Neoplasia

Oncology definedBranch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia

Root wordsNeo- newPlasia- growth

NeoplasiaUncontrolled growth of Abnormal cells1. Benign2. Malignant3. Borderline

Characteristics of NeoplasiaBENIGNWell-differentiatedSlow growthEncapsulated Non-invasiveDoes NOT metastasize

Characteristics of NeoplasiaMALIGNANTUndifferentiatedErratic and Uncontrolled GrowthExpansive and InvasiveSecretes abnormal proteinsMETASTASIZES

leiomyomas

adenoma

adenocarcinoma

carcinoma

Nomenclature of NeoplasiaTumor is named according to:1. Parenchyma, Organ or CellHepatoma- liverOsteoma- boneMyoma- muscle

Nomenclature of NeoplasiaTumor is named according to:2. Pattern and Structure, either GROSS or MICROSCOPICFluid-filled CYSTGlandular ADENOFinger-like PAPILLOStalk POLYP

BENIGN TUMORSSuffix- OMA is usedAdipose tissue- LipOMABone- osteOMAMuscle- myOMABlood vessels- angiOMAFibrous tissue- fibrOMA

MALIGNANT TUMOR-nomenclature Glandular, EpithelialUse the suffix- CARCINOMAPancreatic AdenoCarcinomaSquamos cell Carcinoma

MALIGNANT TUMOR2. connective tissue originUse the suffix SARCOMAFibroSarcomaMyosarcomaAngioSarcoma

OMA but MalignantHepatOMA, lymphOMA, gliOMA, melanOMA

dysplasiadenotes a loss of architectural organization and a loss of cell uniformity in epitheliummild to moderate dysplasia is potentially reversible

dysplasia

normal epithelium

dysplasia

Dysplasia is a non-neoplastic proliferation.Dysplasia may or may not progress to cancer.

differentiationWell-differentiated tumors contain cells that resemble the normal cells of originpoorly-differentiated or undifferentiated tumors contain cells that do not resemble their normal counterparts (ancillary studies may be needed to determine the cell of origin)

well-differentiated

poorly-differentiated

Benign tumors are composed of well-differentiated cells.Malignant tumors are characterized by a wide range of cellular differentiation.

rate of growth In general, well-differentiated malignant tumors have a slower rate of growth than poorly-differentiated malignant tumors.There are exceptions. Blood supply, site, and hormonal stimulation are factors that can affect the growth rate of tumors.

meningioma

basal cell carcinoma

melanoma

metastasisDistant spread of the tumorMethods of metastasis include: lymphatic spread, and hematogenous spread.

metastatic ovarian carcinoma

MRI: metastatic adenocarcinoma

metastatic adenocarcinoma

Spread of Cancer1. LYMPHATICMost common2. HEMATOGENOUSBlood-borne, commonly to Liver and Lungs3. DIRECT SPREADSurrounding organs

Spread of cancer Cancers commonly spread t bone,lungs liver and brain(secondary deposits)

Cancer Diagnosis1. BIOPSY The most definitive2. CT, MRI3. Tumor Markers

grading and stagingGrading is based on the microscopic features of the cells which compose a tumor and is specific for the tumor type.Staging is based on clinical, radiological, and surgical criteria, such as, tumor size, involvement of regional lymph nodes, and presence of metastases. Staging usually has prognostic value.

Cancer GradingThe degree of DIFFERENTIATIONGrade 1- Low gradeGrade 4- high grade

Cancer Staging1. Uses the T-N-M staging systemT- tumorN- NodeM- Metastasis

GENERAL MEDICAL MANAGEMENT

1. Surgery- cure, control, palliate2. Chemotherapy3. Radiation therapy4. Immunotherapy5. Bone Marrow Transplant

GENERAL Promotive and Preventive1. Lifestyle Modification2. Nutritional management3. Screening4. Early detection

SCREENING1. Male and female- Occult Blood, CXR, and DRE2. Female-, Mammography and Paps Smear3. Male- DRE for prostate, Testicular self-exam

