Neoplasms

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Neoplasms

• Chapter 5
• Pgs 84-103

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Overview

• Benign and Malignant Tumors
• Nomenclature
• Characteristics
• Malignant Tumors
• Pathophysiology
• Effects
• Local effects
• Systemic effects
• Diagnostic tests
• Staging
• Etiology
• Carcinogenesis
• Risk factors and prevention
• Host defenses

• Treatment
• Radiation
• Chemotherapy
• Other drugs
• Nutrition
• Prognosis
• Examples of Malignant Tumors
• Skin cancer
• Ovarian cancer
• Brain tumors

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Benign and Malignant Tumors

• Neoplasm (tumor) cellular growth that is no
  longer responding to normal body controls
  
• Cells undergo unnecessary mitosis
• Lack function atypical cells

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Nomenclature

• According to a system
• Root word is cell of origin
• Ex?
• Suffix indicates tissue that tumor occurs in
• Ex?
• Suffix oma indicates benign
• Some have unique names
• Ex?

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Characteristics of Benign and Malignant Tumors

• Benign
• Differentiated cells that reproduce at a high
  rate
  
• Encapsulated expands but does not spread
• Tissue damage from compression
• Not considered life-threatening
• Malignant
• Undifferentiated nonfunctioning cells
• Increase rate of cellular reproduction
• Tumor cells infiltrate surrounding tissue

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Benign vs. Malignant Tumor
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Benign vs. Malignant Tumor
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Pathophysiology of Malignant Tumors

• Growing space occupying mass
• Infection
• Infiltrate
• b/c break off and infiltrate other tissues
• Rapid vs. in situ
• Enlarges
• Inner cells cut off from blood and nutrients
  death
  
• ? necrosis ? inflammation ? infection at
  site
  
• Tumor cells trap nutrients, depriving normal
  cells
  
• Inflammation and loss of normal cells leads to
  progressive break down of organ function
  
• Graded
• Based on degree of differentiation of malignant
  cells
  
• Grade I thru IV

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Effects of Malignant Tumors

• Best treated ASAP
• Warning signs
• Unusual bleeding, discharge anywhere
• Change in bowel/bladder habits
• Change in wart/mole
• Sore that does not heal
• Unexplained weight loss
• Anemia
• Persistent cough without reason
• Solid lump

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Local Effects of Tumors

• Pain
• Not an early symptom
• Severity depends on type of tumor and location
• Caused by
• Direct pressure on nerves
• Stretching of visceral capsule
• Inflammation
• Secondary causes
• Infection, ischemia, bleeding
• Obstruction
• Compresses duct or passageway
• Tissue necrosis and ulceration
• May lead to opportunistic infection around tumor

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Systemic Effects of Cancer

• Weight loss and tissue wasting
• Anemia
• Infections
• Bleeding
• Paraneoplastic syndromes

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Diagnostic Tests

• Blood tests
• Indicator of problem also monitor effects of
  chemo, radiation
  
• Therapy results in
• Thrombocytopenia, erythrocytopenia, leukopenia
• ? Hb, erythrocytes cancer
• Tumor markers
• Carcinoembryonic antigen (CEA)Colon cancer
• Human Chorionic Gonadotropin (HCG)Testicular
  cancer
  
• AlphafetoproteinHepatocellular cancer
• Prostate Specific Antigen (PSA)Prostate cancer
• X-Ray, ultrasound, MRI, CT scans
• Cytologic Tests
• Screens high-risk pt, confirms diagnosis, follows
  clinical course, monitors changes
  
• Biopsies

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Spread of Malignant Tumors

• 3 basic mechanisms
• Invasion
• Metastasis
• Seeding

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Invasion
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Spread of Malignant Tumors Metastasis

• Spreads to distant sites thru blood, lymphatic
  vessels
  
• Typically travels thru lymph vessels 1st
• Only few cancerous cells survive spreading
• Enough to start new colony
• Finds new hospitable location to set up shop

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Metastasis
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Seeding
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Staging of Cancer

• Classification process for malignant tumor at
  time of diagnosis
  
• T Size of primary tumor
• N extent of involvement of local lymph nodes
• M Spread (invasion or metastasis) of tumor
• I-IV

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Etiology Carcinogenesis

• Process by which normal cells converted to cancer
  cells
  
• Malignant tumors develop from sequence of changes
  of relatively long period of time
  
• Some etiologies and carcinogens well known
  others not
  
• Stages
• Initiation
• Promoters
• Cancer

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Carcinogenesis
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Etiology Risk Factors and Prevention

• Geographic areas, ethnic groups, environment,
  diet, genetics
  
• Which risk factors are avoidable?
• Which are not avoidable?

