Mod 2 Cancer and genetics Flashcards
(114 cards)
1
Q
Abrasion
A
an injury caused by rubbing or scraping that results in the loss of the superficial layer of skin
2
Q
Angiogenesis
A
the process of forming new blood vessels.
Occurs in the granulation phase of healing in wound repair.
Or in cancer when cancer cells stimulate blood vessel growth to feed a tumor by sending out growth signals
3
Q
Approximation
A
Word used to describe when wound edges are touching (all wound margins are approximated)
All surfaces need to be touching to heal.
Applies to wounds healing by 1st or 3rd intention
4
Q
Avulsion
A
a wound that results from tissue being torn away in large piece
REQUIRES HEALING BY SECONDARY INTENTION
5
Q
Cellulitis
A
inflammation or infection of the cells in tissues characterized by SHARP
6
Q
Debridement
A
the removal of devitalized or dead tissue and foreign material from the wound bed
A wound should be clear of dead or revitalized tissue to support healing and reduce the risk of infection
there are many ways to debride a wound
7
Q
Dehiscence
A
The splitting open of a surgical wound (a wound that had been sutured closed)
8
Q
Erythema
A
redness of the skin
caused by vasodilation related to inflammation, infection, or injury
9
Q
Exudate
A
Fluid that comes from wounds. can be clear (serous) sanguineous (bloody) or purulent (pus)
10
Q
Granulation Tissue
A
forms in the wound base which fills in wound with scar tissue.
The tissue is red or pink and has a lumpy appearance like small grapes.
The tissue is necessary to fill in wounds for healing.
11
Q
Ischemia
A
A deficiency of blood supply to an area of tissue or an organ
12
Q
Laceration
A
a wound that is produced by the tearing of cutting of the skin
13
Q
Maceration
A
a softening, whitish look to the intact skin around wounds caused by excessive moisture. Often occurs when exudate is not well managed by dressings
also occurs when briefs are not changed often enough.
14
Q
Necrotic Tissue
A
dead tissue that usually presents as black or brown and is hard or leathery in texture (eschar) Must be removed for the wound to heal. Very prone to infection
15
Q
Purulent
A
Containing or forming pus. Usually yan opaque white, green, or yellow exudate
16
Q
3 Types of Healing Intention
A
Primary intention
Secondary Intention
Tertiary Intention
17
Q
Primary Intention
A
Wound margins are brought together by any means
(sutures, steri-strips, glue, band-aid, staples)
and heals with minimal scaring or infection
incisions, cuts, and puncture wounds, are likely to heal by primary intention
18
Q
Secondary intention
A
missing tissues requires margins to contract, and then fills-in, resulting in a large scar. Cannot be sutured closed because too much tissue is missing. High infection potential
*Larger wounds with loss of tissue and contamination (such as experienced in a bicycle crash) are likely to heal by secondary intention. Also pressure ulcers
19
Q
Tertiary Intention
A
Wound margins either separate after being closed (surgery incisions dehisces) or are intentionally left open (to allow infection to drain out of the wound) then brought together (and closed with stitches) after granulation tissue appears. This is a combination of primary and secondary closure
*This type of closure is preferred when wound in heavily contaminated to reduce the risk of wound infection. The wound is cleansed and is watched closely for several days. When the wound appears to be clean on its way to healing it is closed surgically (dog bites etc.)
