CELLULAR ABERRATION

SYSTEMIC EFFECT LEUKOCYTOSIS..

WBCS ARE EITHER GRANULOCYTES (NEUTROPHILS) OR AGRANULOCYTOSIS
(MACROPHAGES)
2 TYPES OF LYMPHOCYTES: T & B
3 TYPES OF T LYMPHOCYTES (THYMUS): CD4, CD8 T & SUPPRESSOR T CELLS;
2 TYPES OF B LYMPHOCYTES (SPLEEN): PLASMA B CELL & MEMORY B CELLS
AT * If a cell membrane touch another cell membrane it wi
stop replication *
e cells will multiply mitotic +++ times
Hair cells are constant +++
s +++
+++

es cells will only have one cell cycle

estriction phase (will /will not divide)

phase (Synthetic phase ) will decide to reproduce self
Will replicate 23 pairs chromosomes
To create an identical twin
Gap 2
Has to be at mature level G2 to reproduce
If interrupted during division will not happen
If you block S-phase it will not divide

hase = thickening of chromatins

aphase = spindle formation
phase = separation of chromosomes
phase = separation of cells
 Adaptive cellular growth and proliferation
HYPERTROPHY- INCREASE IN STRUCTURAL PORTION OF THE CELL WITHOUT ^ NUMBER OF THE CELL JUST
LARGE CELLS
EX: CHRONIC HTN INCREASED NEED INCREASE SIZE OF HEART = CARDIOMEGALY / LARGE MUSCLES =
WEIGHT LIFTING

HYPERPLASIA - THE INCREASE IN THE NUMBER OF CELLS WITHOUT THE INCREASE OF THE STRUCTURAL
NOT THE SIZE PORTION
^ MAMMARY GLAND DURING LACTATION,
WBC = INFECTION
GOITER - HYPERPLASIA OF THYROID CELL DURING IODINE DEFICIENCY

ATROPHY - BODY TISSUE WASTING AWAY = PARALIZED PT = CELLS SHRINK

METAPLASIA - ONE ADULT (CAPABLE TO REPRODUCE =MATURE) CELL TYPE IS REPLACED BY ANOTHER CELL
SMOKER KILL COLUMNAR CELL & IT'S REPLACED WITH STRATIFIED CELL WITHOUT CILIA; PROECTIVE
WORKING WITH HANDS AND CALLUSES = METAPLASIA

DYSPLASIA - NEW SET OF CELLS DOESN'T LOOK LIKE PARENT OR ORIGINAL CELL THESE ARE USUALLY
MATURE CELLS BUT MUTATED LESS DIFFERENTATED = THE REPLACEMENT CELLS ARE DIFFERENT
EX: KELOIDS

ANAPLASIA - DOESN'T LOOK LIKE NORMAL CELLS, IMMATURE & MORE SUSCEPTIBLE TO CA DONT FOLLOW
 PATHOPHYSIOLOGY OF NEOPLASM
MALIGNANT NEOPLASMS = CANCERS = ONCOLOGY.
PRIOR TO THE ABNORMAL GROWTH OF TISSUE, AS NEOPLASIA, CELLS OFTEN UNDERGO AN ABNORMAL PATTERN OF
GROWTH, SUCH AS METAPLASIA OR DYSPLASIA.
HOWEVER, METAPLASIA OR DYSPLASIA DOES NOT ALWAYS PROGRESS TO NEOPLASIA.

ALL LIVING CELLS HAVE CAPACITY TO MULTIPLY

REGULATION OF THIS MULTIPLICATION/REPRODUCTION = CELLULAR BRAKE (CONTACT INHABITION)
BRAKE = NO OVERGROWTH
CELLS ARE INJURED = FEEDBACK = RELEASE OF BRAKE
NEOPLASM = ABNORMAL RELEASE OF THE CELLULAR BRAKE
TUMOR CELLS DONT GROW FASTER THAN NORMAL = DIVISION IS FASTER B/F TUMOR FOUND HAS TO BE 1CM
= 27 DUBBINGS = 1 BILLION CANCER CELLS

SPONGE = SWOLLOWED FOR SAMPLE OF TISSUE IN THROAT = CANCER CELLS

CANCER = FAILS TO OBEY NORMAL BIO CONTROL OVER CELL PROLIFERATION
Mitotic action = cell growth
MALIGANT = FASTER / DOESNT LOOK LIKE ORIGIAL CELL
NO CAPSULE = INVADE ANY PART OF THE BODY
BENIGN = CELL LOOKS LIKE ORIGINAL CELL
WILMS TUMOR / BRAIN = PRESSURE
MUST REMOVE THE CAPSULE
Metastasis is the spread of a cancer or other disease from one organ
or part of the body to another without being directly connected with it.
The new occurrences of disease thus generated are referred to as metastases (mets).

