Title:  _________________________Cancer – Information Sheet                Team-Lead Name: ____________________

Etiology:

DNA mutations that increase the rate of mitosis and decrease the rate of apoptosis (leading to cells that continually divide, and are immortal).  The cells lose their cell-cell contact inhibition, keep growing despite contacting neighbours. Cells have mutation that allows them to break free and spread.

Risk Factors (modifiable + nonmodifiable):

Carcinogens, Rapid rates of mitosis during injury repair may increase the risk of error occurring. Immunosuppression (e.g., HIV) UV, smoked meats, chemicals (asbestos, nickel, formaldehyde), smoking, gamma rays, x-rays, genetic susceptibility, HPV,

Steps of Cell Becoming Cancerous (include more steps if necessary):    Carcinogenesis

1. Cell’s DNA is mutated by viruses, radiation, chemicals, spontaneous errors, UV, x-rays, gamma rays, …smoking, smoked meats, high-fat diet, asbestos, often several mutations occur
2. Multi-stage, Multi-factorial,
3. and the DNA that is mutated affected the transcription/translation/production of regulator genes (coding for growth factors and growth inhibiting factors that control the rate of mitosis and/or the rate of apoptosis). DNA mutations that affect regulator gene expression are non-synonymous, and typically involve an insertion, deletion, and or substitution.  These regulator genes are specifically:
   • Proto-oncogenes = normally stimulate cell division and inhibit cell differentiation and death = Oncogenes = TOO MUCH GAS/GROWTH
   • Tumor suppressor genes = normally slow down cell division and promote apoptosis (e.g., BRAC1, 2) = NO BRAKES
   • Stability genes = normally repair DNA (e.g., p53) = more mutations
   • cell becomes less mature (less differentiated) = dysplasia = pre-cancerous
   • cell may have given rise to a benign tumor (benign neoplasia = new growth = mass of cells that stays in capsule and doesn’t spread) or
   • cell becomes even less mature (not differentiated) = anaplasia = cancerous, malignant tumor (malignant neoplasia = new growth), infiltrate tissue, absorbing nutrients and oxygen (depriving surrounding normal tissue which begins to atrophy), release lytic enzymes (collagenase), travel by blood or lymph.
4. Organ failure, spread of cancer, signs & symptoms

Signs & Symptoms (and why each occurs):

1. Bleeding = as tumor erodes blood vessels
2. Pain = caused by pressure of tumor, cell damage & inflammation caused by tumor, and inflammatory cytokines
3. Fatigue = cancer absorbs a lot of nutrients, nausea/vomit/intake of nutrients is lower, bone marrow (RBC/WBC counts go down, tissues are less oxygenated, so tired)
4. Weight loss, cachexia, (loss of weight) tissue wasting, body becomes catabolic, breaking down muscle proteins for ATP
5. Anorexia= loss of appetite (nauseated) due to GI irritation/damage (from cancer, chemotherapy, and/or radiation)
6. Anemia= low RBC count, either because cancer, chemotherapy, or radiation affecting bone marrow stem cell mitosis, affecting RBC, WBC and platelet production rates.
7. Effusions/swelling= cancer, erodes tissues, cell death occurs – triggers inflammation (around each cancer is zone of inflammation) – red/warmth/swelling/pain
8. Infections = due to low WBC count
9. Slow healing = due to low nutrients, cancer is using up nutrients, WBC count is down, appetite is down
10. Endocrine problems = some Cancers release hormones inappropriately e.g., lung cancer releasing ADH)
11. Obstructions (swallowing, constipation, urination), due to tumor compression of esophagus/intestine/urethra
12. Weird nerve sensations, due to cancer pressure or cell death or neuron death
13. Weakness, due to motor neurons or muscle tissue killed/weakened

Diagnostic Tools:

1. Biopsy = for Grading morphology = gold standard
2. Staging = for spread
3. Genetic tests = BRCA 1 and 2
4. Imaging (X-ray, ultrasound, X-ray, CT, PET, colonoscopy,)
5. Palpation = feeling for lumps
6. Blood Tests = low/high RBC/WBC, CEA (carcino-embryonic antigen), PSA, hCG, CA125, AFP (alpha-fetoprotein)
7. Stool test for blood or signs of polyps or cancerous cells,
8. Visual, skin moles for skin cancer, breast cancer dimpling or discharge

Explain Treatment Option Mechanisms (surgery, radiation, chemotherapy, immunotherapy, hormone therapy):

