ORGAN SPECIFIC

CANCERS

NCM 112 A- Care of Clients

with Cellular Aberrations
 LEARNING
OUTCOMES
After working on this module, you
should be able to:
Determine the organs in the body
affected by cance utilizing the body
systems approach
Distinguish the mortality rate,
incidence, etiology, risk factor,
diagnostics, prevention, clinical
manifestation specific to each type
of cancer
Discuss the medical-surgical
management of the cancers
BRONCHOGENIC CARCINOMA
(LUNG CANCER)
 BRONCHOGENIC CARCINOMA:
ETIOLOGY
• Smoking is •Other common
responsible for causes include
80% to 90% of all high levels of
lung cancers. pollution,
• Tobacco smoke radiation
contains 60 (especially radon
carcinogens in exposure) asbestos,
addition to and prolonged
substances (carbon exposure to
monoxide, industrial agents.
nicotine) that
interfere with
normal cell
development.
 Clinical Manifestations
• Symptoms are usually
nonspecific and appear
late in the disease
process.
• Symptoms may be
masked by a chronic
cough attributed to
smoking or smoking
related lung disease.
• Lung cancer frequently
manifests as a lobar
pneumonia that does not
respond to treatment.
Common Symptoms of Lung Cancer
• Cough that does not go away
or get worse
• Coughing up blood or rust
colored sputum (spit or
phlegm)
• Chest pain that is worse with
deep breathing, coughing or
laughing
• Hoarseness
• Loss of appetite
• Unexplained weight loss
• Shortness of breathing
• Feeling tired or weak
DIAGNOSTICS
✔ Chest X-ray- initial
diagnostic test
used for patients
with suspected
lung cancer.
✔ CT scanning-
further evaluate
the mass
✔ Biopsy- definitive
diagnosis
 TYPE GROWTH THERAPY
NON- SMALL CELL LUNG CANCER (NSCLC)

SQUAMOUS CELL Slow ❑ Surgical resection

CARCINOMA ❑ Adjuvant: Chemotherapy and
Radiation

ADENOCARCINOMA Moderate ❑ Surgical resection

❑ Do not respond well to
chemotherapy

LARGE CELL CARCINOMA Rapid ❑ Surgery is not usually

attempted
SMALL CELL LUNG CANCER (SCLC)

SMALL CELL CARCINOMA Very rapid ❑ Chemotherapy is the

mainstay but prognosis is
poor
❑ Adjuvant: radiation
HEMATOLOGIC NEOPLASMS

• Leukemia
• Myelodysplastic
Syndromes
• Myeloproliferative
Neoplasm
• Lymphoma
• Multiple myeloma
 LEUKEMIA: CAUSES
• Leukemia develops • Abnormal cells do not
when the DNA of die at a natural point in
developing blood cells their life cycle but they
(white cells) incurs build up and occupy
damage. This causes more space.
the blood cells to grow • They begin to
and divide overcrowd the blood,
uncontrollably. preventing the healthy
• Healthy blood cells die, WBC from growing
and new cells replace and functioning
them, which develops normally.
in the bone marrow.
 SYMPTOMS of LEUKEMIA
• Poor blood clotting-
bruise or bleed easily and
heal slowly
• Frequent infections
• Anemia
• Nausea
• Fever
• Chills
• Weigh loss
• Tiredness
 Diagnosis
• Blood tests- Complete blood count
• Bone marrow Biopsy
• Spinal tap
• Imaging tests
 Treatment of Leukemia
• Chemotherapy- uses drugs to kill cancer cells in the blood and
bone marrow
• Radiologic therapy- uses high-energy X-rays to kill leukemia
cells or keep them from growing
• Biologic therapy- also called immunotherapy, helps
your immune system find and attack cancer cells. Drugs like
interleukins and interferon can help boost your body's natural
defenses against leukemia.
• Targeted therapy- uses drugs to block specific genes or
proteins that cancer cells need to grow.
• Stem cell transplant- replaces the leukemia cells in the bone
marrow with new ones that make blood.
• Surgery
 Types of LEUKEMIA
• Acute Myeloid • Chronic Myeloid
Leukemia (AML)- Leukemia- arises
results form a from amutation in
defect in the the myeloid stem
hematopoietic cell.
stem cell that
differentiates into
all myeloid cells:
monocytes,
granulocytes,
erythrocytes and
platelets.
Types of Leukemia
• Acute Lymphocytic • Chronic
Leukemia – results Lymphocytic
from an Leukemia (CLL)-
uncontrolled common
proliferation of malignancy of
immature cells older adults. A
(lymphoblasts) strong familial
derived from the predisposition
lymphoid stem exists with CLL.
cell.
 HEMATOLOGIC
NEOPLASMS
• Leukemia
• Myelodysplastic
Syndromes
• Myeloproliferative
Neoplasm
• Lymphoma
• Multiple myeloma
 Myelodysplastic Syndromes
• Group of clonal disorders of the myeloid
stem cell that cause dysplasia (abnormal
development) in one or more types of cell
lines.
• MOST COMMON FEATURE- dysplasia of
the erythrocyte (macrocytic anemia) and is
present in 80% to 90% of those with
disease
 HEMATOLOGIC
NEOPLASMS
• Leukemia
• Myelodysplastic Syndromes

