34316408 Cellular Aberrations

8/6/2019 34316408 Cellular Aberrations

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CELLULAR

ABERRATIONBy

Mark Vincent C. Cenita, RN,MN


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Safeguards against cancer

Steps in controlling cancer

Diet

Early detection


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CELLULAR ABERRATION

A group of disorders

characterized by abnormal cellgrowth and the ability tometastasize with potential in

killing the host.


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CANCER The term cancer refers to the group

of diseases in which cells grow and

spread unrestrained throughout thebody.

Derives from the latin crab which

means cancer

Synonymous with neoplasm


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Acquire invasive characteristics,changes in occurring in surroundings.

Is not a single disease with a singlecause.

CARCINOGENESIS- Process of transformation from normal cell

to a neoplastic cell

CANCER


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INVASION

Occurs when cancer cells infiltrate adjacenttissues surrounding the neoplasm.

METASTASIS

Occurs when malignant cells travel through

the blood or lymph and invade othertissues and organs to form a secondarytumor.

DIFFERENTIATION

Refers to the process whereby cellsdevelop specific structures and function isorder to specialized in certain task.


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Top 5 cancer incidence by site &

sex:

Male Female

1. Prostate 1. Breast

2. Lungs 2. Lungs

3. Colon 3. Colon

4. Urinary Tract 4. Uterus

5. Leukemia 5. Leukemia & Lymphoma


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MEN High incidence of cancer of the

lung and bladder Most common neoplasm aged 20 to

34 is TESTICULAR CANCER


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WOMEN BREAST CANCER followed by

lung and brochus, colon andrectum


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Classification ofTumor:

1. Benign- are tumors designated byattaching the suffix oma to the cells of

origin.

e.g. Fibroma

Chondroma

Osteoma


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Classification ofTumor:

2. Malignant- tumors that are capableof spreading by invasion and

metastasis.e.g. Fibrosarcoma

Chondrosarcoma


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COMPARISON OF THECHARACTERISTICS OF BENIGN AND

MALIGNANT NEOPLASMCHARACTERISTICS BENIGN MALIGNANT

Speed of growth Slow growth Aggressive growth; rapid cells

division and growth

Grows by expansion Establish new site malignant

lesions

Mode of growth Localized and encapsulated Invade surrounding tissues

Cell characteristic Well differentiated With poor cell differentiated

Metastasis It does not metastasized Ability to migrate, cells move to

distant areas of the body

No tissue damage Destroy surrounding tissues

Prognosis Very good prognosis

Does not cause death

unless localization

affect vital function

Poor prognosis

Can lead to death unless

interventions are taken


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Benign Tumor


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MalignantTumor


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CLASSIFICATION OF

CANCER1. CARCINOMA - Refers to a tumor

arises from epithelial tissue, the nameof the cancer identifies the location,e.g. basal cell carcinoma

2. SARCOMA - Refers to a tumor arising

from supportive tissue; the name of thecancer identifies the specific tissueaffected


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3. LEUKEMIA - A malignant disorder of

the blood-forming tissues of the bonemarrow, spleen, and lymphsystem characterize by unregulatedproliferation ofWBCs and their

precursors.4. LYMPHOMA - A group of malignant

neoplasm that affects the lymphaticsystem resulting in theproliferation of lymphocytes

5. MYELOMA


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NOMENCLATURE OF TUMORS

Tissue of Origin Benign Malignant

Connective tissue

and derivatives Fibroma Fibrosarcoma

Lipoma Liposarcoma

Chondroma Chondrosarcama

Osteoma

Osteogenic

Sarcoma

Blood Vessels Hemangioma Angiosarcoma

Lymph vessels LymphangiomaLymphangio-sarcoma

Brain coverings Meningioma

Invasive

Meningioma

Hematopoietic cells Leukemias


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Lymphoid tissue

Malignant

Lymphomas

Smooth muscles Leiomyoma Leiomyosarcoma

Striated Muscles Rhabdomyoma

Rhabdomyo-

sarcoma

Epithelial tumors

Stratified squamous

Squamos cell

papilloma

Squamos cell

carcinoma

Basal cells

Basal cell

carcinoma

Liver cells

Liver cell

adenoma

Hepatocellular

carcinoma

Placental

epethelium

(trophoblast)

