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Module 19: Cancer Medicine (Oncology)

Introduction

In this module, you will learn medical terminology associated with cancer
medicine, or oncology. When you complete this module, you should be
familiar with terms that describe the growth and spread of tumors;
causes, diagnosis, and treatment of cancer; as well as tumor
classifications and tests and procedures used to diagnose and treat
various types of cancer.

Exercises in all modules may require you to use word parts either
introduced in earlier modules or provided only in your text, so have your
text available for ready reference as you work through the exercises in
this module. Remember that this integrated learning program is intended
as a supplement to your text—not as a substitute.

Each section ends with a quiz that covers the objectives of that section.
The quizzes will be scored and will be used to help measure what you've
learned in that section.

NOTE: Not all terms presented in your text will appear in this module. At
the same time, some additional terms may have been added to the
module to further apply what you've learned in your text.
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Module Objectives

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In this module, you will learn to:

         Identify medical terms that describe the growth and spread of
          tumors.
         Recognize terms related to the causes, diagnosis, and treatment of
          cancer.
         Review how tumors are classified and described by pathologists.
         Describe x-ray studies, laboratory tests, and other procedures used
          by physicians for determining the presence and extent of spread
          (staging) of tumors.
         Apply your knowledge to understanding medical terms in their
          proper contexts, such as medical reports and records.
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Section I: Carcinogenesis and Cancer Diagnosis

Section I Objectives

In this section you should strive to recognize and use terms related to
carcinogenesis and techniques for diagnosing cancer. In particular, you
should be able to:

      Identify medical terms that describe the growth and spread of
       tumors.
      Recognize terms related to the causes, diagnosis, and treatment of
       cancer.
      Describe x-ray studies, laboratory tests, and other procedures used
       by physicians for determining the presence and extent of spread
       (staging) of tumors.
      Apply your new knowledge to understanding medical terms in their
       proper contexts, such as medical reports and records.
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Lesson 1: Types of Tumors

1.1 Threaded Case Study: Mr. Brazzali

Fig. 19-1




Oncology is the study (-logy) of diagnosis and treatment of tumors
(onc/o). To help us understand the etiology, spread, detection, and
treatment of cancer (CA), let's meet Mr. Brazzali, an 82-year-old retired
sheet metal worker who now grows chestnut trees. Mr. Brazzali has come
to the clinic concerned about recent weight loss and shortness of breath.

Dr. Anna Scott, a physician specializing in diseases and treatment of the
respiratory system, listens to Mr. Brazzali's breathing. Dr. Scott checked
Mr. Brazzali's O2 saturation and asks Mr. Brazzali several questions
regarding his previous job as well as how much weight he has lost and in
what period of time. Dr. Scott has ordered several labs and also requests
chest x-rays.

We'll consider Mr. Brazzali's symptoms as we learn about cancer detection
and treatment.
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Lesson 1: Types of Tumors

1.2 Tumors

Fig. 19-2




It's no surprise (given the topic of this module and your text chapter) that
Mr. Brazzali is going to be assessed for the possibility of cancer. Most
people—including Mr. Brazzali—think of any tumor as cancer. But, of
course, not all tumors are cancerous. A tumor, or neoplasm, in itself, is
nothing more than a mass or growth that arises from normal tissue. A
benign tumor is not cancerous. It does not invade and it does not spread
to other sites. A malignant, or cancerous, tumor is characterized by
continuous growth. It is also invasive and infiltrative—that is, it extends
beyond normal tissue boundaries into nearby healthy tissues. In other
words, it undergoes spreading, or metastasis (mets): -stasis = control;
meta- = beyond, change. Benign tumors grow slowly; malignant tumors
grow rapidly.
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Lesson 1: Types of Tumors

1.3 Benign vs. Malignant Tumors (Animation)

Fig. 19-3




Look closely at the cellular makeup of these two types of tumors. The cells
that make up benign tumors are composed of differentiated, or
specialized, cells that form in an organized manner, similar to their normal
counterparts. Malignant cells undergo dedifferentiation so that they are
much more primitive or embryonic, reverting to a less specialized state.
Another name for this characteristic is anaplasia (ana- means
backward). These anaplastic or malignant cells are disorganized as they
come together, too. Cancer cells require less oxygen; therefore, most
malignant cells contain fewer mitochondria than normal cells.




Benign vs. Malignant Neoplasms

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19s01l0303/19s01l0303p1.htm
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Lesson 1: Types of Tumors

1.4 <Catch That? icon>Activity: Catch That?




Did you catch that? The difference between benign tumors and
malignant tumors is that malignant cells are not ___________, or
specialized.

Type your answer in the text box below, then click Submit to check your
answer.




differentiated



Believe it or not, cancer cells were once normal, but they have reverted to
a less specialized state! In benign (or noncancerous) tumors, cells are
differentiated or specialized. They form in an organized manner and are
similar to their normal counterparts. By contrast, malignant cells are
dedifferentiated or undifferentiated; we can describe them as much more
primitive or embryonic; that is, they were once normal but have now
reverted to a less specialized state. Another name for this characteristic is
anaplasia.

Want a quick review to reinforce this fact? Click on the following link to
review Screen 1.3. Or if you prefer, you can come back to it later.

Click here to proceed.
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Lesson 1: Types of Tumors

1.5 Threaded Case Study: Mr. Brazzali

Fig. 19-4




In assessing Mr. Brazzali’s morbidity—that is, his condition of being
unwell—Dr. Scott has ruled out pneumonia and emphysema, along with
several other lung disorders. Mr. Brazzali's chest x-ray exhibited
abnormalities that were suggestive of cancer and needed further work-up.
Dr. Scott will refer Mr. Brazzali to an oncologist.

"Whatever happens, happens," Mr. Brazzali says. "I'm 82 years old and
expecting most anything. The important thing is to buy me enough time
to get my son and grandson out here to plant some chestnut trees
together. They stopped speaking a couple of years ago. All I need is a few
months with them to pass on the chestnut trees—and get my boys back
together again."

As Dr. Scott turns her back, she hears Mr. Brazzali say, "They're a rarity."

She turns back again. "The boys or the chestnuts?"

Mr. Brazzali only smiles.
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Lesson 1: Types of Tumors

1.6 Histogenesis

Fig. 19-5




With so many types of cancer in existence, how can we keep track of
similarities for research, development, diagnostic, and treatment
purposes? The most logical way to categorize these cancers is by
histogenesis. The combining form hist/o means tissue and the suffix
-genesis means origin, so histogenesis refers to the type of tissue from
which tumor cells originate.

For instance, let's look at the distribution of sites for the largest group of
tumors—the solid tumor carcinomas (carcin/o = cancer, cancerous). A
solid tumor is one composed of a mass of cells. Carcinomas occur in
epithelial tissue lining both the external and internal body surfaces,
including skin and glands, as well as the digestive, urinary, and
reproductive organs. This group comprises about 90% of all malignancies.
Screen 7 of 12

Lesson 1: Types of Tumors

1.7 Epithelial Tumors

Fig. 19-6




One of the reasons benign tumors do not invade surrounding tissue is the
fact that they are often encapsulated; that is, they are held within a
fibrous capsule. We saw this demonstrated in the animation in a previous
screen.

Benign tumors that occur in the epithelial sites associated with the
carcinoma sites are called adenomas, rather than carcinomas, which
suggests malignancy. For instance, a gastric adenoma is a benign tumor
of the glandular epithelial cells that line the stomach (Fig. A). By contrast,
a gastric adenocarcinoma is a cancerous (carcin/o) tumor (-oma) of
the glandular (aden/o) cells lining the stomach (Fig. B).
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Lesson 1: Types of Tumors

1.8 <Activity icon>Activity: Word Shop: Types of Tumors

   Objective: Review how tumors are classified and described by
   pathologists.


http://www.coursewareobjects.com/objects/chabner8e_v1/mod19Activitie
s/19s01l0101p1.htm
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Lesson 1: Types of Tumors

1.9 Connective Tissue Tumors

Fig. 19-7




Much less common are the sarcomas, which are derived from connective
tissues such as bone, fat, muscle, cartilage, bone marrow, and lymphatic
tissue (sarc/o = flesh, connective tissue). They commonly arise in the
mesenchymal tissue, that is, embryonic connective tissue. For example,
osteosarcoma is a tumor (-oma) of bone (oste/o) and connective
tissue (sarc/o). Sarcomas can also occur in the lymphatic system, which
is the site of origin of lymphoma, or in bone marrow, in which case the
sarcoma becomes leukemia, a disease of blood-forming organs (-emia)
in which bone marrow is replaced by proliferating leukocytes and their
precursors (leuk/o). Cancer in the connective tissue in the brain is a
glioma. A neuroblastoma is a childhood cancer arising from immature
tissues in the autonomic nervous system or the adrenal medulla
(-blastoma = immature tumor). Another childhood cancer is
retinoblastoma, which arises from immature cells in the retina, the light-
sensitive surface at the back of the interior of the eye.
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Lesson 1: Types of Tumors

1.10 Mixed-Tissue Tumors

Fig. 19-8




The third category of tumors is the mixed-tissue tumors, which are
derived from several different types of cells capable of differentiating into
both epithelial and connective tissue. Sites for these are the kidneys,
ovaries, and testes.

Mr. Brazzali's chest x-rays showed a nodular mass covering the pleural
surface. Dr. Scott has referred Mr. Brazzali to an oncologist, Dr. Simmons.
"This nodular mass may very well be cancerous," explains Dr. Simmons.

Dr. Simmons decides to do the least invasive biopsy possible. Keeping
possible environmental exposures from Mr. Brazzali's former sheet metal
profession in mind, the cell types she'll be looking for (and just discussed)
are either epithelial, sarcomatous, or mixed tissue.
Screen 11 of 12

Lesson 1: Types of Tumors

1.11 Malignant Tumors (Animation)

Fig. 19-9




The main characteristic of any cancer is the unrestrained hyperplasia,
excessive (hyper-) growth or development (-plasia) of cells, resulting in
accumulations known as malignant tumors. Unchecked, these tumors will
compress, invade, and eventually destroy the surrounding tissue. They
can spread from their primary sites to distant sites in a process called
metastasis. We will look at this progression in more detail later. First,
let's look closely at what happens on the cellular level.




