1. Neoplasia

2. Oncology defined Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia

3. “Root words” Neo- new Plasia- growth

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

5. Characteristics of Neoplasia BENIGN Well-differentiated Slow growth Encapsulated Non-invasive Does NOT metastasize

6. Characteristics of Neoplasia MALIGNANT Undifferentiated Erratic and Uncontrolled Growth Expansive and Invasive Secretes abnormal proteins METASTASIZES

7. leiomyomas

9. adenoma

10. adenocarcinoma

11. carcinoma

14. Nomenclature of Neoplasia Tumor is named according to: 1. Parenchyma, Organ or Cell Hepatoma- liver Osteoma- bone Myoma- muscle

15. 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

16. BENIGN TUMORS Suffix- “OMA” is used Adipose tissue- LipOMA Bone- osteOMA Muscle- myOMA Blood vessels- angiOMA Fibrous tissue- fibrOMA

17. MALIGNANT TUMOR- nomenclature Glandular, Epithelial Use the suffix- “CARCINOMA” Pancreatic AdenoCarcinoma Squamos cell Carcinoma

18. MALIGNANT TUMOR 2. connective tissue origin Use the suffix “SARCOMA FibroSarcoma Myosarcoma AngioSarcoma

19. “OMA” but Malignant – HepatOMA, lymphOMA, gliOMA, melanOMA

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

22. dysplasia

23. normal epithelium

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

25. 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)

26. well-differentiated

27. poorly-differentiated

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

29. 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.

30. meningioma

31. basal cell carcinoma

32. melanoma

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

34. metastatic ovarian carcinoma

35. MRI: metastatic adenocarcinoma

36. metastatic adenocarcinoma

37. Spread of Cancer 1. LYMPHATIC Most common 2. HEMATOGENOUS – Blood-borne, commonly to Liver and Lungs 3. DIRECT SPREAD – Surrounding organs

38. Spread of cancer Cancers commonly spread t bone,lungs liver and brain(secondary deposits)

39. Cancer Diagnosis 1. BIOPSY – The most definitive 2. CT, MRI 3. Tumor Markers

40. 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.

41. Cancer Grading The degree of DIFFERENTIATION Grade 1- Low grade Grade 4- high grade

42. Cancer Staging 1. Uses the T-N-M staging system T- tumor N- Node M- Metastasis

43. GENERAL MEDICAL MANAGEMENT 1. Surgery- cure, control, palliate 2. Chemotherapy 3. Radiation therapy 4. Immunotherapy 5. Bone Marrow Transplant

44. GENERAL Promotive and Preventive 1. Lifestyle Modification 2. Nutritional management 3. Screening 4. Early detection

45. SCREENING 1. Male and female- Occult Blood, CXR, and DRE 2. Female-, Mammography and Pap’s Smear 3. Male- DRE for prostate, Testicular self-exam

46. Cancer –causes

47. Etiology of cancer 1. PHYSICAL AGENTS Radiation Exposure to irritants Exposure to sunlight Altitude, humidity

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

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

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

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

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

53. Etiology of cancer 7. Immune Disease AIDS

54. Proposed Molecular cause of CANCER: Change in the DNA structure  altered DNA function  Cellular aberration  neoplastic change

55. CARCINOGENSIS Malignant transformation I  P  P Initiation Promotion Progression

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

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

58. CARCINOGENSIS PROGRESSION Irreversible period Cells undergo NEOPLASTIC transformation then malignancy

59. Colon cancer

60. 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

61. COLON CANCER Sigmoid colon is the most common site Predominantly adenocarcinoma If early  90% survival

62. COLON CANCER PATHOPHYSIOLOGY Benign neoplasm  DNA alteration  malignant transformation  malignant neoplasm  cancer growth and invasion  metastasis (liver)

63. COLON CANCER  ASSESSMENT FINDINGS 1. 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

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

65. Colon cancer Complications of colorectal CA 1. Obstruction 2. Hemorrhage 3. Peritonitis 4. Sepsis

66. Colon cancer MEDICAL MANAGEMENT 1. Chemotherapy- 5-FU 2. Radiation therapy

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

68. 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

70. Breast Cancer The most common cancer in FEMALES Numerous etiologies implicated

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

72. Breast Cancer RISK FACTORS 7. Obesity 8. Hormonal replacement 9. Alcohol 10. Exposure to radiation

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

75. 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

76. Breast Cancer LABORATORY FINDINGS 1. Biopsy procedures 2. Mammography

77. Breast Cancer Breast cancer Staging TNM staging I - < 2cm II - 2 to 5 cm, (+) LN III - > 5 cm, (+) LN IV- metastasis

78. Breast Cancer MEDICAL MANAGEMENT 1. Chemotherapy 2. Tamoxifen therapy 3. Radiation therapy

79. Breast Cancer SURGICAL MANAGEMENT 1. Radical mastectomy 2. Modified radical mastectomy 3. Lumpectomy 4. Quadrantectomy

80. Thank you…