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189 Cards in this Set
- Front
- Back
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cells + plasma
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Blood
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- type of cells
-erythrocytes -survive 90-120 days |
Red Blood Cells
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-type of cells
-leukocytes -granulocytes survive 7 hours |
White Blood Cells
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-type of cells
-thrombocytes -survive 7 days |
Platelets
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-consist of fluid - water and chemicals
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Plasma
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-formation and development of blood cells
-embryo: yolk sac, liver/spleen, bone marrow -child and adult: bone marrow |
Hematopoeisis
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-pluripotent: forms ALL blood cells
-found in bone marrow of adults -self-reproducing -stimulated by: hemopoietic growth factors, cytokines, colony-stimulating factors, erythropoietin, thrombopoietin, and cytokines |
Hematologic stem cells
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-formation of RBCs
-mature RBC: no nucleus, 95% Hb -main function is to carry oxygen to tissue and carbon dioxide away from tissue |
Erythropoiesis
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-chemical structure, center contains an atom of iron
-adult: 4 heme + 2 alpha globin strands + 2 beta globin strands |
Heme
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-protein chain assoc with Hb
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Globin
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-RBC disorders
-erythropenia -too few RBCs and/or abnormal function -result: decrease oxygen to tissues |
anemia
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-RBC disorder
-erythrocytosis -too many RBCs |
Polycythemia
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Morphology Anemia Classification - 3
-size, shape, appearance |
1 - microcytic - hypochromic
2 - macrocytic 3 - normocytic - normochromic |
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Kinetic analysis of Anemia Classification - 3
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1 - Blood loss
2 - decreased production 3 - increased destruction - hemolysis |
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-anemia grouping
-hypochromic -sideroblastic -thalassemia -iron deficiency |
Microcytic
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-type of anemia grouping
-folic acid deficiency -B12 deficiency - pernicious anemia |
Macrocytic
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-type of anemia grouping
-anemia of chronic disease -aplastic anemia -acute blood loss -normochromic |
Normocytic
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-type of anemia grouping
-sickle cell -hereditary spherocytosis -G-6-PD deficiency |
Hemolytic
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-fatigue, tired, weak
-pale skin color -pale conj - one of earliest signs of anemia -shortness of breath -poor exercise tolerance -cold intolerance -pica: compulsive eating |
Anemia
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-Hb = heme + globin
-usually abnormality in production -deficiency of either results in: --> small cells (microcytosis) --> decreased Hb (hypochromia) |
Microcytic - Hypochromic anemia
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-type of microcytic anemia
-heme synthesis defect -iron trapped in nucleus of RBC precursors -ringed sideroblasts -tx: remove cause if possible |
Sideroblastic anemia
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-type of microcytic anemia
-defect in production of globin chains -hemolytic anemia also -normal iron studies -etiology: genetic disorder -beta-this minor: mild anemia, normal lifespans -tx: transfusion if needed |
Thalassemia
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-type of microcytic anemia
-most common anemia in the US -most common anemia in the world -cause: blood loss and/or dietary iron deficiency -adults - chronic blood loss --> GI, menstrual -only 1 in 4 people with iron deficiency develop anemia -Total serum iron, total iron-binding capacity, ferritin level -tx: stop the blood loss, replace iron |
Iron Deficiency
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-part of the iron deficiency panel
-measure of transferring's ability to bind iron - |
TIBC
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-part of iron deficiency panel
-iron/protein complex that stores iron in the intestinal cells -low = iron deficiency |
Ferritin level
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Good response to iron tx
-increase in reticulocytes |
1 week
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-good response to iron tx
-Hb often normal |
6 weeks
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-precursor to mature RBCs
-normal: bone marrow is functional -incrased: acute blood loss, iron therapy -decreased: bone marrow failure, decreased components for RBC production |
Reticulocytes
