Cellular-abberation.pptx

pathophysiology of cancer
• cancer disease in which abnormal cells
divide without control and are able to
invade other tissues
• derived from greek word for crab,
karkinona
• tumor- also referred to as a neoplasm-new
growth

different characteristic of neoplasia
• Neoplasm can be
benign or malignant
• benign- well differentiated resemble the
normal cell, but cant control cell
proliferation
• malignant -lost the ability to control both
proliferation and differentiation
• malignant cell also grow in absence of
growth hormone

Benign Tumors
• contains cell that resemble normal tissue
cells(well diffentiated)
• grow slowly
• sorrounded by fibrous capsule
• do not infiltrate, invade, metastasize
• can damage nearby organ by compressing
them

Category of malignant neoplasms
• solid tumors-initially confined to a specific
tissue or organ
• hematologic cancer involves cell normally
found in blood and lymp so they are
dessiminated from the beginning

Malignant Neoplasm Characteristic
Genetically instability
1. Cancer cell seem unable to correct errors
in cell division
2. May have multiple copies of
chromosomes
3. Gene mutation affect: growth regulation
and cell cycle arrest

G0 cell cycle
• G0-is a form of the resting state, or
quiescence, in which cells reside until they
receive appropriate signals - for example,
from growth factors - stimulating them to
re-enter and progress through the cell
cycle.

G1 phase
• The G₁ phase, gap 1 phase, or growth 1
phase, is the first of four phases of the cell
cycle that takes place in eukaryotic cell
division. In this part of interphase, the cell
synthesizes mRNA and proteins in
preparation for subsequent steps leading
to mitosis.
• RNA and protein synthesis-for cellgrowth

SPhase
• DNA synthesis-radiation-to destroy
• is the period of wholesale DNA synthesis
during which the cell replicates its genetic
content; a normal diploid somatic cell with
a 2N complement of DNA at the beginning
of S phase acquires a 4N complement of
DNA at its end.

MPhase-cell division
• During the mitotic (M) phase, the cell
divides its copied DNA and cytoplasm to
make two new cells. M phase involves two
distinct division-related processes: mitosis
and cytokinesis.

G2
• pre mitotic phase-preparation for cell
division
• is a period of rapid cell growth and protein
synthesis during which the cell prepares
itself for mitosis. Curiously, G2 phase is
not a necessary part of the cell cycle, as
some cell types (particularly young
Xenopus embryos and some cancers)
proceed directly from DNA replication to
mitosi

Carcinogenesis
Carcinogenesis or oncogenesis or
tumorigenesis
• is literally the creation of cancer
• it is the process by which normal cells are
transformed into cancer cells

Assessment,
Diagnosis and
treatment for Cancer

Effect of Cancer
• Pain
• Physical stress

Warning Sign of Cancer
–C-hanges in bladder or bowel habits
–A-sore that doesn’t heal
–U-nusual bleeding or discharges
–T-hickening or lumps
–I-ndigestion od diffuclty swallowing
–O-bvious changes in warts, moles, or the
skin
–N-agging cough or hoarseness of voice
–U-nexplained anemia
–S-udden loss of weight

Screening Test
• early detection and treatment are the
cornerstone of cancer
• educating the public about healthy lifestyle
and early detection

• apoptosis-program and controlled cell
destruction which eliminates damaged,
improperly produced and worn out cells
withouit harming the other areas a normal
process of cell deletion and renewal
• carcinogen-is any substance, radionuclide,
or radiation that promotes carcinogenesis,
the formation of cancer. This may be due
to the ability to damage the genome or to
the disruption of cellular metabolic
processes
Terms

• carcinoma-cancer that forms in epithelial
tissue. Epithelial tissue lines most of your
organs, the internal passageways in your
body (like your esophagus), and your skin.
Most cancers affecting your skin, breasts,
kidney, liver, lungs, pancreas, prostate
gland, head and neck are carcinomas
• hospice-Hospice care focuses on the care,
comfort, and quality of life of a person with
a serious illness who is approaching the
end of life

• differentiation-In cancer, this describes
how much or how little tumor tissue looks
like the normal tissue it came from. Well-
differentiated cancer cells look more like
normal cells and tend to grow and spread
more slowly than poorly differentiated or
undifferentiated cancer cells.

• lymphomas-types of cancer that begin in
the lymphatic system (the various lymph
glands around the body) when abnormal
white blood cells grow. Lymphomas are
the sixth most common form of cancer
overall (excluding non-melanoma skin
cancer).

Leukemia or myelomas
• In leukemia, the cancerous cells are
discovered circulating in the blood and
bone marrow, while in lymphoma, the cells
tend to aggregate and form masses, or
tumors, in lymphatic tissues. Myeloma is a
tumor of the bone marrow, and involves a
specific subset of white blood cells that
produce a distinctive protein

metastasis
• the spread of cancer cells from the place
where they first formed to another part of
the body. In metastasis, cancer cells break
away from the original (primary) tumor,
travel through the blood or lymph system,
and form a new tumor in other organs or
tissues of the body.

nadir
• Nadir is a term that basically means low
point. When a person with cancer reaches
their “nadir” following each chemotherapy
cycle, it means that the person's blood cell
counts are the lowest they will be during
that treatment cycle. Each chemotherapy
treatment comes with a nadir period

neoplasm
• An abnormal mass of tissue that forms
when cells grow and divide more than they
should or do not die when they should.
Neoplasms may be benign (not cancer) or
malignant (cancer). Benign neoplasms
may grow large but do not spread into, or
invade, nearby tissues or other parts of the
body.

sarcoma
• Sarcoma is the general term for a broad
group of cancers that begin in the bones
and in the soft (also called connective)
tissues (soft tissue sarcoma). Soft tissue
sarcoma forms in the tissues that connect,
support and surround other body
structures

tumor markers
• is anything present in or produced by
cancer cells or other cells of the body in
response to cancer or certain benign
(noncancerous) conditions that provides
information about a cancer, such as how
aggressive it is, whether it can be treated
with a targeted therapy, or whether it is
responding to treatment