Cancer occurs after a single cell in a tissue

is progressively genetically damaged to produce cells with uncontrolled proliferation.
This uncontrolled proliferation by mitosis produces a primary heterogeneic tumour.

The cells which constitute the tumor eventually undergo metaplasia, followed by dysplasia
then anaplasia, resulting in a malignant phenotype.

This malignancy allows for invasion into the circulation, followed by invasion to a second site
for
tumorigenesis.

Some cancer cells acquire the ability to penetrate the walls of lymphatic or blood vessels
, after which they are able to circulate through the bloodstream (circulating tumor cells
) to other sites and tissues in the body .

This process is known (respectively) as lymphatic or hematogenous spread.

After the tumor cells come to rest at another site, they re-penetrate the vessel or walls and con
tinue to multiply, eventually forming another clinically detectable
 CLASSIFICATION OF MALIGNANT
NEOPLASM ACCORDING TO CELLULAR
ORIGIN
CARCINOMAS = CANCER OF THE GLAND = PITUITARY CARCINOMA
SKIN AND LINING OF INTERNAL ORGANS

SARCOMAS = CONNECTIVE TISSUE EX. OSTEOSARCOMA = BONE CANCER

COLIN CANCER = KAPOSI SARCOMAS= MALIGNANT TUMOR OF CONNECTIVE TISSUE OR
OTHER NON-EPITHELIAL TISSUE

LYMPHOMAS = CANCER OF LYMPH NODES/ NON HODGKIN LYMPHOMA

LEUKEMIA = CANCER OF THE BLOOD
 US!!!
Unexplained
anemia
Sudden weight
loss
Women = BSE = check breast 7-10 days from the start of their period
Men = TSE = check testis warm shower
NO MORE THAN 3 BM A DAY = DIARRHEA
+ BLEEDING AFTER SEX = CERICAL CANCER

MOST DEATHS = LUNG

MOST CANCER = BREAST
 7 SAFEGUARDS AGAINST CANCER

B-REAST = MONTHLY BSE (2 NDARY DETECTION)

O-RAL = ANNUAL ORAL EXAM (1 OR 2X A YEAR)

L-UNGS = ANNUAL CXR (SMOKING CESSATION)
S-KIN = AVOID OVEREXPOSURE TO UVR
(SKIN CANCER SPF15 / WATERPROOF = BS)

O-VARY/UTERUS = ANNUAL PAP SMEAR = SEXUALLY ACTIVE OR +++PARTNERS 3YEARS RESULTS = CAN DO IT
EVERY 3YEARS
60+ YRS OLD NO PAP EVERY YEAR

B-LOOD = ANNUAL PE AND BLOOD WORK-UP

 CLINICAL STAGING FOR CANCER
TNM SYSTEM
Metastasis
T-PRIMARY TUMOR MO = No evidence of distant
N-REGIONAL LYMPH NODES metastasis
M1 M2 M3 M4 = Ascending
M-DISTANT METASTASES degrees of metastatic
involvement of the HOST

umor clinically
ioma in situ (situ is early cancer & localize/not spread)
T4 = Ascending degrees of increase in tumor size and involvem
worst)

egional node involvement

onal lymph nodes cannot be assessed clinically
N4 = Ascending degrees of node involvement
 INTERVENTIONS FOR CANCER:
SURGICAL INTERVENTION
PREVENTIVE
REMOVAL OF TISSUE SUSCEPTIBLE TO CANCER
EX. DOUBLE MASTECTOMY BC GENETICS
DIAGNOSTIC
BIOPSY/ LIVER BIOPSY / LUNG BIOPSY/ 1CM = SEEN ON XRAY
CURATIVE
REMOVAL OF TUMOR = BREAST CANCER = KIDNEY TUMOR (WILMS
TUMOR = REMOVE KIDNEY)
MASTECTOMY
TAHBSO (TOTAL ABDOMINAL HYSTERECTOMY WITH BILATERAL
SALPINGO OOPHORECTOMY)
RECONSTRUCTIVE
BREAST (MAMMOPLASTY) ORAL CANCER = PALET/ NOSE=RINOPLASTY
PALLIATIVE
SURGERY TO RELIEVE SYMPTOMS (STAGE 4 CANCER) NOT TO CURE
 3 POSSIBLE CAUSES OF CANCER

