Cellular adaptation

By
Ayesha
 Objective
At the end of the session the students will be able to;
Discuss the general changes in cell structure and function that occur as a result of
normal adaptive processes.
Describe cellular changes that occur with Atrophy, Hypertrophy, Hyperplasia,
Metaplasia and dysplasia and general conditions under which these changes
occur.
Differentiate the neoplastic growth from normal adaptive changes.
Differentiate between malignant and benign tumors
Describe the TNM system for cancer staging. the role of Proto oncogene & anti-
oncogene to transform normal cell line to cancer cell line (Carcinogenesis)
Discuss the predisposing factors of aberrant cell growth.
• List the characteristics of cancer cells
Cell structure & functions
.
principles of Cell Theory

All living things are made of cells

•Cells are the basic building blocks of all living things.
The human body is composed of trillions of cells.
•They provide structure for the body
•take in nutrients from food, convert those nutrients into energy
•Carry out specialized functions.
Cells also contain the body’s hereditary material and can make copies of themselves.
•Smallest living unit of structure and function of all organisms is the cell.
characteristics of All
Cells & cellular adaptation

• A surrounding membrane
• Protoplasm – cell contents in thick fluid
• Organelles – structures for cell function
• Control center with DNA
• cellular adaptation In cell biology and pathophysiology, cellular adaptation refers
to changes made by a cell in response to adverse environmental changes. The
adaptation may be physiological (normal) or pathological (abnormal).
Types

• There are five major types of cellular adaptation:

• Atrophy
• Hypertrophy
• Metaplasia
• Hyperplasia
• Dysplasia
 Atrophy

• Atrophy is the partial or complete Wasting away of a part of the body

• Mechanisms include
• Reduced nutrient and oxygen supply.
• Reduced functional demand.
• Reduced hormonal stimulation
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• These can occur under physiologic or pathologic conditions.

Physiological atrophy
• •Ductus arteriosus and umbilical vessels, after birth.
• •Thymus gland after puberty.
• •Postmenopausal atrophy of the breast, uterus and ovaries.
• Pathologic atrophy: Ischemic atrophy:
• Usually due to partial and gradual occlusion of the arterial blood supply by
atherosclerosis, in the heart (atherosclerotic heart disease), brain or kidney
etc.
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• Disuse atrophy: Due to forced inactivity of muscle e.g. after prolonged
immobilization of a limb in plaster
• Neuropathic atrophy: Following lower motor neuron lesions e.g.
poliomyelitis
• Starvation atrophy: depletion of carbohydrates
• •Ischemic atrophy: cerebral atherosclerosis
• •Disuse atrophy: in case of obstruction of pancreatic duct.
• •Neuropathic atrophy: poliomyelitis
• Endocrine atrophy: hypopituitarism , atrophy of thyroid, adrenal & gonads
• •Pressure atrophy: erosion of spine by tumor
• •Idiopathic atrophy: testicular atrophy
Hypertrophy

• Hypertrophy
• •Increase in size of cells and consequently an increase in the size of the organ,
it results from an increased workload imposed on an organ or body part and is
commonly seem in cardiac and skeletal muscles.
• Physiological: Can be physiological e.g. uterine muscles in pregnancy or
skeletal muscles in athletes.
• Pathological: e.g. left ventricle enlargement in hypertension & prostate
enlargement.
• Occurs in response to an increased demand for overwork;
• •Valvular heart disease
 Hypertrophy

• •The uterus in pregnancy.

• • Stomach in pyloric stenosis.
• •Urinary bladder with obstruction
to urine outflow e.g. prostatic
enlargement or urethral stricture.
Hyperplasia

• It is an increase in the size of tissue or organ due to increase in the

number of its specialized cells. This can result from:
• Physiological: hyperplasia of the breast in puberty ,during pregnancy and
lactation. increase in thickness of endometrium during menstrual cycle.
Pathological

• Hyperplasia of endocrine glands:

