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Oncology

The Study of Tumours and

their treatment

2/1/15 compiled by Isaac Amankwaa

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Outline of presentation

e!nitions Incidence of cancer

"eoplasm/tumours

Aetiology

"omenclature

#athophysiology

$arcinogenesis


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e!nitions

1.Oncology: study of tumors%

2.Neoplasm: an abnormal mass of tissue as a

result of neoplasia or cell multiplication%

3.Neoplasiais the abnormal proliferation of

cells

4. Cancer: A malignant growth% &elated terms'

malignant tumours ( neoplasms2/1/1

5 compiled by Isaac Amankwaa

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Terminologies

5.Anaplasia: cells that lack normal cellularcharacteristics%

6.Hyperplasia: an abnormal increase in

the number of cells

7.Metaplasia: transformation of one tissue

to another

8.ysplasia: an abnormality in

de)elopment2/1/15 compiled by Isaac Amankwaa

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Incidence

A leading cause of death worldwide*accounting for +%, million deaths

-.O* 200

A3ect all ethnic groups and all ages

common in the aged -abo)e ,5 yrs%

4ore men die of cancer than women%


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The 10 leading cancer types

-American $ancer Society* 2005


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Tumors'"eoplasms

e!nition

A neoplasm is an abnormal mass of tissue,the growth of which exceeds and is

uncoordinated with that of the normaltissues and persists in the same excessivemanner after cessation of the stimuli

which evoked the change - .illis


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Types of "eoplasm

There are two maor types'

6enign

4alignant neoplasm


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6enign Tumors

If cells LOOK GOOD, they are probably going to

BEHAVE GOOD2/1/15 compiled by Isaac Amankwaa

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4alignantTumors

If cells LOOK BAD, they are probably going toBEHAVE BAD2/1/15 compiled by Isaac Amankwaa

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4alignant tumors

Aka cancer

$ancer is deri)ed from

the 7reek word for crab

$ancers are e8amples

of tumors


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Aetiology /$arcinogens #hysical agents e%g% tobacco and

radiation

$hemicals e%g% Alcohol ( soot

7enetic factors

Infectious agents e%g% hepatitis 6*

ietary factors like fats ( red meat%

ormonal factors e%g% oral2/1/15 compiled by Isaac Amankwaa

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"aming Tumors' 6enignTumors

"amed according

to the tissues from

which they

originate and

include the su=8

oma

i%e% type of tissue

plus oma

Examples include:1% $hondroma' cartilaginoustumor

2% >ibroma; !brous tumor

9% Osteoma;bone tumor

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"aming of tumors'malignant

Sarcomas: mesenchymal tumor

chrondrosarcoma' cartilaginous tumor

!brosarcoma' !brous tumor osteosarcoma' bone tumor

Carcinomas: epithelial tumors

adenocarcinoma' gland forming tumor


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#athophysiology of cancer


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$haracteristics of Normal MaturedCells

$ells normally

di3erentiate* grow*

mature and di)ide%

These are regulated

processes* balanced

in a healthy system

such that cell birth is

nearly eBual to cell

death


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7enes In)ol)ed in cancer

de)elopment

Proto-oncogenes In normal cells

$ode for proteins in)ol)ed in the stimulus of

cell di)ision If altered* may formoncogenes

Alone* do not cause malignant cancer

&eBuire other mutations* including one in atumor suppressor gene


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de)elopment

umor Suppressor !enes

Stop cell growth and di)isionCpre)ent cancer formation

4ay pre)ent e8pression ofoncogenes


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de)elopment


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1% efecti)e cellular proliferation

Normal physiology

Stem cells proliferate and di3erentiate to

produce )arious cells of the body

A state of dynamic eBuilibrium maintained

#roliferation occurs only'

in cellular death

In increased physiologic need for more cells%


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1% efecti)e cellularproliferation

In the case cancer cells* there is'A% ?oss of Contact "nhi#ition

"ormal cells respect the boundaries of cells% This is

known as contact inhibition 4alignant cells ha)e no contact inhibition

6% &espond di3erently to the signals that regulate

the state of dynamic eBuilibrium

$ancer cells therefore di)ide indiscriminately

and may produce more than 2 cells at a time%


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2%$efecti%e cellular di&erentiation

Cellular di&erentiation

All 6ody cells deri)edfrom fertiliDed o)a -ST4$??

