Cancer
Cancer development
Carcinogenesis/oncogenesis = cancer development - Malignant transformation occurs through: -- Initiation -- Promotion -- Progression -- Metastasis
Cancer early warning signs
Change in bowel or bladder - A lesion that does not heal - Unusual bleeding or discharge - Thickening or lump in breast or elsewhere - Indigestion or difficulty swallowing - Obvious changes in wart or mole - Nagging cough or persistent hoarseness
Patient centred care
Chemotherapy-induced nausea and vomiting (CINV) - Mucositis - Alopecia - Cognitive changes - Chemotherapy-induced peripheral neuropathy (CIPN)
Ploidy
Classifies tumor chromosomes as normal or abnormal. Staging classifies clinical aspects of the cancer - The description of cancer cells by chromosome number and appearance - Normal human cells have 46 chromosomes (23 pairs), the normal diploid number (euploidy) - When malignant transformation occurs, changes in the genes and chromosomes also occur - Some cancer cells gain or lose whole chromosomes and may have structural abnormalities of the remaining chromosomes, a condition called aneuploidy - The degree of aneuploidy usually increases with the degree of malignancy - Some specific chromosome changes are associated with specific cancers, and their presence is used for diagnosis and prognosis - One example is the "Philadelphia" chromosome abnormality often present in chronic myelogenous leukemia cells
Type of surgery
Determined by - Extent of disease - Location and structures involved - Tumor growth rate - Tumor invasiveness - Surgical risk of patient - Quality of life expected post op
Malignant
Indicates cancer; serious and can lead to death without intervention, defect in cell proliferation
Carcinogens
May be chemicals, physical agents, or viruses - More than 100 agents, substances, mixtures, and exposures are known or reasonably anticipated to cause cancer in humans, and about another 200 are suspected to be carcinogens
Brachytherapy
Means "short" (close) therapy - The radiation source comes into direct, continuous contact with the tumor for a specific time period - This method provides a high dose of radiation in the tumor and a very limited dose in surrounding normal tissues - Uses radioactive isotopes either in solid form or within body fluids - Isotopes can be delivered to the tumor in several ways - With all types of this, the radiation source is within the patient - Therefore the patient emits radiation for a period of time and is a potential hazard to others - When the isotopes used are unsealed and suspended in a fluid, they are given by the oral or IV routes or instilled within body cavities
Benign tumor cells
Normal cells growing in the wrong place or at the wrong time - Result of problem with cellular regulation - Moles, uterine fibroid tumors, skin tags, endometriosis, nasal polyps
Features of benign tumor cells
Normal chromosomes - specific morphology - small nuclear-to-cytoplasmic ratio - specific differentiated functions -tight adherence - no migration - orderly growth
Teletherapy education
The client will be in exactly the same position for all treatments - Ensure that the patient can get into and maintain this position - Position-fixing devices and markings, either on the patient's body or on the devices, ensure the proper position each day of treatment - The markings may be small permanent "tattoos," ink outlines on the skin, or a marked mask laid over the skin - Position-fixing devices include customized external body molds, foam-based body molds, and fiberglass splints. Increase the client's comfort with these restrictions - Skin care, hydration requirements, specific types of products (soap, lotions, etc...)
Progression
The continued change of a cancer, making it more malignant over time - After cancer cells have grown to the point that a detectable tumor is formed (a 1-cm tumor has at least 1 billion cells in it), other events must occur for this tumor to become a health problem - First, the tumor must develop its own blood supply - The tumor makes vascular endothelial growth factor (VEGF) that triggers nearby capillaries to grow new branches into the tumor, ensuring the tumor's continued nourishment and growth
Surgery
90% of all cancer patients undergo Used for - Diagnosis - Staging - Tumor removal -- debulking (take out part of tumor to decrease pressure on surroundings) - Palliation
Second-look surgery
A repeat examination after treatment to assess the disease status in patients who have been treated and have no symptoms of remaining tumor - The results of this surgery are used to determine whether a specific therapy should be continued or discontinued
Malignant cells
Abnormal - Serve no useful function - Harmful to normal body tissues - Consume other elements in the body and take all their energy
Side effects of radiation therapy
Acute and long-term site-specific changes - Vary according to site - Local skin changes and hair loss - Altered taste sensations and smell - Fatigue - Bone marrow suppression
Chemotherapy drugs
Alkylating agents - Antimetabolites - Antimitotic agents - Antitumor antibodies - Topoisomerase inhibitors - Miscellaneous chemotherapeutic agents
