NCM 112 – Cellular Aberration (10)  Hepatitis B virus (HBV) is the most common cause

of liver cancer in the Philippines

 Search, Read and Understand: 2015 Philippine
 HBV vaccination should prevent majority of liver
Cancer Facts & Estimates
cancer in the country
 CAN CANCER BE PREVENTED?
 Human papilloma virus (HPV) causes cancer of the
 At least 1/3 of all cancers can be prevented
uterine cervix and is transmitted through sexual
 Cancer protecting mechanisms prevent cancer. A
intercourse
healthy lifestyle that is started in childhood,
 Safe sex, including the use of barrier protective
particularly eating a HEALTHY DIET, maintaining
devices such as condoms, is currently the most
PHYSICAL FITNESS and MINIMIZING/ PROPERLY
effective means of preventing sexually transmitted
COPING with STRESS may decrease the risk of
diseases
cancer, coronary artery disease, hypertension,
stroke and diabetes
 Ultraviolet rays from the sun are capable of causing
 A healthy diet is low in animal fat, rich in starchy
skin cancer, particularly in fair-skinned persons.
foods (such as cereals, tubers and pulses), with
Excessive sun exposure should be avoided, and the
substantial fruits and vegetables.
use of umbrellas, wide-brimmed hats and sun-block
 An unhealthy diet is rich in fat, salt and free sugars,
preparations ought to be encouraged
and/or in smoked, salt-pickled/-preserved foods
 NEOPLASMS
 Physical fitness is achieved through a lifelong active
 Derived from the Greek “NEOS” (new) and “PLASIS”
lifestyle
(molding)
 Physically fit individuals are not overweight, quite
 Defined as an abnormal mass of tissue that serves
productive, with high self-esteem, and successful in
no useful purpose & may harm the host organism.
coping with stress (exercise at least 30 mins a day,
 Tumors are named according to tissue from which
twice or thrice a week)
they arise
 Almost all tumors end in –OMA
 Increasing mental, social, psychological and
spiritual stress seems to accompany economic
o Classification of Neoplasms:
progress, and at the same time coping mechanisms
1. BENIGN (non-cancerous)
are eroded (stressed with financial difficulties; know
 A condition capable of disturbing the function
how to cope up with stress)
of an organ; without endangering the life of an
 While increasing stress may be inevitable,
individual.
traditional support structures within the family and
 comes from the Latin word “bene” meaning
community ought to be strengthened, and new
good & “genus” meaning sort; thus, benign
institutional mechanisms established, to help
tumor is “a good sort of tumor”
individuals and families cope with day-to-day stress
(encourage to strengthen support structures with
2. MALIGNANT (cancerous)
family and community; bond with your family like
 Resistant to treatment & of fatal nature, having
watch some movies together, have fun together,
the property of uncontrollable growth &
enjoy each other’s company)
dissemination, capable of metastasizing
 Cancer promoting agents should be avoided.
o Characteristics of Benign and Malignant Tumor
 Cigarette smoke is the most pervasive cancer-
CELL CHARACTERISTICS
causing substance
 BENIGN - Well-differentiated cells mature, cells
 The numerous carcinogenic agents found in
function poorly
cigarette smoke cause cancers of the lung, mouth,
 MALIGNANT - Cells are poorly differentiated
pharynx, larynx, esophagus, other cancers, and
(anaplastic type)
other acute and chronic diseases
 The damage is not inflicted on the smoker alone but
MODE OF GROWTH
on everyone who inhales cigarette smoke (second
 BENIGN – Remains localized
hand smoke [SHS] or passive smoking)
 MALIGNANT – Infiltrates surrounding tissues
 High alcohol consumption also increases the risk of
SPEED OF GROWTH
many cancers
 BENIGN – Grows slowly
 Betel-quid chewing causes cancer of the mouth and
 MALIGNANT – Grows rapidly
this habit should be avoided
CAPSULE
 BENIGN – Encapsulated
 MALIGNANT – Not encapsulated
METASTASIS
 BENIGN – Never occurs
 MALIGNANT – Very common
RECURRENCE
 BENIGN – Extremely unusual when surgically
removed
 MALIGNANT – Common following surgery
EFFECT OF NEOPLASM
 BENIGN – Not harmful to host
 MALIGNANT – Always harmful
PROGNOSIS
 BENIGN – Very good prognosis
 MALIGNANT – Poor prognosis
BENIGN NEOPLASMS
FIBROMAS – found in fibrous tissue frequently in
uterus, cause no manifestations unless, because of their
location, they press on a bone or nerve
