Neoplasia

Oncology defined• Branch of medicine that deals

with the study, detection, treatment and management of cancer and neoplasia

“Root words”• Neo- new• Plasia- growth

NeoplasiaUncontrolled growth of Abnormal cells• 1. Benign• 2. Malignant• 3. Borderline

Characteristics of Neoplasia

• BENIGN• Well-differentiated• Slow growth• Encapsulated • Non-invasive• Does NOT metastasize

Characteristics of Neoplasia

• MALIGNANT• Undifferentiated• Erratic and Uncontrolled Growth• Expansive and Invasive• Secretes abnormal proteins• METASTASIZES

leiomyomas

adenoma

adenocarcinoma

carcinoma

Nomenclature of Neoplasia

Tumor is named according to:1. Parenchyma, Organ or Cell• Hepatoma- liver• Osteoma- bone• Myoma- muscle

Nomenclature of Neoplasia

Tumor is named according to:2. Pattern and Structure, either GROSS or

MICROSCOPIC• Fluid-filled CYST• Glandular ADENO• Finger-like PAPILLO• Stalk POLYP

BENIGN TUMORS• Suffix- “OMA” is used• Adipose tissue- LipOMA• Bone- osteOMA• Muscle- myOMA• Blood vessels- angiOMA• Fibrous tissue- fibrOMA

MALIGNANT TUMOR-nomenclature

Glandular, Epithelial• Use the suffix- “CARCINOMA”• Pancreatic AdenoCarcinoma• Squamos cell Carcinoma

MALIGNANT TUMOR2. connective tissue origin• Use the suffix “SARCOMA• FibroSarcoma• Myosarcoma• AngioSarcoma

“OMA” but Malignant– HepatOMA, lymphOMA, gliOMA, melanOMA

dysplasia

• denotes a loss of architectural organization and a loss of cell uniformity in epithelium

• mild to moderate dysplasia is potentially reversible

dysplasia

normal epithelium

dysplasia

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

differentiation

• Well-differentiated tumors contain cells that resemble the normal cells of origin

• poorly-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

metastasis

• Distant spread of the tumor• Methods of metastasis include: lymphatic

spread, and hematogenous spread.

metastatic ovarian carcinoma

MRI: metastatic adenocarcinoma

metastatic adenocarcinoma

Spread of Cancer

• 1. LYMPHATIC• Most common

• 2. HEMATOGENOUS– Blood-borne, commonly to Liver and Lungs

• 3. DIRECT SPREAD– Surrounding organs

Spread of cancer • Cancers commonly spread t bone,lungs liver

and brain(secondary deposits)

Cancer Diagnosis

• 1. BIOPSY – The most definitive

• 2. CT, MRI• 3. Tumor Markers

grading and staging

• Grading 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 Grading

The degree of DIFFERENTIATION• Grade 1- Low grade• Grade 4- high grade

Cancer Staging

1. Uses the T-N-M staging system• T- tumor• N- Node• M- Metastasis

GENERAL MEDICAL MANAGEMENT

• 1. Surgery- cure, control, palliate• 2. Chemotherapy• 3. Radiation therapy• 4. Immunotherapy• 5. Bone Marrow Transplant

GENERAL Promotive and Preventive

• 1. Lifestyle Modification• 2. Nutritional management• 3. Screening• 4. Early detection

SCREENING• 1. Male and female- Occult Blood, CXR, and

DRE• 2. Female-, Mammography and Pap’s Smear• 3. Male- DRE for prostate, Testicular self-exam

Cancer –causes

Etiology of cancer1. PHYSICAL AGENTS• Radiation• Exposure to irritants• Exposure to sunlight• Altitude, humidity

Etiology of cancer2. CHEMICAL AGENTS• Smoking• Dietary ingredients• Drugs

Etiology of cancer3. Genetics and Family History• Colon Cancer• Premenopausal breast cancer