• Myeloproliferat
ive Neoplasm
• Lymphoma
• Multiple myeloma
 MYELOPROLIFERATIVE
NEOPLASM
• POLYCYTHEMIA VERA- • Essential
proliferative disorder of Thrombocytopenia-
the myeloid stem cells. stem cell disorder
The bone marrow is within the bone
hypercellular and the marrow.
erythrocyte, leukocyte,
and platelet counts in
the peripheral blood are
often elevated.
Myeloproliferative Neoplasm
• Primary myelofibrosis- chronic myeloproliferative
disorder that arises from neoplastic
transformation of an early hematopoietic stem
cell.
• The disease is characterized by marrow fibrosis or
scarring, extramedullary hematopoiesis (typically
involving the spleen and the liver), leukocytosis,
thrombocytosis and anemia.
 HEMATOLOGIC NEOPLASMS
• Leukemia
• Myelodysplastic Syndromes
• Myeloproliferative Neoplasm
• Lymphoma
• Multiple myeloma
 LYMPHOMA
• Neoplasms of cells of lymphoid origin.
• Tumors usually start in lymph nodes but
can involve lymphoid tissue in the spleen,
GI tract, liver or bone marrow
• Hodgkin’s Lymphoma
• Non-Hodgkin’s Lymphoma
 Hodgkin’s Lymphoma
• Relatively rare malignancy that has a high
cure rate.
• Common in men
• Peaks of incidence: one from age 15 to 34
years and the other after 60 years of age
• Malignant cell: REED-STERNBERG CELL- a
gigantic tumor cell that is morphologically
unique and of immature lymphoid origin
 Hodgkin’s Lymphoma
• Etiology- unknown • Clinical
• Interacting factors: Manifestations –
infection with fever, drenching
Epstein-Barr virus, night sweats and
genetic weight loss
predisposition, and
exposure to
occupational toxins
NON-HODGKIN’S LYMPHOMA
• Heterogenous group of cancers that originate
from the neoplastic growth of lymphoid tissue.
• Neoplastic cells are thought to arise from a
single clone of lymphocytes but the cells may
vary morphologically
• Lymph nodes from multiple sites may be
infiltrated, as may sites outside the lymphoid
system.
MULTIPLE MYELOMA

• Malignant disease of the most mature form of

lymphocyte- the plasma cell.
• The malignant plasma cells produce an
increased amount of a specific immunoglobulin
that is non functional.
 SKIN CANCER
• Exposure to
ultraviolet (UV)
radiation, including
the sun and artificial
UV rays
• Incidence is related
to the total amount
of exposure to the
sun
 BASAL CELL CARCINOMA
AND SQUAMOUS CELL
CARCINOMA
BASAL CELL CARCINOMA
✔ Sun exposed areas of the body
✔ Begins as a small, waxy nodule with rolled,
translucent, pearly borders; telangiectatic
vessels may be present.
✔ Characterized by invasion an erosion of
contiguous (adjoining) tissues.
✔ Rarely metastasize
 Squamous cell Carcinoma
• Malignant • SURGICAL
proliferation MANAGEMENT
arising from the • Mohs
epidermis micrographic
• May arise from surgery
normal skin or • Electrosurgery
from pre-existing • Cryosurgery
skin lesions
 Melanoma
• Cancerous neoplasm characterized by neoplastic
melanocytes present in the epidermis and the
dermis
• 2% of all skin cancers
• Most lethal
• May manifest as a change in a nevus or a new
growth on the skin, arising from cutaneous
epidermal melanocytes
• Dark, red or blue colored, or a mix of these and
irregular in shape
• Associated with itching, rapid growth or bleeding
• Lower extremities in women and in the trunk, neck
or head in men
 Kaposi Sarcoma
• Malignancy of the • Four categories
endothelial cells that • Classic Kaposi
line the small blood Sarcoma
vessels. • Endemic Kaposi
• Lesions of the skub, Sarcoma
oral cavity, GI tract • Iatrogenic/organ
and lungs transplant
• Reddish-purple to associated Kaposi
dark blue macules, sarcoma
plaques or nodules • AIDS- related or
Epidemic Kaposi
Sarcoma
 BONE
CANCER
 BONE CANCER
• Primary malignant Musculoskeletal Tumors- rare and
arise from connective and supportive tissue cells or
bone marrow elements
• Metastatic bone disease- more common
• Tumors arising from tissues elsewhere in the body may
invade and produce localized bone destruction or bone
overgrowth
• Most common primary sites of tumors that metastasize
to bone are kidney, prostate, lung, breast, ovary,
thyroid
• Metastatic tumors – skull, spine, pelvis, femur and
humerus and involve more than one bone
Symptoms of Bone Cancer
• SYMPTOMS
• Pain
• Join swelling and
stiffness
• Limping
• Less common
symptoms- fever,
feeling unwell and
weight loss
 GASTROINTESTINAL SYSTEM
• Oropharyngeal
Cancer
• Esophageal
Cancer
• Cancer of the
Pancreas
• Cancer of the
Liver
• Gastric Cancer
• Colorectal
Cancer
 Oropharyngeal Cancer