They ha)e potential todi3erentiate to performall body functions%

This potential is repressedby di3erentiation process

4atured cells onlyperform speci!cfunctions%


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2% $efecti%e cellulardi&erentiation

Proto-oncogenes "ormal genes that regulate cell growth

and di3erentiation

4ay become oncogenes by mutation

Oncogenes ha)e potential to causecancer

umor suppressor genes'

Tumor suppressor genes suppress growth%

4utations can turn these normalgenes into tumour inducing genes%


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$arcinogenesis


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$A&$I"O7"SIS

Tumor de)elopment goes through 9

stagesC

1% Initiation

2% #romotion

9% progression


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1%Initiation

Alteration of cellsE geneticstructure resulting from'

1% An inherited mutation

2% e8posure to carcinogens%

Altered cells mayde)elop into a

clone of neoplastic cells%


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#romotion $haracteriDed by re)ersible

proliferation of the altered cells%

Acti)ities of promoters -e%g% cigarettesmoking are re)ersible

Some carcinogens -$ompletecarcinogens are capable of initiatingand promoting cancer eg is cigarette

smoke% (atent Period:The period between

the initial genetic alteration and the

actual clinical e)idence2/1/15 compiled by Isaac Amankwaa

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#&O7&SSIO"The !nal stage of tumor

de)elopment

$haracteriDed by' Increased growth rate of the tumor*

increased in)asi)eness and

metastasis -spread of cancer to

distant organs%


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$haracteristics of cancercells


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$ancer cells are abnormal in theirgrowth and appearance


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$ancer cells undergometastasis


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Other characteristics of cancer cells

They lack di3erentiation

They ha)e abnormal nuclei

The cell membrane contains tumor;speci!c

antigens e%g% prostate speci!c antigen

-#SA

4alignant cells are less adhesi)e and donEt

adhere to adacent cells easily


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i3erence

Cancer Cells

1% "ondei3erentiated

2% Abnormal nuclei

9% o not undergoapoptosis

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Classi)cation of cancer

$lassi!ed according to

Anatomic sitehistology/grading

e8tent of disease/staging%


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*natomic site

Two classes identi!ed'

+'Carcinomasoriginate from

Ectoderm-skin and glands

Endoderm;mucus membranes lining 7IT* 7F tract (

&T

,'Sarcomas originate from mesoderm 'connecti)e tissue* muscles* bones

and fat


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!*$"N!: degree ofdi&erentiation

+'!*$E ":Mild dysplasia

$ells di3er slightly from normal cells

well di3erentiated%

,' !*$E "": moderate dysplasia

$ells more abnormal

moderately di3erentiated%


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!*$"N!: degree ofdi&erentiation

.' !*$E """: Se%ere dysplasia

$ells )ery abnormal

poorly di3erentiated%

/' !*$E "0 : *naplasia

$ells immature ( primiti)e

undi3erentiated%


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S*!"N!: Classi)cation #y extent ofdisease

"o uniBue staging system

Anatomic extent of the malignant disease

S*!E 1: $ancer in situ

S*!E ": Tumor localiDed to the tissue of origin

S*!E "": ?imited local spread

S*!E """: 8tensi)e local and regional spread

S*!E "0: 4etastasis


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STA7I"7' T"4 classi!cation

Fsed to determine the anatomic e8tent of the disease

Tumor;node;metastasis -T"4 system used for most cancers

6ased on three parameters'

