CELLULAR

ABERRATION MODULE !

IMAGE CREDIT: ELPORTALCANCERCENTER.COM

PREPARED BY:
RIZZA C. ABINSAY, M.A.N
RESPECT BEGETS RESPECT
It is not the status, the skills, the talent, the physical
appearance, that define an individual as a human
being BUT rather….it is the ATTITUDE and the
CHARACTER.
 etiquette

ELIMINATE
BACKGROUND
NOISE AND
DISTRACTIONS

BE BE PUNCTUAL
RESPECTFUL AND PREPARED

DRESS
ACCORDING TO
THE PRESCRIBED
DRESS CODE
NCM 112
Descriptive Title: Care of Clients w/Problems in Cellular Aberrations, Acute
Biologic Crisis including Emergency and Disaster in Nursing: LEC

Safe and Effective

Care Environment Psychosocial Integrity
Learning
objectives
Health Promotion
and Maintenance Physiological Integrity
 GRADING
Midterm and Final Exam – 40%
Quizzes - 30%
Requirement/ Term Project –
15%
Class Participation – 15 %

MID TERM PROJECT

FINAL TERM PROJECT

Terminologies related to the concept of cellular aberration  

🞆 Cancer Anaplasia Carcinoma in Situ

🞆 Metastasis Oncology Carcinogenesis
🞆 Benign neoplasm Adenocarcinoma Vesicant
🞆 Malignant neoplasm Carcinoma Lipoma
🞆 Neoplasia Sarcoma Dysplasia
🞆 Hyperplasia Carcinogens Leiomyoma
🞆 Hypertrophy Fibroma Metaplasia
🞆 Angiogenesis Lymph angiogenesis
 Mortality and Morbidity

= refers to death
◦ =crude mortality rate
◦ =age-specific mortality rate
◦ infant mortality rate
◦ Maternal mortality rate
◦ Under-5 mortality rate

🞆 = refers to disease state

 Review of the Normal Cell Cycle

1.Cell cycle

1.Normal cell
1. Interphase
2. Mitosis
3. Apoptosis

Image credit: Emory Winship Cancer Institute

The Definition of Cancer

🞆 = is a condition where there’s an abnormal growth and

proliferation of a diseased cell, that can invade and spread
to the adjacent tissue or other areas of the body.
🞆 = also known as malignant neoplasm

🞆 image credit: National Cancer Institute

HALLMARKS OF CANCER
(WIKIPEDIA)
Terminologies Related to the Concept of
Cellular Aberration: Cancer Denotation

Cancer (karkinos and cancrum)

Carcinoma
Sarcoma
Neoplasia
Anaplasia
Dysplasia
Metaplasia
Metastasis
Hyperplasia
Atrophy
Proliferative Pattern: Patterns of Cell Growth

🞆 Hyperplasia
🞆 Metaplasia
🞆 Dysplasia
🞆 Anaplasia
🞆 Neoplasia
 Major Dysfunctions: Process of Cancer
IMAGE CREDIT: slideshare.net

🞆 Defect in Cellular
Proliferation
🞆 Defective cellular
differentiation  
Defect in Cellular Proliferation

🞆Abnormal cell cycle

regulation
🞆TP53 (p53)
Defective cellular differentiation  

🞆 Protooncogenes – on switch for cellular growth

🞆 Oncogenes (K-ras)
🞆 Tumor suppressor genes
 CANCER DEVELOPMENT:
Etiologic/Predisposing Factors

