Normal cells and functions a. Most normal human cells have 23 pairs of chromosomes b.

All normal cells (except the sex cells and the mature red blood cells) have the entire human genome in every cell c. Normal cells have about 35,000 genes, and about 50 of these genes are very active during embryonic life d. Normal cells undergo mitosis either to develop normal tissue during embryonic development, childhood, and adolescence or to replace lost or damaged normal tissue

Overview

The Cell Cycle

The Cell Cycle

The Cell Cycle consists of 4 phases: 1. Gap 1 (G1) the cell enlarges and synthesizes proteins to prepare for DNA replication 2. Synthesis (S) phase DNA is replicated and the chromosomes in the cell are duplicated 3. Gap 2 (G) the cell prepares itself for mitosis 4. Mitosis (M) phase final step, where the parent cell divides into two exact copies called daughter cells, each having identical genetic material

The Cell Cycle

The cells after the M phase immediately enter the G1 where they begin another cell cycle again Or the cells divert into a resting phase called G0 The cell cycle is controlled by cyclindependent kinases Some cyclins cause a braking action and prevent the cycle from proceeding Checkpoints in the cell cycle ensure that it proceeds in the correct order

The Cell Cycle

A malfunction of any of these regulators of cell growth and division can result in the rapid proliferation of immature cells In some cases these proliferating immature cells are considered cancerous (malignant) Knowledge of the cell cycle events is used in the development of chemotherapeutic drugs, which are designed to disrupt the cancer cells during different stages of their cell cycle

Overview
In embryonic life, there are early development genes called proto-oncogenes, and their activity is not needed after embryonic life Other genes are called tumor suppressor genes, which slow down cell division, repair DNA mistakes, and tell cells when to die (apoptosis, or programmed cell death) Tumor suppressor genes can also reduce expression of proto-oncogenes by negative feedback mechanisms Proto-oncogenes are not abnormal genes, and are part of every humans normal cellular DNA

Normal Cell (homeostasis)

Reversible Injury

Stress

Injurious stimulus

Mild, transient

Adaptation Inability to adapt

Cell Injury Severe, progressive Irreversible Injury

Necrosis

CELL DEATH

Apoptosis

Overview
Adaptations are reversible changes in the size, number, phenotype, metabolic activity, or functions of cells in response to changes in their environment a. Hypertrophy increase in the size of cells, resulting in an increase in the size of the organ b. Hyperplasia an increase in the number in an organ or tissue, usually resulting in increased mass of the organ or tissue c. Atrophy reduced size of an organ or tissue resulting from a decrease in cell size and number

Overview
e. Metaplasia reversible change in which one differentiated cell type (epithelial or mesenchymal) is replaced by another cell type f. Necrosis cell death g. Apoptosis programmed cell death h. Differentiation - process by which cells or tissues undergo a change toward a more specialized form or function, especially during embryonic development i. Dysplasia j. Anaplasia

Overview
e. Dysplasia - abnormal development or growth of tissues, organs, or cells f. Anaplasia - abnormal development or growth of tissues, organs, or cells

Epidemiology of Cancer
2004 The American Cancer Society estimates that 1,368,030 people will be diagnosed with cancer in the US Cancer continues to be the second leading cause of death in the US 62% of those diagnosed with cancer can expect to be alive in 5 years Incidence and mortality rates for cancer have dropped approximately 1% per year since 1991

Epidemiology of Cancer
The American Cancer Society has established the goal of a 25% reduction in the overall age-adjusted cancer incidence rate and a 50% reduction in the overall age-adjusted cancer mortality rate by 2015 Nurses should play a pivotal role in the attainment of these goals through active involvement in cancer prevention and early detection activities Survival rate represents the percentage of

Estimated New Cases Male Prostate (38%) Lung and bronchus (13%) Colon and rectum (10%) Urinary bladder (7%) Melanoma of the skin (5%) Non-Hodgkin lymphoma (4%) Kidney and renal pelvis (3%) Leukemia (3%) Oral cavity and pharynx (3%) Pancreas (2%) All sites (100%) Female Breast (32%) Lung and bronchus (12%) Colon and rectum (11%) Uterine corpus (6%) Non-Hodgkin lymphoma (4%) Melanoma of the skin (4%) Ovary (3%) Thyroid (3%) Urinary bladder (2%) Pancreas (2%) All sites (100%)

