-
cancer defined
uncontrolled and unregulated growth of cells
-
2 dysfunctions of cancer
- deffective cellular proliferation(growth)
- defective cellular differentiation
-
cellular prolif in normal cells
- growth begins at stem cell
- equilibrium is maintained
- respect boundries and teritories
-
cellular prolif cancer cells
- no respect for boundaries
- invasion
- grows ontop or between other cells
- indiscriminate and continuous
-
class of cells
- asymmetry
- border
- colur
- diameter
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cancer involves the malfunction of genes that control____
differenciation and proliferation
-
normal genes affected by mutation
- protooncogenes
- tumor suppresor genes
-
protooncogenes
- promote growth
- normal genes
-
oncogenes
- tumor inducing genes
- can turn cells from normal to malignant
-
3 stages of cancer development
- initiation
- promotion
- progression
-
initiation
occurs due to mutation in genes
-
initiation can be caused by
- virus
- hormones
- radiation
- chemicals
-
initiation description
- not a tumor cell yet
- still reversable
- inherited or aquired
-
promotion
- increase in altered cell population
- still reversable
-
promoting factors
- smoking alcohol
- dietary fat
- obesity
- prevention is key
-
latent period
- (initiation and promotion)
- the time between the initial genetic mutation and the clinical evidence of cancer
-
smallest detectable cancer on mri
1/2 cm
-
progression
- needs own blood supply
- rapid growth
- matastisis
- tumor angiogenisis
- invading
- traveling
- penetrate lymph and vascular vessles
-
tumor angiogenisis
formation of blood vessles within the tumor itself
-
metastisis
- -active
- -must endure turbulent flow of blood
- -endure hosts immune system
-
role of immune system
- -respond to TAA(tumor assc antigens)
- -immunologic survalience
-
immunologic surveilance
immune systems response to antigens of malignant cells
-
immune cells
- cytotoxic t cells
- natural killer cells
- macrophages
- b cells
-
cytoxic t cells
- -resist tumors
- produce cytokines which stimulate t cell, nk, b cell and macrophage
-
NK cells
directly lyse tumor cells
-
monophages
hemmoragic lytic of tumor cells
-
b cells
produce anitbodies
-
immunologic escape
cancer cells evade the immune system
-
oncofetal antigens
- tumor antigens
- tumor markers
- found on surface and inside cancer cells and fetal cells
-
tumor classification
- -anatomic site
- -histology(grading)
- -extent of diseas(staging)
-
anatomic site classification
- -epithelia tissue(carcinoma)
- -Connective tissue(sarcoma)
- -Hematopoietic(leukemia)
- -nervous tissue(meningeal)
-
histologic class
- -evaluate appearance of cells and degree of differentiation
- -5 grades
- -higher the grade the the worse
- -degree to which cells resemble tissue of organ
-
extent of disease
- -clinical staging
- -TNM classification
-
clinical staging
- -anatomical extent rather than cell appearance
- -5 stages
-
TNM classification
anatomical extent of disease involvement based on tumor size, spread, and metastis to organs
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CAUTION
- C-change in bowl/bladder
- A- a wound that wont heal
- U- unusal bleeding
- T- thinking you have a lump
- I- indigestion, swallowing
- O- obvious change in wart/mole
- N- aging cough or horse voice
-
biopsy
removal of tissue sample for pathologic analysis
-
types of biopsy
- percuetaneous
- endoscopic
- surgical
-
___ is used in conjunction with biopsy
radiographics
-
control
- -for cancers that cant be completely eradicated but are responsive to therapy
- -multiple myloma
- -certain lung cancers
- -chronic lyphocytic leukemia
-
palliation
- -managing symptoms
- -treatment goal
- -radiation or chemo
-
goals of cure, control and palliate
- surgery
- radiation
- chemo
- biologic and target therapy
-
factors used to determine the response of cancer cells to chemo
- -mitotic rate
- -size of tumor
- -age of tumor
- -location of tumor
- -presense of resistant tumor
-
classification of chemo agents
- -according to cell cycle
- 1. specif
- 2. nonspecific
-
cell cycle phase non specific
acts at any point in the cell cycle
-
