Prepared by: Anna Marie M.

Montalban,
RN, US-RN
1. Description of cancer
2. Definition of terms:
- Apoptosis
- Benign
- Carcinogen
- Carcinoma
- Hospice
- Lymphomas
- Leukemia or myeloma
- Malignant
- Metastasis
- Nadir
- Neoplasm
- Sarcoma
- Tumor markers
- Undifferentiated cells
3.Classify cancer.
4. Pathophysiology of cancer cells/theory of pathogenesis
5. Grading and Staging and TNM CLASSIFICATION SYSTEM
6. Elaborate the seven warning signs of cancer .
7. Identify the risk factors.
8. Identify common tumor markers.
9. Identify diagnostic tests.
10. Differentiate benign from malignant neoplasms.
11. Differentiate proliferative patterns from characteristics of a normal
cells.
DESCRIPTION:
- A neoplasic disorder that can involve all body organs
characterized by:
a. Uncontrolled growth and spread of abnormal cells
b. Proliferation: rapid reproduction by cell division
c. Invasion: growth of primary tumor into surrounding
tissue
d. Metastasis: spread or transfer of cancer cells from one
organ or part to another not directly connected.
- Result from a process of altered cell growth and
differentiation which is uncoordinated and lacks
normal regulatory controls over cell growth and
division.
DEFINITION OF TERMS:
apoptosis: program & controlled cell destruction w/c
eliminates damaged, improperly produced & worn out
cells w/out harming the other areas. A normal process
of cell deletion & renewal.
- carcinogen: a physical, chemical, or biological stressor
that causes neoplastic changes in normal cells.
- carcinoma: a new growth or malignant tumor that
originates from epithelial cells, the skin, GIT, lungs ,
uterus, breast and other organs.
- differentiation: a process which normal body cells
have individual characteristics allowing them to
perform different body functions.
- Hospice: a concept of care for terminally ill clients that
includes the idea of intensive caring rather than
intensive care. The family and the client are the focus
of nursing care and the goal is to relieve pain and
facilitate the optimal quality of life.
Lymphomas: neoplasms that originate from the lymphoid
organs.
Leukemia or myelomas: neoplasms that originates from
blood forming organs.
Malignant: term for growth that metastasize and grow;
cancerous lesions that are disordered, uncontrolled
and chaotic proliferation of cells.
Metastasis: the transfer of disease from organ or part to
another not directly connected w/it.
Nadir: the period of time during w/c an antineoplastic
med has its most profound effects on the B.M.
Neoplasm: a new growth, w/c maybe benign or malignant.
Protooncogenes: a normal gene that can become an
oncogene d/t mutation or increased expression.
Oncogene: a gene that has the potential to cause CA;
protooncogenes which is converted via
mutation/chromosomal arrangement.
Sarcomas: neoplasms that originate from muscle, bone,
fat, lymph system, or connective tissues.
Tumor markers: specific bodily subs. that seem to
indicate tumor progression or regression.
Undifferentiated cells: cells that have lost the capacity for
specialized functions.
5 STAGES:
1.) Gap/Growth phase (G1) – time after formation of cell, RNA,
CHON synthesis
2.) Synthesis (S) phase – DNA replication
3.) Gap/Growth phase (G2) – continued RNA & CHON synthesis
4.) Mitosis: cell division: PMAT
- Prophase: chromatin coil shortens forming 2 pairs of
chromatids, centrioles move to opposite end forming a
mitotic spindle
- Metaphase: chromosomes cluster & align midway between
spindle poles
- Anaphase: centromeres divide, divided chromosomes moves
to opposite side of the spindle poles.
- Telophase: chromosome uncoil & become chromatin, nuclear
envelope and nucleoli appear at each daughter cell
5.) Go – cells not yet destined to replicate, ceases at this stage
- Benign & malignant cells display diff. characteristics of
cellular growth, degree of differentiation (anaplasia)
that determines cells malignant potential.
a. hyperplasia: “ increase in the number of cells in a
tissue”; maybe normal/abnormal cellular response.
b. Metaplasia: refers to conversion of 1 type of cell in a
tissue to another type not normal for that tissue – it
results from an outside stimulus affecting parent stem
cells and maybe reversible or progress to dysplasia.
c. Dysplasia: refers to change in size, shape or
arrangement of normal cells into bizarre cells – may
precede an irreversible neoplastic change.
d. Anaplasia: involves a change in the structure of cells
& their orientation to one another, Cx by loss of
differentiation returning to a more primitive form.
e. Neoplasia: refers to abnormal cell growth; maybe
benign or malignant.
Benign: harmless, not infiltrative of other tissues
Malignant: always harmful, may spread or metastasize to
tissues sometimes far removed from the site of origin.
CHARACTERISITIC OF A PROLIFERATIVE CELL/TUMOR
NEOPLASTIC CELLS NEOPLASTIC TUMORS
Appear larger than normal Disorganized, irregular
w/ bigger nuclei nests or sheets or
neoplastic cells
Exhibit uncontrolled Contain high % of
proliferation w/no contact proliferating cells
inhibition.
Serve no homeostatic Some have the ability to
function. metastasize – spread from
the original site to distant
organs.
a.) Solid tumors: associated w/the organs from w/c they
develop, e.g breast or lung CA.
b.) Hematological CA: originates from blood cell forming
tissues e.g. leukemia, lymphoma
RISK FACTORS:
-tobacco
-alcohol
-diet
-reproductive and sexual behavior
-occupation
-pollution
-industrial products
-medicines
-infectious agents
-endogenous hormone
-genetics
 PATHOPHYSIOLOGY OF CANCER CELLS:
CARCINOGENESIS
Involves 3 process:
1. Initiation : carcinogens changes the DNA of the cell
causing cell mutation
2. Promotion: repeated exposure to carcinogen resulting to
expression of cellular abnormality or genetic mutation
3. Progression: the expressed ability to invade and
metastasize.
 Cell alteration
mutation of protooncogene inactivate tumor
(activate cell proliferation suppressing gene
& differentiation)

