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cellular aberration lecture notes presentation 4
cellular aberration lecture notes presentation 4
cellular aberration lecture notes presentation 4
- 2. • Obvious changein a wart or mole • Moles or other skin lesions that change in shape, size, or color should be reported Warning Signs of Cancer
- 3. • Nagging orpersistent cough or hoarseness • Cancers of the respiratory tract, including lung cancer and laryngeal cancer, may cause a cough that does not go away or a hoarse (rough) voice Warning Signs of Cancer
- 4. Warning Signs ofCancer • Unexplained anemia • Sudden unexplained weight loss
- 5. Physical Assessment • Inspection– skin and mucus membranes for lesions, bleeding, petechiae, and irritation • Assess stools, urine, sputum, vomitus for acute or occult bleeding • Scalp noting hair texture and hair loss • Palpation • Abdomen for any masses, bulges or abnormalities • Lymph nodes for enlargement • Auscultation – of lung sounds, heart sounds and bowel sounds Back
- 6. Laboratory & DiagnosticTests • Cancer detection examination • Laboratory tests • Complete blood cell count (CBC) • Tumor markers – identify substance (specific proteins) in the blood that are made by the tumor • PSA (Prostatic-specific antigen): prostate cancer • CEA (Carcinoembryonic antigen): colon cancer • Alkaline Phosphatase: bone metastasis • Biopsy
- 7. Diagnostic Tests • Determinelocation of cancer: • X-rays • Computed tomography • Ultrasounds • Magnetic resonance imaging • Nuclear imaging • Angiography
- 8. • Diagnosis ofcell type: • ▪Tissue samples: from biopsies, shedded cells (e.g. Papanicolaou (PAP) smear), & washings • ▪ Cytologic Examination: tissue examined under microscope
- 9. • Direct Visualization: •▪ Sigmoidoscopy • ▪ Cystoscopy • ▪ Endoscopy • ▪ Bronchoscopy • ▪ Exploratory surgery; lymph node biopsies to determine metastases
- 10. Cancer Detection andDiagnosis
- 11. Early Cancer MayNot Have Any Symptoms
- 12. Effects of Cancer •Disruption of Function- can be due to obstruction or pressure • Hematologic Alterations: can impair function of blood cells • Hemorrhage: tumor erosion, bleeding, severe anemia • Anorexia-Cachexia Syndrome: wasted appearance of client
- 13. Effects of Cancer •Paraneoplastic Syndromes: ectopic sites with excess hormone production • ↑ Parathyroid hormone hypercalcemia → • ↑ secretion of insulin hypoglycemia → • ↑ Antidiuretic hormone (ADH) fluid retention, HTN & → peripheral edema • ↑ Adrenocorticotropic hormone (ACTH): cause excessive secretion of cortisone (ie: fluid retention, glucose levels) ↑
- 14. Effects of Cancer •Pain: major concern of clients and families associated with cancer • Physical Stress: body tries to respond and destroy neoplasm • Psychological Stress Back
- 15. ASSESSMENT • Nursing History •Health History – chief complaint and history of present illness (onset, course, duration, location, precipitating and alleviating factors) • Cancer signs: CAUTION US!
