CELLULAR

ABERRATION
By
Mark Vincent C. Cenita, RN,MN
Safeguards against cancer
Steps in controlling cancer
Diet
Early detection
CELLULAR ABERRATION
A group of disorders
characterized by abnormal cell
growth and the ability to
metastasize with potential in
killing the host.
CANCER
The term cancer refers to the group
of diseases in which cells grow and
spread unrestrained throughout the
body.
Derives from the latin crab which
means cancer
Synonymous with neoplasm
Acquire invasive characteristics,
changes in occurring in surroundings.
Is not a single disease with a single
cause.
CARCINOGENESIS
- Process of transformation from normal cell
to a neoplastic cell
CANCER
INVASION
Occurs when cancer cells infiltrate adjacent
tissues surrounding the neoplasm.
METASTASIS
Occurs when malignant cells travel through
the blood or lymph and invade other
tissues and organs to form a secondary
tumor.
DIFFERENTIATION
Refers to the process whereby cells
develop specific structures and function is
order to specialized in certain task.
Top 5 cancer incidence by site &
sex:
Male Female
1. Prostate 1. Breast
2. Lungs 2. Lungs
3. Colon 3. Colon
4. Urinary Tract 4. Uterus
5. Leukemia 5. Leukemia & Lymphoma
MEN
High incidence of cancer of the
lung and bladder
Most common neoplasm aged 20 to
34 is TESTICULAR CANCER
WOMEN
BREAST CANCER followed by
lung and brochus, colon and
rectum
Classification of Tumor:
1. Benign- are tumors designated by
attaching the suffix oma to the cells of
origin.
e.g. Fibroma
Chondroma
Osteoma
Classification of Tumor:
2. Malignant- tumors that are capable
of spreading by invasion and
metastasis.
e.g. Fibrosarcoma
Chondrosarcoma
COMPARISON OF THE
CHARACTERISTICS OF BENIGN AND
MALIGNANT NEOPLASM
CHARACTERISTICS BENIGN MALIGNANT
Speed of growth Slow growth Aggressive growth; rapid cells
division and growth
Grows by expansion Establish new site malignant
lesions
Mode of growth Localized and encapsulated Invade surrounding tissues
Cell characteristic Well differentiated With poor cell differentiated
Metastasis It does not metastasized Ability to migrate, cells move to
distant areas of the body
No tissue damage Destroy surrounding tissues
Prognosis Very good prognosis
Does not cause death
unless localization
affect vital function
Poor prognosis
Can lead to death unless
interventions are taken
Benign Tumor
Malignant Tumor
CLASSIFICATION OF
CANCER
1. CARCINOMA - Refers to a tumor
arises from epithelial tissue, the name
of the cancer identifies the location,
e.g. basal cell carcinoma
2. SARCOMA - Refers to a tumor arising
from supportive tissue; the name of the
cancer identifies the specific tissue
affected
3. LEUKEMIA - A malignant disorder of
the blood-forming tissues of the bone
marrow, spleen, and lymph
system characterize by unregulated
proliferation of WBCs and their
precursors.
4. LYMPHOMA - A group of malignant
neoplasm that affects the lymphatic
system resulting in the
proliferation of lymphocytes
5. MYELOMA
NOMENCLATURE OF TUMORS
Tissue of Origin Benign Malignant
Connective tissue
and derivatives Fibroma Fibrosarcoma
Lipoma Liposarcoma
Chondroma Chondrosarcama
Osteoma
Osteogenic
Sarcoma
Blood Vessels Hemangioma Angiosarcoma
Lymph vessels Lymphangioma
Lymphangio-
sarcoma
Brain coverings Meningioma
Invasive
Meningioma
Hematopoietic cells Leukemias
Lymphoid tissue
Malignant
Lymphomas
Smooth muscles Leiomyoma Leiomyosarcoma
Striated Muscles Rhabdomyoma
Rhabdomyo-
sarcoma
Epithelial tumors
Stratified squamous
Squamos cell
papilloma
Squamos cell
carcinoma
Basal cells
Basal cell
carcinoma
Liver cells
Liver cell
adenoma
Hepatocellular
carcinoma
Placental
epethelium
(trophoblast)
Hydatidiform
mole Choriocarcinoma
PATHOGENESIS OF
CANCER
Cellular Transformation
and Derangement Theory
Failure of the Immune
Response Theory
Cellular Transformation
and Derangement Theory
conceptualizes that normal
cells may be transformed into
cancer cells due to exposure
to some etiologic agents
Failure of the Immune
Response Theory
advocates that all individuals possess
cancer cells. However, the cancer
cells are recognized by the immune
response system. So, the cancer cells
undergo destruction. Failure of the
immune response system leads to
inability to destroy the cancer cells.