20
Q
Nutritional Status effect on wound healing
A
21
Q
Blood flow/ O2 delivery effect on wound healing
A
22
Q
Impaired Inflammatory/ immune response effect on wound healing
A
23
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Infection effect on wound healing
A
24
Q
Wound separation effect on wound healing
A
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Foreign Bodies effect on wound healing
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Benign Characteristics
Cell characteristics: Well differentiated
cellular cohesiveness: Stays together
growth mode: expands and pushes on surrounding tissue
growth pattern: encapsulated
growth rate: generally slow
metastatic potential: does not metastasize
tumor mobility: movable
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Malignant Characteristics
cell characteristics: Poor differentiation
Cellular cohesiveness: Breaks apart, sluffs off easily
Growth mode: infiltrates into tissue
Growth pattern: infiltrates tissues
Growth rate: usually rapid
metastatic potential: eventually metastasizes
tumor mobility: fixed
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Differentiation with cancers
Tumors lose differentiation features over time as they multiply and become more "malignant"
Poor cellular differentiation increases the growth rate. A tumor neoplasm that is well differentiated (retains most of the cellular characteristics of the tissue it is from)
*well differentiated = benign
*poorly differentiated = malignant
if it is malignant it loses the characteristics that made it a unique type of cell and it no longer functions as normal tissue
29
Contact inhibition with cancers
the cessation of growth after a cell comes in contact with another cell. blocking the synthesis of DNA, rna, and proteins.
When cell membranes come in contact with each other, they stop reproducing.
*cancer cells tend to grow rampantly despite coming into contact with other tissue
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Cohesiveness with cancers
normal cell membranes help support each other by sticking together when they come in contact with each other. Malignant cells lack this cohesiveness
this is why malignant cells SPREAD EASILY. they do not have cellular support from the other cells. the least little bump or contact can cause the cancer cells to shed and spread
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Anchorage independence with cancers
Normal cells must be "anchored" to a membrane or matrix of some kind to grow (except blood cells). Cancer cells can move freely (and therefore metastasize)
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Faulty Cell to Cell communication with cancers
Chemical messengers bind to specific cell surface receptors, control cell growth, and modify cell behavior.
It may interfere with the formation of intercellular connections and responsiveness of membrane-derived signals.
*The cancer cell does not get the message to stop growing
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Antigen Expression with cancers
Cancer cells express a number of cell surface molecules or antigens that are immunologically identified as foreign.
Tumor antigens may be used clinically as markers to indicate the presence or progressive growth of a cancer
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Enzymes with cancers
Most cancers synthesize and secrete enzymes (proteases and glycosidase). breaks down proteins involved in insuring intracellular organization and cell to cell cohesion. may contribute to the breakdown of intercellular matrix
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Sentinel node
the initial lymph node to which the primary tumor drains. Once the sentinel node is identified, it is examined to determine the presence or absence of cancer cells which indicates how far the cancer has spread
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Benign tumors nomenclature
usually are named by adding the suffix -oma
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Malignant tumors of epithelial origin nomenclature
usually named by adding the suffix -carcinoma
Carcinoma is the more common form affecting epithelial tissues, skin and mucous membranes lining body cavities
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Malignant tumors of mesenchymal nomenclature
mesenchymal = connective tissue tumors (bone, muscle, and cartilage)
called sarcomas
sarcoma is the less common cancer but it spreads more rapidly and is highly malignant
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Rapidly growing tumors
show little diffentiation and this lack of form is referred to as anaplasia (meaning without form)
*they are most responsive to radiation treatment
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Oncogenesis
the genetic mechanism whereby *normal cells are transformed into cancer cells*
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Oncogene
mutated gene that now has the potential to cause cancer
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Oncogene types
Proto-oncogene
-cellular oncogenes
-viral oncogenes
Mutated anti-oncogene
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Proto-oncogene
an otherwise normal gene with a "genetic weakness"
more susceptible to being converted into an oncogene due to mutations from either inherited predispositions or external causes
*the mutations in proto-oncogene disable normal apoptosis of cells which then results in over production of cells which is what will lead to cancer*
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Proto-oncogene (Cellular oncogenes)
cancer characteristics that are coded on the host's inherited genes. Most human cancers are due to new mutations of cellular oncogenes to the oncogene form (also called cellular proto-oncogene)
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Proto-oncogene (viral oncogene)
Some viruses are known to cause cancer by transmitting their DNA or RNA into host cells which damages the cells' genes
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Mutated anti-oncogene
When anti-oncogenes (tumor supressing genes) are damaged by mutation this leads to under production of cancer preventing cells
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Host factors
Heredity
hormone
faulty immunologic mechanisms
obesity
smoking
alcohol
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Environmental factors
Chemicals
radiation (including sun)
pollution
food
molds
tanning beds
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oncogenic viruses
mutation of oncogenes by viruses can be linked to cancer formation
-Human papilloma Virus
