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  1. 1. -enna Cellular aberation
  2. 2. pathophysiology of cancer • cancer disease in which abnormal cells divide without control and are able to invade other tissues • derived from greek word for crab, karkinona • tumor- also referred to as a neoplasm-new growth
  3. 3. different characteristic of neoplasia • Neoplasm can be benign or malignant • benign- well differentiated resemble the normal cell, but cant control cell proliferation • malignant -lost the ability to control both proliferation and differentiation • malignant cell also grow in absence of growth hormone
  4. 4. l
  5. 5. Benign Tumors • contains cell that resemble normal tissue cells(well diffentiated) • grow slowly • sorrounded by fibrous capsule • do not infiltrate, invade, metastasize • can damage nearby organ by compressing them
  6. 6. Category of malignant neoplasms • solid tumors-initially confined to a specific tissue or organ • hematologic cancer involves cell normally found in blood and lymp so they are dessiminated from the beginning
  7. 7. Malignant Neoplasm Characteristic Genetically instability 1. Cancer cell seem unable to correct errors in cell division 2. May have multiple copies of chromosomes 3. Gene mutation affect: growth regulation and cell cycle arrest
  8. 8. Cell Cycle Phase
  9. 9. G0 cell cycle • G0-is a form of the resting state, or quiescence, in which cells reside until they receive appropriate signals - for example, from growth factors - stimulating them to re-enter and progress through the cell cycle.
  10. 10. G1 phase • The G₁ phase, gap 1 phase, or growth 1 phase, is the first of four phases of the cell cycle that takes place in eukaryotic cell division. In this part of interphase, the cell synthesizes mRNA and proteins in preparation for subsequent steps leading to mitosis. • RNA and protein synthesis-for cellgrowth
  11. 11. SPhase • DNA synthesis-radiation-to destroy • is the period of wholesale DNA synthesis during which the cell replicates its genetic content; a normal diploid somatic cell with a 2N complement of DNA at the beginning of S phase acquires a 4N complement of DNA at its end.
  12. 12. MPhase-cell division • During the mitotic (M) phase, the cell divides its copied DNA and cytoplasm to make two new cells. M phase involves two distinct division-related processes: mitosis and cytokinesis.
  13. 13. G2 • pre mitotic phase-preparation for cell division • is a period of rapid cell growth and protein synthesis during which the cell prepares itself for mitosis. Curiously, G2 phase is not a necessary part of the cell cycle, as some cell types (particularly young Xenopus embryos and some cancers) proceed directly from DNA replication to mitosi
  14. 14. Carcinogenesis Carcinogenesis or oncogenesis or tumorigenesis • is literally the creation of cancer • it is the process by which normal cells are transformed into cancer cells
  15. 15. breast ca
  16. 16. Assessment, Diagnosis and treatment for Cancer
  17. 17. Effect of Cancer
  18. 18. Effect of Cancer
  19. 19. Effect of Cancer • Pain • Physical stress
  20. 20. Warning Sign of Cancer –C-hanges in bladder or bowel habits –A-sore that doesn’t heal –U-nusual bleeding or discharges –T-hickening or lumps –I-ndigestion od diffuclty swallowing –O-bvious changes in warts, moles, or the skin –N-agging cough or hoarseness of voice –U-nexplained anemia –S-udden loss of weight
  21. 21. Screening Test • early detection and treatment are the cornerstone of cancer • educating the public about healthy lifestyle and early detection
  22. 22. • apoptosis-program and controlled cell destruction which eliminates damaged, improperly produced and worn out cells withouit harming the other areas a normal process of cell deletion and renewal • carcinogen-is any substance, radionuclide, or radiation that promotes carcinogenesis, the formation of cancer. This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes Terms
  23. 23. • carcinoma-cancer that forms in epithelial tissue. Epithelial tissue lines most of your organs, the internal passageways in your body (like your esophagus), and your skin. Most cancers affecting your skin, breasts, kidney, liver, lungs, pancreas, prostate gland, head and neck are carcinomas • hospice-Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life
  24. 24. • differentiation-In cancer, this describes how much or how little tumor tissue looks like the normal tissue it came from. Well- differentiated cancer cells look more like normal cells and tend to grow and spread more slowly than poorly differentiated or undifferentiated cancer cells.
  25. 25. • lymphomas-types of cancer that begin in the lymphatic system (the various lymph glands around the body) when abnormal white blood cells grow. Lymphomas are the sixth most common form of cancer overall (excluding non-melanoma skin cancer).
  26. 26. Leukemia or myelomas • In leukemia, the cancerous cells are discovered circulating in the blood and bone marrow, while in lymphoma, the cells tend to aggregate and form masses, or tumors, in lymphatic tissues. Myeloma is a tumor of the bone marrow, and involves a specific subset of white blood cells that produce a distinctive protein
  27. 27. metastasis • the spread of cancer cells from the place where they first formed to another part of the body. In metastasis, cancer cells break away from the original (primary) tumor, travel through the blood or lymph system, and form a new tumor in other organs or tissues of the body.
  28. 28. nadir • Nadir is a term that basically means low point. When a person with cancer reaches their “nadir” following each chemotherapy cycle, it means that the person's blood cell counts are the lowest they will be during that treatment cycle. Each chemotherapy treatment comes with a nadir period
  29. 29. neoplasm • An abnormal mass of tissue that forms when cells grow and divide more than they should or do not die when they should. Neoplasms may be benign (not cancer) or malignant (cancer). Benign neoplasms may grow large but do not spread into, or invade, nearby tissues or other parts of the body.
