Cellular Aberration

CANCER
A disease whereby cells mutate into abnormal cells that proliferate abnormally
Neoplasia- new cell growth; a mass of new tissue functioning independently and serving no useful
purpose
Benign
Malignant
Medical term for cancer: Malignant Neoplasm
Oncology- study of cancer
Oncology/Cancer Nursing- field of nursing with a specialization in cancer care
Scope, responsibilities and goals are as diverse and complex as those of any nursing specialty
More common today especially in more affluent countries
In February 2010, the World Health Organization (WHO) predicted that the number of cancer deaths in
worldwide will increase from 7.6 million to 17 million deaths in 2030.
Philippine Cancer Statistics
In 2006, malignant neoplasm ranked 3rd in the 10 Leading Causes of Mortality with 43,043 recorded
deaths growing by 5% every year as per population growth and increase in smoking prevalence (DOH)
Out of this 43,043 deaths, 22,472 are males and 20,571 are females

Philippine Cancer Statistics

Breast cancer is also the leading cause of cancer among women, accounting for 28% of the total cases,
followed by cancer of the cervix, ovary, thyroid and lung.
Lung cancer, meanwhile, is the most common cancer for men at 27 % of the total cases, followed by
liver, prostate, colon and rectum
Leading cancer sites/types are:
1. Breast
2. Lung

3. Liver
4. Cervix
5. Colon
6. Thyroid
7. Rectal
8. Ovaries
9. Prostate
10. Lymphatic Tissue (Non-Hodgkins Lymphoma
Biology of Cells
Building Blocks of Cells
Carbohydrates
Carbohydrates are comprised of carbon (C), hydrogen (H), and oxygen (O) molecules.
Sugars are common carbohydrates.
Carbohydrates serve several functions inside cells:
Major energy source
Provide structure
Communication
Cell adhesion
Defense against and removal of foreign material
Proteins
Proteins are comprised of amino acids.
Proteins serve several functions inside living things:
Structure of hair, muscle, nails, cell components, and cell membranes
Cell transport
Biological catalysts or enzymes

Maintaining cell contact (fibronectin)

Control cell activity
Signaling via hormones
Lipids
A wide variety of biomolecules including fats, oils, waxes and steroid hormones.
Lipids do not dissolve in water (they are hydrophobic) and are primarily comprised of carbon (C),
hydrogen (H), and oxygen (O).
Lipids serve several functions in living things:
Form biological membranes
Fats may be stored as a source of energy
Oils and waxes provide protection by coating areas that could be invaded by microbes (i.e. skin or ears)
Steroid hormones regulate cell activity by altering gene expression
Nucleic Acids
All of the information needed to control and build cells is stored in these molecules.
Nucleic acids are comprised of nucleotides which are abbreviated as A, C, G, T, and U.
There are two main types of nucleic acid, deoxyribonucleic acid (DNA) and ribonucleic acid (RNA)
Cells and Cell Structure
Organelles
Organelles are structures that carry out different functions within a cell.
Organelles in a cell are analogous to the organs in a body.
Organelles are suspended in a water-based fluid called cytosol.
The Nucleus
Nucleus can be thought of as the brains of a cell.
Genetic material is stored in this organelle.
The nucleus (plural-nuclei) is roughly spherical and is surrounded by two membranes.
Home to chromosomes.

Nucleus
The Mitochondrion
(Singular- mitochondrion) Mitochondria are the power houses of a cell.
Mitochondria convert biomolecules (i.e. fats and sugars) into energy.
By-products of energy production in mitochondria may damage DNA and cause mutations. are the
energy powerhouses of cells
The Ribosome
Ribosomes are made up of two large complexes comprised of RNA and protein.
Ribosomes are located in the cytosol. Their function is to read RNA and produce proteins in a process
known as translation.
The Cytoskeleton
The cytoskeleton is an intricate network of proteins that criss-cross the cytoplasm of a cell.
Actin and tubulin are the proteins used to build main fibers of the cytoskeleton (microfilaments and
microtubules, respectively).
The cytoskeleton serves several key functions:
Provides structure to cells and a place to anchor organelles
Cell motility
Control of cell division during mitosis
Changes in the cytoskeleton that allow increased movement are observed in cancer cells.
Many anti-cancer drugs work by interfering with the activity of cytoskeletal proteins.
Cell Division and Mitosis
The process by which a cell reproduces to create two identical copies of itself is known as Mitosis.
2 reasons for mitosis:
Develop normal tissue
To replace lost or damaged normal tissue
In order for this to happen, the following must occur:

