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CELLULAR ABERRATION by Louie A. Gallego, RN

 Safeguards against cancer COMPARISON OF THE CHARACTERISTICS OF

 Steps in controlling cancer BENIGN AND MALIGNANT NEOPLASM
 Diet Characteristics Benign Malignant
 Early detection
Speed of Slow growth Aggressive growth;
CELLULAR ABERRATION growth rapid cells division
 A group of disorders characterized by abnormal and growth
cell growth and the ability to metastasize with
potential in killing the host. Grows by Establish new
CANCER expansion site malignant
 The term “cancer” refers to the group of diseases lesions
in which cells grow and spread unrestrained
throughout the body. Mode of growth Localized and Invade surrounding
 Derives from the latin “crab” which means encapsulated tissues
cancer
 Synonymous with neoplasm Cell Well With poor cell
characteristic differentiated differentiated
 Acquire invasive characteristics, changes in
occurring in surroundings.
Metastasis It does not Ability to migrate,
 Is not a single disease with a single cause.
metastasized cells move to distant
 CARCINOGENESIS areas of the body
 Process of transformation from normal
cell to a neoplastic cell No tissue Destroy surrounding
INVASION damage tissues
 Occurs when cancer cells infiltrate adjacent
tissues surrounding the neoplasm. Prognosis Very good Poor prognosis
METASTASIS prognosis Can lead to death
 Occurs when malignant cells travel through the Does not cause unless interventions
blood or lymph and invade other tissues and death unless are taken
organs to form a secondary tumor. localization
DIFFERENTIATION affect vital
 Refers to the process whereby cells develop function
specific structures and function is order to
specialized in certain task. CLASSIFICATION OF CANCER
Top 5 cancer incidence by site & sex: 1. CARCINOMA - Refers to a tumor arises from
MALE FEMALE epithelial tissue, the name of the cancer identifies
Prostate Breast the location, e.g. basal cell carcinoma
Lungs Lungs 2. SARCOMA - Refers to a tumor arising from
Colon Colon supportive tissue; the name of the cancer
Urinary Tract Uterus identifies the specific tissue affected
Leukemia Leukemia & Lymphoma 3. LEUKEMIA - A malignant disorder of the
MEN blood-forming tissues of the bone marrow,
 High incidence of cancer of the lung and bladder spleen, and lymph system characterize by
 Most common neoplasm aged 20 to 34 is unregulated proliferation of WBCs and their
TESTICULAR CANCER precursors.
WOMEN 4. LYMPHOMA - A group of malignant neoplasm
 BREAST CANCER followed by lung and that affects the lymphatic system resulting in the
bronchus, colon and rectum proliferation of lymphocytes
Classification of Tumor: 5. MYELOMA
1. Benign- are tumors designated by attaching the NOMENCLATURE OF TUMORS
suffix – oma to the cells of origin. Tissue of Origin Benign Malignant
e.g. Fibroma
Chondroma Connective tissue Fibroma Fibrosarcoma
Osteoma and derivatives
2. Malignant- tumors that are capable of spreading
by invasion and metastasis. Lipoma Liposarcoma
e.g. Fibrosarcoma
Chondrosarcoma Chondroma Chondrosarcama
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Osteoma Osteogenic
Sarcoma

Blood Vessels Hemangioma Angiosarcoma Mutation of

the cell
Lymph vessels Lymphangioma Lymphangio-
sarcoma

Activation of Alteration of Inactivation

Brain coverings Meningioma Invasive genes
oncogenes of cancer
Meningioma
suppressor
Hematopoietic cells Leukemias
genes

Lymphoid tissue Malignant

Lymphomas Expression of altered
gene products
Smooth muscles Leiomyoma Leiomyosarcoma

Striated Muscles Rhabdomyoma Rhabdomyo- Malignant

sarcoma neoplasm

Epithelial tumors

Stratified Squamos cell Squamos cell

squamous papilloma carcinoma

Basal cells Basal cell

carcinoma

Liver cells Liver cell Hepatocellular

adenoma carcinoma

Placental Hydatidiform Choriocarcinoma

epethelium mole
(trophoblast) Carcinogenesis
PATHOGENESIS OF CANCER Steps:
 Cellular Transformation and Derangement 1. Imitation
Theory 2. Promotions
 Failure of the Immune Response Theory 3. Latency
Cellular Transformation and Derangement Theory 4. Progression
 conceptualizes that normal cells may be 5. Invasion to neighboring organs
transformed into cancer cells due to exposure to Stages of Tumor Progression
some etiologic agents  HYPERTROPY
Failure of the Immune Response Theory - Increase in size of normal cells
 advocates that all individuals possess cancer  ATROPHY
cells. However, the cancer cells are recognized
by the immune response system. So, the cancer
- Shrinkage of cell size
cells undergo destruction. Failure of the immune  HYPERPLASIA
response system leads to inability to destroy the - Increase in number of normal cells
cancer cells.  METAPLASIA
- Conversion from the normal pattern of
Flow Chart Depicting Molecular Basis of differentiation of one type of cells into
Cancer another type of cell not normal for that
Acquired
tissue
(environmental)  DYSPLASIA
Normal Cell - Alteration in the shape, size,
DNA damaging agent:
--Chemicals appearance, and distribution of cells
Radiation Successful DNA  ANAPLASIA
Viruses repair - Disorganized, irregular cells that have
no structure and have lots of
DNA Damage

