ONCOLOGY

ONCOLOGY
Uncontrolled cellular division

Cancer
1. Normal cells- would growth only when they receive such signals
-would grow and mature into distinct cell types
-BLAST: IMMATURE CELLS:NON- FUNCTIONAL
-CYTES: (MONO) MATURE CELLS FUNCTIONAL
- (production of new vessels angiogenesis)

1.Cancer cells- would grow even in the absence of the signals

- would grow too rapidly to even mature.
- may influence normal cells
- may trick immune system (evasive, magaling magtago)
(kaya niya utuin)
- may metastasize

CELL CYCLE
1. Interphase: is the longest phase
-G1: Cell growth (literal na lumaki na lumaki) protein increase larger
-S: DNA Synthesis (no overlaping)
-G2: Prep for mitosis

2. Mitosis: Cell division

-KARYOKINESIS: Nuclear division (no sharing)
-Cytokinesis: Cytoplasmic divison

3.G0: Resting phase: TAMBAYAN PHASE

CARCINOGENESIS
Production of cancer
1.Initiation (transformed of cell)
-Initial cell mutation occurs spontaneous/exposure to carcinogens)
-Irreversible
2. Promotion (neoplastic lesion)
-Cancer cells are stimulated to divide even further (REVERSIBLE WHEN
STOP THE EXPOSURE ON CARCINOGENESIS LIKE SMOKING)
3. Progression (Malignant tumor)
-Cancer cells will compete w/ one another to survive
-the more cancer cells aggressive the more cells will malignant

1. Oncogene: cell growth

2. Tumor suppressor gene: stop/inhibiting cell growth
3. Apoptotic gene: cell death (all of people have this)

CELL ADAPTATION
A. Normal
-have nucleus, basement membranes
B. Cells that have undergone atrophy
-Atrophy the cells shims inside (lumiit ang cells)
-Decrease o2, blood, nerve, nutrient supply
-Aging
-Prolonged immobility
-Decreased use
C. Cells that have undergone Hypertrophy (lumalaki)
-like pag nag gym pag napunit yung muscle at napahiga lumalaki)
D. Hyperplasia at cellular level (dumami)
-pre malignant
-Neoplasia - malignant other word anaplasia
E. Metaplasia
-one cell type converted into another cell type
-chronic smoker
-Cilated columnar epithelium simple squamous epithelium
F. Dysplasia
-Bizarre cell growth (kakaiba itchura)
-complete alteration of cells in terms of size, shapes, amount
-Pre malignant
-don’t have anaplasia

WARNING SIGNS OF CANCER

C-A-U-T-I-O-N U-S

-A-Alteration diarrhea/constipation cause colorectal cancer

-B-Blood in the stool (hematochezia,melena)
-C-Change in the shape of stools (pencil shaped stools

C: Change in bowel or bladder habits

-Urinary frequency, urgency, hesitancy (matagal makaihi 5 sec)
-dysuria (balisawsaw, painful
-hematuria
-obstruction

A: A sore that does not heal

-Melanoma, severe form of skin cancer (Australia most common case)
*ABCDE, assement tool
-A-Asymmetry
-B-Boarder, Perfectly round mole, mole diff is a cancer
-C-Color, mole black or brown (N) some Green Blue (AB)
-D-Diameter, mole is <5MM (N)
-E-Evolving, continuos changing in size, types, color it would be cancer
U: Unusual bleeding or discharge
-pst menoposal bleed
-bleeding betweeen periods
-post coital bleed

-PROLACTINOMA (BENIGN)

PENILE DISCHARGE
-Color discharge clear whitish (N), if greenish and red (AB)
-could be STD’S and should check for the smell
-or could be cancer
-have good hygiene

T: Thickening or lump in the breast o else where.

-Lymphoma thicken diagnose

I: Indigestion or difficulty in swallowing

-self limiting problem

O: Obvious change in a wart or mole

-Elderly melanoma
-Scalp,Face, Behind the ears, nape

N: Nagging cough or hoarseness.

