N304 Exam 2

Front 1

What is cancer?

Back 1

A group of diseases characterized by uncontrolled and unregulated cellular growth with local tissue invasion and/or systemic metastasis

Front 2

What is impaired with cancer?

Back 2

Cellular tissue in which the normal growth-controlling mechanism is impaired permanently, permitting progressive growth

Front 3

How can neoplasms arise?

Back 3

Only from cells which have the ability to proliferate

Front 4

What are “anaplastic” cells?

Back 4

Tumor cells that mature inadequately and therefore, often are spoken of as “anaplastic” or “undifferentiated"

Front 5

What are the basic characteristics of cancer?

Back 5

1. Cancers may arise following a variety of stimuli (chemical, physical, viral) but usually only after a prolonged latent period

2. Cancer cells may lie dormant for prolonged periods

Front 6

What often precede the development of many tumors by months or years?

Back 6

Hyperplasia and dysplasia often precede the development of many tumors by months or years

Front 7

What is the leading cause of death in the U.S.?

Back 7

Cancer

(1 out of every 4 deaths in the U.S. is from cancer)

Front 8

About how many people are diagnosed with cancer yearly?

Back 8

1.4 million

Front 9

What is the survival rate of cancer?

Back 9

1. More than 10M Americans with history of cancer are alive today, nearly 5M of whom can be considered cured

2. The 5-year survival rate represents persons who are living 5 years after diagnosis, whether disease-free, in remission, or under treatment with evidence of cancer

Front 10

What factors influence carcinogenesis?

Back 10

1. Environmental exposure to carcinogens

2. Genetic predisposition

3. Immune function

Front 11

What are carcinogens?

Back 11

Any substance or agent that produces cancer or increases risk of developing cancer

Front 12

What are the chemical carcinogens?

Back 12

1. Tobacco
2. Alcohol
3. Asbestos

Front 13

What are the physical carcinogens?

Back 13

1. Ionizing (from radon, uranium, radium) and ultraviolet radiation

2. Chronic irritation and tissue trauma—suspected, but not supported by theory

Front 14

How do ionizing (from radon, uranium, radium) and ultraviolet radiation cause cancer?

Back 14

By producing gene mutations and chromosomal damage

Front 15

How do chronic irritation and tissue trauma cause cancer?

Back 15

Possibly by undergoing frequent mitosis that lead to DNA mutation

Front 16

How do viral carcinogens (oncoviruses) cause cancer?

Back 16

By infecting body cells, breaking the DNA chain and inserting their own DNA leading to gene mutation

Front 17

What is Epstein-Barr Virus (EBV) associated with?

Back 17

1. Burkitt’s lymphoma
2. B-cell lymphoma
3. Nasopharyngeal carcinoma

Front 18

What is Hepatitis B associated with?

Back 18

Primary liver carcinoma

Front 19

What is HPV associated with?

Back 19

Cervical, vulvar, and other anogenital carcinoma

Front 20

What is Human lymphotropic virus type I associated with?

Back 20

Adult T-cell leukemia

Front 21

What dietary factors cause cancer?

Back 21

1. Low fiber intake
2. High intake of red meat
3. High animal fat intake

(but relationship to cancer is poorly understood)

Front 22

What immunity factor causes cancer?

Back 22

Immune dysfunction

Front 23

Which cancers have an inherited genetic predisposition?

Back 23

1. Breast cancer
2. Prostate cancer
3. Colon cancer

Front 24

Which hormones are associated with cancer development?

Back 24

1. Estrogen
2. Progestin
3. Oral contraceptives

Front 25

How is the immune system associated with cancer development?

Back 25

The body (CMI) fails to recognize the malignant cells as different from self

Front 26

How do malignant cells grow in cancer?

Back 26

Allowed to grow to a size that is too large to be managed by normal immune mechanisms

Front 27

How do tumor antigens hide or mask themselves from normal immune defense mechanisms?

Back 27

1. Tumor antigens combine with antibodies to hide or mask themselves from normal immune defense mechanisms

2. Tumors produce substances that impair usual immune defenses, thus flood the body with tumor antigen

3. Antigens bind to specific antibodies or to receptors on lymphocytes and prevent them from recognizing the cancer cells

Front 28

What impairs the body's ability to mount an appropriate immune response?

