It's about cancer development and treatment

1. Presented by
Rabeeya Ameen

2.  Define Cellular adaptation.
 Define Atrophy, Hypertrophy, Hyperplasia,
Metaplasia and Dysplasia
 Define Aberrant cell growth.
 Define cancer and List the characteristics of cancer cell.
 Differentiate between benign and malignant Tumors.
 Nomenclature of benign and malignant Tumors.
 Explore staging of tumor and grading.
 Identify the goals of cancer therapy
 Discuss different treatment modalities available for
cancer
 Discuss nursing care for a cancer patient

3. The group of changes that occur in a cell in
response to environmental stress is called
cellular adaptation
OR
Cellular adaptation refers to the adjustments
in shape, size, pattern of growth and metabolic
activity that a cell makes in response to
alterations in the environment in which it must
live.

8. Left Normal Right Atrophy
From ROBBINS BASIC PATHOLOGY 2003)

11. Left Normal breast Right Hyperplasia
（From ROBBINS BASIC PATHOLOGY，2003）

17. A 4 year girl has a broken arm. After her cast is removed 6
weeks later, her healing arm is markedly smaller than her
normal arm. Identify the type of adaptation and also
mention its mechanism.
Type of cellular adaptation:
Disuse Atrophy
Mechanism of adaptation:
Immobilization of muscle and decrease in the flow of blood,
than normal, will lead to shrinking of muscle and cause atrophy.
What will be the status of:
ER,
Mitochondria
Myofilaments
Protein synthesis
Autophagic vacuoles
Catabolism
Oxygen demand

18. On a routine visit to the physician, a healthy 51-year-old
man has a blood pressure of 150/95 mm Hg. If his
hypertension remains untreated for years, which of the
following cellular alterations would most likely be seen in
his myocardium? And why?
Type of cellular adaptation:
Hypertrophy of myocardium
Mechanism of adaptation:
Increase blood pressure is a stress for myocardium the
myocardium becomes thicker in response to bear the stress.
The myocyte increase in length and breadth.
Why Hypertrophy and not Hyperplasia?
What will be the status of:
ER, Mitochondria, Myofilaments, Protein synthesis
Autophagic vacuoles, Catabolism, Oxygen demand

19. A 69-year-old man has had difficulty with urination,
including hesitancy and frequency, for the past 5 years. A
digital rectal examination reveals that the prostate gland is
palpably enlarged to about twice normal size. Which of the
following pathologic processes has most likely occurred in
the prostate? And why?
Type of cellular adaptation:
Benign Prostate Hyperplasia (BPH)
Mechanism of adaptation:
Studies show that prostate functions and structure are
maintained by testicular hormone (testosterone). With
aging the hormone become less, this leads to increase
functioning of the gland and therefore, the size of the gland
increases. In addition, aging process is also responsible for
BPH

20.  Proliferation is a process by which cell divide and
reproduce itself. It maintains a balance between the
number of cells dying and the number of cells actively
dividing and this is a regulated activity.
 Differentiation is a process by which proliferating cells
are transformed into different and more specialized cells
for example RBCs takes the shape of a disc, becomes
capable of carrying oxygen and is destined to die in 120
days

21. Aberrant cell growth is defined as any abnormal cell
growth or new growth called neoplasm.
Neoplasm is an abnormal mass of tissue, the growth of
which exceeds and is uncoordinated with that of the normal
tissue and persist in the same excessive manner after the
cessation of the stimuli which evoked the change.
Although not synonymous, tumor and neoplasm are used
interchangeably.
Cancer: A disease process whereby cells proliferate
abnormally, ignoring growth-regulating signals in the
environment surrounding the cells

22.  A disease resulting from the uncontrolled
growth of cells, which causes malignant
cellular tumors.
 The second leading cause of death in
developed countries

24. Neoplasm that contain well differentiated cells that
are clustered together in a single mass are
considered to be benign neoplasm.
Malignant neoplasm are less differentiated and have
the ability to break loose, enter the circulatory or
lymphatic system and form secondary malignant
tumors at other sites. Cancer is a malignant neoplasm
Word cancer is derived from the Greek word
“Karkinos” meaning crab. Malignancy is synonymous
with the medical meaning of cancer.

