Chapter 15

Question 1

Cite the 2 major dysfunctions in cellular regulation which are needed for cancer development.

Answer 1

Defective cell proliferation (growth) and defective cell differentiation.

Question 2

Explain how cancerous cells proliferate by loss of contact inhibition and the pyramid effect.

Answer 2

*Normal cells respect the boundaries and territory of the cells surrounding them
*Cancer cells grown in tissue culture have a loss of contact inhibition. They have no regard for cell boundaries and grow on top of one another and on top of or between normal cells.

Question 3

Describe the function of tumor suppressor genes and what inactivates them.

Answer 3

*Tumor suppressor genes regulate cell growth. They prevent cells from going through the cell cycle. Mutations can change tumor suppressor genes and make them inactive. THis results in a loss of their tumor-suppressing action.
*Eg: BRCA1 and BRCA2

Question 4

Name the 3 stages of cancer development.

Answer 4

1. Initiation
2. Promotion
3. Progression

Question 5

Give examples of cancer promoting factors and what could be done to reduce the risk of cancer (4ex.)

Answer 5

*ex. dietary fat, cigarette smoking, alcohol use
*decreasing or complete cessation of each would decrease risk of developing cancer

Question 6

Define the latent period of stage 2 and what needs to occur before cancer can be detected (3)

Answer 6

*length of time from when 1st genetic alteration occurs and the actual clinical evidence of cancer
*may range 10-40 years
*for diseases to be clinically evident, tumor must reach a critical mass that can be detached.

Question 7

Describe characteristics of the 3rd stage, progression, in cancer development.

Answer 7

Characterized by:
1. increase in growth rate of tumor
2. invasiveness
3. metastasis: spread of cancer to distant site

Question 8

Cite the 5 main sites of metastasis.

Answer 8

1.Lungs
2. Liver
3. Bone
4. Brain
5. Adrenal glands

Question 9

Briefly describe the metastatic process and the importance of tumor angiogenesis. (3)

Answer 9

(1) rapid growth of the primary tumor
(2) tumor angiogenesis
(3) penetration of walls of lymph or vascular vessels

Question 10

tumor angiogenesis

Answer 10

the process of the formation of blood vessels within the tumor itself

Question 11

hematogenous metastasis: (3)

Answer 11

1. penetrate blood vessels,
2. travel through blood throughout body,
3. adhere to and penetrate small blood vessels of distant organs

Question 12

fungating tumors

Answer 12

have a rich blood supply below them, very difficult to operate on these, need to cauterize, huge wounds, etc

Question 13

most common sites of metastases:

Answer 13

lungs, liver, bones and brain

Question 14

Compare sentinel lymph node and skip metastasis.

Answer 14

sentinel lymph node: 1st node confronted as tumor cell spreads through the lymphatic system

skip metastasis: when tumor can travel to distant nodes by bypassing local lymph nodes

Question 15

Explain the importance of cancer classification systems. (4)

Answer 15

1. communicates w/ healthcare team
2. prep and eval tx plan
3. determine prognosis
4. compare groups statistically

Question 16

anatomic site

three classifications

Answer 16

*IDs tissue by origin, atomic site, and behavior of tumor

Question 17

carcinomas originate from

Answer 17

*embryonal ectoderm (skin, glands)

Question 18

Sarcomas originate from

Answer 18

embryonal mesoderm (connective tissue, muscle, bone, and fat

Question 19

Lymphomas and leukemias originate from

Answer 19

hematopoietic system

Question 20

Histological classification (2)

Answer 20

*appearance of cells and degree of differentiation are evaluated to determine how closely cells resemble tissues of origin
*Poorly differentiated tumors have a poorer prognosis than those closer in appearance to normal cells

Question 21

Histological classification grades (5)

Answer 21

Grade I: mild dysplasia, well differentiated

Grade II: moderate dysplasia, moderately differentiation

Grade III: severe dysplasia, poorly differentiated

Grade IV: cells are immature, primitive (anaplasia), and undifferentiated; cell of origin is hard to determine

Grade X: cannot be assessed

Question 22

clinical staging

Answer 22

Based on extent and spread of disease

Question 23

clinical staging stages (5)

Answer 23

Stage 0: cancer in situ (localized, no invasion or metastasis)

Stage I: Tumor limited to tissue of origin, localized growth

Stage II: Limited local spread

Stage III: extensive local and regional spread

Stage IV: metastasis

Question 24

explain the 3 goals of cancer treatment:

Answer 24

cure, control and palliation

Question 25

Cure (2)

Answer 25

*surgery alone or periods of adjunctive systemic therapy (chemo) *timeframe to "cure" may differ according to the tumor and its characteristics

Question 26

Control

Answer 26

Patients may undergo an initial course of treatment followed by maintenance therapy for as long as the disease is responding. * Patients are monitored closely for early signs and symptoms of disease recurrence or progression and the cumulative effects of therapy.

