Chapter 7 (Cancer)- Study Guide Questions

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." What can the nurse say to decrease his anxiety? How would the nurse explain the way chemotherapy works to the boy's parents?

"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." Since the clients cancers found in his blood and bone marrow, surgery cannot be used 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 tumor as well as other distant sites. Cancer chemotherapeutic drugs exert their effects through several mechanisms. At the cellular level, they exert their lethal action by targeting processes that prevent cell growth and replication. These mechanisms include disrupting the production of essential enzymes, inhibiting DNA, RNA, and protein synthesis, and preventing cell reproduction.

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

-oma

List the factors used to describe benign and malignant neoplasm.

1. cell characteristics 2. rate of growth 3. manner of growth 4. capacity to invade and metastasize to other parts of the body 5. potential for causing death

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

30

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

Anaplasia.

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

Anemia.

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.

Compare and contrast benign and malignant tumors.

Benign tumor -> well-differentiated cells; confined to the area of tissue origin (cannot control proliferation, but differentiate normally) Malignant tumors -> less-differentiated cells; reenter circulation and establish secondary tumors in another region of the body (cannot control proliferation OR differentiation)

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

Benign tumors.

A tissue __________ involves the removal of a tissue specimen for microscopic study.

Biopsy.

List some of the common methods used for diagnosing cancer.

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

Tumor-inititating cells

Cancer stem cells.

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

Carcinoma.

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

Cells that display abnormal surface proteins are missed and allowed to persist in the body (usually cleared by a healthy immune system)

Epigenetic effects

Changes in gene expression without DNA mutation.

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.

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.

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

Differentiation.

Cancer is a disorder of altered cell __________ and ___________.

Differentiation; growth.

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

Embryonic.

Anchorage dependence

Epithelial cells must be anchored to either neighboring cells of 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.

Explain how a normal cell turns into a malignant neoplasm.

Growth-promoting oncogenes Inactivation of tumor suppressor genes Alterations in genes that control apoptosis --> unregulated cell growth and differentiation --> eventually a malignant neoplasm

__________ is the only known retrovirus to cause cancer in humans.

Human T cell leukemia virus 1

Cachexia is marked by a hyper metabolic state. Give 2 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 glucose and waste 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.

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?

In terms of cell proliferation, the cells may be divided into 3 groups- 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 reenter the cell cycle and produce large numbers of progenitor cells when the need arises

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

Kinases.

Anaplasia

Loss of cell differentiation.

Describe the process and routes of metastasis.

Lymphatic channels --> tumor cells lodge first in the initial lymph node that receives drainage from the tumor site; then spread from more distant lymph nodes to the thoracic duct and then gain access to the blood vasculature (rest of body) Hematologic spread --> may enter the venous flow that drains the site of the primary neoplasm or blood vessels around the tumor

Genetic instability

Marked by chromosomal aberrations (abnormalities).

Tumor

Mass of cells due to overgrowth.

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

Neoplasm.

Proto-oncogene

Normal gene that can cause cancer if mutated.

What is paraneoplastic syndrome?

Paraneoplastic syndromes are characterized by manifestations in sites that are not directly affected by the disease. Most commonly, manifestations are caused by the elaborate action of hormones by cancer cells and others from the production of circulating factors that produce hematopoietic, neurologic, and dermatological syndromes.

Kinases are enzymes that __________ proteins.

Phosphorylate.

A __________ is growth that projects from a mucosal surface.

Polyp.

Proliferation

Process of cell division.

Differentiation

Process of cell specialization.

Apoptosis

Process that removed senescent (aged) and/or damaged cells *programmed* NOT due to injury (stabs, etc)

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.

What happens when tumor suppressor gene is less active?

Promotes cancer

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.

Proto-oncogenes; suppressor.

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

Radiation.

Growth fraction

Ratio of dividing cells to resting cells.

There are 2 categories of malignant neoplasms: __________ tumors and __________ cancers.

Solid; hematological.

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

Staging --> according to the extent of their disease Grading --> microscopic examination; level of differentiation and the number of mitosis Grades I, II, III, and IV with increasing anaplasia or lack of differentiation

Renewal

Stem cells undergoing numerous mitotic divisions while maintaining an undifferentiated state.

__________ cells remain incompletely undifferentiated throughout life.

Stem.

Oncology

Study of tumors and their treatment.

Doubling time

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

Cellular potency in order from the least differentiated to the most differentiated.

Totipotent, Pluripotent, Multipotent, Unipotent.

p53

Tumor suppressor gene.

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

Ulceration; necrosis.

Malignant mass

Undefined or less-differentiated cellular mass.

Benign mass

Well-differentiated mass of cells.

