Intro to Cancer and Detection Testing

8/8/2019 Intro to Cancer and Detection Testing

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CANCER



Oncology Nurse

y provide care and support for patients who have beendiagnosed with cancer

y required to administer chemotherapy and to otherwisehelp manage symptoms related to their patients'

illnesses

y coordinate care with other health care providers,including oncologists, and share their expertise with

colleagues and patient



Cellular Aberration

ythe act of deviating from the ordinary,

usual, or normal type of cell where itcan alter or destruct in the normalgrowth of cell or tissue





CanceryIs a complex of diseases which

occur when the normal cells

mutate into abnormal cells that

take over normal tissue,

eventually harming anddestroying the host

National Cancer Institute



Cancery A large group of disease characterize by:

Uncontrolled growth and spread of abnormal cells

Proliferation

Metastasis

y Altered cellular mechanism with progressive and

uncontrolled multiplication of cells with selective ability to

invade, metastasize and cause mechanical effects of

pressure, obstruction and interruption of blood supply





Cancer









Cancer Statistics

y A ll Sites of Cancer

y Estimated new Cancer 1,479,350

y

Male - 766,130y Female - 713,220

y Estimated Deaths 562,340

y Male - 292,540

y Female - 269,800



2009 Estimated US Cancer the act of deviating from the ordinary, usual, or normal typeDeaths*

y Lung & bronchus 30%

y Prostate 9%

y Colon & rectum 9%

y Pancreas 6%

y Leukemia 4%y Liver & intrahepatic 4%

bile duct

y Esophagus 4%

y Urinary bladder 3%

y Non-Hodgkin 3%

lymphoma

y Kidney & renal pelvis 3%

y A ll other sites 25%

y ©2009, A merican Cancer Society, Inc.

Men

292,540

Women

269,800 26% Lung & bronchus

15% Breast

9% Colon & rectum

6% Pancreas5% Ovary

4% Non-Hodgkinlymphoma

3% Leukemia

3% Uterine corpus

2% Liver & intrahepaticbile duct

2% Brain/ONS

25% All other sites



Mortality, 2006

Rank cause of Death

y 1. Heart Diseases 631,636 26.0y

y 2. Cancer 559,888 23.1

y 3. Cerebrovascular diseases 137,119 5.7y

y 4. Chronic lower respiratory diseases 124,583 5.1y

y 5. A ccidents (unintentional injuries) 121,599 5.0y

y 6. Diabetes mellitus 72,449 3.0y

y 7. A lzheimer disease 72,432 3.0y

y 8. Influenza & pneumonia 56,326 2.3y

9. Nephritis* 45,344 1.9

y 10. Septicemia 34,234 1. 4

y ©2009, A merican Cancer Society, Inc.y



Incident





Etiology/ Causative Factor

y Extrinsic Factor

y Viruses and bacteria

y Chemical Carcinogens

y Radiation Carcinogens

y Iatrogenic Chemical

agents

y Intrinsic Factor

y Hormonal Factor

y Genetic Factor

y Physical Stressor

y Dietary Factors



Viruses and Bacteriay second most important risk factor for cancer

development in humans

causes the cell to become malignant

alter the activity of cell

viral genetic information inserted to chromosomes of infected cell

nucleic acids of virus stored in cell

Virus infected a person



A. Viruses and Bacteria



Viruses and Bacteria



Viruses and Bacteria

HIV causes an immune

deficiency that makes

people more susceptible to

viral infection



Vir s s ct ri

y H elicobacter pylori, which cancause stomach ulcers, has beenassociated with the development of can



B. Chemical carcinogensChemical carcinogens such

as asbestos, nitrosamine andpolycyclic hydrocarbons

A lter cell behavior,function andreplication

DNA mutation

(mutagens) andcancer(carcinogens)