Viruses and bacteria

 Physical agents
 Genetics and familial factors
 Chemical agents
 Dietary factors
 Medical/ drugs
 Hormonal agents
ROLE OF THE IMMUNE SYSTEM
Normal Immune Responses
- tumor-associated antigen
- T lymphocytes (lymphokines)
- natural killer cells
Immune System Failure
Benign Neoplasm and Malignant Neoplasm
features Benign malignant
structure Well differentiated anaplastic
Growth rate slow fast
Growth/ duration May stop growing/expansive Invasive/ may grow continuously
Metastasis None Metastasize in other areas of the
body
Effect on host Does not usually cause tissue Vast tissue damage
damage except if in certain
location
INVASION AND METASTASIS
image credit: semantic scholar
Carcinogenesis
Is the malignant transformation or the cell mutation
3 steps Cellular Process
1. initiation
2. promotion
3. progression
Diagnosis of Cancer
Extensive testing
1 determine the presence and extent of tumor
2. identify possible metastasis
3. evaluate the involve and uninvolved organ or system function
4. Obtain tissue and cell for analysis
 WARNING SIGNALS OF CANCERS
🞆 Change in bowel or bladder habits/functions
🞆 Any sore that does not heal/new persistent pain
🞆 Unusual bleeding or discharge
🞆 Unexplained weight loss/unexplained anemia
🞆 Thickening or lump in breast or elsewhere
🞆 Indigestion/loss of appetite
🞆 Obvious change in mole or wart/skin changes
🞆 Nagging cough or hoarseness of voice
PREVENTION, SCREENING,EARLY
DETECTION

🞆 Primary Prevention
🞆 Secondary Prevention
🞆 Tertiary Prevention
STAGING AND GRADING: Brunner and Sudarth
TNM Classification System
From American Joint Committee on Cancer. (2006). AJCC cancer staging atlas. Chicago: Springer Science and Business Media, Inc
Regional Lymph Node (N)
Nx – cannot be assessed
N0 – no regional lymph
Primary Tumor (T) node metastasis
🞆 T - the extent of the Tx – primary tumor N!, N2, N3 – increasing
primary tumor cannot be assessed involvement of regional
T0 – no evidence of lymph nodes
🞆 N – The absence or
presence and extent primary tumor
of regional lymph Tis – carcinoma in situ
node metastasis T1, T2, T3, T4 – Distant Metastasis (M)
🞆 M – The absence or increasing size and /or Mx – Distant metastasis cannot be
presence of distant local extent of the assessed
metastasis primary tumor M0 – no distant metastasis
M1 – distant metastasis
METHODS OF CANCER DETECTION:
EARLY DETECTION: IN AVERAGE-RISK ASYMPTOMATIC PEOPLE
Cancer Site Population Test or Procedure
Breast Women, aged > 20 yrs. Breast Self Examination (BSE)
Clinical Breast Examination (CBE)
Mammography

Colorectal Men & Women aged > 50 yrs. Fecal Occult Blood (FOBT)
Fecal Immunochemical Test
Flexible Sigmoidoscopy
Diagnostic Contrast barium Enema

Prostate Men aged > 50 yrs. Digital rectal Examination

Prostate Specific Antigen Test (PSA)
Cervix Women aged > 18 yrs. Papanicolaou Test
Endometrial Women at menopause At the time of menopause, at average risk,
symptoms of endometrial cancer
 Diagnostic Aids to Detect Cancer
Test Description

Tumor Marker Identification Analysis of substances found in body

Genetic Profiling Analysis for the presence of mutations in genes found in
tumors or body tissues.
Mammography Use of X-ray image of the breast
Magnetic Resonance Imaging Use of magnetic fields and radiofrequency signals
Computed Tomography Use of narrow-beam X-ray to scan successive layers of tissue
for a cross sectional view
Fluoroscopy Use of X-rays that identify contrasts n body tissue densities;
may involve the use of contrast agent
 Diagnostic Aids to Detect Cancer
Test Description
Ultrasonography High-frequency sound waves echoing off body tissues; to assess tissues deep
within the body

Endoscopy Direct visualization of a body cavity by insertion of an endoscope

Nuclear medicine imaging Uses intravenous injection or ingestion of radioisotope substances followed by
imaging of tissues that have concentrated the isotopes

Positron emission tomography Used in detection of cancer or its response to treatment

(PET)
PET fusion Use of PET and CT scanner in one, provide image combining anatomic detail,
spatial resolution, and functional metabolic abnormalities

