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Cancer A group of diseases characterized by uncontrolled and unregulated growth of cells. Defective cellular proliferation Defective cellular differentiation
Defect in Cellular Proliferation Normal cells proliferate in an organized fashion “Contact inhibition”contributes to this fashion Cancer cells proliferate in an unorganized fashion Characterized by the loss of“contact inhibition”Grow ontop of one another &ontop of/or between normal cell
Defect in Cellular Proliferation Divide indiscriminately
Defect in Cellular Differentiation Protooncogenes Normal cellular genes that are important regulators on normal cellular processes Mutations that alter their expression can activate them to act as oncogenes (tumor-inducing genes)
Defect in Cellular Differentiation Tumor suppressor genes Suppress growth of tumors Mutations render them inactive
Development of Cancer Chemical, environmental, genetic, immunologic, viral, or spontaneous in origin
Stages of Cancer Initiation Promotion Progression
Initiation Stage Inheritance Exposure to carcinogen
Promotion Stage Characterized by the reversible proliferation of altered cells Activities of promotion are reversible Latent period Initial genetic alteration to clinical evidence of cancer
Progression Stage Characterized by increased growth rate of tumor as well as its invasiveness &metastasis Metastasis process begins w/rapid growth of primary tumor Development of its own blood supply is critical for survival
Tumor angiogenesis is formation of blood vessels within the tumor
Role of Immune System Immune response is to reject or destroy cancer cells if perceived as non-self May be inadequate as cancer cells arise from normal human cells Some cancer cells have changes on their surface antigens Tumor-associated antigens (TAAs)
Role of the Immune System Response to TAAs is termed immunologic surveillance Lymphocytes continually check cell surfaces and detect and destroy cells with abnormalities Involves cytotoxic T cell, natural killer cells, macrophages, and B lymphocytes
Tumor Classification Benign Neoplasm Malignant Neoplasm
Benign Neoplasm Well differentiated Encapsulated Expansive mode of growth Characteristics similar to parent cell
Malignant Neoplasm Able to metastasize Infiltrative and expansive Frequent recurrence Moderate to marked vascularity
Classification of Cancer Anatomic Site Classification Histologic Analysis Classification
Anatomic Site Classification Carcinomas originate from embryonic ectoderm and endoderm Sarcomas originate from embryonic mesoderm Lymphomas and leukemias originate from hematopoietic system
Histologic Analysis Classification Grade 1:Cells differ slightly from normal cells &are well differentiated(mild dysplasia) Grade 2:Cells more abnormal& moderately differentiated(moderate dysplasia) Grade 3:Cells are very abnormal& poorly differentiated(severe dysplasia)
Histologic Analysis Classification Cont'd Grade 4: Cells immature and primitive and undifferentiated. Cell of origin difficult to determine (anaplasia)
Staging Extent and spread of disease classification
TNM Classification Clinical Staging 0: cancer in situ 1: tumor limited to tissue of origin 2: limited local spread 3: extensive local and regional spread 4: metastasis
Prevention and Detection of Cancer Reduce or avoid exposure to known or suspected carcinogens Eat balanced diet Exercise regularly Adequate rest Health examination on a regular basis
Prevention and Detection of Cancer Eliminate, reduce, or change perceptions of stressors and enhance ability to cope Enjoy consistent periods of relaxation and leisure Know 7 warning signs of cancer Self-examination Seek medical care if cancer is suspected
C.A.U.T.I.O.N Change in bowel or bladder habits. A sore that does not heal. Unusual bleeding or discharge from any body orifice. Thickening or a lump in the breast or elsewhere. Indigestion/difficulty swallowing. Obvious change in wart/mole. Nagging cough/hoars
Diagnostic Studies Cytology CXR CBC Colonoscopy Liver function tests Mammography CEA PSA Tumor Markers Imaging Studies
Blood test to determine cancer antigens CEA-Tumor marker carcinic embroyonic,colon cancer. PSA-prostate cancer. Tumor Markers- eg.CA19
Diagnosis of Cancer Biopsy involves histologic examination by a pathologist of a piece of tissue Needle Incisional Excisional
Collaborative Care of Cancer Factors that determine treatment modality Cell type Location and size of tumor Extent of disease
Collaborative Care of Cancer Curative Control treatment Palliation
Treatment Modalities Surgical therapy Radiation therapy Chemotherapy Biologic/ Targeted therapy
Surgical Therapy Used to cure or control disease process of cancer Cancer arising at slow rate of proliferation or replication Margin of normal tissue must surround tumor Remove only as much as necessary and use adjuvant therapy
Surgical Therapy Preventative measures used to reduce surgical seeding of cancer cells Usual sites of regional spread may be removed
Radiation therapy Treatment of neoplastic disease by using x-rays or gamma rays, usually from a cobalt source, to deter the proliferation of malignant cells by decreasing the rate of mitosis or impairing deoxyribonucleic acid synthesis (DNA)
Nursing Management Radiation therapy Fatigue Encourage patient to identify times of day when feeling better may allow for more activity Rest before activity Get assistance with activity Maintain nutritional status
Nursing Management Radiation therapy Anorexia Monitor carefully to avoid weight loss Weight twice weekly Small, frequent, high-protein, high-calorie meals Supplements
Nursing Management Radiation therapy Skin Reactions Dry skin should be lubricated with nonirritating lotion or solution that contains no metal, alcohol, perfume, or additives Wet reaction must be kept clean and protected from further damage Prevention of infection Facilitate wound healing
Nursing Management Radiation therapy Skin Reactions Protect irritated skin from extremes in temperature Avoid constricting garments, harsh chemicals, and deodorants
Nursing Management Radiation Therapy Oral, Oropharynx, and Esophageal Reactions Teach patients to examine oral cavity Dental work should be performed before initiation of radiation therapy Saliva substitutes Oral care
Nursing Management Radiation Therapy Oral, Oropharynx, and Esophageal Reactions Pain relief Frequent feedings of soft, nonirritating, high-protein, high-calorie foods Avoidance of extremes in temperature, alcohol, and tobacco
Nursing Management Radiation Therapy Pulmonary Effects Treatment Bronchodilators Expectorants/cough suppressants Bed rest Oxygen
Nursing Management Radiation Therapy Gastrointestinal Effects Prophylactic administration of antiemetics Assess for S/S of alkalosis and dehydration I&O Nonirritating diet Antidiarrheal medications
Nursing Management Radiation Therapy Coping Assist in planning for transportation, nutrition, and emotional support Patient teaching of symptom management to maintain highest possible quality of life
Nursing Management Chemo Therapy Patient must be told what to expect to decrease anxiety Encourage discussion of fears Reassure patient that situation is only temporary Inform patient of supportive care that will be provided
Nursing Management Chemo Therapy Administration of antiemetic drugs Monitor lab results *Assess for signs of bleeding if platelet count falls below 50,000/μl!
