NCM 112: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,

INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,

ACUTE AND CHRONIC

NCM 112
Module 3.1
NCM 112: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,
INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC

Engagement

WWhat ranks the No. 1 cancer in the world today?

Why is it so?

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NCM 112: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,
INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC

Lesson 1: Introduction to Cellular

Aberrations and Its Pathophysiology

Learning Objectives

1. Understand the different terms in Oncology Nursing

2. Differentiate benign from malignant cells
3. Trace and analyze the process of cancer cell formation and
metastasis.
4. Inculcate importance of having a healthy lifestyle.

Overview

Fact # 1 Cancer is the number 3 killer of Filipinos today – 189 of every 100,000 Filipinos
are afflicted with cancer while four Filipinos die of cancer every hour or 96
cancer patients every day, according to a study conducted by the University of
the Philippines’ Institute of Human Genetics, National Institutes of Health
(PCCP, as cited in doh.gov.ph). Globally, it is the second leading cause of
death and is responsible for an estimated 9.6 million deaths in 2018; about 1 in
6 deaths is due to cancer (WHO, 2018).

Fact #2: Cancer is on the rise and is projected to be the #1 killer of Filipinos in the next 5
years (doh.gov.ph).

Fact #3: The survival rate for adult Filipinos is just 50% compared to at least 70% in the
West. (NationMaster.com, 2020)

Fact #4: Breast cancer is the topmost occurring cancer in the Philippines (Globocan,
2018) and in the world (in equal to lung cancer deaths) in the same year
according to the WHO.

Fact #5: The Philippines has the highest rate of breast cancer in Asia.
NCM 112: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,
INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC

Exploration

REQUIRED READING

SmeltzeR, S. C., Bare, B.G., Hinkle, J. L., & Cheever, K,H, (2010), Brunner &
Suddarth’s Textbook of MedicalSurgical Nursing (12th ed.), Philadelphia; Wolters
Kluwer. pp 336 - 394

STUDY GUIDE

Cancer (World Cancer Day – February 4th)

Cancer was recognized in ancient times by skilled observers who gave it the name cancer.
It was derived from the Latin word “cancri” (crab) because it stretches out in many directions
like the legs of a crab; crab-like because cancerous growth spread by sending crablike
projections into the surrounding tissue.

Each specific cancer occurs through mutations in specific genes.

Cancer is NOT a single disease, but a disorder of altered cell differentiation and growth
(Norris, 2018). It is a group of heterogenous disease that share common biologic properties
(Langhorne, 2011) and begins when an abnormal cell is transformed by the genetic
mutation of cellular DNA, and thus, all cancers are the result of mutations in oncogenes and
tumor suppressor genes (Hinkle and Cheever, 2017).

Fugure 1. Topmost Occurring Cancer Worldwide (Source: Globocan – WHO, 2019)

NCM 112: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,
INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC

Figure 2. Cancer Mortality Rates

Source: Philippine Health Statistics 1982 - 2010, DOH, last update: December 9, 2013 (Left); WHO: The Global Cancer Observatory, May 2019 (Right)

Cancer Nomenclature

The medical diagnosis of cancer usually contains the suffix -oma (Greek root = “tumor”)
such as:

1. Carcinoma = “carcin” – crab-like; POLYGONAL-shaped cells

 Benign tumors of parenchymal (part of an organ) tissue origin
Examples: Fibroma – fibrous tissue

Adenoma – glandular tissue

EXCEPTIONS: Hepatoma - hepatocellular carcinoma (malignant)

Lymphoma – lymphosarcoma

Melanoma – malignant melanoma

Glioma (glial cells) – malignant brain tumor

 Malignant tumors of epithelial origin (terms are added from which it originates)
- Epithelial surfaces: respiratory, GI, biliary, urogenital, skin
- Epithelial-lined organs: breast, pancreas, liver, salivary glands
Examples: Adenocarcinoma – glandular (columnar) epithelium
NCM 112: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,
INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC
Squamous cell carcinoma – from squamous (flat, scale-like) epithelial

Carcinoma in situ – cancer which stayed in place of origin

2. Sarcoma = sarc – fleshy

 Malignant tumors arising from mesenchymal cells/soft cartilage (connective tissues)
Examples: Liposarcoma – from fats

Osteosarcoma – from bones

Leiomyosarcoma – from smooth muscles

Cancer, commonly called as tumor, is also the term used for all malignant tumors. However,
neoplasm and tumor are not synonymous. Neoplasm (neo = new) is an abnormal cell
differentiation and growth in the abnormal mass tissue. A tumor, on the other hand, is a
swelling caused by several conditions (Norris, 2018).