Alpha-fetoprotein (AFP)
• Cancer types: Liver cancer and germ cell
tumors
• What's analyzed: Blood
• How used: To help diagnose liver cancer
and follow response to treatment; to
assess stage, prognosis, and response to
treatment of germ cell tumors

B-cell immunoglobulin gene rearrangement
• Cancer type: B-cell lymphoma
• What's analyzed: Blood, bone marrow, or
tumor tissue
• How used: To help in diagnosis, to
evaluate effectiveness of treatment, and to
check for recurrence

BCL2 gene rearrangement
• Cancer types: Lymphomas, leukemias
• What’s analyzed: Blood, bone marrow, or
tumor tissue
• How used: For diagnosis and planning
therapy

tumor marker for breast Cancer
1. cancer antigen 15-3 (CA 15-3)
2. cancer antigen 27.29 (CA 27.29)
3. carcinoembryonic antigen (CEA) --
• have been used to help monitor metastatic
breast cancer (advanced disease), but
they have not been found to be useful to
find a breast cancer recurrence or
lengthen lives

• CA-125 is the most used tumor marker for
ovarian cancer. But if your CA-125 level is
typical, your doctor might test for HE4 or
CA19-9.
• CA 19-9 is a type of tumor marker of
pancreatic cancer

lung cancer
• The most commonly tested lung cancer
markers include mutations in the following
genes:
• EGFR, which makes a protein involved in
cell division.
• KRAS, which helps control the growth of
tumors.
• ALK, which is involved in cell growth

• Estimating Glomerular Filtration Rate
• Kirsten rat sarcoma viral oncogene
homolog.
• anaplastic lymphoma kinase.

• To prevent
• To diagnose
• To treat

• To determine: Nature and name of disease
• Determine: grading and staging
• Report: molecular changes and
biomarkers
Goals and task of diagnostic pathology

Proliferative terms not neoplastic
1. Metaplasia- one cell type is replaced by
another cell type
2. Hyperplasia- an increase in the number of
cells in an organ or tissue which may be
then an increased in volume
3. Hypertrophy – an increase in size and thus
an increase in the size organ

• Cancer is a condition that results from
abnormal cellular DNA. It is a condition
wherein cells mutate and increase number,
with changes in their morphology and without
any function. The increase in the number of
these cells infects other cells and causes them
to behave the same way, a condition termed
as “malignancy”. Cancer cells infiltrate normal
and healthy tissue and they compete with
normal cells for sustenance from the blood.
Malignant cells compress and kill healthy
tissue and deprive them of nutrition

• Any cell in the body has the potential to
mutate and become a cancer cell.
However, a healthy immune system is able
to kill these cells before they can cause
any aberration in the body. The etiology of
cancer is unknown and anything that has
the potential to cause cellular DNA
mutation has the capacity to cause
malignancy. The etiology varies across the
specific types of cancer on virtually all
cells of the body. Anything that can cause
Causes

• Genetics
–Some genes carry a code for the
transcription of cancer and malignancy.
It is unclear; however, what causes
these genes to cause malignancy.
Certain extrinsic triggers may contribute
to their activation. One thing is sure
though, cancer runs in the family.
Genetic Screening may detect presence
of these oncogenes.

• Tobacco
– Cigarettes contain hundreds of carcinogens
and other harmful chemicals. It has been
clearly shown through various studies that
cigarette smoke, even second-hand smoke
increases the risk of cancers of the lungs, oral
cavity, lips, esophagus, and larynx. Smokers
who inhale the smoke have an increased risk
for lung cancer as the smoke reaches the
lungs. A new study has coined the term “third
hand smoke” wherein smoke particles
become active in surfaces for days and
inhaling near these surfaces also carries
carcinogens into the system.

– Diet It has been noted in studies that a diet
high in nitrates (processed foods),
benzopyrenes (grilled foods), alcohol, red
meat and fat increases cancer risk. Also, a
diet low in vegetables and other greens
significantly increase the risk for colon cancer.
• Physical Activity
– A sedentary lifestyle contributes to the
development of cancer as much as obesity. It
is important to control your weight too. It is
recommended to have at least 150 minutes of
non-vigorous, or 75 minutes of vigorous
exercise per week.

• Sun and UV Exposure
– Sunlight and the Ultraviolet radiation it carries
significantly increases cancer risk and risks
for melanomas. Ultraviolet light alters the DNA
of cells and this causes malignancies if not
controlled by the immune system.
• Other Carcinogens
– Carcinogens, certain drugs, viruses,
chemicals, pollution, and certain infectious
agents all have the potential to cause
malignancy. It is important to live in a clean
environment to be able to avoid these
triggers.

• Cancer symptoms depend on the severity
and specific type of cancer. Most cancers
however are asymptomatic and will only
produces signs once they are at advances
stages. Early detection and treatment is the
key to cancer survival. There are many
symptoms of cancer but some of the
potentially-serious warning signs are:
Symptoms

Management of Cancer depends on the
specific stage and site of the cancer.
Treatment may be primary(to kill cancer cells),
adjuvant(to kill remaining cancer cells), or
palliative(to treat signs and symptoms). Some
treatment modalities include:
Management

• Chemotherapy
• Surgery
• Radiation therapy
• Stem cell transplants
• Biological therapy to improve immune
function
• Hormone therapy

chemotherapy
• Chemotherapy is a type of cancer
treatment that uses one or more anti-
cancer drugs as part of a standardized
chemotherapy regimen. Chemotherapy
may be given with a curative intent or it
may aim to prolong life or to reduce
symptoms.

side effects
• Tiredness. Tiredness (fatigue) is one of the
most common side effects of
chemotherapy. ...
• Feeling and being sick. ...
• Hair loss. ...
• Infections. ...
• Anaemia. ...
• Bruising and bleeding. ...
• Sore mouth. ...
• Loss of appetite.