One group of chemical carcinogens is called indirect-reacting agents. Another term for these agents is pro carcinogens, which become active only after metabolic conversion. One of the most potent procarcinogens is a group of dietary carcinogens called: a. Polycyclic aromatic hydrocarbons b. Aflatoxins c. Initiators d. Diethylstilbestrol

a. Polycyclic aromatic hydrocarbons Most known dietary carcinogens either occur naturally in plants (aflatoxins) or are produced during food preparation. Among the most potent of the procarcinogens are the polycyclic aromatic hydrocarbons. The polycyclic aromatic hydrocarbons are of particular interest because they are produced from animal fat in the process of charcoal-broiling meats and are present in smoked meats and fish. There also are produced in the combustion of tobacco and are present in cigarette smoke. Initiators is another term for procarcinogens. Diethylstilbestrol was a drug that was widely used in the United States from the mid-1940s to 1970 to prevent miscarriages.

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? a. This tumor I have, will I die from it? b. Even though benign tumors can't stop growing, they aren't considered cancer. c. Benign tumors still produce normal cells different from other cells around them. d. This kind of tumor can't invade other organs or travel to other places in the body to start new tumors.

a. This tumor I have, will I die from it? Asking if his tumor will make him die shows lack of understanding of educational material he has been given. For unknown reasons, benign tumors have lost the ability to suppress the genetic program for cell proliferation but have retained the program for normal cell differentiation. They do not have the capacity to infiltrate, invade, or metastasize to distant sites.

A woman diagnosed with breast cancer asks the nurse how a malignant tumor in her breast could spread to other parts of the body. The nurse answers that malignant neoplasm is made up of less well-differentiated cells that have which of the following abilities? (select all that apply) a. break loose b. reinvade their original site c. enter the circulatory or lymphatic systems d. be excreted through the alimentary canal e. form secondary malignant tumors at other sites

a. break loose c. enter the circulatory or lymphatic systems e. form secondary malignant tumors at other sites Form secondary tumors at sites other than the original tumor site Malignant neoplasms are not passed out of the body as waste through the alimentary canal

Childhood cancers are often diagnosed late in the disease process because the signs and symptoms mimic other childhood diseases. However, with the huge strides in treatment methods more and more children survive childhood cancer. These survivors face the uncertainty of what the life-theratening treatment during their childhood may produce what late effects? (select all that apply) a. cardiomyopathy and pulmonary fibrosis b. cognitive dysfunction and hormonal dysfunction c. second malignancies and liver failure d. impaired growth and second malignancies

a. cardiomyopathy and pulmonary fibrosis b. cognitive dysfunction and hormonal dysfunction d. impaired growth and second malignancies With improvement in treatment methods, the number of children who survive childhood cancer is continuing to increase. As these children approach adulthood, there is continued concern that the life-saving therapy they received during childhood may produce late effects, such as impaired growth, cognitive dysfunction, hormonal dysfunction, cardiomyopathy, pulmonary fibrosis, and risk for second malignancies. Liver failure is not viewed as a late effect of childhood cancer therapy.

Therapeutic radiation can be delivered in which of the following ways? (select all that apply) a. external beam b. brachytherapy c. systemic therapy d. light therapy

a. external beam b. brachytherapy c. systemic therapy Therapeutic radiation can be delivered in one of three ways. External beam, where beams generated by a linear accelerator at a distance and aimed at the patient's tumor Brachytherapy, where a sealed radioactive sources placed close to or directly in the tumor site Systemic therapy, in which radioisotopes with a short half-life are given by mouth or injected into the tumor site.

A big difference in the treatment of childhood cancer as opposed to adult cancer is that chemotherapy is the most widely used treatment therapy for childhood cancer. What is the reason for this? a. pediatric tumors are more responsive to chemotherapy than most adult cancers b. children do not tolerate other forms of therapy as well as adults do c. children do not complain about nausea and vomiting caused by chemotherapy like adults do d. children think that losing their hair is cool

a. pediatric tumors are more responsive to chemotherapy than most adult cancers Chemotherapy is more widely used in the treatment of children with cancer than in adults because children better tolerate the acute adverse effects, and in general, pediatric tumors are more responsive to chemotherapy than adult cancers. Children are very adaptable and tolerate more forms of cancer treatment than adults do. Children do complain about the nausea and vomiting chemotherapy can cause, just like adults do, and they do not like losing their hair, just like adults.