Hydatidiform

mole Choriocarcinoma


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PATHOGENESIS OF

CANCER

Cellular Transformation

and Derangement Theory Failure of the Immune

Response Theory


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Cellular Transformation

and Derangement Theory

conceptualizes that normal

cells may be transformed intocancer cells due to exposureto some etiologic agents


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Failure of the Immune

Response Theory advocates that all individuals possess

cancer cells. However, the cancercells are recognized by the immuneresponse system. So, the cancer cellsundergo destruction. Failure of the

immune response system leads toinability to destroy the cancer cells.


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Acquired

(environmental)DNA damagingagent: --Chemicals-Radiation-Viruses

NORMAL

CELL

DNA Damage

SuccessfulDNA repair

Failure ofDNA repair

Mutation ofthe cell

Activation ofoncogenes

Alteration ofgenes

Inactivation ofcancer suppressorgenes

Expression of alteredgene products

Malignantneoplasm

Flow Chart DepictingMolecular Basis ofCancer


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CarcinogenesisSteps:

1. Imitation2. Promotions

3. Latency

4.Progression

5. Invasion to neighboring organs


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Stages of Tumor

Progression HYPERTROPY

-

Increase in size of normal cellsATROPHY

- Shrinkage of cell size

HYPERPLASIA- Increase in number of normal cells


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METAPLASIA

- Conversion from the normal pattern ofdifferentiation of one type of cells into

another type of cell not normal for thattissue

DYSPLASIA

- Alteration in the shape, size,appearance, and distribution of cells


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ANAPLASIA

- Disorganized, irregular cells that have

no structure and have lots ofdifferentiation; the result is almostmalignant


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Classification, Grading &

Stages TNM Classification

T (extent of primary tumor)

TX cannot be adequately assessedTO no evidence of primary tumorTIS Tumor in situ localized; no

spread

T1- 4 progressive increase in size1:5 cm < 2:6-9 cm3:10-15 cm 4:15 cm >


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Stages TNM Classification

N (regional Lymph Node)

Nx cannot be assessed clinically

NO no evidence of regular node

metastasisN1 4 increasing involvement of

nodes


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Stages Stages

0 benign state

I spread to nearby tissue

II 2-5 cm sometimes involve lymph

III more than 5 cm spread

advanced spread to connectivetissue.

IV - Mestastasis


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Types of Metastasis Extension & Invasion

1. Lymphatic Spread

2. Seeding of body cavities & surfaces

3. Hematogenous spread


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ETIOLOGIC FACTORS

(Carcinogens)1. Viruses

2. Chemical carcinogens3. Physical agents

4.

Hormones5. Genetics


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Virusesoncogenic viruses

Prolonged or frequent viralinfections may causebreakdown of the immune

system or overwhelm theimmune system.


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Chemical carcinogens act by causing cell mutation or alteration

in cell enzymes and proteins

E.g.1. Industrial compounds vinyl chloride,

polycyclic aromatic hydrocarbons, fertilizers,weed killers, dyes, drugs

2. Hormones estrogen, diethylstilbestrol (DES)

3. Foods, preservatives nitrites, talc, foodsweeteners, nitrosomines, aflatoxins,polycyclic hydrocarbons


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Physical agents1. Radiation x-ray or radioactive

isotopes, sunlight/UV rays

2. Physical irritation or trauma pipe smoking, multiple deliveries,

jagged tooth, irritation of the

tongue, overuse of anyorgan/body part


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Hormones estrogen as replacement

therapy increases incidence ofvaginal and cervicaladenocarcinoma


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Genetics oncogene when exposed

to carcinogens

changesin cell structure becomesmalignant


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PREDISPOSING FACTORS1. Age older individuals are more prone to

cancer

2. Sex women (more prone to breast,uterus and cervical cancer) while men(prostate and lung cancer)

3. Urban vs. Rural residence cancer ismore common among urban dwellers


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4. Geographic distribution due toinfluence of environmental factors

such as national diet, ethnic customs,type of solutions.

