Pathophysiology
INFLAMMATORY & ● The bronchial epithelium
NEOPLASTIC DISORDERS undergoes cellular metaplasia and
dysplasia due to chronic irritation or
exposure to carcinogens.
LUNG CANCER
● Mutations in tumor suppressor
genes (e.g., p53) and activation of
oncogenes result in uncontrolled
Definition cell proliferation.
● The tumor may obstruct airways,
Lung cancer, also known as bronchogenic leading to atelectasis or
carcinoma, is a malignant tumor originating pneumonitis.
from the epithelial cells of the bronchial tree. ● Cancer cells infiltrate blood vessels
It is characterized by uncontrolled cell and lymphatics, facilitating
growth, local invasion, and distant metastasis to distant organs such
metastasis. It is the leading cause of as the brain, liver, adrenal glands,
cancer-related deaths worldwide and is and bone.
primarily associated with exposure to ● Paraneoplastic syndromes may
carcinogens such as cigarette smoke. occur due to ectopic hormone
production (e.g., ADH, ACTH,
PTHrP).
Etiology / Risk Factors
● Cigarette smoking (primary cause;
Clinical Manifestations
accounts for about 85–90% of
cases) Early Signs and Symptoms:
● Second-hand smoke exposure
● Occupational exposure to ● Persistent cough (often the first
carcinogens (asbestos, radon, symptom; may change in character
arsenic, nickel, chromium, uranium) or become chronic)
● Air pollution and environmental ● Dyspnea or shortness of breath
exposure ● Chest pain or discomfort (localized
● Genetic predisposition (family or pleuritic in nature)
history of lung cancer, genetic ● Hemoptysis (coughing up
mutations such as EGFR, ALK, blood-tinged sputum)
KRAS) ● Hoarseness (due to recurrent
● Radiation exposure to the chest laryngeal nerve involvement)
● Pre-existing lung diseases such as ● Recurrent respiratory infections
chronic obstructive pulmonary such as pneumonia or bronchitis in
disease (COPD), pulmonary fibrosis, the same lobe
or tuberculosis
Late / Advanced Signs and Symptoms:
● Anorexia, fatigue, and 1. Surgical Interventions:
unintentional weight loss ○ Lobectomy (removal of a
● Shoulder or arm pain due to local lobe)
invasion of the chest wall or nerves ○ Pneumonectomy (removal
● Clubbing of the fingers (due to of entire lung)
chronic hypoxia) ○ Segmentectomy or wedge
● Superior vena cava syndrome resection (for localized
(facial and neck edema, distended lesions)
neck veins) 2. Radiation Therapy: used for
● Bone pain, neurologic changes, localized disease or palliation of
or seizures (due to metastasis) symptoms.
● Paraneoplastic manifestations: 3. Chemotherapy: indicated for small
○ SIADH (hyponatremia) cell carcinoma and advanced
○ Hypercalcemia (from non-small cell lung cancer.
ectopic PTHrP production) 4. Targeted therapy and
○ Cushing’s syndrome immunotherapy: based on
(ectopic ACTH secretion) molecular markers (e.g., EGFR
inhibitors, PD-L1 inhibitors).
5. Palliative care: focus on symptom
control and quality of life.
Diagnostic / Laboratory Findings
● Chest X-ray: presence of a mass,
atelectasis, or pleural effusion Nursing Interventions
● CT or MRI scan: detailed imaging of
tumor size, extent, and metastasis ● Assess respiratory status, oxygen
● PET scan: to identify metastatic saturation, and presence of cough,
lesions sputum, or hemoptysis.
● Sputum cytology: detection of ● Maintain airway clearance:
malignant cells encourage deep breathing,
● Bronchoscopy with biopsy: coughing, and use of incentive
definitive diagnosis through spirometry.
histologic confirmation ● Administer oxygen therapy as
● Thoracentesis: cytologic ordered and monitor for hypoxia.
examination of pleural fluid (if ● Monitor for complications such as
effusion present) pneumonia, pleural effusion, or
● Blood tests: may reveal metastasis.
paraneoplastic effects (e.g., ● Provide pain management and
hyponatremia, hypercalcemia) comfort measures.
● Offer nutritional support and small,
frequent meals.
● Educate patient and family regarding
Treatment and Management treatment plan, smoking
Medical Management:
cessation, and energy Pathophysiology
conservation techniques.
● Provide emotional and ● Malignant transformation occurs in
psychological support to address the ductal or lobular epithelium of
anxiety, fear, and body image the breast.
concerns. ● Tumor cells proliferate and invade
surrounding tissue, disrupting ductal
structures.
● Metastasis occurs primarily through
lymphatic spread to axillary,
BREAST CANCER internal mammary, or supraclavicular
nodes and through hematogenous
spread to the bones, liver, lungs,
Definition and brain.
● Tumors may be hormone
Breast cancer is a malignant neoplasm receptor-positive (ER/PR) or
that arises from the epithelial cells of the HER2-positive, influencing
mammary ducts or lobules. It is treatment and prognosis.
characterized by uncontrolled proliferation,
local invasion, and potential metastasis
through lymphatic and hematogenous
routes. It is the most common cancer Clinical Manifestations
among women worldwide.
