CHAPTER 21
Oncology
(Cancer Medicine)
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
2
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
3
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
4
Cancer Terms
• Malignant
– Tending to become worse and cause death
• Metastasis
– Process by which malignant cells spread to
other parts of the body
5
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
6
Benign versus Malignant Tumors
• 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
7
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
8
Classification of Neoplasms
• 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
9
Grading of Neoplasms
• 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
10
Staging of Neoplasms
• 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
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Risk Factors
• Lifestyle and environmental risk factors
– Tobacco
– Alcohol
– Diet
– Sunlight
– Radiation
– Industrial agents and chemicals
– Hormones
12
Risk Factors
• 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
13
Warning Signs of Cancer
• 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
14
SPECIFIC
TYPES OF CANCER
Oncology
(CANCER MEDICINE)
Basal Cell Carcinoma
• 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
16
Carcinoma of the Breast:
Breast Cancer
• 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
17
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
19
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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Endometrial Carcinoma
• 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
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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
22
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
23
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
24
ABCDs of Malignant Melanomas
•
•
•
•
Asymmetry
Borders
Color
Diameter
25
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
27
Ovarian Carcinoma
• 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
28
Pancreatic Cancer
• Pronounced
– (pan-kree-AT-ik CAN-sir)
• Defined
– Life-threatening primary malignant neoplasm
typically found in head of pancreas
29
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
30
Carcinoma of the Prostate
• 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
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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
32
Squamous Cell Carcinoma
• 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
33
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
35
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
36
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
37
Metastatic Intracranial Tumors
(Secondary)
• Pronounced
– (met-ah-STAT-ik in-trah-KRAY-nee-al TOOmorz)
• Defined
– Tumors occurring as a result of metastasis
from a primary site such as the lung or breast
38
Primary Intracranial Tumors
• Pronounced
– (PRIGH-mah-ree in-trah-KRAY-nee-al TOOmorz)
• Defined
– Tumors that arise from gliomas and meninges
• Gliomas = malignant glial cells that are a support
for nerve tissue
39
Primary Intracranial Tumors
• 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
40
Primary Intracranial Tumors
• 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
41
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
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TREATMENT
TECHNIQUES
AND PROCEDURES
ONCOLOGY
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
44
Treatment
Techniques and Procedures
• 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
45
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
46
Treatment
Techniques and Procedures
• 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
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Treatment
Techniques and Procedures
• 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)
48
Treatment
Techniques and Procedures
• 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
49
Treatment
Techniques and Procedures
• 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
50
Treatment
Techniques and Procedures
• Common surgical procedures
– Fulguration
• Destruction of tissue with electric sparks
– Electrocauterization
• Destruction of tissue by burning
51
Treatment
Techniques and Procedures
• Common surgical procedures
– Cryosurgery
• Destruction of tissue by freezing the malignant
tissue
– Exenteration
• Wide resection that removes the organ or origin
and surrounding tissue
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