CELLULAR ABERRATION

The body is made up of approximately 37.2 trillion human cells. That’s a lot of cells.

These normal cells act as the body’s basic building blocks and possess specific characteristics that enable
them to maintain correct functioning of tissues, organs, and organ systems. Normal cell:
- Control their growth using external signals, meaning they grow and divide when required.
- Undergo programmed cell death (apoptosis) as part of normal development, to maintain
tissue homeostasis, and in response to un-repairable damage.
- “Stick together” by maintaining selective adhesions that they progressively adjust which
ensures they remain in their intended location.
- Differentiate into specialized cells with specific functions, meaning they can adopt different
physical characteristics despite having the same genome.

Cancer is a complex genetic disease that is caused by specific changes to the genes in one cell or group
of cells. These changes disrupt normal cell function – specifically affecting how a cell grows and divides,
in contrast to normal cells, cancer cells don’t stop growing and dividing, this uncontrolled cell growth
results in the formation of tumor. Cancer cells have more genetic changes compared to normal cells,
however, not all changes cause cancer. They may be a result of it. The genetic changes that contribute
to cancer usually affect three specific types of gene; proto-oncogenes, tumor suppressor genes and DNA
repair genes.

CANCER – a disease of the cell in which the normal mechanisms of the control of growth and
proliferation have been altered. It is invasive, spreading directly to surrounding tissues as well as to new
sites in the body. Can also be called as malignant neoplasm.

- Altered cellular mechanism with progressive and uncontrolled multiplication of cells with
selective ability to invade, metastasize and cause mechanical effects of pressure, obstruction
and interruption of blood supply.

CHARACTERISTICS OF BENIGN AND MALIGNANT TUMORS

Characteristics Benign Malignant

Cell Well –differentiated cells
resemble normal cells of the
tissue from which the tumor
originated.
Mode of growth Tumors grows by expansion and
does not infiltrate the
surrounding tissues, usually
encapsulated.
Rate of growth Rate of growth is usually slow.
Metastasis Does not spread by metastasis
General Effects Is usually a localized
phenomenon that does not
cause generalized effects unless
its location interferes with vital
functions.
Tissue destruction Does not usually cause tissue
damage unless its location
interferes with blood flow.
Ability to cause death Does not usually cause death
unless its location interferes with
vital functions.
Cells are undifferentiated and
may bear little resemblance to
the normal cells of the tissue
from which they arose.
Grows at the periphery and
overcomes contact inhibition to
invade and infiltrate surrounding
tissues.
Rate of growth is usually variable
and depends on level of
differentiation; the more
anaplastic the tumor, the faster
its growth.
Gains access to the blood and
lymphatic channels and
metastasizes to other areas of
the body or grows across body
cavities such as peritoneum.
Often causes generalized effects,
such as anemia, weakness,
systemic inflammation, weight
loss, and CACS (Cancer- related
anorexia-cachexia syndrome)
Often causes extensive tissue
damage as the tumor outgrows
its blood supply or encroaches
on blood flow to the area; may
also produce substances that
cause cell damage.
Eventually causes death unless
growth can be controlled.

PATHOPHYSIOLOGY 0F THE MALIGNANT PROCESS

Cancer is a disease process that begins when a cell is transformed by genetic mutations of the cellular
deoxyribonucleic acid (DNA). Genetic mutations may be inherited and/ or acquired, leading to abnormal
cell behavior. The initial genetically altered cell forms a clone and begins to proliferate abnormally,
evading normal intracellular and extracellular growth-regulating processes or signals as well as the
immune system defense mechanisms of the body. Genetic mutations may lead to abnormalities in cell
signaling transduction processes (signals from outside and within cells that turn cell activities either on
or off ) that can in turn lead to cancer development. Ultimately cells acquire a variety of capabilities that
allow them to invade surrounding tissues and/or gain access to lymph and blood vessels, which carry the
cells to other areas of the body resulting to metastasis or spread of the cancer.

