Pathophysiology exam 2 Chapter 9

Exposure to mutagens

-If the mutation occurs in somatic cells, it is not passed to progeny or generation to generation -If the mutation occurs in germline cells (gametes), it can be passed to future generations

TNM classification: Regional Lymph Nodes (N) Define NX, N0, N1, N2, N3

-NX Regional lymph nodes cannot be evaluated -N0 No regional lymph node involvement -N1: lymph node is soft and don't appear to have cancer but actually do have cancer inside -N2: appearance of cancer thick and rigid -N3: multiple lymph nodes that appear and are cancerous -Involvement of regional lymph nodes (number of lymph nodes and/or extent of spread)

(diagnosis)Cancer may be discovered in many ways; such as:

-Routine exams: help to catch cancers early -After investigation of symptoms **Universal symptoms that implicate cancer: swallowing troubles or changes in their voice, if they have a mole or any skin tag or tissue that changes size color or shape, a change In bowl or bladder habits, blood coming from anywhere its not suppose to (urine, stool, coughing up brown bloody blood) unexplained or unintentional weight loss, abnormal lump or mass

Tumor markers are used to:

-Screen and identify individuals at high risk for cancer -Can use PSA tumor marker to check and see how well treatment is working -Diagnose specific types of tumors -Observe clinical course of cancer -Problem: false positives and negatives

Clinical Manifestations: Fatigue

-Subjective clinical manifestation -Causes: sleep disturbances, treatment, psychosocial factors, nutritional status -Tiredness, weakness, lack of energy, exhaustion, lethargy, inability to concentrate, depression, sleepiness, boredom, and lack of motivation

Staging: World Health Organization's TNM system (What does T, N, M stand for)

-T for tumor spread -N for node involvement -M for the presence of distant metastasis

the process of cancer

1. mutation inactivates suppressor gene 2. Cells proliferate 3. mutations inactivate DNA repair genes 4. proto-oncogenes mutate to oncogenes 5. more mutations, more genetic instability, metastatic disease

Tumor spread

1st: Direct invasion of contiguous organs(Known as local spread, spread to tissues closest to it) -Macrophages and other cells secrete proteases to digest tissue capsules -Changes in cell-to-cell adhesion, makes cancer cells more mobile (bad) -Invades blood vessels or lymphatic system -Stimulation of neoangiogenesis and lymphangiogenesis aka proliferate and growth -Attachment to new environment -Cellular multiplication=new tumor

Stage IV

Distant metastasis (breast cancer that is now in your lungs)

Stage III

Spread to regional structures (lymph nodes)

Bacterial cause of cancer

ex. Helicobacter pylori *Chronic infections are associated with: -Peptic ulcer disease -Stomach (gastric) carcinoma -Gastric mucosa-associated lymphoid tissue lymphomas (MALT)

Lymphoma

from lymphatic tissue

the suffix oma means

tumor, mass

Proto-oncogenes

(normal genes in the nonmutant state) -Control growth and cell proliferation (don't allow things to run amuck) -Oncogene in its normal, nonmutant state -comes first

Clinical Manifestations: Anemia and its mechanisms

-A decrease of hemoglobin in the blood *Mechanisms: -Chronic bleeding resulting in iron deficiency -Severe malnutrition -Medical therapies (chemotherapy) -Malignancy in blood-forming organs **Seen often in those who have complications with chemptherapy

Malignant tumors are distinguished from benign tumors by more rapid growth and specific microscopic alterations including:

-Anaplasia-loss of differentiation (the microscopic hallmark of cancer cell)...don't look like where they came from Pleomorphic-variable size and shape -cancer is not from outside sources, it is from our own cells that change and mutate

Benign vs. Malignant

-Benign tumor cells grow only locally and cannot spread by invasion or metastasis -Malignant cells invade neighboring tissues, enter blood vessels, and metastasize to different sites

What are some of the characteristics that make cancer cells thrive and survive in different habitats

-Decreased need for growth factors to multiply (don't need our growth factors they multiply on their on) -Lack contact inhibition-pile up on each other (no personal space) -Anchorage independent-continue to divide in soft gel growing environment (don't have to be anchored to my tissue to grow) -Immortal-unlimited life span and will continue to divide for years under appropriate lab conditions and environments

Staging involves

-Determining the size of the tumor -The degree to which it has locally invaded -The extent to which it has spread (metastasized)

