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87 Cards in this Set
- Front
- Back
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T or F: Overall incidence of childhood cancer has increased since the mid-1970's
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True
BUT - rates in past decade have been relatively stable. |
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T or F: Most experts attribute small increases in incidence of CNS tumors, leukemia, and neuroblastoma to changes in diagnostic technology, reporting and classification.
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True
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T or F: When all sites combined, overall childhood cancer incidence was higher for females than for males
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FALSE: Incidence was higher in males
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T or F: If incidence date was examined year by year, the highest rates of childhood cancer were in infants
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True
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T or F: The majority of childhood cancers were solid tumors
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FALSE: majority (57%) were leukemia, CNS tumors, or lymphoma
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T or F: If incidence date was examined year by year, the highest rates of childhood cancer were in infants
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True
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T or F: American Indian children were at intermediate risk for childhood cancer when compared with European, African, Hispanic, and Asian American children
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FALSE: American Indian children have the lowest incidence rates of childhood cancer
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T or F: Overall survival of childhood cancer in estimated at 80%
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True
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What are some ways that cancer in children differs from that in adults?
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Cancer in children differs from adults in sites,
-origin -type of tissue involved - latency - opportunities for prevention & early detection - treatment response - prognosis |
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T or F: Pediatric cancers are grouped by primary site
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FALSE: Adult are grouped by primary site. Pediatrics are tabulated by hsitologic type and primary site.
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What is the International Classification of Childhood Cancer provide?
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To rate the groups of types of Pediatric cancers; Highest rates are for groups I (leukemia), II (lymphoma), III (CNS).
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What does an epidemiolgist look for in regards to cancer?
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Associations between environmental exposures or genetic characteristics that increase the likelihood of developing a disease = risk factors.
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Why is multifactorial etiology more complex in the pediatric cancer patient?
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Because characteristics of the child and child's mother/father and each of their exposures may play a role in the development of child's cancer.
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What is the SEER program?
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the NCI's Surveillance Epidemiology and End Results program. It depicts trends in childhood cancer.
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Why is the concept of multiple causation important when interpreting childhood cancer?
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because studies may indicate that exposure to a certain chemical can cause leukemia; but b/c it doesn't in every child, other studies will be needed to determine other factors that must interact w/exposure to cause disease.
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What summaries does the SEER report include?
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a current knowledge of the causes of various childhood cancers by category
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What are the categories of the causes of childhood cancers used in the SEER report?
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a) known risk factors
b) factors for which evidence is suggestive but no conclusive c) factors for which evidence is inconsistent or limited |
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T or F: Epidemiologist are also conducting studies to identify protective factors that decrease the risk of cancer
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True
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T or F: A known risk factor shown to increase the risk of childhood cancer is prenatal diagnostic irradiation exposure
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True: moderate incr'd risk of childhood leukemia
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T or F: A known risk factor shown to increase the risk of childhood cancer is exposure to pesticides, electromagnetic fields, motor vehicle exhaust
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FALSE: It is only found to be a POSSIBLE risk factor
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T or F: Viral exposure is an example of a known risk factor shown to increase the likelihood of childhood cancer
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True: nasopharyngeal carcinoma and some lymphomas associated with EBV
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What does each chromosome contain?
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DNA molecule
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What does each DNA macromolecule contain two of?
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Two chains of sugar and phosphate molecules.
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What is each sugar molecule attached to?
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a base = Another molecule
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What are bases?
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Purines (Adenine & Guanine)
Pyrimidines (Cytosin & thymine) A,G,C,T;approximately 3 billion base pairs are the full set of instructions to make a person |
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T or F: In a chromosome, a stretch of DNA that stores the instructions for making a protein is a gene
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True
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T or F: The DNA structure can unzip itself (self-reproducing) as well as produce the proteins needed for life
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True; Each of the unzipped halfs can rebuild themselves resulting indentical copies
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T or F: For the majority of childhood cancer cases, there is no evidence of familial cancer susceptibility.
