CANCER

Oncology Nurse
provide care and support for patients who have been
diagnosed with cancer
required to administer chemotherapy and to
otherwise help manage symptoms related to their
patients' illnesses
coordinate care with other health care providers,
including oncologists, and share their expertise with
colleagues and patient
Cellular Aberration
the act of deviating from the ordinary,
usual, or normal type of cell where it
can alter or destruct in the normal
growth of cell or tissue
Cancer
Is a complex of diseases which
occur when the normal cells
mutate into abnormal cells that
take over normal tissue,
eventually harming and
destroying the host
 National Cancer Institute
 Cancer
A large group of disease characterize by:
 Uncontrolled growth and spread of abnormal cells

 Proliferation

 Metastasis
Altered cellular mechanism with progressive and
uncontrolled multiplication of cells with selective ability to
invade, metastasize and cause mechanical effects of
pressure, obstruction and interruption of blood supply
Cancer
Cancer Statistics
All Sites of Cancer
Estimated new Cancer 1,479,350
 Male - 766,130
 Female - 713,220

Estimated Deaths 562,340

 Male - 292,540
 Female - 269,800
2009 Estimated US Cancer the act of deviating from the
ordinary, usual, or normal typeDeaths*

Men Women
 Lung & bronchus 30%
292,540 269,800 26% Lung & bronchus
 Prostate 9% 15% Breast
 Colon & rectum 9%
9% Colon & rectum
 Pancreas 6%
6% Pancreas
 Leukemia 4%
5% Ovary
 Liver & intrahepatic 4%
bile duct
4% Non-Hodgkin
lymphoma
 Esophagus 4%
3% Leukemia
 Urinary bladder 3%
3% Uterine corpus
 Non-Hodgkin 3%
2% Liver & intrahepatic
lymphoma bile duct
 Kidney & renal pelvis 3% 2% Brain/ONS
 All other sites 25% 25% All other sites

 ©2009, American Cancer Society, Inc.

 Mortality, 2006
 Rank cause of Death
 1. Heart Diseases 631,636 26.0


 2. Cancer 559,888 23.1

 3. Cerebrovascular diseases 137,119 5.7

 4. Chronic lower respiratory diseases 124,583 5.1


 5. Accidents (unintentional injuries) 121,599 5.0



 6. Diabetes mellitus 72,449 3.0



 7. Alzheimer disease 72,432 3.0



 8. Influenza & pneumonia 56,326 2.3



9. Nephritis* 45,344 1.9

 10. Septicemia 34,234 1. 4
 ©2009, American Cancer Society, Inc.

Incident
Etiology/ Causative Factor
Extrinsic Factor Intrinsic Factor
Viruses and bacteria
Hormonal Factor
Chemical Carcinogens
Genetic Factor
Radiation Carcinogens
Physical Stressor
Iatrogenic Chemical
Dietary Factors
agents
Viruses and Bacteria
second most important risk factor for cancer
development in humans
A. Viruses and Bacteria
Viruses and Bacteria
 Viruses and Bacteria

HIV causes an immune

deficiency that makes people
more susceptible to viral infection
 Viruses and Bacteria

Helicobacter pylori, which can

cause stomach ulcers, has been
associated with the development of
can
 B. Chemical carcinogens
Chemical carcinogens such as asbestos, nitrosamine and
polycyclic hydrocarbons

Alter cell behavior, function DNA mutation (mutagens)

and replication and cancer(carcinogens)
 carcinogens

Cigarette smoke contains more

than two dozen different chemicals
capable of causing cancer
B. Chemical carcinogens
C. Iatrogenic chemical agents
Chemotherapy drugs

Immunosuppressive agents

The breakdown of immune surveillance as a

possible etiology of cancer
 D. Radiation Carcinogens

Prolonged or repeated exposure to certain

types of radiation can cause cancer
D. Radiation Carcinogens
E. Hereditary Factors
E. Hereditary Factors
F. Dietary Factors
 Obesity

