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What are the characteristics of benign tumors?
- Grow slowly
- Have a well-defined capsule
- Are not invasive
- Are well differentiated; look like tissue from which they arise
- Have a low mitotic index; dividing cells are rare
- Do not metastasize
What are malignant tumors?
- MALIGNANT TUMORS
- Grow rapidly
- Have a well-defined capsule
- Are not encapsulated
- Invade local structures and tissues
- Are poorly differentiated; may not be able to determine tissue of origin
- Have a high mitotic index; many dividing cells
- Can spread distantly, often through blood vessels and lymphatics
What does the classification of tumors start with?
The classification starts with knowing the tissue and organ of origin, the extent of distribution to other sites, and the microscopic and immunohistochemical appearance of the lesion.
What is carcinoma in situ?
These early stage growths are localized to the epithelium but have not penetrated the local basement membrane or invaded the surrounding stroma. Based on these characteristics, they are not malignant but are often called carcinoma in situ
What is personalized medicine of a tumor?
detailed analysis of each tumor is a form of personalized medicine that offers therapy based on a very detailed knowledge of each individual's characteristics and their specific cancer
What are tumor markers?
A biochemical marker sensitive to specific types of tumors that is used to screen, diagnose, assess prognosis and treatment, and monitor recurrence.
What produces tumor markers?
produced by both benign and malignant cells that are either present in or on tumor cells or found in blood, spinal fluid, or urine
What are examples of tumor markers?
Tumor markers include hormones, enzymes, genes, antigens, and antibodies. Liver and germ cell tumors secrete a protein known as alpha fetoprotein (AFP) into the blood, and prostate tumors secrete prostate specific antigen (PSA) into the blood.
What is paraneoplastic synsrome?
- When a tumor marker itself has biologic activity, then it can cause symptom
- A collective term used to describe disorders arising from the metabolic effects of cancer on tissues remote from the tumor or metastatic site. They may result from the production of active proteins, polypeptides, or inactive hormones by the tumor.
What is an example of paraneoplastic syndrome?
- adrenal medulla normally secretes the catecholamine epinephrine (adrenaline). Benign tumors of the adrenal medulla can produce catecholamines (adrenaline) in excess, leading to rapid pulse rate, high bp, diaphoresis (sweating), and tremors
- Detection of elevated blood or urine levels of catecholamines helps to confirm the diagnosis, and treatment of the disease relieves the symptoms.
What are the three ways tumor markers can be used in?
(1)screen % identify individuals at high risk for cancer(2) help diagnose the specific type of tumor in ppl w/ clinical manifestations relating to their tumor, as in adrenal tumors or enlarged liver or prostate; (3) to follow the clinical course of a tumor
Can cancer be a parasite?
Cancers also are parasites, able to selectively extract nutrients from the bloodstream without any evolutionary pressure for balanced metabolism.
How are chronic inflammation and cancer related?
- Chronic inflammation has been recognized for close to 150 years as being an important factor in the development of cancer
- the active immune response in chronic inflammation predisposes to cancer
What are some examples of inflammation leading to cancer?
- Ppl who have ulcerative colitis for 10 years or more have up to a 30-fold increase in the risk of developing colon cancer.
- Chronic viral hepatitis caused by hepatitis B virus (HBV) or hepatitis C virus (HCV) infection markedly increases the risk of liver cancer.
- A study found a 66% increase in risk of lung cancer among women with chronic asthma, an inflammatory disease of the airways.
What is metastasis?
the spread of cancer cells from the site of the original tumor to distant tissues and organs through the body.
What does metastasis contribute to cancer?
contributes significantly to the pain and suffering from cancer, and is the major cause of death from cancer.
Curing cancer: metastasized and non metastasized
Cancer that has not metastasized can often be cured by a combination of surgery, chemotherapy, and radiation. These same therapies are frequently ineffective against cancer that has metastasized.
Breast cancer survival rates metastasized and non metastasized.
in appropriately treated women with low-stage breast cancer, the 5-year survival rate is often greater than 90%. less than 30% of women with metastatic breast cancer are alive 5 years after diagnosis.
What does cancer metastasis require?
Requires a Complex Series of Events. Cancer cells must gain access to blood and lymphatic vessels, survive the trip to distant locations, move back into the tissues, and initiate a new tumor.