ETIOLOGIC FACTORS TO CANCER:

VIRUSES
 “Oncogenic viruses” may be one of the multiple agents acting to initiate
carcinogenesis.
 Prolonged or frequent viral infections may cause breakdown of the immune system
or overwhelm the immune system.
 Viral infections that increase risk of certain forms of cancer are as follows:
1. Human papilloma virus – cervical cancer
2. Epstein-Barr virus – lymphoma
3. Hepatitis B and C – hepatocellular cancer
4. Helicobacter pylori – gastric cancer
5. AIDS virus – Kaposi’s sarcoma
 Chemical Carcinogens
-These factors act by causing cell mutation or alteration in cell enzymes and proteins
causing altered cell replication.
-Chemical carcinogens are as follows:
1. Industrial Compounds
- Vinyl chloride (used for plastic manufacture, asbestos factories,
construction works).
-Polycyclic aromatic hydrocarbons (such as from refuse burning, auto and
truck emission, oil refineries, air pollution)
-Fertilizers, weed killers
-Dyes (analine dyes used in beauty shops, hair bleach)
2. Drugs
-Tobacco (tar nicotine), 90% of all cases of lung cancer are due to smoking
-Alcohol
-Cytotoxic drugs
3. Hormones
-Estrogen
-Diethylstilbestrol
4. Foods, preservatives
-Nitrites (bacon, smoked meet)
-Talc (polished rice, salami, chewing gum)
-Food sweeteners
-Nitrosamines ( rubber baby nipples)
-Aflatoxins (mold in nuts and grains, milk, cheese, peanut butter)
5. Polycyclic hydrocarbons
-charcoal broiling

PHYSICAL AGENTS
1. Radiation: from x-rays of radioactive isotopes; from sunlight / UV rays
2. Physical irritation / trauma: from pipe smoking, multiple deliveries, jagged
tooth, irritation of the tongue, “overuse of any organ/body part
HORMONES
Estrogen as replacement therapy has been found to increase incidence of
vaginal, cervical, uterine cancers.
GENETICS
 When oncogene (hidden or repressed genetic code for cancer that exists in all
individuals) is exposed to carcinogens, changes in cell structure occurs, malignant
tumor develops.
 Regardless of the cause, several cancers are associated with familial patterns,
Examples: retinoblastoma, pheochromocytoma, Wilm’s tumor, lung cancer, breast
cancer.

PREDISPOSING FACTORS:

AGE
Older individuals are more prone to cancer because they have been exposed to
carcinogens longer. In addition, they have developed alterations in the immune system.
 SEX (Gender)
The most common type of cancer in females is breast cancer. Whereas, the most
common type of cancer in males is prostate cancer.

URBAN vs. RURAL RESIDENCE

Cancer is more common among urban dwellers than among rural residents. This is
probably due to greater exposure to carcinogens, more stressful lifestyle and greater
consumption of preservative- cured foods among urban dwellers.
GEOGRAPHIC DISTRIBUTION
The most common type of cancer in Japan is gastric cancer. While the most common
type of cancer in the US is breast cancer. This may be due to influence of environmental
factors as national diet (raw foods greatly consist Japanese diet), ethnic customs, type of
pollutions.
OCCUPATION
E. g . , there is great risk of exposure to carcinogens among chemical factory workers,
farmers, radiology department personnel.
HEREDITY
Positive family history of cancer increases the risk to develop the disease. In adults,
approximately 34% of cancers have a familial basis. Cancers that may have familial link
include breast, ovarian, colorectal, prostate, melanoma, uterine, leukemia, sarcomas
and primary brain tumors.
STRESS
Depression, grief, anger, aggression, despair or life stresses decrease
immunocompetence because of affectation of hypothalamus and pituitary gland.
Immunodeficiency may spur the growth and proliferation of cancer cells.
PRECANCEROUS LESIONS
Pigmented moles, burn scars, senile keratosis, leukoplakia, benign polyps or adenoma of
the colon or stomach, fibrocystic disease of the breast, may undergo transformation
into cancerous lesions and tumors.
OBESITY
Studies have linked obesity to breast and colorectal cancer.

