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what are protooncogenes?
- Keeps cell behavior under control
- --mutations can result in oncogene "amplification" (multiple copies) n-myc x poly-->blastoma
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What are Tumor suppressor genes?
- Inhibit growth and control the development of tumors
- --BRCA-1/2: defects-->decreased tumor suppression activity-->^risk of ovarian/breast cancer
- --P-53: defects-->decreased tumor suppression activity--> ^risk of bladder/breast/colon/liver/lung cancer.
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How do hormone receptors influence the growth of cancer?
- Some cancers have hormone receptors (estrogen, progesterone, androgen, etc). which, when activated-->increased replication of the cells.
- In this case (prostate, breast), hormone suppressant therapy is indicated. (tamoxafen)
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What are some differences between benign and malignant tumors?
 - Benign brain tumors will take up space-->^ICP, and are often hard to remove (deep within hemispheres or brainstem). Therefore "benign" might not be a good word to describe them
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Stages of cancer development?
- Initiation
- Promotion
- Progression
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What happens at initiation?
- Mutation in cell's genetic structure
- Requires "two-hit" insult
- --Mutation + some other stress (could be another mutation) to the mutated area.
- --Mutation is irreversible, but due to apoptosis cells may never progress to a tumor and may never cause problems.
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What happens during promotion?
- Factors encourage growth of the cancer cells?
- --tobacco smoke (1st and 2nd hand), radiation, chemical exposure (petroleum)
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What happens during progression?
- Cancer cells are actively dividing, growing, getting worse.
- --can grow by:
- ----direct extension: invasion into surrounding tissue.
- ----hematogenous spread: through the blood stream-->sites of mets (bone, brain, lung, liver).
- ----Lymphatic spread: same as hematogenous, but through the lymphatic system.
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Immune system's Role in cancer control and spread.
- B-Cells resist tumor growth by anti-carcinogenic antibodies.
- T-Cells: produce cytokines (IL-2 and interferon) that can directly kill tumor cells).
- --Pts with HIV/AIDS are at greater risk for cancer because v immunity.
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What are oncofetal antigens and tumor markers
- cell's ability to return to a more "immature" state.
- --carcinoembryonic antigen (CEA)
- --AFP: Good test for testicular mass. ^AFP = positive for cancer. After resection, v AFP is expected.
- --VMA, HVA, dopamine: ^catecholamines appear in urine.
- Prostate Specific Antigen (PSA): Good test, but have higher than desired false positives.
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What's the difference between palliative and terminal care?
Palliation may contain elements of control to prolong life. Terminal care is purely comfort care/quality of life remaining.
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Who finally makes a diagnosis of cancer?
- The pathologist. Radiologists, and primary care cannot make it.
- --Will usually take 24-48 hrs to process biopsy.
- --Help family to understand the process to help manage anxiety and frustration.
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What is the Goldie-Coldman hypothesis?
- Resistant cell growth is related to "genetic instability" of the tumor.
- --As long as tumor cells are present, there is a risk of those cells developing resistance to treatment.
- --Followup therapy includes includes similar but different drugs in an effort to eradicate any resistant cells that may have developed.
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What is the Norton-Simon Hypothesis?
- Tumors contain both fast and slow-growing populations; use sequential non-cross resistant combinations of drugs.
- Protocols will use efficacy of treatment to evolve new/better protocols.
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What is TNM staging?
- Tumor size?
- Nodes affected? (regional lymph nodes)
- Mets (x means cannot be determined)
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Nursing's role of chemo administration
- Cross-checking orders
- pharmacy communication
- pt/family education (translational therapy)
- medication admin and prep
- monitoring for toxicity (can be acute, slow onset, and cumulative).
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Basics of radiation therapy
- Total dose calculated by tissue to be treated
- --superficial/sensitive vs. deep/tough
- Total dose is divided into equal amounts administered over M-F for a number of weeks.
- Computer sims determine/prepare area to be treated
- Weekly CBCs (hemoglobin >10 -->better outcomes. Transfuse if <10.)
- Toxicity is a big problem: skin, hair (can be permanent if "boosted"), blood counts, GI mucosa (most uncomfortable of adverse effects), fatigue (normal; Tx with sleep).
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Types of radiation
- External beam:
- --2-D
- --3-D conformal: multiple ports with small beams all irradiating at common site. May have smaller/fewer side effects.
- --usually outpatient. Work with pt to determine what time of day is preferable.
- Brachytherapy (Implants):
- --Pt will be radioactive (keep in isolation, disposable meal trays, pt boredom a problem)
- --Inpatient
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