Some chemical such asalcohol

Stimulate rateof cell

division

Less enzymes to repairdamaged DNA

Increasingmutation and

cancer



c rc g s

y Cigarette smoke contains more thantwo dozen different chemicals

capable of causing cancer



B. Chemical carcinogens



C. Iatrogenic chemical agents

yChemotherapy drugs

yImmunosuppressive agents

The breakdown of immune surveillance as a

possible etiology of cancer



D. Radiation Carcinogens

y Prolonged or repeated exposure to certaintypes of radiation can cause cancer







E. Hereditary Factors



E. Hereditary Factors



F. Dietary Factors

Obesity

High fat diet

Diets low in fiber

Diets high in smoked or salted foods

Preservatives and Food additives

A

lcohol



H. AGE



Cancers Nine Warning Signs

y

C hange in bowel or bladder habitsy A sore that does not heal

y U nusual bleeding or discharge

y T hickening or lump in breast or elsewhere

y I ndigestion or difficulty in swallowingy O bvious change in wart or mode

y N agging cough or hoarseness

y U nexplained anemia

y S udden loss of weight





Chemicals andradiation

Alter/dama inenes

viruses

introduce their o nenes into cells

hereditary

passes on alterations inenes

Genes are altered, or"mutated," in various ays

CA NCER

Oncogenesis



















What is Staging?y Staging describes the extent or severity of an

individuals cancer

y

It is base on the extent of the original (primary)tumor and the extent of spread in the body.



Staging is important:y Staging helps the doctor plan a persons treatment.

y The stage can be used to estimate the persons prognosis(likely outcome or course of the disease).

y Knowing the stage is important in identifying clinicaltrials (research studies) that may be suitable for aparticular patient.



Elements of Staging Systemsy Location of the primary tumor

y Tumor size and number of tumors,

y L ymph node involvement

y Cell type and tumor grade

y Presence or absence of metastasis



TNM System:

TheTNM system is based on :

y the extent of the tumor (T)

ythe extent of spread to the lymph nodes (N)

y the presence of metastasis (M).

y A number is added to each letter to indicate the size or

extent of the tumor and the extent of spread.



Primary Tumor (T)y TX - Primary tumor cannot be evaluated

y T0 No evidence of primary tumor

yTis - Carcinoma in situ (early cancer that has notspread to neighboring tissue)

y T1, T2, T3, T4 - Size and/or extent of the primary tumor



Regional Lymph nodesy NX - Regional lymph nodes cannot be evaluated

y N0 - No regional lymph node involvement (no cancer

found in the lymph nodes)y N1, N2, N3 - Involvement of regional lymph nodes

(number and/or extent of spread)



Distant Metastasis (M)y M X - Distant metastasis cannot be evaluated

y M0 - No distant metastasis (cancer has not spread to

other parts of the body)y M1 - Distant metastasis (cancer has spread to distant

parts of the body)



Examples:y breast cancerT3 N2 M0

y It refers to a large tumor that has spread outside thebreast to nearby lymph nodes, but not to other parts of the body.

y Prostate cancerT2 N0 M0

y It means that the tumor is located only in the prostateand has not spread to the lymph nodes or any other partof the body.



y Stage I ( T1, N0, MO)- Early Stage

y Stage II (T2, N1, M0) local Spread

yStage III ( T3, N2, M0)- extensive spread but nometastasis.

y Stage IV (T4, N3, M+) A dvanced stage, with distantmetastasis



5 Main Categories of Cancery In situ is early cancer that is present only in the layer of

cells in which it began.

y Localized is cancer that is limited to the organ in whichit began, without evidence of spread.



y Regional is cancer that has spread beyond the

original (primary) site to nearby lymph nodes ororgans and tissues.

y Distant is cancer that has spread from the primary

site to distant organs or distant lymph nodes.

y Unknown is used to describe cases for which thereis not enough information to indicate a stage.





Why Cancer Detection and Testing Important?

y Detecting cancers early is an important step in

preventing significant health problems.



Four Possible Outcomes.

y True Positive

y False Positive

y TrueNegative

y FalseNegative



y W hen a test is performed to detect a disease,

there are four possible outcomes:

yTrue positive - test indicates that a patient

has a disease that the patient does indeedhave

yFalse positive - test indicates that a patienthas a disease when they do not



yTrue negative - test indicates the patientis disease-free, and this is indeed the case

yFalse negative - test indicates the patientis healthy when in fact the patient has the

disease





Non - Invasive Invasive Techniques A nalysis of Biopsy

Complete Blood Count(CBC)

ltrasoundMR I

T canCT can

Fine Needle AspirationCore Needle Biopsy

Immunohistochemistry (I C)Fluorescent In itu

y ridization (FI )



CBCy It provides information about the number, parts,

shape, and structure of the different cell types found inblood.

y 3 main types of blood cells:

y WBC

y R BC

y

Platelets



MRI

y Used to evaluate suspected malignancies of the CNSbecause of its ability to perform multi-planar images and

ease of instillation of contrast media.



