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Most common types of altered cell growth, such as moles or skin tags, are benign (harmless)
and do not require intervention.
Malignant cell growth, or cancer, however, is serious and, without intervention, leads to
death.
Cancer is a common health problem in the United States and Canada.
Nearly 1.5 million people are newly diagnosed with cancer each year.
Some types of cancers can be prevented and others have better cure rates if diagnosed early.
PATHOPHYSIOLOGY
CANCER DEVELOPMENT
Cancer cells originate from normal body cells that are capable of cell division.
Transformation of a normal cell into a cancer cell involves mutation of the genes (DNA) of
the normal cell and indicates a problem with CELLULAR REGULATION.
Copyright 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Key Points
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Oncogenes that are overexpressed can cause a cell to develop into a tumor.
The process of changing a normal cell into a cancer cell is called malignant transformation.
o Only one cell has to undergo malignant transformation for cancer to begin.
Benign tumors grow by expansion, whereas malignant tumors grow by invasion.
Most tumors arise from cells that are capable of cell division.
A key feature of cancer cells is the loss of apoptosis. These cells have an infinite life span.
Benign tumor cells are normal cells growing in the wrong place or at the wrong time,
such as moles or nasal polyps.
Malignant cells are abnormal, serve no useful function, and are harmful to normal body
tissues.
Cancer cells have the following features:
o
Rapid or continuous cell division
o
Loss of the specific appearance of their parent cells or anaplasia
o
Large nuclear-to-cytoplasmic ratio
o
Loss of specific functions
o
Loose adherence, which leads to migration or metastasis
o
Metastasis is a key feature of cancer cells and a major cause of death.
Abnormal chromosomes or aneuploidy are common in cancer cells as they become more
malignant.
Anaplasia is the cancer cells loss of the specific appearance of their parent cells.
Carcinogenesis and oncogenesis are other names for cancer development.
Rapid or continuous cell division occurs in many types of cancer cells because they re-enter
the cell cycle for mitosis almost continuously because CELLULAR REGULATION is lost.
The original tumor is called the primary tumor and is identified by the tissue from which it
arose, such as in breast cancer or lung cancer.
Metastasis occurs when cancer cells move from the primary location by breaking off from
the original group and establishing remote colonies called metastatic or secondary tumors.
o Tumors that metastasize from the primary site into another organ are still designated
as tumors of the originating tissue.
o Spread to distant organs and tissues requires cancer cells to penetrate blood vessels,
called bloodborne metastasis.
o Another way cancers metastasize is by lymphatic spread.
Cancers are classified by the type of tissue from which they arise, such as connective tissue
tumors.
o Other ways to classify cancer include biologic behavior, anatomic site, and degree of
differentiation.
Systems of grading and staging have been developed to help standardize cancer diagnosis,
prognosis, and treatment.
o Grading of a tumor classifies cellular aspects of the cancer.
o Grading also allows health care professionals to evaluate the results of management
and compare local, regional, national, and international statistics.
Ploidy classifies tumor chromosomes as normal or abnormal.
Staging classifies clinical aspects of the cancer.
Copyright 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Key Points
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o The American Joint Committee on Cancer developed the tumor, node, metastasis
(TNM) system to describe the general anatomic extent of cancers.
o The stages guide treatment and are useful for prognosis and comparison of treatment
results.
o TNM staging is not useful for leukemias or lymphomas.
o Additional specific staging systems include Dukes staging of colon and rectal cancer
and Clarks levels method of staging skin cancer.
Carcinogenesis takes years and depends on several tumor and patient factors.
The three interacting factors that influence cancer development are exposure to carcinogens,
genetic predisposition, and immune function, accounting for variation from one person to
another.
External factors, including environmental exposure, are responsible for about 80% of cancer
in North America.
Personal factors, including immune function, age, and genetic risk, also affect whether a
person is likely to develop cancer.
Genetic risk for cancer occurs in a small percentage of the population; however, people who
have a genetic predisposition are at very high risk for cancer development.
o Patterns of genetic risk for cancer have also been identified, including inherited
predisposition, inherited conditions associated with cancer, and familial clustering.
An emerging issue in this area is that studies of chemoprevention performed using animal
models does not always correlate to a reduction of carcinogenesis in humans.
In addition, there is person-to-person variability in human response to chemoprevention.
It is likely that individual genetic factors influence the effectiveness of any agent in the
prevention of carcinogenesis.
CANCER PREVENTION
Copyright 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Copyright 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.