Topic 1 Cellular Abberation

OVERVIEW
 Cell appearance (morphology)
b. Each normal mature cell type is differentiated,
with a distinct and recognizable appearance, size,
and shape
c. The size of a normal cell nucleus is usually small
compared with the size of the rest of the cell,
including the cytoplasm
d. Normal cells generally have a small N:C ratio
e. As cell matures, the nucleus:cytoplasm ratio
decrease

Anatomy of the Generalized Cell

• Cells are not all the same
• All cells share general structures
• Cells are organized into three main
regions
• Nucleus
• Cytoplasm
• Plasma membrane

Figure 3.1a
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide 3.2

The Nucleus

• Control center
of the cell
• Contains genetic
material (DNA)
• Three regions
• Nuclear
membrane
• Nucleolus
• Chromatin Figure 3.1b


Nuclear Membrane – double membrane or
envelope

• Barrier of nucleus
• Consists of a double phospholipid
membrane
• Contain nuclear pores that allow for
exchange of material with the rest of the
cell – selectively permeable


Nucleoli

• Nucleus contains one or more nucleoli
• Sites of ribosome production
• Ribosomes then migrate to the
cytoplasm through nuclear pores


Chromatin (when not dividing)

• Composed of DNA and protein
• Scattered throughout the nucleus
• Chromatin condenses to form
chromosomes when the cell divides


Plasma Membrane

• Barrier for cell contents
• Double phospholipid layer (fat – water)
• Hydrophilic heads
• Hydrophobic tails
• Other materials in plasma membrane
• Protein
• Cholesterol
• Glycoproteins
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide 3.7a

Plasma Membrane

Figure 3.2
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide 3.7b

Plasma Membrane Specializations

• Microvilli
• Finger-like
projections that
increase surface
area for absorption
• Small intestine and
nephrons of kidney
Figure 3.3


Cytoplasm

• Material outside the nucleus and inside
the plasma membrane
• Cytosol
• Fluid that suspends other elements
• Organelles
• Metabolic machinery of the cell
• Inclusions
• Non-functioning units – fat, pigments…..

Cytoplasmic Organelles

Figure 3.4



• Ribosomes
• Made of protein and RNA
• Sites of protein synthesis
• Found at two locations
• Free in the cytoplasm
• Attached to rough endoplasmic reticulum


• Endoplasmic reticulum (ER)
• Fluid-filled tubules for carrying substances
• Two types of ER
• Rough Endoplasmic Reticulum
• Studded with ribosomes
• Site where building materials of cellular
membrane are formed
• Smooth Endoplasmic Reticulum
• Functions in cholesterol synthesis and
breakdown, fat metabolism, and detoxification
of drugs


• Golgi apparatus
• Modifies and packages proteins



Figure 3.5



• Lysosomes
• Contain enzymes that digest nonusable
materials within the cell
• Peroxisomes
• Membranous sacs of oxidase enzymes
• Detoxify harmful substances
• Break down free radicals
(highly reactive chemicals)
• Replicate by pinching in half


• Mitochondria
• “Powerhouses” of the cell
• Change shape continuously
• Carry out reactions where oxygen is used
to break down food
• Provides ATP for cellular energy



• Cytoskeleton
• Network of protein structures that extend
throughout the cytoplasm
• Provides the cell with an internal framework



• Cytoskeleton
• Three different types
• Microfilaments
• Intermediate
filaments
• Microtubules

Figure 3.6



• Centrioles
• Rod-shaped bodies made of microtubules
• Direct formation of mitotic spindle during
cell division


Cellular Projections

• Not found in all cells
• Used for movement
• Cilia moves materials across the cell
surface
• Flagellum propels the cell


OVERVIEW
 Epithelial (glandular) tissues: breast (ductal),
colon, liver
 Connective (mesenchymal) tissue – adipose,
blood vessel, bone, skeletal and smooth muscle
 Hematopoietic cells – blood cells

Body Tissues
• Cells are specialized for particular functions
• Tissues
• Groups of cells with similar structure and
function
• Four primary types
• Epithelium
• Connective tissue
• Nervous tissue
• Muscle

Epithelial Tissues
• Found in different areas
• Body coverings
• Body linings
• Glandular tissue
• Functions
• Protection
• Absorption
• Filtration
• Secretion

Epithelium Characteristics

• Cells fit closely together
• Tissue layer always has one free
surface
• The lower surface is bound by a
basement membrane
• Avascular (have no blood supply)
• Regenerate easily if well nourished