+' umor si2e and in%asi%eness

,' N presence or a#sence of regional spread to lymph nodes

.' M metastasis to distant organ sites


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Primary umor 34

1 "o sign of primary

tumor

x Tumor canEt be found or

assessed

is $arcinoma in situ

+5 ,5 .5 /: Increasing siDe

and/or e8tension of primary tumor


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egional (ymph Nodes 3N4

N1 "o e)idence of tumor cells in regional

lymph nodes

Nx &egional lymph nodes cannot be

assessed

N+5 N,5 N.5 Increasing in)ol)ement of

regional lymph nodes2/1/15 compiled by Isaac Amankwaa

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$istant Metastasis 3M4

M1 "o distant metastasis

Mx istant metastasis cannot be

assessed

M+ istant metastasis


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$ommon manifestations of

cancer


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=*N"N! S"!NS >?C*NCE


h i d

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The acronym C*;">N is used

C@ change in bowel and bladder habit

*@ A sore that does not heal

;@ Fnusual bleeding or discharge

@Thickening lump in the breast or other

body parts

"@ Indigestion or di=culty in swallowing

>@Ob)ious change in wart or mole

N@ "agging cough or hoarseness


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$iagnosis ofCancer


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iagnosis may in)ol)e

1% ealth history

2% #hysical e8amination

9% Identi!cation of risk factors

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istory taking

family and personal

history of cancer*

e8posure or use ofcarcinogens

?ifestyle' e%g%

chronic alcohol

intake


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S i! di ti t di i l d

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Speci!c diagnostic studies include

1% Tissue biopsy/$ytology

study

2% $hest G;rays

9% $omplete blood count

luoroscopy

12%"uclear medicine

imaging


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7iopsy

The surgical remo)al of a small pieceof tissue to determine if the area iscancerous%

8amples of 6iopsies "eedle biopsy

Incisional biopsy

8cisional biopsy $urettage biopsy

ndoscopic biopsy


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"eedle 6iopsy

A needle is

inserted through

the skin to the

suspicious area

and cells aree8tracted


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6E*P"ES ;SE$ "NE*"N! C*NCES


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7oal for therapy1% $ure

2% control

9% palliation


Approaches used in cancer

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Approaches used in cancer

management

+' (ocal therapy Surgery

radiation therapy

,' Systemic treatment

chemotherapy% ormonal therapy%

4onoclonal antibodies%

&adioacti)e material

.' supporti%e care

/' non-con%entional therapy'


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Introduction

Ideal and commonly used method%

>irst modality used successfully in

the treatment of cancer%


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*"MS >? S;!EA

1% iagnosis

2%

#rimary method of treatment-curati)e

9% #alliation and reconstruction

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$iagnostic surgery

Obtaining tissue sample for

analysisof cells suspected to be

malignant%

This can be done through 7">PSA


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iagnostic surgery

The biopsy may be taken from the

actual tumour or from lymph nodes

near the suspicious tumour


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6iopsy types

They include'

Incisional biopsy

8cisional biopsy

"eedle biopsy

ndoscopic biopsy


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Incisional 6iopsy

small

portion oftissue isremo)ed

ande8amined


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Needle #iopsy

"eedle is usedto aspirate

Huid or tissues


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2% #rophylactic surgery

This is done to pre)ent the

de)elopment of cancer in people who

ha)e high risk of de)eloping cancer%

This may be due to family history and

genetic predisposition e%g% positi)e

7*C+or 7*C, !ndings


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9% P*(("*"0E S;!EA

This is done when cure is not possible

The surgery is performed to make

patient as comforta#leas possible

and promote uality of life'

The surgery relie)e complications of

cancer such as ulcerations and pain%


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NS;C"0ES;!EA

This normally follows curati)e or

radical surgery

Aim'

To impro)e function or obtain a

desirable cosmetic e3ect


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9'*#lati%e surgery

This may be undertaken to remo)ehormonal inHuences on tumour

growth through procedures such asoophorectomy5 adrenalectomyand orchidectomy


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' *$D;0*N 6E*PA

Fsed to remo)e residual mass in

radio or chemo;sensiti)e tumors


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Nursing management in cancersurgery

+' Pre-operati%e assessment Assess factors that may a3ect the

patient undergoing the surgicalprocedure


"ursing 4anagement

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"ursing 4anagementcontd

elie%ing anxiety

7i)e patient and family adeBuate

time to discuss possible changes and

outcomes

#ro)ide necessary information


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C6EM>6E*PA

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C6EM>6E*PA--C>N$

7oal of chemotherapy To reduce the number of cells to a small

number that can be handled by theimmune system

Indication primary or secondary tumors that are

disseminated through the body


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&ole of $hemotherapy

+' Sal%age chemotherapy: used when

patient ha)e relapsed after being treated

with another modality%

,' *du%ant chemotherapy: used after the

remo)al of the primary tumor to destroy

any micro metastatic disease%


&ole of $hemotherapy

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&ole of $hemotherapycontd

.' Neoadu%ant chemotherapy

debulking or reducing the siDe of tumor

/' Palliati%e chemotherapy

use to impro)e the Buality of life of patient%


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4echanism of action he cell cycle


