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PATHOPHYSIOLOGY OF CANCER

PREDISPOSING FACTORS - Age : 60 years old

PRECIPITATING FACTORS - high fat diet

Normal cell

Exposure to carcinogen (INITIATION STAGE)

DNA damage Inherited Mutations in: Failure of DNA repair 1. Genes affecting DNA repair 2. Genes affecting cell growth or apoptosis

Mutations in the genome of somatic cells

Sustaining proliferative signaling Cancer cells reduce their dependence on growth signals by production of their own extracellular growth factors, overexpression of growth factor receptors and alterations to intracellular components of signaling pathways. Evading Growth Suppressors -Cancer cells can become insensitive to these signals by disrupting the retinoblastoma protein pathway (pRb). pRb prevents inappropriate transition from the G1 phase of the cell cycle to the synthesis phase. It also allows cell to divide uncontrollably when damaged.

Resisting Cell Death Cancer cells are resistant to apoptosis which contributes to the ability of the cells to divide uncontrollably Cancer cells also rely on the reprogramming of cellular metabolism including aerobic glycolysis for uncontrolled growth and division

Activating Invasion and Metastasis Eventually tumor may spawn pioneer cells that can invade adjacent tissues and travel to other sites to form new tumors

Inducing Angiogenesis New blood vessels supply the cancer cells with oxygen and nutrients allowing tumor to grow. Angiogenesis is mediated principally through vascular endothelial growth factor, fibroblast growth factor and platelet derivative growth factor

Enabling Replicative Immortality Cancer cells overcome the boundaries on how many times a cell can divide which are usually set by telomeres. But in cancer cells these are maintained and not shortened thereby allowing the cell to divide an unlimited number of times

Increase in multiplication

Progression of tumor formation and wider spread to surrounding tissues Metastasis (routes): a. direct invasion into adjoining organ b. dissemination via lymphatics c. dissemination inn blood vessels d. seeding through body cavity

influenced by: 1. Patterns of blood flow 2. chemical signals and growth factors

Obstruction of bile flow due to the compression of distal common bile duct

Pancreatic mass body and tail

Signs and symptoms present: - weight loss - abdominal pain ( right upper quadrant radiating to the back) - anorexia - weakness Diagnostic test done: CHEST CT SCAN (PLAIN AND CONTRAST) 01/20/14 Result: - multiple complex thyroid nodules, bilateral -enlarged lymph nodes, left supraclavicular area - non specific alveolo-interstitial opacities, maybe due to interstitioalveolar pneumonia or lymphagitic type of METASTASIS - non-specific pleural thickening, posterior Right Hemothorax -multiple hepatic hypodensities worrisome for METASTASIS - hepatic cyst, left lobe - pancreatic mass body and tail

ELECTROCHEMILUMINESCENCE IMMUNOASSAY ( tumor markers) (1/19/14) Alpha feto protein : 1.73 iu/mL NORMAL : 0-5.8 IU/mL (elevated AFP indicates liver cancer) CA 19-9 : more than 1000 NORMAL: 0.0 390 u/ml (elevated levels may indicate cancer in the pancreas CA 125: 362.3 U/mL NORMAL: 0.0 350 mL (may indicate ovarian cancer) CEA :49.82 ng/mL NORMAL: 0-47 ng/mL (may indicate colorectal cancer)

CHEST PA (1/24/14) RESULT : - Pneumonia, Pleural effusion, bilateral -Heart is not enlarged with atheromatous aorta (indicating presence/ formation of fatty deposits in the aortic wall

ECHOCARDIOGRAM (1/28/14) RESULT : - Dilated left atrium with a volume index of 31 cc/m2 - Thickened aortic valve cusps with no restrictions of motion. Aortic annular calcification. - No intracavity thrombus noted - Minimal pericardial effusion - 50% inferior vena caval collapse on inspiration

CHEST PA (1/24/14) RESULT : - Pneumonia Clarithromycin 500 mg BID

Culture and sensitivity Result: No growth after 4 hrs of incubation Lactulose 155 cc @ HS Ivabradine 5 mg BID Procaterol 25 mcg Aldazide 25 mg OD Potassium chloride 10 mEqs TID

CHEST Ultrasound (1/27/14) RESULT : - Pleural effusion, bilateral Salbutamol neb 2cc Ambroxol q 8

HEMATOLOGY (1/29/14) RESULT: WBC- 20.19 X 10 CREATININE 78.68 umoL/L SODIUM- 2.62mmoL/L POTASSIUM 141. 4 mmoL/L CHLORIDE- 97.9 mmol/L BUN- 4.42 mmoL SGOT 52 U/L SGPT 49 U/L

Fasting blood glucose - 6.80 mmoL/L NORMAL: 4.144- 5.88 mmoL/L ABG result Respiratory Alkalosis with severe hypoxemia - O2 inhalation2-3 lpm via nasal cannula ENDOSCOPIC DIAGNOSIS 1/28/14 RESULT: Hiatal hernia H.pylori positive Duodenitis - OMEPRAZOLE 40 mg tab BID - HYDROCORTISONE 50 mg IV q 12

LEGEND - PROCESS - diagnostic tests/confirmatory tests

- signs and symptoms Red - management / intervention - nursing diagnosis

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