• Pituitary gland Excess growth hormone:
• Before puberty Gigantism.
• After puberty Acromegaly.
• Thyroid gland Thyrtoxicosis.* Parathyroid gland Hypercalcemia
• Adrenal cortex Cushing’s syndrome.
• Proliferation of endometrium due to prolonged estrogen stimulate.
Metaplasia
• Metaplasia Metapl
• A reversible change in which one adult cell type is asia
• replaced by another (epithelial or mesenchymal)
• Physiological- Change in cervix during puberty
• •Pathological- Acid reflux through esophagus
 dysplasia

• dysplasia
• •It is characterized by deranged cell growth of specific tissues that
result in cell vary in size, shape and organization. The pattern is most
frequently encountered in areas of metaplastic squamous epithelium
of the respiratory tract and uterine cervix.
• For example;
• •Variation of shape and size of cells
• •Enlargement, irregularity
• •Disordered arrangement of the cell
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• It represents reaction to underlying inflammation or to chronic irritation.

• Mild and moderate degrees of dysplasia are reversible when the evoking stimulus is
removed. However, severe degree is considered pre-malignant.
• In many cases the dysplastic cells revert to their former structure and function.
• Examples of dysplasia:
• Occurs in cervical epithelium &
bronchial epithelium
• In urothelium of urinary bladder
 characteristics of Normal Cells

• characteristics of Normal Cells

• Limited cell division
• Specific morphology
• Small nuclear-cytoplasm
• Perform differentiated functions
• Adhere tightly together
characteristics of Abnormal Cells

• Abnormal, serve no purpose

• Rapid and continuous cell division
• No contact inhibited
• Ana plastic (artificial) morphology
• Large nuclear cytoplasmic ratio
• Lose differentiated function
• Adhere loosely
What is cancer
Cancer
• Cancer is a term that used for disease in which abnormal cells divided
without control & able to involve other tissues.
Background of Cancer
• Background of Cancer
• •Cancer is the 2nd leading cause of death in USA.
• •Affects all age of group people
• •More death in children from 1 – 14 years of age
• •According ACS, 1.3 million new cases found in 2003.
• •556,500 were died through cancer. 62 % get die after 5 years, when
develop cancer
• •It can originate in any part of the body;
• But in men prostate cancer is more common
• In women breast cancer is more common
• •The mortality rate is high in both gender through lung cancer.
 Introduction

• Alterations in three groups of genes are responsible for the deregulated

control mechanisms that are the hallmarks of cancer cells proto-oncogenes,
tumor suppressor genes, and DNA stability genes
• proto- oncogenes
• •Proto- oncogenes are components of signaling networks that act as positive
growth regulators in response to mitogens (stimulate mitosis), cytokines, and
cell-to-cell contact.
• •A gain-of-function mutation in only one copy of a proto-oncogene results in a
dominantly acting oncogene that often fails to respond to extracellular signals
Tumor -suppressor genes
• Tumor -suppressor genes are also components of the same signaling
networks as proto-oncogenes, except that they act as negative growth
regulators.
• They modulate (control) proliferation and survival by antagonizing the
biochemical functions of proto-oncogenes or responding to unchecked
growth signals.
• In contrast to oncogenes, inactivation of both copies of tumor -suppressor
genes is required for loss of function in most cases.
 DNA stability genes

• DNA stability genes form a class of genes involved in both monitoring and maintaining the
integrity of DNA
• Loss of these genes results in defective sensing of DNA lesions as well as improper repair
of the damaged pattern
• Loss of function results in accumulation of mutation.
• Development of Cancer Cells
• Inheritance may increase risk
• Proto- oncogenes and tumor suppressor genes mutate or become damaged by
carcinogens Known carcinogens:
• Viruses and bacteria
• Environmental chemicals
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• Tobacco
• Radiation
• Dietary factors
• An oncogene is a gene that, when mutated or expressed at high levels,
helps turn a normal cell into a tumor cell
TYPES OF CANCER There are two types of tumor
Benign
Malignant
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Benign:
• •Benign tumors do not metastasize or spread from their original
location.
• Malignant:
• • Malignant tumors spread by direct extension in to surrounding tissue,
via the lymphatic system and hematogenously via blood circulation.
 Categories of cancer

