CELLULAR ABBERRATION
growth control. In normal tissues, the
LESSON 1
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.
EPEDIMIOLOGY
 Overall, the incidence of cancer is
higher in men than in women and
higher in industrialized sectors and
nations.
 More than 1.4 million Americans are
diagnosed each year with cancer,
affecting one of various body sites.
 Cancer is second only to
cardiovascular disease as a leading
cause of death in the United States.
 In the Philippines, cancer is now the
third leading cause of death (PNA,
2023).
 There are 184 cases diagnosed in
100,000 patients and that 96 deaths
related to cancer are reported daily.
 In terms of death, lung cancer has the
highest number followed by liver
cancer, breast cancer, colon cancer
and prostate cancer.
PATHOPHYSIOLOGY
CANCER is characterized by the following:
 uncontrolled growth and spread by
abnormal cells
 proliferation
 metastasis
 Cancerous cells are described as
malignant neoplasms because they
demonstrate uncontrolled cellular
growth that follows no physiologic
demand (neoplasia).
 Cancer arises from a loss of normal
rates of new cell growth and old cell
death are kept in balance. In cancer,
this balance is disrupted.
 Apoptosis, or “cell suicide,” is the
mechanism by which old or damaged
cells normally self-destruct.
RISKFACTORS
AGE
 Long term exposure to high dose of
promotional agents.
 Alter immune system.
 Free radicals tend to accumulate in
the cells over time.
 Hormonal changes.
SEX
 High levels of epinephrine and cortisol
causes fatigue and impaired
immunologic surveillance.
HEREDITY
GENDER
 Females with breast cancer.
POVERTY
 Stress, diet, not doing screening tests.
DIET
 Some preserved foods are considered
genotoxic.
OCCUPATION
 exposure to radiation
CELLALTERATION
TYPES:
 Hyperplasia
 Metaplasia
 Dysplasia
 Anaplasia

