types of cancer (2)

8/7/2019 Types of cancer (2)

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1. What is the function of Insulin in Diabetes?

Insulin is a hormone that maintains homeostasis of blood glucose. It is released into circulation when

the levels of glucose rise. Glucose is the primary energy source in cell metabolism. Following its

absorption in the intestine, the blood glucose level rises. The result is an increase in insulin secretion,

which stimulates the body to either store or use the glucose effectively. Insulin secretion is altered in

direct response to the level of glucose present.

Insulin reduces high blood glucose levels by:

y acting and stimulating cellular glucose uptake and utilization by muscle and connective tissuecells

y increasing conversion of glucose to glycogen (glucose stored for immediate release during timesof stress or low glucose), especially in the liver and skeletal muscles

y accelerating uptake of amino acids by cells, and the synthesis of proteiny promoting synthesis of fatty acids and storage of fat in adipose tissue

Sometimes, an insufficient amount of insulin is released. This may occur when the pancreas cannot

produce enough insulin, the insulin receptor sites have lost their sensitivity to insulin, or the person does

not have enough receptor sites to support his or her body size, as in obesity. This insufficiency of insulin

can cause a metabolic disorder known as Diabetes.


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2. What are the Types of Insulin?

Insulin replacement is used to treat diabetic conditions, such as type 2 diabetes mellitus in adults who

have no response to diet, exercise, and oral agents, and for type 1 diabetics who require insulin

replacement. Since it does not cross the placenta, it is used for managing diabetes during pregnancy.

Various preparations of insulin are available to provide short and long-term coverage. The peak, onset,

and duration of the different preparations vary with each type of insulin.

Originally, insulin was prepared from pork and beef pancreas. Today, all insulin is prepared by

recombinant DNA technology and is human insulin produced by genetically altered bacteria. This more

pure form of insulin is not associated with the sensitivity problems that many patients developed with

animal products. Animal insulin may still be obtained for patients who are most responsive to them, but

they are not generally used.

Frequently, more than one preparation of insulin is given to provide insulin coverage at different times

during the day. This may include a combination of regular and NPH insulin in the morning to cover the

glucose peak from breakfast (regular onset: 30-60 minutes), lunch and dinner. Another injection may be

required before bed. The types of insulin used are determined by the anticipated eating and exerciseactivities of any particular individual.


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3. Diabetes and Blood Sugar Levels:

Diabetes is a metabolic disturbance caused by a deficiency or absence of insulin or interference with

insulin activity. It may occur in either of two forms:

(1) Type 1/ Juvenile Onset/ Insulin-dependent- more severe, which typically affects the young

(2)Type 2/ Maturity Onset/ Non-insulin-dependent- has a slow, gradual development

Diabetes causes alterations in the bodys ability to effectively deal with carbohydrate, protein and fat

metabolism. Thus, high blood glucose level results when there is insufficient insulin to deal with the

glucose in the body.

Reasons why blood glucose level remains high after meals in diabetics:

y glucose metabolism by body cells is defectivey conversion of glucose to glycogen in the liver and muscles is diminishedy there is an excessive synthesis of glucose (gluconeogenesis) from protein in response to the

deficient intracellular glucose

When diet and exercise no longer work to control glucose, oral agents are required. However, whenthese are no longer effective, injection insulin may eventually be needed to replace the missing insulin.

High blood glucose levels are treated with insulin or oral agents. However, treatment can lower the

blood sugar too far, causing glucose blood sugar to drop (less than 40 mg/dL). It is important to monitor

ones blood glucose regularly.


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4. Tips for Diabetic Care:

Chronic illness like diabetes requires management and control, especially compliance with prescribed

regimen. This is important since diabetes has serious effects and many of which are life-threatening.

Here are some tips to manage diabetes (regardless of type):

y monitor blood glucose regularly- daily monitoring of blood glucose is necessary. This will allowthe person to achieve metabolic control and decrease the danger of low blood glucose

(hypoglycemia)

y medication compliance- treatment depends on the type of diabetes. Regardless of type, strictdrug compliance is important in balancing food intake and to maintain as near normal blood

glucose levels as possible.

y consistent- carbohydrate meal plan- management of diabetes requires a careful balancebetween the intake of nutrients, the expenditure of energy, and the dose and timing of insulin

or oral antidiabetic agents. Although everyone has the same need for basic nutrition, the person

with diabetes must eat a more structured diet to prevent high blood glucose (hyperglycemia).

y exercise regularly- in people with diabetes, exercise increases the uptake of glucose by musclecells, potentially reducing the need for insulin. Consult the doctor before beginning any exercise

program. The ability to maintain an exercise program is affected by many factors including

fatigue and glucose levels.


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5. What are Diabetic Foot Ulcers?