A tumor is:

o Composed of well differentiated cells that are clustered together in a single mass.
o Does not cause death unless their location or size interferes with vital functions.
o Consist of differentiated cells that reproduce at a higher rate than normal rate.
o A benign tumor is often encapsulated and expands but does not spread. Tissue
damage results from compression of adjacent structures such as blood vessels. Not
considered life threatening unless it is in an area such as brain where the pressure
effect can become critical.

A tumor that does not invade nor destroy the tissue in which it originates nor
spread to the distant sites of the body.

Cell Growth Patterns

1. Hypertrophy – increase cell size leading to increase in organ size caused by:
- Increase in workload
- Hormonal stimulation
- Compensation related to functional loss of tissue
2. Hyperplasia – REVERSIBLE increase in the number of cells in response to specific
stimulus (i.e. endometrial hyperplasia; BPH)
NCM 112: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,
INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC

3. Metaplasia – conversion of 1 cell type to another type not usually found in tissue
involved influenced by:
- Inflammation
- Vitamin deficiency
- Chronic inflammation
- Chemical agents
NOTE! REVERSIBLE if stimulus is removed; may PROGRESS to DYSPLASIA if
stimulus persists.

4. Dysplasia – abnormal change in size, shape, or organization of cells caused by:

- Radiation (common cause)
- Inflammation
- Toxic chemicals
- Chronic irritation
NOTE! REVERSIBLE if stimulus is removed but it PRECEDES a tissue in becoming
CANCEROUS
5. Anaplasia – undifferentiated cells and have variable nuclei and cell structure and
numerous mitotic figures. It is the basis for grading tumor; causes death if left
untreated, a malignant growth pattern
NOTE! It is a tumor that is cancerous

The hallmark of malignant neoplasm is to metastasize (metastasis – spread of cancer cells

from a primary site to distant secondary sites). It is aided by the production of enzymes in
the surface of the cancer cell. growth is usually undifferentiated, nonfunctional cells. These
cells tend to reproduce more rapidly into surrounding tissue and easily break away to
spread to other organs and tissues.

Characteristics of Neoplasia

BENIGN vs MALIGNANT
Cellular Well-differentiated Undifferentiated
differentiation:
Growth rate Progressive and slow Erratic and uncontrolled
Invasion Uncommon (localized and Common (infiltrates tissues
encapsulated) and non-encapsulated)
Recurrence Unusual Common (esp. following a
surgical procedure)
NCM 112: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,
INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC

The Cancer Cell Cycle

Very rapidly dividing cells can take only 8 hours, whereas other cells take longer than 1
year.

Cell cycle time - Amount of time required for a cell to move from one mitosis to another
mitosis

- length of total cell cycle varies with the specific type of cell.
COMMON MISCONCEPTION: Rate of cancer cell proliferation is faster
than that of a normal cell. Usually, cancer cells proliferate at the same rate
as the normal cells of the tissue of origin. The difference is that, the
proliferation of cancer cell is continuous. The length of G0 phase is the
major factor in determining the cell cycle time.

Doubling time – the length of time it takes for a tumor to double its volume. tumor cells
undergo a series of doublings as the tumor increases in size. The average doubling time for
most primary solid tumors is approximately two months (Langhorne, Otto, and Fulton,
2011).

Factors affecting doubling time:

1. Cell Cycle time

2. Growth Fraction -It is the ratio of the total number of cells to the number of
dividing cells.
3. Cells loss by either cell death, differentiation or metastasis
GOMPERTZIAN TUMOR GROWTH: A tumor is usually clinically undetectable until
it has doubled 30 times and contains more than 1 billion cells. At this point, it is
approximately 1 cm in size and equals 1 gm in weight. With only 10 more doublings,
the tumor contains more than 1 trillion cells or weighs 1 kg, which is enough to cause
death. (http://www.pitt.edu)
Phases of Cell Cycle and Checkpoints

