Oncology Chapter 19

Learning Outcomes Define cancer. Describe cell differentiation. Identify the staging system that evaluates the spread of a tumor. Contrast the characteristics of benign and malignant tumors. List the seven warning signals of cancer.

Overview of Cancer Cancer refers to any malignant tumor. Incidence of cancer is five times higher than 100 years ago. Strikes 1 of every 3 Americans. Has become one of the more treatable of the major diseases in the U.S. Highly advanced surgical techniques Chemotherapy and radiation therapy Immunotherapy and photodynamic therapy

Top 10 Cancers by Death RATE in US

Types of Cancer Four broad types of cancer: Carcinomas: arise from epithelial tissue (skin, lining of the intestines and body cavities, surface of body organs, outer portion of glands) Sarcomas : arise from connective tissue (bone, tendon, cartilage, muscle, fat tissues) Leukemias: cancers of the blood which originate in the bone marrow or the lymphatic system Lymphomas: cancers that originate in lymph nodes and glands 7

Classification of Cancer Helps determine appropriate treatment and prognosis. Tumors are classified according to: Anatomic site of origin Grading- determined by pathologists to describe cell division Staging – how the disease is spreading through the body

Classification of Cancer Anatomic Site Indicates where the cancer originated in the body. Carcinomas make up the great majority of all cancers. Malignant tumors of epithelial tissues The opposite of malignant is benign ( Etymology: L, benignus, kind )

Table 19.1 Characteristics of Benign and Malignant Tumors

Classification of Cancer Anatomic Site Carcinomas make up the great majority of all cancers. Examples Squamous carcinoma (squamous epithelium) Basal cell carcinoma (skin cancer) Bronchogenic carcinoma (bronchus of respiratory tract) Sarcomas – sarc/o and omas Leukemia Lymphomas Myelomas (look up in book now, noticed the combining form myel/o

Figure 19.2 Squamous cell carcinoma.

Cell Differentiation and Grading Normal cells Reproduce themselves through mitosis (mit/thread, osis/condition), an orderly process that assures growth, tissue repair, and cell reproduction. Have a distinct appearance and a specialized function. In normal cell development, immature cells undergo normal changes as they mature and assume their specialized functions. This process is called differentiation.

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Cell Differentiation and Grading In cancer, a cell or group of cells undergoes changes and no longer carries on normal cell functions. This failure of immature cells to develop specialized functions is called dedifferentiation. It is believed that this process involves a disturbance in the DNA of the affected cells.

Cell Differentiation and Grading Malignant cells Usually multiply rapidly, forming a mass of abnormal cells that enlarges, ulcerates, and sheds malignant cells that invade surrounding tissues. These malignant cells take the place of normal cells.

Cell Differentiation and Grading Malignant cells Under the microscope, a malignant cell reveals: a loss of differentiation Anaplasia (ana (up and apart)/plasia (formation) nuclei of various sizes that are hyperchromatic (hyper/chromatic (color)) cells in the process of rapid and disorderly division.

Cell Differentiation and Grading Based on microscopic analysis, malignant tumors are classified as: Grade 1 The most differentiated and the least malignant tumors. Only a few cells are undergoing mitosis; however, some abnormality does exist. Grade 2 Moderately undifferentiated. More cells are undergoing mitosis, and the pattern is fairly irregular.

Cell Differentiation and Grading Based on microscopic analysis, malignant tumors are classified as: Grade 3 Many undifferentiated cells. Tissue origin can be difficult to recognize. Many cells are undergoing mitosis. Grade 4 The least differentiated and high degree of malignancy.

Cell Differentiation and Grading Tumor grading is used to: Report the prognosis of the disease. Determine whether the tumor is likely to respond to radiation therapy or chemotherapy. Determine the prognosis for surgery.

Invasive Process Invasive Growth Active migration The malignant cells: Break away from the neoplasm. Invade surrounding tissue. Divide. Form secondary neoplasms. Then reunite with the primary tumor as growth continues.

Invasive Process Metastasis Cancer cells spread from a primary site to distant secondary sites by: invading the bloodstream or lymph system. becoming lodged at a secondary site where they form a neoplasm. Development of a secondary neoplasm depends on the viability and the receptivity of the organ.

Figure 19.3 How cancer cells invade normal tissue.

Staging The staging system that indicates the spread of a tumor uses the letters: T (tumor) N (node) M (metastasis) Uses numerical subscripts to indicate degree of tumor involvement. Example: T2N1M0

Staging Numerical system to classify the staging of cancer: Stage 0: Cancer in situ. Stage I: Cancer limited to the tissue of origin. Stage II: Limited local spread of cancerous cells, sometimes to lymph nodes. Stage III: Extensive local and regional spread of cancer, usually to draining lymph nodes. Stage IV: Distant metastasis.

Characteristics of Neoplasms The American Cancer Society lists seven warning signals of cancer using the first letters of the word CAUTION: Change in bowel or bladder habits. A sore that does not heal. Unusual bleeding or discharge. Thickening or lump in breast or elsewhere. Indigestion or difficulty in swallowing. Obvious change in a wart or mole. Nagging cough or hoarseness

Diagnosis A variety of diagnostic tools and procedures is used to detect the possible presence of cancer: Examination Visualization by endoscopy Laboratory analysis Biopsy (Bx) Diagnostic radiology

Diagnosis Examination American Cancer Society recommends certain cancer detection tests be included in an annual physical examination. Visualization by endoscopy Provides the physician a direct view of certain portions of the body.

Diagnosis Visualization by endoscopy-679 Sigmoidoscopy Laryngoscopy Bronchoscopy Gastroscopy Cystoscopy Colposcopy Proctoscopy Colonoscopy Laparoscopy

Diagnosis Laboratory analysis Plays a key role in detecting specific types of cancer. Pap smear/test Cytologic screening test used to detect the presence of abnormal or cancerous cells from the cervix and vagina. Fecal occult blood test Test to detect occult (hidden) blood. If blood is present, check for possible cancer of the colon.

Diagnosis Laboratory analysis (listed on page 679) Sputum cytology test Microscopic examination of sputum to detect abnormal or cancerous cells of the bronchi and lungs. Blood serum test Analysis of blood serum to obtain useful information about certain proteins synthesized by cancer. Two such tests are the AFP and hCG.

Diagnosis Biopsy The surgical removal of a small piece of tissue for microscopic examination. Method to positively diagnose cancer. Excisional Surgical removal of a piece of tissue from the suspected body site.

Diagnosis Diagnostic radiology Encompassing a wide range of tests and procedures that can reveal tumors that were not detected by other diagnostic procedures.

Treatment Methods of cancer treatment Surgery Chemotherapy Radiation therapy Immunotherapy Photodynamic therapy cancer/treatment/types cancer/treatment/types

Look at pages Prefixes Combining Forms Suffixes Medical Terms