-Laryngeal cancer, larynx is the prob
-Dry, persistent cough

U: Unexplained anemia
-maputla have prob in GI

S: Sudden wt loss
-Cachexia, super payat may binubuhay na bukol sa katawan may kaagaw
sa nutrition 5kg in a week
CANCER DIAGNOSIS
Primary prevention: preventing cancer before it even happens; lifestyles
modification
-poor diet, fast food, oily food
-obesity
-alcohol drinking, cigarette smoking sedentary lifestyles

Secondary prevention: Screening; early detection and diagnosis*** key to

increase survival rate of cancer pts

Tertiary prevention: (remission) preventing recurrence; preventing

complications; rehabilitation.

Tumor staging
Identify the extent of involvement of cancer
TNM STAGING
T: TUMOR
N: NODE
M: METASTASIS

Stage 0; carcinoma in situ

-small incidental findings
Stage 1; tumor small
-hasn’t spread anywhere else
Stage 2; Larger
-still hasn’t spread anywhere else
-local spread
Stage 3; Spread into surroundings tissues;
-extensive spread
Stage 4; Spread to at least one organ
METASTASIS SITE
-Most comon
-Metastasis sites
-liver, lungs, lymph nodes
-bones, brain

EX. cancer diagnosis with another organ

-metastatic breast cancer w/ lung involvement
-metastatic lung cancer w/ brain involvement

TUMOR GRADING
Levels of differentiation
Grade 1; well differentiated: its still closely resembles the cells of the tissue
from w/ it came from (kamukha ng normal but see closely no)
Grade 2; moderately
Grade 3; poorly
Grade 4 Undifferentiated
(the more panget sa microscope the more malignant)

MGT OF CANCER
3 types
1. surgery
PURPOSE:
-diagnostic purpose
-BIOPSY, gold standard to identify
*fine needle aspiration biopsy
*punch biopsy, deeper tissue sample
*shave biopsy, superficial sample tissue sample (sterile razor)
*incisional biopsy, portion of tumor is removed
*excisional biopsy, entire tumor is removed
*bone marrow aspiration (mga fluid type cancer)
-posterior iliac crest: most preferred
-Sternum/ breastbone: pls avoid pediatric pts <12 yr old
-Tibia: pedia
2. Primary tx
A. chemosurgery
-instalattion of chemo agents directly into the body cavity; intraperitoneal
chemo
B. Cryosurgery
-Freezing of the tissue
-Reproductive use
C. Electrosurgery
-dIrect current/ cottery
D. Laser surgery
-light and energy
3. Prophylactic
risk reduction surgery
4. Reconstructive surgery
Surgery; cosmetic effect; to improve function
5.Palliative surgery; improve quality of life
-relieve s/sx

RADIATION THERAPY
*Radiosensitive cancer cells
-tumor is sensitive to radiation
*Radioresistant cancer cells
-difficult to kills; malignant

Radiosensitive normals; highly dividing cells

1. Hair cellls: alopecia, self-esteem, self-care
2. GI Tract cells: inflamation of stomach (stomatitis) no fatty,oily food
-bland diet, avoid alcoholic mouthwash
-radiation induced enteritis; inflammation of intestines; diarrhea
3. Skin cells: radiation induced dermatitis ( avoid chemical irritants-
perfume,alcohol, cosmetics)
4.Blood cells: Anemia,
-bumaba ang white leukopenia
-thrombocytopenia (immunosuppression)
NADIR - lowest point of immunity of pt

