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
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.
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