Term
| Explain important concepts of Cancer |
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Definition
| Chronic, Not one disease, Cellular based with systemic manifestations. Cancer is a disease primarily of aging |
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Term
| What are the cancers of highest incidence? |
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Definition
Gender specific: Men-Prostate, Women- Breast
Non-gender specific: Lung, Colon, Skin |
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Term
| What are some reasons for increase in survival rates? |
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Definition
| Increase in screening and medical technology |
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Term
| Describe progression of cells to neoplasm |
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Definition
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Term
| Explain: characteristics of benign tumor |
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Definition
Cell:Similar to normal cells, differentiated, Mitosis fairly
Growth:normal Growth is relatively slow, expanding mass, Frequently encapsulated
Spread: localized
Systemic effects: Rare
Life-threatening: Depends on location |
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Term
| Explain: characteristics of malignant tumor |
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Definition
Cells: Varie in size and shape with large nuclei, many undifferentiated immature, increased and atypical mitosis
Growth: Rapid, non adhesive cells, infiltrate tissue, unencapsulated
Spread: Invades nearby tissue or metastasizes to distant sites through blood or lymph
Systemic effects: often present
Life-threatening: Yes, by tissue destruction and spread of tissues |
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Term
| Describe: naming nomenclature |
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Definition
Root: location of tumor
Suffix: Benign: -oma
Malignant epithelial tissue: -carcinoma
Malignant connective tissue: -sarcoma |
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Term
| Describe necessary evasion of controls for cancer (areas of control) |
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Definition
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Term
| Describe: traits of malignant tumors |
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Definition
Mass compresses blood vessels
Tumor cells may secrete enzymes or hormones
Inflammation and loss of normal cells
Angiogenesis |
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Term
| State: altered genes that lead to cancer |
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Definition
Mutator genes
Proto-oncogenes that become oncogenes
Mutation of tumor suppressor genes |
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Term
| State: genetic disorders associated with cancer |
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Definition
Inherited traits (ie. retinoblastoma, breast cancer)
Complication of inherited trait (trisomy 21) |
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Term
| Describe types of carcinogens |
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Definition
Radiation
Reactive oxygen species
Hormones
Tobacco
Infectious microorganisms
Certain chemicals |
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Term
| Describe: retroviruses/ oncoviruses |
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Definition
Virus that can insert genes or change existing genes, leading to cancer:
HBV, HCV
Epstein-Barr virus (EBV)
Kaposi's Sarcoma herpes virus (KSHV)
HPV
Human T cell leukemia-lymphoma virus (HTLV)
Merkel Cell Polyoma Virus (MCPV)
HIV
Herpes Simplex Virus |
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Term
| Describe other infections that lead to cancer. |
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Definition
h. Pylori- chronic infection in the gut
Schistosoma haematobium- parasite |
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Term
| State: common diseases that lead to cancer |
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Definition
| GERD, chronic pancreatitis |
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Term
| Describe: relationship of inflammation and cancer |
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Definition
Chronic inflammation is an important factor in the development of cancer due to release of chemical mediators
-Cytokine release from inflammatory cells
-Free Radicals
-Decreased response to DNA damage |
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Term
| Describe: relationship between immunity and cancer |
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Definition
| Immunosupressed are at a higher risk for cancer |
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Term
| Describe: how to reduce risk of cancer |
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Definition
Limit UV exposure
Regular medical and dental exams
Self-exam
Diet high in fiber, low in fat, increase fruit and vegi and foods with antioxidants |
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Term
| State: 8 warning signs of cancer |
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Definition
1. Unusual bleeding or discharge anwhere in body
2. Change in bowel or bladder habits
3. Change in wart or mole
4. A sore that does not heal
5. Unexplained weight loss