  30. 30. sarcoma • Sarcoma is the general term for a broad group of cancers that begin in the bones and in the soft (also called connective) tissues (soft tissue sarcoma). Soft tissue sarcoma forms in the tissues that connect, support and surround other body structures
  31. 31. tumor markers • is anything present in or produced by cancer cells or other cells of the body in response to cancer or certain benign (noncancerous) conditions that provides information about a cancer, such as how aggressive it is, whether it can be treated with a targeted therapy, or whether it is responding to treatment
  32. 32. Alpha-fetoprotein (AFP) • Cancer types: Liver cancer and germ cell tumors • What's analyzed: Blood • How used: To help diagnose liver cancer and follow response to treatment; to assess stage, prognosis, and response to treatment of germ cell tumors
  33. 33. B-cell immunoglobulin gene rearrangement • Cancer type: B-cell lymphoma • What's analyzed: Blood, bone marrow, or tumor tissue • How used: To help in diagnosis, to evaluate effectiveness of treatment, and to check for recurrence
  34. 34. BCL2 gene rearrangement • Cancer types: Lymphomas, leukemias • What’s analyzed: Blood, bone marrow, or tumor tissue • How used: For diagnosis and planning therapy
  35. 35. tumor marker for breast Cancer 1. cancer antigen 15-3 (CA 15-3) 2. cancer antigen 27.29 (CA 27.29) 3. carcinoembryonic antigen (CEA) -- • have been used to help monitor metastatic breast cancer (advanced disease), but they have not been found to be useful to find a breast cancer recurrence or lengthen lives
  36. 36. • CA-125 is the most used tumor marker for ovarian cancer. But if your CA-125 level is typical, your doctor might test for HE4 or CA19-9. • CA 19-9 is a type of tumor marker of pancreatic cancer
  37. 37. lung cancer • The most commonly tested lung cancer markers include mutations in the following genes: • EGFR, which makes a protein involved in cell division. • KRAS, which helps control the growth of tumors. • ALK, which is involved in cell growth
  38. 38. • Estimating Glomerular Filtration Rate • Kirsten rat sarcoma viral oncogene homolog. • anaplastic lymphoma kinase.
  39. 39. • To prevent • To diagnose • To treat
  40. 40. • To determine: Nature and name of disease • Determine: grading and staging • Report: molecular changes and biomarkers Goals and task of diagnostic pathology
  41. 41. Proliferative terms not neoplastic 1. Metaplasia- one cell type is replaced by another cell type 2. Hyperplasia- an increase in the number of cells in an organ or tissue which may be then an increased in volume 3. Hypertrophy – an increase in size and thus an increase in the size organ
  42. 42. • Cancer is a condition that results from abnormal cellular DNA. It is a condition wherein cells mutate and increase number, with changes in their morphology and without any function. The increase in the number of these cells infects other cells and causes them to behave the same way, a condition termed as “malignancy”. Cancer cells infiltrate normal and healthy tissue and they compete with normal cells for sustenance from the blood. Malignant cells compress and kill healthy tissue and deprive them of nutrition
  43. 43. • Any cell in the body has the potential to mutate and become a cancer cell. However, a healthy immune system is able to kill these cells before they can cause any aberration in the body. The etiology of cancer is unknown and anything that has the potential to cause cellular DNA mutation has the capacity to cause malignancy. The etiology varies across the specific types of cancer on virtually all cells of the body. Anything that can cause Causes
  44. 44. • Genetics –Some genes carry a code for the transcription of cancer and malignancy. It is unclear; however, what causes these genes to cause malignancy. Certain extrinsic triggers may contribute to their activation. One thing is sure though, cancer runs in the family. Genetic Screening may detect presence of these oncogenes.
  45. 45. • Tobacco – Cigarettes contain hundreds of carcinogens and other harmful chemicals. It has been clearly shown through various studies that cigarette smoke, even second-hand smoke increases the risk of cancers of the lungs, oral cavity, lips, esophagus, and larynx. Smokers who inhale the smoke have an increased risk for lung cancer as the smoke reaches the lungs. A new study has coined the term “third hand smoke” wherein smoke particles become active in surfaces for days and inhaling near these surfaces also carries carcinogens into the system.
  46. 46. – Diet It has been noted in studies that a diet high in nitrates (processed foods), benzopyrenes (grilled foods), alcohol, red meat and fat increases cancer risk. Also, a diet low in vegetables and other greens significantly increase the risk for colon cancer. • Physical Activity – A sedentary lifestyle contributes to the development of cancer as much as obesity. It is important to control your weight too. It is recommended to have at least 150 minutes of non-vigorous, or 75 minutes of vigorous exercise per week.
  47. 47. • Sun and UV Exposure – Sunlight and the Ultraviolet radiation it carries significantly increases cancer risk and risks for melanomas. Ultraviolet light alters the DNA of cells and this causes malignancies if not controlled by the immune system. • Other Carcinogens – Carcinogens, certain drugs, viruses, chemicals, pollution, and certain infectious agents all have the potential to cause malignancy. It is important to live in a clean environment to be able to avoid these triggers.
  48. 48. • Cancer symptoms depend on the severity and specific type of cancer. Most cancers however are asymptomatic and will only produces signs once they are at advances stages. Early detection and treatment is the key to cancer survival. There are many symptoms of cancer but some of the potentially-serious warning signs are: Symptoms
  49. 49. Management of Cancer depends on the specific stage and site of the cancer. Treatment may be primary(to kill cancer cells), adjuvant(to kill remaining cancer cells), or palliative(to treat signs and symptoms). Some treatment modalities include: Management
  50. 50. • Chemotherapy • Surgery • Radiation therapy • Stem cell transplants • Biological therapy to improve immune function • Hormone therapy
  51. 51. chemotherapy • Chemotherapy is a type of cancer treatment that uses one or more anti- cancer drugs as part of a standardized chemotherapy regimen. Chemotherapy may be given with a curative intent or it may aim to prolong life or to reduce symptoms.
  52. 52. side effects • Tiredness. Tiredness (fatigue) is one of the most common side effects of chemotherapy. ... • Feeling and being sick. ... • Hair loss. ... • Infections. ... • Anaemia. ... • Bruising and bleeding. ... • Sore mouth. ... • Loss of appetite.