5. Occupation

6. Heredity greater risk with positivefamilial history


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7. Stress depression, grief, anger,aggression, despair of life stresses

8. Precancerous lesions may undergotransformation cancer lesions andtumors

9. Obesity studies have linked obesityto breast and colorectal cancer


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ASSESSMENT1. NURSING HISTORY

2. PHYSICAL ASSESSMENT3. DIAGNOSIS

ASSESSMENT


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NURSING HISTORY any previous exposure to known or

suspected risk factor

health history lifestyle

familial history


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PHYSICAL ASSESSMENTa. Identify WARNING SIGNAL OF CANCER

C- change in bladder and bowel habits

A- a sore that does not heal

U- unusual bleeding or discharges

T- thickening or lump in the breast

I- Indigestion and difficulty in swallowingO- overt changes in wart or mole

N- nagging cough and hoarseness of voice


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C change in bowel habits or bladder function

A a sore that does not heal

U unusual bleeding or discharge U unexplained sudden weight loss

U unexplained anemia

T thickening or lump in breast or other body parts

I indigestion or difficulty of swallowing

O obvious change in wart or mole

N nagging cough or hoarseness of voice


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Assessmentb. ImplementSAFEGUARD AGAINST CANCER

BASIC. Annual physical exam and bloodexamination. SKIN. Avoid overexposure to sunlight. ORAL. Annual oral examination. BREAST. Monthly BSE from age 20. COLON. Digital rectal exam for persons over age 40.

Rectal biopsy and proctoscopic examination, Guaiac stool

exam for persons age 50 and above. UTERUS. Annual Paps smear from age 40.

LUNGS. Avoid cigarette smoking; annual chest x-ray


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Assessmentc. Identify classification of cancer according to type of

tissue evolve from.- carcinoma or sarcoma

d. Identify systemic effects1. Anorexia, weakness, weight loss, muscle

wasting.2. Metabolic disturbances3. Fluid and electrolyte imbalances4. Pain5. Hormonial imbalances

e. Assist in diagnostic test


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DIAGNOSIS ASSESSMENTA. TISSUES SAMPLING

B. IM

AGING TECHNIQUESC. LABORATORY STUDIES

D. ROUTINE LAB EXAMS


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TISSUES SAMPLING1. Exfoliative cytology used to study

cells that the body has shed during

the normal sequence of bodytissue growth and development

2. Biopsy surgical removal of a

piece of tissue for microscopicexamination. The most definitivemethod for diagnosing CA


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3 KINDS:

a. Needle biopsy cells are

aspirated through placed in the tissue

b. Incisional biopsy removing ortaking a small sample out of tissuesmass

c. Excisional biopsy involvesremoval all of the know tumor


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IMAGING TECHNIQUES DIRECT VISUALIZATION

IND

IRECT VISUALIZATION


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DIRECT VISUALIZATIONinvolves introduction of fiber optic

endoscopy tubes into hollow organs

to view internal surfaces1. Bronchoscopy Esophagoscopy

2. Gastroscopy

3. Sigmoidoscopy4. Colonoscopy


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INDIRECT

VISUALIZATIONincludes radiologic and imaging test

1. Mammography

2. Barium enema

3. BSE

4. GI SERIES


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5. Computed Tomography

6. MRI

7. Radioisotope studies

8. Ultrasound


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LABORATORY STUDIESTUMOR MARKERS