Acquired
(environmental)
DNA damaging
agent: --Chemicals
-Radiation
-Viruses
NORMAL
CELL
DNA Damage
Successful
DNA repair
Failure of
DNA repair
Mutation of
the cell
Activation of
oncogenes
Alteration of
genes
Inactivation of
cancer suppressor
genes
Expression of altered
gene products
Malignant
neoplasm
Flow Chart Depicting Molecular Basis of
Cancer
Carcinogenesis
Steps:
1. Imitation
2. Promotions
3. Latency
4. Progression
5. Invasion to neighboring organs
Stages of Tumor
Progression
HYPERTROPY
- Increase in size of normal cells
ATROPHY
- Shrinkage of cell size
HYPERPLASIA
- Increase in number of normal cells
METAPLASIA
- Conversion from the normal pattern of
differentiation of one type of cells into
another type of cell not normal for that
tissue
DYSPLASIA
- Alteration in the shape, size,
appearance, and distribution of cells
ANAPLASIA
- Disorganized, irregular cells that have
no structure and have lots of
differentiation; the result is almost
malignant
Classification, Grading &
Stages
TNM Classification
T (extent of primary tumor)
TX cannot be adequately assessed
TO no evidence of primary tumor
TIS Tumor in situ localized; no
spread
T1- 4 progressive increase in size
1:5 cm < 2:6-9 cm
3:10-15 cm 4:15 cm >
Classification, Grading &
Stages
TNM Classification
N (regional Lymph Node)
Nx cannot be assessed clinically
NO no evidence of regular node
metastasis
N1 4 increasing involvement of
nodes
Classification, Grading &
Stages
Stages
0 benign state
I spread to nearby tissue
II 2-5 cm sometimes involve lymph
III more than 5 cm spread
advanced spread to connective
tissue.
IV - Mestastasis
Types of Metastasis
Extension & Invasion
1. Lymphatic Spread
2. Seeding of body cavities & surfaces
3. Hematogenous spread
ETIOLOGIC FACTORS
(Carcinogens)
1. Viruses
2. Chemical carcinogens
3. Physical agents
4. Hormones
5. Genetics
Viruses
oncogenic viruses
Prolonged or frequent viral
infections may cause
breakdown of the immune
system or overwhelm the
immune system.
Chemical carcinogens
act by causing cell mutation or alteration
in cell enzymes and proteins
E.g.
1. Industrial compounds vinyl chloride,
polycyclic aromatic hydrocarbons, fertilizers,
weed killers, dyes, drugs
2. Hormones estrogen, diethylstilbestrol (DES)
3. Foods, preservatives nitrites, talc, food
sweeteners, nitrosomines, aflatoxins,
polycyclic hydrocarbons
Physical agents
1. Radiation x-ray or radioactive
isotopes, sunlight/UV rays
2. Physical irritation or trauma
pipe smoking, multiple deliveries,
jagged tooth, irritation of the
tongue, overuse of any
organ/body part
Hormones
estrogen as replacement
therapy increases incidence of
vaginal and cervical
adenocarcinoma
Genetics
oncogene when exposed
to carcinogens changes
in cell structure becomes
malignant
PREDISPOSING FACTORS
1. Age older individuals are more prone to
cancer
2. Sex women (more prone to breast,
uterus and cervical cancer) while men
(prostate and lung cancer)
3. Urban vs. Rural residence cancer is
more common among urban dwellers
4. Geographic distribution due to
influence of environmental factors
such as national diet, ethnic customs,
type of solutions.