Estimated New Deaths Male Lung and bronchus (31%) Prostate (10%) Colon and rectum (10%) Pancreas (5%) Leukemia (4%) Esophagus (4%) Liver and intrahepatic bile duct (3%) Non-Hodgkin lymphoma (3%) Kidney and renal pelvis (3%) All sites (100%) Female Lung and bronchus (27%) Breast (15%) Colon and rectum (10%) Ovary (6%) Pancreas (6%) Leukemia (4%) Non-Hodgkin lymphoma (3%) Uterine corpus (3%) Multiple myeloma (2%) Brain and other nervous system (2%) All sites (100%)

Estimated Incidence (2008) Male Melanoma of the skin (5%) Oropharynx (3%) Lung (15%) Pancreas (3%) Kidney (4%) Colon and rectum (10%) Urinary bladder (7%) Prostate (25%) Leukemia (3%) Hon-Hodgkin lymphoma (5%) All others (20%) Female Melanoma of the skin (4%) Thyroid (4%) Lung (14%) Breast (26%) Kidney (3%) Colon and rectum (10%) Ovary (3%) Uterus (6%) Leukemia (3%) Non-Hodgkin lymphoma (4%) All others (23%)

Estimated Deaths (2008) Male Lung (31%) Esophagus (4%) Liver (4%) Pancreas (6%) Kidney (3%) Colon and rectum (8%) Urinary bladder (3%) Prostate (10%) Leukemia (4%) Non-Hodgkin Lymphoma (3%) All others (24%) Female Brain (2%) Lung (26%) Breast (15%) Liver (2%) Pancreas (6%) Colon and rectum (9%) Ovary (6%) Uterus (3%) Leukemia (3%) Non-Hodgkin Lymphoma (3%) All others (25%)

Robbins Pathologic Basis of Disease 8th edition

Epidemiology of Cancer
Risk factors 1. Heredity 5 to 10% of cancers have a hereditary component 2. Age 76% of cases occur after age 55; hormonal changes, immune system changes 3. Gender 4. Poverty 5. Stress 6. Diet 7. Occupation 8. Infection 9. Tobacco use 10. Alcohol use 11. Recreational drug use

Epidemiology of Cancer
Endogenous risk factors: 1. Genetic predisposition 2. Sex 3. Age 4. Race 5. Family history Exogenous risk factors: 1. Alcohol 2. Diet 3. Exercise 4. Occupational exposure

Epidemiology of Cancer
Risk Factors and Signs and Symptoms of Common Cancers Cancer Site Breast Risk Factors Female gender Age >50 years Family history Personal history of breast cancer 2 or more first-degree relatives Known BRCA1 or BRCA2 mutation Biopsy history Atypical hyperplasia DCIS or LCIS Postmenopausal obesity Early menarche/late menopause Late first pregnancy/nulliparous OCP Radiation to chest wall Alcohol Obesity and high fat diet Hormone replacement therapy Signs and Symptoms Lump or mass Thickening in breast or axilla Change in size or contour or texture Skin dimpling or retraction Peau dorange skin Nipple discharge, retraction, or scaliness Erythema Pain or tenderness

Epidemiology of Cancer
Risk Factors and Signs and Symptoms of Common Cancers Cancer Site Prostate Risk Factors Male gender Age >50 years African American ethnicity Family history of first-degree relative (greater if first-degree relative diagnosed before age 40) High-fat diet Age >60 years Inflammatory bowel conditions Sedentary lifestyle Diet high in fat and low in fruits and vegetables Heavy alcohol consumption Family history of colorectal cancer especially if before the age of 40 Signs and Symptoms Weak urinary stream and urinary frequency Difficulty in initiating stream or stopping urinary stream Pain or burning on urination Urinary retention Hematuria

Colorectal

Epidemiology of Cancer
Risk Factors and Signs and Symptoms of Common Cancers Cancer Site Risk Factors Signs and Symptoms

Prostate

Male gender Age >50 years African American ethnicity Family history of first-degree relative (greater if first-degree relative diagnosed before age 40) High-fat diet
Familial genetic syndromes, e.g., familial adenomatous polyposis (FAP) and hereditary nonpolyposis colon cancer (HNPCC)

Weak urinary stream and urinary frequency Difficulty in initiating stream or stopping urinary stream Pain or burning on urination Urinary retention Hematuria
Change in bowel habits Rectal bleeding Abdominal pain Decreased diameter of stools Anemia Rectal pressure or pain Weight loss anorexia