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True - so research is being focused on the gene-environment interactions.
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T or F: Inherited cancer susceptibility syndromes account for only about 10% of newly diagnosed cancer cases in the U.S. each year.
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FALSE: Only account for about 5% of cases.
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Why have epidemiologists increased focus on their research on gene-environment interactions?
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Because for the majority of childhood cancer cases there is no evidence of familial cancer susceptibility
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T or F: Cancer is currently understood to be a genetic disease
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True: in the sense that something in the genes must go awry for cancer to develop
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What are the 3 classes of genes that play major roles in triggering cancer?
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1. Oncogenes
2. Tumor suppressor genes 3. DNA damage response (repair) genes |
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What do oncogenes, tumor suppressor & repair genes do when functioning correctly?
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They choreograph the life cycle of the cell and the intricate steps by which the cell enlarges & divides
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What is the role of proto-oncogenes in normal cell division & cell growth?
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They have a role in the signaling process that orchestrates the cell cycle
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If a proto-oncogene is mutated, what do they become?
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Carcinogenic oncogenes
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T or F: Changes produced by specific oncogenes cause the cell cycle to go out of control
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True
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What is an example of an oncogene associated with neuroblastoma?
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N-myc
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T or F: Oncogenes have been compared to a car's accelerator sticking in acceleration mode
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True
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T or F: Tumor suppressor gene malfunction is equated to the loss of a car's braking system
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True
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What do tumor suppressor genes do?
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Keep cell growth in check
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Therefore, what happens when tumor suppressor genes are damaged?
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The cell ignores inhibitory signals and grows out of control
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In what pediatric tumor was the first human tumor suppressor gene identified in by Knudson?
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Retinoblastoma
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What are alleles?
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Two copies of every gene in a cell
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What does having 2 copies/alleles do for a cell?
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Provides a built-in safety mechanism if a normal tumor-suppressing gene is missing or inactive.
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What does LOH stand for?
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Loss of Heterozygosity
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What does LOH mean?
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Losing a functioning copy of a gene
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What philosophy was proposed when the first tumor suppressing gene was identified in Retinoblastoma?
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"Two - Hit hypothesis" by Knudson
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What is the "Two-hit hypothesis" in Retinoblastoma?
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In hereditary Retinoblastoma, the first "hit" occurs in the germ cell, which predisposes other cells (specifically retinal cells) to develop a tumor after another mutation occurs.
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What is different in Non-hereditary Retinoblastoma?
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Both "hits" to the cell occur later in the development of the retina; & no constitutional predisposition to malignancy can be passed on
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T or F: The "two-hit hypothesis" applies to all malignancies that have hereditary and nonhereditary forms
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True - additionally there may be more than two steps
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What do DNA Repair, or Damage Response, Genes do?
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They are the caretakers of the cell that ensure each DNA strand is copied correctly during cell division.
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What happens if the DNA repair genes are mutated?
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Cancer can result from accumulations of mutations in critical growth-regulating genes (proto-oncogenes, tumor-suppressing genes)
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What disorders are associated with faulty DNA repair genes (therefore increased risk of cancer)?
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Bloom Syndrome
Ataxia-telangiectasia Fanconi Anemia Hereditary nonpolyposis colon cancer |
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What understanding has created a new view of cancer as a disease of the cell's microenvironment?
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Understanding the interactions between tumor cells & other cells and substances in their environment, and how they effect each other
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T or F: Cancer results from genetic mutations in a cell
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True
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What can genetic mutations in cells change?
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The amount or activity of proteins involved in regulating cell life
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What basic changes occur when a normal cell transforms into a malignant cell?
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Genetic changes in which a cancer acquires the ability to circumvent normal control mechanisms & manipulate its environment
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What are the six essential alterations in normal cell physiology that dictate malignant growth collectively?
