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terminology
- Cancer
- Malignant neoplasm
- Neoplasm
- Tumor
- Cancer disease of cell invasive, it spreads breast cancer and bowel cancer
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benign v malignant
- benign
- - usually harmiese growth
- - well differentiated doses not spread (looks like the cell)
- Malignant
- - harmful mass
- - change in differentiation may invade other tissue
- - no useful purpose
- (invade)
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Incidence, prevalence, mortality
- Incidence
- - breast CA- 232, 670 new cases 2014 (ACS)
- - Colon CA- 136-830, new cases in 2014 (ACS)
- Prevalence
- - breast CA 2.9 million survivors
- - colon CA 1 million survivors
- Mortality
- - breast CA 40,000 US deaths 2014
- - Colon CA 50, 310 2014
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The Cell
- cell proliferation= cell growth
- cell differiation= maturation (mature)
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Cell Proliferation Normal
- orignate as stem cells (orderly sequence)
- predetermined, orderly sequence
- enter cell cycle and grow into functioning cells generally of tissue surrounds them
- start as undifferiated cell and transformed into cell with specific purpose. cell division (mitosis) and continues cycles
- contact inhibition (normal cells do not grow on top of one another, bone cells surround other bone cells, cells stay in their place)
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Cell proliferation: Cancer
- Divide indiscriminitly (no order)
- no order, does not listen to intracellular signals
- produce more than 2 cells
- loss contact inhibition (no regard for boundaries, grow on top, btwn cells)
- cause: mutations, changes in DNA
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Cellular Differentiation
- Maturation and specialization
- - orderly process
- - not fully understood
- Protooncogenes- "lock", promote growth (protects us from mutations from occuring)
- - Oncogenes: unlocks and carcinogenics- alters and unlocks,
- (mutation to occur, regulates cell growth- suppress tumor growth?)
- Tumor Suppressor Genes
- - suppress tumor growth, regulate cell growth (ex mutation BrCA1, BrCA2- if this is positive you will have increase risk for breast cancer)
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Cellular Differentiation Cancer
- When altered
- - changes in cell appearance
- - appearance of tumor specific antigens (AFP, CEA cell membrane- if + in adults it shows immature in pathways reverted cells)
- - loss of normal function- cell no longer function as to what it is suppose to
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Cancer cells
Teen Bedroom
- Disorganized components (poorly differentiated)- doesn't look like normal bone cell
- variable shapes and sizes
- large/mulitple nuclei (poorly differentiated)
- tumor specific antigens
- serve no useful purpose
- - compress, steal nutrients
- defective cell proliferation (growth)
- - grows at own rate> daughter cells
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Pathophysiology
- Not fully understood
- theory: many factors and several stages that proceed in a very orderly fashion
- Initiation
- Progression
- Promotion
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Initiation
- Cell Mutation
- - DNA flaw- error in replication
- - Carcinogens- causes changes in the cell structure or function, cause cancer
- ex of Carcinogen
- - smoking
- - toxins
- - processed foods meats, hot dogs
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Carcinogens
cancer causing agents produces cellular alterations
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Promotion
- reversible proliferation of altered cells
- cell continues to be assaulted
- promoting agents- ie cigarettes, dietary fat, obesity, ETOH (nicotine, bronchigenic carry)
- withdrawl may reverse progession
- - example smoking cessation (stop, may reverse)
- Latent period- from time the has been assaulted until you show symptoms
- - clinically evident
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Clinically evident
- Tumor
- - to be detected by tests- 0.5 cm, will contain @ .5 billion cells
- - to be palpated- 1 cm or larger (1 billion malignant cell)
- this is why health promotion is so important
- majority of carcinogenics are environmentally causing
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Progression
- increased growth rate
- cell are increasingly malignant
- develop into an invasive cancer
- potential for metastasis (spread to distant sites) moving form one area to another
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Metastasis
- spread of malignant cells to a distant sites
- helps distinguish malignant from benign growths
- may explain failure of treatment
- cells invade surrounding tissue and blood vessels or lymph channels to travel
- cells: less adherent, more mobile, may produce enzyme (promote growth), angiogenesis (new blood vessels- so it could steal blood supply to feed tumor)
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Classification of Cancer
- Purpose:
- - enhance communication
- - assist in treatment planning and eval
- -determine prognosis
- - aid in research
- Anatomic- where is it? tissue of orgin
- Histologic Classification- degree of differention- cells should look like each other
- Clinical staging (0-IV)
- Extent of Disease (TNM)
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TNM Classification
- T- tumor size
- N- lymph node involvement
- M- metastasis
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TNM
Primary tumor (T)
- T0- no evidence of primary tumor
- Tis- carcinoma in situ (localized)
- T1-4- ascending degrees of increase in tumor size and involvement
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TNM
Regional lymph nodes (N)
- N0- no evidence of disease in lymph nodes
- N1-4- ascending degrees of nodule involvement
- Nx- regional lymph nodes unstable to be assessed clinically
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TNM
Distant metastasis (M)
- M0- no evidence of distant metastatases
- M1-4- ascending degrees of metastatic involvement (1-4 more distant in other areas)
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