- 16. • CAUTION US! •Change in bowel or bladder habits • A sore that does not heal • Unusual bleeding or discharge • Thickenings or lumps • Indigestion or difficulty in swallowing • Obvious change in a wart or mole • Nagging or persistent cough or hoarseness • Unexplained anemia • Sudden unexplained weight loss Warning Signs of Cancer
- 17. • Change inbowel or bladder habits • A person with colon cancer may have diarrhea or constipation, or he may notice that the stool has become smaller in diameter • A person with bladder or kidney cancer may have urinary frequency and urgency Warning Signs of Cancer
- 18. • A sorethat does not heal • Small, scaly patches on the skin that bleed or do not heal may be a sign of skin cancer • A sore in the mouth that does not heal can indicate oral cancer Warning Signs of Cancer
- 19. • Unusual bleedingor discharge • Blood in the stool is often the first sign of colon cancer • Similarly, blood in the urine is usually the first sign of bladder or kidney cancer • Postmenopausal bleeding (bleeding after menopause) may be a sign of uterine cancer Warning Signs of Cancer
- 20. • Thickenings orlumps • Enlargement of the lymph nodes or glands (such as the thyroid gland) can be an early sign of cancer • Breast and testicular cancers may also present as a lump Warning Signs of Cancer
- 21. • Indigestion ordifficulty in swallowing • Cancers of the digestive system, including those of the esophagus, stomach, and pancreas, may cause indigestion, heartburn, or difficulty swallowing Warning Signs of Cancer
- 22. AIDS and Kaposi’sSarcoma Kaposi’s sarcoma Without disease Depressed immune system HIV infection KSHV infection
- 23. Heredity and Cancer Inheritedfactor(s) All Breast Cancer Patients Other factor(s)
- 24. Heredity Can AffectMany Types of Cancer Inherited Conditions That Increase Risk for Cancer Back
- 25. PATHOPHYSIOLOGY ABNORMAL CELL FORMEDBY MUTATION OF DNA CELL GROWS AND PROLIFERATES METASTASIS OCCURS WHEN ABN. CELLS INVADE OTHER TISSUE,THROUGH LYMPH AND BLOOD • Cancer development linked to immune system failure • Example of clients susceptible to developing cancer
- 26. Classification of Cancer •According to Behavior of Tumor • Benign - tumors that cannot spread by invasion or metastasis; hence, they only grow locally • Malignant - tumors that are capable of spreading by invasion and metastasis. By definition, the term “cancer” applies only to malignant tumors
- 27. Malignant versus BenignTumors Malignant (cancer) cells invade neighboring tissues, enter blood vessels, and metastasize to different sites Time Benign (not cancer) tumor cells grow only locally and cannot spread by invasion or metastasis
- 28. Why Cancer IsPotentially Dangerous Melanoma cells travel through bloodstream Melanoma (initial tumor) Brain Liver
- 29. Patterns of cellProliferation • Hyperplasia • Dysplasia • Metaplasia • Anaplasia • Neoplasia
- 30. Hyperplasia Hyperplasia Normal • tissue growthbased on an excessive rate of cell division, leading to a larger than usual number of cells; the process of hyperplasia is potentially reversible; can be a normal tissue response to an irritating stimulus. An example is a callus
- 31. Dysplasia Hyperplasia Mild dysplasia Normal •Bizarre cell growth differing in size, shape and cell arrangement
- 32. Carcinoma in Situ Mild dysplasia Carcinomain situ (severe dysplasia) Cancer (invasive) Normal Hyperplasia
- 33. Patterns of cellProliferation • Metaplasia • conversion of one type of cell in a tissue to another type not normal for that tissue • Anaplasia • change in the DNA cell structure and orientation to one another, characterized by loss of differentiation and a return to a more primitive form. • Neoplasia • uncontrolled cell growth, either benign or malignant
- 34. Metastasis • Metastasis: 3stages • Invasion – neoplastic cells from primary tumor invade into surrounding tissue with penetration of blood or lymph. • Spread – tumor cells spread through lymph or circulation or by direct expansion • Establishment and growth – tumor cells are established and grow in secondary site: lymph nodes or in organs from venous circulation
- 35. Cancer Tends toInvolve Multiple Mutations Malignant cells invade neighboring tissues, enter blood vessels, and metastasize to different sites More mutations, more genetic instability, metastatic disease Proto-oncogenes mutate to oncogenes Mutations inactivate DNA repair genes Cells proliferate Mutation inactivates suppressor gene Benign tumor cells grow only locally and cannot spread by invasion or metastasis Time
- 36. Mutations and Cancer GenesImplicated in Cancer
- 37. Cancer Tends to CorruptSurrounding Environment Growth factors = proliferation Blood vessel Proteases Cytokines Matrix Fibroblasts, adipocytes Invasive Cytokines, proteases = migration & invasion Back
- 38. Classification of Tumors •CARCINOMAS: EPITHELIAL TISSUE • BODY SURFACES, LINING OF BODY CAVITIES ETC: (ADENOCARCINOMA) • SARCOMAS: CONNECTIVE TISSUE • STRIATED MUSCLE, BONE, ETC (OSTEOSARCOMA) • LYMPHOMAS AND LEUKEMIAS • HEMATOPOIETIC SYSTEM • NERVOUS TISSUE TUMORS • EX. NERVE CELLS-NEUROBLASTOMA • MYELOMA • Develops in the plasma cells of bone marrow
- 39. Different Kinds ofCancer Lung Breast (women) Colon Bladder Prostate (men) Some common sarcomas: Fat Bone Muscle Lymphomas: Lymph nodes Leukemias: Bloodstream Some common carcinomas:
- 40. Naming Cancers Prefix Meaning adeno-gland chondro- cartilage erythro- red blood cell hemangio- blood vessels hepato- liver lipo- fat lympho- lymphocyte melano- pigment cell myelo- bone marrow myo- muscle osteo- bone Cancer Prefixes Point to Location
- 41. “ Women whosmoke like men, die like men.” U.S. Surgeon General David Satcher Women, Tobacco & Lung Cancer Back
- 42.