25. Benign neoplasm/Tumors Malignant neoplasm/Tumors
Grow slowly Grow rapidly
Have a well-defined capsule Are not encapsulated
Are not invasive Invade local structure and tissues
Well-differentiated; looks like the
tissue from which it arises
Poorly differentiated; may not be
able to tell which tissue it arose from
Have a low mitotic index; dividing
cells are rare
High mitotic index; many dividing
cells
Do not metastasize Can spreads distantly, often through
blood vessels and lymphatics

26. Characteristics Benign Malignant
Cell Well-differentiated cells
resemble normal cells of
the tissue from which the tumor
originated.
Cells are undifferentiated and
may bear little resemblance to
the normal cells of the tissue
from which they arose.
Mode of growth Tumor grows by expansion and
does not infiltrate the
surrounding tissues; usually
encapsulated.
Grows at the periphery and
overcomes contact inhibition to
invade and infiltrate
surrounding tissues
Rate of growth Rate of growth is usually slow. Rate of growth is variable and
depends on level of
differentiation; the
more anaplastic the tumor, the
faster its growth.

27. Characteristics Benign Malignant
Metastasis Does not spread by
metastasis
Gains access to the blood and
lymphatic channels and
metastasizes to
other areas of the body
General effects Is usually a localized
phenomenon that does not
cause generalized effects
unless its location
interferes with vital function
Often causes generalized effects,
such as anemia, weakness,
systemic
inflammation, weight loss, and
CACS
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
CACS, cancer-related anorexia-cachexia syndrome.
Adapted from Porth, C. M., & Matfin, G. (2009). Pathophysiology: Concepts of altered health states (8th ed.). Philadelphia: Lippincott Williams &
Wilkins.

31.  A complete diagnostic evaluation includes identifying
the stage and grade of the tumor. This is accomplished
prior to treatment to provide baseline data for
evaluating outcomes of therapy and to maintain a
systematic and consistent approach to ongoing
diagnosis and treatment. Treatment options and
prognosis are based on tumor stage and grade.
 Staging determines the size of the tumor, the existence
of local invasion, lymph node involvement, and distant
metastasis. Several systems exist for classifying the
anatomic extent of disease. The tumor, nodes, and
metastasis (TNM) system is one system used to
describe many solid tumors

32. TNM Classification System
 T The extent of the primary tumor
 N The absence or presence and extent of
regional lymph node metastasis
 M The absence or presence of distant
metastasis
The use of numerical subsets of the TNM
components indicates the progressive extent of
the malignant disease

33. T (tumor) Cancer Staging
Tx Tumor cannot be adequately assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ (E.g. ductal Ca of breast
is confined to the )
T1—4 Progressive increase in tumor size or
involvement
N (nodes)
Nx Regional lymph nodes cannot be assessed
N0 No evidence of regional node metastasis
N1—3 Increasing involvement of regional lymph
nodes
Cont….

34. M (metastasis)
Mx Not assessed
M0 No distant metastasis
M1 Distant metastasis present, specify sites
Adapted from Edge, S. B., Byrd, D. R., Compton, C. C., et al. (Eds.).(2010).
AJCC cancer staging manual (7th ed.). New York: Springer

35.  "Grading is the pathologic classification of tumor
cells. Grading systems seek 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 (differentiation)
 Grade I : Well differentiated.
 Grade II : Moderately differentiated.
 Grade III : Poorly to very poorly differentiated
 Grade IV : Very poorly differentiated.

