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Nursing 280: Pathophysiology Examination

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Title: Nursing 280: Pathophysiology Examination


1
Nursing 280 PathophysiologyExamination 2
Module ISection E Neoplasia-Alterations in
Cell Proliferation
  • Presented by
  • Ronda M. Overdiek, M.S.N., R.N.

2
Section ENeoplasia Alterations in Cell
Proliferation
  • Chapter 9 Biology of Cancer
  • Chapter 10 Tumor Spread and Treatment

3
Objective 1 Differentiate tumors by site and
name.
  • Carcinoma
  • Arise from endothelial and epithelial tissues
  • Adenocarcinomas Arise from ductal or glandular
    epithelium
  • Sarcoma
  • Arise from mesenchymal (connective) tissues
  • Lymphomas
  • Cancers of lymphatic tissue

4
Objective 1 Differentiate tumors by site and
name.
  • Leukemia
  • Abnormal growth/proliferation of blood forming
    cells
  • Gliomas
  • Glial cells of the central nervous system

5
Objective 2Describe common pathophysiologic
mechanisms that appear to operate in all cancers
  • Autonomy
  • Refers to the cancer cells independence from
    normal cellular controls
  • Anaplasia
  • Loss of differentiation, the process of
    developing specialized functions, and
    organization, meaning literally without form.

6
Objective 2Describe common pathophysiologic
mechanisms that appear to operate in all cancers
  • Transformation
  • Process by which a normal cell becomes a cancer
    cell
  • Progression
  • An increase of abnormal biologic properties and
    not necessarily a progression in tumor size.

7
Objective 2Describe common pathophysiologic
mechanisms that appear to operate in all cancers
  • Contact Inhibition (density-dependent inhibition
    of growth)
  • Two or more normal cells come in contact with
    each other, they tend to stop dividing and form a
    single layer or sheet of cells called a confluent
    monolayer.
  • Cancer cells will continue to grow and pile up on
    top of each other even after forming the
    monolayer.

8
Objective 2Describe common pathophysiologic
mechanisms that appear to operate in all cancers
  • Tumor Cell Markers
  • Substances produced by cancer cells that are
    found on tumor plasma membranes or in the blood,
    spinal fluid, or urine.
  • Produced by cancer cells genetic material when
    it is activated during carcinogenesis.
  • Utilized by
  • To screen/identify patients at high risk for
    cancer
  • To help diagnose the specific type of tumor
  • To observe the clinical course of cancer

9
Objective 3Describe tumor development
  • Carcinogenesis
  • Process of tumor development
  • Multi step process
  • Loss of the ability for the cell to terminally
    differentiate
  • Loss of ability to control growth
  • Loss of ability to travel to distal tissues
  • Loss of the ability to invade and colonize those
    tissues

10
Objective 3Describe tumor development
  • Tumor Grading
  • Estimates tumor differentiation
  • Gauge of the tumors degree of malignancy
  • Grades I-IV
  • Grade I Well differentiated
  • Grade IV Very poorly differentiated

11
Objective 3Describe tumor development
  • Staging Component of cancer diagnosis
  • Stage I Cancer confined to the organ of origin
  • Stage II Locally invasive
  • Stage III Cancer spread to regional structures
    such as lymph nodes
  • Stage IV Cancer spread to distant sights such
    as liver spreading to lung or prostate spreading
    to bone

12
Objective 3Describe tumor development
  • Metastasis
  • The spread of tumor cells from a primary site of
    origin to a distant site
  • Life threatening characteristic
  • Sequential Steps of Metastasis
  • Direct or continuous extension of local invasion
    of tumor cells into surrounding tissue
  • Penetration into lymphatics, blood vessels, or
    body cavities
  • Release into lymph or blood
  • Transport to secondary sites
  • Entry and growth in secondary sites

13
Objective 4Describe clinical manifestations of
cancer
  • Pain
  • Early stages little or no pain, terminally ill
    patients 60-80 have pain
  • Mechanisms that cause pain that are associated
    with cancer
  • Pressure, obstruction, invasion of a sensitive
    structure, tissue destruction, inflammation,
    infection

14
Objective 4Describe clinical manifestations of
cancer
  • Anemia
  • Caused by
  • Chronic bleeding resulting in iron deficiency
  • Severe malnutrition
  • Medical Therapies
  • Malignancy in blood-forming organs

15
Objective 4Describe clinical manifestations of
cancer
  • Cachexia
  • The most severe form of malnutrition associated
    with cancer
  • Results in wasting, emanciation, decreased
    quality of life
  • Includes
  • Anorexia, early satiety, weight loss, anemia,
    asthenia, poor performance, taste alterations,
    altered protein, lipid, and carbohydrate
    metabolism