OVER USE +++SEX

NOT USED NUN / NEVER HAD CHILDREN
MISS USED ANAL SEX / NOT DESIGNED
FOR THAT
 RADIATION THERAPY
Ovarian cancer = Sometimes
removal of the ovary radiation and
= done chemo given
before surgery and
Uterine/ Cervical after
Cancer= no surgery
first = radio therpy
will put chemo on the
cervix or inside the
uterus

Breast cancer =
surgery/lumpectomy
 RADIATION THERAPY
Electromagnetic = shorter but more diffused = whole body
affected body = must be close.
X-ray (cobalt 60) must be close to it
Gamma Ray (radium)

Particulate= snipper more direct (One Part) longer but

narrower doesn't affect whole body
Alpha = can be further away
Beta
 RADIOTHERPY ACCORDING TO SOURCE

EXTERNAL = MACHINES OUTSIDE OF BODY

Teletherapy
=TELETHERAPY
BETATRON
LINEAR ACCELERATION
INTERNAL = INSIDE THE BODY = BRACHYTHERAPY
SEALED SOURCE
INTRACAVITARY = IMPLANT = STOMACH
Brachytherapy
INTERSTITIAL = IMPLANT = INTO TUMOR OR NEXT TO IT
125 IODINE
137 CESIUM
198 GOLD
UNSEALED SOURCE 32P NAPO4 = IV
 EXTERNAL BEAM THERAPY
(TELETHERAPY)
EXTERNAL BEAM RADIATION THERAPY IS RADIATION DELIVERED FROM A
DISTANT SOURCE, FROM OUTSIDE THE BODY AND DIRECT AT THE PT CANCER
SITE.

COLBALT 60
 INTERNAL RADIATION THERAPY
(BRACHYTHERAPY)
Radiation close as possible
to tumor site/inside

Raduiactuve siyrces or
isotopes = wires/seeds (or
molds)/rods

Treats
cervix
Intracavitary
application
uterus
Prostate cancer vagina
Clogged arteries rectum
eye
 PRINCIPLE OF RADIATION
PROTECTION
DISTANCE
ONE STEP FORWARD = DOUBLE RADIATION = PT AWAY FROM
NURSES DESK
TIME
CAN NOT STAY INSIDE THE ROOM FOR LONGER THAN 30 MIN
LONGER THAN 30 = YOU GET RADIATED
PLAN BEFORE ENTERING AND COMPLETE EVERYTHING AT ONCE
AND FAST
SHIELDING
PROPER SHIELDING = LEAD GOWN = PROTECTION FROM RADIATION
NURSE SHOULD WEAR DOSIMETERS AND MEASURES THE AMOUNT OF
RAD YOU HAVE BEEN EXPOSED TO
 SIDE EFFECTS OF RADIOTHERAPY
SKIN TOXICOSIS = BURNED SKIN / LOOK LIKE SUNBURN = LOOSE CLOTHES /
COTTON / BREATHABLE ***DONT PUT ANY LOTION/POWER ETC***
IRRADIATION OF GI-TRACT = N/V, GI UPSET PARITAL CELLS OF GI TRACT,
MEDS: ZOFRAN, BLAND FOOD, NO HOT/COLD FOODS NO SEVERE TEMPS =
SMALL MEALS
MUSOSITIS = MOUTH IS RAW = NO SEVERE TEMPS , BLAND, SOFT
TOOTHBRUSH
MYELOSUPPRESSION = BONE MARROW SUPPRESSION = ****LIMIT
VISITORS!!! REVERSE ISOLATION, NO FRUIT OR FLOWERS + REST = < O2
****
PERMANENT DAMAGE TO VITAL ORGANS = REPRODUCTIVE ORGANS =
OVERY/TESTIS
STERILITY = REPRODUCTIVE ORGANS = SPERM BANKING/EGG
 WHAT IS CHEMOTHERAPY
CHEMO = TREATING CANCER= IV OR ORAL
DISRUPT THE CELL CYCLE = DEATH OF THE CELL/CELL
CYCLE
STOPS THE CELL FROM PROLIFERATION AND THE CELL DIES
UNFORTUNATELY
CHEMO ALSO KILLS GOOD CELLS
KILLS HEALTHY CELLS = HAIR LOSS AND NAILS
CAN NOT KILL JUST ONE TYPE OF CELL = CANT TELL
WHICH CELL IS CANCER
****NERVES NOT AFFECTED B/C IT ONLY HAS ONE CELL
CYCLE****
 CHEMOTHERAPY
CELL CYCLE SPECIFIC (CCS) = ***BLOCKS A CELL CYCLE***
PLANT ALKALOIDS = INHIBITS METAPHASE
EX. VINCRISTINE, VINBLASTINE = PLANTS VINE

