The Normal Cell

Cellular Characteristics Reproduces Reacts to stimuli Moves either by amoeboid motion of by means of cilia or flagella Cellular Activities Synthesis of protein molecules Production of energy for cellular work Maintenance of homeostatic environment within the cell Ingestion and assimilation by the cell of materials from outside (phagocytosis, pinocytosis, active & passive transport) Reproduction Skin - fast Cardiac & skeletal, striated muscle cells & neurons do not Differentiation Cancer cell dedifferentiate loses special structural and functional ability Aging Cell Shrinks in size Protein synthesis slower Golgi complexes begins to break apart Immune cells in number but in function Nice to know: Age: epithelial cells 1 days RBC 120 days Nerve cells 100 years Types of Cellular Aberrations

1. Genetic disturbances 2. Degenerations & infiltrations 3. Disorders in cell growth malignant growth, atrophy & hypertrophy Cancer Facts Cancer is the #3 killer of Filipinos today. 103 die from it everyday. Cancer is on the rise and is projected to be the #1 killer of Filipinos in the next 5 years. The survival rate for adult Filipinos is just 50% compared to at least 70% in the West. 71,526 new cases occur yearly, 20,000 of these are Lung CA. The Philippines has the highest rate of Breast CA in Asia

Estimated leading CA site in 1998

Estimated leading site in 2005

1. Lungs 2. Breast 3. Liver 4. Cervix 5. Leukemia 6. Colon 7. Thyroid 8. Stomach 9. Nasopharynx 10. Lymphomas

1. Lungs 16.1% 2. Breast 13.1% 3. Colon/Rectum 8.0% 4. Liver 7.1% 5. Cervix/ uterine 6.8% 6. Prostate 4.0% 7. Leukemia 3.9% 8. Stomach 3.7% 9. Thyroid 3.3% 10. Ovary 3.1%

Estimated New CA cases in 2005

Estimated CA deaths in 2005 by site and sex

Cancer (med) new growth of tissue resulting from a continuous proliferation of abnormal cells that have the ability to invade and destroy other tissues derived from Latin word which means crablike because cancerous growth spread by sending crablike projections into the surrounding tissue. Definitions Neoplasia literally means new growth; development of a new growth Neoplasm is the new growth Tumor was originally applied to the swelling caused by inflammation; the term is now equated with neoplasm Oncology ( Greek oncos= tumor) is the study of tumors or neoplasm. Kinds of Cancer Carcinoma most common Arise from cells that cover the internal and external body surfaces Examples: lung, breast, colon Sarcoma arise from cells found in the supporting tissue Examples: fat, bones, muscles Lymphomas arise in lymph nodes and tissues of the bodys immune system Example: lymph nodes Leukemia cancer of the immature blood cells that grow in the bone marrow and tend to accumulate in large numbers in the blood stream Example: blood stream Categories of Cancer Solid Tumors initially confined to a specific tissue or organ Hematologic Cancer- involved the blood forming cells that naturally migrate to the blood and lymph nodes

Disseminated disease from the beginning

How are cancer cells different from normal cells?

NORMAL CELLS Mitotic Division in normal tissue, the rate of new cell growth and old cell death are kept in balance
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CANCER CELLS
uncontrolled cell growth or loss of a cells ability to undergo APOPTOSIS or CELL SUICIDE

How do cancers get started? Pathophysiology Etiologic Factors

Radiation

Viruses

Hereditary

CAUSES

Chemical Agents

Physical Agents

A. Host 1. Age Cancer affects people of all ages. Older people develop more - more than 50% of cancer occurs in persons older than age 65. 2. Gender - women are more susceptible to certain types of Ca - men experience a higher overall incidence than women. 3. Genetic Factors if DNA damage occurs in cell population where chromosomal patterns are abnormal, mutant cell population may develop Familial predisposition 4. Immune System Function 5. Viruses e.g: Epstein- barr, herpes simplex type II, cytomegalovirus, papillomavirus, hepa-B 6. Hormonal Factors

hormones influence CA development in 3 ways: a. Preparative action on target tissue making them susceptible to CA. b. Permissive influence on CA development allowing the process to progress c. Conditioning effect on the tumor. 7. Lifestyle practices i. cigarette smoking ii. nutritional habits iii. alcohol intake iv. sexual practice B AGENT 1. Physical Agent prolonged exposure to the heat of the sun exposure to radiation . Non- ionizing Radiation ( ultraviolet rays from the sun, television, computer) . Ionizing radiation ( x-ray, uranium, nuclear weapon) 2. Chemical Agent exposure to toxic substances or toxicants such as asbestos, arsenic, nickel, chromium, cobalt, tar, asphalt, certain plastics, hydrocarbon in cigarette smoke, air pollutants from industry crude paraffin oil, feel oils.