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-part of macrocytic anemia
-large RBC precursor with the nucleus |
Megaloblast
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-part of macrocytic anemia
-impaired DNA synthesis -includes folic acid deficiency, B12 deficiency, and meds |
Megaloblastic
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-part of macrocytic anemia
-normal DNA synthesis -includes alcoholism, hypothyroidism, and chronic liver disease that is related to alcoholism |
Nonmegaloblastic
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-type of macrocytic anemia
-this supplies last 4-5 months -cause could be pregnancy (folic acid essential in neural tube development), dietary (found in raw fruit and veggies, cooking destroys folic acid), alcoholism, bowel disease, and meds - |
Folic Acid Deficiency
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-type of macrocytic anemia
-supplies last 3-5 months -cause could be nutritional (alcoholism, elderly, vegan), malabsorption (pernicious anemia most common of all), and other GI problems -sx are the same as folate deficiency anemia -neurologic problems -atrophic glossitis |
B12 deficiency
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-type of macrocytic anemia
-lack of IF -IF secreted by parietal cells of stomach and assists absorption of B12 in the small bowel -antiparietal cell antibodies -anti-IF antibodies specific for this |
Pernicious anemia
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Tx of Macrocytic anemia - 3
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1 - Remove and treat cause if able
2 - B12 3 - Folate - orally |
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-normocytic-normochromic anemia
-plenty of iron but bone marrow cannot use it -Rheumatoid Arthritis -Renal disease -tx: EPO |
Anemia of Chronic Disease
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-glycoprotein that stimulates erythropoiesis
-kidneys sense hypoxia and produce this -used in end stage renal failure and other diseases such as anemia |
EPO
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-hematopoietic stem cell failure
-pancytopenia: erythropenia, leukopenia, and thrombocytopenia -cause could be primary (idiopathic), or secondary (chemo or infections) -signs/sx: erythropenia (anemia), leukopenia (increased infections), and thrombocytopenia (bleeding, petechiae, and ecchymosis -tx: RBC transfusions, abxs if infection is present, platelet transfusions, untreated - median survival of 2-6 months, bone marrow transplants which can make a long survival in about 75-90% |
Aplastic Anemia
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-usually active site of bleeding
-normocytic anemia -reticulocytosis - increased reticulocytes -tx: shock - main concern, first do fluids, then control and stop the bleeding |
Acute Blood Loss Anemia
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-abnormal Hb S formation
-hemolytic anemia -african: 25% have sickle cell gene and 1% have sickle cell anemia -Hb S thought to provide protection against malaria Major: chronic hemolysis, acute vaso-occlusive crises, and increased suceptibility to infection -tx: oxygen, fluids and transfusions, tx infections, hydroxyurea - may increase Hb F which inhibits the sickling effect, and pain meds |
Sickle Cell Anemia
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-decrease in O2 causes sickling of RBCs
-potentially life threatening -triggers: cold exposure, prego, infections, gallbladder disease, stimulants -anemia signs/symtpoms -muscular and/or abdominal pain -jaundice - heme breakdown produces bilirubin -splenomegaly -infections -stroke |
Sickle Cell Crisis
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-retinopathy
-vitreous hemorrhage -retinal detachments -neovascularization -yearly eye exams |
Sickle Cell Ocular
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-cell membrane defect
-hemolytic anemia -fragile cells, less pliable -splenomegaly -jaundice - increased bilirubin production -tx: splenectomy |
Hereditary Spherocytosis
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-hemolytic anemia
-glucose-6-phosphate dehydrogenase deficiency - antioxidant protecting RBCs -african american males in about 10% -no symptoms unless exposed to certain toxins/drugs/infections -meds that trigger anemia: sulfa, ASA, and antimalarials |
G-6-PD deficiency
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-blood clot
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Thrombosis
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Virchows Triad
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1 - Vessel Wall Injury
2 - Blood flow - stasis or turbulence 3 - Hypercoagulability |
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-major cause of thrombosis
-vessel wall lined by endothelial cells - when damaged -expose collagen -leads to clot formation -especially impt in heart and arterial circulation |
Vessel wall injury
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-venous thrombus - legs
-part of blood flow |
Stasis
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-arterial and cardiac
-part of blood flow |
Turbulence
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-bleeding