Clinical Manifestations: Leukopenia and thrombocytopenia

-Direct tumor invasion to the bone marrow causes leukopenia (decreased total WBC) and thrombocytopenia (decreased total platelets) -Chemotherapy drugs are toxic to the bone marrow -Kill the bad stuff and the good stuff *Infection: -Risk increases when the absolute neutrophil and lymphocyte counts fall (neutropenic)

Clinical Manifestations: Pain & its mechanisms

-Little or no pain is associated with early stages of malignancy -Most feared complication of advanced cancer -Influenced by fear, anxiety, sleep loss, fatigue, and overall physical deterioration *Mechanisms: -Direct pressure -Obstruction -Invasion of sensitive structures -Stretching of visceral surfaces (abdomin) -Tissue destruction -Inflammation

Clinical Manifestations: Syndrome of cachexia

-Most severe form of malnutrition -Present in 80% of cancer patients at death -Includes anorexia, early satiety, weight loss, anemia, asthenia (lack of energy), taste alterations, and altered protein, lipid, and carbohydrate metabolism **does not always associate with cancer

TNM Classification: Primary Tumor (T) Define TX, T0, Tis, T1, T2, T3, T4

-TX Primary tumor cannot be evaluated -T0 No evidence of primary tumor, just infectious tissue -Tis Carcinoma in situ (CIS; abnormal cells are present but have not spread to neighboring tissue; although not cancer, CIS may become cancer and is sometimes called preinvasive cancer) -T1 less than 2 -T2:less than 2- 5 cm -T3: invaded partically local -T4: extensive local invasion T1,T2,T3, T4 Size and/or extent of the primary tumor

Cancer Treatment: surgery

-To prevent cancer (colon polyps) -Biopsy for diagnosis and staging -Lymph node sampling: Sentinel nodes (first node draining a cancer) -Debulking surgery (removing tumor, usually large) -Palliative surgery (alleviate symptoms, helps with comfort)

what are characteristics of a malignant tumor

-grow rapidly -not encapsulated (irregular shape) -invasive (Cancer that has progressed to invade surrounding tissues.) -poorly differentiated cells (don't usually look like the tissue they came from) -rapid mitosis (divide quickly) -metastasis ( can spread distantly)

what are characteristics of a benign tumor

-grow slowly -well defined capsule -not invasive -well differentiated cells (cells that look like where they came from...if its from a epithelial cell, then it will look like an epithelial cell) -slow mitosis (don't divide much) -localized (do not metastasize)

list some examples of benign tumors

-lipoma: a benign tumor of fatty tissue composed of fat cells (squishy feeling) -Glioma-glial cells of brain and spinal cord (any tumors in the brain are bad even if not cancerous) *these are of the glial tissue of the nervous system and can become malignant -Leiomyoma-smooth muscle of uterus -Chondroma-cartilage -Adenoma-epithelial glandular -Fibroma-fibrous tissue -Osteoma-bone

Clonal proliferation or expansion

As a result of these mutations, a cell acquires characteristics of a cancer cell that allow it to have selective advantage over its neighbors -Increased growth rate or decreased apoptosis or programmed cell death...is aggressive

cancer treatment: Chemotherapy

Chemotherapy (kill the bad and the good) -Use of nonselective cytotoxic drugs that target vital cellular machinery or metabolic pathways critical to both malignant and normal cell growth and replication Goal -Eliminate enough tumor cells so the body's defense can eradicate any remaining cells

Inflammation and cancer

Chronic inflammation is an important factor in the development of cancer (if you damage it enough and often enough you weaken it and if you weaken it you give it more opportunity to turn into cancer) -Inflammatory cells release cytokines, which stimulate cellular proliferation and new blood vessel growth. (they can have their own blood supply...growing and feeding itself) -Inflammatory cells release free radicals, which promote mutations and block response to DNA damage. Examples: ulcerative colitis, chronic viral hepatitis

Tumor-suppressor genes

Encode proteins that in their normal state halt proliferation (growth inhibiting) Also referred to as anti-oncogenes

cancer treatment: Ionizing radiation

Goals -Eradicate cancer without excessive toxicity -Avoid damage to normal structures **Ionizing radiation damages the cancer cell's DNA

Chromosome instability

Increase in malignant cells Results in chromosome loss, loss of heterozygosity, and chromosome amplification -Turning off genes without mutation

