Chapter 23 Cancer Development Mrs. M. Kreisel MSN, RN NU130 Adult Health 1 Summer 2011

Cell Growth

Neoplasms

Tumor Growth Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Tumor Cell Division Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Features of Normal Cells Limited cell division Apoptosis (limits growth of tumors by phagocytosis) Specific morphology Small nuclear-to-cytoplasmic ratio Differentiated function Tight adherence Nonmigratory Contact inhibition Normal chromosomes

Features of Early Embryonic Cells Rapid and continuous cell division Anaplasia (loss of cellular differentiation and function=malignancies) Large nuclear-to-cytoplasmic ratio Loose adherence Migration No contact inhibition Normal chromosomes

Features of Benign Tumor Cells Continuous or inappropriate cell growth Specific morphology Small nuclear-to-cytoplasmic ratio Specific differentiated functions Tight adherence No migration Orderly growth Normal chromosomes

Features of Cancer Cells (Malignant) Rapid or continuous cell division Anaplasia Large nuclear-to-cytoplasmic ratio Specific functions lost Loose adherence Migration No contact inhibition Abnormal chromosomes

Cancer Development Carcinogenesis/oncogenesis (tumor formation) are names for cancer development. Malignant transformation occurs through these steps: Initiation Promotion Progression Metastasis

Metastasis occurs through a progression of steps: Extension into surrounding tissues Blood vessel penetration Release of tumor cells Invasion Local seeding Bloodborne metastasis Lymphatic spread

Lymphatic Spread of Tumor Cells Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Steps of Metastasis

Cancer Classification Grading Ploidy (the # of Chromosome sets in a cell) Staging TNM (tumor, node, metastasis) Doubling time and mitotic index

Cancer Etiology and Genetic Risk Oncogene activation Chemical carcinogenesis Physical carcinogenesis Viral carcinogenesis Dietary factors Personal factors, immune function, age, and genetic risk

Cancer Prevention—Primary Avoidance of known or potential carcinogens Modification of associated factors Removal of “at-risk” tissues Chemoprevention Vaccination

Cancer Prevention—Secondary Regular screening Altering damaged genes Genetic screening

NCLEX TIME

Question 1 How many Americans are estimated to be newly diagnosed with cancer yearly? A.1 million B.1.5 million C.2 million D.Answered questions about the procedure and a signed informed consent

Question 2 The single most important risk factor for the development of cancer is: A.Being a woman B.Family history C.Cigarette smoking D.Advancing age

Question 3 What is one of the common sites of metastasis for breast cancer? A.Brain B.Lymph nodes C.Pancreas D.Pelvic nodes

Question 4 An example of a primary prevention strategy for reducing cancer risk would be: A.Yearly mammography for women older than 40 years B.Using skin protection during sun exposure at the beach C.Colonoscopy at age 50 years and then every 10 years D.Yearly prostate-specific antigen (PSA) test and digital rectal examination (DRE) for men older than 50 years

Question 5 A malignant tumor has metastasized from the lungs to the brain. The metastatic tumor is now known as: A.Brain cancer B.Lymph cancer, since it spread via the lymphatic system C.Lung cancer in the brain D.The primary tumor