Title: Neoplasms
1Neoplasms
2Overview
- Benign and Malignant Tumors
- Nomenclature
- Characteristics
- Malignant Tumors
- Pathophysiology
- Effects
- Local effects
- Systemic effects
- Diagnostic tests
- Staging
- Etiology
- Carcinogenesis
- Risk factors and prevention
- Host defenses
- Treatment
- Radiation
- Chemotherapy
- Other drugs
- Nutrition
- Prognosis
- Examples of Malignant Tumors
- Skin cancer
- Ovarian cancer
- Brain tumors
3Benign and Malignant Tumors
- Neoplasm (tumor) cellular growth that is no
longer responding to normal body controls
- Cells undergo unnecessary mitosis
- Lack function atypical cells
4Nomenclature
- According to a system
- Root word is cell of origin
- Ex?
- Suffix indicates tissue that tumor occurs in
- Ex?
- Suffix oma indicates benign
- Some have unique names
- Ex?
5Characteristics of Benign and Malignant Tumors
- Benign
- Differentiated cells that reproduce at a high
rate
- Encapsulated expands but does not spread
- Tissue damage from compression
- Not considered life-threatening
- Malignant
- Undifferentiated nonfunctioning cells
- Increase rate of cellular reproduction
- Tumor cells infiltrate surrounding tissue
6Benign vs. Malignant Tumor
7Benign vs. Malignant Tumor
8Pathophysiology of Malignant Tumors
- Growing space occupying mass
- Infection
- Infiltrate
- b/c break off and infiltrate other tissues
- Rapid vs. in situ
- Enlarges
- Inner cells cut off from blood and nutrients
death
- ? necrosis ? inflammation ? infection at
site
- Tumor cells trap nutrients, depriving normal
cells
- Inflammation and loss of normal cells leads to
progressive break down of organ function
- Graded
- Based on degree of differentiation of malignant
cells
- Grade I thru IV
9Effects of Malignant Tumors
- Best treated ASAP
- Warning signs
- Unusual bleeding, discharge anywhere
- Change in bowel/bladder habits
- Change in wart/mole
- Sore that does not heal
- Unexplained weight loss
- Anemia
- Persistent cough without reason
- Solid lump
10Local Effects of Tumors
- Pain
- Not an early symptom
- Severity depends on type of tumor and location
- Caused by
- Direct pressure on nerves
- Stretching of visceral capsule
- Inflammation
- Secondary causes
- Infection, ischemia, bleeding
- Obstruction
- Compresses duct or passageway
- Tissue necrosis and ulceration
- May lead to opportunistic infection around tumor
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12Systemic Effects of Cancer
- Weight loss and tissue wasting
- Anemia
- Infections
- Bleeding
- Paraneoplastic syndromes
13Diagnostic Tests
- Blood tests
- Indicator of problem also monitor effects of
chemo, radiation
- Therapy results in
- Thrombocytopenia, erythrocytopenia, leukopenia
- ? Hb, erythrocytes cancer
- Tumor markers
- Carcinoembryonic antigen (CEA)Colon cancer
- Human Chorionic Gonadotropin (HCG)Testicular
cancer
- AlphafetoproteinHepatocellular cancer
- Prostate Specific Antigen (PSA)Prostate cancer
- X-Ray, ultrasound, MRI, CT scans
- Cytologic Tests
- Screens high-risk pt, confirms diagnosis, follows
clinical course, monitors changes
- Biopsies
14Spread of Malignant Tumors
- 3 basic mechanisms
- Invasion
- Metastasis
- Seeding
15Invasion
16Spread of Malignant Tumors Metastasis
- Spreads to distant sites thru blood, lymphatic
vessels
- Typically travels thru lymph vessels 1st
- Only few cancerous cells survive spreading
- Enough to start new colony
- Finds new hospitable location to set up shop
17Metastasis
18Seeding
19Staging of Cancer
- Classification process for malignant tumor at
time of diagnosis
- T Size of primary tumor
- N extent of involvement of local lymph nodes
- M Spread (invasion or metastasis) of tumor
- I-IV
20Etiology Carcinogenesis
- Process by which normal cells converted to cancer
cells
- Malignant tumors develop from sequence of changes
of relatively long period of time
- Some etiologies and carcinogens well known
others not
- Stages
- Initiation
- Promoters
- Cancer
21Carcinogenesis
22Etiology Risk Factors and Prevention
- Geographic areas, ethnic groups, environment,
diet, genetics
- Which risk factors are avoidable?