People with diabetes are at high risk for amputation of a lower extremity. The high incidence of both

amputations and problems with the feet is the result of angiopathy, neuropathy, and infection.

Diabetic neuropathy of the foot produces multiple problems. Because the sense of touch and perception

of pain is absent, the person with diabetes may have some foot trauma without being aware of it. The

person thus is increased risk for trauma to tissues of the feet, leading to ulcer development. Infections

commonly occur in traumatized or ulcerated tissue.

Despite the many potential sources of foot trauma in the person with diabetes, the most common are

cracks and fissures caused by dry skin or infections such as athletes foot, blisters caused by improperly

fitting shoes, pressure from stockings or shoes, ingrown toenails, and direct trauma (cuts, bruises, or

burns).

Foot lesions usually begin as a superficial skin ulcer. If the injury goes unattended, the ulcer extends

deeper into muscles and bone and gangrene can develop.

Care of the feet should be included as an essential part of care in a person with diabetes. This includes

checking the feet daily for cut areas or cracks, including between the toes and washing the feet daily

with lukewarm water and mild soap.


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6. What are Diabetic Shoes?

Because the sense of touch and perception of pain is altered, people with diabetes are at increased risk

for foot trauma. Foot care is important. This includes choosing the type of shoes. Improperly fitting

shoes creates pressure, causing blisters.

In buying and wearing shoes, a person with diabetes should note on the following:

y Shoes that allow to inch of toe room are best; there should be room for toes to spread outand wiggle. The lining and inside stitching should be smooth and the insole soft. The sole should

be flexible and cushion the foot. The heel should fit snugly, and the arch support should give

good support.

y Do not wear open-toed shoes, sandals, high heels, or thongs; they increase the risk of trauma.y Buy shoes late in the afternoon, when feet are at the largest; always buy shoes that feel

comfortable and do not need to be broken in.

y Shoes made of natural fibers (leather or canvas) allow perspiration to escape.y Check the shoes before each wearing for foreign objects, wrinkled insoles and cracks that might

cause lesions.

y Wear insulated boots during winter.It is also important to be sure, that if the person is unable to inspect or do foot care daily, someone else

does.


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7. What is Adenoid Cystic Carcinoma?

Adenoid cystic carcinoma (ACC) is a relatively rare form of cancer that most commonly develops in the

salivary glands or other regions of the head and neck. In some cases, ACC may arise in other primary

sites, such as the skin, breast, and neck of the uterus (cervix) in females and prostate gland in males, or

other areas.

ACC tumors are characterized by a distinctive pattern in which abnormal "nests" or cords of certain cells

(epithelial cells) surround and/or infiltrate ducts or glandular structures within the affected organ. These

structures are typically filled with a mucous-like material or contain abnormal fibrous membranes

(hyaline membranes). Such characteristics are apparent during microscopic evaluation of the tumor

cells. ACC is considered a low-grade malignancy that has a history of slow growth, but tends to be

aggressively invasive and to infiltrate nearby lymph nodes as well as the "sheaths" or coatings

surrounding nerve fibers (perineural spaces). This form of cancer may have a tendency to recur later at

the site where it first developed (local recurrence) and to spread to distant bodily sites, particularly the

lungs, potentially resulting in life-threatening complications.

Recommended standard therapy is often based upon primary tumor site, size, location and its ability tometastasize, and other factors. These may include postoperative radiation to help treat known or

possible residual disease. If initial surgery is not an option due to the specific location and progression of

the malignancy, therapy may include radiation alone. Radiation therapy preferentially destroys or

injures rapidly dividing cells, primarily cancerous cells.


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8. What is Adrenal Gland Tumor?

Adrenal glands are small glands resting above the kidney. They produce the hormones collectively

known as corticosteroids. These hormones enable us to better cope with the changing environment.

Important homeostatic adaptations mediated by the adrenal hormones include the maintenance of

sodium and potassium levels (mineralocorticoids) and regulation of blood glucose level (glucocorticoids),

as well as various cardiovascular responses.

A tumor is an abnormal mass of tissue growing on or in the body. Tumors in the adrenal gland involve

the adrenal cortex and adrenal medulla. These tumors may be benign (not cancerous) or malignant

(cancerous). Malignant adrenal gland tumors metastasize extensively and so, has a poor prognosis.

Tumors in the adrenal cortex produce the hypersecretion of glucocorticoids. The hypersecretion of

glucocorticoids may later on develop Cushings syndrome .People who suffer with this condition are

often obese and with a typical pattern of fat deposition in the face (responsible for the puffiness in the

eyelids), the base of the neck and in the abdomen. It is characterized by florid (red) skin and facial

roundness or moon face.