- 43. • Essential Conceptsof Cancer • What is Cancer? • Normal Cell Growth vs. Cancer Cell Growth • Etiology and Causative Factors • Pathophysiology • Classification of Tumors • Effects of Cancer
- 44. • Nursing Process •Assessment • Laboratory & Diagnostic Tests • Tumor Staging and Grading • Nursing Diagnoses & Planning • Implementation and Management • Treatment Modalities • Chemotherapy • End-of-life Issues
- 45. What Is Cancer? CANCERis a complex of diseases which occurs when normal cells mutate into abnormal cells that take over normal tissue, eventually harming and destroying the host
- 46. WHAT IS CANCER •A large group of diseases characterized by: • Uncontrolled growth and spread of abnormal cells • Proliferation (rapid reproduction by cell division) • Metastasis (spread or transfer of cancer cells from one organ or part to another not directly connected) Back
- 47. Loss of NormalGrowth Control Cancer cell division Fourth or later mutation Third mutation Second mutation First mutation Uncontrolled growth Cell Suicide or Apoptosis Cell damage— no repair Normal cell division
- 48. Oncogenes Mutated/damaged oncogene Oncogenes accelerate cell growth anddivision Cancer cell Normal cell Normal genes regulate cell growth
- 49. Example of NormalGrowth Cell migration Dermis Dividing cells in basal layer Dead cells shed from outer surface Epidermis
- 50. The Beginning ofCancerous Growth Underlying tissue
- 51.
- 52. Invasion and Metastasis 3 Cancercells reinvade and grow at new location 1 Cancer cells invade surrounding tissues and blood vessels 2 Cancer cells are transported by the circulatory system to distant sites Back
- 53. • Viruses • Chemicalcarcinogens • Physical stressors • Hormonal factors • Genetic factors ETIOLOGY/CAUSATIVE FACTORS
- 54. What Causes Cancer? Someviruses or bacteria Heredity Diet Hormones Radiation Some chemicals
- 55. Population-Based Studies CANADA: Leukemia Regions ofHighest Incidence BRAZIL: Cervical cancer U.S.: Colon cancer AUSTRALIA: Skin cancer CHINA: Liver cancer U.K.: Lung cancer JAPAN: Stomach cancer
- 56. Genes and Cancer Chromosomes areDNA molecules Heredity Radiation Chemicals Viruses
- 57. Viruses Virus inserts and changes genesfor cell growth Cancer-linked virus
- 58. Examples of HumanCancer Viruses Some Viruses Associated with Human Cancers
- 59. Bacteria and StomachCancer H. pylori Patient’s tissue sample
- 60. Tobacco Use andCancer Some Cancer-Causing Chemicals in Tobacco Smoke
- 61.
Editor's Notes
- #10 Detecting cancer early can affect the outcome of the disease for some cancers. When cancer is found, a doctor will determine what type it is and how fast it is growing. He or she will also determine whether cancer cells have invaded nearby healthy tissue or spread (metastasized) to other parts of the body. In some cases, finding cancer early may decrease a person’s risk of dying from the cancer. For this reason, improving our methods for early detection is currently a high priority for cancer researchers.