The genetic material, the DNA in chromosomes, must be faithfully copied. This occurs via a process
known as replication.
The organelles, such as mitochondria, must be distributed so that each daughter cell receives an
adequate amount to function.
The cytoplasm of the cell must be physically separated into two different cells.
Cell cycle- cell division process occurring at an orderly progression through four different stages.
4 Stages:
G1- G stand for gaps; cell is preparing to divide. The cells take in more nutrients, making more energy.
S- stands for synthesis. This is the phase of the cell cycle in which the DNA is copied or replicated.
G2- cell makes important proteins that will be used in cell division and in normal physiologic functioning
after cell division is complete.
M- stands for mitosis. This is the stage of the cell cycle in which the cell actually divides into two
daughter cells.
Characteristics of Normal & Malignant Cells
Genetic Mutation in Cancer
Mutations in key regulatory genes
Proto-oncogenes
Tumor suppressors
Causes of Genetic Change
Spontaneous Mutations - mutations resulting from unrepaired replication errors or random molecular
events
Induced Mutations - mutations caused by things such as radiation, chemicals, chronic inflammation, and
oxygen radicals.
Abnormal Cell Division - problems in cell division can result in mutations
Viruses - some viral infections can cause mutations
Cancer Types
The following terms are commonly used to distinguish tumors of different origin
Carcinoma- a tumor derived from epithelial cells

Sarcoma- a tumor derived from muscle, bone, cartilage, fat or connective tissues
Leukemia- a cancer derived from white blood cells or their precursors.
Lymphoma- a cancer of bone marrow derived cells that affects the lymphatic system.
Myelomas- a cancer involving the white blood cells responsible for the production of antibodies (B
lymphocytes or B-cells).
PATHOPHYSIOLOGY of
CANCER

CARCINOGENESIS/ONCOGENESIS/CANCER
DEVELOPMENT
Malignant Transformation- the process of changing a normal cell into a cancer cell
1. INITIATION
2. PROMOTION
3. PROGRESSION
4. METASTASIS

Metastatic Mechanisms

Metastatic Mechanisms
Lymphatic spread- transport of tumor cells through the lymphatic circulation
Hematogenous spread- malignant cells are disseminated through the blood stream; enzymes make
large pores into the clients blood vessel allowing tumor cells to enter the blood and circulate
throughout the body
Angiogenesis- induce the growth of new capillaries from the host tissue to meet their needs for
nutrients and oxygen; through this process that tumor emboli can enter through the systemic circulation
and travel into distant sites

Cancer cell invasion and metastasis. (i) Cancer cell invasion of surrounding tissue. (ii)
Angiogenesis and cancer cell transportation via the circulatory system. (iii) Cancer cell metastasis
(spreading from a primary site) and growth at a new location.
CANCER ETIOLOGY

CANCER ETIOLOGY
Oncogene Activation- activation of proto-oncogenes into oncogenes can cause the cell to change
from normal cells to cancerous cells
External Factors Causing Cancer
Chemical Carcinogenesis- produce their toxic effect by altering DNA structures in body sites distant
from chemical exposure
Tobacco smoke- single most lethal chemical carcinogen; initiates and promotes cancer
Found in 30% of all malignant neoplasms
Examples:
Amine/aniline dyes
Pesticides
Formaldehyde
Arsenic
Soot and tar
Asbestos
Nickel and zinc ores
Etc.
Physical Carcinogens- cause cancer by same mechanism as for chemical agents
Radiation
2 types of radiation:
Ionizing- some found naturally in such elements as radon, uranium and radium; x-rays, cosmic radiation
Utraviolet- solar radiation; tanning beds, germicidal lights; clothing styles, use of sunscreen, occupation,
recreational habits

