Nursing 280: Pathophysiology Examination

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Nursing 280 PathophysiologyExamination 2
Module ISection E Neoplasia-Alterations in
Cell Proliferation

• Presented by
• Ronda M. Overdiek, M.S.N., R.N.

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Section ENeoplasia Alterations in Cell
Proliferation

• Chapter 9 Biology of Cancer
• Chapter 10 Tumor Spread and Treatment

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Objective 1 Differentiate tumors by site and
name.

• Carcinoma
• Arise from endothelial and epithelial tissues
• Adenocarcinomas Arise from ductal or glandular
  epithelium
• Sarcoma
• Arise from mesenchymal (connective) tissues
• Lymphomas
• Cancers of lymphatic tissue

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Objective 1 Differentiate tumors by site and
name.

• Leukemia
• Abnormal growth/proliferation of blood forming
  cells
• Gliomas
• Glial cells of the central nervous system

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Objective 2Describe common pathophysiologic
mechanisms that appear to operate in all cancers

• Autonomy
• Refers to the cancer cells independence from
  normal cellular controls
• Anaplasia
• Loss of differentiation, the process of
  developing specialized functions, and
  organization, meaning literally without form.

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Objective 2Describe common pathophysiologic
mechanisms that appear to operate in all cancers

• Transformation
• Process by which a normal cell becomes a cancer
  cell
• Progression
• An increase of abnormal biologic properties and
  not necessarily a progression in tumor size.

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Objective 2Describe common pathophysiologic
mechanisms that appear to operate in all cancers

• Contact Inhibition (density-dependent inhibition
  of growth)
• Two or more normal cells come in contact with
  each other, they tend to stop dividing and form a
  single layer or sheet of cells called a confluent
  monolayer.
• Cancer cells will continue to grow and pile up on
  top of each other even after forming the
  monolayer.

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Objective 2Describe common pathophysiologic
mechanisms that appear to operate in all cancers

• Tumor Cell Markers
• Substances produced by cancer cells that are
  found on tumor plasma membranes or in the blood,
  spinal fluid, or urine.
• Produced by cancer cells genetic material when
  it is activated during carcinogenesis.
• Utilized by
• To screen/identify patients at high risk for
  cancer
• To help diagnose the specific type of tumor
• To observe the clinical course of cancer

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Objective 3Describe tumor development

• Carcinogenesis
• Process of tumor development
• Multi step process
• Loss of the ability for the cell to terminally
  differentiate
• Loss of ability to control growth
• Loss of ability to travel to distal tissues
• Loss of the ability to invade and colonize those
  tissues

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Objective 3Describe tumor development

• Tumor Grading
• Estimates tumor differentiation
• Gauge of the tumors degree of malignancy
• Grades I-IV
• Grade I Well differentiated
• Grade IV Very poorly differentiated

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Objective 3Describe tumor development

• Staging Component of cancer diagnosis
• Stage I Cancer confined to the organ of origin
• Stage II Locally invasive
• Stage III Cancer spread to regional structures
  such as lymph nodes
• Stage IV Cancer spread to distant sights such
  as liver spreading to lung or prostate spreading
  to bone

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Objective 3Describe tumor development

• Metastasis
• The spread of tumor cells from a primary site of
  origin to a distant site
• Life threatening characteristic
• Sequential Steps of Metastasis
• Direct or continuous extension of local invasion
  of tumor cells into surrounding tissue
• Penetration into lymphatics, blood vessels, or
  body cavities
• Release into lymph or blood
• Transport to secondary sites
• Entry and growth in secondary sites

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Objective 4Describe clinical manifestations of
cancer

• Pain
• Early stages little or no pain, terminally ill
  patients 60-80 have pain
• Mechanisms that cause pain that are associated
  with cancer
• Pressure, obstruction, invasion of a sensitive
  structure, tissue destruction, inflammation,
  infection

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Objective 4Describe clinical manifestations of
cancer

• Anemia
• Caused by
• Chronic bleeding resulting in iron deficiency
• Severe malnutrition
• Medical Therapies
• Malignancy in blood-forming organs

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Objective 4Describe clinical manifestations of
cancer