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Hemorrhage
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-pinhead size superficial hemorrhage
-skin and mucous membranes |
Petechia
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-less than 1 cm superficial hemorrhage
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Purpura
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-bruise
-more than 1-2cm subcutaenous hemorrhage |
Ecchymosis
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-red hemorrhage
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Hb
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-yellow hemorrhage
-gone in 2-3 weeks |
Bilirubin
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-brown hemorrhage
-gone in 2-3 weeks |
Hemosiderin
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-control of bleeding
-damage to blood vessel wall and collagen exposure -vasoconstriction -primary - platelet activation -secondary - coagulation -antithrombotic counter-regulation |
Normal Hemostasis
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-platelet activation
-adhesion of platelets -release of intracellular granules and signaling molecules -aggregation of platelets |
Primary Hemostasis
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-type of hemostasis
-coagulation cascade -sequential process -coagulation factors of the blood interact -results in thrombin production -thrombin converts fibrinogen to fibrin -final product - fibrin clot |
Secondary hemostasis
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-part of secondary hemostasis
-causes clots within blood |
Intrinsic initiation
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-part of secondary hemostasis
-causes clots within tissues |
Extrinsic Initiation
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-type of lab test
-intrinsic and common pathway |
Partial Thromboplastin Time
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-type of lab test
-extrinsic and common pathway |
Prothrombin Time or INR
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-type of lab test
-platelt quantity and function |
Bleeding Time
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Three types of Bleeding Disorders
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1 - BV wall fragility
2 - Platelet Abnormalities 3 - Coagulation Disoders |
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-anemia
-petechiae -purpura -ecchymosis -epistaxis - nosebleeds -gum bleeding -subconjunctival hemorrhage -renal, pulmonary, GI, joint, hemorrhage |
Bleeding Disorders
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-type of bleeding disorder
-causes: aging, meds (glucocorticosteroids, PCN, sulfa), vit C deficiency, Henoch-Schlonlein Purpura, Hypersensitivity Vasculitis, Hereditary Hemorrhagic Telangiectasia, and Infections (meningitis) -skin and mucous membranes: petechiae, purpura, ecchymosis -epistaxis, subconjunctival hemorrhage -internal bleeding and anemia uncommon -lab ususally normal |
Blood Vessel Wall Fragility
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-scurvy
-ascorbic acid that is found in citrus fruit -results in decreased collagen formation = weak vessels -originally noted in sailors at sea -limies |
Vit C deficiency
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-type of platelet abnormality
-increased platelets -more than 500,000 -primary (essential) - polycythemia vera -secondary (reactive) - trauma, surgery, blood loss, infections, cancer, and inflammatory diseases |
Thrombocytosis
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-type of platelet abnormality
-decreased platelets -bleeding time is prolonged -PT and PTT are normal -less than 100,000 - prolonged bleeding time 20,000-50,000 petechiae, purpura -less than 10,000 spontaneous bleeding |
Thrombocytopenia
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-type of platelet abnormality
-abnormal platelet function -normal platelet numbers -prolonged bleeding time |
Thrombocytopathia
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-type of Thrombocytopenia
-due to infections, drugs, anemia |
Decreased Production
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-type of Thrombocytopenia
-due to drugs and autoimmune |
Decreased Survivial/Increased Destruction
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-autoimmune disorder
-antiplatelet immunoglobins -children 2-6 years old: often after viral infection -women 20-40 years -tx: steroids, splenectomy, platelet transfusions |
Idiopathic Thrombocytopenia Purpura
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-a med that irreversibly blocks formation of thromboxane in platelets, interferes with platelet aggregation
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ASA
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-type of meds that reveresibly block the formation of thromboxane in platelets
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Other NSAIDs
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Types of Coagulation Disorders - 2
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1 - Hereditary - Hemophilias
2 - Acquired - Vit K dependent factor deficiency |