37. Tumors/neoplasm are named by adding the
suffix-oma to parenchymal tissue type from
which the growth originate. E.g. benign tumor of
glandular epithelial origin is adenoma, of bone
origin is osteoma.
Term carcinoma is used to designate a malignant
tumor of epithelial tissue origin. E.g. malignant tumor
of glandular epithelial origin is adenocarcinoma.
Malignant tumor of parenchymal origin is called
sarcomas (e.g. osteosarcoma)

38. Benign Malignant
Epithelial Tumor
Surface
Glandular
Papilloma
Adenoma
Squamous cell carcinoma
Adenocarcinoma
Connective tissue
Fibrous Fibroma Fibro sarcoma
Adipose Lipoma Liposarcoma
Cartilage Chondroma Chondrosarcoma
Bone Osteoma Osteosarcoma
Blood vessels Hemangioma Hemangiosarcoma

39. Lymph Vessels Lymphangioma Lymphangiosarcoma
Muscle tumors
Smooth Leiomyoma Leiomyosarcoma
Striated Rhabdomyoma Rhabdomyosarcoma
Nerve Cell Tumors
Nerve cell Neuroma
Glial tissue Glioma
Hematologic tumors
Granulocytic Myelocytic leukemia
Erythrocytic Erythroleukemia

40. Plasma Cell Multiple Myeloma
Lymphoid Lymphocytic
leukemia

42.  Chemical agents such as tobacco smoke, asbestos,
& coal dust account for about 75% of cancers
 Physical and Environmental factors
Radiation
Exposure to irritants and pollutants
Exposure to sunlight
 Viruses & bacteria
DNA viruses- Hepa B, Herpes, EBV,
CMV, Papilloma Virus
RNA Viruses- HIV,
Bacterium- H. pylor

43.  Genetic and family history
Colon cancer
Breast cancer
 Dietary habits includes Low-Fiber, High-fat,
processed foods & alcohol

45.  Carcinogens cause mutations in cellular DNA.
 Malignant transformation, or carcinogenesis, is
thought to be at least a three-step cellular
process, involving
 Initiation,
 Promotion
 Progression

46.  Initiation
 Mutation of genetic structure
 Has potential to develop into clone of neoplastic cells
 Promotion
 Characterized by the increased proliferation of
altered cells
 Latent period
• Initial genetic alteration to clinical evidence of cancer
 Progression
 Characterized by increased growth rate of tumor as
well as its invasiveness and metastatic

48.  Vary in size and shape
 Aren’t encapsulated
 Undergo abnormal mitosis
 Function abnormally
 Don’t resemble their cells of origin
 Produce substances rarely associated with the
original cell or tissue
 Can spread to other sites.

49.  Change in bowel/bladder function
 Sores that do not heal
 Unusual bleeding or discharge
 Thickening or lump in breast or other body
parts
 Indigestion or difficulty in swallowing
 Recent change in a wart or mole
 Nagging cough or hoarseness

50.  A cancer diagnosis is based on assessment of
physiologic and functional changes and results of
the diagnostic evaluation.
 Patients with suspected cancer undergo extensive
testing to
 Determine the presence and extent of cancer
 Identify possible spread (metastasis) of disease or
invasion of other body tissues
 Evaluate the function of involved and uninvolved body
systems and organs
 Obtain tissue and cells for analysis, including evaluation
of tumor stage and grade

51.  The diagnostic evaluation includes a review of
systems; physical examination; imaging
studies; tumor marker identification,
laboratory tests of blood, urine, and other body
fluids; procedures; and pathology analysis.
 Knowledge of suspicious symptoms and the
behavior of particular types of cancer assists in
determining relevant diagnostic tests

52. Diagnostic Tests Used to Detect Cancer are
 Mammography
 Magnetic resonance imaging (MRI)
 Computed tomography (CT) scan
 Fluoroscopy
 Ultrasonography ( ultrasound)
 Endoscopy
 Nuclear medicine Imaging
 Positron emission tomography (PET)
 Vascular imaging
 Biopsy

53.  Treatment options offered to patients with
cancer are based on treatment goals for each
specific type, stage, and grade of cancer.
 Treatment approaches are not initiated until
the diagnosis of cancer has been confirmed and
staging and grading has been completed
 Goals
 Cure
 Control
 Palliation

54. 1. To cure the cancer
 Complete eradication of malignant disease
2. To control the cancer
 Prolonged survival and containment of cancer cell
growth
 Continued surveillance
3. To ease cancer symptoms (palliation)
 May involve terminal care if client’s cancer is not
responding to treatment
 Relief of symptoms associated with the disease