Malignant Tumors




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19s01l0311/19s01l0311p1.htm
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Lesson 1: Types of Tumors

1.12 <Activity icon>Activity: Word Shop: Types of Tumors

Let's review the material covered in this lesson.

   Objective: Identify medical terms that describe the growth and spread
   of tumors.

   Objective: Recognize terms related to the causes, diagnosis, and
   treatment of cancer.

   Objective: Review how tumors are classified and described by
   pathologists.



http://www.coursewareobjects.com/objects/chabner8e_v1/mod19Activitie
s/19s01l0101p2.htm
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Lesson 2: Carcinogenesis

2.1 Carcinogenesis

Fig. 19-10




Although carcinogenesis, the origin and development of cancer, is still
pretty mysterious, familiarizing ourselves with the role of the genetic
material of a cell—its DNA, or deoxyribonucleic acid—can help us at
least partially understand this phenomenon. Malignancies arise from
damage to this DNA. However, the precise role a genetic tendency really
plays in the development of certain cancers will be under investigation for
a long time to come.

Here we see a cell in early mitosis. The chromosomes are made up of
strands of DNA in the cell nucleus.
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Lesson 2: Carcinogenesis

2.2 Mitosis

Fig. 19-11




Every time a cell divides, the DNA material in each chromosome copies
itself, thus helping to control cell division by ensuring that the same DNA
is passed to the two new daughter cells. Cell division, proliferation, and
differentiation into specialized new cells are the normal process in every
body system. This cell division process is mitosis.

Between divisions, DNA remains active, engaged in producing new
proteins such as hormones and enzymes that are essential for growth.
This protein synthesis is under the direction of the DNA's coded genes.
Each gene is made up of units called nucleotides. The DNA helps copy
the gene's coded instructions onto another molecule called RNA, or
ribonucleic acid, a cellular substance that represents a copy of the DNA
and which delivers these instructions from the nucleus to the cell's
cytoplasm to direct the formation (-plasm) of new protein inside cells.
Screen 3 of 11

Lesson 2: Carcinogenesis

2.3 Formation of Malignant Cell

Fig. 19-12




When a cell becomes malignant, it reproduces almost continuously, and
abnormal proteins are made. These cancer cells are referred to as
anaplastic, meaning "reversed (ana-) development (plas/o)." In other
words, the cell has reverted to its embryonic type in which it is no longer
capable of differentiation or specialization. The bottom line is this: Its DNA
has stopped making the necessary codes.

When this happens, the control genes within the DNA malfunction. They
become dysfunctional cellular oncogenes, cancer-causing pieces of DNA
that, when activated, now become malignant, sending altered cellular
programs that cause cells to proliferate uncontrolled, invade neighboring
tissues, and metastasize. Passed on to daughter cells, this change in DNA
is called a mutation (-genic = produced by; mut/a = genetic change).
Viral oncogenes are pieces of DNA specifically from viruses that infect a
normal cell and cause it to become malignant. A virus is an infectious
agent that uses the host’s genetic material to make copies of itself.
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Lesson 2: Carcinogenesis

2.4 Causative Factors in Cancer

Fig. 19-13




Mr. Brazzali has already told the nurse and Dr. Simmons that he used to
be a sheet metal worker. This history can be helpful in discerning
exposures to possible disease-carrying substances. In the potential cancer
case, occupational and environmental hazards may help alert the
examiner to possible carcinogens, or cancer-causing agents. Keeping
occupational and environmental hazards in mind, take time to reflect on
possible hazards Mr. Brazzali's work may have exposed him to. Let's look
at a few now.

There are several factors that can lead to these changes. In some cases,
environmental factors damage DNA through such vehicles as toxic
chemicals and substances such as asbestos, sunlight, and tobacco smoke.
In some cases, viruses establish changes in the cell that are then passed
on in mitosis to daughter cells. This is referred to as a mutation, which
can then lead to malignant growth.
Screen 5 of 11

Lesson 2: Carcinogenesis

2.5 Environmental Carcinogens

Fig. 19-14




Let's have a closer look at some of the most well known of these
carcinogens—the environmental agents that cause cancer.

What do you predict these photographs have in common? If you guessed
that each is a source of radiation, you are correct. Radiation is a type of
carcinogen that can take many forms. X-rays, sunlight, atomic
explosions, and radioactive substances may cause DNA mutations that can
cause leukemia, a cancer of the white blood cells, or skin cancer.

Mr. Brazzali has never smoked, had few x-rays, and often his work has
been inside. He was exposed to some explosives in World War II, but the
fact that he was a sheet metal worker for more than 45 years, beginning
in the 1940s, makes Dr. Simmons want to ask him more questions about
certain types of duct insulation he may have come in contact with.
Screen 6 of 11

Lesson 2: Carcinogenesis

2.6 Oncogenic Carcinogens

Fig. 19-15




In the case of this next type of carcinogen (an oncogenic, or cancer-
causing, virus), two kinds of cancer can occur: that caused by RNA
viruses, or retroviruses, and that caused by DNA viruses. Typical cancers
in these categories include human T cell leukemia; Kaposi sarcoma,
which is associated with AIDS; cervical cancer, which is caused by the
papilloma virus; and a tumor of the lymph nodes. Metastasis results
when the cancer spreads to other tissues in the body, as shown here.
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Lesson 2: Carcinogenesis

2.7 Apoptosis

Fig. 19-16




Interestingly enough, mutations do not always lead to uncontrolled cell
growth—sometimes they block DNA repair (leading to malignant tumor
development), or they may act instead to prevent the cells from dying.
This happens if the cancer cell loses the codes or genes that direct aging
or cell death. This programmed cell death that is part of the life cycle of a
normal cell is called apoptosis (apo- = off, away; -ptosis = droop, sag,
or prolapse). A loss of apoptosis can enable the cancer cell to live
indefinitely.
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Lesson 2: Carcinogenesis

2.8 Hereditary Factor

Fig. 19-17




Of great concern is the issue of heredity: Some forms of cancer can be
inherited—transmitted to offspring through DNA defects within egg or
sperm cells. Tumors in this category are thought to arise because of a loss
of suppressor genes, which regulate growth, promote cell specialization or
differentiation, and suppress oncogenes from causing cancer. For
instance, loss or mutation of the retinoblastoma gene (Rb-1) causes a
tumor of the retina of the eye; a loss or mutation of the p53 gene on
chromosome 17 can cause a number of cancers from colon to breast
cancer.

Mr. Brazzali does not report any family tendencies that would lead Dr.
Simmons to suspect this type of carcinogenesis.
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Lesson 2: Carcinogenesis

2.9 <Catch That? icon>Activity: Catch That?




Did you catch that? Some forms of cancer can be inherited—transmitted
to offspring through ________ defects within egg or sperm cells.

Type your answer in the text box below, then click Submit to check your
answer.




DNA



Your clue here is the word "inherited." There is a great deal of concern
about heredity in some forms of cancer, so you can probably figure out
from the word "inherited" in the question that these defects transmitted to
offspring happen through DNA. Tumors in this category are thought to
arise because of a loss of suppressor genes, which regulate growth,
promote cell specialization or differentiation, and suppress oncogenes
from causing cancer.

Want a quick review to reinforce this fact? Click on the following link to
review Screen 2.8. Or if you prefer, you can come back to it later.

Click here to proceed.
Screen 10 of 11

Lesson 2: Carcinogenesis

2.10 Toxic Chemical Carcinogens; Mesothelioma

Fig. 19-18




Dr. Simmons asks Mr. Brazzali, "Did you ever work with asbestos?"

"All the time!‖ he says, ―Until they stopped using it, it was all over the
place."

A common group of carcinogens, the toxic chemical carcinogens, include
the hydrocarbons associated with all forms of smoking and exhausts as
well as other chemicals found in insecticides, dyes, industrial chemicals,
insulation, and even hormones, such as the pregnancy hormone
diethylstilbestrol (DES). For many years, construction workers—in
particular sheet metal workers and roofers—were unknowingly exposed to
asbestos in the products required in their work. After decades of use,
asbestos was found to be one of the most deadly carcinogens, causing a
rare form of lung cancer called mesothelioma.

As a retired sheet metal worker, our patient, Mr. Brazzali, is certainly a
candidate for screening for this type of cancer. In the next lesson, we will
begin patient assessment.
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Lesson 2: Carcinogenesis

2.11 <Activity icon>Activity: Fill-in: Carcinogenesis

Let's review the material covered in this lesson.

   Objective: Identify medical terms that describe the growth and spread
   of tumors.

   Objective: Recognize terms related to the causes, diagnosis, and
   treatment of cancer.

Engine Type    Fill-In (drag and drop)
Screen         <<Drag each term to its definition.>>
Appearance




Engine         Fill-In Flash Engine
Specifications      Use engine master: fillin.swf
                    Engine Size: 580 x 300 pixels
                    Will accommodate an image
                    Questions
                         o Optional randomizing
                         o Maximum # = 10
                         o Maximum # characters per question = 200
                    Answer Choices
                         o Learner drags answer choice to field
                         o Optional randomizing
                         o Maximum # correct = 10
                         o Maximum # distracters = 6
                         o Maximum # characters = 17
                    Feedback
                         o None at the present time
                    Displays inline, framed
Scenario text
               Bold correct answer(s) in each question
Question 1     Origin and development of cancer: carcinogenesis
Question   2   Malignancies arise from damage to DNA.
Question   3   Made up of strands of DNA in the cell nucleus: chromosomes
Question   4   Cell division process: mitosis
Question   5   Cellular substance that represents a copy of the DNA and which
               delivers these instructions from the nucleus: ribonucleic acid
Question 6     Units that, together, compose a gene: nucleotides
Question 7     Pertaining to reversed development: anaplasia
Question 8     Cancer-causing pieces of DNA that, when activated, become
               malignant, sending altered cellular programs that cause cells to
               proliferate uncontrolled, and metastasize: oncogenes
Question 9     Abnormal change in DNA passed on to daughter cells: mutation
Question 10    Programmed cell death that is part of the life cycle of a normal cell:
               apoptosis
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Lesson 3: Laboratory Tests and Endoscopy