Anti-metabolites antitumor activity on S=phase =

blocks DNA
EX. Methotrexate, arobinosyl cytosine
Cell cycle nonspecific (CCNS)
ALKYLATION AGENTS - INTERFERE WITH DNA STRUTURE
EX. CYTOXAN
ANTI-TUMOR ANTIBIOTICS BINDS WITH DNA TO PRVENT
MULTIPLICATION
EX. ACTINOMYCIN
 INFECTION=TREAT CONTRAINDICATION FOR
1ST
CHEMO
CHEMO SIDE EFFECTS
RECENT SURGERY=
SUPPRESION OF
IMMUNO SUPRESSED
HEMOTOPOIESIS
IMPAIRED HEPATIC N/V= b/c toxins from cell
AST/ALT/LDH destruction
RENAL FUNTION= GONADAL ATROPHY=save
CREATININE / GFR
sperm
INTERSTITIAL
RECENT RADIATION PNEUMONTIS AND PUL
THERAPY = HAVE TO FIBROSIS
WAIT 4-6WEEKS FOR RENAL / BLADDER
CHEMO TOXICITY ^fluid
PREGNANCY = ALOPECIA = will grow
WAIT/ABORT back/wig
ALLERGIC REATIONS =
 SPECIFIC NURSING INTERVENTIONS FOR
CHEMOTHERAPEUTIC
GI-TRACT = ZOFRAN/ CRACKERS/ ^CAL DIET
INTERGUMENTARY SYSTEM SIDE EFFECTS
PRUTUS / URTICARIA = SKIN WILL BE DRY, TOXINS OUT THROUGH SKIN PORES = WASH SKIN
OFF + NO POWER/LOTION
STOMATISITS = NO FOOD WITH SPICE/ ^TEMP / SOFT TOOTHBRUSH
ALOPECIA, SKIN PIGMENTATION. NAIL CHANGES (KOILONYCHIA / BEAUS LINES/ CLUBBING)=
WILL COME BACK
HEMATOPOETIC SYSTEM
ANEMIA = DEPRESS REPRODUCTION / REST = HYPOXIA + O2
NEUTROPENIA =
THROMBOCYTOPENIA = BLEEDING PROCAUSIONS / INR / DONT STICK / ELECTIC RAZOR /
MOUTH / NOSE /URINE/STOOL
GENITO-URINARY SYSTEM
HEMORRHAGIC CYSTITIS = URINE /^FLUID INTAKE

REPRODUCTIVE SYSTEM
AMENORRHEA, PREMATURE MENOPAUSE = PREMATURE MENOPAUSAL
IMPOTENCY = NO SINGING /

NEUROLOGIC SYSTEM
 IMMUNE STIMULANTS AND
IMMUNOTHERAPHY
PASSIVE IMMUNOTHERAPHY = YOUR BODY WAS GIVEN
ACTIVE IMMUNOTHERAPHY = 2 WEEKS TO PRODUCE YOUR OWN
ANTIBODIES
ACTIVE NON-SPECIFIC = STIMULATE IMMUNE RESPONSE
ACTIVE SPECIFIC
AUTOLOGOUS VACCINE = MAKE A VAC FROM MY TUMOR TO FIGHT
IF COMES AGAIN
ALLOGENEIC VACCINE = TUMOR CELL VACCINE
LIVE ATTENUATED TUMOR CELLS = CELLS WEAKEN IN LAB AND VAC
MADE (HPV)
ADAPTIVE IMMUNOTHERAPHY
 PAPS SMEAR
Test for cervical
cancer
18
Sexually active
Been sexually active
Some Dr. think dont
need one
65+ Inconclusive :
Class I = normal Normal pap 3yrs dont need
ASC-US = Atypical squ
every year
HPV repeat 12m cell
Class II = inflammation = repeat pap in 3months
Abnormal :
Class III = mild to mod dysplasia = repeat pap LSIL- Low Grade
6weeks-3months Squamous
intraepithelial lesion
Class IV = possible cancer = biopsy asap
HSIL-High Grade
 BETHESDA SYSTEM 2001
NORMAL= NOT LIKELY FOR CANCER
INCONCLUSIVE :
ASC-US = ATYPICAL SQUAMOUS CELL= UNKNOWN SIGNIFICANCE = NOT
NORMAL/NOT ABNORMAL EITHER. FOLLOWED UP WITH DNA TESTING TO IDENTIFY
HIGH RISK INFECTION WITH HPV= REPEAT PAP