• Cachexia
• The most severe form of malnutrition associated
  with cancer
• Results in wasting, emanciation, decreased
  quality of life
• Includes
• Anorexia, early satiety, weight loss, anemia,
  asthenia, poor performance, taste alterations,
  altered protein, lipid, and carbohydrate
  metabolism

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Objective 4Describe clinical manifestations of
cancer

• Leukopenia
• Caused by tumor invasion of the bone marrow
• Decreased leukocyte count
• Results from chemotherapy/radiotherapy
• Thrombocytopenia
• Decrease in number of platelets
• Major cause of hemorrhage in cancer patients

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Objective 4Describe clinical manifestations of
cancer

• Infection
• Most significant cause of complications and death
• Immunosuppression from radiation and chemotherapy

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Objective 5Identify treatment modalities for
cancer

• Chemotherapy
• Use of relatively nonselective cytotoxic drugs
  that target vital cellular machinery or metabolic
  pathways critical to both malignant and normal
  cell growth and replication.
• CURATIVE
• Must eradicate enough tumor cells so that the
  bodys own defenses can eradiate any remaining
  cells.

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Objective 5Identify treatment modalities for
cancer

• Radiation
• Goals are
• 1. Eradicate cancer w/o producing excessive
  toxicity during treatment
• To avoid damage to normal structures
• Damage from radiation can be termed lethal,
  potentially lethal, and sublethal.

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Objective 5Identify treatment modalities for
cancer

• Surgery
• Can be completely curative-cancer is removed
• Debulking surgery majority of tumor removed
• Then chemotherapy/radiation
• Palliative

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Objective 5Identify treatment modalities for
cancer

• Immunotherapy
• Specific method of treatment used to eliminate
  cancer cells without damaging normal tissues
• Referred to as Biologic Response Modifiers
  (BRMs)
• Direct cytotoxic effect on cancer cells
• Initiation/augmentation of the hosts tumor
  immune rejection response
• Modification of cancer cell susceptibility to the
  lytic or tumor-static effects of the immune
  system
• Classifications of BRMs include interferon,
  antigens monoclonal antibodies

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Objective 5Identify treatment modalities for
cancer

• Interferon (BRM)
• Family of cell-derived proteins that have
  antiviral and immune modulating activities.
• Interferon-alpha
• Inhibits tumor growth
• Enhances natural killer cell activity
• Increases cancer cell expression of tumor antigens

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Objective 5Identify treatment modalities for
cancer

• Antigens (BRM)
• Research
• Identify tumor specific antigens used to develop
  anticancer vaccines
• Used either to augment the hosts immune response
  against the tumor
• Preventative immunization techniques to inhibit
  cancer emergence in the population at risk

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Objective 5Identify treatment modalities for
cancer

• Monoclonal Antibodies
• Developed and used as diagnostic reagents for
  detecting cancer because their high specificity
  for antigen could reduce the number of false
  results.
• Provide earlier detection of neoplastic disease

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Objective 6Identify the various theories of
carcinogenesis

• The Three-Step Theory of Invasion
• Three steps include
• Attachment mediated by specific attachment
  factors
• Anchored tumor cells secrete proteolytic enzymes
  or induce host cells to produce them
• Tumor cell locomotion in to the degraded region
  of the matrix

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Objective 6Identify the various theories of
carcinogenesis

• Personal Behavior
• Tobacco use
• Diet
• Alcohol
• Sexual/Reproductive Behavior

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Objective 6Identify the various theories of
carcinogenesis

• Environmental Risks
• Air pollution
• Occupation
• UV Radiation
• Ionizing Radiation
• Hormones
• Oral Contraceptives
• Estrogens/ Progesterones/Androgens

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Objective 7Identify carcinogenic pathogens

• Oncogenic Virus
• Cancer causing viruses
• Cause a specific type of malignant or benign
  tumor in susceptible individuals.
• Three major types of oncogenic viruses
• Papovaviruses
• Adenoviruses
• Herpesviruses

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Objective 7Identify carcinogenic pathogens

• Direct Mechanisms
• Mechanism for viral carcinogenesis
• The tumor cells are or were at some stage
  infected with the oncogenic virus
• Indirect Mechanisms
• Mechanism for viral carcinogenesis
• The neoplastic cells were not altered by the
  virus but were stimulated to grow because of the
  viral infection

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Objective 8Identify common sites for cancer
with relationship to age and sex

• Children
• Women
• Men