Rare tumors arise in the adrenal medulla. One, pheochromocytoma, is usually benign, and the other,

neuroblastoma, is malignant. These tumors arise due to excessive catecholamine secretion. The nature

and severity of symptoms of functioning tumors of the adrenal medulla depend on the relative

proportions of epinephrine and norepinephrine secretion. The typical triad of symptoms is headache,

diaphoresis (profuse sweating), and palpitations in the patient with hypertension. However,

approximately 8% of those affected are completely asymptomatic.


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9. What is Amyloidosis?

Amyloidosis is an increase or accumulation of amyloid beta protein. This type of protein substance is

directly toxic and is involved in triggering and supporting generalized inflammation response.

One systemic effect of inflammation is the rapid increase of this protein. It acts on inflammatory

response by binding directly to the surface of pathogens, particularly bacteria. However, during the

destruction of microorganisms, the DNA that is exposed is bound by these proteins, making it easier to

clear the other debris of inflammation. This takes inflammation longer.

In chronic inflammation, the prolonged presence of these proteins leads to deposition or accumulation.

Accumulated amyloid proteins interfere with the function of the organ within which it is deposited, thus,

facilitating more increase in the inflammatory response. This condition will further complicate the

persons existing problem and worst, can be fatal.

It is important to limit inflammation. Despite its beneficial role in dealing with the agents that produce

tissue damage, problems are associated with excessive or inappropriate inflammation, like Amyloidosis.

For this reason, anti-inflammatory therapy may be necessary. However, the challenge is in applying thetherapy in such a way as to limit inflammation, while allowing a sufficient response to deal effectively

with the problem.


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10. What is Anal Cancer?

The major function of the rectum is to store feces until evacuation. When feces enter the rectum,

peristalsis occurs. Many disorders in the rectal area result from constipation or failure to empty the

rectum when peristalsis occurs.

The mucous membrane at the mucocutaneous border of the anal canal changes to skin that has

cutaneous somatic nerve endings. Because of this anatomic structure, lesions of the external anal canal

are very painful. The two most common manifestations are bleeding and pain. However, blood on the

stool usually indicates a perianal disease, a polyp or carcinoma of the left colon or rectum, inflammatory

bowel disease or carcinoma of the proximal colon or hemorrhoidal bleeding.

Carcinoma and melanoma can occur at the anus but are rare, constituting fewer than 5% of anorectal

cancers. They spread by local extension into the perineal spaces and then to the inguinal nodes.Cancer

of the anal canal or lower rectum can coexist with other rectal conditions, and the client may falsely

attribute bleeding to haemorrhoid instead of carcinoma.

Anal cancers are more common in African Americans, in clients who have had human papilloma virus(HIV), and in clients with pre-existing anal and perianal problems, such as fistulas. Bleeding, local pain

and itching, and tenesmus (ineffective and painful straining during bowel elimination) are characteristic

manifestations. A person is usually aware of a lump near the anus that has bled and that gradually

becomes more and more painful, particularly during or just after a bowel movement.

Many anal cancers are not diagnosed until they are large, and by then the prognosis is poor. Some

tumors are treated with radiation and chemotherapy, whereas others may require surgical excision.

Surgical intervention involves excision of the anus with an abdominoperineal resection.


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11. What is Appendix Cancer?

The lumen of appendix is very small and there is little scope for swelling when it becomes inflamed.

The initial cause of inflammation is not always clear. Microbial infection is commonly superimposed on

obstruction by hard faecal matter (fecoliths), kinking and a foreign body. Inflammatory exudates with

fibrin and phagocytes cause swelling and ulceration of mucous membrane lining. In mild cases the

inflammation subsides and healing takes place. In more severe cases, microbial growth processes leads

to suppuration, abscess formation and further congestion. The rising pressure inside the appendix

occludes first the veins, then the arteries and ischemia (restriction in blood supply) develops, followed

by gangrene and rupture.

With the diagnosis of appendicitis, surgical removal of the appendix is the only treatment. However, in

rare cases, cancer of the appendix is diagnosed after appendectomy. The common causes of appendix

cancer include carcinoid (slow- growing neuroendocrine) tumors, mucinous cystadenocarcinoma

(malignant form of glandular epithelium) tumors, adenocarcinoma (cancer of glandular epithelium) and

paraganglioma (are neuroendocrine tumor). This is often diagnosed after a biopsy, following an

appendectomy. Risk factors also play a role in the contribution of this type of disease like smoking,

stress and poor diet.

As in any type of cancer, its prognosis depends on early diagnosis and treatment. Treatment therefore,

also depends with the tumor size and location. This may include chemotherapy, radiation and

medications to control symptoms.


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12. What is Appendix Cancer?

The vermiform appendix is a potential site of inflammation. This 8-10 cm long structure is a slender

extension of the cecum (pouch, connecting the ileum with the ascending colon of the large intestine)

containing nodules of lymphoid tissue in its submucosa. Acute inflammation of the appendix can occur

at any age, but the highest incidence is in the range of ages 10-20. It is the most common cause of

abdominal surgery in children.

