Oncology Chapter 5 Pathology Oncology Definition Branch of

Oncology Chapter 5 Pathology

Oncology Definition �Branch of medicine that deals with the study, detection, treatment and management of cancer

Oncology � Biology of abnormal cancer cells � They have continuous or inappropriate, usually faster growth or larger growth patterns � They have no specific morphology and often do not resemble their parent cells = anaplastic � They do not respond to signals for apoptosis = programmed cell death

Oncology � Biology of abnormal cancer cells � Have a large nuclear – cytoplasmic ratio; the nucleus may occupy most of the cell area � They lose some or all of their normal cell functions � They do not make fibronectin, and thus cannot connect easily and break off easily

Oncology � Biology of abnormal cancer cells � They are able to migrate throughout the body = metastasis � They invade other tissues and types of cells. � They are not controlled by contact � They have more or less chromosomes than the parent cells = aneuploid or a mutation of the genes

Oncology �Cancer development �Initiation – there are many theories as to when the genes in the cells are damaged, maybe in utero, from physical or chemical exposure, latent oncogenes, viruses, or a lack of suppressor genes from our parents, and at this point the cell is not dividing.

Oncology � Cancer development � Promotion - the stage when the abnormal cell starts to divide, may be stimulated by environmental changes, hormones, drugs, or irritants

Oncology �Cancer development �Progression – the phase when the abnormal cells have continued to grow into a Primary tumor, may produce angiogenesis factors which supply blood and vascular nourishment to the tumor. The tumor may have subcolonies of cells with different genes and features

Oncology �Cancer development �Metastasis the movement of cancer cells into other organs of the body, thus creating new tumor sites.

Oncology � Cancer grading and staging � Cancer is graded upon the resemblance normal cells = G to (The higher the number, the worse the grade of cancer) i. e. G 1, G 2, G 3, G 4 � Staging is based upon � the presence of a primary tumor = � involvement in lymph nodes = N � and appearance of metastasis = M � Numbers of the stage range from x = none to 3 or 4 for each letter T

Oncology �Cancer risks �High alcohol consumption �Low dietary vegetables and fiber (sources of antioxidants) �Previous Viral infections: Hepatitis B or C Herpes viruses Papilloma viruses (HPV) Retrovirus HTLV –I

Oncology � Symptoms of Cancer � Cachexia – weight loss, unexplained � Anorexia � Anemia � Impaired immune response � Pain – when the cancer is large enough to compress nerves or organs � Lymphadema – when the tumor blocks lymph or circulatory flow � Motor or sensory deficits

Oncology �Cancer statistics �The top four cancers found in the United States are: �Lung �Breast �Prostate C �Colorectal

Oncology �Cancer statistics �Prostate cancer is the most common site of cancer and the 2 nd most common cause of cancer death in the United States �The first cause of death in males is Lung Cancer

Oncology �Cancer � Lung statistics cancer has annual new cases (incidence) of 173, 770 people per year: 93, 110 males and 80, 660 females � Annual mortality: 160, 440 per year consisting of 92, 000 males and 68, 510 females

Oncology �Cancer � 28% statistics of all cancer deaths are due to lung cancer � This is the leading cause of cancer death in both men and women � There are more deaths from lung cancer than prostate, breast, and colorectal cancers combined

Oncology �Cancer statistics �Risks for lung cancer: �Smoking (75 -80% of cases) �Occupational exposure �Nutrition/Diet �Genetic factors

Oncology �Cancer statistics � Prostate cancer is number two cause of cancer in men � Breast Cancer is number two cause of cancer in women � Most common non-malignant or non-fatal cancer is non-melanoma type skin cancers

Oncology �Chemotherapy �Prevention chemotherapy – for high risk patients, precancerous lesions, or history of cancer �Antioxidants, vitamins �Aldara cream 3 x weekly for precancerous skin lesions �Aspirin �Protease inhibitors

Oncology �Chemotherapy - typically started after surgical dissection of tumor, unless the tumor is non-operative � Usually given by a long term venous access device, i. e. PICC line, implanted ports, or direct catheratization to the tumor. � Chemotherapy is usually potent and horribly scarring on normal veins

Oncology � Side effects of Chemotherapy � Fatigue � Anemia � Leukopenia � Thrombocytopenia � Always – Nausea, Vomiting, Diarrhea � Neurotoxicity & neuropathies � Capillary leakage � Headaches � Fluid and electrolyte imbalances

Oncology � Side effects of Chemotherapy � Anorexia – change in taste buds � Back aches � Joint aches � Blood clots � Oral mucositis – (reduced significantly glutamine amino acids orally) � Supra opportunistic infections � Septic DIC � Tumor lysis syndrome � Edema or pulmonary edema by L-

Oncology � Pharmacological interventions � Megace, Marinol – for appetite stimulation � Premedications for nausea, vomiting, edema, headaches: usually on the protocol for chemo Antiemetics; Zofran – 24 hour control Tigan, Kytril, ativan, anzamet, Compazine, benadryl, reglan Corticosteroids

Oncology � Pharmacological interventions � Analgesics � IV electrolytes and fluid replacement � Stool softeners to counteract constipation from opioids � GSF for WBC’s � Epogen/Procrit for anemia � Leukine/Prokine for leukopenia � Neupogen for neutrophilia � Neumega for thrombocytopenia � Diuretics for edema

Oncology �Non-Pharmacological • • Massage Reflexology Accupuncture Musical therapy Prayer Meditation Diversional acitivities Dietary counselling interventions

Oncology �Radiation therapy �All types of cells are injured or destroyed by concentrated radiation. Rapidly dividing cells are the most sensitive.

Oncology � Radiation � Types therapy : Gamma knife Local beam treatment Local seeding ARC – stereotactic Radioimmunotherapy Fractionation Total body irradiation Particle beam therapy, i. e. proton or neutron therapy

Oncology �Radiation therapy side effects �Side effects depend on the amount and area being irradiated � Fatigue � Nausea and vomiting � Mild anemia � Leukopenia � Diarrhea � Pain

Oncology �Radiation therapy side effects: � Erythema/burns � Fatigue � Pneumonitis � Esophagitis � Dysphasia

Oncology � Malignant Lymphomas – 2 types � Hodgkin's Lymphoma – most common cancer in 10 to 20 year olds (young adults). Associated with an inflammatory process related to +EBV/mono infection. � Diagnosis: Classic Reed-Steinberg cell with two mirrored nuclei, CT scan � Symptoms: Extreme fatigue, enlarged lymph nodes that are painless. May progress to weight loss fevers, night sweats

Oncology �Leukemia– hematopoeitic cancer of the stem cells. These stem cells proliferate into non-functional immature white cells. �More children get leukemia than any other type of cancer and it is the #1 cause of death in children. �Anyone can get leukemia at any age.