Question 27

Palliative goal (3)

Answer 27

*relief or control of symptoms *maintain quality of life *Palliative care and treatment are not mutually exclusive and can take place concurrently

Question 28

Describe the surgical approaches to cancer treatment: cure or control (2)

Answer 28

*remove only as much tissue as necessary and spare normal tissue *A debulking or cytoreductive procedure may be used if the tumor cannot be completely removed (eg: a tumor attached to a vital organ)

Question 29

Describe the surgical approaches to cancer treatment: prevention (3)

Answer 29

*surgery used to eliminate or reduce risk of cancer in at risk pts *prophylactic removal of nonvital organs *usual sites of regional spread may be removed

Question 30

Describe the surgical approaches to cancer treatment: supportive & palliation

Answer 30

(done when cure and control are no longer possible) *insertion of gastric feeding tube *placement of CV access device *Prophylactic surgical fixation of bones at risk for pathologic fracture

Question 31

Describe 4 types of regional delivery methods of chemotherapy and the main advantage of this type of delivery.

Answer 31

1. Intraarterial chemotherapy 2. Intraperitoneal chemotherapy 3. Intrathecal or Intraventricular chemotherapy 4. Intravesical bladder chemotherapy

Question 32

Intraarterial chemotherapy (what + what it is tx for)

Answer 32

*delivers the drug to the tumor through the arteries supplying the tumor *tx for osteogenic sarcoma; cancers of the head and neck, bladder, and cervix; melanoma; primary liver cancer; and metastatic liver disease

Question 33

Intraperitoneal chemotherapy: (what + what it is tx for)

Answer 33

involves the delivery of chemotherapy to the peritoneal cavity. *tx for peritoneal metastases from primary colorectal and ovarian cancers and malignant ascites.

Question 34

Intrathecal or Intraventricular chemotherapy

Answer 34

*tx for metastasis to the CNS *This method involves a lumbar puncture and injection of chemotherapy into the subarachnoid space

Question 35

Intravesical bladder chemotherapy:

Answer 35

*instilling chemotherapy into the bladder through catheter and letting it sit for 1-3hrs

Question 36

Explain acute, delayed, and chronic adverse effects of chemotherapy on normal tissue: acute (2)

Answer 36

*Acute: Occurs during and right after drug administration. *It includes anaphylactic and hypersensitivity reactions, extravasation or a flare reaction, anticipatory nausea and vomiting, and dysrhythmias

Question 37

Explain acute, delayed, and chronic adverse effects of chemotherapy on normal tissue: delayed (8s/s)

Answer 37

They include delayed nausea and vomiting, mucositis, alopecia, skin rashes, bone marrow suppression, altered bowel function (diarrhea, constipation), and a variety of cumulative neurotoxicities.

Question 38

Explain acute, delayed, and chronic adverse effects of chemotherapy on normal tissue: chronic (2)

Answer 38

*Involve damage to organs, such as the heart, liver, kidneys, and lungs. *Chronic toxicities can be either long-term effects that develop during or right after treatment and persist

Question 39

Describe the effects of ionizing radiation on cancerous cells (6)

Answer 39

*Delivery of high-energy beams, when absorbed into tissue, produces ionization of atomic particles. The energy in ionizing radiation acts to break the chemical bonds in DNA. The DNA is damaged, causing cell death. *bone marrow suppression, fatigue, GI probs, integ/muscle reactions, pulmonary effects, and reproductive issues

Question 40

Contrast external beam vs internal radiation (brachytherapy).

Answer 40

*external (teletherapy): most common. pt exposed to Rad from mega volt machine *internal (brachytherapy): implantation/insertion of radioactive material into or close to tumor. Minimal exposure to healthy tissues. Often used in combo w/ external

Question 41

Estimate the reasons for late effects of radiation and chemotherapy.

Answer 41

*SE if chemo/rad that occur mohts to years after remission. Once they occur may be progressive and generally permanent *Ex: skin telangiectasias to strictures, fistulas, or radiation necrosis. *the additive effects of malignant chem b4, during, or after course of rad therapy can significantly increase resulting late effects *most at risk pts are txed w/ alkylating agents w/ high-dose rad

Question 42

Describe the manifestations of cancer cachexia and relationship with morbidity. (4)

Answer 42

*wasting syndrome: anorexia and or unintentional wt loss *characterized by: generalized tissue wasting, skeletal muscle atrophy, immune dysfunction, metabolic abnorms *tx: wt loss cannot be reversed nutritionally (increased risk of mortality) *best management is to tx cancer, 2nd best is to increase nutrition, 3rd is to use megestrol to sim appetite.

Question 43

List 3 reasons why cancer patients experience life threatening infections.

Answer 43

1. Ulceration and necrosis caused by the tumor 2. The tumor compressing vital organs 3. Neutropenia from the cancer or cancer treatment

Question 44

Describe gerontological considerations when determining cancer treatments.

Answer 44

*cancer s/s may be mistaken for age-related changes *OAs are more vulnerable to complications of cancer and cancer tx *functional status should be considered when a tx plan is selected *benefits and risks of tx should be carefully considered.