ST.

LUKE’S COLLEGE OF NURSING

1st Semester
School Year: 2020-2021

GENERAL DISCUSSION SCHEDULE

COURSE CODE : NCM 106

COURSE TITLE : ONCOLOGY NURSING
LESSON NUMBER : MODULE 1 LESSON 01
TIME ALLOTMENT : 3 Hours
PRESCRIBED FLO : Preferred: e-Learning (E1, E4)
Alternative: Modular (M2)

TOPIC LEARNING OUTCOMES:

After the end of the lesson, the student should be able to:

1. Recall cell cycle

2. Know what is cancer and its pathophysiology
3. Participate in the interactive discussions

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 Activities Strategies TA Remarks
1 ATTENTION Classroom Orientation with icebreaker  15 minutes

2 OBJECTIVE Discussion of the learning objectives for the day  10 minutes

3 RECALL  Conduct a 10-items Pre-test  5 minutes

4 STIMULUS Do a 30-minute lecture  30 minutes Focusing on the highlights and the
essentials
5 GUIDANCE Conduct SGDs to expound on the topic  30 minutes Question for discussion will be posted
in the chat box
6 PERFORMANCE  Do a group presentation on the highlights of the topic  30 minutes

7 FEEDBACK  Provide Immediate feedback at the end of the  10 minutes

presentation
8 ASSESSING  Conduct a 10-item post-test with discussion afterwards  15 minutes

9 RETENTION  Summarize the main points of the lecture and encourage  15 minutes
Q&A before synthesis

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 LESSON/TOPIC DISCUSSION

LEARNING RESOURCES:
Ebooks
1. Sandstorm, S.A. et al. Medical-Surgical Nursing: Assessment and Management of Clinical Problems 10 th edition. Elsevier
https://drive.google.com/drive/folders/1NG4Z1xwjTWMpBDiTJMtBDWHNV6rm2aNX
2. deWit, S.C. et alMedical-Surgical Nursing: Concepts and Practice 3 rd edition. Elsevier
https://drive.google.com/drive/folders/1NG4Z1xwjTWMpBDiTJMtBDWHNV6rm2aNX
3. Sitzman, Kathleen & Eichelberger, Lisa Wright (2017). Understanding the work of nurse theorists: a creative beginning. 3rd Edition, Jones and Bartlett
Learning.
https://drive.google.com/drive/folders/1NG4Z1xwjTWMpBDiTJMtBDWHNV6rm2aNX
4. Wesler, B. B., Schechter, G.P., and Ely, S. (2018). Wintrobe’s Atlas of Clinical Hematology: Vol. 2 nd edition. Wolters Kluwer Health
EBSCO
5. LWW, & Staff, S.P.C. (2016). Medical-Surgical Nursing Made Incredibly Easy! Vol. 4 th edition. Wolters Kluwer Health
EBSCO
6. Webb, A.A. (2016). Nursing Procedures Made Incredibly Easy! Vol. 2 nd edition. Wolters Kluwer Health
EBSCO
7. Capriotti, T. (2016). Pathophysiology Made Incredibly Visual! (Vol. 3 rd edition). Wolters Kluwer Health
EBSCO

LESSON 1 TOPICS:

A. Cell cycle
B. What is Cancer
C. Hallmarks of cancer
D. What is Carcinogenesis
E. What are the 3 routes of cancer spread

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ACTIVITY 1: INTRODUCTION

What is Cancer?

When we see or hear cancer, we easily think of terrifying disease that cannot be treated and chemotherapy will always end on death of the patient. Cancer is a
very heterogeneous group of diseases, that can start almost anywhere in the body. Abnormal growth in parts of the body is not always a cancer. It may be
hypertrophy where in tissues increase in size by cellular enlargement which can be a physiological response to a stimulus or as a result of compensatory
response to injury. Hyperplasia on the other hand is increasing the number of cells which is manifested by increase in tissue size.

To better understand cancer or neoplasm, this chapter will differentiate normal cells from cancer cells. The characteristics or behavior of the genes within the
cells and their roles in cancer formation. Warning signs of cancer will also be discuss in this module including screening programs on the different types of
cancer.

ACTIVITY 2: PRE-TEST

Arrange the following phases of cell cycle accordingly: Cytokinesis, interphase, prophase, anaphase, metaphase
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ACTIVITY 3: CONCEPTS 1

CELL CYCLE
The cell cycle is a step by step series of events involving cell growth and cell replication that produces two new prodigy cells. It is very much regulated and
controlled. Cells on the G0 is on the resting phase, meaning the cells has no plan to replicate, but with proper signal to replicate, it will enter into the 1 st phase
which is interphase.