  53. 53. chemotherapy is used include • As the primary treatment. Sometimes, the goal of chemotherapy treatment is to get rid of all the cancer and keep it from coming back. This might be called "curative chemotherapy." • Before other treatments. Chemotherapy can be given before surgery or radiation therapy to shrink tumors. This can be called "neoadjuvant chemotherapy." • After other treatments. Chemotherapy can be given after surgery or radiation therapy to destroy any remaining cancer cells. This is called "adjuvant chemotherapy." • To slow the progression of cancer and relieve symptoms.
  54. 54. main types of chemotherapy: • Alkylating agents • Antimetabolites • Anti-tumor antibiotics • Topoisomerase inhibitors • Mitotic inhibitors • Plant alkaloids
  55. 55. Alkylating agents • These agents damage DNA and prevent mitosis. They are used to treat leukemia, lymphomas, multiple myeloma, sarcoma and lung, breast, and ovarian cancer. Examples of drugs in this class include: • Nitrogen mustards such as chlorambucil, cyclophosphamide, ifosfamide, and melphalan • Alkylsulfonates such as busulfan • Nitrosoureas such as streptozotocin, carmustine, and lomustine • Triazines such as dacarbazine • Ethylenimines such as thiotepa and altretamine • Platinum drugs such as cisplatin, carboplatin and oxalaplatin
  56. 56. Antimetabolites • These agents interrupt the S phase and substitute normal DNA and RNA with other amino acids, thereby interfering with cell replication and proliferation. Antimetabolites are used to treat leukemia and cancers of the breast and ovary. • Examples of drugs in this class include 5- fluorouracil (5-FU), 6-mercaptopurine (6-MP), cytarabine, capecitabine, fludarabine, gemcitabine, methotrexate, pemetrexed, pentostatin and thioguanine.
  57. 57. • Anthracyclines • Anthracyclines are anti-tumor antibiotics that inhibit the enzymes that bring about DNA replication. Examples of drugs in this class include doxorubicin, daunorubicin, idarubicin and epirubicin. • Topoisomerase inhibitors • These agents inhibit the enzyme topoisomerase which would usually help untangle DNA strands so they can be replicated. They are used to treat leukemia and lung, ovarian and gut cancer. Examples include topotecan, irinotecan, etoposide and teniposide.
  58. 58. • Plant alkaloids • Also called mitotic inhibitors, these drugs interrupt the M phase of the cell cycle and inhibit mitosis. They are used to treat breast and lung cancers and myeloma, lymphoma, and leukemia. Examples of drugs in this class include taxanes such as paclitaxel and docetaxel, vinca alkaloids such as vinblastine, vincristine and vinorelbine.
  59. 59. • Corticosteroids • This drug class includes naturally occurring hormones such as the steroid hormones as well as artificially synthesized analogues of these hormones. They are used to treat lymphoma, leukemia and multiple myeloma and examples include prednisone, methylprednisolone and dexamethasone.
  60. 60. • Hormone therapy. Hormone therapy is a type of cancer treatment that removes, blocks, or adds specific hormones to the body. It is also called hormonal therapy or endocrine therapy. Hormone therapy can be used to treat several types of cancer. • Immunotherapy. This type of treatment helps your body's natural defenses fight the cancer. Immunotherapy has developed rapidly during the last few years, and is now an important part of treatment for several types of cancer. • Targeted therapy. These treatments target and disable genes or proteins found in cancer cells that the cancer cells need to grow. Targeted therapy can treat many types of cancer.
  61. 61. tests and Procedures • Barium Enema • Procedure used to find health conditions in the colon and rectum • Biopsy • tissue sample is used to diagnose cancer • Bone Marrow Aspiration and Biopsy • Procedures that can provide information about blood cells • Bone Scan • Used to find cancer or see how well treatment is working • Breast MRI • Imaging test used to look at breast tissue
  62. 62. • Colonoscopy • Used to view a part of the large intestine • Computed Tomography (CT) Scan • Type of imaging test used to find and learn more about cancer • Fecal Occult Blood Tests • Used to find blood in the stool
  63. 63. • Digital Rectal Exam (DRE) • Used to check the lower rectum, pelvis, and lower belly • Electrocardiogram (EKG) and Echocardiogram • Tests to find problems with the heart muscle, valves, or rhythm • Types of Endoscopy • Procedures used to view the inside of the body
  64. 64. • Magnetic Resonance Imaging (MRI) • Imaging test done without using x-rays • Mammogram • X-ray that checks for breast cancer • MUGA Scan • Test for checking if the lower chambers of heart are pumping blood properly • Pap Test • Procedure to find changes in cells that can lead to cervical cancer
  65. 65. • Positron Emission Tomography and Computed Tomography (PET-CT) Scans • Used to find cancer and learn its stage • Sigmoidoscopy • Test to examine the lower part of the large intestine • Tumor Marker Tests • Types of tests that look for substances made by cells in the body in response to cancer
  66. 66. • Ultrasound • Imaging test that can show tumor's location in the body • Upper Endoscopy • Used to examine the esophagus, stomach, and top of small intestine
  67. 67. • There is no sure way to prevent cancer as it is caused by various factors. • Reduce this risk: eating a proper diet rich in fiber and vegetables, having regular exercise, avoidance of triggers, living in a clean environment and having regular screening drastically reduces the risks of cancer and its complications. Prevention
  68. 68. Cancer of the Breast
  69. 69. • Removal of the breast, with or without surrounding structures. • Mastectomies can be performed in four distinct methods, depending on the diagnosis and the extent of the pathologic findings. Mastectomy
  70. 70. • Partial Mastectomy: Excision of breast tumor, leaving appropriate tumor-free margins. • Subcutaneous Mastectomy: Removal of all breast tissue. Overlying the skin and nipple are left intact.
