Adenocarcinoma -cancer that arises from glandular tissues.

Anaplasia -reverse cellular development in a more primitive or embryonic cell type.

Apoptosis -process of carcinogenesis when cell death does not occur.
Benign neoplasm -a harmless growth that does not invade or spread to other tissues.
Cancer -a disease of the cell in which the normal mechanisms of the control of growth and proliferation
has been altered; it is invasive, spreading directly to the surrounding tissues as well as to new sites in the
body; also called as malignant neoplasm.
Carcinogens -factors associated with cancer causation
Carcinoma in situ -neoplasm of epithelial tissue that remains confined to the site of origin.
Carcinoma -a form of cancer that is composed of epithelial cells, develops in tissues covering or lining
organs of the body such as skin, uterus or breast.
Dysplasia -changes in adult cell size, shape and organization that arises from glandular tissue
Fibroma -a benign tumor composed of fibrous or connective tissue. Fibromas can occur in various parts
of the body, including the skin, tendons, and bones. They can be firm or rubbery to the touch and may
cause pain or discomfort if they grow large enough to affect nearby structures.
Neoplasm - is an unusual growth of tissue that occurs when cells divide and multiply excessively or do
not die when they should.
Neoplasia – uncontrolled cell growth that follows no physiologic demand; cancer
Oncology -field or study of cancer
Tumor- a lump or solid neoplasm like swollen state that would normally relate with inflammation
Benign neoplasm - Non-cancerous, may become large but do not invade surrounding tissues or spread to
other parts of the body.
Malignant Neoplasm – cancerous tumor, likely to spread beyond its point of origin
Intracellular growth - the regulation of gene expression, DNA repair mechanisms, and signaling pathways
that control cell cycle progression.
Extracellular growth - regulating processes involve signals from outside the cell that influence cell
division and growth. These signals can come from neighboring cells, extracellular matrix proteins, or
circulating hormones and growth factors.
Metastasis -the process by which cancer cells spread to other parts of the body
Hyperplasia -increase in cell number.
Hypertrophy -increase in cell size.
Leiomyoma -neoplasm of smooth muscle in origin, most common benign neoplasm in women.
Lipoma -slow growing, painless, soft, & palpable tumor composed of fat cells. A lipoma is a slow-
growing tumor composed of fat cells. It is typically soft and movable and can occur anywhere on the
body where fat cells are present. Lipomas are usually painless and do not require treatment unless they
are causing discomfort or affecting nearby structures
Metaplasia -replacement of one adult cell type by a different adult cell type.
Metastases -spread of cancer cells to distant parts of the body to set up new tumors.
Neoplasia uncontrolled abnormal growth and proliferation of cells leading to the formation of tumors.
Neoplasm -the tumor; the cell that grows abnormally. Either benign or malignant.
Oncology -the study, treatment, management, diagnosis, & prevention of cancers.
Sarcoma a cancer of supporting or connective tissues such as cartilage, bones, muscles or fats.

Causes of Cancer

 Physical agents -radiation, exposure to irritants, and exposure to sunlight

  Chemical agents -smoking, dietary additives, and drugs
 Genetics and family history
 Dietary -low-fiber, high-fat, processed foods, and alcohol
 DNA viruses -Hepatitis B virus, herpes viruses, cytomegalovirus, Epstein-Barr virus, and
papillomaviruses
 Hormonal agents like diethylstilbestrol (DES) and oral contraceptive pills (OCP
 Immune diseases like AIDS
CARCINOGENESIS
Carcinogens -Agents that initiate or promote malignant transformation
Angiogenesis -growth of new blood vessels that allow cancer cells to grow
Oncogenes -responsible for proliferation and differentiation

Proto-oncogenes -overexpression of growth factors; “turn-on” cellular growth; can lead to

uncontrolled cell proliferation;

