CELLULAR ABERRATIONS

- “Oncology Nursing” – related to tumor INVASION AND METASTASIS

- Any characteristic of the cell that changes from its normal 1. Cancer cells invade surrounding tissues and blood vessels
state into an abnormal state 2. Cancer cells are transported by the circulatory system to
- Aberration – a characteristic that deviates from the normal distant sites
type 3. Cancer cells reinvade and grow at new location
Cancer ETIOLOGIC / CAUSATIVE FACTORS
- A large group of disease that can start in almost any organ 1. Viruses
or tissue of the body when abnormal cells grow - Oncogenic viruses
uncontrollably (mutation) o prolonged or frequent viral infections may cause
- Abnormal cells go beyond their usual boundaries to invade breakdown of the immune system
adjoining parts of the body and/or spread to other organs o has the capability to lead to cancer or alteration
- A complex of diseases which occurs when normal cells in the gene mutation
mutate into abnormal cells that take over normal tissue,
eventually harming and destroying the host HPV Cervical cancer
- Greek for “Crab” because it has spreading-like projection Epstein-Barr Virus Lymphoma
like cancer (Burkitt’s)
- Nearly 10 million deaths in 2020 Hepatitis B & C Hepatocellular
o Breast (2.26 million cases) cancer
o Lung (2.21 million cases) Helicobacter Pylori Gastric cancer
(bacteria)
o Colon and Rectum (1.93 million cases)
Human T-cell Adult t-cell
o Prostate (1.41 million cases) Lymphotropic virus leukemia
o Skin – Non-melanoma (1.20 million cases) Kaposi’s Sarcoma – Kaposi’s sarcoma
o Stomach (1.09 million cases) associated Herpes Virus
- More than 200 cancers can be acquired by people
- Prevalence – proportion of people
- Male: Liver, Prostate, Lung, Stomach, Colorectal, Prostate 2. Chemical carcinogens
- Female: Cervical, Breast, Colorectal, Stomach - Substances/chemicals capable of causing cancer
- Occurs at all strata of our society - Act by causing cell mutation in cell enzymes and
- Afflicts all ages but older people have a higher chance of proteins causing altered cell replication
having cancer because they’re more exposed to carcinogenic - Industrial compounds, drugs, alcohol, tobacco,
and has weak immunity food/preservatives, cytotoxic drugs (drug for cancer)
- Poses tremendous holistic impact to the patient and 3. Physical agents/stressors
significant others - When there are stressors, the fight or flight response
- Forster hopelessness and powerlessness gets activated. When the person is always stressed,
- Nurse must examine their own feelings toward cancer the epinephrine is always triggered therefore the cells
- Nurses are involved in all phases of cancer experience in the body are always heightened, which leads to
- The cure and treatment depend on the severity of the gene mutation because it replicates faster.
disease invasion - Radiation - from x-rays or radioactive isotopes, from
- Cancer is Characterized by: sunlight, UV rays
o Uncontrolled growth and spread of abnormal cells - Physical Irritation/Trauma – pipe smoking,
o Proliferation – rapid production by cell division multiple deliveries (overuse of organ can lead to
o Metastasis – spread/transfer of cancer cells from one cancer), irritation of the tongue, overuse of any organ
organ or part to another not directly connected or body part
4. Hormonal factors
LOSS OF NORMAL GROWTH CONTROL - Estrogen as replacement therapy – can trigger
mutation of cell and rapid mutation of cancer cells
- Increased incidence of vaginal, cervical, and uterine
cancers
5. Genetic factors
- When oncogene is exposed to carcinogens, changes in
cell structure occurs, malignant tumor develops
- Several cancers are associated with familial patterns –
34%
- Inherited conditions that increase risk for cancer
Hereditary Retinoblastoma
retinoblastoma
- Apoptosis – death of cell during normal cell division Xeroderma Skin
- When genes that undergo apoptosis mutation, they pigmentosum
rapidly produce abnormal cell instead of dying or instead Wilm’s tumor Kidney
of undergoing apoptosis Li-Fraumeni syndrome Brain, breast,
- Mutated/abnormal genes undergo rapid cell division leukemia
Familial adenomatous Colon, rectum
ONCOGENES
polyposis
- Genes that have a potential to cause cancer when triggered Paget’s disease of bone Bone
- Vulnerable cells that can easily mutate their RNA/DNA Fanconi’s aplastic Leukemia, liver, skin
anemia
NORMAL GROWTH
- Dead cells shed from outer surface, then they’re being
replaced by new cells PREDESPOSING FACTORS TO CANCER
- The beginning of cancerous growth starts with 1. Age (older) = more chances due to increased
proliferation then it becomes tumor (neoplasm) exposure to carcinogens
- Tumor – inflammation around the lump & warm 2. Sex
- Neoplasm – no inflammation around the lump 3. Urban residence – more pollution