Failure of
DNA repair

differentiation; the result is almost
malignant
Classification, Grading & Stages
 TNM Classification
T (extent of primary tumor)
TX – cannot be adequately assessed
TO – no evidence of primary tumor
TIS – Tumor in situ – localized; no
spread
T1- 4 progressive increase in size
1:5 cm < 2:6-9 cm
3:10-15 cm 4:15 cm >
N (regional Lymph Node)
Nx – cannot be assessed clinically
NO – no evidence of regular node
metastasis
N1 – 4 increasing involvement of nodes
 Stages
0 – benign state
I – spread to nearby tissue
II – 2-5 cm sometimes involve lymph
III – more than 5 cm spread –
advanced spread to connective
tissue.
IV - Mestastasis
Types of Metastasis
 Extension & Invasion
1. Lymphatic Spread
2. Seeding of body cavities & surfaces
3. Hematogenous spread
ETIOLOGIC FACTORS (Carcinogens)
1. Viruses
2. Chemical carcinogens
3. Physical agents
4. Hormones
5. Genetics
Viruses
 “oncogenic viruses”
 Prolonged or frequent viral infections may cause
breakdown of the immune system or overwhelm
the immune system.
Chemical carcinogens
 act by causing cell mutation or alteration in cell
enzymes and proteins
 E.g.
1. Industrial compounds – vinyl chloride,
polycyclic aromatic hydrocarbons,
fertilizers, weed killers, dyes, drugs
2. Hormones – estrogen, diethylstilbestrol
(DES)
3. Foods, preservatives – nitrites, talc,
food sweeteners, nitrosomines,
aflatoxins, polycyclic hydrocarbons
Physical agents
1. Radiation – x-ray or radioactive
isotopes, sunlight/UV rays
2. Physical irritation or trauma – pipe
smoking, multiple deliveries, jagged
tooth, irritation of the tongue, “overuse
of any organ/body part”
Hormones
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 estrogen as replacement therapy increases
incidence of vaginal and cervical
adenocarcinoma
Genetics
 oncogene → when exposed to carcinogens →
changes in cell structure → becomes malignant
PREDISPOSING FACTORS
1. Age – older individuals are more prone to cancer
2. Sex – women (more prone to breast, uterus and
cervical cancer) while men (prostate and lung
cancer)
3. Urban vs. Rural residence – cancer is more
common among urban dwellers
4. Geographic distribution – due to influence of
environmental factors such as national diet,
ethnic customs, type of solutions.
5. Occupation
6. Heredity – greater risk with positive familial
history
7. Stress – depression, grief, anger, aggression,
despair of life stresses
8. Precancerous lesions – may undergo
transformation cancer lesions and tumors
9. Obesity – studies have linked obesity to breast
and colorectal cancer
ASSESSMENT
1. NURSING HISTORY
2. PHYSICAL ASSESSMENT
3. DIAGNOSIS ASSESSMENT
NURSING HISTORY
 any previous exposure to known or
suspected risk factor
 health history
 lifestyle
 familial history
PHYSICAL ASSESSMENT
a. Identify WARNING SIGNAL OF CANCER
C- change in bladder and bowel habits
A- a sore that does not heal
U- unusual bleeding or discharges
T- thickening or lump in the breast
I- Indigestion and difficulty in swallowing
O- overt changes in wart or mole
N- nagging cough and hoarseness of voice
b. Implement SAFEGUARD AGAINST CANCER
BASIC. Annual physical exam and blood
examination.
 SKIN. Avoid overexposure to sunlight.
 ORAL. Annual oral examination.
 BREAST. Monthly BSE from age 20.
 COLON. Digital rectal exam for
persons over age 40. Rectal biopsy and
proctoscopic examination, Guaiac stool
exam for persons age 50 and above.
 UTERUS. Annual Pap’s smear from
age 40.
 LUNGS. Avoid cigarette smoking;
annual chest x-ray
c. Identify classification of cancer according to type of
tissue evolve from.
- carcinoma or sarcoma
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d. Identify systemic effects TREATMENT MODALITIES

