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The Normal Cell

Cellular Characteristics Reproduces Reacts to stimuli Moves either by amoeboid motion of by means of cilia or flagella Cellular Activities Synthesis of protein molecules Production of energy for cellular work Maintenance of homeostatic environment within the cell Ingestion and assimilation by the cell of materials from outside (phagocytosis pinocytosis active ! passive transport" Reproduction Skin # fast Cardiac ! skeletal striated muscle cells ! neurons $ do not %ifferentiation Cancer cell $ dedifferentiate $ loses special structural and functional ability Aging Cell Shrinks in si&e Protein synthesis slower 'olgi comple(es begins to break apart Immune cells in number but in function )ice to know* Age* epithelial cells $ + , days R-C $ +./ days )erve cells $ +// years 0ypes of Cellular Aberrations

+1 'enetic disturbances .1 %egenerations ! infiltrations 21 %isorders in cell growth $ malignant growth atrophy ! hypertrophy Cancer Facts Cancer is the 32 killer of 4ilipinos today1 +/2 die from it everyday1 Cancer is on the rise and is pro5ected to be the 3+ killer of 4ilipinos in the ne(t 6 years1 0he survival rate for adult 4ilipinos is 5ust 6/7 compared to at least 8/7 in the 9est1 8+ 6.: new cases occur yearly ./ /// of these are ;ung CA1 0he Philippines has the highest rate of -reast CA in Asia

Estimated leading CA site in 1998

Estimated leading site in 2005

1. Lungs 2. Breast 3. Liver 4. Cervix 5. Leu emia !. C"l"n #. $%&r"id 8. 't"mac% 9. (as")%ar&nx 10. L&m)%"mas

1. Lungs 1!.1* 2. Breast 13.1* 3. C"l"n+,ectum 8.0* 4. Liver #.1* 5. Cervix+ uterine !.8* !. -r"state 4.0* #. Leu emia 3.9* 8. 't"mac% 3.#* 9. $%&r"id 3.3* 10. .var& 3.1*

Estimated New CA cases in 2005

1. Oral cavity 2. Nasopharynx 3. other pharyn eal CA !. Esopha "s 5. #tomach $. Colon%&ect"m '. (iver ). *ancreas +. (arynx 10. ("n s

Estimated CA deaths in 2005 by site and sex

CA #ite ,ale -emale 1. Oral cavity +10 )'$ 2. naso. pharynx 12)$ 51$ 3.other pharynx !22 355 !. Esopha "s 5$+ 30! 5. #tomach 2030 133+ $. Colon% &ect"m 30$! 2!+! '. (iver 55!' 1+30 ). *ancreas +21 +1! +. (arynx )+' 15$ 10. l"n s 12/232 3$!+

Cancer (med" new growth of tissue resulting from a continuous proliferation of abnormal cells that have the ability to invade and destroy other tissues derived from ;atin word which means crablike because cancerous growth spread by sending crablike pro5ections into the surrounding tissue1 %efinitions )eoplasia $ literally means <new growth=> development of a new growth )eoplasm $ is the new growth 0umor $ was originally applied to the swelling caused by inflammation> the term is now e?uated with neoplasm @ncology $ ( 'reek <oncos=A tumor" is the study of tumors or neoplasm1 Binds of Cancer Carcin"ma $ most common Arise from cells that cover the internal and e(ternal body surfaces C(amples* lung breast colon 'arc"ma $ arise from cells found in the supporting tissue C(amples* fat bones muscles L&m)%"mas $ arise in lymph nodes and tissues of the bodyDs immune system C(ample* lymph nodes Leu emia $ cancer of the immature blood cells that grow in the bone marrow and tend to accumulate in large numbers in the blood stream C(ample* blood stream Categories of Cancer '"lid $um"rs $ initially confined to a specific tissue or organ /emat"l"gic Cancer# involved the blood forming cells that naturally migrate to the blood and lymph nodes

%isseminated disease from the beginning

Eow are cancer cells different from normal cellsF

NO&,A( CE((# ,itotic 0ivision in normal tiss"e/ the rate o1 new cell rowth and old cell death are 2ept in balance
. .