6. Anemia or low hemoglobin and persistent fatigue
7. Persistent cough or hoarseness without reason
8. A solid lump, often painless, in the breast or testes or anywhere in the body |
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Term
| Describe: local effects of tumors |
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Definition
Pain- absent until late stage, severity depends on tumor type
Obstruction- compression of duct or passageway, blood or lymph could be restricted, block GI tract, block air flow
Tissue necrosis and ulceration- down stream tissue necrosis |
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Term
| Describe: systemic manifestations of malignant tumors |
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Definition
Weight loss and cachexia- Anorexia, fatigue, pain, stress
Anemia- due to blood loss at tumor
Severe fatigue- due to inflammatory changes, cachexia, anemia
Effusions- fluid buildup due to inflammation
Infections- Occurs frequently as resistance declines
Bleeding- due to erosion of blood vessels
Paraneoplastic syndrome- Associated with certain types of tumors, tumor cells release substances that affect neurologic function and may have hormonal effects |
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Term
| Explain: cancer Dx methods |
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Definition
Routine screening
Self-exam
Blood test to detect tumor markers
Radiographic, ultrasound, MRI, CT
Cytologic tests require Bx of cell sample- determines degree of differentiation, test for growth promoter, most reliable confirmation of malignancy |
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Term
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Definition
-Local spread: local invasion
-Direct Extension: Directly moving to next adjacent area
-Seeding: Tissue breaks off and moves adjacent tissue, lymph or blood
-Metastasis: Seeding through lymph or blood to distant sites |
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Term
| Describe: TNM classification system (T) |
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Definition
Primary tumor (T)
TX- Tumor can't be evaluated
T0- No evidence of primary tissue
Tis- Carcinoma in situ (early cancer not spread to neighboring tissue)
T1- Small T2,T3- Medium, T4- large |
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Term
| Describe: TNM classification system (N) |
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Definition
Regional Lymph Nodes
NX- regional lymph nodes can't be evaluated
N0- No regional lymph node involvement
N1, N2, N3- involvement of regional lymph nodes |
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Term
| Describe: TNM classification system (M) |
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Definition
Distant Metastasis
MX- Distant metastasis can't be evaluated
M0- No distant metastasis
M1- Distant metastasis |
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Term
| Describe: cancer Tx methods |
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Definition
Depends on cancer type, location, and staging
-Chemotherapy
-Radiation
-Surgery
-Immunotherapy
-Hormones
-Palliative care |
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Term
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Definition
Removal of all or some
May be done with laparoscope with several small incisions
Removal of surrounding tissue may result in changes in function
Radiofrequency ablation (RFA)- done for small single tumors in solid or fluid-filled organs except lungs |
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Term
| Describe: radiation therapy |
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Definition
May be done alone or in combination of other therapies
Cause mutations/alterations in target DNA
Most effective in rapidly dividing cells
Some cancers are radio-resistant
May be used as an adjuvant therapy prior to surgery to shrink tumor
Adverse effects: bone marrow depression; epithelial damage; infertility |
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Term
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Definition
May be done alone or in combination of other therapies
Uses antineoplastic drugs
Administered at periodic intervals
Classified as: antimitotics, anti-metabolites, alkylating agents, antibiotics
Interferes with protein synthesis and/or DNA replication
Adverse effects: Bone marrow depression; nausea; epithelial damage; damage to specific areas (kidney, lungs, heart, liver) |
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Term
| Describe: Cervical cancer pathophysiology |
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Definition
| Metaplasia of the squamous and columnar epithelial cells in the transformation zone leading to dysplastic cells |
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Term
| Describe: Cervical cancer risk factors |
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Definition
early onset of sexual activity
Multiple sexual partners
Exposure to HPV
Smoking |
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Term
| Describe: Cervical cancer clinical manifestations |
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Definition
No signs or Sx early on
Later state manifestations: Abnormal vaginal bleeding, watery vaginal discharge, pelvic pain, pain and/or discharge during/after intercourse |
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Term
| Describe: Cervical cancer Dx |
