Neoplasia

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Neoplasia
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Oncology defined

• Branch of medicine that deals with the study,
  detection, treatment and management of cancer and
  neoplasia

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Root words

• Neo- new
• Plasia- growth

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Neoplasia

• Uncontrolled growth of Abnormal cells
• 1. Benign
• 2. Malignant
• 3. Borderline

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Characteristics of Neoplasia

• BENIGN
• Well-differentiated
• Slow growth
• Encapsulated
• Non-invasive
• Does NOT metastasize

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Characteristics of Neoplasia

• MALIGNANT
• Undifferentiated
• Erratic and Uncontrolled Growth
• Expansive and Invasive
• Secretes abnormal proteins
• METASTASIZES

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leiomyomas
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adenoma
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adenocarcinoma
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carcinoma
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Nomenclature of Neoplasia

• Tumor is named according to
• 1. Parenchyma, Organ or Cell
• Hepatoma- liver
• Osteoma- bone
• Myoma- muscle

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Nomenclature of Neoplasia

• Tumor is named according to
• 2. Pattern and Structure, either GROSS or
  MICROSCOPIC
• Fluid-filled? CYST
• Glandular? ADENO
• Finger-like? PAPILLO
• Stalk? POLYP

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BENIGN TUMORS

• Suffix- OMA is used
• Adipose tissue- LipOMA
• Bone- osteOMA
• Muscle- myOMA
• Blood vessels- angiOMA
• Fibrous tissue- fibrOMA

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MALIGNANT TUMOR-nomenclature

• Glandular, Epithelial
• Use the suffix- CARCINOMA
• Pancreatic AdenoCarcinoma
• Squamos cell Carcinoma

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MALIGNANT TUMOR

• 2. connective tissue origin
• Use the suffix SARCOMA
• FibroSarcoma
• Myosarcoma
• AngioSarcoma

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• OMA but Malignant
• HepatOMA, lymphOMA, gliOMA, melanOMA

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dysplasia

• denotes a loss of architectural organization and
  a loss of cell uniformity in epithelium
• mild to moderate dysplasia is potentially
  reversible

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dysplasia
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normal epithelium
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dysplasia

• Dysplasia is a non-neoplastic proliferation.
• Dysplasia may or may not progress to cancer.

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differentiation

• Well-differentiated tumors contain cells that
  resemble the normal cells of origin
• poorly-differentiated or undifferentiated tumors
  contain cells that do not resemble their normal
  counterparts (ancillary studies may be needed to
  determine the cell of origin)

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well-differentiated
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poorly-differentiated
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• Benign tumors are composed of well-differentiated
  cells.
• Malignant tumors are characterized by a wide
  range of cellular differentiation.

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rate of growth

• In general, well-differentiated malignant tumors
  have a slower rate of growth than
  poorly-differentiated malignant tumors.
• There are exceptions. Blood supply, site, and
  hormonal stimulation are factors that can affect
  the growth rate of tumors.

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meningioma
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basal cell carcinoma
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melanoma
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metastasis

• Distant spread of the tumor
• Methods of metastasis include lymphatic spread,
  and hematogenous spread.

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metastatic ovarian carcinoma
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MRI metastatic adenocarcinoma
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metastatic adenocarcinoma
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Spread of Cancer

• 1. LYMPHATIC
• Most common
• 2. HEMATOGENOUS
• Blood-borne, commonly to Liver and Lungs
• 3. DIRECT SPREAD
• Surrounding organs

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Spread of cancer

• Cancers commonly spread t bone,lungs liver and
  brain(secondary deposits)

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Cancer Diagnosis

• 1. BIOPSY
• The most definitive
• 2. CT, MRI
• 3. Tumor Markers

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grading and staging

• Grading is based on the microscopic features of
  the cells which compose a tumor and is specific
  for the tumor type.
• Staging is based on clinical, radiological, and
  surgical criteria, such as, tumor size,
  involvement of regional lymph nodes, and presence
  of metastases. Staging usually has prognostic
  value.

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Cancer Grading

• The degree of DIFFERENTIATION
• Grade 1- Low grade
• Grade 4- high grade

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Cancer Staging

• 1. Uses the T-N-M staging system
• T- tumor
• N- Node
• M- Metastasis

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GENERAL MEDICAL MANAGEMENT

• 1. Surgery- cure, control, palliate
• 2. Chemotherapy
• 3. Radiation therapy
• 4. Immunotherapy
• 5. Bone Marrow Transplant

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GENERAL Promotive and Preventive

• 1. Lifestyle Modification
• 2. Nutritional management
• 3. Screening
• 4. Early detection

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SCREENING

• 1. Male and female- Occult Blood, CXR, and DRE
• 2. Female-, Mammography and Paps Smear
• 3. Male- DRE for prostate, Testicular self-exam

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Cancer causes
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• Etiology of cancer
• 1. PHYSICAL AGENTS
• Radiation
• Exposure to irritants
• Exposure to sunlight
• Altitude, humidity

