Oncology(Cancer Medicine)

CHAPTER 21

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Oncology Overview

• Cancer– Refers to a group of diseases, consisting of

more than 10 different types– Can originate in almost any body organ

• Most common site for women is the breast• Most common site for men is the prostate gland

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Cancer Terms

• Neoplasia– Development of an abnormal growth of new

cells that is unresponsive to normal growth control mechanisms

• Neoplasm– Any abnormal growth of new tissue that

serves no useful purpose– Neoplasm = tumor

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Cancer Terms

• Differentiation– Cells become specialized and differentiated

both physically and functionally• Cells look and act like the parent cell, or tissue of

origin

• Anaplasia– Loss of cellular differentiation and reversion to

a more primitive form• Anaplasia = dedifferentiation

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Cancer Terms

• Malignant– Tending to become worse and cause death

• Metastasis– Process by which malignant cells spread to

other parts of the body

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Benign versus Malignant Tumors

• Benign – Usually encapsulated– Cells similar in structure to cells from which

they originate– Well-defined borders– Slow growing and limited to one area– Possible growth displacement (but not

invasion) to adjacent tissue

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• Malignant – Not encapsulated; not cohesive, and irregular

pattern of growth– No resemblance to cell of origin– No well-defined borders– Growth into adjacent cells rather than

displacing or pushing them aside– Rapid growth through rapid cell division and

multiplication

Benign versus Malignant Tumors

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Classification of Neoplasms

• System for naming neoplasms– Root word to indicate type of body tissue

that gives rise to neoplasm– Suffix to indicate whether tumor is benign

or malignant• Benign tumor suffix = oma• Malignant tumor suffix = carcinoma or sarcoma

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• Carcinomas– Solid tumors that originate from epithelial

tissue • Tissue that covers external and internal body

surfaces, lining of vessels, body cavities, glands, and organs

• Sarcomas– Originate from supportive and connective

tissue• Bone, fat, muscle, and cartilage

Classification of Neoplasms

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• Grading– Measures extent to which tumor cells differ

from their parent tissue– Grade 1 = well-differentiated cells, function

most like the parent tissue• Least malignant

– Grade 4 = least differentiated cells, not like the parent tissue

• Most rapidly increasing in number

Grading of Neoplasms

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• Staging– Extent of disease and relative size of tumor– TNM staging classification system

• Internationally recognized system used for staging neoplasms

• T: (0-4) = tumor size (primary)• N: (0-3) = degree of regional lymph node

involvement• M: (0-3) = presence or absence of distant

metastases

Staging of Neoplasms

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Risk Factors

• Lifestyle and environmental risk factors– Tobacco– Alcohol– Diet– Sunlight– Radiation– Industrial agents and chemicals– Hormones

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• Lifetime risk– Probability that an individual, over the course

of his or her lifetime, will develop cancer or will die from cancer

• Relative risk– Measures the strength of the relationship

between risk factors and particular types of cancer

Risk Factors

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• Need for immediate follow-up– C = Change in bowel or bladder habits– A = A sore that does not heal– U = Unusual bleeding or discharge– T = Thickening or lump in breast or

elsewhere– I = Indigestion or difficulty in swallowing– O = Obvious change in a wart or mole– N = Nagging cough or hoarseness

Warning Signs of Cancer

SPECIFIC TYPES OF CANCER

Oncology

(CANCER MEDICINE)

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• Pronounced– (BAY-sal sell car-sih-NOH-mah)

• Defined– Most common malignant tumor of epithelial

tissue, occurring most often on areas of skin that are exposed to the sun

• Presents as a slightly elevated nodule with a depression or ulceration in center that becomes more obvious as the tumor grows

Basal Cell Carcinoma

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• Pronounced– (kar-sih-NOH-mah of the breast)

• Defined– Malignant tumor of the breast tissue– Most common type, ductal carcinoma,

originates in the mammary ducts

Carcinoma of the Breast:Breast Cancer

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Bronchogenic Carcinoma

• Pronounced– (brong-koh-JEN-ik kar-sih-NOH-mah)