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Definition
H&P exam
Screening tests: Microscopic exam of transformation zone, HPV screening
Dx tests: Bx of cervical tissue for microscopic exam |
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Term
| Describe: Cervical cancer Tx |
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Definition
Risk reduction
Elimination of damaged cells through cryotherapy or surgical excision
Chemotherapy
Hysterectomy |
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Term
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Definition
Heme- Iron
Globin- Amino acid portion
Both are recycled during filtering in spleen and liver |
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Term
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Definition
Intrinsic- damage to blood vessel
Extrinsic- damage to tissue or platelets
Requires Calcium |
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Term
| Describe ABO blood groups |
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Definition
Type O= No antigens/ AB Antibodies
Type A= A antigens/ B Antibodies
Type B= B Antigens/ A Antibodies
Type AB= AB Antigens/ No antibodies |
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Term
| Describe: blood disorder Dx tests |
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Definition
CBC- Includes total RBC, WBC and platelets; leukocytosis; Leukopenia; Increased eosinophils
Differential count for WBC
Morphology- Observed with blood smears, showing size, shape uniformity, and maturity
Hematocrit- % by vol of cellular elements in blood
Hemoglobin- Amount of hemoglobin per unit vol of blood, MCV indicated the oxygen-carrying capacity of blood
Reticulocyte count- Assessment of bone marrow function
Chemical analysis- Determine serum levels of components
Bleeding time- measures platelet function
Prothrombin time and partial thromboplastin time- measures function of various factors in coagulation process |
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Term
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Definition
| Increased WBC, associated with inflammation or infection |
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Term
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Definition
| Decreased WBC, associated with some viral infections, radiation and chemotherapy |
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Term
| State: CBC lab value ranges |
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Definition
RBC (x10^6/ml): 4.5-5.5
WBC (cells/ml) 4500-11000
Hemoglobin (g/dL)- Male: 13.5-16.5 Female: 12.0-15.0
Hematocrit (%): Male: 41-50 Female: 36-44
Platelets (platelets/mcL)- 150,000- 400,000 |
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Term
| State: Clotting studies ranges |
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Definition
Prothrombin time (PT)- normal (sec): 11-13
International normalized ratio (INR)
Normal: 1.0
Prophylactic anticoagulation tx: 2.0-3.0
Clotting tx: 3.0-4.0
Partial thromboplastin time (PTT)- Normal (sec): 60-70
Activated PTT (aPTT) Normal (sec): 30-40 |
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Term
| Describe: blood therapies |
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Definition
For severe anemia or thromocytopenia- Blood products: Whole blood, packed red blood cells, packed platelets
To maintain blood volume- Plasma or colloid volume-expanding solution (contain protein to cause osmosis towards blood vessels)
Artificial blood products- in clinical trials, compatible with all blood types, can not perform all complex functions
Epoetin alfa- Artificial form of erythropoietin, promotes RBC growth. naturally produced in kidney
Bone marrow transplant- Close tissue match necessary, Tx of some cancers, Tx for severe immune deficiency and blood cell diseases |
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Term
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Definition
| Abnormality of the blood or bone marrow leading to abnormal cell characteristics or number |
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Term
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Definition
Disorder of the RBC
Cause a reduction of oxygen transport
O2 deficit leads to : less energy production, compensation mechanisms, general signs of anemia |
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Term
| What are some compensation mechanisms of anemia? |
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Definition
| Tachycardia and peripheral vasoconstriction |
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Term
| What are some general signs of anemia? |
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Definition
| Fatigue, pallor (pale face), dyspnea, tachycardia |
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Term
| What does oxygen deficit lead to? |
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Definition
Decreased regeneration of epithelial cells
-GI tract becomes inflamed and ulcerated- leading to stomatitis
-Inflamed and cracked lips
-Dysphagia
-Hair and skin may show degenerative changes
Severe anemia may lead to angina or CHF |
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Term
| Describe: Iron deficiency anemia |
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Definition
Insufficient iron impairs hemoglobin synthesis
Cells are microcytic and hypochromic
More common in women of child-bearing age and pregnant women |