Chronic irritation

Irritated tissue frequent cell divisions and are at an increased risk of DNA mutation
E.g. Tissue trauma; burn scars skin cancer
Viruses [Oncoviruses]

Viruses as a cause for human cancer are hard to determine because viruses are difficult to isolate
When viruses infect body cells, they break the DNA chain and insert their own genetic material into the
human DNA chain
E.g. Hepatitis B virus Primary liver carcinoma; Human Papilloma virus Cervical Carcinoma
Food substances that appear to reduce cancer risk are as follows:
High-fiber foods
Cruciferous vegetables (cabbage, broccoli, cauliflower)
Carotenoids (carrots, tomatoes, spinach, apricots, dark-green and deep-yellow vegetables)
Vit. E and C, zinc, and selenium
Hormonal Agents
Tumor growth may be promoted by disturbances in hormonal balance either by the bodys own
(endogenous hormone) production or by administration of exogenous hormones
Cancer of breast, prostate, and uterus are thought to depend on endogenous hormonal levels for
growth
DES (Diethylstilbestrol) vaginal carcinomas
Oral contraceptives & prolonged estrogen therapy hepatocellular, endometrial and breast cancer
Hormonal changes with reproduction
Personal Factors
Immune Function- non-self cells that are no longer normal cancer cells
Cell-mediated immunity- part of the immune system that helps protect against cancer
Natural killer (NK) and helper T-cells provide immune surveillance
Immunosuppressed- increased cancer incidence
Organ transplant recipients
HIV/AIDS- cancer incidence is as high as 70%
Age
Advancing age is the single most important risk factor for cancer (American Cancer Society)
Manifestation of cancer in older adults may be overlooked as changes of normal aging

Older adults must be aware of the 7 warning signs of cancer (CAUTION)

C

changes in bladder or bowel habits

a sore that does not heal

unusual bleeding or discharge

thickening or lump in the breast or elsewhere

indigestion or difficulty swallowing

obvious change in wart or mole

nagging cough or hoarseness

Dietary Factors
Risk for cancer increases with long-term ingestion of carcinogens or chronic absence of proactive
substances in the diet
Include: fats, alcohol, salt-cured or smoked meats, foods containing nitrates and nitrites, and a high
caloric dietary intake
Genetic Risk
Familial patterns
Inherited genetic defects
CANCER CLASSIFICATION
Classified by type of tissue/tissue of origin from which they arise
Prefix- adeno, lympho, melano
Tissue of origin- epithelial glands, lymphoid tissues, pigment-producing skin
Suffix- benign tumor:

-oma

malignant tumor: -coma, -sarcoma,

-carcinoma
e.g. adenoma (benign); adenorcarcinoma (malignant)
Type of Tissues/Tissue Origin

Cancer Detection
Cancer Grade and Stage
Developed to help standardize cancer diagnosis, prognosis, and treatment
Accomplished before treatment begins to provide baseline date for evaluating outcomes of therapy
Treatment options and prognosis are determined on the basis of staging and grading.
Grading
One of the first steps in confirming cancer
Refers to the classification of tumor cells
Seek to define the type of tissue from w/c the tumor originated and the degree to which the tumor cell
retain the functional and histologic characteristics of the tissue of origin
Samples of cells for tumor grading may be obtained through cytology, biopsy or surgical excision
Staging
Determines the exact location of the cancer and its degree of metastasis at diagnosis
Influences selection of therapy
Done in 3 ways:
1. Clinical Staging
2. Surgical Staging
3. Pathologic Staging
Specific staging system include Dukes staging of colon and rectal cancer and Clarks level method of
staging skin cancer

TNM (tumor, node, metastasis) system to describe the anatomic extent of cancer
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 distance metastasis
Guide treatment and are useful at prognosis and comparison of treatment results