-human t-cell lymphotropic virus
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Methods of metastasis
Direct extension
seeding
circulation
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Direct extension
tumor cells spread to tissues adjacent to the primary tumor by sending out projections (tentacles) into the surrounding tissue or growing pseudopodia to "walk " to the nearest cells
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Seeding
Tumor cells slough off from the primary tumor and develop into more tumors
ex: during surgery to remove a tumor some tumor cells remain in the tissue after the main tumor is removed and provide the seed for more tumor cells to grow
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Circulation
(through blood and/ or lymph) a secondary tumor develops in a site distant from the primary tumor
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staging definition
describes the severity of a person's cancer based on the size and/ or extent (reach) of the original (primary) tumor and whether or not cancer has spread in the body
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staging is important for several reasons like:
-staging helps the doctor plan the appropriate treatment
-cancer stage can be used in estimating a person's prognosis
-staging helps health care providers and researchers exchange information about patients
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TNM staging system stands for
T- Tumor
N- Lymph Nodes
M- Metastasis
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TNM staging purpose
-To see the size or reach of the tumor
-Whether it reached to lymph nodes
-whether there is the presence of metastasis or secondary tumors formed by the spread of cancer cells to the other parts of the body.
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TNM staging systems numbers meaning
a number is added to each letter to indicate the size and or extent of the primary tumor and the degree of cancer spread
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Primary Tumor abbreviation meanings
TX: primary tumor cannot be evaluated
T0: no evidence of primary tumor
Tis: Carcinoma in situ
T1, T2, T3, T4: Size and/ or extent of the primary tumor
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Regional Lymph Nodes abbreviation meanings
NX: regional lymph nodes cannot be evaluated
N0: No regional lymph node involvement
N1,N2,N3: Degree of regional lymph node involvement (number and location of lymph nodes)
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Distant Metastasis Abbreviation meanings
MX: Distant metastasis cannot be evaluated
M0: No distant metastasis
M1: Distant metastasis is present
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Stage 1 Staging system def
Location of tumor: In situ
Definition: Abnormal cells are present only in the layer of cells in which they developed
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Stage 2 Staging system def
Location of tumor: Localized
Definition: Cancer is limited to the organ in which it began - no evidence of spread
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Stage 3 staging system def
Location of tumor: regional
Definition: Cancer has spread beyond the primary site to nearby lymph nodes or tissues and organs
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Stage 4 staging system def
Location of tumor: Distant/ metastatic
Definition: Cancer has spread from the primary site to distant tissues or organs or to distant lymph nodes
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Unk
Location of tumor: Unknown
Definition: There is not enough information to determine the stage
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Tumor grade
NOT THE SAME AS THE STAGE OF CANCER
-tumor grade is the description of a tumor based on how abnormal the tumor cells and the tumor tissue look under a microscope
-it is an indicator of how quickly a tumor is likely to grow and spread
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Tumor grading scale
GX
Grade 1
Grade 2
Grade 3
Grade 4
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GX
Grade cannot be assessed (undetermined grade)
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Grade 1
Well differentiated, least aggressive
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Grade 2
Moderately differentiated
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Grade 3
Poorly differentiated
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Grade 4
Very poorly differentiated. More likely to progress quickly, highly malignant
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Fatigue
The most frequently reported symptom
Causes of fatigue:
-sleep disturbance
-biochemical changes secondary to disease and treatment
-psychological factors
-activity
-nutritional status
-environmental and physical factors
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Pain
Caused by:
-pressure/stretching
-obstruction
-invasive tissues by tumor
Manifests in later stages
Pain management is a major concern in cancer treatments
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Blood dyscrasias
Blood component disorders
caused by: bone marrow damage from various cancer treatments
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Examples of blood dyscrasias
Anemia
Leukopenia
thrombocytopenia
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Anemia
Low red blood cell count
caused by:
bleeding
malnutrition
cancer treatments (especially radiation)
tumor may ulcerate or erode blood vessels (bleeding)
causes:
decreased delivery of oxygen to tissues and least to patient fatigue and s/s of low O2
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Leukopenia
Low white blood cell count
caused by:
bone cancers
cancer treatments
Cancer patients are prone to infections
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Thrombocytopenia
Low platelet count
caused by:
bone cancers
cancer treatments
causes:
thrombocytopenia (bleeding disorders) which turns into anemia
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Infection
*The most significant cause of mortality of cancer patients*
Increased risk due to:
malnutrition
blood dyscrasias
bone marrow suppression (immunosuppression from radiation and chemo treatments)
Tissue breakdown occurs and the patients immune system is weakened
becoming less mobile causes secretions to build up in lungs (pneumonia)
82
Cachexia
Wasting Syndrome related to malnutrition due to INCREASED BMR (basal metabolic rate) caused by growing tumors
-results in loss of skeletal muscle mass that cannot be fully reversed by nutrition.
