cellular aberration lecture notes presentation 4

cellular aberration lecture notes presentation 4

1. Obvious change in a wart or mole Moles or other skin lesions that change in shape, size, or color should be reported Warning Signs of Cancer

2. Nagging or persistent cough or hoarseness Cancers of the respiratory tract, including lung cancer and laryngeal cancer, may cause a cough that does not go away or a hoarse (rough) voice Warning Signs of Cancer

3. Warning Signs of Cancer Unexplained anemia Sudden unexplained weight loss

4. Physical Assessment Inspection – skin and mucus membranes for lesions, bleeding, petechiae, and irritation Assess stools, urine, sputum, vomitus for acute or occult bleeding Scalp noting hair texture and hair loss Palpation Abdomen for any masses, bulges or abnormalities Lymph nodes for enlargement Auscultation – of lung sounds, heart sounds and bowel sounds Back

5. Laboratory & Diagnostic Tests Cancer detection examination Laboratory tests Complete blood cell count (CBC) Tumor markers – identify substance (specific proteins) in the blood that are made by the tumor PSA (Prostatic-specific antigen): prostate cancer CEA (Carcinoembryonic antigen): colon cancer Alkaline Phosphatase: bone metastasis Biopsy

6. Diagnostic Tests Determine location of cancer: X-rays Computed tomography Ultrasounds Magnetic resonance imaging Nuclear imaging Angiography

7. Diagnosis of cell type: ▪Tissue samples: from biopsies, shedded cells (e.g. Papanicolaou (PAP) smear), & washings ▪ Cytologic Examination: tissue examined under microscope

8. Direct Visualization: ▪ Sigmoidoscopy ▪ Cystoscopy ▪ Endoscopy ▪ Bronchoscopy ▪ Exploratory surgery; lymph node biopsies to determine metastases

9. Cancer Detection and Diagnosis

10. Early Cancer May Not Have Any Symptoms

11. Effects of Cancer Disruption of Function- can be due to obstruction or pressure Hematologic Alterations: can impair function of blood cells Hemorrhage: tumor erosion, bleeding, severe anemia Anorexia-Cachexia Syndrome: wasted appearance of client

12. Effects of Cancer Paraneoplastic Syndromes: ectopic sites with excess hormone production ↑ Parathyroid hormone→ hypercalcemia ↑ secretion of insulin→ hypoglycemia ↑ Antidiuretic hormone (ADH) → fluid retention, HTN & peripheral edema ↑ Adrenocorticotropic hormone (ACTH): cause excessive secretion of cortisone (ie: fluid retention, ↑ glucose levels)

13. Effects of Cancer Pain: major concern of clients and families associated with cancer Physical Stress: body tries to respond and destroy neoplasm Psychological Stress Back

14. ASSESSMENT Nursing History Health History – chief complaint and history of present illness (onset, course, duration, location, precipitating and alleviating factors) Cancer signs: CAUTION US!

15. CAUTION US! Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickenings or lumps Indigestion or difficulty in swallowing Obvious change in a wart or mole Nagging or persistent cough or hoarseness Unexplained anemia Sudden unexplained weight loss Warning Signs of Cancer

16. Change in bowel or bladder habits A person with colon cancer may have diarrhea or constipation, or he may notice that the stool has become smaller in diameter A person with bladder or kidney cancer may have urinary frequency and urgency Warning Signs of Cancer

17. A sore that does not heal Small, scaly patches on the skin that bleed or do not heal may be a sign of skin cancer A sore in the mouth that does not heal can indicate oral cancer Warning Signs of Cancer

18. Unusual bleeding or discharge Blood in the stool is often the first sign of colon cancer Similarly, blood in the urine is usually the first sign of bladder or kidney cancer Postmenopausal bleeding (bleeding after menopause) may be a sign of uterine cancer Warning Signs of Cancer

19. Thickenings or lumps Enlargement of the lymph nodes or glands (such as the thyroid gland) can be an early sign of cancer Breast and testicular cancers may also present as a lump Warning Signs of Cancer

20. Indigestion or difficulty in swallowing Cancers of the digestive system, including those of the esophagus, stomach, and pancreas, may cause indigestion, heartburn, or difficulty swallowing Warning Signs of Cancer

21. AIDS and Kaposi’s Sarcoma Kaposi’s sarcoma Without disease Depressed immune system HIV infection KSHV infection

22. Heredity and Cancer Inherited factor(s) All Breast Cancer Patients Other factor(s)

23. Heredity Can Affect Many Types of Cancer Inherited Conditions That Increase Risk for Cancer Back

24. PATHOPHYSIOLOGY ABNORMAL CELL FORMED BY MUTATION OF DNA CELL GROWS AND PROLIFERATES METASTASIS OCCURS WHEN ABN. CELLS INVADE OTHER TISSUE,THROUGH LYMPH AND BLOOD Cancer development linked to immune system failure Example of clients susceptible to developing cancer

25. Classification of Cancer According to Behavior of Tumor Benign - tumors that cannot spread by invasion or metastasis; hence, they only grow locally Malignant - tumors that are capable of spreading by invasion and metastasis. By definition, the term “ cancer ” applies only to malignant tumors

26. Malignant versus Benign Tumors Malignant (cancer) cells invade neighboring tissues, enter blood vessels, and metastasize to different sites Time Benign (not cancer) tumor cells grow only locally and cannot spread by invasion or metastasis

27. Why Cancer Is Potentially Dangerous Melanoma cells travel through bloodstream Melanoma (initial tumor) Brain Liver

28. Patterns of cell Proliferation Hyperplasia Dysplasia Metaplasia Anaplasia Neoplasia

29. Hyperplasia Hyperplasia Normal tissue growth based on an excessive rate of cell division, leading to a larger than usual number of cells; the process of hyperplasia is potentially reversible; can be a normal tissue response to an irritating stimulus. An example is a callus

