patho 4 Cancer Moore

disorder of cell proliferation and differentiation

second

heart disease

new growth

• 1. proliferate to form new tissue
• 2. often do not differentiate to do the "job" of the tissue where they originate
• 3. they do not undergo apoptosis to control # of cells

• 1. lung
• 2. colon
• 3. breast
• 4. prostrate

to get rid of cells not needed

cancer cells grow faster than normal cells and are not subject to stim to apoptosis so they have huge numbers of cells growing

they are no longer capable of cell division/mitosis

lack of or loss of cell differentiation

means without form

cancer cells are independent from normal cellular controls - do what they want

immature stem cells

a mutation has taken place and can cause a cancer

type of cancer depends on the mutation that occurred

the less differentiated the cell is when the mutation occurs = the more damage will be done and more diff the cell will be from the parent cell and surrounding tissues

more mature cell will be better able to deal with the mutation

the more differentiated a cell is when mutation occurs the less malignant it will be

hair follicles

epithelial lining of the GI tract

bone marrow

cellular degeneration rate

1. myocardium

2. neurons

3. cartilage

b/c the Tx for cancer attack rapid proliferating cells & the cells of hair follicles and GI rapidly proliferate

benign - well-differentiated, slow growing, and doesn't spread - not cancer

malignant - anaplastic or undifferentiated, rapid growth due to doubling time, metastasis

no form

1. look like normal tissue cells and may perform the normal function of the tissue

2. can secrete hormones - may lead to oversecretion

3. usually have a capsule around them

4. usually do not invade neighboring tissues

1. can oversecrete hormones

2. can damage nearby organs by compressing them - can be life-threatening

defined & clearly delineated

not

1. cells don't look like parent cells - not like tissue where they came from - less differentiated

2. can divide rapidly - tumors can grow rapidly

3. tumor has no clear boundaries and sends legs out into surr. tissue

4. do not perform the normal functions of the organ - may secrete hormones ass. with other tissues

5. can compress and/or destroy the surrounding tissues

1 billion

may secrete hormones from other tissues not closeby

• 1. smoking and drinking
• 2. genetics
• 3. sun exposure (UVA/UVB)
• 4. diet
• 5. exposure to toxins/chemicals:  agent orange

multifactorial

a change occurs and multifactors effect it- checkpoints in cell cycle do not catch it and it gets out of control

duplicating the DNA to daughter cells

DNA sequences at the ends of the chromosomes where enzymes that duplicate DNA attach

ends do not get duplicated - cut off each time

will show if DNA in chrom is damaged by radiation or chem

will prevent entry into mitosis if the DNA is not complete/correct - proteins cyclins control cell cycle

this is bad b/c the cell will never die

1. proto-oncogenes

2. tumor suppressor genes

genes that normally code for parts of cell growth activiation

causes cancer

when proto-oncogenes are inapp. stim. or tumor-suppressor genes are lost or inactive

overactive or mutant form of proto-oncogene

genes that normally inhibit cell proliferation

will interrupt normal intracellular communication pathways that normally regulate the growth activiation of cells

when TSG are lost or inhibited

• 1. growth factor
• 2. growth factor receptor
• 3. cytoplasmic signaling
• 4. transcription factors

mutation due to risk factors

1. retroviral invasion into the host

2. mutagenic event

3. regulatory sequence mutation of DNA

4. error in chromosome replication

RNA virus that replicates in a host cell & incorporates its DNA into the host

1. HIV - kaposi sarcoma

2. Epstein-Barr virus - Burkitt lymphoma

3. human T-lymphocyte - leukemia

form of lung cancer

mono

some event leads to inapp. or inaccurate genetic info being passed on

inhibit cell division

cell division is not inhibited and cells will divide continuously

• 1. Rb gene
• 2. P53 gene
• 3. BRCA 1 & BRCA 2

codes for the master break of the cell cycle - blocks cell division by binding transcription factors needed for division

quality control gene - transcription factor that binds to genes and fixes errors

p53

breast cancer

ppl with BRCA 1 & 2 are more predisposed to breast cancer

they induce cell death by mediating P53 to catch probs

cause enough damage to the cell to trigger P53 mediated apoptosis

change from proto-oncogenes to oncogenes

Initiation -normal cell -> carcinogen (virus, sun, toxin, etc) -> DNA damage and cell mutation

