Cellular Aberration MALIGNANT – having cells that are characteristic of

● Branch of medicine that deals with the study, cancer.

detection, treatment and management of cancer
and neoplasia. METASTASIS – spread of cancer cells from primary
tumor to distant sites
Etiologic Factors
● Oncogenes – specialized cells triggering CA cells MUCOSITIS – inflammation of the lining of the mouth,
growth throat, gastrointestinal tract often associated with cancer
therapy
What is Cancer?
➢ A large group of disease characterized by: MYELOSUPPRESSION – suppression of the blood cell
● Uncontrolled growth and spread of producing function of the bone marrow.
abnormal cells
● Proliferation (rapid reproduction by cell CYTOKINES – substance produced primarily by the cells
division) of the immune system to enhance production and
● Metastasis (spread or transfer of cancer functioning components of the immune system.
cells from one organ or part to another not
directly connected) EXTRAVASATION – leakage of intravenous medication
➢ A departure from what is normal, usual or from the veins into the subcutaneous tissues
expected
➢ Typically one that unwelcome or unexpected GRADING – identification of the type of tissue from
➢ A characteristic that deviates from the NORMAL which the tumor originated and the degree to which the
type tumor cells retain the functional and structural
➢ An anomaly due to distinctive morphologic characteristics of the origin alter organs or body
alterations of the cell and aberration of tissue
patterns CANCER CELLS developed ❖ Cancer was recognized in ancient times by skilled
observers who give the name “CANCER” ( Latin,
Definition of Terms: ‘CANCRI’ --- CRAB) because it reaches out in
BRACHYTHERAPY – delivery of radiation therapy many directions like the legs of a crab.
through internal implants placed inside or adjacent to the ❖ Is a disease of the cell in which the normal
tumors. mechanisms of control of growth and proliferation
are disturbed.
CARCINOGENESIS – process of transforming normal ❖ A disease caused when cell divide uncontrollably
cells to malignant cells and spread into surrounding tissues
❖ Resulting to distinctive morphologic alterations of
CARCINOGENS – chemicals; physical factors; and other the cell and aberrations of tissue patterns
agents that cause cancers ❖ Is caused by changes to the DNA or genetic
mutations of the cellular
CHEMOTHERAPY – the use of medications to kill tumor DEOXYRIBONUCLEIC ACID
cells by interfering with cellular functions and production. ❖ Genetic mutations may be inherited and / or
acquired, leading to abnormal cell behavior
ALOPECIA – hair loss
GRAFT – VERSUS – HOST DISEASE (GVHD) = an
ANAPLASIA – a pattern of growth in which cells lack immune response initiated by T lymphocytes or T cells of
normal characteristics and differ in shape and organization donor tissue against the recipient tissues ( skin, GIT, liver);
with respect to their cell's origin. Usually this anaplastic UNDESIRABLE RESPONSE
cells are malignant cells
T – Cells = are WBC that helps the immune system fight
ANGIOGENESIS – growth of new blood vessels that new against infected host cells, producing cytokines and
cancer cells to grow regulating the immune response.

APOPTOSIS – a normal cell mechanism of program cell GRAFT – VERSUS – TUMOR EFFECT = the donor
death immune cell response against the malignancy. Desirable
response.
BENIGN – not cancerous; benign tumors may but are
unable to spread to other organs of the body NADIR – lowest point of white blood cell depression after
therapy that has toxic effects on the bone marrow.
NEOPLASIA – uncontrolled cell growth that follows no
physiologic demands.

PALLIATION – relief of symptoms and promotion of

comfort and quality of life regardless of the disease stage.

RADIATION THERAPY – the use of ionizing radiation

to kill malignant cells ɰɰ

STAGING – process of determining the extent of disease,

including tumor size and spread or metastasis to distant
sites.

STOMATITIS – inflammation of oral tissues, often

associated with some chemotherapeutic agents and
radiation therapy to head and neck region

THROMBOCYTOPENIA – decrease in the number of

circulating platelets associated with the potential bleeding.