Early Signs and Symptoms:
● Painless, hard, irregularly shaped
Etiology / Risk Factors lump in the breast (most common
presentation)
● Female gender and increasing age ● Changes in breast size, shape, or
● Family history of breast or ovarian contour
cancer (BRCA1, BRCA2 mutations) ● Skin dimpling or puckering over the
● Personal history of breast lesions lesion site
or cancer ● Nipple retraction or inversion
● Prolonged exposure to estrogen ● Abnormal nipple discharge
(early menarche, late menopause, (bloody or serous)
hormone replacement therapy) ● Localized tenderness or
● Nulliparity or first pregnancy after discomfort (less common in early
age 30 stages)
● Obesity and high-fat diet
● Alcohol consumption Advanced Signs and Symptoms:
● Radiation exposure to the chest
● Sedentary lifestyle ● Skin changes: redness, thickening,
ulceration, or “peau d’orange”
(orange peel appearance)
● Axillary lymphadenopathy ○ Mastectomy (simple or
(enlarged lymph nodes) modified radical)
● Pain or soreness of the breast or ○ Axillary lymph node
axilla dissection
● Systemic symptoms such as ○ Reconstructive surgery
fatigue, weight loss, or bone pain (optional)
(indicative of metastasis) 2. Radiation Therapy:
● Signs of metastasis: post-lumpectomy or for local control.
○ Bone pain or fractures 3. Chemotherapy: for systemic control
(bone involvement) or high-risk cases.
○ Cough or dyspnea (lung 4. Hormonal Therapy: Tamoxifen,
involvement) aromatase inhibitors for
○ Jaundice (liver involvement) ER/PR-positive tumors.
○ Neurologic symptoms 5. Targeted Therapy: Trastuzumab
(brain metastasis) (Herceptin) for HER2-positive
tumors.
Diagnostic / Laboratory Findings
Nursing Interventions
● Mammography: identifies
suspicious lesions ● Assess for pain, wound status, and
● Ultrasound: differentiates solid from arm mobility postoperatively.
cystic masses ● Monitor for lymphedema; instruct
● MRI: used in dense breast tissue or avoidance of venipuncture or BP
staging measurement on affected arm.
● Biopsy (core needle, excisional): ● Encourage range-of-motion
confirms malignancy exercises and early ambulation.
● Hormone receptor testing (ER/PR) ● Provide pain management and
and HER2/neu: determines emotional support.
treatment plan ● Educate patient on:
● Staging: based on TNM (Tumor, ○ Breast self-examination
Node, Metastasis) classification (BSE) technique
○ Follow-up care and
surveillance
○ Adherence to hormonal or
Treatment and Management chemotherapy regimens
○ Psychological adaptation
Medical and Surgical Management: to body image changes
● Monitor for complications such as
1. Surgery:
infection, hematoma, seroma, or
○ Lumpectomy
recurrence.
(breast-conserving
surgery)
● Collaborate with the multidisciplinary Normal prostate epithelial cells
team for nutritional, psychosocial, → Genetic mutation (BRCA1, BRCA2,
and rehabilitative support. HOXB13, or other oncogenes)
→ Uncontrolled cellular proliferation in
the peripheral zone of the prostate
→ Formation of malignant tumor
(adenocarcinoma)
3. PROSTATE CANCER → Local invasion of the prostatic capsule,
seminal vesicles, and surrounding tissues
Definition → Spread through lymphatic system to
pelvic lymph nodes
Prostate cancer is a malignant neoplasm
→ Hematogenous spread to bones
arising from the epithelial cells of the
(especially vertebrae, pelvis, and femur)
prostate gland, most commonly classified
→ Osteoblastic bone lesions (causing
as adenocarcinoma. It is characterized by
pain and fractures)
uncontrolled proliferation of abnormal
→ Metastatic disease resulting in systemic
prostate cells that can invade surrounding
manifestations such as weight loss, anemia,
tissues and metastasize to bones and
and fatigue.
lymph nodes.
Clinical Manifestations
Etiology / Risk Factors
Early Stage:
● Age: Most common in men older
than 50 years. ● Often asymptomatic.
● Genetic predisposition: BRCA1, ● Urinary obstruction symptoms:
BRCA2, and HOXB13 mutations. hesitancy, weak stream, incomplete
● Family history: First-degree relative emptying, frequency, urgency,
with prostate cancer increases risk. nocturia.
● Race: Higher incidence in ● Hematuria and dysuria in some
African-American men. cases.
● Dietary factors: High-fat, red meat
diet; low fruit and vegetable intake. Advanced Stage:
● Hormonal factors: Increased
androgen levels. ● Bone pain (spine, hips, pelvis).
● Environmental factors: Exposure ● Pathologic fractures from bone
to cadmium, industrial chemicals. metastasis.
● Lifestyle: Obesity, smoking, and ● Neurologic deficits (leg weakness,
sedentary behavior. paresthesia) due to spinal cord
compression.