5. Occupation
6. Heredity greater risk with positive
familial history
7. Stress depression, grief, anger,
aggression, despair of life stresses
8. Precancerous lesions may undergo
transformation cancer lesions and
tumors
9. Obesity studies have linked obesity
to breast and colorectal cancer
ASSESSMENT
1. NURSING HISTORY
2. PHYSICAL ASSESSMENT
3. DIAGNOSIS
ASSESSMENT
NURSING HISTORY
any previous exposure to known or
suspected risk factor
health history
lifestyle
familial history
PHYSICAL ASSESSMENT
a. Identify WARNING SIGNAL OF CANCER
C- change in bladder and bowel habits
A- a sore that does not heal
U- unusual bleeding or discharges
T- thickening or lump in the breast
I- Indigestion and difficulty in swallowing
O- overt changes in wart or mole
N- nagging cough and hoarseness of voice
C change in bowel habits or bladder function
A a sore that does not heal
U unusual bleeding or discharge
U unexplained sudden weight loss
U unexplained anemia
T thickening or lump in breast or other body parts
I indigestion or difficulty of swallowing
O obvious change in wart or mole
N nagging cough or hoarseness of voice
Assessment
b. Implement SAFEGUARD AGAINST CANCER
BASIC. Annual physical exam and blood
examination.
SKIN. Avoid overexposure to sunlight.
ORAL. Annual oral examination.
BREAST. Monthly BSE from age 20.
COLON. Digital rectal exam for persons over age 40.
Rectal biopsy and proctoscopic examination, Guaiac stool
exam for persons age 50 and above.
UTERUS. Annual Paps smear from age 40.
LUNGS. Avoid cigarette smoking; annual chest x-
ray
Assessment
c. Identify classification of cancer according to type of
tissue evolve from.
- carcinoma or sarcoma
d. Identify systemic effects
1. Anorexia, weakness, weight loss, muscle
wasting.
2. Metabolic disturbances
3. Fluid and electrolyte imbalances
4. Pain
5. Hormonial imbalances
e. Assist in diagnostic test
DIAGNOSIS ASSESSMENT
A. TISSUES SAMPLING
B. IMAGING TECHNIQUES
C. LABORATORY STUDIES
D. ROUTINE LAB EXAMS
TISSUES SAMPLING
1. Exfoliative cytology used to study
cells that the body has shed during
the normal sequence of body
tissue growth and development
2. Biopsy surgical removal of a
piece of tissue for microscopic
examination. The most definitive
method for diagnosing CA
3 KINDS:
a. Needle biopsy cells are
aspirated through placed in the tissue
b. Incisional biopsy removing or
taking a small sample out of tissues
mass
c. Excisional biopsy involves
removal all of the know tumor
IMAGING TECHNIQUES
DIRECT VISUALIZATION
INDIRECT VISUALIZATION
DIRECT VISUALIZATION
involves introduction of fiber optic
endoscopy tubes into hollow organs
to view internal surfaces
1. Bronchoscopy Esophagoscopy
2. Gastroscopy
3. Sigmoidoscopy
4. Colonoscopy
INDIRECT
VISUALIZATION
includes radiologic and imaging test
1. Mammography
2. Barium enema
3. BSE
4. GI SERIES
5. Computed Tomography
6. MRI
7. Radioisotope studies
8. Ultrasound
LABORATORY STUDIES
TUMOR MARKERS
Biochemical substance synthesized
and release by tumor cell
1. Oncofetal antigen
2. Hormones
3. Isoenzymes
4. Tissue
ROUTINE LAB EXAMS
E.g. ALT, CBC, BILIRUBIN,
bleeding time, HCG,
TREATMENT MODALITIES
SURGERY
RADIATION
BONE MARROW
TRANSPLANTATION
CHEMOTHERAPY
BIOLOGIC RESPONSE MODIFIER
SURGERY
Often the primary treatment for CA and
may be performed for various
purposes.
