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Cancer
- 1. Guess???? WHY IS CRABHERE!!!!!!
- 3. INTRODUCTION ▪ Cancer iscaused by the failure of genetic mechanisms that control the growth and proliferation of cells. In most cases, cumulative damage to multiple genes (the "multi-hit" model) via physical and chemical agents, replication errors, etc. contribute to oncogenesis. ▪ However, a person's inherited genetic background also may strongly contribute. In cancer, a single transformed cell grows to become a primary tumor, accumulates more mutations and becomes more aggressive, then metastasizes to another tissue and forms a secondary tumor.
- 4. WHAT IS CANCER???? MEANING: ▪ Derived from Latin word ‘cancrum’ meaning crab. ▪ It is a group of diseases characterised by uncontrolled cell division leading to the growth of abnormal tissue / tumor. ▪ Cancer is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA ▪ ONCOLOGY: Branch of medicine that deals with the study, detection, treatment and management of cancer.
- 5. TERMINOLOGIES ▪ neo+ newNeoplasia, ▪ +plasia growth Hyperplasia ▪ +plasm substance Neoplasm ▪ +trophy size Atrophy ▪ +oma tumor Carcinoma ▪ a+ none Atrophy ▪ ana+ lack Anaplasia ▪ hyper+ excessive Hypertrophy ▪ meta+ change Metaplasia ▪ dys+ bad, impaired Dysplasia
- 6. TERMINOLOGIES ▪ epithelial tissues(carcinoma) ▪ glandular tissues (adenocarcinomas) ▪ connective, muscle, and bone tissues (sarcomas) ▪ brain and spinal cord tissues (gliomas) ▪ pigmented cells (melanomas) ▪ plasma cells (myelomas) ▪ lymphatic tissue (lymphomas) ▪ leukocytes (leukemia) ▪ erythrocytes (erythroleukemia)
- 7. PATTERNS OF CANCERGROWTH ▪ Atrophy - Decrease in size of cell - muscle atrophy - pancreatic, lung cancer ▪ Hypertrophy – Increase in size of cell - retinal, iris hyper trophy- ▪ Hyperplasia - Increase in size of cell - breast cancer, endometrial, prostate cancer ▪ Metaplasia - Transformation of one cell to another - fibrous tissue into bone tissue. ▪ Dysplasia - Presence of abnormal cells within a tissue or organ - hip dysplasia ▪ Anaplasia - loss of the mature or specialized features of a cell or tissue - Adenoma to Adenocarcinoma ▪ Neoplasia - the uncontrolled, abnormal growth of cells or tissues in the body,
- 8. CELL STRUCTURE Determine theform and functions of the human body. Basic living unit of all organisms. Are specialized to perform specific functions. The characteristics of normal cells : ▪ Reproduce themselves exactly ▪ Stop reproducing at the right time ▪ Stick together in the right place ▪ Self destruct if they are damaged ▪ Become specialized or 'mature'
- 9. ▪ The cellcycle, or cell-division cycle, is a series of events that takes place in a cell leading to its division and duplication (replication). ▪ In cells without a nucleus (prokaryotic), the cell cycle occurs via a process termed binary fission. ▪ In cells with a nucleus (eukaryotes), the cell cycle can be divided in two brief periods: Interphase & mitosis. Review of cellular division
- 10. Phases of celldivision
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- 12. Cancer cellsshow uncontrolled mitotic divisionscausing unorganized growth. Due to uncontrolled growth and division of cells, a tumor (also called Neoplasm is generally formed). They exhibit a number of alterations on cell surface, in the cytoplasm and in their genes. They do not undergodifferentiation. They lose the ability to communicate with other cells through chemical signals. They also lose sensitivity to anti-growth signals from surrounding cells. They lose the adhesion molecules that keep them bondedto neighboring cells. Properties of Cancer Cells
- 13. Cancer arisesfrom a loss of normal growth control. Cancer is a geneticdisease: Inherited cancer, Sporadic cancer Cancer typically involves a change in geneexpression/function: Qualitative change, Quantitative change Loss of limitations on the number of celldivisions Ability to grow in culture (medium) –normal cells do not grow well in culture. In laboratory cultures, normal cells divide only when attached toa surface. Angiogenesis –secrete substances that cause blood vessels togrow towards tumor. Properties of Cancer Cells
- 14. Normal vs cancercell
- 15. Normal vs cancercell
- 18. Invasion and metastasis: ▪Mechanical pressure exerted by rapidly proliferating neoplasms force finger like projections of tumor cells into surrounding tissue and interstitial spaces ▪ Malignant cells are less adherent and break off from primary tumor and invade adjacent structures ▪ Malignant cells are thought to possess or produce specific destructive enzymes (proteinases), such as collagenases (specific to collagen), plasminogen activators (specific to plasma), and lysosomal hydrolyses
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- 20. Lymphatic spread ▪ Tumoremboli enter the lymph channels by way of the interstitial fluid, which communicates with lymphatic fluid. ▪ Malignant cells penetrate lymphatic vessels by invasion. ▪ Malignant cells either lodge in the lymph nodes or pass between the lymphatic and venous circulations.