Features of malignant cells
Anaplasia - Large nuclear-to-cytoplasmic ratio - Specific functions lost - Loose adherence - Migration (metastasis) - No contact inhibition - Rapid or continuous cell division - Abnormal chromosomes (aneuploidy)
Cancer prevention
Avoidance of known or potential carcinogens - Modifying associated factors - Removal of "at risk" tissues - Chemoprevention - Vaccination - Cancer Screening Guidelines
Secondary (metastatic) tumors
Cancer cells move from primary location - Additional tumor(s)
cytoreductive surgery
Cancer control - Removes part of but not the entire tumor - It is also known as "debulking" surgery and decreases the number of cancer cells, which increases the chances that other therapies can be successful
Staging
Determines the exact location of the cancer and its degree of metastasis at diagnosis - Cancer stage influences selection of therapy - Staging is done by clinical staging, surgical staging, and pathologic staging. Clinical staging assesses the patient's clinical manifestations and evaluates them for tumor size and possible spread - Surgical staging assesses the tumor size, number, sites, and spread by inspection at surgery - Pathologic staging is the most definitive type, determining the tumor size, number, sites, and spread by pathologic examination of tissues obtained at surgery
Systems of grading
Developed to help standardize cancer diagnosis, prognosis, and treatment - Grading of a tumor classifies cellular aspects of the cancer - Needed because some cancer cells are "more malignant" than others, varying in their aggressiveness and sensitivity to treatment - Some cancer cells barely resemble the tissue from which they arose, are aggressive, and spread rapidly - These cells are a "high-grade" cancer - On the basis of cell appearance and activity, grading compares the cancer cell with the normal parent tissue from which it arose - It is a means of evaluating the patient with cancer for prognosis and appropriate therapy - Allows health care professionals to evaluate the results of management
Angiogenesis
Development of new blood vessels
Extravasation injury
Due to chemotherapy - Chemotherapy drugs may be either irritants or vesicants - Irritants will damage the intima of the vein, causing phlebitis and sclerosis and limiting future peripheral venous access, but will not cause tissue damage if infiltrated. - Major concerns associated with the IV administration of antineoplastic drugs include venous access difficulties, device- or catheter-related infection, and extravasation (infiltration of drugs into tissues surrounding the infusion site), causing local tissue damage - It is extremely important to monitor for and promptly recognize symptoms associated with extravasation of a vesicant and to take immediate action if it occurs.
Dry Desquamation
Erythema is an acute response followed by this - Dry reactions are uncomfortable and result in pruritus - Lubricate the dry skin with a nonirritating lotion emollient (such as aloe vera) that contains no metal, alcohol, perfume, or additives that can be irritating to the skin
Palliative surgery
Focuses on improving the quality of life during the survival time, not on cure - Examples include removal of tumor tissue that is causing pain, obstruction, or difficulty swallowing
Cancer classification
Grading - Ploidy - Staging - TNM -- T - Tumor -- N - Regional Lymph Nodes -- M - Metastasis - Doubling time and mitotic index
Benign
Harmless; does not usually require intervention
Oncogenes have the potential to change a normal cell to a malignant one.
How do oncogenes affect cancer development? A. Oncogenes are cancer causing agents. B. Oncogenes have the potential to change a normal cell to a malignant one. C. Oncogenes are part of the surveillance system that recognizes abnormal cellular development. D. Oncogenes are a mutation in the cellular structure.
Primary tumors
Identified by the tissue from which it arose (parent tissue)
Wet Desquamation
If the rate of cell sloughing is faster than the ability of the new epidermal cells to replace dead cells, a wet desquamation occurs with exposure of the dermis and weeping of serous fluid - Wet reaction must be kept clean and protected from further damage. - Wet desquamation of tissues generally produces pain, drainage, and increased risk of infection. - wash by running cool water over it no soap and no rubbing, loose fitting clothes, prevent rubbing
Reconstructive surgery
Increases function, enhances appearance, or both - Examples include breast reconstruction after mastectomy, replacement of the esophagus, bowel reconstruction, revision of scars, and cosmetic reconstruction in head and neck cancer.
Metastasis
Occurs when cancer cells move from the primary location by breaking off from the original group and establishing remote colonies - These additional tumors are called metastatic or secondary tumors - Even though the tumor is now in another organ, it is still a cancer from the original altered tissue - For example, when breast cancer spreads to the lung and the bone, it is still breast cancer in the lung and bone—not lung cancer and not bone cancer.
