ONCOLOGY / CANCER NURSING

THE CELL
Definition of Related Terms
Cell
- The basic unit of living organism; can reproduce itself
Cancer
– a disease process whereby cells proliferate abnormally, ignoring growth
regulating signals in the environment surrounding the cells.
Carcinoma
– a new growth or malignant tumor that originates from epithelial cells, the skin, GIT,
Lungs, Uterus, breast and other organs.
Benign
– usually a reference to growths that are encapsulated, remain localized, and are slow
growing
Malignant

- terms for growth that are encapsulated but metastasize and grow. These growths are cancerous lesions
having the characteristics of disorderly, uncontrolled proliferation of the cell

Tumor
- Abnormal swelling usually from inflammation, or from morbid enlargement.
- They are uncontrolled tissue growth that in which cell rapidly multiplies
Oncology
- The study of cancer
Staging
- a method of classifying malignancies based on the presence and extent of the tumor on
the body
Metastasis

- the transfer of disease from one organ or apart to another not directly connected to
it.
Undifferentiated cells – cells that lost the capacity for specialized functions
Carcinogenesis – process of transforming normal cells into malignant cells
Carcinogens - agents that initiate or promote cellular transformation.
Oncogene

- cancer gene that alters the normal cell

Carcinoma
- usually solid tumors arising from epithelial cell
Sarcoma
- from muscle, bone, fat and other connective tissue
Lymphoma
- malignant tumors in lymphatic system
Leukemia
- cancer of the blood
Nadir
- lowest point of WBC depression after therapy that has toxic effects on th bone marrow
Metastasis
- spread of cancer cells from the primary tumor to distant sites.
Review of Anatomy and Physiology:

Review of Anatomy and Physiology:

Cell
Centrioles
- self-replicating organelles
made uf o nine bundles of microtubules and
are found only in animal cells
Cilia and Flagella – essential for locomotion
(single-celled). Cilia function to move fluid

or materials past an immobile cell as well as moving a cell or group of cells.

Endoplasmic Reticulum –a network of sacs

that manufactures, processes and transports chemical compounds for use inside and outside of the cell.

Provides a pipeline between the

nucleus and the
cytoplasm.
Golgi Apparatus – The distribution and
Shipping department for the cell’s
chemical products
Lysosymes

- Main function is digestion. Breaks down cellular waste products and debris from outside the
cell into simple compounds, which are transferred to the cytoplasm as new cell-building
materials.
Mitochondria - are oblong shaped. The main power generators, converting oxygen and
nutrients into energy
Nucleus
- Serves as the information processing and administrative center of the
cell.
- Stores DNA
- Coordinates cell activities
o

Growth
o

Intermediary metabolism
o

Protein synthesis
o

Reproduction (cell division)

Perixosomes - found inside the cytoplasm
Plasma membrane – encloses cell contents. Selectively
Permeable.
Ribosomes
- comprised of approx. 60% RNA and 40%
protein
Cell Division
Overview of Mitosis

Cell division is an elegant process that enables organisms to grow and reproduce. Through a sequence
of
steps, the replicated genetic material in a parent cell is equally distributed to two daughter cells. While
there are some subtle differences, mitosis is remarkably similar across organisms.

Before a dividing cell enters mitosis, it undergoes a period of growth called interphase. Interphase is
the
"holding" stage or the stage between two successive cell divisions.
In this stage, the cell replicates its genetic material and organelles in preparation for division.

Mitosis is composed of several stages:

Prophase
In prophase, the chromatin condenses into discrete chromosomes. The nuclear envelope breaks down
and spindles form at opposite "poles" of the cell.
Metaphase
In metaphase, the chromosomes are aligned at the metaphase plate (a plane that is equally distant from
the two spindle poles).
Anaphase
 In anaphase, the paired chromosomes (sister chromatids) move to opposite ends of the cell.
Telophase
In this last stage, the chromosomes are cordoned off in distinct new nuclei in the emerging daughter
cells. Cytokinesis is also occurring at this time.
At the end of mitosis, two distinct cells with identical genetic material are produced.

Before a dividing cell enters mitosis, it undergoes a period of growth called interphase. Some 90
percent
of a cell's time in the normal cellular cycle may be spent in interphase.
Stages of Interphase
•

G1 phase: The period prior to the synthesis of DNA. In this phase, the cell increases in mass
in preparation for cell division. Note that the G in G1 represents gap and the 1 represents
first, so the G1 phase is the first gap phase.

••

S phase: The period during which DNA is synthesized.

In most cells, there is a narrow window of time during which DNA is synthesized. Note that the
S represents synthesis.
•

G2 phase: The period after DNA synthesis has occurred but prior to the start of prophase. The
cell synthesizes proteins and continues to increase in size. Note that the G in G2 represents
gap and the 2 represents second, so the G2 phase is the second gap phase.