Epidermal Growth Factor Receptor (EGFR), transcription factors such as c-Myc, or cell
signaling proteins such as Kirsten ras (KRAS), act as “on switches” for cellular growth
(when amplified -can lead to uncontrolled cell proliferation)

Note: genetic alterations in the gene for KRAS have been associated with pancreatic,
lung, and colorectal cancers

Cancer Suppressor Genes -“turn off” or regulate, unneeded cellular proliferation; when
mutated, resulting in loss of function or expression, the cells begin to produce mutant cells

 Initiation Stage - carcinogens can cause mutations in cellular DNA; mutations are
reversed by DNA repair mechanisms, apoptosis, or cell senescence
 Promotion Stage - damaged or mutated cell begins to divide and multiply, forming a
small cluster of abnormal cells; repeated exposure to promoting agents or co-carcinogens
can cause the expansion and proliferation of initiated cells, leading to increased
expression or manifestation of abnormal genetic information
 Progression Stage – altered cells exhibit increasingly malignant behavior cells
acquire the ability to stimulate angiogenesis to invade adjacent tissues, and to
metastasize
Proliferative Patterns -how cells multiply and spread

 atrophy
 hypertrophy,
 hyperplasia,
 metaplasia
 dysplasia
Etiology
Factors that induce carcinogenesis:
I. Viruses/Bacteria – DNA viruses insert a part of their own DNA near the infected
cell genes causing cell division
 human papillomavirus (HPV) -cervical and head and neck cancers
 hepatitis B virus (HBV) -liver cancer
 Epstein–Barr virus (EBV) -Burkitt lymphoma; nasopharyngeal
cancer
 II. Physical Agents –
 sunlight
 radiation - ionizing radiation from repeated diagnostic x-ray
procedures; radiation therapy; radioactive materials at nuclear
weapon manufacturing sites or nuclear power plants; radon
 chronic irritation inflammation
 tobacco carcinogens
 industrial chemicals
 asbestos
III. Chemical Agents -chemicals produce their toxic effects by altering DNA
structure
 Tobacco -can cause cancer of:
o oral cavity and pharynx
o larynx
o lung
o esophagus
o pancreas
o uterine cervix
o kidney
o bladder
o stomach
o colorectal
o liver
o myeloid leukemia.
 Environmental Tobacco Smoke (ETS) – linked with cancers of the:
o Larynx
o Pharynx
o nasal sinuses
o brain
o bladder
o rectum
o stomach
o breast
 Electronic Nicotine Delivery Systems (ENDS) - e-cigarettes, e-pens,
e-pipes, e-hookah and e-cigars (contain highly addictive nicotine and
other potentially harmful substances, such as volatile organic
compounds, formaldehyde, and flavoring chemicals)
Note: the long-term health effects of these products
remain unknown
 Smokeless tobacco products -chewing tobacco, snuff and snus;
associated with an increased risk of oral, pancreatic, and esophageal
cancer
 aromatic amines and aniline dyes
 pesticides
 formaldehydes
 arsenic
 soot
 tars
 asbestos
 benzene
 cadmium
 chromium
 compounds
 nickel and zinc ores
 wood dust
 beryllium compounds
 polyvinyl chloride
IV. Genetics and Familial Factors - extra chromosomes, too few chromosomes, or
translocated chromosomes; the associated genetic mutation is found in all cells in
the body (germline mutation) and represents an inherited susceptibility to cancer
for all family members who carry the mutation.
  Predisposition Hallmarks:
o cancer in two or more first-degree relatives (the parent, sibling,
or child of an individual)
o onset of cancer in family members younger than 50 years
o the same type of cancer in several family members
o individual family members with more than one type of cancer
o rare cancer in one or more family members
 Familial Inheritance Syndromes:
o hereditary breast and ovarian cancer syndrome (BRCA1 and
BRCA2)
o multiple endocrine neoplasia syndrome (MEN1 and MEN2)
o nephroblastomas
o pheochromocytomas
o colorectal
o stomach
o thyroid
o renal
o prostate
o lung cancers
V. Lifestyle Factors
 Obesity - cancers of the breast (in postmenopausal women), colon
and rectum, endometrium, esophagus, kidney, and pancreas,
gallbladder, liver, ovary, and cervix, and for multiple myeloma,
Hodgkin lymphoma, and aggressive forms of prostate cancer
Note: excess fat may cause:
a. chronic inflammation resulting in DNA damage
b. increased levels of certain hormones (e.g.,
estrogen, insulin, adipokines)
c. disruptions in levels of cell growth regulators
(e.g., mammalian target of rapamycin and AMP-
activated protein kinase
 Alcohol intake -risk of cancers of the mouth, pharynx, larynx,
esophagus, liver, colon, rectum, and breast
 Poor diet -fats, alcohol, salt-cured
 or smoked meats, nitrate- and nitrite-containing foods, and red and
processed meats
 Physical inactivity
VI. Hormonal Agents - Tumor growth may be promoted by disturbances in
hormonal balance, either by the body’s own (endogenous) hormone production or
by administration of exogenous hormones
 Cancers of the breast, prostate, ovaries, and
 endometrium are thought to depend on endogenous hormonal levels
for growth.
 Prenatal exposure to diethylstilbestrol (a synthetic form of the female
hormone estrogen) -risk factor for clear cell adenocarcinoma of the
lower genital tract
Increased risk of breast cancer:
o Hormonal changes related to the female reproductive cycle
o Early onset of menses before age 12
o Delayed onset of menopause after age 55
o null parity (never giving birth)
o Delayed childbirth after age 30
Note: increased numbers of pregnancies are associated
with a decreased incidence of breast, endometrial, and
ovarian cancers
Mnemonic for CANCER
C -arcinogens
A -ging
N -utrition
C -ommon virus and bacteria
E -xcessive alcohol intake and smoking
R -ace and sex