Have specific prognostic value for each solid tumor type

Example of Staging- Breast Cancer
Stage I: T1-tumor 2 cm or less in diameter; N0- no lymph nodes involved; M0- no metastasis
Stage II: T0 to T2- tumor less than 5cm in diameter; N1- nodes involved; M0- no metastasis
Stage III: T3- tumor larger than 5cm in diameter; N1 or N2- nodes involved, tumor may be fixed; M0- no
metastasis
Stage IV: T4- tumor any size but fixed to chest wall or skin; N3- clavicular nodes involved (spread); M1metastasis present
Invasive Techniques
Fine needle aspiration (FNA) uses a small needle to collect small samples of a lesion.
Core needle biopsy (BPA) uses a larger needle to collect samples of a lesion.
Pap smears- use a sample of cells from the cervix to detect cervical cancer. Pap smears may also detect
ovarian and uterine cancers that have migrated to the cervix.
Colonoscopy uses a small tube containing viewing equipment to view the colon.
Endoscopy- Direct visualization of a body cavity or passageway by insertion of an endoscope into a body
cavity or opening
Non-invasive Techniques
Ultrasound- uses reflection of sound waves to create an image of a part of the body
MRI- uses magnetic fields and radio waves to produce images of the body.
CT scans- use x-rays to take multiple image slices in order to create a 3D image.
PET scans- use radioactive molecules to create a dynamic image of internal tissues and organs. PET
scans are able to measure the metabolic activity of cells, not just their structure.
X-rays- utilize high energy beams to create an image.
Mammography uses low dose x-ray to create an image of a breast.
Normal Breast
Analysis of Biopsy/Cytology Samples
Immunohistochemistry (IHC)- measures protein expression using specially labeled antibodies.

Fluorescence in situ hybridization (FISH)- measures genetic changes (i.e. amplification) using
fluorescently labeled DNA probes.
Tumor Identification Marker
Analysis of substance found in blood and other body fluids that are made by the tumor or by the body in
response to the tumor
Tumor marker- protein substances found in the blood
or body fluids
Derived from the tumor itself
Tumor Markers
Tissue-specific antigens- identify the type of tissue affected by malignancy
E.g. Prostate Specific Antigen (PSA) to identify prostate cancer
Oncofetal Antigens- present normally in fetal tissue, may indicate an anaplastic process in tumor cells
E.g. Carcinoembryonic Antigen (CEA), Alfafetoprotein (AFP)
Hormones- present in large quantities in a body with cancer
Antidiuretic hormone (ADH), Human Chorionic Gonadotropin (HCG)
Isoenzymes- present in the blooodstream if tissue is experiencing rapid, excessive growth as the result
of a tumor
E.g. Prostatic Acid Phosphatase (PAP)
Cancer Prevention
Primary Prevention
Avoidance of known or potential carcinogens
Modification of associated factors
Removal of at risk tissues
Chemoprevention
Use of drugs, chemicals, natural nutrients or other substances to disrupt one or more steps in cancer
development
Chemoprevention

Secondary Prevention
Screening programs
Recommended screenings (American Cancer Society)
Beginning at age 20, routinely perform BSE
Yearly mammography for women older than 40 years
Yearly clinical BSE for women older than 40 years
Yearly Pap Smear for sexually active females and any female over 18 years
Colonoscopy at age 50 years and then q10 years
Yearly FOBT in adults of all ages
Yearly PSA test and digital rectal exam for men over 50 years
Screening programs should be based on an individuals age, sex, family history of cancer, ethnic group or
race
Gene therapy for cancer prevention
E.g. of gene mutations:
BRCA 1 gene- increases the risk for breast and ovarian cancer
BRCA 2- increases the risk for breast cancer
APC gene- increases the risk for colon cancer
Cancer Prevention
7 steps to reduce risk recommended by Mayo Clinic:
1. Don't use tobacco
2. Eat a variety of healthy foods
3. Stay active and maintain a healthy weight
4. Protect yourself from the sun
5. Get immunized
6. Avoid risky behaviors
7. Get screened