Radioimmunoconjugates Monoclonal antibodies are labeled with a radioisotope and injected

intravenously, the antibodies that aggregate at the tumor site are visualized
with scanners
 Cancer Management: Goals
PROMOTING NUTRITION
RELIEVING PAIN
🞆 Cure DECREASING FATIGUE
🞆 Control IMPROVING BODY IMAGE AND SELF-
🞆 Palliation ESTEEM
MONITORING AND MANAGING
POTENTIAL COMPLICATIONS
 Cancer Management
1. Surgery
2. Chemotherapy
3. Radiation therapy
4. Bone Marrow Transplantation (BMT)
5. Hyperthermia
6. Targeted Therapies
◦ A. Biologic Response Modifiers
◦ B. Gene Therapy
◦ C. Complimentary and Alternative Medicine
◦ D. Unproven and Unconventional Therapies
 Management of Cancer: Surgery
🞆 Diagnostic surgery
◦ Biopsy – the conclusive way of diagnosing cancer and collect
histological proof of malignancy
🞆 Types :
🞆 Excisional biopsy
Incisional biopsy
Needle biopsy
 Management of Cancer: Surgery

Surgery as primary tx
2 approaches
◦ Local excision
◦ Wide / radical excision (en bloc dissection)
◦ NOTE: SALVAGE SURGERY-additional surgical treatment
Management of Cancer: Surgery
Prophylactic Surgery
Palliative Surgery
Reconstructive Surgery
 SURGERY

SURGERY – is indicated to diagnose, stage, and treat certain types of cancer

🞆 Prophylactic surgery – clients with premalignant condition or with family
history or genetic mutation that predispose the client as high risk to the
development of cancer
🞆 Palliative surgery – carry out or improve quality of life spend for survival
time
🞆 Reconstructive or rehabilitative surgery – improve quality of life
(restoring maximal function and physical appearance)
 Nursing Management/Intervention in
Cancer Surgery
🞆 Prepare the client for the diagnostic procedure and instruction.
🞆 Ensure that informed consent has been signed and obtained.
🞆 Provide educational and emotional support to patient and family.
🞆 Assess and monitor the patient’s response to surgery and for
possible complications.
🞆 Ensure continuity of care.
 Adverse effects of Surgery

🞆 Loss of function of a specific body part

🞆 Diminished organ function
🞆 Scarring or disfigurement
🞆 Grieving about altered body image / imposed change in lifestyle
🞆 Pain, infection, bleeding and thromboembolism
 CHEMOTHERAPY Normal cells are
affected and killed in
Killing and inhi- the process
Systemic in effect
biting neoplastic cells
replication

Common side effects: fatigue, alopecia, nausea,

Can be used in vomiting, mucositis, skin changes,
combination therapy myelosuppression (neutropenia, anemia,
thrombocytopenia)
 CHEMOTHER
APY
1.Neoadjuvant Cell-cycle specific
2.Adjuvant A. Topoisomerase 1 Inhibitors
3.Primary treatment -Irotecan C. Mitotic spindle
-Topotecan poisons
1. Plant alkaloids
1.Connection to the cell - Etoposide
B. Antimetabolites
cycle - Teniposide
- 5 fluorouracil
= cell-cycle specific agents - Vinblastine
- Pentostatin
= cell-cycle nonspecific agents - Vincristine
- methotrexate
2. By chemical group - Vinorelbine
2. Taxanes
- paclitaxel
- docetaxel
CHEMOTHER
APY
C. Antitumor antibiotics
-bleomycin -mitomycin
Cell-cycle nonspecific
-dactinomycin -mitoxantrone
A. Alkalating agents
-daunorubicin -plicamycin
-busulpan -cisplastin
-dexorubicin
-carboplatin -cyclophosphemide
D. Hormonal agents (suppresses
-chlorambucil -melphalan
aromatase)
B. Nitrosureas
-androgens & antiandrogens
-carmustine
-estrogens & antiestrogens
-lomustine
-LH releasing hormones analogues
-semustine
-progestine & antiprogestine
-streptozocin
-aromatase inhibitors
CHEMOTHER
APY

