Oncology - Lectures
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Transcript Oncology - Lectures
Chapter 5
Pathology
Branch
of medicine that deals with the
study, detection, treatment and
management of cancer
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
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
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
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.
Cancer
development
Promotion - the stage when the abnormal
cell starts to divide, may be stimulated by
environmental changes, hormones, drugs, or
irritants
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
Cancer
development
Metastasis
the movement of cancer cells into
other organs of the body, thus creating
new tumor sites.
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. G1, G2, G3, G4
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
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
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
Cancer
statistics
The top four cancers found in the
United States are:
Lung
Breast
Prostate
C
Colorectal
Cancer
statistics
Prostate cancer is the most common
site of cancer and the 2nd most
common cause of cancer death in the
United States
The first cause of death in males is
Lung Cancer
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
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
Cancer
statistics
Risks for lung cancer:
Smoking (75-80% of cases)
Occupational exposure
Nutrition/Diet
Genetic factors
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
Chemotherapy
Prevention
chemotherapy – for high
risk patients, precancerous lesions, or
history of cancer
Antioxidants, vitamins
Aldara cream 3x weekly for
precancerous skin lesions
Aspirin
Protease inhibitors
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
Side effects of Chemotherapy
Fatigue
Anemia
Leukopenia
Thrombocytopenia
Always – Nausea,Vomiting, Diarrhea
Neurotoxicity & neuropathies
Capillary leakage
Headaches
Fluid and electrolyte imbalances
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-
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
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
Non-Pharmacological
• Massage
• Reflexology
• Accupuncture
• Musical therapy
• Prayer
• Meditation
• Diversional acitivities
• Dietary counselling
interventions
Radiation
therapy
All types of cells are injured or
destroyed by concentrated radiation.
Rapidly dividing cells are the most
sensitive.
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
Radiation
therapy side effects
Side effects depend on the amount and
area being irradiated
Fatigue
Nausea
and vomiting
Mild anemia
Leukopenia
Diarrhea
Pain
Radiation
therapy side effects:
Erythema/burns
Fatigue
Pneumonitis
Esophagitis
Dysphasia
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
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.