In the latter part of interphase, the cell still has nucleoli present.
•

The nucleus is bounded by a nuclear envelope and the cell's chromosomes have duplicated
but are in the form of chromatin.
•

In animal cells, two pair of centrioles formed from the replication of one pair are located
outside of the nucleus.
Pathogenesis of Cancer
a. Cellular Transformation & Derangement Theory
- Conceptualizes that normal cells may be transformed into cancer cells due to
exposure to some etiologic agents.
b. 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 cell undergo destruction. Failure of the immune response
system leads to inability to destroy the cancer cells.

ROLE OF THE IMMUNE SYSTEM

- malignant cells are capable of developing on a regular basis
- Immune system can detect the development of malignant cells and destroys them
before cell growth becomes uncontrolled.
- Clinical cancer develops when the immune system fails to identify and stop the
growth of malignant cells.
Normal Immune Response
- recognizes as foreign certain antigens(tumor associated antigens) on the cell

membrane of cancer cells

- macrophages, T lymphocytes, soldiers of the cellular immune response
- T-lymphocytes has cytotoxic properties
-Lymphokines – produced by lymphocytes, capable of killing or damaging various
 types of malignant cells
-Interferon(IFN) – produce by the body in response to viral infection, possesses anti
tumor properties.
-Natural Killer Cells – subpopulation of lymphocytes, producing lymphokines and
certain enzymes that kills tumors

Immune System Failure

- Body fails to recognize malignant cells as different from “self”
- Immune response may not be activated
- Tumor antigens combine with antibodies produced by the immune system and

hides/disguise themselves from normal immune defense mechanism.

ASSESSMENT
ETIOLOGY:
A. VIRUSES & BACTERIA – viruses incorporate themselves in the genetic structure of cells,
altering future generation of that cell population – perhaps leasing to Cancer.

e.g. Epstein-Barr Virus – Highly suspect as a cause in

- Burkitt’s lymphoma
- Nasopharyngeal Ca
- some types of non-Hodgkin’s Lymphoma
- Hodgkin’s Disease

Herpes Simplex II, CMV, HPV 16, 18, 31, 33

o

Dysplasia
o

Ca of the cervix
Hepatitis B virus
o

Liver Ca
Human T cell lymphotropic Virus
o

lymphocytic leukemia
o

lymphomas
HIVo
Kaposi’s Sarcoma
Helicobacter pylori (bacteria)
o

Gastric Malignancy
B. PHYSICAL AGENTS –

a. Exposure to UV rays of the sun

b. Exposure to Ionizing radiation
c. Chronic inflammation or Irritation

d. Tobacco use
C. CHEMICAL AGENTS –
- 75 % of all Ca are thought to be related to the environment
-Tobacco smoke – single most lethal chemical carcinogen 30% of Ca deaths

- Chemical substances found in workplace (amines, aniline dyes, pesticides and formaldehydes, arsenic, tars,
asbestos, benzene, Cadmiun, Nickel and Zinc ores, PVC’s etc.)
 - Chemical agents alters DNA structure in body sites distant from chemicalexposure
(liver, lungs and kidneys are most commonly affected)
D. GENETIC & FAMILIAL FACTORS
- genetics, shared environments, cultural or lifestyle factors, chance.
E. DIETARY FACTORS
-Proactive (protective) substances – High fiber, cruciferous vegetables, carotenoids,,
Vit. E & C, Zinc and Selenium
-Cacinogenic & Co-Carcinogenic substances – High fat, Low Fiber, Alcohol, Salt-
cured or smoked meats, foods w/ nitrates & nitrites, High Caloric.
F. HORMONAL AGENTS
- Endogenous vs. Exogenous hormones

- DES (Diethylstilbestrol) – vaginal carcinomas

- Oral contraceptives and prolonged estrogen replacement therapy
Predisposing Factors
Age
- Older individuals are more prone to cancer, they have been exposed to carcinogens
longer, they may have developed immune system alteration.
Sex
- Women = more prone to breast, uterus, cervical cancer
Men = more prone to prostate, lung cancer
Residence
-Urban dwellers are more prone to cancer thanRural dwellers.

Geographic distribution
- Japan = cancer of the stomach
- US = cancer of the breast

- Due to influence of environmental factors such as, national diet, ethnic customs, type

of pollutions
Occupation - Chemical factory workers, farmers, radiology department person
Heredity

- Greater risk with positive family history

Stress

- Depression, grief, anger, aggression, despair or life stresses decreases

immunocompetence (affect hypothalamus and pituitary gland)
- immunodeficiency may spur the growth and proliferation of cancer cells

Precancerous lesions
- May undergo transformation into Ca lesions and tumors.
- E.g. pigmented moles, burn scars, senile keratosis, leoukoplakia, benign
polyps/adenoma of the colon or stomach, fibrocystic disease of the breast
Obesity
- Studies have linked obesity to breast and colorectal Ca
American Cancer Society 7 Warning Signs (CAUTION)
C-
Change in bowel or bladder HABITS
A-
A sore that does not heal
U-
Unusual bleeding or discharges
T-
Thickening or a lump in the breast or elsewhere
I–
Indigestion and difficulty of swallowing
O-
Obvious change in a wart or a mole
N-
Nagging cough or hoarseness of the voice
Cancer Classification
1. Solid Tumors – Associated with the organs from which they develop. Such as breast cancer or
lung cancer
2. Hematological Cancer – Originate from blood cell-forming tissues, such as theLeukemia sans
theLym p h oma s

