Nsg 1140 Cancer Student Copy

8/8/2019 Nsg 1140 Cancer Student Copy

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Cancer

Dr. Tracey Hodges,

Ed.D, MSN, RN


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ETIOLOGY AND EPIDEMIOLOGYGENDER AND SITE

Basal and Squamous cell skin

cancers

Men

Prostate

Lung

Colon

Rectum

Women Breast

Lung

Colon

Rectum

AGE

CA is a disease of aging

Age 20 less than 1%

Age 50

7%

Age 60

>16% for men

>10% for women


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ETIOLOGY AND EPIDEMIOLOGYRACE AND ETHNICITY

Delayed diagnosis, unequal

socioeconomic status, and

unequal access to care

African-American men

Caucasian women

African-American women

Hispanic-Americans,Asian-Americans/Pacific

Islanders, and Native

Americans

GEOGRAPHIC FACTORS

Worldwide distribution of CA dueto significant differences among

different populations Primary CA of liver common in

Indonesia and parts of Africa andAsia

Breast CA more common in U.S.and Western Europe than in

Japan Ugandans, Nigerians, and South

African blacks have lowerincidence of CA of the lung,stomach, large intestine, uterus,and kidney compared to Westerncountries


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MULTISTEP PROCESS OFCARCINOGENESIS


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MULTISTEP PROCESS CONTD

3 overlapping and complexstages

Initiation

Promotion

Progression


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RISK FACTORS

Endogenous

Age

Genetic Factor

Hormonal factors

External

Tobacco

Radiation

Nutrition

Inactivity and obesity

Infectious organisms


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RISK FACTORS: AGE

Median age

67

3 theories

Exposure

Decreased cellular repair

Immune system


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RISK FACTORS: HORMONAL

Hormones influence

carcinogenesis in 3 ways:

Preparatory action on

target tissues

Allowing the process to

progress

A conditioning effect on

the tumor

Hormone Therapy

Treatment (HRT)

risks and benefits must

be investigated


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RISK FACTORS:

PRECANCEROUS LESIONS


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RISK FACTORS: IMMUNOLOGIC

Higher incidence of CA in

Older population immune system

Immunodeficiency

Immunosuppressant

drug therapy


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RISK FACTORS:

DRUGS AND CHEMICALS

Oral contraceptives Cancer therapy


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RISK FACTORS: RADIATIONIONIZING RADIATION


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RISK FACTORS:RADIATION CONTINUEDUV Radiation Radon


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RADIATION CONTINUEDELECTROMAGNETIC RADIATION


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RISK FACTORS:

LIFESTYLE PRACTICES

Smoking and tobacco use

Nutrition Obesity

Sexual and reproductive factors

Viruses and other microorganisms Psychosocial factors


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LIFESTYLE PRACTICES CONTINUED

SMOKING AND TOBACCO USE

Single most lethal cause of CAin the U.S.

Lung Cancer

Other Cancers

Mouth

Pharynx

Larynx

Esophagus Pancreas

Kidney

Bladder

Colon

Rectum

Chronic Diseases

CV disease Acute and chronic respiratory

diseases

Detrimental effects on

Fertility

Bone mass

Dentition


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NUTRITION

High-fat diet

Red meat Colon and prostate Cancer

Alcohol Mouth

Larynx Esophagus

Liver

Obesity

Colon

Breast

Endometrial

Renal

Esophageal


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Sexualand ReproductiveFactors

STDs linked to cancer

Early menarche

Late menopause


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PSYCHOSOCIAL FACTORS

Stress due to psychosocial trauma, loss of a

significant other, and personality variables, such ashelplessness and repression have been suggested

as etiologic factors for cancer


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PHYSIOLOGY

NORMAL CELLULAR PROLIFERATION

CELL CYCLE

G1, RNA and protein

synthesis occurs S a period of DNA

synthesis

G2 further RNA andprotein synthesis and

development of mitoticspindle

M - Mitosis

DIFFERENTIATION

Body tissue

Stem Cells Immature with no specific

cell lineage

Rapid growth into the cells

needed

Kidney

Muscle


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PATHOPHYSIOLOGYAlterationsinCell Growth

Hyperplasia Increase in cell number

Hypertrophy Increase in cell size

Metaplasia Reversible process in which one

adult cell type in an organ isreplaced by another adult cell type

Dysplasia Alteration in adult cells

characterized by changes in theirsize, shape, and organization

Neoplasia

Abnormal cellular division notnecessary for normal cell growthand repair

Anaplasia Total loss of differentiation

Metastasis

Migration of cancer cells to otherbody organs/locations


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PATHOPHYSIOLOGY CONTINUEDSitesofMetastases

