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San Juan de Dios Educational Foundation Inc.

Oncology Nursing: An Introduction

Prepared By: Kristina Sevilla, RN

Cancer Statistics
• All Sites of Cancer
– Estimated new Cancer
• Male - 766,130 • Female - 713,220


– Estimated Deaths
• Male - 292,540 • Female - 269,800


2009 Estimated US Cancer the act of deviating from the ordinary, usual, or normal typeDeaths*
• • • • • • • • • • • Lung & bronchus 30% Prostate Colon & rectum Pancreas Leukemia 9% 9% 6% 4%

Men Women 292,540 269,800 26%
15% 9% 6% 5% 4%

Lung & bronchus Breast Colon & rectum Pancreas Ovary Non-Hodgkin lymphoma Leukemia Uterine corpus Liver & intrahepatic bile duct Brain/ONS All other sites

Liver & intrahepatic 4% bile duct Esophagus Urinary bladder Non-Hodgkin lymphoma Kidney & renal pelvis3% All other sites 25% 4% 3%

3% 3% 2%

©2009, American Cancer Society, Inc.

2% 25%

Mortality, 2006
 Rank cause of Death

1. Heart Diseases 2. Cancer 3. Cerebrovascular diseases 4. Chronic lower respiratory diseases 5. Accidents (unintentional injuries) 6. Diabetes mellitus 7. Alzheimer disease 8. Influenza & pneumonia 9. Nephritis* 10. Septicemia
©2009, American Cancer Society, Inc.

631,636 559,888 137,119 124,583 121,599 72,449 72,432 56,326 45,344 34,234

26.0 23.1 5.7 5.1 5.0 3.0 3.0 2.3 1.9 1. 4

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• Greek Word “Karkinoma” for Crab

A group of more than 270 different diseases characterized by: • • • • Proliferation Invasion and Metastasis Loss of Differentiated Function Mutations

The Precise Etiology of Cancer is “UNKNOWN”

How does Cancer Develop
Initiation Promotion Progressio n

Defect in Cellular Proliferation
• Under normal situations there is control of the number of cells in the body.
– Balance between cellular proliferation and cellular death. – Contact inhibition

• If something goes wrong in the control mechanism, it can result in rapid proliferation of immature cells.

Normal Cells VS. Malignant Cells

Normal Cells Malignant Cells

Leads to two daughter cell

Leads to multiple daughter cells that may or may not resemble the present.

Normal Cells Malignant Cells
1. Cells of the same type, 1. Cells larger and grow more homogenous in size, rapidly than normal. shape, and growth. 2. Cells cohesive, form 2. Cells not as cohesive, regular pattern expansion. irregular patterns of 3. Uniform size to nucleus. expansion. 4. Have characteristics 3. Larger more prominent pattern of organization. nucleus. 4. Lack characteristic pattern of organization of host cells.

Normal Cells 1. Do not invade adjacent tissues 2. Proliferate In response to specific stimuli 3. Grow in ideal condition Malignant Cells 1. Invade adjacent tissues 2. Proliferate in response to abnormal stimuli 3. Grow in adverse condition such as lack of nutrients.

Normal Cells 1. Exhibit Contact Inhibition Malignant Cella Do not exhibit Contact Inhibition

2. Cell birth equals Cell death Cell birth exceeds Cell Death 3. Stable Cell Membrane Loss of Cell Control as a result of cell membrane changes

Normal Cell 1. Constant or Predictable growth rate 2. Cannot grow outside specific environment Malignant Cell 1. Growth rate erratic

2. Able to break off cells and migrate. May grow in the other sites.

Normal Cells
Reproduce themselves exactly Stop reproducing at the right time Stick together in the right place Self destruct if they are damaged Become specialized or 'mature‘

Cancer Cells
Cancer cells don't stop reproducing Cancer cells don't stick together May self destruct more slowly than they reproduce Cancer cells don't specialize, but stay immature Cancer cells don't obey signals from other cells

Cells communicate well

Reactive and Neoplastic Growth Process

• Atrophy • Hypertrophy


Reactive & Neoplastic Growth Process Metaplasia “ cell type conversion” Dysplasia “ maturation Abnormality” Anaplasia “DeDifferentiation” Neoplasia “abnormal Proliferation”

What is Neoplasm?
• is an abnormal proliferation of tissues, usually caused by genetic mutations. • Any overgrowth of tissue can form a TUMOR. • Either Benign or malignant.



