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CELLULAR ABERRATION

DISTURBANCE IN CELLULAR FUNCTIONING

Prepared by:

Ma – Roa Arroyo Serrano, RN, MAN


Lecturer
THE CELL
Aberrations Of Cell Disturbance
 Agenesis – absence of an organ, occurs during embryonic
development of organ Example: only one kidney is develop
 Aplasia – failure of an organ to grow during embryonic dev.
Example: scapula do not descend
 Dysplacia – abnormal tissue development
 Hyperplacia - an increase in the number of cells in the tissue
producing as an increase in the size of tissue organ Example:
increase in breast tissue during pregnancy
 Hypertrophy – individual cell enlarge and thus organs decrease
Example: Athletes muscle increase in size as a result of weight
lifting
 Neoplasma – abnormal cell or a mass of proliferating cells
growth of new tissue
CELL CYCLE
 Mitosis cycle -> division of the cell -> Goes into
production of organ or tissue
 GI – RN and the protein synthesis (building) begin
 The more the differentiated the cell, good
 Anaplastic cell – you can not see the resemblance, the
more the cell (Anaplastic the more malignant or
undifferentiated not good, malignant)
 Cell growth – cell loss
 Cell inhibitor – replace the cell
 Precursor - the triggering period, beginning/start
 Cancer –comes from the latin word cancre/crabs the
symbol of cancer
 Cachexia – tissue/muscle wasting
 Direct extension – seeding
 Diagnostic procedure
 Cytology – scraping tissues or cells on organs,
example: Papsmear, washing like urine, bronchial
washing
 Endoscopy – direct visualization of hollow organ
 Example: visualization of the stomach
(Gastroscopy) for occult blood, examines fetal
matter
 Nursing intervention: Enema before the
procedure, perineal wash
 Radiology – it can’t compare CA or malignancy,
it can only detect a mass
 Example: mammography – breast tissue
 Anteriography – radiopaque dye, examination of
the artery
 Scanning – can use dye or not
 Example: Gallbladder – intervention: NPO, no
fat diet; Head scanning - intervention: no
shampoo before the procedure, no hairpins
 Ultrasound – drink a lot of fluids before the
procedure
Differentiation Of The Cell

1. The more differentiated the cell the better


2. Anaplastic cell – can not be differentiated
anymore
3. Benign tumor – mild, not dangerous, grow
slowly, no ability to occur
4. Malignant tumor – dangerous rapid growth,
ability to occur
Mode of Growth

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

Characteristic of the cell


 BT – well differentiated
 MT – undifferentiated

Effect to the cell


 BT – can not cause compression of vessels cause injury
to other cell
 MT – injure other tissue, destruction of fxn of other cell
result in bleeding and ulceration
ASSESSMENT/ACS WARNING
SIGNS
1. C – change in bowel or bladder habits
2. A – sore that does not heal
3. U – unusual bleeding or discharge
4. T – thickening or lump
5. I – indigestion or difficulty in swallowing
6. O – obvious change in wart or mole
7. N – nagging cough or hoarseness of voice
8. U – unexplained anemia
9. S- sudden weight loss
SCREENING
 Early detection and treatment are the
cornerstones of cancer survival
 Educating the public about a healthy lifestyle and
early detection
 Health education
 Reduce and avoid exposure to known
carcinogens
 Eat a balanced diet of vegetables, fruits and
whole grains, reducing fat and red smoked and
cured meat.
 Limit alcohol beverages
 Exercise regularly
 Reduce stress and encourage adequate rest and
relaxation
 Follow screening recommendations
 Know the seven warning signs
 Seek medical attention
NURSING HISTORY TO
DETERMINE/ASSESSMENT

1. Previous hx of CA, method of treatment


2. Presence of Predisposing factor
3. Onset duration, and severity of Sx
4. Psychosocial Responses
 Degree of anxiety
 Feelings about cell with cancer
 Feelings of others perceive self
Later Signs

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

2. Regardless the cause, several cancers are associated


with familial patterns

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

 Maybe one of the multiple agents acting to initiate


carcinogenesis
 Prolonged or frequent viral infections may cause
breakdown of the immune system or overwhelm the
immune system. “Failure of the immune Response Theory”
 Herpes simplex Type II, cytomegalovirus and HPV type
16,18,31,33, Cervix Ca
Causative Factors cont…
E. Hormones
1. Estrogen
 Oral contraception or HRT, Inc.
incidence of hepatocellular, endometrial
and breast Ca
2.  Diethylstilbestrol (DES)
Causative Factors cont…
G. Foods, Preservatives
Nitrates (bacon, smoked meat)
 Talc (polished rice, salami, chewing gum)
 Foods sweeteners
 Nitrosomines (rubber baby nipples)
 Aflatoxins (nuts, grains, milk, cheese, peanut butter)
 Polycyclic hydrocarbons (charcoal broiling)