Although appendix cancer is very rare, 40% of its cases are diagnosed after an appendectomy. There are

various types of cancer tumors causing appendix cancer. These includes cancer include carcinoid (slow-

growing neuroendocrine) tumors, mucinous cystadenocarcinoma (malignant form of glandular

epithelium) tumors, adenocarcinoma (cancer of glandular epithelium) and paraganglioma (are

neuroendocrine tumor).

More often, signs and symptoms are attributed to appendicitis and a varying change in bowel function is

usually present. Protrusion of the abdomen and bloating are also very common. Prognosis depends on

early diagnosis and treatment of the disease. High incidence of survival is also associated when appendix

cancer is still small.

Treatment includes surgery, radiation, chemotherapy and drug therapy to control symptoms. Metastasis

often depends on the aggressiveness of the type of tumor causing it.


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13. What is Astrocytoma? Childhood

Brain tumors are expanding lesions within the skull. Approximately 20% of the malignant tumors that

occur in children are brain tumors. One of the main types of brain tumors that appear in children are

Cerebellar astrocytoma.

Cerebellar astrocytoma is a slow-growing, often cystic type of tumor of the cerebellum that accounts

10% to 20% of all pediatric brain tumors. This tumor produces slowly increasing intracranial pressure. It

is classified according to its malignancy, from grade I (least malignant) to grade IV (most malignant).

Cerebellar astrocytoma has insidious onset and slow course. Common manifestations show evidence of

increased intracranial pressure- especially headache, visual disturbances, papilledema (optic disc

swelling), and personality changes; Cerebellar signs- ataxia (loss of muscle coordination), dysmetria

(inability to control the range of muscular movement), nystagmus (involuntary eye movement);

behavioural changes; seizures

Computed tomography (CT) scan, magnetic resonance (MRI), myelogram, positron emission tomography

(PET) are the common procedures used to diagnose and determine the type of tumor that is suspected,localize and determine its extent.

Treatment includes surgery, radiation therapy, chemotherapy, ventriculoperitoneal shunting and the

use of immunotherapy or gene transfer therapy. Prognosis is improved in cases that involve early

diagnosis and adequate therapy. Five-year survivors are increasing, especially in children with low-grade

astrocytomas.


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14. What is Ataxia-telangiectasia?

T-cell and B-cell immune deficiencies comprise a heterogeneous group of disorders, all characterized by

profound impairment in the development or function of the cellular, the humoral, or both parts of the

immune system. A variety of inherited (autosomal recessive and X-linked) conditions fit this description.

These conditions are typified by disruption of the normal communication system of B-cells and T-cells

and impairment of the immune response, and they appear early in life.

Ataxia-telangiectasia is an autosomal recessive neurodegenerative disorder that arises because of a

defect on chromosome 11; the ataxia-telangiectasia mutation that affects both T- and B-cell immunity.

In 40% of patients with this disease, a selective IgA deficiency exists. IgA and IgG subclass deficiencies,

along with IgE deficiencies, have been identified. Variable degrees of T-cell deficiencies are observed

and become more severe with advancing age.

The disease is associated with neurologic, vascular, endocrine, hepatic, and cutaneous abnormalities. It

is accompanied by progressive cerebellar ataxia (loss of muscle coordination), telangiectasias (vascular

lesions caused by dilated blood vessels), recurrent bacterial infection of the sinuses and lungs, and an

increase incidence of cancer.

Treatment of ataxia-telangiectasia includes early management of infections with antimicrobial therapy,

management of chronic lung disease with postural drainage and physical therapy, and management of

other presenting symptoms.


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15. What is Attenuated Familial Adenomatous Polyposis (AFAP)?

More than 95% of colorectal cancers develop from adenomatous polyps (adenomas). The three types of

adenomas are tubular, tubulovillous, and villous. The last type has the highest risk of becoming

cancerous. The polyps grow slowly, and most take 5 to 10 years or longer to become malignant. As a

polyp becomes malignant, it increases in size within the lumen and begins to invade the bowel wall.

Tumors in the right intestine tend to be bulky and to cause necrosis and ulceration. Tumors in the left

intestine start as small, button-like masses that cause ulceration of the blood supply.

Attenuated familial adenomatous polyposis (AFAP) is a subtype of familial adenomatous polyposis (FAP).

It is often attributed genetically. It is associated with the presence of an inherited gene adenomatous

polyposis coli (APC). A person with familial adenomatous polyposis (AFAP) develop hundreds of

thousands of polyps in their colons at an early age and have an almost 100% chance of developing

cancer by the age of 40. As a result, some elect to have prophylactic colectomy (surgical resection of any

extent of the large intestine) as a preventive measure and genetic counselling for couples might be

necessary. However, little is still known about this type and further studies are still being made.