  71. 71. • Simple Mastectomy • Radical Mastectomy: – Modified radical – removal of breast and axillary lymph nodes. Most frequently performed. – Classic radical – includes removal of the entire breast, pectoralis muscles, axillary lymph nodes, fats, fascia, and adjunct tissue. – Extended radical – bloc removal of breast, axillary contents, pectoralis muscles, and internal mammary lymph nodes.
  72. 72. • Mastectomy • Removal of the breast, with or without surrounding structures. • Discussion • Mastectomies can be performed in four distinct methods, depending on the diagnosis and the extent of the pathologic findings. • Partial Mastectomy: Excision of breast tumor, leaving appropriate tumor-free margins. • Subcutaneous Mastectomy: Removal of all breast tissue. Overlying the skin and nipple are left intact.
  73. 73. Surgery of the breast
  74. 74. Radical Mastectomy: –Modified radical – removal of breast and axillary lymph nodes. Most frequently performed. –Classic radical – includes removal of the entire breast, pectoralis muscles, axillary lymph nodes, fats, fascia, and adjunct tissue. –Extended radical – bloc removal of breast, axillary contents, pectoralis muscles, and internal mammary lymph nodes.
  75. 75. • Is the leading type of cancer in women.Most breast cancer begins in the lining of the milk ducts, sometimes the lobule. • The cancer grows through the wall of the duct and into the fatty tissue. • Breast cancer metastasizes most commonly to auxiliary nodes, lung, bone, liver, and the brain. • The most significant risk factors for breast cancer are gender (being a woman) and age (growing older). Breast Cancer
  76. 76. • Other probable factors include nulliparity, first child after age 30, late menopause, early menarche, long term estrogen replacement therapy, and benign breast disease. • Controversial risk factors include oral contraceptive use, alcohol use, obesity, and increased dietary fat intake.
  77. 77. • About 90% of breast cancers are due not to heredity, but to genetic abnormalities that happen as a result of the aging process and life in general. • A woman’s risk of breast cancer approximately doubles if she has a first- degree relative (mother, sister, daughter) who has been diagnosed with breast cancer. About 20-30% of women diagnosed with breast cancer have a family history of breast cancer.
  78. 78. • Stage O- Cancer cells remain inside the breast duct, without invasion into normal adjacent breast tissue. • Stage 1- Cancer is 2 centimeters or less and is confined to the breast (lymph nodes are clear). • Stage IIa- No tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm) or the tumor measures 2 centimeters or smaller and has spread to the axillary lymph nodes or the tumor is larger than 2 but no larger than 5 centimeters and has not spread to the axillary lymph nodes. Stages of Breast Cancer
  79. 79. • Stage Iib- The tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodesORthe tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.
  80. 80. • Stage IIIa - No tumor is found in the breast. Cancer is found in axillary lymph nodes that are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone or the tumor is any size. Cancer has spread to the axillary lymph nodes, which are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone.
  81. 81. • Satge IIIb- The tumor may be any size and has spread to the chest wall and/or skin of the breast and may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone.Inflammatory breast cancer is considered at least stage IIIB.
  82. 82. • Stage IIIc-There may either be no sign of cancer in the breast or a tumor may be any size and may have spread to the chest wall and/or the skin of the breast and the cancer has spread to lymph nodes either above or below the collarbone and the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone.
  83. 83. • The cancer has spread — or metastasized — to other parts of the body. Stage IV
  84. 84. Assessment • A firm lump or thickness in breast, usually painless; 50% are located in the upper outer quadrant of the breast. • Spontaneous nipple discharge; may be bloody, clear or serous. • Asymmetry of the breast may be noted as the woman changes positions; compare one breast with the other. • Nipple retraction or scalliness, especially in Paget’s disease. • Enlargement of auxiliary or supraclavicular lymph nodes may indicate metastasis.
  85. 85. • Mammography (most accurate method of detecting non-palpable lesions) shows lesions and cancerous changes, such as microcalcification. Ultrasonography may be used to distinguish cysts from solid masses. • Biopsy or aspiration confirms diagnosis and determines the type of breast cancer. Diagnostic Evaluation
  86. 86. • Estrogen or progesterone receptor assays, proliferation or S phase study (tumor aggressive), and other test of tumor cells determine appropriate treatment and prognosis. • Blood testing detects metastasis; this includes liver function tests to detect liver metastasis and calcium and alkaline phosphatase levels to detect bony metastasis. • Chest x-rays, bone scans, or possible brain and chest CT scans detect metastasis.
  87. 87. • Chemotherapy is the primary used as adjuvant treatment postoperatively ; usually begins 4 weeks after surgery (very stressful for a patient who just finished major surgery). – Treatments are given every 3 to 4 weeks for 6 to 9 months. Because the drugs differ in their mechanisms of action, various combinations are used to treat cancer. Pharmacological Intervention
  88. 88. –Principal breast cancer drugs include cyclosphosphamide, methotrexate, fluorouracil, doxorubicin, and paclitaxel. –Additional agents for advanced breast cancer include docetaxel, vinorelbine, mitoxantrone, and fluorouracil. –Herceptin is a monoclonal antibody directed against Her-2/neu oncogene; may be effective for patients who express this gene
  89. 89. • Indications for chemotherapy include large tumors, positive lymph nodes, premenopausal women, and poor prognostic factors. • Chemotheraphy is also used as primary treatment in inflammatory breast cancer and as palliative treatment in metastatic disease or recurrence. • Anti-estrogens, such as tamoxifen, are used as adjuvant systemic therapy after surgery. • Hormonal agents may be used in advanced disease to induce remissions that last for months to several years.
