Human Diseases, 8th Edition - Chapter 4

Chapter 4: Cancer CHAPTER OVERVIEW The epidemiology of cancer is presented. Tumor formation is discussed. Tumor naming is presented. Risk factors for cancer are listed. The signs and symptoms of cancer and introduced. The etiology of cancer is explained. Diagnostic testing for cancer is presented. The grading and staging of tumors is introduced. Cancer treatments are presented and explained. Preventative measures for cancer are listed. TRANSITION GUIDE/NEW TO THE EIGHTH EDITION Chapter reviewed to ensure accuracy and to include any updates or changes in chapter content. Updated and reviewed the professional references at the end of the chapter. CHAPTER OUTLINE Introduction Epidemiology Tumor Formation Naming Tumors Known Risk Factors for Cancer Signs and Symptoms of Cancer Etiology of Cancer Diagnosis of Cancer Blood Tests Diagnostic Imaging Biopsy Grading and Staging Cancer Cancer Treatment Surgery Radiation Therapy Chemotherapy Hormone Therapy Immunotherapy Cancer Prevention CHAPTER OBJECTIVES Define basic cancer terminology Compare benign and malignant tumors Explain how benign and malignant tumors are named Identify the risk factors for cancer Describe the etiology of cancer Describe how cancer is diagnosed Describe how cancer is treated Describe how cancer can be prevented INSTRUCTIONAL GOALS Objective 1: Define basic cancer terminology. Utilize the PowerPoint presentations as a starting point for your lecture. Utilize one or more of the Classroom Activities to augment the chapter and student learning. (A list of the Classroom Activities and instructions can be found in the preface of the Instructor's Manual.) Choose a Classroom Activity using Tables 4-1, 4-2, 4-3, and 4-4. Objective 2: Compare benign and malignant tumors. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 3: Explain how benign and malignant tumors are named. Utilize the PowerPoint presentations as a starting point for your lecture. Utilize one or more of the Classroom Activities to augment the chapter and student learning. (A list of the Classroom Activities and instructions can be found in the preface of the Instructor's Manual.) Choose a Classroom Activity using Table 4-5. Objective 4: Identify the known risk factors for cancer. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 5: Describe the etiology of cancer. Utilize the PowerPoint presentations as a starting point for your lecture. Objective 6: Describe how cancer is diagnosed. Utilize the PowerPoint presentations as a starting point for your lecture. Utilize one or more of the Classroom Activities to augment the chapter and student learning. (A list of the Classroom Activities and instructions can be found in the preface of the Instructor's Manual.) Choose a Classroom Activity using Table 4-6. Objective 7: Describe how cancer is treated. Utilize the PowerPoint presentations as a starting point for your lecture. Utilize one or more of the Classroom Activities to augment the chapter and student learning. (A list of the Classroom Activities and instructions can be found in the preface of the Instructor's Manual.) Choose a Classroom Activity using Tables 4-6 and 4-7. Objective 8: Describe how cancer can be prevented. Utilize the PowerPoint presentations as a starting point for your lecture. Review the feature Healthy Aging: Cancer Treatment. Review the feature Promote Your Health: Cancer-Fighting Foods. Review the feature Prevention PLUS!: Recommended Cancer Screenings. WORKSHEET 1: Define the Terms benign carcinogens carcinoma malignant sarcoma tumor (neoplasm) WORKSHEET 2: Testbank Questions and Answers 4.1 Multiple-Choice Questions 1) Cancer is the _____ most common cause of death in the United States. A) first B) second C) third D) fourth Answer: B Objective 1 2) Benign tumors are _____, and remain localized. life threatening, grow rapidly life threatening, grow slowly not life threatening, grow rapidly not life threatening, grow slowly Answer: D Objective 2 3) Benign tumors have a _____. A) rough surface and are asymmetrical B) rough surface and are symmetrical C) smooth surface and are