1 NORMAL CELL CELL Fundamental unit of living matter divided into; a) Nucleus b) Cytoplasm Organelles = subcellular structures within

the nucleus or cytoplasm. Plasma membrane or plasmalemma separates cell from the external environment. CELL FUNCTION a) INTRACELLULAR Maintain internal milieu Produce RNA Reproduce DNA Synthesis of transmitters hormones or secretions Metabolism of exogenous and endogenous substances Production of chemical energy Cell movement and motility. Control of intracellular functions Activation of 2nd messengers Regulate gene expression Receptor changes Enzyme activation or inhibition Changes in permeability. b) EXTRACELLULAR FUNCTIONS Chemical, electrical or mechanical interaction Intracellular communication via neurotransmitters, hormones, secretions. Release of Cytokines Control of extracellular functions 1. Autocrine - Substances acting on the cell itself eg. Inflammation 2. Paracrine -Substances released acting on the others cells eg. Prostaglandins, leukotrienes or thromboxane.

2 COMPONENTS OF CELL 1. 2. 3. 4. 5. 6. Plasma Membrane: Outer membrane containing contents of cell. Cytoplasm : All intracellular contents outside the nucleus & include the cystosol and organelles. Cytosol : Intracellular fluid consisting of proteins and electrolytes forms 40% Body weight. Cytoskeleton : Support structure that maintains cell structure. Mitochondria: Cytoplasmic organelles that provide energy via oxidation phosphorylation generating ATP. Endoplasmic Reticulum: Membranous structures with folds & microtubules. (a) Rough ER: Granular ER with ribosomes attached; important for protein synthesis (b) Smooth ER : A granular ER - site for detoxification and steroid synthesis. 7. 8. 9. Ribosomes : Protein structure, that may be free in cytosol or attached to ER. Golgi Apparatus : Organelle that process protein for secretion from cell. Lysosomes: Organelles that breakdown and eliminate intracellular debris or exogenous substances. 10. Peroxisomes : Organelles that catalyse anabolic or catabolic reactions eg. Breakdown of long chain fatty acid. 11. Centrosomes: Organelle that are responsible for the formation of mitotic spindle in cell divisions.
CANCER / MALIGNANT NEOPLASM Cancer is not a single disease. There are many types of cancers as there are types of tissues in the body. Cancer develops when cells in a part of the body begin to grow out of control. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person’s life, normal cells divide more rapidly until the person becomes an adult. After that, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries. Cancer cells, however, continue to grow and divide even when there is no need to do so. Instead of dying, they outlive the normal cells and continue to form new abnormal cells. They compete with normal cells for the blood supply and nutrients that normal cells need thus causing weight loss. Cancer cells often travel to other parts of the body where they begin to grow and replace normal tissue. This process is called metastasis. It occurs as the cancer cells get into the bloodstream or lymph vessels of our body. The immune system seems to play a role in the development and spread of cancer. When the immune system is intact, isolated cancer cells will usually be detected and removed from the body.

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When the immune system is impaired as in people with immunodeficiency disease, people with organ transplants who are receiving immunosuppressant drugs, or in AIDS, there is usually an increase in cancer incidence. CAUSES OF CANCER Normal cells transform into cancer cells because of damage to DNA. People can inherit damaged DNA, which accounts for inherited cancers. Many times though, a person’s DNA becomes damaged by exposure to something toxic to the environment such as chemicals, radiation or viruses. Remember though that most cancers have multiple causes and risk factors.

Hereditary/Family History  Certain types of cancers run in the family such as breast cancer. Carcinogens  A carcinogen is an agent capable of causing cancer. This may be a chemical, an environment agent, radiation and viruses.  Effects of carcinogenic agents usually depend on the dose or amount of exposure; the larger the dose or the longer the exposure, the greater the risk of cancer.  Many cancers are associated with lifestyle risk factors such as smoking, dietary factors and alcohol consumption. Chemical & Environmental Agents  Polycyclic hydrocarbons are chemicals found in cigarette smoke, industrial agents, or in food such as smoked foods. Polycyclic hydrocarbons are also produced from animal fat in the process of broiling meats and are present in smoked meats and fish.  Aflatoxin is found in peanuts and peanut butter.  Others include benzopyrene, nitrosamines, and a lot more. Benzopyrene  Produced when meat and fish are charcoal broiled or smoked (e.g. tinapa or smoked fish). Avoid eating burned food and eat smoked foods in moderation.  Also produced when food is fried in fat that has been reused repeatedly. Avoid reusing cooking oil. Nitrosamines  These are powerful carcinogens used as preservatives in foods like tocino, longganisa, bacon and hotdog.  Formation of nitrosamines may be inhibited by the presence of antioxidants such as Vitamin C in the stomach. Limit eating preserved foods and eat more vegetables and fruits that are rich in dietary fiber. Radiation  Radiation can also cause cancer including ultraviolet rays from sunlight, x-rays, radioactive chemicals and other forms of radiation. Viruses  A virus can enter a host cell and cause cancer. This is found in cervical cancer (human papilloma virus), liver cancer (hepatitis B virus), certain leukemias, lymphoma and nasopharyngeal cancer (Epstein-Barr virus).

