Notes

Gene is code for one protein.
Structural proteins: collagen of connective tissue
Functional proteins: hemoglobin of RBCs

Transcription and translation: Cription makes a copy of code needed for a protein. Lation occurs at ribosome where nucleotide code of nucleic acids in translated into the amino acid code of protein.
DNA mistakes=mutations (any change in the DNA code) caused by UV rays or certain chemicals. Changes can kill affected cells or alter their function.

Mitosis is necessary for the growth of boyd and the replacement of dead or damaged cells. Rate of division varies by tissue type. Neurons lose ability to divide shortly after birth. Muscle cells have limited mitotic capability.

Duration of cell life, Time it takes for mitosis to occur, growth ratio, frequency of cell loss, doubling time ALL relate to tumor growth and treatment options. Inactive cells continue to synthesize (RNA) and protein.

4 tissue types: epithelial, connective, muscle, nervous.

cells reproduce abnormally result in neoplasms (tumors). Neo=new. plasia=form. Organ containing benign tumor usually continues to function normally. Tumor difficult to detect until it contains about 500 cells and is about 1 cm in diameter.
Cancer takes over function of affected organ. cells are poorly constructed, loosely formed, and disorganized. "confused cell". Malignant means the tumor resists tx and tends to worsen and threaten life.

BENIGN MALIGNANT
slow growth Rapid, infiltrate surrounding tissue
cells typical of the tissue of origin cells atypical in varying degrees compared
with the tissure of originl altered cell
membrane, contain tumor-specific antigens
minor tissue damage necrosis and ulceration of tissue
not metastasize, localized at origin spreads to form tumors in other parts
seldom recurs after surgical removal recurrence can be seen after
surgery/radiation/chemo
Hyperplasia, polyp, benign neoplasia cancer, malignancy, malignant neoplasia
Not injurous unless location causes obstruction to vital organs death if uncontrolled

Cancer is many diseases with different causes, manifestations, tx, and prognoses. more than 100 types. normal cells limited to about 50-60 division before death. cancers cells no limit and are inmortal. Lack contact inhibition. 2 step process. INITIATION AND PROMOTION. Initiation causes alteration in genetic structure of DNA associated with exposure to carcinogen. Promotion occurs after repeated exposure to carcinogens causing the initiated cells to mutate. Tumor forms in this step from mutated cell reproduction. Healthy immune system destroys before they replicate. ANY SUBSTANCE THAT WEAKENS IMMUNE SYSTEM PUTS INDIVIDUAL AT RISK FOR CELL MUTATION.
Risk factors: specific viruses, genetics, diet, hormones, general immunity. ethic and racial groups.
Europeans: stomach cancer.
Eastern european immigrants: thyroid and leukemia
African Americans: prostate, breast, lung, colon, rectum, cervix, pacreas, esophagus.
Hispanics: Central and South American women= cervical
Mexican Americans= Pancreas, liver, gallbladder
Chinese Americans: Cervical, liver, lung, stomach, multiple myeloma, esophageal, pancreatic,
nasopharyngeal
Korea: Stomach and Liver
Japanese: Stomach, breast, colon, rectal
Arab American: Lung and others related to smoking.
American Indians: skin, pancreatic, gallbladder, liver, prostate

VIRUSES
oncoviruses and retroviruses. Ebstein barr virus (EBV) associated with Burkitt's lymphoma. Herpes 2 associated with cervical and penile cancers. HPV associated with cervical and penile cancers. and anal cancer, and some head and neck cancers. Hep B linked with liver cancer. Vaccine for HPV recommended at age 11-12.

RADIATION: Ionizing radiation involving UV rays such as sunlight, x-rays, alpha, beta, and gamma rays promote leukemia and skin cancers, primary melanomas. Radiation leak or atomic bomb exposure at risk for leukemia, breast, bone, lung and thyroid cancer.

