Cancer develops when cells in a part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because of out-of-control growth of abnormal cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide more rapidly until the person becomes an adult. After that, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries. Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to form new abnormal cells. Cancer cells develop because of damage to DNA. This substance is in every cell and directs all activities. Most of the time when DNA becomes damaged the body is able to repair it. In cancer cells, the damaged DNA is not repaired. People can inherit damaged DNA, which accounts for inherited cancers. More often, though, a person's DNA becomes damaged by exposure to something in the environment, like smoking. Cancer usually forms as a tumor. Some cancers, like leukemia, do not form tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate through other tissues where they grow. Often, cancer cells travel to other parts of the body where they begin to grow and replace normal tissue. This process is called metastasis. Regardless of where a cancer may spread, however, it is always named for the place it began. For instance, breast cancer that spreads to the liver is still called breast cancer, not liver cancer. Not all tumors are cancerous. Benign (noncancerous) tumors do not spread (metastasize) to other parts of the body and, with very rare exceptions, are not life threatening. Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That is why people with cancer need treatment that is aimed at their particular kind of cancer. Cancer is the second leading cause of death in the United States. Half of all men and one third of all women in the United States will develop cancer during their lifetimes. Today, millions of people are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changes in a person's lifestyle, for example, by quitting smoking and eating a better diet. The sooner a cancer is found and treatment begins, the better are the chances for living for many years.
Term neoplasm can be used interchangeably with tumor New growth or formation that serves no useful purpose Growth that is uncontrollable and progressive and detrimental to other parts of the body Cancer is a group of diseases that may cause almost any sign or symptom. The signs and symptoms will depend on where the cancer is, the size of the cancer, and how much it affects the surrounding organs or structures. If a cancer spreads (metastasizes), then symptoms may appear in different parts of the body. As a cancer grows, it begins to push on nearby organs, blood vessels, and nerves. This pressure creates some of the signs and symptoms of cancer. If the cancer is in a critical area, such as certain parts of the brain, even the smallest tumor can produce early symptoms. Sometimes, however, cancers form in places where there may be no symptoms until the cancer has grown quite large. Pancreas cancers, for example, do not usually grow large enough to be felt from the outside of the body. Some pancreatic cancers do not produce symptoms until they begin to grow around nearby nerves, causing a backache. Others grow around the bile duct, which blocks the flow of bile and leads to a yellowing of the skin known as jaundice. By the time a pancreatic cancer causes these signs or symptoms, it has usually reached an advanced stage. A cancer may also cause symptoms such as fever, fatigue, or weight loss. This may be caused by cancer cells using up much of the body’s energy supply or releasing substances that change the body’s metabolism. Or the cancer may cause the immune system to react in ways that produce these symptoms. Sometimes, cancer cells release substances into the bloodstream that cause symptoms not usually thought to result from cancers. For example, some cancers of the pancreas can release substances which cause blood clots to develop in veins of the legs. Some lung cancers make hormone-like substances that affect blood calcium levels, affecting nerves and muscles and causing weakness and dizziness.