asymmetrical D) smooth surface and are symmetrical Answer: D Objective 2 4) Malignant tumors have a _____-like appearance and an irregular surface. A) benign B) crab C) nerve D) polyp Answer: B Objective 2 5) Malignant tumors _____. A) are encapsulated, making excision easier B) are encapsulated, making excision more difficult C) are not encapsulated, making excision easier D) are not encapsulated, making excision more difficult Answer: D Objective 2 6) Malignant tumors of the supportive tissue are named with the prefix that designates the cell or tissue of origin followed by the term _____. A) adenoma B) metastasize C) neoplasm D) sarcoma Answer: D Objective 3 7) An osteosarcoma is a malignant tumor of _____ A) bone B) kidney C) liver D) skin Answer: A Objective 3 8) The most important risk factor for cancer is _____. A) growing older B) infections C) radiation D) tobacco use Answer: A Objective 4 9) Cigarette smoking causes about _____ of all cancer deaths in the United States. A) 10% B) 30% C) 50% D) 70% Answer: B Objective 4 10) The _____ increases the risk for cancers of the cervix, penis, vagina, anus, and vulva. A) Epstein-Barr virus B) Human herpesvirus 8 C) Human papillomavirus D) Human T-lymphotrophic virus Answer: C Objective 4 11) _____ secrete chemicals that cause pores to form in the membrane of abnormal cells, leading to cell death. A) Cytotoxic T cells B) Lymphotropics C) Natural killer cells D) Oncogenes Answer: C Objective 4 12) Uncontrolled cell division is the result of _____ in genes that play a role in cell division. A) metastasizes B) mutations C) nodes D) nuclei Answer: B Objective 5 13) _____ tell cells when to divide. A) DNA repair genes B) Oncogenes C) Suicide genes D) Tumor suppressor genes Answer: B Objective 5 14) _____ cause uncontrolled cell division that may result in cancer. A) DNA repair genes B) Oncogenes C) Suicide genes D) Tumor suppressor genes Answer: D Objective 5 15) _____ tell cells when not to divide. A) DNA repair genes B) Oncogenes C) Suicide genes D) Tumor suppressor genes Answer: D Objective 5 16) Mutation in the four genes that are responsible for the cell division can be _____. A) acquired B) caused by carcinogenics C) inherited D) inherited or acquired Answer: D Objective 5 17) Mutations inherited from parent to child account for _____ of all cancers. A) 5–10% B) 10–20% C) 15–30% D) 20–40% Answer: A Objective 5 18) More than 50% of all cancers involve an acquired mutation in the tumor suppressor gene _____. A) antigen 125 B) BRCA1 C) BRCA2 D) p53 Answer: D Objective 5 19) _____ is the use of x-rays to form a still or moving picture of the inside of the body. A) Computed tomography B) Magnetic resonance imaging C) Radiography D) Ultrasonography Answer: C Objective 6 20) _____ is a scanning type of radiography that creates a three-dimensional picture of the inside of the body. A) Computed tomography B) Magnetic resonance imaging C) Radiography D) Ultrasonography Answer: A Objective 6 21) During _____, high-frequency sound waves are reflected off internal tissues to produce an image. A) computed tomography B) magnetic resonance imaging C) radiography D) ultrasonography Answer: D Objective 6 22) Tumor markers are produced by _____. A) cancer cells B) neither normal cells nor cancer cells C) normal cells D) normal cells and cancer cells Answer: D Objective 6 23) Part of a cancer diagnosis, _____ is helpful in making a prognosis of the disease. A) chemotherapy B) grading C) radiation D) staging Answer: B Objective 6 24) Malignant tumors are generally graded on a scale of _____. A) A to D B) gray to black C) one to four D) small to large Answer: C Objective 6 25) Malignant tumors are staged to _____. A) ascertain whether it has metastasized B) determine the diagnosis C) develop a treatment plan D) identify the type of tumor Answer: C Objective 6 26) _____ is classifying a tumor based on its size and the extent of its spread. A) Chemotherapy B) Grading C) Radiation D) Staging Answer: D Objective 6 27) _____ of all people with cancer receive radiation therapy as part of their cancer treatment. A) About 25% B) About 50% C) About 