Classification of Epithelium

• Number of cell layers
• Simple – one layer
• Stratified – more than
one layer

Figure 3.16a


Classification of Epithelium

• Shape of cells
• Squamous – flattened
• Cuboidal – cube-shaped
• Columnar – column-like

Figure 3.16b


Simple Epithelium

• Simple squamous
• Single layer of flat
cells
• Usually forms
membranes
• Lines body
cavities
• Lines lungs and
capillaries Figure 3.17a


Simple Epithelium
• Simple cuboidal
• Single layer of
cube-like cells
• Common in
glands and their
ducts
• Forms walls
of kidney tubules
• Covers the
ovaries Figure 3.17b


Simple Epithelium

• Simple columnar
• Single layer of tall
cells
• Often includes
goblet cells, which
produce mucus
• Lines digestive
tract
Figure 3.17c


Simple Epithelium
• Pseudostratified
• Single layer, but
some cells are
shorter than others
• Often looks like a
double cell layer
• Sometimes ciliated,
such as in the
respiratory tract
• May function in
absorption or Figure 3.17d

secretion

Stratified Epithelium
• Stratified squamous
• Cells at the free edge
are flattened
• Found as a protective
covering where
friction is common
• Locations
• Skin
• Mouth
• Esophagus Figure 3.17e


• Stratified cuboidal
• Two layers of cuboidal cells
• Stratified columnar
• Surface cells are columnar, cells
underneath vary in size and shape
• Stratified cuboidal and columnar
• Rare in human body
• Found mainly in ducts of large glands


• Transitional
epithelium
• Shape of cells
depends upon the
amount of stretching
• Lines organs of the
urinary system
Figure 3.17f


Glandular Epithelium
• Gland – one or more cells that secretes a
particular product
• Two major gland types
• Endocrine gland
• Ductless
• Secretions are hormones
• Exocrine gland
• Empty through ducts to the epithelial surface
• Include sweat and oil glands

Connective Tissue

• Found everywhere in the body
• Includes the most abundant and widely
distributed tissues
• Functions
• Binds body tissues together
• Supports the body
• Provides protection

Connective Tissue Characteristics

• Variations in blood supply
• Some tissue types are well vascularized
• Some have poor blood supply or are
avascular
• Extracellular matrix
• Non-living material that surrounds living
cells

Connective Tissue Types
• Bone (osseous tissue)
• Composed of:
• Bone cells in lacunae
(cavities)
• Hard matrix of calcium
salts
• Large numbers of
collagen fibers
• Used to protect and
support the body Figure 3.18a



• Hyaline cartilage
• Most common
cartilage
• Composed of:
• Abundant collagen
fibers
• Rubbery matrix
• Entire fetal skeleton
is hyaline cartilage Figure 3.18b



• Elastic cartilage
• Provides elasticity
• Example: supports the external ear



• Fibrocartilage
• Highly compressible
• Example: forms
cushion-like discs
between vertebrae

Figure 3.18c


• Dense connective
tissue
• Main matrix element
is collagen fibers
• Cells are fibroblasts
• Examples
• Tendon – attach
muscle to bone
• Ligaments – attach
bone to bone Figure 3.18d


• Areolar connective
tissue
• Most widely
distributed
connective tissue
• Soft, pliable tissue
• Contains all fiber
types
• Can soak up excess
fluid Figure 3.18e


• Reticular
connective tissue
• Delicate network of
interwoven fibers
• Forms stroma
(internal supporting
network) of
lymphoid organs
• Lymph nodes
• Spleen
• Bone marrow Figure 3.18g


• Blood
• Blood cells
surrounded by fluid
matrix
• Fibers are visible
during clotting
• Functions as the
transport vehicle
for materials
Figure 3.18h

Muscle Tissue

• Function is to produce movement
• Three types
• Skeletal muscle
• Cardiac muscle
• Smooth muscle


Muscle Tissue Types

• Skeletal muscle
• Can be controlled
voluntarily
• Cells attach to
connective tissue
• Cells are striated
• Cells have more than
one nucleus
Figure 3.19b


Muscle Tissue Types
• Cardiac muscle
• Found only in the
heart
• Function is to pump
blood (involuntary)
• Cells attached to
other cardiac muscle
cells at intercalated
disks
• Cells are striated
• One nucleus per cell Figure 3.19c


