1. 1 Altered Cell Growth and Cancer Development Keith Rischer RN, MA, CEN

2. 2 Elsevier items and derived items © 2006 by Elsevier Inc. Characteristics of Normal Cells  Have limited cell division  Undergo apoptosis  Show specific morphology  Perform specific differentiated functions  Adhere tightly together  Nonmigratory  Grow in an orderly and well-regulated manner

3. 3 Elsevier items and derived items © 2006 by Elsevier Inc. Pathophysiology: Cell Cycle  Cellular proliferation  Permanent Brain Heart  Labile Hematopoetic GI  Stable  Cellular differentiation  Apoptosis  Cell Cycle  Cancerous mutation

4. 4 Oncogenesis: Key Concepts  Normal cell growth  Controlled by tumor suppressor genes  Oncogenesis  Multifactorial  Environmental  Lifestyle  Genetic  Immune function

5. 5 Cancer Development  Malignant transformation occurs through the following steps:  Initiation Carciniogens –Chemicals, physical agents, viruses –Table 27-4 p.473  Promotion Hormones, drugs or chemicals –Smoking has both initiation and promotion factors  Progression Develop blood supply  Metastasis

6. 6 Elsevier items and derived items © 2006 by Elsevier Inc. Metastasis  Extension into surrounding tissues  Blood vessel penetration  Release of tumor cells Loosely held together  Invasion  Local seeding Shedding of cancer cells locally Peritoneal, pleural  Bloodborne metastasis Most common  Lymphatic spread

7. 7 Benign vs. Malignant Neoplasms  Cell characteristics  Well differentiated  Resemble cells of tissue of origin  Rate of growth  Slow or may stop  Mode of growth  Does not invade surrounding tissues  Usually encapsulated  Metastasis  None  Cell characteristics  Undifferentiated  Does not resemble tissue of origin  Rate of growth  Variable-can be slow or rapid  Mode of growth  Grows by invasion…infiltrates surrounding tissues  Metastasis  Obtains access to blood and lymph systems to spread throughout body

8. 8 Elsevier items and derived items © 2006 by Elsevier Inc. Cancer Staging  Clinical Staging  Based on clinical manifestations  biopsy  Surgical Staging  Assess tumor size directly  Pathologic Staging  Most definitive  YouTube - Breast Cancer Pathology YouTube - Breast Cancer Pathology

9. 9 Elsevier items and derived items © 2006 by Elsevier Inc. External Factors that Promote Carconogenesis  Chemical  30% all cancers due to smoking  Physical  Radiation Ionizing Ultraviolet  Viral HPV Hep. B  Dietary  Personal  Immune function  Age  Genetic

10. 10 Primary vs. Secondary Prevention  Avoid known carcinogens  Modification of behavior  Remove “at risk” tissue  Chemoprevention  Routine screening  Pap test annually  Yearly mammography >40  Colonoscopy >50  Prostate screening >50