Promotion - activation of oncogenes by a promoter agent

Progression - malignant tumor has formed

1. initiation

2. promotion

3. progression

gene mutation

• 1. tabacco
• 2. radiation
• 3. certain viruses
• 4. asbestos
• 5. chemicals
• 6. chemotherapeutic and immunosppressive agents
• 7. alcohol

mutant cell is induced to replicate and divide

mutant cell receives properties that allow it to be malignant

• 1. pancreas
• 2. bladder
• 3. kidney
• 4. mouth
• 5. esophagus
• 6. cervical
• 7. lung

certain kinds can cause cancer and can also be used to Tx it

complete - affects initiation and promotion

lung cancer

15

if use tobacco and alcohol together

• 1. increased dietary fat
• 2. obesity
• 3. cigarette smoking
• 4. alcohol consumption
• 5. prolonged severe stress
• 6. hormones- estrogen and testosterone
• 7. infection

mutant cells begin to exhibit malignant behavior

1. anaplastic with abnormal cell size and shape and/or undifferentiated

2. doubling time

3. infiltrates and spreads distantly through blood stream and lymphatic system (metastasis)

4. tumor necrosis

it is reversible

1. produce telomerase

2. insufficient P53

3. tumor necrosis

enzyme that allows malignant cells to survive and thrive - telomeres are not shortened and the cell does not die

prevents apoptosis of cells b/c P53 is what will recognize that the cell is abnormal

malignant cells produce special enzymes and receptors to help them escape the original tissue and go through endothelial tissue of vessels -> bloodstream or lymph -> metastasize & enter new tissues

through the bloodstream or lymphatic system

no form

substances found in body fluids or tissue that can help Dx tissue type effected

• 1. ID tissue type
• 2. det Tx
• 3. eval pt progress

help guide selection of Tx according to behavior of malignant tumor

T - size of the original tumor & whether it has invaded nearby tissue

N - nearby lymph nodes that are involved

M - metastasis to distant tissues

• 1. antigen
• 2. hormones
• 3. isoenzyme
• 4. immunoglobulins

• 1. carcinoembryonic origin (CEA):  lots of areas
• 2. CA 125:  ovaries
• 3. CA 15-3:  breast
• 4. CA 27-29
• 5. prostate-specific antigen (PSA) for prostate cancer

PSA checked - if elevated could be s/s of prostate cancer

formation of new blood vessels

tumor cannot grow to more than 2cm without angiogenesis b/c need nutrients and O2

histologic characterization of tumor cells

determines degree of anaplasia (nondifferentiated) & form of the tumor

will get a score

late stages of cancer

describes the location and pattern of spread of the tumor

benign tumors -oma

• malignant tumors:
• carcinoma - epithelial tissue
• sarcoma - mesenchymal tissue

cancer tumors

forms linings of the body

conn. tissues

nerve cell benign

nerve cell malignant

• CAUTION:
• C - change in bowel or bladder
• A - a sore that does not heal
• U - unusual bleeding or discharge:  vomiting blood, bleeding after menapause
• T - thickening or lump:  SBE, mammogram
• I - indigestion/difficulty swallowing: 
• O - obvious change in mole or wart
• N- nagging cough or hoarsness

• CHILDREN:
• C - continued, unexplained weight loss
• H - HA with vomiting in the am
• I - increased swelling or persistent pain in bones or joints
• L - lump or mass in abd, neck, or elsewhere
• D - dev of whitish appearance of pupils
• R - recurrent fevers not caused by infections
• E - excessive bleeding or bruising
• N- noticeable paleness or prolonged tiredness

if they have a sore that doesn't heal they will be less likely to report it

may be esophageal or other cancer

• 1. metastasis
• 2. pain
• 3. fatigue
• 4. cachexia
• 5. altered carbohydrate metabolism = diabetes-like syndrome
• 6. anemia
• 7. leukopenia/neutropenia
• 8. thrombocytopenia
• 9.infection

will rule out other causes before cancer is considered

• 1. pain
• 2. cachexia - wasting/atrophy of body tissues
• 3. myelosuppression
• 4. alopecia & mucositis

effects pain receptors - will have diff need for pain meds than others

need more pain meds

most severe form of malnutrition/anorexia of cancer r/t toxin release by cancer cells

this is r/t to the cancer not the Tx's

bone marrow suppression that causes decrease in blood cells - RBC, WBC, & platelets

disease process or secondary to treatment

chemo and/or radiation

inflammation/ulceration of MM of digestive tract

H&H low

decreased WBC

low neutrophils

low platelets

risk for bleeding and infection

• 1. weight loss
• 2. muscle wasting
• 3. weakness
• 4. anorexia
• 5. anemia

poor quality of life

causes a syndrome similar to diabetes where insulin resistance causes hyperglycemia

• risk for bleeding and infections
• 1. soft toothbrushes
• 2. not using razors to shave
• 3. hand washing
• 4. reverse isolation- protect the pt from what others have

can cause organ failure or overproduction of normal organ secretions

benign usually cause increased secretions and malignant will usually decrease secretions r/t interruption of function

