Lymphoid System – consists of the lymph nodes, spleen, thymus, tonsils, lymphoid tissues and bone marrow (involves in blood cell formation). • Thymus Gland – assists in T – lymphocyte formation which is involved in cell mediated immunity. • Bone marrow sources – iliac crest, sternum and bone cavities throughout the body.  serve as diagnostic predictor for immunologic, hematologic and oncologic disorders.  give rise to B lymphocytes and humorally mediated responses (humoral immunity) – involve production of antibodies. • Tonsils – found in palatine area of the oropharynx in the mouth. • Lymph Nodes – found throughout the body and consist of small rounded mass of tissue from which the lymph fluid drains. • Mucosa – associated lymph tissue – consists of grouping of lymph tissue that is found in many organs of the body that work together to promote an immune response. • Spleen – composed of white and red pulp (white pulp - composed of B and T lymphocytes; red pulp – composed of erythrocytes)  site of destruction of RBC as well as storage site of blood  filters and removes foreign materials, worn out cells and forms of cellular debris. • Mononuclear Phagocyte System (MPS) – protect body by participating in the immune response; secretes chemical component and factors (enzymes, complement protein and interleukins).  monocytes are the largest components of WBC  macrophages are considered to be the matured cells of MPS  migrate to different areas of the body specialized cell to perform their function of defense. 2. Normal Immune Response a. Defense • the body provides for a communication network of protection that involves both specific and non-specific forms of defense.  Non-specific defenses – external reaction that include anatomic and chemical barriers ( skin, mucous membrane, sweat and sebaceous glands, acidic secretions and body’s ph )  Non-selective – activated against any foreign substance that the body would encounter.  Specific defenses – internal physiological reactions of the body that include both cell mediated and humorally mediated antibodies (considered specific unique substances that required activation). • the body initiates its immune response in the presence of ANTIGEN (a protein substance that triggers antibody production). b. Homeostasis • the body seeks to maintain an immune balance where it can successfully removed damaged cells. • there is balanced response of circulation and resident lymphocytes to maintain adequate protection. c. Surveillance • the ability of the body to use memory and recognition in order to maintain adequate protection. • the body will remember the activation response even if the person doesn’t remember the specific insult. 3. Types of Immunity a. Acquired Immunity • Active Acquired Immunity – is a long term response in an organism that leads to the development of antibodies that offer protection.  developing antibodies in response to having the disease process or by a response to artificial antigens ( vaccine or toxoid ).  this immunization response can be boosted and maintained via repeated injection. • Passive Acquired Immunity – requires that antibody be introduced to the individual, either by maternal transfer (placenta/colostrums) or immune serum antibody injection to promote a specific antigen response.


b. Natural Immunity • the type of immunity that exist in an individual is related to a specific race or genetic traits. • the individual is born with natural immunity. c. Humoral Immunity • this involves the recognition of antigens by the B lymphocytes • B lymphocytes  memory cells lead to a more rapid response by remembering the original insult.  plasma cells secrete IMMUNOGLOBULINS (a group of lycoproteins) • Types of Immunoglobulins 1. IgG – makes up ¾ of the total immunoglobulins  the only one that crosses the placenta  located at plasma, interstitial fluid  protects against viruses, bacteria and toxins  complement fixation, secondary immune response 2. IgA – 2nd most common immunoglobulins in the bloodstream  present in the body secretions, tears, saliva, colostrums and breastmilk  first line of defense against organisms invading the respiratory or GI or urinary tract.  lines mucous membrane, protects body surfaces. 3. IgD – located in the bloodstream (plasma) in a very small amount  present on lymphocytes  may increase in myeloma or with some CNS tumor 4. IgE – present in the plasma interstitial fluid and exocrine secretions  increase in allergic/anaphylactic states and in the event of parasitic infestations 5. IgM – most important component in primary immune response  found in plasma  IgM antibodies are indicators of an active infection  Involves in ABO antigens  Complement fixation d. Cell Mediated Immunity • T lymphocytes recognize a specific major histocompatibility complex (MHC) – a group of proteins that play a role in auto immune recognition and tissue rejection on the surface of T cells – help to define specific function receptor sites. CD – means cluster of differentiation • CD markers serve as an important prognostic indicator of immune function and are used in the diagnosis of HIV and AIDS. e. Other Immune System Participants • Natural Killer Cell – activity is present at birth, increases as one reaches adulthood. • Cytokins – lymphokins and monokins (infernos, interleukins – mediators of cellular immunity, promote development of cytotic T cells. • Complement System – group of glycoproteins that are activated in sequential order and provide a link of humoral response. II. ALTERED IMMUNE RESPONSE: HYPERSENSITIVOTY REACTION

1. Hypersensitivity – an abnormal exaggerated response to a specific indicator that leads to an
overactive immune response. 2. Cell and Coombs Classifications of Hypersensitivity Reaction Type I: Anaphylactoid Reactions Class: Immediate Hypersensitivity Immunity: Humoral Etiology: Involves the characteristic activation of IgE Histamine is released. Clinical Signs/Symptoms: Bronchospasm, wheezing, rhinorrhea, urticaria to angioedema. Management: Antihistamine, decongestants, corticosteroids, Epinephrine Nursing Care: Immediately withdraw the offending allergen; manage the client according to ABC protocol Type II: Cytotoxic and Cytolytic Reaction Class: Activation of complement Immunity: Humoral Etiology: Involves the production of autoantibodies that results in destruction of one’s own cells or tissues.


e. ischemia and eventual tissue destruction may ensue. Grave’s Disease and Myasthenia Gravis.Proteinuria on urinalysis Management: .complement assay indicates acute or chronic. pyrexia.use topical and oral medication to alleviate many of the symptoms complained. causing inflammation and leading to activation of complement cascade.monitor for evidence of potential transplant rejection . Type IV: Delayed Hypersensitivity Reactions • a form of cell mediated immunity involving T lymphocytes • involves the recognition and response of T lymphocytes to foreign substances Clinical Manifestations: . Diagnostic/Lab. lymphadenopathy . Findings: .  Immune Complex Disease (associated with the deposition of immune complexes at the serum level).  Antibody – mediated autoimmunity (associated with the development of autoantibodies that affect specific receptor sites causing tissue and organ damage). awareness of potential drug interactions can cause antigen complex activation remain with the client for 15 minutes during BT. • leads to the activation of serum factors. there can be an overabundance of t-cytotoxic (killer) cells or deficiency of t-suppressor (helper) cells. . Clinical Manifestations: . AUTOIMMUNITY • Autoimmunity – is an abnormal response of the body’s immune system whereby it perceives “self” as a threat. kidney can be compromised).  There are several mechanisms of action that can affect the autoimmune process  Cell mediated immunity (associated with an abnormal T-cell response). edema and failure of transplanted organ) .destructions seen in Good Pasteur’s Syndrome (an autoimmune disease affecting pulmonary and renal systems) proper identification during BT. registration #). • Treatment for Autoimmunity 3 . poison ivy. pain. Management: .abnormal test results indicating declining function of the transplanted organ are used to diagnose transplanted rejection.analgesics.there is a wide range of presentation from tuberculin response. are involved with the diagnosis of many auto immune diseases and also used for tissue typing. . monitor client for potential complications (organ damage can occur.Arthrus reaction involves a localized inflammatory response with excess IgG causing joint pain. • Genetic Components:  Genetic traits are associated with autoimmune diseases.if symptoms arise.identify potential irritants that can cause contact dermatitis and avoid exposure.ESR is elevated . proper verification of blood (inc.be aware that it is possible for localized inflammatory reactions to develop at the site of serum injections after one week. erythroblastosis fetalis.edema. can be followed by a more systematic response involving regional and generalized lymphadenopathies.Clinical Signs/Symptoms: Management: Nursing Care: . antihistamines and topical steroids (provide symptom relief) . . . Diagnostic/Lab.hemolytic reactions (transfusion. and contact dermatitis to transplant or graft rejection (pyrexia.medicate patient with immunosuppressive protocol drugs to prevent tissue rejection. Type III: Immune Complex Reactions • involves the production of antigen-antibody complexes (binding together of an antibody and an antigen). Findings: .disease process is self-limiting because the use of human ATS and the availability of the antibiotics. hemolytic anemia and drug-induced hemolysis) to target cells. • rheumatoid arthritis and systemic lupus erythematosus are examples of type III reactions Etiology: complement activation impacts vulnerable organs and leads to intravascular changes.  Human leukocytes antigens (HLA’s) genetic markers found on chromosomes 6.g.purified protein derivative ( PPD ) test result of induration > 5 mm – identifies type IV hypersensitivity to TB .Serum sickness involves a system’s response – edema and necrotic tissue. Nursing Care: . .