"ncontrolled cell rowth or loss o1 a cell3s ability to "nder o 4A*O*5O#6#7 or 4CE(( #86C60E7

Eow do cancers get startedF Pathophysiology Ctiologic 4actors





Chemical Agents

Physical Agents

A1 Eost +1 Age Cancer affects people of all ages1 @lder people develop more # more than 6/7 of cancer occurs in persons older than age :61 .1 0ender # women are more susceptible to certain types of Ca # men e(perience a higher overall incidence than women1 21 'enetic 4actors if %)A damage occurs in cell population where chromosomal patterns are abnormal mutant cell population may develop 4amilial predisposition G1 Immune System 4unction 61 Hiruses e1g* Cpstein# barr herpes simple( type II cytomegalovirus papillomavirus hepa#:1 Eormonal 4actors

I hormones influence CA development in 2 ways* a1 Preparative action on target tissue making them susceptible to CA1 b1 Permissive influence on CA development allowing the process to progress c1 Conditioning effect on the tumor1 81 ;ifestyle practices i1 cigarette smoking ii1 nutritional habits iii1 alcohol intake iv1 se(ual practice - A'C)0 +1 Physical Agent prolonged e(posure to the heat of the sun e(posure to radiation 1 )on# ioni&ing Radiation ( ultraviolet rays from the sun television computer" 1 Ioni&ing radiation ( (#ray uranium nuclear weapon" .1 Chemical Agent e(posure to to(ic substances or to(icants such as asbestos arsenic nickel chromium cobalt tar asphalt certain plastics hydrocarbon in cigarette smoke air pollutants from industry crude paraffin oil feel oils1

C1 C)HIR@)MC)0 J/7 # K/7 of all CA came from the environment # 9ork environments $ workers e(posed to substances such as asbestos nickel and lead1 # Socio#economic class $ higher rates of tobacco smoking alcohol consumption and poor nutrition among the poor1 # C(posure to high level of pollutants e1g* Air pollution in diesel e(haust %IC0 Carcinogen $ any substance situation or e(posure that can damage the genetic material (%)A" Carcinogenesis $ mutations in a variety of genes responsible for controlling the growth of cells either directly or indirectly 4our Stages of cancer cell growth* Initiation $ irreversible mutation of a gene that leads to malignant transformation Promotion $ promoting agent stimulates the growth and divisions of a cell Progression $ series of changes that lead to the characteristics of undifferentiated cell Metastasis $ tumor has properties needed to spread to other organs in the body Metastasis Invasion of ad5acent tissues through basement membranes Cntrance into nearby vessels (lymph or blood" Invasion of the immune system Reentrance into distant tissues Implantation of malignant cell in new tissue Signs and Symptoms Ca Cell -r"li1erati"n 222 3isru)ti"n "1 n"rmal cell gr"4t% and inter1ere 4it% tissue 1uncti"ns. 1.-ressure 5 due t" increase in si6e "1 ne")lastic gr"4t%. 2..7structi"n 8 as tum"r c"ntinues t" gr"49 %"ll"4 "rgans and vessels 7ec"me c"m)ressed and "7structed e.g: es")%agus9 7r"nc%i9 ureters9 7"4el9 7l""d vessels l&m)%atic s&stem.

3. -ain due t": . )ressure "n nerve endings . distenti"n "1 "rgans+ vessels . lac "1 .2 t" tissues and "rgans . release "1 )ain mediat"rs 7& t%e tum"r