• 1. bleeding
• 2. compression of BV, lymph vessels, hollow organs, or nerves

ischemia and clots

lymph nodes enlarge and edema

pain & movement may be affected

cause unknown

manifestations in sites other than where tumor is - cancer cells produce hormones or hormone-like proteins that affect body in diff ways and areas

hypercalcemia

1. PTH - hormone secreted = hypercalcemia

2. ACTH released = cushing syndrome

3. ADH = hyponatremia and water overload

4. cancer cells may produce proteins that affect clotting

5. may cause neurologic disorders

clotting and bleeding

paraneoplastic syndrome s/s

fatigue

further fatigue

• depends on type of cancer suspected
• 1. pap smear
• 2. biopsy - gold standard
• 3. tumor markers
• 4. staging and grading

1. curative

2. control

3. palliative

cell found in Hodgkins lymphoma that can be Dx of this cancer

• 1. surgery
• 2. radiation
• 3. chemo
• 4. immunotherapy
• 5. interferon
• 6. interleukins
• 7. monoclonal antibodies
• 8. gene and molecular therapy
• 9. stem cell transplantation

• 1. N/V, abd pain
• 2. alopecia
• 3. anemia
• 4. leukopenia/neutropenia
• 5. thrombocytopenia
• 6. infection

• 1. Dx
• 2. staging
• 3. palliative
• 4. curative

may use radiation to decrease tumor size so can operate, may be used in conjunction

radiation - local

chemo - systemic

chemo

does not distinguish b/t cancer cells and normal body cells esp. MM & hair follicles

fatigue is primary s/s

will also have nausea

must monitor WBC - if get too low cannot do the Tx

use hormones necessary for the cancer to grow to kill it

fever - infection risk

harvest from bone marrow or peripheral blood

bone marrow is richer source

may have stem cell donars

zofran/ondansetron is primary

• teaching and therapeutic comm are imp
• 1. teach about SE and provide emotional and physical issues

2. wig info

3. therapeutic teaching is imp

4. when might expect to lose their hair

5 can be rapid and occur in clumps

6. can grow back and may look diff than when they lost it:  diff color or texture

teach pt risk and to report fever even if low-grade and taking temp is important

any temp increase in cancer is bad

• 1. autologous - from pt
• 2. allogenic - tissue matched person
• 3. syngeneic - identical twin

• 1. brain and NS tumors
• 2. neuroblastoma
• 3. Wilms' tumor
• 4. retinoblastoma
• 5. osteosarcoma
• 6. Ewing's sarcoma

• 1. an earlier age of onset
• 2. higher frequency of multifocal lesions
• 3. bilateral involvement of paired organs or multiple primary tumors

often overlooked

• 1. prolonged/recurrent fever not ass. with infection
• 2. unexplained weight loss
• 3. growing masses

nephroblastoma - cancer of kidneys that usually occurs in children

cancer that dev in the cells of the retina

aggressive malignant neoplasm that starts in the bone

rare bone cancer

double that of normal population

malignant neoplasm of blood-forming tissues of the bone marrow, spleen, and lymph system that causes abnormal proliferation and accumulation of immature WBC

abnormal or immature WBC form and do not function properly -> massive proliferation of abnormal immature cells -> fewer normal WBCs are produced -> normal bone marrow becomes diffusely replaced with abnormal or immature WBC -> interferes with bone marrow ability to produce cells -> bone marrow does not function

by type of WBC affected and the course and duration of the disease

• 1. immature lymphocytes proliferate in the marrow
• 2. rapid onset & progression with short clinical course

acute lymphocytic/lymphoblastic leukemia

most common in children b/t 2 -10 but can occur in middle age or older

immature granulocytes proliferate and accumulate in marrow

granulocyte precursor/stem cell

bone marrow is damaged and makes dysfunctional or immature blood cells

AKA pre-leukemia

can progress to acute myelogenous/myelocytic leukemia (AML)

mayelodysplastic syndrome bone marrow makes dysfunctional or immature blood cells

in aplastic anemia blood cells are not made

• 1. rapid onse
• 2. rapid progression with short clinical course
• 3. left untreated death will result in days to months

age over 50

abnormal incompetnet lymphocytes proliferate and accumulate

more common in men and ppl b/t age 50-70

more gradual onset with age 50-70

abnormal stem cells lead to an uncontrolled proliferation of granulocyte cells resulting in a marked increase in circulating blast cells

ages 30-50

men

gradual onset

chromasomal abnormality ass. with CML

presence is highly Dx of CML

• 1. insidious onset
• 2. more prolonged clinical course
• 3. asymptomatic early in disease
• 4. life expectancy may be more than 5 years

• 1. anemia
• 2. leukopenia
• 3. thrombocytopenia
• 4. dyspnea
• 5. fatigue/malaise
• 6. decreased activity tolerance
• 7. anorexia and weight loss
• 8. bone or joint pain
• 9. HA
• 10. visual disturbances
• 11. fever
• 12. lymphadenopathy - enlarge lymph nodes
• 13. hyperuricemia - high uric acid
• 14. splenomegaly
• 15. increased WBC
• 16. hepatomegaly

