LU 3.1 Introduction to Cancer

What is the origin of the word cancer ?

• originates from the Greek term “karkinos” meaning crab

What are the key genes involved in regulation of cellular functions ?

• Proto-oncogenes (promote normal cell growth and division)

• Tumor Suppressors genes (prevent uncontrolled cell growth)

How does cancer develops in term of mutation roles ?

• mutation can convert proto-oncogenes into oncogenes (genes that promote cancer)

• damage tumor suppressor (allowing uncontrolled cell growth)

What are the indication (hallmarks) of cancer cells ?

• uncontrolled proliferation

• evasion of apoptosis

• sustained angiogenesis

• tissue invasion and metastasis

• immortalization

What are the cancer types ?

• Carcinoma

• Sarcomas

• Leukemias

• Lymphomas

Briefly explain the cancer cells : carcinomas in terms of

• origin

• common location

• subtypes

• origin : epithelial cells

• common location : skin, breast, prostate

• subtypes :

• i) adenocarcinoma (breast)

• ii) squamous cell carcinoma (skin)

• iii) basal cell carcinoma (bottom layer of epidermis)

Briefly explain the cancer cells : sarcomas in terms of

• origin

• common location

• subtypes

• origin : mesenchymal cells

• common location : bones, muscles, fat

• subtypes :

• i) osteosarcoma : in bones

• ii) liposarcoma : fat cells

• iii) chondrosarcoma : in cartillage

• iv) leiomyosarcoma : in smooth muscle tissues

Briefly explain the cancer cells : leukemias in terms of

• origin

• characteristics

• subtypes

• origin : blood-forming tissues (bone marrow)

• characteristics : overproduction of abnormal white blood cells

• subtypes :

• i) Acute Lymphoblastic Leukemia (ALL)

• ii) Chronic Lymphocytic Leukemia (CLL)

• iii) Acute Myeloid Leukemia (AML)

• iv) Chronic Myeloid Leukemia (CML)

Briefly explain the cancer cells : lymphomas in terms of

• origin

• subtypes

• origin : lymphocytes

• subtypes :

• i) Hodgkin lymphoma

• ii) Non-Hodgkin Lymphoma

What are the etiology (causes) of cancer ?

• Host (age, genetics and family history)

• Occupational (radiation & asbestos exposure)

• Physical environment (Ultraviolet radiation)

• Environmental pollutants (Air pollution)

• Lifestyle (Tobacco use)

• Iatrogenic (Radiation therapy)

• Viral exposure (Hepatitis B & C viruses)

What are the 9 warning signs of cancer based on Ministry of Health ?

1. Vaginal bleeding that occurs between menstrual periods or after menopause.

2. Changes in bowel movement patterns.

3. Lump in the breast or any change detected in the breast.

4. A sore that does not heal or a lump, or white or red patches in the mouth.

5. A lump in the neck that was not present before.

6. Persistent pain or discomfort in the abdomen.

7. Hoarseness of voice lasting more than 2 weeks.

8. Unusual bleeding from the nose or loss of hearing, or a ringing sound in the ears.

9. Persistent cough with blood in the sputum.

What are the general sign and symptoms of cancer ?

• unexplained weight loss of 5% of body weight in six months

• frequent fever

• persistent and extreme fatigue

• pain

What are the localized symptoms of cancer ?

• lumps or masses

• persistent cough or hoarseness

• changes in bowel or bladder habit

• skin changes

• difficulty swallowing

What are the symptoms related to specific cancer of

• breast cancer

• lung cancer

• colorectal cancer

• prostate cancer

• breast cancer : lumps in the breast, change of shape or size

• lung cancer : persistent coughing, coughing up blood

• colorectal cancer : blood in stool, abdominal pain

• prostate cancer : difficulty urinating, blood in urine

What are the paraneoplastic syndromes ?

• Hypercalcemia (high calcium levels) : nausea, confusion, muscle weakness

• Cushing’s syndrome : tumor that produces hormones that lead to weight gain, high BP, high blood sugar

What are the diagnostics tests required to diagnose cancers ?

• Medical history and physical examination

• Radiology imaging tests : X-rays, CT scan

• Histology biopsy : needle biopsy, core biopsy

• Laboratory tests : complete blood count (CBC)

• Molecular and genetic tests

• Endoscopy : colonoscopy, bronchoscopy

• Cytology : pap smear

What are the key aspects of palliative care ?

• symptom management

• holistic approach

What are the example of symptoms management ?

• emotional and psychological support

• spiritual support

• social and family support

What are the pain management protocols according WHO Analgesic Ladder for cancer patients ?

• Mild pain (Non-opioid analgesics) : paracetamol, NSAIDs

• Moderate pain (Weak opioids) : codeine, tramadol

• Severe pain (Strong opioids) : morphine, fentanyl

What are the nursing intervention for pain ?

• Physical : RICE (rest, immobilize, compress, elevate)

• Psychological : family support, reassurance

• Nociceptive pain : mild (pcm), moderate (pcm + weak opioid), severe (pcm + strong opioid)

• Neuropathic pain : antineuropathic agents such as Gabapentin