Activate oncogene
cell lose control/differentiation

unregulated cell growth

malignant neoplasm

Epithelial lining of the Hematopoietic

Mammary ducts/lobules E.L. of the stem cells
(breast CA) major bronchi (Leukemia)
(lung CA)
Theory of Pathogenesis
1. Transform by unknown mechanism on exposure to
certain etiologic agents including:
Virus: (EBV, HSV II, HPV,CMV,Hepa B) - oncovirus
Chemical: cobalt, tar, asphalt, aniline dyes, hydrocarbons
in cigarette smoke, air pollutants from industry, fuel
oils
Physical stressors: excessive exposure to sunlight or
radiation, diet: high fat & low fiber diets, high animal
fat intake, preservatives, additives, nitrates
Genetic: abnormal chromosome patterns – Burkitt’s
lymphoma, AML/CML, skin CA or familial
predispositions e.g breast, colorectal, stomach & lung
CA
2. Dev’t of CA is often closely linked to immune system
failure as evidenced by:
-increased incidence of malignancy in organ transplant
recipients who receive immunosuppressive therapy.
- Increased risk for dev’t of 2nd malignancies in pt receiving long
term chemo to treat 1st malignancy.
3. CA occurrence typically reflects a combination of genetic
inheritance, host mechanism, and envt’l influences 
contribute 80-90% of all CA.

Predisposing factors Precipitating factors

CA begins at molecular stage, begins mutation & damage of 1 or

more genomes.

Abnormal cells forms a clone & begins to proliferate abnormally.