Review of The Cell Cycle

4 STAGES OF THE CELL CYCLE:

1. G1 Phase – Gap Phase 1: Every sub-cellular structure (organelle) within the cell is
doubled (except chromosomes); RNA and protein synthesis occurs
2. S Phase – Synthesis: The DNA replicates to form two copies of each chromosome.
Within the cell, each of the 23 pairs of chromosomes is duplicated, leading to 46
duplicated chromosomes.
3. G2 Phase – Gap Phase 2: Chromosomes within the cell are checked for errors to ensure
that no errors are passed down to daughter cells; premitotic phase; DNA synthesis is
complete; mitotic spindle forms
4. M Phase – Mitosis: In this stage, the cell divides into two identical daughter cells;
duplicated chromosomes separate, cell division occurs
1. Note: Mitosis -a type of cell division that produces two
identical diploid daughter cells; daughter cells produced
from mitosis have identical DNA and are also identical
to the parent cell
 REMEMBER! All cells have identical DNA
composition. There are 23 pairs of chromosomes
in each cell of the body.
2. Stages of Mitosis
1. Interphase – G1, S and G2 stages of the cell cycle occur
during interphase; cell spends most of its life in this
phase; DNA in chromosomes must replicate before
mitosis can produce two diploid cells from one (this
ensures that chromosome numbers remain consistent
after cell division)
 2. Prophase –chromosomes and their copies condense to
become more visible; membrane around the nucleus
disappears.
3. Metaphase –Chromosomes and their copies line up in
the middle of the cell
4. Anaphase –Chromosomes and their copies are pulled to
different ends of the cell
5. Telophase –new membranes form around the
chromosomes at each end of the cell. The cell membrane
pinches in and eventually divides into two daughter cells
(cytokinesis)