Health Alert: screening mammograms
- Screening women 50 and older might reduce the risk of dying from breast cancer by 15% to 20%, but most women die of other diseases
- Screening mammograms also can miss 25% or more of breast cancers
- 9 out of 10 suspicious mammograms interpreted as abnormal are eventually determined to be noncancerous
Is there pain in early stages of cancer?
Although pain can be one of the presenting symptoms of cancer, most commonly there is little or no pain during the early stages of malignant disease
Significant pain and cancer?
Significant pain, however, occurs in a large fraction of those individuals who are terminally ill with cancer.
Why does pain happen with cancer?
Pain is strongly influenced by fear, anxiety, sleep loss, fatigue, and overall physical deterioration. It occurs through an interaction among physiologic, cultural, and psychologic components.
How does cancer-associated pain arise from?
Cancer-associated pain can arise from a variety of direct and indirect mechanisms. Direct pressure, obstruction, invasion of a sensitive structure, stretching of visceral surfaces, tissue destruction, infection, and inflammation all can cause pain.
Are specific sites more prone to cancer pain?
Specific sites are more prone to cancer-associated pain. Bone metastases, common in advanced breast and prostate cancer, can cause significant pain because of periosteal irritation, medullary pressure, vertebral collapse, and pathologic fractures.
What pain does brain tumors cause?
Brain tumors (primary or metastatic) can, depending on the location, cause headache, seizures, or neurologic deficits.
What is pain in the abdomen caused by in cancer?
Pain in the abdomen may be caused by bowel obstruction, or inflammation and infection Hepatic malignancies can stretch the liver, resulting in a dull pain or a feeling of fullness over the right upper abdominal quadrant.
Mucosal surfaces and pain with cancer?
Mucosal surfaces can develop painful ulcerative lesions from the cancer, chemotherapy, and radiation or leukopenia (or both)
What are the priorities of treatment of cancer-associated pain?
The first priority of treatment is to control pain rapidly and completely as judged by the individual. The second priority is to prevent recurrence of pain
Hospitals and pain management?
Many institutions are using specialized pain management teams that are trained to recognize different types of acute and chronic pain, as well as the individual's response to that pain
What is the most frequent reported symptom of cancer?
Fatigue is the most frequently reported symptom of cancer and cancer treatment
What causes fatigue with cancer?
include sleep disturbances, various biochemical changes secondary to disease and treatment, numerous psychosocial factors, level of activity, nutritional status, and other environmental and physical factors.
What is cachexia?
A syndrome common in individuals with cancer that includes anorexia, early filling (satiety), weight loss, anemia, weakness, poor performance, and altered metabolism.
What is Anemia?
Anemia is commonly associated with malignancy, with 20% of persons diagnosed with cancer having hemoglobin concentrations less than 9 g/dl
What causes anemia?
Mechanisms that cause anemia in persons with cancer include chronic bleeding (resulting in iron deficiency), severe malnutrition, cytotoxic chemotherapy, and malignancy in blood-forming organs.
What is leukopenia and thrombocytopenia?
Direct tumor invasion of the bone marrow causes both leukopenia (a decreased total white blood cell count) and thrombocytopenia (a decreased number of platelets)
What is the most significant cause of complications and death with malignant disease?
Infection is the most significant cause of complications and death
treatment of cancer
Many types of cancer can be effectively treated with chemotherapy, radiotherapy, surgery, and combinations of these modalities.
What is chemotherapy?
- Induction chemotherapy seeks to cause shrinkage or disappearance of tumors
- Adjuvant chemotherapy is given after surgical excision of a cancer with the goal of eliminating micrometastases.
- Neoadjuvant chemotherapy is given before localized (surgical or radiation) treatment of a cancer. it shrinks cancer so surgery can spare more normal tissue.
What is radiation therapy?
- Radiation therapy is used to kill cancer cells while minimizing damage to normal structures
- Effective cell killing by radiation also requires good local delivery of oxygen, something not always present in large cancers.
- Radiation produces slow changes in most cancers and irreversible changes in normal tissues as well.
Surgery and cancer
- Surgical therapy is used for nonmetastatic disease (in which cure is possible by removing the tumor) and as a palliative measure to alleviate symptoms.
- It is also indicated for the relief of symptoms, for instance, those caused by tumor mass obstruction.
what is an example of surgery used for preventative reasons?
individuals with familial adenomatous polyposis because of germline mutations of the APC gene have close to a 100% lifetime risk of colon cancer, so a prophylactic colectomy is indicated