CANCER

CANCER

KRISHNA B. BALSARZA, RN
MAN-NURSING SERVICE

C - cancer derives from the Greek word

karkinoma meaning crab which is used to
describe
appendage-like
projections
extending from tumors
A - abnormal cells divide in an uncontrolled
way
N - normal cell suddenly turns into a rouge
cell and start dividing continuously without
check, leading to the development of solid
lumps
C - condition wherein cells mutate and
increase number, with changes in their
morphology and without any function.
E - estimates that it is the second leading
cause of death
R - results from abnormal cellular DNA

THEORIES OF
maintains
that somatic
CARCINOGENESIS
1. Gene
Mutation
Theorygene mutati

the basis of neoplastic transformat

and their clonal expansion leading
carcinogenesis

2.

a carcinogen inititates ca
preneoplastic aneuploidy
Aneuploidy mitosis.
TheoryThis initiates an
karyotype evolution that
chromosomal variants

3. Epigenetic
Theorystable changes oc
non-mutational

cellular genome which can contrib

to carcinogenesis

TUMOR
CLASSIFICATION

MALIGNANT
grows rapidly
not encapsulated
invade local
structures and
tissues
poorly
differentiated
high mitotic index
spread distantly

BENIGN

grows slowly
well-defined
capsule
not invasive
well differentiated
low mitotic index
do not
metastasize

 Epithelial tissues (Carcinoma)

Glandular tissues (Adenocarcinomas)
Connective, Muscle, and Bone tissues
(Sarcomas)
Brain and Spinal Cord tissues (Gliomas)
Pigmented cells (Melanomas)
Plasma cells (Myelomas)
Lmphatic tissue (Lymphomas)
Leukocytes
(Leukemia)
Erythrocytes (Erythroleukemia)

FACTORS
AFFECTING
Age andCANCER
Diet
Hormonal
Status
Family
history
Genetic
Predispositio
n

Chemicals
Smoking
Radiation
Infection
Role of Free
Radicals

BREAST
CANCER

Family History
High-fat
Diet
Obesity after Menopause
Early Menarche, Late Menopause
Alcohol Consumption
Postmenopausal Estrogen and
Progestin
First Child after Age 30

OVARIAN CANCER
Multiple Sexual Partner
Having Sex at Early Age
Exposure to Human
Papilloma Virus
Smoking

COLORECTAL CANCER
Family History
Low Fiber Diet
History of Rectal Polyps

ESOPHAGEAL
CANCER
Heavy Alcohol Consumption
Smoking

CERVICAL CANCER
Multiple Sexual Partner
Having Sex at Early Age
Exposure to Human Papilloma
Virus
Smoking

STOMACH CANCER
Family History
Diet Heavy in Smoked, Pickled or
Salted Foods

LUNG CANCER
Cigarette Smoking
Asbestos, Arsenic, and Radon
Exposure
Secondhand SmokeTB

SKIN CANCER
Excessive Exposure to UV Radiation
(Sun)
Fair Complexion
Work With Coal, Tar, Pitch or
Creosote
Multiple or Atypical Nevi

TESTICULAR CANCER
Undescended Testicles
Consumption of Hormones by
Mothers during Pregnancy

PROSTATE CANCER
Increasing Of Age
Family History
Diet High in Animal Fat

 Oncogenesis refers
to the genetic
mechanism whereby normal cells are
transformed into cancer cells.
Three kinds of genes control cell growth
and replication:
procto-oncogenes
tumor suppresor genes
apoptosis

Acute Lympocytic
Leukemia

WARNING SIGNS
FOR CANCER

C hanges in bladder or bowel habits

A sore that does not heal
U - nusual bleeding or discharges
T hickening or lumps
I ndigestion or difficulty swallowing
O bvious changes in warts, mole or
the skin
N aging cough or hoarseness of
voice
U nexplained anemia
S udden loss of weight

CLINICAL
MANIFESTATION
1. PARANEOPLASTIC
S SYNDROME
2. PAIN
3. FATIGUE
4. CACHEXIA
5. ANEMIA
6. LEUKOPENIA &
THROMBOCYTOPENIA
7. INFECTION

PARANEOPLASTIC
Proposed
Mechanism
SYNDROME
Some are caused by the elaboration of

Types of
Associated
Syndrom
Tumor Type
e
Syndrome of
Inappropriate
hormone
ADH

Production and
release of ADH by
tumor

Small
Cell Lung
Ca
by
cancer
cells
Result from the production of circulating
Small Cell
Lung Ca, Production
and
factors that
produce
hematopoietic,
Cushing's
Bronchial
release of ACTH by
Syndrome
neurolofic Carcinoid
and dermatologic
syndromes
Ca
tumor
May be the earliest indication
that a
Production and
person hasSquamos
cancerCell
release of
Hypercalcemia
Cancers of involves
Lung,
polypeptide
factor

