Neoplastic Diseases

Revision

Cell division:

I

P

M

A

T

Cells divide for a number of reasons such as growth, repair,

healing, replacement and reproduction.

Cell differentiation: the process whereby cells are transformed

into more specialised cell types as they proliferate.

Normal Cellular Differentiation

Cell Division (Revision )

There are three types of cells in this regard:

Labile cells that continue to divide and multiply

throughout life such as GIT cells.

Stable cells which only multiply under certain

circumstances such as nerve and heart cells.

Permanent cells which do not have the ability to

divide such as the brain.

Definitions

Pathology:

General pathology:

Anatomical:

Histopathology: examination of tissues

Cytopathology: pathology on the cellular level

Molecular pathology: molecular level

Clinical : laboratory analysis and investigation

Oncology

Autopsy

Post mortem

Biopsy

Definitions

Anaplasia: irreversible lack of differentiation

Hyperplasia: increase in volume and number of cells

Dysplasia: abnormality in maturation, shape and size

Metaplasia: reversible conversion of cell type

Neoplasia: abnormal (proliferation) cell growth

Definitions

Anisocytosis: unequal sizes of cells

Poikilocytosis: abnormality in shape (of the

cell)

Apoptosis: programmed cell death (suicide)

Definitions

Tumour: swelling (a sign of inflammation)

Tumour:

Benign

Malignant

Cancer

Carcinoma

Precancerous

Definitions

Neoplasia: (Greek=new formation)

development of abnormal cell growth that is

unresponsive to normal control mechanisms

Neoplasm: a group of neoplastic cells.

Benign: will not invade surrounding tissue

Malignant: will grow by invading surrounding tissue

Neoplasms

Neoplasms are composed of two tissue

types:

Parenchymal cells, the functional components

Supporting tissue (stroma), consisting of

connective tissue, blood vessels and lymph

Cancer

A group of more than 200 diseases that are

characterised by abnormal and uncontrolled cell

growth

Carcinos

Facts about Cancer

Major health problem

Diseases of all:

ages

ethnicities

Aging: 4 x more

Incidence rate is increasing

Higher in men (generally)

Maori have higher incidence rate and mortality rate

Certain risk factors have been identified and can be reduced or

eliminated

Nursing Roles

Identify risk factorsRecognise warning signsAssist in the line of cancer management and

medication administrationDischarge plan and long term follow upHealth promotion and educational strategies to

assist individuals to be able to: recognise and eliminate risk factors comply with cancer management approaches cope with the effects of cancer and related

interventions

General manifestations of cancer

Local effects Obstruction Bleeding Pain

Systemic effects Tiredness Anaemia Weight loss Fever Loss of appetite Organomegally

Biology of Cancer

Defective proliferation Stem cells Cellular proliferation= cellular degeneration Contact inhibition

Boundaries Apoptosis Identification of damage Cell repair Loss of cell-to-cell communication Expression of tissue antigens

Defective differenation Protoonconogenes Tumour suppressor genes Immaturity –maturity

ONCE THE CELL HAS MUTATED

Cellular suicide

Identification of damage

Death due to damage

Repair

Survival of the damaged cell

Ability to pass the damage to daughter cells

Benign and Malignant Tumours

Metastasis

The development of a secondary tumor at a location distant from the primary tumor Lymph:

Tumor cells lodge in regional lymph nodes that receive drainage from a tumor site. Lymph empties into venous circulation

Blood Venous blood carries tumor cells around the body. Blood from G.I, pancreas and spleen is routed through the portal vein to the liver before entering normal circulation. Liver cancer. 

