10/7/2013 Cancer occurs when cells proliferate rapidly and irregularly. Cured- 5 years free of cancer.

r. o Lowers probability of recurrence.**** igher rate in !en" industrial nations #en$ lung" prostate" colorectal %o!en$ lung" breast" colorectal &bnor!al cell transfor!s by genetic !utation" clones" !assi'e reproduction. (ery aggressi'e" 'ery in'asi'e. o Changes occur in surrounding tissues o Cancer cells infiltrate tissues" gains access by ly!ph and blood. o )te! cells- i!!ature cells. #ost susceptible" loss of intracellular control of proliferation" *+& is substituted. o ,nce !utated- can die fro! da!age or by initiating progra!!ed cellular suicide -apoptosis." can recogni/e da!age and repair self" sur'i'e on da!age. o Contact inhibition- touching of different sides- continues to grow. 0row on top of one another or between nor!al cells -neoplas!s." !ultiply. o yperplasia- increased nu!ber of cells in tissues o *ysplasia- bi/arre cell growth" changes si/e and shape o +eoplas!s- 1ust grow- no discri!ination. o #etaplasia- replace!ent of one i!!ature to one !ature differential cell. 2enign- non cancerous #alignant- cancerous 3yra!id effect- each cell di'ision creates two or !ore offspring cells" continuous tu!or growth. ,ncogenes- defect in cellular differentiation 4tu!or inducing5 3roto-oncogenes- nor!al cellular genes that are i!portant regulators on nor!al cellular processes o &cts as 4on switch5 for cellular growth #utations that alter e6pression can acti'ate the! to grow 7u!or suppressor genes- anti- oncogenes o 3rotects cells fro! beco!ing cancer o %hen suppressor gene is !utated" and 86 of protector di!inishes" cell can progress to cancer o *eter!ine where cells li'e and die after da!age. )uppresses tu!or growth** 7u!ors- benign neoplas! o encapsulated o &poptosis- cell suicide 7u!ors- !alignant neoplas!

o #etastasi/e" infiltrate and e6pand" fre9uent recurrence" !ar:ed 'ascularity. o +eeds blood supply for sur'i'al** 7u!or angiogenesis- for!ation of blood 'essels within tu!or 7&&;s- tu!or- associated antigens- on cell !e!brane. o Capable of sti!ulating i!!une responses -t ly!phoytes" natural :illers. o <!!une response is to re1ect or destroy cell if percei'ed as nonself. o 7u!ors do not ha'e 7&&;s to be recogni/ed as foreign. Co!bine with i!!une syste! antibodies to disguise the!sel'es to e'ade recognition Carcino!as- originate fro! e!bryonic endoder! -inside. or ectoder! -outside. )arco!as- originate fro! e!bryonic !esoder! -inside. Ly!pho!as and leu:e!ia originate fro! he!atopoietic syste! -occur in blood" ly!ph nodes" spleen, bone marrow. 0rading and )taging cancer****** loo: up= o 7reat!ent based on wants and needs of patient *** if pt does not want to start i!!ediately" does not need to. 0rading$ appearance of cells and degree of acti'ity 1- differ slightly well differentiated 2- !ore abnor!al and !oderately differentiated 3- 'ery abnor!al and poorly differentiated. >- i!!ature and pri!iti'e and undifferentiated" cell origin difficult to deter!ine. )taging$ clinical aspects with location and !ets. 0- in situ -original for!. 1- li!ited to tissue of origin 2- li!ited local spread 3- e6tensi'e local and regional spread >- !etastasis 7+# classification )i/e of tu!or -T." e6istence of local in'asion -N." e6istence of distant !etastasis -M. #?)7 @+,% CL&))<8<C&7<,+" 0A&*<+0" )7&0<+0 &+* )<B<+0 &22AC(<&7<,+)**** o 7D- not noticed o 70o 7iso 71-> +D- not noticed +0 +1-3 #D- not noticed

#0- no !etastasis #1->

@now 7 warning signs of cancer$ CAUTION o Change in 22 -bowel/ bladder. o A sore non healing o Unusual bleeding or discharge o Thic:ening or lu!p anywhere o Indigestion or difficulty swallowing o Ob'ious changes of wart" !ole" !outh sores o Nagging cough or hoarseness *iagnosiso 2iopsy with needle" incision -cut." e6cision -re!o'al. Clinical trailso 3hase 1- s!all group of people tested" deter!ine dosage and identify side effects. o 3hase 2- larger group to test efficacy and further e'aluated safety o 3hase 3- larger group tested to confir! efficacy" collect infor allowing drug or treat!ent to be used safely. )urgicalo *iagnostic o 3ri!ary o 3rophylactic- re!o'al of non- essential organs and tissues to pre'ent occurrence. o 3alliati'e- 1ust to !a:e !ore conduci'e to sur'i'ing a little longer- to help alle'iate so!e pain. *efined by pt- not anyone else. o Aeconstructi'e- to rebuild for cos!etic appealing. Aadiation$ o Locali/ed treat!ent so only affected tissue is targeted. o <ncreased sensiti'ity to te!perature changes Che!otherapy$ o 0oal to reduce nu!ber of cells in tu!or sites. o Cancer cells can escape death o #ain proble! is drug resistant and noncycling cells 86 of che!o o )- phase" synthesis o #- phase- !itosis o <ndependent of cell cycles- longer affect so can stay in body and :ill for longer a!ount of ti!e. o as greatest affect in early stage of tu!or when total nu!ber of cancer cells is s!all and when greatest percentages of cells are acti'ely di'iding. 3har!acology$ o &l:ylating agents- non specific )/C$ bone !arrow suppressant" causes alopecia" +" ( o +itrosureas- non specific