Classification by Chemical Group

- Classification that distinguishes the different

mechanisms of actions
CHEMOTHER Vesicants
-cisplatin
APY -Dactinomycin
-vincristine
-daunorubicin
Classification by -doxorubicin
potential to damage
-paclitaxel
tissues (extravasation)
- Nonvesicant -mitomycin
- Irritant -vinblastine
- vesicants
Vessicants = a big NO NO in peripheral
veins of the hands and wrist
CHEMOTHER
APY
SIGNS OF
EXTRAVASATION OF Nursing Care depends on the
VESSICANTS vesicant agent
- Absence of blood flow - Cold compress =
return from the IV
catheter
doxorubicin
- Resistance to IV flow - Warm compress = vinca
- Pain or burning alkaloid
sensation, swelling, or
- Neutralizing solution
redness at the site.
CHEMOTHER
APY

Common side effects:

fatigue, alopecia, nausea, vomiting, mucositis, skin changes,
myelosuppression (neutropenia, anemia, thrombocytopenia),
renal damage, pulmonary fibrosis, pulmonary edema, cumulative
cardiac toxicity, cough and dyspnea, respiratory failure, sterility,
metabolic encephalopathy, neurologic damages
CHEMOTHER
APY
Nursing Management in Chemotherapy:

1.Assessing fluid and electrolyte status

2. Modifying risk for infection and bleeding
3. Careful administration of chemotherapeutic
agent
4. Protecting self, caregivers and significant others
 RADIATION THERAPY
Cancer cells are destroyed,
normal cell are minimally
expose to the damaging Side effects:
effects of radiation local skin changes and irritation, alopecia, fatigue
(MCSE), altered taste sensation

NOTE: effects may vary depending to the site of

Operative on tissues right treatment
with in the course of the
radiation beam
 RADIATION THERAPY
Radiation-shrinks or kill
2 types of ionizing radiation
cancer cells
-electromagnetic
Localized treatment
-particulate

#Surgery is impossible
#As neoadjuvant
#Prophylactic to disrupt Radiation dosage
metastasis of PT = lethal tumor dose 95 % destruction, preserving
#palliative tx healthy surrounding cells
#for oncologic emergencies -fraction (daily doses over several weeks)
 RADIATION THERAPY

Primary Application

Administration of Radiation 1. Teletherapy

2. Brachytherapy
3. Systemic
4. Contact or Surface Molds
 TELETHERAPY: mode of delivery
1. Intensity Modulated radiation – shortens duration of tx. Hyper fractionated
(daily of twice daily fraction)
2. Image-guided Radiation Therapy – monitor status of tumor (size and position)
with ultrasound or Ct scans
3. Respiratory – gating – simultaneous with patient’s respiratory cycle
4. Stereotactic Body radiotherapy – higher doses of radiation penetrating deep
seated tumors
5. Proton therapy – high-linear transfer of charged protons generated from
cyclotron
TELETHERAPY: CLIENT DOES NOT EMIT
RADIATION
SAUNDER’S
BRACHYTHERAPY: RADIATION SOURCE IS WITHIN
THE CLIENT

UNSEALED RADIATION SEALED RADIATION

SOURCE SOURCE
= ORAL
= IV = TEMPORARY
= BEADS = PERMANENT IMPLANT
= NEEDLES
BRACHYTHERAPY: RADIATION SOURCE IS WITHIN
THE CLIENT
High-dose Radiation

= 1. Intraluminal
TEMPORARY 2. Intra-cavitary isotopes
 high-dose 3. Interstitial implants
4. Systemic
radiation Strontium 89
 Low-dose samarium 153
radiation phosphorus 32
BRACHYTHERAPY: RADIATION SOURCE IS WITHIN
THE CLIENT

 Altered skin integrity

 Altered oral mucosa
TOXIC EFFECTS  GI mucosa involvement
OF RADIATION  Bone marrow site involvement
THERAPY  Systemic side effect
 Chronic late effects
BRACHYTHERAPY: SEALED RADIATION
SOURCE
Saunder’s
 Nursing Management:

PROTECTING Caregivers:
Pt. in private room
1. Regular assessment of Radiation safety
skin and oropharyngeal
Docimeter badges
mucosa
Non-pregnant staff
2. Assessed nutritional and Children
general well-being Limit at 30 mins.
3. Patient education 6 feet distance
Explain
Image credit: slideplayer.com (Pius hospital Oldenburg
BONE MARRROW/PERIPHERAL BLOOD
STEM CELL TRANSPLANTATION
🞆 BMT & PBSCT – procedures that replace stem; destroyed by
high doses of chemotherapy and/or radiation therapy
🞆 Commonly used in the treatment of leukemia and lymphoma
TYPES OF DONOR STEM CELLS
Allogeneic
Syngeneic
Autologous
 Allogeneic

- AlloBMT – fr. Other person

= primary used is for bone marrow diseases

= Immunologically resistant to patient’s malignancy which
causes graft versus tumor effects
 AlloBMT may entail: Non-ablative (mini doses)
chemotherapy
-suppress pts. Immune system to
Ablative (high doses) allow engraftment
chemotherapy -for older pts. / c underlying organ
-peripheral blood stem cells dysfunction
administered IV
-engraftment 2-4 wks.
GVHT (Clinical Manifestation)
= Diffuse rash-blister-desquamation
=mucosal shedding(diarrhea > 2l/day
Graft – versus – host disease = biliary stasis
= hepatomegaly
-T lymphocytes from donor = elevated liver enzymes
destroys recipient’s tissues = acute liver failure
= death
Image credit: cancer.uams.edu (Winthrop P. Rockefeller cancer Institute)
 AutologousBM
T:
AuBMT – fr. Pt. itself
-pt. with healthy bone-marrow
but require bone marrow
ablative doses of chemotherapy
to cure malignancy Tumor cells may remain in
the bone marrow

- Pt. will undergo ablative chemo/total

body irradiation
- Stem cells will undergo purging
- Stem cells are re-infused &
engrafted
Syngeneic
BMT:

Syngeneic – fr. Identical twin

-incidence of GVHD and graft
rejection reduced
- Graft versus tumor effect also
reduce
COMPLICATIONS (BMT)
HEPATIC VENO-
OCCLUSIVE
DISEASE
GRAFT-VERSUS- CAUSED BY:
>THROMBOSIS OR
FAILURE TO HOST DISEASE IN
PHLEBITIS
ENGRAFT ALLOGENIC =S/
TRANSPLANTS = RUQAP
= JAUNDICE
= ASCITES
= WEIGHT GAIN
= HEPATOMEGALY
 NURSING MANAGEMENT IN BMT
IMPLEMENTING PROVIDING
PRETRANPLANTA- POSTTRANSSPLAN-
TION CARE PROVIDING TATION CARE
=EVALUATION/ CARE DURING (RECIPIENT AND
TO ASSESS TREATMENT DONOR)
CURRENT CLINCIAL = LATE EFFECTS
STATUS OF THE (100 DAYS+)
DISEASE
 HYPERTHERMIA (THERMAL
THERAPY)
Side Effects:
Temperature - Skin burns
greater than 41.5 C - tissue damage Nrsg. Mx:
or 106.6 F - fatigue -explain the procedure,
=more effective - hypotension goals, effects
with radiation, - nausea -assessment of adverse
chemo, and - vomiting effects
biologic therapy - diarrhea -minimize the development
(hyperthermia and - peripheral and severe adverse effects
radiation) neuropathies -promote skin care (site of
- thrombophlebitis probe implantation)
- electrolyte imbalance
 HYPERTHERMIA: mode of delivery
LOCAL
Image credit:
[email protected]/search
WHOLE BODY
Image credit: healthnavigator.com and arcadia Praxisklinik at
google.com/search

REGIONAL
Image credit: pyrexaratgoogle.com/search
Image credit: ResearchGate at google.com/search
HYPERTHERMIA: side effects
credit image: health.Harvard.edu at google.com/search

> skin burn and tissue damage

> Fatigue
> hypotension
> diarrhea
> peripheral neuropathies
> thrombophlebitis
> nausea and vomiting
> electrolyte imbalance
> development of resistance
 HYPERTHERMIA: Nursing
Management

