Chapter 23

Cancer Development

Mrs. M. Kreisel MSN, RNNU130 Adult Health 1Summer 2011

Cell Growth

Neoplasms

Tumor Growth

Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Tumor Cell Division

Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Features of Normal Cells

• Limited cell division• Apoptosis (limits growth of tumors by

phagocytosis)• Specific morphology• Small nuclear-to-cytoplasmic ratio• Differentiated function• Tight adherence• Nonmigratory• Contact inhibition • Normal chromosomes

Features of Early Embryonic Cells

• Rapid and continuous cell division• Anaplasia (loss of cellular differentiation

and function=malignancies)• Large nuclear-to-cytoplasmic ratio• Loose adherence• Migration• No contact inhibition• Normal chromosomes

Features of Benign Tumor Cells

• Continuous or inappropriate cell growth• Specific morphology• Small nuclear-to-cytoplasmic ratio• Specific differentiated functions• Tight adherence• No migration• Orderly growth• Normal chromosomes

Features of Cancer Cells (Malignant)

• Rapid or continuous cell division• Anaplasia• Large nuclear-to-cytoplasmic ratio• Specific functions lost• Loose adherence• Migration • No contact inhibition• Abnormal chromosomes

Cancer Development

• Carcinogenesis/oncogenesis (tumor formation) are names for cancer development.

• Malignant transformation occurs through these steps:• Initiation• Promotion• Progression• Metastasis

Metastasis

• Metastasis occurs through a progression of steps:• Extension into surrounding tissues• Blood vessel penetration• Release of tumor cells• Invasion• Local seeding• Bloodborne metastasis• Lymphatic spread

Lymphatic Spread of Tumor Cells

Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Steps of Metastasis

Cancer Classification

• Grading• Ploidy (the # of Chromosome sets in a

cell)• Staging• TNM (tumor, node, metastasis)• Doubling time and mitotic index

Cancer Etiology and Genetic Risk

• Oncogene activation• Chemical carcinogenesis• Physical carcinogenesis • Viral carcinogenesis• Dietary factors• Personal factors, immune function, age,

and genetic risk

Cancer Prevention—Primary

• Avoidance of known or potential carcinogens

• Modification of associated factors• Removal of “at-risk” tissues• Chemoprevention• Vaccination

Cancer Prevention—Secondary

• Regular screening• Altering damaged genes• Genetic screening

NCLEX TIME

Question 1

How many Americans are estimated to be newly diagnosed with cancer yearly?

A. 1 million B. 1.5 millionC. 2 millionD. Answered questions about the procedure

and a signed informed consent

Question 2

The single most important risk factor for the development of cancer is:

A. Being a woman B. Family historyC. Cigarette smokingD. Advancing age

Question 3

What is one of the common sites of metastasis for breast cancer?

A. Brain B. Lymph nodes C. PancreasD. Pelvic nodes

Question 4

An example of a primary prevention strategy for reducing cancer risk would be:

A. Yearly mammography for women older than 40 years

B. Using skin protection during sun exposure at the beach

C. Colonoscopy at age 50 years and then every 10 years

D. Yearly prostate-specific antigen (PSA) test and digital rectal examination (DRE) for men older than 50 years

Question 5

A malignant tumor has metastasized from the lungs to the brain. The metastatic tumor is now known as:

A. Brain cancerB. Lymph cancer, since it spread via the

lymphatic systemC. Lung cancer in the brainD. The primary tumor