Crosses blood brain barrier o &ntitu!or- non specific )/C$ bone !arrow suppression" +"("*" anore6ia" alopecia" cardiac to6icity -da!age to heart !uscles" causes C 8" heart transplant. o &nti!etabolites- s phase )/C$ +" (" *" )to!atitis -swelling of !outh with or without ulcerations- affect ## of !outh and lips r/t poor oral hygiene" poor diet" bad dentures." bone !arrow suppression o 3lant -(inca. al:aloids- cell specific )/C$ bone !arrow suppressant" neuropathies" sto!atitis o Corticosteroids o or!one therapy 0lucocorticoids 3rednisone" decadron" !edrol o &ntiestrogen agents *epro'era" progestational agents 7a!o6ifen <nterferons o #en ta:ing estrogen ac9uire fe!inine features. &ndrogens o Causes acne" hypercalce!ia and li'er dysfunction o Cause !asculine features in wo!en -androgen and antiestrogen. o #isc C6tra'asation- when <(;s are painful" cause infiltration. o %hen do not get blood return" line is not good. o Aesistance with flushing- not in correct place. L,,@ ?3 bronchodilators" e6pectorants" cough suppressants **** Che!o on nor!al tissueso Cannot distinguish between nor!al and cancer cells. o %t based )/C$ fatigue" anore6ia" taste alterations. &cute to6icity$ (" allergic reactions" arrhyth!ias *elayed effects$ !ucositis" alopecia" bone !arrow suppression. Chronic- da!age to heart" :idney" li'er and lungs. C&#- co!ple!entary and alternati'e !edicine o @now that between holistic and non traditional approaches. )ynergistic- affect of two drugs together with i!pro'ed response. +adir- low point- really low blood count -%2C" A2C and platelet.. o &ffects di'iding cells and cells of body o %hen :ills cells- new labs drawn and %2C decreased !ar:edly. Late effects of Aadiation and Che!o o A/o leu:e!ia and secondary !alignancies

2reast" o'arian" uterine" thyroid and lung cancers o 8ibrosarco!as o )econdary usually resistant to therapy. 2A#- biologic response !odifiers affect nor!al and cancerous cells. o Cyto:ines- enhance i!!une response. o <8+- interferon- 4charge up5 cannot be ad!in orally" anti'iral/ antitu!or properties ?sed for airy Leu:e!ia -@aposi. )/C$ flu- li:e" anore6ia with wt loss" fatigue" lethargy" depression" cogniti'e changes" bone !arrow suppression. o <8- interleu:ins 4slow down5 &lter f6 of cancer cells with i!!une syste!. )/C$ hypotension" ascites" flu-li:e" pul!onary ede!a" fatigue" anore6ia" * 0ene 7herapy- e6peri!ental C& t6" in1ection into cells and allows i!!une to respond as foreign and :ill cells" targeted therapy. *eath and 0rie'ing stages$ DABDA- Kubler Ross stages o *enial o &nger o 2argaining o *epression o &cceptance *r. 7e!es stages$ NDR +u!bness *isorgani/ation Aeorgani/ation #o&bs- !onoclonal antibodies o *estroy cancer cells- spare nor!al o A/o anaphyla6is o )/C$ capillary lea: syndro!e" hepatoto6icity" C+) effects" cardiac dysf6 E )/s of infiltrations- )lows/ stops" cool at site" s:in tightens" ede!a" returned blood flow" pain. e!atopoietic 0rowth 8actor o Colony sti!ulating- glycoproteins sti!ulate production" !aturation" regulation and acti'ation of cells. asten reco'ery fro! bone !arrow depression o Crythropoietin- sti!ulates A2C production" decreases chronic ane!ia" !ade by :idneys o ,prel'e:in- platelet growth" pre'ention of se'ere thro!bocutopenia. &d'erse$ ede!a" dyspnea" tachy" con1ucti'a redness 2#7- bone !arrow tranplant o 32)C7- peripheral blood ste! cell transplantation &llows safe use of 'ery high dose of che!o or radiation