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4echanism of actionThey sustain their maor cytoto8ic

e3ects during a particular phase ofthe life cycle

*cti%ely di%iding cells:the mostsensiti)e to chemotherapy

Non-di%iding cells: least sensiti)eto cytoto8ic drugs ence repeated doses of chemotherapy

needed to kill nondi)iding cells that are

about to di)ide2/1/15 compiled by Isaac Amankwaa

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$lassi!cation of chemotherapeauticagents

$hemotherapeautic agents can beclassi!ed by'

The relationship to the cell cycle $hemical group


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Classi)cation #y relationship to the cellcycle

Cell Cycle Specific Agents

Antimetabolites

Bleomycin

Podophyllin Alkaloids

Plant Alkaloids

Cell Cycle Non-

Specific Agents

Alkylating Agents

Antibiotics

Cisplatin

Nitrosoureas


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*N"ME*7>("ES They resemble substances normally used

by cells in their growth or metabolism e%g%

folic acids%

Are mistakenly incorporated into cellsC

antagoniDing cellular processes%

Are cell speci!cC act only on rapidly

di)iding cells%

%g% 4ercaptopurine* 4ethotra8ate and2/1/15 compiled by Isaac Amankwaa

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M">"C "N6"7">S

They block cell di)ision during mitosis%

4 phase of cell cycle

%gs% )inblastine and )incristine and

Kinca alkaloids


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*N";M> ME*7>("ES

These interfere with "A synthesis and &"Atranscription%

eg% o8orubicin and 6leomycin


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Antibiotics

These are antineoplastic agents deri)ed

from microorganisms

The di3erence btn8 this and antibiotics

used in treating infections is that

antineoplastic antibiotics lack selecti)eto8icity


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Antibiotics

Mechanism of action

They interfere with one or more

stages of &"A or "A synthesis or

both

They are cell cycle non;speci!c

8amples' o8orubicin and 6leomycin


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>P>"S>ME*SE "N6"7">S

Inhibit the enDyme topoisomerase

which is essential for the

maintenance of the "A replication

%g Irinotecan and Topotecan


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6>M>NE 6E*PA

ormones are capable of selecti)ely

suppressing the growth of certain tissues of

the body without e8erting cytoto8ic e3ects

>or e8ample* estrogen can be employed to

alter the hormonal en)ironment of the

tissues dependent on them

g Tamo8ifen and &alo8efen


6iological;response

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6iological responsemodi!ers

They work by targeting and

enhancing the immune system

The personEs own immune system

is acti)ated to !ght cancer cells

8amples include' interferons


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$hemotherapy ; strategy

single drug L used rarely combination

pro)ides ma8imal cell kill withintolerable to8icity

pro)ides broader range of co)erage ofresistant cells in a heterogeneoustumor

pre)ents/slows the de)elopment ofresistant cells


$hemotherapy L routes of

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$hemotherapy L routes ofadministration

oral

intra)enous

intramuscular

intrathecal

intraperitoneal intrapleural

intrapericardial

intraarterial

isolated organ

perfusion

portal )ein limb


To8icities associated with

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chemotherapy

$ytoto8ic chemotherapyEs general mechanism

of action is to preferentially kill di)iding cells%

"ormal cells with rapid growth rate are )ery

susceptible to damage

$ells that ha)e highly susceptible to to8icities

are 6air follicles5 !" tract5 >ral mucosa5!erm cells and 7one marro8


!"amples of to"icities

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myelosuppression

immunosuppression

nausea/vomiting

alopecia

mucositis

diarrhea flulike symptoms

!"amples of to"icities

#/$/$% compiled by &saac Amank'aa

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A?O#$IA air loss is a relati)ely common side e3ect of

chemotherapy% It is one of the most often feared and

psychologically damaging conseBuences ofchemotherapy% It most commonly a3ects scalp hair* but can

a3ect eyebrows* a8illary* and pubic hair as

well% It is often self;limited and transient* with hair

returning after cessation of therapy% Often* the new hair has di3erent color or

te8ture2/1/15 compiled by Isaac Amankwaa

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A?O#$IA It is important to discuss alopecia

when initiating a chemotherapyregimen* especially one that is)ery likely to cause it%