  90. 90. • Surgeries include lumpectomy (breast- preventing procedure), mastectomy (breast removal), and mammoplasty (reconstructive surgery). • Endocrine related surgeries to reduce endogenous estrogen as a palliative measure. • Bone marrow transplantation may be combined with chemotherapy Surgical Interventions
  91. 91. • Monitor for adverse effects of radiation therapy such as fatigue, sore throat, dry cough, nausea, anorexia. • Monitor for adverse effects of chemotherapy; bone marrow suppression, nausea and vomiting, alopecia, weight gain or loss, fatigue, stomatitis, anxiety, and depression. • Realize that a diagnosis of breast cancer is a devastating emotional shock to the woman. Provide psychological support to the patient throughout the diagnostic and treatment process. • Involve the patient in planning and treatment. • Describe surgical procedures to alleviate fear. • Prepare the patient for the effects of chemotherapy, and plan ahead for alopecia, fatigue. Nursing Intervention
  92. 92. • Administer antiemetics prophylactically, as directed, for patients receiving chemotherapy. • Administer I.V. fluids and hyperalimentation as indicated. • Help patient identify and use support persons or family or community. • Suggest to the patient the psychological interventions may be necessary for anxiety, depression, or sexual problems. • Teach all women the recommended cancer-screening procedures.
  93. 93. Lung cancer
  94. 94. • Also called bronchogenic cancer. • It is a malignant tumor of the lung arising within the bronchial wall or epithelium. • The lung is also a common site of metastasis from cancer elsewhere in the body through venous circulation or lymphatic spread.
  95. 95. • Epidermoid (squamous cell – most common), • Adenocarcinoma, • Small cell (oat cell) carcinoma, and • Large cell (undifferentiated) carcinoma Bronchogenic cancer is classified according to cell type
  96. 96. Epidermoid (squamous cell – most common), • Squamous cell carcinoma (SCC) of the lung, also known as epidermoid carcinoma, is a form of lung cancer. There are two types of lung cancer: small lung cell cancer (SCLC) and non-small cell lung cancer (NSCLC). Squamous cell carcinoma is a type of non-small cell carcinoma.
  97. 97. Adenocarcinoma • Adenocarcinoma of the lung forms when cells lining the outside of the lungs become cancerous.
  98. 98. Small-cell carcinoma (SCLC) or oat-cell • Small-cell carcinoma of the lung is also known as small-cell lung cancer (SCLC) or oat-cell cancer because the cancer cells may appear to look like oats under a microscope. Small-cell carcinoma is a type of cancer that can appear in various parts of the body, but most often occurs in the lung.
  99. 99. Large cell undifferentiated carcinomas (LCUD) • which are also called simply large cell carcinomas, are malignant neoplasms of the lung that show no squamous, glandular, or small cell (neuroendocrine) differentiation in routinely stained sections of the tissues or smears of the cytologic specimens
  100. 100. The primary predisposing factor in lung cancer is cigarette smoking • Lung cancer risk is also high in people occupationally exposed to asbestos, arsenic, chromium, nickel, iron, radioactive substances, isopropyl oil, coal tar products, and petroleum oil mists. • Complications include superior vena cava syndrome, hypercalcemia (from bone metastasis), syndrome of inappropriate antidiuretic hormone (SIADH), pleural effusion, pneumonia, brain metastasis, and spinal cord compression.
  101. 101. Modifiable • Approximately 80% of lung cancers are related to cigarette smoking. Lung cancer is 10 times more common in smokers than in nonsmokers. In particular,squamous cell and small cell carcinoma are associated with smoking • Other risk factors include exposure to carcinogenic industrial and air pollutants—such as asbestos,coal dust,radon,and arsenic Non-modifiable Family history Risk Factors
  102. 102. • New or changing cough, dyspnea, wheezing, excessive sputum production, hemoptysis, chest pain (aching, poorly localized), malaise, fever, weight loss, fatigue, or anorexia. • Decreased breath sounds, wheezing, and possible pleural friction rub (with pleural effusion) on examination. Assessment
  103. 103. • Chest X-ray may be suspicious for mass; • CT or position emission tomography scan will be better visualize tumor. • Sputum and pleural fluid samples for cytologic examination may show malignant cells. Diagnostic Evaluation
  104. 104. • Fiberoptic bronchoscopy determines the location and extent of the tumor and may be used to obtain a biopsy specimen. • Lymph node biopsy and mediastinoscopy may be ordered to establish lymphatic spread and help plan treatment. • Pulmonary function test, which may be combined with a split-function perfusion scan, determines if the patient will have adequate pulmonary reserve to withstand surgical procedure.
  105. 105. • Oxygen through nasal cannula based on level of dyspnea. • Enteral or total parenteral nutrition for malnourished patient who is unable or unwilling to eat. • Removal of the pleural fluid (by thoracentesis or tube thoracostomy) and instillation of sclerosing agent to obliterate pleural space and fluid recurrence. • Radiation therapy in combination with other methods. Medical Management
  106. 106. Surgical Intervention • Resection of tumor, lobe, or lung. Pharmacologic Intervention • Expectorants and antimicrobial agents to relieve dyspnea and infection. • Analgesics given regularly to maintain pain at tolerable level. Titrate dosages to achieve pain control. • Chemotherapy using cisplatin in combination with a variety of other agents and immunotherapy treatments may be indicated.
  107. 107. • Elevate the head of the bed to ease the work of breathing and to prevent fluid collection in upper body (from superior vena cava syndrome). • Teach breathing retraining exercises to increase diaphragmatic excursion and reduce work of breathing. • Augment the patient’s ability to cough effectively by splinting the patient’s chest manually. • Instruct the patient to inspire fully and cough Nursing Intervention
  108. 108. • Teach relaxation techniques to reduce anxiety associated with dyspnea. Allow the severely dyspneic patient to sleep in reclining chair. • Encourage the patient to conserve energy by decreasing activities. • Ensure adequate protein intake such as milk, eggs, oral nutritional supplements; and chicken, fowl, and fish if other treatments are not tolerated – to promote healing and prevent edema.