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 4. Geographic distribution – prevalence in country

5. Occupation – rad-tech, exposure to chemicals

6. Heredity/genetics
7. Stress
8. Precancerous lesions – triggered benign
9. Obesity – breast & colon cancer

NAMING CANCER
- Adeno – gland
- Chondro – cartilage
- Erythro – RBC
- Hemangio – blood vessels
- Hapato – liver
- Lipo – fat
- Lympho – lymphocyte
- Melano – pigment cell
- Myelo – bone marrow
- Myo – muscle
- Osteo – bone

TERMINOLOGIES
Benign neoplasm
- Harmless growth that does not spread or invade
other tissues

Neoplasia
- Abnormal cellular changes and growth of new tissue

Hyperplasia
- Increase in cell number or amount

Hypertrophy
- Increase in cell size

Metaplasia
- Replacement of one cell type by a different adult cell
type

Dysplasia
- Changes in cell size, shape, and organization

Anaplasia
- Reverse cellular development to a more primitive or
embryonic cell type

Metastases
- Spread of cancer cells to distant parts of the body to
set up new tumors

Adenocarcinoma
- Cancer that arises from glandular tissues

Carcinoma
- Form of cancer
- Composed of epithelial cells
- Develop in tissues covering or lining organs of the
body like skin, uterus, breast

Sarcoma
- Cancer of supporting or connective tissues like
cartilage, bones, muscles, fats

Carcinogen
- Factors associated with cancer causations

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CLASSIFICATION ACC TO BEHAVIOR OF TUMOR lymph or circulation or by direct expansion

1. Benign
- cannot spread by invasion or metastasis
- not harmful or cancerous
- only grow locally
- idiopathic
- cell undergo trauma = excessive grow of cell
- RNA & DNA doesn’t mutate
- can become malignant like myoma
- can be surgically removed

2. Malignant
- capable of spreading by invasion and metastasis
- cancerous
- RNA & DNA mutates
CHARACTERISTIC BENIGN MALIGNANT
Speed of growth slowly Rapidly
Mode of growth localized Infiltrates
surrounding
tissues
capsule Encapsulated – has Not
thin line or w/ encapsulated
edges
Cell characteristic Well-differentiated Poorly
differentiated
Recurrence Extremely unusual Common
following
surgery
metastasis Never occur Very common
Effects of Not harmful to Always harmful
neoplasm host unless it to host
compresses tissues Produces
or obstruct organs cachexia
Prognosis Very good Poor prognosis

PATTERNS OF PROLIFERATION

1. Hyperplasia
- Based on an excessive rate of cell division, larger than
usual number of cells // larger amount of cell
- Process is potentially reversible
- A result of external stimuli
- Hypertrophy = normal number of cell but bigger
- Ex: callus
2. Dysplasia
- Bizarre cell growth differing in size, shape, and
arrangement
- Usually a response to chronic irritation
- Carcinoma in SITU – earliest form of cancer and has
capability to become full grown cancer // stage 0 //
severe form of dysplasia
3. Metaplasia
- Conversion of cell type of tissue into another
- Change in cell type
- Changes are reversible if stimulus is removed
4. Anaplasia
- Change in the DNA cell structure and orientation to
one another
- Characterized by loss of differentiation and a return
to its primitive form
5. Neoplasia
- Uncontrolled cell growth, either benign or malignant
- New form of cell
- Denotes abnormal multiplication due to loss of
normal proliferation regulation and absence of
stimuli
- Also known as “cells manifesting hyperplasia with
atypia”

3 STAGES OF METASTASIS

1. Invasion – invade into surrounding tissue with

penetration of blood or lymph
2. Spread – tumor cells spread through other tissue through