Muscle Tissue Types

• Smooth muscle
• Involuntary muscle
• Surrounds hollow
organs
• Attached to other
smooth muscle cells
• No visible striations
• One nucleus per cell Figure 3.19a


Nervous Tissue
• Neurons and
nerve support
cells
• Function is to
send impulses to
other areas of
the body
• Irritability
• Conductivity Figure 3.20


OVERVIEW
 Normal cell functions
b. Gastric cells – secrete HCl
c. Nerve cells – generate action potential and
conduct impulses
d. Beta cells of the pancreas
e. Type II pneumocytes
f. Immune system

OVERVIEW
 Immunity – the body’s specific protective
response to a foreign agent or organism
 Immune system – part of the body’s defense
mechanism against invasion and allows a rapid
response to foreign substance
 Genetic and cellular responses result when the
immune system is activated
 Tolerance – mechanism by which the immune
system is programmed to eliminate foreign
substances such as microbes, toxins, and cellular
mutations but maintains the ability to accept
self-antigens

OVERVIEW
 Immunopathology – the study of diseases that
result from dysfunctions within the immune
system
 Immune function is affected by a variety of
factors
3. Central nervous system integrity
4. General physical status
5. General emotional status
6. Stress
7. Illness
8. Trauma
9. Surgery

IMMUNE SYSTEM DISORDERS
 Autoimmunity - is the failure of an organism to recognize
its own constituent parts as ''self'', which allows an immune
response against its own cells and tissues.
 Hypersensitivity - refers to excessive, undesirable
(damaging, discomfort-producing and sometimes fatal) reactions
produced by the normal immune system.
 Gammopathies - abnormal proliferation of the lymphoid
cells producing immunoglobulins. Ex: hodgkins disease
 Immune deficiencies - is a state in which the immune
system's ability to fight infectious disease is compromised or
entirely absent.
e. Primary
f. Secondary

ANATOMIC AND PHYSIOLOGIC
OVERVIEW
 Epitopes – antigenic determinants that are
present on foreign materials, initiating a series of
action in a host, including the inflammatory
response, the lysis of microbial agents, and the
disposal of foreign toxins
 Bone marrow (B lymphocytes originates)
 Lymphoid tissues – spleen, lymph nodes
 WBCs, antibodies
 Types of immunity
 Natural immunity – or innate immunity is
nonspecific and is present at birth (intact skin,
phagocytes, compliment system)
 Acquired or adaptive immunity – specific and
develops after birth (humoral & Cellular

BASIC CONCEPTS

Components of the Immune System
 Immune cells

 Central immune structures: bone marrow and
thymus (where immune cells are produced and
mature)
 Peripheral immune structures: lymph nodes,
spleen (where the immune cells interact with the
antigen)

BASIC CONCEPTS

 Immune cells: T and B lymphocytes
(primary cells), macrophages (accessory
cells) which aid in processing and
presentation of antigens to the lymphocytes
 Cytokines: molecules that form a
communication link between immune cells
and other tissues and organs of the body

Lymph Nodes

Figure 12.3

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide

Lymph Node Structure

Figure 12.4


Other Lymphoid Organs

• Several other
organs contribute
to lymphatic
function
• Spleen
• Thymus
• Tonsils
• Peyer’s patches
Figure 12.5

The Spleen

• Located on the left side of the abdomen
• Filters blood
• Destroys worn out blood cells
• Forms blood cells in the fetus
• Acts as a blood reservoir


The Thymus

• Located low in the throat, overlying the
heart
• Functions at peak levels only during
childhood
• Produces hormones (like thymosin) to
program lymphocytes


Tonsils

• Small masses of lymphoid tissue around
the pharynx
• Trap and remove bacteria and other
foreign materials
• Tonsillitis is caused by congestion with
bacteria


Peyer’s Patches

• Found in the wall of the small intestine
• Resemble tonsils in structure
• Capture and destroy bacteria in the
intestine


Mucosa-Associated Lymphatic
Tissue (MALT)
• Includes:
• Peyer’s patches
• Tonsils
• Other small accumulations of lymphoid
tissue
• Acts as a guard to protect respiratory
and digestive tracts

Body Defenses
• The body is constantly in contact with
bacteria, fungi, and viruses (pathogens)
• The body has two defense systems for
foreign materials
• Nonspecific defense system
• Mechanisms protect against a variety of
invaders
• Responds immediately to protect body
from foreign materials

