2. OVERVIEW
Cell appearance (morphology)
b. Each normal mature cell type is differentiated,
with a distinct and recognizable appearance, size,
and shape
c. The size of a normal cell nucleus is usually small
compared with the size of the rest of the cell,
including the cytoplasm
d. Normal cells generally have a small N:C ratio
e. As cell matures, the nucleus:cytoplasm ratio
decrease
57. OVERVIEW
Normal cell functions
b. Gastric cells – secrete HCl
c. Nerve cells – generate action potential and
conduct impulses
d. Beta cells of the pancreas
e. Type II pneumocytes
f. Immune system
58. OVERVIEW
Immunity – the body’s specific protective
response to a foreign agent or organism
Immune system – part of the body’s defense
mechanism against invasion and allows a rapid
response to foreign substance
Genetic and cellular responses result when the
immune system is activated
Tolerance – mechanism by which the immune
system is programmed to eliminate foreign
substances such as microbes, toxins, and cellular
mutations but maintains the ability to accept
self-antigens
59. OVERVIEW
Immunopathology – the study of diseases that
result from dysfunctions within the immune
system
Immune function is affected by a variety of
factors
3. Central nervous system integrity
4. General physical status
5. General emotional status
6. Stress
7. Illness
8. Trauma
9. Surgery
60. IMMUNE SYSTEM DISORDERS
Autoimmunity - is the failure of an organism to recognize
its own constituent parts as ''self'', which allows an immune
response against its own cells and tissues.
Hypersensitivity - refers to excessive, undesirable
(damaging, discomfort-producing and sometimes fatal) reactions
produced by the normal immune system.
Gammopathies - abnormal proliferation of the lymphoid
cells producing immunoglobulins. Ex: hodgkins disease
Immune deficiencies - is a state in which the immune
system's ability to fight infectious disease is compromised or
entirely absent.
e. Primary
f. Secondary
61. ANATOMIC AND PHYSIOLOGIC
OVERVIEW
Epitopes – antigenic determinants that are
present on foreign materials, initiating a series of
action in a host, including the inflammatory
response, the lysis of microbial agents, and the
disposal of foreign toxins
Bone marrow (B lymphocytes originates)
Lymphoid tissues – spleen, lymph nodes
WBCs, antibodies
Types of immunity
Natural immunity – or innate immunity is
nonspecific and is present at birth (intact skin,
phagocytes, compliment system)
Acquired or adaptive immunity – specific and
develops after birth (humoral & Cellular
62. BASIC CONCEPTS
Components of the Immune System
Immune cells
Central immune structures: bone marrow and
thymus (where immune cells are produced and
mature)
Peripheral immune structures: lymph nodes,
spleen (where the immune cells interact with the
antigen)
63. BASIC CONCEPTS
Components of the Immune System
Immune cells: T and B lymphocytes
(primary cells), macrophages (accessory
cells) which aid in processing and
presentation of antigens to the lymphocytes
Cytokines: molecules that form a
communication link between immune cells
and other tissues and organs of the body
89. Interferons are a family species-specific proteins synthesized by
eukaryotic cells in response to viruses and a variety of natural and
synthetic stimuli. There are several different interferons commonly
used as therapeutics, termed alpha, beta, and gamma. These peptides
are used to treat hairy cell leukemia, AIDS-related Kaposi's sarcoma,
laryngeal papillomatosis, genital warts, and chronic granulomatous
disease. Side effects include black tarry stools, blood in the urine,
confusion, and loss of balance.