May be
1. Preventive
2. Diagnostic
3. Curative
4. Palliative
RADIATION
Often high energy ionizing radiation to
treat tumors
Used to kill the tumor, reduce the tumor
size, relieve obstruction or decrease pain,
causes lethal injury to DNA, so it can
destroy rapidly multiplying CA cells as well
as normal cells e.g. xrays, gamma rays &
radioactive particles
THREE SAFETY
PRINCIPLES :
Time refers to the length of exposure
minimize time spent in close proximity to
the radiation source (30 mins in 8 hr.
shift)
Distance minimum distance of 6 ft.,
from the radiation source
Shielding - use lead shields and other
precautions to reduce exposure to
radiation
SOURCES
EXTERNAL (Teletherapy)
INTERNAL (Brachytherapy
sealed)
SOURCES OF INTERNAL
RADIATION :
Implanted into affected tissue or body
cavity
Ingested as a solution, ingested as solution
Injected as a solution into the bloodstream
or body cavity
Introduced thru a catheter into the tumor
Sealed involves temporarily implanting sealed
applicators that contain radioactive substance
into various organs of the body
Unsealed involves the administration of
isotopes orally or by injection
SIDE EFFECTS :
Alopecia
1. Wear wig, hat, bonnet, bandana, scarf or
anything that could be worn as a head
dress.
2. Inform patient that hair will eventually
grow back after chemotherapy.
Skin reactions (erythema, dry/moist
desquamation)
1. Observe for early signs of skin reaction
and report.
2. Keep area dry.
3. Wash area with WATER ONLY and pat
dry.
4. Do not apply ointments, powders or
lotions.
5. Do not apply heat, avoid direct sunshine
or cold.
6. Use soft cotton fabrics for clothing.
7. Do not erase markings on the skin.
These serve as guide for areas of
irradiation.
Infection
1. Monitor blood counts weekly.
2. Good personal hygiene, nutrition and
adequate rest.
3. Teach signs of infection to report to
physician.
Hemorrhage
1. Monitor platelet count.
2. Avoid physical trauma or use of aspirin.
3. Teach signs of hemorrhage.
4. Monitor stool and skin for signs of
hemorrhage.
5. Use direct pressure over injection sites
until bleeding stops.
Fatigue
Plenty of rest and good nutrition.
Weight loss due to anorexia, nausea and
vomiting
1. Arrange meal times
2. Encourage bland foods
3. Provide small attractive meals
4. Avoid extremes of temperature
5. Administer antiemetics as ordered before
meals
Ulceration of oral mucosa (Stomatitis)
1. Administer analgesics before meals.
2. Bland diet
3. No smoking/alcohol
4. Good oral hygiene (saline rinses q2)
5. Sugarless lemon drops or mint to
increase salivation.
Diarrhea
1. Encourage low residue, bland, high-
protein foods
2. Administer antidiarrheal drugs as ordered
3. Provide good perineal care
4. Monitor electrolytes particularly Na, K, Cl
Anorexia, nausea and vomiting
- arrange meal times
- encourage bland foods
- provide small attractive meals
- avoid extremes of temperature
- administer antiemetics as ordered before
meals
Headache
Social isolation
BONE MARROW
TRANSPLANTATION
It is used in the treatment of leukemia,
in conjunction with radiation or
chemotherapy, it is usually harvested
from the iliac crest then transfused
intravenously.