abdominal pain. indicating presence of inflammation. Myasthenia Gravis 4.  The resultant fibrosis leads to inability of involved organs to function with normal motility. corticosteroids for inflammation. HIV (Human Immunodeficiency Syndrome) • An RNA retrovirus attacks the immune system at the CD4 antigen. burns. Systemic Lupus Erythematosus 2. usually of the throat.Increase ESR.Throat Culture : + for group A beta hemolytic streptococcus .Medication therapy: antimicrobial. Rheumatic Heart Disease  The patient develops antibodies which react to the body’s own antigens in the connective tissues of the heart. leading to infections may be caused by opportunistic agents (opportunistic infections) .  They can be seen across the life span. malnutrition.  A late sequelae of acute rheumatic fever (an inflammatory process and is not contagious or infectious). complement or phagocytic cells that result in severe infection that can be recurrent or chronic in nature. antistreptokinase (ASK) titer test for strep antibodies.Antistreptolysin O (ASO) titer. nutrition and care of specific symptoms. affecting both children and adult.Careful handling of patient for joint pain. splenectomy has been performed as part of therapeutic management of many autoimmune diseases. B. . rest. .  Symptoms management: anti-inflammatory agent (to minimize pain)  Plasmapheresis is used to remove circulating immune complexes (plasma is removed from the body. polyarthritis. as well as in other systems. will be reactive to protein tests. weakness.carditis. some autoimmune disease and AIDS are examples of precipitating disease process. antifungal.  In many cases. weight loss  Major manifestations: . • Progression of Disease  Autoimmune diseases are characterized by acute exacerbation of a chronic condition. early treatment of infection and replacement of immunologic factors.Antibiotics (Penicillin). A. sent through a machine membrane that traps immune complexes. cough.Immunosuppressive agents and corticosteroids are given to suppress the abnormal immune response.  The antibodies are produced in response to repeated and untreated streptococcal infections. AIDS • A progression of HIV Disease 4 .Drug therapy. malaise.client’s overall immune response is abnormal. chills. erythema marginatum  Diagnostic Examinations : . and is returned to the body). . chorea. SECONDARY IMMUNODEFICIENCY DISORDER • Disease process cause a secondary immunosuppressive response • DM.signs and symptoms of infection and inflammation: fever. respiratory complaints associated with difficulty of swallowing and breathing. D.  Current therapeutic regimen: chemotherapy AUTOIMMUNE DISEASES 1.  Manifestations: . anorexia.  Management: . causing cell mutation that leads to eventual disease progression. C. Scleroderma: Progressive Systematic Sclerosis  A multisystem disease present with fibrosis (hardening) of visceral organs and the skin. . PRIMARY IMMUNODEFICIENCY DISORDER • Are caused by primary defect or deficiency involving B lymphocytes. Rheumatoid Arthritis 3.ECG reveals prolonged PR interval  Management: . WBC. .recurrent infection can lead to subsequent tissue and organ damage . gamma globulins to support and maintain deficient immunoglobulins.bone marrow transplant or thymus transplant .  Fever.infection prophylaxis. T lymphocytes. 5.

31 are associated with dysplasia and cancer of the cervix  The hepatitis B virus is implicated in cancer of the liver. appearance and distribution of cells. synonymous with tumor • Metastasis – the ability of the cancer cells to disseminate and establish growth in another area of the body at distance from its origin • Invasion – occurs when cancer cells infiltrate adjacent tissue surrounding the neoplasm • Aberrant cellular growth – an alteration in normal cellular growth. and some type of non-hodgkin’s lymphoma and Hodgkin’s disease  Herpes simplex virus type II. recurrent pneumonia) DISTURBANCES IN CELLULAR FUNCTIONING OR CELLULAR ABBERATIONS TERMINOLOGY: • Neoplasia – development of an abnormal type of growth that is unresponsive to normal growth mechanisms • Neoplasm – a group of clump of neoplastic cells. or lethargy. should be referred to a doctor. Physical agents  Exposure to sunlight or radiation.comes from the Greek word Karkinos: meaning a crab-a graphic description of disease growth pattern . Although one or more symptoms may be indicative of something other than cancer. The result is always malignant. Symptoms / early warning signs: C – Change in bowel or bladder habits A – A sore throat that does not heal U – Unusual bleeding or discharge T – Thickening or lump in the breast or elsewhere I – Indigestion or difficulty in swallowing O – Obvious change in a wart or mole N – Nagging cough or hoarseness U – Unexplained anemia S – Sudden unexplained weight loss Any of these symptoms: any unexplained lump.new growth of tissue resulting from a continuous proliferation of abnormal cells that have the ability to invade and destroy other tissues. which usually means that the normal cell escape the hosts control of growth and differentiation • Hyperplasia – refers to an increase in number of normal cell • Metaplasia – refers to conversion from a normal pattern of differentiation of one type of cell into another type for that tissue • Dysplasia – refers to alteration in the shape. • Anaplasia – refers to disorganized. malignancies. 18. The human T cell lymphotropic virus may be a cause of some lymphocytic leukemias and lymphomas  The human immunodeficiency virus is associated with Kaposi’s sarcoma  Bacterium Helicobacter pylori has been associated with an increased incidence of gastric malignancy 2. weight loss. size. Cytomegalovirus and human papillomavirus type 16. blue or green -eyed people increases the risk of skin cancers  More than 80% of exposure to radiation is from natural sources  Ionizing radiation from cosmic rays and radioactive materials such as radon gas. radium and uranium  About 15% of radiation exposure comes from diagnostic or therapeutic procedures  Radiographs.• Diagnosed when there is a CD4 count of 200/min in the presence of an AIDS defining disease (opportunistic infections. chronic irritation or inflammation and tobacco use  Excessive exposure to ultraviolet rays of the sun. pain. CANCER . and radioisotopes used in diagnostic imaging  5% of all secondary cancers are clearly linked to radiation therapy from a previous cancer 5 . a check-up to confirm their cause is the best course of action. especially in fair skinned. radiation therapy. altering the future generations of cell population-perhaps leading to a cancer  a virus at some point infected the cell causing genetic damage to the cell’s deoxyribonucleic acid (DNA) thus leading to the development of cancer  Example:  Epstein-Barr Virus – highly suspected as a cause in Burkitt’s lymphoma. irregular cells that have no structure and have loss differentiation. EPIDEMIOLOGY 1. nasopharyngeal cancer. Viruses and Bacteria  Viruses are thought to incorporate in the genetic structure of cells. Thus.

Some cells do not replicate. bladder. alcohol. cadmium. retinoblastomas. zinc and selenium  Obesity is associated with endometrial cancer and possibly postmenopausal breast cancer. cruciferous vegetables(cabbage. tomatoes. Chemical agents  About 75%of all cancers are thought to be related to the environment  Tobacco has been linked not only with lung cancer but also with oropharyngeal. G2 phase – biochemical processes. kidney and gallbladder 6. prostate and uterus are thought to depend on endogenous hormonal levels for growth  Oral contraceptives and prolonged estrogen therapy are associated with increased incidence of hepatocellular. including malignant melanoma  Approximately 5% to 10% of cancers of adulthood and childhood display a familial predisposition. or steps with the letter G standing for “gap”. Brussels sprouts. and kidney cancer  People can be exposed to chemicals in the workplace have proven to be carcinogens or cocarcinogens o Aromatic amines and anliline dyes o Pesticides and formaldehydes o Betel nut and lime. and tars. also increase the risk for cancers of the colon. G0 Phase – this phase is the interval in which the cell is at rest for cell division until a trigger in the intermediate environment signal the beginning of the G1 phase. lungs and kidney are the organ systems most often affected presumably because of their roles in detoxifying chemicals 4. S Phase – synthesis of both DNA and proteins of new chromosomes occurs during the S phase. M phase – actual division of the cells (mitosis) occurs during this phase. CHARACTERISTICS MITOTIC CELL DIVISION NORMAL CELLS • Mitotic cell division leads to two daughter cells. meningiomas. individuals may develop multiple cancer. foods containing nitrates and nitrites and a high caloric dietary intake  Foods that appear to reduce cancer risk include high-fiber foods.3. endometrial and breast cancers THE CELL CYCLE The cell replication cycle is divided into the following intervals. chromium compounds o Arsenic soot. ovarian. stomach. acute leukemias. pancreatic. asbestos. Genetic and Familial Factors  Abnormal chromosomal patterns of cancer have associated with extra chromosomes. the interval separating cell division or mitosis (M) and synthesis(S). apricots. occur in preparation for mitosis.  Foods associated with increased cancer risk includes: fats. kohlrabi) carotenoids (carrots. although it vies in certain cell populations and under different conditions. benzene o Most hazardous chemicals produce their toxic effect by altering DNA structure in body o The liver. including the synthesis of some RNA. prostate and lung cancers 5. producing two daughter cells usually ranges from less than an hour to few hours. too few chromosomes or translocated chromosomes  Specific cancers with underlying genetic abnormalities – chronic myelogenous leukemia. two or more first degree relatives share the same cancer type  Cancers associated with familial inheritance includes retinoblastomas. Little is known about this phase which lasts only a few hours. broccoli. cauliflower. peaches. C.premenopausal breast cancer  In cancers wit familial predisposition. • CANCER CELLS Mitosis leads to multiple daughter cells that may or may not resemble the parent 6 . Hormonal agents  Tumor growth may be promoted by disturbance in hormonal balance either by the body’s own (endogenous) hormone production by administration of exogenous hormones  Cancers of the breast. Dietary Factors  Diet is probably linked to about 30 to 35% of all environmental cancers. spinach. colorectal. Dietary substances can be proactive (protective) carcinogenic or cocarcinogenic. commonly. dark green and deep yellow vegetables possibly vitamins E. or they replicate so infrequently that they are said to always be in G0 or resting phase. malignant neurofibromatosis. endometrial. G1 Phase – this phase is the interval in which ribonucleic acid (RNA) and protein are synthesized. and breast. cervical. Wilm’s tumor and skin cancer. salt-cured or smoked meats. pheochromocytomas. The interval of time is probably 6 to8 hours.

