Oncology 2

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cells divide/increase=mitosis normal cells divide replace lost cells repair injuries then stop dividing: cancer abnormal continuouss multiplying of cells divide uncontrollably grow into adjacent tissue spread to distant parts of body
mass of cancer cells large enough produce masses lumps tumors benign or malignant: benign tumors
not cancerous
usally be removed
do not come back
do not spread to other parts of body/invade other tissues
malignant tumors cancerous invade/damage nearby tissues/organs metastasize(c cells break away from malignant tumor enter bloodstream or lymphatic system form secondary tumors other parts of body): smallest cancer detected by exam x-ray scan less than 1/4 inch in diameter contains million-billion cancer cells
carcin/o cancer cry/o cold onc/o swelling scirrh/o hard: meta- beyond
-oma tumor
-plasis formation
-plasm living substance
general categories of cancer adenocarcinomass carcinomas: carcinomas*** occur in epithelial surfaces cells form outer surface of body to line or cover body's cavities tubes and passageways
adenocarcinomas****
form on glandular surface lung,breast,prostate, orvary or kidney: sarcomas****
occur in supporting structures bone, muscle cartilage, fat or fibrous tissue
leukemias and lymphomas cancers in blood cell elements: brain cancers, nerve cancers, melanomas, certain testicular and ovarian cancers do not fall into general category
cancers begin in a single cell = site of primary*** cancer the cancer is named for the primary site of origin skin/colon/breast: if cancer found in liver but originated in colon
called colon cancer that has metastaszied to the liver
NOT liver cancer
Liver cancers originated from liver cell if spread to lung still liver cancer NOT lung cancer: when cancer spreads to regional lymph nodes they are said to contain metastatic cancer
Primary cancers cell that cancer began in: cancers that originate in lymph cells of node called lymphomas
metastatic cancers cancer that spread from original location to other parts of body: spreading may occur by direct extension or invasion into adjacent tissues
systemic spread throughout body may occur by blood system=arteries/veins take blood to and from all areas of body: lymphatic system-network of lymphatic vessels in all areas of body drain/filter infectious agents
cerebrospinal fluid: metastatic cancer = cancer spreads to another part of body
cancer group of many related diseases*** begins in cells body's basic unit of life: many types of cells
cells grow divide produce more cells when body needs them keeps body healthy
when cells keep dividing when new cells not needed form a mass of tissue called growth or tumor: cancers named for organ or type of cell in which they begin.
cancer that begins in lung called lung cancer
cancer that begin in cells in skin melanocytes called melanoma: cancer spreads metastasizes found in nearby or regional lymph nodes/lymph glands if cancer reached these nodes means cancer cells have spread to other organs liver, bones, or brain
when cancer spreads from original location to another part of body new tumor has same kind of abnormal cells and same name as primary tumor: if lung cancer spreads to brain cancer cells in brain are lung cancer cells disease called metastatic lung cancer NOT brain cancer
researchers study patterns of cancer in population to look for risk factors/conditions increase chance cancer might occur protective factors decrease risk: learn causes of cancer find ways to prevent it
in lab scientists explore possibe causes of cancer determine what happens in cells when cancerous
cancer not caused by injury bump or bruise cancer is not contagious*****: cancer develops over time mix of factors lifestyle heredity environment*****
cancers related to use of tobacco what people eat and drink exposure to UV ****radiation from sun exposure to carcinogens cancer-causing agents in environment and workplace: some people more sensitive than others to factors that cause cancer
most people who get cancer have none of known risk factors
most people who do have risk factors do not get disease: some cancer risk factors can be avoided inherited factors unavoidable avoid known rissk factors/regular chekups/ cancer screening tests
FACTORS INCREASE CANCERS tobacco/smokeless tobacco/environmental tobacco smoke 1/3 all cancer deaths in US most preventable: 85% lung cancer deaths getting lung cancer increases amount of tobacco smoked each day number years smoked type of tobacco product how deeply inhaled.
