# Cancer --- **Cancer** is a general term for a [[disease]] caused by unregulated division of [[cell|cells]]. It is the second highest cause of death in the United States after heart disease. Cell is transformed by DNA mutations, alter both signaling patterns, and mechanisms to stop production of mutated cells. This is when cancer cells are not stopped and proliferate. If you have a cell, it can be a cancer. Mutations may be from inherited or acquired source Initial cell forms a clone and then begins to proliferate abnormally There are two main types of defects that cause cancer: giving a cell "too much gas" and essentially "cutting their breaks". - **"Giving it Too Much Gas"** - Defects that activate proteins required for cell growth that shouldn't. - [[Oncogenes]] like RAS can be stuck in the "on" state, triggering unchecked cell growth. - **"Cutting the Break Lines"** - Defects that prevent tumor suppressing genes from shutting down the cell cycle. - [[cell cycle regulation|P53]] is an example of a tumor supperssor gene. Most common types of cancer in men are: - skin - prostate - lung/broncus Most common types of cancer in women are: - breast - lung/broncus - colorectal ## Metastasis **Metastasis** is what it's called when cancer spreads. This happens when there is a loooot of mutations. Cells have to be really messed up to be searching for a new home, and they're especially hungry for sugar and oxygen. Cells do not follow the normal growth regulating processes then begin to invade surrounding tissues Cells gain access to blood and lymph vessels, which allows spread of cancer cells to other areas ## Cancer Care Trajectory ## Preventing Cancer **Primary prevention** targets people *befrore* they have cancer cells. It's about decreasing risk factors—lifestyle factors account for ¼-1/3 of all cancers - Avoid exposure to known carcinogens - gasoline - chemicals created by combustion - benzene - butadiene, - vehicle fuel - tobacco - smoke and burned or charred food - Eat a balanced diet - Maintain optimal weight - Adequate rest - Reduce stressors - Periods of relaxation and leisure - HPV vaccine - Wearing sunscrean **Secondary prevention** is about screening for cancers and early detection. So we can treat things before develops from pre-cancerous to cancerous, or early stages for those without signs or symptoms. Secondary Prevention and Treatment associated with better outcomes. It is important to encourage patients to not ignore or dismiss symptoms. Follow up on Screening Recommendations Encourage patients to talk to the provider regarding concerns regarding close family member having cancer and keep provider up-to-date with siblings or parents get a diagnosis Monitor for the following: Irregular skin bumps/moles Oral cavity, especially tongue and under the tongue Thyroid labs **Tertiary prevention** is monitoring for and preventing reoccurance of primary tumor for patients who have had cancer in the past. Screening for secondary malignancies in cancer survivors Developing lymphoma or leukemia as a result of chemo or radiation Monitor any other malignancies not related to treatment given but inherited mutations, environment exposure, or risk factors ## Normal versus Abnormal Cell Growth Cell Differentiation Benign cells resemble normal cells Malignant cells bear little resemblance to normal cells Benign cells do not infiltrate surrounding tissues Malignant cells infiltrate surrounding tissues Benign cells grow slowly Malignant cell growth varies Benign cells do not metastasize Malignant cells move to other parts of the body through blood or lymph vessels ## Causes of Cancer - oncogenic viruses - Epstein-Barr Virus (Mononucleosis) - Hepatitis B Virus (Blood or body fluids) - Human Papilloma Virus (HPV, usually sexually transmitted) - Human Immune Deficiency Virus (HIV- Kaposi Sarcoma, - Non-Hodgkin’s Lymphoma, Cervical Cancer - Chemical Carcinogens - Medications - Alkylating agents (Cytotoxin) - Immunosuppressive agents (Cyclosporin) - Hormones (Estrogen and Progesterone) - Initiators (genotoxic effects) - Polycyclic hydrocarbons (Soot) - Benzopyrene (Cigarette smoke) - Arsenic (Pesticides) - Promotors - Asbestos (Mesothelioma) - Polymer esters (Plastics and Paints) - Carbon tetrachloride (Cleaning agents) - Dietary factors (Aspartame sugar substitute, alcohol, nitrates, low fiber, and high animal fat) ## Types of Cancer ### Classification by Tissue of Origin - **Carcinoma** is a cancer of the [[epithelial tissue]] - **Adenocarcinoma** is from grandular epithelium (organs/glands capable of secretion) - beast, lung, prostate, etc - **Squamous cell carcinoma** lines all external and interanal body surfaces - skin, lungs, esophagus - **Sarcoma** is a cancer of the [[connective tissue]] - **Osteocarcinoma** is the most common form of cancer in the bone. - **Rhabdosarcoma** muscle cancer is most common in children - **Mesothelioma** is a cancer of the membranes that line the inner cavities - **Lymphoma** is a cancer of the [[lymphocytes]] - Non-Hodgkin and Hodgkin lymphomas - may involve the lymph nodes or body organs - B-cell and T-cell - **Leukemia** is a cancer of the [[hematopoiesis|hematopoietic]] cells in the bone marrow - WBCs = acute myelogenous leukemia - Lymphocytes = acute lymphocytic leukemia * - RBCs = polycythemia vera ## Tumor Markers Tumor markers are made by the body in responce to cancer existing. They can be used to stage cancers. There are a bunch of different tumor markers out there. Circulating tumor markers- found in blood, urine, & stool in some of the patients with cancer. Example blood test for CA-125 for ovarian cancer. Tumor tissue or cell markers- found in the actual tumor. Example, estrogen and progesterone receptors tested to determine if breast cancer pt. may respond to treatment of hormonal therapy ## Treatment [[radiation therapy]] [[chemotherapy]] Cytokines • Uses the body's immune system to fight cancer cells • Interferons (IFN-alfa) • Interleukins (IL-2 or IL-7) • Antiviral and antitumor properties • Administered 1M or SQ • Toxicity includes flu-like syndrome Filgastrim (Neupogen) • Granulocyte Colony Stimulating Factor • Prevents neutropenia and associated infections in Pt's receiving myeloablative chemo or radiation, or after bone marrow transplantation • Action: binds to and stimulates immature neutrophils to divide and differentiate • Route: IV or SQ • Common Side Effects: medullary bone pain • Monitor CBC, monitor for bone pain and VS periodically • Severe adverse reactions: monitor for allergic reaction, ARDS, splenic enlargement or rupture (LU abdominal or shoulder pain). Epoetin Alfa • Anti-anemics • Action: stimulates erythropoiesis- production of RBCs Maintains and elevates RBCs , decreases need for transfusions • IV or Subcutaneous Onset 7-10 days, lasts 2 weeks Common side effects: hypertension -know for NCLEX ## Cancers - Solid organ cancers (in no particular order) - [[skin cancer]] - [[stomach cancer]] - [[thyroid cancer]] - [[colon cancer]] - [[ovarian cancer]] - [[menstrual cycle]] - [[testicular cancer]] - [[prostate cancer]] - [[liver cancer]] - [[kidney cancer]] - [[bladder cancer]] - [[cervical cancer]] ___