cell cycle phase specific
interrupts cell division at specific points
-
chemical structure classifications
- chemical fam with the most common side effects
- alkylating agents
- nitroureas
- platinum drugs
- antimetabolites
- -antitumor AB
- -mitotic inhibitors
- topoisomes
-
extravsion
infiltration of drugs into tissue surrounding infusion site causing local tissue damange
-
radiation therapy
- used to treat local or regional disease
- aim is to destroy malignant cells
-
radiosensitivity
normal and cancer:
nondividing:
Exception:
Tumor:
Normal:
- -affected by radiation
- -"slowly dividing" less radiosensitive
- --small lymph and salivary are non dividing but very radiosensitive
- -not able to repair dna damage
- -are able to repair dna damage
-
teletherapy
- -external radiation therapy
- -most widely used
- -larger areas o be treated
- -5 days a week over 2-7 weeks
-
brachytherapy
- -internal radiation
- -directly on or near tumor
- -alone or w/ other therapies
- -sealed seeds and ribbons
-
radio pharmaceutical therapy
oral
-
brachytherapy safety
- ALARA
- time
- distance
- shielding
-
myelosuppresion
- -most common effects of chemo and radiation
- -RBC, WBC, Platelets
- -decrease in blood count
- -monitor CBC
-
Nadir
- -lowest blood cell count
- -7-10 days post chemo
- -onset depends on drug regime and host
- -neutrophil, platelet and RBC
-
pulmonary reaction
- cough
- sob
- pneumonitis
- pulmonary fibrosis
-
cardio reactions
- ecg changes
- lv dysfunction
- heart failure
- cardiac ischemia
-
biologic immune therapy
- -antibodies bind to and target antigens
- -antibodie is specific to an antigen(key for target therapy)
-
target therapy
- --more specific for molecular targets than chemo
- -do less damage to normal cells than chemo
-
immune and target therapies
- -cytokines
- -kinase inhibitors
- -vaccines
- -monoclonal antibodies
- -angiogenesis inhibitors
- -proteasome inhibitors
- -programmed death receptor blockers
- -human epidural growth
-
biological/ target therapies side effects
- flu like s/s
- cap leak and pulm edema
- bone marrow depression
- fatigue
-
hormone therapy
- cortigo steroids
- estrogen
- aromatase
- androgen
-
hematopoietic growth factors
-
hematopoietic growth factors
CSF
- -glycoproteins
- -stim production, maturation, regulation and activation of hema cells
- -specific
-
hematopoietic growth factors
ESA
- -only for anemia caused by chemo
- -avoided in curative situations
- -monitor hemoglobin
-
hematopoietic stem cell transplant
- -BMT and PSCT
- -safe in high doses
- -tumors have resisted standard dose of chemo/radiation
- -long term/delayed complications
- -eradicate tumor cells and marrow to make way for transplant
-
types of stem cell transplant
- allogenic
- syngeneic
- autologous
-
-
synergeneic
- type of allogenic
- identical twins
-
autologus
receive their own stem cells after myeoblative chemo
-
harvest
- collect bone marrow
- PIV blood draw and separate marrow
-
complications of stem cell transplant
- -bacterial, fungal, viral
- -prophylactic measures are taken
-
SVC syndrom
-facial periorbital edema, head neck chest vein distention due to compression of SVC
-
oncologic emergencies
obstructive
- -tumor related emergencies
- SVC syndrome, spinal cord compression, third spacing
-
spinal cord compression
neuro s/s caused by compression of spinal cord
-
third spacing
s/s of shock due to fluid shifts from vascular to interstitial space
-
metabolic emergencies
- caused by ectopic hormones produced by cancer cells
- SIADH
- Hypercalcemia
- tumor lysis syndrom
-
SIADH
-due to abnormal production of ADH which leads to H2O retention and hyponatremia
-
Hypercalcemia
from bone mets or increased PTH release
-
tumor lysis syndrom
- -massive cellular destruction
- -hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia
- -goal is to prevent renal failure and sever electrolyte imbalance
-
infiltrative emergencies
- when malignant tumors infiltrate major organs
- -cardiac tamponade
- -carotid artery rupture
-
cardiac tamponade
fluid accumulation in the pericardium
-
carotid artery rupture
due to invasion of artery by tumor
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