It is important to know what some of the general (non-specific) signs and symptoms of cancer are. They include unexplained weight loss, fever, fatigue, pain, and changes in the skin. Of course, it’s important to remember that having any of these does not necessarily mean that cancer is present -- there are many other conditions that can cause these signs and symptoms as well. Unexplained weight loss: Most people with cancer will lose weight at some time with their disease. An unexplained (unintentional) weight loss of 10 pounds or more may be the first sign of cancer, particularly cancers of the pancreas, stomach, esophagus, or lung. Fever: Fever is very common with cancer, but is more often seen in advanced disease. Almost all patients with cancer will have fever at some time, particularly if the cancer or its treatment affects the immune system and reduces resistance to infection. Less often, fever may be an early sign of cancer, such as with leukemia or lymphoma. Fatigue: Fatigue may be a significant symptom as cancer progresses. It may occur early, however, in cancers such as with leukemia or if the cancer is causing a chronic loss of blood, as in some colon or stomach cancers. Pain: Pain may be an early symptom with some cancers, such as bone cancers or testicular cancer. Most often, however, pain is a symptom of advanced disease. Skin changes: In addition to cancers of the skin (see next section), some internal cancers can produce visible skin signs such as darkening (hyperpigmentation), yellowing (jaundice), reddening (erythema), itching, or excessive hair growth. In addition to the above general symptoms, you should be watchful for the following common symptoms, which could be an indication of cancer. Again, there may be other causes for each of these, but it is important to bring them to your doctor’s attention as soon as possible so that they can be investigated. Change in bowel habits or bladder function: Chronic constipation, diarrhea, or a change in the size of the stool may indicate colon cancer. Pain with urination, blood in the urine, or a change in bladder function (such as more frequent or less frequent urination) could be related to bladder or prostate cancer. Any changes in bladder or bowel function should be reported to your doctor. Sores that do not heal: Skin cancers may bleed and resemble sores that do not heal. A persistent sore in the mouth could be an oral cancer and should be dealt with promptly, especially in patients who smoke, chew tobacco, or frequently drink alcohol. Sores on the penis or vagina may either be signs of infection or an early cancer, and should not be overlooked in either case. Unusual bleeding or discharge: Unusual bleeding can occur in either early or advanced cancer. Blood in the sputum (phlegm) may be a sign of lung cancer. Blood in the stool (or a dark or black stool) could be a sign of colon or rectal cancer. Cancer of the cervix or the endometrium (lining of the uterus) can cause vaginal bleeding. Blood in the urine is a sign of possible bladder or kidney cancer. A bloody discharge from the nipple may be a sign of breast cancer. Thickening or lump in breast or other parts of the body: Many cancers can be felt through the skin, particularly in the breast, testicle, lymph nodes (glands), and the soft tissues of the body. A lump or thickening may be an early or late sign of cancer. Any lump or thickening should be reported to your doctor, especially if you’ve just discovered it or noticed it has grown in size. You may be feeling a lump that is an early cancer that could be treated successfully. Indigestion or trouble swallowing: While they commonly have other causes, these symptoms may indicate cancer of the esophagus, stomach, or pharynx (throat). Recent change in a wart or mole: Any change in color or shape, loss of definite borders, or an increase in size should be reported to your doctor without delay. The skin lesion may be a melanoma which, if diagnosed early, can be treated successfully. Nagging cough or hoarseness: A cough that does not go away may be a sign of lung cancer. Hoarseness can be a sign of cancer of the larynx (voice box) or thyroid. While the signs and symptoms listed above are the more common ones seen with cancer, there are many others that are less common and are not listed here. If you notice any major changes in the way your body functions or the way you feel, especially if it lasts for a long time or gets worse, let your doctor know. If it has nothing to do with cancer, your doctor can investigate it and treat it, if needed. If it is cancer, you’ll give yourself the best chance to have it treated early, when treatment is most likely to be effective.
Carcinoma: solid tumors of epithelial tissue either internal or external body surfaces; most common; suffix determines benign or malignant (-oma=benign, -carcinoma=malignant)
Sarcoma Soft tissue sarcomas are malignant (cancerous) tumors that can develop from fat, muscle, nerve, fibrous tissues surrounding joints, blood vessel, or deep skin tissues. They can develop in any part of the body. Around 55% to 60% of them develop in the arms or legs. The rest begin in the trunk (15% to 20%), head and neck area (8% to 10%), internal organs, or the retroperitoneum (15%) (the back of the abdominal cavity). Sarcoma is the term used for cancers of these tissues. The term soft tissue is used to distinguish these sarcomas from bone sarcomas. Bone sarcomas (osteosarcomas)
Leukemia Symptoms Acute myelogenous leukemia ( AML ) symptoms result from the body not producing enough healthy blood cells. Healthy bone marrow makes stem cells that grow into the three types of blood cells: red blood cells, white blood cells, and platelets. An AML patient's bone marrow makes too many blast cells (immature white blood cells). Normal blast cells turn into a type of white blood cell called granulocytes, but the leukemia blast cells do not. At the same time, the marrow cannot grow enough normal red blood cells, white blood cells, and platelets. Someone with too few red blood cells (anemia) may: · Feel tired · Be short of breath · Look pale Someone with too few normal white blood cells and too many leukemia blast cells may: · Develop a lot of infections, for example, a sore throat · Experience pain in the bones or joints · Have a mild fever Someone with too few platelets may: · Bleed easily, such as swollen and bleeding gums, frequent nose bleeds or cuts that bleed for a long time · Bruise more easily than usual · Develop pin-head sized spots under the skin · Develop cuts that heal slowly or do not heal Some people with AML, however, do not notice any symptoms. Their AML may be discovered only during a blood test. Hodgkins disease: Non-Hodgkin’s disease: malignant disorder of lymphoid tissue; characterized by painless, enlargement of cervical lymph nodes. Cause unknown. Risk factors include exposure to viruses like Ebstein-Barr, genetic factors, immunosuppression. Characterized microscopically by presence of multinucleated giant cells (macrophages) called Reed-Sternberg cells. Non-Hodgkin’s There are many different types of non Hodgkin's lymphomas. Some are so mild that they require little or no treatment; some are very active. Broadly, NHL is divided into Low Grade (slow growing) or High Grade (the faster growing lymphomas).