Etiology of cancer4. Dietary Habits Low-Fiber High-fat Processed foods alcohol

Etiology of cancer5. Viruses and Bacteria• DNA viruses- Hep, Herpes, EBV, CMV,

Papilloma Virus• RNA Viruses- HIV, • Bacterium- H. pylori

Etiology of cancer• 6. Hormonal agentsOCP especially estrogen

Etiology of cancer• 7. Immune Disease• AIDS

Proposed Molecular cause of CANCER:

• Change in the DNA structure altered DNA function Cellular aberration

neoplastic change

CARCINOGENSIS• Malignant transformation• IPP• Initiation• Promotion• Progression

CARCINOGENSIS• INITIATION• Carcinogens alter the DNA of the cell• Cell will either die or repair

CARCINOGENSIS• PROMOTION• Repeated exposure to carcinogens• Abnormal gene will express• Latent period

CARCINOGENSIS• PROGRESSION• Irreversible period• Cells undergo NEOPLASTIC transformation

then malignancy

Colon cancer

COLON CANCER• Risk factors• 1. Increasing age• 2. Family history• 3. Previous colon CA or polyps• 4. History of IBD• 5. High fat, High protein, LOW fiber• 6. Breast Ca and Genital Ca

COLON CANCER• Sigmoid colon is the most common site• Predominantly adenocarcinoma• If early 90% survival

COLON CANCER• PATHOPHYSIOLOGY• Benign neoplasm DNA alteration

malignant transformation malignant neoplasm cancer growth and invasion metastasis (liver)

COLON CANCERASSESSMENT FINDINGS

1. Change in bowel habits- Most common• 2. Blood in the stool• 3. Anemia• 4. Anorexia and weight loss• 5. Fatigue• 6. Rectal lesions- tenesmus, alternating D and C

Colon cancer• Diagnostic findings• 1. Fecal occult blood• 2. Sigmoidoscopy and colonoscopy• 3. BIOPSY• 4. CEA- carcino-embryonic antigen

Colon cancer• Complications of colorectal CA• 1. Obstruction• 2. Hemorrhage• 3. Peritonitis• 4. Sepsis

Colon cancer• MEDICAL MANAGEMENT• 1. Chemotherapy- 5-FU• 2. Radiation therapy

Colon cancer• SURGICAL MANAGEMENT• Surgery is the primary treatment• Based on location and tumor size• Resection, anastomosis, and colostomy

(temporary or permanent)

Colon cancerNURSING INTERVENTIONPre-Operative care• 1. Provide HIGH protein, HIGH calorie and

LOW residue diet• 2.Provide information about post-op care and

stoma care• 3. Administer antibiotics 1 day prior

Breast Cancer• The most common cancer in FEMALES• Numerous etiologies implicated

Breast CancerRISK FACTORS• 1. Genetics- BRCA1 And BRCA 2• 2. Increasing age ( > 50yo)• 3. Family History of breast cancer• 4. Early menarche and late menopause• 5. Nulliparity• 6. Late age at pregnancy

Breast CancerRISK FACTORS• 7. Obesity• 8. Hormonal replacement• 9. Alcohol• 10. Exposure to radiation

Breast CancerPROTECTIVE FACTORS• 1. Exercise• 2. Breast feeding• 3. Pregnancy before 30 yo

Breast CancerASSESSMENT FINDINGS• 1. MASS- the most common location is the

upper outer quadrant• 2. Mass is NON-tender. Fixed, hard with

irregular borders• 3. Skin dimpling• 4. Nipple retraction• 5. Peau d’ orange

Breast Cancer• LABORATORY FINDINGS• 1. Biopsy procedures• 2. Mammography

Breast Cancer• Breast cancer Staging• TNM staging• I - < 2cm• II - 2 to 5 cm, (+) LN• III - > 5 cm, (+) LN• IV- metastasis

Breast Cancer• MEDICAL MANAGEMENT• 1. Chemotherapy• 2. Tamoxifen therapy• 3. Radiation therapy

Breast Cancer• SURGICAL MANAGEMENT

1. Radical mastectomy2. Modified radical mastectomy3. Lumpectomy4. Quadrantectomy

Thank you…