1. Causes of Cancer Defective cellular growth
Stem cells
Generation time
Contact Inhibitor
Defective cellular differentiation
Exposure to carcinogens
Moves to less mature form
Leads to invasion and metastasis

2. Characteristics of Normal Cells
Limited Cell Division
Specific Morphology
Small Nuclear-Cytoplasmic Ratio
Perform Specific Differentiated Functions
Adhere tightly together…
Are nonmigratory
Grow in an orderly and well differentiated manner
Are contact inhibited

3. Characteristics of Early Embryonic Cells
Demonstrate rapid and continuous cell division
Show anaplastic morphology
Have a large nuclear-cytoplasmic ratio
Perform no differentiated functions
Adhere loosely together
Are able to migrate
Are not contact inhibited.

4. Characteristics of Benign Cells
Demonstrate continuous or inappropriate cell growth.
Show specific morphology
Have a small nuclear-cytoplasmic ratio
Perform differentiated functions
Adhere tightly together
Are nonmigratory
Grow in an orderly and well regulated fashion.

5. Characteristics of Malignant Cells
Demonstrate rapid or continuous cellular division.
Show anaplastic morphology
Have a large nuclear-cytoplasmic ratio
Lose some or all differentiated functions
Adhere loosely together
Are able to migrate
Grow by invasion
Are not contact-inhibited

6. Definitions
Anaplasia
Anaplastic
Carcinogen
Carcinoma

7. Hyperplasia
Hypertrophy
Metastasis
Neoplasia
Neoplasm

8. Stages of Carcinogenesis (Oncogenesis)
Initiation
Promotion
Progression
Metastasis

9. Common Steps in Metastasis
Extension into Surrounding Tissues
Penetration into Blood Vessels
Release of Tumor Cells
Invasion of Tissue at the Site of Arrest

10. Immune Response Attempts to destroy abnormal cells Surface Antigens
Used as tracers to indicate success of treatment
CEA (carcinoembrionic antigen) - GI tract
AFP (alphafetoprotein) - liver
CA ovarian
PSA – prostate

11. Cancer Grade and Stage
Grading; Classifies cellular aspects of a cancer.
Staging; Classifies clinical aspects of the cancer.

12. Histologic Class I - Well differentiated II - Moderate differentiation
III - Poor differentiation
IV - Immature & Undifferentiated

13. Clinical Staging O - Ca in situ I (A) - Localized growth
II (B) - Limited local growth
III (C) - Extensive local and regional growth
IV (D) - Metastasis

14. TNM Classification Tis No Mo T4 N3 M1 T - Primary tumor
N - Regional lymph nodes
M - Distant metastasis
Tis No Mo
T4 N3 M1

15. Goal
Education and early detection C A U T I O N

16. Surgical Interventions
Biopsy
Cure
Control - Debulking
Palliative
Staging
Reconstructive
Prophylaxis

17. Radiation Destroys cells, causes inflammatory response Side Effects
Goals:
Cure
Control
Palliative
Radiation Recall
External
Implants
Isotopes

18. Chemotherapy Cell Cycle Non-specific
Alkylating –Cytoxan, Leukeran, N.Mustard
Antitumor antibiotics - Adriamycin
Nitrosoureas –Carmustine, Hydrourea
Corticosteroids –Prednisone, Decadron
Hormones –Estrogen, Provera, Androgen
Cell Cycle Specific
Antimetabolities –Methotrexate, 5-FU
Plant Alkaloids (Miotic Inhibitors) –Vinblastine, Vincristine
Cisplatin
Tamoxifen

19. Synergistic Effect The total is greater than the individual parts
Each agent has:
action against cancer
different site of action
different organ toxicity or time of toxicity

20. MOPP Protocol Agent Action Toxicity Synergistic Effect
Complete response
Agent
Action
Toxicity
20%
Mustargen
DNA
Marrow – 10 days
 10%
Oncovin
Mitosis
Neurotoxic
Procarbazine
RNA Synthesis
Marrow – 21 days
 5%
Prednisone
Cell membrane
Immune suppression
80%
Synergistic Effect

21. bone marrow suppression
Side Effects
Cluster the common ones:
bone marrow suppression
alopecia
nausea and vomiting
Adriamycin - Cardiac
Cisplatin – Renal

22. Complications Pain Control Bone Marrow Suppression Infarction
Infection - Neutropenia
Hemorrhage
Anemia
Infarction
Superior Vena Cava Syndrome
Spinal Cord Compression
Tumor Lysis Syndrome

23. Common Problems/Complications Associated With Cancer
Tumor Lysis Syndrome (TLS);
Destruction of cells (lysis)
Release of Purine and Potassium (K+) into Bloodstream
Purines converted to uric acid (in liver) K+ into Bloodstream
Hyperuricemia Hyperkalemia
Obstruction of Kidney Tubules
ARF

24. Paraneoplastic Syndromes
Secretion of Insulin
Secretion of ACTH
Hypercalcemia
SIADH

25. SIADH - Syndrome of Inappropriate ADH
ADH release
Water Reabsorption into circulation -Renal Tubules
Extravascular Fluid
Plasma Osmolality
Glomerular Filtration Rate
Serum Sodium Levels CEREBRAL EDEMA

26. Leukemia AML - Acute Myelogenous ALL - Acute Lymphocytic
Age of Onset (15-39 yrs), usually affects adults
Prognosis is generally poor, best with bone marrow transplant
Most common type of leukemia
Equal incidence in males and females
ALL - Acute Lymphocytic
Age of Onset (<15 yrs), usually affects children, accounts for approx 10% of adult leukemia's
Prognosis is poorer for adults than for children
Fever & Bleeding
Increased incidence in males

27. Leukemia CML - Chronic Myelogenous CLL - Chronic Lymphocytic
Age of Onset (>50 yrs)
Involves liver & spleen
Blastic Crisis
CLL - Chronic Lymphocytic
Older patients – over 50
Lymph node involvement

28. Lymphoma Lymph system Lymphocytes & histiocytes (macrophages) Hodgkins
15-35 and over 50 yrs.
Non-Hodgkins
Outside of lymph nodes
Wide spread before Dx
Multiple Myeloma
Infiltrates marrow
destroys bone

29. Breast Early detection - Education Treatment options Mastectomy care
Referrals

30. Gynecological
Cervical
Endometrial
Ovarian

31. Genetics and Cancer
BRCA