Body Defenses

• Specific defense system
• Specific defense is required for each type
of invader
• Also known as the immune system


Nonspecific Body Defenses

• Body surface coverings
• Intact skin
• Mucous membranes
• Specialized human cells
• Chemicals produced by the body


Surface Membrane Barriers –
First Line of Defense

• The skin
• Physical barrier to foreign materials
• pH of the skin is acidic to inhibit bacterial
growth
• Sebum is toxic to bacteria
• Vaginal secretions are very acidic


Surface Membrane Barriers –
First Line of Defense
• Stomach mucosa
• Secretes hydrochloric acid
• Has protein-digesting enzymes
• Saliva and lacrimal fluid contain
lysozyme
• Mucus traps microogranisms in
digestive and respiratory pathways

Defensive Cells
• Phagocytes
(neutrophils and
macrophages)
• Engulfs foreign
material into a
vacuole
• Enzymes from
lysosomes digest
the material
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Figure 12.6b Slide

Macrophage attacking e-coli.
•

Defensive Cells

• Natural killer cells
• Can lyse and kill
cancer cells
• Can destroy virus-
infected cells

Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Figure 12.6b Slide

Inflammatory Response -
Second Line of Defense
• Triggered when body tissues are injured
• Produces four cardinal signs
• Redness
• Heat
• Swelling
• Pain
• Results in a chain of events leading to
protection and healing

Functions of the Inflammatory
Response

• Prevents spread of damaging agents
• Disposes of cell debris and pathogens
• Sets the stage for repair


Steps in the Inflammatory Response

Figure 12.7

Antimicrobial Chemicals

• Complement
• A group of at
least 20
plasma
proteins
• Activated when
they encounter
and attach to
cells
(complement
fixation) Figure 12.8


• Complement
(continued)
• Damage
foreign cell
surfaces
• Will rupture or
lyse the foreign
cell membrane

Figure 12.8



• Interferon
• Secreted proteins of virus-infected cells
• Bind to healthy cell surfaces to inhibit viruses
binding


Interferons are a family species-specific proteins synthesized by
eukaryotic cells in response to viruses and a variety of natural and
synthetic stimuli. There are several different interferons commonly
used as therapeutics, termed alpha, beta, and gamma. These peptides
are used to treat hairy cell leukemia, AIDS-related Kaposi's sarcoma,
laryngeal papillomatosis, genital warts, and chronic granulomatous
disease. Side effects include black tarry stools, blood in the urine,
confusion, and loss of balance.

Fever
• Abnormally high body temperature
• Hypothalmus heat regulation can be
reset by pyrogens (secreted by white
blood cells)
• High temperatures inhibit the release of
iron and zinc from liver and spleen
needed by bacteria
• Fever also increases the speed of tissue
repair

Specific Defense: The Immune
System – Third Line of Defense
• Antigen specific – recognizes and acts
against particular foreign substances
• Systemic – not restricted to the initial
infection site
• Has memory – recognizes and mounts
a stronger attack on previously
encountered pathogens

Types of Immunity

• Humoral immunity
• Antibody-mediated immunity
• Cells produce chemicals for defense
• Cellular immunity
• Cell-mediated immunity
• Cells target virus infected cells


Antigens (Nonself)
• Any substance capable of exciting the
immune system and provoking an immune
response
• Examples of common antigens
• Foreign proteins
• Nucleic acids
• Large carbohydrates
• Some lipids
• Pollen grains
• Microorganisms

Self-Antigens

• Human cells have many surface
proteins
• Our immune cells do not attack our own
proteins
• Our cells in another person’s body can
trigger an immune response because
they are foreign
• Restricts donors for transplants

Allergies
• Many small molecules (called haptens
or incomplete antigens) are not
antigenic, but link up with our own
proteins
• The immune system may recognize and
respond to a protein-hapten
combination
• The immune response is harmful rather
than protective because it attacks our
own cells

Cells of the Immune System
• Lymphocytes
• Originate from hemocytoblasts in the red bone
marrow
• B lymphocytes become immunocompetent in
the bone marrow
• T lymphocytes become immunocompetent in
the thymus
• Macrophages
• Arise from monocytes
• Become widely distributed in lymphoid organs

Activation of Lymphocytes

Figure 12.9

Humoral (Antibody-Mediated)
Immune Response

• B lymphocytes with specific receptors
bind to a specific antigen
• The binding event activates the
lymphocyte to undergo clonal selection
• A large number of clones are produced
(primary humoral response)