3.1 Laboratory Testing

Fig. 19-19




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A number of laboratory tests aid in detecting either cancer or conditions
associated with cancer. Perhaps one of the most simple is the stool
guaiac test. This chemical test acts on the feces to detect blood in the
patient's stool. However, not every laboratory test is intended strictly for
diagnosis. For instance, the concentration of estrogen receptors (ERs)
in tumor cells of breast cancer patients is used more to guide treatment
choices than to diagnose. The estrogen (estradiol) receptor assay
pinpoints the tumor's receptivity to estrogen. If this is positive, the patient
is likely to respond to antiestrogen hormone therapy.
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Lesson 3: Laboratory Tests and Endoscopy

3.2 Specific Cancer Assays

Fig. 19-20




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Other tests used specifically for cancer assays measure tumor-generated
proteins, or protein markers, that are present in the bloodstream. Several
examples of these protein marker tests include the CA-125 test and
the CEA test, which detects carcinoembryonic antigen (CEA), associated
with colorectal and other GI tumors. Other assays include the following:

         Acid phosphatase test and the prostate-specific antigen
          (PSA) test (for prostate cancer)
         Beta-hCG test, which is used to detect the presence of human
          chorionic gonadotropin (hCG) in serum (for testicular cancer)
         Alpha-fetoprotein test (testicular and liver cancers)
         Cytogenetic analysis, which examines chromosomes for breaks,
          translocations, or deletions of DNA, which is used for leukemia and
          other cancers
         Immunohistochemistry (IHC), which localizes antigens or
          proteins in tissues using marked antibodies to assess presence and
          amount of specific molecules in both normal and tumor cells

Finally, if Mr. Brazzali’s cancer has a genetic component, his son and
grandson may be eligible for genetic screening, which tests family
members to determine whether they have inherited a cancer-causing
gene.
Screen 3 of 9

Lesson 3: Laboratory Tests and Endoscopy

3.3 Threaded Case Study: Needle Biopsy

Fig. 19-21




Mr. Brazzali is having even more shortness of breath, with some
abdominal swelling. A chest x-ray has shown that he has fluid
accumulating between the lining of his lungs and his chest cavity—or
pleural effusion—that is making his breathing more difficult. As more
fluid accumulates, his shortness of breath (or dyspnea) and the pain he
sometimes experiences are increasing. A biopsy (bx), which removes a
living (bi/o) tissue sample for visual examination (-opsy), will be the
next diagnostic step.

To relieve this shortness of breath from effusion, Dr. Simmons has
scheduled a needle biopsy with fine needle aspiration (as illustrated)
by either of two methods: either by removing a thin core of tissue from an
organ or mass using a large-bore needle (called core needle biopsy) or
by extracting or aspirating free cells from a fluid-filled cavity or from
inside a solid tumor mass using a fine needle; this second procedure is
called fine needle aspiration (FNA) biopsy.
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Lesson 3: Laboratory Tests and Endoscopy

3.4 Threaded Case Study: Thoracocentesis

Fig. 19-22 DEVELOPER: Pasted-in ill. Keeps showing up corrupted
with black background. Original ill. can be picked up at:

NEW ART Source:
http://coursewareobjects.elsevier.com/objects/leonard_quick5e
_v1/mod08/images/08s03l0110.gif




               QuickTime™ and a
                 decompressor
        are needed to see this picture.




Needle biopsy does much more than relieve the pressure from fluid
accumulation, however. Another key purpose of this procedure is to
enable the specialist to examine cells with minimal invasion.

In the presence of a pleural effusion (Fig. A), excessive fluid can
accumulate in the pleural space. When the cause is unknown, diagnostic
thoracocentesis (Fig. B), also called thoracentesis, is useful for
diagnosis. It consists of a surgical puncture by insertion of a needle or
catheter into the pleural space (thorac/o) to obtain pleural fluid for
analysis (-centesis means surgical puncture to remove fluid).
Screen 5 of 9

Lesson 3: Laboratory Tests and Endoscopy

3.5 Bone Marrow Biopsy

Fig. 19-23




Bone marrow biopsy is a very similar procedure except that, of course,
bone marrow is the material to be aspirated and examined microscopically
for evidence of cancerous cells.
Screen 6 of 9

Lesson 3: Laboratory Tests and Endoscopy

3.6 <Catch That? icon>Activity: Catch That?




Did you catch that? Needle biopsy and bone marrow biopsy have a
process called ________ in common.


Type your answer in the text box below, then click Submit to check your
answer.




aspiration



These seem, on the surface, like quite different procedures. A needle
biopsy can be used to relieve the pressure from fluid, but it also enables
the specialist to examine cells with minimal invasion by either of two
methods: either by removing a core of tissue from an organ or mass or by
removing free cells from a fluid-filled cavity or mass. In bone marrow
biopsy, the thing that changes is the material to be aspirated and
examined microscopically for evidence of cancerous cells, that is, the bone
marrow. But in both procedures, aspiration is the (very important)
common denominator.

Want a quick review to reinforce this fact? Click on the following link to
review Screens 3.4 and 3.5. Or if you prefer, you can come back to it
later.

Click here to proceed.
Screen 7 of 9

Lesson 3: Laboratory Tests and Endoscopy

3.7 Pap Smear

Fig. 19-24

DEVELOPER: This Pap smear image keeps disappearing or showing
up “muddied”. Please pick up from previous edition, unchanged,
at:

http://www.coursewareobjects.com/objects/chabner8e_v1/mod
19/images/19s01l0506.gif




In exfoliative cytology, the suspicious region is scraped for cell
examination under a microscope. The Papanicolaou (Pap smear) is one of
the most common forms of this test and helps to test for carcinoma of the
cervix or vagina.
Screen 8 of 9

Lesson 3: Laboratory Tests and Endoscopy

3.8 Endoscopic Procedures

Fig. 19-25




A fiberoptic colonoscopy (Fig. A) allows visual examination of the colon
using a fiberoptic instrument and without the need for an incision. A
slightly more invasive procedure is the laparoscopy or laparoscopic
surgery, or peritoneoscopy (Fig. B). A small incision is made in the
abdominal wall for insertion of a laparoscope (or peritoneoscope). This
provides for inspection of the abdominal cavity for tumors.

Of course, in a staging laparotomy, a much wider incision in the
abdomen allows the examiner to explore the abdominal cavity to
determine, more specifically, the extent of the spread of a malignant
disease.
Screen 9 of 9

Lesson 3: Laboratory Tests and Endoscopy

3.9 Activity: [Take It In icon] “Take It In!”

Fig. 19-26

NEW ART Source: Photos.com #4824794

Let’s review material covered in this lesson.

   Objective: Describe x-ray studies, laboratory tests, and other
   procedures used by physicians for determining the presence and
   extent of spread (staging) of tumors.

   Objective: Apply your new knowledge to understanding medical terms
   in their proper contexts, such as medical reports and records


Engine Type     “Take It In!” (multiple choice)
Screen
Appearance      Screen will show Patient Photo plus Scenario, plus
                question (for easy referral to Scenario while
                solving). Designer may exhibit either (1) all
                questions or (2) one question at a time (with ―Next‖
                arrow)—at Designer’s discretion.



Engine         Case Study Flash Engine
Specifications    Use engine master: casestudychoices.swf
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Instructions    Click on the correct answer to each question.

Photo




                        QuickTime™ and a
                         decompressor
                are needed to see thi s pi ct ure.




Scenario text   Leila has been having increasing problems with
                shortness of breath, diffuse lower back pain, weight
                loss, and inexplicable feelings of anxiety.

                ―By the time I get home from work,‖ she says, ―I’m
                so exhausted I don’t want to eat. I don’t have any
                energy left to even speak, let alone play with my
                granddaughters.‖

                On auscultation, the physician can hear that she
                has fluid in her lungs.

Question 1      First of all, the physician schedules fine needle
                _________ to relieve pressure from fluid
                accumulation to relieve Leila’s shortness of breath.
Answer          Answer Choices
Choices         (Bold the correct response)
               biopsy
                effusion
                dyspnea
                aspiration
Question 2      Besides relieving Leila’s shortness of breath, the
                procedure used to relieve pressure from fluid
                accumulation can also be used to:
Answer          Answer Choices
Choices         (Bold the correct response)
               Inject chemotherapeutic agents
                Examine cells with minimal invasion
                Gently inject air into the pleural cavity to aid breathing
                Repair microscopic tears in the pleural lining
Question 3      The difference between core needle biopsy and fine
                needle technique is that core needle biopsy can:
Answer          Answer Choices
Choices         (Bold the correct response)
               Remove free cells from a fluid-filled cavity
                Remove free cells from a tumor mass
             Remove a thin core of tissue from an organ or mass
             Remove a small polyp or other abnormal structure in total

Question 4   Leila’s medical report indicates that at her last
             annual gynecologic checkup, she had a Pap smear
             procedure. This procedure is a type of:
Answer       Answer Choices
Choices      (Bold the correct response)
            Exfoliative cytology
             Endoscopic procedure
             Laparoscopy
             Aspiration
Question 5   Leila’s sister and mother both have had breast
             cancer. For this reason, Leila is a candidate for
             _________, even though she does not currently
             have breast cancer.
Answer       Answer Choices
Choices      (Bold the correct response)
            stool guaiac test
             genetic screening
             laparoscopy
             estrogen (estradiol) receptor assay
Question 6   Of the following tests, which is Leila most likely to
             receive if liver cancer is suspected?
Answer       Answer Choices
Choices      (Bold the correct response)
            Alpha-fetoprotein test
             PSA test
             Acid phosphatase test
             Chorionic gonadotropin
Question 7   __________ localizes antigens or proteins in tissues
             using marked antibodies to evaluate the presence
             of specific molecules in both normal and tumor
             cells.
Answer       Answer Choices
Choices      (Bold the correct response)
            Alpha-fetoprotein test
             Immunohistochemistry
             Acid phosphatase test
             Chorionic gonadotropin
Screen 1 of 6