✔ Usually squamous cell carcinoma

✔ Any areas of the oropharynx, but lips, lateral
aspects of the tongue and the floor of the
mouth are most commonly affected.
✔ Most frequent symptom- painless sore or lesion
that easily bleeds and does not heal
 Esophageal cancer
• Either adenocarcinoma or squamous cell
carcinoma
• Risk factors: chronic esophageal irritation or
GERD, associated with ingestion of alcohol or
use of tobacco
• Mucosa or submucosa
 Esophageal Cancer
• Symptoms include
dysphagia initially with
solid foods and
eventually with liquids,
a sensation of mass in
the throat, painful
swallowing, substernal
pain or fullness,
regurgitation of
undigested food with
halitosis and hiccups
• Diagnosis is confirmed
by EGD with biopsy
and brushings
Cancer of the Pancreas
• Risk factors: cigarette
smoking, exposure to
industrial chemicals or
toxins in the
environment, diet high
in fat, meat or both
• At risk are patients
with diabetes, chronic
pancreatitis and
hereditary pancreatitis
 Tumors of the head of the
Pancreas
• 60% to 80% of all • Symptoms: jaundice, clay
pancreatic tumors colored stool and dark urine
• Obstruct the common bile • Malabsorption of nutrients and
duct where the duct passes fat-soluble vitamins
through the head of the • Management:
pancreas to join the cholecystojejunostomy
pancreatic duct and empty
at the ampulla of Vater into
the duodenum.
 Pancreatic Islet Tumors
• 2 types: INSULINOMA (secrete insulin) and
NONFUNCTIONING ISLET CELL
CANCER (insulin secretion is not increased
• Neuroendocrine tumors
• Insulinomas produce hypersecretion of
insulin and cause an excessive rate of
glucose metabolism (hypoglycemia results)
• Symptoms- weakness, mental confusion,
seizures
• ORAL or IV administration of glucose
• 5-hour glucose tolerance test
 Ulcerative Tumors
(Zollinger-Ellison Syndrome)
• Some tumors of • Hypersecrecretion
the islets of is excessive that
Langerhans are even after partial
associated with gastric resection,
hypersecretion of acid is still
gastric acid that produced to cause
produces ulcers in ulceration.
the stmacj, • Ulcerogenic tumor
duodenum, and of the islets of
jenunum. Langerhans
 Cancer of the LIVER