chemotherapy is used include
• As the primary treatment. Sometimes, the goal of
chemotherapy treatment is to get rid of all the cancer
and keep it from coming back. This might be called
"curative chemotherapy."
• Before other treatments. Chemotherapy can be given
before surgery or radiation therapy to shrink tumors. This
can be called "neoadjuvant chemotherapy."
• After other treatments. Chemotherapy can be given after
surgery or radiation therapy to destroy any remaining
cancer cells. This is called "adjuvant chemotherapy."
• To slow the progression of cancer and relieve symptoms.

main types of chemotherapy:
• Alkylating agents
• Antimetabolites
• Anti-tumor antibiotics
• Topoisomerase inhibitors
• Mitotic inhibitors
• Plant alkaloids

Alkylating agents
• These agents damage DNA and prevent mitosis. They
are used to treat leukemia, lymphomas, multiple
myeloma, sarcoma and lung, breast, and ovarian cancer.
Examples of drugs in this class include:
• Nitrogen mustards such as chlorambucil,
cyclophosphamide, ifosfamide, and melphalan
• Alkylsulfonates such as busulfan
• Nitrosoureas such as streptozotocin, carmustine, and
lomustine
• Triazines such as dacarbazine
• Ethylenimines such as thiotepa and altretamine
• Platinum drugs such as cisplatin, carboplatin and
oxalaplatin

Antimetabolites
• These agents interrupt the S phase and
substitute normal DNA and RNA with other
amino acids, thereby interfering with cell
replication and proliferation. Antimetabolites are
used to treat leukemia and cancers of the breast
and ovary.
• Examples of drugs in this class include 5-
fluorouracil (5-FU), 6-mercaptopurine (6-MP),
cytarabine, capecitabine, fludarabine,
gemcitabine, methotrexate, pemetrexed,
pentostatin and thioguanine.

• Anthracyclines
• Anthracyclines are anti-tumor antibiotics that inhibit the
enzymes that bring about DNA replication. Examples of
drugs in this class include doxorubicin, daunorubicin,
idarubicin and epirubicin.
• Topoisomerase inhibitors
• These agents inhibit the enzyme topoisomerase which
would usually help untangle DNA strands so they can be
replicated. They are used to treat leukemia and lung,
ovarian and gut cancer. Examples include topotecan,
irinotecan, etoposide and teniposide.

• Plant alkaloids
• Also called mitotic inhibitors, these drugs
interrupt the M phase of the cell cycle and
inhibit mitosis. They are used to treat
breast and lung cancers and myeloma,
lymphoma, and leukemia. Examples of
drugs in this class include taxanes such as
paclitaxel and docetaxel, vinca alkaloids
such as vinblastine, vincristine and
vinorelbine.

• Corticosteroids
• This drug class includes naturally
occurring hormones such as the steroid
hormones as well as artificially
synthesized analogues of these
hormones. They are used to treat
lymphoma, leukemia and multiple
myeloma and examples include
prednisone, methylprednisolone and
dexamethasone.

• Hormone therapy. Hormone therapy is a type of cancer
treatment that removes, blocks, or adds specific hormones
to the body. It is also called hormonal therapy or endocrine
therapy. Hormone therapy can be used to treat several types
of cancer.
• Immunotherapy. This type of treatment helps your body's
natural defenses fight the cancer. Immunotherapy has
developed rapidly during the last few years, and is now an
important part of treatment for several types of cancer.
• Targeted therapy. These treatments target and disable
genes or proteins found in cancer cells that the cancer cells
need to grow. Targeted therapy can treat many types of
cancer.

tests and Procedures
• Barium Enema
• Procedure used to find health conditions in the colon and rectum
• Biopsy
• tissue sample is used to diagnose cancer
• Bone Marrow Aspiration and Biopsy
• Procedures that can provide information about blood cells
• Bone Scan
• Used to find cancer or see how well treatment is working
• Breast MRI
• Imaging test used to look at breast tissue

• Colonoscopy
• Used to view a part of the large intestine
• Computed Tomography (CT) Scan
• Type of imaging test used to find and learn
more about cancer
• Fecal Occult Blood Tests
• Used to find blood in the stool

• Digital Rectal Exam (DRE)
• Used to check the lower rectum, pelvis,
and lower belly
• Electrocardiogram (EKG) and
Echocardiogram
• Tests to find problems with the heart
muscle, valves, or rhythm
• Types of Endoscopy
• Procedures used to view the inside of the
body

• Magnetic Resonance Imaging (MRI)
• Imaging test done without using x-rays
• Mammogram
• X-ray that checks for breast cancer
• MUGA Scan
• Test for checking if the lower chambers of
heart are pumping blood properly
• Pap Test
• Procedure to find changes in cells that can
lead to cervical cancer

• Positron Emission Tomography and
Computed Tomography (PET-CT) Scans
• Used to find cancer and learn its stage
• Sigmoidoscopy
• Test to examine the lower part of the large
intestine
• Tumor Marker Tests
• Types of tests that look for substances
made by cells in the body in response to
cancer

• Ultrasound
• Imaging test that can show tumor's
location in the body
• Upper Endoscopy
• Used to examine the esophagus, stomach,
and top of small intestine

• There is no sure way to prevent cancer as it is
caused by various factors.
• Reduce this risk: eating a proper diet rich in fiber
and vegetables, having regular exercise,
avoidance of triggers, living in a clean
environment and having regular screening
drastically reduces the risks of cancer and its
complications.
Prevention

• Removal of the breast, with or without
surrounding structures.
• Mastectomies can be performed in four
distinct methods, depending on the
diagnosis and the extent of the pathologic
findings.
Mastectomy

• Partial Mastectomy: Excision of breast
tumor, leaving appropriate tumor-free
margins.
• Subcutaneous Mastectomy: Removal of all
breast tissue. Overlying the skin and
nipple are left intact.