Malignant tumors commonly spread by direct invasion to a nearby organ, such as the stomach from thetransverse colon, lymphatic and hematogenous channels, usually to the liver and seeding or implanting

of cells into peritoneal cavity. Blood-borne metastasis extends most commonly to the liver but may also

involve the lungs, kidneys and bones.


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16. What is Beckwith-Wiedemann Syndrome?

Beckwith-Wiedemann syndrome is a congenital (present from birth) condition and growth disorder that

causes large body size and large organs. The cause is not yet clear. However, it is often attributed

genetically and is often associated with a defect in chromosome 11. Genetic counseling may necessary

to couples planning to have children. A higher incidence of tumor development is also associated with

this condition. Adrenal carcinoma and Wilm's tumor are the most common tumors to exist.

The most common signs and symptoms include large protruding tongue, enlarged kidneys, liver, and

spleen, large and prominent eyes , creases in ear lobes ,low blood sugar (hypoglycemia), a ridge in the

forehead caused by premature closure of the bones (metopic ridge), abdominal wall defects like

umbilical hernia or omphalocele, enlarged fontanelle (soft spot), and large newborn size.

Swelling of the tongue can cause problems with feeding and sleeping, thus, the child may need

assistance to prevent aspiration. Low blood sugar may be treated with intravenous fluid. Defects in the

abdominal wall may need to be repaired and the child must be watched closely for the development of

tumors.

Children with Beckwith-Wiedemann syndrome who survive infancy are likely to do well. However,

normal to a slight decreased in mental development is common.


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17. What is Bile Duct Cancer?

The liver supports metastatic growth and the vast majority of hepatic tumors are secondary growths,

usually, originating in the colon, breast, stomach, or lung. Multiple tumor emboli (detached

intravascular mass carried by the circulation) typically establish several metastatic foci in the liver, with

their location reflecting the path taken through hepatic vessels. In advanced stages, secondary tumors

may produce pronounced liver enlargement. Approximately one-third of all malignant tumors growing

in the liver are secondary.

Primary hepatic tumors are rare. If benign, such as bile duct adenoma (benign tumor of glandular origin)

or liver cell adenoma, they are well tolerated and seldom produce liver enlargement. The incidence of

bile duct adenoma is low but seems linked to the use of birth control pills. The hormones in these pills

seem, in some way, to favour the development of growth of bile duct adenomas. When growing near

the livers surface, these tumors can break through it to produce serious haemorrhage into the

abdominal cavity.

Malignant tumors arise from two different hepatic cell types. The most common (80%) is the

hepatocarcinoma or hepatoma, which derives from the hepatocyte.

However, of primary hepatic malignancies, 20% originate in bile duct epithelium, forming a scirrhous

(hard, slow-growing) tumor termed as cholangiocarcinoma, also called bile duct cancer.


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18. What is Birt-Hogg-Dub Syndrome?

Birt-Hogg-Dub syndrome (BHDS) is a rare autosomal dominantdisorder characterized by a triad of

benign tumors of the hair follicle, spontaneous pneumothorax (collection of air or gas in the pleural

cavity) and kidney tumors. The BHD gene (OMIM 135150) codes for the protein folliculin,which is

expressed in multiple tissues including kidney, lung,and skin. This tumor-suppressor gene, results in the

cutaneous hamartomas associated with internal neoplasia (abnormal proliferation of cells). Cutaneous

tumors are fibrofolliculomas, trichodiscomas and acrochordons. Fibrofolliculomas and trichodiscomas

tend to appear in the third or fourth decade of life as small white or skin-colored multiple papules on

the face, neck and upper trunk.

Affected individuals have a high chance of developing cysts in the lungs and spontaneous

pneumothorax. Although almost all patients who have BHDS have lung blebs (90%), only one fifth will

have spontaneous pneumothorax. The strong association of spontaneous pneumothorax with BHDS

suggests that the presence of this in a member of a BHDS family could be used as a criterion for its

diagnosis.

However, no specific medical treatment exists for the cutaneous lesions of BHDS. Surgical removal hasprovided definitive treatment of solitary perifollicular fibromas and electrodesiccation may be helpful in

removal of multiple lesions, but these can recur. Prognosis of this condition depends on age and the

number and type of tumors.


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19. What is Bladder Cancer?

Cancer of the bladder is more common in people between the ages of 50 and 70 years. It affects more

men than women. Bladder cancer is the fourth leading cause of cancer in men and has a high worldwide

incidence.

Cancers arising from the prostate, colon, and rectum in males and from the gynaecologic tract in

females may metastasize to the bladder. Tobacco is the leading risk factor of bladder cancer. People

who smoke get bladder cancer twice as often as those who do not smoke.