  109. 109. • Advise the patient to eat small amounts of high-calorie and high-protein foods frequently, rather than three daily meals. • Suggest eating the major meal in the morning if rapid satiety is the problem. • Change the diet consistency to soft or liquid if patient has esophagitis from radiation therapy. • Consider alternative pain control methods, such as biofeedback and relaxation methods, to increase the patient’s sense of control.
  110. 110. sarcomas
  111. 111. • Sarcoma is the general term for a broad group of cancers that begin in the bones and in the soft (also called connective) tissues (soft tissue sarcoma). Soft tissue sarcoma forms in the tissues that connect, support and surround other body structures. This includes muscle, fat, blood vessels, nerves, tendons and the lining of your joints.
  112. 112. Signs and symptoms • A lump that can be felt through the skin that may or may not be painful • Bone pain • A broken bone that happens unexpectedly, such as with a minor injury or no injury at all • Abdominal pain • Weight loss
  113. 113. Causes • It's not clear what causes most sarcomas. • In general, cancer forms when changes (mutations) happen in the DNA within cells. The DNA inside a cell is packaged into a large number of individual genes, each of which contains a set of instructions telling the cell what functions to perform, as well as how to grow and divide.
  114. 114. • Mutations might tell cells to grow and divide uncontrollably and to continue living when normal cells would die. If this happens, the accumulating abnormal cells can form a tumor. Cells can break away and spread (metastasize) to other parts of the body.
  115. 115. Factors that can increase the risk of sarcoma include: • Inherited syndromes. Some syndromes that increase the risk of cancer can be passed from parents to children. Examples of syndromes that increase the risk of sarcoma include familial retinoblastoma and neurofibromatosis type 1. • Radiation therapy for cancer. Radiation treatment for cancer increases the risk of developing a sarcoma later. • Chronic swelling (lymphedema). Lymphedema is swelling caused by a backup of lymph fluid that occurs when the lymphatic system is blocked or damaged. It increases the risk of a type of sarcoma called angiosarcoma. • Exposure to chemicals. Certain chemicals, such as some industrial chemicals and herbicides, can increase the risk of sarcoma that affects the liver. • Exposure to viruses. The virus called human herpesvirus 8 can increase the risk of a type of sarcoma called Kaposi's sarcoma in people with weakened immune systems.
  116. 116. Diagnosis Tests and procedures used to diagnose sarcoma and determine its extent (stage) include: • A physical exam. Your doctor will likely do a physical exam to better understand your symptoms and look for other clues that will help with your diagnosis. • Imaging tests. Which imaging tests are right for you will depend on your situation. Some tests, such as X-rays, are better for seeing bone problems. Other tests, such as MRI, are better for seeing connective tissue problems. Other imaging tests might include ultrasound, CT, bone scans and positron emission tomography (PET) scans. • Removing a sample of tissue for testing (biopsy). A biopsy is a procedure to remove a piece of suspicious tissue for lab testing.
  117. 117. Treatment for sarcoma might involve: • Surgery. The goal of surgery for sarcoma is to remove all of the cancer cells. Sometimes it's necessary to amputate an arm or leg to remove all of the cancer, but surgeons try to preserve limb function when possible. Sometimes all of the cancer can't be removed without hurting important structures, such as nerves or organs. In these situations, the surgeons work to remove as much of the sarcoma as possible.
  118. 118. • Radiation therapy. Radiation therapy uses high-powered energy beams, such as X- rays and protons, to kill cancer cells. The radiation can come from a machine that moves around your body directing the beams of energy (external beam radiation). Or the radiation might be placed in your body temporarily (brachytherapy). Sometimes radiation is done during an operation to remove the cancer (intraoperative radiation).
  119. 119. • Chemotherapy. Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Some types of sarcoma are more likely to respond to chemotherapy treatment than others.
  120. 120. • Targeted therapy. Targeted therapy is a drug treatment that uses medicines that attack specific weaknesses in cancer cells. Your doctor may have your sarcoma cells tested to see if they are likely to respond to targeted therapy drugs.
  121. 121. • Immunotherapy. Immunotherapy is a drug treatment that uses your immune system to fight cancer. Your body's disease- fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy drugs work by interfering with that process.
  122. 122. • Ablation therapy. Ablation therapy treatments destroy cancer cells by applying electricity to heat the cells, very cold liquid to freeze the cells or high- frequency ultrasound waves to damage the cells.
  123. 123. Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer.
  124. 124. cervical cancer
  125. 125. Symptoms • Early-stage cervical cancer generally produces no signs or symptoms. Signs and symptoms of more-advanced cervical cancer include: • Vaginal bleeding after intercourse, between periods or after menopause • Watery, bloody vaginal discharge that may be heavy and have a foul odor • Pelvic pain or pain during intercourse
  126. 126. Causes • Cervix and squamous and glandular cells • Cervical cancer begins when healthy cells in the cervix develop changes (mutations) in their DNA. A cell's DNA contains the instructions that tell a cell what to do.
  127. 127. Types of cervical cancer • Squamous cell carcinoma. This type of cervical cancer begins in the thin, flat cells (squamous cells) lining the outer part of the cervix, which projects into the vagina. Most cervical cancers are squamous cell carcinomas. • Adenocarcinoma. This type of cervical cancer begins in the column-shaped glandular cells that line the cervical canal.
  128. 128. Risk factors for cervical cancer include: • Many sexual partners. The greater your number of sexual partners — and the greater your partner's number of sexual partners — the greater your chance of acquiring HPV. • Early sexual activity. Having sex at an early age increases your risk of HPV. • Other sexually transmitted infections (STIs). Having other STIs — such as chlamydia, gonorrhea, syphilis and HIV/AIDS — increases your risk of HPV. • A weakened immune system. You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV. • Smoking. Smoking is associated with squamous cell cervical cancer. • Exposure to miscarriage prevention drug. If your mother took a drug called diethylstilbestrol (DES) while pregnant in the 1950s, you may have an increased risk of a certain type of cervical cancer called clear cell adenocarcinoma.
