Oncology

Farrahiyah Ismail
Definition :

Tumors, or neoplasms, are defined as abnormal growths of

new tissue that serve no useful purpose and may harm the host
cells by competing for vital blood supply and nutrients.

These new growths may be

1. Benign or malignant
2. Primary or secondary
Terminology used in the Oncology

Term Explanation

Oncology Study of cancer (neoplastic) growth

Neoplasm Cell composing new growth

Metastasis Disease manifestation from one organ to

another

Anaplasia Ability / capability for multiplication

Primary and secondary tumor:

A primary tumor arises from cells that are normally local to the
given structure.

A secondary tumor arises from cells that have metastasized from

another part of the body.
 Classification of tumor

A neoplasm can be classified on the

1. Anatomic site.
2. Whether it is benign or malignant.

Nomenclature
Benign: oma (adenoma, fibroma)

Malignant: carcinoma (adenocarcinoma)

sarcoma (fibrosarcoma)
Type of tissues involve Benign Malignant

Muscle Myoma Myosarcoma

Bones Osteoma Osteosarcoma

Articula cartilage Chondroma Chondrosarcoma

Liver cells Adenoma Hepatocellullar carsinoma

Respiratory passages Bronchial adenoma Bronchogenic carcinoma

Blood vessel Hemangioma Angiosarcoma

Lymph vessels Lymphangioma Lymphangiosarcoma

The terms benign and malignant describe the biologic behavior of a tumor.

Benign : localized and amenable to surgical removal; patient

usually survives

Malignant : invasive tumor capable of destroying structures and

spread to distant sites (metastasis); may result in early
death of the patient
 Characteristic comparison between Benign and malignant

No Characteristic Benign Malignant

1 Differentiation / Well differentiated : structure Lack of differentiated : Atypical

Anaplasia may be typical of origin structure from origin tissues.
tissues

2 Rate of growth Progressive and slow and Rapid, may be numerous in

remain the same quantity and abnormal in shape
/ figure

3 Local invasion Do not invade the Invasive to the surrounding

surrounding normal tissues tissues

4 Metastasis Absent More likely are metastases

Staging and Grading of Tumor.

Stage
1 Early stage, local cancer.

2 Increased risk of spread because of tumor size.

3 Local cancer has spread but may not be disseminated to

distant regions.

4 Cancer has spread and disseminated to distant sites

Agents that known to cause Cancer

No Agents Elements

1 Physical agents Radiation

Sunlight

2 Chemical agents Smoking

Drugs
Detergents

3 Bacteria and Viruses HPV

Hectobacter Pylori
HIV
Hepatitis B Virus

4. Diseases HIV
Immune Diseases
 Pathogenesis of neoplasm.

Initiation.
The primary and essential step in the process. It is very rapid in nature.
The initial change has taken place the initiated cells may persist for a
considerable time, perhaps the life span of the individual.

Transformed cells (singe clone)

The consequence of initiation is the cells being transformed.
These transformation cells may grow gradually.
Causing the cell to divide (Being trigger by the cancer agents / elements)
The transformed cell may develop through following process,
1. Activation on Oncogenes
2. Alteration of genes that regulate apoptosis
3. Inactivation of cancer suppressor genes

Invasion and metastasis

Cell proliferation and metastasis takes place within the normal cells.
It utilized nutrients (protein) of host cells to multiple, invade and
metastasis
 Origin from own body

Contributing factors ;
1. Tobacco use and
Risk of developing cancer cells.
2. Exposure to high risk
life style
3. Numerous cancer
agents

Develop Cancer cell due to

numerous contributing factors

Proliferates and metastasis

Pathogenesis of
Neoplasm
Aging.

Age over 40 years old are susceptible to cancer development.

1. Older people may be more susceptible to cancer simply

because they have been exposed to carcinogens longer than
younger people.

2. Reduce immune system capability

Hormonal exposure

Mainly on female.
Prolong exposure of estrogen
1. Early onset of menses,
2. Menopause after age 50,
3. No children, or first child after age 30,
4. Never breastfed children.
Alcohol

Increased rates of cancer of the mouth, pharynx, larynx, esophagus, liver,

breast, and probably colon.

Alcohol intake can increase the circulating levels of estrogens

Tobacco

Tobacco use accounts for approximately 30 % of cancer deaths with lung

cancer
Heavy chemical available in the tobacco acts as synergic in cancer
development
Diet and nutritional.

Consumption of a poor diet may blunt the immune system's natural defense
mechanisms against genetic damage caused by long-term exposure to an
environmental carcinogen.

Sexual and Reproductive Behaviors

Sexual and reproductive behaviors are linked to the risk of developing
various cancers.
1. The risk of developing cervical cancer is linked with early sexual
intercourse and multiple partners.

2. Pregnancy and childbearing seem to be protective against cancers

of the endometrium, ovary, and breast.

3. Prolonged lactation may also have a significant impact in the

reduction of breast cancer
Stress

Chronic physical or emotional stress can cause hormonal or immunologic

changes and can facilitate the growth and proliferation of cancer cells.

Distress and depression are associated with two important processes for
carcinogenesis:
1. Poorer repair of damaged DNA
2. Alterations in cell apoptosis.

Cancer associated viruses.