 High fat diet

 Diets low in fiber

 Diets high in smoked or salted foods

 Preservatives and Food additives

 Alcohol
H. AGE
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 udden loss of weight
Oncogenesis
Chemicals and radiation

viruses hereditary

Alter/damaging genes

passes on alterations in
genes

introduce their own

genes into cells
Genes are altered, or
"mutated," in various ways

CANCER
Stages Of Cancer
What is Staging?
Staging describes the extent or severity of an
individual’s cancer
It is base on the extent of the original (primary)
tumor and the extent of spread in the body.
Staging is important:
Staging helps the doctor plan a person’s treatment.
The stage can be used to estimate the person’s prognosis
(likely outcome or course of the disease).
Knowing the stage is important in identifying clinical
trials (research studies) that may be suitable for a
particular patient.
Elements of Staging Systems
Location of the primary tumor
Tumor size and number of tumors,
Lymph node involvement
Cell type and tumor grade
Presence or absence of metastasis
 TNM System:
The TNM system is based on :
the extent of the tumor (T)
the extent of spread to the lymph nodes (N)
the presence of metastasis (M).

A number is added to each letter to indicate the size or

extent of the tumor and the extent of spread.
Primary Tumor (T)
TX - Primary tumor cannot be evaluated
T0 – No evidence of primary tumor
Tis - Carcinoma in situ (early cancer that has not
spread to neighboring tissue)
T1, T2, T3, T4 - Size and/or extent of the primary
tumor
Regional Lymph nodes
NX - Regional lymph nodes cannot be evaluated
N0 - No regional lymph node involvement (no cancer
found in the lymph nodes)
N1, N2, N3 - Involvement of regional lymph nodes
(number and/or extent of spread)
Distant Metastasis (M)
MX - Distant metastasis cannot be evaluated
M0 - No distant metastasis (cancer has not spread to
other parts of the body)
M1 - Distant metastasis (cancer has spread to distant
parts of the body)
Examples:
breast cancer T3 N2 M0
It refers to a large tumor that has spread outside the
breast to nearby lymph nodes, but not to other parts of
the body.
Prostate cancer T2 N0 M0
It means that the tumor is located only in the prostate
and has not spread to the lymph nodes or any other part
of the body.
Stage I ( T1, N0, MO)- Early Stage
Stage II (T2, N1, M0) – local Spread
Stage III ( T3, N2, M0)- extensive spread but no
metastasis.
Stage IV (T4, N3, M+) Advanced stage, with distant
metastasis
5 Main Categories of Cancer
In situ is early cancer that is present only in the layer of
cells in which it began.
Localized is cancer that is limited to the organ in which
it began, without evidence of spread.
Regional is cancer that has spread beyond the
original (primary) site to nearby lymph nodes or
organs and tissues.

Distant is cancer that has spread from the primary

site to distant organs or distant lymph nodes.

Unknown is used to describe cases for which there

is not enough information to indicate a stage.
Cancer detection and
testing
Why Cancer Detection and Testing Important?

Detecting cancers early is an important step in

preventing significant health problems.
Four Possible Outcomes.

True Positive
False Positive
True Negative
False Negative
When a test is performed to detect a
disease, there are four possible outcomes:

True positive - test indicates that a

patient has a disease that the patient does
indeed have

False positive - test indicates that a

patient has a disease when they do not
True negative - test indicates the
patient is disease-free, and this is indeed
the case

False negative - test indicates the patient

is healthy when in fact the patient has the
disease
General Detection and
Diagnostic Techniques
Non - Invasive Invasive Techniques Analysis of Biopsy