• Carcinoma - Cancer that begins in the skin or in tissues that line or cover
internal organs.
• •Sarcoma - Cancer that begins in bone, cartilage, fat, muscle, blood
vessels, or other connective or supportive tissue.
• Leukemia - Cancer that starts in blood-forming tissue such as the bone
marrow and causes large numbers of abnormal blood cells to be
produced and enter the blood.
• •Lymphoma and myeloma Cancers that begin in the cells of the immune
system.
 Cancer continue

• Central nervous system cancers

• - Cancers that begin in the tissues of the brain and spinal cord.
• Neoplasm: New growth- “abnormal mass of tissue, the growth of which is
almost autonomous and exceeds that of normal tissues. The growth is
uncoordinated and persists after the cessation of the stimuli that initiated
the change”
• Cancer: From the Latin “crab”- the pathological condition characterized
by the proliferation of neoplastic cells that tend to invade surrounding
tissue and metastasize to new body sites.
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• Tumor: Swelling, originally for inflammation

• Metastasis: The development of secondary malignant growths at a distance from a
primary site of cancer.
• Carcinogen: A substance capable of causing cancer in living tissue.
• Classification All Tumours have two basic components:
• Parenchyma: Any cell that is a functional element of an organ (e.g. Neuron, Myocyte,
Nephron and Hepatocyte etc.
• Stroma: Connective tissue cells and blood cells
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• Benign Tumours :
• From glandular tissues (epithelial origin)
• adenoma: Hepatocellular adenoma, Fibro adenoma, Adrenocortical
adenoma.
• Cyst adenoma: Benign ovarian cyst, benign tumor of pancreas.
• Papilloma: A small benign epithelial tumor, such as a wart
• Polyp : Mass of overgrown tissue, (nasal cavity , colon and rectum)
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• From stromal tissues

• (mesenchymal origin)
• Fibroma: A benign fibrous tumor of connective tissue
• Lipoma: A benign tumor of fat cells
• Angioma: A tumor of lymph and blood vessels
• Leiomyoma: Smooth muscles tumor
• Osteoma / Chondroma : A benign tumor composed of bony tissue
 Diagnosis

• Laboratory methods
• Cytology FNA
• Histology (Biopsy, incisional or excisional biopsy)
• Other methods
• Tumour typing
• Immunocyto / histochemistry
• Tumour markers
 early Detection/Prevention

• Early Detection/Prevention
• Avoid obesity
• Decrease alcohol consumption
• Obtain adequate rest and exercise
• Choose plant source foods
• Eat 5 or more servings of fruits & vegetables each day
• Other foods from plant sources, such as breads, cereal, grain products,
rice, pasta, or beans several times each day
• Limit fat (esp. animal fats) intake
• Be physically active
 Secondary & tertiary Prevention
Screenings Prevention
secondary Prevention
Mammography, PAP test (Papanicolaou ), Stools for occult blood
• Sigmoidoscopy, Breast self-exam
• Testicular self-exam
• tertiary Prevention Screenings Prevention Cancers of the breast, colon,
rectum, cervix, prostate, testis, tongue, mouth, and skin can be detected at
earlier stages
• •The above noted cancers account for
• 50% of all new cancers
• Present 5-year survival rate is 80%.
 The TNM Stages of Cancer

• The American Joint Committee on Cancer (AJCC) and the International

Union for Cancer Control (UICC) maintain the TNM classification system
as a tool for doctors to stage different types of cancer based on certain
standards. It’s updated every 6 to 8 years to include advances in our
understanding of cancer.
• •In the TNM system, each cancer is assigned a letter or number to
describe the tumor, node, and metastases. T stands for the original
( primary ) tumor.
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• N stands for nodes. It tells whether the cancer has spread to the
nearby lymph nodes
• •M stands for metastasis. It tells whether the cancer has spread to
distant parts of the body
• •The T category gives information about aspects of the original
(primary) tumor, such as its size, how deeply it has grown into the
organ it started in, and whether it has grown into nearby tissues TX
means the tumor can’t be measured.
• •T0 means there is no evidence of a primary tumor (it cannot be
found).
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• Tis means that the cancer cells are only growing in the most superficial
layer of tissue, without growing into deeper tissues. This may also be
called in situ cancer or pre-cancer.
• •Numbers after the T (such as T1, T2, T3, and T4) might describe the
tumor size and/or amount of spread into nearby structures. The higher
the T number, the larger the tumor and/or the more it has grown into
nearby tissues.
• •The N category describes whether the cancer has spread into nearby
lymph nodes.
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• NX means the nearby lymph nodes cannot be evaluated.