Lesson 4: Imaging Procedures

4.1 Imaging Techniques

Fig. 19-27




Now with a diagnosis of mesothelioma, Dr. Simmons wants to do further
testing in the form of a PET scan to learn the stage, or extent, of the
disease. This will help her form the best treatment plan for Mr. Brazzali. A
positron emission tomography (PET) scan (Fig. A) uses the injection
of a radionuclide into a body part to be scanned. Recording the
distribution of radioactivity through emission of positrons creates a cross-
section image. What distinguishes this procedure from a CT scan is the
fact that radioisotopes are used instead of contrast and x-rays. An
imaging technique specifically for early cancer detection of the breast is
mammography (Fig. B); -graphy = process of recording; mamm/o =
breast.
Screen 2 of 6

Lesson 4: Imaging Procedures

4.2 Radionuclide Scans

Fig. 19-28




Of course, in addition to scopes, aspirations, and exfoliatives, other
diagnostic procedures involve imaging techniques. In radionuclide
scans, radioactive substances, injected intravenously, reveal
abnormalities in the organs that are scanned into images. Each type of
scan, however, must be read according to different rules. For instance,
the liver scan (Fig. A) demonstrates irregular distribution of radioactivity.
In this case, an absence of radioactivity indicates possible liver disease.
By contrast, look at the bone scan (Fig. B). In this case, the
interpretation is just the opposite: A concentration, rather than an
absence, of radioactivity suggests possible bone destruction and repair
associated with metastasis.
Screen 3 of 6

Lesson 4: Imaging Procedures

4.3 Thallium-201

Fig. 19-29




When the radioactive substance thallium-201 is used to detect head and
neck tumors, brain abnormalities appear as an increased accumulation of
radioactivity (as demonstrated in the illustration). This is because the
blood-brain barrier prevents normal brain tissue from taking up
radioactivity.
Screen 4 of 6

Lesson 4: Imaging Procedures

4.4 <Catch That? icon>Activity: Catch That?




Did you catch that? The reason the use of thallium-201 is so effective in
detecting head and neck tumors is that normal brain tissue cannot take up
________.

Type your answer in the text box below, then click Submit to check your
answer.




radioactivity



Because thallium-201 is a radioactive substance, we know that its use in
imaging is probably going to be to detect areas of radioactivity. The
blood-brain barrier prevents normal brain cells from taking up any
radioactivity; thus, those that show the presence of radioactivity
(specifically the presence of injected thallium-201) are abnormal.

Want a quick review to reinforce this fact? Click on the following link to
review Screen 4.3. Or if you prefer, you can come back to it later.

Click here to proceed.
Screen 5 of 6

Lesson 4: Imaging Procedures

4.5 Threaded Case Study: Mr. Brazzali’s Diagnosis

Fig. 19-30




Today Mr. Brazzali returned to the clinic needing relief for severe
shortness of breath. During fine needle aspiration (which we discussed in
the previous lesson), Dr. Simmons also performed a needle biopsy,
extracting cells from the pleural cavity. It is ultimately this needle biopsy
of the pleural lining of the lung that confirms a diagnosis of mesothelioma.
Screen 6 of 6

Lesson 4: Imaging Procedures

4.6 <Activity icon>Activity: Write It, Find It: Imaging Procedures

Let’s review material covered in this lesson.

   Objective: Describe x-ray studies, laboratory tests, and other
   procedures used by physicians for determining the presence and
   extent of spread (staging) of tumors.


Engine Type     Write It, Find It (text version)
Screen          <<Type in the correct answers.>>
Appearance




Engine         Write It, Find It Flash Engine
Specifications    Use engine master: writeit1.swf
                  Engine Size: 580 x 350 pixels
                  Questions
                        o No randomizing
                        o Maximum # = 10
                        o Maximum # characters per question = 200
                  Answer Choices
                        o Learner types answer in field
                        o No randomizing
                        o Maximum # correct = 10
                        o Maximum # characters = 17
                        o No distracters
                  Feedback
                        o Rationale of 250 maximum characters per question
                  Displays inline, framed
             Bold the correct answer(s) in each question
Question 1   A positron emission tomography scan uses the injection of a
             radionuclide into a body part to be scanned for production of a
             cross-sectional image or visual ―slice‖ of the area.
Rationale:   Recording the distribution of radioactivity through emission of
             positrons creates a cross-section image (remember: tom/o = to
             cut). What distinguishes this procedure from a CT scan is the fact
             that radioisotopes are used instead of contrast and x-rays.
Question 2   An imaging technique specifically for early cancer detection of the
             breast is mammography.
Rationale:   Here’s another case in which knowing your word parts solves the
             entire puzzle: -graphy = process of recording; mamm/o = breast.
Question 3   Rick has recently had a radionuclide scan of his liver; Eileen has
             just had a bone scan. Rick’s scan’s absence of radioactivity
             indicates possible liver disease. Eileen’s concentration of
             radioactivity suggests bone changes associated with metastasis.
Rationale:   Each radionuclide scan is read according to different rules. In a
             liver scan, an absence of radioactivity indicates possible disease.
             By contrast, it is a concentration, rather than an absence, of
             radioactivity that suggests possible bone destruction and repair
             associated with metastasis.
Question 4   Archie is administered thallium-201 to determine whether he might
             have a brain tumor. If he does, it will appear as a(n) increased
             amount of radioactivity.
Rationale:   When the radioactive substance thallium-201 is used to detect
             head and neck tumors, brain abnormalities appear as an increased
             accumulation of radioactivity. This is because the blood-brain
             barrier prevents normal brain tissue from taking up radioactivity.
Screen 1 of 1

Section I Quiz

You have completed Section I: Carcinogenesis and Cancer Diagnosis.

If you feel comfortable with all the information, you may return to the
module folder and begin the Section I Quiz. If you pass this quiz, you will
have fulfilled the objectives of this section.

Click Next to begin Section II: Tumor Classification and Treatment.
Screen 1 of 1

Section II: Tumor Classification and Treatment

Section II Objectives

In this section you should strive to recognize and use terms related to ear
pathology. In particular, you should be able to:

      Review how tumors are classified and described by pathologists.
      Recognize terms related to the causes, diagnosis, and treatment of
       cancer.
Screen 1 of 9

Lesson 1: Gross Descriptions of Tumors

1.1 Threaded Case Study: Mr. Brazzali

Fig. 19-31




Now that Mr. Brazzali has been diagnosed with mesothelioma, a lung
cancer caused by his years of exposure to asbestos in his work, he returns
to Dr. Simmons for grading and staging.

Today he is back, his "boys" with him. Dr. Simmons notices that one or
the other of them tends to hold Mr. Brazzali's arm or elbow as Mr. Brazzali
walks.
Screen 2 of 9

Lesson 1: Gross Descriptions of Tumors

1.2 Threaded Case Study: Cachexia

Fig. 19-32




Dr. Simmons is sorry to see that her patient has lost more weight in the
short time since his last appointment. Mr. Brazzali's weight loss is an
important concern here. Coupled with the exhaustion, anemia, weakness,
or asthenia, as well as his reported taste alterations, it is very likely that
he is beginning to experience the syndrome of cachexia. Characterized
by these symptoms, cachexia is the most severe (cac/o means bad;
-hexia means state or condition) form of malnutrition associated with
cancer. It leads to wasting, emaciation, and decreased quality of life.

Dr. Simmons is concerned about seeing cachexia so soon. She knows that
many of these clinical manifestations are not detected until after
metastasis, which is the spread of the cancer from the original or
primary tumor to multiple secondary tumor sites. For that reason, she
is anxious to classify tumor type, stage, and grade. Let's look at a few
tumor types now.
Screen 3 of 9

Lesson 1: Gross Descriptions of Tumors

1.3 <Catch That? icon>Activity: Catch That?




Did you catch that? Many clinical symptoms of cancer do not manifest
themselves until after ________, or the spreading of cancer from the
primary site to secondary sites.



Type your answer in the text box below, then click Submit to check your
answer.




metastasis



Knowing your word parts comes in handy here: The prefix meta- means
change or beyond, and the suffix -stasis means to stop, control, or place.
Metastasis is the change of distant cells beyond the primary site.

Want a quick review to reinforce this fact? Click on the following link to
review Screen 1.2. Or if you prefer, you can come back to it later.

Click here to proceed.
Screen 4 of 9

Lesson 1: Gross Descriptions of Tumors

1.4 Fungating Tumors

Fig. 19-33




Sometimes prognosis can be made based on what is referred to as gross
description of tumors—that is, their visual appearance to the naked
eye—or based on microscopic description of tumors, which is just
what it looks like. Let’s look at a few tumors that have distinctive visual
characteristics that fall under the category of gross observation.

Let’s start with with overall distinctive shapes. For example, tumors in the
colon are often fungating tumors with a mushrooming pattern of growth
(fung/i = fungus, mushroom), as seen in the photo. Notice how the cells
pile on top of one another and project from a tissue surface.
Screen 5 of 9

Lesson 1: Gross Descriptions of Tumors

1.5 Cystic Tumors

Fig. 19-34




Tumors can vary widely in appearance. Here we see two cystic tumors,
characterized by large open spaces filled with fluid (cyst/o = sac of fluid).
These are frequently found in the ovaries. Figure A is called a mucinous
tumor because it is filled with thick, sticky mucus. Figure B is a serous
tumor because it is filled with a watery fluid resembling serum (serous
means having the appearance of a thin, watery fluid, or serum).
Screen 6 of 9

Lesson 1: Gross Descriptions of Tumors

1.6 Medullary, Verrucous Tumors

Fig. 19-35




A medullary tumor (Fig. A) is frequently encountered in the breast or
thyroid. These tumors are large, soft, and fleshy (medull/o = soft, inner
part). The verrucous tumor (Fig. B) shows a definite wartlike pattern
(verruc/o = wart); these are most frequently seen in the gingiva or
cheek.
Screen 7 of 9

Lesson 1: Gross Descriptions of Tumors

1.7 Polyps

Fig. 19-36




Both of the tumors seen here are referred to as polypoid because they
have projection-like growths that extend outward from a base. They are
sometimes more familiarly referred to as polyps (-oid = resembling or
derived from; polyp/o = polyp). Polyps can be malignant or benign, but
they are usually benign. They are often found in the colon and, even when
benign, should be removed to prevent becoming malignant over time. The
sessile polypoid tumor extends from a broad base (the term sessile
means having no stem). The pedunculated polypoid tumor extends
from a stalk or stem (pedunculated means having a stem or stalk).
Screen 8 of 9

Lesson 1: Gross Descriptions of Tumors

1.8 Changes in Tumors

Fig. 19-37




Sometimes tumors take on new characteristics as they undergo, or cause,
changes. For instance, an inflammatory tumor (Fig. A), not surprisingly,
gets the name from the characteristic features of inflammation—redness
and swelling are evident here, but heat is another characteristic. These
changes occur when the tumor blocks the skin's lymphatic drainage. The
necrotic tumor (Fig. B) is so called because it contains dead tissue
(necr/o = death); tumors can sometimes outgrow their blood supply and
die.