but they frequently make their home in the uterus .are easily removed surgically 2. they do not function normally or may actually cause damage (e.e. Proliferation without stimulus. as in the brain. Cells larger and grow more rapidly than normal (pleomorphic) i. actually feed off host without contributing anything.g.rarely pressure on surrounding tissues as they expand 3. space. Proliferate in response to specific stimuli. Do not contribute to the well being of the host. shape and growth. erode and spread. compressing. Cells function in specific predetermined manners (e. Carcinogens cause changes in the structure and function of the cell at the genetic or molecular level. Do not exhibit contact inhibition.APPEARANCE • GROWTH PATTERN • • • Cells of some type homogenous in size. CLASSIFICATION OF NEOPLASMS A. nutrients. Contributions to the well being of the host. Cells have irregular patterns of expansion. these genetic events results in malignant conversion 4. Growth in ideal conditions (e. Carcinoma 7 . Benign tumors  are characterized by entirely localized growth and are usually separated from neighboring tissue by a surrounding capsule. parasitic. At some point. arises in adipose tissue .(fibrosarcoma-malignant) .  generally grow slowly. Growth rate erratic. Cannot grow in the presence of necrosis or inflammation • • FUNCTION • • • OTHER • • • • CARCINOGENESIS .malignant) . Fibromas . Do not invade adjacent tissue.g. Loss of cell control as result of cell membrane changes. Growth in adverse condition such as lack of nutrients. 4 stages of carcinogenesis: 1. Cell birth exceeds cell death. oxygen.may develop anywhere in the body.  comes from the latin benigumus (kind) Most common Benign Neoplasms: 1. but most often they grow I the uterus rarely these neoplasms become malignant B. designated purpose. Leimyomas . or by metastasis 1. heterogenous in size and shape. Invade. Have characteristic pattern of organization. or displacing neighboring structures. the cells are increasingly malignant in appearance and behavior and develop into an invasive cancer with metatasis to distantbody parts. cells in the thyroid secrete thyroid hormone) Cannot invade. With progression. Invade in the presence of necrosis and inflammatory cells such as lymphocytes. lung cancer secretes ACTH and cause excessive stimulation of adrenal cortex). Initiation – occurs when a carcinogens damages DNA. Able to break off cells that migrate through bloodstream or lymphatics. • • • • • • Have specific. Lipomas (liposarcoma. correct biochemical environment). the mutations may not lead immediately to cancer. Invade adjacent tissues.very common in benign neoplasm. Serve no useful purpose. • • • • • • multiple mitotic spindles. If cells functions at all. This damage maybe reversible or may led to genetic mutations if not repaired. or seed to distant sites and grow in other sites. Promotion – occur with additional assaults to the cells resulting in further genetic damage 3. Malignant tumors  has the ability to spread beyond the site of origin  cancerous cells that may invade neighboring tissues by direct extension or infiltration. 2. erode or spread.a benign neoplasm of smooth muscle origin is the most common benign tumor in women .g. and in structure closely resemble the tissue of origin.may grow anywhere in the body.the process through which normal cells are transformed into malignant or cancer cells. regular pattern of expansion. however.  in some instances they may endanger the patient by obstructing.

• Not harmful to host unless located in area where it compresses tissues or obstruct vital organs. Mode of growth Capsule Cells characteristics • Recurrence Metastasis Effects of Neoplasm • Metastasis never occurs. • Surgical removal of tumor difficult. Tumor generally removed 8 . Sarcoma . • May remain localized (in situ) but usually infiltrates other tissues. • Poor prognosis if cells are poorly differentiated and evidence of Prognosis • • Very good. anemia. GROWTH OF THE PRIMARY MALIGNANT TUMOR Environmental Factors Chemicals Radiation Viruses Changes in genome of somatic cells Genetic Factors Activation of growth promoting gene (oncogene) Inactivation of growth inhibiting gene (cancer suppressing gene) Expression of altered products. etc.tumor that arises from epithelial cells. • Capsule does not prevent expansion of the neoplasm but does not prevent growth by infiltration. hemorrhage. the name of the cancer identifies the tissue affected (osteosarcoma).e. • Absence of capsule allows neoplastic cells to invade surrounding tissues. • Recurrence extremely when surgically removed. • Encapsulated tumor can be removed surgically. • Never contained within a capsule. • Grows by infiltrating surrounding tissues. 2. Usually poorly differentiated • Cells tend to be anaplastic i. disrupted organ function. • Metastasis very common. • Causes disfigurement. • Does not produce cachexia (weight loss. • Always harmful to host. • Occasionally a malignant tumor arising in glandular tissues secretes hormone. • Rarely neoplasm may regress spontaneously. • May result ulcerations. perforation. loss of regulatory gene products. • recurrence common following surgery because tumor cells spread into surrounding tissues. • Almost always produces cachexia which leaves person to pneumonia. never infiltrates surrounding tissues. nutritional imbalances. anemia. sloughing of tissues. unusual MALIGNANT NEOPLASM • Usually grow rapidly.. • May have periods of remissions. • Almost always contained within the fibrous capsule. • Grows by enlarging and expanding.tumor arising from supportive tissue. Malignant Neoplasms CHARACTERISTICS Spread of growth BENIGN NEOPLASM • Grows slowly • Usually continue to grow throughout life unless surgically removed. the name of the cancer identifies the location(basal cell carcinoma). weakness and wasting). • Usually cell differentiated • Mitotic figures absent or scanty • Mature cells • Anaplastic cells absent. sepsis. young embryonic type. • Cells function poorly in comparison with normal cells from which they arise. • Always remains localized. • Cause death unless removed surgically or destroyed by radiation or chemotherapy. • Cells too abnormal to perform any physiologic functions. • Tends to grow relentlessly throughout life. debilitation.

