1. Chapter 5 Pathology

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

3.  Biology of abnormal cancer cells  They have continuous or inappropriate, usually faster growth or larger growth patterns  They have no specific morphology and often do not resemble their parent cells = anaplastic  They do not respond to signals for apoptosis = programmed cell death

4.  Biology of abnormal cancer cells  Have a large nuclear – cytoplasmic ratio; the nucleus may occupy most of the cell area  They lose some or all of their normal cell functions  They do not make fibronectin, and thus cannot connect easily and break off easily

5.  Biology of abnormal cancer cells  They are able to migrate throughout the body = metastasis  They invade other tissues and types of cells.  They are not controlled by contact  They have more or less chromosomes than the parent cells = aneuploid or a mutation of the genes

6.  Cancer development  Initiation – there are many theories as to when the genes in the cells are damaged, maybe in utero, from physical or chemical exposure, latent oncogenes, viruses, or a lack of suppressor genes from our parents, and at this point the cell is not dividing.

7.  Cancer development  Promotion - the stage when the abnormal cell starts to divide, may be stimulated by environmental changes, hormones, drugs, or irritants

8.  Cancer development  Progression – the phase when the abnormal cells have continued to grow into a Primary tumor, may produce angiogenesis factors which supply blood and vascular nourishment to the tumor. The tumor may have subcolonies of cells with different genes and features

9.  Cancer development  Metastasis the movement of cancer cells into other organs of the body, thus creating new tumor sites.

10.  Cancer grading and staging  Cancer is graded upon the resemblance to normal cells = G (The higher the number, the worse the grade of cancer) i.e. G 1, G 2, G 3, G 4  Staging is based upon  the presence of a primary tumor = T  involvement in lymph nodes = N  and appearance of metastasis = M  Numbers of the stage range from x = none to 3 or 4 for each letter

11.  Cancer risks  High alcohol consumption  Low dietary vegetables and fiber (sources of antioxidants)  Previous Viral infections: Hepatitis B or C Herpes viruses Papilloma viruses (HPV) Retrovirus HTLV –I

12.  Symptoms of Cancer  Cachexia – weight loss,unexplained  Anorexia  Anemia  Impaired immune response  Pain – when the cancer is large enough to compress nerves or organs  Lymphadema – when the tumor blocks lymph or circulatory flow  Motor or sensory deficits

13.  Cancer statistics  The top four cancers found in the United States are:  Lung  Breast  Prostate  Colorectal C

14.  Cancer statistics  Prostate cancer is the most common site of cancer and the 2 nd most common cause of cancer death in the United States  The first cause of death in males is Lung Cancer

15.  Cancer statistics  Lung cancer has annual new cases (incidence) of 173,770 people per year: 93,110 males and 80,660 females  Annual mortality: 160,440 per year consisting of 92,000 males and 68,510 females

16.  Cancer statistics  28% of all cancer deaths are due to lung cancer  This is the leading cause of cancer death in both men and women  There are more deaths from lung cancer than prostate, breast, and colorectal cancers combined

17.  Cancer statistics  Risks for lung cancer:  Smoking (75-80% of cases)  Occupational exposure  Nutrition/Diet  Genetic factors

18.  Cancer statistics  Prostate cancer is number two cause of cancer in men  Breast Cancer is number two cause of cancer in women  Most common non-malignant or non-fatal cancer is non-melanoma type skin cancers

19.  Chemotherapy  Prevention chemotherapy – for high risk patients, precancerous lesions, or history of cancer  Antioxidants, vitamins  Aldara cream 3x weekly for precancerous skin lesions  Aspirin  Protease inhibitors

20.  Chemotherapy - typically started after surgical dissection of tumor, unless the tumor is non-operative  Usually given by a long term venous access device, i.e. PICC line, implanted ports, or direct catheratization to the tumor.  Chemotherapy is usually potent and horribly scarring on normal veins

21.  Side effects of Chemotherapy  Fatigue  Anemia  Leukopenia  Thrombocytopenia  Always – Nausea,Vomiting, Diarrhea  Neurotoxicity & neuropathies  Capillary leakage  Headaches  Fluid and electrolyte imbalances

22.  Side effects of Chemotherapy  Anorexia – change in taste buds  Back aches  Joint aches  Blood clots  Oral mucositis – (reduced significantly by L- glutamine amino acids orally)  Supra opportunistic infections  Septic DIC  Tumor lysis syndrome  Edema or pulmonary edema

23.  Pharmacological interventions  Megace, Marinol – for appetite stimulation  Premedications for nausea, vomiting, edema, headaches: usually on the protocol for chemo Antiemetics; Zofran – 24 hour control Tigan, Kytril, ativan, anzamet, Compazine, benadryl, reglan Corticosteroids

24.  Pharmacological interventions  Analgesics  IV electrolytes and fluid replacement  Stool softeners to counteract constipation from opioids  GSF for WBC’s  Epogen/Procrit for anemia  Leukine/Prokine for leukopenia  Neupogen for neutrophilia  Neumega for thrombocytopenia  Diuretics for edema

25.  Non-Pharmacological interventions Massage Reflexology Accupuncture Musical therapy Prayer Meditation Diversional acitivities Dietary counselling

26.  Radiation therapy  All types of cells are injured or destroyed by concentrated radiation. Rapidly dividing cells are the most sensitive.

27.  Radiation therapy  Types : Gamma knife Local beam treatment Local seeding ARC – stereotactic Radioimmunotherapy Fractionation Total body irradiation Particle beam therapy, i.e. proton or neutron therapy

28.  Radiation therapy side effects  Side effects depend on the amount and area being irradiated  Fatigue  Nausea and vomiting  Mild anemia  Leukopenia  Diarrhea  Pain

29.  Radiation therapy side effects:  Erythema/burns  Fatigue  Pneumonitis  Esophagitis  Dysphasia

30.  Malignant Lymphomas – 2 types  Hodgkin's Lymphoma – most common cancer in 10 to 20 year olds (young adults). Associated with an inflammatory process related to +EBV/mono infection.  Diagnosis: Classic Reed-Steinberg cell with two mirrored nuclei, CT scan  Symptoms: Extreme fatigue, enlarged lymph nodes that are painless. May progress to weight loss fevers, night sweats

31.  Leukemia– hematopoeitic cancer of the stem cells. These stem cells proliferate into non-functional immature white cells.  More children get leukemia than any other type of cancer and it is the #1 cause of death in children.  Anyone can get leukemia at any age.