Transcript Oncology - Lectures

Chapter 5
Pathology
 Branch
of medicine that deals with the
study, detection, treatment and
management of cancer
 Biology
of abnormal cancer cells
 They have continuous or inappropriate,
usually faster growth or larger growth
patterns
 They have no specific morphology and often
do not resemble their parent cells =
anaplastic
 They do not respond to signals for apoptosis
= programmed cell death
 Biology
of abnormal cancer cells
 Have a large nuclear – cytoplasmic ratio; the
nucleus may occupy most of the cell area
 They lose some or all of their normal cell
functions
 They do not make fibronectin, and thus
cannot connect easily and break off easily
 Biology
of abnormal cancer cells
 They are able to migrate throughout the
body = metastasis
 They invade other tissues and types of cells.
 They are not controlled by contact
 They have more or less chromosomes than
the parent cells = aneuploid
or a mutation of the genes
 Cancer
development
 Initiation – there are many theories as
to when the genes in the cells are
damaged, maybe in utero, from
physical or chemical exposure, latent
oncogenes, viruses, or a lack of
suppressor genes from our parents,
and at this point the cell is not
dividing.
 Cancer
development
 Promotion - the stage when the abnormal
cell starts to divide, may be stimulated by
environmental changes, hormones, drugs, or
irritants
 Cancer
development
 Progression – the phase when the
abnormal cells have continued to grow
into a Primary tumor, may produce
angiogenesis factors which supply
blood and vascular nourishment to the
tumor. The tumor may have
subcolonies of cells with different
genes and features
 Cancer
development
 Metastasis
the movement of cancer cells into
other organs of the body, thus creating
new tumor sites.
 Cancer grading and staging
 Cancer is graded upon the resemblance
normal cells = G
to
(The higher the number, the worse the grade of cancer)
i.e. G1, G2, G3, G4
 Staging is based upon
 the presence of a primary tumor =
 involvement in lymph nodes = N
 and appearance of metastasis = M
 Numbers of the stage range from
x = none to 3 or 4 for each letter
T
 Cancer
risks
 High alcohol consumption
 Low dietary vegetables and fiber
(sources of antioxidants)
 Previous Viral infections:
Hepatitis B or C
Herpes viruses
Papilloma viruses (HPV)
Retrovirus HTLV –I
 Symptoms
of Cancer
 Cachexia – weight loss,unexplained
 Anorexia
 Anemia
 Impaired immune response
 Pain – when the cancer is large enough to
compress nerves or organs
 Lymphadema – when the tumor blocks
lymph or circulatory flow
 Motor or sensory deficits
 Cancer
statistics
 The top four cancers found in the
United States are:
 Lung
 Breast
 Prostate
C
 Colorectal
 Cancer
statistics
 Prostate cancer is the most common
site of cancer and the 2nd most
common cause of cancer death in the
United States
 The first cause of death in males is
Lung Cancer
Cancer
 Lung
statistics
cancer has annual
new cases (incidence)
of 173,770 people
per year: 93,110 males and
80,660 females
 Annual mortality: 160,440 per year
consisting of 92,000 males and
68,510 females
Cancer
 28%
statistics
of all cancer deaths are due to lung
cancer
 This
is the leading cause of cancer death
in both men and women
 There
are more deaths from lung cancer
than prostate, breast, and colorectal
cancers combined
 Cancer
statistics
 Risks for lung cancer:
 Smoking (75-80% of cases)
 Occupational exposure
 Nutrition/Diet
 Genetic factors
 Cancer
statistics
 Prostate
cancer is number two cause of
cancer in men
 Breast
Cancer is number two cause of
cancer in women
 Most
common non-malignant or non-fatal
cancer is non-melanoma type skin cancers
 Chemotherapy
 Prevention
chemotherapy – for high
risk patients, precancerous lesions, or
history of cancer
 Antioxidants, vitamins
 Aldara cream 3x weekly for
precancerous skin lesions
 Aspirin
 Protease inhibitors
 Chemotherapy
- typically started after
surgical dissection of tumor, unless the
tumor is non-operative
 Usually given by a long term venous access
device, i.e. PICC line, implanted ports, or
direct catheratization to the tumor.
 Chemotherapy is usually potent and
horribly scarring on normal veins
 Side effects of Chemotherapy
 Fatigue
 Anemia
 Leukopenia
 Thrombocytopenia
 Always – Nausea,Vomiting, Diarrhea
 Neurotoxicity & neuropathies
 Capillary leakage
 Headaches
 Fluid and electrolyte imbalances
 Side effects of Chemotherapy
 Anorexia – change in taste buds
 Back aches
 Joint aches
 Blood clots
 Oral mucositis – (reduced significantly
glutamine amino acids orally)
 Supra opportunistic infections
 Septic DIC
 Tumor lysis syndrome
 Edema or pulmonary edema
by L-
 Pharmacological interventions
 Megace, Marinol – for appetite stimulation
 Premedications for nausea, vomiting,
edema, headaches: usually on the protocol
for chemo
Antiemetics;
Zofran – 24 hour control
Tigan, Kytril, ativan, anzamet, Compazine,
benadryl, reglan
Corticosteroids
 Pharmacological interventions
 Analgesics
 IV electrolytes and fluid replacement
 Stool softeners to counteract constipation
from opioids
 GSF for WBC’s
 Epogen/Procrit for anemia
 Leukine/Prokine for leukopenia
 Neupogen for neutrophilia
 Neumega for thrombocytopenia
 Diuretics for edema
 Non-Pharmacological
• Massage
• Reflexology
• Accupuncture
• Musical therapy
• Prayer
• Meditation
• Diversional acitivities
• Dietary counselling
interventions
 Radiation
therapy
 All types of cells are injured or
destroyed by concentrated radiation.
Rapidly dividing cells are the most
sensitive.
 Radiation
 Types
therapy
:
Gamma knife
Local beam treatment
Local seeding
ARC – stereotactic
Radioimmunotherapy
Fractionation
Total body irradiation
Particle beam therapy, i.e.
proton or neutron therapy
 Radiation
therapy side effects
 Side effects depend on the amount and
area being irradiated
 Fatigue
 Nausea
and vomiting
 Mild anemia
 Leukopenia
 Diarrhea
 Pain
 Radiation
therapy side effects:
 Erythema/burns
 Fatigue
 Pneumonitis
 Esophagitis
 Dysphasia
 Malignant Lymphomas – 2 types
 Hodgkin's Lymphoma – most common
cancer in 10 to 20 year olds (young adults).
Associated with an inflammatory process
related to +EBV/mono infection.
 Diagnosis: Classic Reed-Steinberg cell with
two mirrored nuclei, CT scan
 Symptoms: Extreme fatigue, enlarged lymph
nodes that are painless. May progress to
weight loss fevers, night sweats
 Leukemia–
hematopoeitic cancer of
the stem cells. These stem cells
proliferate into non-functional
immature white cells.
 More children get leukemia than any
other type of cancer and it is the #1
cause of death in children.
 Anyone can get leukemia at any age.