• Simple Mastectomy
• Radical Mastectomy:
– Modified radical – removal of breast and
axillary lymph nodes. Most frequently
performed.
– Classic radical – includes removal of the
entire breast, pectoralis muscles, axillary
lymph nodes, fats, fascia, and adjunct tissue.
– Extended radical – bloc removal of breast,
axillary contents, pectoralis muscles, and
internal mammary lymph nodes.

• Mastectomy
• Removal of the breast, with or without
surrounding structures.
• Discussion
• Mastectomies can be performed in four distinct
methods, depending on the diagnosis and the
extent of the pathologic findings.
• Partial Mastectomy: Excision of breast tumor,
leaving appropriate tumor-free margins.
• Subcutaneous Mastectomy: Removal of all breast
tissue. Overlying the skin and nipple are left
intact.

Radical Mastectomy:
–Modified radical – removal of breast and
axillary lymph nodes. Most frequently
performed.
–Classic radical – includes removal of the
entire breast, pectoralis muscles,
axillary lymph nodes, fats, fascia, and
adjunct tissue.
–Extended radical – bloc removal of
breast, axillary contents, pectoralis
muscles, and internal mammary lymph
nodes.

• Is the leading type of cancer in women.Most
breast cancer begins in the lining of the milk
ducts, sometimes the lobule.
• The cancer grows through the wall of the duct
and into the fatty tissue.
• Breast cancer metastasizes most commonly to
auxiliary nodes, lung, bone, liver, and the brain.
• The most significant risk factors for breast
cancer are gender (being a woman) and age
(growing older).
Breast Cancer

• Other probable factors include nulliparity,
first child after age 30, late menopause,
early menarche, long term estrogen
replacement therapy, and benign breast
disease.
• Controversial risk factors include oral
contraceptive use, alcohol use, obesity,
and increased dietary fat intake.

• About 90% of breast cancers are due not
to heredity, but to genetic abnormalities
that happen as a result of the aging
process and life in general.
• A woman’s risk of breast cancer
approximately doubles if she has a first-
degree relative (mother, sister, daughter)
who has been diagnosed with breast
cancer. About 20-30% of women
diagnosed with breast cancer have a
family history of breast cancer.

• Stage O- Cancer cells remain inside the breast duct,
without invasion into normal adjacent breast tissue.
• Stage 1- Cancer is 2 centimeters or less and is
confined to the breast (lymph nodes are clear).
• Stage IIa- No tumor can be found in the breast, but
cancer cells are found in the axillary lymph nodes
(the lymph nodes under the arm) or the tumor
measures 2 centimeters or smaller and has spread
to the axillary lymph nodes or the tumor is larger
than 2 but no larger than 5 centimeters and has not
spread to the axillary lymph nodes.
Stages of Breast Cancer

• Stage Iib- The tumor is larger than 2 but
no larger than 5 centimeters and has
spread to the axillary lymph nodesORthe
tumor is larger than 5 centimeters but has
not spread to the axillary lymph nodes.

• Stage IIIa - No tumor is found in the
breast. Cancer is found in axillary lymph
nodes that are sticking together or to
other structures, or cancer may be found
in lymph nodes near the breastbone or the
tumor is any size. Cancer has spread to
the axillary lymph nodes, which are
sticking together or to other structures, or
cancer may be found in lymph nodes near
the breastbone.

• Satge IIIb- The tumor may be any size and
has spread to the chest wall and/or skin of
the breast and may have spread to axillary
lymph nodes that are clumped together
or sticking to other structures, or cancer
may have spread to lymph nodes near
the breastbone.Inflammatory breast
cancer is considered at least stage IIIB.

• Stage IIIc-There may either be no sign of
cancer in the breast or a tumor may
be any size and may have spread to the
chest wall and/or the skin of the breast
and the cancer has spread to lymph nodes
either above or below the collarbone and
the cancer may have spread to axillary
lymph nodes or to lymph nodes near the
breastbone.

• The cancer has spread — or metastasized
— to other parts of the body.
Stage IV

Assessment
• A firm lump or thickness in breast, usually
painless; 50% are located in the upper outer
quadrant of the breast.
• Spontaneous nipple discharge; may be bloody,
clear or serous.
• Asymmetry of the breast may be noted as the
woman changes positions; compare one breast
with the other.
• Nipple retraction or scalliness, especially in
Paget’s disease.
• Enlargement of auxiliary or supraclavicular
lymph nodes may indicate metastasis.

• Mammography (most accurate method of
detecting non-palpable lesions) shows
lesions and cancerous changes, such as
microcalcification. Ultrasonography may
be used to distinguish cysts from solid
masses.
• Biopsy or aspiration confirms diagnosis
and determines the type of breast cancer.
Diagnostic Evaluation

• Estrogen or progesterone receptor assays,
proliferation or S phase study (tumor
aggressive), and other test of tumor cells
determine appropriate treatment and prognosis.
• Blood testing detects metastasis; this includes
liver function tests to detect liver metastasis and
calcium and alkaline phosphatase levels to
detect bony metastasis.
• Chest x-rays, bone scans, or possible brain and
chest CT scans detect metastasis.

• Chemotherapy is the primary used as
adjuvant treatment postoperatively ;
usually begins 4 weeks after surgery (very
stressful for a patient who just finished
major surgery).
– Treatments are given every 3 to 4 weeks for 6
to 9 months. Because the drugs differ in their
mechanisms of action, various combinations
are used to treat cancer.
Pharmacological Intervention

–Principal breast cancer drugs include
cyclosphosphamide, methotrexate,
fluorouracil, doxorubicin, and paclitaxel.
–Additional agents for advanced breast
cancer include docetaxel, vinorelbine,
mitoxantrone, and fluorouracil.
–Herceptin is a monoclonal antibody
directed against Her-2/neu oncogene;
may be effective for patients who
express this gene

• Indications for chemotherapy include large
tumors, positive lymph nodes, premenopausal
women, and poor prognostic factors.
• Chemotheraphy is also used as primary
treatment in inflammatory breast cancer and as
palliative treatment in metastatic disease or
recurrence.
• Anti-estrogens, such as tamoxifen, are used as
adjuvant systemic therapy after surgery.
• Hormonal agents may be used in advanced
disease to induce remissions that last for months
to several years.

