For MMC-CN Students. Lectured by Prof. Julius Floresta.

1. 3. CELLULAR ABERRATION
The Biology Cancer Part 2

2. DIAGNOSIS
 Imaging studies
 Excision or Fine Needle Aspiration Biopsy with
microscopic histologic examination
 Pap smear
 Blood tests – for example PSA for prostate
carcinoma, CEA or AFP for HCC or testicular, CEA
for colorectal carcinoma, CA-125 for ovarian
carcinoma, ALP for HCC or bone
 Cytologic examination of blood cells – for leukemia

8. Urine with
cancer cells
(urine cytology

12. DIAGNOSTIC AIDS USED TO DETECT CANCER
 Tumor markers – breast, colon, lung, ovarian,
testicular, prostate cancers
 MRI – neurologic, pelvic, abdominal, thoracic
cancers
 Fluoroscopy – neurologic, pelvic, skeletal,
abdominal, thoracic cancers
 UTZ – abdominal and pelvic cancers
 Endoscopy – bronchial, GIT cancers

13. Fluoroscopy
MRI UTZ

15. DIAGNOSTIC AIDS USED TO DETECT CANCER
 Nuclear medicine imaging – bone, liver, kidney,
spleen, brain, thyroid cancers
 PET – lung, colon, liver, pancreatic, head and neck
cancers; Hodgkin and Non-Hodgkin lymphoma and
melanoma
 PET fusion – see PET
 Radioimmunoconjugates – colorectal, breast,
ovarian, head and neck cancers; lymphoma and
melanoma

16. Nuclear Imaging

17. Nuclear Imaging
PET scan

18. Nomenclature
Tissue of origin Benign Malignant
Ectoderm/endoderm Epithelium Papilloma Carcinoma
Gland Adenoma Adenocarcinoma
Liver cells Adenoma HCC
Neuroglia Glioma Glioma
Melanocytes Malignant
melanoma
Basal cells Basal cell
carcinoma
Germ cells Mature teratoma Seminoma
Mesoderm Connective tissue
Adipose tissue Lipoma Liposarcoma
Fibrous Fibroma Fibrosarcoma
Bone Osteoma Osteosarcoma
Cartilage Chondroma Chondrosarcoma

19. Nomenclature
Tissue of origin Benign Malignant
Mesoderm Muscle
Smooth muscle Leiomyoma Leiomyosarcoma
Striated muscle Rhabdomyoma Rhabdomyosarcom
a
Neural tissue
Nerve cells Ganglioneuroma Neuroblastoma
Endothelial tissue
Blood vessels Hemagioma Angiosarcoma
Kaposi sarcoma
Meninges Meningioma Malignant
meningioma
Hematopioetic Granulocytes Leukemia
tissue
Plasma cells Multiple myeloma
plasmacytoma
Lymphocytes Lymphoma

20. Site Gender Age Evaluation Frequency
Breast F 20-39 Clinical breast Every 3 years
examination
(CBE)
Self breast Every month
examination
(SBE)
>40 CBE Every year
SBE Every month
Mammogram Every year
Colon and F/M >50 Fecal occult Every 5 years
rectum blood and
flexible Every 10 years
sigmoidoscopy
or colonoscopy
or double- Every 5 years
contrast barium
enema

21. Site Gender Age Evaluation Frequency
Prostate M >50 (or 40-45 if PSA and DRE Every year
at high risk)
Cervix F >21 or within 3 Pap smear Every year if
years after regular Pap;
starting to have every 2 years if
intercourse liquid Pap test
Cancer-related M/F >20-39 Pelvic Every year
check ups examination
Examination for Every 3 years
cancers of the
thyroid, testicles,
ovaries, lymph
nodes, oral cavity
and skin as well
as counseling
about health
practices and risk
factors
40+ Same as 20-39 Every year

22. MANAGEMENT OF CANCER
 Surgery surgical removal of the entire cancer
remains the ideal and most frequently used
treatment method
a. Diagnostic surgery – biopsy
b. As primary treatment
c. Prophylactic treatment
d. Palliative treatment
e. Reconstructive surgery

23. MANAGEMENT OF CANCER
 Nursing management in cancer surgery
a. The nurse completes a thorough preoperative
assessment for factors that may affect the patient
undergoing the surgical procedure
b. The patient and family require time and
assistance to deal with the possible changes and
the outcomes resulting from the surgery
c. The nurse provides education and emotional
support by assessing the needs of the patient and
family and by discussing their fear and coping
mechanisms with them

24. MANAGEMENT OF CANCER
 Nursing management in cancer surgery
d. After surgery, the nurse assesses the patient’s
responses to the surgery and monitors the patient for
possible complications, such as infection, bleeding,
thrombophlebitis, wound dehiscence, fluid and
electrolyte imbalance, and organ dysfunction
e. The nurse also provides for the patient’s comfort.
Postoperative teaching addresses wound care,
activity, nutrition, and medication information
f. Plans for discharge, follow-up and home care, and
treatment are initiated as early as possible to ensure
continuity of care from hospital to home or from a
cancer referral center to the patient’s local hospital
and health care provider.