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-variable presentation depending on the level of deficiency
-sx: bleeding after major surgery, bleeding after trauma, hemarthrosis, spontaneous bleeding |
Hemophilias
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-type of hemophilia
-factor VIII deficiency -Normal vWF -prolonged PTT -Male - x linked recessive trait -female carriers -tx: factor VIII transfusions, genetically engineered Factor VIII |
Hemophilia A
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-abnormal vWF that facilitates the platelet adhesion to vessel, plasma carrer of Factor VIII
-prolonged PTT -autosomal dominant trait: affects both sexes equally -most common inherited bleeding disorder -tx: plasma, factor VIII, vWF |
Von Willebrand's Disease
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-type of Hemophilia
-factor IX deficiency -prolonged PTT -Christmas disease -x linked recessive trait: disease in males, carried by females -tx: factor IX replacement |
Hemophilia B
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-dependent factors: II, VII, IX, X
-produced in liver -prolonged PTT and PT -caused by malabsorption and/or nutritiional deficiency, and liver failure -tx: remove any drug causing problem, liver disease, nutritional disorder, vit k, fresh frozen plasma - immediate effect |
Vit K deficiency
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-coagulopathy - fibrinogen deficiency
-rarely causes significant bleeding problems |
Rattlesnake Bite
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-usually in the lower extremities
-higher risk: elderly, recent surgery, confined to bed, malignancy -diagnosis: increased d-dimer and doppler ultrasound |
Deep Vein Thrombosis
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-platlet inhibitors - prevention - NSAIDs, ASA, Plavix, etc
-anticoagulants: heparin-PTT, low molecular weight, warfarin - PT -thrombolytics - streptokinase |
Thrombus tx
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-excessive clotting and consumption of coagulation components and platelets
-clotting AND bleeding -diagnosis: increased fibrin degradation products - FDPs |
Disseminated Intravascular Coagulation
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-erythrocytosis
-increase in Hb, hetaocrit, total RBCs -primary - vera -secondary - dehydration, increased erythropoietin: hypoxia from lung disease, high altitude |
Polycythemia
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-type of polycythemia
-abnormality of stem cell -myeloproliferative disorder - cancer -thrombocytosis, leukocytosis -peak age: 50-75 -without tx: 50% die within 18 months -with tx: median survival 10-15 years -headache, visual changes -complications: thrombosis, retinal vein, stroke, heart attack, digital pain -tx: avoid iron, hydroxyurea, antiplateltes that prevent thrombosis, phlebotomy |
Polycythemia Vera
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-aka leukocytes
-main functions are to protect against microorganisms and immune response |
WBC
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-type of WBC
-presence of granules in cytoplasm -neutrophils, basophils, eosinophils |
Granulocytes
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-type of WBC
-absence of granules in the cytoplasm -monocytes, lymphocytes |
Agranulocytes
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-type of WBC - cell line differentiation
-neutrophils, basophils, eosinophils, monocytes, macrophages -also called phagocytes -ingest microorganisms, antigens, tissue debris |
Myelocytic
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-type of WBC - cell line differentiation
-T cells and B cells |
Lymphocytic
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-increased number of neutrophils due to infection (bacterial), stress, glucocorticoids, cancer (esp leukemia), and smoking
-increased bands |
Neutrophilia
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-decreased number of neutrophils due to infection, meds, chemo, and rheumatologic disorders
-G-CSF - treat chemo induced |
Neutropenia
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-increased number of eosinophils due to allergic response, parasite infestation, and cancers
-Granules - MBP toxic to various parasites |
Eosinophilia
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-increased count in basophils
-immediate hypersensitiviity reactions (asthma, urticaria, allergic rhinits, and anaphylaxis) |
Basophilia
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-leave blood and enter tissue and enlarge to become macrophages
-enhance the neutrophil function -perform tissue maintenance functions -involved in immune regulation esp with T and B cells - lymphocytes -infection control |
Monocytes
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-type of lymphocytes
-produced in bone marrow -mature in bone marrow -produce antibodies - gammaglobulins |
B cells
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-type of lymphocytes
-produced in bone marrow -mature in thymus -cell-mediated immunity -secrete molecules - alter immune response |
T cells
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-increased number in lymphocytes