● Weight loss, fatigue, and anemia.
● Palpable nodular or hard prostate
Pathophysiology on DRE.
● Urinary retention and renal ● External Beam Radiation Therapy
dysfunction due to obstruction. (EBRT) or Brachytherapy for
localized tumors.
Diagnostic Findings
Nursing Interventions
● Prostate-Specific Antigen (PSA):
Elevated (>4 ng/mL). ● Assess for urinary retention, pain,
● Digital Rectal Examination (DRE): and fatigue.
Hard, irregular prostate. ● Monitor PSA levels and urinary
● Transrectal Ultrasound (TRUS): output.
Detects lesions and guides biopsy. ● Educate the patient about treatment
● Biopsy: Confirms malignancy. options and side effects (e.g.,
● Bone Scan, CT, or MRI: Detects impotence, incontinence).
metastasis. ● Provide emotional support and
promote coping strategies.
● Encourage hydration and mobility to
prevent complications.
Management ● Teach Kegel exercises for urinary
control post-surgery.
Medical:
● Active Surveillance: For
slow-growing tumors.
● Androgen Deprivation Therapy 4. COLORECTAL CANCER
(ADT):
○ LHRH agonists (Leuprolide, Definition
Goserelin)
○ Antiandrogens (Bicalutamide, Colorectal cancer (CRC) is a malignant
Flutamide) tumor of the colon or rectum that arises
● Chemotherapy: Docetaxel for from the epithelial lining of the
advanced cases. gastrointestinal tract, usually beginning as a
● Targeted therapy: Abiraterone polyp (adenomatous polyp) that
acetate, Enzalutamide. undergoes malignant transformation over
time.
Surgical:
● Radical Prostatectomy: Removal
of the prostate, seminal vesicles, Etiology / Risk Factors
and part of the bladder neck.
● Orchiectomy: Bilateral removal of ● Age: Common in individuals older
testes to reduce testosterone. than 50 years.
Radiation Therapy:
● Genetic Factors: Familial ● Abdominal cramping or pain.
adenomatous polyposis (FAP), ● Sensation of incomplete
Lynch syndrome. evacuation (tenesmus).
● Diet: High in red and processed ● Unexplained weight loss and
meats, low in fiber. fatigue.
● Inflammatory bowel diseases: ● Anemia (iron-deficiency) — often
Ulcerative colitis, Crohn’s disease. the first sign in right-sided colon
● Lifestyle: Physical inactivity, obesity, cancer.
smoking, alcohol use. ● Palpable abdominal mass in
● History of polyps: Adenomatous advanced disease.
polyps increase risk.
● Type 2 Diabetes Mellitus and Right-Sided (Ascending Colon):
high-fat diets.
● Dull abdominal pain.
● Occult bleeding → anemia,
weakness, and fatigue.
Pathophysiology
Left-Sided (Descending/Sigmoid Colon):
Normal colonic mucosa
● Constipation and narrow stools due
→ Formation of adenomatous polyp
to obstruction.
(precancerous lesion)
● Bright red blood in stool.
→ Accumulation of genetic mutations
(APC, KRAS, p53) Rectal Cancer:
→ Dysplasia and transformation into
carcinoma in situ ● Tenesmus, rectal fullness, and
→ Invasion into the muscularis propria bleeding with defecation.
→ Penetration of the serosa and
surrounding structures
→ Spread via lymphatic system to
regional lymph nodes Diagnostic Findings
→ Hematogenous metastasis (commonly
to liver, lungs, and bones). ● Fecal Occult Blood Test (FOBT):
Detects hidden blood.
● Colonoscopy: Gold standard for
diagnosis and biopsy.
Clinical Manifestations ● Carcinoembryonic Antigen (CEA):
Tumor marker for monitoring.
General Signs: ● CT Scan / MRI: Detects local
invasion and metastasis.
● Change in bowel habits: ● Barium Enema: Visualizes
alternating constipation and obstruction or mass.
diarrhea.
● Rectal bleeding or blood in stool
(hematochezia or melena).
● Narrow or ribbon-like stools.
Management ● Educate about follow-up
colonoscopy and CEA monitoring.
Medical:
● Chemotherapy:
○ 5-Fluorouracil (5-FU),
Capecitabine, Oxaliplatin,
Irinotecan.
● Targeted Therapy:
○ Bevacizumab, Cetuximab.
Surgical:
● Partial Colectomy: Removal of the
affected portion of colon with lymph
nodes.
● Abdominoperineal Resection
(APR): For rectal cancer requiring
colostomy.
● Colostomy/Ileostomy: For bowel
diversion.
Radiation Therapy:
● Used preoperatively to shrink tumor
or postoperatively to reduce
recurrence (especially rectal
cancer).
Nursing Interventions
● Assess bowel patterns and monitor
for bleeding.
● Administer prescribed bowel
preparation before surgery.
● Provide colostomy care education
and emotional support.
● Encourage high-protein,
high-calorie, low-residue diet
postoperatively.
● Monitor fluid and electrolyte balance.
● Promote early ambulation and pain
management.