25. MANAGEMENT OF CANCER
 Radiation therapy
a. External radiation
b. Internal radiation or brachytherapy
c. Radiation dosage – dependent on the sensitivity
of the target tissue to radiation and on the tumor
size
d. Toxicity – localized to the region being irradiated

26. MANAGEMENT OF CANCER
 Nursing Management in Radiation therapy
a. The nurse can explain the procedure for
delivering radiation and describe the equipment,
the duration of the procedure (often minutes only),
the possible need for immobilizing the patient
during the procedure
b. The nurse informs the family about restrictions
placed on visitors and health personnel and other
radiation precautions, for radioactive implants

27. MANAGEMENT OF CANCER
 Chemotherapy
a. Antineoplastic agents are used in an attempt to
destroy tumor cells by interfering with cellular
functions, including replication
b. Used primarily to treat systemic disease rather
than localized lesions that are amenable to
surgery or radiation
c. May be combined with surgery, radiation therapy,
or both, to reduce tumor size preoperatively, to
destroy any remaining tumor cells postoperatively,
or to treat some forms of leukemia
d. Goals: cure, control and palliation

28. MANAGEMENT OF CANCER
 Classification of Chemotherapeutic Agents
a. Alkylating agents – busulfan, carboplatin,
cisplatin, cyclophosphamide
b. Nitrosureas – carmusine, streptozocin
c. Topoisomerase I inhibitors – irinotecan, topotecan
d. Antimetabolites – cytarabine, 5-FU, hydroxyurea,
methotrexate
e. Antitumor antibiotics – bleomycin, daunorubicin,
doxorubicin, mitomycin

29. MANAGEMENT OF CANCER
 Classification of Chemotherapeutic Agents
f. Mitotic spindle poisons – plant alkaloids
(vinblastine, vincristine), taxanes (paclitaxel,
docetaxel)
g. Hormonal agents – androgens and
antiandrogens, estrogens and antiestrogens,
progestins and antiprogestins, aromatase
inhibitors, LH-releasing hormone analogues,
steroids
h. Miscellaneous agents - asparaginase,
procarbazine

30. MANAGEMENT OF CANCER
 Nursing management in chemotherapy
a. Assess fluid and electrolyte imbalance
b. Modify risks for infection and bleeding
c. Administering chemotherapy
d. Protecting caregivers

31. MANAGEMENT OF CANCER
 Bone Marrow Transplantation
a. Allogenic (from a donor other than the patient);
either a related donor or a matched unrelated
donor
b. Autologous (from patient)
c. Syngeneic (from an identical twin)

32. MANAGEMENT OF CANCER
 Nursing Management in Bone Marrow
Transplantation
a. Implementing pretransplantation care
b. Providing care during treatment
c. Providing posttransplantation care

33. MANAGEMENT OF CANCER
 Hyperthermia
 Targeted therapies
a. BRM
b. Gene therapy
c. Growth factors
 Photodynamic therapy
 Cancer rehabilitation

35. SQUAMOUS CELL CARCINOMA
 SCC
 The second most common tumor arising on sun-
exposed sites in older people, exceeded only by
basal cell carcinoma
 Except for lesions on the lower legs, these tumors
have a higher incidence in men than in women
 The most important cause of cutaneous SCC is
DNA damage induced by exposure to UV light
 Is invasive, can recur and metastasize

36. SQUAMOUS CELL CARCINOMA
 Other Risk Factors
1. Age older than 50 years
2. Light skin; blonde or light brown hair; green, blue,
or gray eyes
3. Skin that sunburns easily (Fitzpatrick skin types I
and II)
4. Geography (closer to the equator)
(http://emedicine.medscape.com/article/1101535-overview)

