CHAPTER 21 Oncology Cancer Medicine Oncology Overview Cancer

CHAPTER 21 Oncology (Cancer Medicine)

Oncology Overview • Cancer – Refers to a group of diseases, consisting of more than 10 different types – Can originate in almost any body organ • Most common site for women is the breast • Most common site for men is the prostate gland 2

Cancer Terms • Neoplasia – Development of an abnormal growth of new cells that is unresponsive to normal growth control mechanisms • Neoplasm – Any abnormal growth of new tissue that serves no useful purpose – Neoplasm = tumor 3

Cancer Terms • Differentiation – Cells become specialized and differentiated both physically and functionally • Cells look and act like the parent cell, or tissue of origin • Anaplasia – Loss of cellular differentiation and reversion to a more primitive form • Anaplasia = dedifferentiation 4

Cancer Terms • Malignant – Tending to become worse and cause death • Metastasis – Process by which malignant cells spread to other parts of the body 5

Benign versus Malignant Tumors • Benign – Usually encapsulated – Cells similar in structure to cells from which they originate – Well-defined borders – Slow growing and limited to one area – Possible growth displacement (but not invasion) to adjacent tissue 6

Benign versus Malignant Tumors • Malignant – Not encapsulated; not cohesive, and irregular pattern of growth – No resemblance to cell of origin – No well-defined borders – Growth into adjacent cells rather than displacing or pushing them aside – Rapid growth through rapid cell division and multiplication 7

Classification of Neoplasms • System for naming neoplasms – Root word to indicate type of body tissue that gives rise to neoplasm – Suffix to indicate whether tumor is benign or malignant • Benign tumor suffix = oma • Malignant tumor suffix = carcinoma or sarcoma 8

Classification of Neoplasms • Carcinomas – Solid tumors that originate from epithelial tissue • Tissue that covers external and internal body surfaces, lining of vessels, body cavities, glands, and organs • Sarcomas – Originate from supportive and connective tissue • Bone, fat, muscle, and cartilage 9

Grading of Neoplasms • Grading – Measures extent to which tumor cells differ from their parent tissue – Grade 1 = well-differentiated cells, function most like the parent tissue • Least malignant – Grade 4 = least differentiated cells, not like the parent tissue • Most rapidly increasing in number 10

Staging of Neoplasms • Staging – Extent of disease and relative size of tumor – TNM staging classification system • Internationally recognized system used for staging neoplasms • T: (0 -4) = tumor size (primary) • N: (0 -3) = degree of regional lymph node involvement • M: (0 -3) = presence or absence of distant metastases 11

Risk Factors • Lifestyle and environmental risk factors – Tobacco – Alcohol – Diet – Sunlight – Radiation – Industrial agents and chemicals – Hormones 12

Risk Factors • Lifetime risk – Probability that an individual, over the course of his or her lifetime, will develop cancer or will die from cancer • Relative risk – Measures the strength of the relationship between risk factors and particular types of cancer 13

Warning Signs of Cancer • Need for immediate follow-up – C = Change in bowel or bladder habits – A = A sore that does not heal – U = Unusual bleeding or discharge – T = Thickening or lump in breast or elsewhere – I = Indigestion or difficulty in swallowing – O = Obvious change in a wart or mole – N = Nagging cough or hoarseness 14

SPECIFIC TYPES OF CANCER Oncology (CANCER MEDICINE)

Basal Cell Carcinoma • Pronounced – (BAY-sal sell car-sih-NOH-mah) • Defined – Most common malignant tumor of epithelial tissue, occurring most often on areas of skin that are exposed to the sun • Presents as a slightly elevated nodule with a depression or ulceration in center that becomes more obvious as the tumor grows 16

Carcinoma of the Breast: Breast Cancer • Pronounced – (kar-sih-NOH-mah of the breast) • Defined – Malignant tumor of the breast tissue – Most common type, ductal carcinoma, originates in the mammary ducts 17