-infection and cancer esp leukemia |
Lymphocytosis
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-decreased number of lymphocytes due to infection, cancer, and inherited disorders
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Lymphopenia
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-B cell immunodeficiency - agammaglobulinemia
-x linked disease - males -symptoms start - 6 months -clinically: recurring infections -tx: bone marrow transplant |
Bruton's syndrome
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-T cell immunodeficiency
-thymus is absent or not completely functional -clinically: recurring infections -tx: bone marrow transplant and/or thymus transplant |
DiGeorge's Syndrome
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-type of blood cell neoplasms
-includes Myelodysplastic Syndrome and Myelogenous Leukemias -myeloid cell line WBCs, platelets, RBCs |
Myeloproliferative
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-type of blood cell nepolasm
-80-805% are of B cell origin -includes lymphomas, multiple myeloma, and lymphocytic leukemias -lymphocytic cell line WBCs |
Lymphoproliferative
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-type of myeloproliferative blood cell nepolasm
-involves myelogenous cell line: RBCs, platelets, granulocytes -results in cytopenias in these cell lines -can convert to acute myelocytic leukemia resulting in a concurrent myeloproliferative disorder -cause: genetic, chemo and radiation -tx: poor response |
Myelodysplastic Syndrome
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-found throughout the body
-spleen, thymus, tonisls, bone marrow, lymph nodes -lymph nodes enlarge with infection/cancer |
Lymphatic Tissue
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-B-cell lymphoma
-Epstein-Barr virus implicated in cause -may be fastest growing human cancer -tx: complete remission possible -children/young adults |
Burkitt's Lymphoma
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-ages 15-35 and 50-70 years old
-spreads from lymph node group to next group -usual presentation - painless enlargement of lymph nodes -tx: complete remission possible -long term surviviors may develop cancer from the chemo -type of lymphoma |
Hodgkin's
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-more than 50 years old
-spreads throughout body through blood/lymph -more common -organ transplant pts - may develop this cancer -type of lymphoma |
Non-Hodgkin's
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-increased plasma cells - subtype of B cells
-M component antibody overproduction in the blood -Bence Jones Protein - in urine -lytic bone lesions -peak age 50-60 years old -bone pain is common -multifocal destructive bone lesions are common -hypercalcemia - lethargy, confusion -recurring infections -renal insufficiency -tx: chemo and bone marrow transplant |
Multiple Myeloma
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-bone marrow disorder
-cells overproduced and last longer than normal -cells replace bone marrow - suppress formation of other cells such as RBCs, platelets and normal WBCs -tx: suppress abnormal clone and allow normal cells to recover -leukocytosis -leukopenia - 50% have initial value less than 10,000 -blasts - immune leukocytes -anemia -low platelet count |
Leukemia
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-high number of leukocytes
-no blasts -not leukemia -often no anemia with normal platelet count -cause: acute infection and chronic inflammatory reaction |
Leukemoid Reaction
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-rapid onset of symtpoms
-can be rapidly fatal -fatigue, bleeding/bruising, infections |
Acute Leukemia
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-similar clinical symptoms to acute leukemia
-gradual onset -slow progressive course -more commonly seen in adults |
Chronic Leukemia
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-type of myeloproliferative blood cell nepolasm
-involves myelogenous cell line: RBCs, platelets, granulocytes -results in cytopenias in these cell lines -can convert to acute myelocytic leukemia resulting in a concurrent myeloproliferative disorder -cause: genetic, chemo and radiation -tx: poor response |
Myelodysplastic Syndrome
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-found throughout the body
-spleen, thymus, tonisls, bone marrow, lymph nodes -lymph nodes enlarge with infection/cancer |
Lymphatic Tissue
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-B-cell lymphoma
-Epstein-Barr virus implicated in cause -may be fastest growing human cancer -tx: complete remission possible -children/young adults |
Burkitt's Lymphoma
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-ages 15-35 and 50-70 years old
-spreads from lymph node group to next group -usual presentation - painless enlargement of lymph nodes -tx: complete remission possible -long term surviviors may develop cancer from the chemo -type of lymphoma |
Hodgkin's
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-more than 50 years old
-spreads throughout body through blood/lymph -more common -organ transplant pts - may develop this cancer -type of lymphoma |