Biochemical substance synthesizedand release by tumor cell

1. Oncofetal antigen

2. Hormones

3. Isoenzymes

4. Tissue


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ROUTINE LAB EXAM

S E.g. ALT, CBC, BILIRUBIN,

bleeding time, HCG,


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TREATM

ENTM

ODALITIES

SURGERY

RADIATION

BONE MARROWTRANSPLANTATION

CHEMOTHERAPY

BIOLOGIC RESPONSE MODIFIER


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SURGERYOften the primary treatment for CA and

may be performed for various

purposes. May be

1. Preventive

2. Diagnostic

3. Curative

4. Palliative


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RAD

IATION Often high energy ionizing radiation to

treat tumors

Used to kill the tumor, reduce the tumorsize, relieve obstruction or decrease pain,causes lethal injury to DNA, so it candestroy rapidly multiplying CA cells as well

as normal cells e.g. xrays, gamma rays &radioactive particles


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THREE SAFETYP

RINCIP

LES : Time refers to the length of exposure

minimize time spent in close proximity to

the radiation source (30 mins in 8 hr.shift)

Distance minimum distance of 6 ft.,from the radiation source

Shielding - use lead shields and otherprecautions to reduce exposure toradiation


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SOURCE

S

EXTERNAL (Teletherapy)

INTERNAL (Brachytherapy sealed)


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SOURCES OF INTERNAL

RAD

IATION : Implanted into affected tissue or body

cavity Ingested as a solution, ingested as solution Injected as a solution into the bloodstream

or body cavity Introduced thru a catheter into the tumor

Sealed involves temporarily implanting sealed

applicators that contain radioactive substanceinto various organs of the body Unsealed involves the administration of

isotopes orally or by injection


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SID

E EFFECTS : Alopecia

1. Wear wig, hat, bonnet, bandana, scarf or

anything that could be worn as a headdress.

2. Inform patient that hair will eventuallygrow back after chemotherapy.


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Skin reactions (erythema, dry/moistdesquamation)

1. Observe for early signs of skin reactionand report.

2. Keep area dry.

3. Wash area with WATER ONLY and pat

dry.4. Do not apply ointments, powders or

lotions.


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5. Do not apply heat, avoid direct sunshineor cold.

6. Use soft cotton fabrics for clothing.7. Do not erase markings on the skin.

These serve as guide for areas ofirradiation.


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Infection

1. Monitor blood counts weekly.

2. Good personal hygiene, nutrition andadequate rest.

3. Teach signs of infection to report to

physician.


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Hemorrhage

1. Monitor platelet count.

2. Avoid physical trauma or use of aspirin.

3. Teach signs of hemorrhage.

4. Monitor stool and skin for signs of

hemorrhage.5. Use direct pressure over injection sites

until bleeding stops.


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Fatigue Plenty of rest and good nutrition.

Weight loss due to anorexia, nausea andvomiting1. Arrange meal times

2. Encourage bland foods

3. Provide small attractive meals

4. Avoid extremes of temperature

5. Administer antiemetics as ordered before

meals


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Ulceration of oral mucosa (Stomatitis)

1. Administer analgesics before meals.

2. Bland diet

3. No smoking/alcohol

4. Good oral hygiene (saline rinses q2)

5. Sugarless lemon drops or mint toincrease salivation.


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Diarrhea

1. Encourage low residue, bland, high-

protein foods2. Administer antidiarrheal drugs as ordered

3. Provide good perineal care

4. Monitor electrolytes particularly Na, K, Cl


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Anorexia, nausea and vomiting- arrange meal times

- encourage bland foods

- provide small attractive meals- avoid extremes of temperature- administer antiemetics as ordered beforemeals

Headache

Social isolation


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BONE MARROW

TRANSP

LANTATION It is used in the treatment of leukemia,

in conjunction with radiation or

chemotherapy, it is usually harvestedfrom the iliac crest then transfusedintravenously.


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TYPES :1. Autologous the client is infused with

own bone marrow harvested duringremission disease

2. Syngeneic marrow donor is an identicaltwin

3. Allogenic the client is infused withdonor bone marrow harvested from ahealthy individual


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SIDE EFFECTS :

1. Malnutrition

2. Infection related to immunosuppression

3. Thrombocytopenia


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Nursing Mgt .