Back 28

As a result of prolonged contact with a tumor antigen, the body may be depleted of the specific lymphocytes and no longer able to mount an appropriate immune response

Front 29

How does cancer affect the immune system?

Back 29

Cancer cells can originate in or spread to the bone marrow, disrupting synthesis and maturation of immune system cells

Front 30

What is the function of malignant cells?

Back 30

Malignant cells are abnormal, serve no useful function, and are harmful to normal body tissues

Front 31

What are the general features of cancer cells?

Back 31

1. Pleomorphism

2. Hyperchromatism

3. Increased nuclear to cytoplasmic ratio

4. Abnormal mitosis

5. Anaplasia

Front 32

What is plemorphism?

Back 32

Having many shapes

Front 33

What is hyperchromatism?

Back 33

Overpigmentation

Front 34

What are the early warning signs of cancer?

Back 34

CAUTION:

1. Change in bowel or bladder habits—constipation or diarrhea, either alone or alternating, accompanied by abdominal pain. May be a sign of colorectal cancer.

2. A sore that does not heal or that bleeds easily—ex. Oral cancer from heavy drinking and smoking.

3. Unusual bleeding or discharge from the rectum, vagina, bladder

4. Thickening or lump in the breast

5. Indigestion or difficulty in swallowing (esophageal or gastric cancer)

6. Obvious change in a mole or wart (skin ca, melanoma)

7. Nagging cough or hoarseness (lung cancer)

Front 35

What are the stages in cancer development?

Back 35

1. Initiation
2. Promotion
3. Progression
4. Metastasis

Front 36

What is initiation?

Back 36

Carcinogens penetrate a cell and damage the DNA, initiating gene mutation

Front 37

What is promotion?

Back 37

The cell takes on cancer cell characteristics and proliferates

Front 38

What is progression?

Back 38

The tumor establishes its own blood supply by secreting tumor angiogenesis factor (TAF)

Front 39

What is a significant characteristic of the progression stage?

Back 39

This stage is characterized by increased growth rate and invasiveness of the tumor

Front 40

What is metastasis?

Back 40

Cancer cells move from original site and travel to other parts of the body

Front 41

What are the steps of metastasis?

Back 41

1. Extension into surrounding tissues- enzymes secreted by tumors open up areas of surrounding tissues. Mechanical pressure, created as the tumor increases in size, forces tumor cells to invade new territory.

2. Penetration into blood vessels: tumors enter blood vessels and circulate throughout the body

3. Release of tumor cells: clumps of cells break off the primary tumor into blood vessels to transport

4. Invasion of tissue at the site of arrest—cells stop circulating and form secondary tumors

Front 42

How is metastasis produced?

Back 42

Tumor cells must detach from the primary tumor and enter the circulation, survive in circulation, adhere to capillary basement membrane, gain entrance into the organ parenchyma, respond to growth factors, proliferate and induce angiogenesis, and evade host defenses

Front 43

What are the routes for metastasic spread?

Back 43

1. Local seeding
2. Bloodborne metastasis
3. Lymphatic spread

Front 44

What is local seeding?

Back 44

Involves distribution of shed cancer cells in the local area of primary tumor (ovarian ca- cells shed in the peritoneal cavity)

Front 45

What is bloodborne metastasis?

Back 45

Tumor cells release into the blood

Front 46

What is lymphatic spread?

Back 46

Related to the number, structure, and location of lymph nodes and vessels. Primary sites that are rich in lymphatics are more susceptible to early spread than are area with few lymphatics.

Front 47

What is the most common cause of metastasis?

Back 47

Bloodborne metastasis

Front 48

What are the common sites of metastasis of breast cancer?

Back 48

1. Bone
2. Lung
3. Liver
4. Brain

Front 49

What are the common sites of metastasis of lung cancer?

Back 49

1. Brain
2. Bone
3. Liver
4. Lymph nodes
5. Pancreas

Front 50

What are the common sites of metastasis of colorectal cancer?

Back 50

1. Liver
2. Lymph nodes
3. Adjacent structures

Front 51

What are the common sites of metastasis of prostate cancer?