Neutropenic Precautions Neutrophil count <1,000 *Serious risk of developing infection!
Instruct patient to report: Temp >100.4 F, sore throat, chills, flushed skin, flu-like symptoms No fresh fruits, veggies, flowers in patient room Wear gown, gloves, mask when in direct contact with patient No crowds Hand hygiene Other measures?
Late Effects of Radiation and Chemotherapy Risk for leukemias and other secondary malignancies resulting from therapy Secondary malignancies other than leukemia have been reported Includes breast, ovarian, uterine, thyroid, and lung cancers
Biologic and Targeted Therapy Medications that therapeutically alter a patient’s immune response to malignant tumor cells Drugs that modify the body’s own immune response so that it can destroy various viruses and cancerous cells
Hematopoietic Stem Cell Transplantation Allows for safe use of very high doses of chemotherapy or radiation therapy Procedure with many risks, including death Highly toxic
Hematopoietic Stem Cell Transplantation Allogeneic Infused bone marrow acquired from donor matched to recipient Goal is to administer large doses of systemic therapy Then “rescue” bone marrow through engraftment and subsequent normal proliferation and differentiation of donated marrow
Hematopoietic Stem Cell Transplantation Autologous Patient receives their own bone marrow Marrow is removed, treated, stored, and reinfused
Hematopoietic Stem Cell Transplantation Syngeneic Obtaining stem cells from one identical twin and infusing them into the other
Hematopoietic Stem Cell Transplantation Complications Bacterial, viral and fungal infections are common Prophylactic antibiotic therapy
Hematopoietic Stem Cell Transplantation Complications Graft-versus-host disease T lymphocytes from donated marrow recognize recipient as foreign Attack organs such as skin, liver, and intestines Seen more frequently with allogenic transplantation
Complications of Cancer Malnutrition Characterized by fat and muscle depletion Suggest supplements as soon as 5% weight loss is noted or if patient has potential Supplemental shakes (Ensure)
Complications of Cancer Altered taste sensation Can teach patient to experiment with spices and seasonings in attempt to mask alterations
Complications of Cancer Infection Can cause death related to neutropenia
Complications of Cancer Superior vena cava syndrome Obstruction of the SVC by tumor Manifestations include Facial edema Distention of neck and chest veins Seizures Headache
Complications of Cancer Spinal cord compression Presence of malignant tumor in epidural space Manifestations Intense, localized, persistent back pain Motor weakness and dysfunction Change in bowel and bladder function
Complications of Cancer Hypercalcemia Parathyroid hormone-like substance is secreted from cancer cells in absence of bony metastasis Immobility and dehydration can contribute to or exacerbate
Hypercalcemia Primary manifestations include Apathy/depression Fatigue Muscle weakness Polyuria and nocturia Anorexia N/V
Complications of Cancer Hypercalcemia Can be life-threatening Treatment is aimed at primary disease Acute is treated by hydration, diuretic, and a bisphosphonate
Complications of Cancer Carotid artery rupture Invasion of artery wall by tumor or erosion following surgery or radiation Bleeding can manifest as minor oozing in case of blowout Pressure should be applied directly to site of bleeding IV fluids and blood administration to stabilize for surgery
Management of Cancer Pain Patient report should always be believed and accepted as primary pain assessment data Drug therapy NSAID’s, Opioids Nonpharmacologic interventions can be effectively used Pet therapy, guided imagery, breathing, relaxation techniques
Cancer Psychologic Support Emphasis placed on maintaining optimal quality of life Positive attitude of patient, family, and health care providers has significant positive impact on quality of life for patient May also influence prognosis
Cancer Psychologic Support Continue to be available Exhibit caring attitude Listen actively to fears and concerns Provide relief from distressing symptoms Maintain relationship based on trust and confidence
Cancer Psychologic Support Use touch to exhibit caring Assist patient in setting realistic short- term goals Assist in maintaining usual lifestyle patterns Maintain hope, which can vary Provides control over what is occurring Basis of positive attitude
Cancer Gerontologic Considerations Clinical manifestations may be mistaken for age-related changes Vulnerable to complications of cancer and cancer therapy Functional status considered in treatment
Created by: LauraHall
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