75% D) 100% Answer: B Objective 6 28) _____ of cancer patients receive chemotherapy treatment. A) About 25% B) About 50% C) About 75% D) 100% Answer: B Objective 6 29) The side effects of chemotherapy are _____. A) permanent and cannot be treated B) permanent but can often be treated C) temporary and can often be treated D) temporary but cannot be treated Answer: C Objective 7 30) _____ cancers are preventable. A) One-quarter of all B) One-third of all C) One-half of all D) All Answer: B Objective 8 4.2 True/False Questions 1) Cancer is characterized by uncontrolled growth of abnormal cells in the body. Answer: True Objective 1 2) Tumors that are classified as cancer are called benign. Answer: False Objective 2 3) A benign tumor may grow and enlarge in an area but will not invade surrounding tissue or spread to other parts of the body. Answer: True Objective 2 4) Under a microscope the cells of a malignant tumor do not resemble cells of their origin. Answer: True Objective 2 5) Most benign tumors are named by adding the suffix -itis to the prefix that designates the cell or tissue origin. Answer: False Objective 3 6) An adenocarcinoma is a malignant tumor of a gland. Answer: True Objective 3 7) Sarcomas metastasize primarily through the blood. Answer: True Objective 3 8) Helicobacter pylori increases the risk for gastric cancer. Answer: True Objective 4 9) There are two main types of radiation linked to increased risk of cancer: ultraviolet and ionizing radiation. Answer: True Objective 4 10) Both specific and nonspecific immunity are involved in the elimination of abnormal cells, such as cancer. Answer: True Objective 4 11) Immunosuppressive medications decrease immune function and therefore decrease the risk for development of cancer. Answer: False Objective 4 12) The signs and symptoms of cancer will depend on the location of the tumor, its size, and how much it affects the organs or tissues in the area. Answer: True Objective 5 13) DNA repair genes instruct a cell to repair DNA and RNA. Answer: False Objective 5 14) Because the immune system should recognize and destroy mutated cells, cancer may indicate a failure of the immune system. Answer: True Objective 5 15) Particular viruses and bacteria can serve as carcinogens. Answer: True Objective 5 4.3 Short-Answer Questions 1) Abnormal cancer cells can infiltrate normal body tissue and in some cases spread or _____. Answer: metastasize Objective 1 2) The result of uncontrolled cell division is an abnormal growth of cells or a tumor, known as a _____. Answer: neoplasm Objective 1 3) Tumors that are not cancer are called _____ Answer: benign Objective 2 4) _____ tumors rarely reoccur after removal. Answer: Benign Objective 2 5) A benign tumor that projects from an epithelial surface is called a _____. Answer: polyp Objective 3 6) Malignant tumors of epithelial origin are named with the prefix that designates the cell or tissue of origin, followed by the term _____. Answer: carcinoma Objective 3 7) Hepatitis B and Hepatitis C viruses increase the risk for _____ cancer. Answer: liver Objective 4 8) The mechanism of all cancers is uncontrolled cell _____. Answer: division Objective 5 9) Suicide genes control _____ (programmed cell death) and tell the cell to kill itself if something goes wrong. Answer: apoptosis Objective 5 10) Inherited mutations in the tumor suppressor BRCA1 or BRCA2 genes increase a woman's risk of developing breast or _____ cancer. Answer: ovarian Objective 5 11) Mutations can be caused by _____ or cancer-causing agents or substances. Answer: carcinogens Objective 5 12) Tumor _____ are chemicals made by tumor cells that can be detected in blood. Answer: markers Objective 6 13) Magnetic _____ imaging is a type of scanning that uses magnetic fields, not x-rays, to induce tissues to emit radio waves. Answer: resonance Objective 6 14) In most cases a _____ must be done for a cancer diagnosis by taking a small tissue sample to be viewed under a microscope. Answer: biopsy Objective 6 15) In the TNM staging system, the letter "N" stands for _____. Answer: node Objective 6 WORKSHEET 3: Discussion Questions and Answers 4.4 Discussion Questions 1. Briefly describe the process of tumor formation. Answer: As an adult, most cells divide only to replace worn out or dying cells or to repair injuries. Sometimes cell division becomes uncontrolled; cells do not die when they should and new cells form when the body does not need them. The result of uncontrolled cell division is an abnormal growth of cells or a tumor. 