1. G1 or Gap1 – RNA and protein synthesis prepares for DNA replication; lasts from
hours to days or longer
G1 CHECKPOINT – apoptosis can occur id DNA is damaged beyond repair
2. S phase or synthesis – DNA replication occurs in preparation for division; lasts
approximately 10-20 hrs
3. G2/ gap2 –DNA synthesis stops but RNA and protein synthesis continues; ranges
from 2 to 10 hours (precursors of the mitotic spindle apparatus are produced)
G2 CHECKPOINT – mitosis will not occur until DNA has replicated well; occurs
before proceeding to M phase
NCM 112: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,
INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC

4. M phase or mitosis – cell division occurs; lasts for 30-60 minutes

After mitosis the daughter cells enter the G1 phase and begin the cell reproductive
cycle again or redirect themselves into a resting phase, called G0.
M CHECKPOINT – checks for proper chromosome alignment

5. G0 or resting phase – performs all functions other than those related to cell
proliferation. Cells in the G0 phase are activated to re-enter the cell cycle in
response to various stimuli that signal for cell renewal.

Source: Nigerian Scholars, 2020

Figure 3. Cell Cycle Phases

Carcinogenesis

Most cancers studied reveal numerous genetic alterations involving oncogenes (cancer
causing genes) and tumor suppressor genes (genes that prevent replication of cells that
have become cancerous). It is believed that each of these changes represents a crucial
step in the progression from a normal cell to a malignant tumor. There are several theories
that explains why cancer cells arise. But the most discernible are the:
NCM 112: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,
INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC

1. CELLULAR TRANSFORMATION & DERANGEMENT THEORY

This theorizes that normal cells may be transformed into cancer cells due to
exposure to some health-hazard agents (DNA mutation during mitosis). In
particular, malignant transformation may be due to the combination of oncogene
activation and inactivation of tumor suppressor genes in three stages: initiation,
promotion and progression.
2. FAILURE OF THE IMMUNE RESPONSE THEORY
This advocates that all individuals possess cancer cells. However, the cancer cells
are recognized by the immune response system and, thus, the cancer cells undergo
destruction. Malfunction of the immune response system leads to failure in
destroying the cancer cells.

Figure 4. Molecular Basis of Cancer

Source: Langhorne, Otto, and Fulton, 2011

Stages:

1. Initiation – irreversible mutation

2. Promotion – a promoting agent stimulates cell growth and division
3. Transformation – series of changes leading to formation of undifferentiated cells
4. Metastasis – cancer cells spread to other organs in the body
NCM 112: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,
INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC

Characteristics of Cancer Cells

It is to be noted that the growth rate of new cells and death rate of old cells are kept in
balance. Cancer cells have altered cell differentiation. In normal cell growth, cells become
more specialized as they mature and acquire specific structural and functional
characteristics. During transformation from a normal cell to a malignant cell, altered
differentiation can result from changes in the appearance and metabolism of the cell, the
presence of tumor specific antigens, and the loss of normal function.

1. Self-sufficiency in growth signals – tumors possess the capability to proliferate

without external stimuli
2. Insensitivity to growth-inhibitory signals – alterations in tumor suppressor genes
(gate keepers and caretakers) lead to failure to inhibit tumor cell growth
3. Evasion of apoptosis – mutations in the genes that regulate the programmed cell
death may lead to proliferation of cancer cells.
4. Defects in DNA repair – DNA of normal dividing cells is susceptible to damage from
environmental agents and alterations resulting from errors occurring unexpectedly
during DNA replication. If DNA repair does not occur promptly, malignant
transformation of the cell can occur
5. Limitless replication potential – maintenance of telomere length and telomerase
activity is essential for cancer cells to maintain unlimited replication potential and
attain immortality
6. Sustained angiogenesis – tumors promote the formation of a vascular supply
(angiogenesis) which is essential for continued growth and metastasis. They
produce angiogenic factors, like the vascular endothelial growth factor (VEGF), to
stimulate and sustain blood vessel growth
7. Ability to invade and metastasize – a complex process where tumor cells break
loose from the primary or main tumor and enter the blood vessels or the lymphatic
system and produce a secondary tumor at another distant location in the body

Spread of Cancer

Metastasis is the spread of cancer cells to distant locations in the body by blood, lymphatic
channels or via direct spread. The tumor cells grind down into a vein or lymphatic travel
through the body and eventually stay in a welcoming environment to reproduce and create
one or more secondary tumors. Only a few tumor cells survive this transfer, but it only takes
a few to start a new tumor.
NCM 112: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,
INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC

Explanation

Name: Score:
Group No: Date:

Answer the following questions based on your own understanding.