A viral etiology of cancer shows that an infective agent could induce new
sarcomas.
Transmitted from one individual to other individual
Transmitted - sexually, perinatal, intravenous drug
e.g. Hepatitis B is associated with hepatocellular carcinoma
Compounds that induce cancer ( carcinogents )
Common examples of carcinogents,
1. Hydrocarbons
Found in tobacoo, coal tar, vehicle exhaust fumes and charred foods
Tobacco smoke is a powerful carcinogen agent

2. Ultraviolet radiation
Causing mutagenesis of cells

3. Cancer chemotherapy substances

Risk of leukaemia in long term survivors of cancer therapy
 Neoplasia : Etiology environmental

Agent Occupation Cancer Site

Ultraviolet farmers, sailors, etc. Skin

radiation

Hydrocarbons chimney sweepers, oil workers scrotum, skin, bronchus

Asbestos shipyard and insulation workers, Mesothelioma lung

car workshop

Arsenic sheep dip manufacturers, gold skin and bronchus

miners

Benzene workers with glues, varnishes, marrow (leukemia

etc.

Vinyl chloride PVC manufacturers liver (angio-sarcoma)

 EARLY DETECTION.

1. Any change in bowel or bladder habit.

2. Unusual bleeding or discharge from any part of the body e.g. vaginal
bleeding between menstruations or after menopause.

3. An unexplained lump that does not go away e.g. lump in the breast or in
the neck.

4. A sore that does not heal.

5. Changes to a skin spot, wart or mole.

6. Hoarseness of voice or nagging cough lasting more than two weeks.

7. Unusual nose bleed, deafness or ringing sound in the ears.

8. Indigestion or difficulty in swallowing.

Investigation.

1. Breast self examination

Is a screening method used in an attempt to detect early breast
cancer. The method involves the woman herself looking at and
feeling each breast for possible lumps, distortions or swelling.

2. Mammogram examination
Is the process of using low-energy x-rays to examine the
human breast.

3. Tomography scan
A computerized tomography (CT) scanner uses X-rays to produce
cross-sectional images of the body.

4. Blood examination
Alpha fetoprotein (AFP). Measure protein level in blood
High AFP in cancerous conditions.
Self Breast Examination
Tomography scan

Mammogram
 Blood e.g - Alpha Fetoprotien (AFP)

Alpha Fetoprotein level

Normal Less 6 ng / mL
Pregnancy 500 ng / mL
Cancer More than 1000 ng / mL
The goals of treatment ;

1. Cure (realistic in absence of clinically apparent metastatic disease)

2. Prophylactic treatment / destruction of early stages metastatic disease

3. Long term control of primary disease ( contributing factors )

4. Palliative care. To improve quality of life and prolong survival.

Surgery.

Excision of the tumors mass (including a margin of apparently normal and healthy
tissue

Patient are expose to subsequent complication from surgery

- Deep vein thrombosis
- Muscle wasting (muscle weakness)
- Postsurgical pain
- Wound infection
- Phantom sensation
- Specific loss of function resulting from tissue / organ resection
e.g. paralysis, vision impairment
- Psychological effects
e.g. total mastectomy, amputation leg @ arm
Radiotherapy

To eradicate or control local recurrence of the disease

It directly damaging the cells DNA

Radiotherapy destroy both cells - normal cells

- cancer cells
Chemotherapy
uses chemical substances, especially one or more anti-cancer drugs
(chemotherapeutic agents) that are given as part of a standardized
chemotherapy regimen.
Chemotherapeutic agents act by killing cells that divide rapidly.
 PREVENTION.

A healthy lifestyle can help prevent up to 2/3 of all cancers. Making slight changes to
daily habits will reduce the risk of developing cancer.

Do not smoke. If you smoke, quitting will significantly reduce your risk for many
cancers.

Be active every day or try to exercise three times a week, 30 minutes each time.
(More oxygen down to the cellular level)

Eat plenty of vegetables, fruit and dietary fibre (oats, brown rice, cereal etc).
(Source for strong body immune system)

Eat food low in fat, sugar and salt and consume less red meat intake. (red meat
contain acidic and cancer cells thrive in an acid environment)

Drink at least 8 glasses of plain water every day. Avoid caffeine

Avoid activities that can produce heavy chemical

e.g. Plastic container heated in Microwave can produced dioxin
 PALLIATIVE CARE.

An approach that improves the quality of life of patients and their families facing the
problem associated with life-threatening illness.

Palliative care combines treatment, nursing, occupational therapy and / or

physiotherapy for people with advanced cancer

Objective of care.

Providing relief from pain and other uncomfortable symptoms

Can be provided in home, hospital or a hospice setting

Not ending a life deliberately

Supporting families and friends during ones illness and bereavement

Cancer Pain

An Overview

One of the most common symptoms of cancer is pain.

affecting between 50 % and 70 % of patients in its early stages and

70 % to 90 % of patients in late stages of the disease.

Depression and anxiety may increase the person's perception of pain

or may be the result of the cancer pain.

Symptoms often go unreported or underreported because clients

are reluctant to take the pain medication prescribed.
Etiology and Pathogenesis

The cause of cancer pain is multifaceted.

The characteristics of the pain depend on the tissue structure.

Some pain is caused by pressure on nerves or by the displacement of nerves.

Nature of pain :
Continuous, sharp, stabbing pain generally following the pattern of nerve
distribution.

Ischemic pain (throbbing) may also result from interference with blood supply.
Clinical Manifestations

Signs and symptoms accompanying mild-to-moderate.

Superficial pain may include hypertension,
tachycardia, and tachypnea (rapid, shallow breathing) as the result of
a sympathetic nervous system response.

In severe or visceral pain, a parasympathetic nervous system response

is more characteristic, with hypotension, bradycardia, nausea, vomiting,
tachypnea, weakness, or fainting.

Inflammation with its accompanying symptoms of redness, edema, pain, heat,

and loss of function may progress to infection, necrosis, and sloughing of tissue.