1 pack a day smokers 10 x's greater than nonsmokers to get cancer: cigarette smokers develop several other types of cancer oral/llarynx/esophagus/pancreas/bladder/kidney/cervix
also stomach liver prostate colon and rectum: risk of cancer decreases soon after smoker quits continues to decline gradually each year after quitting
cigars or pipes risk oral cavity/lung larynx/esophagus/pancreas/liver*****: smokeless tobacco chewing tobacco/snuff cancers of mouth and throat precancerous conditions goes away when stops
secondhand smoke/smokeless tobacco increases lung cancer for nonsmokers: need help quitting talk with doctor dentist health professional join a smoking cessation group
Cancer info service CIS 1-800-4-cancer printed materialss suggestions: diet
high-fat diet certain cancers colon uterus and prostate**** seriously overweight older women cancers of prostate pancreas uterus colon ovary
foods containing fiber nutrients help protect against some cancers: reduce cancer risk healthy food choices fiber vitaminss minerals low in fat fruits vegies whole-grain breads cereals less eggs less high-fat meat/dairy products
UV ****radiation
from sun premature aging of skin can lead to skin cancer ssunlampa and tanning booths: reduce exposure from ten-three pm avoid sun when shadow is shorter than you wear hat sunglasses long pants long sleeves sunscreen
SPF 12-29 adequate: alcohol
heavy drinkers cancers of mouth throat esophagus larynx liver******
ionizing radiation x-ray procedures radioactive substances rays from outer space leukemia cancers of breast thyroid lung stomach other organs: before 1950 x-rays treat noncancerous conditions enlarged thymus enlarged tonsils adenoids ringworm of scalp/acne
those who received radiation therapy to head and neck thyroid cancer later: cancer radiation therapy risk of second cancer later in life
x-rays used for diagnosis lower levels of radiation than x-rays for therapy: repeated exposure harmful shields for other parts of body
chemical/metals pesticides
asbestos nickel**** cadmium uranium radon vinyl chloride benzidine benzene=carcinogens: may act alone or with other carcinogen inhaling asbestos and smoking high cancer risk
hormone replacement therapy HRT
estrogen progesterone**** for hot flashes vaginal drynesss during menopause: estrogen alone risk of cancer to uterus progesterone counteracts estrogens harmful effect prevents overgrowth of lining of uterus
estrogen for women with hysterectomy uterus removal but increased risk of breast cancer: diethylstilbestrol DES
synthetic form of estrogen *****1940-1971 during pregnancy prevent complications
DES daughters dysplasia in cervix and vagina rare cancer moms who took DES breast cancer DES sons testicular cancer: close relatives certain cancers
melanoma breast/ovary/prostate/colon occur some families heredity environment lifestyle chance
changes mutations alterations in genes control cell growth/death lifestyle or environment inherited risk increased: checking for conditions lead to cancer who does not have symptoms of disease called screening
screening tests lab tests x-rays used for few types cancers: screening mammogram best tool to find breast cancer before symptoms 40's over have mammograms every 1-2 years
cervix Pap test/smear cancer of the cervix cells rom cervix under microscope detects cancer/changes: colon/rectum
colorectal cancer over 50 family histoy sometimes bleed fecal occult blood test checks for blood in stool
thin lighted tube/sigmoidoscope examine rectum lower colon entire colon rectum lighted instrument colonoscope: barium enema x-rays of colon and rectum solutions outlines colon digital rectal exam check for abnormal areas
screening suggested for cancers of skin lung oral cavity prostate testicular ovarian cancers: many factors before recommending screening test age/med history/general health/family history/lifestyle
person's risk for developing specific types of cancer assess accuracy risks of screening test followup tests: consider effectiveness side effects of treatment discuss concerns questions screening with doctors weigh pros/cons informed decisions before screening tests
CANCER SYMPTOMS
thickening lump**** any part of body
change in wart/mole****: sore**** does not heal
nagging cough/hoarsness****
bowel bladder**** habit changes
indigestion****/difficulty swallowing
unexplained changes in weight****
unusual bleeding discharge: not always caused by cancer may be infecions benign tumors other problems do not wait to feel pain early cancer does not cause pain
DIAGNOSIS symptoms medical history physsical exam various tests exams lab tests imaging procedures biopsy necessary: Lab tests
blood urine*** tests info about health measure amount substances tumor markers in blood urine tissues lab tests alone not used to diagnose cancer
IMAGING images/pictures inside body check for tumor: x-rays organs/bones*****
CT/CAT scan imaging/computer/x-ray series of pictures
radionuclide**** scanning
swallows receives injection radioactive substance machine/scanner measures radioactivity levels organs prints picture paper/film: detect abnormal areas looking at amount radioactivity in organs radioactive substance eliminated by patient's body after test done
ultrasonography****
high-frequency sound waves cannot be heard enter body bounce back echoes called sonogram shown on monitor printed: MRI