LIPOMAS - arises in adipose tissues, may exert pressure
on surrounding tissue as they expand
LEIOMYOMAS - smooth muscles origin, may develop
anywhere in the body but usually they grow in the
uterus
MALIGNANT NEOPLASMS
CARCINOMA IN SITU - neoplasms in epithelial cells that
remains confined to the site of origin
FIBROSARCOMA - bulky well-differentiated tumor
masses in the connective tissues
BRONCHOGENIC CARCINOMA - usually develop in the
lower trachea (can readily metastasize)
o Tumor Staging and Grading
 Treatment options and prognosis are based on
tumor stage and grade
o Staging
 Determines the size of the tumor, the existence of
local invasion, lymph node involvement, and distant
metastasis
STAGING OF CANCER
Stage 0 - indicates that the cancer is where it started (in
situ) and is not spreading
Stage I - the tumour is less than 2cm (0.8 inches) and is
not spreading
Stage II - the tumour is 2-5cm (0.8-1.97 inches) with or
without lymph node involvement and has not spread
Stage III - the tumour is larger than 5cm (1.97 inches)
but fixed either to chest wall, muscle or skin, or has
spread to lymph nodes above the collarbone
Stage IV - the tumour is any size; it may affect the
lymph nodes but has definitely spread to other parts of
the body
o Grading Systems
 Seek to define the type of tissue from which the
tumor originated and the degree to which the
tumor cells retain the functional and histologic
characteristics of the tissue of origin
(differentiation)
 Samples of cells used to establish the tumor grade
may be obtained from tissue scrapings, body fluids,
secretions, washings, biopsy, or surgical excision.
o Grading
 Is the pathologic classification of tumor cells
 Refers to the classification of tumor cells
 Seeks to define the type of tissue from which the
tumor originated
 Helps us understand how aggressive or malignant a
tumor is
 It describes the appearance of the cancerous cell
 The grade of a cancer depends on what the cells
look like under a microscope
 In general, a lower grade indicates a slower-growing
cancer and a higher grade indicates a faster-growing
one
The grading system that’s usually used is as follows:
Grade I - cancer cells that resemble normal cells and
aren't growing rapidly
Grade II - cancer cells that don't look like normal cells
and are growing faster than normal cells
Grade III - cancer cells that look abnormal and may
grow or spread more aggressively
 The TNM System
 The American Joint Committee on Cancer (AJCC)
and the International Union for Cancer Control
(UICC) maintain the TNM classification system as a
tool for doctors to stage different types of cancer
based on certain standards. It is reviewed every 6 to
8 years to include advances in our understanding of
cancer
 In the TNM system, each cancer is assigned a letter
or number to describe the tumor, node, and
metastases
 T stands for tumor. It’s based on the size of the
original (primary) tumor and whether it has grown
into nearby tissues
 N stands for node. It tells whether the cancer has
spread to the nearby lymph nodes
 M stands for metastasis. It tells whether the cancer
has spread to distant parts of the body
o The T category describes the original (primary)
tumor. The tumor size is usually measured in
centimeters or cm (2½ cm = about 1 inch) or
millimeters or mm (10 mm = 1 cm)
 TX means the tumor can’t be measured.
 T0 means there is no evidence of primary tumor (it
cannot be found)
 Tis means that the cancer cells are only growing in
the most superficial layer of tissue, without growing
into deeper tissues. This may also be called in
situ cancer or pre-cancer
 Numbers after the T – T1, T2, T3, and T4 – describe
the tumor size and/or amount of spread into nearby
structures. The higher the T number, the larger the
tumor and/or the more it has grown into nearby
tissues.
 T1- 5cm↓: T2 - 6-9cm: T3 - 10-15cm: T4 - 15cm↑
o The N category describes whether the cancer
has spread into nearby lymph nodes
 NX means the nearby lymph nodes cannot be
evaluated
 N0 means nearby lymph nodes do not contain
cancer
 Numbers after the N – N1, N2, and N3 – describe
the size, location, and/or the number of lymph
nodes involved. The higher the N number, the more
lymph nodes there are that contain cancer
o The M category tells whether there are distant
metastases (spread of cancer to other parts of
body)
 MX means metastasis cannot be evaluated
 M0 means that no distant cancer spread was found.