CLASSIFICATIONOF CANCER
BENIGN
 Tumors that cannot spread by
invasion or metastasis. Grows locally.
MALIGNANT
 Tumors that are capable of spreading
by invasion and metastasis.
CARCINOGENESIS
 Carcinogenesis is the process of the
change of normal cells into neoplastic
cells and subsequently into a tumor.
 A malignant transformation that
involves initiation (initiators such as
chemicals, physical factors, and
biologic agents, escape normal
enzymatic mechanisms and alter the
genetic structure of the cellular DNA),
promotion (repeated exposure to
carcinogens causes the expression of
abnormal or mutant genetics
information), and progression (the
altered cells exhibit increased
malignant behavior).
CELLULAR MUTATION
 Carcinogens cause cellular mutations
in cellular DNA.
Three stages of carcinogenic process:
 Initiation Stage - permanent damage
in cellular DNA in a result of exposure
to carcinogen.
 Promotion Stage - may last for years,
includes conditions such as smoking,
long alcohol intake, etc.
 Progression Stage - inherited changes
acquired during the cell replication,
that develop into cancer.
ONCOGENES
 Genes that promote cell proliferation
and are capable of triggering
cancerous characteristics.
 Can be classified according to their
overall function.
 A decrease in the body's immunity
may allow the expression of
oncogenes.
TUMORSUPPRESSION GENES
 Normally suppress oncogenes.
 Become inactive by deletion or
mutation.
 Inherited cancers have been
associated with tumor suppressor
genes.
TUMOR INVASION AND METASTASIS
INVASION
 the ability of the cancer cells to
invade adjunct tissues.
  the pressure of growing tumor can
cause atrophy and necrosis to adjunct
tissues.
 many cancer cells release enzymes
that lyse cell membranes of normal
tissues.
 cancer cells are easily separated from
neoplasm and moves into
surrounding tissues.
 motile cells are easily attracted by
chemical signals produced by activity
within normal cells.
TUMOR INVASION ANDMETASTASIS
METASTASIS
 travelling of the malignant cells from
the primary tumor to invade other
tissues and organs of the body and
form a secondary tumor.
MECHANISM OF METASTASIS
BLOOD-OR-LYMPH BORNE through the
following steps:
 INTRAVASATION: through blood or
lymphatic vessel walls and into
circulation.
 SURVIVAL: of the malignant cells in
the blood (from detection of immune
system).
 EXTRAVASATION: from circulation
and implantation in a new tissue.
BODY CAVITIES:
 from the wall of the organ to the
nearby cavity.
Example: from colon cancer to the peritoneal
cavity form a tumor in the mesenteric
epithelium.
Factors that may alter the immune response
and enhance the establishment of
metastasis:
 Increased age
 Depression
 Accumulated stress
 Pregnancy
 Chemotherapy treatment for the
primary cancer
PHYSIOLOGIC & PSYCHOLOGICEFFECTS OF
CANCER
DISRUPTION OF FUNCTION
 By obstruction of pressure.
Ex: Tumor in the bowel can stop intestinal
motility.
HEMATOLOGIC ALTERATION
 Can impair the normal function of the
blood cells.
Ex: In Leukemia, immature leukocytes
causes compromised immunity
INFECTION
 Ex: Invading bowel or bladder walls
causes fistula and infections.
HEMORRHAGE
 Ex: Tumor erosion through blood
vessels.
ANOREXIA-CACHEXIA SYNDROME
 Unexplained weight loss.
PARANEOPLASTIC SYNDROME
 Indirect effects of cancer, may be
early warning signs of cancer or
indicate complications
 Ex: increased hormones in the breast,
ovarian, renal cancers
PAIN
 Acute and chronic.
  Caused by pressure, necrosis or side
effects of therapies.
PHYSICAL STRESS
 Immune system needs high energy to
destroy the neoplasm.
 Continued immune process causes
fatigue, weight loss, anemia or
dehydration.
PSYCHOLOGIC STRESS
 Ex: fear, grief, hopelessness or anger
LESSON 2
DETECTION & PREVENTION OF CANCER
PRIMARY PREVENTION
 concerned with reducing risks of
diseases through health promotion
strategies.
SECONDARY PREVENTION
 includes programs that promote
screening and early detection
activities.
 Ex: breast and testicular examination,
Pap Smear
DIAGNOSIS OF CANCER
DIAGNOSTIC EVALUATION
Tumor Marker Identification
 Analysis of substances found in
body tissues, blood or other body
fluids that are made by the tumor
or by the body in response to the
tumor.
Genetic profiling
 Analysis for the presence of
mutations in genes found in
tumors or body tissues.
Mammography
 Mammography is the use of x-ray
images of the breast.
Magnetic resonance imaging (MRI)
 MRI uses magnetic fields and
radio-frequency signals to create
sectioned images of various body
structures.
Computed tomography (CT)
 CT scan uses narrow-beam x-ray
to scan successive layers of tissue
for a cross sectional view.
Fluoroscopy
 Use of X-rays that identify
contrasts in the body tissue
densities; may involve the use of
contrast agents.
Ultrasonography
 Ultrasound uses high-frequency
sound waves echoing off body
tissues and is converted
electronically into images; used to
assess deep tissues within the
body.
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.
Nuclear medicine imaging
 Uses intravenous injection or
ingestion of radioisotope
substances followed by imaging of
tissues that have concentrated
the radioisotopes.
Positron emission tomography (PET)

 Through the use of a tracer,

provides black and white or color-
coded images of the biologic
activity of a particular area, rather
than its structure.

PET Fusion

 Use of a PET scanner and a CT

scanner in one machine to
provide an image combining
anatomic detail, spatial
resolution, and functional
metabolic abnormalities.

Radioimmunoconjugates

 Monoclonal antibodies are

labeled with a radioisotope and
injected intravenously into the
patient.