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Term
| Describe the etiology of Iron deficiency anemia |
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Definition
Frequently a sign of underlying problem
Chronic blood loss
Insufficient intake of iron
Impair absorption of iron
Severe liver disease |
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Term
| Describe: Clinical manifestation of iron deficiency anemia |
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Definition
Pallow
Fatigue, lethargy, cold intolerance
Irritability
Degenerative changes
Stomatitis and glossitis
Menstrual irregularities
Delayed healing
Tachycardia, heart plalitations, dyspnea, syncope |
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Term
| Describe: Tx of iron deficiency anemia |
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Definition
Iron supplementation
Address absorption issues
Address blood loss |
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Term
| Describe: Pernicious anemia |
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Definition
Lack of absorption of B12 due to lack of intrinsic factor
Macrocytic, immature, nucleated erythrocytes and normochromic |
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Term
| Describe: Pernicious anemia etiology |
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Definition
Dietary insufficiency- very rarely the cause
Genetic factor has been implicated
Often accompanies gastritis or is an outcome of gastric surgery |
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Term
| Describe: Clinical manifestations of pernicious anemia |
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Definition
Tongue is typically enlarged, red, sore, shiny
Digestive discomfort, often with nausea and diarrhea
Tingling in limbs ("pins and needles") |
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Term
| Describe: additional Dx factors for pernicious anemia |
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Definition
Bone marrow exam (hyperactive)
B12 serum levels below normal
Gastric atrophy with hypochlorhydria or achlorhydria |
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Term
| Describe: Tx for pernicious anemia |
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Definition
B12 tablets
B12 Injections
Address underlying cause (ie. hypochlorhydria leads to impaired absorption of B12)
Address lifestyle choices (nutrition and diet) |
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Term
| Describe: Aplastic anemia |
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Definition
Impairment or failure of the bone marrow
Temp or perm
Idiopathic but might be caused by : -Myelotoxins, -Viruses (HVC), - Genetic abnormalities |
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Term
| Additional diagnostic/ manifestations for Aplastic anemia |
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Definition
Pancocytopenia- All blood cells decreased in CBC
Identify cause and prompt Tx needed for bone marrow recovery. Removal of any bone marrow suppressants
Failure to identify and treat is life-threatening due to pancocytopenia |
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Term
| Describe: Sickle cell anemia |
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Definition
Type of hemolytic anemia (excessive destruction of RBCs)
Genetic- autosomal, homozygous recessive. corecessive trait presents with sickle cell
Most common in African ancestry
Abnormal hemoglobin |
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Term
| Explain: Sickle cell crisis |
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Definition
When O2 levels are lowered RBCs take on the sickle shape
Altered hemoglobin is unstable and changes shape in hypoxemia
Abnormal hemoglobin = (HbS)
Sickle-shaped cells are too large to pass through microcirculation
Obstruction leads to multiple infarctions and areas of necrosis |
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Term
| Describe: clinical manifestations of sickle cell anemia |
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Definition
Hyperbilirubinemia (jaunidice)
severe pain due to tissue ischemia/ infarction
Pallor, weakness, tachycardia, dyspnea
Splenomegaly
Vascular occusions
delayed growth and development
CHF |
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Term
| Dx and Tx of Sickle cell anemia |
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Definition
Dx: Hemoglobin electrophoresis, prenatal DNA analysis
Tx: Hydration, Hydroxyurea, Folic acid supplementation, Bone marrow transplant, Immunizations |
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Term
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Definition
Too many cells
Primary polycythemia- polycythemia vera
-increased production of RBCs and other cells in the bone marrow
-Neoplastic disorders
-Serum erythropoietin levels are low
Secondary polycythemia- erythrocytosis
Increase in RBCs response to prolonged hypoxia
Increased erythropoietin secretion
Compensation mechanism to provide increased O2 transport |
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Term
| Describe: clinical manifestations of polycythemia |
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Definition
Distended blood vessels, sluggish blood flow, increased blood pressure
Cardiac hypertrophy
Hepatomegaly, splenomegaly
Dyspnea
Headaches
Visual disturbances
Thromboses and infarctions |