Humoral (Antibody Mediated)
Immune Response

• Most B cells become plasma cells
• Produce antibodies to destroy antigens
• Activity lasts for four or five days
• Some B cells become long-lived memory
cells (secondary humoral response)


Humoral Immune Response

Figure 12.10

Active Immunity

• Your B cells
encounter
antigens and
produce
antibodies
• Active immunity
can be naturally
or artificially
acquired
Figure 12.12


Passive Immunity
• Antibodies are obtained from someone
else
• Conferred naturally from a mother to her
fetus
• Conferred artificially from immune serum or
gamma globulin
• Immunological memory does not occur
• Protection provided by “borrowed
antibodies”

Antibodies (Immunoglobulins) (Igs)

• Soluble proteins secreted by B cells
(plasma cells)
• Carried in blood plasma
• Capable of binding specifically to an
antigen


Antibody Classes
• Antibodies of each class have slightly
different roles
• Five major immunoglobulin classes –
(Do Not Need to know!)
• IgM – can fix complement
• IgA – found mainly in mucus
• IgD – important in activation of B cell
• IgG – can cross the placental barrier
• IgE – involved in allergies

Cellular (Cell-Mediated) Immune
Response
• Antigens must be presented by
macrophages to an immunocompetent
T cell (antigen presentation)
• T cells must recognize nonself and self
(double recognition)
• After antigen binding, clones form as
with B cells, but different classes of cells
are produced

Cellular (Cell-Mediated) Immune
Response

Figure 12.15


T Cell Clones

• Cytotoxic T cells
• Specialize in killing infected cells
• Insert a toxic chemical (perforin)
• Helper T cells
• Recruit other cells to fight the invaders
• Interact directly with B cells


T Cell Clones

• Suppressor T cells
• Release chemicals to suppress the activity
of T and B cells
• Stop the immune response to prevent
uncontrolled activity
• A few members of each clone are
memory cells


Summary of the Immune Response

Figure 12.16

Organ Transplants and Rejection
• Major types of grafts
• Autografts – tissue transplanted from one
site to another on the same person
• Isografts – tissue grafts from an identical
person (identical twin)
• Allografts – tissue taken from an unrelated
person
• Xenografts – tissue taken from a different
animal species

Organ Transplants and Rejection

• Autografts and isografts are ideal
donors
• Xenografts are never successful
• Allografts are more successful with a
closer tissue match


BASIC CONCEPTS

 Major Histocompatibility Complex (MHC) –
membrane molecules that help the immune system
recognise the self from the non-self
 HLA – (Human Leukocyte Antigens) are human
MHC proteins that were first detected on white
blood cells; play a role in transplant rejection and
are detected in immunologic tests

BASIC CONCEPTS

Major Histocompatibility Complex
 Key recognition molecules which is an essential
feature of adaptive or specific immunity
 Able to discriminate between the body’s own
molecules against foreign antigens
 Coded by closely linked genes in chromosome 6

BASIC CONCEPTS

Major Histocompatibility Complex (Two Classes):
 MHC I - differentiate viral infected and abnormal
cells from normal cells
 MHC II - allow appropriate interactions among
immune cells

Properties HLA antigens Distribution Functions

Class I MHC HLA-A, HLA-B, Virtually all Present
HLA-C nucleated cells processed
(Human antigen to
Leucocyte Antigen cytotoxic CD8 T-
- helps the immune cells; restrict
system distinguish the cytolysis to virus-
body's own proteins
from proteins made by infected cells,
foreign invaders such tumor cells and
as viruses transplanted cells
and bacteria. )

Class II MHC HLA-DR, HLA-DP, Immune cells, Present
HLA-DQ antigen- processed
presenting cells, antigenic
and macrophages fragments to CD4
T-cells; necessary
for effective
interaction
among immune
cells

OVERVIEW
 Normal cells and functions
b. Most normal human cells have 23 pairs of
chromosomes
c. All normal cells (except the sex cells and the
mature red blood cells) have the entire human
genome in every cell
d. Normal cells have about 35,000 genes, and about
50 of these genes are very active during
embryonic life
e. Normal cells undergo mitosis either to develop
normal tissue during embryonic development,
childhood, and adolescence or to replace lost or
damaged normal tissue

