ONCO LECTURE - Cellular Aberrations

Cellular Aberrations Oncology Nursing What is an Aberration? ▪ Aberration is a deviation from normal. And this is happening to the cells of a person who is afflicted with cancer, a disease characterized as uncontrolled division of abnormal cells which may occur in any part of the body. CE...

Cellular Aberrations Oncology Nursing What is an Aberration? ▪ Aberration is a deviation from normal. And this is happening to the cells of a person who is afflicted with cancer, a disease characterized as uncontrolled division of abnormal cells which may occur in any part of the body. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 2 What is Cancer? Is a large group of disorders with different causes, manifestations, treatments and prognoses. The normal cell process breaks down and then the abnormal or damaged cells grows and multiply. these cells may form tumors, which are lumps of tissue Tumors can be cancerous or not cancerous (benign) CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 3 Cell Types CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 4 How do cells multiply (Cell Cycle) Cell Division – is a process where cells produce other cells to repair damage tissue, to grow, and to make more cells. To start, the DNA must be copied for it to be able to produce another cell. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 5 QUESTION In cancer cells, a mutation in which tumor suppressor gene commonly allows the cell to bypass the G1/S checkpoint, leading to uncontrolled cell proliferation? A. BRCA1 B. p53 C. Cyclin D D. HER2 CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 6 CELL TYPES ▪PERMANENT CELLS Always in G0 Does not divide They regenerate from stem cells CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 7 CELL TYPES ▪ STABLE CELLS QUIESCENT CELLS When stimulated G0 to G1 Divide under certain conditions CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 8 CELL TYPES ▪ LABILE CELLS NEVER in G0 Very short G1 Chemotherapy will be a problem for them CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 9 Normal Cells vs Cancer Cells October 12, 2024 10 CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 Cell Cycle Regulation: Normal cells: Have functional checkpoints (G1/S, G2/M, and M phase) to ensure that DNA is Normal Cells vs Cancer Cells undamaged, and that replication occurs correctly. Tumor suppressor genes (like p53) and proteins (like RB) help control this regulation. Cancer cells: Often have mutations in key regulatory genes, such as tumor suppressors or oncogenes (genes that, when mutated, promote cell growth). These mutations allow cancer cells to bypass checkpoints and avoid apoptosis, leading to unchecked cell cycle progression. Apoptosis (Programmed Cell Death): Normal cells: Undergo apoptosis when they are damaged beyond repair or are no longer needed. This helps prevent damaged cells from proliferating. Cancer cells: Often evade apoptosis, continuing to survive and multiply even when their DNA is damaged. This contributes to the development and growth of tumors. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 11 QUESTION Which of the following statements best describes a benign tumor? A) It can invade surrounding tissues and metastasize to distant organs. B) It grows slowly and remains localized without invading surrounding tissues. C) It is always life-threatening and requires aggressive treatment. D) It is characterized by poorly differentiated cells and irregular nuclei. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 12 QUESTION Which of the following is a characteristic of malignant tumors? A) Well-differentiated cells that resemble the tissue of origin. B) Encapsulation within a fibrous capsule. C) Ability to metastasize to distant organs. D) Slow growth and low mitotic activity. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 13 What are the types of tumors? CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 14 BENIGN Benign tumors do not spread into, or invade, nearby tissues when removed, benign tumors usually don’t grow back can sometimes be quite large some can cause serious symptoms or be life threatening (benign tumors in the brain) CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 15 MALIGNANT More than 2 cells; abnormal chromosomes are commonly found Invasion and Metastasis Contact inhibition is absent Does not form intracellular junction Rampant growth CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 16 Tumors with Borderline Behavior (Pre-cancerous or In-situ Tumors) Characteristics: These tumors are not yet invasive but have the potential to become malignant over time. They are sometimes called carcinoma in situ when confined to the layer of cells where they originated without invading deeper tissues. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 17 Metastatic Tumors Characteristics: These tumors occur when malignant cancer cells from the original (primary) tumor spread to other parts of the body and form new (secondary) tumors. The secondary tumors are made of the same type of cancer cells as the primary tumor. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 18 BENIGN vs MALIGNANT CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 19 CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 20  Which of the following is a common characteristic of carcinoma?. A) It arises from mesenchymal tissue. B) It often metastasizes through the bloodstream. C) It is typically more common in children than adults. D) It generally grows more slowly than sarcomas. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 21  Which type of cancer typically presents with the following characteristics: a fast growth rate, a higher tendency to metastasize, and a poorer prognosis? A) Sarcoma B) Carcinoma C) Both sarcoma and carcinoma D) Neither sarcoma nor carcinoma CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 22  METASTASIS Carcinoma Epithelial Tissues LUNGS Lymphatic System (Common site for Metastasis) Cancer Cells General Spillage over the Circulation Blood Stream LIVER From the Lymphatic system to the Blood CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 23  METASTASIS Sarcoma Connective Tissues Thyroid General Gland Circulation Cancer cells goes directly to the Blood to other parts of the body or organs CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 24 Differentiation Between Sarcoma and Carcinoma CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 25 Differentiation Between Sarcoma and Carcinoma CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 26 3 Step Cellular Process of Carcinogenesis CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 29 3 Step Cellular Process of Carcinogenesis INITIATION Initiators (carcinogens) such as chemicals ,physical factors, and biologic agents alter the genetic structure of the cellular DNA Normally, cells will either repair or die. But occasionally, cells escape these protective mechanisms and permanent cellular mutation occurs These mutations usually are not significant to cells until the second step of carcinogenesis CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 30 3 Step Cellular Process of Carcinogenesis PROMOTION Repeated exposure to promoting agents causes the expression of abnormal or mutant genetics information even after long latency periods Proto-oncogene, responsible for cellular growth is mutated and transformed to oncogene (gene that causes cancer) which is switched “on”, thus, cellular growth and proliferation are stimulated Multiple growth factors such as EGF (epidermal Growth Factor) influence cellular growth and proliferation CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 31 3 Step Cellular Process of Carcinogenesis PROMOTION Tumor suppressor gene becomes mutated and is turned “off” allowing malignant cells to reproduce. When suppressor genes become mutated, they lose their regulatory capabilities. Apoptosis will not happen. VEGF (Vascular Endothelial Growth Factor) promotes tumors angiogenesis which nourishes the tumors cells CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 32 3 Step Cellular Process of Carcinogenesis PROMOTION P53 P53 (TP53) –frequently mutated tumor suppressor gene guardian of genome –responsible in conserving cellular stability by preventing genome mutation determines whether the damaged cell will live or die alteration may decrease apoptotic signals, decreasing mutant cell death TUMOR PROTEIN 53 Mutant TP53 is associated with poor prognosis CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 33 3 Step Cellular Process of Carcinogenesis PROGRESSION Cellular changes formed during initiation and promotion exhibit increased malignant behaviour Invades adjacent tissues and metastasizes CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 34 3 Step Cellular Process of Carcinogenesis PROGRESSION INVASION Growth of primary tumor to surrounding host tissue How: mechanical pressure –finger like projections –surrounding tissues and interstitial spaces Destructive enzymes-destroy surrounding tissues, structural tissues of the vascular membrane CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 35 3 Step Cellular Process of Carcinogenesis PROGRESSION METASTASIS spread of cancer cells Lymphatic Spread -most common mechanism of metastasis Haematogenous Spread Angiogenesis Direct Extension Seeding or Diffusion CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 36 3 Step Cellular Process of Carcinogenesis CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 37 ETIOLOGY PHYSICAL AGENTS Radiation Too much exposure to sunlight CHEMICAL AGENTS Tobacco use Drugs Toxic & Chemical Wastes CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 38 ETIOLOGY CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 39 ETIOLOGY VIRUSES & BACTERIA When viruses cause an infection, they spread their DNA, affecting healthy cells genetic makeup and potentially causing them to turn into cancer HPV infections, for instance, cause the virus DNA to combine with the host's DNA, disrupting the normal function of cells. HELICOBACTER Some bacteria are notorious as PYLORI carcinogenic bacteria, which cause tumorigenesis, while some bacteria have the potential of cancer therapy, targeted to hypoxic tumor region and leading to the eradication of tumor cells by releasing of therapeutic molecules. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 40 ETIOLOGY LIFESTYLE Notably, it has been argued that between one third and half of all cancer cases may be avoided by primary prevention. Lifestyle factors implicated as causes of cancer and cancer mortality, which are considered as main targets for prevention, include smoking, alcohol consumption, obesity, diet, and physical inactivity. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 41 ETIOLOGY HORMONE in CANCER When a tumor is hormone-sensitive, its cells have proteins on their surfaces called receptors. They link to hormones like a lock and key. When the hormone “key” opens the “lock” of the receptor, the cancer cell grows and spreads. Hormone-related cancers, namely breast, endometrium, ovary, prostate, testis, thyroid and osteosarcoma, share a unique mechanism of carcinogenesis. Endogenous and exogenous hormones drive cell proliferation, and thus the opportunity for the accumulation of random genetic errors. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 42 WARNING SIGNS OF CANCER CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 43 PREVENTION OF CANCER CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 44 PREVENTION OF CANCER PREVENTION OF CANCER Primary Prevention Risk reduction Limit carcinogen exposure Lifestyle interventions Secondary Prevention Set of interventions leading to the discovery and control of cancerous or precancerous processes while localized Early Diagnosis Prompt Intervention Tertiary Prevention care aimed at reducing morbidity and disability in people diagnosed with, and being treated for, disease. This is also includes rehabilitation CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 46 PRIMARY PREVENTION QUIT SMOKING REDUCE ALCOHOL CONSUMPTION OF INTAKE PRESERVED FOODS OVEREXPOSURE TO SUN CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 47 PRIMARY PREVENTION LAY FORUMS & SUPPORT GROUPS CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 48 SECONDARY PREVENTION BREAST MAMMOGRAPHY WOMEN ages 40 – Above Diagnostic Test of Choice A breast ultrasound is most often done to find out if a problem found by a mammogram or physical exam of the breast may be a cyst filled with fluid or a solid tumor. Breast ultrasound is not usually done to screen for breast cancer. This is because it may miss some early signs Breast Ultrasound of cancer. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 49 SECONDARY PREVENTION CERVIX WOMEN Ages 21 – 29 The Papanicolaou test is a method of cervical screening used to detect potentially precancerous and cancerous processes in the cervix or colon. PAP SMEAR TEST WOMEN Ages 30 – 65 A laboratory test in which cells are scraped from the cervix to look for DNA of human papillomaviruses (HPV). HPV can cause abnormal tissue growth (for example, warts) and other changes to cells. Infection for a long time with certain types of HPV can cause cervical cancer. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 50 SECONDARY PREVENTION COLORECTAL GUAIAC This test can detect small amounts of blood in stool. It requires abstaining from red meat and certain medications for a number of days before. An FOBT is more specific to finding blood from further up the digestive tract, such as the stomach. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 51 SECONDARY PREVENTION COLORECTAL A colonoscopy is a test that allows a healthcare provider to see inside your large intestine. This procedure is done with a flexible camera called a scope. This test is used to check out symptoms like bleeding, as well as look COLONOSCOPY for polyps and possible Men & Women signs of colon cancer Ages 50 and Above CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 52 DIAGNOSTICS TREATMENTS MANAGEMENT DIAGNOSTICS CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 54 DIAGNOSIS OF CANCER 1. Determine the presence and extent of cancer 2. Identify possible disease metastasis 3. Evaluate the function of involved and uninvolved body systems and organs 4. Obtain tissue and cells for analysis, including tumor grade and stage. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 55 STAGING & GRADING STAGING Determines the size of the tumor Refers also to the size of the tumor and the extent of the disease and its metastasis. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 56 STAGING & GRADING CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 57 STAGING & GRADING GRADING Grade I – cancer cells resemble It is the pathologic classification of normal cells and aren’t growing rapidly the tumor cells. It also seeks to Grade II –cancer cells don’t look like define the type of tissue from which normal cells and are growing faster the tumor originated. than normal cells Evaluates the amount of cell Grade III –cancer cells look abnormal and may grow or spread more differentiation and estimates the aggressively rate of growth of the tumor cells. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 58 STAGING & GRADING GRADING Grade X – grade isn’t known Grade 1 – Well differentiated, low grade Grade 2 – Moderately differentiated, intermediate grade Grade 3 – Poorly differentiated, high grade Grade 4 – Undifferentiated, high grade CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 59 DIAGNOSTIC AIDS & TUMOR MARKERS Tumor Markers sometimes called cancer markers in the blood, urine or body tissues. These are substances made by cancer cells or by normal cells in response to cancer in the body. Some tumor markers are specific to one type of cancer (e.g. PSA-prostate specific antigen). Others can be found in several types of cancer (e.g. CEA - Carcino Embryonic Antigen). CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 60 TUMOR MARKERS CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 61 TREATMENT OPTIONS CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 62 TREATMENT OPTIONS SURGERY Cancer surgery removes the tumor and nearby tissue during an operation. A doctor who treats cancer with surgery is called a surgical oncologist. Surgery is the oldest type of cancer treatment. And it is still effective for many types of cancer today. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 63 TREATMENT OPTIONS CHEMOTHERAPY It is the use of antineoplastic drugs in an attempt to destroy cancer cells by interfering with other cellular functions including replication and repair of DNA. It can also be combined with other treatments such as Surgery & Radiation or BOTH. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 64 TREATMENT OPTIONS RADIATION THERAPY Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. It can also be used to control the cancer is removal or surgery is not possible, it can reduce the size of the tumor or cancer. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 65 TREATMENT OPTIONS TARGETED THERAPIES is a drug treatment that targets specific features of cancer cells to stop the cancer growing and spreading. Monoclonal antibodies (MoAbs), also known as therapeutic antibodies, are proteins produced in the lab. These proteins are designed to attach to specific targets found on cancer cells. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 66 TREATMENT OPTIONS FDA APPROVED MoAbs DRUG TARGET Alemtuzumab Marker on cell membranes of lymphocytes, (Campath) monocytes, and macrophages. Bevaciumab VEGF (Vascular Endothelial Growth Factor) (Avastin) Cetuximab EGF(Epidermal Growth Factor) (Erbitux) Rituximab Marker on cell membrane of lymphocytes (Rituxan) Trastuzumab Growth factor protein on cell membrane (Herceptin) Ibritumomab-tiuxetan Marker on cell membrane of lymphocytes (Zevalin) CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 67 TREATMENT OPTIONS IMMUNOTHERAPY Immunotherapy or biological therapy is the treatment of disease by activating or suppressing the immune system. Immunotherapy is a type of biological therapy. Biological therapy is a type of treatment that uses substances made from living organisms to treat cancer. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 68 BREAST CANCER Frequently begins as a hard, non- tender, relatively fixed nodule; found most often in the upper outer quadrant of the breast Most are adenocarcinomas originating in the ducts and lobes CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 80 BREAST CANCER Among Asian countries, the Philippines has the No. 1 incidence of breast cancer. “Three out of 100 (Filipino) women will get breast cancer before age 75 and one out of 100 will die before reaching 75,” CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 81 BREAST CANCER T = tumor This tells you the size and location of the tumor. CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 82 BREAST CANCER CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 83 BREAST CANCER METASTASIS CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 84 BREAST CANCER MANAGEMENT CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 85 CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 86  THANK YOU! Mr. Rhyan Hitalla RN, ET CENTRO ESCOLAR UNIVERSITY: FOR INTERNAL CIRCULATION ONLY 2019 October 12, 2024 87