Note - Mitosis is continuously occurring

throughout our bodies; Mitosis produces
new cells and replaces cells that are old,
lost or damaged; these cells need to be
continuously replaced for an individual
to stay alive and fully functional;
Mitosis is the reason we can grow, heal
wounds, and replace damaged cells.
Mitosis is responsible for:
o Growth for multicellular organisms
o Repair of damaged tissues
o Replacement of cells

THEORIES OF CANCER
a) Cellular Transformation Theory –
 exposure to carcinogenic chemicals can damage the DNA of normal
cells, leading to genetic mutations that can cause the cells to become
cancerous
 carcinogenic chemicals can cause damage to the DNA of cells by
directly interacting with the DNA or by generating reactive oxygen
species that can cause oxidative stress and DNA damage
 this damage can lead to alterations in the expression of genes
involved in cell growth, division, and death, leading to uncontrolled
cell proliferation and the formation of tumors
 the effects of chemical exposure on cell transformation can depend
on various factors, such as the type and dose of chemical, the
duration of exposure, and the individual's genetic susceptibility
b) The Failure of the Immune Response Theory
 the immune system can sometimes fail to recognize and destroy
cancer cells, allowing them to grow and proliferate
 cancer cells can use various mechanisms to evade the immune
system, such as producing proteins that suppress the immune
response or altering their surface proteins to avoid detection
 cancer cells can create an environment that is hostile to immune cells,
making it difficult for them to function properly
  can also be related to a weakened immune system, which can occur
due to various factors such as aging, chronic infections, or certain
medical treatments
 a weakened immune system may not be able to mount an effective
response against cancer cells, allowing them to grow and proliferate.
Note: Immunotherapy is a type of cancer
treatment that works by boosting the immune
system's ability to recognize and destroy cancer
cells. This treatment involves:
o use of drugs that target specific proteins
on cancer cells or that stimulate the
immune system's response
o adopting healthy behaviors, managing
chronic infections, and reducing
exposure to environmental toxins.
BODY DEFENSES AGAINST TUMOR
T cell (T lymphocyte)

 A type of leukocyte (white blood cell) that is an essential part of the immune system
 one of two primary types of lymphocytes
 originate in the bone marrow
 The T cell system
a. recognize specific proteins, called antigens, on the
surface of cancer cells and become activated to attack
the cancer cells directly
b. cancer cells may evade detection by the immune system
by producing proteins that suppress the immune
response or by altering their surface proteins to avoid
detection
Note: Immunotherapy is a type of cancer
treatment that works by boosting the immune
system's ability to recognize and destroy cancer
cells. This treatment can involve the use of drugs
that target specific proteins on cancer cells or
that stimulate the immune system's response.
 The B Cell System
a. B-cells sometimes inhibit tumor development
by producing antibodies that may attack cancer cells or
oncogenic viruses, such as human papillomavirus
(HPV), which is responsible for most cervical, anal,
penile and other reproductive cancers
b. B cells create antibodies. These antibodies bind to
pathogens or to foreign substances, such as toxins, to
neutralize them
c. B cells can also recruit other cells to help destroy an
infected cell.
 Phagocytic Cells (macrophages and neutrophils)
a. cells are able to engulf and digest foreign particles,
including cancer cells.
b. recognize and respond to cancer cells by recognizing
specific proteins on the surface of the cancer cells. Once
activated, these cells can engulf and digest the cancer
cells, helping to prevent their growth and spread.

CELL SIGNALING PROCESS THAT CONTROL CELL GROWTH - prevent cell mutations and
maintain normal cellular growth. When these processes become disrupted, it can lead to abnormal cell
growth and the development of cancer.
 1. DNA repair mechanisms -detect and repair mutations before they become permanent
and lead to abnormal cell growth
2. Apoptosis -a programmed cell death process that occurs when a cell is damaged or no
longer needed; this process helps eliminate cells with damaged DNA or other abnormalities
that could lead to cancer
3. Cell cycle checkpoints -help ensure proper DNA replication and division; at these
checkpoints, the cell checks for DNA damage and other abnormalities before proceeding to
the next phase of the cell cycle
4. Tumor suppressor genes -help prevent the development of cancer by regulating cell
growth and division; mutations in these genes can lead to uncontrolled cell growth and
contribute to the development of cancer
5. Immune system surveillance -the immune system plays a role in detecting and
eliminating abnormal cells, including those with mutations that could lead to cancer

