Weitere ähnliche Inhalte Ähnlich wie Week two notes (20) Mehr von Erin Yesenosky (17) Kürzlich hochgeladen (20) Week two notes1. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1
Biology, Clinical Manifestations,
and Treatment of Cancer
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Cancer
Derived from Greek word for crab,
karkinoma
Malignant tumor
Tumor
Also referred to as a neoplasm—new growth
Let’s review the two different types:
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Benign vs. Malignant Tumors
Benign Malignant
Grow slowly Grow rapidly
Well-defined capsule Not encapsulated
Not invasive Invasive
Well differentiated Poorly differentiated
Low mitotic index High mitotic index
Do not metastasize Can spread distantly
(metastasis)
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Classification and Nomenclature
Benign tumors
Named according to the tissues from which
they arise and include the suffix “-oma”
• Lipoma
• Glioma
• Leiomyoma
• Chondroma
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Classification and Nomenclature
(cont’d)
Malignant tumors
Named according to the tissues from
which they arise
• Malignant epithelial tumors are referred to
as carcinomas
Adenocarcinoma
• Malignant connective tissue tumors are
referred to as sarcomas
Rhabdomyosarcomas
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Classification and Nomenclature
(cont’d)
Cancers of lymphatic tissue are
lymphomas
Cancers of blood-forming cells are
leukemias
Carcinoma in situ (CIS)
Preinvasive epithelial malignant tumors of
glandular or epithelial origin that have not
broken through the basement membrane or
invaded the surrounding stroma
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Histology and Genetics
Tumors are classified based on
immunohistochemical analysis of genetic
alterations for improved treatment
Determine specific genetic mutation
Identify multiple subdivision
• Breast cancer—six different types
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Tumor Markers
Tumor cell markers (biologic markers) are
substances produced by cancer cells or
that are found on plasma cell membranes,
in the blood, CSF, or urine
Hormones
Enzymes
Genes
Antigens
Antibodies
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Tumor Markers (cont’d)
Tumor markers are used to:
Screen and identify individuals at high risk for
cancer
Diagnose specific types of tumors
Observe clinical course of cancer
Problem: false positives and negatives
What tumor markers can you state?
What are the values?
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Cancer Stem Cells
New Research
Stem cells self-renew
Cell divisions create new stem cells
Stem cells are pluripotent
Ability to differentiate into multiple different cell
types
Current cancer chemotherapy does not kill
cancer stem cells
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Inflammation and Cancer
Chronic inflammation is an important factor
in the development of cancer
Cytokine release from inflammatory cells
Free radicals
Mutation promotion
Decreased response to DNA damage
Examples: ulcerative colitis, chronic viral
hepatitis
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Immune System and Cancer
Normal immune system protects against
cancer
Immunosuppression fosters cancer
Non-Hodgkin lymphoma (10X)
Kaposi sarcoma (1000X)
In some cases cancer promotes secretion of
cytokines that foster cancer
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Viruses and Cancer
Implicated
Hepatitis B and C viruses
Epstein-Barr virus (EBV)
Kaposi sarcoma herpesvirus (KSHV)
Human papillomavirus (HPV)
Human T cell leukemia–lymphoma virus
(HTLV)
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Bacterial Cause of Cancer
Helicobacter pylori
Chronic infections are associated with:
• Peptic ulcer disease
• Stomach carcinoma
• Mucosa-associated lymphoid tissue lymphomas
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Three-Step Theory of Invasion
Tumor cell attachment
Fibronectin and laminin
Degradation or dissolution of the matrix
Enzymes
Locomotion into the matrix
Invadopodia (pseudopodia)
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Sequential Process of Metastasis
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Clinical Manifestations
Many Different clinical manifestations occur:
Syndrome of cachexia
Most severe form of malnutrition
Present in 80% of cancer patients at death
Includes anorexia, early satiety, weight loss,
anemia, asthenia, taste alterations, and altered
protein, lipid, and carbohydrate metabolism
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Cachexia
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Clinical Manifestations
Anemia
A decrease of hemoglobin in the blood
Mechanisms:
• Chronic bleeding resulting in iron deficiency
• Severe malnutrition
• Medical therapies
• Malignancy in blood-forming organs
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Clinical Manifestations (cont’d)