Many cells stay longer on this phase. It is composed of G1, S Phase and G2. In G1 the cell becomes active and accumulating building blocks of DNA and proteins.
Next is the S Phase, major activity on this phase is the formation of identical pairs of DNA molecules, centrosome and centrioles. Next is G2, additional cell
growth and duplication of organelles for the final preparation to mitotic phase.
Second phase of cell cycle is the mitotic phase which is the separation and formation of two daughter cells. This phase has 4 parts: (1) Prophase (2) Metaphase
(3) Anaphase and (4) Cytokinesis

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Cells in the body have different pace of duplication. Labile cells are those cells that are always actively dividing like epithelium of skin and red bone marrow
stem cells. Stable cells are those that replicate only if needed an example is liver cells, once a person donates part of its liver it will regenerate. Permanent cells
are those cells that do not have the ability proliferate like neurons.

In studying cancer, we need to understand that the cell cycle of the cells becomes abnormal. To better understand oncology, we must know the hallmarks or
characteristics of cancer.

HALLMARKS OF CANCER

1. Self-sufficient in growth signal – proliferation is controlled, normal cells will undergo replication in response to signal or stimulus example
injury, however cancer cells becomes mutated because of cell damage that causes proliferate of its own, it is autonomous in producing own
signal. An example of mutation is duplication of the gene responsible for proliferation or we can say that the mutation of the gene is gain of
function. If the damage is so severe or lethal to the cells, the cells will die and cancer is impossible. The gene responsible for the normal
proliferation of cells is called Proto oncogene, once this gene responsible for the proliferation of cancer cell is it will be called Oncogene.

2. Insensitive to growth inhibitory signal – once the injury is healed then gene will send signal to the cell to stop proliferating, the name of this
gene is Tumor Suppressor Gene (TSG), unfortunately this gene is also damaged or mutated that it has lost its function. It cannot serve its
purpose to stop the gene from sending signal to proliferate.

All cells have this 2 type of genes that is well regulated and controlled. It can be compared to the car, Proto oncogene is the accelerator and TSG
is the break of the car. In neoplasm, accelerator is always on and break failed to do its job to stop the accelerator.

3. Dysfunction of DNA repair system – we have about 10,000 DNA damage daily, in all cells of our body we have this DNA repair gene wherein it
corrects abnormality in the replication process. In cancer this gene is also mutated that it has lost its function to repair the cells.

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 4. Evasion of apoptosis – usually if the damage in the DNA cannot be repaired, the cell will undergo apoptosis or cell suicide. The 2 gene
responsible for the survival and death of the cell. Gene for survival of the cell has the mutation which is gain of function and gene for cell death
has also mutated which is loss of function. Apoptosis is impossible because of this mutations

5. Limitless replicating capacity – on the end of each DNA lies a telomere, it is like an aglet of the shoelace. In every replication this telomere will
shorten and will decrease its replicating capacity, once it reached a certain size it will no longer replicate. In cancer cells there is a gene that
expressing telomerase, this is an enzyme that works on the end of telomerase to keep their size longer to sustain fast replication

6. Sustained angiogenesis – delivery of nutrition to cancer cells is through diffusion. However if the cancer tumor is 1cm (1billion cells) diffusion
is not enough. Cancer cells will produce products like VEGF to promote formation of cancer cells own blood supply

7. Capacity for evasion and metastasis – normal cells adhere tightly together and non-migratory. Cancer cells are loosely held together and are
able to migrate. To make tumor really malignant and dangerous is that they have the ability of evasion which is the spread of cancer cells in a
nearby structure while metastasis is the transfer of some cancer cells into far areas from the primary cancer site

8. Escape from immunity – our immune system plays an important role in prevention of cancer. Strict surveillance is always on in our body, they
are very hostile in pathologic micro-organisms and abnormal cells including cancer cells. Another gene will be expressed by cancer cells so
that they cannot be recognize by the immune system.

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 HENRIETTA LACKS (1920-1951) an African-American descent that has a big contribution in the formation of drugs and vaccines over the world.
She was diagnosed with cervical cancer when she was 31 years old. Her cancer cells behaved very aggressive, she was confined and died in John
Hopkins Hospital and the doctors used her cancer in the laboratory and found out that her cancer cells was so aggressive that it is living up to this
date. Her family discovered that they took the cells without permission from the patient or from any member of the family last 1978. They
demanded compensation and recognition of Henrietta lacks from the medical community. HeLa Cells was used in the success of polio vaccine,
chromosome counting, Genome mapping, HPV vaccine and others.

CARCINOGENESIS – it is the process of changing a normal cell into a cancer cells. It is also known as Malignant Transformation which involves 4
stages.

1. INITIATION – this is the 1st step in carcinogenesis, where anything that can penetrate a cell and get into the nucleus and damage the DNA that
damages the genes. These substances is called CARCINOGENS they can change the activity of the cell’s genes so that the cell becomes a cancer
cells. This damage can turn on genes that should remain suppress and turn off normal genes.