COMMON CAUSES OF CANCER

1. Breast Cancer
 Early menarche
 Late menopause
 Nulliparous or older than 30 years at the birth of a first child.
2. Lung Cancer
 Tobacco abuse
 Asbestos
 Radiation exposure
 Air pollution
3. Colorectal Cancer
 Greater incidence in men
 Familial polyposis
 Ulcerative colitis
 High fat, low fiber diet
4. Prostate Cancer
 Common among males who are 50 years old and older.
 African-Americans have the highest incidence of prostate cancer in the world.
 Positive family history
 Exposure to cadmium
5. Cervical Cancer
 Sexual behavior
-First intercourse at an early age
-Multiple sexual partners
-Sexual partners who has had multiple sexual partners.
-Human papilloma virus and AIDS (acquired immunodeficiency
syndrome)
-Low socioeconomic status
-Cigarette smoking
6. Head and Neck Cancer
 More common among males
 Alcohol and tobacco use
 Poor oral hygiene
 Long term sun exposure
 Occupational exposures- asbestos, tar, nickel, textile, wood or leather
work, machine tool experience.
7. Skin Cancer
 Individuals with fair complexion
  Positive family history
 Moles (nevi)
 Exposure to coal tar, creosote, arsenic, radium
 Sun exposure between 10am to 3pm
CANCER’S NINE WARNING SIGNS

Change in bowel or bladder habits

-Change in bowel habits, e.g. alternating constipation and diarrhea is the most
characteristic manifestation of colon cancer.
-Change in bladder habits may signify bladder or prostate cancer.
A sore that does not heal
-A sore that does not heal characterize cancer because the tumor causes impaired
circulation and oxygenation in the area. This leads to tissue necrosis, ulceration,
bleeding and infection.
Unusual bleeding or discharge
-Unusual bleeding or discharge from the body part affected by cancer is also due to
impaired circulation and oxygenation in the area. This leads to necrosis, ulceration,
bleeding and infection. Erosion of capillaries in the affected area causes bleeding.
Infection causes unusual discharge.
Thickening or lump in breast or elsewhere
-Thickening or lump in any body part may signify abnormal cellular growth.
Indigestion or difficulty in swallowing
-Indigestion is the usual initial manifestation of gastric cancer.
Obvious change in wart or mole
-Obvious change in wart or mole, like sudden growth in size of wart or mole, uneven
coloring, change in the texture may signify transformation into cancerous lesion.
Nagging cough or hoarseness
-Nagging cough or hoarseness of voice signify cancer of the larynx or cancer of the lungs.
Unexplained anemia
-Unexplained anemia is due to the following factors: the cancer cells take up iron faster
than the normal cells; bleeding contributes to anemia; cancer cells tend to destroy
normal red blood cells.
Sudden loss of weight
-Unexplained sudden weight loss is due to excessively rapid metabolism caused by the
cancer cells. Rapid metabolism is caused by rapid multiplication of the cancer cells. The
normal cells are deprived of nutrients by the cancer cells.

CLASSIFICATION OF CANCER

Tumor classification systems are attempts to provide standardized methods to:

1. Communicate the extent of the cancer to members of the health care team.
2. Serve as basis for determining the most effective treatment plan.
3. Evaluate the treatment plan.
4. Assist in determining the prognosis.
5. Compare like groups for statistical purposes.