• Surgeries include lumpectomy (breast-
preventing procedure), mastectomy
(breast removal), and mammoplasty
(reconstructive surgery).
• Endocrine related surgeries to reduce
endogenous estrogen as a palliative
measure.
• Bone marrow transplantation may be
combined with chemotherapy
Surgical Interventions

• Monitor for adverse effects of radiation therapy such
as fatigue, sore throat, dry cough, nausea, anorexia.
• Monitor for adverse effects of chemotherapy; bone
marrow suppression, nausea and vomiting,
alopecia, weight gain or loss, fatigue, stomatitis,
anxiety, and depression.
• Realize that a diagnosis of breast cancer is a
devastating emotional shock to the woman. Provide
psychological support to the patient throughout the
diagnostic and treatment process.
• Involve the patient in planning and treatment.
• Describe surgical procedures to alleviate fear.
• Prepare the patient for the effects of chemotherapy,
and plan ahead for alopecia, fatigue.
Nursing Intervention

• Administer antiemetics prophylactically, as
directed, for patients receiving
chemotherapy.
• Administer I.V. fluids and
hyperalimentation as indicated.
• Help patient identify and use support
persons or family or community.
• Suggest to the patient the psychological
interventions may be necessary for
anxiety, depression, or sexual problems.
• Teach all women the recommended
cancer-screening procedures.

• Also called bronchogenic cancer.
• It is a malignant tumor of the lung
arising within the bronchial wall or
epithelium.
• The lung is also a common site of
metastasis from cancer
elsewhere in the body through
venous circulation or lymphatic
spread.

• Epidermoid (squamous cell – most
common),
• Adenocarcinoma,
• Small cell (oat cell) carcinoma, and
• Large cell (undifferentiated)
carcinoma
Bronchogenic cancer is classified
according to cell type

Epidermoid (squamous cell – most common),
• Squamous cell carcinoma (SCC) of the
lung, also known as epidermoid
carcinoma, is a form of lung cancer. There
are two types of lung cancer: small lung
cell cancer (SCLC) and non-small cell lung
cancer (NSCLC). Squamous cell
carcinoma is a type of non-small cell
carcinoma.

Adenocarcinoma
• Adenocarcinoma of the lung forms when
cells lining the outside of the lungs
become cancerous.

Small-cell carcinoma (SCLC) or oat-cell
• Small-cell carcinoma of the lung is also
known as small-cell lung cancer (SCLC) or
oat-cell cancer because the cancer cells
may appear to look like oats under a
microscope. Small-cell carcinoma is a type
of cancer that can appear in various parts
of the body, but most often occurs in the
lung.

Large cell undifferentiated carcinomas (LCUD)
• which are also called simply large cell
carcinomas, are malignant neoplasms of
the lung that show no squamous,
glandular, or small cell (neuroendocrine)
differentiation in routinely stained sections
of the tissues or smears of the cytologic
specimens

The primary predisposing factor in lung cancer
is cigarette smoking
• Lung cancer risk is also high in people
occupationally exposed to asbestos, arsenic,
chromium, nickel, iron, radioactive substances,
isopropyl oil, coal tar products, and petroleum oil
mists.
• Complications include superior vena cava
syndrome, hypercalcemia (from bone metastasis),
syndrome of inappropriate antidiuretic hormone
(SIADH), pleural effusion, pneumonia, brain
metastasis, and spinal cord compression.

Modifiable
• Approximately 80% of lung cancers are related to
cigarette smoking. Lung cancer is 10 times more
common in smokers than in nonsmokers. In
particular,squamous cell and small cell carcinoma
are associated with smoking
• Other risk factors include exposure to carcinogenic
industrial and air pollutants—such as asbestos,coal
dust,radon,and arsenic
Non-modifiable
Family history
Risk Factors

• New or changing cough, dyspnea,
wheezing, excessive sputum production,
hemoptysis, chest pain (aching, poorly
localized), malaise, fever, weight loss,
fatigue, or anorexia.
• Decreased breath sounds, wheezing, and
possible pleural friction rub (with pleural
effusion) on examination.
Assessment

• Chest X-ray may be suspicious for mass;
• CT or position emission tomography scan
will be better visualize tumor.
• Sputum and pleural fluid samples for
cytologic examination may show malignant
cells.
Diagnostic Evaluation

• Fiberoptic bronchoscopy determines the
location and extent of the tumor and may be
used to obtain a biopsy specimen.
• Lymph node biopsy and mediastinoscopy
may be ordered to establish lymphatic spread
and help plan treatment.
• Pulmonary function test, which may be
combined with a split-function perfusion scan,
determines if the patient will have adequate
pulmonary reserve to withstand surgical
procedure.

• Oxygen through nasal cannula based on
level of dyspnea.
• Enteral or total parenteral nutrition for
malnourished patient who is unable or
unwilling to eat.
• Removal of the pleural fluid (by
thoracentesis or tube thoracostomy) and
instillation of sclerosing agent to obliterate
pleural space and fluid recurrence.
• Radiation therapy in combination with
other methods.
Medical Management

Surgical Intervention
• Resection of tumor, lobe, or lung.
Pharmacologic Intervention
• Expectorants and antimicrobial agents to
relieve dyspnea and infection.
• Analgesics given regularly to maintain pain
at tolerable level. Titrate dosages to
achieve pain control.
• Chemotherapy using cisplatin in
combination with a variety of other agents
and immunotherapy treatments may be
indicated.