• •N0 means nearby lymph nodes do not contain cancer.
• •Numbers after the N (such as N1, N2, and N3) might describe the size,
location, and/or the number of nearby lymph nodes affected by cancer. The
higher the N number, the greater the cancer spread to nearby lymph nodes.
• •The M category tells whether the cancer has spread (metastasized) to
distant parts of body).
• •M0 means that no distant cancer spread was found.
• M1 means that the cancer has spread to distant organs or tissues (distant
metastases were found).
Goals of cancer therapy
• Depending on the type of cancer, and how advanced
it is, chemotherapy can be used for different goals:1
• Cure the cancer: Cancer is considered cured when the
patient remains free of any evidence of cancer cells
for a long period of time.
• Control the cancer: Control is keeping the cancer
from spreading; slowing the cancer's growth; and
killing cancer cells that may have spread to other
parts of the body from the original tumor.
Cont…
• Relieve symptoms that the cancer may be causing. Relieving
symptoms such as pain and discomfort can help patients live more
comfortably. This is sometimes called palliative care.
Treatment modalities for cancer
• There are three basic treatment modalities for cancer.
1. Chemotherapy.
2. Radiotherapy.
3. Surgery.
Chemotherapy
• Chemotherapy is the general term for any treatment involving the use
of chemical agents to stop cancer cells from growing. Chemotherapy
can eliminate cancer cells at sites great distances from the original
cancer. As a result, chemotherapy is considered a systemic treatment.
Types of chemotherapy
• Combined modality chemotherapy: it is the use of
drugs with other cancer treatments, such as radiation
therapy or surgery.
• Neoadjuvant chemotherapy(preoperative treatment)
is used to shrink a large tumor so that it can then be
removed by surgery or can be treated more effectively
with radiation.
• Adjuvant chemotherapy (postoperative treatment) is
used to prevent the growth of cancer cells remaining in
the body after surgery or radiation.
• Palliative chemotherapy is given without curative intent,
but simply to decrease tumor load and increase life
expectancy.
Types of chemotherapeutic drugs
• Alkylating agents: Alkylating agents directly damage
DNA to prevent the cancer cell from reproducing. It
includes mechlorethamine, streptozocin, busulfan.
• Platinum drugs: The platinum drugs (cisplatin,
carboplatin, and oxalaplatin) are sometimes grouped
with alkylating agents because they kill cells in a
similar way. These drugs are less likely than the
alkylating agents to cause leukemia.
Cont…
• Antimetabolites are a class of drugs that interfere with DNA and RNA
growth by substituting for the normal building blocks of RNA and
DNA. Examples includes Floxuridine, Hydroxyurea, Methotrexate.
• Anti-tumor antibiotics: Anti-tumor antibiotics interfere with enzymes
involved in DNA replication such as Anthracyclines, Actinomycin-D,
Bleomycin, Mitomycin-C.
Side effects of chemotherapy
• Some common side effects of chemotherapy are:
• Pancytopenia
• Pain.
• Diarrhea
• Constipation.
• Mouth sores.
• Nausea.
• Vomiting.
• Hair loss.
• Fatigue.
Indication of chemotherapy
• Chemotherapy is used in the following conditions.
• Late-stage cancer treatment.
• Palliative or symptomatic treatment in cancer patients.
• Treatment for cancer before and after surgery or radiation therapy.
• Treatment for lupus and rheumatoid arthritis.
Radiation therapy
• Radiation therapy (also called radiotherapy), is
the treatment of cancer with high-energy rays
that damage cancer cells and stop them from
growing and dividing.
Types of radiation therapy
• There are three main types of radiation therapy:
• External beam radiation therapy
• Brachytherapy (internal radiation therapy).
• Systemic radioisotope therapy
• The differences relate to the position of the radiation source; external
is outside the body, brachytherapy uses sealed radioactive sources
placed precisely in the area under treatment, and systemic
radioisotopes are given by infusion or oral ingestion.
Brachytherapy involves placing a radioactive material directly inside or
next to the tumor. Brachytherapy, also called internal radiation therapy,
allows a physician to use a higher total dose of radiation to treat a