Leukopenia and thrombocytopenia
Direct tumor invasion to the bone marrow causes
leukopenia and thrombocytopenia
Chemotherapy drugs are toxic to the bone marrow
Infection
Risk increases when the absolute neutrophil and
lymphocyte counts fall
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Clinical Manifestations (cont’d)
Paraneoplastic syndromes
Symptom complexes that cannot be explained by
the local or distant spread of the tumor or by the
effects of hormones released by the tissue from
which the tumor arose
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Environmental Risk Factors
Tobacco
Multipotent carcinogenic mixture
Linked to cancers of the lung, lower urinary tract,
upper aerodigestive tract, liver, kidney, pancreas,
cervix uterus
Linked to myeloid leukemia
Secondhand smoke (ETS) contains many toxic
chemicals
Cigar and pipe smoking equally harmful
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Environmental Risk Factors
Diet
May account for 30% of the overall risk factors for
cancer
Xenobiotics
• Hydrocarbons and amines produced during cooking of meat
protein
• Toxic, mutagenic, and carcinogenic chemicals in food
• Examples:
– Compounds produced in the cooking of fat, meat, or
proteins
– Alkaloids or mold by-products
• May influence epigenetics
Research ongoing regarding vitamin influe
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Cancer in Children
Incidence
Rare but is leading cause of death from disease in
children
In 2004, mortality rate was 2.4 per 100,000 cases
Survival rates have dramatically improved over
past 30 years
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Cancer in Children
Most originate from the mesodermal germ
layer
Layer gives rise to connective tissue, bone,
cartilage, muscle, blood, blood vessels, gonads,
kidneys, and the lymphatic system
Most sarcomas vs. carcinomas in adults
Diagnosed during vs. peak growth periods
Fast growing and without early signs
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Etiology with Children
Most do not demonstrate predisposing
environmental factors
Genetic factors:
Chromosome abnormalities
• Aneuploidy, amplifications, deletions, translocations, and
fragility
• Certain congenital syndromes and cancers occur
together
Wilms tumor and urogenital abnormalities
Down syndrome and leukemia
Oncogenes and tumor-suppressor genes
• Fanconi anemia, Bloom syndrome
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Prognosis
More than 70% of children cured
Survival rates higher in children under 15
years
Younger are more likely to be enrolled in
clinical trials
Survivors have increased risk of cancer later
in life
Residual and long-term effects of treatment
Psychologic sequelae
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Components of the hematologic
system
Chief functions:
Delivery of substances needed for cellular
metabolism
Removal of wastes
Defense against microorganisms and injury
Maintenance of acid-base balance
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Components of the hematologic
system
As a review remember what the following
functions are:
Bone Marrow
Lymphoid Organs
Platelets
RBC
WBC
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Erythropoiesis
Erythrocytes are derived from erythroblasts
(normoblasts)
Maturation is stimulated by erythropoietin
Erythropoietin causes an increase in red cell
production and release from bone marrow
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Regulation
Numbers of circulating red cells in healthy
individuals remain constant
The peritubular cells of the kidney produce
erythropoietin
Hypoxia stimulates the production and
release of erythropoietin
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Erythropoiesis
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Evaluation of the Hematologic
System
Tests of bone marrow function:
Bone marrow aspiration
Bone marrow biopsy
Measurement of bone marrow iron stores
Differential cell count
Blood tests
Large variety of tests
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Pediatrics and the Hematologic
System
Blood cell counts increase above adult levels at
birth
Trauma of birth and cutting the umbilical cord
The hypoxic intrauterine environment stimulates
erythropoietin production
Results in polycythemia
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Aging and the Hematologic
System
Erythrocyte life span is normal but erythrocytes are
replaced more slowly
Possible causes:
Iron depletion
Decreased total serum iron, iron-binding
capacity, and intestinal iron absorption
Lymphocyte function decreases with age
The humoral immune system is less responsive
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Multiple Myeloma (MM)
Malignant proliferation of plasma cells
Infiltrate bone marrow and aggregate into
tumor masses in skeletal system
M-proteins
Bence Jones protein
Hypercalcemia, renal failure, bone lesions
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Multiple Myeloma