pathophysiology - neoplasia/ exam 2

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Terms in this set (...)

Cancer
2nd leading cause of death in U.S.
25%
this is the percent of U.S. population that will develop cancer
50%
this percent is the percent that will die of cancer-related cause
Infection
Bleeding
Malnutrition
2/3
this is the amount of cancer deaths that occur ages greater than 65. 1/2 die from complications rather than cancer itself
Carcinogenesis
these have No single cause they can be Cellular & molecular factors (genetic level) or even External factors
Genetic mutation
occur in one gene in one cell in one moment in time.
its a cellular and molecular factor.
they also can be Immunologic mechanisms or Hormones
External Factors
these are things such as heredity, lifestyle, and the environment
Lifestyle
this is an external factor such as
Obesity
Foods
Tobacco
Tobacco
single greatest lifestyle risk
environment
this is an external factor such as
Chemicals
Radiation
Oncogenic viruses
smoked foods
these are foods that are cooked in an open grill. tar can get on them
Nitrosamines
sulfur and nitrogen foods that are often used as preservatives : bacon, sausage, deli meats
high fat diet
some tumors feed of byproducts of this ( estrogen)
high alcohol intake
this creates cell damage
low fiber intake
food sits in gut
Carcinogenesis
clinical syndrome can occur any type of cell and tissue ( almost)
Primarily disorder of DNA error within one cell, one DNA mechanical mutation
Cancer is a genetic abnormality it can be hereditary but it may not be.
oma
Benign tumor
carcinoma
Malignant, epithelial tissue
sarcoma
Malignant, mesenchymal tissue
Hematopoietic/ Lymphoid
Word Exceptions
Leukemia
Lymphoma
Melanoma
Hepatoma
Leukemia
malignancy in the WBC
malignant omas
Lymphoma
Melanoma
Hepatoma
Cancer Characteristics
Abnormal cell differentiation and growth. some characteristics are same but its different than cells in that part of the body should be.
Chaotic cell division, independent of normal
growth signals. host dies or kills cells.
Results in new growth - NEOPLASIA
Cell Characteristics
Proliferation
Differentiation
Apoptosis
Proliferation
Process of cell division
Normal cell replacement process
new cells are born to replace dieing cells
Differentiation
Process of specialization of cell types
New cells acquire structure & function of cells being replaced
poorly differentiated; doesn't look like cell should look like. Loss of function due to abnormal cell.
Apoptosis
Programmed cell death to replace old/unwanted cells
Cell suicide- cells know how long life span should be.
80-120 days
regular life span of RBC
72 hours
this is the life span of the cells in the colon
Cell growth rate
this = Cell death rate
new cells grow in response to cells that are dying
Cell Growth Rules
Cells multiply only when growth-stimulating signal
Cells respond to apoptosis
Cell suicide message
Cancer cells
DON'T obey growth rules
Grow in absence of growth signal- genetic defect in cells allow them to do this.
Unlimited replication possible
cancer cells
these can replicate so much that they can overwhelm the organs. pick up in bloodstream and deposit somewhere else in the body. they matasticise
Cancer & Genes
Proto-oncogenes
Tumor suppression genes
Genes that control apoptosis
Genes that regulate repair of damaged DNA
Proto-oncogenes
before cancer
control messages
Over 60 identified
Direct cell growth-activating pathways
Overactivity increases proliferation (division of cells)
Proliferation r/t cancer ( say how become cancer)
Normal genes
Proto-oncogenes
Have normal cell to cell communication functions r/t:
Growth factors
Growth factor receptors
Cytoplasmic signaling molecules
Nuclear transcription factors
HELP CONTROL COMMUNICATION FROM CELL TO CELL
Proto-oncogene to Oncogene
Abnormal cell growth signals
Introduced into cell by retrovirus ( external to body that infects cell)
Intracellular mutation
Damaged or lost DNA sequence
Chromosome replication error yields extra gene copies
Cancer & Mutant Genes
Tumor suppressor genes ( specific gene involved in production of cancer. function is to suppress or prevent growth of tumor cells)
Inhibit cell proliferation
Absence of tumor suppression function ( look and see if normal)
Growth inhibition pathway abnormal in most cancers
Rb gene
Retinoblastoma- hereditary form of cancer growing in eye
P53 gene
Lacking in > 50% tumors
BRCA I, BRCA II
abnormalities can lead to breast cancer Breast CA
Factor in all types of reproductive cancers - male & female
only 10% related to abnormalities
defect in the gene
50-65
more likely due to BRCA abnormalities
males
these individuals have prostate cancer, vesicular, breast cancer risks.
P53 Gene
ALWAYS LOOK FOR THIS
Most common tumor suppression defect
Mediates action of chemotherapy & radiation to kill cancer.
not responsive to some chemotherapy & radiation
> 1/2
this is the amount of tumors that lack functional P53 gene
Renal cell carcinoma
malignant
Adenoma
benign
Fibrosarcoma
malignant
Adenocarcinoma
malignant
Hemangioma
benign
Differentiating Benign & Malignant Neoplasms
Cell characteristics