DIAGNOSIS
Warning Signs of Cancer
C – change in bowel or bladder habits
A – sore throat that does not heal
U – unusual bleeding or discharge
U – unexplained sudden weight loss
T - thickening or lump in the breast or elsewhere
I – indigestion or difficulty in swallowing
O – obvious change in warts or moles
N – nagging cough or hoarseness of voice
 CANCER DETECTION EXAMINATION
1. Pap Smear -cells are scraped from the cervix and examined under a microscope to check
for cancer or other problems
2. Biopsy – removal of cells or tissue for analysis
3. Ultrasound - a noninvasive imaging test that shows structures inside the body using high-
intensity sound waves.
4. MRI (Magnetic Resonance Imaging) - a type of scan that uses strong magnetic fields and
radio waves to produce detailed images of the inside of the body
5. Fluoroscopy -a medical procedure that makes a real-time video of the movements inside
a part of the body by passing x-rays through the body over a period of time

DIAGNOSTIC EXAMINATIONS
1. TUMOR MARKER IDENTIFICATION -used for breast, colon, lung, ovarian, testicular
analysis of the substance found in the body
2. MAMMOGRAPHY -for breast examination
3. MRI -neuro, pelvic, thoracic, breast
4. FLUOROSCOPY -skeletal, lung

CANCER CLASSIFICATION
I. Grading -identifies what type of tissue arises from the original
a) G1 -well-differentiated
b) G2 -moderately well-differentiated
c) G3 – poorly differentiated
d) G4 – very poorly differentiated with high degree of malignancy
II. Staging - determines the size of the tumor and extent metastasis; determines extent of the disease
a) Stage 0 – in situ
b) Stage I – limited to tissue of origin; localized
c) Stage II – limited local spread
d) Stage III –regional spread
e) Stage IV – metastasis
III. TNM Staging –provides categorization of primary lesion and extent of involvement in the clinical
assessment of cancer
a) T – primary tumor extent
b) N – lymph node involvement
c) M – metastasis

MANAGEMENT

I. Dietary Management
a) Avoid obesity
b) Cut down on Fats
c) High fiber diet
d) Food rich in Vit A & C
e) Vegetable Diet
f) Moderation in alcoholic beverage
g) Moderation in salty food, preservatives
II. Therapeutic Modalities -surgery, chemotherapy, radiation therapy,
immunotherapy, bone marrow transplantation
1. Surgery
1) Diagnostic – biopsy
2) Radical surgery (wide resection) – remove all tumors
2. Chemotherapy - admin. of cytotoxic meds and chem to promote death of tumor cells; iv
is the best route; oral is the most convenient

Classification Of Chemotherapeutic Drugs

 1. Cell Cycle Specific Drugs -works on a specific phase
o antimetabolites-interferes with the
metabolites or nucleic acids necessary
for RNA (Ex: methotrexate
hydroxyurea)
o Topoisomerase Inhibitors -blocks
enzyme needed for DNA synthesis (Ex:
irinotecan)
o Mitotic Inhibitors -stops metaphase (Ex:
vinblastine; vincristine)
2. Cell Cycle Non-Specific Drugs - affects all phases
o Alkylating agents -interfere with DNA
replication (Ex: Cytoxan, busulfan)
o Cytotoxic- disrupts or inhibits DNA
synthesis (Ex: bleomycin)

