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Neoplasms Flashcards

1
Q

Define cancer

A

A disease of genomic alterations

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2
Q

A neoplasm is characterized by

A

uncontrolled growth of anaplastic cells that tend to invade surrounding tissue & metastasize to distant sites

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3
Q

How does cancer arise?

A

from mutations in a cell’s gene, genomic instability, &/or inflammation

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4
Q

Define neoplasia

A

New growth or tumor

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5
Q

Solid tumors

A

Carcinoma
Adenocarcinoma
Sarcoma

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6
Q

Carcinoma

A

Originates in epithelial tissue

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7
Q

Adenocarcinoma

A

Originates in glandular tissue
lung cancer → small cell
Colon cancer → adenocarcinoma of colon

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8
Q

Sarcoma

A

Originates in connective or supportive tissue
i.e. osteosarcoma

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9
Q

How can hematologic malignancies be described?

A

As liquid or blood cancers

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10
Q

List examples of hematologic malignancies

A

Leukemia → AML; CML; ALL; CLL
Lymphoma → hodgkin’s/ non-hodgkin’s
Multiple myeloma
Myelodysplastic syndrome

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11
Q

Physical carcinogens

A

Ionizing radiation
Ultraviolet radiation from sunlight

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12
Q

Chemical carcinogens

A

Abestos
Arsenic
Benzene
Insecticides
Tobacco smoke

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13
Q

Viral/ bacterial carcinogens

A

HPV
HIV
Retroviruses
H. pylori

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14
Q

Cancer causes:

Host factors

A

Genetics
Obesity
Aging
Lifestyle

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15
Q

Cancer causes:

Environmental factors

A

Pollution
Smoking
Alcohol
Poor nutrition
Occupational exposure

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16
Q

Normal cell growth (8)

A

Well differentiated
Controlled, slow growth
Uniform shape
Cellular communication
Monolayered
Encapsulated
Cell cohesiveness
Mortal (Apoptosis)

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17
Q

Malignant cell growth (8)

A

Poorly differentiated
Abnormal appearance
Lack of cohesiveness
Uncontrolled growth
Multilayered
Loss of cellular communication
Invasive, capable of spreading
Immortal (avoid apoptosis)

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18
Q

Characteristics that increase the development of malignancies (6)

A

Genomic instability
Tumor-promoting inflammation
Unlocking phenotypic plasticity
Non-mutational epigenetic reprogramming
Polymorphic microbiomes
Senescent cells

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19
Q

Mutations in regulatory cells:

Proto-oncogene

A

Genes that code for proteins involved in normal cell growth
→ when mutated, enable cancer cells to grow uncontrollably = oncogene

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20
Q

Mutations in regulatory cells:

Tumor suppressor gene

A

Gene that codes protein products that inhibit cellular division, repair damaged DNA, & promote apoptosis

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21
Q

What happens when tumor suppressor genes are altered?

A

These genes become inactivated & allow uncontrolled proliferation

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22
Q

List examples of tumor suppressor genes

A

BRCA1 & BRCA2

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23
Q

Mutations in regulatory cells:

DNA repair genes

A

Allow cells to repair DNA damage
5 pathways → active at different stages of cell cycle

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24
Q

What can happen if DNA repair genes don’t correct?