5. reproductive tract cells: dec libido, sterility

1.permanence of side effects; defends on the radiation on the exposure

2. depending of interval of intervention

Radioresistant normal cell: cartilage, soft tissues

EXTERNAL VS INTERNAL
External: AKA teletherapy work common mode of radiation than internal, in
sessions
1. the total dose want doctor to give pt is large given at once
2. This will allow the normal cell to recover
3. It will allow tumor to be more radiosensitive
Internal: AKA brachytherapy
Sealed: form of implants, seeds,rods, beads
Unsealed
-Give by IV/ORAL; pt s radioactive; even ody fluids radioactive as well;
private CR
-no private CR, should flush the toilet twice
-pt is no longer radioactive 48hrs after admissions
DTS PRINCIPLES
-D-Distance: maintain 6 ft away; Private room; limit visitors; away from
nurses station with radioactive pt
-T-Time: 30mins/shift; cluster your activities
-S-Shield: Use lead shield; Dosimeter badge put on scrub

(no pregnant, pedia, elderly, immunocompromise, pregannt nurse not

allow)
Side effects radiation therapy
-copy radiosensitive normal cells
-Cachexia,anorexia,**fatigue**common side effect,N/V

Chemotherapy
is administration of anti neoplastic agent to kill cancer cells

Chemotherapeutic agents
Cell cycle specific phase: inhibits DNA Synthesis

-Topoisomerase l inhibitors: irinotecan, topotecan

-Topoisomerase ll inhibitors: etoposide, teniposide
-Antimetabolites: methotrexate, hydroxyurea, cytarabine

Cell cycle specific M phase: inhibits cellular division

-Mitotic spindle inhibitors:
*plant alkaloids: vincristine, vinblastine, vinorelbine
*taxanes: docetaxel, paclitaxel

Cell cycle none-specific

-Alkylating agents: Cisplatin, carboplatin, busulfan, thiotepa, nitrogen mustard
-Nitrosureas: Carmustine, lomustine
-Anti tumor antibiotics: Doxurubicin, epirubicin, dactinomycin, bleomycin
-Hormonal Agents: Tamoxifen (breast cancer), fulvestrant, goserelin

Side effects
-Alopecia
-Dermatitis, enteritis, immunosupression
-dec libido, sterility
-cachexia, anorexia, fatigue (N/V*** nausea & vomiting MOST SIDE EFFECT OF
CHEMO)

-pulmonary toxicity
-cardiac toxicity
-nephrotoxicity
-neurotoxicity, peripheral, neuropathy, cognitive impairment
Meds:
Ondansetron IV
metoclopromide IV

Chemotherapy Toxicity
-methrotexade cause stomatitis
-bleomycin cause pulmonary fibrosis
-Doxorubicin cause cardiac toxicity
-Cisplatin cause ototoxicity and nephrotoxicity
*most ototoxic drugs
1.anti malaria: quinine, no to pregnant
2. Chemo: cisplatin
3.amino-glycosides: streptomycin,gentamycin, kanamycin
-Cyclophosphamide cause hemorrhage cyctitis
*MESNA, encourage rage to increase OFI
-Vincristine/Vinblastine cause peripheral neuropathy
(photo sensitive)

EXTRAVASATION
Infiltration of chemo agents
Irritans vs vesicants
*Localized tissue damage *Tissue necrosis permanent tissue damage

BREAST CANCER
-most common type of cancer worldwide
-Upper outer quadrant because there are lymph nodes
-infiltrating ductal carcinoma (terminal lungs lobular units)

RISK FACTORS
-gender: 99.99% female; 1% male
-Age: >62 yrs old
-Family hx
-personal hx
Genetics: BRCA1, BRCA2 gene

-Nulliparity
-Early menarche ,112 yrs old
-Late menopause >55 yrs old

Lifestyle risk factors:

-Cigarette smoking, alcohol drinking, obesity

Diagnostics test:
1.Mammography, xray of the breast
-avoid deodorants, powders, perfume, lotion
High risk: 30 yrs old mag mammography
-40-44 yrs old if not optional to start screening
-45-55 yrs old required annually
-55 yrs old above limit biennially every other year, every 2 yrs

Change to have breast cancer

-Larger, because the more to have estrogen have fatty tissue
-Small, it should but it is painfully because of the compress of the fatty
Flat chested, YES should mammography
Lesbian, YES should “
Implants, YES should “
Trans, Yes should “
Male, Yes should “
Matectomy, No