NOTE:Proactive diet: high fiber, Cruciferous vegetables


( cabbage, broccoli, cauliflower, brussels, sprouts)
Carotenoids (carrots, tomatoes, spinach, apricots, peaches,
dark green and yellow vegetables), vit E, C, zinc and
selenium
PREDISPOSING FACTORS
1. Age – older individuals are more prone to Cancer;
they have been exposed to carcinogens longer; they
have developed immune system alteration
2. Sex
 Women – more prone to breast cancer
 Men – more prone to prostate, lung cancer

3. Urban VS Rural residence – cancer is more


common among urban dwellers than rural residents
(because of greater exposure to carcinogens)
3. Geographic distribution
 E.g’s
 Cancer of the stomach in Japan, ca of the breast
in the US
 due to influence of environmental factors as
national diet, ethnic customs, type of pollution
4. Occupation
 E.g’s
 Chemical factory workers
 Farmers
 Radiology department personnel,
5. Hereditary – Greater risk with positive
family history
6. Stress
 Depression, grief, anger, aggression, despair
of life stresses decrease immunocompetence
(affect the hypothalamus and pituitary gland)
 Immunodeficiency may spur the growth of
CA proliferation
6. Precancerous lesions
 May undergo transformation into CA
lesions and tumors
 E. g’s – pigmented moles, burn scars,
senile Keratosis, leukoplakia benign
polyps/Adenoma of the colon or stomach,
fibrocystic disease of the breast
7. Obesity – studies have linked obesity to
breast CA and colorectal CA
Nomenclature of Neoplasia
Tumor is Named according to:
1. Parenchyma, Organ or Cell
 Hepatoma- liver
 Osteoma- bone
 Myoma- muscle
Nomenclature of Neoplasia
cont…
2. Pattern and Structure, either GROSS or
MICROSCOPIC
 Fluid-filled CYST
 Glandular ADENO
 Finger-like PAPILLO
 Stalk POLYP
Nomenclature of Neoplasia
cont…
3. Embryonic origin
 Ectoderm ( usually gives rise to epithelium)
 Endoderm (usually gives rise to glands)
 Mesoderm (usually gives rise to Connective
tissues)
BENIGN TUMORS
 Suffix- “OMA” is used
 Adipose tissue- LipOMA
 Bone- osteOMA
 Muscle- myOMA
 Blood vessels- angiOMA
 Fibrous tissue- fibrOMA
“PASAWAY”
1. “OMA” but Malignant
HepatOMA, lymphOMA, gliOMA, melanOMA
2. THREE germ layers “TERATOMA”
3. Non-neoplastic but “OMA”
 Choristoma
 Hematoma
CLASSIFICATION
A. CARCINOMA (Malignant) Tumor – Named
according to embryonic cell origin
 Ectodermal, Endodermal, Glandular, Epithelia,
Attach in the skin
 Use the suffix- “CARCINOMA”
 Pancreatic AdenoCarcinoma
 Squamos cell Carcinoma
 
B. SARCOMA (Malignant)
Named according to embryonic cell origin
 attach to the organ or tissue Mesodermal,
connective tissue origin

 E.g’s – bone connective tissue


 Use the suffix “SARCOMA”
 Fibrosarcoma
 Myosarcoma
 Angiosarcoma
 Osteosarcoma
C. Lymphoma (Malignant) Tissue
 Neoplasms of cells of lymphoid origin
 Usually starts in lymph nodes

Hodgkin’s Lymphoma (Example)


 Rare malignancy that has impressive
cure rate.
 Common in men than women peaks at
early 20’s and after 50 years
 Malignant is Reed-Sternberg cells
(hallmark of the disease)
Clinical Manifestation:
 Painless enlargement of one or more
lymphnodes on one side of the neck. (cervical,
supraclavicular and mediatinal)
 Mediatinal mass on chest x-ray
 Pain after drinking alcohol
 “B” symptoms
Diagnosis:
 Excisional lymphnode biopsy finding Reed-
Sternberg cells
 Elevated ESR and serum copper level assess
disease activity.
Treatment:
 The intent in treating is cure regardless of the
stage of the tumor.
 Shortcourse chemotherapy followed by
radiation therapy
 ABVD standard of treatment, Adriamycin,
Bleomycin, Vinblastine, Decarbazine
Non Hodgkin’s Lymphoma:
 Involved malignant B lymphocytes
 Incidence increases with age at diagnosis of 50 to 60
years old.
 Common in immunodeficiencies or autoimmune
disorders

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

 Common malignancy in older adults >60 years old.