115. BASIC CONCEPTS
Components of the Immune System
Major Histocompatibility Complex (MHC) –
membrane molecules that help the immune system
recognise the self from the non-self
HLA – (Human Leukocyte Antigens) are human
MHC proteins that were first detected on white
blood cells; play a role in transplant rejection and
are detected in immunologic tests
116. BASIC CONCEPTS
Major Histocompatibility Complex
Key recognition molecules which is an essential
feature of adaptive or specific immunity
Able to discriminate between the body’s own
molecules against foreign antigens
Coded by closely linked genes in chromosome 6
117. BASIC CONCEPTS
Major Histocompatibility Complex (Two Classes):
MHC I - differentiate viral infected and abnormal
cells from normal cells
MHC II - allow appropriate interactions among
immune cells
119. Properties HLA antigens Distribution Functions
Class I MHC HLA-A, HLA-B, Virtually all Present
HLA-C nucleated cells processed
(Human antigen to
Leucocyte Antigen cytotoxic CD8 T-
- helps the immune cells; restrict
system distinguish the cytolysis to virus-
body's own proteins
from proteins made by infected cells,
foreign invaders such tumor cells and
as viruses transplanted cells
and bacteria. )
Class II MHC HLA-DR, HLA-DP, Immune cells, Present
HLA-DQ antigen- processed
presenting cells, antigenic
and macrophages fragments to CD4
T-cells; necessary
for effective
interaction
among immune
cells
121. OVERVIEW
Normal cells and functions
b. Most normal human cells have 23 pairs of
chromosomes
c. All normal cells (except the sex cells and the
mature red blood cells) have the entire human
genome in every cell
d. Normal cells have about 35,000 genes, and about
50 of these genes are very active during
embryonic life
e. Normal cells undergo mitosis either to develop
normal tissue during embryonic development,
childhood, and adolescence or to replace lost or
damaged normal tissue
123. THE CELL CYCLE
The Cell Cycle – consists of 4 phases:
2. Gap 1 (G1) – the cell enlarges and synthesizes
proteins to prepare for DNA replication
3. Synthesis (S) phase – DNA is replicated and the
chromosomes in the cell are duplicated
4. Gap 2 (G) – the cell prepares itself for mitosis
5. Mitosis (M) phase – final step, where the parent
cell divides into two exact copies called daughter
cells, each having identical genetic material
124. THE CELL CYCLE
The cells after the M phase immediately enter
the G1 where they begin another cell cycle again
Or the cells divert into a resting phase called G0
The cell cycle is controlled by cyclin-dependent
kinases
Some cyclins cause a “braking” action and
prevent the cycle from proceeding
Checkpoints in the cell cycle ensure that it
proceeds in the correct order
125. THE CELL CYCLE
A malfunction of any of these regulators of cell
growth and division can result in the rapid
proliferation of immature cells
In some cases these proliferating immature cells
are considered cancerous (malignant)
Knowledge of the cell cycle events is used in the
development of chemotherapeutic drugs, which
are designed to disrupt the cancer cells during
different stages of their cell cycle
126. OVERVIEW
In embryonic life, there are early development
genes called proto-oncogenes, and their
activity is not needed after embryonic life
Other genes are called tumor suppressor
genes, which slow down cell division, repair
DNA mistakes, and tell cells when to die
(apoptosis, or programmed cell death)
Tumor suppressor genes can also reduce
expression of proto-oncogenes by negative
feedback mechanisms
Proto-oncogenes are not abnormal genes, and are
part of every human’s normal cellular DNA
127. Normal Cell Reversible
(homeostasis) Injury
Stress Injurious Mild,