Back 51

1. Bone (spine and legs)
2. Pelvic nodes

Front 52

What are the common sites of metastasis of melanoma?

Back 52

1. GI tract
2. Lymph nodes
3. Lung
4. Brain

Front 53

How are tumors classified?

Back 53

On the basis of:

1. Cell type
2. Tissue of origin
3. Whether benign or malignant
4. Degree of differentiation
5. Anatomic site
6. Function

Front 54

How are tumors named?

Back 54

According to the tissues from which they arise, generally with the suffix “oma”

Front 55

What are the malignant neoplasms of epithelial origin called?

Back 55

Carcinomas

Front 56

What are the origins of carcinomas?

Back 56

1. Squamous cells of skin/lung

2. Gastric cells

Front 57

What are the malignant neoplasms of glandular or ductal origin called?

Back 57

Adenocarcinomas

Front 58

What are the origins of adenocarcinomas?

Back 58

1. Adenoca lung
2. Colon

Front 59

What are the lesions with hybrid features between glandular and squamous carcinomas called?

Back 59

Transitional cell cancer

Front 60

What are the origins of transitional cell cancer?

Back 60

Transitional bladder

Front 61

What are the connective tissue sarcomas?

Back 61

1. Rhabdomyosarcoma
2. Fibrosarcoma

Front 62

What are cancers of the lymphatic tissue called?

Back 62

Lymphoma

Front 63

What are cancers of the glial cells of the CNS called?

Back 63

Glioma

Front 64

What are cancers of the blood-forming organs (primarily the bone marrow) called?

Back 64

Leukemia

Front 65

What is carcinoma in situ?

Back 65

Tumors that have not broken through the basement membrane of their epithelial site

Front 66

What is grading of malignant tumors?

Back 66

1. Grading compares the cancer cell with the normal parent tissue from which it arose

2. Grading provides a means of evaluating the client for prognosis and appropriate therapy

Front 67

What is the lowest grading of malignant tumors?

Back 67

The lowest rating is given to those tumors that closely resemble normal cells

Front 68

What is the highest grading of malignant tumors?

Back 68

The highest rating is given to those that least resemble normal cells

Front 69

What is a grade X malignant tumor?

Back 69

One that cannot be assessed

Front 70

What is a grade I malignant tumor?

Back 70

Well differentiated – closely resembles tissue of origin

Front 71

What is a grade II malignant tumor?

Back 71

1. Moderately differentiated — less resemblance to tissue of origin

2. More variation in size and shape of tumor cells

Front 72

What is a grade III malignant tumor?

Back 72

1. Poorly differentiated – does not closely resemble tissue of origin

2. Much variation in size and shape of tumor cells

Front 73

What is a grade IV malignant tumor?

Back 73

Very poorly differentiated – no resemblance to tissue of origin

Front 74

What is cancer staging?

Back 74

1. Determines the cancer’s exact location and degree of metastasis present at diagnosis

2. Tumor stage also influences choice of therapy

Front 75

What is clinical cancer staging?

Back 75

1. Assessment of clinical manifestations and evaluation of clinical signs for tumor size and degree of metastasis

2. Clinical tests are used (tumor markers, radiographs, scans) and tumor cells may be obtained for biopsy

Front 76

What is surgical cancer staging?

Back 76

Determines tumor size, number, sites and degree of metastasis by inspection at surgery

Front 77

What is pathologic cancer staging?

Back 77

Pathologic exam of tissues

Front 78

What is the most definitive type of cancer staging?

Back 78

Pathologic staging

Front 79

What is TMN classification?

Back 79

Tumor, Node, Metastasis staging

Front 80

What does TMN classification describe?

Back 80

Describes the anatomic extent of the cancers

Front 81

What are the advantages of tumor staging?

Back 81

The stages guide treatment and are useful for prognosis and comparison of end results of treatment

Front 82

What are TMN staging systems specific to?

Back 82

TNM staging systems are specific to each solid tumor site

Front 83

What is the disadvantage of tumor staging?

Back 83

Not useful for cancers that arise in the bone marrow or lymphoid tissues

Front 84

What are the types of TMN classification?