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RISK FACTORS OF CANCER Risk factors for cancer include a person’s age, sex and family medical history. Others are linked to cancer-causing factors in the environment. Still others are related to lifestyle factors such as tobacco and alcohol use, diet and sun exposure. Having a risk factor for cancer means that a person is more likely to develop the disease at some point in his/her life. However, having one or more risk factors does not necessarily mean that a person will get cancer. Some people with one or more risk factors never develop the disease, while other people who do develop cancer have no apparent risk factors. This has a lot to do with a person’s immune system. Different kinds of cancer have different risk factors. Some of the major risk factors associated with particular types of cancer include the following: CANCER RISK FACTORS Lung Cancer • Tobacco use, including cigarettes, cigars, chewing tobacco and snuff. • Radiation exposure • Second-hand smoke Oral Cancer • Tobacco use (cigarette, cigar, pipe, smokeless tobacco) • Excessive alcohol use • Chronic irritation (e.g. ill-fitting dentures) • Vitamin A deficiency Laryngeal Cancer • Tobacco use (cigarette, cigar, pipe, smokeless tobacco) • Poor nutrition • Alcohol • Weakened immune system • Occupational exposure to wood dust, paint fumes • Gender: 4-5 times more common in men • Age: more than 60 years Bladder Cancer • Tobacco use (cigarette, cigar, pipe, smokeless tobacco) • Occupational exposure: dyes, solvents • Chronic bladder inflammation Renal Cancer • Tobacco use (cigarette, cigar, pipe, smokeless tobacco): increase risk by 40% • Obesity • Diet: well-cooked meat • Occupational exposure: asbestos, organic solvents • Age: 50-70 years old • Tobacco use (cigarette, cigar, pipe, smokeless tobacco) • Human papillomavirus infection • Chlamydia infection • Diet: low in fruits and vegetables • Family history of cervical cancer • Tobacco use (cigarette, cigar, pipe, smokeless tobacco) • • • Gender: 3 times more common in men Alcohol Diet: low in fruits and vegetables

Cervical Cancer

Esophageal Cancer

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Breast Cancer • Early menarche/late menopause • Age-changes in hormone levels throughout life, such as age at first menstruation, number of pregnancies, and age at menopause • High fat diet • Obesity • Physical inactivity • Some studies have also shown a connection between alcohol consumption and an increased risk of breast cancer • Women with a mother or sister who have had breast cancer are more likely to develop the disease • While all men are at risk, several factors can increase the chances of developing the disease, such as advancing age, race and diet • Race: more common among African-American men than among white men • High fat diet • Men with a father or brother who has had prostate cancer are more likely to get prostate cancer themselves • Certain types of viral hepatitis • Cirrhosis of the liver • Long-term exposure to aflatoxin (carcinogenic substance produced by a fungus that often contaminates peanuts, wheat, soybeans, corn and rice) • Unprotected exposure to strong sunlight • Fair complexion • Occupational exposure • Personal/family history of polyps • High fat diet and/or low fiber diet • History of ulcerative colitis • Age: >50 years • Estrogen replacement therapy • Early menarche/late menopausal

Prostate Cancer

Liver Cancer

Skin Cancer

Colonic Cancer

Uterine/Endometrial Cancer

Among these factors, tobacco use, unhealthy diet and physical inactivity are more likely to affect personal cancer risk. Smoking alone causes one-third of all cancer deaths. Research also shows that about one-third of all cancer deaths are related to dietary factors and lack of physical activity in adulthood. PATHOPHYSIOLOGY

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When you are healthy, your body has over a trillion cells that divide at standard rate and pace. When you develop cancer your normal cells turn into cancer cells. Cancer cells have different DNA than healthy cells. One of the first steps in a healthy cell becoming a cancer cell is the change of the proto-oncogens to oncogenes. Proto-oncogenes are genes that are coded to maintain normal cell growth. An oncogene is a gene that has changed to make the cells grow and divide faster. In cancer cells the cell grows and divides very quickly. The second step to becoming a cancer cell is the tumor suppressor genes get turned off. Tumor suppressor genes are a part of a healthy cells DNA that help stop cancer from forming in healthy cells. Tumor suppressor genes help slow down cell growth, when these genes are turned off the cell with grow and divide very quickly. The last step to becoming a Cancer cell is the DNA repair genes gets turned off. DNA repair genes help your healthy cells know if something is wrong with its DNA and how to fix it. When these genes get turned off the cell doesn’t know if it is sick, and it can’t fix any problems with its DNA.

