Learning objectives:

1. Describe the prevalence and incidence of cancer

2. Describe the process involved in the biology of
cancer
3. Describe the role of immune system related to
cancer
4. Describe the use of classification systems for
cancer
5. Explain the role of the nurse in the prevention and
detection of cancer
6. Differentiate between internal and external beam
radiation
7. Identify the classifications of chemotherapy agents
and methods of administration.
8. Describe the effects of radiation therapy and
chemotherapy on normal tissues
9. Identify the types and effects of biologic
therapy agents
10. Describe the nursing management of the
patient receiving radiation therapy,
chemotherapy and biologic therapy
11. Describe the nutritional therapy for patients
with cancer
12. Describe the complications that can occur in
advanced cancer
13. Describe the appropriate physiologic support
of the patient with cancer and patient’s family.
Oncology defined
•Branch of medicine that deals
with the study, detection,
treatment and management
of cancer and neoplasia
What Is Cancer?
CANCER is a complex of diseases which occurs when normal
cells mutate into abnormal cells that take over normal tissue,
eventually harming and destroying the host
• Disorders that can involve all body organs with manifestations that vary
according to the body system affected and type of tumor cells

• Cells lose their normal growth controlling mechanisms and the growth of
cells is uncontrolled.

• Cancer produces serious health problems such as impaired immune and

hematopoietic function, altered GIT structure and function, sensory
deficits and decreased respiratory function.
CANCER
A large group of diseases characterized
by:
– Uncontrolled growth and spread of abnormal cells
– Proliferation (rapid reproduction by cell division)
– Metastasis (spread or transfer of cancer cells from one organ or part
to another not directly connected)
NORMAL CELL
CELL
• the structural and functional unit of all known
living organisms
• the smallest unit of an organism that is classified
as living, and is sometimes called the building
block of life
Structure of a Typical cell
I. Cell membrane or Plasma membrane
II. Nucleus
III. Cytoplasm
IV. Cytoplasmic organelles
▪ ribosomes
▪ Golgi bodies
▪ Endoplasmic reticulum
▪ Lysosomes
▪ Mitochondria
▪ Peroxisomes
▪ Centrosomes and centriole
▪ Filaments and microtubules
Structure of a Typical cell
I. Cell membrane or Plasma membrane
II. Nucleus
III. Cytoplasm
IV. Cytoplasmic organelles
▪ ribosomes
▪ Golgi bodies
▪ Endoplasmic reticulum
▪ Lysosomes
▪ Mitochondria
▪ Peroxisomes
▪ Centrosomes and centriole
▪ Filaments and microtubules
Components
• Cell membrane- separate and protect a cell from
its surrounding environment
• Cytoskeleton - acts to organize and maintain the
cell's shape
• Genetic material
• DNA - for their long-term information storage
• RNA - used for information transport
Cell functions
• Cell growth and metabolism
• Creation of new cells
• Protein synthesis
• Cell movement or motility
Cell Cycle
• Cell Proliferation – process by which the cells
divide and reproduce
• regulated
• Cell differentiation – transformation of cell into
specialized cells
Healthy cells
• Dynamic, active and orderly
• Small powerhouse , laboratory, factory and
duplicating machine- perfectly copying itself
over and over.
PROLIFERATIVE PHASE
• Abnormal cellular growth is classified as nonneoplastic
or neoplastic growth.

A. NON-NEOPLASTIC GROWTH PATTERNS

HYPERTROPHY
• -increase in cell size, resulting from increased workload,
hormonal stimulation or compensation related to
functional loss of other tissue.
• HYPERPLASIA
• Reversible increase in the number of cells of a certain
tissue type.
• Resulting in increase in the tissue mass such as in
adolescence and pregnancy.
•
• METAPLASIA
• Process in which one adult type cell is
substituted for another type not usually found in
the involved tissue( glandular for squamous)
• Reversible if the stimulus is remove
• Metaplasia may progress to dysplasia if stimulus
persists.
• Common site –uterine cervix
• DYSPLASIA
• -characterized by an alteration in healthy adult
cells in which the cells varies from its normal
size, shape or organization or one mature cell
type is replaced with a less mature cell type
• -reversible if the stimulus is removed.
B.NEOPLASTIC GROWTH PATTERN