Bladder tumors usually arise at the base of the bladder and involve the ureteral orifices and bladder

neck. Visible, painless hematuria (presence of blood cells in the urine) is the most common symptom of

bladder cancer. Infection of the urinary tract is a common complication, producing frequency, urgency,

and dysuria (painful urination). However, any alternation in voiding or change in urine may indicate

cancer of bladder. Pelvic or back pain may occur with metastasis.

Treatment of bladder cancer depends on the grade of the tumor (the degree of cellular differentiation),

the stage of tumor growth (the degree of local invasion and the presence or absence of metastasis), andthe multicentricity (having many centers) of the tumor. The patients age and physical, mental, and

emotional status are considered when determining treatment modalities.


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20. What is Bone Cancer?

Bone provides a supportive environment for metastases and so is a very common site of secondary

tumor growth. Its usual primary tumor most often arise from the prostate, breast, thyroid, lung or

kidney. Access to bone is by way of blood, rather than lymph, and the sites most often involved are the

bones of the axial bone (bones in the head and trunk) (except the skull) and the proximal femur and

humerus.

Once established, a secondary tumor may grow and invade locally, disrupting the organization of the

osseous tissue by inducing bone breakdown (osteolysis) of new bone formation. These effects are due

to the release by the metastatic cells of substances that activate local osteoclasts, osteoblasts, or both.

The result is a mix of growing tumor, resorbing bone, and new bone formation at secondary site.

In bone cancer, primary tumors are much less common than secondary tumors, but can have

devastating effects in that they arise most often in the young. Actively growing bone is much more likely

to undergo a neoplastic transformation, and pain is an early indication of the tumors expansion within

the densely organized bone tissue. Like secondary tumors, primary bone tumors induce osteolysis, so

that weakening of the bone, which produces a tendency for a fracture. In addition, normal boneadjacent to the tumor may respond to tumor pressure by altering its pattern of remodelling. This

response produces an altered and expanded contour of the bones surface.

The danger in malignancies is, of course, metastasis, and in bone cancer, it typically involves the lung. In

many tragic cases, amputation is necessary to cope with primary tumor when therapy is too little or too

late.


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22. What is Brain Tumor?

Tumors of the central nervous system constitute about 3-5% of over one million cases of cancer

diagnosed in adults yearly. In children, this type of cancer is much less common.

Since tumors can arise only in tissues capable of mitosis, brain tumors exclude arising from neurons or

primitive precursor cells. These cells, capable of tumorigenesis, include astrocytes.Cells producing blood

vessels also give rise to tumors (e.g., arteriovenous malformations).

Outside the brain, the danger posed by tumor is largely a function of its malignancy. In the cranial vault,

malignancy is only one factor that may affect morbidity and mortality. If it is located in or near strategic

sites, for example, adjacent to the cerebral aqueduct or in the brain stem, even a small, slowly benign

tumor can have devastating effects.

Tumor excision is usually the treatment. However, brain tumors can be physically inaccessible, may have

infiltrated diffusely and require the resection of too much tissue, or may be small but located in vital

brain centers. The blood-brain barrier (restricts the diffusion of microorganisms and large molecules into

CSF) makes chemotherapy ineffective for most brain tumors, and this fact, combined with the foregoing,often makes radiation the chief acceptable therapy. The limited capacity of the cranial vault is an

additional variable that blurs the distinction between malignant and benign. Even though malignant

brain tumor will probably increase in mass faster, the ultimate impact of compression, herniation, and

increased intracranial pressure from benign but inoperable tumor will probably be the same.


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23. What is Breast Cancer?

Currently over 10% of North American women can be expected to develop breast cancer. Most cases

are diagnosed in menopausal and post-menopausal women, with much lower incidence prior to the

mid-20s. There are numerous factors that predispose to greater risk.

Genetic factors are involved in breast cancer. These are involved in genetic transmission of a

predisposition to cancer. Dependence in estrogen is also a growth stimulus for this type of cancer. In

such cases, over a womans life, high exposure to the estrogen peaks that are associated with normal

ovarian cycling seem to enhance breast cancer development. Since estrogen peaking is reduced during

pregnancy, factors that prolong normal cycling, like an early menarche (first menstrual cycle), a delayed

first pregnancy, having no children at all (nulliparity), and an extended reproductive life span, are all

associated with increased breast cancer incidence. Ultimately, breast cancer appears to result from a

complex interplay between genetic predisposition and environmental agents interacting in a supportive

hormonal milieu.

Broadly, there are two classes of breast cancer: carcinoma in situ (CIS) is non-invasive, with its growth

confined within the basement membrane of the duct or gland in which it arises. The other class isinvasive carcinoma, where tumor cells infiltrate adjacent tissues, gain access to lymphatics and

metastasize.

Treatment involves appropriate combinations of surgery, usually mastectomy (removal of the tumor

mass or the entire breast), radiation, and chemical agents.