Another change tumors may undergo is ulceration. An ulcerating tumor
(Fig. C) exhibits an exposed surface from the death of overlying tissue.

We have just looked at a few tumors that are distinguishable by gross
observation. In the next lesson, we’ll look at the more microscopic
changes tumors undergo as a result of dysplasia, an abnormality in
cellular development (plas/o; -plasia = formation).
Screen 9 of 9

Lesson 1: Gross Descriptions of Tumors

1.9 <Activity icon>Activity: Fill-in: Gross Descriptions of Tumors

Let’s review material covered in this lesson.


   Objective: Review how tumors are classified and described by
   pathologists.


http://www.coursewareobjects.com/objects/chabner8e_v1/mod19Activitie
s/19s01l0102p2.htm
Screen 1 of 9

Lesson 2: Microscopic Descriptions, Grading, and Staging of
Tumors

2.1 Cellular Level of Tumors

Fig. 19-38




The photographs we saw in the previous lesson show us characteristic
appearances of malignant tumors that can be seen with the naked eye—
that is, gross description of tumors. Even more characteristics are
visible on the microscopic or cellular level, under the category defined as
microscopic description of tumors.

Undifferentiated cells help us detect malignancies. You probably
remember that undifferentiated cells lack microscopic structures typical of
normal mature cells. Similarly, dysplasia is an abnormality in cellular
development (plas/o; -plasia = formation); dysplastic cells—adult cells
that are abnormal (dys-) in size, shape, and organization—certainly
exhibit highly abnormal cell formation, but they are not yet clearly
cancerous in appearance. Moles or nevi on the skin are good examples of
dysplastic cell growth.
Screen 2 of 9

Lesson 2: Microscopic Descriptions, Grading, and Staging of
Tumors

2.2 Metaplasia

Fig. 19-39

NEW ART Source:
http://coursewareobjects.elsevier.com/objects/elr/Huether4e/IC
/jpg/Chapter03/003001.jpg

DEVELOPER: My PhotoShop App is not functioning for some
reason. Please crop this diagram to show only (a) Normal and (b)
Metaplasia. Thanks!




One interesting phenomenon is metaplasia, in which adult differentiated
cells transform to differentiated tissue of another kind (meta- = beyond;
change). What makes this fascinating is the fact that it is reversible. For
instance, a habitual cigarette smoker may experience a change in the
shape and structure of the pulmonary epithelial cells. If he or she stops
smoking, this abnormal cellular change can reverse itself.
Screen 3 of 9

Lesson 2: Microscopic Descriptions, Grading, and Staging of
Tumors

2.3 Carcinoma in Situ

Fig. 19-40




A third early sign of possible malignancy that can be captured only on the
cellular level is that of the carcinoma in situ (top). These localized tumor
cells are cancerous but have not yet invaded adjacent structures. The
excellent cure rate for cancer of the cervix owes success to the fact that it
frequently begins as a carcinoma in situ.

By contrast, a less encouraging sign is diffuse tumor growth (bottom).
It is clear that this cancer is spreading evenly throughout the affected
tissue. This level of involvement is characteristic of malignant lymphomas
as they spread through the lymph nodes.
Screen 4 of 9

Lesson 2: Microscopic Descriptions, Grading, and Staging of
Tumors

2.4 Microscopic Examination of Tumors

Fig. 19-41

EDITOR: Please note: Please do not link “alveolar” in this screen
to the Glossary. The definition there is for pulmonary alveoli, and
these alveolar tumor cells have nothing to do with the lungs (and
in fact don’t develop in the lungs at all). Thanks!




Besides helping to anticipate malignancy, microscopic examination of
tumors reveals specific cell types that can also help in the diagnosis and
treatment planning.

Alveolar tumor cells (Fig. A) form patterns that resemble small,
microscopic sacs (alveol/o). These are commonly found in tumors of
muscle, bone, fat, and cartilage. In Figure B, we see the thin, platelike
epidermoid cells, frequently encountered in the respiratory tract. Finally,
the follicular tumor cells (Fig. C) are common in thyroid gland cancer
and can form glandular sacs of their own (follicul/o = small glandular
sacs).
Screen 5 of 9

Lesson 2: Microscopic Descriptions, Grading, and Staging of
Tumors

2.5 Nodular, Papillary Cells

Fig. 19-42




The nodular cells (Fig. A) are often seen in malignant lymphomas when
there is extended lymph node involvement; contrast their tightly packed
clusters with the lightly populated areas in between. Papillary cells (Fig.
B) are characterized by finger-like or nipple-like (papill/o) projections
and are frequently seen in bladder cancer.
Screen 6 of 9

Lesson 2: Microscopic Descriptions, Grading, and Staging of
Tumors

2.6 Pleomorphic, Scirrhous Tumors

Fig. 19-43




Remember earlier in Section 1 when we talked about mixed-cell tumors?
These are just what their name implies: tumors made up of a mixed
variety of cell types. At the cellular level, this type of tumor is referred to
as pleomorphic (Fig. A); -ic = pertaining to; ple/o means many or
more; morph/o means shape or form. Note the variation in cell types
within the tumor. An interesting contrast is the scirrhous tumor (Fig. B).
Scirrhous tumors are densely packed and overgrown with fibrous tissue
(scirrh/o = hard). The term scirrhous means hard. These cell types are
common in breast or stomach cancers.

Mr. Brazzali's tumor is of a mixed-tissue type, something consistent with
his diagnosis of mesothelioma. Thus, Dr. Simmons' next step is in grading
and staging the tumor.
Screen 7 of 9

Lesson 2: Microscopic Descriptions, Grading, and Staging of
Tumors

2.7 Grading Cancerous Tumors

Fig. 19-44




Whatever the tumor type, degrees of tumor maturity and advancement
must be measured in some way. Two systems for this exist: grading and
staging.

Grading is based on the microscopic appearance of the tumor cells. What
the pathologist looks for specifically is the degree of maturation or
differentiation. For example, the grade I tumor is well differentiated,
closely resembling the normal tissue of origin. The more advanced grade
IV cells are anaplastic, or undifferentiated, so that it is difficult to
recognize what might be original tissue (-tic = pertaining to; ana- =
backward; plas/o = development).

Grades II and III differ moderately, depending on the number of grades
used. The upshot is that patients with grade I tumors have the highest
survival rate and patients with subsequent grades have poorer survival
rates.
Screen 8 of 9

Lesson 2: Microscopic Descriptions, Grading, and Staging of
Tumors

2.8 Staging Cancerous Tumors

Fig. 19-45




Staging cancerous tumors focuses more on the extent of its metastasis
or spread rather than on its microscopic appearance. One of the most
common staging systems is referred to as TNM, which stands for tumor,
nodes, metastases. For example, a tumor with a label of T1N2M0 would be
described as follows: The T refers to the size and extent of the tumor
itself; thus, a T1 suggests a small tumor. The letter N in this same code
represents the number of regional lymph nodes involved. Finally, the
letter M refers to the spread to distant sites—in other words, the number
of metastases, which in this case is zero.

There are other staging systems as well, such as the Duke Staging
System, which is used specifically for staging colon cancer, including
hereditary non-polyposis colon cancer (HNPCC).
Screen 9 of 9

Lesson 2: Microscopic Descriptions, Grading, and Staging of
Tumors

2.9 <Activity icon>Activity: Write It, Find It: Microscopic
Descriptions, Grading, and Staging of Tumors

Let's review the material covered in this lesson.

   Objective: Review how tumors are classified and described by
   pathologists.

   Objective: Describe x-ray studies, laboratory tests, and other
   procedures used by physicians for determining the presence and
   extent of spread (staging) of tumors.




Engine Type     Write It, Find It (text version)
Screen          <<Type in the correct answers.>>
Appearance




Engine         Write It, Find It Flash Engine
Specifications    Use engine master: writeit1.swf
                  Engine Size: 580 x 350 pixels
                  Questions
                        o No randomizing
                        o Maximum # = 10
                        o Maximum # characters per question = 200
                  Answer Choices
                        o Learner types answer in field
                        o No randomizing
                        o Maximum # correct = 10
                        o Maximum # characters = 17
                        o No distracters
                  Feedback
                        o Rationale of 250 maximum characters per question
                   Displays inline, framed