• Either malignant or benign

• Benign liver tumors are most frequent in
women in their reproductive years who are
taking oral contraceptives
• Primary liver tumors are associated with
chronic liver disease, hepatitis
• Cigarette smoking and alcohol use are risk
factors
 LIVER CANCER
• No initial • Weight loss
symptoms • Loss of appetite
• May have vague • Jaundice
symptoms such as • itching
fatigue, fever,
chills, and night
sweats
• Pain, swelling or
tenderness in the
upper right section
of the abdomen
GASTRIC CANCER
 GASTRIC CANCER
• More common diagnosis in adults
• AT RISK- diet high in smoked, salted,
pickled foods and low in fruits and
vegetables
• H.pylori- major risk factor
• Other factors- chronic inflammation of
the stomach, pernicious anemia,
smoking, obesity, gastic ulcers
• Prognosis is generally poor
COLORECTAL CANCER
 COLORECTAL CANCER
• Risk factor- older age (65-74 years old), family
history
• 5 year survival rate is 90%; 39% are detected at
an early age
• Cancer of the colon and rectum is predominantly
adenocarcinoma
• Symptoms are determined by the location of the
tumor, stage of the disease and function of the
affected intestinal segment
• MOST COMMON PRESENTING SYMPTOM-
change in bowel habits
ENDOCRINE SYSTEM
• Thyroid Cancer
• Cancer of the adrenal
medulla
THYROID CANCER
• RISKS- external radiation of the
neck and chest in infancy and
childhood
• Treatment of Choice- surgical
removal (total or near-total
thyroidectomy)
 CANCER OF THE ADRENAL MEDULLA
(PHEOCHROMOCYTOMA)
• Usually benign and • Typical triad (for a hypertensive
originates from the patient): headache.
chromatoffin cells of the Diapohoresis, palpitatios
adrenal medulla • Nature and severity of
• Peak age- 40 and 50, both symptoms of functioning
mean and women tumor depend on the relative
• Cause of high blood proportions of epinephrine,
pressure in 0.1% of norepinephrine secretion)
patients with hypertension
REPRODUCTIVE
SYSTEM
• Breast cancer
• Vaginal Cancer
• Cervical Cancer
• Uterine/Endometrial
Cancer
• Fibrioids
• Cancer of the Fallopian
tube
• Ovarian Cancer
• Cancer of the Penis
• Prostate Cancer
• Testicular Cancer
 Breast Cancer: TYPES
• Ductal Cancer in Situ • Diagnostic:
• The presence of MAMMOGRAM
abnormal cells inside a • Symptoms: breast
milk duct lump and bloody
• Considered the earlies nipple disharge
form of breast cancer
• Invasive and has not
spread out of the milk
duct and low risk of
becoming invasive
 Invasive Cancer
• Starts in the breast • Infiltrating ductal carcinoma
ducts or glands but • Infiltraing lobular carcinoma
grows into breast • Medullary carcinoma
tissue, it can
• Mucinous carcinoma
spread into the
nearby lymph • Tubular ductal carcinoma
nodes and beyond • Inflammatory carcinoma
• Paget’s disease
 Signs and symptoms of Invasive
Breast Cancer
• A lump of thickening in or near the breast or in the underarm
that continues after menstrual cycle
• Mass or lump which may feel as small as a pea
• A change in the size, shape, or contour of the breast
• A blood stained or clear fluid from the nipple
• Change in the feel or appearance of the breast- dimpled,
puckered, scaly or inflamed
• Redness
• Marble like hardened area under the skin
Cause of Breast Cancer
• No specific cause
• Combination of GENETIC,
HORMONAL, and possibly
ENVIRONMENTAL FACTORS
 Prevention
• Breastfeeding for at • Early detection
least 1 year measures
• Regular or moderate • Additional screening
physical activity using MRI
• Maintaining a healthy • Clinical breast
body weight examinations
• Mammogams
Treatments for Breast Cancer
• Surgery (lumpectomy
or mastectectomy)
• Chemotherapy
• Radiation
• Hormone Therapy
 VAGINAL CANCER
• Uncommon, 1 to 3%
• Most are secondary and invasive
• RISK FACTORS: previous cervical cancer, in
utero exposure to diethystillbesterol,
previous vaginal or vulvar cancer, previous
radiation therapy, history of HPV
• Treatment: local excision, topical
chemotherapy or laser
 CERVICAL CANCER
• Clinical manifestations: thin, watery vaginal discharge often
noticed after douching or intercourse. If with irregular
bleeding or pain or bleeding after intercourse, the disease
may be advanced
• TREATMENT- surgery and chemotherapy
• Preventive Measures- pelvic examinations and pap smears,
especially for older women past childbearing age;
preventive counselling
Uterine or Endometrial Tumor
• Mostly are endometrioid (originating on the lining
of the uterus)
• 2 types of Endometrioid: TYPE 1 (estrogen
dependent), TYPE 2 (estrogen independent)
• Risk factors: obesity, cumulative exposure to
estrogen, infertility, diabetes, use of tamoxifen
• Treatment: surgical staging, total or radical
hysterectomy and bilateral salpingo-oophorectomy
and lymph node sampling
 Benign Tumors of the Uterus:
Fibroids (Leiomyomas/Myoma)
• Fibroids- may cause no symptoms or may produce
abnormal bleeding
• Other symptoms results from pressure on the
surrounding organs and include pain, backache,
pressure, bloating, constipation and urinary
problems.
• Menorrhagia and metorrhagia
• Treatment: myomectomy and hysterectomy
 CANCER OF THE
FALLOPIAN TUBE
• Most common in
• Enlarged fallopian
women who are
tube may be found
postmenopausal
on sonogram
• Symptoms are
• Treatment:
often minimal
Surgery followed
• Symptoms- by radiation
abdominal pain,
abnormal
bleeding, and
vaginal discharge
 OVARIAN CANCER
• Family history- most important risk factor
• Enlargement of abdomen from an
accumulation of fluid is a common sign.
• Diagnostic test- MRI scan, Transvaginal and
pelvic ultrasound, chest xrays and a blood tests
for CA-125
• Treatment: Surgical staging, exploration, and
reduction of tumor mass; surgical removal is
the treatment of choice
 Cancer of the Penis
• 5 year survival rate approaches 80%
• Penile cancer is rare
• Symptoms: penile lesions, painless lump,
ulcer, wartlike growth on the skin of the
penis, change in skin color such as a red
rash, bluish growths or whitish patches
and malodorous and persistent
discharge in late stages
 PROSTATE CANCER
• Most common • Diagnosis: abnormal
cancer in men finding in the DRE,
• Risk factors: age, serum PSA, and
family disposition, ultrasound guided
diet contains TRUS with biopsy
excessive amounts
of red meat or dairy
products that are
high in fat,
endogenous
hormones
 TESTICULAR CANCER
• Most common cancer diagnosed in men
between 15 and 35 years old
• Risk factors: undescended testis, family
history and personal history of testicular
cancer
• Symptoms: mass or lump in the testicla and
usually painless enlargement, heaviness in
the scrotum or inguinal area
• TSE should be performed monthly
• Primary treatment- removal of the affected
testis by orchiectomy
 URINARY SYSTEM
• RENAL CANCER
• BLADDER CANCER
 RENAL CANCER
• Tobacco use is a significant risk
• May metastasize early to the lungs, bone, liver,
brain and contralateral kidney
• Clinical manifestations- hematuria, pain, and a
mass in the flank, painless hematuria
• Diagnosis: intravenous urography, cystoscopic
examination, renal angiograms, Ultrasound and
CT SCAN
• Treatment – combination of surgery and
pharmacologic management
 BLADDER CANCER
• Tobacco use- leading risk factor
• Bladder tumors usually arise at the base of
the bladder and involve the ureteral orifices
and bladder neck.
• Visible, painless hematuria is the most
common symptom
• Diagnosis: ureteroscopy, excretory urography,
CT and MRI scans, ultrasound and biannual
examination
 NEUROLOGIC SYSTEM

