ONCOLOGY

MR. JILS SURESH MSC

(N)
NORMAL CELLS & CANCER CELLS DIFFERENCES
All living organisms are composed of cells. These cells grow
and divide in a controlled manner in order for the organism to
function properly. Changes in normal cells can cause them to
grow uncontrollably. This uncontrollable growth is the hallmark
of cancer cells.
 NORMAL CELL PROPERTIES
Normal cells have certain characteristics that are important for the proper functioning of
tissues, organs, and body systems. These cells have the ability to reproduce correctly, stop
reproducing when necessary, remain in a specific location, become specialized for specific
functions, and self destruct when necessary.

 Cell Reproduction: Cell reproduction is needed to replenish the cell population that ages or
becomes damaged or destroyed. Normal cells reproduce properly. Except for sex cells, all
cells of the body reproduce by mitosis. Sex cells reproduce through a process called meiosis.

 Cell Communication: Cells communicate with other cells through chemical signals. These
signals help normal cells to know when to reproduce and when to stop reproducing. Cell
signals are usually transmitted into a cell by specific proteins.
 NORMAL CELL PROPERTIES
 Cell Adhesion: Cells have adhesion molecules on their surface that allow them to stick to
the cell membranes of other cells. This adhesion helps cells to stay in their proper location
and also aids in the passage of signals between cells.

 Cell Specialization: Normal cells have the ability to differentiate or develop into specialized
cells. For example, cells can develop into heart cells, brain cells, lung cells or any other cell
of a specific type.

 Cell Death: Normal cells have the ability to self destruct when they become damaged or
diseased. They undergo a process called apoptosis in which cells break down and are
disposed of by white blood cells.
 Cancer Cell Properties
Cancer cells have characteristics that differ from normal cells.
• Cell Reproduction: Cancer cells acquire the ability to reproduce uncontrollably. These cells
may have gene mutations or chromosome mutations that affect the reproductive properties of the
cells. Cancer cells gain control of their own growth signals and continue to multiply unchecked.
They don't experience biological aging and maintain their ability to replicate and grow.
• Cell Communication: Cancer cells lose the ability to communicate with other cells through
chemical signals. They also lose sensitivity to anti-growth signals from surrounding cells. These
signals normally restrict cellular growth.
• Cell Adhesion: Cancer cells lose the adhesion molecules that keep them bonded to neighboring
cells. Some cells have the ability to metastasize or spread to other areas of the body through the
blood or lymph fluid. Once in the bloodstream, cancer cells release chemical messengers called
chemokines that enable them to pass through blood vessels into the surrounding tissues.
 Cancer Cell Properties
• Cell Specialization: Cancer cells are unspecialized and do not develop into cells of a specific
type. Similar to stem cells, cancer cells proliferate or replicate many times, for long periods of
time. Cancer cell proliferation is rapid and excessive as these cells spread throughout the body.

• Cell Death: When the genes in a normal cell are damaged beyond repair, certain DNA checking
mechanisms signal for cell destruction. Mutations that occur in gene checking mechanisms
allow for the damages to go undetected. This results in the loss of the cell's ability to undergo
programmed cell death.
 Cancer Cell Properties
• There are many different types of cancer

• Each type of cancer is distinguished by the cells in which it originates. For example, a cancer
may arise from cells of a gland, muscle cells, nerve cells, or fat cells. Each of these cancers
behaves differently and has a different name:

• • adenocarcinoma (cancer of a gland)

• • leiomyosarcoma( cancer of the muscle cells)

• • neurosarcoma (cancer of the nerve cells)

• • liposarcoma (cancer of the fat cells)

DETECTION AND PREVENTION OF CANCER
 DETECTION AND PREVENTION OF CANCER

Nurses and physicians have traditionally been involved with tertiary prevention,
the care and rehabilitation of the patient after cancer diagnosis and treatment. In
recent years, however, the American Cancer Society, the National Cancer
Institute, clinicians, and researchers have placed greater emphasis on primary and
secondary prevention of cancer.
 DETECTION AND PREVENTION OF CANCER

TYPES OF PREVENTION
1. Primary cancer prevention
• Primary cancer prevention gives importance to a healthy lifestyle and includes
all measures to avoid carcinogen exposure and promote health.
• The focus of primary prevention is to prevent a cancer from developing or to
delay the development of a malignancy.
• For individuals with a particularly high risk of a cancer (such as those with a
known genetic predisposition), primary prevention may include the use of
chemopreventive agents or prophylactic surgery to prevent or significantly
reduce the risk of developing a malignancy.
 DETECTION AND PREVENTION OF CANCER
1. Secondary prevention
 Secondary prevention refers to the early detection and treatment of subclinical,
asymptomatic, or early disease in individuals without obvious signs or symptoms of cancer.
 Secondary cancer prevention includes identifying people who are at risk for developing
malignancy and implementing appropriate screening recommendations based on the risk
assessment.
 Screening may include physical examinations, self-examinations, radiologic procedures,
laboratory tests, or other examinations.
 Examples of secondary cancer prevention include the use of the Pap smear to detect
cervical cancer, mammography to detect a nonpalpable breast cancer, or colonoscopy to
detect and remove a polyp or early colon cancer. Screening tests seek to decrease the
morbidity and mortality associated with cancer. Following a positive screening test, further
diagnostic testing is required to determine if a malignancy exists.
 DETECTION AND PREVENTION OF CANCER
3. Tertiary cancer prevention
• Tertiary cancer prevention includes monitoring for and preventing recurrence of the
originally diagnosed cancer and screening for second primary cancers and long-term effects
of treatment in cancer survivors.
• The focus of this form of prevention is aimed at detecting complications and second cancers
in long-term survivors when treatment is most likely to be effective and ultimately improve
their quality of life.
 DETECTION AND PREVENTION OF CANCER
When teaching individual patients or groups, nurses can recommend the following cancer prevention
strategies:

1. Increase consumption of fresh vegetables (especially those of the cabbage family) because
studies indicate that roughage and vitamin-rich foods help to prevent certain kinds of cancer.

