Prepared By:

JOHNRYL L. FRANCISCO, RN

Phase

G0

M
Phase

Cell Cycle
G2 S
Phase

Phase

G1

Phase

CELL CYCLE

G0 Phase
Resting phase; Post-mitotic resting phase Encompasses that the cell cycle normal renewable tissue in not actively proliferating

CELL CYCLE

G1 Phase
Growth or Pre-synthesis Period 12-14 hours It extends from the completion of the previous cell division to the beginning of chromosomal replication Carries out designated physiologic function and synthesis of CHONs and RNA RNA synthesis Stage of readiness

CELL CYCLE

S Phase
Synthesis Stage 7-20 hours RNA is synthesized which is essential for DNA synthesis The cells are already vulnerable to damage

CELL CYCLE

G2 Phase
Post-synthetic/Pre-mitotic Period 1-4 hours Encompasses the interval from the termination of DNA synthesis to the beginning of cell division

CELL CYCLE

M Phase
Mitosis/ Stage of Mitosis 40 minutes 2 hours Interphase silent stage PMAT

M Phase - PMAT
Prophase shortening and darkening of chromosomes Metaphase spindle fiber alignment to the center of chromosomes Anaphase separation of chromosomes; division of cell membranes Telophase lightening of the chromosomes *2 Daughter cells formation of nucleolus

Common Terminologies

Hyperplasia

increase in the number of cells of a certain tissue type resulting to an increase in tissue mass

Hypertrophy
increase in the size of the tissue increase in an organ size because of an increased cell size

Common Terminologies Metaplasia

one differentiated cell is substituted for another an adult cell changes from one type to another

Dysplasia
benign change in which an adult cell or one mature cell varies from its normal size, shape, organization one mature cell type is replaced with a less mature cell type Contributing factors: RACS

Common Terminologies Anaplasia

irreversible change where the structures of adult cell regress to more primitive level without form Pleomorphic lost of function due to wide range of change in size and shape

Neoplasm

new growth that goes beyond its normal boundary

Common Terminologies

Carcinoma

malignant neoplasm occurring in the epithelial cells

malignancy in connective tissue tumors may remain localized in its tissue, in its place of origin

Sarcoma

In Situ

Common Terminologies

Metastasis

malignant cells which may leave their site of origin and spread to other tissues via blood vessels and lymph nodes decreased in cell size

Atrophy

Common Terminologies

Carcinogens

substances that causes cancer both chemical and physical irritants abnormal new growth of tissue which serves no purpose and which harm the host organism

Cancer

Characteristics of Cancer Cells

Loss of proliferative control Loss of capacity to differentiate Altered biochemical property Chromosomal instability Capacity to metastasize

Theories of Carcinogenesis
1. Failure of immune Response Theory All individuals have cancer cells Tumor Specific Antigens (TSA) foreign body that proliferate and cause cancer when the immune system weakened

Theories of Carcinogenesis 2. Berenblum Theory

3 STEPS: Initiation presence of carcinogens (initiators) Promotion repeated exposure to initiators that leads to mutation Progression cellular changes that exhibits malignant behavior of metastasis

Theories of Carcinogenesis 3. Hormonal Theory

Changes in persons hormonal development most likely result in overproduction of endogenous hormones or an excessive administration of exogenous hormones

Theories of Carcinogenesis 4. Chemical Theory

Includes chemicals and compounds that alter the DNA synthesis: Tobacco Aromatic hydrocarbons Benzines Inorganic compounds Aromatic amines Benzelines Alkylating agents - ether

Theories of Carcinogenesis 5. Viral or Bacterial Origin

Epstein-Barr virus HIV Kaposis sarcoma HPV Cervical cancer Helicobacter pylori

Theories of Carcinogenesis 6. Radiation Theory

Act on the DNA of the cell that causes changes in the DNA structure that may eventually lead to cell death UV rays (10AM 2PM)

Predisposing/Precipitating Factors of Cancer

Age Sex Geographical location Occupation Heredity Stress Lifestyle

CHARACTERISTIC OF A TUMOR
CHARACTERISTICS
1. Cell characteristics

BENIGN Well differentiated

MALIGNANT Undifferentiated

2. Mode of growth

Usually encapsulated
Usually SLOW

Non-encapsulated
Variable; The more anaplastic the tumor, the faster its growth

3. Rate of Growth

4. Metastasis

Does not spread by Metastasize to other metastasis areas of the body

CHARACTERISTIC OF A TUMOR
CHARACTERISTICS
5. General effects

BENIGN Usually localized

MALIGNANT Causes generalized effects such as Anemia, Weakness and Weight Loss Often causes extensive tissue damage

6. Tissue Destruction

Does not usually cause tissue damage unless its location causes obstruction

7. Ability to cause death

Does not usually Usually cause death cause death unless its unless growth can location interferes be controlled with vital function