             Bold the correct answer(s) in each question
Question 1   Tumor characteristics visible on the cellular level fall under the
             category defined as microscopic description of tumors.
Rationale:   Characteristic appearances of malignant tumors that can be seen
             with the naked eye are categorized under gross description of
             tumors. Even more characteristics are visible on the microscopic or
             cellular level, under the category defined as microscopic description
             of tumors.
Question 2   Dysplastic cells—adult cells that are abnormal in size, shape, and
             organization—exhibit highly abnormal cell formation, but they are
             not yet clearly cancerous in appearance.
Rationale:   Moles or nevi on the skin are good examples of dysplastic cell
             growth. These may be abnormalities in cellular development—that
             is, dysplasia (plas/o; -plasia = formation; dys- = abnormal), but
             they are not yet cancerous.
Question 3   The destructive process of metaplasia—in which adult
             differentiated cells transform to differentiated tissue of another
             kind—is actually reversible.
Rationale:   This encouraging phenomenon makes metaplasia unique from
             dysplasia seen in cancer: in metaplasia (meta- = beyond;
             change), the transformation to differentiated tissue of another kind
             can be reversed. For example, abnormal cellular changes from
             smoking can be reversed if the subject stops smoking.
Question 4   Ms. Harrison’s physician was concerned that she might have diffuse
             tumor growth, but microscopic examination revealed that the
             malignancy had been caught as a carcinoma in situ—that is, the
             malignant cells are still localized and have not yet metastasized.
Rationale:   These localized tumor cells are cancerous but have not yet invaded
             adjacent structures.
Question 5   Alveolar tumor cells form patterns that resemble small,
             microscopic sacs.
Rationale:   The combining form alveol/o means sac. Alveolar tumor cells are
             commonly found in tumors of muscle, bone, fat, and cartilage.
Question 6   Follicular cells are common in thyroid gland cancer and can form
             glandular sacs of their own.
Rationale:   Use word part knowledge here: the combining form follicul/o =
             small glandular sacs.
Question 7   The nodular cells are often seen with extended lymph node
             involvement; papillary cells are finger-like or nipple-like.
Rationale:   In the case of nodular cells, the word ―node‖ is your best clue. In
             the case of papillary cells, which are nipple-like, the combining
             form papill/o means nipple.
Question 8   Tumors made up of a mixed variety of cell types are described as
             being pleomorphic.
Rationale:   At the cellular level, this type of tumor is referred to as
             pleomorphic: -ic = pertaining to; ple/o means many or more;
             morph/o means shape or form.
Question 9   Breast and stomach tumors often fall into the category of
             scirrhous tumors.
Rationale:   Think of ―hard‖; scirrh/o means hard. Scirrhous tumors are hard
              because they are densely packed and overgrown with fibrous
              tissue.
Question 10   TNM stands for tumor, nodes, and metastases.
Rationale:    A tumor with a label of T1N2M0 would be described as follows: The
              T refers to the size and extent of the tumor (T1 is a small tumor);
              N is the number of lymph nodes involved, and M refers to the
              number of metastases, which in this case is zero.
Screen 1 of 12

Lesson 3: Surgery and Radiation Therapy

3.1 Threaded Case Study: Mr. Brazzali

Fig. 19-46




Mr. Brazzali is entering a cancer treatment clinic, where Dr. Simmons
guides him in selecting the most appropriate treatment options. Because
every case is unique, based on grading and staging, as well as type of
cancer, two individuals may have the same type of cancer and receive
different prognoses and treatment plans.

First, let's look at surgical options most typically associated with cancer.
When patients think of surgery with cancer, they often think first of
biopsies. This is a natural association since biopsies often precede, or are
combined with, surgical removal of a cancer.
Screen 2 of 12

Lesson 3: Surgery and Radiation Therapy

3.2 Surgical Options for Cancer

Fig. 19-47




An excisional biopsy is the removal of the tumor, along with a margin of
normal tissue (Fig. A). Used for diagnosis, this removal also often cures
small, noninvasive tumors. An incisional biopsy involves removal of a
piece of the tumor for diagnosis and may be followed by additional
treatment to remove the bulk of the tumor.

A wide resection, involving removal not just of the tumor but its original
site, along with surrounding tissue in the body space, is called
exenteration (Fig. B). Similarly, en bloc resection involves removal of
the tumor along with a large area of the surrounding tissue and usually
lymph node removal as well. Classic examples of en bloc resection
(-ectomy) include the modified radical mastectomy, colectomy, and
gastrectomy.
Screen 3 of 12

Lesson 3: Surgery and Radiation Therapy

3.3 Other Treatment Options

Fig. 19-48




In some cases, classic surgical resection is not the best option. For
instance, in cryosurgery, subfreezing temperature is used to destroy the
malignant tumor (cry/o = cold). By contrast, cauterization destroys the
tumor by burning it (cauter/o = burn, heat). In yet another variation,
electric sparks generated by a high-frequency current destroy tissue in a
process called fulguration. A debulking procedure may be used if the
tumor is attached to a vital organ and cannot be completely removed;
instead, as much of the tumor as possible is removed and adjuvant
radiation or chemotherapy is given.
Screen 4 of 12

Lesson 3: Surgery and Radiation Therapy

3.4 Bone Marrow Transplant

Fig. 19-49




Another procedural intervention that is an alternative to traditional
excision or resection takes place in bone marrow transplant (BMT). In
autologous bone marrow transplant, stored marrow from the patient's
own body is reinfused when needed. In allogeneic marrow transplant,
someone else donates the marrow. In a peripheral (blood) stem cell
transplant (PSCT), the patient receives a reinfusion of stem cells selected
and harvested from his or her own peripheral blood, or from someone
else's, to repopulate the bone marrow with blood cells.
Screen 5 of 12

Lesson 3: Surgery and Radiation Therapy

3.5 <Activity icon>Activity: Fill-in: Surgery and Radiation Therapy

   Objective: Recognize terms related to the causes, diagnosis, and
   treatment of cancer.



http://www.coursewareobjects.com/objects/chabner8e_v1/mod19Activitie
s/19s01l0102p6.htm
Screen 6 of 12

Lesson 3: Surgery and Radiation Therapy

3.6 Radiation Therapy (Animation)

Fig. 19-50




In addition to surgery and other therapeutic procedures, ionizing
radiation therapy (RT, XRT), or radiotherapy, can be used to destroy
tumor cells (radi/o = rays) by delivering a maximum dose of ionizing
radiation, or irradiation, to tumor tissue while minimizing the morbidity,
or DNA and cellular damage, to normal tissue. Radiation therapy may be
used alone or in conjunction with other forms of treatment, such as
chemotherapy. It can also be used either before and/or after a surgical
procedure as well as intraoperatively—referred to as intraoperative
radiation therapy (IORT).




Radiation Therapy


http://www.coursewareobjects.com/objects/chabner8e_v1/mod19/assets/
19s02l0207/19s02l0207p1.htm
Screen 7 of 12

Lesson 3: Surgery and Radiation Therapy

3.7 Importance of Controlled Radiation Dose

Fig. 19-51




Minimizing exposure of normal tissue is important because radiation
damage causes fibrosis, an increase in connective tissue (fibr/o =
fibers) in normal tissue, along with loss of surface lining cells and blood
vessel damage. Here we see skin desquamation caused by irradiation.

Exposure is limited through both carefully defined target fields as well as
through tight control of the administration of unit doses of radiation,
measured as gray (Gy) (absorbed radiation dose) and its older term,
rad (radiation absorbed dose).
Screen 8 of 12

Lesson 3: Surgery and Radiation Therapy

3.8 Specific Damage Caused by Irradiation

Fig. 19-52

DEVELOPER: Please crop new art below to delete flow chart below
image, to show the damaged cell image only. Thanks.

NEW ART Source:
http://coursewareobjects.elsevier.com/objects/elr/McCance5e/IC/thumbs/
002023tn.jpg




Radiation can damage cells both directly and indirectly. Specific side
effects include (among a number of others) the following:

      Fibrosis: Increase in connective tissue (fibr/o)
      Pneumonitis (shown here): Inflammation (-itis) in the lungs
       (pneumon/o)
      Myelosuppression: Bone marrow (myel/o) depression
       (-suppression = to stop)
      Anemia: -emia = blood condition; an- = no or without
      Thrombocytopenia: A deficiency of platelets or thrombocytes:
       -penia = deficiency; thomb/o = clot; cyt/o = cell
      Mucositis: -itis = inflammation; mucos/o = mucous membrane
      Xerostomia: Dryness of the mouth: -ia = condition; xer/o = dry;
       stom/o = mouth
      Alopecia: Partial or complete hair loss
Screen 9 of 12

Lesson 3: Surgery and Radiation Therapy

3.9 Procedures to Limit Damage

Fig. 19-53




Another method of limiting damage to normal tissue is through the
technique of fractionation, in which radiation is divided into small,
repeated doses rather than fewer large doses. Despite lessened damage
to normal tissues, this technique actually enables larger total dosages.

Similarly, in treatment of prostatic and brain tumors, brachytherapy
tightly limits exposure by implanting seeds of radioactive material directly
into a tumor (interstitial therapy) or into the cavity of a tumor
(intercavitary therapy). The short distance (brachy-) in drug delivery
to its target site gives this treatment its name of brachytherapy.
Screen 10 of 12

Lesson 3: Surgery and Radiation Therapy

3.10 External Beam Radiation

Fig. 19-54




By contrast to brachytherapy, external beam radiation (teletherapy)
is applied to the tumor from a distant (tele-) source, one outside the
body—namely, a linear accelerator. Because of the precision with which
the beams can be directed, the treatment can be very localized, that is,
restricted to the cancerous site.

Electron beam radiation produces low-energy rays to treat skin cancer
and surface tumors. Proton therapy tightly focuses positive subatomic
particles (protons) to a finite target point using a cyclotron. Similarly, in
proton stereotactic radiosurgery, or PSRS (also called stereotaxic
radiosurgery), a single large dose of radiation is delivered under highly
precise guidance to treat small intracranial or arteriovenous abnormalities.
This is also called gamma knife surgery.
Screen 11 of 12

Lesson 3: Surgery and Radiation Therapy

3.11 Radiocurable and Radiosensitive Tumors

Fig. 19-55




Tumors do vary in their responsiveness to radiation therapy. The
lymphoma shown in the illustration, for instance, can be completely
eradicated by radiation therapy. For this reason, it is referred to as a
radiocurable tumor.

In the next lesson, we’ll look at options for tumors that are more resistant
to radiation.
Screen 12 of 12

Lesson 3: Surgery and Radiation Therapy

3.12 <Activity icon>Activity: Crossword: Surgery and Radiation
Therapy

Let's review the material covered in this lesson.

   Objective: Describe x-ray studies, laboratory tests, and other
   procedures used by physicians for determining the presence and
   extent of spread (staging) of tumors.