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3. Establishment and growth – establish and grow in - non-invasive procedure
secondary site: lymph nodes or in organs from venous
circulation

TUMOR STAGING AND GRADING

Staging – determines size of tumor and existence of metastasis

Grading – classifies tumor cells based on type of tissue

TNM System is based on the tumor (T), the extent of spread to

the lymph Nodes (N), and the presence of Metastasis (M)

DIAGNOSTIC AIDS FOR CANCER

1. Tumor marker Identification
- Analysis of substances found in the body that are made
by the tumor or cancers by the body in response to the
tumor
- Prostate Specific Antigen (PSA) – presence of low
concentration of PSA in the blood
- Prostatic Acid Phosphate (PAP) – indicator of
testicular cancer and non-hodgkin’s lymphoma
- CA 125 – ovarian cancer
- Carcinoembryonic Antigen (CEA) – colorectal cancer //
can rise due to smoking
- Alpha-Fetoprotein (AFP) – normally elevated in
pregnant women since it’s produced by the fetus // liver
or testicular cancer in men, ovarian in women
- CA 19-9 – advanced cancer in the pancreas
- CA 15-3 – advanced breast cancer
- CA 27-29 – advanced breast cancer
- Neuron-specific enolase (NSE) – neuroblastoma, small
cell lung carcinoma
- Bladder tumor marker studies – bladder cancer //
it leaks in the urine
2. Genetic profiling
- Analysis for the presence of mutations in genes
found in tumors or body tissues
- Assists in diagnosis, selection of treatment,
prediction of response to therapy
3. Mammography
- Use of x-ray images of breast
4. Computed tomography scan
- Use of narrow-beam x-ray to scan successive layers
of tissue for a cross-sectional view
- Emits less radiation
- Can be done with contrast (iodine-based dye)
5. Magnetic resonance imaging
- Use of magnetic fields and radiofrequency signals
to create sectioned images of various body
structures
- higher radio frequency signal
- More defined than CT-Scan
6. Ultrasonography
- High-frequency sound waves echoing off body
tissues are converted electronically into images
- Used to assess tissues deep within the body

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7. Fluoroscopy
8. Endoscopy
- Direct visualization of a body cavity or passageway by
insertion of an endoscope into a body cavity or
opening
- Allows tissue biopsy, fluid aspiration, and excision of
small tumors and can be used for therapeutic
purposes
9. Positron emission tomography (PET) scan
- Through the use of a tracer, provides black and white
or colored-coded images of the biologic activity of a
particular area
- Used in detection of cancer in response to treatment
10. Biopsy/Aspiration/Histopathology
- Confirmatory
- Aspiration- withdrawal of fluid
- Biopsy - removal and exam of tissue (solid)
o Incision biopsy- small area tissue
o Excisional biopsy- entire abnormality or area
- Histopathology- microscopic changes or
abnormalities in tissues that are caused as a result of
disease // a report or examination
Always refer to the official reading (objective data)

EFFECTS OF CANCER

Cancer Proliferation
- Pressure on an area
- Obstruction
- Pain
- Effusion – pulling of blood, tubig sa baga
- Ulcerations and necrosis – pag-sukat and nabubulok
yung area if di na nadadaluyan ng dugo
- Vascular thrombosis (clot na nakadikit sa tissue),
embolism (free-flowing na clot sa blood vessel), and
thrombophlebitis (inflamed vein) – all has abnormal
coagulation or clotting

Paraneoplastic Syndrome
- Anemia
- Hypercalcemia – can cause stones
- Disseminated intravascular coagulation

ANOREXIA-CACHEXIA SYNDROME
- Deprived normal cells from nutrition
- Cancer cells – mas malakas mag-consume ng
nutrition, wala natitira sa normal cells
- Normal cells get nutrition from stored fats and
muscles (nitrogen)
- Glucose and glycogen from liver depletes faster
- Tumors use lots of sodium = less water = dehydration
- Altered taste sensation
- Final outcome of unrestrained cancer growth