Treatment
concurrent
Neck, Ovary with close
treatment Head,
og the
underlying
cancer and
relationship to PTH
suppression of the mediator causing the
Venous
Pancreatic, Lung,
syndrome
Thrombosis
Other Cancer
Nonbacterial
Thrombocytic

Other Advanced
Cancers

Production of
Procoagulation
factors

PAIN
occurs
in
a
large
fraction
of
those
individuals who are
terminallly
ill
with
cancer
influenced
by
fear,
anxiety,
sleep
loss,
fatigue and overalll
physical deterioration
occur at the site of the
primary tumor or can
result from a distant
metastatic lesion

FATIGUE
studies of muscle function suggest
that some individuals with cancer
may lose portions of muscle function
needed to perform normal physical
activies
described as tiredness, weakness,
lack of energy, exhaustion, lethargy,
inability to concentrate, depression,
sleepines,
boredom,
lack
of
motivation and decreased mental

CACHEXIA
severe form of malnutrition
associated with cancer and result
in wasting, emaciation and quality
of life
constellation
of
symptoms
including anorexia, weight loss,
early satiety, anemia , asthenia,
taste alterations and altered
protein, lipid and carbohydrate
metabolism

ANEMIA
mechanisms that cause anemia
includes
chronic
bleeding,
severe malnutrition, cytotoxic
chemotherapy, malignancy in
blood forming organs
defects in erythropoietin and
shortened duration of red blood
cells

LEUKOPENIA /
NEUTROPENIA /
THROMBOCYTOPENIA
Direct tumor invasion of the
bone
marrow
causes
leukopenia
thrombocytopenia

both
and

Availability
of
hematopoietic
growth
factors
like
GCSF
(Granulocyte Colony-Stimulating
Factor), Erythropoietin, which
stimulates
red
blood
cell
production and IL-11 which

INFECTION
cause of complications and
death
in
person
with
malignant disease
persons with cancer have
debility with advance disease
and immunosuppression from
the underlying cancer and
treatment

GASTROINTESTIN
AL TRACT

Both
chemotherapy
and
radiation therapy may cause a
decreased
cell
turnover
thereby leading to oral ulcers,
malabsorption and diarrhea
Disruption of barrier defenses
also increases the risk for
infection

TUMOR STAGING
In situ, meaning early cancer
that is present only in the layer of
cells in which it began.
Regional, meaning the cancer has
spread to nearby lymph nodes,
organs, or tissues.
Unknown, meaning there is not
enough information to designate a

INVASION AND
METASTASIS

Metastasis is the spread of

cancer cells from the site of
the original tumor to distant
tisses and organs through
the body.

LYMPHATIC
SPREAD
Tumor emboli enter the lymph

channels by way of the interstitial

fluid,
which
communicates
withlymphatic fluid.

Malignant
cells
penetrate
lymphatic vessels by invasion.
Malignant cells either lodge in the
lymph nodes or pass between the
lymphatic and venous circulations.

HEMATOGENOUS
SPREAD

Dissemination of malignant cells via

the bloodstream and is directly
related to the vascularity of the
tumor.

Malignant
cells
attach
to
endothelium
and
attract
fibrin,
platelets, and clotting factors to seal
themselves from immune system
surveillance.
Malignant cells to enter the basement
membraneand
secrete
lysosomal
enzymes.

IMAGING
PROCEDURES
CT
SCAN
ULTRASO
UND
PET SCAN
MRI
NUCLEAR
SCAN

TUMOR MARKERS
Are antigens that are expressed on
the surface of the tumor cells or
substances released from normal cells
in response to the presence of tumor
Are substances, mostly proteins, that
are produced by the body or by the
tumor itself in response to cancer.
The value of a marker depends on:
sensitivity
specificity
proportionality
feasibility