- 21. Haematogenous spread ▪ Disseminationof 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 membrane and secrete lysosomal enzymes
- 22. Cancer ▪ Disease processthat begins when a cell is transformed by genetic mutation of cellular DNA ▪ Metastasis: Abnormal cells invade surrounding tissue and gain access to lymph and blood vessels carrying them to other areas of the body ▪ Malignant cancer cells: cells or processes that are characteristic of cancer ▪ Benign cancer cells: cells that are not cancerous
- 23. Epidemiology ▪ Second leadingcause of death in the US ▪ 1 in 4 deaths is caused by cancer ▪ Leading causes of cancer death in men 1) Lung 2) Prostate 3) colorectal
- 24. Epidemiology ▪ Leading causesof cancer death in women 1) Lung 2) Breast 3) Colorectal ▪ 78% of cancer diagnoses are people >55 years of age ▪ Overall, incidence is higher in men than women ▪ Racial & geographical disparities
- 25. Carcinogensis ▪ Malignant transformation ▪Three-step process ▪ Initiation: apoptosis ▪ Promotion: preneoplastic/benign lesions ▪ Progression: ▪ altered cells exhibit increasingly malignant behavior ▪ angiogenesis
- 26. CAUSES OF CANCER? ▪VIRUSES AND BACTERIA ▪ PHYSICAL AGENTS ▪ CHEMICAL AGENTS ▪ GENETIC FACTORS ▪ HEREDITY ▪ DIETARY FACTORS ▪ HORMONAL FACTORS
- 27. Etiology: Nutrition Chemical Tobacco Pollution Virus Bacteria Parasites Physical Age Sex Genetic factors Hormones Habits Agent factor Biologicfactor Host factor Environmental factor
- 28. Etiology - Agentfactor: • Nutritional: High fat diet is related to breast and colon cancer, high fiber diet to intestinal cancer, smoked fish to stomach cancer and beef consumption is related to bowel cancer. Alcohol can cause esophageal and liver cancer. • Chemical: Exposure to chemical substances such as arsenic, cadmium, chromium, asbestos, aniline, benzol and coal tar are related to cancers involving various sites/organs. • Tobacco: Tobacco use in various forms of its usage, e.g. Smoking and betel chewing causes cancers of the lung, pharynx, mouth, esophagus, bladder, pancreas and probably kidney.
- 29. Smoking ▪ Thought tobe the single most lethal chemical carcinogen ▪ Accounts for about one third of cancer deaths ▪ Strongly associated with cancers of the ▪ lung ▪ head and neck ▪ Esophagus ▪ stomach, pancreas ▪ Cervix ▪ kidney, and bladder ▪ acute myeloblastic leukemia
- 30. Virus: Hepatitis Band C are usually related to hepato-cellular carcinoma. HIV infection is a risk factor for Kaposi’s sarcoma. Human papilloma virus is a risk factor for cancer of cervix. Parasites:Schistosomiasis in Middle East is associated with risk of bladder cancer. Physical: Factors such as sunlight heat and ionizing radiation are related to cancer such as basal cell cancer, oral cancer and leukemia. Etiology - Biological factor:
- 31. Eiology - Hostfactor: Sex:Males are more often affected than females except for cancers of the reproductive organs. Age:Elderly people are often affected than younger age groups. Some cancers have bimodal occurrence like Hodgkin’s disease, kidney cancer and leukemia which are common in young adults and elderly persons. Habits:Habits of chewing pan, zarda and tobacco are associated with orophayngeal cancer. Excessive sex with multiple partners is associated with cancer of cervix. Smoking and alcoholism are associated with lung cancer. Poor personal hygiene increases the chance of occurrence of cancer of the cervix.