magnet**** linked to computer detailed pictures of areas in body viewed on monitor printed
biopsy***
diagnosis of cancer tissue removed examined under microscope by pathologist: tissue removed 3 ways
endoscopy needle surgical
endoscopy***=thin lighted tube inside body take pictures remove tisue/cells
needle biopsy small tissue sample inserting needle into abnormal area: surgical biopsy
excisional/incisional*****
excisional=removes entire tumor
incisional=removes portion of tumor
if tissue sample removed from more than one site different instruments for each one normal tissue removed along with tumor: STAGING*****
when cancer diagnosed stage or extent of disease staging=attempt to find out if cancer spread to what parts
treatment decisions depend on results of staging maybe more lab tests/imaging studies/biopsies: laparotomy help for cancer in abdomen incision in abdomen sample tissues removed
HANDLING DIAGNOSIS understanding nature of cnacer what to expect help plana treament/lifestyle change/financcial decisions: prognosis=prediction of future course outcome of diseaseindication of likelihood recovery from disease only prediction
prognosis affected many factors type of cancer stage grade how closely cancer resembles normal tissue how fast likely grow/spread age health response to treatment as factros change prognosis changes: statistics try figure chances of being cured seldom helpful reflect large group patients cannot predict no patients same treatment responses vary greatly
treatment depends on type of cancer size location stage of disease health treatment plan each person's situation: treated by team of specialists surgeon radeation oncologist medical oncologist
treated with surgery radiation therapy chemotherapy hormone therapy biological therapy one/combo: clinical trials research studies treatment options evaluate promising new theapies scientific questions
find treatments more effective/less side effects clinical trials: second opinion
cancer information service tells callers about cancer treatment facilitiess all over country
names of doctors from local medical society nearby hospital med school: methods of treatments side effects
local or systemic
local treatments**** affect cancer cells in tumor and area near it systemic**** treatments travel through bloodsteam reaching cancer cells all over body: surgery radiation**** therapy local treatment****
chemo**** hormone therapy biological therapy systemic ****treatment
treatment damages healthy cells tissues side effects depend on type and extent of treatment may not be same for each person: surgery remove cancer surrounding tissue and lymph nodes near tumor outpatient/in hospital
radiation therapy rediotherapy high-energy rays kill cancer cells primary treatment: neoaduvant therapy radiation theapy before surgery shrink tumor easier to remove
adjuvant therapy radiation therapy after surgery destroys cancer cells remain in area: radiation used alone or with other types of treatment
radiation therapy 2 forms
external/internal**** sometimes both needed: external radiation machine aims rays at specific area of body outpatient no radioactivity in body after treatment
internal radiation/implant radiation/interstitial radiation/brachytherapy: radioactive material sealed in needles seeds wires or catheters placed directly in or near tumor
may stay in hospital level of radiaton highest implant permanent amount of radiation safe level before leaves hospital or temporary no radioactivity left in body after implant removed: side effects of radiation depends on treatment dose*** part of body treated extremely tired*** during radiation therapy later weeks
extra rest necessary external radiation permanent darkening or bronzing of skin in treated area hair loss skin red dry tender itchy decrease wbc (fight infection)temporary: chemotherapy****
drugs kill cancer cells neoaduvant chemo drugs given before surgery shrink tumor
adjuvant chemo drugs after surgery
chemo in cycles treatment period/recovery period injection into vein IV into muscle or under skin or mouth: sometimes through catheter stays until treatment over into large vein in arm/chest
anticancer drugs also given through intraperitoneal chemotherapy directly through ab through catheter: intrathecal chemotherapy reach cells in central nervous system CNS enter cerebrospinal fluid needle in spinal colum/device under scalp
chemo outpatient short hospital stay may be needed: side effects of chemo depend on drugs/doses vary from person to person anticancer drugs affect cells divide rapidly blood cells whcih fight infection help blood to clot carry oxygen to all parts
when blood cells affected more infecstions/bruise/bleed/weak/tired cells in hair roots line digestive tract=hair loss nausea vomiting diarrhea: hair loss major concern sometimes hair thins/loss all body hair prepare wig/hat
long-term side effects loss of fertility temp/perm depending on drugs age sex: hormone therapy
cancers hormones for growth keeps cancer cells from getting or using hormones they need
may include use of drugs stop production of hormones or change or surgery remove organs ovariess testicles: hormone therapy side effects
tired fluid retention weight gain hot flashes nausea vomiting appetitie blood clots
interrupted menstrual periods vaginal dryness loss increase in fertility impotence loss of sexual desire: biological therapy**** immunotherapy