  129. 129. Prevention To reduce your risk of cervical cancer: • HPV vaccine. • Have routine Pap tests. at age 21 and repeating them every few years. • Practice safe sex. • Don't smoke. help you quit.
  130. 130. Screening tests include: • Pap test • HPV DNA test DIAGNOSIS • Punch biopsy, • Endocervical curettage, • If the punch biopsy or endocervical curettage is worrisome, • Electrical wire loop, • Cone biopsy (conization),
  131. 131. Staging • Staging exams include: • Imaging tests. Tests such as X-ray, CT, MRI and positron emission tomography (PET) help your doctor determine whether your cancer has spread beyond your cervix. • Visual examination of your bladder and rectum. Your doctor may use special scopes to see inside your bladder and rectum.
  132. 132. Treatment • Treatment for cervical cancer depends on several factors, such as the stage of the cancer, other health problems you may have and your preferences. Surgery, radiation, chemotherapy or a combination of the three may be used.
  133. 133. Surgery • Early-stage cervical cancer is typically treated with surgery. Which operation is best for you will depend on the size of your cancer, its stage and whether you would like to consider becoming pregnant in the future.
  134. 134. 1. Surgery to cut away the cancer only. For a very small cervical cancer, it might be possible to remove the cancer entirely with a cone biopsy. This procedure involves cutting away a cone-shaped piece of cervical tissue, but leaving the rest of the cervix intact. This option may make it possible for you to consider becoming pregnant in the future.
  135. 135. 2.Surgery to remove the cervix (trachelectomy). Early-stage cervical cancer might be treated with a radical trachelectomy procedure, which removes the cervix and some surrounding tissue. The uterus remains after this procedure, so it may be possible to become pregnant, if you choose.
  136. 136. 3. Surgery to remove the cervix (trachelectomy). Early-stage cervical cancer might be treated with a radical trachelectomy procedure, which removes the cervix and some surrounding tissue. The uterus remains after this procedure, so it may be possible to become pregnant, if you choose.
  137. 137. Radiation • Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. Radiation therapy is often combined with chemotherapy as the primary treatment for locally advanced cervical cancers. It can also be used after surgery if there's an increased risk that the cancer will come back.
  138. 138. Radiation therapy can be given: • Externally, by directing a radiation beam at the affected area of the body (external beam radiation therapy) • Internally, by placing a device filled with radioactive material inside your vagina, usually for only a few minutes (brachytherapy) • Both externally and internally
  139. 139. Chemotherapy • Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. It can be given through a vein or taken in pill form. Sometimes both methods are used.
  140. 140. Targeted therapy • Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die. Targeted drug therapy is usually combined with chemotherapy. It might be an option for advanced cervical cancer.
  141. 141. Immunotherapy • Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body's disease-fighting immune system might not attack cancer because the cancer cells produce proteins that make them undetectable by the immune system cells. Immunotherapy works by interfering with that process. For cervical cancer, immunotherapy might be considered when the cancer is advanced and other treatments aren't working.
  142. 142. Supportive (palliative) care • Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care.
  143. 143. COLON CANCER
  144. 144. OVERVIEW • Colon cancer is a type of cancer that begins in the large intestine (colon). The colon is the final part of the digestive tract. • Colon cancer typically affects older adults, though it can happen at any age. It usually begins as small, noncancerous (benign) clumps of cells called polyps that form on the inside of the colon. Over time some of these polyps can become colon cancers.
  145. 145. Signs and symptoms of colon cancer include: 1. A persistent change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool 2. Rectal bleeding or blood in your stool 3. Persistent abdominal discomfort, such as cramps, gas or pain 4. A feeling that your bowel doesn't empty completely 5. Weakness or fatigue 6. Unexplained weight loss
  146. 146. Causes • In general, colon cancer begins when healthy cells in the colon develop changes (mutations) in their DNA. A cell's DNA contains a set of instructions that tell a cell what to do.
  147. 147. Factors that may increase your risk of colon cancer include: • Older age. Colon cancer can be diagnosed at any age, but a majority of people with colon cancer are older than 50. The rates of colon cancer in people younger than 50 have been increasing, but doctors aren't sure why. • African-American race. African-Americans have a greater risk of colon cancer than do people of other races. • A personal history of colorectal cancer or polyps. If you've already had colon cancer or noncancerous colon polyps, you have a greater risk of colon cancer in the future. • Inflammatory intestinal conditions. Chronic inflammatory diseases of the colon, such as ulcerative colitis and Crohn's disease, can increase your risk of colon cancer.
  148. 148. • Obesity. People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight. • Smoking. People who smoke may have an increased risk of colon cancer. • Alcohol. Heavy use of alcohol increases your risk of colon cancer. • Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat previous cancers increases the risk of colon cancer.
  149. 149. • Low-fiber, high-fat diet. Colon cancer and rectal cancer may be associated with a typical Western diet, which is low in fiber and high in fat and calories. Research in this area has had mixed results. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat and processed meat. • A sedentary lifestyle. People who are inactive are more likely to develop colon cancer. Getting regular physical activity may reduce your risk of colon cancer. • Diabetes. People with diabetes or insulin resistance have an increased risk of colon cancer.
  150. 150. • Obesity. People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight. • Smoking. People who smoke may have an increased risk of colon cancer. • Alcohol. Heavy use of alcohol increases your risk of colon cancer. • Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat previous cancers increases the risk of colon cancer.
  151. 151. • Eat a variety of fruits, vegetables and whole grains. • Drink alcohol in moderation • Stop smoking. • Exercise most days of the week. • Maintain a healthy weight.