OBTAINING TISSUE
PROCE
BIOPSY
PURPOSE
EXAMPLE
DURE
Excisi
onal

complete removal,
usually with margin of
normal tissue

full resection

Incisio
nal

removal of portion of
lesion

lymph node
biopsy, muscle
mass biopsy

Core
Needl
e

performed with direct

vision, or guided wit
ultrasound or CT Scan

needle biopsy
of prostate or
liver mass

Fine
obtains dissociated
Needl
cells for cytology study
e
but does not preserve
Aspira

thyroid, breast
mass

TREATMENT

CHEMOTHERAPY
BIOTHERAPY
SURGERY
RADIOTHERAPY
BONE MARROW
TRANSPLANTATION

Chemotherapy
It is a systemic treatment that
enables drugs to reach the site of
the tumor as well as distant
sites.
At cellular level, they exert their
lethal
action
by
targeting
processes
that
prevent
cell
growth and replication. These
mechanisms include disrupting
production of essential enzymes;
inhibiting DNA, RNA and protein
synthesis; preventing cell mitosis
Most effective in treating tumors
that have a high growth fraction
because of their ability to kill
rapidly diving cells

CHEMOTHERAPY
PROTOCOL

Colon CA,/Colorectal CA
- FOLFOX, FOLFIRI,
MFOLFOX
Burkitts Lymphoma
CODOX
AML/CML/ALL
DOXOROBICIN,
CYTARABINE

Breast CA PACLITAXEL,
CARBOPLATIN

Most
chemotherapeutic
drugs
suppress bone marrow function
and formation of blood leading to
NEUTROPENIA,
THROMBOCYTOPENIA
and
ANEMIA.
Hematopoietic growth factors like
GCSF
(Granulocyte
ColonyStimulating
Factor),
Erythropoietin

ANOREXIA,
NAUSEA AND
this symptom
is due to
VOMITING
the stimulation of the
chemoreceptor trigger
one in the medulla that
stimulates vomiting.
Seronotin (5-HT3)
receptor antagonists
(Ondansetron,
Granisetron,
Dolasetron,
Palonosetron)

3.DIARRHEA chemotherapy can cause

temporary
lactose
intolerance
or
increase in gastric motility.
Patients are advised to eat, small
frequent feedings and small residue
meals, to refrain from eating spicy or
greasy foods and to avoid extreme
temperatures in food or beverages.
4.HAIR LOSS results from impaired
proliferation of the hair follicles and is a
side effect of a number of cancer drugs.

BIOTHERAPY
Involves the use of immunotherapy
and biologic response modifiers as
a means of changing the persons
own immune response to cancer.
The major mechanism by which
biotherapy exerts its effects are
modification of host responses,
direct destruction of cancer cells
by suppressing tumor growth or
killing
the
tumor
cell
and
modification of tumor cell biology.

SURGERY
First line of treatment for solid
tumors.
Used for diagnosis, staging of
cancer, tumor removal and
palliation when cure cannot be
achieved.
Type of surgery to be used is
determined by the extent of the
disease, the location and
structures involved, the tumor
growth and invasiveness, the
surgical risk to the patient and
the quality of life the patient
will experience after the
surgery
It can be primary, curative
treatment for cancers

RADIOTHERAPY
The goal of radiation is to achieve regional
local control of the cancerous growth
without
permanently
damaging
the
surrounding tissues.
Can be delivered by either external beam
radiation machines that have sources of
radiation located some distance from the
patient (TELETHERAPY) or by short-distance
therapy (BRACHYTHERAPY) in which a sealed
radioactive source is placed close to or
directly in the tumor site.

TELETHERAPY
is commonly delivered by a
linear
accelerator
or
a
cobalt-60
machine.
It
produces ionizing radiation
through a process in which
electrons are accelerated a
very high rate, strike a
target and produce high
energy
x-rays.
Photon

BRACHYTHERA
PY
UNSEALED
SEALED
involves
the
insertion of sealed
radioactive
sources
into a body cavity or
directly
into
body
tissues.
Most
commonly, they are
packed into needles,
beads,
seeds,
ribbons, or catheters
which
are
then
implanted
directly
into the tumor

injected
intravenously
or
administered
by
mouth. Iodine- 131,
given by mouth is
used
in
the
treatment of thyroid
cancer.
Strontium89,
is
given
to
control bone pain
due
to
multiple
skeletal metastasis

Bone Marrow
Transplantation

Involves high dose chemotherapy

and radiation therapy that are
either marrow ablatie or marrow
suppressive followed by
hematopoietic rescue.
Utilizes stem cells obtained from
bone marrow
Transplantation techniques can
identify source of the marrow or
peripheral stem cells as
ALLOGENIC, in which recipient
receives stem cells from another
person whose Human Leukocyte
Antigen (HLA) matches; Syngeneic
from identical twins; Autologous
in which the recipients own bone
marrow or stem cells are used.

You cannot always save lives,

but you can always love them
- CANCER UNIT 1 / BMT InPatient Unit