A

Leads to a mutation that can lead to cancer formation
i.e with BRCA1 & 2

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25
Mutations in regulatory cells: Epigenetic changes
Changes in genetic expression rather than DNA sequence that can affect efficacy of DNA repair genes → tells genes when to turn on or off
26
Mutations in regulatory cells: Chromosome translocation
Occurs when one piece of a chromosome moves to another chromosome
27
Chromosome translocation is a genetic alteration that activates an ______
oncogene
28
Give an example of chromosome translocation
The BCR gene on chromosome 9 is fused to the ABL gene on chromosome 22
29
Mutations in regulatory cells: Genetic instability
defective mechanisms that lead to increased rate of genetic alterations
30
Genetic instability is the clonal evolution of _____ _____
tumor cells **Classic sign of cancer**
31
Mutations in regulatory cells: Inflammation
enhances the process of carcinogens
32
Characteristics of cancer cells: Pleomorphism
cells in various shapes & sizes
33
Characteristics of cancer cells: Hyperchromatism
nuclear chromatin more pronounced with staining
34
Characteristics of cancer cells: Polymorphism
Nucleus enlarges & variable in shape
35
Abnormal chromosome arrangements: Translocation
exchange of chromosomal material
36
Abnormal chromosome arrangements: Deletions
Loss of chromosome segment
37
Abnormal chromosome arrangements: Amplification
Increase number of copies of a DNA sequence
38
Abnormal chromosome arrangements: Aneuploidy
Abnormal number (extra or missing) of chromosomes
39
Characteristics of benign cells (6)
Well-differentiated Controlled growth Uniform shape Cell cohesiveness Contact inhibition Mortal (apoptosis)
40
Characteristics of malignant cells (7)
Poorly differentiated Abnormal appearance Uncontrolled proliferation Accelerated use of nutrients Loss of contact inhibition Invasive Immortal (avoids apoptosis)
41
What does cellular differentiation & grading refer to?
the extent cancer cells resemble normal cells, both in structure & maturity
42
Grading = degree of differentiation (scale)
Grade 1 → well differentiated (low grade) Grade 2 → moderate differentiated/ intermediate grade Grade 3 → poorly differentiated / high grade Grade 4 → undifferentiated / unable to tell where the cell came from
43
Define anaplasia
Lack of differentiation
44
What is metastasis and how does it spread?
It's the spread of cancer cells from original site → spreads via bloodstream or lymphatic system
45
Symptoms of metastatic disease
SOB Pain Headache Seizures
46
Site of metastasis for melanoma
Brain, lung
47
Site of metastasis for lung cancer
Brain, bone, liver
48
Site of metastasis for colon cancer
Liver, lung, brain
49
Site of metastasis for prostate cancer
Bone, lung
50
Site of metastasis for breast cancer
Bone, lung, liver, brain
51
List the sequential process of metastasis
Transformation → angiogenesis → motility & invasion (cap, venules, lymph vessels) → multi-cell aggregates (lymphs, PLTs) → embolism & circulation → arrest in capillary beds → extravasation into organ parenchyma → response to microenvironment → tumor cell proliferation & angiogenesis → metastases → metastasis of metastases
52
List the clinical manifestations of cancer (10)
Anorexia/ Cachexia Bleeding Immunosuppression Infections Weight loss Fatigue Pain Sleep disorders Paraneoplastic syndromes
53
What are paraneoplastic syndromes?
They are caused by cancers & may be a presenting sign
54
List examples of paraneoplastic syndromes
SIADH Cushing's Hypercalcemia venous thrombosis
55
List the 4 goals of cancer therapy
Prevention Cure Control Palliation
56
List 6 different treatments of cancer
Surgery Radiation therapy Chemotherapy Hormones Targeted therapy/ biotherapy Immunotherapy
57
Tx of cancer: Surgery
Directly removes the tumor &/or affected lymph nodes
58
With surgery pathologic specimens are examined for?
Clear margins
59
What are some adverse effects to surgery as a cancer Tx?
inability to remove all the tumor bleeding infection
60
What kind of therapy is chemotherapy?
Systemic therapy **Some cells are cell-cycle specific and others are non-specific**
61
Chemotherapy interrupts
Tumor growth & kills tumor cells
62
Toxicities & adverse effects of chemotherapy
Based on their effect on particular cells
63
Common side effects of chemo
N/V Alopecia Immunosuppression Increased risk of infection/ bleeding
64
Chemotherapy drugs are often administered
in combination w/ one or more agents &/or other Tx modalities
65
Radiation therapy
Uses focused ionizing radiation to damage DNA & prevent further growth of tumor
66
Internal radiation
Implanted into or near the tumor in small capsules or other containers
67
External radiation
Aimed at tumor from outside the body
68
Side effects of radiation therapy
Skin redness irritation ulceration fibrosis atrophy
69
Biotherapy: Use of natural & manufactured substances derived from the body to:
1. Stimulate or restore the ability of immune system 2. Uses Ab to fight cancer 3. Change or modify the relationship between the cancer & host
70
Biotherapy uses targeted therapy that:
1. blocks a specific receptor 2. attaches to a specific receptor to assist the immune system to kill the cancer 3. carries chemotherapy or a radioisotope into the cell
71
Immunotherapy helps ...
effector cells in the body to become activated &/or enhance results in targeted cancer cell death
72
Treatment approaches (4)
1. neoadjuvant therapy 2. adjuvant therapy 3. conditioning / preparative therapy 4. immunosuppression
73
Neoadjuvant therapy
**Use of one or more Tx modalities before the primary therapy** Goal is to shrink tumor size
74
Adjuvant therapy
**Follows the primary modality** Goal is to target minimal disease or micrometastasis
75
Conditioning or preparative therapy
Goal is to empty marrow space before transplant or to eliminate residual disease
76
Immunosuppression
To blunt immune response
77
Nursing management for cancer Tx/ care:
Interprofessional approach Patient education!! Issue of adherence Monitoring of labs Sx management
78
Nursing management: Sx management includes
Use of common terminology criteria for adverse events grading system (CTCAE)
79
CTCAE: Granulocytopenia
Grade 1 → 1,500-3,000/μL Grade 2 → 1,000-1,499/μL Grade 3 → 500-999/μL Grade 4 → < 500/μL Grade 5 → N/A
80
CTCAE: Thrombocytopenia
Grade 1 → 100,000-150,000/μL Grade 2 → 50,000-99,000/μL Grade 3 → 25,000-49,000/μL Grade 4 → < 25,000/μL Grade 5 → N/A
81
CTCAE: Anorexia
Grade 1 → coaxing/ dietary change needed Grade 2 → oral intake altered < 3 days, no sig weight loss Grade 3 → 3-5 day duration, tube feeding Grade 4 → life threatening, > 5 day duration Grade 5 → death
82
CTCAE: Diarrhea
Grade 1 → > 2 stools per day over baseline Grade 2 → 2-6 stools over baseline, IV or SC fluids < 24 hrs Grade 3 → > 6 stools, incontinence, IV fluids & hospitalization > 24 hrs grade 4 → life threatening, hemodynamic collapse grade 5 → death
83
CTCAE: Vomiting
Grade 1 → < 3 episodes in 24 hrs Grade 2 → 3-5 episodes in 24 hrs, fluids for < 24 hrs Grade 3 → > 5 episodes/ day or > 4 day duration Grade 4 → life threatening, hemodynamic collapse Grade 5 → death
84
Question: Which of the following genes, when mutated is NOT implicated in the development of neoplasms? A) Carcinogens B) tumor suppressor gene C) oncogenes D) mutator genes
A) Carcinogens
85
Question: Which of the following is a characteristic of benign neoplasms? A) high undifferentiated B) invasive C) destructive D cell overproliferation
D cell overproliferation
86
Question: As a public health nurse, which intervention would have the greatest impact on reducing cancer rates? A) smoking cessation programs B) routine genetic testing C) distributing sunscreen each summer D) eliminating unnecessary radiation
A) smoking cessation programs
87
Question: Identify 4 goals of cancer Tx (SATA) A) cure B) control C) Decrease side effects of Tx D) palliation E) prevention F) research into new Tx
A) cure B) control D) palliation E) prevention

NUR516 (36 decks)

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