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PREVENTION OF CANCER

Primary Prevention
- Concerned with reducing the risks of disease through UNDERSTANDING BREAST CANCER
health promotion strategies // wala pang impending - Leading cancer in PH
attack yung cancer, tinatry palang iwasan - Breast is made up of fatty tissues and contain small
- Almost 1/3 of all cancers worldwide could be prevented chambers called lobules (where milk is made) and is
through primary prevention efforts connected to ducts
How? - Lymph nodes are connected by lymph vessels
- Reduce the risk of cancer is to help patients avoid known - Pectoral muscle: minor and major
carcinogens - Lobular = lobules
- Keeping the disease from occurring by reducing
exposure to risk factors: lifestyle modification, removing BREAST CANCER
environmental risks, or giving drugs to prevent cancer - Unregulated growth of abnormal cells in the breast tissue
from developing – tamoxifen (50% chance), Gardasil Etiology:
(HPV vaccine), hormonal problem = hormonal treatment, 1. Menarche before age 11-12 = early exposure to
sunscreen for skin cancer estrogen
2. Menopause after age 50
Secondary Prevention 3. Older age
- Procedures that detect a disease before it is 4. Family history of breast cancer especially mother or
symptomatic, when early intervention can change the sister
course of the disease 5. Nulliparity – did not bear a child // 9 months = 9
- Before obvious symptoms manifest months no menstruation + lactation (6m) = no mens
- Prognosis of treating cancer depends on the time of 6. Inherited gene mutation of BRCA 1 and BRCA 2
detection and severity 7. History of uterine cancer // uterine/cervical cancer
- Has small intervention = need breast cancer screening monthly
- There’s already a possibility to have a 8. Link with obesity, diabetes, and hypertension // can
lower the immune system
cancer How? 9. Presence of benign breast cancer // fibroadenoma,
benign tumors can be cancerous when always
- Promote screening and early detection activities – triggered, prevent benign from being bumped
testicular examination, pap smear, mammogram, 10. Men can develop breast cancer – 1/8= women,
endoscopy 1/1000= men
WARNING SIGNS
PREVENTION
Breast Self-Examination
 Start from age 20
 Done after menstruation (5-7 days after) = breast is
not lumpy
 Post-menopausal – same date each month
 Done 3x per breast
 How?
C – change in blood bowel or bladder habits // bowel = colon o In front of a mirror
A – a sore that does not heal // aphthous stomatitis o In the shower
U – unusual bleeding or discharge – nipple, stool, urine, penis, o Lying down
for menopause = uterine cancer, cough = lung cancer o Inspection and palpation
T – thickening or lump in the breast or elsewhere o Take note of the following:
I – indigestion or difficulty in swallowing // pyrosis  Changes in size, shape, and contour
O – obvious change in wart or mole // ABCD technique –  Swelling, dimpling, or puckering of the skin
asymmetry, boarder, color, diameter (more than 6mm)  Increased in the vascularity of the breast that
N – nagging cough or hoarseness – non-stop cough // indicate a growth of a tumor // more blood
laryngeal or lung cancer vessel = more blood tissue being supplied //
U – unexplained anemia // cancer cells take the iron, bone warmer = more flow of blood
cancer = bone marrow (produces RBC)  Should be done monthly to see changes in the
S – sudden unexplained weight loss // cachexia syndrome previous BSE

PATHOPHYSIOLOGY OF CANCER
- Cancer begins when an abnormal cell is transformed
by the genetic
- This abnormal cell forms a clone and begins to
proliferate abnormally, ignoring growth-regulating
signals in the environment surrounding the cell. –
Instead of undergoing apoptosis, mutated cells ignore
the growth regulating signals because their DNA is
abnormal
- The cells acquire invasive characteristics, and Patterns: wedge, linear, circular/clock (from 12 to nipple)
changes occur in surrounding tissues
- The cells infiltrate these tissues and gain access to
lymph and blood vessels, which carry the cells to
other areas of the body.