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 2. PROMOTION – once a normal cells has been initiated by a carcinogen, it can become a tumor if its growth is enhanced. PROMOTERS are
substances that promote or enhance growth of the initiated cancer cells. Presence of these promoters can cause rapid cellular division causing
a single cancer cell to grow in numbers forming a tumor

3. PROGRESION – it is a time wherein a detectable tumor is formed, the tumor size may be 1 cm or equivalent to 1 billion cancer cells. In early
stage of tumor, it receives nutrition through DIFFUSION but after the tumor reaches 1 cm delivery of nutrition in not enough through
DIFFUSION. Cancer cells will release substances that enhances formation of new blood vessel to deliver more nutrition to the tumor to further
increase its size.

The original tumor is called PRIMARY TUMOR, it is usually identified by the tissue from which it arose (parent tissue). When the tumor
spreads from the original site into vital areas life functions can be disrupted

4. METASTASIS – cancer cells move from primary location by breaking off from original group and establishing remote colonies. These additional
tumors are called METASTATIC or SECONDARY TUMORS. Metastasis occurs through many steps: local seeding, blood borne and lymphatic
spread

THREE (3) ROUTES OF METASTASIS

A. LOCAL SEEDING – during early embryonic life, primitive cells does not require any special environment, when they developed into high
specialized cells they require a special environment, for example neurons can only live within the nervous system. It is impossible for the
neuron s to live in the liver or lungs. Cancer cells becomes so primitive that it does not require special environment. They can live in any
parts of the body. Local seeding is a spread from nearby structure.

B. BLOOD BORNE – this is the most common cause of cancer spread. Clumps of cancer cells can become trapped in capillaries. These clumps damage
the capillary wall and allowing tumor cells to enter the blood and circulate throughout the body. Because tumor cells are loosely held together,
clumps of cells break off of the primary tumor into blood vessel for transport

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 C. LYMPHATIC SPREAD – it is also an important mechanism of cancer spread wherein tumor cells are able to reach the basement membrane
of the ephethilial cells then to the underlying connective tissue. During reabsorption of the lymphatic system in the tissue cancer cell are
able join lymphatic fluid thus cancer cells carried into the lymphatics and can metastasize in different areas of the body

WHO ARE AT RISK FOR CANCER – EVERYONE is at risk of having cancer because 80-90% of cancers are caused by external factors

ACTIVITY 4: DISCUSSION/EXERCISE

https://www.youtube.com/watch?v=mufb0Hx2438 (enumerate all risk factors in the video and associated cancers)

ACTIVITY 5: POST TEST

1. Normal cells typically can only divide a limited number of times before programmed cells death occurs. However, cancer cells do not have the ability to
initiate death via _______ and may divide indefinitely
a. Evasion b. Mitotic catastrophe c. Spindle chaos d. Apoptosis
2. Which of the following contribute to the metastatic spread of cancer cells
a. Loss of contact inhibition b. increased enzyme production c. pseudopod formation d. all are correct
3. Cancer cells ______
a. Are not stimulated to enter into “cell cycle” and thus never reproduce
b. Age faster than normal cells, causing premature cell death
c. Have acquired a specific set of capabilities and characteristics due to genetic changes
d. Stop dividing when they come in contact with normal cells
4. Which of the following is true of normal adult cells but NOT cancer cells
a. Large telomerase is present
b. Division in the presence of “stop signal”
c. Cell death after a finite number of cell division
d. Contact with other cells increases like hood of cell division
5. Cancer cells are said to “break all the rules” because they _____
a. Divide without appropriate external signals
b. Do not go through mitosis

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 c. Kill the organism in which they live
6. If you get cancer, it is usually because someone in your family had cancer
a. True b. False
7. Which food is linked to colon cancer
a. Tofu b. Fruits c. Luncheon meat d. Oysters
8. Heavy drinking can raise your chances of gtting cancer
a. True b. False
9. For most cancers, a biopsy will cause cancer cells to spread
a. True b. False
10. What can you do to lower your chance of getting cancer
a. Eat dessert often b. exercise c. nothing

ACTIVITY 6: SYNTHESIS / EXERCISE

Cancer is a very heterogeneous group of diseases, that can start almost anywhere in the body . The following are the characteristics of cancer cells: (1) self
sufficient in growth signal (2) insensitive to growth inhibitory signal (3) dysfunctional DNA repair system (4) evasion of apoptosis (5) limitless replicating
capacity (6) sustained angiogenesis (7) capacity for evasion and metastasis (8) escape from immunity.

CARCINOGENESIS – it is the process of changing a normal cell into a cancer cells. It is also known as Malignant Transformation which involves 4 stages: (1)
initiation (2) promotion (3) progression (4) metastasis. # routes of metastasis are: (1) local seeding (2) blood spread (3) lymphatic spread

Prepared by Edited by Reviewed by

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 Ms. Edna U. Robles, MAN, RN Mr. Dennis D. Abellera, MAN, RN Dr. John Michael O. Lorena, MAN, RN
Faculty Academic Coordinator Dean, SLCN

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