The nurse in an oncology unit has jut 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? a. The cancer cells are not able to float around the original tumor in body fluids. b. Cancer cells enter the body's lymph system and thereby spread to other parts of the body. c. Cancer cells are moved from one place in the body to another by transporter cells. d. Cancer cells replicate and form a chain that spreads from the original tumor site to there site of the metastatic lesion.

b. Cancer cells enter the body's lymph system and thereby spread to other parts of the body. Via blood or lymph; can shed into fluid surrounding tumor

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? a. Colon and rectal cancers b. Lung and ovarian cancers c. Breast and colon cancers d. Ovarian and rectal cancers

b. Lung and ovarian cancers *Lung cancers*, breast cancers, and lymphomas account for about 75% of malignant pleural effusions. Complaints of abdominal discomfort, swelling, and a feeling of heaviness and an increase in abdominal girth, which reflect the presence of peritoneal effusions, are the most common presenting symptoms in *ovarian cancer*, occurring in up to 65% of women with the disease.

Cancer cells differ from normal cells in many ways. They have lost their 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? (select all that apply). a. cancer cells have an increased tendency to stick together. b. cancer cells have an unlimited life span. c. cancer cells need decreased amounts of growth factor to proliferate d. cancer cells need increased amounts of growth factor to proliferate e. cancer cells are termed genetically unstable

b. cancer cells have an unlimited life span. c. cancer cells need increased amounts of growth factor to proliferate e. cancer cells are termed genetically unstable Immortal with an unlimited life span Cancer cells often lose cell density-dependent inhibition, which is the cessation of growth after cells reach a particular density. This is sometimes referred to as contact inhibition because cells often stop growing when they come into contact with each other Ability to proliferate even in the absence of growth factors Genetic instability

Which is an abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues? a. transformation b. neoplasm c. mutation d. insertion

b. neoplasm An abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues is called a neoplasm Transformation occurs when a cell has become cancerous Mutation is an alteration in the DNA that may or may not result in a transformation Insertion is a type of mutation

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? a. Body type, age, and hereditary. b. Radiation, cancer-causing viruses, and color of skin. c. Hormonal factors, chemicals, and immunologic mechanisms. d. Immunologic mechanisms, cancer-causing viruses, and color of skin.

c. Hormonal factors, chemicals, and immunologic mechanisms. Cancer occurs because of interactions among multiple risk factors or repeated exposure to a single carcinogenic agent. Among the traditional risk factors that have been linked to cancer are heredity, hormonal factors, immunological mechanisms, and environmental agents such as chemicals, radiation, and cancer-causing viruses. More recently, there has been an interest in obesity and type 2 diabetes mellitus as risk factors for a number of cancers. Body type, age, and color of skin have not been identified as risk factors for cancer.

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? a. prostate-specific antigen (PSA) and deoxyribonucleic acid b. deoxyribonucleic acid and carcinoembryonic antigen c. alpha-fetoprotein and human chorionic gonadotropin d. chorionic gonadotropin and cyclin-dependent kinases

c. alpha-fetoprotein and human chorionic gonadotropin Human chorionic gonadotropin (hCG), CA 125, prostate-specific antigen (PSA), alpha-fetoprotein, carcinoembryonic antigen, and CD blood cell antigens Deoxyribonucleic acid is DNA and is not a serum tumor marker Cyclin-dependent kinases come from a family of proteins called cyclins, which control entry and progression of cells through the cell cycle Cyclins act by complexing with proteins called cyclin-dependent kinases (CDKs). They are not serum tumor markers.

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 cancer. There is 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 carries the gene? a. Retinoblastoma b. Osteosarcoma c. Acute lymphocytic leukemia d. Colon cancer

d. Colon cancer Familial adenomatous polyposis of the colon also follows an autosomal dominant inheritance pattern. It is caused by mutation of another tumor suppressor gene, the APC gene. In people who inherit this gene, hundreds of adenomatous polyps may develop, some of which inevitably become malignant. Retinoblastoma is inheritable through an autosomal dominant gene, but only about 40% of retinoblastomas are inherited. Osteosarcoma and ALL are not inheritable through an autosomal dominant process.

Which screening test is used to detect prostate cancer? a. mammography b. self-examination c. pap smear d. PSA

d. PSA PSA stands for prostate specific antigen. PSA is measured in simple blood tests and is used as an indicator for prostate cancer risk.

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? a. hypocalcemia b. cardiovascular longevity c. hyperinsulinemia d. dyslipidemia

d. dyslipidemia Growth hormone deficiency in adults is associated with increased prevalence of dyslipidemia, insulin resistance, and cardiovascular mortality. Hypocalcemia is a deficiency of calcium in the serum that may be caused by hypoparathyroidism, vitamin D deficiency, kidney failure, acute pancreatitis, or inadequate amounts of plasma magnesium and protein. It does not result from cancer therapy during childhood. Hyperinsulinemia is associated with syndrome X, which is a condition characterized by hypertension with obesity, type 2 diabetes mellitus, hypertriglyceridemia, increased peripheral insulin resistance, hyperinsulinemia, and elevated catecholamine levels.

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

p53 (tumor suppressor gene)