38. SQUAMOUS CELL CARCINOMA
 Immunosuppression may contribute to
carcinogenesis by reducing host surveillance and
increasing the susceptibility of keratinocytes to
infection and transformation by oncogenic viruses,
particularly HPV subtypes 5 and 8
 Other risk fatcors include industrial carcinogens
(tars and oils), chronic ulcers and draining
osteomyelitis, old burn scars, ingestion of
arsenicals, ionizing radiation, and (in the oral cavity)
tobacco and betel nut chewing

43. SQUAMOUS CELL CARCINOMA
 History
 A new and enlarging lesion that concerns the patient
 Most lesions are slow growing, while others rapidly
enlarges
 Symptoms such as bleeding, weeping, pain, or
tenderness may be noted, especially with larger tumors
 Numbness, tingling, or muscle weakness may reflect
underlying perineural involvement, and this history
finding is important to elicit because it adversely impacts
prognosis.
 May be asymptomatic
(http://emedicine.medscape.com/article/1101535-
overview)

48. SQUAMOUS CELL CARCINOMA
 Imaging studies like CT scan are done for patients
with neurologic symptoms and with (+)
lymphadenopathy
 FNAB or excision biopsy of palpable lymph nodes
 Small biopsies of the lesion suspected to be SCC
(http://emedicine.medscape.com/article/1101535-
overview)

53. SQUAMOUS CELL CARCINOMA
 Nonsurgical treatment options:
1. topical chemotherapy - 5-FU
2. topical immune response modifiers – sirolimus,
prednisone, cyclosporine, azathioprine, and
mycophenolate
3. photodynamic therapy (PDT)
4. Radiotherapy
5. Systemic chemotherapy – 5-FU and cetuximab
(EGFR antagonist)
(http://emedicine.medscape.com/article/1101535-
overview)

54. SQUAMOUS CELL CARCINOMA
 Surgical treatment options:
1. Cryotherapy – for in-situ lesions; makes use of
liquid nitrogen
2. Electrodesiccation and curettage – for low-risk
carcinomas of the trunk and extremities
3. Excision with conventional margins
(http://emedicine.medscape.com/article/1101535-
overview)

55. Electrodesiccation

57. Excision biopsy

58. BASAL CELL CARCINOMA
 BCC
 The most common invasive cancer in humans
 Slow-growing tumors that rarely metastasize
 Have a tendency to occur in sun-exposed areas
and in lightly pigmented people
 Incidence rises sharply with immunosuppression
and in people with inherited defects in DNA repair

59. BASAL CELL CARCINOMA
 Tumors present clinically as pearly papules often
containing prominent dilated subepidermal blood
vessels
 Advanced lesion may ulcerate, and extensive local
invasion of bone and facial sinuses may occur after
many years of neglect (rodent ulcers)

68. BASAL CELL CARCINOMA
 Treatment
1. Electrodessication and curettage involves destroying
the tumor with an electrocautery device then scraping
the area with a curette
2. Surgical excision of the lesion including a margin of
normal skin. This method is preferred for larger lesions
(>2cm) on the cheek, forehead, trunk, and legs
3. Radiation therapy - may also be used where tumors
are difficult to excise or where it is important to
preserve surrounding tissue such as the lip. Its use is
declining.
4. Cryotherapy - involves destroying the tissue by
freezing it with liquid nitrogen. This may be effective
for small, well-defined superficial tumors

69. BASAL CELL CARCINOMA
 Prevention
1. Avoid UVB radiation from sun exposure especially
midday sun
2. Use protective clothing
3. Use sunscreen with an SPF of at least 15. This is
especially important for children.
4. Have suspicious lesions checked out - If you have
a question, get it checked out. Treating
premalignant lesions prevents their transformation
to potentially metastatic cancers.

70. MELANOMA
 A relatively common neoplasm that remains deadly
if not caught at its earliest stages
 Can occur in the oral and anogenital mucosal
surfaces, esophagus, meninges, and the eye
 Melanomas evolve over time from localized skin
lesions to aggressive tumors that metastatize and
are resistant to therapy
 Early recognition and complete excision are critical

72. MELANOMA
 Usually asymptomatic
 Itching or pain may be an early manifestation
 Majority of lesions are greater than 10 mm in
diameter at diagnosis
 Most consistent clinical signs (in pigmented
lesions):
1. Changes in color
2. Changes in size
3. Changes in shape

73. MELANOMA
 Unlike benign tumors, these tumors show variations
in color (shades of black, brown, red, dark blue, and
gray)
 There may be areas of hypopigmentation
 Borders are irregular and often notched, not
smooth, round, and uniform
 Important warning signs (ABCs):
1. Asymmetry
2. Irregular borders
3. Variegated color