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Etiology Host Defenses

• Immune system reacts to nonself antigens on tumor
  cells
  
• Cell mediated humoral response
• Temporary or long-term immunodeficiencies
  increase risk

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Treatment

• Curative vs. palliative
• Prophalytic
• Surgery
• Chemotherapy
• Radiation
• Other drugs
• Nutrition

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Surgery

• Involves removal of tumor and surrounding tissue
• Also nearby lymph nodes
• Why?
• Tumor cells and boundaries checked to ensure to
  complete removal
  
• Sometimes only a portion is removed

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Radiation

• Causes mutations
• Prevents mitosis
• Damages blood vessels
• Most effective on cells undergoing mitosis or DNA
  synthesis
  
• Consists of
• Electromagnetic waves
• High-energy penetrating particles
• Methods of administration
• External sources
• Cobalt machine
• Internal insertion
• at tumor site

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Adverse Effects of Radiation

• Bone Marrow Depression
• ? leukocytes increased risk of infection
• ? platelets excessive bleeding
• ? RBC fatigue, tissue break down
• Cell damage
• Bv, skin, alopecia, mucosa of digestive tract
• Abdominal radiation
• Damage to ovaries or testes
• Nonspecific fatigue
• Long-term
• Inflammation
• Necrosis
• Scar tissue

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Chemotherapy

• Combo of 2-4 drugs
• Antimitotics
• Antimetabolites
• Alkylating agents
• Antibiotics
• Administered through IV

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ABVDHodgkins lymphoma
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Adverse Effects of Chemotherapy

• Normal cells damaged
• Bone marrow depression
• Limiting factor
• Vomiting
• Hair loss
• Break down in skin and mucosa
• Some have unique effects
• Ex fibrosis in the lungs

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Other Drugs

• Hormones
• Glucocorticoid
• ? mitosis and ? RBC counts
• ? inflammation and swelling
• Sex hormones
• Biologic Response Modifiers (BRMs)
• Augment natural immune response
• Interferon
• Bacillus Calmette-Guerin (BCG)
• Angiogenesis Inhibitor Drug
• Inhibits bv genesis
• Analgesics

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Treatment Nutrition

• Concern w/ advanced pts
• Contributing factors
• Anorexia, vomiting, sore mouth, loss of teeth,
  pain, fatigue, malabsorption, altered metabolism,
  nutrient-trapping tumor
  
• Some might need TPN
• Total parenteral nutrition
• Given intravenously

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Prognosis

• Depends on type of cancer and when diagnosed
• Cure 5 yr survival rate w/o recurrence after
  diagnosis and treatment
  
• Typically doctors will not give time line

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Examples of Malignant Tumors

• Skin Cancer
• Ovarian Cancer
• Brain Cancer

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Ex Skin Cancer

• Visible, easily diagnosed, good prognosis
• Highest rate of recurrence
• Most common in
• Fair skin
• Family history
• Lots of moles or freckles
• Increase of cases (from all you people who go
  to tanning salons!)
  
• Basal cell carcinoma most common form

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Skin CancerBenign Carcinoma
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Ex Ovarian Cancer

• Many types
• Hormonal and genetic factors
• Very poor prognosis
• Tumor hidden in peritoneal cavity
• Silent tumor
• 1st signs appear only when tumor is large and
  presses on adjacent structures
  
• 1st indication altered bowel or bladder function
• Spreads thru lymph to peritoneal membranes
• No tumor marker for early prognosis
• Treatment
• Surgery, radiation, chemo

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Ovarian Cancer
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Brain Tumors

• Benign or malignant
• Both equally serious
• Why?
• If on brain surface easily removed
• Early indications
• Pressure (headache)
• Drowsiness
• Vomiting
• Vision problems
• Impaired motor function
• Malignant tumors do not metastasize outside of CNS

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Brain Tumors
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Brain Tumors