Setting the e8pectation candecrease the an8iety associated

with the condition* and gi)e thepatient time to prepare analternati)e strategy%


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Infertility

Testicular and o)arian function can bea3ected by chemotherapeutic agents

4en may ha)e aDoospermia -absence of

spermatoDoa%


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#re)ention of infertility Sperm banking and cryopreser)ation

If no )iable sperm or unable to produce

specimen* can perform testicular biopsy to

har)est directly from semineferous tubules%

#atients and their partners must be

informed of the abt the potential changes

in reproducti)e system


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7IT e3ects

+' Nausea and 0omiting The most common side e3ect Antiemetics can be used to control this "onpharmacologic approaches' imagery

and rela8ation techniBues Small freBuent meals and bland foods may

reduce the " and K%


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7IT e3ects

The e3ect of chemotherapy on the

epithelium the 7IT may lead to'

Stomatitis

iarrhea


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"ursing management in

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"ursing management inchemotherapy

"ursing diagnosis include'

1% &isk for inury* infection related to bone

marrow suppression secondary to

chemotherapy

2% &isk for bleeding related to bone marrow

suppression secondary to chemotherapy

9% Impaired oral mucus membrane

-stomatitis related to chemotherapy2/1/15 compiled by Isaac Amankwaa

"ursing management in

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"ursing management inchemotherapy

"ursing diagnosis include'

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&adiation therapy

Obecti)e cure' as in thyroid carcinomas

$ontrol malignant disease whentumout cannot be remo)ed surgically

#rophylactic' e%g% As in pre)entingthe spreading of primary tumour%


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&adiation therapy

4echanism of action IoniDing radiation cause direct

alteration of the "A molecule withinthe cells of tissue It breaks the strands of the "A heli8*

leading to cell death% If the "A cannot repair itself* the cell

may die immediately


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&adiation therapy

4echanism of action $ells are most )ulnerable to the

disrupti)e e3ects of radiation during"A synthesis and mitosis -early S*72 and 4 phases%

6ody tissues that undergo freBuent

di)isions are most sensiti)e toradiation therapy

This includes' bone marrow*lymphatic tisssue* 7IT epithelial* hair


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4ode of deli)ery

Teletherapy' e8ternal beam

radiation

6rachytherapy' internal deli)ery

Systemic

$ontact or surface molds


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&adiation To8icities

1% 6one marrow suppression

2% Stomatitis /mucositis

9% iarrheaatigue

5% Alopecia

,% $onstipation


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&adiation to8icities

+% >atigue

% .eight loss

:% Anore8ia10% "ausea and )omiting

11% 4alaise

12% Ototo8icity

19%Teratogenic e3ect


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"ursing care

1% Assessment

1% ptEs skin ( oropharyngeal mucosa

2% #atientEs nutritional status2% 8planation of ad)erse e3ects to

patients


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#rotecting caregi)ers #ts recei)ing internal radiation emit

radiation while the implant is in place

$ontact with healthcare team is thereforeguided by time5 distance5 and

shielding'

&adiation safety o=cer pro)ides

information abt

ma8imum amount of time to be spent in ptEs


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#rotecting caregi)ers

#recautions for pts recei)ing brachytherapyinclude' Assigning patients to pri)ate rooms

#osting appropriate notices abt radiationprecautions

Sta3 wearing dosimeter badges "ot assigning pregnant women to ptEs room

?imiting )isits to 90 mins Kisitors to maintain a ,;feet distance frm

the radiation source


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>urther reading

6one marrow transplants 7ene therapy

Fnpro)en or uncon)entionaltherapies


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&eferences

6runner ( SuddarthEs Te8tbook of

Medical-Surgical Nursing -12thedition

6onita et al% Pharmacological *spects

of Nursing Car 3

Oncology 2

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