San Juan de Dios Educational Foundation Inc.

Oncology Nursing: An
Introduction

Prepared By: Kristina Sevilla, RN

 Cancer Statistics
• All Sites of Cancer
– Estimated new Cancer 1,479,350
• Male - 766,130
• Female - 713,220
– Estimated Deaths 562,340
• Male - 292,540
• Female - 269,800
 2009 Estimated US Cancer the act of deviating
from the ordinary, usual, or normal typeDeaths*
Men Women
• Lung & bronchus 30%
• Prostate 9%
292,540 269,800 26% Lung & bronchus
• Colon & rectum 9% 15% Breast
• Pancreas 6%
9% Colon & rectum
• Leukemia 4%
• Liver & intrahepatic 4% 6% Pancreas
bile duct
5% Ovary
• Esophagus 4%
• Urinary bladder 3% 4% Non-Hodgkin
• Non-Hodgkin 3% lymphoma
lymphoma 3% Leukemia
• Kidney & renal pelvis3%
3% Uterine corpus
• All other sites 25%
2% Liver & intrahepatic
bile duct
• ©2009, American Cancer Society, Inc.
2% Brain/ONS
25% All other sites
 Mortality, 2006
 Rank cause of Death
• 1. Heart Diseases 631,636 26.0
•

• 2. Cancer 559,888 23.1

• 3. Cerebrovascular diseases 137,119 5.7
•

• 4. Chronic lower respiratory diseases 124,583 5.1

•

• 5. Accidents (unintentional injuries) 121,599 5.0

•

• 6. Diabetes mellitus 72,449 3.0

•

• 7. Alzheimer disease 72,432 3.0

•

• 8. Influenza & pneumonia 56,326 2.3

•

9. Nephritis* 45,344 1.9

• 10. Septicemia 34,234 1. 4
• ©2009, American Cancer Society, Inc.
•
Incident
 History

•
Greek Word
“Karkinoma” for Crab
 CANCER

A group of more than 270 different diseases

characterized by:

• Proliferation
• Invasion and Metastasis
• Loss of Differentiated Function
• Mutations
 The Precise
Etiology of Cancer
is “UNKNOWN”
How does Cancer Develop

Initiation

Promotion

Progressio
n
 Defect in Cellular Proliferation
• Under normal situations there is control of
the number of cells in the body.
– Balance between cellular proliferation and
cellular death.
– Contact inhibition
• If something goes wrong in the control
mechanism, it can result in rapid
proliferation of immature cells.
 Normal Cells
VS.
Malignant Cells
 MITOTIC CELL DIVISION
Normal Cells Malignant Cells

Leads to two daughter cell Leads to multiple daughter

cells that may or may not
resemble the present.
 APPEARANCE
Normal Cells Malignant Cells
1. Cells of the same type, 1. Cells larger and grow more
homogenous in size, rapidly than normal.
shape, and growth.
2. Cells cohesive, form 2. Cells not as cohesive,
regular pattern expansion. irregular patterns of
3. Uniform size to nucleus. expansion.
4. Have characteristics 3. Larger more prominent
pattern of organization. nucleus.
4. Lack characteristic pattern
of organization of host
cells.
 GROWTH PATTERN
Normal Cells Malignant Cells
1. Do not invade adjacent 1. Invade adjacent tissues
tissues

2. Proliferate In response to 2. Proliferate in response to

specific stimuli abnormal stimuli

3. Grow in ideal condition 3. Grow in adverse condition

such as lack of nutrients.
 GROWTH PATTERN
Normal Cells Malignant Cella
1. Exhibit Contact Inhibition Do not exhibit Contact
Inhibition

2. Cell birth equals Cell death Cell birth exceeds Cell Death

3. Stable Cell Membrane Loss of Cell Control as a

result of cell membrane
changes
 GROWTH PATTERN
Normal Cell Malignant Cell
1. Constant or Predictable 1. Growth rate erratic
growth rate

2. Cannot grow outside 2. Able to break off cells and

specific environment migrate.

May grow in the other sites.