2. Most benign tumors are named by adding the suffix -oma to the prefix that designates the cell or tissue of origin. Name three of the prefixes and their cell or tissue of origin. Answers: adeno- gland angio- vessels chondro- cartilage fibro- fibrous tissue hemangio- blood vessels lymphangio- lymph vessels lipo- fat myo- muscle neuro- nerve osteo- bone 3. Certain infections increase the risk of some types of cancer. Name two of those infectious agents and what tissue is at risk. Answers: Human papillomavirus increases the risk for cancers of the cervix, penis, vagina, anus, and vulva. Hepatitis B and Hepatitis C viruses increase the risk for liver cancer. Epstein-Barr virus increases the risk for lymphoma and nasopharynx cancer. Human herpesvirus 8 has been found in nearly all tumors in patients with Kaposi sarcoma. Human T-lymphotrophic virus-1 has been linked to adult T-cell leukemia. Helicobacter pylori increases the risk for gastric cancer. 4. Describe some of the signs and symptoms of cancer and why they occur. Answer: Signs and symptoms of metastasized cancer may appear in different parts of the body. General signs and symptoms include: Unexplained weight loss: may result from cancer cells competing for nutrients, often at the expense of normal cells' growth and metabolism. Fever: a systematic response to infection or a foreign substance. Fatigue: may result from the cancer's effect on the body or the body's response to the cancer. Pain: can result from the malignant tumor putting pressure on nerves, bones, or organs. Skin changes: serves as a marker for underlying internal disease. 5. Explain what the initials TNM stand for and what it means. Answer: T stands for tumor; it is based on the size of the original (primary) tumor and whether it has grown into nearby tissues. N stands for node; it tells whether the cancer has spread to the nearby lymph nodes. M stands for metastasis; it tells whether the cancer has spread to distant parts of the body. 6. Pick one initial of TNM cancer staging and identify what the different stages are and what they mean. Answers: T (Tumor) TX Tumor can't be measured. TO No evidence of primary tumor Tis Cancer cells are only growing in the most superficial layer of tissue without growing into deeper tissues. This may also be called in situ cancer. T1–4 Describe the tumor size and/or amount of spread into nearby structures. The higher the T number, the larger the tumor and/or the more it has grown into nearby tissue. N (Nodes) NX Nearby lymph nodes cannot be evaluated. NO Nearby lymph nodes do not contain cancer. N1–3 Describe the size, location, and/or the number of lymph nodes involved. The higher the N number, the more lymph nodes there are that contain cancer. M (Metastasis) MX Metastasis cannot be evaluated. MO No distant metastasis was found. M1 Distant metastasis found. 7. Besides surgical intervention, there are four different types of therapy that may be used for cancer. Pick one of the four and describe how it is used and how it is effective. Answers: Radiation therapy uses high-energy rays to damage DNA of cells, interfering with cell division and growth. Both normal and cancer cell DNA is damaged during radiation therapy. Chemotherapy uses medications that target rapidly dividing cells and therefore kills cancer cells and some normal cells. Normal rapidly growing cells include blood cells, bone marrow cells, cells of hair follicles, and cells that line the digestive tract. Hormone therapy. Some cancers need hormones to grow. Hormone therapy medications can suppress hormone synthesis or block the actions of hormones. Immunotherapy stimulates and strengthens the immune system so it can recognize and kill cancer cells.