- #11 Some people visit the doctor only when they feel pain or when they notice changes like a lump in the breast or unusual bleeding or discharge. But don’t wait until then to be checked because early cancer may not have any symptoms. That is why screening for some cancers is important, particularly as you get older. Screening methods are designed to check for cancer in people with no symptoms.
- #22 People who develop AIDS after being infected with the human immunodeficiency virus (HIV) are at high risk for developing a specific type of cancer called Kaposi’s sarcoma. Kaposi’s sarcoma is a malignant tumor of blood vessels located in the skin. This type of cancer is not directly caused by HIV infection. Instead, HIV causes an immune deficiency that makes people more susceptible to viral infection. Infection by a virus called KSHV (Kaposi’s sarcoma-associated herpesvirus) then appears to stimulate the development of Kaposi’s sarcoma.
- #23 Cancer is not considered an inherited illness because most cases of cancer, perhaps 80 to 90 percent, occur in people with no family history of the disease. However, a person’s chances of developing cancer can be influenced by the inheritance of certain kinds of genetic alterations. These alterations tend to increase an individual’s susceptibility to developing cancer in the future. For example, about 5 percent of breast cancers are thought to be due to inheritance of particular form(s) of a “breast cancer susceptibility gene.”
- #24 Inherited mutations can influence a person’s risk of developing many types of cancer in addition to breast cancer. For example, certain inherited mutations have been described that increase a person’s risk of developing colon, kidney, bone, skin or other specific forms of cancer. But these hereditary conditions are thought to be involved in only 10 percent or fewer of all cancer cases.
- #27 Depending on whether or not they can spread by invasion and metastasis, tumors are classified as being either benign or malignant. Benign tumors are tumors that cannot spread by invasion or metastasis; hence, they only grow locally. Malignant tumors are tumors that are capable of spreading by invasion and metastasis. By definition, the term “cancer” applies only to malignant tumors.
- #28 A malignant tumor, a “cancer,” is a more serious health problem than a benign tumor because cancer cells can spread to distant parts of the body. For example, a melanoma (a cancer of pigmented cells) arising in the skin can have cells that enter the bloodstream and spread to distant organs such as the liver or brain. Cancer cells in the liver would be called metastatic melanoma, not liver cancer. Metastases share the name of the original (“primary”) tumor. Melanoma cells growing in the brain or liver can disrupt the functions of these vital organs and so are potentially life threatening.
- #30 Instead of finding a benign or malignant tumor, microscopic examination of a biopsy specimen will sometimes detect a condition called “hyperplasia.” Hyperplasia refers to tissue growth based on an excessive rate of cell division, leading to a larger than usual number of cells. Nonetheless, cell structure and the orderly arrangement of cells within the tissue remain normal, and the process of hyperplasia is potentially reversible. Hyperplasia can be a normal tissue response to an irritating stimulus. An example of hyperplasia is a callus that may form on your hand when you first learn to swing a tennis racket or a golf club.
- #31 In addition to hyperplasia, microscopic examination of a biopsy specimen can detect another type of noncancerous condition called “dysplasia.” Dysplasia is an abnormal type of excessive cell proliferation characterized by loss of normal tissue arrangement and cell structure. Often such cells revert back to normal behavior, but occasionally they gradually become malignant. Because of their potential for becoming malignant, areas of dysplasia should be closely monitored by a health professional. Sometimes they need treatment.
- #32 The most severe cases of dysplasia are sometimes referred to as “carcinoma in situ.” In Latin, the term “in situ” means “in place,” so carcinoma in situ refers to an uncontrolled growth of cells that remains in the original location. However, carcinoma in situ may develop into an invasive, metastatic malignancy and, therefore, is usually removed surgically, if possible.
- #35 Cancer may begin because of the accumulation of mutations involving oncogenes, tumor suppressor genes, and DNA repair genes. For example, colon cancer can begin with a defect in a tumor suppressor gene that allows excessive cell proliferation. The proliferating cells then tend to acquire additional mutations involving DNA repair genes, other tumor suppressor genes, and many other growth-related genes. Over time, the accumulated damage can yield a highly malignant, metastatic tumor. In other words, creating a cancer cell requires that the brakes on cell growth (tumor suppressor genes) be released at the same time that the accelerators for cell growth (oncogenes) are being activated.