74. MELANOMA
 Other features:
1. Diameter greater than 6 mm
2. Any change in appearance
3. New onset of itching
4. Or new onset of pain

80. MELANOMA
 Prognostic factors:
1. Tumor depth - <1.7mm (favorable)
2. Number of mitoses – no or few mitoses
(favorable)
3. Evidence of tumor regression – absence
(favorable)
4. The presence and number of tumor infiltrating
lymphocytes – brisk (favorable)
5. Gender – female (favorable)
6. Location – location on an extremity (favorable)

86. MELANOMA
 The two most important predisposing factors are
inherited genes and sun exposure
 Treatment is by stage

87. Stage 0 melanoma. Abnormal melanocytes are in the epidermis (outer
layer of the skin).

88. Stage I melanoma. In stage IA, the tumor is not more than 1 millimeter thick, with no
ulceration (break in the skin). In stage IB, the tumor is either not more than 1
millimeter thick, with ulceration, OR more than 1 but not more than 2 millimeters thick,
with no ulceration. Skin thickness is different on different parts of the body.

89. Stage II melanoma. In stage IIA, the tumor is either more than 1 but not more than 2
millimeters thick, with ulceration (break in the skin), OR it is more than 2 but not more than 4
millimeters thick, with no ulceration. In stage IIB, the tumor is either more than 2 but not more
than 4 millimeters thick, with ulceration, OR it is more than 4 millimeters thick, with no
ulceration. In stage IIC, the tumor is more than 4 millimeters thick, with ulceration. Skin
thickness is different on different parts of the body.

90. Stage III melanoma. The
tumor may be any
thickness with or without
ulceration. It has spread
either (a) into a nearby
lymph vessel and may
have spread to nearby
lymph nodes; OR (b) to 1
or more lymph nodes,
which may be matted (not
moveable). Skin thickness
is different on different
parts of the body.

91. Stage IV melanoma. The tumor has spread
to other parts of the body.

92. MELANOMA
 Stage 0 (Melanoma in Situ) - Treatment of stage 0 is
usually surgery to remove the area of abnormal cells
and a small amount of normal tissue around it.
 Stage I Melanoma
1. Surgery to remove the tumor and some of the normal
tissue around it.
2. A clinical trial of surgery to remove the tumor and
some of the normal tissue around it, with or without
lymph node mapping and lymphadenectomy.
3. A clinical trial of new techniques to detect cancer cells
in the lymph nodes.
4. A clinical trial of lymphadenectomy with or without
adjuvant therapy.

93. MELANOMA
 Stage II Melanoma
1. Surgery to remove the tumor and some of the
normal tissue around it, followed by removal of
nearby lymph nodes.
2. Lymph node mapping and sentinel lymph node
biopsy, followed by surgery to remove the tumor
and some of the normal tissue around it. If cancer
is found in the sentinel lymph node, a second
surgery may be done to remove more nearby
lymph nodes.
3. Surgery followed by high- dose biologic therapy.
4. A clinical trial of adjuvant chemotherapy and/or
biologic therapy.
5. A clinical trial of new techniques to detect cancer
cells in the lymph nodes.

94. MELANOMA
 Stage III Melanoma
1. Surgery to remove the tumor and some of the normal tissue around it.
2. Surgery to remove the tumor with skin grafting to cover the wound
caused by surgery.
3. Surgery followed by biologic therapy.
4. A clinical trial of surgery followed by chemotherapy and/or biologic
therapy.
5. A clinical trial of biologic therapy.
6. A clinical trial comparing surgery alone to surgery with biologic therapy.
7. A clinical trial of chemoimmunotherapy or biologic therapy.
8. A clinical trial of hyperthermic isolated limb perfusion using
chemotherapy and biologic therapy.
9. A clinical trial of biologic therapy and radiation therapy.

95. MELANOMA
 Stage IV Melanoma
1. Surgery or radiation therapy as palliative therapy to
relieve symptoms and improve quality of life.
2. Chemotherapy and/or biologic therapy.
3. A clinical trial of new chemotherapy, biologic
therapy, and/or targeted therapy with monoclonal
antibodies, or vaccine therapy.
4. A clinical trial of radiation therapy as palliative
therapy to relieve symptoms and improve quality of
life.
5. A clinical trial of surgery to remove all known
cancer.