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Cancer lecture June 19, 2012


OncologyCare of the Patient with Cancer

Objectives Differentiate between benign and malignant tumors Screening procedures for cancer

General signs and symptoms of cancer Discuss the prevalence of cancer Identify risk factors for cancer Treatment and nursing care of patients with cancer with cancer

What Is Cancer? Cancer = abnormal, uncontrolled cellular growth Benign versus malignant tumors Malignant tumor = cancerous and capable of spreading; neoplasm Benign tumor = noncancerous and nonspreading 1.3 million cases of cancer per year; 550,000 deaths

Oncology branch of medicine that deals with the study of tumors Pathophysiology of Cancer Defect in cellular proliferation No contact inhibition Proliferate indiscriminately

How Cancer Spreads: Metastasis Metastasis = spread of cancer cells from one part of the body to another Blood vessels Lymphatic system Secondary tumors or metastases Carcinogen = any substance that causes cancer

Statistics Cancer is the second leading cause death in the United States

Men have a 1 in 2 lifetime risk of developing cancer

Women have a 1 in 3 lifetime risk developing cancer Lung cancer is the leading cause of death in both men and women death in both men and women

Tumor Development

Normal Body Cells

Look like other cells from the tissue of originWhen mature serve a specific purpose

Reproduce in a controlled predictable manner Stop dividing when nutrients are insufficient or space is inadequate Remain in tissue of origin, except blood cells

Benign Tumors Slow steady growth Enlarges and expands but remains localized but remains localized Resembles parent tissue Rarely recurs

Malignant TumorsVaried rate of growth, often rapid metastasizes

Little or no resemblance to parent tissue to parent tissueCommonly recurs after removal Can cause tissue necrosis, ulceration, perforation, tissue sloughing, and can be fatal Irregular edges, more immobile when palpated

Usually does not cause tissue destruction in compression or obstruction Smooth, well defined edges, may be movable edges, when palpated

MalignantCharacteristic Encapsulated Differentiated Metastasis Recurrence Vascularity Mode of growth Malignant Rarely Poorly Frequently present Frequent Moderate to marked Infiltrative & Expansive



Benign Usually Partially Absent Rare Slight Expansive

Cell Characteristics

Cells not similar to parent cells

Fairly normal similar to parent cells

MetastasisProcess by which tumor cells are spread to distant parts of body to distant parts of body

Occurs several different ways: Direst spread of cells by diffusion Circulation by way of blood and lymph Accidental transplant during procedures

Staging Staging is a way of describing a cancer, such as the size of the tumor and where it has spread Clinical diagnostic staging Bone and liver scan Ultrasonography Computed tomography MRI

Staging is the most important tool doctors have to determine a patients prognosis The type of treatment a person receives depends on the stage of the cancer

Surgical Staging Describe extent of the disease after biopsy or surgical exploration

Grading and Staging of Tumors Grading: based on the degree of malignancy, how alike the cells are to the parent tissue or differentiated Staging: general extent of cancer and spread of disease rather than cell appearance

Grade 1 most differentiated Grade 4 least differentiated, most malignant

Stage 1 No invasion of other tissues, localizedStage IV Metastasized to distant parts

Grading and Staging of TumorsT=Primary Tumor Size N=lymph node involvement M = distant metastases

T0- no evidence of metastasis Tis tumor is in epithelial tumor is in epithelial T1 T1 minimal size and extension T2, T3, T4 progressively larger and extensive larger and extensive

N0- indicates no abnormal M0 = no evidence lymph nodes detected metastasis

N1 minimal involvementN2,N3,N4 progressively more involvement more involvement

M1 distant metastasis present (specify site/s)

Risk Factors The following promotes additional damage to cells causing further genetic alteration Dietary fats Cigarette smoking Alcohol consumption Prolonged severe stress

Reversible proliferation of altered cells is a key concept in cancer prevention

Risk Factors of Cancer

Heredity Age - Inactivity and obesity

Diet Dietary fat and meat Fruits and vegetables

Chemical Agents Tobacco

Carotenoids Antioxidants Phytochemicals

Environmental Carcinogens in the environment Ingested chemicals Environmental and industrial pollution Radiation Microorganisms


Percentage of All Cancer Deaths Linked to Risk Factors

Seven Major Warning Signs of Cancer

The Causes of Cancer: Role of DNA DNA basics DNA = deoxyribonucleic acid, a chemical substance thatcarries genetic information

Chromosome = threadlike body in a cell nucleus thatcontains molecules of DNA

Gene = section of chromosome that contains theinstructions for making a particular protein

The Causes of Cancer: Role of DNA DNA mutations and cancer A mutated gene no longer contains the proper code for producing its protein

Oncogene = gene involved in the transformation of a normal cell into a cancer cell

Cancer promoters = compounds that accelerate cell growth

Dietary Guidelines for Cancer Prevention Eat a varied plant-based diet Eat 59 servings of fruits and vegetables each day Cruciferous vegetables Citrus fruits and berries Dark-green leafy vegetables Dark-yellow, orange, or red fruits or vegetables Eat high-fiber foods Limit consumption of meat and total fat; favor monounsaturated and omega-3 polyunsaturated fats Limit consumption of charred, blackened, cured, and smoked meat and fish Be moderate in consumption of alcohol

SOURCE: National Cancer Institute

Levels of Disease Prevention Primary Prevention Avoidance of causative agent Secondary Prevention Early detection, screening Tertiary Prevention Treatment, symptom control, rehabilitation

Primary PreventionAvoidance of causative agent Alteration in lifestyle behaviors to eliminate or reduce exposure to carcinogens Avoid smoking. Tobacco is linked with lung, oropharyngeal, bladder, pancreatic, cervical, kidney cancer Risk is related to: Pack Years number of packs of cigarettes smoked per day multiplied by the number of years a person has smoked Example Patient smoked 1 pack per day for 30 years 1x 30 = 30 pack years

Primary Prevention continuedAvoidance of causative agent (1) Abstain from smoking Major single cause of cancer death in US Most preventable cause of premature death

(2) Dietary Eat variety of foods, with emphasis on plant sources Limit consumption of red meat, especially high in fat and processed

Primary Prevention continuedAvoidance of causative agent (3) Adopt a physically active lifestyle Moderate activity 30 minutes or more 5x or more days of the week Vigorous activity 45 minutes or more further decrease risk of breast and colon cancer (4) Maintain a healthy weight throughout lifetime Overweight increase risk of cancer breast, colon, endometrium, kidney, etc.

Primary Prevention continued (5)Alcoholic beverage limit consumption Alcohol increases risk of cancers of mouth, pharynx, larynx, esophagus, liver, breast, colon (6) Sunlight & Ultraviolet Exposure UV exposure can increase skin cancer risk Actinic keratosis small (