TUMOR STAGING & GRADING

STAGING TNM SYSTEM

 determines the size of the tumor TUMOR, NODES, METASTASIS SYSTEM
and the existence of local invasion
and distant metastasis.  frequently used, where T is the
extent of the primary tumor, N is
GRADING the absence or presence and
 refers to the classification of the extent of regional lymph node
tumor cells, and it seeks to define metastasis, and M is the absence
the type of tissue from which the or presence of distant metastasis.
tumor originated and the degree
to which the tumor cells retain
the functional and histologic
characteristics of the tissue of
origin.
LESSON 3
MANAGEMENT OF CANCER
SURGERY
 Surgical removal of entire cancer
remains as the ideal and most
frequently used treatment
method.
BIOPSY
 is usually performed to obtain a
tissue sample for analysis of the
cells suspected to be malignant.
THREE TYPES OF BIOPSY
 Excisional biopsy: most
frequently used for easily
accessible tumors of the skin,
breast, and upper and lower
gastrointestinal and upper
respiratory tracts.
 Incisional biopsy: performed if
the tumor mass is too large to be
removed.
 Needle biopsy: are performed to
sample suspicious masses that are
easily accessible, such as growths
in the breasts, thyroid, lung, liver,
and kidney.
SURGERY AS PRIMARY TREATMENT
LOCAL EXCISION
 often performed on an outpatient
basis, is warranted when the mass is
small, and it includes removal of the
mass and a small margin of normal
tissue that is easily accessible.
WIDE OR RADICAL EXCISION
 include removal of the primary tumor,
lymph nodes, adjacent involved
structures, and surrounding tissues
that may be at high risk for tumor
spread.
VIDEO-ASSISTED ENDOSCOPIC SURGERY
 In this minimally invasive procedure,
an endoscope with intense lighting
and an attached multichip mini-
camera is inserted into the body
through a small incision.
SALVAGE SURGERY
 is an additional treatment option that
is an extensive surgical approach to
treat the local recurrence of cancer
after the use of a less extensive
primary approach.
ELECTROSURGERY
 Uses electric current to destroy tumor
cells.
CRYOSURGERY
 Uses liquid nitrogen or a very cold
probe to freeze tissue and cause cell
destruction.
CHEMOSURGERY
 Uses chemicals or chemotherapy
applied directly to the tissue to cause
destruction.
LASER SURGERY
 Uses light and energy aimed at an
exact tissue location and depth to
vaporize cancer cells.
PHOTO DYNAMIC SURGERY
 Intravenous administration of a light-
sensitizing agent that is taken up by
cancer cells, followed by exposure to
laser within 24-48 hours.
RADIOFREQUENCY ABLATION
 Uses localized application of thermal
energy that destroys cancer cells
through heat.
PROPHYLACTIC SURGERY Reconstructive Surgery

 Prophylactic surgery involves  Reconstructive surgery may be

removing nonvital tissues or organs performed in an attempt to improve
that are at increased risk to develop function or obtain a more desirable
cancer. cosmetic effect.
 Ex: Colectomy, mastectomy, and
Indications
oophorectomy are examples of
prophylactic surgery.  Reconstructive surgery may be
 Prophylactic surgery is offered indicated for breast, head and neck,
selectively to patients and discussed and skin cancers.
thoroughly with patients and families.
RADIATION THERAPY
PALLIATIVE SURGERY
Uses
When a cure is not possible, the goals of
treatment are to make the patient as  Radiation may be used to cure cancer,
comfortable as possible. as in thyroid carcinomas, localized
cancers of the head and neck, and
Palliative Surgery cancers of the uterine cervix; it may
control malignant disease when a
 Palliative surgery is performed in an
tumor cannot be removed surgically
attempt to relieve complications of
or when local nodal metastasis is
cancer.
present, or it can be used neo-
Communication adjuvantly.

 Honest and informative Types

communication with the patient and
 Two types of ionizing radiation-
family about the goal of surgery is
electromagnetic radiation (xrays and
essential to avoid false hope and
gamma rays) and particulate
disappointment.
radiation (electrons, beta particles,
protons, neutrons, and alpha
particles)- can lead to tissue
disruption.

RADIATION DOSAGE

Lethal tumor dose

 The lethal tumor dose is defined as

that dose that will eradicate 95% of
the tumor yet preserve normal tissue.

