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Causes of Cancer Defective cellular growth Defective cellular growth –Stem cells –Generation time –Contact Inhibitor Defective cellular differentiation.

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Presentation on theme: "Causes of Cancer Defective cellular growth Defective cellular growth –Stem cells –Generation time –Contact Inhibitor Defective cellular differentiation."— Presentation transcript:

1 Causes of Cancer Defective cellular growth Defective cellular growth –Stem cells –Generation time –Contact Inhibitor Defective cellular differentiation Defective cellular differentiation –Exposure to carcinogens –Moves to less mature form –Leads to invasion and metastasis

2 Characteristics of Normal Cells Limited Cell Division Limited Cell Division Specific Morphology Specific Morphology Small Nuclear-Cytoplasmic Ratio Small Nuclear-Cytoplasmic Ratio Perform Specific Differentiated Functions Perform Specific Differentiated Functions Adhere tightly together… Adhere tightly together… Are nonmigratory Are nonmigratory Grow in an orderly and well differentiated manner Grow in an orderly and well differentiated manner Are contact inhibited Are contact inhibited

3 Characteristics of Early Embryonic Cells Demonstrate rapid and continuous cell division Demonstrate rapid and continuous cell division Show anaplastic morphology Show anaplastic morphology Have a large nuclear-cytoplasmic ratio Have a large nuclear-cytoplasmic ratio Perform no differentiated functions Perform no differentiated functions Adhere loosely together Adhere loosely together Are able to migrate Are able to migrate Are not contact inhibited. Are not contact inhibited.

4 Characteristics of Benign Cells Demonstrate continuous or inappropriate cell growth. Demonstrate continuous or inappropriate cell growth. Show specific morphology Show specific morphology Have a small nuclear-cytoplasmic ratio Have a small nuclear-cytoplasmic ratio Perform differentiated functions Perform differentiated functions Adhere tightly together Adhere tightly together Are nonmigratory Are nonmigratory Grow in an orderly and well regulated fashion. Grow in an orderly and well regulated fashion.

5 Characteristics of Malignant Cells Demonstrate rapid or continuous cellular division. Demonstrate rapid or continuous cellular division. Show anaplastic morphology Show anaplastic morphology Have a large nuclear-cytoplasmic ratio Have a large nuclear-cytoplasmic ratio Lose some or all differentiated functions Lose some or all differentiated functions Adhere loosely together Adhere loosely together Are able to migrate Are able to migrate Grow by invasion Grow by invasion Are not contact-inhibited Are not contact-inhibited

6 DefinitionsDefinitions Anaplasia Anaplasia Anaplastic Anaplastic Carcinogen Carcinogen Carcinoma Carcinoma

7 Hyperplasia Hyperplasia Hypertrophy Hypertrophy Metastasis Metastasis Neoplasia Neoplasia Neoplasm Neoplasm

8 Stages of Carcinogenesis (Oncogenesis) Initiation Initiation Promotion Promotion Progression Progression Metastasis Metastasis

9 Common Steps in Metastasis Extension into Surrounding Tissues Extension into Surrounding Tissues Penetration into Blood Vessels Penetration into Blood Vessels Release of Tumor Cells Release of Tumor Cells Invasion of Tissue at the Site of Arrest Invasion of Tissue at the Site of Arrest

10 Immune Response Attempts to destroy abnormal cells Attempts to destroy abnormal cells Surface Antigens Surface Antigens –Used as tracers to indicate success of treatment –CEA (carcinoembrionic antigen) - GI tract –AFP (alphafetoprotein) - liver –CA 125 - ovarian –PSA – prostate

11 Cancer Grade and Stage Grading; Classifies cellular aspects of a cancer. Grading; Classifies cellular aspects of a cancer. Staging; Classifies clinical aspects of the cancer. Staging; Classifies clinical aspects of the cancer.

12 Histologic Class I - Well differentiated I - Well differentiated II - Moderate differentiation II - Moderate differentiation III - Poor differentiation III - Poor differentiation IV - Immature & Undifferentiated IV - Immature & Undifferentiated

13 Clinical Staging O - Ca in situ O - Ca in situ I (A) - Localized growth I (A) - Localized growth II (B) - Limited local growth II (B) - Limited local growth III (C) - Extensive local and regional growth III (C) - Extensive local and regional growth IV (D) - Metastasis IV (D) - Metastasis

14 TNM Classification T - Primary tumor T - Primary tumor N - Regional lymph nodes N - Regional lymph nodes M - Distant metastasis M - Distant metastasis –T is N o M o –T4 N3 M1–T4 N3 M1–T4 N3 M1–T4 N3 M1