nerve tissue) is called sarcoma (from Greek sarx. body fluids. adenoma) or their macroscopic appearance (e.  Grade IV: Cells are immature (anaplasia) and undifferentiated. metastasis spread exists. may originate as benign fibromas.surgically. T2. TUMOR STAGING AND GRADING 1. • A malignant neoplasm that arises from mesenchymal origins (e. flesh) • Hematopoetic – erythrocytes (erythroleukemia) lymphatic tissue (hodgkin’s disease) plasma cells (multiple myeloma). • For example: An adenomyoma is benign neoplasm that contains both glandular and muscle (Greek genitive: myos) cells. (adenocarcinoma).g. • Grading system seek to define the type of tissue from which the tumor originated and the degree to which the tumor cells retain the functional and histologic characteristics of the tissue of origin. Three Representative Examples of Malignant Neoplasm 1. localized tumor growth.  This type of cancer readily gives rise to metastasis. cell of origin is difficult to determine • The TNM system is frequently used:  T – refers to the extent of the primary tumor (size). N3b – regional lymph nodes involvement with metastasis suspected  M – refers to metastasis  M0 – no metastasis 9 .  T0 – no involvement  Tis – tumor in situ  T1.  Grade II: Cells are more abnormal and are moderately differentiated (moderate dysplasia). and pous for foot) • A malignant neoplasm that arises from epithelial tissue is called a carcinoma. Carcinoma in situ  This is the neoplasm of epithelial tissue that remains confined to the site of origin.g. if this occurs. it typically affects the cervix.  Stage II: Limited local spread. Malignant Fibrosarcoma  These tumors are similar to benign fibromas. • Samples of cells to be used to establish the grade of a tumor or maybe obtained through cytology (examination of cells from tissue scrapping. • Benign tumors of epithelial origin are classified according to either their microscopic appearance (e. 3. Fortunately they rarely metastasize. well differentiated tumor masses are usually responsive to surgery. T4 – progressive degrees of tumor size and involvement  N – refers to lymph node involvement  N0 – abnormal lymph nodes detected  N1a. T3. 2. secretions or washings).  Surgical excision of the tumor is the intervention of choice. surgery is contraindicated.  Grade III: Cells are very abnormal and are poorly differentiated (severe dysplasia).g. GRADING • Refers to the classification of the tumor cells.  Stage IV: Metastasis 2. blood vessels. Bronchogenic carcinoma  These tumors account for 90% of all cases of lung cancer. tumor.  localized and can be removed surgically but can become invasive.  In situ carcinoma. N2b.  It usually develops in the trachea and lower bronchi. N3a – regional lymph nodes involvement  N1b. tend to grow in the same sites. later becoming malignant. biopsy or surgical excision. from the Greek polys for many. TISSUE OF ORIGIN • Almost all names for neoplasms end in the suffix -oma meaning.  Grade I: Cells differ slightly from normal cells and are well differentiated (mild dysplasia). eroding into surrounding tissues.  Stage III: Extensive local and regional spread. STAGING • Determines the size of the tumor and the existence of metastasis  Stage 0: Carcinoma in situ  Stage I: Tumor limited to the tissue of origin. N2a. poly. lymphatic tissue.  These bulky.

• Angionesis. In this case a wedge of tissue from the tumor is removed for analysis. suspicious masses that are easily accessible. b. C. • Presence or absence of symptoms. breast.  After entering the lymphatic circulation. lung. 1. insufficient oxygenation or destruction by the body’s immune system. released either by the tumor itself or by the body as a defense in response to the tumor (e. Needle Biopsy . . • Family history and genetic predisposition. Lymphatic Spread  The most common mechanism of metastasis is the lymphatic spread. If the specimen does not contain representative tissue and cells. liver and kidney.g.M1.  Malignant cells also may penetrate lymphatic vessels by invasion. is another important process. upper and lower GIT and URT. Diagnostic Surgery – such as biopsy is usually performed in obtaining a tissue sample for analysis of cells suspected to be malignant. through the lymphatic circulation. e. malignant cells either lodge in the lymph nodes or pass between lymphatic and venous circulation. c. Surgery as a Primary Treatment – the goal is to remove the entire tumor as a much as is feasible (procedure sometimes called debulking) and any involved surrounding tissue.the cells of the tissue wedge must be representative of the tumor mass so that the pathologist can provide an accurate diagnosis. AFP – alpha feto protein). TUMOR MARKER – protein substance found in the blood or body fluids. clavicular and thorax lymph channel. 3. including regional lymph nodes. Palliative Surgery – when cure is not possible. the goals of treatment are to make the patient as comfortable as possible and to promote a satisfying and productive life for as long as possible. colectomy. • Ability to detect cancer at an early stage. B. . such as some growth in the breast. oophorectomy D. Excision Biopsy . Angiogenesis  Malignant cells also have the ability to induce the growth of new capillaries from the host tissue to meet their needs for nutrients and oxygen.g. Prophylactic Surgery – involves removing non-vital tissues or organs that are likely to develop cancer. M3 – indicates ascending degrees of distant metastasis and includes distant lymph nodes  METASTATIC MECHANISM • Lymph and blood are key mechanisms by which cancer cells spread.  Tumor emboli enter the lymphatic channels by way of the interstitial fluid. a mechanism by which the tumor cells ensured a blood supply. negative biopsy result do not guarantee the absence of cancer. Hematogenous Spread  Malignant cells are disseminated through the blood stream. mastectomy. SURGERY A.  Few malignant cells can survive the turbulence of arterial circulation. • Patient’s acceptance of the postoperative outcome.  Large tumors emboli that become trapped in the microcirculation of distant sites may further metastasize to other sites.  It is through this vascular network that tumor emboli can enter the systematic circulation and travel to distant sites. Most Common Biopsy a. 2. thyroid.used for easily accessible tumors of the skin. MANAGEMENT OF CANCER 1. Incision Biopsy . The following factors are considered when electing prophylactic surgery.  Hematogenous spread is directly related to the vascularity of the tumor. M2.is performed if the tumor is too large to be removed.  Breast tumors frequently metastasize in this manner through axillary. 10 .this approach not only provides the pathologist what stage and grade the cells with the entire tissue specimen but also decrease the chance of seeding the tumor.performed to sample.

as well as normal cells. or a machine containing a radioisotope). wash marked area of the skin with plain water and pat skin dry. • Types of Radiation Therapy: A. scratching or scrubbing the treatment site.sparing effect that is the maximum effect of radiation occurs at tumor depth in the body and not on the skin surface. 2.  The major advantage of high energy radiation is its skin. RADIATION SAFETY STANDARDS 1. Reconstructive Surgery – may follow curative or radical surgery and is carried out in an attempt to improve function or obtain a more desirable cosmetics effect. Shielding – the use of shielding devices whenever possible reduces radiation exposure.you should aim to minimize the amount of time you are exposed to the radiation source. sloughing. no soaps.  The radiation oncologist makes specific locations for radiation treatment using semi-permanent type of ink. maintain balance diet. • Causes lethal injury to DNA. Side Effects: a. protect skin from sun exposure during the treatment and for at least 1 year after the treatment is complete ( Sunblock SPF15 ). anorexia c. c. e. if implant is temporarily. 5 days per week. immunosuppresion CLIENT EDUCATION: a. the lesser the exposure dose of ionizing rays. wear soft. Distance and radiation exposure are inversely related.g. you are exposed approximately ¼ the amount of radiation you would receive at 2 feet. small. deodorants. thus the intensity of radiation decrease inversely with the square of the distance from the source. SIDE EFFECTS: a. Types of IRT  Sealed Source RT – in which radioactive material is administered in a container. Distance – the greater distance from the radiation source. Your exposure time should generally be limited to 30 minutes of direct care per 8 hour shift. fluid intake 2 – 3 L/day d. do not apply extreme heat or cold. B. immunosuppression Client Education: a.  Treatment is usually given 15-30 minutes per day. cobalt betratron.  Unsealed Source RT – in which the radioactive material is administered systematically. avoid close contact with others until treatment is completed. vomiting. monitor for adverse side effects of radiation b. diet are essential to promote health and repair of normal tissues. avoiding rubbing. d.  It is administered in the RT department by high energy X-Ray or gamma X-Ray machines (e. radiation pneumonia g. External Beam Radiation Therapy – (teletherapy) is the delivery of radiation from a source placed at some distance from the target site. maintain proper rest. maintain bed rest to avoid dislodging the implant. frequent meals. Nursing Care: a. RADIATION THERAPY • Ionizing radiation is used to interrupt cellular growth.E. The dose of X-Rays and gamma rays reduces as the thickness of the lead shield is increased. GI – nausea. 11 . fatigue b. monitor for significant decrease in WBC and platelet counts. Linear accelerator. b. tissue damage to target area (erythema. Internal Radiation Therapy – involves placement of specially prepared radioisotopes directly into or near the tumor itself (brachytherapy) or into the systemic circulation. loose fitting clothing over the treatment area. ulceration of oral mucous membrane c. hemorrhage). c. so it can destroy rapidly multiplying cells. For Example: If you stand 4 feet from the source of radiation.  The client does not pose risk for radiation exposure to other people. 3. 1 meter 2 meters (1/4 of exposure) 3 meters 4 meters 1/16 exposure 2. such as by injection or orally. diarrhea d. b. lotion powder on site during the duration of treatment. Time . for 2-7 weeks. kill a tumor. fatigue e alopecia f. although you must still meet the client’s care needs. and reduce tumor size. b.