Fractions
RECONSTRUCTIVE SURGERY
 In external beam radiation, the total
 Reconstructive surgery may follow radiation dose is delivered over
curative or radical surgery. several weeks in daily doses called
fractions.
Fractionated doses
 Repeated radiation treatments over
time also allow for the periphery of
the tumor to be reoxygenated
repeatedly, because tumors shrink
from the outside inward.
ADMINISTRATION OF RADIATION
Teletherapy (external beam radiation)
 is the most commonly used form of
radiation, in which, depending on the
size, shape, and location of the tumor,
different energy levels are generated
to produce a carefully shaped beam
that will destroy the targeted tumor,
yet spare the surrounding healthy
tissues and organs in an effort to
reduce the treatment toxicities for the
patient.
Brachytherapy (internal radiation)
 delivers a high dose of radiation to a
localized area and can be implanted
by means of needles, seeds, beads, or
catheters into body cavities (vagina,
abdomen, pleura) or interstitial
compartments (breast, prostate).
CHEMOTHERAPY
Goal
 The goal of treatment is the
eradication of enough tumor so that
the remaining tumor cells can be
destroyed by the body’s immune
system.
Proliferating cells
 Actively proliferating cells within a
tumor are the most sensitive to
chemotherapeutic agents.
Nondividing cells
 Nondividing cells capable of future
proliferation are the least sensitive to
antineoplastic medications and
consequently are potentially
dangerous.
Cell cycle-specific
 Cell cycle-specific agents destroy cells
that are actively reproducing by
means of the cell-cycle; most affect
cells in the S phase by interfering with
DNA and RNA synthesis.
Cell cycle-nonspecific
 Chemotherapeutic agents that act
independently of the cell cycle phases
are cell cycle nonspecific, and they
usually have a prolonged effect on
cells, leading to cellular damage and
death.
ANTINEOPLASTIC AGENTS
Alkylating agents
 Alters DNA structure by misreading
DNA code, initiating breaks in the
DNA molecule, cross-linking DNA
strands
Nitrosoureas
 Similar to the alkylating agents, but
they can cross the blood-brain barrier.
Topoisomerase I inhibitors
 Induce breaks in the DNA strand by
binding to enzyme topoisomerase
I,preventing cells from dividing.
Antimetabolites
 Antimetabolites interfere with the
biosynthesis of metabolites or nucleic
 acids necessary for RNA and DNA
synthesis.
Antitumor antibiotics
 Interfere with DNA synthesis by
binding DNA and prevent RNA
synthesis.
Mitotic spindle poisons.
 Arrest metaphase by inhibiting mitotic
tubular formation and inhibiting DNA
and protein synthesis.
Hormonal agents
Hormonal agents bind to hormone
receptor sites that alter cellular growth;
blocks binding of estrogens to receptor
sites; inhibit RNA synthesis; suppress
aromatase of P450 system, which
decreases level.
BONE MARROW TRANSPLANTATION
Types of BMT based on the source of donor
cells include:
 Allogeneic. Allogeneic is from a
related donor other than the
patient;donor may be a related donor
or a matched unrelated donor.
 Autologous. Autologous BMT is from
the patient himself.
 Syngeneic. Syngeneic BMT is from an
identical twin.
BIOLOGIC RESPONSE MODIFIERS
Nonspecific biologic response modifiers
 Nonspecific agents such as Calmette-
Guérin (BCG) and Corynebacterium
parvum, when injected into the
patient, may serve as antigens that
can stimulate an immune response in
the hopes of eradicating malignant
cells.
Monoclonal antibodies
 Monoclonal antibodies (MoAbs) have
become available through technologic
advances, and this type of specificity
allows MoAbs to destroy the cancer
cells and spare normal cells.
Cancer Vaccines
 Cancer vaccines are used to mobilize
the body’s immune response to
recognize and attack cancer cells, as
these cancer vaccines contain either
portions of cancer cells alone or
portions of cells in combination with
other substances that can augment or
boost immune responses.
GENE THERAPY
Gene therapy includes approaches that
correct genetic defects or manipulate genes
to induce tumor cell destruction in the hope
of preventing or combating the disease.
Challenges Risk
 Because of the possibility of herb-
 One of the challenges confronting
vitamin-drug interactions, there is
cancer gene therapy is the multiple
concern about the use of biologicals
somatic mutations involved in the
and dietary supplements, which are
development of cancer, making it
not regulated by the FDA nor
difficult to identify the most effective
subjected to rigorous scientific
gene therapy approach.
evaluation.
Viruses

 Viruses used as vectors that transport

a gene into a target cell via the cell
membrane include retroviruses,
adenoviruses, vaccinia virus, fowlpox,
herpes simplex viruses, and Epstein-
Barr viruses.

APPROACHES IN GENE THERAPY

Tumor-directed therapy

 This is the introduction of a

therapeutic gene (suicide gene) into
tumor cells in an attempt to destroy
them.

Active immunotherapy

 Active immunotherapy is the

administration of genes that will
invoke the antitumor responses of the
immune system.

Adoptive immunotherapy

 Active immunotherapy is the

administration of genetically altered
lymphocytes that are programmed to
cause tumor destruction.

COMPLEMENTARY & ALTERNATIVE

MEDICINE

Complementary and Alternative Medicine

(CAM)

 CAM was defined as diverse medical

and health care systems, practices,
and products that are not presently
considered to be part of conventional
medicine.