1. Anorexia, weakness, weight loss, muscle  SURGERY
wasting.
2. Metabolic disturbances  RADIATION
3. Fluid and electrolyte imbalances  BONE MARROW TRANSPLANTATION
4. Pain  CHEMOTHERAPY
5. Hormonial imbalances
e. Assist in diagnostic test
 BIOLOGIC RESPONSE MODIFIER
SURGERY
DIAGNOSIS ASSESSMENT
Often the primary treatment for CA and may be
A. TISSUES SAMPLING performed for various purposes.
B. IMAGING TECHNIQUES  May be
C. LABORATORY STUDIES 1. Preventive
D. ROUTINE LAB EXAMS 2. Diagnostic
TISSUES SAMPLING 3. Curative
1. Exfoliative cytology – used to study cells that the 4. Palliative
body has shed during the normal sequence of RADIATION
body tissue growth and development  Often high energy ionizing radiation to treat
2. Biopsy – surgical removal of a piece of tissue for tumors
microscopic examination. The most definitive  Used to kill the tumor, reduce the tumor size,
method for diagnosing CA relieve obstruction or decrease pain, causes
3 KINDS: lethal injury to DNA, so it can destroy rapidly
a. Needle biopsy – cells are aspirated multiplying CA cells as well as normal cells e.g.
through placed in the tissue x–rays, gamma rays & radioactive particles
b. Incisional biopsy – removing or taking THREE SAFETY PRINCIPLES :
a small sample out of tissues mass  Time – refers to the length of exposure minimize
c. Excisional biopsy – involves removal time spent in close proximity to the radiation
all of the know tumor source (30 mins in 8 hr. shift)
IMAGING TECHNIQUES  Distance – minimum distance of 6 ft., from the
 DIRECT VISUALIZATION radiation source
 INDIRECT VISUALIZATION  Shielding - use lead shields and other precautions
DIRECT VISUALIZATION to reduce exposure to radiation
involves introduction of fiber optic endoscopy tubes into SOURCES
hollow organs to view internal surfaces  EXTERNAL (Teletherapy)
1. Bronchoscopy Esophagoscopy  INTERNAL (Brachytherapy – sealed)
2. Gastroscopy SOURCES OF INTERNAL RADIATION :
3. Sigmoidoscopy  Implanted into affected tissue or body cavity
4. Colonoscopy  Ingested as a solution, ingested as solution
INDIRECT VISUALIZATION  Injected as a solution into the bloodstream or
includes radiological and imaging test body cavity
1. Mammography  Introduced thru a catheter into the tumor
2. Barium enema  Sealed – involves temporarily
3. BSE implanting sealed applicators that
4. GI SERIES contain radioactive substance into
5. Computed Tomography various organs of the body
6. MRI  Unsealed – involves the administration
7. Radioisotope studies of isotopes orally or by injection
8. Ultrasound SIDE EFFECTS :
LABORATORY STUDIES  Alopecia
TUMOR MARKERS 1. Wear wig, hat, bonnet, bandana, scarf
 Biochemical substance synthesized and release or anything that could be worn as a
by tumor cell head dress.
2. Inform patient that hair will eventually
1. Oncofetal antigen grow back after chemotherapy.
2. Hormones  Skin reactions (erythema, dry/moist
3. Isoenzymes desquamation)
4. Tissue 1. Observe for early signs of skin reaction
ROUTINE LAB EXAMS and report.
E.g. ALT, CBC, BILIRUBIN, bleeding time, HCG, 2. Keep area dry.