• Elevate the head of the bed to ease the work
of breathing and to prevent fluid collection in
upper body (from superior vena cava
syndrome).
• Teach breathing retraining exercises to
increase diaphragmatic excursion and reduce
work of breathing.
• Augment the patient’s ability to cough
effectively by splinting the patient’s chest
manually.
• Instruct the patient to inspire fully and cough
Nursing Intervention

• Teach relaxation techniques to reduce
anxiety associated with dyspnea. Allow the
severely dyspneic patient to sleep in
reclining chair.
• Encourage the patient to conserve energy
by decreasing activities.
• Ensure adequate protein intake such as
milk, eggs, oral nutritional supplements;
and chicken, fowl, and fish if other
treatments are not tolerated – to promote
healing and prevent edema.

• Advise the patient to eat small amounts of
high-calorie and high-protein foods
frequently, rather than three daily meals.
• Suggest eating the major meal in the
morning if rapid satiety is the problem.
• Change the diet consistency to soft or
liquid if patient has esophagitis from
radiation therapy.
• Consider alternative pain control methods,
such as biofeedback and relaxation
methods, to increase the patient’s sense
of control.

• Sarcoma is the general term for a broad
group of cancers that begin in the bones
and in the soft (also called connective)
tissues (soft tissue sarcoma). Soft tissue
sarcoma forms in the tissues that connect,
support and surround other body
structures. This includes muscle, fat, blood
vessels, nerves, tendons and the lining of
your joints.

Signs and symptoms
• A lump that can be felt through the skin
that may or may not be painful
• Bone pain
• A broken bone that happens unexpectedly,
such as with a minor injury or no injury at
all
• Abdominal pain
• Weight loss

Causes
• It's not clear what causes most sarcomas.
• In general, cancer forms when changes
(mutations) happen in the DNA within
cells. The DNA inside a cell is packaged
into a large number of individual genes,
each of which contains a set of
instructions telling the cell what functions
to perform, as well as how to grow and
divide.

• Mutations might tell cells to grow and
divide uncontrollably and to continue living
when normal cells would die. If this
happens, the accumulating abnormal cells
can form a tumor. Cells can break away
and spread (metastasize) to other parts of
the body.

Factors that can increase the risk of sarcoma include:
• Inherited syndromes. Some syndromes that increase the risk of
cancer can be passed from parents to children. Examples of
syndromes that increase the risk of sarcoma include familial
retinoblastoma and neurofibromatosis type 1.
• Radiation therapy for cancer. Radiation treatment for cancer
increases the risk of developing a sarcoma later.
• Chronic swelling (lymphedema). Lymphedema is swelling caused
by a backup of lymph fluid that occurs when the lymphatic system is
blocked or damaged. It increases the risk of a type of sarcoma
called angiosarcoma.
• Exposure to chemicals. Certain chemicals, such as some
industrial chemicals and herbicides, can increase the risk of
sarcoma that affects the liver.
• Exposure to viruses. The virus called human herpesvirus 8 can
increase the risk of a type of sarcoma called Kaposi's sarcoma in
people with weakened immune systems.

Diagnosis
Tests and procedures used to diagnose sarcoma and determine its
extent (stage) include:
• A physical exam. Your doctor will likely do a physical exam to better
understand your symptoms and look for other clues that will help
with your diagnosis.
• Imaging tests. Which imaging tests are right for you will depend on
your situation. Some tests, such as X-rays, are better for seeing
bone problems. Other tests, such as MRI, are better for seeing
connective tissue problems. Other imaging tests might include
ultrasound, CT, bone scans and positron emission tomography
(PET) scans.
• Removing a sample of tissue for testing (biopsy). A biopsy is a
procedure to remove a piece of suspicious tissue for lab testing.

Treatment for sarcoma might involve:
• Surgery. The goal of surgery for sarcoma is to
remove all of the cancer cells. Sometimes it's
necessary to amputate an arm or leg to remove
all of the cancer, but surgeons try to preserve
limb function when possible. Sometimes all of
the cancer can't be removed without hurting
important structures, such as nerves or organs.
In these situations, the surgeons work to remove
as much of the sarcoma as possible.

• Radiation therapy. Radiation therapy uses
high-powered energy beams, such as X-
rays and protons, to kill cancer cells. The
radiation can come from a machine that
moves around your body directing the
beams of energy (external beam
radiation). Or the radiation might be placed
in your body temporarily (brachytherapy).
Sometimes radiation is done during an
operation to remove the cancer
(intraoperative radiation).

• Chemotherapy. Chemotherapy is a drug
treatment that uses chemicals to kill
cancer cells. Some types of sarcoma are
more likely to respond to chemotherapy
treatment than others.

• Targeted therapy. Targeted therapy is a
drug treatment that uses medicines that
attack specific weaknesses in cancer cells.
Your doctor may have your sarcoma cells
tested to see if they are likely to respond
to targeted therapy drugs.

• Immunotherapy. Immunotherapy is a drug
treatment that uses your immune system
to fight cancer. Your body's disease-
fighting immune system may not attack
your cancer because the cancer cells
produce proteins that blind the immune
system cells. Immunotherapy drugs work
by interfering with that process.

• Ablation therapy. Ablation therapy
treatments destroy cancer cells by
applying electricity to heat the cells, very
cold liquid to freeze the cells or high-
frequency ultrasound waves to damage
the cells.

Cervical cancer
is a type of cancer that occurs in the cells of
the cervix — the lower part of the uterus that
connects to the vagina.
Various strains of the human papillomavirus
(HPV), a sexually transmitted infection, play
a role in causing most cervical cancer.

Symptoms
• Early-stage cervical cancer generally produces no signs
or symptoms.
Signs and symptoms of more-advanced cervical
cancer include:
• Vaginal bleeding after intercourse, between periods or
after menopause
• Watery, bloody vaginal discharge that may be heavy and
have a foul odor
• Pelvic pain or pain during intercourse

Causes
• Cervix and squamous and glandular cells
• Cervical cancer begins when healthy cells
in the cervix develop changes (mutations)
in their DNA. A cell's DNA contains the
instructions that tell a cell what to do.