• Defined– Malignant lung tumor that originates in

bronchi– Lung cancer

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Cervical Carcinoma

• Pronounced– (SER-vih-kal kar-sih-NOH-mah)

• Defined– Malignant tumor of the cervix

• Most common malignancies of female reproductive tract

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Colorectal Cancer• Pronounced

– (koh-loh-REK-tal CAN-ser)

• Defined– Presence of a malignant neoplasm in large

intestine• Most are adenocarcinomas • At least 50 percent originate in the rectum, causing

bleeding and pain

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• Pronounced– (en-doh-MEE-tree-al kar-sih-NOH-mah)

• Defined– Malignant tumor of inner lining of uterus– Also known as adenocarcinoma of uterus

• Classic symptom is inappropriate uterine bleeding• Most common cancer of female reproductive tract

after menopause

Endometrial Carcinoma

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Lymphoma

• Pronounced– (LIM-foh-mah)

• Defined– Lymphoid tissue neoplasm that is typically

malignant– Painless enlarged lymph node(s)– Progressing to anemia, weakness, fever, and

weight loss

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Kaposi’s Sarcoma

• Pronounced– (KAP-oh-seez sar-KOH-mah)

• Defined– Rare malignant lesions that begin as soft

purple-brown nodules or plaques on feet and gradually spread throughout the skin

• Most often associated with AIDS

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Malignant Melanoma

• Pronounced– (mah-LIG-nant mel-ah-NOH-mah)

• Defined– Malignant skin tumor originating from

melanocytes in preexisting nevi, freckles, or skin with pigment

– Darkly pigmented tumor with irregular surfaces and borders

– Variable colors

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ABCDs of Malignant Melanomas

• Asymmetry

• Borders

• Color

• Diameter

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Neuroblastoma

• Pronounced– (noo-roh-blass-TOH-mah)

• Defined– Highly malignant tumor of the sympathetic

nervous system

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Oral Leukoplakia

• Pronounced– (OR-al loo-koh-PLAY-kee-ah)

• Defined– Precancerous lesion occurring anywhere in

the mouth• Elevated gray-white or yellow-white leathery

surfaced lesions have clearly defined borders

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• Pronounced– (oh-VAY-ree-an car-sin-OH-mah)

• Defined– Malignant tumor of the ovaries– Most commonly occurring in women in their

50s• Rarely detected in early stage

Ovarian Carcinoma

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Pancreatic Cancer

• Pronounced– (pan-kree-AT-ik CAN-sir)

• Defined– Life-threatening primary malignant neoplasm

typically found in head of pancreas

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Carcinoma of the Prostate

• Pronounced– (car-sin-OH-mah of the PROSS-tayt)

• Defined– Malignant growth within the prostate gland,

creating pressure on upper part of urethra

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• Symptoms – Occur in later stages and may include:

• Urinary frequency, especially at night• Difficulty starting or stopping urine flow• Inability to urinate• Weak or interrupted flow or urine when urinating• Pain or burning when urinating• Pain or stiffness in lower back, hips, or thighs• Painful ejaculation

Carcinoma of the Prostate

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Renal Cell Carcinoma

• Pronounced– (REE-nal SELL kar-sih-NOH-mah)

• Defined– Malignant tumor of the kidney, occurring in

adulthood• Patient is asymptomatic until latter stages of the

disease

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• Pronounced– (SKWAY-mus sell car-sih-NOH-mah)

• Defined– Malignancy of the squamous or scalelike cells

of the epithelial tissue– Much faster growing than basal cell

carcinoma – Greater potential for metastasis if not treated

Squamous Cell Carcinoma

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Squamous Cell Carcinoma

• Frequent sites on sun-exposed areas– Top of nose– Forehead– Margin of external ear– Back of hands– Lower lip

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Carcinoma of the Testes

• Pronounced– (car-sin-OH-mah of the TESS-teez)

• Defined– Malignant tumor of the testicle that appears

as a painless lump– Also called testicular cancer

• Rare type of tumor• Usually occurs in men under the age of 40

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Cancer,Thyroid Gland

• Pronounced– (CAN-sir, THIGH-royd gland)

