[5.1] ONCO Part I (Cancer Definition to Extravasation)

From Ma'am Jaidee Rojas' lecture Last August 1, 2025

Cancer

Uncontrolled Cellular Division

1. Interphase

2. Mitosis

Cell Cycle: Two main components

G1

Cell Cycle: Cell growth

S Phase

Cell Cycle: DNA Synthesis

G2

Cell Cycle: Preparation for mitosis

G2

Cell Cycle: Checkpoint if pangit hindi makakatawid sa mitosis

Mitosis

Cell Cycle: Cell Division

Karyokinesis

Cell Cycle: Nuclear Division

Cytokinesis

Cell Cycle: Cytoplasm Division

G0 Phase

Cell Cycle: Resting Phase; “Tambayan Place”

G0 Phase

Cell Cycle: This is where cells that do no regenerate go to after damage (e.g., neurons, inner ear hair cells)

Carcinogenesis

Production of cancer; Theory of cancer causation

1. Initiation

2. Promotion

3. Progression

What are the steps of carcinogenesis?

Initiation

Carcinogenesis: Spontaneous exposure to carcinogens; Initial cell mutation occurs

Promotion

Carcinogenesis: Cancer cells are stimulated to divide even further

b. Promotion

• If the patient is not exposed to the stimulant, the division stops

Reversible

a. Initiation
b. Promotion

Progression

Carcinogenesis: Cancer cells compete with one another to survive

c. Progression

Poor prognosis:

a. Initiation
b. Promotion
c. Progression

TRUE

TRUE or FALSE: The more aggressive the cancer cells are, the more malignant they become

1. Promotion

2. Progression

3. Initiation

Carcinogenesis: Identify the following stage being described

1. Neoplastic lesion

2. Malignant tumor

3. Transformed Cell

Atrophy

Cell Adaptation: Cells shrink in size

Hypertrophy

Cell Adaptation: Cells increase in size

Hyperplasia

Cell Adaptation: Cells increase in amount

Metaplasia

Cell Adaptation: One cell type converted/replaced/transformed into another type

Dysplasia

Cell Adaptation: Bizarre cell growth, complete alteration of cells in terms of size, shape, amount, color, etc.

f. Neoplasia

SATA: Malignant

a. Atrophy
b. Hypertrophy
c. Hyperplasia
d. Metaplasia
e. Dysplasia
f. Neoplasia

CAUTION US

• Changes in bowel or bladder habits

• A sore that does not heal

• Unusual bleeding or discharge

• Thickening or lump in the breast or elsewhere

• Indigestion or difficulty in swallowing

• Obvious changes in a wart or mole

• Nagging cough or hoarseness

• Unexplained anemia

• Sudden weight loss (Cachexia)

What are the warning signs of cancer?

1. Constipation

2. shape (pencil)

3. Blood

   1. Hematochezia; Lower

   2. Melena; Upper

4. frequency, urgency, hesitancy, dysuria, obstruction

Warning Signs of Cancer: Examples of changes in bowel or bladder habits (Fill in the blanks)

1. Alteration: Diarrhea or _________

2. Change in the ________ of stools (____-shaped)

3. _______ in stools

   1. _______= fresh, red blood in stools (___ GI)

   2. _______= black, tarry stools (______- GI)

4. Urinary f_______, u________, h_______, d______, o______

Colon cancer

Warning Signs of Cancer: Blood in stools is a sign of what type of cancer

Bladder cancer

Warning Signs of Cancer: Urinary frequency, urgency, hesitancy, dysuria, obstruction are signs of what type of cancer

• No. 1: Cigarette Smoking

• Exposure to heavy metals

• Reproductive tract cancer

What are the risk factors of colon cancer?