 M1 means that the cancer has spread to distant
organs or tissues (distant metastases were found
 Tumor, Nodes, and Metastasis (TNM)
 Is one system used to describe many solid tumors;
cannot be used in non-solid tumors
TNM CLASSIFICATION SYSTEM
T – The extent of primary tumor
N - The absence or presence and extent of regional
lymph node metastasis
M - The absence or presence of distant metastasis
 Primary Tumor
Tx - Primary tumor cannot be assessed
T0 - No evidence of primary tumor
Tis - Carcinoma in situ
T1, T2, T3, T4 - Increasing size and/or local extent of the
primary tumor

 Regional Lymph Nodes
Nx - Regional lymph nodes cannot be assessed
N0 - No regional lymph nodes metastasis
N1, N2, N3 - Increasing involvement of regional lymph
nodes
 Distant Metastasis
Mx - Distant metastasis cannot be assessed
M0 - No distant metastasis
M1 - Distant metastasis
 SIGNS AND SYMPTOMS OF CANCER:
LOCAL AND GENERAL
A. LUMP
 Cancer lumps usually harder than lumps from other
causes, not cystic and not tender unless quite
advanced
 Lumps adhere to and invade nearby structures
therefore become less mobile
B. ULCER
 Malignant ulcers often have raised or heaped up
edges
 Tend to grow into nearby tissues on which they lie
and there is usually surrounding swelling and
induration
 Malignant ulcer in the mouth and throat-tender in
the later stage
 Any such ulcer may be of potential concern if it has
been present for more than 2 -3 weeks with no
evidence of healing
C. BLEEDING & EVIDENCE OF BLOOD LOSS
 There may be obvious blood loss or hidden (occult)
blood loss with evidence of anemia due to chronic
blood loss
 Occult blood - screening test for bowel or gastric
cancer
 Blood in the urine - feature of cancer of the kidney
or bladder (Hematuria – blood in the urine)
D. BLEEDING
 Internal cancers - stomach, bowel, kidney, bladder,
uterus, or lungs, bleeding is often the one of the
earliest features
 Bleeding from the bowel (fresh or dark red), urine,
sputum or mole in the skin (may be an indicator but
does not necessarily mean cancer)
 May be an indicator but it does not necessarily
mean cancer
E. LYMPH NODE ENLARGEMENT
 Evidence of metastatic spread of cancer may be
revealed by examination of the draining lymph node
areas
 Example: head and neck CA- submandibular,
submental and cervical nodes must be examined
 Breast/cancer of the skin of the arm or chest wall is
suspected- axillary lymph nodes
 CA in lower limb, skin of the abdomen, lower back,
scrotum, anus or vulva-inguinal lymph node
F. PAIN
 Most cancers are painless in their early stages
(which is why it is quite difficult to detect)
 Pain may develop after tumour has become big
enough to invade or press upon and damage
surrounding tissues or nerves (become worse or
painful once surrounding tissues are damaged)
 Small painless lump is more likely to be a cancer
than a small painful lump - people should not wait
for pain to develop before seeking medical advice
G. WEIGHT LOSS
 Approximately 2/3 of cancer patients will
experience weight loss - first symptoms that prompt
them to visit their doctor (5 lbs or 6 lbs)
 Involuntary weight loss of greater than 5% in 6
months often prognostic indicator for cancer (lose
5-10kg within few months without weight loss
regimen, you may suspect for cancer)
 Due to cancer cachexia (look gaunt and
malnourished)-caused by tumour metabolically
adapted to the anaerobic utilization of glucose
(glycolysis) such that it consumes a lot of glucose &
produce a lot of lactic acid
H. INTERFERENCE WITH TISSUE OR ORGAN FUNCTION
 Vary a great deal depending upon the site of a
cancer
o Examples: CA in mouth or throat make speaking or
swallowing difficult
o CA in larynx usually cause hoarseness or change in
voice
o CA in stomach - difficulty with eating or change
in appetite or vomiting
o CA in colon or bowel - changes in bowel habits

o CA in
prostate -
interferes
with
passage
of urine
o CA of
bladder -
difficulty
or
frequency of passing urine (dysuria – painful
urination)
o CA of the lungs - persistent cough (that never
goes away, even after taking cough
medications)
o CA of liver, bile ducts, or pancreas - may block
flow of bile from liver causing jaundice