Bronchogenic Carcinoma • Pronounced – (brong-koh-JEN-ik kar-sih-NOH-mah) • Defined – Malignant lung tumor that originates in bronchi – Lung cancer 18

Cervical Carcinoma • Pronounced – (SER-vih-kal kar-sih-NOH-mah) • Defined – Malignant tumor of the cervix • Most common malignancies of female reproductive tract 19

Colorectal Cancer • Pronounced – (koh-loh-REK-tal CAN-ser) • Defined – Presence of a malignant neoplasm in large intestine • Most are adenocarcinomas • At least 50 percent originate in the rectum, causing bleeding and pain 20

Endometrial Carcinoma • Pronounced – (en-doh-MEE-tree-al kar-sih-NOH-mah) • Defined – Malignant tumor of inner lining of uterus – Also known as adenocarcinoma of uterus • Classic symptom is inappropriate uterine bleeding • Most common cancer of female reproductive tract after menopause 21

Lymphoma • Pronounced – (LIM-foh-mah) • Defined – Lymphoid tissue neoplasm that is typically malignant – Painless enlarged lymph node(s) – Progressing to anemia, weakness, fever, and weight loss 22

Kaposi’s Sarcoma • Pronounced – (KAP-oh-seez sar-KOH-mah) • Defined – Rare malignant lesions that begin as soft purple-brown nodules or plaques on feet and gradually spread throughout the skin • Most often associated with AIDS 23

Malignant Melanoma • Pronounced – (mah-LIG-nant mel-ah-NOH-mah) • Defined – Malignant skin tumor originating from melanocytes in preexisting nevi, freckles, or skin with pigment – Darkly pigmented tumor with irregular surfaces and borders – Variable colors 24

ABCDs of Malignant Melanomas • • Asymmetry Borders Color Diameter 25

Neuroblastoma • Pronounced – (noo-roh-blass-TOH-mah) • Defined – Highly malignant tumor of the sympathetic nervous system 26

Oral Leukoplakia • Pronounced – (OR-al loo-koh-PLAY-kee-ah) • Defined – Precancerous lesion occurring anywhere in the mouth • Elevated gray-white or yellow-white leathery surfaced lesions have clearly defined borders 27

Ovarian Carcinoma • Pronounced – (oh-VAY-ree-an car-sin-OH-mah) • Defined – Malignant tumor of the ovaries – Most commonly occurring in women in their 50 s • Rarely detected in early stage 28

Pancreatic Cancer • Pronounced – (pan-kree-AT-ik CAN-sir) • Defined – Life-threatening primary malignant neoplasm typically found in head of pancreas 29

Carcinoma of the Prostate • Pronounced – (car-sin-OH-mah of the PROSS-tayt) • Defined – Malignant growth within the prostate gland, creating pressure on upper part of urethra 30

Carcinoma of the Prostate • Symptoms – Occur in later stages and may include: • • Urinary frequency, especially at night Difficulty starting or stopping urine flow Inability to urinate Weak or interrupted flow or urine when urinating Pain or burning when urinating Pain or stiffness in lower back, hips, or thighs Painful ejaculation 31

Renal Cell Carcinoma • Pronounced – (REE-nal SELL kar-sih-NOH-mah) • Defined – Malignant tumor of the kidney, occurring in adulthood • Patient is asymptomatic until latter stages of the disease 32

Squamous Cell Carcinoma • Pronounced – (SKWAY-mus sell car-sih-NOH-mah) • Defined – Malignancy of the squamous or scalelike cells of the epithelial tissue – Much faster growing than basal cell carcinoma – Greater potential for metastasis if not treated 33

Squamous Cell Carcinoma • Frequent sites on sun-exposed areas – Top of nose – Forehead – Margin of external ear – Back of hands – Lower lip 34

Carcinoma of the Testes • Pronounced – (car-sin-OH-mah of the TESS-teez) • Defined – Malignant tumor of the testicle that appears as a painless lump – Also called testicular cancer • Rare type of tumor • Usually occurs in men under the age of 40 35