30. Dysplasia Hyperplasia Mild dysplasia Normal Bizarre cell growth differing in size, shape and cell arrangement

31. Carcinoma in Situ Mild dysplasia Carcinoma in situ (severe dysplasia) Cancer (invasive) Normal Hyperplasia

32. Patterns of cell Proliferation Metaplasia conversion of one type of cell in a tissue to another type not normal for that tissue Anaplasia change in the DNA cell structure and orientation to one another, characterized by loss of differentiation and a return to a more primitive form. Neoplasia uncontrolled cell growth, either benign or malignant

33. Metastasis Metastasis: 3 stages Invasion – neoplastic cells from primary tumor invade into surrounding tissue with penetration of blood or lymph. Spread – tumor cells spread through lymph or circulation or by direct expansion Establishment and growth – tumor cells are established and grow in secondary site: lymph nodes or in organs from venous circulation

34. Cancer Tends to Involve Multiple Mutations Malignant cells invade neighboring tissues, enter blood vessels, and metastasize to different sites More mutations, more genetic instability, metastatic disease Proto-oncogenes mutate to oncogenes Mutations inactivate DNA repair genes Cells proliferate Mutation inactivates suppressor gene Benign tumor cells grow only locally and cannot spread by invasion or metastasis Time

35. Mutations and Cancer Genes Implicated in Cancer

36. Cancer Tends to Corrupt Surrounding Environment Growth factors = proliferation Blood vessel Proteases Cytokines Matrix Fibroblasts, adipocytes Invasive Cytokines, proteases = migration & invasion Back

37. Classification of Tumors CARCINOMAS: EPITHELIAL TISSUE BODY SURFACES, LINING OF BODY CAVITIES ETC: (ADENOCARCINOMA) SARCOMAS: CONNECTIVE TISSUE STRIATED MUSCLE, BONE, ETC (OSTEOSARCOMA) LYMPHOMAS AND LEUKEMIAS HEMATOPOIETIC SYSTEM NERVOUS TISSUE TUMORS EX. NERVE CELLS-NEUROBLASTOMA MYELOMA Develops in the plasma cells of bone marrow

38. Different Kinds of Cancer Lung Breast (women) Colon Bladder Prostate (men) Some common sarcomas: Fat Bone Muscle Lymphomas: Lymph nodes Leukemias: Bloodstream Some common carcinomas:

39. Naming Cancers Prefix Meaning adeno- gland chondro- cartilage erythro- red blood cell hemangio- blood vessels hepato- liver lipo- fat lympho- lymphocyte melano- pigment cell myelo- bone marrow myo- muscle osteo- bone Cancer Prefixes Point to Location

40. “ Women who smoke like men, die like men.” U.S. Surgeon General David Satcher Women, Tobacco & Lung Cancer Back

41. UNDERSTANDING CANCER

42. Essential Concepts of Cancer What is Cancer? Normal Cell Growth vs. Cancer Cell Growth Etiology and Causative Factors Pathophysiology Classification of Tumors Effects of Cancer

43. Nursing Process Assessment Laboratory & Diagnostic Tests Tumor Staging and Grading Nursing Diagnoses & Planning Implementation and Management Treatment Modalities Chemotherapy End-of-life Issues

44. What Is Cancer? CANCER is a complex of diseases which occurs when normal cells mutate into abnormal cells that take over normal tissue, eventually harming and destroying the host

45. WHAT IS CANCER A large group of diseases characterized by: Uncontrolled growth and spread of abnormal cells Proliferation (rapid reproduction by cell division) Metastasis (spread or transfer of cancer cells from one organ or part to another not directly connected) Back

46. Loss of Normal Growth Control Cancer cell division Fourth or later mutation Third mutation Second mutation First mutation Uncontrolled growth Cell Suicide or Apoptosis Cell damage— no repair Normal cell division

47. Oncogenes Mutated/damaged oncogene Oncogenes accelerate cell growth and division Cancer cell Normal cell Normal genes regulate cell growth

48. Example of Normal Growth Cell migration Dermis Dividing cells in basal layer Dead cells shed from outer surface Epidermis

49. The Beginning of Cancerous Growth Underlying tissue

50. Tumors (Neoplasms) Underlying tissue

51. Invasion and Metastasis 3 Cancer cells reinvade and grow at new location 1 Cancer cells invade surrounding tissues and blood vessels 2 Cancer cells are transported by the circulatory system to distant sites Back

52. Viruses Chemical carcinogens Physical stressors Hormonal factors Genetic factors ETIOLOGY/CAUSATIVE FACTORS

53. What Causes Cancer? Some viruses or bacteria Heredity Diet Hormones Radiation Some chemicals

54. Population-Based Studies CANADA: Leukemia Regions of Highest Incidence BRAZIL: Cervical cancer U.S.: Colon cancer AUSTRALIA: Skin cancer CHINA: Liver cancer U.K.: Lung cancer JAPAN: Stomach cancer

55. Genes and Cancer Chromosomes are DNA molecules Heredity Radiation Chemicals Viruses

56. Viruses Virus inserts and changes genes for cell growth Cancer-linked virus

57. Examples of Human Cancer Viruses Some Viruses Associated with Human Cancers

58. Bacteria and Stomach Cancer H. pylori Patient’s tissue sample

59. Tobacco Use and Cancer Some Cancer-Causing Chemicals in Tobacco Smoke

60. High-Strength Radiation Most High Low Least Leukemia Incidence X-ray Dose (atomic radiation)