Types of cervical cancer
• Squamous cell carcinoma. This type of
cervical cancer begins in the thin, flat cells
(squamous cells) lining the outer part of
the cervix, which projects into the vagina.
Most cervical cancers are squamous cell
carcinomas.
• Adenocarcinoma. This type of cervical
cancer begins in the column-shaped
glandular cells that line the cervical canal.

Risk factors for cervical cancer include:
• Many sexual partners. The greater your number of sexual partners
— and the greater your partner's number of sexual partners — the
greater your chance of acquiring HPV.
• Early sexual activity. Having sex at an early age increases your
risk of HPV.
• Other sexually transmitted infections (STIs). Having other STIs
— such as chlamydia, gonorrhea, syphilis and HIV/AIDS —
increases your risk of HPV.
• A weakened immune system. You may be more likely to develop
cervical cancer if your immune system is weakened by another
health condition and you have HPV.
• Smoking. Smoking is associated with squamous cell cervical
cancer.
• Exposure to miscarriage prevention drug. If your mother took a
drug called diethylstilbestrol (DES) while pregnant in the 1950s, you
may have an increased risk of a certain type of cervical cancer
called clear cell adenocarcinoma.

Prevention
To reduce your risk of cervical cancer:
• HPV vaccine.
• Have routine Pap tests. at age 21 and
repeating them every few years.
• Practice safe sex.
• Don't smoke. help you quit.

Screening tests include:
• Pap test
• HPV DNA test
DIAGNOSIS
• Punch biopsy,
• Endocervical curettage,
• If the punch biopsy or endocervical
curettage is worrisome,
• Electrical wire loop,
• Cone biopsy (conization),

Staging
• Staging exams include:
• Imaging tests. Tests such as X-ray, CT,
MRI and positron emission tomography
(PET) help your doctor determine whether
your cancer has spread beyond your
cervix.
• Visual examination of your bladder and
rectum. Your doctor may use special
scopes to see inside your bladder and
rectum.

Treatment
• Treatment for cervical cancer depends on
several factors, such as the stage of the
cancer, other health problems you may
have and your preferences. Surgery,
radiation, chemotherapy or a combination
of the three may be used.

Surgery
• Early-stage cervical cancer is typically
treated with surgery. Which operation is
best for you will depend on the size of your
cancer, its stage and whether you would
like to consider becoming pregnant in the
future.

1. Surgery to cut away the cancer only. For
a very small cervical cancer, it might be
possible to remove the cancer entirely
with a cone biopsy. This procedure
involves cutting away a cone-shaped
piece of cervical tissue, but leaving the
rest of the cervix intact. This option may
make it possible for you to consider
becoming pregnant in the future.

2.Surgery to remove the cervix
(trachelectomy). Early-stage cervical cancer
might be treated with a radical
trachelectomy procedure, which removes
the cervix and some surrounding tissue. The
uterus remains after this procedure, so it
may be possible to become pregnant, if you
choose.

3. Surgery to remove the cervix
(trachelectomy). Early-stage cervical cancer
might be treated with a radical
trachelectomy procedure, which removes
the cervix and some surrounding tissue. The
uterus remains after this procedure, so it
may be possible to become pregnant, if you
choose.

Radiation
• Radiation therapy uses high-powered
energy beams, such as X-rays or protons,
to kill cancer cells. Radiation therapy is
often combined with chemotherapy as the
primary treatment for locally advanced
cervical cancers. It can also be used after
surgery if there's an increased risk that the
cancer will come back.

Radiation therapy can be given:
• Externally, by directing a radiation beam at
the affected area of the body (external
beam radiation therapy)
• Internally, by placing a device filled with
radioactive material inside your vagina,
usually for only a few minutes
(brachytherapy)
• Both externally and internally

Chemotherapy
• Chemotherapy is a drug treatment that
uses chemicals to kill cancer cells. It can
be given through a vein or taken in pill
form. Sometimes both methods are used.

Targeted therapy
• Targeted drug treatments focus on specific
weaknesses present within cancer cells.
By blocking these weaknesses, targeted
drug treatments can cause cancer cells to
die. Targeted drug therapy is usually
combined with chemotherapy. It might be
an option for advanced cervical cancer.

Immunotherapy
• Immunotherapy is a drug treatment that
helps your immune system to fight cancer.
Your body's disease-fighting immune
system might not attack cancer because
the cancer cells produce proteins that
make them undetectable by the immune
system cells. Immunotherapy works by
interfering with that process. For cervical
cancer, immunotherapy might be
considered when the cancer is advanced
and other treatments aren't working.

Supportive (palliative) care
• Palliative care is specialized medical care
that focuses on providing relief from pain
and other symptoms of a serious illness.
Palliative care specialists work with you,
your family and your other doctors to
provide an extra layer of support that
complements your ongoing care.

OVERVIEW
• Colon cancer is a type of cancer that
begins in the large intestine (colon). The
colon is the final part of the digestive tract.
• Colon cancer typically affects older adults,
though it can happen at any age. It usually
begins as small, noncancerous (benign)
clumps of cells called polyps that form on
the inside of the colon. Over time some of
these polyps can become colon cancers.

Signs and symptoms of colon cancer
include:
1. A persistent change in your bowel habits,
including diarrhea or constipation or a
change in the consistency of your stool
2. Rectal bleeding or blood in your stool
3. Persistent abdominal discomfort, such as
cramps, gas or pain
4. A feeling that your bowel doesn't empty
completely
5. Weakness or fatigue
6. Unexplained weight loss

Causes
• In general, colon cancer begins when
healthy cells in the colon develop changes
(mutations) in their DNA. A cell's DNA
contains a set of instructions that tell a cell
what to do.

Factors that may increase your risk of
colon cancer include:
• Older age. Colon cancer can be diagnosed at any age,
but a majority of people with colon cancer are older than
50. The rates of colon cancer in people younger than 50
have been increasing, but doctors aren't sure why.
• African-American race. African-Americans have a
greater risk of colon cancer than do people of other
races.
• A personal history of colorectal cancer or polyps. If
you've already had colon cancer or noncancerous colon
polyps, you have a greater risk of colon cancer in the
future.
• Inflammatory intestinal conditions. Chronic inflammatory
diseases of the colon, such as ulcerative colitis and
Crohn's disease, can increase your risk of colon cancer.

