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cancer1.pdf
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Lecture notes of 14 pages for the course nur at LUC (good)
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Care of the Client with Cancer, pg 1 of 13Definitions
• Neoplasm: abnormal mass with no useful purpose.
• Benign: harmless, unless space-occupying. If it is located near a vital structure it can be harmful.
• Malignant: harmful mass capable of invasion
• Cancer: refers to malignant neoplasms
Benign Malignant
Slow growing, expansive Proliferate rapidly
Localized Infiltrative patterns, metastasize to nearby tissues
Encapuslated No enclosing capsule
Rarely recur May recur
Regular in shape Irregular shape
Well differentiated Poorly differentiated
Slight vascularity Significant vascularity
Properties of Cancer
• Disease of the cell
• Mechanisms controlling growth is altered
• Invasive
• Spreads to surrounding tissues
Epidemiology
In 2007 there were 1.4M new cancer diagnoses. Approx. 10.1 million Americans are living with a history of cancer.
Interestingly the incidence of cancer is increasing but perhaps this doesn’t necessarily mean there is more cancer. It may
just be an issue of diagnostic methods that are more precise, the increased use of screening exams, improved data
collection procedures, more accurate reports and longer life spans.
Trends in Cancer
Median age of cancer diagnosis is 67 years. From 1995 - 2002 the incidence was stable in males and there was a 0.3%
increase in females. Mortality rates for all cancers decreased 1.1% annually from 1999 - 2002
Risk Factors…
• Tobacco is the #1 cause of cancer-preventable death in the world. It is responsible for increased cancers of: lung, mouth
and esophagus.
• Obesity
• Poor Diet (red & processed meat over plant foods)
• Inadequate Physical Activity (< 30 min./day)
• Drugs & chemicals
• Sexual activity (women who start sexual activity early and have multiple partners run the increased risk of cervical
cancer d/t the potential for developing HPV which is often a precursor to cervical cancer.)
• Alcohol
• Age
• Genetic predisposition
• Immune dysfunction
Risk factors, cont’d
• Hormones
• Viruses
• Radiation
, Care of the Client with Cancer, pg 2 of 13
• UV-A & UV-B rays
• What about Stress? Stress & the relationship to neoplasms is still being Note that hormones can be “feeders” for
investigated. We definitely know that ↑ stress compromises the immune system. tumors...you will hear the term
“estrogen dependent tumor”. This is why
7 Warning Signs of Cancer “CAUTION” women of child-bearing age who get
• Change in bowel or bladder habits breast cancer, uterine or ovarian cancer
• A sore that does not heal have a very grim prognostic outcome.
• Unusual bleeding or discharge
• Thickening or lump in breast or elsewhere
• Indigestion or difficulty swallowing
• Obvious change in a wart or mole
• Nagging cough or hoarseness
Pathophysiology (may add more here)
• Begins at the molecular level
• Cancer is many diseases (not sure what she means by this)
• Cells that are transformed, but are able to multiply and grow
• May begin with a mutation
• Change from normal to neoplastic cell is a process
• Occurs over many years
Carcinogenesis
Transformation of normal cells into cancer cells. It involves four stages: Initiation, promotion, malignant conversion and
progression.
• Initiation occurs when a carcinogen damages DNA. This causes changes in the structure and function of the cell at
the genetic or molecular level. This damage by be reversible or may lead to genetic mutation. The mutation may or
may not lead to cancer.
• Promotion occurs with additional insults to the cell that results in further damage to the cell.
• Malignant conversion. If the insult continues, then malignant conversion occurs.
• Progression is when the cells are increasingly malignant in appearance and behavior, and develop into invasive
cancer with metastasis to distant organs or system.
• Currently scientists are focusing on the underlying biology of the process of carcinogenesis. They have untaken the
identification of ONCOGENES. Oncogenes are genes that when mutated or expressed at abnormally high levels
contribute to converting a normal cell into a cancer cell. An oncogene is a gene that has sustained some genetic
damage and thus produces a protein capable of cellular transformation. As a result of this research, scientists have
begun developing better treatments. New chemotherapy drugs known as BIOTHERAPIES are becoming the
standard in addition to surgery, chemotherapy and radiation.
Cell Differentiation
• Occurs in the embryonic phase & enables stem cells to become nephrons or hepatocytes or alveoli or neurons.
• Normal cells have well-organized structure, similar cellular components.
• Cancer cells come in variable sizes & shapes
• Notes: In a cancer cell, the nuclei may be abnormally large or there may be multiple nuclei. There may be an
abnormal number of chromosomes or an abnormal arrangement of the chromosomes (aneuploidy). This finding is
an unfavorable prognostic indicator.
• Cancer cells have some properties that enable us to not only identify them, but treat them.
• Benign masses are very well differentiated from normal tissue. The body encapsulates it off and prevents it
from invading other tissues
• Malignant masses are poorly differentiated from normal tissues and the body has difficulty recognizing that the
malignant tissue is not its own.
Cancer Cell Properties
• Heterogeneity: There may be a number of variations of the malignant cell...won’t all look the same and they’ll mutate in
different ways. This is caused by random mutations during tumor progression. One chemo may work on one type of
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