C. ENVIRONMENT 80% - 90% of all CA came from the environment Work environments workers exposed to substances such as asbestos, nickel and lead. Socio-economic class higher rates of tobacco smoking, alcohol consumption and poor nutrition among the poor. Exposure to high level of pollutants e.g: Air pollution in diesel exhaust DIET Carcinogen any substance, situation, or exposure that can damage the genetic material (DNA) Carcinogenesis mutations in a variety of genes responsible for controlling the growth of cells either directly or indirectly Four Stages of cancer cell growth: Initiation irreversible mutation of a gene that leads to malignant transformation Promotion promoting agent stimulates the growth and divisions of a cell Progression series of changes that lead to the characteristics of undifferentiated cell Metastasis tumor has properties needed to spread to other organs in the body Metastasis Invasion of adjacent tissues through basement membranes Entrance into nearby vessels (lymph or blood) Invasion of the immune system Reentrance into distant tissues Implantation of malignant cell in new tissue Signs and Symptoms Ca Cell Proliferation *** Disruption of normal cell growth and interfere with tissue functions. [Link] due to increase in size of neoplastic growth. [Link] - as tumor continues to grow, hollow organs and vessels become compressed and obstructed e.g: esophagus, bronchi, ureters, bowel, blood vessels lymphatic system.

3. Pain due to: . pressure on nerve endings . distention of organs/ vessels . lack of O2 to tissues and organs . release of pain mediators by the tumor

4. Effusion - - - when lymphatic flow is obstructed, there may be effusion in serous cavities. e.g: Pleural Effusion effusion in the pleural cavity Ascites - effusion into the abdominal cavity. 5. Ulceration in necrosis - result as the tumor erodes blood vessels and pressure on tissue causes ischemia- - - tissue damage and bleeding - - - infection 6. vascular thrombosis, embolus, thrombophlebitis - - - tumors tend to produce abnormal coagulation factors that cause increased clotting (pulmonary emboli - - life threatening.) Paraneoplastic syndrome *** malignant cells produce enzymes, hormones and other substances. 1. 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.

2. Hypercalemia - 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. 3. DIC ( Dessiminated Intravascular Disease) - more likely to occur in Ca of the lungs, pancreas, stomach, prostate - precipitated by the release of tissue thromboplastin or endothelial injury. Anorexia & Cachexia Syndrome 1. the final outcome of unrestrained Ca cell growth. 2. malignant neoplasm deprive normal cells of nutrition 3. tumors produce alteration in enzyme system necessary for normal metabolism --- stored fat is lost, tissues lose nitrogen. 4. tumors revert to anaerobic metabolism consume glucose, deplete glycogen stores in the liver and convert glucose to lactate. 5. Protein depletion, serum albumin levels decrease. 6. tumors take up Na. Water retention masks malnutrition and is not immediately reflected as weight loss. 7. Ca cells produce anorexigenic substances that act in the satiety center of the hypothalamus, causing ANOREXIA. 8. Taste sensation diminishes or becomes altered and the individual may have aversion to eating, particularly meat. CANCER OF THE TONGUE PRIMAR CLIENT WHO SMOKE AND DRINK ALCOHOL IN LARGE AMOUNT IS USUALLY LOCATED AT THE FLOOR OF THE MOUTH

METASTASIS TO THE NECK IS VERY COMMON CA OF THE SUB MAXILLARY GLANDS ARE HIGHLY MALIGNANT AND GROWS RAPIDLY. CA OF THE ORAL CAVITY CLINICAL FINDINGS : S= PAIN ALTERATION IN TASTE O= Leukopenia( white patches over mucosa ) considered a pre cancerous lesion Ulcerated areas, or bleeding in the areas of the mouth THERAPEUTIC INTERVENTION Reconstructive Surgery if needed Radiation Implantation of radioactive materials may arrest the growth of the tumor TPN and enteral tube feedings CANCER OF THE LUNGS CA of the Lungs maybe primarily or metastasis SMOKING is the most significant factors Leading type of CA that cause death High incidence in men 40 yrs old and above Symptoms may occur after metastasis to other organ: ribs liver adrenal glands mediastinal organs kidney brain CLINICAL FINDINGS S= Dyspnea Chills Fatigue Chest pain O= persistent cough Hemoptysis Unilateral wheezes Weight loss Clubbing of fingers Chest X-ray Pleural Effusion COIN LESION + Cytologic test for Sputum exam NURSING CARE OF CLIENT WITH BRONCHOGENIC CARCINOMA ASSESSMENT Sputum quantity and characteristics Lung auscultation for absent breath sounds Chest percussion for dullness over tumors Respirations for Shallowness STRIDOR, and use of accessory muscles Persistent cough

THERAPEUTIC INTERVENTION SURGICAL LOBECTOMY: removal of one lobe of the lungs when lesion is limited to one area RESECTION- removal of small confined lesion, may also be done for biopsy PNEUMONECTOMY- removal of the entire lungs EXPLORATORY THORACOTOMY- opening of the thoracic cavity to determine the extent and further therapy THORACOPLASTY- removal of the ribs to reduce the size of the pleural cavity, done to prevent complication after resection of the lungs LASER SURGERY- removal of tumor via ENDOSCOPE inserted between the ribs THORACENTESIS- removal of fluid / blood in the pleural cavity RADIATION THERAPY- used to adjunct therapy or to alleviate symptoms of pain, dyspnea and hemoptysis. CHEMOTHERPY ( Cyclophospaide, Methotrexate, Vincristine ) ANALYSIS AND NURSING DIAGNOSIS 1. Impaired gas exchange