others from the production of circulating factors that produce hematopoietic, neurlogic, and dermatological syndromes.

Chemical carcinogens act in 2 distinct ways. What are they?

Chemicals will cause cellular transformation either directly (direct reacting agents) or indirectly, only becoming activated via a metabolic process (initiators)

---- is a systemic treatment that enables drugs to reach the site of the tumor as well as other distant sites

Chemotherapy

Several cancers have been identified as inheritable through an autosomal dominant gene. People who inherit these genes are generally only at increased risk for developing the cancer. There is only one type of cancer, however, that is almost certain to develop in someone who inherits the dominant gene. Which cancer carries the highest risk of developing in someone who carriers the gene?

Colon cancer

---- is the process of specialization whereby new cells acquire the structure and function of the cells they replace

Differentiation

Cranial radiation therapy (CRT) has been used to treat brain tumors, ALL, head and neck soft tissue tumors, and retinoblastoma in children. Childhood cancer survivors who had CRT as therapy for their cancers are prone to growth hormone deficiency. In adults, what is growth hormone deficiency associated with?

Dyslipidemia

---- stem cells are pluripotent cells derived from the inner cell mass of the blastocyst stage of the embryo

Embryonic

Therapeutic radiation can be delivered in which of the following ways?

External beam Brachytherapy Systemic therapy

It is well known that cancer is not a single disease. It follows then that cancer does not have a single cause. It seems more likely that the occurrence of cancer is triggered by the interactions of multiple risk factors. What are some identified risk factors for cancer?

Hormonal factors, chemicals, and immunologic mechanisms

---- is the only known retrovirus to cause cancer in humans

Human T-cell leukemia virus-1

Cachexia is marked by a hypermetabolic state. Give two reasons for this and explain the consequences.

Hypermetabolism is the result of the rapidly growing tumor and the increased expression of uncoupling proteins. The tumor uses large quantities of glucose via glycolysis, therefore producing high levels of lactic acid. The lactic acid undergoes the energy-requiring process of gluconeogenesis in order to convert it back to glucose. This uses large amounts of ATP. The second reason is the presence of uncoupling proteins. The uncoupling proteins uncouple oxidative phosphorylation, thereby reducing the amount of ATP produced.

In some cancers, the presenting factor is an effusion, or fluid, in the pleural, pericardial, or peritoneal spaces. Research has found that almost 50% of undiagnosed effusions in people not known to have cancer turn out to be malignant. Which cancers are often found because of effusions?

Lung and ovarian cancers

Genetic instability

Marked by chromosomal aberrations

Describe the process and routes of metastasis

Metastasis occurs via lymph channels and blood vessels. When metastasis occurs by way of the lymphatic channels, the tumor cells lodge first in the initial lymph node that receives drainage from the tumor site. If they survive, cancer cells may spread from more distant lymph nodes to the thoracic duct, and then gain access to the blood vasculature. With hematologic spread, the blood borne cancer cells may enter the Venus flow that drains the site of the primary neoplasm. Cancer cells may also enter tumor-associated blood vessels that either infiltrate the tumor or are found at the periphery of the tumor.

Which screening test is used to detect prostate cancer?

PSA

A big difference in the treatment of childhood cancer as opposed to adult cancer is the chemotherapy is the most widely used treatment therapy for childhood cancer. What is the reason for this?

Pediatric tumors are more responsive to chemotherapy than adult cancers

One group of chemical carcinogens is called indirect-reacting agents. Another term for these agents is procarcinogens, which become active only after metabolic conversion. One of the most potent procarcinogens is a group of dietary carcinogens called:

Polycyclic aromatic hydrocarbons

---- therapy uses high-energy particles or waves to destroy or damage cancer cells

Radiation

---- cells remain incompletely undifferentiated throughout life

Stem

Renewal

Stem cells undergoing numerous mitotic divisions while maintaining an undifferentiated state

Cancers are graded and staged on their characteristics in order to determine a treatment regimen. Explain the grading and staging system and how it is met.

The clinical staging of cancer is intended to group patients according to the extent of their disease. Grading tumors involves the microscopic examination of cancer cells to determine their level of differentiation and the number of mitoses.

Malignant mass

Undefined or less differentiated cellular mass

Benign mass

Well-differentiated mass of cells

The term ---- is used to describe the loss of cell differentiation in cancerous tissue

anaplasia

A common manifestation of solid tumors is the cancer ---- syndrome and is associated with weight loss and wasting of body fat and muscle

anorexia-cachexia

-blastoma

associated with embryological tissue as the origin of cancer

A tissue ---- involves the removal of a tissue specimen for microscopic study

biopsy

Tumor-initiating cells

cancer stem cells

The term ---- is used to designate a malignant tumor of epithelial tissue origin

carcinoma

Malignant neoplasms are less well ---- and have the ability to break loose, enter the circulatory or lymphatic systems, and form secondary malignant tumors at other sites

differentiated

Cancer is a disorder of altered cell ---- and ----

differentiation and growth

Anchorage dependence

epithelial cells must be anchored to either neighboring cells or the underlying extracellular matrix to live and grow

A characteristic of cancer cells is the ability to proliferate even in the absence of ----

growth factors

Proteins called ---- control the entry and progression of cells through the cell cycle

kinases

Anaplasia

loss of cell differentiation

Tumor

mass of cells due to overgrowth

The term ---- refers to an abnormal mass of tisse in which the growth exceeds and is uncoordinated with that of the normal tissues

neoplasm

Which is an abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues?

neoplasm

Protooncogene

normal gene that can cause cancer if mutated

With homologous loss of ______ gene activity, DNA damage goes unrepaired and mutations occur in dividing cells, leading to malignant transformations.

p53

Kinases are enzymes that ---- proteins

phosphorylate

A ---- is growth that projects from a mucosal surface

polyp

Proliferation

process of cell division

Apoptosis

process that removes senescent and/or damaged cells

Continually renewing cell populations rely on ___________ cells of the same lineage that have not yet differentiated to the extent that they have lost their ability to divide.

progenitor

The process of cell division results in cellular ----

proliferation

Tumor suppressor gene

promote cancer when less active

The types of genes involved in cancer are numerous, with 2 main categories being the ----, which control cell growth and replication, and tumor ---- genes, which are growth-inhibiting regulatory genes

protooncogenes and suppressor

Growth fraction

ratio of dividing cells to resting cells

There are 2 categories of malignant neoplasms: ---- tumors and ---- cancers

solid and hematological

Oncology

study of tumors and their treatment

Differentiation

the process of cell specialization

Doubling time

time it takes for the total mass of cells in a tumor to double

p53

tumor suppressor gene

As cancers grow, they compress and erode blood vessels, causing ________ and _______ along with frank bleeding and sometimes hemorrhage.

ulceration and necrosis