ABNORMAL :
LSIL- LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION = FREQUENTLY DUE TO HPV,
^RISK FOR CERVICAL CANCER, FOLLOWED UP WITH DNA TESTING TO IDENTIFY HIGH
RISK INFECTION WITH HPV

HSIL-HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION = VERY ATYPICAL CELLS

THAT MAY RESULT IN CANCER

TERMS TO IDENTIFY TYPES OF CANCER

SQUAMOUS CELL CARCINOMA OR ADENOCARCINOMA :
 CERVICAL CANCER
HPV / HIV / Chlamydia / +++partners /
unprotected
Use of DES = diethylstilbestrol =
miscarriage drug
TX= cryo therapy / brachytherapy
 HODGKINS LYMPHOMA
IS A CANCER OF THE LYMPHATIC SYSTEM
CELLS IN THE LYMPHATIC SYSTEM GROW ABNORMALLY AND MAY SPREAD BEYOND
THE LYMPHATIC SYSTEM.
AS HL PROGRESSES, IT COMPROMISES YOUR BODY'S ABILITY TO FIGHT
INFECTION.
@ ANY AGE MOSTLY YOUNG ADULTS AND PAINLESS LYMPHADENOPATHY
- (+) REED-STERNBERG CELLS TX: CHEMO / RADIATION
MALES+
CERVICAL NODES 60% (NECK)
AXILLARY 10-15% (ARMPITS)
INGUINAL NODES 6-12% (GROWNING)
SPLENOMEGALY 50% B/C B LYMPHOCYTES WILL
FILTER THROUGH
S/S NIGHT SWEATS/UNEXPLAINED FEVER
WEIGHT LOSS / TIREDNESS
COUGH / BREATHLESSNESS
PERSISTENT ITCH ALL OVER
LUNG
COLORECTIAL CANCER

TRIGGERS:
IBS
Ulcerative colitis
Crones disease

 COMMON ESOPHAGEAL CANCER

How to detect:
sponge
Early detection
COMMON SITES OF LIVER CANCER
 TESTICULAR CANCER
18-40 YEARS OLD WHITE MALES
UNDESCENDED TESTI
FAMILY HISTORY
TSE HOW WARM SHOWER
PAINLESS LUMP
*** REMOVE TESTI ***
+ NODULES
 BREAST CANCER SYSPTOMS

0180718035
Painless lump
Changes in breast size/shape
Swelling in armpit (lymph nodes)
Nipple changes/discharge
Get pt in office for testing
Pain in breast (not common)
SELF EXAM
7-10 DAYS FROM 1ST DAY OF
PERIOD
SAME DAY EACH MONTH IF
MENOPAUSAL

MOST LUMPS FOUND IN THE TALE

OF SPENCE

A DIMPLING OF THE BREAST SKIN

THAT LOOKS LIKE AN ORANGE
PEEL (PEAU D'ORANGE) = MOST
LIKELY CANCER
 Needle biopsy
taking small tissue
BIOPSY sample
part or entire lump
AND STAGING
Results =
Staging cancer/benign
How big Type of cancer
Spreading
Staging 0-4
Localized/invaded lymph/organs

Stage 4 = cancer in distant sites

Bone
Liver
Lungs
brain
 BREAST CANCER SURGERY
LUMPECTOMY (BREAST CONSERVATION SURGERY)
TAKING OUT THE AREA AROUND THE LUMP
MASTECTOMY
REMOVE THE ENTIRE BREAST
TX FOR CANCER:
CHEMO
RADIATION
OSTEOSARCOMA
 APT
ALKALINE PHOSPHATASE TEST
ALKALINE PHOSPHATASE TEST
MEASURES AMOUNT OF ENZYME ALKALINE PHOSPHATASE IN BLOOD

IN MOST TISSUE = CONCENTRATED IN LIVER AND BONES

PARTICULARLY IN OSTEOBLAST = REFLECTS OSTEOPLASTIC ACTIVITY
CELLS AND CALCIUM ARE MOVING OUT OF THE BONES

AMOUNT IN BLOOD = HELPS DIAGNOSE LIVER AND BONE DISEASE

TEST RESULTS
ADULTS = 39-117 UNITS PER LITER (U/L)
^ = LIVER OR BONE DISEASE
< = ANEMIA OR GLANDULAR DISORDERS
 SKIN CANCER
MOST COMMON TYPES
BASAL CELL Malignant Basal cell
melanoma
SQUAMOUS CELL
MALIGNANT MELANOMA

ABCD RULE
A= ASYMETRICAL
B = BORDERS IRR
C = COLOR VARIES
D DIAMETER OF 6MM OR LARGER
Squamous cell
 THE END

HAPPY TESTING