TYPES :
1. Autologous the client is infused with
own bone marrow harvested during
remission disease
2. Syngeneic marrow donor is an identical
twin
3. Allogenic the client is infused with
donor bone marrow harvested from a
healthy individual
SIDE EFFECTS :
1. Malnutrition
2. Infection related to immunosuppression
3. Thrombocytopenia
Nursing Mgt .
1. Provide private room for the hospitalized
client for 6 8 wks
2. Encourage contact with significant others
3. Management of side effects
CHEMOTHERAPY
Uses antineoplastic agents to treat CA
cells locally and systematically
Provides palliative measure for the pt.
Who has widespread metastasis
Disrupts the cell cycle in various
phases, interfering with cellular
metabolism and reproduction.
Cell kill hypothesis
During each cycle a fixed percentage of
cells are killed by chemotherapy,
leaving some tumor cells remaining,
this necessitates the repeated dosages
of chemotherapy in order to reduce
the number of cells, allowing the bodys
immune system to destroy any
remaining tumor cells.
CONTRAINDICATIONS
Infection
Recent Surgery
Impaired renal or hepatic function
Recent radiation therapy
Pregnancy
Bone marrow depression
Safety precautions in handling
chemotherapeutic agents
All used and unused equipment and
drugs should be treated as hazardous
wastes.
Place contaminated material in leak
proof labeled as hazardous waste.
Prepare chemotherapeutic agents in a
private and clean setting.
Strict use of body protection techniques
includes gloves, garment with close
front, cuffed long sleeves, face shield
and mask.
Prevent spillage, use luer lock fitting
on syringes and IV sets.
Flush immediately with water if it
comes in contact with skin and mucous
membranes.
5 MAJOR CATEGORIES
Alkylating agents
Antimetabolites
Antitumor antibiotics
Hormones and hormones
antagonists
Vinca Alkaloids
Nursing Interventions
1. GI SYSTEM
Nausea and vomiting - Administer
antiemetics.
Diarrhea - Replace fluid electrolyte
losses, low fiber diet.
Constipation Increase OFI and fiber
in diet.
2. INTEGUMENTARY SYSTEM
Pruritus, uriticaria Provide good skin
care.
Stomatitis Provide oral care and avoid
hot and spicy food.
Alopecia Reassure that it is only
temporary and encourage to wear wigs,
hats or head scarf.
Skin pigmentation Inform that it is
temporary.
Nail changes Reassure that nails may
grow normally after chemotherapy.
3. HEMATOPOIETIC SYSTEM
Anemia Provide frequent rest periods.
Neutropenia Protect from infection and
avoid people with infection.
Thrombocytopenia Protect from trauma
and avoid ASA (Aspirin).
4. GENITO-URINARY SYSTEM
Hemorrhagic cystitis Provide 2 to 3 L of
fluids per day.
Urine color changes Reassure that it is
harmless.
5. REPRODUCTIVE SYSTEM
Premature menopause or amenorrhea
Reassure that menstruation resumes
after chemotherapy.
BIOLOGIC RESPONSE
MODIFIER
agents that make CA pts. Biologic
response to the tumor cell more
effective.
1. Immunotherapy
2. Biotherapy
Immunotherapy
Stimulates the bodys natural immune
system that restrict and destroy CA
cells
a. Nonspecific
b. Monoclonal antibody
c. Cytokines - substance that immune
system cells produce to enhance the
immune system, normal growth
regulating molecules possessing anti
tumor abilities
1. Interleukin - 2(IL-2)
2. Interferons
3. Hematopoietic growth factors
Biotherapy
Involves replacing altered genes.
DIETARY RECOMMENDATIONS
AGAINST CANCER
Avoid obesity.
Cut down on total fat intake
Eat more high fiber foods raw
fruits and vegetable, whole grain
cereals.
Include foods rich in Vitamin A &
C in daily diet.
Include cruciferous vegetables in
the diet (broccoli, cabbage,
cauliflower, brussel sprouts)
Be moderate in the consumption
of alcoholic beverages.
Be moderate in the consumption
of salt (cured, smoked and
nitrate-cured foods).