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 or 1. Viruses
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 like Epstein-Barr Virus Lymphoma
(Burkitt’s)
cancer
Hepatitis B & C Hepatocellular
- Nearly 10 million deaths in 2020
cancer
o Breast (2.26 million cases)
Helicobacter Pylori Gastric cancer
o Lung (2.21 million cases) (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, the
- Nurse must examine their own feelings toward cancer epinephrine is always triggered therefore the cells in
- Nurses are involved in all phases of cancer experience the body are always heightened, which leads to gene
- The cure and treatment depend on the severity of the disease mutation because it replicates faster.
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, multiple
o Proliferation – rapid production by cell division deliveries (overuse of organ can lead to cancer),
o Metastasis – spread/transfer of cancer cells from one irritation of the tongue, overuse of any organ or body
organ or part to another not directly connected 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 rapidly pigmentosum
produce abnormal cell instead of dying or instead of Wilm’s tumor Kidney
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
NORMAL GROWTH anemia
- 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 exposure
proliferation then it becomes tumor (neoplasm) 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 3. Establishment and growth – establish and grow in
secondary site: lymph nodes or in organs from venous
1. Benign circulation
- cannot spread by invasion or metastasis
- not harmful or cancerous TUMOR STAGING AND GRADING
- only grow locally
- idiopathic Staging – determines size of tumor and existence of metastasis
- cell undergo trauma = excessive grow of cell Grading – classifies tumor cells based on type of tissue
- RNA & DNA doesn’t mutate
- can become malignant like myoma TNM System is based on the tumor (T), the extent of spread to
- can be surgically removed the lymph Nodes (N), and the presence of Metastasis (M)

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 host Always harmful DIAGNOSTIC AIDS FOR CANCER
neoplasm unless it to host 1. Tumor marker Identification
compresses tissues Produces - Analysis of substances found in the body that are made by
or obstruct organs cachexia the tumor or cancers by the body in response to the tumor
Prognosis Very good Poor prognosis - Prostate Specific Antigen (PSA) – presence of low
concentration of PSA in the blood
PATTERNS OF PROLIFERATION - Prostatic Acid Phosphate (PAP) – indicator of testicular
cancer and non-hodgkin’s lymphoma
1. Hyperplasia - CA 125 – ovarian cancer
- Based on an excessive rate of cell division, larger than - Carcinoembryonic Antigen (CEA) – colorectal cancer //
usual number of cells // larger amount of cell can rise due to smoking
- Process is potentially reversible - Alpha-Fetoprotein (AFP) – normally elevated in pregnant
- A result of external stimuli women since it’s produced by the fetus // liver or
- Hypertrophy = normal number of cell but bigger testicular cancer in men, ovarian in women
- Ex: callus - CA 19-9 – advanced cancer in the pancreas
2. Dysplasia - CA 15-3 – advanced breast cancer
- Bizarre cell growth differing in size, shape, and - CA 27-29 – advanced breast cancer
arrangement - Neuron-specific enolase (NSE) – neuroblastoma, small
- Usually a response to chronic irritation cell lung carcinoma
- Carcinoma in SITU – earliest form of cancer and has - Bladder tumor marker studies – bladder cancer // it
capability to become full grown cancer // stage 0 // leaks in the urine
severe form of dysplasia 2. Genetic profiling
3. Metaplasia - Analysis for the presence of mutations in genes found
- Conversion of cell type of tissue into another in tumors or body tissues
- Change in cell type - Assists in diagnosis, selection of treatment, prediction
- Changes are reversible if stimulus is removed of response to therapy
4. Anaplasia 3. Mammography
- Change in the DNA cell structure and orientation to - Use of x-ray images of breast
one another 4. Computed tomography scan
- Characterized by loss of differentiation and a return to - Use of narrow-beam x-ray to scan successive layers of
its primitive form tissue for a cross-sectional view
5. Neoplasia - Emits less radiation
- Uncontrolled cell growth, either benign or malignant - Can be done with contrast (iodine-based dye)
- New form of cell 5. Magnetic resonance imaging
- Denotes abnormal multiplication due to loss of normal - Use of magnetic fields and radiofrequency signals to
proliferation regulation and absence of stimuli create sectioned images of various body structures
- Also known as “cells manifesting hyperplasia with - higher radio frequency signal
atypia” - More defined than CT-Scan
6. Ultrasonography
3 STAGES OF METASTASIS
- High-frequency sound waves echoing off body tissues
1. Invasion – invade into surrounding tissue with are converted electronically into images
penetration of blood or lymph - Used to assess tissues deep within the body
2. Spread – tumor cells spread through other tissue through - non-invasive procedure
lymph or circulation or by direct expansion
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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 UNDERSTANDING BREAST CANCER

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