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Clinical Examination
Mammogram
- Involves x-ray examination of the breast
- The breast is supported on flat firm surface
- Involves use of two X-ray films
- Instruct to avoid use of deodorant, cream powder in
the axilla to prevent false positive result
- Done at age 40 years old
- If there’s predisposing cancer, 30 years old
- Women over 40 years old should do this annually at
the same month
Board Exam Questions: A
ASSESSMENT
 Firm, non-tender, non-mobile mass // intact because
nakapakat sa muscle or skin
 Solitary irregular shaped mass // not grouped
 Adherence to muscle or skin causing dimpling effect
 Involvement of upper outer quadrant or central nipple
portion of breast = because there’s more lymph node
there and there’s a bigger chance for it to be cancer
 Asymmetry of breast
 Orange peel skin // Peau d’ orange (french for “orange
peel”) is a condition that affects the skin on the breast
 Retraction of the nipple
 Abnormal discharge from the nipple
STAGES OF BREAST CANCER
Stage 1 = 2cm
Stage 2 = up to 5cm with axillary lymph node involvement
Stage 3 = more than 5cm with axillary and neck lymph node
involvement
Stage 4 = metastasis to distant organs (liver as most common
site of metastasis, lungs, bone, and brain)
COLLABORATIVE MANAGEMENT
 Lumpectomy
- Removal of lump
- Small incision site
- Not entirely a treatment but main problem is removed
- Combined with other therapy for treatment
 Simple Mastectomy
- Removal of the entire breast
- Pectoralis muscles remain intact
 Modified Radical Mastectomy (MRM)
- Removal of entire breast and the axillary lymph nodes
- Pectoralis muscled are conserved
- Most common mastectomy
 Radical Mastectomy or Halsted Surgery
- Rarely done
- Removal of entire breast, pectoralis major and minor,
and axillary lymph nodes
- Done where there’s invasive and extensive degree of
cancer’s penetration
- Followed by skin grafting // pag-tapal ng skin
 Chemotherapy
 Radiation therapy
 Hormone therapy
 Combination therapy
Board Exam Question – psychological
PREOPERATIVE CARE
 Psychosocial support, include the husband when
necessary
 Teach arm exercises to prevent lymphedema
 Inform about wound suction drainage, Hemovac,
Jackson Pratt to prevent high BP // 24 hrs= red/pink,
after 24 hrs= lighter color of blood
 Most teachings are done before surgery
Board Exam Question
POST OPERATIVE CARE
 Place client in Semi-fowlers position with arm abducted
and elevated on pillow // for drainage, so the fluid
won’t accumulate and so it will go to the systemic
circulation
 monitor hemovac output (normal drainage is
serosanguinous for the first 24 hours). Serosanguinous
drainage is composed of plasma and small amounts of
RBC. It is pinkish or reddish in appearance but not
viscous.
 check behind patient bleeding. blood flows to the back
by gravity
 Post signs warning against taking blood pressure,
starting IVs, or drawing blood on affected site. To
prevent obstruction of venous and lymphatic flow
 Initiate exercise to prevent stiffness and contractures of
shoulder girdle. Give analgesics before initiating
exercises // Isometric exercise
 Reinforce special mastectomy exercises as prescribed.
To prevent lymphedema
 Provide adequate analgesia to promote ambulation and
exercise. The client cooperates with ambulation and
exercise if she is free from pain or discomfort
 Breathing exercises for proper lung expansion so there
will be good perfusion for better healing and also to
prevent lung collapse
 Patient can wear bra but prosthesis can be worn more
than 4 to 6 weeks after surgery
 Continuous breast examination for another breast that
wasn’t removed
COMPLICATION OF SURGERY
Lymphedema
- Swelling due to build-up of lymph fluid in the body
- May occur after the surgery or after week/s because of
accumulation of fluid in the lymphatic vessels
- This may also be because of wound infection, delayed
healing, or damage to lymphatic channels by radiation
therapy
PREVENTIVE MEASURES
 Place an arm on pillow with each joint higher than the
proximal joint
 Do NOT sleep on the involved arm
 Do not use arm on surgery side to take BP, draw
blood, place an IV, and give vaccinations
 Do not wear tight-fitting jewelry or watches
 Do not wear elastic sleeves of tight-fitting bras
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 Do not carry or move heavy objects

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  Avoid cutting yourself. Do not cut cuticles.
 Exercise the arm to increase the circulation and
develop collateral lymphatic
 Isometric exercises, with the physician’s approval and
immediately after surgical procedures, promote
lymphatic drainage or drainage by muscle
contractions. Such exercises may be done by
squeezing a rubber ball or opening and closing
fist
// because muscle contracts and joints won’t move
 Wear loose clothing so that there is no constriction or
impeded circulation
 Check arm and hand DAILY for changes
 Contact HCP immediately if fever, redness,
tenderness, warmth, or swelling of the arm or hands
develops

Board Exam Question: Sign of Lymphedema

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