Stages of CANCER

STAGING
determines the size of the tumor and the existence of metastasis

Stages of CANCER
STAGE INTERPRETATION
Cancer in situ, no invasion of the cancer, with very early lesion
Early invasion but no metastasis Limited local extension of tumor and/or minimal regional node involvement without detectable distant metastasis Extensive local tumor and/or extensive regional node involvement, no detectable distant metastasis Distant metastasis either by hematogenous or lymphatic spread

0
I II III IV

TNM Classification System

T extent of primary tumor N absence/presence of regional

lymph node involvement

M absence/presence of metastasis

TUMOR

TUMOR INTERPRETATION Primary tumor cannot be TX

T0 Tis T1,T2, T3,T4

assessed No evidence of primary tumor

Carcinoma in situ Increasing size and/or local extent of the tumor

NODE/S

NODES INTERPRETATION Regional Lymph Nodes cannot NX

N0 N1 N2 N3

be assessed No Regional Lymph Node metastasis Increasing involvement of Regional Lymph Node

METASTASIS

METASTASIS INTERPRETATION Distant metastasis cannot MX M0 M1

be assessed No distant metastasis
Distant metastasis

Grading of CANCER GRADING

refers to the classification of the tumor cells seeks to define the types 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

Grading of CANCER
GRADE INTERPRETATION
Cannot be assessed
Well-differentiated and mature, resembles normal parent tissue; mild dysplasia/low-grade tumor Moderately well-differentiated, some immaturity present; moderate dysplasia/intermediate Poorly differentiated; very immature, little resemblance to normal parent tissue; severe dysplasia/high-grade tumor Undifferentiated, no resemblance to tissue of origin; ANAPLASIA

X
I II III IV

Diagnostic Procedures

2.Biopsy

3. Cytology
4. Diagnostic Work-up

1. Health and Physical Exam

Breast Self-Examination
Once a month, 5-7 days after menstruation STEP 1: Stand before a mirror Check both breasts for any unusual Look for discharge from the nipple, peeling, dimpling and scaling of the skin

Breast Self-Examination
STEP 2: Watch closely in the mirror as you clasp your hand behind your head and press your hand forward Note any change in the contour of your breast STEP 3: Press your hands in your hips and bow slightly towards the mirror as you pull your shoulders and elbows forward Note any changes in the contour of your breast

Breast Self-Examination
STEP 4: (Done in the shower) Raise your left arm Use 3 or 4 fingers of your right hand to feel your breast firmly, carefully and thoroughly (using pads of the fingers) Beginning at the outer edge, press the flat part of your finger in small circles moving the circles slowly around the breast

Breast Self-Examination
STEP 4: (Done in the shower) (cont.) Gradually work toward the nipple Be sure to cover the whole breast Pay special attention to the area between the breast and the underarm including the underarm itself Feel for any unusual lymphs or masses under the skin

Breast Self-Examination
STEP 4: (Done in the shower) (cont.) If you have any spontaneous discharge during the months consult your physician Do the same on Right Breast

Breast Self-Examination
STEP 5: (Done flat on bed) Step 4 should be done lying down Lie flat on your back with your left arm over your head and a pillow or folded towel under left shoulder Use the same circular motion Repeat on Right Breast

1. Health and Physical Exam

Testicular Self-Examination
Once a month, after warm shower STEP 1: Use both hands to palpate the testes. The normal testicle is smooth and uniform in consistency. STEP 2: With the index and middle fingers under the testes, the thumb on top, roll the testes gently in a horizontal plane between the thumb and fingers.

Testicular Self-Examination STEP 3: Feel for any evidence of a small lump or abnormality. STEP 4: Follow the same procedure and palpate upward along the testes. STEP 5: Locate and palpate the epididymis and also the spermatic cord.

Testicular Self-Examination
STEP 6: Repeat the examination to other testis and epididymis. STEP 7: If you have any evidence of a small pea-like lump, consult the physician.

NOTE: It is normal to find that one testis is larger or hung lower than the other.

2. Biopsy

BIOPSY
Distinctive or definitive means of diagnosing cancer and provides histological proof of malignancy.