Stage II

Local invasion (has invaded the tissue next to it)

TNM classification: Distant Metastasis (M) Define MX, M0, M1, M2

MX Distant metastasis cannot be evaluated M0 No distant metastasis M1 Distant metastasis is likely or possible M2 Definite Distant metastasis is present

What are the four stages

Microscopic analysis for staging-based presence of metastasis -Stage I: No metastasis (hasn't moved or invaded anwhere) -Stage II: Local invasion (has invaded the tissue next to it) -Stage III: Spread to regional structures (lymph nodes) -Stage IV: Distant metastasis (breast cancer that is now in your lungs)

What areas do most cancers occur? Give examples

Most cancer occurs in tissues with cells that replicate faster (ex: skin, respiratory tract, reproductive tract, bone marrow, GI tract, bone)

Stage I

No metastasis (hasn't moved or invaded anwhere)

Diagnostic testing

Obtain tumor tissue (biopsy)

Carcinoma in situ (CIS)

Preinvasive epithelial malignant tumors of glandular or epithelial origin that have not broken through the basement membrane or invaded the surrounding stroma.

Oncogenes

Results from the mutation of proto-oncogenes -Can cause increased growth and replication

Viruses and cancer

Viruses implicated in causing cancer: -Hepatitis B (third world countries) and C viruses (if you have hep C and continue drinking you will have liver cancer in ten years) -Epstein-Barr virus (EBV) (there is an association with EBV (mono) and b cell lymphoma, burkitt's lymphoma, hodgkin's lymphoma -Kaposi sarcoma herpesvirus (KSHV) -Human papillomavirus (HPV): associated with cervical cancer -Human T cell leukemia association with lymphoma virus (HTLV)

Gene silencing

Whole regions of chromosomes are shut off while the same regions in other cells remain active -Turning off genes without mutation

Mutagens

agents causing mutations can be chemical or genetic material

Cancer is predominantly a disease of

aging

tumor

also referred to as a neoplasm "new growth"

can benign tumors be problematic or are the in the clear because they are benign?

benign tumors don't cause cancer but the fact that they are there can cause problems

Leukemia

cancers of blood-forming cells/tissues hindering the body's ability to fight infection

Malignant epithelial tumors are referred to as _____ what is an example?

carcinomas -Adenocarcinoma-from ductal or glandular tissue

The prognosis generally worsens with ...

increasing tumor size, lymph node involvement, and metastasis. -Staging may also alter the choice of therapy.

Metastasis

is the spread of cancer cells from the site of the original tumor to distant tissues and organs through the body -Lymphatics and blood -Requires great efficiency -Usually occurs late -More dangerous in aggressive cancer

If a clients lymph nodes are swelling does this indicate that a client has lymphoma?

lymph nodes can swell up secondary to infection...this is normal and not necessarily lymphoma

The term Cancer refers to a

malignant tumor

(tumor spread) Changes in cell-to-cell adhesion makes cancer cells ...

more mobile (bad)

how many diagnoses and how many deaths result from cancer in a years time

more than 1 million cases diagnosed each year, and more than 500,000 deaths each year result from cancer

An individual acquires______________ causing cancer to develop

multiple mutations or genetic "hits" over time,

are all tumors cancerous?

not all tumors are cancerous (some are benign)

Stimulation of neoangiogenesis and lymphangiogenesis aka (tumor spread)

proliferate and growth

(tumor spread) Macrophages and other cells secrete

proteases to digest tissue capsules

Malignant connective tissue tumors are referred to as

sarcomas Rhabdomyosarcomas: from striated muscle tissue

cancer is the ____ leading cause of death in the U.S.

second *first leading cause is cardiovascular disease.

Manifestations of cancer are based on_____. What are some manifestations or indications of cancer?

site, tumor size -Physical pressure on surrounding tissue causing pain -Obstruction -Loss of normal function -Compression of nerves *lymph nodes can swell up secondary to infection...this is normal and not necessarily lymphoma

Tumor cell markers (biologic markers)

substances produced by benign and malignant cells that are either present in or on tumor cells or found in blood (alpha fedia protein AFP found in the blood), CSF, or urine. They include: -Hormones -Enzymes -Genes -Antigens: prostate specific antigen PSA -Antibodies

tumors are named according to

this tissue from which they arise

Cancer cells are sometimes described as ______. Why is this?

transformed cells because they can be created from normal cells...have things that make their survival area