stimulus transient
Adaptation Cell Injury
Inability
to adapt Severe,
progressive
Irreversible
Injury
Necrosis CELL Apoptosis
DEATH
128. OVERVIEW
Adaptations are reversible changes in the size,
number, phenotype, metabolic activity, or
functions of cells in response to changes in their
environment
l Hypertrophy – increase in the size of cells,
resulting in an increase in the size of the organ
i Hyperplasia – an increase in the number in an
organ or tissue, usually resulting in increased
mass of the organ or tissue
n Atrophy – reduced size of an organ or tissue
resulting from a decrease in cell size and number
129. OVERVIEW
a. Metaplasia – reversible change in which one
differentiated cell type (epithelial or
mesenchymal) is replaced by another cell type
b. Necrosis – cell death
c. Apoptosis – programmed cell death
d. Differentiation - process by which cells or
tissues undergo a change toward a more
specialized form or function, especially during
embryonic development
e. Dysplasia
f. Anaplasia
130. OVERVIEW
a. Dysplasia - abnormal development or growth of
tissues, organs, or cells
b. Anaplasia - abnormal development or growth of
tissues, organs, or cells
138. EPIDEMIOLOGY OF CANCER
2004 – The American Cancer Society estimates
that 1,368,030 people will be diagnosed with
cancer in the US
Cancer continues to be the second leading cause
of death in the US
62% of those diagnosed with cancer can expect to
be alive in 5 years
Incidence and mortality rates for cancer have
dropped approximately 1% per year since 1991
139. EPIDEMIOLOGY OF CANCER
The American Cancer Society has established the
goal of a 25% reduction in the overall age-
adjusted cancer incidence rate and a 50%
reduction in the overall age-adjusted cancer
mortality rate by 2015
Nurses should play a pivotal role in the
attainment of these goals through active
involvement in cancer prevention and early
detection activities
Survival rate represents the percentage of
persons alive 5 years from now after diagnosis,
whether cured, in remission, or with evidence of
disease
140. Estimated New Cases Estimated New Deaths
Male Female Male Female
Prostate (38%) Breast (32%) Lung and Lung and
Lung and Lung and bronchus (31%) bronchus (27%)
bronchus (13%) bronchus (12%) Prostate (10%) Breast (15%)
Colon and rectum Colon and rectum Colon and rectum Colon and rectum
(10%) (11%) (10%) (10%)
Urinary bladder Uterine corpus Pancreas (5%) Ovary (6%)
(7%) (6%) Leukemia (4%) Pancreas (6%)
Melanoma of the Non-Hodgkin Esophagus (4%) Leukemia (4%)
skin (5%) lymphoma (4%) Liver and Non-Hodgkin
Non-Hodgkin Melanoma of the intrahepatic bile lymphoma (3%)
lymphoma (4%) skin (4%) duct (3%) Uterine corpus
Kidney and renal Ovary (3%) Non-Hodgkin (3%)
pelvis (3%) Thyroid (3%) lymphoma (3%) Multiple myeloma
Leukemia (3%) Urinary bladder Kidney and renal (2%)
Oral cavity and (2%) pelvis (3%) Brain and other
pharynx (3%) Pancreas (2%) All sites (100%) nervous system
Pancreas (2%) All sites (100%) (2%)
All sites (100%) All sites (100%)
141. Estimated Incidence (2008) Estimated Deaths (2008)
Male Female Male Female
Melanoma of the Melanoma of the Lung (31%) Brain (2%)
skin (5%) skin (4%) Esophagus (4%) Lung (26%)
Oropharynx (3%) Thyroid (4%) Liver (4%) Breast (15%)
Lung (15%) Lung (14%) Pancreas (6%) Liver (2%)
Pancreas (3%) Breast (26%) Kidney (3%) Pancreas (6%)
Kidney (4%) Kidney (3%) Colon and rectum Colon and rectum
Colon and rectum Colon and rectum (8%) (9%)
(10%) (10%) Urinary bladder Ovary (6%)
Urinary bladder Ovary (3%) (3%) Uterus (3%)
(7%) Uterus (6%) Prostate (10%) Leukemia (3%)
Prostate (25%) Leukemia (3%) Leukemia (4%) Non-Hodgkin
Leukemia (3%) Non-Hodgkin Non-Hodgkin Lymphoma (3%)
Hon-Hodgkin lymphoma (4%) Lymphoma (3%) All others (25%)
