Oncology

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neoplasia

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new growth tumor
abnormal mass of tissue who's growth exceeds and is uncoordinated with normal tissues
both malignant and benign

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benign

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have a capsule and push surrounding tissue aside but don't invade surrounding tissue
hyperplastic masses
named from the type of tissue they arise from (add -oma)

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malignant

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cancer
ill defined edges, no capsule, locally invasive by direct extension
larger due to autonomous growth
mestastasize (cells break off from parent tumor and move to distant tissue)

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metastasize mechanisms

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hematogenous spread - via blood/vascular system
lymphogenous spread - via the lymphatic system

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naming malignant tumors

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add suffix carcinom to epithelial
sarcoma to connective
glioma to CNS tumor
blastoma to peripheral nerve tumor

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factors contributing to the metastic quality of malignant cells

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lack of adhesiveness(cells don't adhere to each other)
lack of contact inhibition (cell's behavior isn't governed by surrounding cells)
increased motility (cells are very active and mobile)
lack of contact guidance (cells growthis independent of surrounding cells)

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microstructural cellular changes

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dysplasia (cells have abnormal appearance)
metaplasia (early form of dysplasia, benign, adult cell changes from one type into another)
pleomorphism (cells have different sizes and shapes)
anaplasia (cells resemble embryonic cells, lack differentiation, high reproductive rate, most advance form of metaplasia, malignant cells)

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summary staging

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in situ (cells are present only in the layer of cells they develop in and haven't spread to other parts of that organ or body)
invasion of local tissue (cells have spread beyond the original later of tissue)
invasion of regional lymph nodes
distant metatasis (cells have spread to other organs in the obdy)

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TMN staging system

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asseses tumors in 3 ways:
T-extent of primary tumor
N-absence or presence of regional lymph node involvement
M-absence or presence of distance metastasis

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staging by cell type of origin (grading)

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low grade (localized)-cell types resemble normal, fully differentiated cells

high grade (metastatic)-cell types are poorly differentiated and tend to metastisize early to distance organ sites

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Endogenous cancer

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show hereditary pattern
breast cancer (protooncogens)
colon cancer (family polyposis)
aging is most common genetic condition that underlies cancer

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Exogenous cancer

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attributed to some external cause
environmental factors, behavioral factors
tobacoo use, viruses, chemicals, radiation

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Pathogenesis

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tumors form when there is as increased mitotic rate, DNA mutation with chromosomal abnormalities, and hyperplasia with accumulation
tumor cells live longer than normal cells and make them more durable and accumulate in a mass

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oncogenes (protooncogenes)

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genes that have mutations and cause an individual to develop a particular kind of cancer

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invasion and metastasis

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cancer cells have lack of adhesiceness and increased motility and spread to local tissue by direct extension
allows other cells to break off from each other and travel to distant organs (metastasis)

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seeding

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mestastatic tumor cells deposit in highly vascular organs
cells float in body fluids until they find a solid spot to latch on to (filter organs)
brain, liver, lungs, bone, lymph nodes

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S&S of malignant neoplasm

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oressure on tissue to cause obstruction
erosion of normal tissue
bleeding
infection (ulceration or obstruction)
anemia (blood loss, vit B12 malabsorption, bone marrow depression)
hormones with metabolic disturbancese (paraneoplastic syndromes)
cachexia (anorexia, liver damage, metabolic drag)
palpable enlargement
migratory thrombophlebitis (blood clots)

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cancer pain

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pressure on nerves and/or displacement of nerves
microscopic infiltration of nerves by cancer cells
interference with blood supply to organs or tumor blockage of hollow organs (bile and pancreatic duct)
metastsis to bone (pressure placed on sensory endings of the periosteum, bone destruction)

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cancer related fatigue

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result of catabolic effects of the disease or may be due to tx
radiation therapy, chemotherapy, and bone marrow transplant

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Primary prevention of cancer

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screening for risk factos
eleminate risk factors that are modifiable

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secondary prevention

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early detection and prompt tx of local malignancies before they become invasive and spread
tx instituted for individuals having high risk for cancer (breast cancer - drug tamoxifen)

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tertiary prevention

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managing symptoms
limit complications
prevent disability

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eliminate risk factors

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know which environmental, chemical, and infectious agents cause cancer
eliminate smoking, chewing tobaccor, avoid 2nd hand smoke
reduce intake of smoked foods
reduce red meats
avoid overexposure to sun

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screening procedures

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pap smears
digital exam (colonoscopy)
mammogram
self exam
blood test

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treatments

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radiation therapy
adjuvant chemotherapy
surgical excision
neoadjuvant chemotherapy
immunotherapy
angiostasis
rehabilitation

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radiation therapy

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kills cancer cells

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adjuvant chemotherapy

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toxic to tumor cells
may make patient anemic and susceptible to infection

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surgical excision

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primary tumor or regional lymph nodes

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neoadjuvant chemotherapy

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combing surgery and chemotherapy
neoplasm reduced in size by administration of chemotherapy and then surgically excised

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immunotherapy

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stimulate the patients immun system to combat and eliminate cancer

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angiostasis

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eliminate the cancer by interrupting its blood supply