55. Multiple modalities are commonly used in cancer
treatment including
 Surgery
 Radiation therapy
 Chemotherapy
 Biologic Therapy
 Bone marrow or stem cell transplant
 Immunotherapy, and
targeted therapy

56.  Factors that determine treatment modality
 Cell type
 Location and size of tumor
 Extent of disease
 Physiologic and psychological status and
expressed needs also determine treatment

57.  Primary treatment used when tumors are confined
& have not invaded vital organs; considered
curative
 Surgical removal of the entire cancer remains the
ideal and most frequently used treatment method
Types of Cancer Surgeries:
Diagnostic Surgery
 Biopsy
 Excisional ( remove entire tumor and send for biopsy)
 Incisional ( remove a small part of a large tumor)
 Endoscopic biopsy
 Needle methods
 Fine needle biopsy
 Core biopsy

58.  Salvage surgery is when there has been a local
recurrence of cancer
 Prophylactic surgery
 Prophylactic surgery performed when the client is
at considerable risk for cancer
 Prophylactic surgery involves removing non vital
tissues or organs that are at increased risk to
develop cancer.
 Colectomy, mastectomy, and oophorectomy are
examples of prophylactic surgeries.

59.  Palliative surgery is used to relieve
uncomfortable symptoms or prolong life.
When cure is not possible, the goals of
treatment are to make the patient as
comfortable as possible and to promote quality
of life
 Reconstructive or plastic surgery done after
extensive surgery or to correct defects caused
by the original surgery

60.  Surgical therapy
 To cure or control
 Extent of the disease
 Actual pathology
 Age and physical condition of patient
 Anticipated results

63.  Complete a thorough preoperative assessmentfor all
factors thatmay affect patients undergoingsurgery.
 Assist patient and family in dealing with the possible
changes and outcomes resulting from surgery; provide
education and emotional support by assessing patient
and family needs and exploring with them their fears and
coping mechanisms. Encourage them to take an active
role indecision making when possible.
 Explain and clarify information the physician hasprovided
about the resultsof diagnostic testingand surgical
procedures, ifasked.
 Communicate frequently with the physician and other
health care team members to ensure that the information
provided is consistent

64.  After surgery, assess patient’s responses to the
surgery and monitor for complications such as
infection, bleeding, thrombophlebitis, wound
dehiscence, fluid and electrolyte imbalance,
and organ dysfunction.
 Provide postoperative teaching that addresses
wound care, activity, nutrition, and
medications.
 Initiate plans for discharge, follow-up care, and
treatment as early as possible to ensure
continuity of care

65.  Radiation therapy is a type of cancer treatment
that uses high doses of radiation to kill cancer
cells and shrink tumors
 Emission and distribution of energy through
space or material medium
 Energy produced breaks bonds in DNA,
leading to death at time of reproduction
 Affects both cancer as well as normal cells
 Normal tissues are usually able to recover

66.  Emission and distribution of energy
1.Curative
 as in thyroid carcinomas, localized cancers of the
head and neck, and cancers ofthe uterine cervix.
2. Control
 When a tumor cannot be removed surgically or
when local nodal metastasis is present, or it can be
used neoadjuantly (prior to local definitive
treatment) with or without chemotherapy to
reduce the size of a tumor to enable surgical
resection.

67. 3.Prophylactic
 To prevent the spread of a primary cancer
to a distant area (e.g, irradiating the brain
to prevent leukemic infiltration or
metastatic lung cancer)
4.Palliative
 To relieve the symptoms of metastatic disease

68.  Two types of ionizingradiation
 Electromagneticradiation(x-raysand gamma rays)
 Particulateradiation(electrons, beta particles,
protons, neutrons, and alphaparticles)
 Administrationof Radiation
 Teletherapy(external beam radiation),
 Brachytherapy(internal radiation),
 Systemic(radioisotopes),
 contact or surfacemolds.
 Combination of internal and external radiation can
also be used