1. Provide private room for the hospitalized

client for 6 8 wks2. Encourage contact with significant others

3. Management of side effects


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CHEMOT

HERAP

Y Uses antineoplastic agents to treat CA

cells locally and systematically

Provides palliative measure for the pt.Who has widespread metastasis

Disrupts the cell cycle in various

phases, interfering with cellularmetabolism and reproduction.


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Cell kill hypothesis During each cycle a fixed percentage of

cells are killed by chemotherapy,

leaving some tumor cells remaining,this necessitates the repeated dosagesof chemotherapy in order to reduce

the number of cells, allowing the bodysimmune system to destroy anyremaining tumor cells.


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CONTRAIND

ICATIONS Infection

Recent Surgery

Impaired renal or hepatic function

Recent radiation therapy

Pregnancy

Bone marrow depression


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Safety precautions in handling

chemotherapeutic agents All used and unused equipment and

drugs should be treated as hazardous

wastes. Place contaminated material in leak

proof labeled as hazardous waste.


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Prepare chemotherapeutic agents in aprivate and clean setting.

Strict use of body protection techniquesincludes gloves, garment with closefront, cuffed long sleeves, face shield

and mask.


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Prevent spillage, use luer lock fittingon syringes and IV sets.

Flush immediately with water if itcomes in contact with skin and mucousmembranes.


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5M

AJOR CATEGORIES Alkylating agents

Antimetabolites

Antitumor antibiotics

Hormones and hormonesantagonists

Vinca Alkaloids


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Nursing Interventions1. GI SYSTEM

Nausea and vomiting - Administer

antiemetics. Diarrhea - Replace fluid electrolyte

losses, low fiber diet.

Constipation IncreaseO

FI and fiberin diet.


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2. INTEGUMENTARYSYSTEM

Pruritus, uriticaria Provide good skin

care. Stomatitis Provide oral care and avoid

hot and spicy food.

Alopecia Reassure that it is onlytemporary and encourage to wear wigs,hats or head scarf.


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Skin pigmentation Inform that it istemporary.

Nail changes Reassure that nails maygrow normally after chemotherapy.


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3. HEMATOPOIETIC SYSTEM

Anemia Provide frequent rest periods.

Neutropenia Protect from infection andavoid people with infection.

Thrombocytopenia Protect from traumaand avoid ASA (Aspirin).


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4. GENITO-URINARYSYSTEM

Hemorrhagic cystitis Provide 2 to 3 L of

fluids per day. Urine color changes Reassure that it is

harmless.


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5. REPRODUCTIVE SYSTEM

Premature menopause or amenorrhea

Reassure that menstruation resumesafter chemotherapy.

BIOLOGIC RESPONSE


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BIOLOGIC RESPONSEM

OD

IFIER agents that make CA pts. Biologic

response to the tumor cell more

effective.1. Immunotherapy

2. Biotherapy


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ImmunotherapyStimulates the bodys natural immune

system that restrict and destroy CA

cellsa. Nonspecific

b. Monoclonal antibody


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c. Cytokines - substance that immune

system cells produce to enhance theimmune system, normal growthregulating molecules possessing antitumor abilities

1. Interleukin - 2(IL-2)

2. Interferons

3. Hematopoietic growth factors


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BiotherapyInvolves replacing altered genes.


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DIETARY RECOMMENDATIONS

AGAINST CANCER

Avoid obesity.

Cut down on total fat intake

Eat more high fiber foods rawfruits and vegetable, whole grain

cereals.


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Include foods rich in Vitamin A &C in daily diet.

Include cruciferous vegetables inthe diet (broccoli, cabbage,cauliflower, brussel sprouts)


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Be moderate in the consumptionof alcoholic beverages.

Be moderate in the consumptionof salt (cured, smoked andnitrate-cured foods).

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34316408 Cellular Aberrations