NCM 1832

LEC | Finals

Cellular Aberration
Cancer
a disease process that begins when an
abnormal cell is transformed by the genetic
mutation of the cellular DNA.

The cells acquire invasive characteristics,

and changes occur in surrounding tissues.
The cells infiltrate these tissues and gain
access to lymph and blood vessels, which
carry the cells to other areas of the body.
This phenomenon is called metastasis.

is a large group of malignant diseases with

some or all of the following characteristics:

❖ Abnormal cell proliferation caused by a

series of cellular and/or genetic
alterations or translocation.
❖ Lack of controlled growth and cell
division that leads to the formation of
tumors and to invasion of tissues that
are proximate to tumor cells.
❖ Ability to spread (metastasize) to distant
site(s) and establish secondary tumors.
❖ Involves any tissue of the body.
❖ Evades natural cell death (apoptosis)

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❖ Molecular Process
➢ Initiation
➢ Promotion
➢ Progression
❖ Epidemiology
➢ most cancers occur in people older
than 65 years of age.
➢ the incidence of cancer is higher in
men than in women and higher in
industrialized sectors and nations.
➢ Lung, prostate, and colorectal cancer
in men
➢ Breast, lung, and colorectal cancer in
women.
❖ Etiology
➢ Viruses and bacteria
▪ Human Papillomavirus (HPV)
▪ Epstein-Barr virus (EBV)
▪ Hepatitis B virus (HBV)
➢ Physical agents
▪ exposure to sunlight or
radiation
▪ Tobacco carcinogens
➢ Chemical agents,
▪ Tobacco; Tobacco smoke,
thought to be the single most
lethal chemical carcinogen,
accounts for at least 30% of
cancer deaths.
➢ Genetic or familial factors
▪ Hereditary (breast cancer, colon
cancer, prostate cancer, Wilm’s
tumor, ovarian cancer)
➢ Dietary/Lifestyle/Environmental
factors
Occupational exposure to
substances:
▪ Asbestos
▪ Benzene
▪ Radiation
▪ Arsenic
▪ Nickel
➢ Hormonal agents. Tumor growth
may be promoted by disturbances in
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hormonal balance either by the
body’s own (endogenous) hormone
production or by administration of
exogenous hormones. Cancers of
the breast, prostate, and uterus are
thought to depend on endogenous
hormonal levels for growth.
Diethylstilbestrol (DES) has long
been recognized as a cause of
vaginal carcinomas
❖ Role of the Immune System
➢ Tumor-associated antigens (TAAs;
also called tumor cell antigens)
❖ Detection of cancer
➢ Changes in bowel habits
➢ A sore that does not heal
➢ Unusual bleeding
➢ Thickening or lump in breast or
elsewhere
➢ Indigestion or difficulty in
swallowing
➢ Obvious change in wart/mole
➢ Nagging coughing/hoarseness
➢ Unexplained anemia
➢ Sudden loss of weight
❖ Prevention
➢ Mammography
➢ Papanicolaou’s (PAP Smear)
➢ Stool for occult blood
➢ Sigmoidoscopy
➢ Skin inspection
➢ Breast self-exam
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➢ Testicular exam ➢ X-Ray Scan

❖ Diagnostic procedure ➢ PET scan
Diagnostic Surgery (Biopsy) ➢ MRI
▪ Needle ➢ Tumor marker test
➢ Prostate CA (Prostatic –Specific
Antigen)
➢ Colon Ca (Carcinoembryonic
Antigen)
➢ Alkaline Phosphatase – bone
metastasis
➢ CA 125 – cancer of the breast and
endometrium

▪ Incisional Tumor Staging and Grading

Staging. Several systems exist for
▪ Excisional= frozen section
classifying the anatomic extent of disease.

The TNM system is frequently used. In this

system,

❖ T refers to the extent of the primary

▪ Staging= multiple needle or
incisional biopsies in tissues
where metastasis is suspected.
▪ Liver
▪ Endoscopy
tumor,
➢ the primary tumor is measured to
document it size and to determine
the depth of invasion of the tumor.
❖ N refers to lymph node involvement,
and
➢ nodes in the area of the primary
tumor are examined for the evidence
of disease spread. Their size,
number, and location are
documented.
❖ M refers to the extent of metastasis

Grading. seek to define the type of tissue

from which the tumor originated and the
degree to which the tumor cells retain the
functional and histologic characteristics of
the tissue of origin.

❖ GX – grade cannot be assessed.

