Cancer Definition & Significance

A group of more than 200 diseases characterized by unregulated growth of cells.

Cancer is the 2nd leading cause of death in the U.S. (CAD is # 1).

An estimated 30% of Americans now living will experience cancer at some point in their lives.

Cancer Con’t…. Two major dysfunctions present in the

process of CA are:> Defective cellular proliferation

(growth) > Defective cellular differentiation The natural history of CA is an orderly

process occurring in 3 phases over time: > Initiation-genetic change occurs-altering growth &

function > Promotion-the altered cell continues to

undergo additional malignant changes.> Progression-involves the continued

growth of the cell containing the malignant phenotype.

Cancer Classification

Anatomic site (tissue of origin & behavior of tumor> Carcinomas-grown from epithelial cells;usually solid

tumors (skin,stomach, colon,breast)

> Sarcomas - arise from muscle, bone, fat, or connective tissue-may be solid.

> Lymphomas & leukemias- arise from lymphoid tissue(infection-fighting organs)& grow from bld.forming organ.

Histologic analysis (Grade 1- IV) Extent of disease (Clinical staging 0-IV)

> Stage 0: CA in situ > Stage 1: Localized tumor growth> Stage 11: Limited local spread> Stage 111: Extensive local & regional spread> Stage IV: Metastasis

Comparison of Benign & Malignant Tumors

Malignant BenignCell type Abnormal from

those of original tissues

Close to those of original tissues

Growth Rapid;infiltrates surrounding tissues in all directions

Slow & noninfiltrating

Encapsulated

Infrequent Frequent

Metastasis Through blood,lymph,or new tumor sites

Remains localized

Cancer Risk Factors

EndogenousAge- incidence increases with

age. Genetic heritage- exhibit a inheritance pattern.

Hormonal factors – influence the process of carcinogenesis.

Immunologic factors – malignant cells are antigenically different and should be recognized & destroyed by an intact immune system.

Cancer Risk Factors

External:Drugs and Chemicals- are proven carcinogen

Radiation- both ionizing & ultraviolet can cause CA.Tobacco- single most lethal known carcinogen

Nutrition- high in fat & calories.Viruses- several viruses have shown to

cause CA. Sexual practices- multiple partners are associated with cancer in females.

Psychological factors – life stressors can cause CA

Cancer Diagnosis-General

Cytology studies- (e.g. PAP smear) CXR Serum studies (e.g. CBC, liver

function test, oncofetal antigens) Proctoscopic exam Radiographic studies (e.g.

mammogram) CT/MRI Biopsy

Cancer Early warning signs

Change in bowel or bladder habits Any sore that does not heal Bleeding or unusual discharge Lump or thickening in breast or

elsewhere Indigestion or difficulty swallowing Obvious change in wart or mole Nagging cough or hoarseness

Cancer Treatment

Goal(s): Cure, Control, Palliation Treatment: > Chemotherapy > Radiation > Biologic Response Modifiers > Surgery

Cancer Chemotherapy- General

Effect of chemo is at the cellular level1. Interrupting cell life-modifies or interferes

with DNA synthesis.2. Eradicate cells, both normal & malignant, that

are in the process of cell reproduction.

PO & IV administration most common Adverse effect classified as:

> Acute:N/V, allergic reactions, disrhythmias> Delayed: mucositis, alopecia, bone

marrow suppression. > Chronic: damage to organs (e.g. heart, liver, kidneys & lungs)

Cancer Radiation- General

The major target of the radiation effect is DNA

Administration accomplished by:> External radiation-gamma rays, linear

accelerator > Internal radiation- isotopes, radium needles

Side effects include:> Fatigue

> Anorexia> Bone marrow suppression> Skin reactions> Pulmonary effects > GI effects > Reproductive effects

Radiation Therapy Implementation

Maintain bedrest when radiation source in place

Administer ROM exercises Observe for untoward effects:dehydration Observe & report skin eruption, discharge,

abnormal bleeding. Observe frequently for dislodging of

radiation source (linen & dressing) Notify MD if N/V, diarhea, frequent

urination or bowel movements or temp. above 100 F.

CancerBiologic Response Modifiers- General

Agents that modify the relationship between the host & the tumor

Classified as: > Interferons > Interleukins > Monoclonal Antibodies > Tumor necrosis Factor > Colony- Stimulating Factors

Common side effect: flu-like symptoms

Cancer Surgery

Classified as:> Cure & control: removal of

localized CA tissue: Primary site and site of metastasis. > Supportive care: insertion of therapeutic devices

> Palliation of symptoms: surgery to promote quality of life. > Rehabilitative management: reconstructive surgery.

Psychological Care for the Cancer Patient

Develop a collaborative relationship with the patient.

Always be honest with the client. Assist to cope with pain Provide general comfort measures Do not undermedicate for cancer pain Support family as they move through the

grieving process Introduce the hospice concept-provides

care for the terminally ill pt. & family.

Oncologic Emergencies

Sepsis- life-threatening & common death in pts, with CA.

DIC-triggered by many illnesses, including CA.Caused by sepsis from cancer cells. Strict adherence to aseptic technique.

SIADH- excessive amts. Of water are reabsorbed by the kidney & put into systemic circulation. Caused hypoNA. & some degree of fluid retention. Mild S/S-weakness, muscle cramps, anorexia, fatigue.

Oncologic Emergencies Superior Vena Cava Syndrome- is

compressed or obstructed by tumor growth.S/S- edema of the face, periorbital edema, tightness of the shirt or blouse collar(Stoke’s sign). High-dose radiation the most common tx.

Tumor Lysis Syndrome- large quantities of tumor cells are destroyed rapidly. TLS is a positive sign that CA tx. is effective. S/S-hyperuricemia. Hydration-3L to 5L of fluid.

Oncologic Emergencies

Spinal Cord Compression- when a tumor directly enters the spinal cord or when the vertebral column collapses from tumor entry. S/S- back pain, tingling; loss of urethral, vaginal, & rectal sensation, muscle weakness. Tx-palliative-high dose radiation-reduce the size of the tumor.

Hypercalcemia- CA in bones causes the bone to release calcium into the bloodstream. S/S-fatigue, anorexia, N/V, constipation, & polyuria.