Non-Hodgkin's
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-increased plasma cells - subtype of B cells
-M component antibody overproduction in the blood -Bence Jones Protein - in urine -lytic bone lesions -peak age 50-60 years old -bone pain is common -multifocal destructive bone lesions are common -hypercalcemia - lethargy, confusion -recurring infections -renal insufficiency -tx: chemo and bone marrow transplant |
Multiple Myeloma
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-bone marrow disorder
-cells overproduced and last longer than normal -cells replace bone marrow - suppress formation of other cells such as RBCs, platelets and normal WBCs -tx: suppress abnormal clone and allow normal cells to recover -leukocytosis -leukopenia - 50% have initial value less than 10,000 -blasts - immune leukocytes -anemia -low platelet count |
Leukemia
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-high number of leukocytes
-no blasts -not leukemia -often no anemia with normal platelet count -cause: acute infection and chronic inflammatory reaction |
Leukemoid Reaction
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-rapid onset of symtpoms
-can be rapidly fatal -fatigue, bleeding/bruising, infections |
Acute Leukemia
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-similar clinical symptoms to acute leukemia
-gradual onset -slow progressive course -more commonly seen in adults |
Chronic Leukemia
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-hemorrhage - retinal, subconjunctival
-papilledema -EOM paralysis/weakness |
Leukemia ocular effects
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-type of acute leukemia
-most common leukemia in children -80% of leukemias in children -20% of leukemias in adults -peak incidence around 4 years old |
ALL
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-type of acute leukemia
-most common AL in adults -child: usually less than 1 year -often from toxic exposure: radiation, chemicals, chemo -prognosis poorer than ALL |
AML
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-usually more than 50 years old
-tx: conservative, nothing significantly improves the survival -type of CL |
CLL
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-Type of CL
-25-60 year olds -15-20% of leukemias -Ph chrom 22 -Ph results in a BCR-ABL fusion gene -most die in blast crisis - a conversion to AL |
CML
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-part of CML
-produces tyrosine kinase that stimulates abnormal cell proliferation |
BCR-ABL fusion gene
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-type of CML tx
-antimetabolite - interferes with cell growth |
Hydroxyurea
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-type of CML tx
-suppresses cell reproduction -attracts killer T cells -may be curative |
Interferon
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-type of CML tx
-imatinib mesylate -engineered to bind to BCR-ABL gene -tyrosine kinase inhibitor -first line therapy -overall survival rate 89% in 5 years -$3000 per month, oral |
Gleevec
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-type of cell growth
-proliferation, differentiation, and apoptosis |
Normal Cell Growth
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-type of cell growth
-abnormality limited to the cell BM usually intact |
Preneoplasia
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-type of cell growth
-cancer, malignancy |
Neoplasia
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-spread of cancer cells into the lymph and blood system
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Metastasis
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-multistep involvement
-low probability to advance to next stage -usually due to mutations of specific cellular growth-controlling genes -mutations give growth advantage over other cells |
Process of Cancer
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-Cancer Abnormalaties - 3
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1 - Mitogens
2 - Oncogenes 3 - Tumor Suppressor Genes |
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-cancer abnormality
-chemicals produced by one cell that act on another cell -growth stimulatory and inhibitory |
Mitogens
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-type of cancer abnormality
-a mutated gene that causes an abnormal cell and/or abnormal cell growth -aka mutant growth stimulatory genes -can be transferred to human via viruses |
Oncogenes
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-type of cancer abnormality
-suppress oncogenes -aka-anti-oncogenes -function: oppose cell proliferation -experiment: combining a mutant cell with a normal cell often resulted in conversion of the abnormal cell into a normal cell |
Tumor Suppressor Genes
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-tumor suppressor gene inactivation due to a mutation
-50% chance of inheriting gene -increased familial tendency for cancer -common to see cancer before age 45 |
Li-Fraumeni Syndrome
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-second leading cause of death in US
-develops in 1 in 3 Americans -1 in 4 Americans die from disease |
Cancer