15 Goal Education and early detection Education and early detection C A U T I O N

16 Surgical Interventions Biopsy Biopsy Cure Cure Control - Debulking Control - Debulking Palliative Palliative Staging Staging Reconstructive Reconstructive Prophylaxis Prophylaxis

17 Radiation Destroys cells, causes inflammatory response Destroys cells, causes inflammatory response Side Effects Side Effects Goals: Goals: –Cure –Control –Palliative Radiation Recall Radiation Recall External External Implants Implants Isotopes Isotopes

18 Chemotherapy Cell Cycle Non-specific Cell Cycle Non-specific –Alkylating –Cytoxan, Leukeran, N.Mustard –Antitumor antibiotics - Adriamycin –Nitrosoureas –Carmustine, Hydrourea –Corticosteroids –Prednisone, Decadron –Hormones –Estrogen, Provera, Androgen Cell Cycle Specific Cell Cycle Specific –Antimetabolities –Methotrexate, 5-FU –Plant Alkaloids (Miotic Inhibitors) –Vinblastine, Vincristine Cisplatin Cisplatin Tamoxifen Tamoxifen

19 Synergistic Effect The total is greater than the individual parts The total is greater than the individual parts Each agent has: Each agent has: –action against cancer –different site of action –different organ toxicity or time of toxicity

20 MOPP Protocol Complete response AgentActionToxicity 20%MustargenDNA Marrow – 10 days  10% OncovinMitosis Neurotox ic  10% Procarbazine RNA Synthesis Marrow – 21 days  5% PrednisoneCell membrane Immune suppression 80% Synergistic Effect

21 Side Effects Cluster the common ones: bone marrow suppression alopecia nausea and vomiting Adriamycin - Cardiac Cisplatin – Renal

22 Complications Pain Control Pain Control Bone Marrow Suppression Bone Marrow Suppression –Infection - Neutropenia –Hemorrhage –Anemia Infarction Infarction Superior Vena Cava Syndrome Superior Vena Cava Syndrome Spinal Cord Compression Spinal Cord Compression Tumor Lysis Syndrome Tumor Lysis Syndrome

23 Common Problems/Complications Associated With Cancer Tumor Lysis Syndrome (TLS); Tumor Lysis Syndrome (TLS); Destruction of cells (lysis) Release of Purine and Potassium (K+) into Bloodstream Purines converted to uric acid (in liver) K+ into Bloodstream HyperuricemiaHyperkalemia Obstruction of Kidney Tubules ARF ARF

24 Paraneoplastic Syndromes Secretion of Insulin Secretion of Insulin Secretion of ACTH Secretion of ACTH Hypercalcemia Hypercalcemia SIADH SIADH

25 SIADH - Syndrome of Inappropriate ADH ADH release ADH release Water Reabsorption into circulation -Renal Tubules Water Reabsorption into circulation -Renal Tubules Extravascular Fluid Extravascular Fluid Plasma Osmolality Plasma Osmolality Glomerular Filtration Rate Glomerular Filtration Rate Serum Sodium Levels CEREBRAL EDEMA Serum Sodium Levels CEREBRAL EDEMA

26 Leukemia AML - Acute Myelogenous AML - Acute Myelogenous –Age of Onset (15-39 yrs), usually affects adults –Prognosis is generally poor, best with bone marrow transplant –Most common type of leukemia –Equal incidence in males and females ALL - Acute Lymphocytic ALL - Acute Lymphocytic –Age of Onset (<15 yrs), usually affects children, accounts for approx 10% of adult leukemia's –Prognosis is poorer for adults than for children –Fever & Bleeding –Increased incidence in males

27 Leukemia CML - Chronic Myelogenous CML - Chronic Myelogenous –Age of Onset (>50 yrs) –Involves liver & spleen –Blastic Crisis CLL - Chronic Lymphocytic CLL - Chronic Lymphocytic –Older patients – over 50 –Lymph node involvement

28 Lymphoma Lymph system Lymph system Lymphocytes & histiocytes (macrophages) Lymphocytes & histiocytes (macrophages) Hodgkins Hodgkins –15-35 and over 50 yrs. Non-Hodgkins Non-Hodgkins –Outside of lymph nodes –Wide spread before Dx Multiple Myeloma Multiple Myeloma –Infiltrates marrow –destroys bone

29 Breast Early detection - Education Early detection - Education Treatment options Treatment options Mastectomy care Mastectomy care Referrals Referrals

30 Gynecological Cervical Cervical Endometrial Endometrial Ovarian Ovarian

31 Genetics and Cancer BRCA BRCA


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