 Normal Cells
Reproduce themselves exactly
Stop reproducing at the right time
Stick together in the right place
Self destruct if they are damaged
Become specialized or 'mature‘
Cells communicate well
Cancer Cells
Cancer cells don't stop reproducing
Cancer cells don't stick together
May self destruct more slowly than
they reproduce
Cancer cells don't specialize, but
stay immature
Cancer cells don't obey signals from
other cells
Reactive and Neoplastic Growth Process

• Atrophy

• Hypertrophy

• Hyperplasia
 Reactive & Neoplastic Growth Process

Metaplasia “ cell type conversion”

Dysplasia “ maturation Abnormality”

Anaplasia “DeDifferentiation”

Neoplasia “abnormal Proliferation”

 What is Neoplasm?
• is an abnormal proliferation of tissues,
usually caused by genetic mutations.
• Any overgrowth of tissue can form a
TUMOR.
• Either Benign or malignant.
 BENIGN NEOPLASM
1. Composed of cells that look like 1. Composed of Undifferentiated
the tissue origin
2. Usually encapsulated
3. Grow slowly and by expansion
4. Do not recur and metastasize
5. Do not destroy tissue generally
6. Do not cause systemic
symptoms or death generally.
MALIGNANT NEOPLASM
Cells
2. Little semblance to tissue of
origin
3. Grows rapidly
4. Expands at Periphery and
Invades and destroys
surrounding tissue
5. It Spreads by way of lymph and
blood to distant parts of the body
6. Causes systemic signs and may
cause death
 What is TUMOR?
• is the name for a swelling or lesion formed
by an abnormal growth of cells (termed
neoplastic).
• Tumor is not synonymous with cancer.
• A tumor can be benign or malignant.
 Cancer Types
• Carcinoma- a tumor derived from epithelial
cells, those cells that line the surface of our skin
and organs.
– This is the most common cancer type and
represents about 80-90% of all cancer cases
reported.

• Sarcoma- a tumor derived from muscle, bone,

cartilage, fat or connective tissues.
• Leukemia- a cancer derived from white blood
cells or their precursors.

• Lymphoma- a cancer of bone marrow derived

cells that affects the lymphatic system.

• Myelomas- a cancer involving the white blood

cells responsible for the production of antibodies
Where Cancers Spread Locally?

• tumors grow along the

“path of least resistance”.
 How Cancer Spreads?

• The cancer that grows where it first started

in the body is called the 'primary cancer'.

• The place a cancer spreads to and then

starts growing is called the 'secondary
cancer' or 'metastasis'.
How Cancer Spreads?
 Three main ways a cancer spreads.

• Local spread
• Through the blood
circulation
• Through the
lymphatic system
GENES and MUTATIONS
 Normal Genes
1. proto-oncogene
•A gene that has functions to
promote cell division.
•are responsible for providing the
positive signals that lead to cell
division. Some proto-oncogenes
work to regulate cell death
2. Tumor Suppressor
•A gene that functions in the control
of cell division.
•These genes work to limit cell
division and may be contrasted with
oncogenes
Mutated Genes
1. Oncogenes
• A defective gene that is involved
in triggering cancer cell growth
• can cause a cell to divide in an
unregulated manner.
2. The loss of function of these
genes leads to abnormal cellular
behavior
 FACTS:

All cancers demonstrate

alterations in one or more
tumor suppressors
and oncogenes
 Hallmarks of Cancer

1. Tissue Invasion and Metastasis

2. Failure to Respond to “STOP” Signals
3. Evading Apoptisis
4. Growth without “GO” Signals
5. Unlimited Number of Cell Divisions
6. Continued Angiogenesis
 Risk Factors of Cancer
Non – Controllable Controllable
• Gender M> F • Stress
• Age • Diet
• Race • Occupation
• Infection
• Lifestyle
• Drugs
 Etiology/ Causative Factor
• Extrinsic Factor • Intrinsic Factor
– Viruses and bacteria
– Hormonal Factor
– Chemical Carcinogens
– Genetic Factor
– Radiation Carcinogens
– Physical Stressor
– Iatrogenic Chemical
agents – Dietary Factors
A. Viruses and Bacteria
Viruses and Bacteria
• Chemical Agents
– Industrial wastes, pesticides, cigarette
smoking, asbestos, phenol
– Natural body substance in body: Bile acids
– Food Additives: Sodium Saccharine, Nitrites

• Drugs and Hormone

 Physical Agents: Radiation

• -Radiation (both solar and ionizing), and

radon, nuclear radiation.
Hereditary Factors
Cancer’s Nine Warning Signs
• C hange in bowel or bladder habits
• A sore that does not heal
• U nusual bleeding or discharge
• T hickening or lump in breast or elsewhere
• I ndigestion or difficulty in swallowing
• O bvious change in wart or mode
• N agging cough or hoarseness
• U nexplained anemia
• S sudden loss of weight
 Levels of Cancer
Prevention and Control
 1. Primary Prevention
• Focus on eliminating the conditions that
cause cancer to develop.

• Cancer not yet develop or is in pre-

cancerous stage.
 2. Secondary Prevention
• Refers to early detection coupled with
effective therapy.

• Cancer maybe curablein early stage.

 3. Tertiary Prevention
• Refers to te prevention of cancer
recurrences, symptoms and
complications.

• It involves supportive care, Rehabilitation

and Pain Relief.
Thank You!