- 32. Cont… Genetics: Genetic factors suchas translocation of chromosomes are found in certain forms of cancers such as in myeloid leukemia. Mongols are more likely to develop cancer than normal children. Defective gene present on the long arm of chromosome13 predisposes to familial retinoblastoma. There is a familial tendency in the occurrence of breast cancer. Hormones: Over use of estrogen can lead to cancer of the body of the uterus.
- 33. Environmental Factors : Airpollution: due to hydrocarbons emitted by automobiles predisposes to lung cancer.
- 34. WARNING SIGNALS OFCANCER
- 35. Prevention and controlof cancer Pre-modial Prevention: Measures in this concentrate on modification or elimination of risk factors among population group in which they have not yet developed eg. people can be made aware about protecting from carcinogenic exposures and danger signs of cancer by health education. Women can be educated about warnings signs of cancer of cervix such as bleeding after menopause or bleeding in between menstrual period. Young girls in particular and women in general should be taught menstrual and genital hygiene for prevention of cancer cervix.
- 36. Cont… Educating children andadolescents to develop healthy habit and lifestyle, educating about hazards of smoking and alcohol, benefits of exercise, healthy diet and personal hygiene. Parents and teachers should be role model for children in the family school and colleges. Tobacco free society should be aimed at school and colleges.
- 37. Cont… Primary Prevention: High Riskstrategy: This is aimed at bringing preventive care to those people who are at special risk of getting cancer. High risk individuals should be educated regarding the association or risk factor with cancer smoking, use of tobacco, alcohol, eating beef, smoked fish, exposure to carcinogens history of breast cancer in immediate family members poor perineal hygienic practices etc. are related different types of cancers.
- 38. Cont… Nurses can teachthe following to high risk groups : Toquit smoking and stop chewing tobacco. Alcohol intake should be restricted Tohave only one faithful married partner. Family history breast cancer. Change dietary habits. Women should have marriage at appropriate age. Practice good personal hygiene and perinel hygiene Women should have pap smear test for screening cervical cancer Individuals who have the above risk factors should be referred for screening for cancer.
- 39. warning signals ofcancer:
- 40. Cont… Health education topeople regarding the following: Maintaining personal and genital hygiene. Exercise regularly to reduce the risk of obesity and early menarche Breast Self Examination (BSE) - encourages women to perform BSE every month, a week after menstruation. Women after menopause also should perform BSE every month Testicular Self Examination should be performed by men regularly to detect any lump in the testis. To prevent certain specific cancer vaccines are available. Cancer vaccines are either intended to treat existing cancer or to prevent the development of cancer
- 41. Cont… Avoid exposure toradiation: Special efforts should be made to reduce the radiation amount received by each individual to a minimum without reducing the benefits. Specific Protection Avoiding X-ray and radiation exposures by wearing protecting devices and rotation of workers if harmful effects are found after every two monthly examination Industrial workers should wear protective devices apron lead gloves and respirators Educate to use fruit, vegetables at least 500 g/day, legumes and whole grain cereals and avoid foods, junk foods and avoid coloring agents. Fatty foods should be avoided and obesity should be prevented to prevent breast cancer.
- 42. Secondary Prevention: Cancer Registration:It provides a baseline data regarding magnitude of the cancer problem and for planning and implementing the required services they are of two types Hospital Based Registries: It includes all out patient as well as in patients on treatment in the hospital. It should be done as per “WHO handbook for standardized cancer registers” Population Based Registries: It should include situation in a given geographical area. The optimum size of base population recommended for cancer registry is from 2-7million such data can provide significant information about incident of cancer and causes of cancer time trends common cancer for planning and evaluation of operational activities related to all cancer control activities.
- 43. Cont… Early Detection ofcases: This is done by cancer screening at a stage where the lesion is localized. Treatment: Treatment of cancer include the following methods: Surgery Chemotherapy Radiotherapy Immunotherapy
- 44. Tertiary Prevention: Tertiary preventionaims at disability limitation and rehabilitation Disability limitation: This is done by intensive treatment to prevent development of disability patient may develop disability due to pain, decreased vitality, loss of weight, fatigue, and discomfort in advance stage of cancer. Rehabilitation: Patients who have undergone surgery are rehabilitated. After amputation of leg they are given prostheses and physiotherapy in order to train them to walk with prostheses. Rehabilitation also includes management of psychological problem of the patient and management of the social spiritual and family problem.
- 45. ▪ GradeX ▪ Gradecannot be determined ▪ GradeI ▪ Cells differ slightly from normal cells and are well differentiated (Mild Dysplasia) ▪ GradeII ▪ Cells are abnormal and are moderately differentiated (Moderate Dysplasia)
- 46. ▪ GradeIII ▪ Cellsare very abnormal and are poorly differentiated (Severe Dysplasia) ▪ GradeIV ▪ Cells are immature (Anaplasia) and undifferentiated, cell of origin is difficult to determine.