1. Composed of cells that look like 1. Composed of Undifferentiated the tissue origin Cells 2. Usually encapsulated 2. Little semblance to tissue of 3. Grow slowly and by expansion origin 4. Do not recur and metastasize 3. Grows rapidly 4. Expands at Periphery and 5. Do not destroy tissue generally Invades and destroys 6. Do not cause systemic surrounding tissue symptoms or death generally. 5. It Spreads by way of lymph and blood to distant parts of the body 6. Causes systemic signs and may cause death

What is TUMOR?
• is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic). • Tumor is not synonymous with cancer. • A tumor can be benign or malignant.

Cancer Types
• Carcinoma- a tumor derived from epithelial cells, those cells that line the surface of our skin and organs. – This is the most common cancer type and represents about 80-90% of all cancer cases reported. • Sarcoma- a tumor derived from muscle, bone, cartilage, fat or connective tissues.

• Leukemia- a cancer derived from white blood cells or their precursors. • Lymphoma- a cancer of bone marrow derived cells that affects the lymphatic system. • Myelomas- a cancer involving the white blood cells responsible for the production of antibodies

Where Cancers Spread Locally?
• tumors grow along the “path of least resistance”.

How Cancer Spreads?
• The cancer that grows where it first started in the body is called the 'primary cancer'. • The place a cancer spreads to and then starts growing is called the 'secondary cancer' or 'metastasis'.

How Cancer Spreads?

Three main ways a cancer spreads.
• Local spread • Through the blood circulation • Through the lymphatic system


Normal Genes
1. proto-oncogene •A gene that has functions to promote cell division. •are responsible for providing the positive signals that lead to cell division. Some proto-oncogenes work to regulate cell death

Mutated Genes
1. Oncogenes • A defective gene that is involved in triggering cancer cell growth • can cause a cell to divide in an unregulated manner.

2. The loss of function of these 2. Tumor Suppressor genes leads to abnormal cellular •A gene that functions in the control behavior of cell division. •These genes work to limit cell division and may be contrasted with oncogenes

All cancers demonstrate alterations in one or more tumor suppressors and oncogenes

Hallmarks of Cancer
1. 2. 3. 4. 5. 6. Tissue Invasion and Metastasis Failure to Respond to “STOP” Signals Evading Apoptisis Growth without “GO” Signals Unlimited Number of Cell Divisions Continued Angiogenesis

Risk Factors of Cancer
Non – Controllable • Gender M> F • Age • Race Controllable • Stress • Diet • Occupation • Infection • Lifestyle • Drugs

Etiology/ Causative Factor
• Extrinsic Factor
– Viruses and bacteria – Chemical Carcinogens – Radiation Carcinogens – Iatrogenic Chemical agents

• Intrinsic Factor
– Hormonal Factor – Genetic Factor – Physical Stressor – Dietary Factors

A. Viruses and Bacteria

Viruses and Bacteria

• Chemical Agents
– Industrial wastes, pesticides, cigarette smoking, asbestos, phenol – Natural body substance in body: Bile acids – Food Additives: Sodium Saccharine, Nitrites

• Drugs and Hormone

Physical Agents: Radiation
• -Radiation (both solar and ionizing), and radon, nuclear radiation.

Hereditary Factors

Cancer’s Nine Warning Signs
• • • • • • • • • C hange in bowel or bladder habits A sore that does not heal U nusual bleeding or discharge T hickening or lump in breast or elsewhere I ndigestion or difficulty in swallowing O bvious change in wart or mode N agging cough or hoarseness U nexplained anemia S sudden loss of weight

Levels of Cancer Prevention and Control

1. Primary Prevention
• Focus on eliminating the conditions that cause cancer to develop. • Cancer not yet develop or is in precancerous stage.

2. Secondary Prevention
• Refers to early detection coupled with effective therapy. • Cancer maybe curablein early stage.

3. Tertiary Prevention
• Refers to te prevention of cancer recurrences, symptoms and complications. • It involves supportive care, Rehabilitation and Pain Relief.

Thank You!