1. Oral

   1. Cigarette smoking

2. Melanoma

   1. Australia

Warning Signs of Cancer: A sore that does not heal; fill in the blanks:

1. _____ cancer: Painless

   1. What is the number 1 risk factor?

2. _______: Most malignant skin cancer

   1. Where is this most prevalent?

TRUE

TRUE or FALSE: Melanoma is one of the cancer types that are hard to diagnose

FALSE

• Any form or physical injury or trauma is not enough to lead to cancer

TRUE or FALSE: Repeated physical injury or trauma is enough for cancer to develop

Identification of potential melanoma

• A - Asymmetry

• B - Irregular Borders

• C - Color (N: Brown or black, but this could also be present in melanoma)

• D - Diameter (N: < 5mm or smaller than pencil tip)

• E - Evolution (Change in size, color, amount, organization)

What is the ABCDE Assessment tool for? Identify its components

1. menopausal

2. coital

3. periods

4. nipple

5. vaginal

6. penile

Warning Signs of Cancer: Examples of unusual bleeding or discharge (fill in the blanks)

1. Post m______ bleeding

2. Post c____ bleeding

3. Bleeding in between __________

4. Abnormal n____ discharge

5. Abnormal v____ discharge

6. Abnormal p____ discharge

1. Infection

2. Cancer

3. Color and odor

   1. N: clear/white and not foul odor

Warning Signs of Cancer (Unusual bleeding or discharge):

1. Greenish: _________

2. Brownish + Spotting: ________

3. What should you assess for vaginal and penile discharge?

1. Breast

2. Testes

3. Lymph nodesf

Warning Signs of Cancer: Where to check thickening or lumps

Prolactinoma

What type of cancer does abnormal nipple discharge point to?

Indigestion or difficulty in swallowing

Warning Signs of Cancer: Dysphagia and head & neck cancer

Gastric cancer

What type of cancer does chronic indigestion point to?

1. Scalp

2. Face

3. Behind the ear

4. Nape (males usually nagcocomplain kasi mahaba hair ng females, hindi nakikita agad)

Warning Signs of Cancer: Where should you find warts or moles among the elderly?

Upper back

Warning Signs of Cancer: Where should you find warts or moles among the adults?

Naggin cough or hoarseness

Warning Signs of Cancer: Laryngeal cancer and head & neck cancer

Lung cancer

Warning Signs of Cancer: Dry, persistent cough is a sign of what type of cancer?

Unexplained anemia (due to multiple internal bleeding)

Warning Signs of Cancer: Colon cancer (aside from changes in bladder or bowel habits)

Pinapakain ang both normal and cancer cells

Warning Signs of Cancer: Why is there cachexia?

a. Tumor staging

Identify the extent of involvement of cancer

a. Tumor staging
b. Tumor grading

b. Tumor grading

Levels of differentiation

a. Tumor staging
b. Tumor grading

Heart

• Pure daw kasi ang pumapasok na blood

What organ is not affected by any type of cancer?

Stage 0

Tumor staging: Carcinoma in situ; incidental findings

Stage 0 (definition of in situ)

Tumor staging: Small, enclosed in a sac

Tumor, Node, Metastasis

What does TNM mean in TNM staging?

Stage 1

Tumor staging: Small; hasn’t spread anywhere else

Stage 2 (locali2ed)

Tumor staging: Larger but still has not spread anywhere else; local spread

Stage 3 (r3gional)

Tumor staging: Spread into surrounding tissues; extensive spread; regional spread

Stage 4

Tumor staging: Spread into at least one organ; distant metastasis

LLLBB

1. Lungs

2. Liver

3. Lymph nodes

4. Brain

5. Bones

What organs are the most common metastasis sites?

Grade 1; Stage 1

Tumor Grading: Well differentiated; still closely resemble the cells of the tissues to which it came from. What tumor stage does this correspond to?

Grade 2

Tumor Grading: Moderately differentiated

Grade 3

Tumor Grading: Poorly differentiated

Grade 4; Stage 4

Tumor Grading: Undifferentiated; look nothing like the normal cells. What tumor stage does this correspond to?

Grade 1

Tumor Grading: Benign

Stage 4

Tumor Grading: Malignant

Surgery

What is the most common management for cancer?