- #36 While the prime suspects for cancer-linked mutations are the oncogenes, tumor suppressor genes, and DNA repair genes, cancer conspires even beyond these. Mutations also are seen in the genes that activate and deactivate carcinogens, and in those that govern the cell cycle, cell senescence (or “aging”), cell suicide (apoptosis), cell signaling, and cell differentiation. And still other mutations develop that enable cancer to invade and metastasize to other parts of the body.
- #37 In addition to all the molecular changes that occur within a cancer cell, the environment around the tumor changes dramatically as well. The cancer cell loses receptors that would normally respond to neighboring cells that call for growth to stop. Instead, tumors amplify their own supply of growth signals. They also flood their neighbors with other signals called cytokines and enzymes called proteases. This action destroys both the basement membrane and surrounding matrix, which lies between the tumor and its path to metastasis--a blood vessel or duct of the lymphatic system.
- #39 Cancer can originate almost anywhere in the body. Carcinomas, the most common types of cancer, arise from the cells that cover external and internal body surfaces. Lung, breast, and colon are the most frequent cancers of this type in the United States. Sarcomas are cancers arising from cells found in the supporting tissues of the body such as bone, cartilage, fat, connective tissue, and muscle. Lymphomas are cancers that arise in the lymph nodes and tissues of the body’s immune system. Leukemias are cancers of the immature blood cells that grow in the bone marrow and tend to accumulate in large numbers in the bloodstream.
- #40 Scientists use a variety of technical names to distinguish the many different types of carcinomas, sarcomas, lymphomas, and leukemias. In general, these names are created by using different Latin prefixes that stand for the location where the cancer began its unchecked growth. For example, the prefix “osteo” means bone, so a cancer arising in bone is called an osteosarcoma. Similarly, the prefix “adeno” means gland, so a cancer of gland cells is called adenocarcinoma--for example, a breast adenocarcinoma.
- #45 Cancer is a renegade system of growth that originates within a patient’s biosystem, more commonly known as the human body. There are many different types of cancers, but all share one hallmark characteristic: unchecked growth that progresses toward limitless expansion. It is difficult to imagine anyone who has not heard of this illness. Most people have been affected because either they or their loved ones or friends are cancer survivors. Because cancer is so prevalent, people have many questions about its biology, detection, diagnosis, possible causes, and strategies for prevention.
- #47 Cancer arises from a loss of normal growth control. In normal tissues, the rates of new cell growth and old cell death are kept in balance. In cancer, this balance is disrupted. This disruption can result from uncontrolled cell growth or loss of a cell’s ability to undergo cell suicide by a process called“apoptosis.” Apoptosis, or “cell suicide,” is the mechanism by which old or damaged cells normally self-destruct.
- #48 One group of genes implicated in the development of cancer are damaged genes, called “oncogenes.” Oncogenes are genes whose PRESENCE in certain forms and/or overactivity can stimulate the development of cancer. When oncogenes arise in normal cells, they can contribute to the development of cancer by instructing cells to make proteins that stimulate excessive cell growth and division.
- #49 To illustrate what is meant by normal growth control, consider the skin. The thin outermost layer of normal skin, called the epidermis, is roughly a dozen cells thick. Cells in the bottom row of this layer, called the basal layer, divide just fast enough to replenish cells that are continually being shed from the surface of the skin. Each time one of these basal cells divides, it produces two cells. One remains in the basal layer and retains the capacity to divide. The other migrates out of the basal layer and loses the capacity to divide. The number of dividing cells in the basal layer, therefore, stays the same.
- #50 During the development of skin cancer, the normal balance between cell division and cell loss is disrupted. The basal cells now divide faster than is needed to replenish the cells being shed from the surface of the skin. Each time one of these basal cells divides, the two newly formed cells will often retain the capacity to divide, thereby leading to an increase in the total number of dividing cells.
- #51 This gradual increase in the number of dividing cells creates a growing mass of tissue called a “tumor” or “neoplasm.” If the rate of cell division is relatively rapid, and no “suicide” signals are in place to trigger cell death, the tumor will grow quickly in size; if the cells divide more slowly, tumor growth will be slower. But regardless of the growth rate, tumors ultimately increase in size because new cells are being produced in greater numbers than needed. As more and more of these dividing cells accumulate, the normal organization of the tissue gradually becomes disrupted.
