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Julie Mann, NP
What is Cancer

 Uncontrolled cellular proliferation that knows no limits and serves no

the cell Cycle

 Cells reproduce at an inherit rate

 Respond to environmental changes in the body by

sending messengers called growth signals

 Growth signals reach the nucleus and proteins called

transcription factors turn on and off genes that promote

cell proliferation
Cancer & the Cell Cycle

 CA cells do not respond to normal cues about cellular

 CA cells:

 Have autonomy
Go through anaplasia
Have immortality
Characteristics of CA cells
• unregulated growth

• low differentiatiated

• genetic instability

• independent of growth factors

• low cell to cell adhesion

• no density-dependent inhibition
Tumor Classification

• Benign Tumors

• Malignant Tumors
Gene and Chromosome Abnormalities

 Mutation

 Proto-oncogenes

 Oncogenes

 Tumor Suppressor genes

 DNA repair genes
 Alterations of pro-growth and antigrowth signals
Tumor Markers

 Def: substances produced by CA cells that are found on

tumor plasma membranes or in blood, spinal fluid, or
 Examples: hormones, enzymes, genes, antigens, and

Viral and bacterial cause of CA

 Initial acute infection not associated with CA

 Chronic infection can lead to CA

 Examples:
 Viral:
 Bacterial: Helicobacter Pylori
Environmental Risk Factors
 Tobacco use
 Diet
 Alcohol Consumption
 Sexual and Reproductive behavior
 Air pollution
 Occupational hazards
 Ultraviolet radiation
 Ionizing radiation
 Hormones
Oral contraceptives
Progestogen and Androgens
Tumor Spread

• Local spread by direct invasion of contiguous organs

• Metastasis to distant organs by lymphatics and veins
• Metastasis by implantation
Mechanism of Local Spread

 Cellularmultiplication
 Mechanical pressure

 Release of lytic enzymes

 Decreased cell to cell adhesion

 Increased motility of individual tumor cells

Cancer Warning Signs

• Change in Bowel/Bladder Habits

2. A Sore that does not heal
• Unusual bleeding or discharge
• Thickening or lump in breast or elsewhere
• Indigestion or difficulty swallowing
• Obvious change in wart or mole
• Nagging cough or hoarseness
Tumor Staging

 TNM System
 T: tumor spread
 N: node involvement
 M: presence of distant metastasis

Grading System I-IV

Case #1
• Colin
is a 30 year old caucasian male who
presents to a clinic with c/o frequent diarrhea
and constipation and change in bowl pattern.
He recently traveled to the Caribbean islands
and a fellow travel also is having bowl problems.
He has not seen doesn’t have a primary care
physician and hasn’t sought medical care for
over 5 years prior to today.

• What might be going on with Colin?

• What would you anticipate might be ordered?

• Colin, who isn’t a fan of the medical
community since his mom died of
breast CA 5 years ago, sees several
Primary care doctors and a holistic
healer before one of the Doctors orders
a colonoscopy and a CT of his abdomen.
During this time Colin thinks he
developed either a tropical illness, as
his friend did, or picked up a tape worm.
Several months has past and he has
lost about 20 lbs and is pale and
• TheCT results indicate a mass in his
colon and small masses in his liver.

• He has surgery to remove the tumor in

the colon and the liver is evaluated for
possible removal of the tumors.
However the tumors were so numerous
in his liver that removal wasn’t possible.

• What stage do you think his CA was at?

• What do you think his prognosis was?

Risk Factors

• Age > 50 years old

• family history of CA

• Crohn Disease & Ulcerative Colitis

• familial adenomatous polyposis of the colon

• Poor diet

• bleeding

• change in bowel habits

• diarrhea or constipation

• sense of urgency or incomplete emptying of the


• pain (a late symptoms)

Case #2

• Mary is a 60 year old post menopausal female

with a pmh of smoking 30 pack years. She
presents to her GYN for her annual exam and
her MD notices her left nipple is retracted and
she feels a lump under her areola.

• What puts her at risk for breast CA?

• What tests would be ordered?

Breast CA

 Fibroadenoma

 Carcinoma of the Breast

Susceptible genes
• Ductal carcinoma
• Lobular carcinoma
Case #3

• Johnis a 72 year old man with a pmh significant

for smoking (120 pack/years)
Lung CA

 Types

Bronchogenic carcinoma
Squamous cell carcinoma
Large cell carcinoma
Small cell carcinoma
Smoking and Lung CA

 Risk
is related to:
Amount smoked
Age of smoking onset
Product smoked (tar, nicotine, filters)
Depth of inhalation
Case #4

• Lenny is a 64 year old a.a. man who presents

with c/o frequency and difficulty starting to void.
On digital rectal exam his prostate is fixed and

• What is causing his symptoms?

• What would your nursing plan of care include?

Prostate CA

• exact cause is unclear

• androgens are believed to play a role

• risk factors:

• age, race, heredity, high fat diet

Clinical manifestations
• urgency

• frequency

• nocturia

• hesitancy

• dysuria

• hematuria

• Bone (low back pain)

• vertebral column, ribs, & pelvis

• lung

• bladder
Clinical Manifestations

• Anorexia

• Cachexia

• Fatigue

• Sleep Disorders

• Anemia
Clinical Manifestations

• Altered Tissue Integrity

• compression and erosion of blood vessels

• development of effusions
Please also review

• Uterine CA

• Bladder CA

• Lymphoma (hodgkins and nonhodgkins)

• Leukemia (both acute and chronic forms)