 Average survival time ranges from 14 years to 2.5
years
 Most of cells are fully mature

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

Primary Tumor (T)


 TX – primary tumor cannot be assessed
 TO – no evidence of primary tumor
 Tis – carcinoma in situ
 T1,2,3,4 – increasing size or local extent of primary tumor

 
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

 Skin integrity, impaired protection, altered


PLAN / IMPLEMENTATION
1. SURGERY – Is called prophylactic (pre –
cancerous), palliative procedure to relieve from
pain,
2. Diagnostic surgery - biopsy
 Example: Ca of sigmoid area or rectum
(Colostomy);
 Oophorectomy – removal of the ovaries to
decrease the production of estrogen and
progesterone indication for Ca of the breast
CHEMOTERAPHY
 To destroy cancer cells by the use of drugs
 Drugs and hormonal preparations

1. Hormone and steroid compounds – to cause


imbalance, counter act the effect of estrogen and
progesterone (Ca hormones) Example:
Androgens male hormones
2. Alkylating agents damage the DNA within the
cell nucleus, the cell cannot grow multiply
 Example: Busulfan(Myleran)
 Chlorambucil (Leukeran)
 Cycloplosephamide (Cytoxan)
Chemo cont…
3. Antimetabolites – interrupt the manufacture of
metabolites that are needed for the normal functions of
cell
 Example: Methotrexate (Amothopterin)
 5 Flourouracil (5 Fu)
 6 Mercapthopurine (6 MP)

4. Plant Alkaloids – inhibit mitotic/mitotic


inhibitor
 Example: Vinvastin (Velban)
 Vincristin (Oncovin)
Antineoplastin/Antibiotic – interfere with NA and RNA
synthesis
Route Of Administration
1. Topical
2. Intrathecal – spinal columns
3. IV line
4. Intracavitary – inside the cavity
5. Oral
6. Intraperitoneal
7. CVP
8. IM
Nursing Responsibilities
1. Quiet relax environment
2. Monitor the patient closely
3. Check the reaction for redness, irritation, watch
for signs of shock, difficulty of breathing, KVO,
stop the drugs asap, infused NSS
Radiation Therapy
1. High energy ionizing rate that is applied to the Ca area
2. Destroy the Ca cell, adjunct to other therapy, Palliation
Sources of Radiation:
3. External Radiation/External Beam or Teletherapy (no
radioactive effect) administered to an X – ray machine
Cobalt 60
Cesium 137
2. Internal Radiation: Implanted inside the tissue
organ/body tissue
Types

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

 Patient with peacemaker


 Patient with claustrophobia
 Patient with heart problems can lead to heart
attack
Nursing Intervention
1. Placing patient in a separate room
2. Warning Radiotherapy Sign
3. Chart note: “With Radiotherapy”
4. Limit contact with patient/exposure with patient
5. Use the intercom to communicate with the
patient
6. Nurse should stay far from the body with
isotopes
Nursing Intervention cont…
1. Wear a shield or apron, can be the patient or
nurse
2. Limit the time of the visitor, not allowing
children and pregnant women
9. Check linens or bedpans
10. Get tong or forceps to pick – up things inside the
room (never pick –up things with bare hands
Immunotherapy

 Immune mechanism of the patient


Example: giving immunizations like BCG, this
stimulates the T – Cell body to produce immune
bodies – comes from the Lymphocytes TE
Biologic Response Modifiers
1. Agents that restore, strengthens or modify the
immune system
 Example: Interferon

2. Direct Antitumor Activities


 Example: Monoclonal antibodies

3. Agents that has other biologic effect like


interfering with cell activity to metastasize or
survive
 Example: Interleukon, Lymphokin
4. Bone Marrow Transplantation – used for
Leukemia patients
 Vitamins:
 A – enhance cell differentiation, prevent
chemical carcinogens (external agents that
transformed normal cells to normal tissue)
 C and E – serves as scavengers, to prevent
carcinogens to act into the body
 C – Stimulates lymphogenesis
 B Complex – energy transformation
General Nursing Care
 Provide Good Skin Care – free from pruritus, Urticaria, and
systemic signs
 Provide good oral care – free from stomatitis, avoid hot and
spicy foods
 Hair care – Alopecia reassure that it is temporary, encourage
to wear wigs, hats or head scarf
 Nutritional changes – administer antiemetic to relieve N&V,
diarrhea, constipation, replace/increase fluid intake ,Fibers
diet to relieve constipation, diarrheaS
 Pain relief
 Activity level
 Psychosocial issues
Psychosocial Issue

 Feelings that the body failed him


 Fears of self- disintegration and dependency
 Feeling the cancer has controlled
 Self – rejection and helplessness
 Feelings that others are uncomfortable with him
Thank You!

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