lymphoma (5%) All others (23%) All others (24%)
All others (20%)
Robbins Pathologic Basis of Disease 8th edition
142. EPIDEMIOLOGY OF CANCER
Risk factors
2. Heredity – 5 to 10% of cancers have a hereditary component
3. Age – 76% of cases occur after age 55; hormonal changes,
immune system changes
4. Gender
5. Poverty
6. Stress
7. Diet
8. Occupation
9. Infection
10. Tobacco use
11. Alcohol use
12. Recreational drug use
13. Obesity – increased risk of hormone-dependent cancers
14. Sun exposure
143. EPIDEMIOLOGY OF CANCER
Endogenous risk factors:
2. Genetic predisposition
3. Sex
4. Age
5. Race
6. Family history
Exogenous risk factors:
8. Alcohol
9. Diet
10.Exercise
11.Occupational exposure
12.Cigarette smoking
13.Sexual activity
144. EPIDEMIOLOGY OF CANCER
Risk Factors and Signs and Symptoms of Common Cancers
Cancer Site Risk Factors Signs and Symptoms
Breast Female gender Lump or mass
Age >50 years Thickening in breast or
Family history axilla
Personal history of breast cancer Change in size or contour
2 or more first-degree relatives or texture
Known BRCA1 or BRCA2 mutation Skin dimpling or retraction
Biopsy history Peau d’orange skin
Atypical hyperplasia Nipple discharge,
DCIS or LCIS retraction, or scaliness
Postmenopausal obesity Erythema
Early menarche/late menopause Pain or tenderness
Late first pregnancy/nulliparous
OCP
Radiation to chest wall
Alcohol
Obesity and high fat diet
Hormone replacement therapy
145. EPIDEMIOLOGY OF CANCER
Risk Factors and Signs and Symptoms of Common Cancers
Cancer Site Risk Factors Signs and Symptoms
Prostate Male gender Weak urinary stream and
Age >50 years urinary frequency
African American ethnicity Difficulty in initiating
Family history of first-degree stream or stopping urinary
relative (greater if first-degree stream
relative diagnosed before age 40) Pain or burning on
High-fat diet urination
Colorectal Age >60 years Urinary retention
Inflammatory bowel conditions Hematuria
Sedentary lifestyle
Diet high in fat and low in fruits
and vegetables
Heavy alcohol consumption
Family history of colorectal cancer
especially if before the age of 40
146. EPIDEMIOLOGY OF CANCER
Risk Factors and Signs and Symptoms of Common Cancers
Cancer Site Risk Factors Signs and Symptoms
Prostate Male gender Weak urinary stream and
Age >50 years urinary frequency
African American ethnicity Difficulty in initiating
Family history of first-degree stream or stopping urinary
relative (greater if first-degree stream
relative diagnosed before age 40) Pain or burning on
High-fat diet urination
Colorectal Familial genetic syndromes, e.g., Urinary in bowel habits
Change retention
familial adenomatous polyposis Hematuria
Rectal bleeding
(FAP) and hereditary nonpolyposis Abdominal pain
colon cancer (HNPCC) Decreased diameter of
stools
Anemia
Rectal pressure or pain
Weight loss
anorexia
147. EPIDEMIOLOGY OF CANCER
Risk Factors and Signs and Symptoms of Common Cancers
Cancer Site Risk Factors Signs and Symptoms
Lung Cigarette smoking Chronic cough and
Occupational exposure to asbestos, wheezing
arsenic, chromium, coal products, Persistent respiratory
nickel refining, smelter workers, infections
ionizing radiation, radon Dull chest pain
Hemoptysis
Dyspnea
Weight loss
148. EPIDEMIOLOGY OF CANCER
Carcinogens
b. Viruses
c. Drugs and hormones – can be either genotoxic or
promotional
d. Chemical agents – both genotoxic and
promotional
e. Physical agents – for example radiation
149. Chemical Carcinogens and Relationship to Occupation
Chemical Agent Action Occupation
Polycyclic hydrocarbons Genotoxic Miners, coal/gas
(smoke, soot, tobacco, workers, chimner
smoked foods) sweeps, migrant worker,
workers in offices where