• Defined– Malignant tumor of the thyroid gland– Leads to dysfunction of the gland and thus

inadequate or excessive secretion of the thyroid hormone

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Intracranial Tumors

• Pronounced– (in-trah-KRAY-nee-al TOO-morz)

• Defined– Tumors occurring in any structural region of

the brain• May be malignant or benign• Classified as primary or secondary• Named according to tissue from which they

originate

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• Pronounced– (met-ah-STAT-ik in-trah-KRAY-nee-al TOO-

morz)

• Defined– Tumors occurring as a result of metastasis

from a primary site such as the lung or breast

Metastatic Intracranial Tumors (Secondary)

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Primary Intracranial Tumors

• Pronounced– (PRIGH-mah-ree in-trah-KRAY-nee-al TOO-

morz)

• Defined– Tumors that arise from gliomas and meninges

• Gliomas = malignant glial cells that are a support for nerve tissue

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• Glioblastoma multiforme – Most rapidly growing of the gliomas

• Astrocytomas– Tend to invade surrounding structures

• Ependymomas – Occur more commonly in children and

adolescents– Usually encapsulated and benign

Primary Intracranial Tumors

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• Oligodendrogliomas– Usually slow growing

• Medulloblastomas– Occur most frequently in children between

5 and 9 years of age– Rapid growing; poor prognosis

• Meningiomas– Occur most often in adults– Slow growing

Primary Intracranial Tumors

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Wilms’ Tumor

• Pronounced– (VILMZ TOO-mor)

• Defined– Malignant tumor of the kidney occurring

predominately in childhood• Most frequent finding is palpable mass in the

abdomen

TREATMENT TECHNIQUES

AND PROCEDURES

ONCOLOGY

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Treatment Techniques and Procedures

• Chemotherapy– Use of cytotoxic drugs and chemicals to

achieve a cure, decrease tumor size, provide relief of pain, or slow metastasis

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• Immunotherapy– Agents capable of changing the relationship

between a tumor and the host are known as biological response modifiers (BRMs)

• Agents are used to strengthen individual’s immune responses

Treatment Techniques and Procedures

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Treatment Techniques and Procedures

• Mohs Surgery– Surgical procedure in which the cancerous

tumor is removed in stages– Tissue is examined for evidence of cancer– Additional tissue is removed until negative

boundaries are confirmed• Advanced treatment procedure for skin cancer

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• Radiation therapy– Delivery of ionizing radiation to accomplish

one or more of the following:• Destruction of tumor cells• Reduction of tumor size• Decrease in pain• Relief of obstruction• To slow or stop spread of cancer cells

Treatment Techniques and Procedures

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• Radiation therapy – Destroys rapidly multiplying cells regardless

of whether they are cancerous– Goal is to reach maximum tumor control with

no, or minimum, normal tissue damage– May be delivered by teletherapy (external)– May be delivered by brachytherapy (internal)

TreatmentTechniques and Procedures

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• Surgery– Tumor removal through surgery– In more than 90 percent of all cancers,

surgery is used for diagnosing and staging– In more than 60 percent of all cancers,

surgery is the primary treatment• When feasible, the primary tumor is excised in its

entirety

Treatment Techniques and Procedures

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• Common surgical procedures– Incisional biopsies

• Used to remove a piece of a tumor for examination and diagnosing

– Excisional biopsies• Used to remove the tumor and a portion of normal

tissue

– En block resection• Removal of a tumor and a large area of

surrounding tissue that contains lymph nodes

Treatment Techniques and Procedures

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• Common surgical procedures – Fulguration

• Destruction of tissue with electric sparks

– Electrocauterization• Destruction of tissue by burning

Treatment Techniques and Procedures

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• Common surgical procedures – Cryosurgery

• Destruction of tissue by freezing the malignant tissue

– Exenteration• Wide resection that removes the organ or origin

and surrounding tissue

Treatment Techniques and Procedures