❖ Diagnostic Exam & Imaging
❖ G1- well differentiated (resembles the
➢ Urinalysis
parent cell)
➢ Blood test
❖ G2- moderately differentiated
➢ Liver function test
❖ G3- poorly differentiated (bears little
➢ PSA test
resemblance to the parent cell)
➢ CT scan
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❖ G4- undifferentiated (impossible to tell
which cell is the parent; These tumors
tend to be more aggressive and less
responsive to treatment than well-
differentiated tumors.)
Treatment Modalities for Cancer
Treatment options offered to cancer
patients should be based on realistic and
achievable goals for each specific type of
cancer.
The range of possible treatment goals may
include complete eradication of malignant
disease (cure), prolonged survival and
containment of cancer cell growth (control),
or relief of symptoms associated with the
disease (palliation).
❖ Surgery
➢ Is a precise local treatment.
➢ May remove all of the primary tumor
or a portion of it.
➢ May be the method of obtaining
specimens for cytopathology
➢ May be the only treatment a patient
requires.
➢ May be used in the palliative setting
to alleviate or lessen intolerable
symptoms.
a. Diagnostic Surgery. such as a
biopsy, is usually performed to
obtain a tissue sample for analysis of
cells suspected to be malignant. In
most instances, the biopsy is taken
from the actual tumor.
b. Palliative Surgery. When cure is not
possible, the goals of treatment are
to make the patient as comfortable
as possible and to promote a
satisfying and productive life for as
long as possible. Whether the period
is extremely brief or lengthy
c. Reconstructive surgery may follow
curative or radical surgery and is
carried out in an attempt to improve
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function or obtain a more desirable
cosmetic effect. It may be
performed in one operation or in
stages.
❖ Radiation Therapy
➢ A local treatment in that a beam is
precisely directed at a specific
target.
➢ May follow surgery to prevent
recurrence of the primary tumor.
➢ Is more effective for some diseases
than others.
➢ Is sometimes used after
chemotherapy because radiation can
permanently damage bone marrow,
making it impossible to give
chemotherapy in the doses needed
for curative therapy.
➢ Sometimes in combination with
chemotherapy (Chemoradiation)
a. External Radiation. Depending on
the amount of energy they contain,
x-rays can be used to destroy
cancerous cells at the skin surface or
deeper in the body. The higher the
energy, the deeper the penetration
into the body. Gamma rays are
another form of energy used in
radiation therapy. This energy is
produced from the spontaneous
decay of naturally occurring
radioactive elements such as cobalt
60.
b. Internal radiation implantation, or
brachytherapy, delivers a high dose
of radiation to a localized area. The
specific radioisotope for implantation
is selected on the basis of its half-
life, which is the time it takes for
half of its radioactivity to decay. can
be implanted by means of needles,
seeds, beads, or catheters into body
cavities (vagina, abdomen, pleura)
or interstitial compartments (breast).
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Brachytherapy may also be
administered orally as with the
isotope I, used to treat thyroid
carcinomas.
❖ Chemotherapy
➢ Are systematic therapy rather than
local treatments, as drugs are
distributed throughout the body by
the bloodstream.
➢ Maybe used as single agents or
more commonly in combination with
other drugs.
➢ Are limited by toxic effects on
normal tissues.
➢ May have a tumoricidal effect in
hormone-sensitive tumors because
of reduction or blockage of the
source of the hormone or receptor
site where hormone is active.
a. Cell Kill and the Cell Cycle. Each time
a tumor is exposed to a
chemotherapeutic agent, a
percentage of tumor cells (20% to
99%, depending on dosage) is
destroyed. Repeated doses of
chemotherapy are necessary over a
prolonged period to achieve
regression of the tumor
b. Administering Chemotherapy. The
local effects of the chemotherapeutic
agent are also of concern. The
patient is observed closely during its
administration because of the risk
and consequences of extravasation
(particularly of vesicant agents,
which may produce necrosis if
deposited in the subcutaneous
tissues).
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Cell-cycle Nonspecific (CCNS)
➢ Alkylating agents –
CYCLOPHOSPHAMIDE
➢ Antitumor antibiotics –
DOXORUBICIN
➢ Hormones – CORTICOSTEROIDS
Cell specific (CCS)
➢ Antimetabolites – FLOUROURACIL
➢ Mitotic inhibitors – VINCA
ALKALOIDS
ALKYLATING AGENTS
1. Busulfan (myleran)
2. Carboplatin (Paraplatin)
3. Carnustine ( BCNU)
4. Chlorambucil ( Leukeran)
5. Cisplatin ( Platinol AQ)
6. Cyclophosphamide ( Cytoxan)
7. Ifosfamide ( (Ifex)
8. Lomustine ( CCNU)
9. Melphalan ( Alkeran)
10. Streptozocin ( Zanosar)
11. Temozolamide ( Temodar)
ANTIMETABOLITES
1. Capecitabine ( Xeloda)
2. Cladribine ( Leustatin)
3. Clofarabine ( Clolar)
4. Cytarabine Hcl ( Cytosar)
5. Fludarabine ( Fludara)
6. Fluorouracil ( 5-FU)
7. Gemcitabine ( gemzar)
8. Mercaptopurine ( 6-MP, Purinethol)
9. Methotrexate ( MTX)
10. Thiohuanine ( TG, Tabloid)
Anti-tumor antibiotics
1. Daunorubicin ( Cerubidine)
2. Doxorubicin ( Adriamycin)
3. Epirubicin ( Ellence)
4. Idarubicin ( Idamycin)
5. Mitomycin C ( Mutamycin)
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6. Mitoxantrone ( Novantrone)
7. Valrubin ( valstar)

Other cancer agents

CORTICOSTEROIDS – anti-inflammatory
HORMONE
ESTROGEN – retards prostate cancer
PROGESTINS – retards breast and uterine
cancer
TAMOXIFEN – synthetic anti-estrogen

❖ Bone Marrow Transplantation

➢ Allogeneic (from a donor other than
the patient): either a related donor
(ie, family member) or a matched
unrelated donor (national bone
marrow registry, cord blood registry)
➢ Autologous (from patient)
➢ Syngeneic (from an identical twin)
❖ Nursing dx
➢ Anxiety
➢ Disturbed body image
➢ Anticipatory grieving
➢ Risk for infection
➢ Risk for injury
➢ Altered nutrition: less than body
requirements
➢ Impaired tissue integrity

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