As in any type of cancer, intervention in early stages is related to better prognosis. However, it is widely

accepted that by the time of diagnosis, 50% of breast cancers have already metastasized.


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24. What is Breast Cancer-Inflammatory?

The increase use of mammography as a screening tool has contributed to the dramatic increase in the

diagnosis of breast cancer. An estimated 62,000 new cases are diagnosed annually. The most common

are non-invasive form of breast cancer. It is characterized by the proliferation of malignant cells inside

the milk ducts without invasion into the surrounding tissues. However, if left untreated, there is an

increased likelihood that it will progress to invasive type of cancer.

One type of invasive breast cancer is inflammatory breast cancer. It is a rare (1 % to 2%) and aggressive

type of breast cancer that has unique symptoms. This type is characterized by diffuse edema (abnormal

accumulation of fluid) and brawny erythema (redness) of the skin often referred to as peau d orange

(resembling an orange peel). This is due to malignant cells blocking the lymph channels in the skin. An

associated mass may or may not be present; if there is, it is often a large area of indiscrete thickening.

Inflammatory breast cancer can be confused with an infection because of its presentation. The disease

can spread to other parts of the body rapidly. Chemotherapy often plays an initial role in controlling the

disease progression, but radiation and surgery may also be useful.


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25. Breast Cancer in Males:

Although men have much less breast tissue than women, they do have breast cells that can undergo

cancerous changes. Breast cancer in men accounts for approximately 1% of all breast cancers. Although

this is not very common, in most case, it is not known what triggers cancer cells to grow to men.

However, it is often attributed genetically. This means that men who have parents or first degree

relatives with defective breast cancer genes are at risk in developing breast cancer. However, most

genetic abnormalities related to breast cancer are not inherited but develop during a persons lifetime.

These genetic abnormalities may occur as a result of exposure to radiation, chemotherapy,

environmental toxins, viruses and other still unknown factors.

Other factor that might predispose men from having breast cancer is estrogen. Although estrogen is

predominantly female hormone, mens bodies also produce estrogen, but in very small amounts. When

estrogen levels rise above normal, mens breast tissues are stimulated and enlarged. Exposure to high

levels of estrogen increases the risk of breast cancer development.

Certain illnesses may also increase the levels of estrogen produced by the body, or prolong exposure to

estrogen. One condition is Klinefelters syndrome. In males, this chromosomal abnormality results inproduction of more of the female estrogen. When a man has liver cirrhosis, the liver is unable to

degrade estrogen and the body produces less of the proteins that bind and inhibit estrogen. This results

increased estrogen activity. Obesity is also a risk factor for breast cancer in men, because of the

increased number of fat cells that are able to convert the male hormone androgen to estrogen.


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26. What is Breast Cancer-Metaplastic?

Breast cancer or carcinoma is the leading cause of cancer among American women. One of eight women

develops breast cancer. Most breast cancer begins in the lining of the milk ducts, sometimes in the

lobule. Eventually it grows through the wall of the duct and into the fatty tissue. Family history accounts

approximately 7% of breast cancers. However, carcinogens are not associated to have an important role

in its development. Hormones such as estrogen are not thought to produce this type of cancer;

however, they may influence its growth.

Metaplastic breast cancer is a rare type of invasive breast cancer. As the name implies, this type of

cancer cells are metaplastic or can withstand a new environment. They change into another type more

suited to the new environment to survive. However, its symptoms are the same with the other types.

Invasive tumors may produce various changes at the breasts surface due to contraction of the tumors

fibrous stoma. Dimpling of the surface may result, or nipple may be drawn inward. When the invading

tumor cells reach the overlying dermis, they may infiltrate and obstruct its lymphatics. The result is a

local reddening and hardening of the skin that is termed peau d orange, since it has some resemblance

to an orange peel.

Metastasis of most breast cancers is via lymphatic drainage to the regional nodes of the axilla, but

blood-borne spread also occurs. The tumor emboli disseminate widely to grow at multiple sites, most

often the lung, liver, adrenal glands, brain, skin and bone.


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27. What is Carcinoid Tumor?

Carcinoid tumors of the gastrointestinal tract are rare and slow growing. Most tumors occur in the small

intestines, followed by the rectum and stomach. Non functioning tumors cause symptoms of

intermittent intestinal entrapment secondary to mesenteric fibrosis. Functional tumors secrete notably

serotonin, leading to the manifestations of carcinoid syndrome, characterized by diarrhea,

bronchoconstriction and palpitations. Excess serotonin contributes to carcinoid heart disease

(endomyocardial fibrosis, tricuspid insufficiency and pulmonary valvular disease). Liver metastasis and a

large tumour burden contribute to the severity of the carcinoid syndrome.