Complete Blood Count Fine Needle Aspiration Immunohistochemistry

(CBC) Core Needle Biopsy (IHC)
Ultrasound Fluorescent In Situ
MRI Hybridization (FISH)
PET Scan
CT Scan
CBC
It provides information about the number, parts,
shape, and structure of the different cell types found
in blood.
3 main types of blood cells:
WBC
RBC
Platelets
MRI
Used to evaluate suspected malignancies of the CNS
because of it’s ability to perform multi-planar images and
ease of instillation of contrast media.
MRI
When contrast agent is not used an
MRI can show:
• contrast agent is not used an MRI can
show:
•The shape, size, appearance, and
location of organs, bones, and joints
•The presence of abnormal growths
•Signs of inflammation or infection
When contrast agent is used MRI
can show:
•size and location of benign or
malignant growths
•enlarged lymph nodes
•changes in blood flow
extracellular volume
Positron Emission Tomography (PET)
Uses nuclear medicine with the precise localization to
penetrate body’s metabolism to measure blood
volume/flow and protein metabolism.
In oncology, it detect the metabolic changes precede
anatomic changes.
PET scans use radioactively labeled tracers
(radiotracers) that are injected into the bloodstream
PET Scanning is able to:
Differentiate scar or radiation necrosis from active
tumor.
Determine if a mass lesion is malignant or benign.
Characterize enlarged lymph nodes as malignant or
benign.
Evaluate early tumor treatment response.
Computed Tomography
It uses x-rays in the same way as a conventional x-ray
but instead of taking one image a CT scanner takes
multiple images, or slices.
It can provide a 3 dimensional image of an internal
structure, it can detect differences in tissue density.

Ultrasound uses reflection of sound waves to

create an image of a part of the body
Biopsy Techniques
Fine Needle Aspiration
Core Needle Biopsy
Biopsy
Is the removal of cells, tissue, or fluid for examination.
Types of Biopsy
Excisional biopsy- removes all suspicious tissue.
Incisional biopsy- removes a sample of tissue from a
mass.
Needle Aspiration- aspiration of small amount of core
tissue from a suspicious area.
Invasive Techniques
Fine needle aspiration (FNA) uses a small needle to
collect small samples of a lesion.

Core needle biopsy uses a larger needle to collect

samples of a lesion
 Fine Needle Aspiration Core Needle Biopsy
Removes a small portion in most
Sample Removed Removes only a very small portion of the lesion cases, occasionally removes the
entire lesion
Needle Size 22-27 gauge 11-18 gauge
Pathology Type Cytopathology Histopathology
Interpretation Time Immediately Delayed
Strong ability to specifically
Limited ability to specifically diagnose benign
diagnose benign lesions.
lesions
Diagnostic Abilities Some ability to differentiate
No ability to differentiate between in situ and
between in situ and invasive breast
invasive breast cancer
cancer.
More invasive, time consuming,
Disadvantages Cannot be used for additional study
expensive
Can be used for additional study
Inexpensive, quick, readily available, and very
Advantages and has more specific diagnostic
safe
abilities than FNA
Examination of Tissue Samples

Immunohistochemistry (IHC)

Fluorescence in Situ Hybridization (FISH)

Immunohistochemistry (IHC)

Is a technique used to determine the presence and

level of specific cellular proteins.

An example: Three proteins of particular interest in

breast cancer are HER2, the estrogen receptor (ER)
and the progesterone receptor (PR).
 Fluorescence in Situ
Hybridization (FISH)
Is a cytogenetic technique used to detect and localize
the presence or absence of specific DNA sequences on
chromosomes.

FISH uses fluorescent probes that bind to only those

parts of the chromosome with which they show a high
degree of sequence similarity.
Cancer Specific Techniques

Mammography uses low dose x-ray to create an image

of a breast.
Sigmoidoscopy uses a small tube containing viewing
equipment to view the colon.
Virtual Colonoscopy uses an MRI or CT scan to create
an image of the inside of the colon.
Pap smears use a sample of cells from the cervix to
detect cervical cancer. Pap smears may also detect
ovarian and uterine cancers that have migrated to the
cervix.

Prostate specific antigen (PSA) test measures levels of

a glycoprotein in the blood. Elevated levels of PSA are
associated with prostate cancer
Sentinel Lymph Node Biopsy (SLN)
is used to detect metastasis.