Site depends on

Venous or lymphatic

drainage of the organ

involved

The type of CA

Tissue factors inpotential metastatic

sites

Common sites for

metastasis

Liver

Lung

Bone

Brain

Adrenal glands


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PATHOPHYSIOLOGY CONTINUED

CLASSIFYING AND NAMING NEOPLASMS

2 main cell types

Epithelial

Mesenchymal (connectivetissue)

Carcinoma

malignant tumor ofepithelial cells

Sarcoma malignant tumor of

connective tissue

Carcinomas may be further

divided

adeno

arising from glandular

epithelium or squamous

Teratoma

contains all 3 types of

embryonal tissue

Blastomas

arise during blastula

embryonic phase


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PATHOPHYSIOLOGY CONTINUEDGRADING

Grading examines the CA for its maturity

and characteristics

Tumors graded by Arabicnumerals into 4 grades, thehigher number, the moreabnormal and aggressive

STAGING

Staging describes the extent of the tumor

throughout the body 3 types

clinical staging

surgical staging

pathologic staging

TNM system

T Primary tumor N Regional lymph nodes

M Metastasis

See Box 23-3, p. 524


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CLINICAL MANIFESTATIONS

Tumors can causeobstructive problems if

within tubular structures(trachea, ureter, or GItract)

Intraspinal andintracranial tumorsS&S of increasedpressure

Systemic S&S:Fatigue, loss ofappetite, weight loss

Lung CA persistentcough and hemoptysis

Changes in bowelhabits or blood in stoolcan be early signs ofcolon CA

Changes in appearanceor texture of breasttissue or lumps can besigns of breast CA


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COLLABORATIVE CARE MANGEMENT

Diagnostic Tests

LAB TESTS

CBC

Chemistry profile Body fluids

Presence of tumor markers or

proteins associated with

specific cancers

PSA, CEA

Radioimmunoassays

CYTOLOGY TESTS

Study of cells

Pap smear


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Diagnostic Tests

TUMOR IMAGING

Radiographs or X-rays

CT scans

Positron emission tomography

(PET) studes

Barium enema

Nuclear medicine procedures

(person ingests radiolabeled

material)

BIOPSY AND ENDOSCOPY

Only definitive way to

diagnose CA Can be aspirational

(needle) or incisional

Specimen is used to

examine the tissuehistologically

Fiberoptic tubes with light

sources used to

illuminate body surfaces


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COLLABORATIVE CARE MANGEMENTCancerTreatment

Medications

Biotherapy

Cytokines

Interferons

Interleukins

Hematopoietic growth

factors

Monoclonal antibodies

Bind to almost any antigen

Effective in the serologicdetection of tumors

Usually given IV

May have fever, chills, and

rigors during administration of

the drug

Cellular therapies Immunomodulators

Retinoids


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CancerTreatmentADVERSE EFFECTS OF BIOTHERAPY

Flulike side affects fever,

chills, rigors, h/a, and malaise

NSAIDs

Nurses

help patients identify ways to

conserve energy

encourage use of relaxation andstress-reducing activities

Must assess mental status due to

neurologic toxicities

CV and pulmonary toxicities:

arrhythmias and hypotension,

fluid retention

Nurse must monitor I&O

GI effects: anorexia, nausea,

diarrhea

Nurses must optimize nutritionalintake and use of antiemetics and

antidiarrheal meds


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Surgical Management

4 major forms of cancer

therapy: Chemotherapy Radiotherapy

Biotherapy

Surgery

Surgery is the oldest and

most widely used option Surgery may be used for

staging, cure, adjuvanttreatment, control ofoncologic emergencies,or palliation of symptoms

See Box 23-11, p. 531


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CancerTreatment

DIET

Role of diet in CA has

been under investigation

for years

Role of high-fat and

obesity has been studied


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HEALTH PROMOTION AND PREVENTION

PRIMARY PREVENTION

Attempts to reduce apersons exposure to

known CA risk factors that

might lead to disease

SECONDARY PREVENTION

Aimed at early diagnosisand treatment

Screenings

Pap smear

PSA

CXR


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RADIOTHERAPY

Use of radiation in the tx of

diseases Ionizing radiation contains

energy that is capable of

causing cellular damage or cell

death

Cells in the M phase of the cell

cycle are most sensitive to

radiation; but can be effective

in the S phase


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INTERNAL RADIOTHERAPY

Sealed

Delivers a concentrated doseof radiation directly to themalignant lesion or tumor