THE CELL CYCLE
 The Cell Cycle – consists of 4 phases:
2. Gap 1 (G1) – the cell enlarges and synthesizes
proteins to prepare for DNA replication
3. Synthesis (S) phase – DNA is replicated and the
chromosomes in the cell are duplicated
4. Gap 2 (G) – the cell prepares itself for mitosis
5. Mitosis (M) phase – final step, where the parent
cell divides into two exact copies called daughter
cells, each having identical genetic material

THE CELL CYCLE
 The cells after the M phase immediately enter
the G1 where they begin another cell cycle again
 Or the cells divert into a resting phase called G0

 The cell cycle is controlled by cyclin-dependent
kinases
 Some cyclins cause a “braking” action and
prevent the cycle from proceeding
 Checkpoints in the cell cycle ensure that it
proceeds in the correct order

THE CELL CYCLE
 A malfunction of any of these regulators of cell
growth and division can result in the rapid
proliferation of immature cells
 In some cases these proliferating immature cells
are considered cancerous (malignant)
 Knowledge of the cell cycle events is used in the
development of chemotherapeutic drugs, which
are designed to disrupt the cancer cells during
different stages of their cell cycle

OVERVIEW
 In embryonic life, there are early development
genes called proto-oncogenes, and their
activity is not needed after embryonic life
 Other genes are called tumor suppressor
genes, which slow down cell division, repair
DNA mistakes, and tell cells when to die
(apoptosis, or programmed cell death)
 Tumor suppressor genes can also reduce
expression of proto-oncogenes by negative
feedback mechanisms
 Proto-oncogenes are not abnormal genes, and are
part of every human’s normal cellular DNA

Normal Cell Reversible
(homeostasis) Injury

Stress Injurious Mild,
stimulus transient

Adaptation Cell Injury
Inability
to adapt Severe,
progressive
Irreversible
Injury

Necrosis CELL Apoptosis
DEATH

OVERVIEW
 Adaptations are reversible changes in the size,
number, phenotype, metabolic activity, or
functions of cells in response to changes in their
environment
l Hypertrophy – increase in the size of cells,
resulting in an increase in the size of the organ
i Hyperplasia – an increase in the number in an
organ or tissue, usually resulting in increased
mass of the organ or tissue
n Atrophy – reduced size of an organ or tissue
resulting from a decrease in cell size and number

OVERVIEW
a. Metaplasia – reversible change in which one
differentiated cell type (epithelial or
mesenchymal) is replaced by another cell type
b. Necrosis – cell death
c. Apoptosis – programmed cell death
d. Differentiation - process by which cells or
tissues undergo a change toward a more
specialized form or function, especially during
embryonic development
e. Dysplasia
f. Anaplasia

OVERVIEW
a. Dysplasia - abnormal development or growth of
tissues, organs, or cells
b. Anaplasia - abnormal development or growth of
tissues, organs, or cells

EPIDEMIOLOGY OF CANCER
 2004 – The American Cancer Society estimates
that 1,368,030 people will be diagnosed with
cancer in the US
 Cancer continues to be the second leading cause
of death in the US
 62% of those diagnosed with cancer can expect to
be alive in 5 years
 Incidence and mortality rates for cancer have
dropped approximately 1% per year since 1991

 The American Cancer Society has established the
goal of a 25% reduction in the overall age-
adjusted cancer incidence rate and a 50%
reduction in the overall age-adjusted cancer
mortality rate by 2015
 Nurses should play a pivotal role in the
attainment of these goals through active
involvement in cancer prevention and early
detection activities
 Survival rate represents the percentage of
persons alive 5 years from now after diagnosis,
whether cured, in remission, or with evidence of
disease

Estimated New Cases Estimated New Deaths
Male Female Male Female
Prostate (38%) Breast (32%) Lung and Lung and
Lung and Lung and bronchus (31%) bronchus (27%)
bronchus (13%) bronchus (12%) Prostate (10%) Breast (15%)
Colon and rectum Colon and rectum Colon and rectum Colon and rectum
(10%) (11%) (10%) (10%)
Urinary bladder Uterine corpus Pancreas (5%) Ovary (6%)
(7%) (6%) Leukemia (4%) Pancreas (6%)
Melanoma of the Non-Hodgkin Esophagus (4%) Leukemia (4%)
skin (5%) lymphoma (4%) Liver and Non-Hodgkin
Non-Hodgkin Melanoma of the intrahepatic bile lymphoma (3%)
lymphoma (4%) skin (4%) duct (3%) Uterine corpus
Kidney and renal Ovary (3%) Non-Hodgkin (3%)
pelvis (3%) Thyroid (3%) lymphoma (3%) Multiple myeloma
Leukemia (3%) Urinary bladder Kidney and renal (2%)
Oral cavity and (2%) pelvis (3%) Brain and other
pharynx (3%) Pancreas (2%) All sites (100%) nervous system
Pancreas (2%) All sites (100%) (2%)
All sites (100%) All sites (100%)