Abnormal cells infiltrate to tissues, gain access to lymph & blood

vessels causing an access to other areas in the body.
 GRADING AND STAGING
GRADING:
Grade I: Cells differ slightly from normal cells and are
well differentiated (mild dysplasia).
Grade II: cells are more abnormal and are moderately
differentiated(moderate dysplasia).
Grade III: cells are very abnormal and are poorly
differentiated (severe dysplasia)
Grade IV: cells are immature (anaplasia) &
undifferentiated
 STAGING
Stage 0: carcinoma in situ
Stage I: tumor limited to the tissue of origin, localized
tumor growth (in primary site but has not spread)
Stage II: Limited local spread (spread to nearby area but
still in primary site)
Stage III: Extensive local and regional spread (spread
throughout nearby area)
Stage IV: Metastasis (spread to close or distant organs)
COMMON SITES OF METASTASIS
BREAST CA: bone, lung
LUNG CA: brain
COLORECTAL CA: liver
PROSTATE CA: bone, spine
BRAIN TUMORS: CNS
 TNM CLASSIFICATION SYSTEM
Green, F., et al. 6th edition. AJCC Cancer Staging Manual

SYMBOL INTERPRETATION
T The extent of the primary tumor
N The absence or presence and extent of regional lymph
node metastasis
M The absence or presence of distant metastasis

THE USE OF NUMERICAL SUBSETS OF TNM

COMPONENTS INDICATES THE PROGRESSIVE
EXTENT OF THE MALIGNANT DISEASE.
T PRIMARY TUMOR
N REGIONAL LYMPH NODE
M DISTANT METASTASIS
PRIMARY TUMOR (T)

Tx Primary tumor cannot be assessed.

T0 No evidence of primary tumor.

Tis Carcinoma in Situ

T1, T2, T3, T4 Increasing size and/or local extent of the primary tumor

REGIONAL LYMPH NODES (N)

Nx Regional Lymph nodes cannot be assessed.

N0 No regional lymph node metastasis.

N1, N2, N3 Increasing involvement of regional lymph nodes

DISTANT METASTASIS (M)

Mx Distant metastasis cannot be assessed.

M0 No distant metastasis

M1 Distant metastasis
 C A U T I O N UP
C – hange in bowel/bladder habits
A – ny sore that does not heal
U – nusual bleeding or discharge
T – hickening or lump in breast or elsewhere
I – ndigestion
O – bvious change in wart or mole
N – agging cough or hoarseness
U –nusual anemia
P - ain
Benign and Malignant cells DIFFERS in:
 Cellular growth characteristics
 Method of growth
 Rate of growth
 Ability to metastasize or spread
 General effects
 Destruction of tissue
 Ability to cause death
 Difference Between Benign and malignant
BENIGN MALIGNANT
Cell Well- differentiated Cells are
characteristics cells that resemble undifferentiated
normal cells of the Often bear little
tissue from which resemblance to the
the tumor originated normal cells of the
tissue from which
they arise

Mode of growth Tumor grows by Grows at the

expansion and does periphery and sends
not infiltrate the out processes that
surrounding tissues; infiltrate and destroy
usually the surrounding
encapsulated tissues
 BENIGN MALIGNANT
Rate of growth slow Variable; depends on level of
differentiation (the more
anaplastic the tumor the faster
its growth
Metastasis Does not spread by Gains access to the blood
metastasis and lymphatic channels and
metastasize to other areas of
the body
BENIGN MALIGNANT

General Usually localized Often causes generalized

effects phenomenon that effects, such as anemia,
does not cause weakness, and wt. loss
generalized effects
unless its location
interferes with vital
functions
 BENIGN MALIGNANT

Tissue Does not usually Often causes extensive tissue

destruction cause tissue damage damage as the tumor outgrows
unless its location its blood supply or encroaches
interferes with blood on blood flow to the area; may
flow also produce substances that
cause cell damage

