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Areas of Comparison
BT – Benign tumor
Expand
Extend
Contain capsule
MT – infiltrate tissues
Ability to metastasize
Site of Origin
BT – not affect distant tissue
MT – in situ – ability affect distant tissue
1. Pain
2. Cachexia
3. Obstruction
4. Necrosis and ulceration of involve tissue
5. Hemorrhage
6. Infection
7. Abnormal hormone production
I. CAUSATIVE FACTORS
A. Physical agents
1. Radiation
From X-Rays or radioactive isotopes
From sunlight/ultraviolet rays
2. Physical Irritation/Trauma
Pipe smoking
Multiple deliveries
Jagged tooth, irritation of the tongue, “overuse of
any organ body parts”
Causative Factors cont….
B. Chemical carcinogens
1. Act by causing by causing cell mutation or
alteration in cell enzymes and proteins ->
altered replication
2. E. g.’s/Industrial compounds
Vinyl chloride (plastic manufactures, asbestos
factories, construction works )
Polycyclic aromatic hydrocarbons (refuse burning,
auto and truck emission, oil refineries) air
pollutions
Causative Factors cont…
Fertilizers, weed killers
Dyes
Analine dyes (beauty shops and home use)
Hair bleach
Drugs
Tobaco (Tar nicotine, alcohol)
Cytotoxic drugs (Melphalan)
Causative Factors cont…
C. Genetics
1. Oncogene (hidden/repressed genetic code for cancer
that exists in all individuals) -> when exposed to
carcinogens -> changes in cell structure -> becomes
malignant
3. E. g’s
Retinoblastoma, pheochromocytoma , Wilm’s
tumor, lung CA, breast CA
Causative Factors cont….
D. Viruses
“Oncogenic Viruses”
Epstein Bar virus, burkitt’s lymphoma, nasopharyngeal Ca,
non-Hodgkin and Hodgkin's lymphoma
Clinical manifestation:
At early stage symptoms are virtually absent until late in
the course
Lymphadenopathy in the later stage and B symptoms
management
Radiation alone in early non aggressive tumor.
D. Leukemia/Blood
“white blood” neoplastic proliferation
of one particular cell type.
Unregulated proliferation of WBCs in
the bone marrow
Classified into lymphoid or myeloid,
acute and chronic
TYPES OF LEUKEMIA
1. Acute Myeloid leukemia
Defect in hematopoietic stem cells that
differentiate into all myeloid cells.
All age group are affected and incidence
increases with age with peak at age 60
With treatment patients survive an average
of 1 year with death usually due to
infection or hemorrhage.
Leukemia cont…
Clinical manifestation:
Most of signs and symptoms evolve from
insufficient production of normal blood
cells.
Fever, infection, weakness, fatigue,
bleeding tendencies.
Pain from enlarged liver and spleen
Hyperplasia of gums
Leukemia cont…
Diagnostics:
CBC, decrease erythrocytes and platelets
Bone marrow aspiration, excess of immature
blast cells (>30%)
Medical management:
The objective is to achieve complete remission
by aggressive chemotherapy called induction
therapy.
High doses of cytarabine and daunorubicin
Acute Myeloid Leukemia cont….
The aim is eradication of leukemic cells but it is
often accompanied by eradication of normal
type of myeloid cells.
Consolidation therapy (postremission therapy)
eliminate any residual leukemia cells that are
not clinically detectable, diminishing the chance
of remission.
70% experience relapse
Leukemia cont…
2. Acute Lymphocytic Leukemia
Uncontrolled proliferation of immature cells
(lymphoblast)
Common in young children, with boys affected more
than girls
>80% of children survive at least 5 years
Clinical manifestation:
Immature lymphocytes proliferate in bone marrow
Decrease WBC, RBC and platelets
Leukemic cell infiltration causing pain from enlarged
liver, spleen, bone pain, headache and vomiting
Acute Lymphocytic Leukemia cont…
Clinical manifestation
Immature lymphocytes proliferate in bone marrow
Decrease WBC, RBC and platelets
Leukemic cell infiltration causing pain from
enlarged liver, spleen, bone pain, headache and
vomiting
Treatment:
Very sensitive to corticosteroids and vinca alkaloids
Prophylaxis of intrathecal chemotherapy
(methotrexate)
3. Chronic Myeloid Leukemia
Arises from mutation in the myeloid stem cell.
Normal myeloid cells continue to produced, but
there is preference for immature (blast) forms.
Uncontrolled proliferation results in marrow
expansion of long bones, liver and spleen
resulting in pain.
Chromosome 22 (philadelphia chromosome)
and chromosome 9 (BCR-ABL gene)
producing an abnormal protein (tyrosine
kinase) causing WBC to divide rapidly.
Chronic Myeloid Leukemia cont…
Common in 40 – 50 years old
Median life expectancy of 3 to 5 years
Patient is usually assymptomatic
WBC exceeds to 100000/mm3.
Shortness of breath or confused due to
decrease capillary perfusion of brain and lungs
from leukostasis.
