Oncology

1. Oncology Chapter 5 Pathology

2. Oncology Definition Branch of medicine that deals with the study, detection, treatment and management of cancer

3. Oncology • Biology of abnormal cancer cells • They have continuous or inappropriate, usually faster growth or larger growth patterns • They have no specific morphology and often do not resemble their parent cells = anaplastic • They do not respond to signals for apoptosis = programmed cell death

4. Oncology • Biology of abnormal cancer cells • Have a large nuclear – cytoplasmic ratio; the nucleus may occupy most of the cell area • They lose some or all of their normal cell functions • They do not make fibronectin, and thus cannot connect easily and break off easily

5. Oncology • Biology of abnormal cancer cells • They are able to migrate throughout the body = metastasis • They invade other tissues and types of cells. • They are not controlled by contact • They have more or less chromosomes than the parent cells = aneuploid or a mutation of the genes

6. Oncology • Cancer development • Initiation – 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.

7. Oncology • Cancer development • Promotion - the stage when the abnormal cell starts to divide, may be stimulated by environmental changes, hormones, drugs, or irritants

8. Oncology • Cancer development • Progression – 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 features

9. Oncology • Cancer development • Metastasis the movement of cancer cells into other organs of the body, thus creating new tumor sites.

10. Oncology • Cancer grading and staging • Cancer 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 = T • involvement in lymph nodes = N • and appearance of metastasis = M • Numbers of the stage range from x = none to 3 or 4 for each letter

11. Oncology • Cancer risks • High alcohol consumption • Low dietary vegetables and fiber (sources of antioxidants) • Previous Viral infections: Hepatitis B or C Herpes viruses Papilloma viruses (HPV) Retrovirus HTLV –I

12. Oncology • Symptoms of Cancer • Cachexia – weight loss,unexplained • Anorexia • Anemia • Impaired immune response • Pain – when the cancer is large enough to compress nerves or organs • Lymphadema – when the tumor blocks lymph or circulatory flow • Motor or sensory deficits

13. Oncology • Cancer statistics • The top four cancers found in the United States are: • Lung • Breast • Prostate • Colorectal C

14. Oncology • Cancer statistics • Prostate cancer is the most common site of cancer and the 2nd most common cause of cancer death in the United States • The first cause of death in males is Lung Cancer

15. Oncology • Cancer statistics • Lung cancer has annual new cases (incidence) of 173,770 people per year: 93,110 males and 80,660 females • Annual mortality: 160,440 per year consisting of 92,000 malesand 68,510 females

16. Oncology • Cancer statistics • 28% 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

17. Oncology • Cancer statistics • Risks for lung cancer: • Smoking (75-80% of cases) • Occupational exposure • Nutrition/Diet • Genetic factors

18. Oncology • Cancer 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 cancers

19. Oncology • Chemotherapy • Prevention chemotherapy – for high risk patients, precancerous lesions, or history of cancer • Antioxidants, vitamins • Aldara cream 3x weekly for precancerous skin lesions • Aspirin • Protease inhibitors

20. Oncology • Chemotherapy- typically started after surgical dissection of tumor, unless the tumor is non-operative • Usually 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 veins

21. Oncology • Side effects of Chemotherapy • Fatigue • Anemia • Leukopenia • Thrombocytopenia • Always – Nausea,Vomiting, Diarrhea • Neurotoxicity & neuropathies • Capillary leakage • Headaches • Fluid and electrolyte imbalances

22. Oncology • Side effects of Chemotherapy • Anorexia – change in taste buds • Back aches • Joint aches • Blood clots • Oral mucositis – (reduced significantly by L-glutamine amino acids orally) • Supra opportunistic infections • Septic DIC • Tumor lysis syndrome • Edema or pulmonary edema

23. Oncology • Pharmacological interventions • Megace, Marinol – for appetite stimulation • Premedications for nausea, vomiting, edema, headaches: usually on the protocol for chemo Antiemetics; Zofran – 24 hour control Tigan, Kytril, ativan, anzamet, Compazine, benadryl, reglan Corticosteroids

24. Oncology • Pharmacological interventions • Analgesics • IV electrolytes and fluid replacement • Stool softeners to counteract constipation from opioids • GSF for WBC’s • Epogen/Procrit for anemia • Leukine/Prokine for leukopenia • Neupogen for neutrophilia • Neumega for thrombocytopenia • Diuretics for edema

25. Oncology • Non-Pharmacological interventions • Massage • Reflexology • Accupuncture • Musical therapy • Prayer • Meditation • Diversionalacitivities • Dietary counselling

26. Oncology • Radiation therapy • All types of cells are injured or destroyed by concentrated radiation. Rapidly dividing cells are the most sensitive.

27. Oncology • Radiation therapy • Types : Gamma knife Local beam treatment Local seeding ARC – stereotactic Radioimmunotherapy Fractionation Total body irradiation Particle beam therapy, i.e. proton or neutron therapy

28. Oncology • Radiation therapy side effects • Side effects depend on the amount and area being irradiated • Fatigue • Nausea and vomiting • Mild anemia • Leukopenia • Diarrhea • Pain

29. Oncology • Radiation therapy side effects: • Erythema/burns • Fatigue • Pneumonitis • Esophagitis • Dysphasia

30. Oncology • Malignant Lymphomas – 2 types • Hodgkin'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 scan • Symptoms: Extreme fatigue, enlarged lymph nodes that are painless. May progress to weight loss fevers, night sweats

31. Oncology • Leukemia–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.