4. E11usi"n 8 8 8 4%en l&m)%atic 1l"4 is "7structed9 t%ere ma& 7e e11usi"n in ser"us cavities. e.g: -leural E11usi"n 5 e11usi"n in t%e )leural cavit& Ascites 8 e11usi"n int" t%e a7d"minal cavit&. 5. ;lcerati"n in necr"sis 8 result as t%e tum"r er"des 7l""d vessels and )ressure "n tissue causes isc%emia8 8 8 tissue damage and 7leeding 8 8 8 in1ecti"n !. vascular t%r"m7"sis9 em7"lus9 t%r"m7")%le7itis 8 8 8 tum"rs tend t" )r"duce a7n"rmal c"agulati"n 1act"rs t%at cause increased cl"tting <)ulm"nar& em7"li 8 8 li1e t%reatening.= -arane")lastic s&ndr"me 222 malignant cells )r"duce en6&mes9 %"rm"nes and "t%er su7stances. 1. Anemia 8 Ca cells )r"duce c%emicals t%at inter1ere 4it% r7c )r"ducti"n 8 >r"n u)ta e is greater in t%e tum"r t%an t%at de)"sited in t%e liver. 8 7l""d l"ss ma& result 1r"m 7leeding.

2. /&)ercalemia 8 tum"rs "1 t%e 7"ne9 s?uam"us cell lung Ca9 Ca "1 t%e 7reast )r"duce a )arat%&r"id 5 li e %"rm"ne t%at increases "r accelerates 7"ne 7rea d"4n and release "1 calcium. 8 als" results 1r"m metastasis t" t%e 7"nes. 8 en%anced 7& imm"7ili6ati"n and de%&drati"n. 3. 3>C < 3essiminated >ntravascular 3isease= 8 m"re li el& t" "ccur in Ca "1 t%e lungs9 )ancreas9 st"mac%9 )r"state 8 )reci)itated 7& t%e release "1 tissue t%r"m7")lastin "r end"t%elial in@ur&. An"rexia A Cac%exia '&ndr"me 1. t%e 1inal "utc"me "1 unrestrained Ca cell gr"4t%. 2. malignant ne")lasm de)rive n"rmal cells "1 nutriti"n 3. tum"rs )r"duce alterati"n in en6&me s&stem necessar& 1"r n"rmal meta7"lism 888 st"red 1at is l"st9 tissues l"se nitr"gen. 4. tum"rs revert t" anaer"7ic meta7"lism 5 c"nsume gluc"se9 de)lete gl&c"gen st"res in t%e liver and c"nvert gluc"se t" lactate. 5. -r"tein de)leti"n9 serum al7umin levels decrease. !. tum"rs ta e u) (a. Bater retenti"n mas s malnutriti"n and is n"t immediatel& re1lected as 4eig%t l"ss. #. Ca cells )r"duce an"rexigenic su7stances t%at act in t%e satiet& center "1 t%e %&)"t%alamus9 causing A(.,EC>A. 8. $aste sensati"n diminis%es "r 7ec"mes altered and t%e individual ma& %ave aversi"n t" eating9 )articularl& meat. CA(CE, .F $/E $.(0;E -,>DA, CL>E($ B/. 'D.EE A(3 3,>(E ALC./.L >( LA,0E AD.;($ >' ;';ALLF L.CA$E3 A$ $/E FL.., .F $/E D.;$/

