Oncology

OncologyChapter 5PathologyOncology DefinitionBranch of medicine that deals with the study, detection, treatment and management of cancer OncologyBiology of abnormal cancer cellsThey have continuous or inappropriate, usually faster growth or larger growth patternsThey have no specific morphology and often do not resemble their parent cells = anaplasticThey do not respond to signals for apoptosis = programmed cell death

OncologyBiology of abnormal cancer cellsHave a large nuclear cytoplasmic ratio; the nucleus may occupy most of the cell areaThey lose some or all of their normal cell functionsThey do not make fibronectin, and thus cannot connect easily and break off easilyOncologyBiology of abnormal cancer cellsThey are able to migrate throughout the body = metastasisThey invade other tissues and types of cells.They are not controlled by contactThey have more or less chromosomes than the parent cells = aneuploidor a mutation of the genesOncologyCancer developmentInitiation 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.OncologyCancer developmentPromotion - the stage when the abnormal cell starts to divide, may be stimulated by environmental changes, hormones, drugs, or irritants

OncologyCancer developmentProgression 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 featuresOncologyCancer developmentMetastasisthe movement of cancer cells into other organs of the body, thus creating new tumor sites.OncologyCancer grading and stagingCancer is graded upon the resemblance to normal cells = G(The higher the number, the worse the grade of cancer) i.e. G1, G2, G3, G4

Staging is based upon the presence of a primary tumor = Tinvolvement in lymph nodes = N and appearance of metastasis = MNumbers of the stage range from x = none to 3 or 4 for each letterOncologyCancer risksHigh alcohol consumptionLow dietary vegetables and fiber (sources of antioxidants)Previous Viral infections:Hepatitis B or CHerpes virusesPapilloma viruses (HPV)Retrovirus HTLV IOncologySymptoms of CancerCachexia weight loss,unexplainedAnorexiaAnemiaImpaired immune responsePain when the cancer is large enough to compress nerves or organsLymphadema when the tumor blocks lymph or circulatory flowMotor or sensory deficitsOncologyCancer statisticsThe top four cancers found in the United States are:LungBreastProstateColorectal C

OncologyCancer statisticsProstate cancer is the most common site of cancer and the 2nd most common cause of cancer death in the United StatesThe first cause of death in males is Lung CancerOncologyCancer statisticsLung cancer has annual new cases (incidence) of 173,770 people per year: 93,110 males and 80,660 femalesAnnual mortality: 160,440 per year consisting of 92,000 males and 68,510 females

OncologyCancer statistics28% 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

OncologyCancer statisticsRisks for lung cancer:Smoking (75-80% of cases)Occupational exposureNutrition/DietGenetic factors

OncologyCancer 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 cancersOncologyChemotherapyPrevention chemotherapy for high risk patients, precancerous lesions, or history of cancerAntioxidants, vitaminsAldara cream 3x weekly for precancerous skin lesionsAspirinProtease inhibitors

OncologyChemotherapy - typically started after surgical dissection of tumor, unless the tumor is non-operativeUsually 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 veinsOncologySide effects of ChemotherapyFatigueAnemiaLeukopeniaThrombocytopeniaAlways Nausea,Vomiting, Diarrhea Neurotoxicity & neuropathiesCapillary leakageHeadachesFluid and electrolyte imbalancesOncologySide effects of ChemotherapyAnorexia change in taste budsBack achesJoint achesBlood clotsOral mucositis (reduced significantly by L-glutamine amino acids orally)Supra opportunistic infectionsSeptic DICTumor lysis syndromeEdema or pulmonary edema

OncologyPharmacological interventionsMegace, Marinol for appetite stimulationPremedications for nausea, vomiting, edema, headaches: usually on the protocol for chemoAntiemetics;Zofran 24 hour controlTigan, Kytril, ativan, anzamet, Compazine, benadryl, reglanCorticosteroidsOncologyPharmacological interventionsAnalgesicsIV electrolytes and fluid replacementStool softeners to counteract constipation from opioidsGSF for WBCsEpogen/Procrit for anemiaLeukine/Prokine for leukopeniaNeupogen for neutrophiliaNeumega for thrombocytopeniaDiuretics for edema

OncologyNon-Pharmacological interventionsMassageReflexologyAccupunctureMusical therapyPrayerMeditationDiversional acitivitiesDietary counselling

OncologyRadiation therapyAll types of cells are injured or destroyed by concentrated radiation. Rapidly dividing cells are the most sensitive.

OncologyRadiation therapyTypes :Gamma knifeLocal beam treatmentLocal seedingARC stereotacticRadioimmunotherapyFractionationTotal body irradiationParticle beam therapy, i.e. proton or neutron therapyOncologyRadiation therapy side effectsSide effects depend on the amount and area being irradiatedFatigueNausea and vomitingMild anemiaLeukopeniaDiarrhea Pain

Oncology Radiation therapy side effects:Erythema/burnsFatiguePneumonitisEsophagitisDysphasia

OncologyMalignant Lymphomas 2 typesHodgkin'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 scanSymptoms: Extreme fatigue, enlarged lymph nodes that are painless. May progress to weight loss fevers, night sweatsLeukemia 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.Oncology