A. Classification of Cancer by Tissue of Origin:

Classification Tissue of Origin Characteristics Term Examples

Carcinoma Epithelial Account for 80-90%
of all cancers

-Glandular Organs or glands Adenocarcinoma Adenocarcinoma of

Epithelium capable of secretion breast,lung,prostate
Covers or lines all Squamous cell
external and internal Squamous cell
-Squamous body surfaces carcinoma cancer of the
Epithelium skin,lung,esophagus

Sarcoma Connective or
Supportive
-Bone Most common form Osteosarcoma Osteosarcoma of
of cancer of the bone the femur, humerus

-Cartilage Rare, arises from Chondrosarcoma Chondrosarcoma of

within bones the femur, pelvis
 -Adipose Arises from deep soft Liposarcoma Liposarcoma of the
tissue retroperitoneum,
thigh

-Smooth muscle Very rare Leiomyosarcoma Leiomyosarcoma of

the uterus,
intestines, stomach

Rhabdosarcoma of
-Skeletal muscle Most common in Rhabdosarcoma the headand neck,
young children limbs

Fibrosarcoma of the
Often involves lung femur, tibia,
-Fibrous tissue or flat bones Fibrosarcoma mandible

Mesothelioma of
Most often related to the pleura or
-Membranes lining asbestos exposure Mesothelial peritoneum
body cavities sarcoma or
mesothelioma
Angiosarcoma of
the liver
With liver Angiosarcoma
-Blood vessels involvement may be
related to
occupational
exposure to vinyl
chloride monomer

Myeloma Plasma cells Produced by B-cell N/A N/A

lymphocytes; plasma
cells produce
antibodies
Lymphoma Lymphocytes Two main Non-Hodgkin B-cell lymphoma, T-
classification; may lymphoma cell lymphoma
involve lymph nodes
and/or body organs Hodgkin N/A
lymphoma
Leukemia Hematopoietic cells May involve various
in the bone marrow cell lines produced in
the bone marrow

-White blood N/A

cells(WBC’s) Myelogenous Acute myelogenous
leukemia
-Lymphocytes N/A Acute lymphocytis
Lymphocytic
leukemia

-Red blood Involves Polycythemia vera

cells(RBC’s) overproduction of Erythremia
RBC’s and is
associated with
increased levels of
WBC’s and platelets,
also risk of additional
bone marrow disease

B. Histologic Classification
 The appearance of cells and the degree of differentiation are evaluated pathologically.
 Grade I– Cells differ slightly from normal cells (mild dysplasia) and are well
differentiated.
 Grade II- Cells are more abnormal (moderate dysplasia ) and moderately differentiated.
 Grade III- Cells are very abnormal (severe dysplasia) and poorly differentiated.
 Grade IV- Cells are immature and primitive (anaplasia) and undifferentiated: cell of
origin is difficult to determine.
C. Clinical Staging
  Determines the anatomic extent of the malignant disease process by stages.
 Stage 0: cancer in situ
 Stage I: tumor limited to the tissue of origin; localized tumor growth
 Stage II: limited local spread
 Stage III: extensive local and regional spread
 Stages IV: metastasis

STAGING and GRADING OF NEOPLASIA

 Staging is determining the size of the tumor and existence of metastases.
 Grading is classification of tumor cells.
 Staging is necessary at the time of diagnosis to determine the extent of disease (local
versus metastatic), to determine prognosis and to guide proper management.

 The American Joint Committee of Cancer (AJCC) has developed the TNM classification
system that can be applied to all tumor types.
T – tumor size
N – presence or absence of regional lymph node involvement
M – presence or absence of distant matastasis

T – primary tumor
Tx – primary tumor is unable to be assessed
To – no evidence of primary tumor
Tis – carcinoma in situ
T1, T2, T3, T4 – increasing size and/or local extent of primary tumor.
N – presence or absence or regional lymph node involvement.
Nx – regional lymph nodes are unable to be assessed.
No – no regional lymph node involvement
N1, N2, N3, N4 – increasing involvement of regional lymph nodes.
M – absence or presence or distant metastasis
Mx – metastasis is unable to be assessed
Mo – absence of distant metastasis
M1 – presence of distant metastasis