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-interruption of cancer process to prevent/delay
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Primary cancer prevention
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-early detection - cancer screening
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Secondary cancer prevention
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Cancer Tx Options - 3
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1 - Surgery
2 - Radiation Therapy 3 - Chemo |
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Cancer Staging - 3
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T = Tumor
N = Nodes M = Metastasis |
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-tx of cancer
-usually done first for diagnosis -best for slow growing cancers |
Surgery
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-type of cancer tx
-50% require radiation therapy at some point in the disease process -pre-op - tumor regression post-op - decrease reoccurrence -good for fast growing tumors -SE: inflammation, fibrosis/scarring, malaise, fatigue, decreased blood cell count, anorexia |
Radiation
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-type of cancer tx
-less than 25% of cancer pts treated not with this -10% of cancer pts experience prolonged remission with this only -kills most actively reproducing cells - cancer, hair, stomach, bone -combos are used to prevent drug resistance |
Chemo
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-interferes with DNA, RNA, and various nuclear and cytoplasmic proteins
-produce free radicals that kill cell -does not differentiate between reproducing and resting cells -cytotoxic: can cause secondary cancers - leukemia |
Alkylating Agents
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-inhibits cell division by interfering with microtubules
-vinca alkaloids - vincristine, vinblastine -neurotoxicity, bone marrow suppression, alopecia |
Microtubule Inhibitors
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-bind with DNA
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Antibiotics
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-interfere with RNA and DNA synthesis
-structurally similar to DNA or RNA precursors |
Antimetabolites
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-blocks the enzyme that is used in the replication of DNA
-myelosuppression - esp neutropenia |
Topoisomerase I Inhibitors
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-epidermal GF inhibitor that attaches to the HER2 receptor protein
-also attracts immune cells -breast cancer -type of monoclonal antibody |
Trastuzumab
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-type of monoclonal antibody
-genetically engineered against CD20 antigen on malignant lymphocytes -non-hodgkins lymphoma |
Rituximab
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-binds and crosslinks DNA
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Platinum analogues
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-chemo complication
-aggressive search for cause -differentiate between chemo induced vs infection -often develop unusual infections -infection is a common cause of death in cancer pts |
Leukopenia
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-chemo complication
-bone destruction -weakness, nausea, fatigue,lethargy, confusion |
Hypercalcemia
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-tx for N and V with stomach cells and chemo -2
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1 - Serotonin receptor antagonist
2 - Dronabinol |
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-released during chemo in GI tract
-causes nausea and vomiting -antagonist blocks the receptor -given prior to chemo |
Serotonin
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-leading cause of death from cancer in both men and women in the US
-one of the poorest prognoses of all cancers -overall 5 year survival in 15% -can be small-cell carcinoma - average survival time is 2-4 months without treatment -sx: cough, hemoptysis, pneumonia that doesn't clear tx: very little helps with long-term survival -tobacco is assoc with 87% -industrial carcinogens and air pollution are other risk factors -screen for tobacco use and asbestos exposure -90% of smokers with a 40 pack per year history do not develop cancer |
Lung Cancer
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-335 of all newly diagnosed cancers in women
-most common diagnosed cancer in women -most common cause of death in women 40-55 years old -Li-Fraumeni Syndrome - tumor suppressor gene inactivation -mutations in BRCA 1 gene or BRCA 2 gene -HER-2/neu oncogene -diagnosis: breast lump or discharge that is often bloody, mammogram and/or ultrasound, ER analysis -ER + cancers are stimulated by estrogen -70%: long term remissions -oophorectomy possible - decreases estrogen -radiation -chemo and hormonal therapy -risk factors: early menarche or last menopause, more than 30 at first pregnancy or never pregnant, exposure to high-dose radiation, hormonal exposure, first degree famiily member with disease, prior, and alcohol -mammorgram - baseline age 35-40 years old, every 1-2 years age 40-50 and yearly at age 50, stop age 75-80 -MRI: detects twice as many cancers as mammogram or ultrasound, may cause cancer in BRCA + pts |