VESICANT – substance that can cause inflammation,

damage and necrosis with extravasation from blood vessels
and contact with tissues

HYPERPLASIA – an increase in cell number

HYPERTROPHY – an increase in cell size

METAPLASIA – replacement of one adult cell type by a

different adult cell type

DYSPLASIA - changes in cell size, shape and organization

ADENOCARCINOMA – cancer arises from glandular

tissues. E.g., Cancer of the breast, lung, thyroid, colon, and
pancreas

CARCINOMA – a form of cancer that is composed of

epithelial cells; develops in tissues covering or lining
organs of the body such as skin, uterus or breast

SARCOMA – a cancer of supporting or connective tissues

such as cartilage, bones, muscles of fats
ETIOLOGY/ CAUSATIVE FACTORS OF CANCER
1. Viruses
2. Chemical Carcinogens
3. Physical Stressors
4. Hormonal Factors
5. Genetic Factors
 Classification of Cancer
According to behavior of Tumor:
● Benign
➔ tumors that cannot spread by invasion or
metastasis; hence, they grow locally
● Malignant
➔ tumors that are capable of spreading by
invasion and metastasis. By definition, the
term “cancer” applies only to malignant

Characteristics of Neoplasia (BENIGN)

Pathophysiology of CA ● 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

Abnormal cell formed by mutation of DNA Cell grows and

proliferates Metastasis occurs when ABN.

Cells invade other tissue, through lymph and blood

Cancer development linked to immune system failure

Example of clients susceptible to developing cancer

● CANCER is a disease process that begins when a

cell is transform by genetic mutations of the
cellular DEOXYRIBONUCLEIC ACID (DNA)
● GENETIC MUTATIONS may be inherited and /
or acquired leading to abnormal cell growth.
● leading to form a clone and proliferate abnormally
( cells grow abnormally faster than normal cells)
● evading (avoiding) the normal intracellular and
extracellular growth- regulating process as well as
the immune system defense mechanism of the
body.
● lead to abnormalities in the cell signaling
Transduction process (virus transfers genetic
material from one bacterium to another) that can in
turn lead to cancer development.
● Then cells acquire a variety of capabilities that
allow them to invade surrounding tissues and gain
access to lymph nodes and blood vessels.
● Then to other areas of the body resulting in
metastasis or spread of the cancer cells.
 Stage 3: PROGRESSION
● The altered cells exhibit increasingly malignant
behavior. These cells has the ability to stimulate
angiogenesis (growth of new blood vessels to
allow cancer cells to grow), to invade adjacent
tissues and to metastasize
Pathogenesis of Cancer
CELLULAR TRANSFORMATION AND
DERANGEMENT THEORY
● Conceptualizes that normal cells may be
transformed into cancer cells due to exposure to
some etiologic agents.