Ability to cause Does not usually Usually causes death unless

death cause death unless growth can be controlled
its location interferes
with vital functions
 Tissue of origin
Adeno glandular tissue (with glands)
Angio blood vessels(arteries, veins, capillaries)
Basal cell epithelium,mainly sun exposed areas
embryonal gonads
fibro fibrous tissue (ligaments & tendons)
lympho lymphoid tissue (tonsils, peyer’s,lymph
nodes
Melano pigmented cells of epithelium
Myo muscle tissue (heart)
osteo bone
squamous epithelium cell
 Cellular origin
Oligodendroglioma – dendrites
Meningioma – meninges
Medulloblastoma – medulla
Epindydomas - ependymal cells
Astrocytoma - astrocytes
 MARKER CLINICAL SIGNIFICANCE

Alpha fetoprotein (AFP) Testicle cancer

Carcinoembryonic antigen (CEA) Colon cancer

Prostate specific antigen (PSA) Prostate cancer

CA 15-3 Breast cancer

CA 125 Ovarian cancer

HCG Gestational trophoblastic disease

General Cancer Signs And
Symptoms

1. Weight loss
2. Fever
3. Fatigue
4. Pain
5. Changes in skin
Specific Cancer Signs and Symptoms

1. Changes in bowel habits and bladder fnx

2. Sores that do not heal
3. Unusual bleeding or discharge
4. Thickening or lump in breast or other parts of the body
5. Ingestion or trouble swallowing
6. Recent change in wart or mole
7. Nagging cough or hoarseness
DETECTION
and
PREVENTION
of CANCER
PRIMARY PREVENTION
1. Acquisition of knowledge and skills to educate
client, community and society about cancer risk
2. Assisting patients to avoid known carcinogenic
substances
3. Involvement in the adopting dietary and various
lifestyle changes
4. Use of teaching and counseling skills to
encourage patients to participate in cancer
prevention programs and promotion of healthy
lifestyles
SECONDARY PREVENTION
1. Cancer screening programs
 PREVENTION OF CANCER
 Smoking damages nearly every organ in the human
body, is linked to at least 10 different cancers, and
accounts for some 30% of all cancer deaths
 Quit smoking!

 A sunburn will fade, but damage to deeper layers of

skin

 Finding a shade, wearing hats, sunglasses, and

clothing—are needed to shield your skin from the
sun. Sunscreen alone is not enough protection.

 Eating right, being active, and maintaining a healthy

weight are important ways to reduce your risk of
cancer—as well as heart disease and diabetes
 Control food portions for a great start for
weight loss. Use low-fat cooking methods like
roasting, baking, broiling, steaming, or
poaching. Choose foods that are rich in anti-
oxidants. Minimal amount of oil please…

 Find activities to fit your lifestyle and ideas for

raising active kids as well as staying motivated
yourself.

 Incorporate fitness into your lifestyle.

Motivate yourself.
a.) Early detection: SCREENING TEST
- 7 early warning signs of cancer: C A U T I O N UP
- BSE: perform 7-10 days after menses; postmenopausal
/hysterectomy clients should select “specific day” of
the month.
TSE:
- Papanicolaou’s test (Pap) smear test: cytologic analysis
of a sample scrape from the cervix & other tissues –
cervical neoplasia.
- Stools for occult blood – guiac test
- Sigmoidoscopy ( using flexible scope to examine the rectum &
sigmoid colon), colonoscopy (fiberoptic endoscopy study in the
lining of the large intestine).
- Mammography
b.) Primary prevention:
b.1) focuses on reducing risk factors –
external/internal environment that increases
the susceptibility of the pt for CA dev’t.
b.2) General factors that influences CA
incidence & mortality:
-sex, age, geographic location, socioeconomic
status
-ethnic/cultural background, personal habits,
occupation and personal/family health
histories.
 