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• Etiology of cancer
• 2. CHEMICAL AGENTS
• Smoking
• Dietary ingredients
• Drugs

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• Etiology of cancer
• 3. Genetics and Family History
• Colon Cancer
• Premenopausal breast cancer

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• Etiology of cancer
• 4. Dietary Habits
• Low-Fiber
• High-fat
• Processed foods
• alcohol

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• Etiology of cancer
• 5. Viruses and Bacteria
• DNA viruses- Hep, Herpes, EBV, CMV, Papilloma
  Virus
• RNA Viruses- HIV,
• Bacterium- H. pylori

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• Etiology of cancer
• 6. Hormonal agents
• OCP especially estrogen

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• Etiology of cancer
• 7. Immune Disease
• AIDS

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Proposed Molecular cause of CANCER

• Change in the DNA structure? altered DNA
  function? Cellular aberration
• ? neoplastic change

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• CARCINOGENSIS
• Malignant transformation
• I?P?P
• Initiation
• Promotion
• Progression

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• CARCINOGENSIS
• INITIATION
• Carcinogens alter the DNA of the cell
• Cell will either die or repair

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• CARCINOGENSIS
• PROMOTION
• Repeated exposure to carcinogens
• Abnormal gene will express
• Latent period

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• CARCINOGENSIS
• PROGRESSION
• Irreversible period
• Cells undergo NEOPLASTIC transformation then
  malignancy

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Colon cancer
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COLON CANCER

• Risk factors
• 1. Increasing age
• 2. Family history
• 3. Previous colon CA or polyps
• 4. History of IBD
• 5. High fat, High protein, LOW fiber
• 6. Breast Ca and Genital Ca

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COLON CANCER

• Sigmoid colon is the most common site
• Predominantly adenocarcinoma
• If early? 90 survival

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COLON CANCER

• PATHOPHYSIOLOGY
• Benign neoplasm? DNA alteration? malignant
  transformation? malignant neoplasm ? cancer
  growth and invasion ? metastasis (liver)

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COLON CANCER

• ASSESSMENT FINDINGS1. Change in bowel habits-
  Most common
• 2. Blood in the stool
• 3. Anemia
• 4. Anorexia and weight loss
• 5. Fatigue
• 6. Rectal lesions- tenesmus, alternating D and C

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Colon cancer

• Diagnostic findings
• 1. Fecal occult blood
• 2. Sigmoidoscopy and colonoscopy
• 3. BIOPSY
• 4. CEA- carcino-embryonic antigen

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Colon cancer

• Complications of colorectal CA
• 1. Obstruction
• 2. Hemorrhage
• 3. Peritonitis
• 4. Sepsis

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Colon cancer

• MEDICAL MANAGEMENT
• 1. Chemotherapy- 5-FU
• 2. Radiation therapy

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Colon cancer

• SURGICAL MANAGEMENT
• Surgery is the primary treatment
• Based on location and tumor size
• Resection, anastomosis, and colostomy (temporary
  or permanent)

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Colon cancer

• NURSING INTERVENTION
• Pre-Operative care
• 1. Provide HIGH protein, HIGH calorie and LOW
  residue diet
• 2.Provide information about post-op care and
  stoma care
• 3. Administer antibiotics 1 day prior

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Breast Cancer

• The most common cancer in FEMALES
• Numerous etiologies implicated

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Breast Cancer

• RISK FACTORS
• 1. Genetics- BRCA1 And BRCA 2
• 2. Increasing age ( gt 50yo)
• 3. Family History of breast cancer
• 4. Early menarche and late menopause
• 5. Nulliparity
• 6. Late age at pregnancy

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Breast Cancer

• RISK FACTORS
• 7. Obesity
• 8. Hormonal replacement
• 9. Alcohol
• 10. Exposure to radiation

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Breast Cancer

• PROTECTIVE FACTORS
• 1. Exercise
• 2. Breast feeding
• 3. Pregnancy before 30 yo

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pathophysiology
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Breast Cancer

• ASSESSMENT FINDINGS
• 1. MASS- the most common location is the upper
  outer quadrant
• 2. Mass is NON-tender. Fixed, hard with irregular
  borders
• 3. Skin dimpling
• 4. Nipple retraction
• 5. Peau d orange

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Breast Cancer

• LABORATORY FINDINGS
• 1. Biopsy procedures
• 2. Mammography

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Breast Cancer

• Breast cancer Staging
• TNM staging
• I - lt 2cm
• II - 2 to 5 cm, () LN
• III - gt 5 cm, () LN
• IV- metastasis

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Breast Cancer

• MEDICAL MANAGEMENT
• 1. Chemotherapy
• 2. Tamoxifen therapy
• 3. Radiation therapy

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Breast Cancer

• SURGICAL MANAGEMENT1. Radical mastectomy
• 2. Modified radical mastectomy
• 3. Lumpectomy
• 4. Quadrantectomy

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Thank you