FAILURE OF THE IMMUNE RESPONSE THEORY

Patterns of Cell Proliferation ● Advocates that all individuals possess cancer cells,
● Metaplasia however, these cancer cells are recognized by the
➔ conversion of one type of cell in a tissue to immune response system. So, the cancer cells
another type not normal for that tissue undergo destruction
● Anaplasia ● Failure of the immune response system leads to
➔ change in the DNA cell structure and inability to destroy the cancer cells.
orientation to one another, characterized
by loss of differentiation and a return to a ETIOLOGIC FACTORS TO CANCER
more primitive form. 1. Viruses and Bacteria
● Neoplasia 2. Physical Agents
➔ uncontrolled cell growth, either benign or 3. Chemical Agents
malignant 4. Genetic and Familial factors
5. Lifestyle Factors
METASTASIS: 3 STAGES 6. Hormonal Agents
● Stage 1: Invasion
➔ neoplastic cells from primary tumor ● Viruses and Bacteria
invade into surrounding tissue with ➔ Estimated about 11% of all cancers
penetration of blood or lymph worldwide are linked to viral infection.
● Stage 2: Spread ➔ After infecting the individual, DNA virus
➔ tumor cells spread through lymph or insert a part of their own DNA near the
circulation or by direct expansion infected cell genes causing cell division
➔ These new formed cells now carry viral
● Stage 3: Establishment and growth
DNA that lack normal controls on growth
➔ tumor cells are established and grow in
➔ Oncogenic viruses may be one of the
secondary site: lymph nodes or in organs
multiple agents acting to initiate
from circulation
carcinogenesis.
➔ Prolonged or frequent viral infections may
CARCINOGENESIS; 3 STEPS
cause breakdown of the immune system or
Step 1: INITIATION
overwhelm the immune system.
● Carcinogens (substance that can cause cancer)
➔ Example of Viral Infections that Increase
● Causes mutations in the cellular DNA
Risk of certain CAncer are as follows:
● Normally these alterations are reversed by DNA ➢ HUMAN PAPILLOMAVIRUS (
repair mechanisms or changes initiate programmed HPV ) ---- CERVICAL
cellular death (APOPTOSIS}. CANCER; HEAD and NECK
● On this stage the mutation are not significant until CANCER
the second step ➢ HEPATITIS “B” and “C”
VIRUS (HBV)----hepatocellular /
Stage 2: PROMOTION Liver Cancer
● Repeated exposure to carcinogens causes ➢ EPSTEIN – BARR VIRUS
proliferation and expansion of initiated cells with (EBV) --- (nasopharyngeal cancer
increased abnormal genetic formation. Generally and Burkitt lymphoma ( a non
leads to the formation of preneoplastic or benign Hodgkin lymphoma (NHL). A
lesion cancer of the lymphatic system.
 ➢ HELICOBACTER PYLORI --- CARCINOGENS , changes in cell
GASTRIC CANCER due to structures occur > then malignant tumors
chronic irritation and develop.
inflammatory reaction to bacteria ➔ Regardless of the cause , several cancers
are associated with familial patterns
● Physical Agent ➔ Example:
➔ EXPOSURE TO SUNLIGHT ➢ Retinoblastoma (nerve cells in the
➔ Radiation retina develop genetic mutation
➔ Chronic irritation or inflammation forming to tumors.
➔ Tobacco carcinogens ➔ Genetic:
➔ Industrial chemicals ➢ Pheochromocytoma – small
➔ Asbestos vascular tumor of the adrenal
➔ Physical irritation / trauma : from pipe medulla, causing irregular
smoking; multiple deliveries; jagged secretion of epinephrine and
tooth; irritation of the tongue; “overuse of norepinephrine.
any organ / body part ➢ Wilms tumor – or
➔ Excessive exposure to ultraviolet light nephroblastoma, the most
rays of the sun, especially to fair skinned common pediatric abdominal
people, increases the risk of SKIN cancer
CANCER ➢ Meningiomas - central nervous
➔ Exposure to ionizing radiation can occur system tumor usually begins in
with repeated diagnostic X-RAY the brain or spinal cord
procedures or with radiation therapy. ➢ Lung cancer/ breast cancer / acute
➔ Radiation therapy used in cancer treatment leukemia / ovarian cancer /
and exposure to material radioactive colorectal / stomach / thyroid.
materials at nuclear weapon
manufacturing and nuclear power plants ● Lifestyle factors
has bee associated with a higher incidence ➔ Approximately ¼ to 1/3 of all cancers
of LEUKEMIA; MULTIPLE have been linked to lifestyle factors such
MYELOMA ( bone marrow cancer ); as obesity; diet; and insufficient physical
CANCER OF THE LUNGS; BREAST; activity.
THYROID AND OTHER TISSUES ➔ Above factors are second only to tobacco
➔ RADON are odorless, invisible use as the major risk factors associated
radioactive gas naturally released from with cancer development
ROCKS, SOIL, AND WATER. --- ➔ Tobacco ( TAR nicotine) – 90 % of all