place client in private room c. 2. Chemotherapeutic Agents: 1. intra-arterial and intracavity. in the vent of dislodged implant. decreased platelet count (thrombocytopenia) • monitor stool and urine for bleeding (>20. Methotrexate) 3. d. inhibiting cell division. f.the client who is at risk for the recurrence but shows no evidence of current disease may be the candidate to this type of therapy. Side Effects: 1. no visitors with infection b. during each cell cycle. protect from exposure to radiation: time. • Chemotherapy disrupts the cell cycle in various phases interfering with cellular metabolism and reproduction. b. mouthwash to decrease risk to hemorrhage and protect gum 12 . Neoadjuvant Chemotherapy – refers to the preoperative use of chemotherapy to reduce the bulk and lower the stage of a tumor. excreted body fluid may be radioactive. use long handed forceps and place the implant into a lead container. assuring the container are marked appropriately. diarrhea 3. • They may also be administered oral. 2. • The IV route is the most preferred for administration of chemotherapeutic agents. NURSING MANAGEMENT: a. Bone marrow suppression a.000 platelet count) • assess skin of ecchymosis. Goals of Chemotherapy: a. double flush toilets after use. e. distance and shielding. avoid undercooked and raw fruits and vegetables • no pets. allowing the body’s immune system to destroy the remaining tumor cell. decreased WBC count (immunosuppression) • risk for infection. Anti-metabolites – interferes with metabolites nucleic acids necessary for RNA and DNA synthesis (5 Fluoroucil. people with infection • meticulous personal hygiene. Plant alkaloids – Vinka alkaloids phase specific.e. never directly touch the implant. GI effects: anorexia. • These necessities repeated dosage of chemotherapy is in order to reduce the number of cells. instruct visitors to maintain at least a distance of 6 feet from the client and limit visits to 10 – 30 minutes. petechiae and trauma • for shaving. cure b. ensure proper handling and disposal of body fluids. palliation of manifestations Types of Chemotherapy: 1. use electric razor only • avoid contact sports and other activities that may cause trauma • avoid dental work or other invasive procedure (IM injection) 2. avoid crowds. mouth swabs during acute episode • avoid mouthwash containing alcohol • use chloroxidine. 3. Stomatitis – inflammation of the mouth • use of soft toothbrush. no pregnant women to come in contact with radiation sources. Alkalyting agents – non-phase specific and act by interfering with the DNA replication (Cytoxan. Cytotoxic antibiotics – disrupt or inhibit DNA synthesis 4. CHEMOTHERAPY • Involves the administration of cytotoxic medications and chemicals to promote tumor cells death. Adjuvant Chemotherapy . • Is a systematic intervention and appropriate when:  disease is widespread  the risk of undetectable disease is high  the tumor cannot be resected and is resistant to radiation therapy. topical. nausea and vomiting. a fixed percentage of cells are killed by chemotherapy leaving some tumor cells remaining. Busulfan). control c. making it amenable to surgery or possibly even cure with subsequent local therapy. • According to the cell kill hypothesis. intrathecal.

Other approaches: Involves biological agents that stimulate certain cells. abdomen. radiation. TREATMENT 1. cervix. 6. endometrium (uterine lining). Other New Approaches –gene therapy Employs various methods to introduce genetic material into the cancer to make it more recognizable to the immune system.the only definitive method for the diagnosis of a cancer. colon. 4. neck. Mammography . Do not smoke. antihormones.  Bowel Cancer Screening . breasts. and thyroid. which can then attack the malignant cells. The best example is the use of interleukin-2 to stimulate the patient’s lymphokine-activated killer lymphocytes (LAK cells). Steps in controlling cancer: 1. Biopsy . oral cavity. rectum. Avoid sunburn. prostate. hard candy or mints to help with dryness • avoid smoking and alcohol • drink cool liquids. Alopecia • encourage patient to choose a wig before hair loss occurs in order to match texture and hair color • care of hair and scalp (no blow dryer) • allow client to express feelings concerning altered body image 5. 3. testicles. • allow rest period in between Expected outcome of clients with Cellular Disorders:  5 year survival rate for cancer is 59%. This may consist of removing the source of the stimulating hormone or the administration of various hormones. a section of tissue is removed from the tumor itself or from a metastasis. A high dose of this radiation is guided by laser targeting to a localized area of treatment.  Breast Cancer Screening – through breast self examination and mammography. and hormone blockers.is a special X-ray technique that is used to visualize soft tissues of the breast as a means for screening women for breast cancer.Radiation Therapy Radioisotope cobalt-60 is used as the source of gamma radiation.Hormone Therapy Tissues that are hormone-dependent. use artificial saline. such as tamoxifen. are responsive to hormone manipulation. Eat a healthy diet. Fatigue • assure client that it is a normal response to chemotherapy and it does not indicate progression of disease. In a biopsy. 13 .involves inspection and palpation of all accessible sites. especially the skin. including adjacent tissues and lymph node. and other hazards increases risk.Chemotherapy Chemotherapy is the use of drugs in the treatment of cancer.  Approximately 552. 2. 2.Surgery The principal approach to curing cancer is to remove all the malignant cells by a surgical operation. prostate. 3 Take up offers of cancer screening tests. and lymph-node areas • Screening and Self-Examination  Cervical Smear – can detect cervical cancer.  Cancer of the breast. skin – 5 year survival rate is 80%. It can prevent this cancer because it detects pre-cancerous cells. 5. Drink only moderate amounts of alcohol. DETECTION AND DIAGNOSIS • Physical Examination .• for xerostomia – apply lubricating agent to protect the mucous membrane. may turn cancerous. 4. In the past this meant the removal of all of the involved tissue and as much potentially involved tissue as possible.one method under consideration uses a thin flexible tube (a sigmoidoscope) to detect polyps in the bowel that.000 cancer related deaths occurred in 2000. if left. such as the breast. avoid hot and irritating foods 4. Observe safety rules in jobs where exposure to chemicals.

• Risk factors include genetic. immunological. chemicals. • Avoid the use of alcohol. bone marrow. or an organ such as the spleen. • Leukemia may be acute. causing anemia. Age of onset is after 50 years. usually at an immature stage. leucopenia. and spleen. • •   Mouth Care for the Client with Mucositis • • • Inspect mouth daily. cells in the lymphatic system either divide or grow without order or control. • Provide mouth rinses every 12 hours (saline or sodium bicarbonate and water. It may occur in a single lymph node. with a sudden onset and short duration. as prescribed). and environmental factors and exposure to radiation. • The cause is unknown and appears to involve gene damage of cells. Offer complete mouth care before and after every meal and at bedtime. • Chronic Lymphocytic Leukemia  Mostly lymphocytes present in the bone marrow.  Age of onset is after 50 years. with a slow onset and persistent symptoms over a period of years.  NON-HODGKIN’S LYMPHOMA Description  Non-Hodgkin's lymphoma (NHL) is cancer of the cells of the lymphatic system. in the bone marrow. the body becomes less and less able to produce blood cells that carry oxygen to other tissues or to protect itself from infection. • Avoid foods that are hard or spicy. leading to the transformation of cells from a normal state to a malignant state. This causes bleeding problems and infections. lymphoma cells replace the normal cells in the bone marrow. tonsils. and a decline in immunity. viral.  Classification of Leukemia • Acute Lymphocytic Leukemia  Mostly lymphoblasts present in bone marrow. and medications. HODGKIN’S DISEASE  Description  Hodgkin’s disease (lymphoma) is a malignancy of the lymph nodes that originates in a single lymph node or a single chain of nodes. adjacent lymph structures and eventually invades nonlymphoid tissue. Brush teeth and tongue with a soft-bristled toothbrush or sponges. or chronic. Chronic Myelogenous Leukemia Mostly granulocytes present in the bone marrow. • Administer topical anesthetic agents to the mouth sores as prescribed. • Leukemia affects the bone marrow.  Age of onset is less than 15 years.  Non-Hodgkin's lymphoma can start almost anywhere in the body.  The disease usually involves lymph nodes. 14 . or old cells do not die as cells normally do. In nonHodgkin's lymphoma.  Metastasis occurs to other.or glycerin-based mouthwashes or swabs. Non-Hodgkin's lymphoma can spread to almost any part of the body. a group of lymph nodes. Acute Myelogenous Leukemia  Mostly myeloblasts present in the bone marrow. the production of the immature cells. spleen.  Over time.  As the lymphoma cells spread. thrombocytopenia.  Age of onset is between 15 and 39 years. including the liver. and bone marrow and is characterized by the presence of Reed-Sternberg cell in the nodes.  Possible causes include viral infections and previous exposure to alkylating chemical agents.ONCO-SPECIFIC DISORDERS LEUKEMIA  Description • Leukemia is a malignant exacerbation in the number of leukocytes.