Nursing Management For Chemotherapy

1. IV routes will be administered via subclavian veins
2. Extravasation-leaking of chemotherapeutic agents is the most
common IV administration
3. Never test the vein with chemotherapeutic agents
Side Effects of Chemotherapeutic Agents:
1. Bone Marrow Suppression -decreased white blood cells
a. Avoid crowd and infectious people
b. Avoid undercooked foods
c. Avoid contact sports
d. Avoid aspirin
e. Apply ice pack to affected area
2. Gastrointestinal Effects –NAVDAC
a. Eat frequent small fat diet
b. Avoid spicy and fatty foods
c. Avoid extremely hot foods
d. Administer antiemetics prior to chemotherapy
e. Weigh the patient daily
3. Stomatitis -inflammation of the mouth
a. Use soft -bristled toothbrush
b. Avoid alcohol-containing mouthwashes
c. Apply moisturizer to protect the mucous membrane
d. Avoid smoking and alcohol which can irritate the oral
mucosa
e. Drink cold liquids
4. Alopecia (hair loss) -it goes back 1 month after chemotherapy
a. wash the hair 2-3x per day
b. alopecia from radiation is irreversible
5. Fatigue
a. it is a normal response
b. provide rest periods
c.
3. Radiation Therapy -kills a tumor, reduces tumor size, relieves obstruction

Classifications of Radiation Therapy

1) Brachytherapy (Internal Radiation)
a. Sources of Internal Radiation
o ingested as a solution
o implanted into a tissue
o injected in the blood stream
o introduced through a catheter
 o
b. Side Effects
o fatigue
o anorexia
o immunosuppression
c. Client Education
o avoid close contact with patient not until
treatment is complete
o allow extra periods
o balanced diet
o 2-3 liters per day of fluids
o double flush the toilet due to
contamination
d. Nursing Management
o Observe time-limit contact to a total of
30 mins per 8-hour shift
o Observe distance -6 feet distance from
the source
o Observe shielding -use lead shields
o place the patient in a private room
o ask the visitors to have a 30 minutes
stay and maintain 6 feet distance when
in contact with the patient
o ensure proper handling of instruments
o never touch the implant directly
2) Teletherapy (External Radiation) - the radiation oncologist marks specific
locations for radiation treatment using semi-permanent ink; treatment is usually
given to 15-30 mins per day, 5 days per week, for 2-7 weeks
a. Side Effects
o tissue damage
o ulcerations
o radiation pneumonia
b. Management
o wash the marked part with plain water
only and pat dry; do not use anything on
the affected part
o avoid rubbing the affected part
o do not apply extreme temperature on
that part
o wear soft loose fitting clothes over the
treatment area
o protect the skin from sun exposure for at
least a year
o use wigs
o maintain proper diet
c. Teaching Guidelines regarding Radiation Therapy
o It is painless
o Lie very still on a special table
o Sometimes client may be placed in a
special position
o Each treatment last for few minutes
o Sound will be heard on the machine
 o Client will be alone while procedure is
ongoing
o Personnel will be observing client
through a glass window
o No residual radioactivity after radiation
therapy
o Client may resume activities of daily
living
o
4. Bone Marrow Transplant - used in the treatment for leukemia; used in conjunction with
radiation or chemotherapy
Types of Bone Marrow Transplant
1) Autologous -the client is infused with his own bone marrow harvested
during the remission of disease
2) Allogenic -the patient is infused with donor bone marrow harvested from
a healthy individual; iliac crest is used, frozen, and stored until
transfused; immunosuppressive therapy is admin first to destroy the
immune system before receiving bone marrow transplant; bone marrow
transplant is transfused through a central line

a. Side Effects
o malnutrition
o infection related to immunosuppression
o bleeding
b. Management
o monitor for graft versus host disease
o provide a private room for 6 to 8 weeks
o encourage other means of
communication
5. Immunotherapy -immunotherapy is treatment that uses the body's own immune system
to fight cancer; the immune system is stimulated by an outside source, such as an
antibody, or synthetic immune system proteins; also known as “Biological Response
Modifiers”