2. Biopsy
TYPES OF BIOPSY: a. FROZEN SECTION it is made quickly at freezing point wherein the tissue is cut thinly after freezing and chemically stained b. ASPIRATION BIOPSY Fine Needle Aspiration Biopsy Aspirate cells and examine under the microscope

2. Biopsy
c. INCISIONAL BIOPSY The removal of a wedge of a suspected tissue from a larger mass d. EXCISIONAL BIOPSY Complete removal of all entire lesion

3. Cytology

CYTOLOGY
Papanicolau Smear Determine Cervical CA Done annually

Pap Smear Classes

CLASS INTERPRETATION

I
II III IV V

Normal Inflammation Mild to Moderate Dysplasia

Probably Malignant Malignant

4. Diagnostic Work-up
Computed Tomography (CT) Scan Magnetic Resonance Imaging (MRI) Endoscopy Mammography (25 & above) Chest X-Ray Intravenous Pyelogram (IVP) Barium Enema/Studies GI Series

5. Laboratory Studies Carcinoembryonic Antigen (CEA) determine Colon CA

Prostatic Specific Antigen (PSA) determine Prostate CA

5. Laboratory Studies
a. Bone Marrow Aspiration/Biopsy for patient with leukemia (Iliac or femur) b. Blood Chemistry Liver Enzymes SGPT ALT SGOT AST Bilirubin

5. Laboratory Studies
c. CBC/ Hematology WBC, RBC, Platelet count d. Creatinine Clearance test of kidney function 24-hour urine collection discard first voided urine

5. Laboratory Studies
e. Occult Blood Test Guaiac test (stool) Determine presence of blood in the stool (microscopic); for BPUD f. Serum Electrophoresis Determine the serum CHON and immunoglobulin level Used to determine Multiple Myeloma Presence of Bench Jones Protein (urine) g. Urine Catecholamines Determine if patient has Pheochromocytoma

Danger Signs of Cancer (CAUTION US)

hanges on bladder/bowel movement/routine sore that does not heal nusual bleeding or discharges hickening or lump in breast or elsewhere ndigestion bvious change of wart or mole agging cough and hoarseness of voice

Danger Signs of Cancer (CAUTION US)

nexplained anemia udden weight loss

DIETARY RECOMMENDATION FOR CANCER PREVENTION

Reduce the amount of saturated and unsaturated fats in the diet from 30-40% of total daily caloric intake Increase the amount of fiber and Vitamins ACE in the diet by eating fresh fruits, vegetables and whole grain breads or cereals Drink alcoholic beverages in moderation or not at all

DIETARY RECOMMENDATION FOR CANCER PREVENTION Eat limited amounts of broiled, charcoaled, smoked and salt and nitrate cured foods Maintain ideal body weight

Treatment Modalities

A. SURGERY B. CHEMOTHERAPY

A. SURGERY

SURGERY
Is used to diagnose stage and treat cancer to prevent metastasis

TYPES OF SURGERY for CA Patients

1. Prophylactic Surgery
Performed in clients with an existing premalignant condition or unknown family history that strongly predisposes the person to the development of cancer

TYPES OF SURGERY for CA Patients

2. Curative Surgery
All gross and microscopic tumor is removed or destroyed

3. Control/Cytoreductive Surgery
Is a debulking procedure that consist of removing a part of the tumor and decreases the number of cancer cells and increases the chance that other therapies will be successful

TYPES OF SURGERY for CA Patients

4. Palliative Surgery

Performed to improve quality of life during the survival time Performed to reduce pain, relieve airway obstruction, relieve obstruction in the GIT and urinary tract, relieve pressure in the brain and spinal cord, prevent hemorrhage, remove infected or ulcerated tumors or drain abscess

TYPES OF SURGERY for CA Patients

5. Reconstructive Surgery/Rehabilitative
Performed to improve quality of life by restoring maximal function and appearance

SIDE EFFECTS of SURGERY

Loss of function of a specific body part Reduce function as a result of organ loss Scarring and disfigurement Grieving about altered body image/imposed change in lifestyle

Factors That Affect the Selection of Surgery

1. Tumor Factor The location of the tumor The histologic feature and size of the tumor 2. Tumor Cell Kinetics Growth and extent of metastasis of the tumor 3. Patient Variables Health status of the patient (age) Host resistance and immune competence Desire for treatment Quality of life

B. CHEMOTHERAPY
CHEMOTHERAPY it kills or inhibits the reproduction of neoplastic cells and also attacks and kills normal cells has systemic effect cells affected by chemo Skin dryness Hair alopecia GIT N & V, diarrhea Hematopoeitic - pancytopenia administered through IV or orally

SAFE AND EFFECTIVE CARE OF DEALING WITH ANTINEOPLASTIC MEDICATION

1. Prepare IV chemotherapy in an air-vented space (biohazard cabinet area). 2. Wear gloves, a gown, eye protectors (goggles), and a mask when handling IV medications. 3. Nurses who are pregnant should not administer IV chemotherapeutic drugs (teratogenic). 4. Discard IV equipment in designated container.

SAFE AND EFFECTIVE CARE OF DEALING WITH ANTINEOPLASTIC MEDICATION

5.

6. 7. 8.

Prepare to administer the antineoplastic medications in a short, high-dose, intermittent courses as prescribed to maximize antineoplastic effect while allowing normal cells to recover. Monitor for phlebitis with IV administration. Monitor for extravasation Give anti-emetic 30-60 minutes before administering antineoplastic agent as ordered