Staging: process of classifying the extent or spread of disease from the site of orgin. Refers to tumor size, location, lymph node involvement, and spread. The higher the number, the more extensive the tumor size and spread. Treatment decisions often based on staging criteria. TNM classification system frequently used to stage tumors. TNM stands for T=tumor size indicates presence and size of primary tumor N=node (lymph) involvement M=metastasis Grading: Process of differentiating the level of anaplasia depicted by tumor. Tumors graded from I (well differentiated) to IV (highly undifferentiated). As the tumor grade increases, the cells become more deviant from the tissue of orgin. Those that are graded lower (I or II) resemble the tissue of orgin in terms of size, shape, structure. Those with a higher grade (III, IV) demonstrate little resemblance to the tissue of orgin
Have students match cancer to carcinogen
Chemotherapy ( Antineoplastic Agents) Drugs used to treat cancer are mutagenic, teratogenic (fetal malformation), and carcinogenic. Do not kill tumor cells directly but interrupt development, growth or spread of abnormal (and normal) cells by interfering with cell reproduction May be primary treatment or combination with surgical, radiation Different classes of chemo : Alkylating agents – inhibit cell growth (example Mustargen nitrogen mustard, mustard gas) Antimetabolites – block chemical reactions necessary for cell division (example: Cytosar leukopenia within 24 hours, highly toxic to CNS ) Hormone therapy – adrenocorticosteroids regulate RNA, given as palliation, (example: Estrogen) what if given to male for prostate? what if androgens given to females for breast cancer? or antiestrogens (inhibit hormone production) such as Tomoxifen (decrease breast cancer while increases risk endometrial cancer) Antiangiogenesis – block blood vessel formation to tumor, still in clinical trials Usually given parenterally Some are oral If IM or SQ change to smallest possible gauge before administering to reduce surrounding tissue necrosis If IV, central venous catheter set Common side effects : stomatitis, nausea, vomiting, diarrhea, alopecia, local tissue injury, suppression of blood elements Reportable side effects to physician : rashes; loss of taste; tingling in face, fingers and toes; dizziness, headache, confusion, slurred speech, convulsions (these are signs of neurotoxicity); unusual bleeding, bruising, fever, sore throat, mouth sores (these are signs of bone marrow dysfunction); yellowing of eyes or body, clay-colored stools, dark urine (hepatotoxicity); couch, shortness of breath, weight gain, fluid retention (pulmonary or cardiotoxicity) Precautions in handling: Follow OSHA guidelines Follow written instructions from packaging Women of child-bearing age should not reconstitute cytoxic drugs Use biological safety cabinet with air flow hood Prepare in closed room with excellent ventilation and equipment for irrigating skin & eyes in case of spills. OSHA spill kit readily available. Biohazardous waste disposal Use PPE when working ( face masks, long sleeved clothing, apron, goggles) Reconstituted medications must not be sprayed into the atmosphere. Diluents must be allowed to slowly run down the sides of the ampules to prevent back spray. Air in the syringe must be expelled into sterile cotton or gauze to prevent spray. Powders must be reconstituted so that no excess pressure in the vial would allow the medication to spray through needle hole. Radiation Therapy Uses x-rays, electron beams or radioactive isotopes to damage chromosomes in cells so can’t multiply. Local treatment (aimed beam, placement) Used in combo with chemo to shrink tumor before surgery, reduce pain, bleeding, blockage Side effects generally specific to area of body treated. External Beam Radiation : most common use of measurements from