69. Side Effects of Radiation therapy
 Altered skinintegrityisa common effect and can include
alopecia
 Alterations in oral mucosa secondary to radiation therapy
include stomatitis (inflammation of the oral tissues),xerostomia
(drynessofthe mouth)
 The entire gastrointestinal mucosa may be involved, and
esophageal irritation with chest pain and dysphagia may
result
 radiation field, anemia, leukopenia (decreased white blood
cells [WBCs]), and thrombocytopenia(a decrease in platelets)
may result
 Thepatient isthen at increased riskfor infection and bleeding
until blood cell counts return tonormal.
 Systemicside effects include fatigue, malaise, and anorexia

70.  Answer questions and fears of patient and family
about the effects of radiation on others, on the
tumor, and on normal tissues and organs.
 Explain the procedure for delivering radiation.
Describe the equipment; the duration of the
procedure (often minutes); the possible need for
immobilizing the patient during the procedure;
and the absence of new sensations, including
pain, during the procedure.

76.  Chemotherapy involves the use of antineoplastic
drugs in an attempt to destroy cancer cells by
interfering with cellular functions, including
replication and DNA repair (Levine, 2010).
 Chemotherapy is used primarily to treat systemic
disease rather than localized lesions that are
amenable to surgery or radiation. Chemotherapy
may be combined with surgery, radiation therapy,
or both to reduce tumor size preoperatively
(neoadjuvant), to destroy any remaining tumor cells
postoperatively (adjuvant), or to treat some forms of
leukemia or lymphoma (primary).

77. Classes of ChemotherapyDrugs
Alkylating agents
 1. Action: create defects intumorDNA
 2. Examples: Nitrogen Mustard,Cisplatin
Antimetabolites
 1. Action: specific for Sphase
 2. Examples: Methotrexate; 5fluorouracil
 3. Toxic Effects: nausea, vomiting,stomatitis, diarrhea,
alopecia, leukopenia
Antitumor Antibiotics
 1. Action: interfere withDNA
 2. Examples: Actinomycin D,Bleomycin
 3. Toxic effect: damage to cardiacmuscle

78. Mitotic inhibitors
 1.Action: Preventcell division during M phase
 2.Examples: Vincristine, Vinblastine
 3.Toxic Effects:affects neurotransmission, alopecia, bone
marrow depression
Hormones
 1. Action: stage specific G1
 2.Example:Corticosteroids

79.  Acute toxicity
 Vomiting
 Allergic reactions
 Arrhythmias
 Delayed effects
 Mucositis
 Alopecia
 Bone marrowsuppression
 Alopecia (hairloss)
Generally reversible
 New hair often
different color and
texture
 Wigs
 Anorexia
Fatigue
Nausea & vomiting

80.  Trained and certified personnel, according to
established guidelines
 Preparation
 Protect personnel from toxiceffects
 Extreme care for correct dosage; double check
with physician orders, pharmacist’s preparation
 Routes
 Oral
 Body cavity(intraperitoneal or intrapleural)
 Intravenous

81. A. Useof vascularaccess devices because of threat of
extravasation (leakage into tissues)and long-term
therapy
B. Typesof vascular accessdevices
1. PICC lines(peripherallyinsertedcentral catheters)
2. Tunnelledcatheters
3. Surgicallyimplanted ports(accessed with90oangle
needle)

82. 1. Assessand manage
a) Toxic effects of drugs (report to physician)
b) Side effects of drugs:manage nausea and vomiting,
inflammation and ulceration of mucous membranes,
hair loss, anorexia, nausea and vomiting with specific
nursingand medical interventions
2. Monitor lab results(drugs withheld ifblood counts
seriouslylow); blood and blood product administration
3. Assessfordehydration
4. Teach regarding fatigue, immunosuppression precautions
5. Provide emotional and spiritualsupport to clients and
families

83.  HSCT has been used to treat several malignant
and nonmalignant diseases for many years.
The use of HSCT for solid tumors is limited to
clinical trials. However, the use of HSCT in the
treatment of certain adult hematologic
malignancies (i.e., malignant myeloma, acute
leukemias, and non-Hodgkin lymphoma) is
considered the standard of care.