help body's natural ability fight disease immune system may be temp/perm
monoclonal antibodies interferon*** inerleukin2 colony-stimulating factors biological therapy: side effects bilogical therapy vary flu-like symptoms chills fever muscle aches weakness loss of appetite nausea vomitin diarrhea bleed bruise rash swelling severe but go away
bone marrow transplantaion BMT/peripheral stem**** cell trasplantation PSCT transplant may be autologous own cells allogenic*** cells from another person syngeneic cells from identical twin: BMT/PSCT healthy stem cells immature cells mature into blood cells they replace stem cells damaged/destroyed bey chemo/radiation
increased risk of infeciton bleeding due to high doses chemotherapy/radiation: most common side effects with transplant nausea vomitin during transplant chills fever first day
graft-verus-host disease GVHD occurs in patients receive bone marrow from donor: donated marrow graft reacts against patient's host's tissues liver skin digestive tract
GVHD mild or very severe occur any time after transplant even years later: drugs given to reduce risk of GVHD and treats problem if it occurs
TYPES OF SURGERY USED
biopsy *****removal of sample tissue hollow needle/scalpel: endoscopy*****
very flexible tube with lens/camera light at end connected to computer screen see inside suspisious area
laparoscopy*****
very flexible tube lens/camera light on end connected to computer screen examine contents of abdomen remove tissue samples: laparotomy**** surgical incision upper to lower ab used making diagnosis less intrusive tests difficult impossible
laser surgery****
powerful beam of light directed to specific parts without large incision: cryosurgery****
liquid nitrogen/probe very cold to freeze/kill cancer cells
electrosurgery***
high-frequency electrical currents destroy cancer cells: excisional*** cutting cancerous tissue with scalpel remove it and surrounding tissue
many types excisional surgeries each named for particular area of body or particular purpose
Pain common problem grows presses against organs/nerves or side effect of treatment: reduced/relieved prescription meds or OTC drugs relaxation exercises report pain to help relieve it
rehabilitation improve person's quality of life medical team doctor/nurse/phyiscal therapist/occupational therapist/social worker/ rehab plan meet physical emotional needs: work witht occupational therapist overcome any difficulty in eating dressing bathing toilet others
physical therapy regain strength in muscles prevent stiffness/swelling: may also be necessary if arm leg weak or paralyzed trouble with balance
CLINICAL TRIALS research studies people help doctors find ways to improve health/cancer care answer scientific questions ways to prevent diagnose treat cancer: clinical trial final stage long tocareful cancer research process appoaches cancer prevention diagnosis treatment are safe effective
treatments trials test new treatments***** cancer drug surgery radiation therapy combos of treatments gene therapy: prevention trials test new approaches meds vitamins mineral supplements lower risk of certain cancers look for best way to prevent who never had cancer/prevent cancer coming back/new cancer occuring in person who already had cancer
screening trials
test best way find**** cancer especially in early stages: Quality of Life trials/Supportive Care trials
explore ways improve***** comfort/quality of life cancer patients
PHASES OF CLINICAL TRIALS
clinical trials research ***studies testing new drug progresses in orderly series of steps/phases ask/answer questions: phase I***
first studies evaluate how new drug shsould be given mouth/injected blood/muscle how often safe dose small number of patients/dozen
phase II***
continues to test safety of drug evaluates how well works focus on particular type of cancer: phase III***
studies test new drug/combo/surgical procedure compared to current participant assigned to standard group/random randomization enroll large numbers of people conducted at doctors' offices clinics cancer centers
CANCER STAGING
systems describes how far cancer has spread anatomically**** put patients with similar prognosis/treatment same staging group: prognosis/treatment depend on stage other factors general health preference results of biochemical tests on cancer cells determine prognosis/treatment
staging not applicable to most leukemias leukemias not anatomically localized involves all of blood: few leukemias have staging systemes how advanced disease is
solid tumors 2 stagins systems Overall Stage Grouping TNM system: overall stage groupings/roman numeral staging
4 stages I-IV or recurrent
stage I small localized cancers curable stage II/III locally advanced and or involvement of local lymph nodes: stage IV
inoperable metastatic cancer
prognosis for given stage depends on cancer
common for cancer to return months/years after primary tumor cells broken away lodged indistant locations: sometimes tiny bit of primary tumor not cut out in initial surgery grows into macroscopic tumor
cancer recurs after all visible tumor eradicated called recurrent disease: disease that recurs in area of primary tumor locally recurrent
disease recurs as metastases distant recurrence
distant recurrence treated as stage IV investigate options for both: solid tumors I-IV TNM system
