Cachexia (severe tissue wasting) – occurs in many malignancies (look at weight loss) • Anorexia – food doesn’t taste good d/t treatment, N/V are also factors • Anemia – decreased hemoglobin d/t anorexia (decreased food intake), chronic bleeding, bone marrow depression, decreased oxygen available to cells fatigue, and poor growth/healing • Fatigue • Infections – host resistance declines, immune system less effective • Bleeding – tumor may erode the blood vessels or cause tissue ulceration, depression of bone marrow poor clotting, chronic bleeding leads to iron deficiency anemia • Additional problems – paraneoplastic syndromes (tumors secreting hormone like substances) • Can also be dependant on the type of cancer and what part of the body is affected, also if the tumor is benign or malignant Diagnosis of cancer 1. Tumour staging and grading 2. Diagnostic Tests 1. Tumor Classification • Benign tumors- usually end in ‘ oma’
• Malignant tumors- usually end in ‘ carcinoma’ • ‘Carcinomas’ compose about 90% of human cancers • ‘Sarcomas’ compose about 10% of human cancers Benign Malignant Cells Similar to normal cell growth, differentiated, fairly normal mitosis Varied in size/shape, large nuclei, many undifferentiated, increased, and atypical mitosis Growth Fairly slow, expanding mass, frequently encapsulated Rapid growth, non-adhesive cells, infiltrate tissue, no capsule Spread Remains localized Invades nearby tissue, and metastasizes to different sites through blood or lymph Systemic effects Rare Often present Life - threatening Only in some locations (eg. Brain) Yes, d/t tissue destruction and spread Staging: TNM Classification Classification process applied to specific types of malignant tumors at the time of diagnosis, this process may be repeated during treatment, used to describe the extend of the disease • T (tumor) – size of primary tumor • N (nodes) – extent of involvement of regional lymph nodes • M (metastasis) – spread, invasion of the tumor to other areas of the body Staging: Clinical Staging • Clinical staging- determines extent of the disease process of cancer by stages: o Stage 1 - T1- tumor 2 cm or less in diameter; N0- no lymph nodes involved; M0- no metastasis o Stage II - To to T2- tumor less than 5 cm in diameter; N1- nodes involved; MO no metastasis o Stage III - T3- tumor larger than 5 cm in diameter; N1 or N2- notes involved; tumor may be fixed; MO- no metastasis o Stage IV - T4- tumor any size but fixed to chest wall or skin; N3- clavicular nodes involved (spread); M1- metastasis present Staging: Gleason Scale • Gleason Scale (histological analysis) - the appearance of cells and the degree of differentiation are evaluated- For many tumor cells 4 grades are used- o Grade 1- cells differ slightly from normal cells (mild dysplasia) and are well differentiated o Grade 2- cells are more abnormal 9moderate dysplasia) and moderately differentiated o Grade 3- cells are very abnormal (sever dysplasia) and poorly differentiated o Grade 4- Cells are immature and primitive (anaplasia) and undifferentiated; cell of origin is difficult to determine
Staging: Karnofsky Performance Scale
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- Fall '19