Applied Pathophysiology: Altered Cellular Proliferation and Differentiation Flashcards


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1

Proliferation

Generation of new daughter cells divided from progenitor (parent cells)

2

Differentiation

Orderly process of cellular maturation to achieve a specific function

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Stem cells

Highly undifferentiated units

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Neoplastic Cells ignore genetic controls resulting in:

Autonomy- excessive cellular proliferation

Anaplasia- Loss of cellular differentiation

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Carcinogens

Origin and development of cancerous neoplasms: radiation, hormones, chemicals, tobacco, microbes: viral hepatitis can cause liver cancer, HPV can cause cervical cancer...

Types of gene mutation affecting cell growth and division

  • 5% are inherited
  • 95% are acquired

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Mutator genes

Repair DNA and protect genome

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Oncogenes

Code for proteins involved in cell growth or regulation

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Tumor Suppressor Genes

Prohibit overproliferation of cells and regulate apoptosis

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Progression Theory

Initiation- Exposure of cells to a carcinogenic agent

Promotion- a promoter agent activates oncogenes

Progression- independent growth

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Benign Tumors

Remain localized

Closely resemble tissue of origin

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Malignant Tumors

Are invasive and destructive

Proliferate rapidly

Metastasize

Do not resemble tissue of origin

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Cancer Spread

Local spread- proliferation of neoplasm within the tissue of origin

Direct extension- process of tumor cells moving into adjacent tissues or organs

Seeding- like direct extension. Disseminated cells colonize secondary sites

Metastasis- neoplasms are spread to different sites often by the lymphatic or blood vessels

Tropism- the predictability of where the tumor or neoplasm will spread

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General Manifestations of Cancer

Lymphadenopathy, fever, anorexia, cachexia, palpable mass, loss of tissue function- variable depending on site.

First: indigestion or difficulty swallowing

Second: unexplained clotting in the extremities- cancer is a hypercoagulable state.

Then: unexplained weight loss

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CAUTION for cancer

C: change in bowel or bladder habits

A: a sore throat that does not heal

U: unusual bleeding or discharge

T: thickening or lump in the breast or elsewhere

I: indigestion

O: obvious change in warts or moles

N: nagging cough

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Cancer Diagnosis

History and physical exam

Imaging studies: radiographs, endoscopic, ultrasound, CT, MRI

Biopsy and cytology studies

Tumor markers

Other blood, urine, and tissue tests

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Cancer treatment

Surgery, chemotherapy, radiation, hormones, immunotherapy, bone marrow transplantation, palliative care

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Pros and Cons of surgery for cancer

Removes tumor, organ, or affected lymph nodes to stop the spread and study for margins

Sometimes not all the cells are removed. Infection and bleeding may result

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Pros and Cons of Chemotherapy

Interrupts tumor growth or kills tumor cells. Commonly combined with two or more agents

N&V, hair loss, poor wound healing, immunosuppression, infection, bleeding

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Pros and Cons of Radiation

Damage cell DNA and replication of proliferating cells

Skin penetration causes skin redness and irritation, itching, poor wound healing, skin ulceration, hyperpigmentation and atrophy. Bleeding, infection, and anemia from loss of blood cells. Fibrosis of tissues and organs leading to diarrhea esophageal or intestinal strictures, and fibrosis of the heart and lungs

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Pros and Cons of Hormone Replacement

Inhibits RNA and protein synthesis and binds to receptor sites

Response of the hormones is exaggerated. May cause cancer

21

Lung Cancer

Leading cause of cancer deaths- both men and women

Smoking and industrial exposures

Tumors originate in the epithelial lining of the bronchi, bronchioles, and alveoli

4 subtypes: adenocarcinoma, squamous cell, large cell, and small cell carcinomas

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Lung Cancer Manifestations

LOUD COUGH, persistent

Hemoptysis, chest pain, SOB

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Lung Cancer Diagnosis

History and physical exam, bronchoscopy, chest x-ray, CBC, tissue biopsy/cytology

*50% of thoracentesis biopsies end up in a pneumothorax due to severity of lung damage

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Lung Cancer Treatment

Based on tumor type

Small cell carcinoma- chemotherapy

Non-small cell carcinoma

  • surgery
  • chemotherapy
  • radiation

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Colon Cancer Risk Factors

Age- over 50, family history, smoking, alcohol use, bowel disease, obesity, inactivity, high fat diet

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Colon Cancer Common Tumors and Mutation Pathways

Tumors- nonneoplastic polyp, neoplastic polyps, adenocarcinomas

Mutation Pathways- chromosomal instability, replication errors

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Colon Cancer Manifestations

CHANGE IN BOWELS

OCCULT or FRANK BLOOD IN STOOL

Abdominal pain

Bowel obstruction

Anemia

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Colon Cancer Diagnosis

CBC, LFT, sigmoidoscopy, biopsy of suspicious lesions

SERUM CARCINOEMBRYONIC ANTIGEN (CEA)

COLONOSCOPY- STARTS AT AGE 45 NOW

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Colon Cancer Treatment

Surgery

Chemotherapy

Biological agents

Radiation

30

Brain Cancer

Metastasis is much more common to brain than primary tumors

Primary tumors- gliomas, meningiomas, pituitary adenomas, acoustic neuromas

31

Brain Cancer Manifestations

Loss of motor or sensory function, cognitive or behavioral changes, headache, vomiting, seizures

HEADACHES, PROJECTILE VOMITING, NARROWING OF VISUAL FIELD

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Brain Cancer Diagnosis

Neurologic Exam- cranial nerves, reflexes, sensory function, motor function

Direct visualization- brain scan, x-ray, CT/MRI, cerebral angiography, PET scan

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Brain Cancer Treatment

Surgery- excision

Radiation

Chemotherapy

Palliative care

34

Brain Cancer Tumor Grading

Grade II- lesions that are generally infiltrating and low in mitotic activity but recur more frequently than grade I. May progress to higher grades of malignancy

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Leukemia

Malignant neoplasms of blood and blood-forming organs

Acute- Lymphocytic (ALL), myeloid (CML)

ALL affects children more than any other age group

AML affects adults

AML is the worst- 95% mortality, ALL has 96% remission rate

36

Leukemia Manifestations

Anemia, bruising, bleeding (epistaxis), fatigue, bone pain, headache, visual disturbances, nausea/vomiting, weight loss, fever, lymph node and organ enlargement

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Leukemia Diagnosis

Patient history and physical exam

CBC

Bone marrow biopsy

Cytology exam of blood cells

38

Leukemia Treatment

Chemotherapy

Radiation

Bone marrow or stem cell transplantation

39

Lymphoma

Derived from WBCs and lymph tissues and form solid organ tumors in the lymph tissue and later in the bone marrow

Classified as either: Hodgkin lymphoma, non-Hodgkin lymphoma

40

Hodgkin lymphoma Manifestations

Painless progressive enlargement of cervical (neck) lymph nodes

Low-grade fever, night sweats, pruritus, weight loss, fatigue

41

Non-Hodgkin Manifestations

Painless enlargement of lymph nodes

Systemic manifestations may also occur

42

Lymphoma Diagnosis

Hodgkin- presences of Reed-Sternberg cells

Non-Hodgkin- history and physical exam, lymph node biopsy, chest and abdominal CT scans

43

Lymphoma Treatment

Hodgkin- Chemo, radiation, hematopoietic stem cell transplantation. 85% remission rate

Non-Hodgkin- radiation, Chemo (aggressive forms). 65% remission rate