Cancer causes

Etiology of cancer1. PHYSICAL AGENTSRadiationExposure to irritantsExposure to sunlightAltitude, humidity

Etiology of cancer2. CHEMICAL AGENTSSmokingDietary ingredientsDrugs

Etiology of cancer3. Genetics and Family HistoryColon CancerPremenopausal breast cancer

Etiology of cancer4. Dietary HabitsLow-FiberHigh-fatProcessed foodsalcohol

Etiology of cancer5. Viruses and BacteriaDNA viruses- Hep, Herpes, EBV, CMV, Papilloma VirusRNA Viruses- HIV, Bacterium- H. pylori

Etiology of cancer6. Hormonal agentsOCP especially estrogen

Etiology of cancer7. Immune DiseaseAIDS

Proposed Molecular cause of CANCER:

Change in the DNA structure altered DNA function Cellular aberration neoplastic change

CARCINOGENSISMalignant transformationIPPInitiationPromotionProgression

CARCINOGENSISINITIATIONCarcinogens alter the DNA of the cellCell will either die or repair

CARCINOGENSISPROMOTIONRepeated exposure to carcinogensAbnormal gene will expressLatent period

CARCINOGENSISPROGRESSIONIrreversible periodCells undergo NEOPLASTIC transformation then malignancy

Colon cancer

COLON CANCERRisk factors1. Increasing age2. Family history3. Previous colon CA or polyps4. History of IBD5. High fat, High protein, LOW fiber6. Breast Ca and Genital Ca

COLON CANCERSigmoid colon is the most common sitePredominantly adenocarcinomaIf early 90% survival

COLON CANCERPATHOPHYSIOLOGYBenign neoplasm DNA alteration malignant transformation malignant neoplasm cancer growth and invasion metastasis (liver)

COLON CANCERASSESSMENT FINDINGS 1. Change in bowel habits- Most common2. Blood in the stool3. Anemia4. Anorexia and weight loss5. Fatigue6. Rectal lesions- tenesmus, alternating D and C

Colon cancerDiagnostic findings1. Fecal occult blood2. Sigmoidoscopy and colonoscopy3. BIOPSY4. CEA- carcino-embryonic antigen

Colon cancerComplications of colorectal CA1. Obstruction2. Hemorrhage3. Peritonitis4. Sepsis

Colon cancerMEDICAL MANAGEMENT1. Chemotherapy- 5-FU2. Radiation therapy

Colon cancerSURGICAL MANAGEMENTSurgery is the primary treatmentBased on location and tumor sizeResection, anastomosis, and colostomy (temporary or permanent)

Colon cancerNURSING INTERVENTIONPre-Operative care1. Provide HIGH protein, HIGH calorie and LOW residue diet2.Provide information about post-op care and stoma care3. Administer antibiotics 1 day prior

Breast CancerThe most common cancer in FEMALESNumerous etiologies implicated

Breast CancerRISK FACTORS1. Genetics- BRCA1 And BRCA 22. Increasing age ( > 50yo)3. Family History of breast cancer4. Early menarche and late menopause5. Nulliparity6. Late age at pregnancy

Breast CancerRISK FACTORS7. Obesity8. Hormonal replacement9. Alcohol10. Exposure to radiation

Breast CancerPROTECTIVE FACTORS1. Exercise2. Breast feeding3. Pregnancy before 30 yo

Breast CancerASSESSMENT FINDINGS1. MASS- the most common location is the upper outer quadrant2. Mass is NON-tender. Fixed, hard with irregular borders3. Skin dimpling4. Nipple retraction5. Peau d orange

Breast CancerLABORATORY FINDINGS1. Biopsy procedures2. Mammography

Breast CancerBreast cancer StagingTNM stagingI - < 2cmII - 2 to 5 cm, (+) LNIII - > 5 cm, (+) LNIV- metastasis

Breast CancerMEDICAL MANAGEMENT1. Chemotherapy2. Tamoxifen therapy3. Radiation therapy

Breast CancerSURGICAL MANAGEMENT 1. Radical mastectomy2. Modified radical mastectomy3. Lumpectomy4. Quadrantectomy

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