PATTERNS OF CELL GROWTH • Hyperplasia – increase in the size of an organ because of an increase in cell number • Metaplasia – a reversible process in which one adult cell type in an organ is replaced by another adult cell type • Dysplasia – alteration in adult cells characterized by changes in their size, shape, and organization • Anaplasia – reversed cellular development to a primitive cell type • Neoplasia – abnormal cellular changes and growth of new tissues STAGES IN CARCINOGENESIS Carcinogenesis is the process during which normal genes are damaged so that cells lose normal control mechanisms of growth and proliferate out of control. When the genes of a single cell are altered by a carcinogenic event, the offspring of the single cell continue to mutate and divide, producing even more virulent mutant clones. • Initiation – exposure of normal cells to carcinogens • Promotion – cigarette smoking, alcohol abuse or dietary components that act on the transformed cell • Progression – uncontrollable growth of malignant tumor capable of metastatic activity WARNING SIGNS OF CANCER C – hange in bowel or bladder habits A – sore that doesn’t heal U – nusual bleeding/discharge T – hickening of lump – breast or elsewhere I – ndigestion/dysphagia O – bvious change in a wart/mole

8 N – agging cough/hoarseness U – nexplained anemia S – udden and unexplained weight loss Persistent headache CLASSIFICATION • Grading – defines the origin of the tumor and degree to which tumor cells retain the functional and histologic characteristics of tissue origin  Grade X: Grade cannot be determined  Grade I: Cells differ slightly from normal cells and are well differentiated (Mild Dysplasia)  Grade II: Cells are abnormal and are moderately differentiated (Moderate Dysplasia)  Grade III: Cells are very abnormal and are poorly differentiated (Severe Dysplasia)  Grade IV: Cells are immature (Anaplasia) and undifferentiated, cell of origin is difficult to determine. • Staging – determines the size of the tumor and extent metastasis; determines extent of the disease  Stage 0 – carcinoma in situ; cancer in place  Stage I – tumor limited to the tissue of origin; localized tumor growth  Stage II – limited local spread  Stage III – extensive local and regional spread  Stage IV- metastasis DIAGNOSTIC TESTS • Biopsy – is the definitive means of diagnosing cancer and provides histological proof of malignancy. It involves the surgical incision of a small piece of tissue of microscopic examination Types:  Needle: Aspiration of Cells  Incisional: Removal of a wedge of suspected tissue from a larger mass  Excisional: Complete removal of the entire lesion  Staging: Multiple needle or incisional biopsies in tissues where metastasis is suspected or likely. • Other means of Detection  Mammography  Papanicolaou’s (Pap) test  Stools for occult blood  Sigmoidoscopy  Colonospcopy  Skin Inspection KEY AREAS FOR PRIMARY PREVENTION OF CANCERS • Smoking Cessation – quit smoking for active smokers. Prevent passive smoking. Advise smokers not to smoke inside living areas and workplaces to prevent exposure of others to second-hand smoke.

9 • Encourage proper nutrition  Increase intake of dietary fiber by eating more leafy green and yellow vegetables, fruits and unrefined cereals. Beta-carotene, vitamins A, C, E and fiber may be potential anti-cancer substances. Eat less fat and fatty foods.  Limit consumption of smoked, charcoal-broiled, salt-cured, and saltpickled foods. Avoid moldy foods. Drink alcohol beverages in moderation. Avoid/control obesity through proper nutrition and exercise. The sooner a cancer is diagnosed and treatment begins, the better the chances of living longer and enjoying a better quality life.

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Difference between a cancer cell and a normal cell
Cancer is a disease characterised by uncontrollable cell growth. the causative factors include genetic factors, exposure to carcinogens, etc. Carcinogenesis is the development of cancer.The gene which cause cancer is ONCO GENE.Carcinogens activate the onco gene hence causing cancer. Cancer cells are abnormal cells and they have characteristics that can be associated with their ability to grow uncontrollably.Cancer cells are charectarized by undifferentiated and uncontrolled cell division.Cancer cells are non-specialized, and divide uncontrollably. Cancer in situ is a tumor located in its place of origin. Malignant tumors establish new tumor distant from the primary tumors. Cancer cells characteristics distinguish them from normal cells. They have abnormal nuclei with many chromosomal irregularities. They form tumors because they do not exhibit contact inhibition. They induce angiogenesis and cause nearby blood vessels to form a capillary network that services the tumor.