Treatment
Imatinib mesylate (Gleevec) tyrosine kinase
inhibitor – blocking BCR-ABL protein
preventing cells to divide.
Avoid antacid, grape juice and acetaminophen
Correction of chromosome abnormality
Interferon alfa and cytosine administered
subcutaneously daily.
Many patient cannot tolerate profound fatigue,
depression, anorexia, mucositis and inability to
concentrate.
Leukopheresis – blood of patient is removed
and seperated, leukocytes removed and
remaining blood returned. Causing temporary
decrease in WBC.
4. Chronic Lymphocytic Leukemia
Clinical Manifestation:
Enlargement of lymphnodes, painful
Splenomegally
“B” symptoms – constellation of symptoms
including fever, drenching sweating, and
unintentional weight loss.
Absent reaction to skin test (Anergy)
Treatment
Chemotherapy with corticosteroid and
chlorambucil (leukeran)
Fludarabine (fludara) frontline therapy – major
side effect is prolonged bone marrow supression
PATHOPHYSIOLOGIC BASIS OF MALIGNANT
NEOPLASIA
Predisposing factors/etiologic factors
Cellular aberrations
CA proliferation
• Disrupt normal cell
growth and interfere with Malignant cells produce
tissue fxn enzymes, hormones and
Pressure Anorexia and Cachexia
other substances
Obstruction syndrome
(Paraneoplastic syndrome)
Pain Tissue wasting
Anemia
Effusion Severe weght loss
Hypercalemia
ulceration Severe debilitation
Edema
Vascular thrombosis, DIC
embolus,
thrombophlebitis
Proliferation of Ca Cells
Pressure due to increase in size of neoplastic
growth
Obstruction – as tumor continues to grow, hollow
organs and vessels become compress and obstructed
Examples: esophagus, bronchi, ureters, bowel,
blood vessels lymphatic system
Pain due to: pressure on nerve endings, distension
of organs/vessels, lack of O2 to tissues and organs,
release of pain mediators by the tumor, Late sign of
Ca
Effusion - when lymphatic flow is obstructed,
there may be effusion of serous cavities Example:
effusion into the pleural cavity: pleural effusion;
effusion into abdominal cavity: ascites
Ulceration and necrosis – results as tumor erodes
blood vessels and pressure on tissue causes
ischemia -> tissue damage and bleeding ->
infection
Thrombosis, embolus, thrombophlebitis -
Vascular Tumors tend to produce abnormal
coagulation factors that cause increased clotting
(pulmonary emboli -> life threatening)
Paraneoplastic Syndrome
Anemia – Ca cells produce chemicals that interfere
with RBC production
Iron uptake is greater in the tumor than that
deposited in the liver
Blood loss may result from bleeding
Hyperkalemia - Tumors of the bone
Squamous cell lung Ca, Ca of the breast produce
a parathyroid – like hormone that increases or
accelerates bone breakdown and release of
calcium
Also results from metastasis to the bones
Enhanced by immobilization and dehydration
DIC (Disseminated Intravascular
Coagulation)
Characteristics of Ca
Metastasis:
1. Lymphatics
the most common mechanism
breast tumors, axillary, clavicular, and thoracic LN
2. Hematogenous
disseminated through the blood stream
related to the vascularity of the tumor
Angiogenesis – ability to induce the growth of new capillaries
from the host tissue to meet the nutrients and oxygen
A. Classification And Staging Tissue Of
Origin
a. Carcinoma Squamous cell Ca – surface
epithelium
c. Adenocarcinoma – glandular or parenchymal
d. Sarcoma – connective tissue
d. Leukemia, Lymphoma
B. Staging – determines the size of the tumor and the existence of metastasis
TNM Classification
T – extent of primary tumor
N – absence or presence and extent of regional lymph node
metastasis
M – absence or presence of distance metastasis
Regional lymph nodes (N)
NX – regional LN cannot be assessed
NO – no regional LN metastasis
N1,2,3 – increasing involvement of LN
Distant Metastasis
MX – Distance metastasis cannot be assessed
MO – No distant metastasis
M1 – distant metastasis
Grading
Classification of tumor cells
Grade I – IV, define the type of tissue which the
tumor originated
Normal T0, N0, M0
Stage I T1, N0, M0
Stage II T2, N1, M0
Stage III T3, N2, M0
Stage IVwith metastasis
Common Sites Of Metastasis
LN
Bone
Brain
Contralateral lung
Adrenal glands
liver
Potential Nursing Diagnosis
Isotopes
1. can be sealed, (Brachytherapy)in a
catheter needle; It can be inserted into
tumor cell or tissue
2. Unsealed – given per oral, Systemic -
parenteral, IV, IM, IS, given directly
Isotopes Radiation Unsealed
1. Alpha – Helium nuclear – long penetrating
power, it can passed through paper
2. Beta – Electrons – moderate penetrating power,
but they cannot penetrate wound
3. Gamma – Electromagnetic – they cannot
penitrate concrete, cement or hollow blocks
Patient Contraindicated to MRI