- 47. T The extent ofthe primary tumor N The absence or presence of regional lymph node metastasis. M The absence or presence of distant metastatsis.
- 48. 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.
- 49. 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.
- 50. DISTANT METASTASIS (M) MX:distant metastasis cannot be assessed. M0: no metastasis M1: distant metastasis
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- 52. MAMMOGRAPHY PAPANICOLAOU’S (PAP) TEST STOOLSFOR OCCULT BLOOD SIGMOIDOSCOPY COLONOSPCOPY SKIN INSPECTION
- 53. ONCOFETAL ANTIGENS Carcinoembryonic Antigen (CEA)Alpha- feto Protein
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- 55. ▪ ISOENZYMES ▪Neurospecific enolase(NSE) ▪Prostatic acid phosphatase (PAP)
- 56. ▪ Prostate-specific antigen(PSA) TISSUE-SPECIFIC ANTIGENS
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- 59. SOURCES implanted intothe affected tissue or body cavity ingested as a solution Injected as a solution into the bloodstream or body cavity introduced through a catheter into the tumor SIDE EFFECTS fatigue anorexia immunosuppression
- 60. CLIENT EDUCATION Avoidclose contact with others until the treatment is completed Maintain daily activities unless contraindicated Rest Maintain a balanced diet and fluid intake If implant is temporary, the client should be on bed rest Excreted body fluids may be radioactive; double flush toilets after use
- 61. NURSING MANAGEMENT Minimizetime spent in close proximity to the radiation sources Minimum distance should be 6 feet Use lead shields Place the client in a private room Ensure proper handling and disposal of body fluids Pregnant women and children are not allowed inside the client’s room
- 62. SIDE EFFECTS Tissuedamage to target area Ulcerations of oral mucous membranes Nausea, vomiting, and diarrhea Radiation pneumonia Fatigue Alopecia Immunosuppression
- 64. CLIENT EDUCATION Washmarked area of the skin with plain water only and pat dry. Do not wash off the treatment site marks Avoid rubbing, scratching, or scrubbing the treatment site. Do not apply extreme temperatures to the treatment site. If shaving is necessary, use electric razor. Wear soft, loose-fitting clothing over the treatment area
- 65. CLIENT EDUCATION Protectskin from sun exposure during the treatment and for at least 1 year after the treatment is completed. Maintain proper rest, diet, and fluid intake Hair loss may occur.
- 66. ROUTE OF ADMINISTRATION IV Oral Intrathecal Topical Intra-arterial Intracavity Intravesical
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- 70. ▪ HORMONES ANDHORMONE ANTAGONISTS ▪ Diethylstilbestrol (DES) ▪ Tamoxifen (Nolvadex) Prednisone
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- 72. IV routesmay be obtained by subclavian catheters, implanted ports, or peripherally inserted catheters. Extravasation is the major complication of IV chemotherapy. WARNING: NEVER TEST VEIN PATENCY WITH CHEMOTHERAPEUTIC AGENTS. Monitor client closely for anaphylactic reactions or serious side effects. Discontinue infusion according to protocol if reaction occur Use caution when preparing, administering, or disposing chemotherapeutic agents
- 74. Bone marrow suppressionleads to: a. LEUKOPENIA Avoid crowds, people with infections, and small children when WBC count is low Avoid undercooked meat and raw fruits and vegetables
- 75. Bone marrow suppressionleads to: b. THROMBOCYTOPENIA Use electric razor when shaving Avoid contact sports If trauma occurs, apply ice and seek medical assistance Avoid dental work or other invasive procedures. Avoid aspirin and aspirin-containing products
- 76. GI effects Clienteducation a. Eat small, frequent, low-fat meals b. Avoid spicy and fatty foods c. Avoid extremely hot foods Administer antiemetics prior to chemotherapy Weigh client routinely
- 77. Stomatitis and mucositosis Client education a. Use a soft toothbrush. Mouth swabs may be needed during an acute episode b. Avoid mouthwashes containing alcohol. Do not use lemon glycerin swabs or dental floss c. Consider using chlorhexidine mouthwash to decrease risk of haemorrhage and protect gums from trauma
- 78. Stomatitis and mucositosis Client education d. For xerostomia, apply lubricating and moisturizing agents to protect the mucous membranes from trauma and infection e. Consider using “artificial saliva” and hard candy or mints f. Avoid smoking and alcohol g. Drink cool liquids, and avoid hot and irritating foods
- 79. Alopecia (hair loss) a.Encourage the client to choose a wig before hair loss occurs b. Care of hair and scalp includes washing hair two to three times a week with mild shampoo. Pat hair dry and avoid the use of blow dryer.