Characteristic of Malignant vs. Benign neoplasm

CHARACTERISTICS BENIGN MALIGNANT

Rate of growth Usually slow Variable and depends on level

of differentiation; the more
anaplastic the tumor, the faster
its growth
Mode of growth Grows by expansion; does not Grows at he periphery and sends
infiltrate out processes that infiltrate and
surrounding destroy surrounding tissues
tissues;
usually encapsulated

Cell characteristics Well differentiated cells that Undifferentiated and often bear
little

- DES (Diethylstilbestrol) – vaginal carcinomas

- Oral contraceptives and prolonged estrogen replacement therapy
Predisposing Factors
Age
- Older individuals are more prone to cancer, they have been exposed to carcinogens
longer, they may have developed immune system alteration.
Sex
- Women = more prone to breast, uterus, cervical cancer
Men = more prone to prostate, lung cancer
Residence
-Urban dwellers are more prone to cancer thanRural dwellers.
Geographic distribution
- Japan = cancer of the stomach
- US = cancer of the breast

- Due to influence of environmental factors such as, national diet, ethnic customs, type

of pollutions
Occupation - Chemical factory workers, farmers, radiology department person
Heredity

- Greater risk with positive family history

Stress

- Depression, grief, anger, aggression, despair or life stresses decreases

immunocompetence (affect hypothalamus and pituitary gland)
- immunodeficiency may spur the growth and proliferation of cancer cells

Precancerous lesions
- May undergo transformation into Ca lesions and tumors.
- E.g. pigmented moles, burn scars, senile keratosis, leoukoplakia, benign
polyps/adenoma of the colon or stomach, fibrocystic disease of the breast
Obesity
- Studies have linked obesity to breast and colorectal Ca
American Cancer Society 7 Warning Signs (CAUTION)
C-
Change in bowel or bladder HABITS
A-
A sore that does not heal
U-
Unusual bleeding or discharges
T-
Thickening or a lump in the breast or elsewhere
I–
Indigestion and difficulty of swallowing
O-
Obvious change in a wart or a mole
N-
Nagging cough or hoarseness of the voice
Cancer Classification
1. Solid Tumors – Associated with the organs from which they develop. Such as breast cancer or
lung cancer
2. Hematological Cancer – Originate from blood cell-forming tissues, such as theLeukemia sans
theLym p h oma s
Characteristic of Malignant vs. Benign neoplasm
CHARACTERISTICS
BENIGN
MALIGNANT
Rate of growth
Usually slow

Variable and depends on level of differentiation; the more anaplastic the tumor, the faster its growth

Mode of growth
Grows by expansion; does not
infiltrate
surrounding
tissues;
usually encapsulated

Grows at he periphery and sends out processes that infiltrate and destroy surrounding tissues

Cell characteristics
Well differentiated cells that Undifferentiated and often bear little

resembles normal cells of the tissues from which the tumor originated

resemblance to the normal cells of the

tissue from which they arose
Metastasis
Not spread by metastasis

Gains access to the blood and lymphatic channels and metastasizes to other areas of the body

General effects

Usually a localized phenomenon that does not cause generalized effects unless its location interferes
with blood flow

Often causes generalized effects such as Anemia, Weakness, and weight loss

Tissue destruction
Does not usually cause tissue
damage
unless
its
location
interferes with blood flow

Often causes extensive tissue damage as the tumor outgrows its blood supply or encroaches on blood
flow to the area; may also produce substances that cause cell damage

Ability to cause death

Does not usually cause death unless its location interferes with vital functions

Usually causes death unless growth

can be controlled
Grading and Staging of Tumors
Staging – determines the size of the tumor and the existence of metastasis
TNM system – most frequently used system in classifying the extent of disease.
T – Extent of Primary Tumor
N – Lymph node involvement
M – extent of mmetastasis

Primary Tumor (T)

TX – Primary tumor cannot be assessed

T0 – No evidence of primary tumor
Tis – carcinoma in situ
T1, T2, T3, T4 – increasing size and / or local extent of the primary tumor

Regional Lymph Node (N)

NX – Regional lymph nodes cannot be assessed

N0 – No regional Lymph node metastasis
N1,N2,N3 – Increasing involvement of regional lymph nodes

Distant Metastasis (M)

MX – distant metastasis cannot be assessed

M0 – No distant metastasis
M1 – Distant metastasis

Grading – refers to the classification of the tumor cells.

- seeks to define the type of tissue from which the tumor originated and the degree to which the tumor cells
retain the functional and histologic characteristics of the tissue of origin.

- done through Cytology, Biopsy, Surgical Excision.

GRADING
Grade I
Cells differ slightly from normal cells and are well differentiated (mild dysplasia)