Cancer, Thyroid Gland • Pronounced – (CAN-sir, THIGH-royd gland) • Defined – Malignant tumor of the thyroid gland – Leads to dysfunction of the gland thus inadequate or excessive secretion of the thyroid hormone 36

Intracranial Tumors • Pronounced – (in-trah-KRAY-nee-al TOO-morz) • Defined – Tumors occurring in any structural region of the brain • May be malignant or benign • Classified as primary or secondary • Named according to tissue from which they originate 37

Metastatic Intracranial Tumors (Secondary) • Pronounced – (met-ah-STAT-ik in-trah-KRAY-nee-al TOOmorz) • Defined – Tumors occurring as a result of metastasis from a primary site such as the lung or breast 38

Primary Intracranial Tumors • Pronounced – (PRIGH-mah-ree in-trah-KRAY-nee-al TOOmorz) • Defined – Tumors that arise from gliomas and meninges • Gliomas = malignant glial cells that are a support for nerve tissue 39

Primary Intracranial Tumors • Glioblastoma multiforme – Most rapidly growing of the gliomas • Astrocytomas – Tend to invade surrounding structures • Ependymomas – Occur more commonly in children and adolescents – Usually encapsulated and benign 40

Primary Intracranial Tumors • Oligodendrogliomas – Usually slow growing • Medulloblastomas – Occur most frequently in children between 5 and 9 years of age – Rapid growing; poor prognosis • Meningiomas – Occur most often in adults – Slow growing 41

Wilms’ Tumor • Pronounced – (VILMZ TOO-mor) • Defined – Malignant tumor of the kidney occurring predominately in childhood • Most frequent finding is palpable mass in the abdomen 42

TREATMENT TECHNIQUES AND PROCEDURES ONCOLOGY

Treatment Techniques and Procedures • Chemotherapy – Use of cytotoxic drugs and chemicals to achieve a cure, decrease tumor size, provide relief of pain, or slow metastasis 44

Treatment Techniques and Procedures • Immunotherapy – Agents capable of changing the relationship between a tumor and the host are known as biological response modifiers (BRMs) • Agents are used to strengthen individual’s immune responses 45

Treatment Techniques and Procedures • Mohs Surgery – Surgical procedure in which the cancerous tumor is removed in stages – Tissue is examined for evidence of cancer – Additional tissue is removed until negative boundaries are confirmed • Advanced treatment procedure for skin cancer 46

Treatment Techniques and Procedures • Radiation therapy – Delivery of ionizing radiation to accomplish one or more of the following: • • • Destruction of tumor cells Reduction of tumor size Decrease in pain Relief of obstruction To slow or stop spread of cancer cells 47

Treatment Techniques and Procedures • Radiation therapy – Destroys rapidly multiplying cells regardless of whether they are cancerous – Goal is to reach maximum tumor control with no, or minimum, normal tissue damage – May be delivered by teletherapy (external) – May be delivered by brachytherapy (internal) 48

Treatment Techniques and Procedures • Surgery – Tumor removal through surgery – In more than 90 percent of all cancers, surgery is used for diagnosing and staging – In more than 60 percent of all cancers, surgery is the primary treatment • When feasible, the primary tumor is excised in its entirety 49

Treatment Techniques and Procedures • Common surgical procedures – Incisional biopsies • Used to remove a piece of a tumor for examination and diagnosing – Excisional biopsies • Used to remove the tumor and a portion of normal tissue – En block resection • Removal of a tumor and a large area of surrounding tissue that contains lymph nodes 50

Treatment Techniques and Procedures • Common surgical procedures – Fulguration • Destruction of tissue with electric sparks – Electrocauterization • Destruction of tissue by burning 51

Treatment Techniques and Procedures • Common surgical procedures – Cryosurgery • Destruction of tissue by freezing the malignant tissue – Exenteration • Wide resection that removes the organ or origin and surrounding tissue 52