Estimated Incidence (2008) Estimated Deaths (2008)
Male Female Male Female
Melanoma of the Melanoma of the Lung (31%) Brain (2%)
skin (5%) skin (4%) Esophagus (4%) Lung (26%)
Oropharynx (3%) Thyroid (4%) Liver (4%) Breast (15%)
Lung (15%) Lung (14%) Pancreas (6%) Liver (2%)
Pancreas (3%) Breast (26%) Kidney (3%) Pancreas (6%)
Kidney (4%) Kidney (3%) Colon and rectum Colon and rectum
Colon and rectum Colon and rectum (8%) (9%)
(10%) (10%) Urinary bladder Ovary (6%)
Urinary bladder Ovary (3%) (3%) Uterus (3%)
(7%) Uterus (6%) Prostate (10%) Leukemia (3%)
Prostate (25%) Leukemia (3%) Leukemia (4%) Non-Hodgkin
Leukemia (3%) Non-Hodgkin Non-Hodgkin Lymphoma (3%)
Hon-Hodgkin lymphoma (4%) Lymphoma (3%) All others (25%)
lymphoma (5%) All others (23%) All others (24%)
All others (20%)

Robbins Pathologic Basis of Disease 8th edition

 Risk factors
2. Heredity – 5 to 10% of cancers have a hereditary component
3. Age – 76% of cases occur after age 55; hormonal changes,
immune system changes
4. Gender
5. Poverty
6. Stress
7. Diet
8. Occupation
9. Infection
10. Tobacco use
11. Alcohol use
12. Recreational drug use
13. Obesity – increased risk of hormone-dependent cancers
14. Sun exposure

 Endogenous risk factors:
2. Genetic predisposition
3. Sex
4. Age
5. Race
6. Family history
 Exogenous risk factors:
8. Alcohol
9. Diet
10.Exercise
11.Occupational exposure
12.Cigarette smoking
13.Sexual activity

Risk Factors and Signs and Symptoms of Common Cancers
Cancer Site Risk Factors Signs and Symptoms
Breast Female gender Lump or mass
Age >50 years Thickening in breast or
Family history axilla
Personal history of breast cancer Change in size or contour
2 or more first-degree relatives or texture
Known BRCA1 or BRCA2 mutation Skin dimpling or retraction
Biopsy history Peau d’orange skin
Atypical hyperplasia Nipple discharge,
DCIS or LCIS retraction, or scaliness
Postmenopausal obesity Erythema
Early menarche/late menopause Pain or tenderness
Late first pregnancy/nulliparous
OCP
Radiation to chest wall
Alcohol
Obesity and high fat diet
Hormone replacement therapy

Prostate Male gender Weak urinary stream and
Age >50 years urinary frequency
African American ethnicity Difficulty in initiating
Family history of first-degree stream or stopping urinary
relative (greater if first-degree stream
relative diagnosed before age 40) Pain or burning on
High-fat diet urination
Colorectal Age >60 years Urinary retention
Inflammatory bowel conditions Hematuria
Sedentary lifestyle
Diet high in fat and low in fruits
and vegetables
Heavy alcohol consumption
Family history of colorectal cancer
especially if before the age of 40

Prostate Male gender Weak urinary stream and
Age >50 years urinary frequency
African American ethnicity Difficulty in initiating
Family history of first-degree stream or stopping urinary
relative (greater if first-degree stream
relative diagnosed before age 40) Pain or burning on
High-fat diet urination
Colorectal Familial genetic syndromes, e.g., Urinary in bowel habits
Change retention
familial adenomatous polyposis Hematuria
Rectal bleeding
(FAP) and hereditary nonpolyposis Abdominal pain
colon cancer (HNPCC) Decreased diameter of
stools
Anemia
Rectal pressure or pain
Weight loss
anorexia

Lung Cigarette smoking Chronic cough and
Occupational exposure to asbestos, wheezing
arsenic, chromium, coal products, Persistent respiratory
nickel refining, smelter workers, infections
ionizing radiation, radon Dull chest pain
Hemoptysis
Dyspnea
Weight loss