• Obesity. People who are obese have an
increased risk of colon cancer and an
increased risk of dying of colon cancer
when compared with people considered
normal weight.
• Smoking. People who smoke may have an
increased risk of colon cancer.
• Alcohol. Heavy use of alcohol increases
your risk of colon cancer.
• Radiation therapy for cancer. Radiation
therapy directed at the abdomen to treat
previous cancers increases the risk of
colon cancer.

• Low-fiber, high-fat diet. Colon cancer and rectal
cancer may be associated with a typical Western
diet, which is low in fiber and high in fat and
calories. Research in this area has had mixed
results. Some studies have found an increased
risk of colon cancer in people who eat diets high
in red meat and processed meat.
• A sedentary lifestyle. People who are inactive
are more likely to develop colon cancer. Getting
regular physical activity may reduce your risk of
colon cancer.
• Diabetes. People with diabetes or insulin
resistance have an increased risk of colon
cancer.

• Obesity. People who are obese have an
increased risk of colon cancer and an increased
risk of dying of colon cancer when compared
with people considered normal weight.
• Smoking. People who smoke may have an
increased risk of colon cancer.
• Alcohol. Heavy use of alcohol increases your
risk of colon cancer.
• Radiation therapy for cancer. Radiation therapy
directed at the abdomen to treat previous
cancers increases the risk of colon cancer.

• Eat a variety of fruits, vegetables and
whole grains.
• Drink alcohol in moderation
• Stop smoking.
• Exercise most days of the week.
• Maintain a healthy weight.

• Prostate cancer is cancer that occurs in
the prostate. The prostate is a small
walnut-shaped gland in males that
produces the seminal fluid that nourishes
and transports sperm.

signs and symptoms
1. Trouble urinating
2. Decreased force in the stream of urine
3. Blood in the urine
4. Blood in the semen
5. Bone pain
6. Losing weight without trying
7. Erectile dysfunction

Causes
A cell's DNA contains the instructions that tell a
cell what to do. The changes tell the cells to grow
and divide more rapidly than normal cells do. The
abnormal cells continue living, when other cells
would die.The accumulating abnormal cells form a
tumor that can grow to invade nearby tissue. In
time, some abnormal cells can break away and
spread (metastasize) to other parts of the body.

• Older age. Your risk of prostate cancer increases as you
age. It's most common after age 50.
• Race. For reasons not yet determined, Black people
have a greater risk of prostate cancer than do people of
other races. In Black people, prostate cancer is also
more likely to be aggressive or advanced.
• Family history. If a blood relative, such as a parent,
sibling or child, has been diagnosed with prostate
cancer, your risk may be increased. Also, if you have a
family history of genes that increase the risk of breast
cancer (BRCA1 or BRCA2) or a very strong family
history of breast cancer, your risk of prostate cancer may
be higher.

• Obesity. People who are obese may have
a higher risk of prostate cancer compared
with people considered to have a healthy
weight, though studies have had mixed
results. In obese people, the cancer is
more likely to be more aggressive and
more likely to return after initial treatment.

• Cancer that spreads (metastasizes).
Prostate cancer can spread to nearby
organs, such as your bladder, or travel
through your bloodstream or lymphatic
system to your bones or other organs.
Prostate cancer that spreads to the bones
can cause pain and broken bones. Once
prostate cancer has spread to other areas
of the body, it may still respond to
treatment and may be controlled, but it's
unlikely to be cured.

• Incontinence. Both prostate cancer and its
treatment can cause urinary incontinence.
Treatment for incontinence depends on the type
you have, how severe it is and the likelihood it
will improve over time. Treatment options may
include medications, catheters and surgery.
• Erectile dysfunction. Erectile dysfunction can
result from prostate cancer or its treatment,
including surgery, radiation or hormone
treatments. Medications, vacuum devices that
assist in achieving erection and surgery are
available to treat erectile dysfunction.

Prostate screening and diagnostic
Exam:
• Digital rectal exam (DRE).
• Prostate-specific antigen (PSA) test.
• Ultrasound. .
• Magnetic resonance imaging (MRI).
• Collecting a sample of prostate tissue.

Techniques used to determine the
aggressiveness of the cancer include:
• Gleason score. The most common scale
used to evaluate the grade of prostate
cancer cells is called a Gleason score.
Gleason scoring combines two numbers
and can range from 2 (nonaggressive
cancer) to 10 (very aggressive cancer),
though the lower part of the range isn't
used as often.

• Most Gleason scores used to assess
prostate biopsy samples range from 6 to
10. A score of 6 indicates a low-grade
prostate cancer. A score of 7 indicates a
medium-grade prostate cancer. Scores
from 8 to 10 indicate high-grade cancers.

• Genomic testing. Genomic testing
analyzes your prostate cancer cells to
determine which gene mutations are
present. This type of test can give you
more information about your prognosis.
But it's not clear who might benefit most
from this information, so the tests aren't
widely used. Genomic tests aren't
necessary for every person with prostate
cancer, but they might provide more
information for making treatment decisions
in certain situations.

Determining whether the cancer has
spread
• Bone scan
• Ultrasound
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET) scan

Permanent prostate brachytherapy

Types of radiation therapy.
• Freezing prostate tissue. Cryoablation or
cryotherapy for prostate cancer involves
using a very cold gas to freeze the
prostate tissue. The tissue is allowed to
thaw and the procedure repeats. The
cycles of freezing and thawing kill the
cancer cells and some surrounding
healthy tissue.
• Heating prostate tissue. High-intensity
focused ultrasound (HIFU) treatment uses
concentrated ultrasound energy to heat
the prostate tissue and cause it to die.

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