2. Increase fiber intake because high-fiber diets may reduce the risk for certain cancers (eg, breast,
prostate, and colon).

3. Increase intake of vitamin A, which reduces the risk for esophageal, laryngeal, and lung cancers.

4. Increase intake of foods rich in vitamin C, such as citrus fruits and broccoli, which are thought to
protect against stomach and esophageal cancers.

5. Practice weight control because obesity is linked to cancers of the uterus, gallbladder, breast, and
colon.
 DETECTION AND PREVENTION OF CANCER
6. Reduce intake of dietary fat because a high-fat diet increases the risk for breast, colon,
and prostate cancers.
7. Practice moderation in consumption of salt-cured, smoked, and nitrate-cured foods;
these have been linked to esophageal and gastric cancers.
8. Stop smoking cigarettes and cigars, which are carcinogens.
9. Reduce alcohol intake because drinking large amounts of alcohol increases the risk of
liver cancer. (Note: People who drink heavily and smoke are at greater risk for cancers of
the mouth, throat, larynx, and esophagus.)
10. Avoid overexposure to the sun, wear protective clothing, and use a sunscreen to prevent
skin damage from ultraviolet rays that increase the risk of skin cancer.
WARNING SIGNS OF CANCER
 WARNING SIGNS OF CANCER

SYMPTOMS OF CANCER
• In its early stages, cancer may have no symptoms, but eventually a malignant tumor will
grow large enough to be detected.
• As it continues to grow, it may press on nerves and produce pain, penetrate blood vessels
and cause bleeding, or interfere with the function of a body organ or system.
 WARNING SIGNS OF CANCER
THE SEVEN WARNING SIGNS OF CANCER
The American Cancer Society uses the word C-A-U-T-I-O-N to help recognize the
seven early signs of cancer:
1. Change in bowel or bladder habits
2. A sore that does not heal
3. Unusual bleeding or discharge
4. Thickening or lump in the breast, testicles, or elsewhere
5. Indigestion or difficulty swallowing
6. Obvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore
7. Nagging cough or hoarseness
 WARNING SIGNS OF CANCER
The following symptoms may also signal the presence of some types of cancer:
• Persistent headaches
• Unexplained loss of weight or loss of appetite
• Chronic pain in bones or any other areas of the body
• Persistent fatigue, nausea, or vomiting
• Persistent low-grade fever, either constant or intermittent
• Repeated infection
THE TNM CLASSIFICATION OF CANCER
 THE TNM CLASSIFICATION OF CANCER

The American Joint Committee on Cancer (AJCC) and the International Union for Cancer
Control (UICC) maintain the TNM classification system as a tool for doctors to stage different
types of cancer based on certain standards. It’s reviewed every 6 to 8 years to include advances
in our understanding of cancer.
In the TNM system, each cancer is assigned a letter or number to describe the tumor, node, and
metastases.
• T stands for tumor. It’s based on the size of the original (primary) tumor and whether it has
grown into nearby tissues
• N stands for node. It tells whether the cancer has spread to the nearby lymph nodes
• M stands for metastasis. It tells whether the cancer has spread to distant parts of the body
 THE TNM CLASSIFICATION OF CANCER

The T category describes the original (primary) tumor. The tumor size is usually measured in
centimeters or cm (2½ cm = about 1 inch) or millimeters or mm (10 mm = 1 cm).
• TX means the tumor can’t be measured.
• T0 means there is no evidence of primary tumor (it cannot be found).
• Tis means that the cancer cells are only growing in the most superficial layer of tissue,
without growing into deeper tissues. This may also be called in situ cancer or pre-cancer.
• Numbers after the T – T1, T2, T3, and T4 – describe the tumor size and/or amount of spread
into nearby structures. The higher the T number, the larger the tumor and/or the more it has
grown into nearby tissues.
 THE TNM CLASSIFICATION OF CANCER

The N category describes whether the cancer has spread into nearby lymph nodes.

 NX means the nearby lymph nodes cannot be evaluated.

 N0 means nearby lymph nodes do not contain cancer.

 Numbers after the N – N1, N2, and N3 – describe the size, location, and/or the
number of lymph nodes involved. The higher the N number, the more lymph
nodes there are that contain cancer.
 THE TNM CLASSIFICATION OF CANCER

The M category tells whether there are distant metastases (spread of cancer to other parts of
body).

 MX means metastasis can’t be evaluated.

 M0 means that no distant cancer spread was found.

 M1 means that the cancer has spread to distant organs or tissues (distant metastases were
found).