Week two notes

411 views

Published on

Published in: Health & Medicine, Technology
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
411
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
3
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Week two notes

  1. 1. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1 Biology, Clinical Manifestations, and Treatment of Cancer
  2. 2. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2 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:
  3. 3. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3 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)
  4. 4. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4 Classification and Nomenclature  Benign tumors  Named according to the tissues from which they arise and include the suffix “-oma” • Lipoma • Glioma • Leiomyoma • Chondroma
  5. 5. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5 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
  6. 6. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 6 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
  7. 7. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 7 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
  8. 8. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 8 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
  9. 9. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 9 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?
  10. 10. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 10 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
  11. 11. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11 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
  12. 12. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 12 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
  13. 13. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 13 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)
  14. 14. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 14 Bacterial Cause of Cancer  Helicobacter pylori  Chronic infections are associated with: • Peptic ulcer disease • Stomach carcinoma • Mucosa-associated lymphoid tissue lymphomas
  15. 15. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 15 Three-Step Theory of Invasion  Tumor cell attachment  Fibronectin and laminin  Degradation or dissolution of the matrix  Enzymes  Locomotion into the matrix  Invadopodia (pseudopodia)
  16. 16. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 16 Sequential Process of Metastasis
  17. 17. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 17 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
  18. 18. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 18 Cachexia
  19. 19. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 19 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
  20. 20. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 20 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
  21. 21. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 21 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
  22. 22. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 22 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
  23. 23. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 23 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
  24. 24. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 24 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
  25. 25. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 25 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
  26. 26. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 26 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
  27. 27. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 27 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
  28. 28. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 28 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
  29. 29. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 29 Components of the hematologic system  As a review remember what the following functions are:  Bone Marrow  Lymphoid Organs  Platelets  RBC  WBC
  30. 30. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 30 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
  31. 31. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 31 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
  32. 32. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 32 Erythropoiesis
  33. 33. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 33 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
  34. 34. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 34 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
  35. 35. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 35 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
  36. 36. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 36 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
  37. 37. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 37 Multiple Myeloma

×