cellular growth and aberrations

8/8/2019 Cellular Growth and Aberrations

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CELLULAR GROWTH AND ABERRATIONSBy: Godwin B. Gonzales, RN, USRN, MAN©



TYPES OF NEOPLASM

1. BENIGN ± usually a reference togrowth s tha t a re enc apsula ted, rem ain

loc aliz ed, a nd slow grow ing



TYPES OF NEOPLASM

2 . MALIGNANT ± Term for growth s tha t a re not

enc apsula ted b ut met as tasiz e a ndgrow.

- The s e growth s a re c a ncero us le sion s havi ng the ch a r a cter is tics of disorder ly, uncontro lled a nd ch a ot icpro lifer a tion of ce lls.



B ENIGN vs. MALIGNANT BENIGN MALIGNANT

1. CellCharacteristics

C e lls re s emb le norm al ce lls of pa rent t issu e s/ ce lls

Be a r s little re s emb lance frompa rent ce lls; with a naplasia a ndplemor phism

2 . Mode of Growth

Grow b y ex pa nsion a nd doe s not sp re a d to su rround ing

tissu e

Grow s a t the per ipher y a ndinf iltr a te s the su rround ing t issu e

3. Rate of Growth S low a nd often limited in siz e Grow s r api dly

4. Metastasis Doe s not sp re a d nor inf iltr a te s a dja cent t issu e s; loc aliz ed

Inf iltr a te s a dja cent t issu e a ndgains a cce ss to lymph node s

5. Recurrence Doe s not rec ur a fter remo val Tend s to rec ur a fter remo val6. General Effects Loc aliz ed phenomenon on ly C aus e s gener aliz ed effect s su ch

as a nem ia & we ak ne ss

7. TissueDestruction

Doe s not c aus e t issu eda ma ge

C aus e s exten siv e t issu e d a ma gea nd t umor o utgrow s blood supply

8. Ability toCause Death Doe s not c aus e de a th unle ss interfere s with vital f unct ion Will caus e de a th unle ss growthca n be contro lled



C OMMONLY USED C ANC ER STAGINGMETHODS

1. Over all St a ge Gro upi ng - This sys tem us e s numer als I, II, III, a nd IV ( plus the 0) to de s cr ibethe progre ssi on of c a ncer.

2 . Ann Arbor s ta ging - is the s ta ging sys tem for lymphom as , both in Hodg kin's a nd Non-Hodg kinlymphom a .

3. Gle as on Gr a ding sys tem - us ed to he lp e valua tethe progno sis of men w ith pros ta te c a ncer.

4. Duk e s classi f ica tion - f a mo us classi f ica tion

sys tem for co lorect al ca ncer.5. TNM - a ca ncer s ta ging sys tem th a t de s cr ibe s the

extent of c a ncer in a pa tient¶s bod y.



The TNM Staging System

T de s cr ibe s the siz e of the tumor a ndwhether it h as inva ded ne a rby tissu e,

N de s cr ibe s reg ion al lymph nodestha t a re involved,

Mde s cr ibe s dis ta nt metastasis(sp re a d of c a ncer from one bod y pa rt to

a nother).




The TNM s ta ging sys tem for all s olid t umor s was de vis ed b y P ierre Deno ix between 1943 a nd 195 2 ,usi ng the siz e a nd exten sion of the pr ima r y tumor, its lympha tic involvement, a nd the pre s ence of met as tas e s to c lassi f y the progre ssi on of c a ncer.

TNM is de ve loped a nd m aintained b y theIntern a tion al Un ion Ag ains t C a ncer (UI CC ) toa ch ie ve con s en sus on one g lob ally recogn izeds ta nd a rd for c lassi f ying the extent of sp re a d of ca ncer.

The TNM c lassi f ica tion is als o us ed b y the Amer ica nJo int C omm ittee on C a ncer (AJ CC ) a nd theIntern a tion al Feder a tion of G yneco log y a ndOb s tetr ics (FIGO). In 1987, the UI CC a nd AJ CC s ta ging sys tem s were unif ied into a sing le s ta ging

sys tem.




Mos t of the common t umor s hav e the ir own TNM c lassi f ica tion. Not all tumor s hav eTNM c lassi f ica tion s , (e.g., br ain t umor s ).

Uses and aims Aid med ical s ta ff in s ta ging the t umor he lpingto pla n the tre a tment.Give a n ind ica tion of progno sis .

Assis t in the e valua tion of the re sul ts of tre a tment. Ena ble f a cilitie s a round the wor ld to co llate

inform a tion more prod uct ive ly.




T SubclassesTx ± tumor c a nnot be a deq ua te ly ass e ss edT0 ± no e vidence of pr ima r y tumor

TIS ± ca rc inom a in si tuT1 ± a mob ile sup erf icial tumor ; < 2 cm in d iameter T2 ± a loc aliz ed t umor ; 2 -5 cm in d iameter, w ith

s ome loss of mob ility

T3 ± a dva nced t umor, > 5 cm in d iameter, w ithcom plete loss of mob ilityT4 ± a massiv e t umor, > 10 cm in d iameter




N SubclassesNx ± reg ion al lymph node s ca nnot be ass e ss ed

clinicallyN 0 - t umor ce lls a bs ent from reg ion al lym ph node s

N1 ± reg ion al lymph node met as tasis pre s ent ; (a ts ome si te s: tumor sp re a d to c los e s t or s mall number of reg ion al lym ph node s )

N2 ± palpa ble, mob ile, f irm to h a rd node s a t 3-5cm d iameter ; involved node s may s how pa rtial mus cle invasi on.