 BREAST SELF
 EXAMINATION
- Cervical CA: early age @ 1st intercourse, multiple sexual
partners, HPV infection (condyloma/warts),smoking
DIAGNOSTIC
EXAMS
 Laboratory exams
1. Blood and urine tests

2. Alkaline phosphates - increase in osteogenic carcinoma

3. Calcium - elevated in multiple myeloma bone metastases

4. Sodium - decreased in bronchogenic carcinoma

5. Potassium - decreased in extensive liver carcinoma

6. Serum Gastrin - measures gastric secretions

7. Neutrophilic leukocytosis – tumors

8. Eosinophilic leukocytosis – brain tumors, Hodgkin’s disease

9. Lymocytosis – chronic lymphocytotic anemia

1. Biopsy: surgical incision of a small piece of tissue for
microscopic examination, provides histological proof
of malignancy.
Types:
- needle: aspiration of cells
- Incisional: removal of a wedge of suspected tissue
from a larger mass
- Exicisional: complete removal of the entire lesion
- Staging: multiple needle or incisional biopsies in
tissues where metastasis is suspected.
Tissue Examination:
- Following excision: frozen section or permanent
paraffin section.
FROZEN SECTION: quick, takes minutes – diagnosis (+)
PARAFFIN SECTION: takes about 24 hours – clearer details
Interventions:
- OPD setting – prepare pt w/doc’s order – obtain Inform
consent.
2. BMA – if hematolymphoid malignancy is suspected.
3. Chest radiograph
4. CBC
5. CT scan: computed tomography
6. Cytological studies: Pap smear
7. Liver function test: ALT/AST
8. MRI
9. Presence of oncofetal Ag such as CEA & AFP
10. Protoscopic examination: Guaiac for occult blood
11. Radiographic studies: mammogram
12. Radioisotope scans: liver, brain, bone, lung
Magnetic Resonance Imaging (MRI)
scan
PREVENTION OF
CANCER
USING
ANTI-OXIDANTS
 Antioxidants
substances that may protect cells from the
damage caused by unstable molecules known as free
radicals.

1. Beta-carotene
•sweet potatoes Some green leafy
vegetables like:
• carrots
• cantaloupe •collard greens
• squash • spinach
• apricots • kale
• pumpkin
• mangos
2. Lutein
 for healthy eyes is found in green leafy vegetables
such as:

• collard greens
• Spinach
• kale
3. Lycopene
• Tomatoes • apricots
• watermelon • pink
• guava grapefruit
• papaya • blood
 4. Selenium ( mineral)
 a component of antioxidant enzymes.
Plant foods like:
• rice & wheat
• Brazil nuts contain selenium.
 5. Vitamin A
• Liver
• sweet potatoes
• Carrots
• Milk
• egg yolks
• mozzarella cheese.
 6. Vitamin C (ascorbic acid)
• fruits and vegetables
• Cereals
• Beef
• poultry and fish.
 7. Vitamin E (alpha-tocopherol)
 in many oils including:
• wheat germ
• Safflower
• corn and soybean oils
also found in: Mangos, Nuts, & broccoli
a.) Prophylactic surgery: perform w/existing premalignant
condition or known family hx predisposing the person
to CA dev’t.
b.) Curative surgery: all gross & microscopic tumor is
removed or destroyed.
c.) control (cytoreductive): a “debulking” procedure
consist of removing part of the tumor thus decreasing
the number of CA cells, increasing the chance of other
therapies.
d.) Palliative: improve quality of life during survival time;
Done to reduce pain, relieve airway, GIT or urinary tract
obstruction; relieve pressure on the brain or spinal
cord, prevent hemorrhage, remove infected or
ulcerated tumors or drain abscess.
e.) reconstructive or rehabilitative: improve quality of life
by restoring maximal fxn & appearance.
S/E of surgery:
1. Loss of function of a specific body part
2. Reduced function as a result of organ loss
3. Scarring or disfigurement
4. Grieving about altered body image or imposed change
in lifestyle.
- Assignment: Saturday. June 18, 2011

Read on radiation therapy, bone marrow transplantation.

Quiz on the discussed topics.
Magnetic Resonance Imaging (MRI)
scan
 Cellular origin

Oligodendroglioma – dendrites
Meningioma – meninges
Medulloblastoma – medulla
Epindydomas - ependymal cells
Astrocytoma - astrocytes