breathing in high levels of these can cause cases of lung cancer
LUNG cancer. ➔ Dietary substances such alcohol use fats;
alcohol; salt-cured or smoked meats;
● Chemical Agent nitrate and nitrate containing and red and
➔ These factors act by causing cell mutation processed meats.
or alteration in cell enzymes and proteins ➔ Heavy alcohol use increases the risk of
causing altered cell replication. cancers of the mouth, pharynx; larynx;
➔ EXAMPLE: esophagus; liver, colon; rectum and breast.
➢ Industrial compounds - Vinyl ➔ Poor diet and obesity are contributing
chloride ( used for plastic factors to cancer of the breast; (in
manufacture; asbestos factories) menopausal women); colon;
➢ Polycyclic aromatic hydrocarbons endometrium; esophagus and kidneys.
( refuse burning; auto and truck ➔ Obesity is associated with cancer of the
emissions; oil refineries; air pancreas; gallbladder; thyroid; ovary and
pollution.). cervix and for multiple myeloma,
➢ fertilizers and weed killers / Hodgkin lymphomas; and aggressive
pesticides prostate cancer.
➢ Dyes (aniline dyes, hair bleach)
● Hormonal Agents
● Genetics and Familial Factors ➔ TUMOR growth are also related to
➔ When oncogene ( hidden or repressed disturbance in hormonal balance either by:
genetic code for cancer that exists to all ➔ ENDOGENOUS ( body’s own hormonal
individuals) is EXPOSED to production)
 ➔ EXOGENOUS ( administration of probably due to greater exposure to carcinogens,
hormone not produce not produced by the more stressful lifestyle and greater consumption of
patient endocrine glands). preservatives.
➔ Early menarche (before age 12) and ● GEOGRAPHIC DISTRIBUTION
delayed menopause (after 55) never giving - the most common type of cancer in Japan
birth and delayed child birth ( after 30) are is Gastric cancer
associated with increase risk of BREAST - In the US Breast cancer may be due to
cancer influence of environmental factors such as
➔ Women who take ESTROGEN or diet, ethnic customs and types of
combined with PROGESTERONE after pollution. Japanese diets usually consist of
menopause got a high risk to breast cancer RAW foods
● OCCUPATION: Chemical factory workers,
Roles of Immune System farmers, radiology have a greater risk of exposure
● WHEN THE IMMUNE system fails to identify to carcinogens
and stop the growth of transformed (abnormal) ● HEREDITY : positive family history to cancer
cells, a tumor can develop and progress. increases the risk of developing the disease.
● Patients who are immune compromised have an - In adult, approx. 34 % cancers have
increase incidence of developing cancer familial basis that includes breast/ ovarian
● Post transplanted client who are receiving / colorectal / prostate / melanoma / uterine
immunosuppressive therapy to organ rejection / leukemia / sarcomas / and primary brain
● Acquired immune deficiency syndrome > Kaposi tumors
sarcoma (a cancer that forms in the lining of blood ● STRESS : depression; grief ; anger; aggression;
and lymph vessels despair; or life stresses decreases
● Patients who were previously treated for ONE - immunocompetence because of affected
cancer are at risk for secondary hypothalamus and pituitary gland. -
immunodeficiency may spur the growth
Normal Immune Response and proliferation of cancer cells.
● An intact immune system has the ability to ● PRECANCEROUS LESIONS
recognize and combat cancer cells - PIGMENTED MOLES / BURN SCARS /
● Once the TAA ( Tumor- Associated Antigen , also senile keratosis / leukoplakia / Benign
called as Tumor Cells Antigen) are found in the polyps / adenoma of the colon or stomach
membranes of many cells and are recognized as / fibrocystic disease of the breast may
FOREIGN, >>>> T- Cell lymphocytes release undergo transformation into cancerous
several cytokines (helps regulate the body’s lesions and tumors.
immune response to inflammation and disease) ● OBESITY : Linked to breast and colorectal cancer
● These cytokines elicit various immune system
action including:
1. Proliferation of cytotoxic T- lymphocytes
capable of direct destruction of cancer
cells.
2. Induction of cancer apoptosis.
3. Recruitment of additional immune system
cells ( B-cell lymphocytes that produce
antibodies, natural killer and
macrophages) that contribute to the
destruction and degradation of cancer
cells.

Contributing Factors to Cancer

● AGE .. Older individuals are more prone to cancer
because they have been exposed to carcinogens .
And they have developed alterations in the immune
system.
● SEX …. The most common type of cancer in
females is BREAST cancer. For males is
PROSTATE cancer
● URBAN vs RURAL … cancer are more common
among urban dwellers than rural residents.