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Term
| Describe: Dx and Tx of Polycythemia |
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Definition
Dx: Increased RBC count, hemoglobin and increased hematocrit
Tx: Identify cause
If secondary- address underlying cause
If primary- utilize drugs or radiation to suppress bone marrow
Utilize phlebotomy to remove excess RBC |
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Term
| Describe: clinical manifestations of Blood clotting disorders |
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Definition
Persistent bleeding from gums
Repeated epistaxis
Excessive bleeding with trauma
Frequent ecchymosis
Hemarthroses
Hemoptysis
Hematemesis
Blood in stool
Petechiae
Anemia
feeling faint and anxious
Low BP
Rapid pulse |
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Term
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Definition
Classic hemophilia- deficit or abnormality of factor VIII
X-linked recessive trait
Manifested in men, carried by women
Varying degrees of severity
Typical manifestation of clotting disorders |
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Term
| Dx and Tx of Hemophilia A |
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Definition
Dx: Bleeding time and PT normal
PTT, aPTT, coagulation time prolonged
Serum levels of factor VIII are low
Tx: Demopressin (DDAVP)
Replacement therapy for factor VIII |
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Term
| Describe: Disseminated Intravascular Coagulation (DIC) |
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Definition
Excessive clotting in circulation
Clotting factors are reduced
Widespread, uncontrollable hemorrhage results
Very poor Px w/ high fatality rate
Complication of many primary problems
-Obstetric compliations (abruptio placentae)
-Infection
-Carcinomas
-Major trauma or severe burns |
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Term
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Definition
Tx: Treat underlying cause
Hemorrhaging- platelet and factor replacement
Clotting- Heparin |
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Term
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Definition
Neoplastic disorder involving WBC
Uncontrollable production in bone or lymph nodes
Other hemopoeitic tissues are reduced
One or more types of leukocytes are undifferentiated
Large numbers released into general circulation
Infiltrate lymph nodes, spleen, liver, brain, other organs |
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Term
| Describe: Acute leukemias |
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Definition
High proportion of immature, nonfunctional cells in bone marrow and peripheral circulation
Onset usually abrupt
Types:
Acute Lymphocytic Leukemia (ALL)- most common cancer in children
Acute Myelogenous Leukemia (AML)- low RBC, WBC, platelets |
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Term
| Describe: Chronic leukemias |
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Definition
Higher proportion of mature cells
Insidious onset
Mild signs and better prognosis
Most often seen in older adults
2 types:
-Chronic Lymphocytic Leukemia (CLL)
-Chronic Myelogenous Leukemia (CML)- typically caused by philadelphia chromosomes |
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Term
| Clinical manifestations of acute leukemia |
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Definition
Frequent or uncontrolled infections
Perechiae and purpura
Signs of anemia
Severe and steady bone pain
Weight loss and fatigue, possible fever
Headache, visual disturbances, drowsiness, emesis |
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Term
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Definition
Dx: Peripheral blood smear- immature leukocytes, increased WBC, decreased RBC and platelets, Bone marrow Bx
Tx: Chemotherapy, ALL in young children respond well to drugs with 1 year plus remissions, Biologic therapy (interferon) may be used to stimulate the immune system, Bone marrow stem cell transplant |
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Term
| Complications of Leukemia which lead to mortality |
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Definition
Opportunistic infections including pneumonia
Sepsis
CHF
Hemorrhage
Hepato failure
Renal failure
CNS depression and coma |
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Term
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Definition
Malignant neoplasms involving lymphocyte proliferation in lymph nodes
Idiopathic
Higher risk in adults who received radiation during childhood
Two main disorders:
Hodgkin's lymphoma
Non-Hodgkin's lymphoma:
-Distinguished my multiple node involvement
-Non-organized with widespread metastases |
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Term
| Describe: Hodgkin's lymphoma |
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Definition
Initially involves a single lymph node
Cancer spreads to adjacent nodes then to organs via lymphatics
T-lymphocytes seem to be defective and lymphocyte count decreased
Presence of Reed-Sternberg cell |
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Term
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Definition
Sx: First indicator- usually a painless enlarged lymph node
Later- Splenomegaly and enlarged lymph nodes
General cancer Signs and Sx
Tx- Radiation, chemotherapy, surgery |
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