1. ANAPLASIA( without form)

• Irreversible change in which the structure of
adult cells regresses to more primitive levels.
• Cells loss the capacity for specialized functions.
• Positionally and cytologically disorganized.
• HALLMARK OF CANCER
2. NEOPLASTIC GROWTH (NEW GROWTH)
• Abnormal tissue
• Extends beyond the boundaries of healthy tissue
• Fail to fulfill the normal function of cells in that
tissue
• Uncontrolled functioning, unregulated division
and growth
• Abnormal motility( characterized neoplasm)
•
CANCER RISK FACTORS:
1. Environmental Factors: tobacco
2. Nutrition
3. Fatty, creamy foods, red meat, spicy and very
saucy
4. Fruits and vegetable rich
5. Alcohol
6. Cancer of the oropharynx ,larynx, esophagus,
liver
7. Beer- rectal cancer
8. Sexual Behavior
9. Multiple sexual partners
10. Married
11. Radiation
12. Ionizing radiation
13. Tv, cellphone, computer, tanning machines
14. Drugs
15. Progestin,diethylstilbestrol
16. Lifestyle
17. Stress, rat race pace, pent up emotions, emotional
hurts, deep frustration, burn out
18. Trauma
19. predisposition and familial tendencies
20. Lymphocytic lymphoma, ALL, Hodgkin’s disease,
ovarian, gastric, breast
•
WAYS TO MAINTIAN A HEALTHY BODY AND
AVOID CANCER:
• DIET- vegetables, fruits and fiber
• Exercise and regular body movements such as
walking, swimming
• Optimum body rest and sleep
• Positive pleasant kind thoughts about self and
others
• Abundance of fresh drinking water, milk, fresh
juice at day time
• Avoidance of daily intake of red meat, fats,
animal skin
• Restricted intake of salt and sugar in meals and
snacks.
• Enhancing friendship and camaraderie to avoid
recourse to drugs
• A strong prayer life
• Avoidance of cigarette smoking , alcohol and
excessive sexual indulgence.
•
 1. Loss of proliferative control
CHARACTERISTICS OFproduction
• -in normal cells, cells CANCER CELLS:
stops when the
stimulus is gone, producing a balance between cell
production and cell loss.
•
2. Loss of capacity to differentiate
• Undifferentiated – the more undifferentiated, the
more virulent and malignant.
•
3. Altered biochemical properties –cancer cells may
inappropriately secrete hormones in an organ or
tissue that does not normally produce or release
those hormones.
4. Chromosomal instability –less genetically
stable than normal due to the development of
abnormal DNA or nutritional deficiency.
•
5. Capacity to metastasize- the spread from
primary ( parent) site to distant secondary sites.
•
The 3 Major categories of Cell Proliferation in
Normal tissues:
• 1. Static tissues
➢ they do not retain the capacity to divide after
the post embryonic period.
- they cannot divide. When destroyed or damaged,
cannot be replaced.
2. Expanding tissues
- cells of this type temporarily cease proliferating
when tissue reaches it’s normal adult size.
- They reenter the cell cycle to replace injured or
dead cells.
3. Renewing tissues
- have finite life span and are continuously
proliferating.
CELL CYCLE
• 1. G0 PHASE
• 2. G1 PHASE
• 3. S PHASE
• G2 PHASE
• M PHASE OR MITOSIS
CELL CYCLE
• Is the sequence of events involved in replication
of DNA and it’s equal distribution to the
daughter cells produced by cell division.
• All cells, nonmalignant and malignant progress
through the 5 phases of the cell cycle.
Preface
The division cycle of most cells consists of four
coordinated processes:
1. Cell growth
2. DNA replication
3. Distribution of the duplicated chromosomes to
daughter cells
4. Cell division
• G0 phase(POSTMITOTIC
RESTING PHASE)
➢Cells that are not active,
resting includes cells that
will never divide and cells
that are dormant but are
capable of being stimulated
to enter the cell cycle.
G1 phase(GROWTH PERIOD)
➢Period of decreased metabolic activity prepares
for copying it’s DNA in the S phase of the cell
cycle.
➢Lasts 12 to 14 hours
➢Syn thesize proteins and ribonucleic acid(RNA)
➢Is primarily the “stage of readiness” as cells
prepare for entry into the S phase.
• S Phase( SYNTHESIS)
➢DNA is duplicated. DNA synthesis is limited
exclusively to this phase.
➢Lasts approx. 7 to 20 hours.
➢Cells are most vulnerable to damage in this
phase.
➢A disarray of DNA molecules can lead to cell
death.
G2 Phase (Gap)
➢Which last from 1 to 4 hrs; there is hypoactivity
as the cells awaits entry in to the mitotic phase.
➢The period between the completion of DNA
synthesis and the next phase (M)
mitosis
➢Last from 40 min to 2 hours, includes both
nuclear and cytoplasmic division.
➢Divided into 4 Phases:

1. Interphase –cells grow in size, DNA replicates,

chromosomes elongate.

2. Prophase – the first appearance of

chromosomes; DNA coils.; special fibers called”
spindle fibers” form on each end of the cell
and grow toward the DNA chromosomes.
3. Metaphase - chromosomes align across cell
equator----forms a line; nucleoli and nuclear
membrane disappears.

4. Anaphase – chromosomes divide or pulled

apart by the spindle fibers to opposite sides of
the cell; chromosomes move to opposite poles;
by the end of this phase, there are 46
chromosomes lying at each side of the cell.
5. Telophase - chromosomes elongate; nuclear
membranes reappear and enclose
chromosomes; cytokinesis occurs-------( where
the cells divides into 2); centrioles replicate; at
the end of this phase, 2 identical daughter cells
have been formed.
Regulation of the Cell Cycle

Regulatory signals
Check-points
Cyclins
CDKs
Cell-Cycle Checkpoints
6 HALLMARKS OF CANCER
1. Self- sufficiency in growth signals
2. Insensitivity to antigrowth signals
3. Evading apoptosis
4. Limitless replicative potential
5. Sustained angiogenesis
6. Tissue invasion and metastasis.
6 HALLMARKS OF CANCER
Characteristics of Cancer cells
1. Loss of proliferative control
▪ in cancer , proliferation continues once the
stimulus initiates the process
▪ Cancer cells progress in continued,
uncontrolled growth.
2.Loss of capacity to differentiate
▪ Differentiation – is the process by which cells
diversify and acquire specific structural and
functional characteristics
▪ Well differentiated-
▪ Undifferentiated – or poorly differentiated
▪ The more undifferentiated a malignant cells,
the more virulent.
3. Altered biochemical properties
▪ Because the cell’s loss of the capacity to
differentiate, certain biochemical properties may
be missing because of the cell’s new immature
state.
▪ Or cells may acquire new properties because
of enzyme pattern changes or alterations in
DNA.
➢Continued reproduction despite diminished
concentration in growth hormones
➢Less dependence on oxygen for glycolysis
➢ectopic hormone production
5. Capacity to metastasize
Metastasis –the spread of cancer cells from a
primary site to distant secondary sites.
➢Is a property unique to cancer cells.