If a large tumor was removed. BRAIN TUMORS  Description  An infratentorial (below the tentorium cerebelli) tumor is located in the posterior third of the brain ( primarily in the cerebellum or brainstem ) and accounts for the frequency of symptoms resulting from increased intracranial pressure (ICP).  STAGE II – Involvement of two or more lymph node regions on the same side of the diaphragm or localized involvement of an extralymphatic organ or site. radiation. grains.  STAGE IV – Diffuse or disseminated involvement of one or more extralymphatic organs with or without associated lymph node involvement. metastasis. the use of nitrates and a history of gastric ulcers.  Therapeutic management includes a combined treatment of surgery (partial to total nephrectomy) and chemotherapy with or without radiation.  STAGE III – Involvement of lymph node regions on both sides of the diaphragm.  WILM’S TUMOR (NEPHROBLASTOMA)  Description  Wilm’s Tumor is a tumor of the kidney that may present unilaterally and localized or bilaterally. Never place the child in the Trendelenburg’s position because it increases ICP and the risk for hemorrhage. and dumping syndrome. therefore the prognosis is poor. leafy vegetables and fresh fruit. and exposure to environmental chemicals.  The occurrence of pancreatic cancer has been linked to diabetes mellitus. the treatment of choice is total removal of the tumor without residual neurological damage. depending on the clinical staging of the disease. and low in fresh. each may be used alone or in combination. sometimes with metastasis to other organs. and salt. In an infratentorial procedure the child usually is positioned flat and on either.  A supratentorial tumor is located within the anterior two thirds of the brain. obstruction. mainly the cerebrum. PANCREATIC CANCER  Description  Pancreatic cancer is the most common neoplasm affecting the pancreas. and chemotherapy. In a supratentorial procedure the head usually is elevated above the heart level to facilitate cerebrospinal fluid drainage and to decrease excessive blood flow to the brain to prevent hemorrhage.  The goal of treatment is to remove the tumor and provide a nutritional program. smoking. Positioning Following Craniotomy     Assess the physician’s order for positioning. including the degree of the neck flexion.  Pancreatic cancer is more common in blacks than in whites.  Complications include hemorrhage. The prognosis depends on the stage of the disease. and in men.  The signs and symptoms of a brain tumor depend on its anatomical location and size and to some extent on the age of the child. history of previous pancreatitis. ingestion of a high-fat diet.  Bone marrow transplantation may be consideration in treating Hodgkin’s disease.  Therapeutic management includes surgery.  The occurrence is associated with genetic inheritance and with several congenital anomalies. alcohol use. depending on the clinical stage and histologic pattern.  The primary treatment modalities are radiation and chemotherapy. GASTRIC CANCER  Description  Gastric cancer is a malignant growth in the stomach. alcohol ingestion.  Symptoms usually do not occur until the tumor is large. the prognosis is excellent in children with localized disease. green.  Risk factors include a diet high in complex carbohydrates. smoking. the child is not placed on the operative side because the brain may shift suddenly to that cavity. in smokers. PROSTATE CANCER 15 .  The peak incidence is at 3 years of age. Staging in Hodgkin’s Disease  STAGE I – Involvement of a simple lymph node region or an extralymphatic organ or site.

abscess and fistula formation. to carcinoma in situ. BREAST CANCER  Description  Breast cancer is classified as invasive when it penetrates the tissue surrounding the mammary duct and grows in an irregular pattern. through the bloodstream and lymphatics.  Metastasis occurs via the circulatory or lymphatic system or by direct extension to other areas in the colon or other organs.  Metastasis usually confined to the pelvis. the atypia becomes frankly malignant and the neoplasm grows in size. Eventually the neoplasm spreads to regional lymph nodes and distant organs such as 16 .  Prostate cancer can spread via direct invasion of surrounding tissues or by metastasis. Description  This slow-growing cancer of the prostate gland is usually an androgendependent type of adenocarcinoma.  Complications include bowel perforation with peritonitis.  Diagnosis is made by breast biopsy through a needle aspiration or by surgical removal of the tumor with microscopic examination of the malignant cells.  An exploratory laparotomy is performed to diagnose and stage the tumor. hemorrhage. CERVICAL CANCER Description Preinvasive cancer is limited to the cervix. underlying muscles. spreads fast. Pathology Bronchogenic carcinomas begin as a small focus of atypical epithelial cells within the bronchial mucosa. OVARIAN CANCER Description  Ovarian cancer grows rapidly. Surgical Breast Procedures  Lumpectomy  Tumor is excised and removed.  Metastasis occurs by direct spread to the organs in the pelvis.  Metastasis occurs via lymph nodes. lungs. along the mucosa or into the bronchial wall and adjacent lung parenchyma. The neoplasm may grow into the bronchial lumen. or by peritoneal seeding.  The risk increases in men with each decade after age 50.  Modified Radical mastectomy  Breast tissue. INTESTINAL TUMORS Description  Intestinal tumors are malignant lesions that develop in the cells lining the bowel wall or develop as polyps in the colon or rectum. to the bony pelvis and spine.  Lymph nodes are left intact. the most advanced premalignancy change. As the lesion progresses. BRONCHOGENIC CARCINOMA is a malignant neoplasm of the lung arising from the epithelium of the bronchus or bronchiole. by distal spread through lymphatic drainage.  Muscles are left intact.  Bone metastasis is a concern.  Prognosis is usually poor because the tumor usually is detected late. and lymph nodes are removed.  Lymph node dissection may also be performed. metastasis also occurs to the brain and liver. nipple.  Common sites of metastasis are the bone. but distant metastasis occurs through lymphatic spread. and lymph nodes are removed. and is often bilateral.  Simple Mastectomy  Breast tissue and the nipple are removed. which is the earliest premalignancy change.  Premalignant changes are described on a continuum from dysplasia.  Halsted Radical Mastectomy  Breast tissue. and complete intestinal obstruction. nipple.  Invasive cancer is in the cervix and other pelvic structures.

Primary liver cancer is rarely discovered early and often doesn't respond to current treatments — thus. These neoplasms also have the capacity to secrete hormones or hormone-like substances which have a variety of clinical effects. These cancers aren't called liver cancer. Even when treatments fail to provide much improvement in the liver cancer itself. The neoplastic cells are columnar. Pathophysiology • Bronchogenic carcinoma tends to form an intraluminal mass which may partially or completely obstruct the bronchus. DNA damage causes changes in these instructions. It is a very aggressive neoplasm. but researchers believe that cancer starts with damage to DNA — the material that contains the instructions for every chemical process in your body. esophagus. Instead. Liver cancer occurs when liver cells begin to grow abnormally. The neoplasm also may compress or invade local structures such as aorta. lining alveoli or form palliary growths which project into the alveolus.  Primary liver cancer is divided into several types based on the type of cells that become cancerous. Most children with hepatoblastoma can be successfully treated. It starts in the hepatocytes. they are named after the organ in which the cancer began — such as metastatic colon cancer to describe cancer that begins in the colon and spreads to the liver. LIVER CANCER  Primary liver cancer begins in the cells of the liver itself. liver cancer diagnosis occurs on average at about age 60. In the United States and Europe. This type of cancer begins in the small tube-like bile ducts within the liver. chest pain and dyspnea. superior vena cava or cervical sympathetic chain. including: • Sex. The neoplasm arises from the epithelium of the terminal bronchiole or the alveolus. Although many cancers are declining. though it isn't clear why. other neoplasms may vary from forming papillary structures to solid neoplasms without any gland formation.  Cancer affecting the liver is more commonly metastatic cancer. form a mass in the periphery of the lung. CLINICAL NOTE: This neoplasm is the most common type in women and nonsmokers. Some neoplasms. rather than being treated as primary liver cancers. Adenocarcinoma: The neoplasm is composed of malignant glandular epithelium which may vary in degree of differentiation from tumor to tumor. • Hepatoblastoma. CLINICAL NOTE: This neoplasm is strongly related to smoking. • Age. Well differentiated neoplasms may form distinct glands. This type of cancer is sometimes called bile duct cancer. 17 . • Bronchioloalveolar carcinoma: The neoplasm is a distinctive form of adenocarcinoma. Adenocarcinomas tend to be smaller than other bronchogenic carcinomas and located in the periphery of the lung.  Cancers that commonly spread to the liver include colon. • Cholangiocarcinoma. Risk factors Primary liver cancer can affect people of all ages and races. A distinctive type of adenocarcinoma is bronchioloalveolar carcinoma. brain and bone. Most bronchogenic carcinomas form a mass in or near the hilus. • Bronchogenic carcinoma may present with a variety clinical manifestations but the major findings are cough.the liver. Types include: • Hepatocellular carcinoma (HCC). This rare type of liver cancer affects children younger than 4 years of age. undifferentiated malignant cells. the leading causes of the disease. • Large cell carcinoma: The neoplasm is composed of large. • Small cell carcinoma: The neoplasm is composed of small cells containing dark blue. These metastatic cancers are treated based on where the cancer began. lung and breast cancers. especially the adenocarcinomas. These cells resemble (but are not) lymphocytes and are arranged in clusters. • Angiosarcoma or hemangiosarcoma. which occurs when tumors from other parts of the body spread (metastasize) to the liver. but certain factors may increase your risk. People in Asia and Africa tend to be diagnosed with liver cancer at younger ages — between 20 and 50. It's not completely understood why this happens. But the most important news about primary liver cancer is that you can greatly reduce your risk by protecting yourself from hepatitis infection and cirrhosis. round nuclei and sparse cytoplasm. pain and other signs and symptoms caused by liver cancer can be aggressively treated to improve quality of life. generally having metastasized at the time of diagnosis. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of malignant cells. Squamous Cell Carcinoma: The neoplasm is composed of malignant squamous cells which may vary in degree of differentiation from tumor to tumor. including the rate of cellular growth. A well differentiated squamous cell carcinoma may form keratin and intercellular bridges. the main type of liver cell. These rare cancers begin in the blood vessels of the liver and grow very quickly. This is the most common form of primary liver cancer in both children and adults. Men are more likely to develop liver cancer than are women. new cases of primary liver cancer are increasing. weight loss. the prognosis is often poor.