  153. 153. • Prostate cancer is cancer that occurs in the prostate. The prostate is a small walnut-shaped gland in males that produces the seminal fluid that nourishes and transports sperm.
  154. 154. signs and symptoms 1. Trouble urinating 2. Decreased force in the stream of urine 3. Blood in the urine 4. Blood in the semen 5. Bone pain 6. Losing weight without trying 7. Erectile dysfunction
  155. 155. Causes A cell's DNA contains the instructions that tell a cell what to do. The changes tell the cells to grow and divide more rapidly than normal cells do. The abnormal cells continue living, when other cells would die.The accumulating abnormal cells form a tumor that can grow to invade nearby tissue. In time, some abnormal cells can break away and spread (metastasize) to other parts of the body.
  156. 156. • Older age. Your risk of prostate cancer increases as you age. It's most common after age 50. • Race. For reasons not yet determined, Black people have a greater risk of prostate cancer than do people of other races. In Black people, prostate cancer is also more likely to be aggressive or advanced. • Family history. If a blood relative, such as a parent, sibling or child, has been diagnosed with prostate cancer, your risk may be increased. Also, if you have a family history of genes that increase the risk of breast cancer (BRCA1 or BRCA2) or a very strong family history of breast cancer, your risk of prostate cancer may be higher.
  157. 157. • Obesity. People who are obese may have a higher risk of prostate cancer compared with people considered to have a healthy weight, though studies have had mixed results. In obese people, the cancer is more likely to be more aggressive and more likely to return after initial treatment.
  158. 158. • Cancer that spreads (metastasizes). Prostate cancer can spread to nearby organs, such as your bladder, or travel through your bloodstream or lymphatic system to your bones or other organs. Prostate cancer that spreads to the bones can cause pain and broken bones. Once prostate cancer has spread to other areas of the body, it may still respond to treatment and may be controlled, but it's unlikely to be cured.
  159. 159. • Incontinence. Both prostate cancer and its treatment can cause urinary incontinence. Treatment for incontinence depends on the type you have, how severe it is and the likelihood it will improve over time. Treatment options may include medications, catheters and surgery. • Erectile dysfunction. Erectile dysfunction can result from prostate cancer or its treatment, including surgery, radiation or hormone treatments. Medications, vacuum devices that assist in achieving erection and surgery are available to treat erectile dysfunction.
  160. 160. Prostate screening and diagnostic Exam: • Digital rectal exam (DRE). • Prostate-specific antigen (PSA) test. • Ultrasound. . • Magnetic resonance imaging (MRI). • Collecting a sample of prostate tissue.
  161. 161. Techniques used to determine the aggressiveness of the cancer include: • Gleason score. The most common scale used to evaluate the grade of prostate cancer cells is called a Gleason score. Gleason scoring combines two numbers and can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer), though the lower part of the range isn't used as often.
  162. 162. • Most Gleason scores used to assess prostate biopsy samples range from 6 to 10. A score of 6 indicates a low-grade prostate cancer. A score of 7 indicates a medium-grade prostate cancer. Scores from 8 to 10 indicate high-grade cancers.
  163. 163. • Genomic testing. Genomic testing analyzes your prostate cancer cells to determine which gene mutations are present. This type of test can give you more information about your prognosis. But it's not clear who might benefit most from this information, so the tests aren't widely used. Genomic tests aren't necessary for every person with prostate cancer, but they might provide more information for making treatment decisions in certain situations.
  164. 164. Determining whether the cancer has spread • Bone scan • Ultrasound • Computerized tomography (CT) scan • Magnetic resonance imaging (MRI) • Positron emission tomography (PET) scan
  165. 165. Radiation
  166. 166. Permanent prostate brachytherapy
  167. 167. Types of radiation therapy. • Freezing prostate tissue. Cryoablation or cryotherapy for prostate cancer involves using a very cold gas to freeze the prostate tissue. The tissue is allowed to thaw and the procedure repeats. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue. • Heating prostate tissue. High-intensity focused ultrasound (HIFU) treatment uses concentrated ultrasound energy to heat the prostate tissue and cause it to die.

Hinweis der Redaktion

  • in normal cell after proliferation they will die but in cancer continous to clonal proliferate and decrease the ability of apoptisis-cell deletion and renewal
  • well difenciated means that we can identify if columnar cell or squamous or the appearance of cell, they are encapsulated covered by thick protein and contained in thick membrane, cant differentiation, also a cancer is a malignant neoplasm, dont mature, ct differentiate function, increase function like example if the affected organ is the pituitary gland hich secrete growth hormone if it is affected by cancer, then they will secrete more hormone
  • secrete signals and enzyme or toxic substance-intense pain, infiltrate cant travel,
  • breakthrough and invade nd metastasize by entering the blood and the system while hemato involves cells found in blood, b caells and t cells
  • meaning d pa sya nageerode sa basement membrane d pa nagmetastasize
  • in normal cell errors in cell division may delete if abnornal cell, but in cancer will continue to divide, gene mutation will not stop continue multiply
  • make their own growth factor others produce numerous active receptor may mga cell na active receptors and highly stimulated kaya mabilis lumaki, many pharmaceutical produced drugs to control the growth of a cancer by blocking the receptor therfore d n makapasok ang ang growth factor to stop mutation,
    inhibit other cell but ca continually multiply and destroy cell
  • telomeres control the division of cell, replace telomerase in ca continous to proliferate
  • fetal antigen
  • genes must be essential to normal cell but in ca this genes must be stop, in cell cycle protein- inhibit to stop growth factor while in apop must die but unable to apop
    suppressor -continous to grow dec ability to stop growth
  • initiatiom damage to DNA by radiation chemical exposure, suposedly the cell damage will die but in ca will be mutated,
  • insulin
  • lost of appetite and severe wasting
  • inc calcium level, insulin- hypoglycemia, adh will not produce urine=fluid retention, acth