ighly to6ic &llogeneic 2#7 o <nfused bone !arrow fro! !atched donor o )/C$ inf6" sepsis" alopecia" +" (" (" sto!atitis" sterility" cardiac dysf6" li'er disease &utologous o %ithout suitable donor" recei'e own bone !arrow o #arrow re!o'ed" treated" stored and reinfused )yngeneic o ,btaining ste! cells fro! identical twins and infusing the! into the other. ar'esting- done in ,A" !ultiple aspirations -iliac crest or sternu!. cryopreser'ed 0( -graft 's host. o 7 ly!phocytes fro! donated !arrow recogni/e recipient as foreign &ttac:s s:in" li'er and intestines )uperior 'ena ca'a syndro!eo ,bstruction by co!pressions by tu!or o )/s$ facial ede!a" distention of nec: and chest 'eins" sei/ures" & )pinal cord co!pressiono #alignant tu!or in epidural space o )/s$ bac: pain" !otor wea:ness dysf6" paresthesia and loss of senses" changes in bowel and bladder f6. 7hird space syndro!e- shifting fro! 'ascular space to interstitial space" s/s hypo'ole!ia. )<&* - abnor!al production of &* - t6 with 3F +aCL ypercalce!ia- s/s$ o Life threatening 7u!or lysis syndro!e- rapid destruction of tu!or cells o 8atal bioche!ical changes o )/s$ hyperurice!ia" hyperphosphate!ia" hyper:ale!ia" hypocalce!ia Cardiac ta!ponadeo 8luid accu!ulation in pericardial sac" constrict of pericardiu! and pericarditis o #/b$ dyspnea" tachy" an6iety" G L,C" pulses parado6us -pulses do not !atch 23." distant !uted heart sounds. Carotid artery ruptureo <n'asion of artery wall by tu!or or erosion. 3t;s with radioacti'e i!plants- wo!en wor:ers -concei'ing or desire to concei'e in future. should always stay E feel away and li!it interactions to 30 !ins HI . <f pregnant a'oid all together.******

10/10/2013

&ll cancer cells grow out of control and abnor!al. o <n'asion of different cells that tra'el through blood strea! into ly!ph nodes and organs and infect. o &ny new cell growth not needed for nor!al d'!t. o *e'elop fro! nor!al cells. ypertrophy- cell growth with enlage!ent. yperplasia- increasing nu!ber of cells. +eoplasia- not needed for d'!t and tissues air" s:in" intestines where nor!al cells regrow. o Aeplace nor!al or da!aged cells. *ysplasia- disorgani/ed growth yperplasia- increased growth #etaplasia- nor!al transfor!ation fro! one to another +or!al cells only grow as needed. %ill grow and !utate as long as there is roo! for the! Carcinogenesis- when nor!al cell beco!es cancer o ,nly ta:es 1 cell to start. 2enign grow by e6pansion. #alignant grow by in'asion 3ri!ary pre'ention is to a'oid e6posure. o &sbestos o )!o:ing 30 F !alignant neoplas! o Cn'iron!ental o )un- prolonged Cancer cells lac: contact inhibition- can touch other sides/ edges and does not affect growth. 0oes through 30 doublings" which create billions of cells- earliest stage of cancer. o 7hen !ultiply 10 !ore ti!es. #etastasis$ o C6tension into surrounding o 2lood 'essel penetration o Aelease of tu!or cells o <n'asion o Local seeding o 2lood borne !etastasis o Ly!phatic spread 0rading and staging diagnose" treat!ent and prognosis o 0rading- basis of cell appearance and acti'ity with nor!al parent tissues o )taging clinical aspects of cancer and location and deter!ines e6act degree of !ets. 7+# 7- e6tent of tu!or o 76- cannot assess

o 70- no tu!or o 7is- without !ets o 71->- worsening of tu!or. +- e6tent of spread to ly!ph nodes o +6- cannot assess o +0- no in'ol'e!ent o +1-3- increasing in'ol'e!ent #- !etastasis or not. o #6- cannot assess o #0- no !et o #1- distant !ets Cpstein 2arr" ep 2 and 3( :nown for r/t C&. 2enign +eoplas! -cells rese!ble nor!al fro! tissues originated fro!.. o *oes not infiltrate o Cncapsulated o 0rowth slow o *oes not !ets o *oes not recur when re!o'ed &bility to !ets o <n'asion of ad1acent tissues through base!ent !e!branes o Cntrance into nearby 'essels o C'asion of i!!une o Aeentrance into distant tissues o <!plant of !alignant cell in new tissues. 7u!or #ar:ers o &83- aloha- fetoprotein o CC&- carcinoe!bryonic &ntigen- colon" rectu!" pancreas" sto!ach" breast" o'ary o C&12J- epithelial o'arian neoplas!" breast" colorectal o C&1K-K- colorectal" pancreas" sto!ach" li'er o C0- testicular terato!a o 3)&- prostate specific antigen- adenocarcino!a of prostate o 7erato!a -abnor!al growth with teeth" hair or nails. 7reat!ent o Curati'e 76$ eradicate !alignant d6" aggressi'e treat!ent. &d1u'ant therapy- with che!o and another t6. o 3alliati'e 76$ when disease not curable" sur'i'al li!ited" alle'iates sy!pto!s" i!pro'e 9uality of life. 7estosterone con'erts into *ihydrotestosterone -* 7. o 2elie'ed to contribute to d'!t of prostate C&. Aadiation 7herapy o 7o destroy cancer cells with !ini!al e6posure to nor!al cells o Derosto!ia- dry s:in