Compare and contrast how the Philippines fair in the global battle with cancer in an essay of
200-300 words. Use the following indicators as basis: incidence rate, mortality rate, and
survival rates.
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INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC

Extension

TERMINOLOGIES
Apoptosis – a genetically directed process of cell self-destruction or cell “suicide” that is
activated either by the presence of a stimulus or removal of a suppressing agent or
stimulus. It is a normal process of eliminating DNA-damaged or unwanted cells

Cancer - a disorder of altered cell differentiation and growth that share common biologic
properties and begins when an irregular cell is transformed by the genetic mutation, result
of mutations in oncogenes and tumor suppressor genes
Carcinogensis – refers to the initiation of cancer formation

Differentiation – refers to the extent to which cancer cells resemble similar normal cells.
Cancer cells vary in their ability to retain the morphologic and functional traits of the original
tissue. Cells that are more mature in appearance and closely resemble the normal cell are
well-differentiated but have poor cell functions.

Oncology Nursing – a specialized field in nursing dealing with treating and caring for
people with cancer

FURTHER READINGS

Chan, D. (13 June, 2017). Why the US has better cancer survival rates than the rest of the
world, Forbes. Retrieved from https://www.forbes.com/sites/quora/2017/06/13/why-the-
us-has-better-cancer-survival-rates-than-the-rest-of-the-world/#354b07f44b67

DOH. (n.d.). Philippine cancer control program (PCCP). Retrieved from

https://www.doh.gov.ph

WHO. (12 September, 2018). Cancer. Retrieved from https://www.who.int/news-

room/fact-sheets/detail/cancer
NCM 112: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,
INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC

Evaluation

Name: Score:
Group No: Date:

Download a Nursing research article from ScienceDirect authored by Kousoulou, M.,

Suhonen, R., and Charalambous, A. and write a 300-500-word essay as reflection.

Article is found in the reference. Attach it to your file submissions.

NCM 112: CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES,
INFECTIOUS, INFLAMMATORY AND IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS,
ACUTE AND CHRONIC

REFERENCES

Chan, D. (13 June, 2017). Why the US has better cancer survival rates than the rest of the
world, Forbes. Retrieved from https://www.forbes.com/sites/quora/2017/06/13/why-the-
us-has-better-cancer-survival-rates-than-the-rest-of-the-world/#354b07f44b67

DOH. (2013). Leading causes of mortality. Retrieved from

https://www.doh.gov.ph/Statistics/Leading-Causes-of-Mortality

DOH. (n.d.). Philippine cancer control program (PCCP). Retrieved from

https://www.doh.gov.ph/philippine-cancer-control-program

Hinkle, J. and Cheever, K. (2017). Brunner & Suddharth’s Textbook of Medical-Surgical

Nursing, 14th ed. USA: Wolters Kluwer

Kousoulou, M., Suhonen, R., and Charalambous, A. (August 2019). Associations of

individualized nursing care and quality oncology nursing care in patients diagnosed with
cancer, European Journal of Oncology Nursing, 41: 33-40. Retrieved from
https://www.sciencedirect.com/science/article/pii/S1462388919300602

Langhorne, M. E., Fulton, J. S., & Otto, S. E. (2011). Oncology Nursing, 5th ed. St. Louis,
Mo.: Mosby/Elsevier.

Nigerian Scholars. (2020). Introducing the cell cycle. Retrieved from

https://nigerianscholars.com/tutorials/introducing-the-cell/introducing-cell-cycle/

Norris, T. (2018). Porth’s Pathophysiology: Concepts of Altered Health States, 10th ed.
USA: Wolters Kluwer

WHO. (May 2019). The Global Cancer Observatory, Retrieved from

https://gco.iarc.fr/today/data/factsheets/populations/608-philippines-fact-sheets.pdf

WHO. (12 September, 2018). Cancer. Retrieved from https://www.who.int/news-

room/fact-sheets/detail/cancer

University of Pittsburgh. (n.d.) Cancer development. Retrieved from

http://www.pitt.edu/~super1/lecture/lec0192/007.htm