 Carcinogens
b. Viruses
c. Drugs and hormones – can be either genotoxic or
promotional
d. Chemical agents – both genotoxic and
promotional
e. Physical agents – for example radiation

Chemical Carcinogens and Relationship to Occupation
Chemical Agent Action Occupation
Polycyclic hydrocarbons Genotoxic Miners, coal/gas
(smoke, soot, tobacco, workers, chimner
smoked foods) sweeps, migrant worker,
workers in offices where
Benzopyrene Genotoxic smoking is allowed
Pesticide manufacturers,
Arsenic mining
Vinyl chloride Promotional Plastic workers
Artistis
Methylaminobenzine Genotoxic Fabric workers
Rubber and glue workers

Chemical Carcinogens and Relationship to Occupation
Chemical Agent Action Occupation
Asbestos Promotional Construction workers,
workers in old, run-down
buildings with asbestos
insulation, insulation
makers
Wood and leather dust Promotional Woodwrokers,
carpenters, leather
Chemotherapy drugs Genotoxic toolers
Drug manufacturers,
pharmacists, nurses

Occupational Cancers
Agent Cancer Typical use or occurrence
Arsenic and arsenic Lung, skin, Byproduct of metal
compounds hemangiosarcoma smelting; component of
alloys, electrical and
semiconductor devises,
medications and
herbicides, fungicides,
and animal dips
Asbestos Lung, mesothelioma, Formerly used for many
esophagus, stomach, applications because of
large intestine fire, heat and friction
resistance, still found in
existing construction as
well as fire-resistant
textiles, friction
materials (brake linings),
underlayment and
roofing papers, floor tiles

Benzene Leukemia, Hodgkin Principal component of
lymphoma light oil, despite known
risk, many applications
exist in printing and
lithography, paint,
rubber, dry cleaning,
adhesives and coatings,
and detergents, formerly
widely used as solvent
and fumigant
Beryllium and beryllium Lung Missile fuel and space
compounds vehicles, hardener for
lightweight metal alloys,
particularly in aerospace
applications and nuclear
reactors

Chromium compounds Lung Component of metal
alloys, paints, pigments,
and preservatives
Nickel compounds Nose, lung Nickel plating,
component of ferrous
alloys, ceramics, and
batteries, by-product of
stainless steel arc
Radon and its decay Lung welding
From decay of minerals
products containing uranium,
potentially serious hazard
in quarries and
underground mines
Vinyl chloride Angiosarcoma Refrigerant, monomer for
vinyl polymers, adhesive
for plastics, formerly
inert aerosol propellant
un pressurized containers

Cadmium and cadmium Prostate Uses include yellow
compounds pigments and phosphors;
found in solders; used in
batteries and as alloy and
in metal platings and
coatings

 HSV types I and II
b. Carcinoma of the lip

c. Cervical carcinoma

d. Kaposi sarcoma
 Human CMV

f. Kaposi sarcoma

g. Prostate carcinoma

 EBV
a. Burkitt lymphoma
 HBV

a. Primary HCC
 Papillomavirus

f. Malignant melanoma

g. Cervical, penile, and laryngeal cancers
 HTLV

i. Adult T-cell leukemia and lymphoma

j. Kaposi sarcoma

 Approximately three fourths of all cancers occur
in people over the age of 55
 Overall cancer incidence in males has stabilized
in recent years when compared with that in
females
 Men have a higher lifetime probability of
developing and dying of cancer than women, but
men have a greater recent decline in death rates
 Children – overall, cancer is the leading cause of
death due to disease in children between 1 and
14 years of age

Cause of Death by Age
Age (years) Males Females
20-39 1. Brain/CNS 1. Breast
2. Leukemia 2. Uterine/cervix
3. Lung 3. Leukemia
40-59 1. Lung 1. Breast
2. Colorectal 2. Lung
3. Pancreas 3. Colorectal
60-79 1. Lung 1. Lung
2. Colorectal 2. Breast
3. Prostate 3. Colorectal
>80 1. Lung 1. Lung
2. Prostate 2. Colorectal
3. Colorectal 3. Breast

THE ROLE OF THE NURSE
 Education
 Monitoring

 Documentation

 Proper referral

 Being up to date

Topic 1 Cellular Abberation

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Topic 1 Cellular Abberation