Colorectal

Epidemiology of Cancer
Risk Factors and Signs and Symptoms of Common Cancers

Cancer Site
Lung

Risk Factors
Cigarette smoking Occupational exposure to asbestos, arsenic, chromium, coal products, nickel refining, smelter workers, ionizing radiation, radon

Signs and Symptoms

Chronic cough and wheezing Persistent respiratory infections Dull chest pain Hemoptysis Dyspnea Weight loss

Epidemiology of Cancer
Carcinogens a. Viruses b. Drugs and hormones can be either genotoxic or promotional c. Chemical agents both genotoxic and promotional d. Physical agents for example radiation

Chemical Carcinogens and Relationship to Occupation Chemical Agent

Polycyclic hydrocarbons (smoke, soot, tobacco, smoked foods) Benzopyrene Arsenic Vinyl chloride Methylaminobenzine

Action
Genotoxic

Occupation
Miners, coal/gas workers, chimner sweeps, migrant worker, workers in offices where smoking is allowed Pesticide manufacturers, mining Plastic workers Artistis Fabric workers Rubber and glue workers

Genotoxic Promotional Genotoxic

Chemical Carcinogens and Relationship to Occupation

Chemical Agent Asbestos Action Promotional Occupation Construction workers, workers in old, run-down buildings with asbestos insulation, insulation makers Woodwrokers, carpenters, leather toolers Drug manufacturers, pharmacists, nurses

Wood and leather dust Chemotherapy drugs

Promotional Genotoxic

Occupational Cancers Agent Arsenic and arsenic compounds Cancer Lung, skin, hemangiosarcoma Typical use or occurrence Byproduct of metal smelting; component of alloys, electrical and semiconductor devises, medications and herbicides, fungicides, and animal dips Formerly used for many applications because of fire, heat and friction resistance, still found in existing construction as well as fireresistant textiles, friction materials (brake linings), underlayment and roofing papers, floor tiles

Asbestos

Lung, mesothelioma, esophagus, stomach, large intestine

Occupational Cancers Agent Benzene Cancer Leukemia, Hodgkin lymphoma Typical use or occurrence Principal component of light oil, despite known risk, many applications exist in printing and lithography, paint, rubber, dry cleaning, adhesives and coatings, and detergents, formerly widely used as solvent and fumigant

Beryllium and beryllium compounds

Lung

Missile fuel and space vehicles, hardener for lightweight metal alloys, particularly in aerospace applications and nuclear reactors

Occupational Cancers Agent Chromium compounds Cancer Lung Typical use or occurrence Component of metal alloys, paints, pigments, and preservatives Nickel plating, component of ferrous alloys, ceramics, and batteries, by-product of stainless steel arc welding From decay of minerals containing uranium, potentially serious hazard in quarries and underground mines Refrigerant, monomer for vinyl polymers, adhesive for plastics, formerly inert aerosol propellant un pressurized containers

Nickel compounds

Nose, lung

Radon and its decay products Lung

Vinyl chloride

Angiosarcoma

Occupational Cancers
Agent Cadmium and cadmium compounds Cancer Prostate Typical use or occurrence Uses include yellow pigments and phosphors; found in solders; used in batteries and as alloy and in metal platings and coatings

Epidemiology of Cancer
HSV types I and II a. Carcinoma of the lip b. Cervical carcinoma c. Kaposi sarcoma Human CMV a. Kaposi sarcoma b. Prostate carcinoma

Epidemiology of Cancer
EBV a. Burkitt lymphoma HBV a. Primary HCC Papillomavirus a. Malignant melanoma b. Cervical, penile, and laryngeal cancers HTLV a. Adult T-cell leukemia and lymphoma

Epidemiology of Cancer
Approximately three fourths of all cancers occur in people over the age of 55 Overall cancer incidence in males has stabilized in recent years when compared with that in females Men have a higher lifetime probability of developing and dying of cancer than women, but men have a greater recent decline in death rates Children overall, cancer is the leading

Epidemiology of Cancer
Cause of Death by Age Age (years) 20-39 Males 1. Brain/CNS 2. Leukemia 3. Lung 1. Lung 2. Colorectal 3. Pancreas 1. Lung 2. Colorectal 3. Prostate 1. Lung 2. Prostate 3. Colorectal Females 1. Breast 2. Uterine/cervix 3. Leukemia 1. Breast 2. Lung 3. Colorectal 1. Lung 2. Breast 3. Colorectal 1. Lung 2. Colorectal 3. Breast

40-59

60-79

>80

The Role of the Nurse

Education Monitoring Documentation Proper referral Being up to date