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1. Self-sufficiency in growth signals
2. Insensitivity to antigrowth signals 3. Tissue invasion & metastasis 4. Limitless replicative potential 5. Sustained angiogensis 6. Evading apoptosis |
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What happens when a cell secretes proteins known as growth factors?
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Growth-stimulating signals communicate from outside the cell to deep within its interior & bind to receptors
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T or F: A hallmark of cancer is that cancer cells do not depend on normal mechanisms in order to proliferate
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True - the concept is that cancer cells hijacked normal endothelial cells & fibroblasts and forced them to release growth-stimulating signals.
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What does insensitivity to antigrowth signals translate to in regards to cancer cell growth?
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Cancer cells overstimulate cell growth-promoting mechanisms & ignore or evade a cells normal stopping system
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What important discovery was made regarding the cell clock?
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The cell clock is malfunctioning in almost every malignancy
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What is the cell clock in a normal cell?
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It is the point in the nucleus that promotes or inhibits growth.
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What does the cell clock do in a normal cell?
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It programs the events of the cell cycle through various molecules.
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What are two important molecules in programing of the events of the cell cycle?
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1. Cyclins
2. Cyclin-dependent kinases (CDK) |
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Define apoptosis
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Apoptosis is a backup system that tells a cell to destroy itself if something essential is damaged or if controls are deregulated.
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How does evading apoptosis play into developing cancer?
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It can allow a tumor to grow and may make them more resistant to treatment.
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What do telomeres do?
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They count within a cell, how many time the cell reproduces itself.
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T or F: Telomeres shorten every time chromosomes are replicated
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True - they are at the end of a DNA segment
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What happens when telomeres get too short?
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An alarm signal is sent that tells the cell to stop reproducing.
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How do malignant cells by-pass this alarm?
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They produce an enzyme called telomerase, that replaces telomeric segments & allows the cell to reproduce endlessly.
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Define angiogenesis
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The proliferation of new capillaries
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When is angiogenesis activated in a normal functioning cell?
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1. Menstruation
2. Placental nourishment of fetus 3. Wound healing |
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How can tumors benefit from angiogenesis?
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They can switch it on and increase their blood supply, allowing them to expand.
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How are tumors able to turn on angiogenesis?
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Tumors can produce growth factors such as vascular endothelial growth factor (VEGF) & basic fibroblast growth factor (bFGF).
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What counteracts growth factor secretion?
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Angiogenesis inhibitors; 1. angiostatin or 2. Endostatin
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What happens to allow the angiogenic switch?
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Regulatory molecules move between cells & their enviornment relaying signals that change the balance of angiogensis activators & inhibitors
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What do tumors require in order to grow beyond a 1-2mm size?
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A blood supply
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What characteristics are needed for a tumor to metastasize?
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Mutated cells that have altered the cell-to-cell adhesion molecules
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What are the cell-to-cell adhesion molecules?
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Integrins - which link cells to the extracellular matrix (a cells structure)
Proteases - enzymes that facilitate invasion of cancer cells across vessel walls & normal epithelial tissue |
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What is essential in the metastatic cascade (metastasis)?
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Angiogenesis
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T or F: Particular types of primary tumor metastasize preferentially to specific anatomic sites
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True
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T or F: Most deaths caused by cancer is as a result of metastatic disease
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True
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Common Patient & Family Concerns re: Epidemiology of Cancer
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Where did the cancer come from?
Is it part of a cancer cluster? |
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What current research is being conducted in regards to epidemiology of cancer?
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1. Direct evidence of exposure (carcinogenic effects of DNA)
2. inherited variation of genes that predispose children to cancer |
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What is one goal of the nursing assessment & intervention regarding the epidemiology of childhood cancer?
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#1: Adequate inform patient & family about diagnosis & biological/epidemiological factors related to the cancer
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What is the 2nd goal of the nursing assessment & intervention regarding epidemiology of childhood cancer?
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#2: Patient & family adequately cope with information
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