Breast Cancer
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-estrogen receptor antagonist
-use if ER+ -retinopathy a rare side effect -minimal toxicity |
Tamoxifen
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-part of BRCA screening
-57% risk breast cancer, 40% risk ovarian cancer before age 70 |
+BRCA 1
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-part of BRCA screening
-49% risk breast cancer, 18% risk ovarian cancer |
+BRCA 2
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-fourth most common cancer in the US
-2nd highest mortality rate in men, 3rd in women -60% have metastases at time of diagnosis -Bowel movement changes - constipation, diarrhea, stool caliber -abdominal pain -rectal bleeding - a late finding -increased CEA - usually used for monitoring disease progress and not diagnosis -tx: --> surgery - colostomy - temporary vs permanent --> radiation - common pre and pose surgery --> chemo risk factors: familial history, ulcerative colitis or Crohn's disease, polyps, high fat and/or low fiber diets, obesity -screen stools for DNA, colonoscopy - age 50, stop age 75-80, virtual colonoscopy, 75% of new cancers occur in pts with no increased risk |
Colorectal cancer
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-type of tx for colorectal cancer
-epidermal growth factor receptor inhibitos, human IgG monoclonal antibody, ocular toxicities may occur |
Panitumumab
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-type of tx for colorectal cancer
-epidermal growth factor receptor inhibitor -murine IgG monoclonal antibody |
Cetuximab
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-risk: hep B or C, cirrhosis, hemochromatosis, alcoholism
-diagnosis: CT or US of liver, increased AFP |
Liver Cancer
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-5th leading cause of cancer death
-60% male -majority are more than 60 years old -smoking 2x greater risk, alcohol increases risk -5 year survival - 2% without surgery -abdominal pain common problem |
Pancreas Cancer
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-increased incidence in Barrett's esophagus, alcohol, tobacco use
-type of GI cancer |
Esophagus cancer
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-type of GI cancer
-increased risk with non-healing ulcers |
Stomach cancer
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-median age at diagnosis is 64
-95% are more than 40 years old -tobacco and alcohol use big risk factors -53% have spread by time of initial diagnosis |
Oral Cancer
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-use to be one of the most common cause of cancer death
-cancer death rate decreased by 50% in the past 30 years -cause is E7 - an oncogene product of one of the HPVs - risk factors: smokers, multiple sex partners, early onset of sex, HIV infection, HPV infection -screening: no clinical symptoms until cancer advanced, begin PAP with onset of sexual activity, at least every 3 years, stop at age 65 if previous paps are all normal |
Cervical Cancer
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-vaccination for HPV 6,11,16, and 18
-HPV 6 + 11 - cause about 90% of venereal warts -HPV 16 +18 - cause more than 70% of cervical cancers -females age 9-26 |
Gardasil
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-most common gynecologic malignancy
-most common symptom: abnormal bleeding -risks: obesity, diabetes, polycystic ovarian disease, unopposed estrogen use |
Uterine Cancer
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-5th leading cause of cancer deaths in women
-most lethal gynecologic cancer -CA-125 marker - cancer antigen 125 -BRCA screening |
Ovarian Cancer
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-most common male cancer
-2nd to 3rd most common cause of death in men -median age of death - 81 years old -risk increases with age beginning at 50 -AA, family hx -tx: surgical complications (urinary incontinence and impotence), abiraterone -screenings: digital rectal exam beginning age 50, PSA (baseline around age 50, monitor rate of increase), 80% of men more than 70years have subclinical on autopsy |
Prostate Cancer
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-tx for Prostate cancer
-blocks hormones that fule cancer growth |
Abiraterone
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-peak 20-35 years of age
-major predisposing factor - undescended testicle |
Testicular Cancer
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-urine dipstick for blood
-smoking increaes the risk |
Bladder cancer
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-primary vs secondary (metastasis)
-difficult to treat, highly fatal -may cause visual symptoms, headaches -leading cause of pediatric cancer deaths |
Brain Cancer
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-primary is rare
-usually secondary with metastasis -bone marrow development? |
Bone cancer
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-Rb1 gene mutation
-absence of tumor suppressor gene |
Retinoblastoma
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