N3 ± a node extended be yond c apsul e (> 5 cm)a nd f ixed to bone

N4 ± f ixed a nd de s tr uct ive node s (> 10 cm)




M SubclassesMx ± not ass e ss ed / no met as ta tic wor k ± up doneM0 ± no known d is ta nt met as tasisM1 ± dis ta nt met as tasis pre s ent / met as tasis to

dis ta nt org a nsM2 ± multiple met as tasis in one org a n w ith no

minimal f unct ion al impai rment

M3 ± met as tasis to m ultiple org a ns with no or minimal to moder a te f unct ion al im pai rmentM4 ± met as tasis to m ultiple org a n w ith moder a te

to s e vere f unct ion al im pai rment




Other P a r a meter s1. G (1 ±4) : the grade of the c a ncer ce lls (i.e. the y a re

"low gr a de" if the y app e a r sim ilar to norm al ce lls,a nd "h igh gr a de" if the y app e a r poor ly different ia ted)

2 . R (0 /1/2 ): the com pletene ss of the o per a tion(resection -bo und a r ie s free of c a ncer ce lls or not)

3. L (0 /1) : invasi on into lym pha tic ve ss e ls 4. V (0 /1/2 ): invasi on into ve in (no, m icro s co pic,

ma cro s co pic)5. C (1 ±5) : a mod if ier of the cert ainty (quali ty) of the

las t ment ioned pa r a meter




P refix modifiersc : s ta ge g iven b y clinical ex a mina tion of a pa tientp : s ta ge g iven b y pa tho log ic ex a mina tion of a su rg ical sp ec imen

y: s ta ge ass e ss ed a fter neo a djuva nt ther apy For the T, N a nd M pa r a meter s ex is t su bc lassi f ica tion s for s ome c a ncer-t ype s (e.g. T1a , Tis , N1 i)

Histo p athologyC 1 ± we ll different ia ted gr a deC2 ± moder a te ly we ll different iated gr a deC 3, C 4 ± poor ly to ver y poor ly different ia ted gr a de



Example:

1. Sm all, low-gr a de c a ncer, no met as tasis , nosp re a d to reg ion al lymph node s , c a ncer com plete ly remo ved, re s ect ion m a ter ial s een b y pa tho log is t.

Answer : pT 1 pN0 M0 R0 G1 ; this gro upi ng of T,N, a nd M wo uld be con sidered St a ge I.

2. La rge, h igh gr a de c a ncer, w ith sp re a d to reg ion al lymph node s a nd other org a ns , not com plete ly

remo ved, s een b y pa tho log is t. Answer : pT 4 pN2 M1 R1 G3 ; this gro upi ng of T,

N, a nd M wo uld be con sidered St a ge IV.



PHYSIOLOGI C and PSY C HOLOGI C EFFEC TS OF C ANC ER

C a ncer is , as we know, a life ch a ng ingex per ience for both the c a ncer su fferer, the ir fr iend s a nd f a milie s .

C a ncer a nd c a ncer tre a tment both h av er a ther dr as tic psy cho log ical a nd physiolog ical effect s on the su fferer.

Know ing of the s e effect s before tre a tmentmay give you a he a d-s ta rt a nd a ch a nce toment ally pre pa re your s e lf, jus t a little, for wh a tis to come.

This inform a tion m ay als o he lp you we ighup the odd s , on whether you wa nt to gothro ugh w ith tre a tment or not.



Physiological Effects

1. S exual Dysfunction : Some c a ncer pa tient s a ndsu r vivor s , m ay ex per ience a le ve l of s ex ual dys f unct ion.This ca n h app en to both m ale s a nd fem ale s a nd therea re w ays a round it.

2 . Ch ronic Pain : The c a ncer pa tient m ay ex per iencecon sis tent, chron ic pai n a fter pro longed c a ncer tre a tment.

3 . C onstant Fatigue : P a tient s a nd su r vivor s may fee l likethe y a re con s ta nt ly tired a nd do not h av e the mot iva tion

or energ y to com plete simple, e ver yday tasks .4 . N umbness: Numbne ss is caus ed b y a cond ition c alled

'Ne uropa thy'. The n umbne ss is mo s t common in thepa tient s ha nd s a nd feet .



Physiological Effects

5. I nfertility: Both m ale a nd fem ale pa tient s a nd su r vivor s may ex per ience infert ility.

6. Osteoporosis : Is a cond ition wh ich c aus e s your bone s tobecome ver y fr a gile a nd we ak . Maki ng the c a ncer pa tient

more sus ce ptible to bro ken bone s a nd fr a cture s .7. I ncontinence: Uncontro llable ur ina tion is a n effect s ome

pa tient s may ex per ience.8. Multiple C ancers: It is possi ble to get a s econd c a ncer,

other then the one d iagno s ed for. It is be s t to f ind th is outthro ugh your doctor, as s oon as possi ble.9. Hair Loss: Hair loss is common d ur ing the tre a tment of

ca ncer.10. Ostomies: An O s tom y is a su rg ical open ing, w ith a tube

connect ing to a ba g on the o utside of the bod y.



Psychological Effects

1. S tress: A h igh le ve l of s tre ss is often a ttr ibutedto c a ncer a nd c a n be a common side effect.

2 . Low C onfidence: Du e to the physical a nd

ment al ch a nge s ca ncer a nd c a ncer tre a tmentca n h av e on the pa tient s , it c a n often re sul t inlow s e lf e s teem a nd conf idence.

3. Depression: De pre ssi on is common ly foundin c a ncer pa tient s a nd su r vivor s . This co uld bea ttr ibuted to the physical effect s of the c a ncer tre a tment.



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cellular growth and aberrations

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