• 1. pain
• 2. nutrition
• 3. signs of bleeding
• 4. signs of infection
• 5. vital signs
• 6. oral mucosa
• 7. neutropenia
• 8. H&H/CBC/PLT count

bone marrow biopsy

• 1. pain
• 2. antiemetics
• 3. chemo - induction therapy

initial treatment - usually chemo with leukemia

can be curative

chemo to destory abnormally deviding blast cells of pt -> marrow removed from hip/long bones of donar is injected into pt blood stream -> will migrate to bone marrow and start to produce healthy cells

• 1. flu-like s/s:  fever, chills, body aches
• 2. chest pain
• 3. N/V & diarrhea

s/s may last a few weeks

• 1. destroys WBC - risk for infection
• 2. transplant rejection

prophylactic ABX

posterior iliac crest, anterior iliac crest, or sternum

assess coagulation before procedure

after procedure apply firm pressure for 5 minutes

• 1. vital sign assessments
• 2. neutropenic precautions
• 3. monitor Nadir - lowest blood count of WBC

chemo will cause nadir point then will climb back up

• 1. meds
• 2. bone marrow transplant
• 3. bone marrow biopsy
• 4. protect from infection
• 5. prevent bleeding
• 6. prevent fatigue
• 7. maintain hydration & nutrition
• 8. stomatitis
• 9. discuss concerns and fears
• 9. alopecia

group of malignant neoplasms that affect the lymphatic system

• 1. Hodgkin's disease
• 2. Non-Hodkin's Lymphoma

hodgkins- char by the presence of Reed-Sternberg cell

nonhodgkins - include all lymphomas except hodgkin

giant cells from B lymphocytes that are ass. with/Dx of Hodgkin's lymphoma

unknown

Reed-Sternberg cells replace normal cells in 1 lymph node -> spreads to adjacent structures through lymph system-> infiltrates other tissues

peaks in 2 age groups:  15 to 35 and 55-75

occurs more often in men

cells that make up lymphoid tissue become a bnormal and eventually crowd out normal cells

originates outside lymph nodes and disseminates rapidly

Reed sternberg cells

incidence increases b/t 50-70

more often in men

• 1. viral infections - Epstein Barr
• 2. env factors
• 3. exposure to chem/radiation
• 4. H. pylori

will have AGGRESSIVE TX

• 1. insidious onset
• 2. painless unilateral or bilateral lymph node enlargement
• 3. enlarged lymph nodes - cervical first then  to axillary to inguinal

• 1. weight loss
• 2. night sweats
• 3. malaise
• 4. chills
• 5. pruritis
• 6. anorexia
• 7. non-productive cough
• 8. dyspnea
• 9. renal failure

• 1. lymph nodes
• 2. pain
• 3. nutrition
• 4. weight
• 5. activity level
• 6. respiratory status
• 7. kidney function
• 8. Dx tests

• 1. CBC
• 2. BUN/creatinine
• 3. lymph node biopsises

kidneys and lungs

• 1. meds
• 2. raidation
• 3. post-procedure lymphangiogram
• 4. protect from infection
• 5. maintain normal body temp
• 6. pain
• 7. adequate nutrition
• 8. aggressive treatment

plasma cell neoplasms

WBC that are normally in lymph nodes and act as antigen presenting/immune response cells

mostly men 50-69

more prominent in Aa

unknown

malignant plasma cells arise form 1 clone of B cells & proliferate withing the hematopoietic tissue -> infiltrate bone to produce osteolytic lesions -> bone destruction leads to hypercalcemia and pathologic fractures -> proliferation of plasma cells crowds marrow space -> plasma cells synth and secrete abnormal small number of immunoglobulins & large # of proteins -> marked increase in IgG or IgA & increased blood viscosity r/t proteins ->

proteins that are a part of regular antibodies & will spill into the urine with mult myeloma

• 1. gradual insidious onset
• 2. pain
• 3. infection
• 4. cord compression
• 5. osteoporosis
• 6. renal stones
• 7. hypercalcemia
• 8. GI distress
• 9. altered musculoskeletal status
• 10. F&E imbalance
• 11. altered cardiopulmonary function

• 1. pain
• 2. fractures
• 3. pneumonia
• 4. kidney probs
• 5. MS problems
• 6. CV probs

• 1. electrolytes
• 2. CXR
• 3. labs
• 4. CT
• 5. UA for bence jones proteins

• 1. antimicrobials
• 2. chemo
• 3. management of hypercalcemia

palliative only - no cure

meds and radiation

adequate hydration & ROM

• 1. manage pain
• 2. blood products
• 3. when occurs:  rest joint, apply ice, admin hemophilia factors