Diagnostic imaging includes 111Indium-Pentetreotide Scintigraphy (Octreotide scan) is highly sensitive

and specific for both functioning and non-functioning carcinoid tumours which express somatostatin

receptors. It can show early evidence of lesions not revealed by other procedures. It should be done at

baseline, after curative surgery and annually thereafter. CT scan, MRI and ultrasound may also be

helpful in evaluating the extent of disease. The main goals of carcinoid tumour management include

symptom, biochemical and objective tumor control, and quality of life improvement.

External radiation therapy is recommended for bone and brain metastasis. Tumor targeted treatmentwith radioactive octreotide derivatives are associated with tumor shrinkage in up to 25% and

biochemical response in up to 50%. However, the exact role of this treatment is not yet defined, but it is

an accepted alternative in the therapy of these neoplasms.


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28. What is Carney Complex?

Carney complex (CNC) is a rare autosomal dominant inheritedtrait expressed as pigmented skin lesions,

cardiac, cutaneous,mucosal myxomas (usually non-cancerous primary tumor of the heart), neural and

functioning endocrine tumorscausing endocrine overactivity. Although most cases are familial, sporadic

cases may occur.

A gene implicated in Carney complex, a rare disorder of the adrenal glands, appears to function as a

molecular switch to limit cell growth and division. The normal process by which cells in the adrenal gland

grow old and die is put on hold when the gene, known as Prkar1a, is deactivated. The Prkar1a gene is

known to be involved in how the cell regulates its activities.

Individuals with Carney complex typically develop Cushings syndrome, a combination of weight gain,

high blood pressure, diabetes, and other symptoms stemming from the overproduction of the hormone

cortisol, which is produced by the adrenal glands. People with Carney complex are also predisposed to

developing benign tumors of the heart and connective tissue, as well as benign and cancerous tumors of

the adrenal and other glands. Previous studies have shown that people with Carney complex are likely

to have a mutation in the Prkar1a gene. Appropriate referrals to cardiology, endocrinology, gynecology,and urology should be made.


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29. How does Central Nervous System Tumor begin during childhood?

The nervous system continues to mature through the first 12 years of life. It actually consists of two

separate systems: the central nervous system (CNS) and the peripheral nervous system (PNS).

The CNS consists of the brain, the spinal cord, and the surrounding membranes or meninges that protect

the delicate tissues from normal trauma. These tissues are also protected by the skull, the vertebral

column, the cerebrospinal fluid (CSF), the fluid in the subarachnoid space, which serves as a cushion.

CNS tumor can be either benign (growth is limited) or malignant (cancerous). Even when tumor is

benign, however, it may not be completely harmless. It can cause damage by pressing adjacent tissues.

Brain tumors in children, for example, are often benign, but they can cause extensive respiratory center

depression from increasing pressure.

The exact origin of tumor growth is unknown, and any growth may actually involve more than one

cause. In children, tumors frequently occur in organs unexposed to the environment (brain, bloodstream

and kidney). A common theory on why these tumors grow is cell mutation. This suggests that

carcinogenic agents and hereditary susceptibility combine to alter the nature of cells, leading to itsabnormal growth.

One common neurologic sign that may occur with these space-occupying lesions or tumors is an

increased intracranial pressure. This can cause local injury and severe pressure elevation that compress

the brain stem and lead to cardiac and respiratory failure. It is therefore important, that CNS tumors are

identified and removed as quickly as possible to prevent further injury when possible.


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30. What is Cervical Cancer?

The cervix (neck) forms the lower third of the uterus. In the young adult, the exocervix (portion of the

cervix that projects into the proximal vagina), consists of layer of columnar cells resting on a bed of

reserve cells. These cells are the source of new cells needed to replace those normally sloughed from

the surface. With maturity, the exocervix is exposed to various vaginal irritants, as well as pH and

estrogen changes, and to the trauma of coitus and childbirth. These induce an adaptive thickening and

strengthening of the exocervix.

Over a period of years, the continuing growth of new tissue from the site, leads to the development of

tumor. Unless there is intervention to interrupt its progression, tumor cells break through the basement

membrane to invade locally. With more extensive invasion, adjacent organs are affected and access to

lymphatics is achieved, followed by metastasis to regional lymph nodes.

Previously more common, cervical cancer has been declining because of the ease with which a sample of

cervical epithelium can be obtained via a Pap smear. Early detection is strongly related to the

therapeutic success in cervical cancer. When the diagnosis is made while the tumor confined in the

epithelium, it is relatively simple to remove or destroy the lesion. At later stages, the treatment mayinclude hysterectomy (surgical removal of the uterus), excision of invading tumor, and radiation therapy.

Previous studies about this type of cancer shows sexual transmission of a viral agent. Incidence of the

tumor is high when sexual activity starts early and involves multiple partners.

types of cancer (2)

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