Engine Type    Crossword
Screen         <<Type each answer in the row or column corresponding to its
Appearance     clue.>>




Engine         Crossword Flash Engine
Specifications     Use engine master: [under development]
                   Engine Size:
                   Clues and Terms
                       o Learner types answer in blocks
                       o Optional randomizing
                       o Maximum # = 30
                       o Maximum # characters per clue = unlimited
                       o Maximum # characters per answer: 20
                       o
                   Feedback
                       o
                   Displays inline, framed
Questions
            Terms               Clues
            excisional          Type of biopsy requiring the removal of the
                                tumor, along with a margin of normal tissue
            incisional          Biopsy involving removal of only a piece of
                                the tumor for diagnosis
            exenteration        Resection of a tumor, its original site, and
                                more surrounding tissue
            en bloc resection   Resection of a tumor along with a large area
                                of the surrounding tissue, and usually
                                requiring lymph node removal as well (3
                                words)
            mastectomy          Surgical removal of the breast
            cryosurgery         Use of subfreezing temperature to destroy a
                                malignant tumor
            cauterization       Destruction of a tumor by burning it
            fulguration         Procedure in which electric sparks generated
                                by a high-frequency current destroy tissue
            debulking           ________ procedure: used if a tumor is
                                attached to a vital organ and cannot be
                                completely removed
            autologous          _______ bone marrow transplant:
                                reinfusion of stored marrow from the
                                patient's own body
            peripheral stem     The ―PSC‖ in PSCT (3 words)
            cell
            gray                Unit of measure of absorbed radiation dose
                                in radiotherapy
            intraoperative      The ―IO‖ in IORT
            brachytherapy       Procedure in which seeds of radioactive
                                material are implanted directly into a tumor
            teletherapy         Another name for external beam radiation,
                                so called because it is applied to the tumor
                                from a distant source, one outside the body
            electron            Type of external beam radiation that
                                produces low-energy rays to treat skin
                                cancer and surface tumors
            proton              The ―PS‖ in PSRS, which is another name for
            stereotactic        gamma knife surgery (2 words)
            radiocurable        Descriptive term for a tumor that can be
                                completely eradicated by radiation therapy:
                                a ________ tumor
Screen 1 of 11

Lesson 4: Chemotherapy, Hormonal Therapy, and Biologic Therapy

4.1 Use of Radiosensitizing Agents

Fig. 19-56




In the previous lesson we learned that radiation therapy can be highly
effective, especially with those tumors categorized as radiocurable.
Similar to these are radiosensitive tumors, in which irradiation can
cause cell death at fairly low doses of radiation without serious damage to
the surrounding tissue, such as the leukemic cells pictured in the top
illustration. But what about those tumors that are radioresistant? What
becomes of those? How can they be treated?

Radioresistant tumors require large doses of radiation to produce cell
death. Pancreatic tumors, melanoma, and renal carcinoma, like the one
shown in the bottom illustration, fall into this category. These
radioresistant tumors may benefit more from chemotherapy, particularly
from the use of radiosensitizers, drugs that increase the tumor’s
sensitivity to x-rays—drugs such as 5-fluorouracil (5-FU) and cisplatin.
Screen 2 of 11

Lesson 4: Chemotherapy, Hormonal Therapy, and Biologic Therapy

4.2 Chemotherapy

Fig. 19-57




Chemotherapy (abbreviated ―chemo‖) is the use of drugs or chemicals to
damage the DNA of cancer cells and is the standard treatment for a
number of types of cancer. Such a drug can be used alone, as an
adjuvant, or enhancement, to surgery, or it can involve the use of more
than one agent in combination chemotherapy.

Pharmacokinetics, the study of the distribution and excretion of drugs
(pharmac/o) from the body over time, is invaluable in creating the best
protocol (abbreviated ―prot.‖) or treatment plan for optimal
chemotherapy.
Screen 3 of 11

Lesson 4: Chemotherapy, Hormonal Therapy, and Biologic Therapy

4.3 <Catch That? icon>Activity: Catch That?




Did you catch that? The use of chemicals or drugs to treat cancer is
called ________.




Type your answer in the text box below, then click Submit to check your
answer.




chemotherapy




Feedback:

This one's a piece of cake if you know that it's all about word building! The
combining form chem/o means drug or chemical and -therapy, naturally,
means treatment.

Want a quick review to reinforce this fact? Click on the following link to
review Screen 4.2. Or if you prefer, you can come back to it later.

Click here to proceed.
Screen 4 of 11

Lesson 4: Chemotherapy, Hormonal Therapy, and Biologic Therapy

4.4 Range of Responses to Cancer Therapy

Fig. 19-58

NEW ART Source: Photos.com # 12545109




        QuickTime™ and a
         decompressor
are needed to see thi s pi ct ure.




       QuickTime™ and a
         decompres sor
are needed to s ee this picture.




A patient’s protocol is intended to be followed until the patient achieves
remission—that is, a partial or complete disappearance of signs of the
disease. No two people respond quite the same to any one treatment. For
example, a medical record that reports complete response (CR)
indicates the disappearance of all tumor, while partial response (PR)
indicates that the tumor is now one-half its original size, and NED in a
treatment report means ―no evidence of disease‖. Note that the opposite
of remission is relapse, a recurrence of the tumor after treatment.
Similar to this is PD, which means progressive disease—indicating that
the tumor has increased in size; and SD means stable disease, in that the
tumor does not shrink, but does not grow.
Screen 5 of 11

Lesson 4: Chemotherapy, Hormonal Therapy, and Biologic Therapy

4.5 Chemotherapeutic Agents

Fig. 19-59

NEW ART Source: Photos.com #4932464



       QuickTime™ and a
         decompres sor
are needed to s ee this picture.




Let's have a look at how some of these chemotherapeutic agents work:

      Drug or Drug Group                         Drug Action
Alkylating agents                   Attack DNA molecules, causing
                                    strand breaks
Antibiotics                         Promote breakage of the DNA
                                    strands, preventing their replication
Antimetabolites                     Inhibit synthesis of DNA
                                    components or block DNA
                                    replication
Antimitotics                        Block mitosis (division or
                                    replication) in cells
Steroids                            Can modulate cancer cell apoptosis
Differentiating agents              Promote tumor cells to differentiate,
                                    stop growing, and die
Molecularly targeted drugs          Block the function of growth factors,
                                    their receptors, and signaling
                                    pathways in tumor cells
Antiangiogenic drugs                Interfere with angiogenesis
                                    needed for tumor cell growth
Screen 6 of 11

Lesson 4: Chemotherapy, Hormonal Therapy, and Biologic Therapy

4.6 Hormonal Agents

Fig. 19-60




A final chemotherapeutic class is the hormonal agents made by the
body's endocrine system, such as estrogens and androgens. Hormones
attach to receptor proteins in target tissues and can have growth-
inhibiting effects on certain types of cancer, such as leukemia and breast
cancer. Still, others can, in turn, block these effects. The key to the use of
hormonal agents is an awareness of appropriate receptors associated with
each cancer.
Screen 7 of 11

Lesson 4: Chemotherapy, Hormonal Therapy, and Biologic Therapy

4.7 Biologic Therapy

Fig. 19-61




A still newer approach to cancer treatment is biological therapy, which
attempts to use the body's own defense mechanisms to fight tumor cells.
Several body defense substances, the biologic response modifiers,
have been used with some degree of success. For example, the
interferons (IFN), monoclonal antibodies (MoAb), and colony-
stimulating factors (CSFs) can combat chemotherapy side effects.
Finally, interleukins stimulate the immune system to destroy tumors.
Screen 8 of 11

Lesson 4: Chemotherapy, Hormonal Therapy, and Biologic Therapy

4.8 Clinical Trials

Fig. 19-62

NEW ART Source: Photos.com #4909891




                        QuickTime™ and a
                          decompressor
                are needed to see this picture.




       QuickTime™ and a
         decompres sor
are needed to s ee this picture.




New treatment options for cancer and other patients are constantly being
investigated. Clinical trials are research studies designed to test the
risks and efficacy of investigational new drugs. These studies are divided
into four phases:

Phase I trials: Experimental drug or treatment is tested, usually just for
safety, dosage, and schedule of administration, in a small group of people
(20 to 80).

Phase II trials: Experimental treatment is tested for risks to a specific
population and disease among a larger group of people (200 to 300).

Phase III trials: Experimental treatment is tested in a more definitive
trial for risks vs. benefits in a larger group of people (hundreds or
thousands).

Phase IV trials: Large studies are conducted after FDA approval of the
drug for marketing. These are designed to monitor safety and identify new
indications, if possible.
Screen 9 of 11

Lesson 4: Chemotherapy, Hormonal Therapy, and Biologic Therapy

4.9 Threaded Case Study: Hospice

Fig. 19-63




Because of metastasis now to the left side of his body, Mr. Brazzali is not
a candidate for invasive surgery or the stress, exhaustion, and discomfort
of chemotherapy. His prognosis is that he may have 2 to 4 more months
at best. It could be even less than that. He considers brachytherapy but
declines, and within four weeks, he is in hospice. He and his son and
grandson have decided to just concentrate now on palliative care.

The goal of palliative care will be to relieve as many of Mr. Brazzali's
symptoms as possible, including his pain, shortness of breath, fatigue,
dryness of mouth (xerostomia), loss of appetite, gastrointestinal
problems, and dry skin. Dr. Simmons talks to Mr. Brazzali and his family
about hospice care and how to work as a team to keep Mr. Brazzali and
the family as emotionally and physically comfortable during the dying
process as possible.
Screen 10 of 11

Lesson 4: Chemotherapy, Hormonal Therapy, and Biologic Therapy

4.10 <Activity icon>Activity: Matching: Chemotherapy, Hormonal
Therapy, and Biologic Therapy

Let's review the material covered in this lesson.

   Objective: Recognize terms related to the causes, diagnosis, and
   treatment of cancer.




Engine Type        Matching
Screen             <<Drag each term to its corresponding description.>>
Appearance




                                                                      (mockup)

Engine             Matching Flash Engine
Specifications        Use engine master: matching.swf
                      Engine Size: 580 x 300 pixels
                      Maximum # question sets: 4
                      Clues per question set
                           o Optional randomizing
                           o Maximum # = 8
                           o Maximum # characters = unlimited
                           o Will accommodate multimedia and hyperlinks
                      Answers
                           o Learner drags number of answer choice to field
                           o Optional randomizing
                           o Maximum # characters = unlimited
                           o Maximum # distracters = 6
                           o Will accommodate multimedia and hyperlinks
                      Number of attempts:
                           o 2 to unlimited
                      Feedback
                           o Specific or general
                     o Maximum # characters = unlimited
                     o Will accommodate multimedia and hyperlinks
                 Displays inline, framed

Questions
            Answers            Clues
            Phase I trials     Test for safety, dosage, and schedule of
                               administration in a small group of people
                               (20 to 80)
            Phase II trials    Test for risks to a specific population and
                               disease among a larger group of people
                               (200 to 300)
            Phase III trials   Definitive trial for risks vs. benefits in a
                               larger group of people (hundreds or
                               thousands)
            Phase IV trials    Large studies after FDA approval; monitor
                               for safety and identify new indications, if
                               possible
Screen 11 of 11

Lesson 4: Chemotherapy, Hormonal Therapy, and Biologic Therapy

4.11 <Activity icon>Activity: Table Drop: Chemotherapy, Hormonal
Therapy, and Biologic Therapy

   Objective: Recognize terms related to the causes, diagnosis, and
   treatment of cancer.

