Cancer
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| Cancer | A group of diseases characterized by uncontrolled and unregulated growth of cells.
Defective cellular proliferation
Defective cellular differentiation
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| 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
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| Defect in Cellular Proliferation | Divide indiscriminately
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| 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)
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| Defect in Cellular Differentiation | Tumor suppressor genes
Suppress growth of tumors
Mutations render them inactive
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| Development of Cancer | Chemical, environmental, genetic, immunologic, viral, or spontaneous in origin
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| Stages of Cancer | Initiation
Promotion
Progression
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| Initiation Stage | Inheritance
Exposure to carcinogen
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| 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
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| 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
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| Tumor angiogenesis | is formation of blood vessels within the tumor
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| 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)
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| 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
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| Tumor Classification | Benign Neoplasm
Malignant Neoplasm
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| Benign Neoplasm | Well differentiated
Encapsulated
Expansive mode of growth
Characteristics similar to parent cell
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| Malignant Neoplasm | Able to metastasize
Infiltrative and expansive
Frequent recurrence
Moderate to marked vascularity
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| Classification of Cancer | Anatomic Site Classification
Histologic Analysis Classification
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| Anatomic Site Classification | Carcinomas originate from embryonic ectoderm and endoderm
Sarcomas originate from embryonic mesoderm
Lymphomas and leukemias originate from hematopoietic system
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| 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)
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| Histologic Analysis Classification Cont'd | Grade 4: Cells immature and primitive and undifferentiated. Cell of origin difficult to determine (anaplasia)
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| Staging | Extent and spread of disease classification
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| 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
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| 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
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| 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
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| 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
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| Diagnostic Studies | Cytology
CXR
CBC
Colonoscopy
Liver function tests
Mammography
CEA
PSA
Tumor Markers
Imaging Studies
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| Blood test to determine cancer antigens | CEA-Tumor marker carcinic embroyonic,colon cancer.
PSA-prostate cancer.
Tumor Markers- eg.CA19
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| Diagnosis of Cancer Biopsy involves histologic examination by a pathologist of a piece of tissue | Needle
Incisional
Excisional
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| Collaborative Care of Cancer Factors that determine treatment modality | Cell type
Location and size of tumor
Extent of disease
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| Collaborative Care of Cancer | Curative
Control treatment
Palliation
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| Treatment Modalities | Surgical therapy
Radiation therapy
Chemotherapy
Biologic/ Targeted therapy
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| 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
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| Surgical Therapy | Preventative measures used to reduce surgical seeding of cancer cells
Usual sites of regional spread may be removed
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| 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)
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| 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
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| Nursing Management Radiation therapy Anorexia | Monitor carefully to avoid weight loss
Weight twice weekly
Small, frequent, high-protein, high-calorie meals
Supplements
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| 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
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| Nursing Management Radiation therapy Skin Reactions | Protect irritated skin from extremes in temperature
Avoid constricting garments, harsh chemicals, and deodorants
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| 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
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| 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
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| Nursing Management Radiation Therapy Pulmonary Effects | Treatment
Bronchodilators
Expectorants/cough suppressants
Bed rest
Oxygen
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| Nursing Management Radiation Therapy Gastrointestinal Effects | Prophylactic administration of antiemetics
Assess for S/S of alkalosis and dehydration
I&O
Nonirritating diet
Antidiarrheal medications
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| 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
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| 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
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| Nursing Management Chemo Therapy | Administration of antiemetic drugs
Monitor lab results
*Assess for signs of bleeding if platelet count falls below 50,000/μl!
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| Neutropenic Precautions | Neutrophil count <1,000
*Serious risk of developing infection!
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| 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?
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| 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
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| 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
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| 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
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| 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
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| Hematopoietic Stem Cell Transplantation Autologous | Patient receives their own bone marrow
Marrow is removed, treated, stored, and reinfused
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| Hematopoietic Stem Cell Transplantation Syngeneic | Obtaining stem cells from one identical twin and infusing them into the other
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| Hematopoietic Stem Cell Transplantation Complications | Bacterial, viral and fungal infections are common
Prophylactic antibiotic therapy
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| 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
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| 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)
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| Complications of Cancer Altered taste sensation | Can teach patient to experiment with spices and seasonings in attempt to mask alterations
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| Complications of Cancer Infection | Can cause death related to neutropenia
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| 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
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| 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
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| 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
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| Hypercalcemia Primary manifestations include | Apathy/depression
Fatigue
Muscle weakness
Polyuria and nocturia
Anorexia
N/V
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| Complications of Cancer Hypercalcemia | Can be life-threatening
Treatment is aimed at primary disease
Acute is treated by hydration, diuretic, and a bisphosphonate
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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