- Which are not avoidable?
23Etiology Host Defenses
- Immune system reacts to nonself antigens on tumor
cells
- Cell mediated humoral response
- Temporary or long-term immunodeficiencies
increase risk
24Treatment
- Curative vs. palliative
- Prophalytic
- Surgery
- Chemotherapy
- Radiation
- Other drugs
- Nutrition
25Surgery
- Involves removal of tumor and surrounding tissue
- Also nearby lymph nodes
- Why?
- Tumor cells and boundaries checked to ensure to
complete removal
- Sometimes only a portion is removed
26Radiation
- Causes mutations
- Prevents mitosis
- Damages blood vessels
- Most effective on cells undergoing mitosis or DNA
synthesis
- Consists of
- Electromagnetic waves
- High-energy penetrating particles
- Methods of administration
- External sources
- Cobalt machine
- Internal insertion
- at tumor site
27Adverse Effects of Radiation
- Bone Marrow Depression
- ? leukocytes increased risk of infection
- ? platelets excessive bleeding
- ? RBC fatigue, tissue break down
- Cell damage
- Bv, skin, alopecia, mucosa of digestive tract
- Abdominal radiation
- Damage to ovaries or testes
- Nonspecific fatigue
- Long-term
- Inflammation
- Necrosis
- Scar tissue
28Chemotherapy
- Combo of 2-4 drugs
- Antimitotics
- Antimetabolites
- Alkylating agents
- Antibiotics
- Administered through IV
29ABVDHodgkins lymphoma
30Adverse Effects of Chemotherapy
- Normal cells damaged
- Bone marrow depression
- Limiting factor
- Vomiting
- Hair loss
- Break down in skin and mucosa
- Some have unique effects
- Ex fibrosis in the lungs
31Other Drugs
- Hormones
- Glucocorticoid
- ? mitosis and ? RBC counts
- ? inflammation and swelling
- Sex hormones
- Biologic Response Modifiers (BRMs)
- Augment natural immune response
- Interferon
- Bacillus Calmette-Guerin (BCG)
- Angiogenesis Inhibitor Drug
- Inhibits bv genesis
- Analgesics
32Treatment Nutrition
- Concern w/ advanced pts
- Contributing factors
- Anorexia, vomiting, sore mouth, loss of teeth,
pain, fatigue, malabsorption, altered metabolism,
nutrient-trapping tumor
- Some might need TPN
- Total parenteral nutrition
- Given intravenously
33Prognosis
- Depends on type of cancer and when diagnosed
- Cure 5 yr survival rate w/o recurrence after
diagnosis and treatment
- Typically doctors will not give time line
34Examples of Malignant Tumors
- Skin Cancer
- Ovarian Cancer
- Brain Cancer
35Ex Skin Cancer
- Visible, easily diagnosed, good prognosis
- Highest rate of recurrence
- Most common in
- Fair skin
- Family history
- Lots of moles or freckles
- Increase of cases (from all you people who go
to tanning salons!)
- Basal cell carcinoma most common form
36Skin CancerBenign Carcinoma
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38Ex Ovarian Cancer
- Many types
- Hormonal and genetic factors
- Very poor prognosis
- Tumor hidden in peritoneal cavity
- Silent tumor
- 1st signs appear only when tumor is large and
presses on adjacent structures
- 1st indication altered bowel or bladder function
- Spreads thru lymph to peritoneal membranes
- No tumor marker for early prognosis
- Treatment
- Surgery, radiation, chemo
39Ovarian Cancer
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41Brain Tumors
- Benign or malignant
- Both equally serious
- Why?
- If on brain surface easily removed
- Early indications
- Pressure (headache)
- Drowsiness
- Vomiting
- Vision problems
- Impaired motor function
- Malignant tumors do not metastasize outside of CNS
42Brain Tumors
43Brain Tumors