1. Surgery = including using laparoscope, Radiofrequency Ablation (heat is applied in the form of radio waves through electrodes), removal of cancer
2. Radiation Therapy = (Xray, gamma ray, high energy electrons/protons) = short-half life (decay rapidly), high energy waves/particles that disrupt DNA causing extensive mutations and therefore cell death.
   1. Cobalt machine (beam, directed by imaging),
   2. Brachytherapy (radioactive isotope pack in a seed implant into the prostate cancer),
   3. radioactive isotope solution, inject in peritoneal cavity
   4. oral (e.g., radioactive iodine), thyroid gland sucks up all iodine – thyroid gland makes TH (contains iodine).
3. Chemotherapy = anti-mitotic drug
4. Hormone therapy = glucocorticoid (reducing inflammation, increasing RBC count), sex hormones (estrogen blocker for breast cancer, treat prostate cancer with estrogen or testosterone blocker for testicular cancer)
5. Immunotherapy =
   1. antibodies against cancerous cell,
   2. radiolabelled antibodies,
   3. interferons (cytokines chemical messages that trigger WBC activity,
   4. BCG vaccine against tuberculin bacteria trigger WBC activity,

Adverse Effect to Chemotherapy and Radiation Therapy:

1. Bone marrow depression (low RBC/WBC/platelet count – risk of infection, excessive bleeding, slow healing),
2. Nausea (GI mucosa is damaged),
3. Epithelial cell damage (vasculitis, alopecia (hair loss), xerostomia (dry mouth), melena (blood in stool), hematemesis (blood in vomit), blood in spit, vomiting, diarrhea, cystitis, loss of appetite,
4. Fatigue, lethargy, infertility (if damage done to reproductive structures)

Word Bank: Possible Lesson 3 Terms to use:

benign, malignant, tumor, neoplasia, anaplasia, dysplasia metastasize, undifferentiated, DNA mutation, telomere, telomerase, regulator genes, tumor suppressor gene, protooncogene, oncogene, growth factors, growth-inhibiting factors, apoptosis regulation, cell cycle regulation, mitosis, oncoviruses, radiation, carcinogens (UV, radiation, x-rays, gamma rays, asbestos, smoking, nickel, solvents, dyes, rubber, high-fat diet, smoked foods, some viruses, formaldehyde, heavy metals), nucleobase insertion mutation, nucleobase substitution mutation, nucleobase deletion mutation, synonymous mutation, non-synonymous mutation, transcription, translation, dysfunction, cell death, dedifferentiation, mature/immature, atypical cell morphology, blood & lymph vessels, bleeding, compression, obstruction, nutrients, hypermetabolic, angiogenesis, basement membrane, invasion, spread, tumor capsule, local effects, systemic effects, in situ, carcinoma, sarcoma, glioma, natural killer cells (NK lymphocytes), inflammation, diarrhea, nausea, vomiting, anorexia, fatigue, pain, discharge, ischemia, bleeding, ulcers, infection (e.g., pneumonia, septicemia), nerve impairment, airway blockage, anemia, bone marrow depression, RBC count, WBC count, hemoglobin levels, thrombocytopenia, hematemesis, xerostomia, alopecia, stomatitis, vasculitis & skin rashes, dehydration, malnutrition, melena, infertility, lethargy, scars, fibrosis, adhesions, immunosuppression, cachexia, depression, delayed healing, coughing, hoarseness, unexplained weight loss, constipation, lump, paraneoplastic syndrome, x-ray, ultrasound, MRI, CT scan, PET scan mammogram, Pap smear, stool test, colonoscopy, biopsy, cytology, self-examination, blood tests (cancer/tumor markers, e.g., CEA, PSA, hCG, CA125, AFP), genetic tests, BRCA1, BRCA2, stability genes, p53, DNA repair genes, grading and staging cancer, lymph nodes, loss of cell-cell contact inhibition, multistage carcinogenesis, first-degree relatives and family history, modifiable risk factors, nonmodifiable risk factors, chronic irritation/inflammation, immunotherapy, surgery, radiation therapy (using x-rays, high-energy electrons/protons, gamma rays, radioactive isotopes, such as radium or cobalt), chemotherapy (anti-mitotics, anti-metabolites), curative therapy, palliative therapy, proper hygiene, nutrition, counselling, physiotherapy, laparoscope, Radiofrequency ablation (RFA), radioresistant cancer, radiation therapy administration (external beam, radioisotope seeds, brachytherapy, radioactive solutions, oral radioisotopes), hormone therapy (glucocorticoid, sex hormones), antibodies, biological response modifiers (BRMs, interferons, BCG vaccine), angiogenesis inhibitors, analgesics, massage, meditation, exercise, remission, recurrence.