with higher numbers indicating cancers that are more advanced. Your doctor may use a thin needle or a lighted instrument (laparoscope) to obtain the sample. A drink is one 4. Not all malignant liver tumors produce AFP. the American Association for the Study of Liver Diseases recommends liver cancer screening for those thought to have a high risk. Doctors sometimes use a blood test that checks for the presence of alphafetoprotein (AFP) — a type of protein found in small amounts in adults — to detect liver cancer. Exposure to aflatoxins. and some people may experience an allergic reaction to the contrast dye.5-ounce shot of 80-proof distilled spirits. Moderate consumption is defined as no more than two drinks a day for men and one drink for women. including the liver. 18 . Biopsy carries a risk of bleeding. Liver cancer may be staged in different ways. The test can take from 15 minutes to an hour. This progressive and irreversible condition causes scar tissue to form in your liver and increases your chances of developing liver cancer.  Computerized tomography (CT) scan.to 5-ounce glass of wine. have liver cirrhosis. 12 ounces of beer or a 1. Staging  Staging tests help determine the size and location of cancer and whether it has spread. Having both diabetes and hepatitis C infection increases the risk even more. Consuming foods contaminated with fungi that produce aflatoxins greatly increases the risk of liver cancer. Diabetes. MRI creates images using a magnetic field and radio waves. Excessive alcohol consumption. Sometimes a contrast dye also may be used. Smoking. For this reason. other types of cancer and even some noncancerous liver diseases can raise AFP levels. In addition. It emits sound waves that are reflected from your liver and transformed into a computer image. A CT angiogram. Liver biopsy is considered the only definitive way to diagnose liver cancer. This test uses sound waves to produce a picture of internal organs. a wand-shaped device (transducer) is placed on your body. Tests and procedures used to diagnose liver cancer include:  Ultrasound (ultrasonography).  Magnetic resonance imaging (MRI). Cirrhosis. can provide detailed information on the number and location of liver tumors. which may take up to an hour to perform. While you lie on a bed or examining table. You may also have a variation of the test — known as a CT angiogram — in which contrast dye is injected into an artery in your liver. One method uses the Roman numerals I through IV. Asian female older than 50 or African and older than 20. texture and makeup of tumors. But the test isn't perfect. Diagnosis  If you experience any of the symptoms of liver cancer. Screening typically involves blood tests and an ultrasound exam once or twice each year.• • • • • • • Chronic infection with HBV or HCV. Crops such as corn. 2.  Liver biopsy. A disease called primary sclerosing cholangitis can cause inflammation and scarring of the liver's bile ducts. your doctor will ask you about your medical history and perform a physical exam.  Blood tests. Screening  Screening for liver cancer hasn't been definitively proved to reduce the risk of dying of liver cancer. Bile duct disease. Consuming more than a moderate amount of alcohol can lead to irreversible liver damage and increase your risk of liver cancer. or have a family history of liver cancer  Liver cirrhosis from alcohol use  Hepatitis C  An inherited form of hemochromatosis  Primary sclerosing cholangitis  Discuss the pros and cons of screening with your doctor. Ultrasound is painless and usually takes less than 30 minutes. many medical groups don't recommend liver cancer screening. but a CT scan exposes you to more radiation than conventional X-rays do. including people who have:  Hepatitis B and one or more of the following: Are an Asian male older than 40. Screening and diagnosis 1. Chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) is by far the most important risk factor for liver cancer. However. This increases your risk of bile duct cancer. Ultrasound provides information about the shape. In this procedure. Newer MRIs can show images of the ducts that transport bile from the liver to the upper part of the small intestine (duodenum) as well as of the arteries and veins within the liver. bruising and infection. Together you can decide whether screening is right for you based on your risk. soybeans and peanuts can become contaminated with aflatoxins. This test uses X-rays to produce cross-sectional images of your body. Smoking tobacco of any kind makes it more likely that you'll develop liver cancer. and those that do may be advanced by the time protein levels become elevated. X-rays then track the dye as it flows through the blood vessels in your liver. People with this blood sugar disorder have a greater risk of liver cancer than do people who don't have diabetes. a sample of tissue is removed from your liver and examined under a microscope.

This stage of cancer has spread to other parts of the body. but it can shrink tumors in a certain percentage of people. Chemoembolization isn't curative. Discuss all of your options carefully with your treatment team. • Stage III. Treatment  Treatments for primary liver cancer depend on the extent (stage) of the disease as well as your age. Although the procedure has a somewhat higher risk of serious complications than alcohol injection does. Treatments for primary liver cancer in adults Treatments for adults with primary liver cancer include: • Surgery. The idea is that by targeting the tumor directly.  The goal of any treatment is to eliminate the cancer completely. This stage of cancer has spread throughout the liver or to other parts of your body. At this stage. It usually develops when there is extensive damage to liver cells. losing their ability to filter fluids and waste and causing dangerous levels of these substances to accumulate in the body. At this stage. and chemotherapy drugs are injected between the blockage and the liver. By stage IV. the focus may be on preventing the tumor from growing or spreading.  Doctors may also use the following stages to describe primary liver cancer in adults: • Localized resectable. A stage I tumor is small and confined to one lobe of the liver. Each treatment consists of one injection. veins and bile ducts. When the needles reach the tumor. You're more likely to have advanced cancer if you also have cirrhosis or chronic hepatitis. either through the skin or during an operation. which may provide symptom relief and improve survival. Chemoembolization is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver. they're heated with an electric current. doctors can use potent doses of drugs 19 . destroying the malignant cells. • Recurrent. The kidneys also may fail. In this procedure. When that isn't possible. • Radiofrequency ablation. pure alcohol is injected directly into tumors. During the procedure. In some cases. the cancer can be removed with surgery. At this stage. Most stage II liver cancers can be removed with an operation. unresectable hepatocellular tumors and for some types of metastatic liver cancers. This means the cancer has returned after it has been treated. This occurs when the liver is no longer able to function adequately. Even when resections are successful. or malignant cells may have spread to other parts of the body. Cancer that spreads to areas outside the liver becomes more difficult to treat. You aren't a candidate for surgical removal of liver tumors if you have cirrhosis or only a small amount of healthy liver tissue. it appears to provide better outcomes. but can't be completely removed. either because the noncancerous portion of your liver isn't healthy or because the cancer is located near your liver's main arteries. • Stage IV. Liver cancer most commonly spreads to the lungs and bones. In this procedure. the area of the liver where the cancer is found can be completely removed. The term "resectable" refers to a tumor that can be surgically removed. Using an ultrasound or CT scan as a guide. but some will remain in the lymph nodes or abdomen. It may also be used to help reduce symptoms in cases of metastatic liver cancer. there is a chance the cancer can recur elsewhere in the liver or in other areas within a few years. It may recur in the liver or in another part of the body. overall health. Alcohol dries out the cells of the tumor and eventually the cells die. although you may need a series of injections for the best results. The most common side effect is leaking of alcohol onto the liver or into the abdominal cavity. The best treatment for localized resectable cancer is usually an operation known as surgical resection. particularly the bones or lungs. The cancer is found in only one part of your liver. • Localized unresectable. feelings and personal preferences. electric current in the radiofrequency range is used to destroy malignant cells. your surgeon inserts several thin needles into small incisions in your abdomen.  Palliative care refers to treatment aimed not at removing or slowing the disease but at helping relieve symptoms and making you as comfortable as possible. the tumor is confined to one lobe of your liver and can be completely removed in an operation. • Recurrent. Radiofrequency ablation is an option for people with small. the hepatic artery — the artery from which liver cancers derive their blood supply — is blocked. several tumors may exist in different lobes. but microscopic amounts of cancer remain in the liver after surgery. • Kidney failure. • Chemoembolization. • Alcohol injection. Alcohol injection has been shown to improve survival in people with small hepatocellular tumors. Complications People with liver cancer may sometimes experience the following complications: • Liver failure. • Spread of the cancer cells (metastasis). • Stage II. This means the cancer has returned to your liver or to another part of your body after being treated. • Advanced. Stages of primary cancer in children Doctors use the following stages to describe childhood liver cancer: • Stage I. some of the cancer may be surgically removed. In some cases palliative care only is appropriate.