- #52 Cancers are capable of spreading throughout the body by two mechanisms: invasion and metastasis. Invasion refers to the direct migration and penetration by cancer cells into neighboring tissues. Metastasis refers to the ability of cancer cells to penetrate into lymphatic and blood vessels, circulate through the bloodstream, and then invade normal tissues elsewhere in the body.
- #54 Cancer is often perceived as a disease that strikes for no apparent reason. While scientists don’t yet know all the reasons, many of the causes of cancer have already been identified. Besides intrinsic factors such as heredity, diet, and hormones, scientific studies point to key extrinsic factors that contribute to the cancer’s development: chemicals (e.g., smoking), radiation, and viruses or bacteria.
- #55 One way of identifying the various causes of cancer is by studying populations and behaviors. This approach compares cancer rates among various groups of people exposed to different factors or exhibiting different behaviors. A striking finding to emerge from population studies is that cancers arise with different frequencies in different areas of the world. For example, stomach cancer is especially frequent in Japan, colon cancer is prominent in the United States, and skin cancer is common in Australia. What is the reason for the high rates of specific kinds of cancer in certain countries?
- #56 Chemicals (e.g., from smoking), radiation, viruses, and heredity all contribute to the development of cancer by triggering changes in a cell’s genes. Chemicals and radiation act by damaging genes, viruses introduce their own genes into cells, and heredity passes on alterations in genes that make a person more susceptible to cancer. Genes are inherited instructions that reside within a person’s chromosomes. Each gene instructs a cell how to build a specific product--in most cases, a particular kind of protein. Genes are altered, or “mutated,” in various ways as part of the mechanism by which cancer arises.
- #57 In addition to chemicals and radiation, a few viruses also can trigger the development of cancer. In general, viruses are small infectious agents that cannot reproduce on their own, but instead enter into living cells and cause the infected cell to produce more copies of the virus. Like cells, viruses store their genetic instructions in large molecules called nucleic acids. In the case of cancer viruses, some of the viral genetic information carried in these nucleic acids is inserted into the chromosomes of the infected cell, and this causes the cell to become malignant.
- #58 Only a few viruses that infect human cells actually cause cancer. Included in this category are viruses implicated in cervical cancer, liver cancer, and certain lymphomas, leukemias, and sarcomas. Susceptibility to these cancers can sometimes be spread from person to person by infectious viruses, although such events account for only a very small fraction of human cancers. For example, the risk of cervical cancer is increased in women with multiple sexual partners and is especially high in women who marry men whose previous wives had this disease. Transmission of the human papillomavirus (HPV) during sexual relations appears to be involved.
- #59 Viruses are not the only infectious agents that have been implicated in human cancer. The bacterium Helicobacter pylori, which can cause stomach ulcers, has been associated with the development of cancer, so people infected with H. pylori are at increased risk for stomach cancer. Research is under way to define the genetic interactions between this infectious agent and its host tissues that may explain why cancer develops.
- #60 Among the various factors that can cause cancer, tobacco smoking is the greatest public health hazard. Cigarette smoke contains more than two dozen different chemicals capable of causing cancer. Cigarette smoking is the main cause of lung cancer and contributes to many other kinds of cancer as well, including cancer of the mouth, larynx, esophagus, stomach, pancreas, kidney, and bladder. Current estimates suggest that smoking cigarettes is responsible for at least one out of every three cancer deaths, making it the largest single cause of death from cancer. Other forms of tobacco use also can cause cancer. For example, cigars, pipe smoke, and smokeless tobacco can cause cancers of the mouth.
- #61 Increased rates of cancer also have been detected in people exposed to high-strength forms of radiation such as X-rays or radiation emitted from unstable atoms called radioisotopes. Because these two types of radiation are stronger than ultraviolet radiation, they can penetrate through clothing and skin into the body. Therefore, high-strength radiation can cause cancers of internal body tissues. Examples include cancer caused by nuclear fallout from atomic explosions and cancers caused by excessive exposure to radioactive chemicals.