scans and calculations to determine precise location to aim radiation tattoo dots to ensure consistent target treatment lasts only few minutes, but as often as 5 x week or several times day Internal Radiation systemic : isotope injected into vein or organ. (example: Thyroid cancer for Iodine 131, Strontium for bone cancer) interstitial : (also known as brachytherapy) place radioactive sources directly into tumor, can be temporary or permanent intracavitary radioactive substance placed in applicator and positioned into area affected. Left in place for several hours and removed. Pt must remain in hospital bed during radiation (early rectal cancer) Surgery Can be used for: Diagnosis (needle biopsy or excisional biopsy) – pathologist examines tissue to determine if malignant or benign, aids physician in making choice about next step in treatment Removal of tumor – depends if tumor localized, attached to blood vessels, nerves, or other organs; adjacent lymph nodes removed also (lymph node involvement may indicate further treatment needed) Relieve symptoms – Example: tumor blocking colon, may be removed to allow bowels to function Prevention - prevent development of cancer in hereditary conditions Immunotherapy (biotherapy) Stimulate immune system with proteins that help to job more effectively Side effects not unlike other cancer treatments Biologic Response Modifiers: Interferons and interleukins are substances that blood cells use to communicate and coordinate into managing the immune response (different white blood cells fighting antigens) macrophages : first line of defense, break down antigens into smaller pieces so T lymphocytes can attach, produce cytokines to regulate activity of lymphocytes lymphocytes: B and T cells; B’s recognize and interlock, antibody marks antigen for destruction then T cells recognize, respond the remember antigens, can destroy targeted cells on contact neutrophils (major component of pus) job is phagocytosis basophils & eosinophils (granulocytes) play role in allergic reaction Colony Stimulating Factors: Stimulates the production of blood cells (white, red, platelets). Often chemotherapy suppresses production of blood
121 Week 3 Chapter 5 Neoplasm
Chapter 5 Objectives <ul><li>Define neoplasm </li></ul><ul><li>List 7 warning signs of cancer </li></ul><ul><li>Describe 3 main classifications for cancer </li></ul><ul><li>Compare benign and malignant tumors </li></ul><ul><li>Identify staging and grading of neoplasm </li></ul><ul><li>List at least 4 possible causes of cancer </li></ul><ul><li>Discuss 4 major forms of cancer treatment </li></ul>
Define Neoplasm <ul><li>Altered cellular proliferation and differentiation </li></ul><ul><li>Characterized by autonomy (unregulated cell growth) and anaplasia (loss of differentiation) </li></ul>
7 warning signs of cancer <ul><li>C change in bowel or bladder habit </li></ul><ul><li>A a sore that doesn’t heal </li></ul><ul><li>U unusual bleeding or discharge </li></ul><ul><li>T thickening or lump </li></ul><ul><li>I indigestion </li></ul><ul><li>O obvious change in wart or mole </li></ul><ul><li>N nagging cough or hoarseness </li></ul>
3 main classifications for cancer Blood & Lymph Neoplasms
Causes death if uncontrolled Is not injurious unless located in areas where there is pressure of obstruction to vital organs Course and Results Frequently spreads to form distant tumors Does not spread to other parts of the body Spread Commonly recurs Rare Recurrence (post surgery) Commonly causes necrosis and ulceration Minor tissue destruction Tissue Destruction Cells are atypical in varying degrees of the tissue of orgin cells are fairly typical of the tissue or orgin Microscopic Features Infiltration of surrounding tissue Expansion Mode of Growth may be rapid; grows according to specific tumor doubling time Usually slow Rate of Growth Malignant Benign