16
Objective 4Describe clinical manifestations of
cancer
  • Leukopenia
  • Caused by tumor invasion of the bone marrow
  • Decreased leukocyte count
  • Results from chemotherapy/radiotherapy
  • Thrombocytopenia
  • Decrease in number of platelets
  • Major cause of hemorrhage in cancer patients

17
Objective 4Describe clinical manifestations of
cancer
  • Infection
  • Most significant cause of complications and death
  • Immunosuppression from radiation and chemotherapy

18
Objective 5Identify treatment modalities for
cancer
  • Chemotherapy
  • Use of relatively nonselective cytotoxic drugs
    that target vital cellular machinery or metabolic
    pathways critical to both malignant and normal
    cell growth and replication.
  • CURATIVE
  • Must eradicate enough tumor cells so that the
    bodys own defenses can eradiate any remaining
    cells.

19
Objective 5Identify treatment modalities for
cancer
  • Radiation
  • Goals are
  • 1. Eradicate cancer w/o producing excessive
    toxicity during treatment
  • To avoid damage to normal structures
  • Damage from radiation can be termed lethal,
    potentially lethal, and sublethal.

20
Objective 5Identify treatment modalities for
cancer
  • Surgery
  • Can be completely curative-cancer is removed
  • Debulking surgery majority of tumor removed
  • Then chemotherapy/radiation
  • Palliative

21
Objective 5Identify treatment modalities for
cancer
  • Immunotherapy
  • Specific method of treatment used to eliminate
    cancer cells without damaging normal tissues
  • Referred to as Biologic Response Modifiers
    (BRMs)
  • Direct cytotoxic effect on cancer cells
  • Initiation/augmentation of the hosts tumor
    immune rejection response
  • Modification of cancer cell susceptibility to the
    lytic or tumor-static effects of the immune
    system
  • Classifications of BRMs include interferon,
    antigens monoclonal antibodies

22
Objective 5Identify treatment modalities for
cancer
  • Interferon (BRM)
  • Family of cell-derived proteins that have
    antiviral and immune modulating activities.
  • Interferon-alpha
  • Inhibits tumor growth
  • Enhances natural killer cell activity
  • Increases cancer cell expression of tumor antigens

23
Objective 5Identify treatment modalities for
cancer
  • Antigens (BRM)
  • Research
  • Identify tumor specific antigens used to develop
    anticancer vaccines
  • Used either to augment the hosts immune response
    against the tumor
  • Preventative immunization techniques to inhibit
    cancer emergence in the population at risk

24
Objective 5Identify treatment modalities for
cancer
  • Monoclonal Antibodies
  • Developed and used as diagnostic reagents for
    detecting cancer because their high specificity
    for antigen could reduce the number of false
    results.
  • Provide earlier detection of neoplastic disease

25
Objective 6Identify the various theories of
carcinogenesis
  • The Three-Step Theory of Invasion
  • Three steps include
  • Attachment mediated by specific attachment
    factors
  • Anchored tumor cells secrete proteolytic enzymes
    or induce host cells to produce them
  • Tumor cell locomotion in to the degraded region
    of the matrix

26
Objective 6Identify the various theories of
carcinogenesis
  • Personal Behavior
  • Tobacco use
  • Diet
  • Alcohol
  • Sexual/Reproductive Behavior

27
Objective 6Identify the various theories of
carcinogenesis
  • Environmental Risks
  • Air pollution
  • Occupation
  • UV Radiation
  • Ionizing Radiation
  • Hormones
  • Oral Contraceptives
  • Estrogens/ Progesterones/Androgens

28
Objective 7Identify carcinogenic pathogens
  • Oncogenic Virus
  • Cancer causing viruses
  • Cause a specific type of malignant or benign
    tumor in susceptible individuals.
  • Three major types of oncogenic viruses
  • Papovaviruses
  • Adenoviruses
  • Herpesviruses

29
Objective 7Identify carcinogenic pathogens
  • Direct Mechanisms
  • Mechanism for viral carcinogenesis
  • The tumor cells are or were at some stage
    infected with the oncogenic virus
  • Indirect Mechanisms
  • Mechanism for viral carcinogenesis
  • The neoplastic cells were not altered by the
    virus but were stimulated to grow because of the
    viral infection

30
Objective 8Identify common sites for cancer
with relationship to age and sex
  • Children
  • Women
  • Men
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