-Loss of skeletal muscle leads ultimately to loss of body function.
Multifactorial causes including:
fatigue, stress, anorexia, and rapidly growing tumor "stealing nutrition" from the body
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Cachexia commonly caused by
Tumors: Increase the patient's basal metabolic rate (more calories are needed to maintain muscle mass)
Chemo: Taste buds are destroyed, patients don't wanna eat, also causes severe nausea and vomiting (CINV = "Chemotherapy-induced nausea and vomiting)
Immunosuppressed: Allows overgrowth of opportunistic pathogens such as oral yeast that causes mouth sores (mucositis or stomatitis) patients will not eat because it is too painful
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Curative
Cancer will be eliminated from the individual. Treatment is intended to bring out a COMPLETE CURE of the cancer (doesn't always work)
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Control
if the cancer is treated but does not completely go away it can be controlled and managed as a chronic disease
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Palliative
treatment given ONLY TO RELIEVE CANCER SYMPTOMS AND REDUCE THE SUFFERING caused by cancer
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Adjuvant Therapy
Treatment that is given IN ADDITION to the primary treatment to make sure the cancer is eradicated
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Chemotherapy TX
not selective in the cells it kills
-*chemo drugs kill ALL FAST GROWING cells whether they are cancerous or not
Other normal fast-growing cells are damaged
- *GI Tract cells and bone marrow
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Adverse reactions of chemotherapy
GI Tract
Bone Marrow Suppression
Secondary malignancies
Alopecia
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Adverse reactions of chemotherapy: GI tract
the lining of the GI tract consists of fast growing cells
-Severe nausea/ vomiting (CINV)
-Mucositis/ stomatitis
-diarrhea or constipation (bowel obstructions can cause death)
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Adverse reactions of chemotherapy: Bone Marrow Suppression
Bone marrow: fast-growing blood cells
chemo can result in a reduction of ALL blood components- RBC, WBC, and platelets
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Adverse reactions of chemotherapy: Secondary malignancies
can be caused by the caustic chemotherapy agents used to treat the primary tumor
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Adverse reactions of chemotherapy: Alopecia
Hair loss because hair follicles are fast-growing cells.
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Mucositis (stomatitis)
Chemotherapy-induced mucositis common complication of therapy
3-10 days after the initiation of chemotherapy and lasts 7-14 days
causes ulcers in the mouth
ulcers act as a site for local infection
contributes to: Pain, Malnutrition, Cachexia, and infection
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Radiotherapy (radiation) TX
ionizing radiation may be used externally or internally (implants) most effective for rapidly growing, poorly differentiated tumor cells
-usually used with chemotherapy and or surgery as adjuvant therapy
-can be used to reduce the size of a tumor and provide comfort
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adverse reactions of radiotherapy
Skin burns
GI tract
Bone marrow suppression
Alopecia
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Surgery TX
May be curative, adjuvant, or palliative therapy
Surgery may be done to assist with TNM
Adverse outcomes are related to:
-the nature of the surgery
-how far advanced the cancer has progressed
-blood loss
-patients general condition prior to surgery etc.