3. Wash area with WATER ONLY and
pat dry.
4. Do not apply ointments, powders or
lotions.
5. Do not apply heat, avoid direct
sunshine or cold.
6. Use soft cotton fabrics for clothing.
7. Do not erase markings on the skin.
These serve as guide for areas of
irradiation.
 Infection
1. Monitor blood counts weekly.
2. Good personal hygiene, nutrition and
adequate rest.
3. Teach signs of infection to report to
physician.
 Hemorrhage
1. Monitor platelet count.
2. Avoid physical trauma or use of
aspirin.
3. Teach signs of hemorrhage.
4. Monitor stool and skin for signs of
hemorrhage.
5. Use direct pressure over injection sites
until bleeding stops.
 Fatigue
1. Plenty of rest and good nutrition.
 Weight loss due to anorexia, nausea and
vomiting
1. Arrange meal times
2. Encourage bland foods
3. Provide small attractive meals
4. Avoid extremes of temperature
5. Administer antiemetics as ordered
before meals
 Ulceration of oral mucosa (Stomatitis)
1. Administer analgesics before meals.
2. Bland diet
3. No smoking/alcohol
4. Good oral hygiene (saline rinses q2)
5. Sugarless lemon drops or mint to
increase salivation.
 Diarrhea
1. Encourage low residue, bland, high-
protein foods
2. Administer antidiarrheal drugs as
ordered
3. Provide good perineal care
4. Monitor electrolytes particularly Na, K,
Cl
 Anorexia, nausea and vomiting
1. Arrange meal times
2. Encourage bland foods
3. Provide small attractive meals
4. Avoid extremes of temperature
5. Administer antiemetics as ordered
before meals
 Headache
 Social isolation
BONE MARROW TRANSPLANTATION
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 It is used in the treatment of leukemia, in
conjunction with radiation or chemotherapy, it is
usually harvested from the iliac crest then
transfused intravenously.
TYPES :
1. Autologous – the client is infused with
own bone marrow harvested during
remission disease
2. Syngeneic – marrow donor is an
identical twin
3. Allogenic – the client is infused with
donor bone marrow harvested from a
healthy individual
SIDE EFFECTS :
1. Malnutrition
2. Infection related to immunosuppression
3. Thrombocytopenia
Nursing Mgt .
1. Provide private room for the
hospitalized client for 6 – 8 wks
2. Encourage contact with significant
others
3. Management of side effects
CHEMOTHERAPY
 Uses antineoplastic agents to treat CA cells
locally and systematically
 Provides palliative measure for the pt. Who has
widespread metastasis
 Disrupts the cell cycle in various phases,
interfering with cellular metabolism and
reproduction.
Cell kill hypothesis
 During each cycle a fixed percentage of cells are
killed by chemotherapy, leaving some tumor cells
remaining, this necessitates the repeated dosages
of chemotherapy in order to reduce the number
of cells, allowing the body’s immune system to
destroy any remaining tumor cells.
CONTRAINDICATIONS
 Infection
 Recent Surgery
 Impaired renal or hepatic function
 Recent radiation therapy
 Pregnancy
 Bone marrow depression
Safety precautions in handling chemotherapeutic agents
 All used and unused equipment and drugs
should be treated as hazardous wastes.
 Place contaminated material in leak proof labeled
as “hazardous waste.”
 Prepare chemotherapeutic agents in a private and
clean setting.
 Strict use of body protection techniques includes
gloves, garment with close front, cuffed long
sleeves, face shield and mask.
 Prevent spillage, use luer – lock fitting on
syringes and IV sets.
 Flush immediately with water if it comes in
contact with skin and mucous membranes.
5 MAJOR CATEGORIES
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 Alkylating agents Biotherapy

 Antimetabolites Involves replacing altered genes.
 Antitumor antibiotics DIETARY RECOMMENDATIONS AGAINST
 Hormones and hormones antagonists CANCER
 Vinca Alkaloids  Avoid obesity.
Nursing Interventions  Cut down on total fat intake
1. GI SYSTEM  Eat more high fiber foods – raw fruits and
 Nausea and vomiting - Administer vegetable, whole grain cereals.
antiemetics.  Include foods rich in Vitamin A & C in daily
diet.
 Diarrhea - Replace fluid – electrolyte  Include cruciferous vegetables in the diet
losses, low fiber diet.
(broccoli, cabbage, cauliflower, brussel sprouts)
 Constipation – Increase OFI and fiber  Be moderate in the consumption of alcoholic
in diet. beverages.
2. INTEGUMENTARY SYSTEM  Be moderate in the consumption of salt (cured,
 Pruritus, uriticaria – Provide good skin smoked and nitrate-cured foods).
care.
 Stomatitis – Provide oral care and
avoid hot and spicy food.
 Alopecia – Reassure that it is only
temporary and encourage to wear wigs,
hats or head scarf.
 Skin pigmentation – Inform that it is
temporary.
 Nail changes – Reassure that nails may
grow normally after chemotherapy.
3. HEMATOPOIETIC SYSTEM
 Anemia – Provide frequent rest periods.
 Neutropenia – Protect from infection
and avoid people with infection.
 Thrombocytopenia – Protect from
trauma and avoid ASA (Aspirin).
4. GENITO-URINARY SYSTEM
 Hemorrhagic cystitis – Provide 2 to 3 L
of fluids per day.
 Urine color changes – Reassure that it
is harmless.
5. REPRODUCTIVE SYSTEM
 Premature menopause or amenorrhea –
Reassure that menstruation resumes
after chemotherapy.
BIOLOGIC RESPONSE MODIFIER
 agents that make CA pts. Biologic response to the
tumor cell more effective.
1. Immunotherapy
2. Biotherapy
Immunotherapy
Stimulates the body’s natural immune system that restrict
and destroy CA cells
a. Nonspecific
b. Monoclonal antibody
c. Cytokines - substance that immune
system cells produce to enhance the
immune system, normal growth
regulating molecules possessing anti
tumor abilities
a. Interleukin - 2(IL-2)
b. Interferons
c. Hematopoietic growth factors