TNM staging Tumor Nodes Metastases: each categorized separately classified with number total stage TINIM0 TI tumor/NI lymph node involvement M0/no**** metastases
T
classifies extent primary tumor T0-T4 T0=non invading tumor to local tissues ******IN SITU T4 large primary tumor invaded other organs direct extension/inoperable******: N
classifies amount regional lymph node involvement only from draining area of primary***** tumor N0/no lumph node involvement N/4 extensive involvement combo nodes involved
M M0 no metastases MI/there is metastases depends on type of cancer: TNM more presice than I-IV system more categories
4 prognostic groups not enough for some cancers classified IIA IIIB must find specicfic staging prognostic info for your cancer to know what staging means in prognosis: leukemias/others don't form solid tumors staging different depends on blood cocunt bone marrow involvment presence/absence symptoms
prostate colon cancer sometimes staged A-D more than one staging system in use at same time can figure out stage in other system with sspecific info extent of cancer from path/operative reports: ThinPrep Pap test alternative
testing cervical cells cost more requires fewer repeat tests detects early-stage lesions
ThinPrep liquid-based procedure cells from cervix put into vial of liquid instead of smeared on slide: liquid filtered only cervical cellss placed onto sslide for exam
200 ****different cancers develop in any organ fluid tissue blood/skin/bone/muscle/nerve: Hodgkin's Disease*****
lymphoma lymphatic ssystem cancer 3rd most common type 10-14 years rare
lymphatic system fight off infections tonsils/spleen/bone marrow/chains of lymph nodes masses tissues throughout body lymphoma begins in cells of lymph system: Hodgkin's disease 3out of 100,000 young/old linked to Epstein-Barr Disease EBV infectious mononucleosis mono EBV affects lymphatic system change cells later cancerous
Leukemia ****
common kids rare involves blood blood-forming organs bone marrow: produces abnormal wbc's in bone marrow usually fight infection not with leukemia wbc's multiply out of control
filling bone marrow rbc's carry oxygen and platelets blood clot crowded out by wbc's of leukemia may move through blood stream continue to multiply: most times treatable kids get better treated with chemo through catheter into blood vessel upper chest drugs attack cancer cells after several weeks kids get better
radiation therapy used sometimes high-energy waves if chemo/radiation higher doses harm normal cells in bone marrow can't produce normal blood cells: bone marrow tissue transplant needed
bone metastasis
bone mets *****
cancer cells from primary tumor relocate to bone: prostate breast lung cancers spread to bone
primary bone cancers rare
cancer cells metastasize to bone changes damages called osteolysis small holes result osteolytic lesions/lytic lesions weaken bones pain with lesions: brain cancer
brain spinal cord central nervous system cancer in brain may start in brain or spread from another cancer lung/breast children/over 45 years
brain tumors benign/malignant both very serious as tumor grows pressure builds in brain: Liver cancer
grow in liver***** rapid disorderly manner tumor interferes/destroys liver tissue primary liver cancer/malignant hepatoma or hepatocellular cancer
lung cancer 2 groups non-small cell lung cancer/small cell lung cancer depends how cells look under microscope each type grows spreads differnt ways: non-small cell lung ****cancer
more common grows/spreads slowly 3 types (named for type of cells in which cancer develops)
1 squamous cell carcinoma/epidermoid carcinoma 2 adenocarcinoma 3 large cell carcinoma: small cell lung cancer/oat cell cancer
less common grows quickly spread to other organs
cervical cancer****
found in cervix narrow seciton of uterus leads to vagina: ovarian cancer
disease of body cells metastasize abdominal cavity
uterine cancer womb upside-down pear endometrial cancer lining of upper rounded part: sarcoma*****
family of cancers connective tissues fat/muscle/blood vessels/deep skin tissues/nerves/bones/cartilage
sarcoma 2 types
soft tissue tumors/bone tumors***** rare**** children young mostly in arms/legs: most common bone sarcomas
osteosarcoma**** tumor ends of long bones where new bone tissue forms
Ewing's sarcoma****
tumor develops in middle of large bones pelvis thigh upper arms ribs: chondrosarcoma****
adults cartilage
bone sarcomas 0.2% all cancers 2500 new cases a year spread to other parts of body lungs: terms related to bone sarcomas cocnfusing
Melanoma****
most serious type of skin cancer 53,600 per year US Western countries more common every year in US melanoma more than doubled in 30 years: Basal Cell Carcinoma
most common skin***/all cancers
caused by chronic exposure to sun face nose ears neck scalp shoulders
dysplatic nevi
abnormal-looking moles atypical moles more likely than normal moles develop melanoma*****: sometimes few or many dysplastic nevi examine moles regularly watch for changes
dysplastic nevi look like melanoma Dr. special training in skin diseases decide abnormal watched or removed and checked for cancer: some families many members have lots of dysplastic nevi some have melanoma
frequent checkups 3-6 months: might take pictures of skin to help show when changes occur

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