84. Types of Hematopoietic Stem Cell
Transplantation
Types of HSCT are based on the source of donor
cells
 Allogeneic HSCT (AlloHSCT): From a donor
other than the patient (may be a related donor
such as a family member or a matched
unrelated
 Autologous: From the patient
 Syngeneic: From an identical twin

85.  Immunotherapy uses biologic response
modifiers (BRM) to stimulate the body’s
natural immune system to restrict & destroy
the cancer cells
 Hyperthermia uses temperatures > 106.4F to
destroy tumor cells
 Gene therapy replaces altered genes with
correct genes
Clinical trials – testing new treatments for specific
cancers

86.  Reduce or avoid exposure to known or
suspected carcinogens
 Eat balanced diet
 Exercise regularly
 Adequate rest
 Health examination on a regular basis

87.  Eliminate, reduce, or change perceptions of
stressors and enhance ability to cope
 Enjoy consistent periods of relaxation and
leisure
 Know 7 warning signs of cancer
 Self-examination
 Seek medical care if cancer is suspected

88.  Change in bowel or bladder habits
 A sore throat that does not heal
 Unusual bleeding or discharge from body
orifice
 Thickening or lump in breast or elsewhere
 Indigestion of difficulty in swallowing
 Obvious change in wart or mole
 Nagging cough or hoarseness

90.  Impaired oral mucous membrane: stomatitis
 Impaired tissue integrity: alopecia
 Imbalanced nutrition: less than body requirements
 Fatigue
 Chronic pain
 Grieving related to loss; altered role functioning
 Disturbed body image and situational low self-
esteem related to changes in appearance, function,
and roles
 Risk for infection
 Risk for impaired skin integrity

91.  MAINTAIN TISSUE INTEGRITY
 Handle skin gently
 Do NOT rub affected area
 Lotion may be applied
 Wash skin only with SOAP and Water

92.  MANAGEMENT OF STOMATITIS
 Use soft-bristled toothbrush
 Oral rinses with saline gargles/ tap water
 Avoid ALCOHOL-based rinses

93.  RELIEVE PAIN
 Mild pain- NSAIDS
Moderate pain- Weak opioids
 Severe pain- Morphine
 Administer analgesics round the clock with
additional dose for breakthrough pain

94.  DECREASE FATIGUE
 Plan daily activities to allow alternating rest
periods
 Light exercise is encouraged
 Small frequent meals

95.  MANAGEMENT OF ALOPECIA
Alopecia begins within 2 weeks of therapy
 Regrowth within 8 weeks of termination
 Encourage to acquire wig before hair loss occurs
 Encourage use of attractive scarves and hats
 Provide information that hair loss is temporary
BUT anticipate change in texture and color

96.  PROMOTE NUTRITION
 Serve food in ways to make it appealing
 Consider patient’s preferences
 Provide small frequent meals
 Avoids giving fluids while eating
 Oral hygiene PRIOR to mealtime
 Vitamin supplements

97.  ASSIST IN THE GRIEVING PROCESS
 Some cancers are curable
 Grieving can be due to loss of health, income,
sexuality, and body image
 Answer and clarify information about cancer and
treatment options
 Identify resource people
 Refer to support groups

98.  IMPROVE BODY IMAGE
 Therapeutic communication is essential
 Encourage independence in self-care and
decision making
 Offer cosmetic material like make-up and wigs

99.  Emphasis placed on maintaining optimal
quality of life
 Positive attitude of patient, family, and health
care providers has significant positive impact
on quality of life for patient
 May also influence prognosis

100.  Continue to be available
 Exhibit caring attitude
 Listen actively to fears and concerns
 Provide relief from distressing symptoms
 Maintain relationship based on trust and
confidence

101.  Use touch to exhibit caring
 Assist patient in setting realistic short- term
goals
 Assist in maintaining usual lifestyle patterns
 Maintain hope, which can vary
 Provides control over what is occurring
 Basis of positive attitude

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