Metastasis

To metastasise, a cancer cell must:

Break loose from primary tumor

Gain access to a blood vessel

Survive its passage in the blood stream

Emerge at a favourable site

Invade new tissue

Grow

Carcinogens

Are agents that can cause cancer.Carcinogens may be:

Viral HIV EBV HBC

Chemicals Smoking Drugs Asbestos

Radiation Genetic anomalies

Classification

AnatomicalHistological

Appearance and differentiation Dysplasia Anaplasia

Staging: Stage (0 – iv) TNM

T: tumour size and invasiveness N: regional lymph nodes M: metastasis

Classification

Warning Signs

Abnormal bleedingAbnormal dischargeAbnormal skin lesions or spotsAbnormal pigmentationAbnormal and unplanned weight lossAlteration in bowl motionAbnormal lumps or massesRapid growing lesions or massesUnexplained fever, depression, pain and loss of appetiteUnusual tiredness, anaemia and neurological deficits

including cognitive changes

Caution

Change in bowl and bladder habit

A lesion that does not heal

Unusual bleeding or discharge

Thickening, mass or lump

Indigestion or difficulty in swallowing

Obvious change in a mole or wart

Nagging cough and voice change

Investigation

CytologyBiopsyRadiology:

X-ray Mammography Ultrasound CT scan PET

CBCBone marrow examinationLFTEndoscopy

Treatment

Chemotherapy is the administration of drugs to kill cells or prevent mitotic division. Severe side effects: fatigue, anaemia, bleeding, infection, nausea

and vomiting, hair loss, etc. RadiationSurgery

Surgery is curative if the tumor is localised, has not metastasised or invaded major organs

Hormonal (e.g. tamoxifen)RehabilitationPsychotherapy

Peer group support Survival stories and support Online communities

Chemotherapy

Preparation

Methods and routs of administration

Intravenous

Vesicant

CVAD

Oral

Regional:

Intrarterial

Intraperitoneal

Intrathecal

Intravesical

Extravasation Injury due to infiltration

Radiation

The use of radiation to kill cancer cells. This

will also kill normal cells.

Radiation can be:

External

internal

Scarring can lead to a loss of normal organ function

Post Radiation Skin Changes

Cancer Complications

MalnutritionCachexia Taste alterationInfectionObstructionCompression BleedingDepressionSuicidal attacksTumour lyses syndromeHormonal imbalances

TLS

Hyperuricemia

Hyperphosphatemia

Hypocalcaemia

Hyperkalaemia

CANCER PAIN

Intractable pain

Advanced and terminal cases

Management

Ethical and lawful aspects

Potent analgesia

Palliative care

Preventive Measures

Reduce alcoholExercise regularlyMaintain healthy weightSmoking cessationHealthy foodRegular doctor visitRegular screeningUse sunscreenSeek advise

Common Neoplasms

Lung cancer

Cervical cancer

Prostate cancer

Breast cancer

Bowel cancer

Pancreatic cancer

Ovarian cancer

Melanoma and other skin cancer

Skin Tumour

http://www.freshstart.org/OurStories/EleanorsStory.aspx

Strawberry Angioma

Skin Tumours

Skin Tumours

Skin Tumours

Skin Tumours

Skin Tumours

Skin Tumours

Huang Chuncais, better known as the ‘Chinese Elephant Man

Skin Tumours

Melanoma

Melanoma

Basal Cell Carcinoma

Squamous Cell Carcinoma

References

Brown, D. & Edwards, H. (Eds). (2012). Lewis’s medical-surgical nursing: Assessment &management of clinical problems (2nd ed). Sydney, Australia: Elsevier-Mosby.

Craft, J., Gordon, K. L., & Tiziani, A. (2011). Understanding Pathophysiology. Sydney, Australia: Elsevier-Mosby.

Encyclopædia Britannica. (2010). Permanent, labile and stable cells. Retrieved April 20, 2012, from http://www.britannica.com/EBchecked/topic/452210/permanent-cell

Gates, R., & Fink, R. (2008). Oncology nursing secrets. St. Louis, Mo: Mosby Elsevier.

McArdle, O. (2008). Oncology : An illustrated colour text. Edinburgh New York: Elsevier Churchill Livingstone.