Engine Type   Table Drop
Screen        <<Drag each answer to its correct spot in the table below to
Appearance    identify the correct action for each anticancer drug or drug
              group.>>




Engine         Table Drop Flash Engine
Specifications    Use engine master: tabledrop.swf
                  Engine Size: 580 x 350 pixels
                  Columns:
                       o Maximum number = 3
                       o Column headings max # characters = 5 characters/ 2
                          lines
                       o May include pre-filled answers
                  Rows
                       o Learner drags answer choice to field
                       o Maximum number = 5
                       o Row headings max # characters = 10 characters/3
                          lines
                       o Max number of characters per choice = unlimited
                       o Automatically randomized
                       o Must be entered multiple times if they are used
                          multiple times
                       o Will accommodate images
                       o No distracters
                  Feedback
                       o None at the present time
                 Displays inline, framed
Correct        Label column and row headings
Answers        Bold any answers that should be prefilled
               Indicate whether field is text or image
               Supply file name for images

              Drug or Drug           Drug Action
              Group
              Differentiating        Promote tumor cells to
              agents                 differentiate, stop growing, and die
              Antiangiogenic drugs   Interfere with angiogenesis
                                     needed for tumor cell growth
              Antimitotics           Block mitosis (division or
                                     replication) in cells
              Steroids               Can modulate cancer cell
                                     apoptosis
Screen 1 of 1

Section II Quiz

You have completed Section II: Tumor Classification and Treatment.

If you feel comfortable with all the information, you may begin the Section
II Quiz. If you pass this quiz, you will have fulfilled the objectives for this
section.

Click Next to begin Section III: Building Your Word Bank.
Screen 1 of 4


Section III: Building Your Word Bank

If you've completed this chapter in your text, you're now ready for the
additional practice you'll receive with word parts in this module. For
definitions of all the word parts used in the following exercises, consult the
glossary and your text. To review construction of medical terms using
prefixes, combining forms, and suffixes, have your textbook handy.
Screen 2 of 4


<Activity icon>Activity: Sound It Out



http://www.coursewareobjects.com/objects/chabner8e_v1/mod19Activitie
s/19s01l0103p1.htm
Screen 3 of 4

<Activity icon>Activity: Word Shop


http://www.coursewareobjects.com/objects/chabner8e_v1/mod19Activitie
s/19s01l0103p5.htm

NOTE: In this activity, in each question, delete the period at the end of
the phrase.
Screen 4 of 4

<Activity icon>Activity: Part Puzzler



http://www.coursewareobjects.com/objects/chabner8e_v1/mod19Activitie
s/19s01l0103p6.htm
Screen 1 of 3

Section IV: Applications

Medical Report

Click on the Medical Report link below. There are two sets of exercises for
this activity. Be sure to complete all pop-up questions within the Medical
Report itself; then answer the questions in the follow-up set on the next
screen.

DEVELOPER: Questions to appear within each inter-Medical Report
Question Pop-Up follow in Write It, Find It Engine template below.




Medical Report
Shore County Oncology Associates

HOSPICE TRANSFER REPORT
ANTHONY BRAZZALI

CHIEF COMPLAINT:

Patient presents with cachexia, asthenia, anemia, muscle atrophy,
dyspnea, some nausea, and vomiting.


<Q1 Pop-up>

<Q2 Pop-up>

HISTORY OF PRESENT ILLNESS:

The patient is an 82-year-old man whose extended exposure to asbestos
in his 40+ years as a sheet metal worker has induced development of
mesothelioma. Patient has Grade III, Stage T3N1M1 mesothelioma of the
right lung (including: pleura, chest wall, ribs, and heart) with metastasis
to the GI tract. Patient has had CXR, undergone needle aspiration biopsy
12 weeks prior, followed by PET scan to determine the extent of his
cancer.


<Q3 Pop-up>

<Q4 Pop-up>

<Q5 Pop-up>

<Q6 Pop-up>
TREATMENT PLAN:

In light of the prognosis, patient has declined both chemotherapy and
brachytherapy and chose palliative care with hospice as his cancer has
progressed. Pt requiring more physical care and pain management. Social
worker reports overall acceptance and positive attitude focusing on
meaningful closure. Solid family support.

Advance Directives in place: DNR order signed.

ALLERGIES: Penicillin.

MEDICATION: Duragesic 100 mcg/72 hr; prochlorperazine rectal 25 mg
PR q12 prn. Boost supplement 100-200 mL q 2-4 hr prn.


<Q7 Pop-up>

<Q8 Pop-up>
Pop-up questions for Medical Report:


Engine Type   Write It, Find It (text version)
Screen        <<Type in the correct answers.>>
Appearance




Engine         Write It, Find It Flash Engine
Specifications    Use engine master: writeit1.swf
                  Engine Size: 580 x 350 pixels
                  Questions
                        o No randomizing
                        o Maximum # = 10
                        o Maximum # characters per question = 200
                  Answer Choices
                        o Learner types answer in field
                        o No randomizing
                        o Maximum # correct = 10
                        o Maximum # characters = 17
                        o No distracters
                  Feedback
                        o Rationale of 250 maximum characters per question
                  Displays inline, framed
             Bold the correct answer(s) in each question
Question 1   The term in this medical report that describes Mr. Brazzali’s
             wasting condition is cachexia.
Rationale:   The term cachexia is the most severe form of malnutrition
             associated with cancer: cac/o means bad; -hexia means state or
             condition. It leads to wasting, emaciation, and decreased quality of
             life.
Question 2   In this report, Dr. Simmons has recorded Mr. Brazzali’s lack of
             strength as asthenia.
Rationale:   The term asthenia is sometimes a suffix; both mean, literally, ―lack
             of strength‖.
Question 3   Mr. Brazzali’s lung cancer due to asbestos poisoning is identified in
             this report as mesothelioma.
Rationale:   After decades of use, asbestos was found to be one of the most
             deadly carcinogens, causing a rare form of lung cancer called
             mesothelioma.
Question 4   This report describes Mr. Brazzali’s cancer as Stage T3N1M1
             mesothelioma. The ―M‖ stands for metastases.
Rationale:   A tumor with a label of T3N1M1 is interpreted this way: The T refers
             to the size and extent of the tumor. N is the number of lymph
             nodes involved, and M refers to the number of metastases, which
             in this case is one—to the GI tract.
Question 5   A term in this report that describes the spread of cancer to the GI
             tract is metastasis.
Rationale:   The term metastasis is the spread of the cancer from the original
             or primary tumor to multiple secondary tumor sites.
Question 6   The report says that Mr. Brazzali has undergone needle
             aspiration biopsy—which is a technique that not only drains fluid
             from the lung to relieve pressure and ease breathing, but can be
             used for diagnostic purposes as well.
Rationale:   Extracting or aspirating free cells from a fluid-filled cavity or from
             inside a solid tumor mass using a fine needle is called fine needle
             aspiration (FNA) biopsy—it provides both relief and diagnosis.
Question 7   The term in this report that describes a procedure for planting
             radioactive ―seeds,‖ providing a direct attack on tumor cells, is
             brachytherapy.
Rationale:   In this procedure, seeds of radioactive material are implanted
             directly into a tumor or into the cavity of a tumor. The short
             distance (brachy-) in drug delivery to its target site gives this
             treatment its name of brachytherapy.
Question 8   The term palliative care in this report focuses exclusively on
             providing as much physical and emotional comfort as possible.
Rationale:   The goal of palliative care is to relieve as many of a dying patient’s
             symptoms as possible and to make both patient and family as
             emotionally and physically comfortable as possible during the dying
             process.
Screen 2 of 3

Medical Report Follow-up: Listen and Spell


DEVELOPER: Keep Tab 2 Question Set (in the link below—“Listen
and Spell”) for this activity. Thanks.

http://www.coursewareobjects.com/objects/chabner8e_v1/mod19Activitie
s/19s01l0104p1-t1.htm
Screen 3 of 3

Case Study

Fig. 19-64




                  Mrs. Thatcher, a 53-year-old female cancer patient,
shows signs of cachexia, exhaustion, anemia, and asthenia as well as
reported taste alterations. She enters the hospital for further assessment
of her abdominal tumor. The physician uses laparotomy to stage her
cancer; during the procedure he discovers scirrhous tumor tissue. Mrs.
Thatcher undergoes brachytherapy, but later, further biopsies reveal
general metastasis with development of a glioma.




There are two sets of exercises for this activity (see tabs numbered 1–2).
Be sure to complete all of the questions in each set. When you have
completed all of the questions under a tab, select the next tab.




http://www.coursewareobjects.com/objects/chabner8e_v1/mod19Activitie
s/19s01l0104p2-t1.htm
Screen 1 of 1

Learning Links

For additional information about prevention, detection, and treatment of
cancer, visit the following websites:




       American Cancer Society
       American Institute for Cancer Research—AICR—Diet, Nutrition, and
        Cancer Prevention
       Canadian Cancer Society
       Mesothelioma
       National Cancer Institute

Links

http://www3.us.elsevierhealth.com/cgi-bin/redirect.pl?www.cancer.org

http://www3.us.elsevierhealth.com/cgi-bin/redirect.pl?www.aicr.org

http://www3.us.elsevierhealth.com/cgi-bin/redirect.pl?www.cancer.ca


http://www3.us.elsevierhealth.com/cgi-
bin/redirect.pl?www.MesotheliomaWeb.org

http://www3.us.elsevierhealth.com/cgi-bin/redirect.pl?www.nci.nih.gov

				
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