CHEMICALS
implicated as triggering mechanisms in malignant tumor development. Length of exposure time, degree of exposure intensity=risk for cancer development. Chemical agents more toxic when used with alcohol. Alcohol and tobacco most frequent causes of mouth and throat. Vinyl chloride associated with liver cancer.

IRRITANTS
chronic irritation or inflammation such as snuff or pipe smoke cause local cancer. Nevi (moles) chronically irritated by clothing contaminated by chemical residue can become malignant. Abestos in temp and sound insulation cause lung cancer.

GENETICS
breast cancers linked to gene mutation. Skin, colo, ovaria, prostate cancers=genetic tendency. Down Syndrome=acute leukemia

DIET
high fat, low fiber=colon cancer. high fat linked to breast and prostate cancer. Pickled, smoked, charbroiled foods=esophageal and stomach cancer. Low in Vit. A, C, E = lung, esophagus, mouth, larynx, cervix, breast.

HORMONES
long term estrogen=breast cancer, uterus, ovaries, cervix, vagina. DES (synthetic hormone with estrogen-like properties to prevent miscarriage)=increased incidence of reproductive cancers. Tx for breast cancer depends on dependence of estrogen or progesterone.

IMMUNE FACTORS
Suppression allows malignant cells to develop in large numbers. stressful period in life=increased risk of cancer. AIDS=higher risk.

Cancers identified by tissue affected, speed of cell growth, cell appearance, and location. occuring in epithelial=carcinomas (most common type, skin, GI systems, lungs) Connective=sarcomas (fat, sheath containing nerves, cartilage, muscle, bone) Lymphatic=lymphomas (lymph nodes, spleen)
tumors in 1 area or localized=in situ (difficult to visualize, detect through microscopic cell exam). Metastasize occurs mainly because cells break away more easily than normal cells and can survive for a time independently from other cells. 3 STEPS:
1. invade blood or lymph vessels
2. move by mechanical means
3. lodge and gow in new location
Common sites to metastasize: lungs, liver, bones, brain
Incidence higher above 60 for cancer. next is 70. higher in men. Wilm's tumor of kidney and acute leukemia more common in young. Most common type in adults is skin (most preventable). Lung cancer=highest mortality in both genders (commonly preventable). Men 60-79=prostate. colon and rectum=high fat, low fiber diet (3rd highest in men). breast=women (genetic, oncogene, Ashkenazi jewish population).
1990s, cancer decreased for both genders.
educate on risk factors, self-exam, screening programs.

EARLY DETECTION
mammography=every 1-2 years after age 40.
clincal breast exam= every 3 yrs in 20s and 30s
clinical breast exam=annualy after age 40
pap smear=every 3 yrs from 21-29
Nursing role to help develop trust and providing info
ACS=monthly breast Self exam and testicular Self exam for men
Flexible sigmoidoscopy=every 5 years after age 50
colonoscopy=every 10 years after age 50
Double contrast barium enema=every 5 years after age 50
colonography= every 5 years after age 50
FECAL OCCULT BLOOD TEST EVERY YEAR
FECAL IMMUNOCHEMICAL TEST EVERY YEAR
if any tests are positive, a colonscopy should be done.

GENETIC TESTING
cooroperation of family members is important. family members feelings of guilt over role they may have played in increasing risk for their children

HEALTHY LIFESTYLE
proper diet and exercise=help strengthen immune system. Smoking cessation. secondhand smoke increases risk as well

PROTECTANT FOODS
Diet poor in folate, B vit.=colon, rectum, breast cancer. find folate in fruits, vegetables, enriched grain products. Obesity (diet high in saturated fat)=risk factor or colon, prostate, and breast.
Rich in veggies and fruits=reduce risk for lung, oral, esophageal, stomach, colon

VACCINES
Gardasil=vaccine for HPV.
FDA approved=sipuleucel-T for tx of prostate cancer that no longer responds to hormone therapy