smaller area and in a shorter time than is possible with external beam
radiation treatment.
Side effects of radiation therapy
• Nausea and vomiting
• Damage to the epithelial surfaces
• Mouth and throat sores
• Intestinal discomfort
• Swelling (edema)
• Infertility
• Fibrosis
• Epilation (hair loss)
• Dryness
Indications for radiation therapy
• Radiation therapy is used in the following conditions
• Malignant cells.
• To treat tumors' that cannot be removed surgically (e.g., brain
tumors).
• Used combined with chemotherapy to prevent recurrence as well as
to treat or prevent the development of metastatic disease (the spread
of cancer to other parts of the body).
Nursing care for chemotherapy and
radiotherapy
• Managing stomatitis
• Maintaining skin integrity
• Helping patients cope with alopecia
• Managing malignant skin lesions
• Promoting nutrition
• Relieving pain
• Decreasing fatigue
• Improving body image and self-esteem
• Assisting in the grieving process
• Monitoring and managing complications
Cancer Surgery
• Surgery (the removal of cancerous tissue from the body) is the oldest
type of cancer therapy, and it remains an effective treatment for
many types of cancer today.
• The goal of surgery varies. It can be used to diagnose cancer;
determine where it is located, whether it has spread, and whether it
is affecting the functions of other organs in the body; remove all or
some of the cancerous tissue; restore the body's appearance or
function; or relieve side effects.
Types of cancer surgery
• Diagnostic: For most cancers, a biopsy is needed to make an accurate
diagnosis. A surgical biopsy involves a surgeon making an incision in
the skin and removing some or all of the suspicious tissue.
• Staging: Staging surgery determines the size of the tumor and
whether it has spread to lymph nodes and other organs in the area.
• Tumor removal (also called curative or primary surgery). The most
common type of cancer surgery is to remove the tumor and
surrounding tissue (called a margin).
Cont…
• Debulking: When the complete removal of a tumor is
not possible or might cause excessive damage to the
body, surgery can be used to remove as much of the
tumor as possible. Other treatments, such as
radiation therapy or chemotherapy, are then used to
address the remaining cancer.
• Palliation: Palliative surgery is used to relieve side
effects caused by a tumor. It plays an important role in
extending survival or improving quality of life for
patients with advanced cancer or widespread disease.
Cont…
• Prevention: Some surgeries are performed to reduce the risk of
developing cancer. For instance, the removal of precancerous polyps
in the colon is recommended to prevent colon cancer
Nursing care for patient undergoing
cancer surgery
• The nurse provides education and emotional support by assessing
patient and family needs .
• Prepare the patient for surgery.
• After surgery, assess the patient’s responses to the surgery and
monitors for possible complications, such as infection, bleeding,
thrombophlebitis, wound dehiscence, fluid and electrolyte imbalance,
and organ dysfunction.
• The nurse also provides comfort to the patient.
Cont…
• Postoperative teaching addresses wound care, activity, nutrition, and
medication information.
• Plans for discharge, follow-up and home care, and treatment are
initiated as early as possible to ensure continuity of care from hospital
to home.
Wound dehiscence is a surgical complication in which a wound ruptures
along a surgical incision. Risk factors include age, collagen disorder such
as Ehlers–Danlos syndrome, diabetes, obesity, poor knotting or
grabbing of stitches, and trauma to the wound after surgery.
Ehlers–Danlos syndromes (EDS) are a group of genetic connective
tissue disorders. Symptoms may include loose joints, stretchy skin,
and abnormal scar formation.
Palliative Care
• An approach that improves the quality
of life of patients and their families
facing the problems associated with
life-threatening illness, through the
prevention and relief of suffering by
means of early identification and
impeccable assessment and
treatment of pain and other
problems, physical, psychosocial, and
spiritual. ---World
Health Organization (2009)
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