Diagnostic

Purpose of Surgery: Biopsy

1. Fine needle aspiration

2. Punch

3. Shave

4. Incision

5. Excision

6. Bone marrow aspiration

Purpose of Surgery (Diagnostic): Identify the type of biopsy being described

1. For solid tumors (breast, lungs, liver, thyroid, brain)

2. Deeper tissue sample (skin, vulva)

3. Superficial tissue sample; use of sterile razor

4. Large tumors; portion of tumor is removed

5. Entire tumor is removed

6. For leukemia, lymphoma

Posterior Iliac Crest

What is the most preferred site for bone marrow aspiration?

Sternum/Breastbone

What is the second most preferred site of bone marrow aspiration avoided for pediatric patients less than 12 yo?

Tibia

Most preferred site of bone marrow aspiration for pediatric patients?

As primary treatment

Purpose of Surgery: Surgery before chemo or radiation

Prophylactic

Purpose of Surgery: Risk reduction sx

Reconstructive

Purpose of Surgery: Cosmetic effects; To improve function “Skin grafting”

Palliative

Purpose of Surgery: Improve Sx; QOL

Radiosensitive cancer cells

Radiation therapy: [Positive] Response to radiation

Radioresistant cancer cells

Radiation therapy: Difficult to kill; Malignant

Radiosensitive Normal Cells

• Mabilis tumubo, mabilis mamatay

Radiation therapy: Highly actively dividing cells

1. Hair cells

2. GI Tract cells

3. Blood cells

4. Skin cells

5. Reproductive Tract cells

Radiation therapy: What are the radiosensitive normal cells?

Alopecia; Temporary hair loss (but it could never be the same)

Radiosensitive normal cells: What happens to hair cells?

1. Improve self esteem

   1. Offer wigs, scarves, hats

2. Improve self care

   1. Brush, shampoo, condition hair

Radiation therapy: What interventions to do for the reduction of hair cells

Stomatitis, Mucositis, Esophagitis

Radiation therapy: What are the effects of radiation therapy on GI Tract Cells?

1. Avoid alcoholic mouthwashes (use orahex, bactidol, betadine)

2. Avoid hot, rough, spicy, acidic food → Bland diet

3. Radiation induced enteritis: Diarrhea → Low fiber diet

Radiation therapy: What are the interventions for the effects of radiation therapy on GI tract?

Anemia, Leukopenia, Thrombocytopenia

Radiation therapy: What are the effects of radiation therapy on blood cells?

Immunosuppression; Risk for infection

Radiation therapy: What is the emphasis on the effects of radiation therapy on blood cells?

Radiation induced dermatitis

Radiation therapy: What are the effects of radiation therapy on skin cells?

1. Avoid powders, lotion, perfumes, etc.

2. Avoid extremes of temps → dryness → pruritus

Radiation therapy: What are the interventions for the effects of radiation therapy on skin cells?

Reproductive tract cells

Radiation therapy: What are the effects of radiation therapy on reproductive tract cells?

1. Connective tissues

2. Bones

3. Muscles

4. Cartilage

Radiation therapy: What are the radioresistant normal cells?

1. External

2. Internal

What are the types of radiation therapy?

a. External

Teletherapy

a. Internal
b. External

a. Internal

Brachytherapy

a. Internal
b. External

External

• Do not erase markers hanggang di pa tapos

Type of Radiation Therapy: More common than the other; patient is not radioactive; happens in sessions. What should the priority nursing intervention during this?

1. Sealed

2. Unsealed

Radiation Therapy: What are the two types of brachytherapy

Sealed

Internal Radiation Therapy: Implant; Localized

Bed rest to avoid dislodgement

What should the patient’s activity be when they have sealed brachytherapy?

Pick up the implant using long-handed forceps and place it in a lead lined container, then refer

What should you do when the patient’s sealed brachytherapy drops and it could be located?

Notify the safety radiation team

What should you do when the patient’s sealed brachytherapy drops but it could not be located?

Unsealed

Type of Radiation Therapy: IV, Oral, Systemic; Patient himself if radioactive, even body fluids

a. Private CR
d. Flush twice

SATA: Unsealed Brachytherapy:

a. Private CR
b. Communal CR
c. Flush once
d. Flush twice

48 hours after

Unsealed Brachytherapy: When is the patient no longer radioactive?