DE$A'$A'>' $. $/E (ECE >' GE,F C.DD.( CA .F $/E ';B DAC>LLA,F 0LA(3' A,E />0/LF DAL>0(A($ A(3 0,.B' ,A->3LF. CA .F $/E .,AL CAG>$F CL>(>CAL F>(3>(0' : 'H -A>( AL$E,A$>.( >( $A'$E .H Leu ")enia< 4%ite )atc%es "ver muc"sa = c"nsidered a )re cancer"us lesi"n ;lcerated areas9 "r 7leeding in t%e areas "1 t%e m"ut% $/E,A-E;$>C >($E,GE($>.( ,ec"nstructive 'urger& i1 needed ,adiati"n >m)lantati"n "1 radi"active materials ma& arrest t%e gr"4t% "1 t%e tum"r $-( and enteral tu7e 1eedings CA(CE, .F $/E L;(0' CA "1 t%e Lungs ma&7e )rimaril& "r metastasis 'D.E>(0 is t%e m"st signi1icant 1act"rs Leading t&)e "1 CA t%at cause deat% /ig% incidence in men 40 &rs "ld and a7"ve '&m)t"ms ma& "ccur a1ter metastasis t" "t%er "rgan: ri7s liver adrenal glands mediastinal "rgans idne& 7rain CL>(>CAL F>(3>(0' 'H 3&s)nea C%ills Fatigue C%est )ain .H )ersistent c"ug% /em")t&sis ;nilateral 4%ee6es Beig%t l"ss Clu77ing "1 1ingers C%est C8ra& 5 -leural E11usi"n C.>( LE'>.( I C&t"l"gic test 1"r ')utum exam (;,'>(0 CA,E .F CL>E($ B>$/ B,.(C/.0E(>C CA,C>(.DA A''E''DE($ ')utum ?uantit& and c%aracteristics Lung auscultati"n 1"r a7sent 7reat% s"unds C%est )ercussi"n 1"r dullness "ver tum"rs ,es)irati"ns 1"r '%all"4ness '$,>3.,9 and use "1 access"r& muscles -ersistent c"ug%

$/E,A-E;$>C >($E,GE($>.( ';,0>CAL L.BEC$.DF: rem"val "1 "ne l"7e "1 t%e lungs 4%en lesi"n is limited t" "ne area ,E'EC$>.(8 rem"val "1 small c"n1ined lesi"n9 ma& als" 7e d"ne 1"r 7i")s& -(E;D.(EC$.DF8 rem"val "1 t%e entire lungs EC-L.,A$.,F $/.,AC.$.DF8 ")ening "1 t%e t%"racic cavit& t" determine t%e extent and 1urt%er t%era)& $/.,AC.-LA'$F8 rem"val "1 t%e ri7s t" reduce t%e si6e "1 t%e )leural cavit&9 d"ne t" )revent c"m)licati"n a1ter resecti"n "1 t%e lungs LA'E, ';,0E,F8 rem"val "1 tum"r via E(3.'C.-E inserted 7et4een t%e ri7s $/.,ACE($E'>'8 rem"val "1 1luid + 7l""d in t%e )leural cavit& ,A3>A$>.( $/E,A-F8 used t" ad@unct t%era)& "r t" alleviate s&m)t"ms "1 )ain9 d&s)nea and %em")t&sis. C/ED.$/E,-F < C&cl")%"s)aide9 Det%"trexate9 Gincristine = A(ALF'>' A(3 (;,'>(0 3>A0(.'>' 1. >m)aired gas exc%ange

$E'$>C;LA, CA(CE, A malignant condition that affects the cells within a testis1 Commonly affects white males ages +6 to 26 Clinical Dani1estati"ns +1 .1 21 G1 61 C"m)licati"ns +1 .1 scrotal mass or nodule in a testicle heavy sensation in the scrotum pain or discomfort in the affected testis or in the scrotum dull aching sensation in the abdomen or groin abrupt accumulation of fluid within the scrotum

infertility (only if both testicles are removed as a means of treatment" metastatic disease

'creening guidelines 1"r $esticular cancer +1 performance of monthly self#testicular e(aminations beginning at age +6 .1 clinical testicular self e(amination by a health care provider performed annually $esticular 'el1 Examinati"n +1 Instruct the patient to perform an e(amination following a warm bath or shower (rela(es the scrotum" .1 Instruct the patient to use his thumb and fingers to palpate each testicle thoroughly for lumps1 21 0ell the patient to visually inspect the scrotum for any color changes or asymmetry G1 Instruct the patient to report any suspicious nodules to the physician promptly $reatment D"dalities +1 SLR'CRM Radical Inguinal Orchiectomy- one or both testes are removed through an incision made in the groin .1 C(ternal -eam Radiation

G1 61 :1

21 Chemotherapy Cmphasi&e the importance of close medical follow#up Cncourage e(ercise to decrease blood pressure Monitor the patient for complications including hypercalcemia and polycythemia and notify the physician if any occur1 81