Benzopyrene Genotoxic smoking is allowed
Pesticide manufacturers,
Arsenic mining
Vinyl chloride Promotional Plastic workers
Artistis
Methylaminobenzine Genotoxic Fabric workers
Rubber and glue workers
150. Chemical Carcinogens and Relationship to Occupation
Chemical Agent Action Occupation
Asbestos Promotional Construction workers,
workers in old, run-down
buildings with asbestos
insulation, insulation
makers
Wood and leather dust Promotional Woodwrokers,
carpenters, leather
Chemotherapy drugs Genotoxic toolers
Drug manufacturers,
pharmacists, nurses
151. Occupational Cancers
Agent Cancer Typical use or occurrence
Arsenic and arsenic Lung, skin, Byproduct of metal
compounds hemangiosarcoma smelting; component of
alloys, electrical and
semiconductor devises,
medications and
herbicides, fungicides,
and animal dips
Asbestos Lung, mesothelioma, Formerly used for many
esophagus, stomach, applications because of
large intestine fire, heat and friction
resistance, still found in
existing construction as
well as fire-resistant
textiles, friction
materials (brake linings),
underlayment and
roofing papers, floor tiles
152. Occupational Cancers
Agent Cancer Typical use or occurrence
Benzene Leukemia, Hodgkin Principal component of
lymphoma light oil, despite known
risk, many applications
exist in printing and
lithography, paint,
rubber, dry cleaning,
adhesives and coatings,
and detergents, formerly
widely used as solvent
and fumigant
Beryllium and beryllium Lung Missile fuel and space
compounds vehicles, hardener for
lightweight metal alloys,
particularly in aerospace
applications and nuclear
reactors
153. Occupational Cancers
Agent Cancer Typical use or occurrence
Chromium compounds Lung Component of metal
alloys, paints, pigments,
and preservatives
Nickel compounds Nose, lung Nickel plating,
component of ferrous
alloys, ceramics, and
batteries, by-product of
stainless steel arc
Radon and its decay Lung welding
From decay of minerals
products containing uranium,
potentially serious hazard
in quarries and
underground mines
Vinyl chloride Angiosarcoma Refrigerant, monomer for
vinyl polymers, adhesive
for plastics, formerly
inert aerosol propellant
un pressurized containers
154. Occupational Cancers
Agent Cancer Typical use or occurrence
Cadmium and cadmium Prostate Uses include yellow
compounds pigments and phosphors;
found in solders; used in
batteries and as alloy and
in metal platings and
coatings
155. EPIDEMIOLOGY OF CANCER
HSV types I and II
b. Carcinoma of the lip
c. Cervical carcinoma
d. Kaposi sarcoma
Human CMV
f. Kaposi sarcoma
g. Prostate carcinoma
156. EPIDEMIOLOGY OF CANCER
EBV
a. Burkitt lymphoma
HBV
a. Primary HCC
Papillomavirus
f. Malignant melanoma
g. Cervical, penile, and laryngeal cancers
HTLV
i. Adult T-cell leukemia and lymphoma
j. Kaposi sarcoma
157. EPIDEMIOLOGY OF CANCER
Approximately three fourths of all cancers occur
in people over the age of 55
Overall cancer incidence in males has stabilized
in recent years when compared with that in
females
Men have a higher lifetime probability of
developing and dying of cancer than women, but
men have a greater recent decline in death rates
Children – overall, cancer is the leading cause of
death due to disease in children between 1 and
14 years of age
158. EPIDEMIOLOGY OF CANCER
Cause of Death by Age
Age (years) Males Females
20-39 1. Brain/CNS 1. Breast
2. Leukemia 2. Uterine/cervix
3. Lung 3. Leukemia
40-59 1. Lung 1. Breast
2. Colorectal 2. Lung
3. Pancreas 3. Colorectal
60-79 1. Lung 1. Lung
2. Colorectal 2. Breast
3. Prostate 3. Colorectal
>80 1. Lung 1. Lung
2. Prostate 2. Colorectal
3. Colorectal 3. Breast
159. THE ROLE OF THE NURSE
Education
Monitoring
Documentation
Proper referral
Being up to date