Back 84

1. T0
2. Tis
3. T1, T2, T3, T4
4. N0
5. N1, N2, N3
6. M0
7. M1

Front 85

What is T0?

Back 85

No evidence of primary tumor

Front 86

What is Tis?

Back 86

Carcinoma in situ

Front 87

What are T1, T2, T3, and T4?

Back 87

Increasing size and/or local extent of the tumor

Front 88

What is N0?

Back 88

No regional lymph node metastasis

Front 89

What are N1, N2, and N3?

Back 89

Increasing involvement of regional lymph nodes

Front 90

What is M0?

Back 90

No distant metastasis

Front 91

What is M1?

Back 91

Distant metastasis

Front 92

What are the types of TMN staging?

Back 92

1. Stage I, T1, N0, M0
2. Stage II, T2, N1, M0
2. Stage III, T3, N2, M0
4. Stage IV, T4, N3, M+

Front 93

What is Stage I, T1, N0, M0?

Back 93

Clinical examination reveals a mass limited to the organ of origin

Front 94

What is Stage II, T2, N1, M0?

Back 94

Evidence of local spread into surrounding tissue and lymph nodes

Front 95

What is Stage III, T3, N2, M0?

Back 95

Extensive primary tumor with fixation to deeper structure, bone invasion, and lymph nodes of a similar nature

Front 96

What is Stage IV, T4, N3, M+?

Back 96

Evidence of distant metastasis beyond the site of origin

Front 97

What are the stages of breast cancer?

Back 97

1. Stage I
2. Stage II
3. Stage IIIA
4. Stage IIIB
5. Stage IV

Front 98

What is stage I breast cancer?

Back 98

Tumor = or < 2 cm and no lymph nodes involved

Front 99

What is stage II breast cancer?

Back 99

Tumor between 2-5 cm OR has spread to the axillary lymph nodes on the same side as the breast

Front 100

What is stage IIIA breast cancer?

Back 100

Tumor > 5cm OR has spread to lymph nodes

Front 101

What is IIIB breast cancer?

Back 101

Tumor of any size with metastasis to the breast skin, chest wall, or internal mammary lymph nodes

Front 102

What is Stage IV breast cancer?

Back 102

Metastasis beyond the breast, axilla, supraclavicular lymph nodes, lungs, liver, bone, brain

Front 103

What are the ACS recommendations for the early detection of breast cancer?

Back 103

1. Annual mammogram, clinical breast exam (CBE), monthly breast self-exam (BSE) for all women 40 and older

2. CBE every 3 years and monthly BSE for women 20-39 years

Front 104

What are the ACS recommendations for the early detection of prostate cancer?

Back 104

1. Beginning at age 50, prostate specific antigen (PSA) and digital rectal exam (DRE) annually

2. Men at high risk (AA, men with first degree relative diagnosed with prostate cancer at a young age) should begin testing at age 45

Front 105

What are the ACS recommendations for the early detection of colon and rectal cancers?

Back 105

Beginning at age 50, one of the following:

1. Fecal occult blood test (FOBT) annually

2. Flex sigmoidoscopy every 5 years

3. FOBT and flex sigmoidoscopy every 5 years

4. Double-contrast barium enema every 5 year

5. Colonoscopy every 10 years.
People at high risk should be screened earlier.

Front 106

What are the ACS recommendations for the early detection of uterine/cervical cancer?

Back 106

1. Cervix: all sexually active women or who are 18 or older should have annual Pap test and pelvic exam. After 3 or more consecutive satisfactory exams with normal findings, Pap test may be performed less frequently.

2. HPV vaccine (Gardasil) for girls and women 9-26 years. HPV types 16 and 18 cause 70% of cervical cancer case. Given as 3 injections over 6 months. Regular cancer screening still recommended.

Front 107

Which HPV types cause 70% of cervical cancer case?

Back 107

HPV types 16 and 18 cause 70% of cervical cancer case

Front 108

What are the ACS recommendations for the early detection of endometrial cancer?

Back 108

Beginning at age 35, women with or at risk for hereditary non-polyposis colon cancer should be offered endometrial biopsy annually to screen for endometrial cancer