MRI

W hen contrast agent is not used anMR I can show:

W hen contrast agent is usedMR I can show:

contrast agent is not used an MRI can

show:The shape, size, appearance, andlocation of organs, bones, and jointsThe presence of abnormal growthsSigns of inflammation or infection

size and location of benign or

malignant growthsenlarged lymph nodeschanges in blood flowextracellular volume



Positron Emission Tomography

(PET) y Uses nuclear medicine with the precise localization to

penetrate bodys metabolism to measure blood volume/flow and protein metabolism.

y In oncology, it detect the metabolic changes precedeanatomic changes.

y PET scans use radioactively labeled tracers(radiotracers) that are injected into the bloodstream



PET Scanning is able to:y Differentiate scar or radiation necrosis from active

tumor.

y

Determine if a mass lesion is malignant or benign.y Characterize enlarged lymph nodes as malignant or

benign.

y Evaluate early tumor treatment response.



Computed Tomographyy It uses x-rays in the same way as a conventional x-ray

but instead of taking one image a CT scanner takesmultiple images, or slices.

y It can provide a 3 dimensional image of an internalstructure, it can detect differences in tissue density.

yUltrasound uses reflection of sound waves tocreate an image of a part of the body



FineNeedle A spirationCoreNeedle Biopsy



Biopsyy Is the removal of cells, tissue, or fluid for examination.



Types of Biopsyy Excisional biopsy- removes all suspicious tissue.

y Incisional biopsy- removes a sample of tissue from a

mass.y Needle A spiration- aspiration of small amount of core

tissue from a suspicious area.



Invasive Techniques

y Fine needle aspiration (FNA ) uses a small needle tocollect small samples of a lesion.

y Core needle biopsy uses a larger needle to collectsamples of a lesion



FineNeedle A spiration CoreNeedle Biopsy

Sample Removed Removes only a very small portion of the lesion

Removes a small portion in most

cases, occasionally removes the

entire lesion

Needle Size 22-27 gauge 11-18 gauge

Pathology Type Cytopathology Histopathology

Interpretation Time Immediately Delayed

Diagnostic Abilities

Limited ability to specifically diagnose benign

lesions

No ability to differentiate between in situ and

invasive breast cancer

Strong ability to specificallydiagnose benign lesions.

Some ability to differentiate

between in situ and invasive breast

cancer.

Disadvantages Cannot be used for additional studyMore invasive, time consuming,

expensive

AdvantagesInexpensive, quick, readily available, and very

safe

Can be used for additional study

and has more specific diagnosticabilities than FNA



Examination of Tissue Samples

y Immunohistochemistry (IHC)

y Fluorescence in SituH ybridization (FISH)





y Is a cytogenetic technique used to detect and localizethe presence or absence of specific DNA sequences onchromosomes.

y FISH uses fluorescent probes that bind to only those

parts of the chromosome with which they show a highdegree of sequence similarity.

Fluorescence in Situ

Hybridization (FISH)



Cancer Specific Techniques

y Mammography uses low dose x-ray to create an imageof a breast.

y Sigmoidoscopy uses a small tube containing viewingequipment to view the colon.

y Virtual Colonoscopy uses an MRI or CT scan to createan image of the inside of the colon.



y Pap smears use a sample of cells from the cervix todetect cervical cancer. Pap smears may also detectovarian and uterine cancers that have migrated to the

cervix.

y Prostate specific antigen (PS A ) test measures levels of a glycoprotein in the blood. Elevated levels of PS A areassociated with prostate cancer



Sentinel Lymph Node Biopsy (SLN)y is used to detect metastasis.

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Intro to Cancer and Detection Testing