> Explain procedure, goals, and

effects
> Assess for signs of adverse
effects
> Prevent & reduce the occurrence
and severity of adverse effects
> Local skin care on the implanted
probe site
Image credit: Lippincott at google.com/search
 TARGETED THERAPIES
= seek to reduce the adverse
effects on healthy tissues (signal To disrupt cell functions on
transduction) = malignant transformation
=cell communication pathways
= the use of drugs to determine = processes on growth and
and strike the particular cancer metastasis
cell types minimizing the = genetic coding
danger to normal cells
 TARGETED THERAPIES

Action
= stimulation or augmentation of the body’s immune
response through:
1.Biologic Response Modifiers (BRM)
2.Gene Therapy
Biologic Response Modifiers (BRM):
The natural immune
Targeted
defense of the body against
Therapies
cancer

The use of recombinant agents that can change the immunologic

relationship of the tumor cell and the cancer patient to provide
therapeutic effect.
= the basis for use
⮚Restoration
⮚Modification
⮚Stimulation
⮚Augmentation
Biologic Response Modifiers (BRM):
The natural immune
Targeted
defense of the body against
Therapies
cancer

1. Nonspecific Biologic
Response Modifiers BACILLE CALMETTE-
-immune system is GUERIN (BCG)
stimulated using CORYNEBACTERIUM
nonspecific agents PARVUM
Targeted Therapies: Monoclonal Antibodies (MoAbs)
image credit: BBC.com at google.com/search

= dependent on
specific tumor
antigen

= binding with
specific tumor
antigen, blocking the
tumor cell’s ability to
reproduce or killing
the tumor cell thru
delivering cytotoxic
agents directly into it.
 Monoclonal antibodies
TYPE ACTION EXAMPLE

angiogenesis Cut and reduce the blood supply to a bevacizumab

inhibitors tumor to prevent or stop it from
growing
HER2-targeted Destroy or consume the HER2 trastuzumab
agents positive cancer cells, or minimize their pertuzumab
ability to replicate and grow.
anti-CD20 It aims to target and destroy a protein rituximab
monoclonal antibodies called CD20 found on some B-cell obinutuzumab
leukaemia and non-Hodgkin
lymphomas
 Targeted Therapies: Cytokines
image credit: News Medical at google.com/search

– REGULATES CELL
SIGNALLING
 Targeted Therapies: RETINOIDS
image credit: News Medical at google.com/search

– influence cell growth,

reproduction,
apoptosis, epithelial cell
differentiation, immune
function
Nursing Management in Biologic Response
Modifier Therapy

MONITORING THERAPEUTIC
AND ADVERSE EFFECT

PROMOTING HOME AND

COMMUNITY-BASED
CARE
GENE THERAPY
GENERAL APPROACHES IN THE
DEVELOPMENT OF GENE
THERAPY
1. TUMOR DIRECTED (SUICIDE
GENE GENE INTRODUCE INTO
TUMOR CELLS)
MANIPUL 2. ACTIVE IMMUNOTHERAPY
A-TION (GENES THAT WILL INITIATE
ANTITUMOR RESPONSES OF
THE IMMUNE SYSTEM)
3. ADOPTIVE IMMUNOTHERAPY
(GENETICALLY MODIFIED TO
INVOKE TUMOR
DESTRUCTION)
COMPLEMENTARY AND ALTERNATIVE MEDICINE

COMPLEMENTARY
ALTERNATIVE
MEDICINE THERAPIES
MEDICINE THERAPIES
IN CONJUNCTION
USED INSTEAD OF
WITH
CONVENTIONAL
CONVENTIONAL
MEDICINE
THERAPY
UNPROVEN & UNCONVENTIONAL
THERAPIES

WITHOUT SCIENTIFIC EVIDENCE OF THE

ABILITY TO CURE OR CONTROL CANCER
THANK YOU
 Cancer cells and Normal cells

Cancer Cells Normal Cells

> Disregards the signal to grow—keeps on growing > Only grows when signal is received
> Ignores the act of the regulatory process > Follows the process of apoptosis
> Invade adjacent areas/spread to other site > Recognize cell boundaries
> Blood vessels are directed to assist the tumor
> They device a scheme of tricking the immune system
> Acquire multiple changes in their chromosomes
> Dependent on diversified nutrients to grow