Neoplasms

Tumor Nomenclature Key: carcinoma vs. sarcoma

Leading sites of new cancer cases & deaths

Benign vs. Malignant Tumors Key differences: Encapsulation vs. infiltration Differentiated cells vs. undifferentiated cells

Benign vs. Malignant

Malignant Tumors -- Pathophysiology Staging vs. grading Staging = describes the extent of the disease at the diagnosis time In-situ = malignant cells in pre-invasive stage Usually I through IV ( higher = worse) T, N, M system T = tumor; N = involvement of lymph nodes; M = metastasis Grading = describes the degree of differentiation of the malignant cells Usually I through IV (higher = more undifferentiated)

Local Effects Pain Not an early sx Infection From tissue necrosis and ulceration From destruction of normal flora Obstruction When growth of the tumor compresses a duct or passageway

Systemic effects Weight loss Anemia Infections Cachexia = severe tissue wasting Anemia Causes = anorexia, chronic bleeding, & bone marrow depression Infections Especially pneumonia Reason = stasis of secretions & weaker cough efforts Paraneoplastic syndromes Substances released from certain tumors have effects on: Endocrine system (e.g. ACTH-like effect & ADH-like effect)

Diagnostic tests Blood tests Imaging techniques Exfoliative cytology General = CBC (esp. when undergoing chemo or radiation) Specific = called tumor markers Exp = PSA Imaging techniques CAT, MRI, nuclear scanning (includes PET) Exfoliative cytology Biopsies

Spread of malignant tumors Primary tumor = parent tumor; initial site & cell type Secondary tumor =other sites of identical tumor cells 3 basic mechanisms (1) invasion into adjacent tissue (2) metastasis via blood and/or lymphatics (3) seeding = spread of tumor cells along serous membranes and in body fluids within serous body cavities

Staging correlates with degree of spread

Etiology of Cancer Carcinogenesis = process when normal cells transformed into cancer cells Factors in carcinogenesis are multiple & include: Changes in DNA (mutations) Genetic oncogenic factor Radiation (gamma rays, X-rays, & ultraviolet rays) Chemicals --- called carcinogens Biological factors Chronic irritation Hormonal excess Diet Pathogens --- primarily viruses Host defenses Immune system has 3 types of cells that are “killers” (cytotoxic) NK lymphocytes (NK = natural killer) Killer T-lymphocytes Macrophages

Stages in carcinogenesis: Initiating factors --- get irreversible DNA changes Promoters ----repeated exposure to carcinogens Promoters ---- continued exposure to carcinogens

Cancer Treatment 3 basic modalities (1) surgery (2) chemotherapy (3) radiation Curative treatment Palliative treatment Prophylactic adjunct therapy Radiation therapy Especially affects cells that rapidly reproduce Epithelium, bone marrow, gonads Adverse effects Bone marrow depression Epithelial tissue inflammation & ulceration --- get stricture & fibrosis Ovarian or testicular damage Non-specific fatigue & lethargy Chemotherapy’s adverse effects Hair loss, breakdown of mucus membranes, N&V, bone marrow depression

Newer treatment modalities Angiogenesis inhibitor drugs These block endothelial cell regeneration Anti- telomerase Immunotherapy (biologic response modifiers) Radioimmunotherapy (monoclonal antibodies & radioactive isotopes Prognosis Cure = 5 year survival without recurrence Follow-up for metastasis Key = Bone, Brain, Liver, & Lungs

Treatments Curative Palliative Prophylactic Adjuvant therapy