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Biotherapy (immunotherapy) TX
Medications stimulate the immune system to identify and destroy cancer cells without damaging surrounding normal cells.
BRMs are a class of drugs that are used to treat cancer by altering or augmenting naturally occurring processes within the body
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BRM Medications:
Enhance: an immune response (as might be needed to stimulate "seek and destroy" actions against cancer cells
Suppress: suppresses the immune system as might be needed to treat autoimmune disorders where a person's immune system is over active
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Advantaged of immunotherapy
-High specificity for antigens - means less damage to healthy tissue (but there are still negative side effects)
-immune memory cells give long protection
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Disadvantages of immunotherapy
-Negative side effects are similar to chemotherapy and radiotherapy
-Side effects include: Nausea and vomiting, diarrhea, loss of appetite, fever and chills, muscle aches, weakness, skin rash, and increased tendency to bleed or swelling
-Patients need to be instructed to AVOID CROWDS OR PLACES WEHRE EXPOSURE TO PATHOGENS IS MORE LIKELY BECAUSE THEY ARE IMMUNOSUPPRESSED when taking these drugs
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Types of BRMs
MAB = Must Avoid Bugs
Monoclonal Antibodies (Mab drugs)
Interleukin-2 (a cytokine)
Alpha interferon (IFN)
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When a MONOCLONAL ANTIBODY attaches to a cancer cell:
Make the cancer cell more visible to the immune system
Block growth signals
stop new blood vessels from forming (blocks angiogenesis)
Deliver radiation to cancer cells
deliver chemotherapy to cancer cells
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Adult Cancers
Greater than 99%
environmental cause high
80% can be prevented
found during routine screening exams
intolerant to treatment
less responsive to chemo
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Pediatric cancer
Diagnosed during peak growth times
less than 1%
genetic cause, not much environmental
few can be prevented
found accidentally
tolerant to treatment but long term consequences
very responsive to chemo
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Teratogens
chemical, biological, or physical factors that might cause an abnormal development of a fetus in the mother's womb (congenital birth defects)
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When are teratogens most effective
First week of pregnancy (all-or-nothing)
-baby either dies from tetratogens or survives without any harm
Three to with weeks of pregnancy
-considered the most critical. Organs start to form and are sensitive to harmful factors
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Examples of teratogens
Diseases (maternal illness): chicken pox, herpes, german measels, HIV, AIDS, infections etc.
Drugs/ chemicals: tetracycline, acne medication, aspirin, antacids, diet pills, alcohol, etc.
Environmental: mercury (even small amounts in fish) lead, radiation (like x-rays)
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Fetal Alcohol Syndrome
-One drink for mom = ten for the baby
-Harmful effects to the fetus from maternal alcohol use will happen * throughout the pregnancy and is the #1 cause of mental retardation in children
-defects caused by fetal alcohol syndrome irreversible
-Distinctive facial features, including wide set eyes, an exceptionally thin upper lip a short upturned nose and a smooth skin surface between nose and upper lip
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Alchohol sydrome in fetal also causes
developmental delays
physical defects
seizures during withdrawl
behavioral problems
intellectual impairment
brain malformation
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TORCH infections
perinatal infections account for 2% to 3% of all congenital anomalies
TORCH includes
Toxoplasmosis
Other (syphilis, varicella-zoster, parvovirus B19)
Rubella
Cytomegalovirus (CMV)
Herpes Infections
112
TORCH causes
Mild maternal morbidity but have serious fatal consequences
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Epigenetics
"on top" of genetics
Epigenetic changes are modifications of DNA
*Which occur without any alteration in on or off and how much of a particular message is made
Child abuse has been shown to alter the epigenetic profile of the brain when examined post-mortem
epigenetic changes can also be handed down from mother or father
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