Placement of the sealedcontainer is done in the OR,

radiation dept, or tx room

X-rays are used to confirmplacement

Unsealed

Delivered by mouth or by

IV

Special Precautions


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PROTECTION OF HEALTH CARE

WORKERS FROM RADIATION

Radiation tx rooms are

shielded with concrete and

lead walls Patients with internal

radiation sources with

gamma rays are cared for in

a length of time that is

protective to the health careworker

Exposure controlled in 3

ways: time, distance, and

shielding


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SIDE EFFECTS OF RADIOTHERAPY

Acute toxicities

Late toxicities

Most patients experience Erythema

Dry desquamation

Alopecia Fatigue

Bone marrow suppression

Long-term effects

Cataracts

Pulmonary fibrosis

Strictures

See Table 23-16, p. 540


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NURSING MANAGEMENT FOR RADIOTHERAPY

HEALTH HISTORY

Dx and tx history

Medical history Family history

Chronic illnesses

Medications

Allergies

Social support

Financial resources

Knowledge of tx plan

Fears and concerns

PHYSICAL EXAM

Self-care abilities

Nutritional status Elimination pattern

Mobility status

Skin and mucous membrane

integrity


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CHEMOTHERAPY

May be used for cure, long-

term control of cancer

growth, or for palliation totemporarily shrink a tumor

mass

Most chemotherapy agents

cause cell death by

interrupting cell growth andreplication at some point

Drugs classified by their

mechanism of action

Most effective when the tumor

is small and growing rapidly

(cell population growth) Thought to kill a fixed % of

total # of CA cells; so it is

scheduled in multiple courses

of time (cell-kill hypothesis)

Combination chemotherapy

used since drugs that attack

tumor cells in various ways

may produce maximal tumor

kill


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CHEMOTHERAPY CONTINUED

Most effective when

sufficient doses are

delivered within a specifiedtime

Malignant neoplasms may

become resistant; may be

primary or secondary

MDR can occur

Different classifications

Normal cells are also

affected

Bone marrow, GI epithelium,

and hair follicles most

sensitive to chemotherapy

Fatigue and organ toxicities

also seen


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CHEMOTHERAPY EFFECTSBONE MARROW

Myelosuppression Neutropenia

Thrombocytopenia

enemia

Prone to infection and

bleeding

Nadir most often 7 to 10 days after

med is administered

Most serious Complication

Infection

Stomatitis


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CHEMOTHERAPY EFFECTS

CONTINUEDGASTROINTESTINAL

N/V

Constipation Diarrhea

GI tract susceptible to

complication of infection and

bleeding

ALOPECIA

Not caused by all chemo

drugs Ranges from mild

thinning on scalp to

complete loss of body

hair

Hair loss usually begins 2

to 3 weeks after start of

therapy


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CONTINUEDFATIGUE

A common side effect

Compromises thepatients quality of life

Complaining of feeling

weak with no energy

SEXUAL DYSFUNCTION

Affects germinal epithelium ofovary and testes

Reproductive dysfunction oftenexperienced during and afterchemotherapy

Women may becomeamenorrheic during chemo

Testicular damage results indecreased sperm production


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CONTINUEDSPECIFIC ORGAN TOXICITIES

Heart

Electrocardiogram changes Heart failure

Lungs

Pulmonary Fibrosis

Liver With high doses of drugs

Kidney

With high doses of drugs Bladder

Hemorrhagic cystitis


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CHEMOTHERAPY ADMINISTRATION

Must be given by specially trained R.N.

Chemo meds Serious side effects Doses usually based on persons body surface area

Route of choice chosen to deliver the optimal dose

Can be given orally, Sub Q, IM, IV, or topically

Can also be instilled directly into the bladder,peritoneum, cerebrospinal fluid, or tumor bed


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NURSING MANAGEMENT FOR

CHEMOTHERAPY

Health history

Physical exam, p. 553

Risk for infection: nursemust assess for S&S,minimize source of infection,teach patient S&S

Mucous membrane integrityusually altered: dryness,

painful ulcerations, andinfections, nurse mustassess these areas

Bleeding precautions

Assess for S&S of bleeding

Fatigue; alternate periods of

rest with activity

GI tract: anorexia, N/V;

administer anti-emetics, and

anti-nausea meds, give oral

supplements if necessary


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DISTURBED BODY IMAGE

Alopeciavery disturbing to the patient

Weight loss, changes in body function Refer to appropriate places, help client to

identify resources

Fertilitysperm banking for men;

contraception

Patient teaching


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CANCER PAIN

Pain one of most fearedsymptoms of CA

30% of patients experiencepain while undergoing tx;90% as CA progresses andmetastasizes

Pain may be:

Somatic

Visceral

Neuropathic

Goal of pain management is

relief from pain

May be prescribed non-opioid analgesics, opioids,

or other agents

Pain may not be effectively

managed: person may fear

addiction


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