• Brain tumors
• Spinal cord tumors
 BRAIN TUMORS
• Can occur at any part of the brain
• PRIMARY- arising from tissues within the brain
• SECONDARY- resulting from metastasis from a malignant
neoplasm elsewhere in the body
• A variety of physiologic changes result, causing any of
the following:
• 1. increased intracranial pressure and cerebral edema
• 2. seizure activity and focal neurologic signs
• 3. hydrocephalus
• 4. altered pituitary function
• Clinical manifestation: HEADACHE, usually dull and
constant but occasionally throbbing
 Brain tumors: classification in
ADULTS
• Intracerebral • Tumors arising from
TUMORS supporting
• Gliomas- infiltrate structures
any portion of the • Meningiomas,
brain, most common neuromas, pituitary
type of brain tumor adenomas
• Astrocytomas,
glioblastoma,
oligodendroglioma,
ependyoma,
medullablastoma
 Brain tumors: classification in
ADULTS
• Developmental Tumors • Metastatic LEsions
• Angiomas, dermoid,
epidermoid, teratoma,
craniopharyngioma
BRAIN TUMORS: diagnosis and
treatment
• Neurologic exam
• CT scans enhanced y contrast agent
• MRI
• Treatment- surgery, chemotherapy and
radiation therapy
 SPINAL CORD TUMORS
• Classified according to their anatomic
relation to the spinal cord
• Intramedullary lesions, extramedullary
intradural lesions and
extramedullary-extradural lesions
• Clinical Manifestations: localized or shooting
pains, weakness and loss of reflexes below
the tumor level to progressive loss of motor
function and paralysis
 SPINAL CORD TUMORS
• Diagnostics- CT scans, MRI Scans, biopsy
and CSF analysis
• Treatment: Surgical intervention and
chemotherapy
Thank you!!!