- 80. ▪ It isa type of biological therapy that helps the immune system to act better against cancerous cells. ▪ Immune cells are sometimes found in and around tumors cells, which are called tumor-infiltrating lymphocytes or TILs, and are signs that the immune system is responding to the tumor. ▪ It is not common as Surgery, chemotherapy and radiation therapy. ▪ Common side effects of immunotherapy include skin changes (rashes, itchiness, sore, redness), swelling, pain, flu-like symptoms, etc.
- 81. ▪ There arevarious types of Immunotherapy. Some of them are: ▪ Immune checkpoints inhibitor. ▪ T-cell transfer therapy. ▪ Monoclonal antibodies. ▪ Treatment vaccines. ▪ Immune system modulators.
- 82. Slows or stopsthe growth of cancer that uses hormones to grow. ▪ Hormone therapy falls into two broad groups Those that block the body’s ability to produce hormones Those that interfere with how hormones behave in the body. ▪ Hormonal therapy can be mainly given through oral, injections, or surgery ( removing organ producing hormone). ▪ Ex: Luteinizing hormone-releasing hormone (LHRH) or gonadotropin-releasing hormone (GnRH) agonists and antagonists — prevent your body's cells from receiving messages to make testosterone. As a result, your testicles stop producing testosterone.
- 83. ▪ Restore blood-formingstem cells in people who have had theirs destroyed by the very high doses of chemotherapy or radiation therapy that are used to treat certain cancers. ▪ They directly don't help to treat cancer but help to form the blood-forming stem cells which fight against cancer cells. ▪ The blood-forming stem cells that are used in transplants can come from the bone marrow, bloodstream, or umbilical cord. Transplants can be autologous, allogeneic, and syngeneic. ▪ Stem cell transplants are most often used to help people with leukemia and lymphoma.
- 84. Surgical removal ofthe entire cancer remains the ideal and most frequently used treatment method. Primary treatment Prophylactic Palliative Reconstructive
- 85. ▪ Surgery isoften the first line of choice for solid tumors, whenever possible. ▪ Surgery may/may not be combined with other modalities. ▪ The size, type, location of tumor and factors such as age, comorbid conditions of a patient are key determinant factors in choosing surgery. ▪ In some cases where primary tumor has not metastasized surgery may be considered as curative therapy.
- 86. COMMON TYPES OFSURGICAL INTERVENTION IN ONCOLOGY TYPES OF SURGICAL INTERVENTION IN ONCOLOGY •A. Primary Tumor resection •B. Resection of Metastases •C. Cytoreduction •D. Palliative surgery •E. Reconstructive surgery •F. Diagnostic surgery
- 87. ▪ Primary Tumorresection: If a primary tumor has not metastasized, surgery may be curative. Establishing a complete margin of normal tissue around the primary tumor (as in breast cancer surgery) is critical for the success of primary tumor resection and prevention of recurrence. ▪ Resection of metastases: When cancer has metastasized to regional lymph nodes, nonsurgical modalities may be the best initial treatments, as in locally advanced lung cancer or head and neck cancer. Single metastases, especially those in the lungs or liver, can sometimes be resected with a reasonable rate of cure.
- 88. ▪ Cytoreduction: Cytoreduction(surgical resection to reduce tumor burden) is often an option when removal of all tumor tissue is impossible, as in most cases of ovarian cancer. ▪ 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. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulcerations, obstructions, hemorrhage, pain, and malignant effusions.
- 89. ▪ Reconstructive surgery:Reconstructive surgery may improve a patient’s comfort or quality of life after tumor resection (e.g., breast reconstruction after mastectomy). ▪ Diagnostic surgery: 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
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Editor's Notes
- #26 Agents that initiate or promote malignant transformation are referred to as carcinogens. carcinogens (substances that can cause cancer), such as chemicals, physical factors, or biologic agents, cause mutations in the cellular DNA. Normally, these alterations are reversed by DNA repair mechanisms or the changes initiate programmed cellular death (apoptosis). Cells can escape these protective mechanisms with permanent cellular mutations occurring, but these mutations usually are not significant to cells until the second step of carcinogenesis.