Manner of growth

Rate of growth

Potential for spread (metastasis)

Ability to destroy tissue and haste

Capacity to cause death
Benign Neoplasms
Slow, progressive growth that may stop or regress


Expansive growth

Unable to spread to distant sites

Well-differentiated cells that resemble cell of origin. share the characteristics of normal cells that grow in that area.
benign neoplasms can they become large
yes
true or false do benign neoplasms grow within their tissue in a specific area.
true - doesn't kill the person but may grow large.
Malignant Neoplasms
Rapid, widespread growth

Potential to cause mortality

Compress vessels and outgrow their blood supply, leading to ischemia/necrosis

Steal nutrients from normal tissue( reason see weight loss)

Liberate toxins & enzymes that destroy tumor & normal tissue
growth in the arm that will not go into the blood stream is this benign or malignant
benign
a prostate tumor that is growing outside the prostate is this benign or malignant?
malignant
malignant
grows outside area
pick up in blood stream
grow large can erode blood vessels and cause hemorrhage
common cause malignant tumor death
hemorrhage or infection
Cancer Spread
Direct invasion & extension ( direct contact)

Deposit of cancer cells in cavities

Metastasis via blood/lymph system
erode microscopic blood and lymph vessels
Carcinogenesis Initiation
DNA damage
Malignant potential possible
Carcinogenesis promotion
Unregulated abnormal cell growth
Carcinogenesis progression
Cancerous phenotype ( genetically established)
Malignant cell established
metastasis is this guaranteed?
no
Metastasis
Cells penetrate basement membrane of blood/lymph vessels ( potential malignant cells deposited in tissue)

Abnormal growing cells migrate

Metastasis not guaranteed
Metastasis
< 1/ 10,000 migrating cells survive

Attacked by immune cells or apoptosis
Metastasis
most abnormal cells the bodies immune system attacks and kills. the immune function decreases across the lifespan that the reason you see more cancers in older individuals.
Tumor Grading & Staging
Necessary for treatment & prognosis

Grading - r/t cell histology ( degree of abnormalities how far different cancer cells are from normal cells)
Staging - r/t clinical spread
Grading
this is determined by the degree of analpasia ( the extent of abnormality). this is not universal it can be numbers or letters.
Anaplasia
"Lack of differentiated features in a cancer cell" they look much different in comparison of a normal cell
Grading
Specific histology
Cell characteristics

Degree of abnormality

Ranking 1-3, 1-4

Higher number = higher malignancy potential is related to the higher the letter is in the alphabet.
Staging
Location & spread pattern

Several staging systems exist

Most common jargon is TNM
T - Tumor
N - Node
M - Metastasis
Tx
cannot be assessed
T0
no evidence of primary tumor
Tis
carcinoma in situ
T1-4
growing increase in tumor size or involvement
Nx
Nodes
cannot be assessed
No
Nodes
no evidence of regional metastasis
N1
regional lymph nodes involved
Nodes
MX
Metastasis
not assessed
Mo
Metastasis
no distant metastasis
M1
Metastasis
distant metastasis present (sites specified
Tumor Detection
Surgery
Radiography
Computed Tomography
Magnetic Resonance Imaging
Cancer: Clinical Manifestations
Pain
Altered tissue integrity ( may not be at site of tumor)
Immune deficiency
Malnutrition
Altered Tissue Integrity
Compressed, eroded blood vessels ( healthy areas of tissue)
Ulceration ( erode inside out sometimes)
Necrosis
Bleeding
Hemorrhage
FATAL EVENT MAY OCCUR
Cancer Cachexia
Weight loss below normal
Muscle and fat wasting
Anorexia
Weakness
Anemia
OBVIOUS CONDITION OF WASTING
Unintentional weight loss
this is a high suspicion of cancer. the primary question is have you lost weight recently. didn't intend to loose you should assume cancer until proven otherwise
Paraneoplastic Syndromes
Inappropriate hormone release

Release of factors that damage skin, nervous system, blood system

Widespread immune dysfunction
What are reasons that individuals with cancer easily develop malnutrition?
some cells steal nutrients for tumor.
chemotherapy increases nausea and vomiting
drugs and cancer process alter sense of taste and smell
add flavoring to food ( sweet usually remains a taste)
Cancer Clinical Manifestations
Bone marrow suppression
Anemia
Leukopenia
Thrombocytopenia
Anemia
Severe fatigue
Mental status changes
Leukopenia
Infection
Thrombocytopenia
Bleeding
true or false do all blood forming cells depress with any type of cancer
true
What are common causes of mortality in individuals with cancer of any source?
infection
bleeding
malnutrition
anemia
usually don't die from primary tumors rather secondary complications such as malnutrition.
Cancer Therapy
USUALLY A COMBINATION OF THESE
Surgery
Radiation
Chemotherapy
Immunotherapy
Gene therapy
Stem cell transplant