This treatment uses powerful drugs to kill cancer cells. Sorafenib is a targeted therapy designed to interfere with a tumor's ability to generate new blood vessels. The best way to protect yourself from HCV is not to inject drugs. Needles that may not be properly sterilized can spread the virus. use a new latex condom every time you have vaginal or anal sex. Sorafenib (Nexavar). Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells. But the fact is that chemoembolization causes many of the same side effects as other forms of chemotherapy. and the best approach depends on the stage and type of cancer as well as the child's age and overall health. and don't share it. Don't engage in unprotected sex unless you're absolutely certain your partner isn't infected with HBV.  Take measures to prevent hepatitis C. Systemic chemotherapy is generally not effective in treating liver cancer. Treatments for primary liver cancer in children  Liver cancer in young people is rare. Protection lasts years and may even be lifelong. Or you may have radiation therapy following surgical removal of a tumor to help destroy any remaining malignant cells. use a clean needle. including infants. But you can greatly reduce your risk by taking steps to protect yourself from hepatitis B and C. • Know the health status of any sexual partner. donated organ. make sure any needle you use is sterile. which provides more than 90 percent protection for both adults and children. Prevention  In many cases it's not possible to prevent the spread of cancer from another site to the liver. And it may not always be possible to prevent primary liver cancer. use a female condom. Radiation side effects may include fatigue. It may also be used in addition to surgery. The single most effective way to prevent hepatitis B is to receive the hepatitis B vaccine. Sorafenib was approved by the Food and Drug Administration in 2007 for use in advanced inoperable liver cancer. nausea and vomiting. 4 and 9 months of age. Sorafenib has been shown to slow or stop advanced liver cancer from progressing for a few months longer than with no treatment. In this surgical procedure. your doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumors. Cryoablation may be an option for people with inoperable primary and metastatic liver cancers. Chemotherapy may be systemic — meaning it travels throughout your body in your bloodstream — or regional. In other cases.  In general. As a result. nausea and vomiting. If you don't know the health status of your partner. Radiation therapy. but may be a treatment option in certain cases.• • • • • without creating as many side effects as occur with systemic chemotherapy. • Avoid body piercing and tattooing. chemotherapy or other standard treatments. • Don't use IV drugs. Take advantage of needle exchange programs in your community and consider seeking help for your drug use. Infants often receive the vaccine in the first year of life — typically at 2. early-stage liver tumors and for certain people with bile duct tumors.  Get vaccinated.  There are no guarantees with clinical trials. More studies are needed to understand how targeted therapies may be used to control advanced liver cancer. This treatment uses extreme cold to destroy cancer cells. most children with the disease are treated at centers that specialize in childhood cancers. the treatments available for children are the same as for adults. Because no vaccine for hepatitis C exists. Contaminated drug paraphernalia is responsible for about half of all new hepatitis C cases. a transplant may not improve long-term outlook because the cancer may recur outside the new liver. This can give you access to experimental therapies that might not otherwise be available. Radiation may come from a machine outside your body or from radiationcontaining materials inserted into your liver. but if you do. Liver transplantation may be an option for some people with small. the following measures can play a key role in protecting your health: • Educate yourself and others. The vaccine can be given to almost anyone. cirrhosis and other liver diseases. Radiation may be used on its own to treat localized unresectable cancer. Side effects include damage to the bile ducts and major blood vessels. and you should fully understand the potential risks as well as possible benefits before taking this step. Chemotherapy. During the procedure. Liver transplantation. Cryoablation (cryosurgery or cryotherapy). including abdominal pain. 20 . This treatment uses high-powered energy beams to destroy cancer cells and shrink tumors. If you don't have a male condom. Make sure you understand what viral hepatitis is and how it's transmitted. you may want to consider participating in a clinical trial — a research study that tries to improve current treatments or find new treatments. however. But if that isn't an option for you. Clinical trials  Because standard treatments often aren't effective in treating liver cancer. leading to bleeding or infection. HCV or any other sexually transmitted disease. a diseased liver is removed and replaced with a healthy. especially when tumors are larger or blood vessels are involved. Chemoembolization is less likely to cause some side effects such as lowered blood cell counts or hair loss. older adults and those with compromised immune systems.

Although support groups aren't for everyone. The National Cancer Institute also can provide a list of support groups. talk to a doctor. Or you may not have a large social network. 21 . Coming to terms with your illness may be the hardest thing you've ever done. up-to-date information on all aspects of living with cancer.  If you're interested in learning more about support groups. having a strong faith or a sense of something greater than themselves makes this process easier. the concern and understanding of a counselor. They may be able to put you in touch with a group in your area. Avoid exposure to environmental toxins. such as a medical social worker. Learn everything you can about liver cancer — how the disease progresses. But coping with a diagnosis of liver cancer can be especially difficult. Many people also take steps to ensure that their end-of-life wishes are known and respected. try it out a few times. Although friends and family can be your best allies. Alcohol speeds the progression of any liver disease you may have and is the leading cause of cirrhosis — a key factor in primary liver cancer. Avoid medications that may cause liver damage. How will you tell your children? Will your partner be able to cope? Who will take care of all of the things you normally do if you can't?  Although there are no easy answers for people dealing with liver cancer. You can reach the Cancer Information Service 24 hours a day at 800-4-CANCER. If so. Or check your local phone book.  Come to terms with your illness. Most Americans with HCV became infected through blood transfusions received before 1992 — the year improved blood-screening tests became available. If it doesn't seem useful or comfortable. inhale or apply to your skin. get tested for HCV and HBV as soon as you return home. Avoid mixing alcohol and acetaminophen (Tylenol. look for information in books and reputable sources on the Internet. After deciding to participate in a group. library or a cancer organization. Your doctor can advise you about these medications. the less likely the chance of cure. they can sometimes be a good resource for practical information about your disease. in some cases they may have trouble dealing with your illness. If an emergency requires that you receive blood or blood products in another country. You may also find strength and encouragement in being with people who are facing the same challenges you are. some of the following suggestions may be of help:  Learn all you can about your illness. which may include over-the-counter medications as well as prescription drugs. As a result. social worker or psychologist. you may feel overwhelmed just when you need to make crucial decisions. It provides access to trained counselors and accurate. Although the blood supply is now well screened in the United States. others) — a combination known to cause liver damage.• • • • Be cautious about blood products in certain countries. you don't have to continue. You're also likely to be even more concerned about others than yourself. Coping skills  Learning you have any life-threatening illness can be devastating. You will have many decisions to make in the weeks and months ahead. psychologist or chaplain. For that reason. For some people. Be sure you understand whether a particular approach is used to treat cancer or provide palliative care. Don't be afraid to seek a second opinion and to explore treatments available through clinical trials. this isn't always the case in other countries. Your liver filters every substance you ingest.  In addition to talking to your medical team. The National Cancer Institute offers a toll-free information line called the Cancer Information Service. The more you know the more active role you can take in the decision-making process. including both experimental and standard treatments and their side effects. your prognosis and your treatment options. The more advanced the disease when it's discovered. nurse.  Maintain a strong support system. or 800-4226237. medical social worker or even a formal support group can be helpful. Strong relationships are crucial in dealing with lifethreatening illnesses. Avoid or limit alcohol. avoid unnecessary chemical exposure. Others seek counseling from someone who understands life-threatening illnesses.

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