Cancer etiology
Oncogene activation - Chemical carcinogenesis Physical carcinogenesis - Viral carcinogenesis - Dietary factors - Genetic, Life Style factors -- Immune function -- Advancing age -- Genetic risk
Protection from side effects
Patient protection from Chemotherapy - Infection risk - Bone marrow suppression - Neutropenia - Anemia thrombocytopenia risk - Bone marrow suppression - Impaired clotting
Oldest cancer treatment
Prophylaxis - Diagnosis - Cure - Control - Palliation - Assessing therapy effectiveness (biopsy) - Reconstruction (implants after mastectomy)
Collaborative care
Provide accurate information to help clients cope - Skin care needs during radiation therapy (no dies, fragrances, scents, alcohol) - Do Not remove temporary ink markings - AVOID skin irritation (Keep dry, wear lose/comfy fabric, no tanning, no swimming in pool or ocean due to chemicals and salt) - Follow radiation-oncology department's policy for skin care product use - Nutritional support - Care for xerostomia (dry mouth) -- Chew gum, soft tooth brush, rinse with water - Teach about risk for fractures (for bone exposed to radiation) - Exercise and sleep interventions for fatigue (Maintain circadian rhythm, relaxation techniques)
Radiation therapy for cancer
Purpose - Destroy cancer cells with minimal damaging effects of surrounding normal cells; maintain safe environment - Local treatment - Ionizing radiation - Exposure - Amount of radiation delivered - Radiation dose - Amount of radiation absorbed
teletherapy
Radiation delivered from a source outside of the patient - Because the source is external, the patient is not radioactive and is not hazardous to others - Newer teletherapy delivery methods improve the accuracy of the dose delivered - Intensity modulated radiation therapy (IMRT) breaks the single beam into thousands of smaller beams that better focus on the tumor - Stereotactic body radiotherapy (SBRT) uses three-dimensional tumor imaging to identify the exact tumor location, which allows precise delivery of higher radiation doses and spares more of the surrounding tissue - Usually, the total dosage is delivered in one to five separate treatment sessions - Regardless of the delivery method, the exact tumor location is first determined for therapy accuracy
Brachytherapy education
Radiation precautions - How to handle body waste - Family education
Consequences of cancer
Reduced immune and blood-producing function - Altered GI structure and function - Motor and sensory deficits - Decreased respiratory function
Cancer Prevention (secondary)
Regular screening - genetic screening - Limit alcohol use - Get regular physical activity - Maintain a normal body weight - Have regular physical examination - Obtain regular colorectal screenings - Avoid cigarette smoking and other tobacco use - Get regular mammography screening and pap tests - Know your family history - Know the risk factors of cancer - Get adequate consistent periods of rest - Use sunscreen with an SPF or 15 or higher. - Avoid tanning beds - Manage & decrease stress - Eat a balanced diet of vegetables, fresh fruits, whole grains, adequate fiber - Decrease fat, preservatives, salt-cured meats
Prophylactic surgery
Removes "at-risk" tissue to prevent cancer development. It is performed when a patient has either an existing premalignant condition or a strong predisposition for development of a specific cancer - For example, removing a benign polyp from the colon before it can develop into colon cancer is a prophylactic action
Curative surgery
Removes all cancer tissue - Surgery alone can result in a cure rate of about 30% when all visible and microscopic tumor is removed or destroyed - This number could increase with screening and early detection efforts
Health care provider safety
Specific protocol for handling chemotherapy drugs, or excreta from patients receiving IV chemotherapy - eye protection - masks - double gloves (chemo gloves) - gown
Promotion
The enhanced growth of an initiated cell by substances known as promoters - Once a normal cell has been initiated by a carcinogen and is a cancer cell, it can become a tumor if its growth is enhanced - Many normal hormones and body proteins, like insulin and estrogen, can act as promoters and make cells divide more frequently - The time between a cell's initiation and the development of an overt tumor is called the latency period, which can range from months to years - Exposure to promoters can shorten the latency period
Initiation
The first step in carcinogenesis - Normal cells can become cancer cells if they lose cellular regulation by having their genes promoting cell division, oncogenes, turn on excessively (overexpressed) - A change in gene expression caused by anything that can penetrate a cell, get into the nucleus, and mutate the DNA, leading to loss of cellular regulation - Changes can activate oncogenes that should have only limited expression and can damage suppressor genes, which normally limit oncogene activity - Leads to excessive cell division through DNA damage that results in loss of cellular regulation by either loss of suppressor gene function or enhancement of oncogene function. - Irreversible event that can lead to cancer development. - After initiation, a cell can become a cancer cell if the cellular regulation loss that occurred during initiation continues. If growth conditions are right, widespread metastatic disease can develop from just one cancer cell
Oncogene activation
The main mechanism of carcinogenesis regardless of the specific cause - These oncogenes are 366turned on (expressed) under controlled conditions for cellular regulation when cells divide for normal growth and replacement of dead or damaged tissues - At other times they are turned off, controlled, or suppressed by products of "suppressor genes."
primary tumor
The original tumor is called the this - It is usually identified by the tissue from which it arose (parent tissue), such as in breast cancer or lung cancer - When primary tumors are located in vital organs, such as the brain or lungs, they can grow and either lethally damage the vital organ or interfere with that organ's ability to perform its vital function - In soft tissue that can expand without damage as the tumor grows - One such site is the breast - Breast is not a vital organ, and even with a large tumor, the primary tumor alone would not cause the patient's death - When the tumor spreads from the original site into vital areas, life functions can be disrupted and death may follow.
Cancer Metastasis
The pathogenesis of cancer metastasis - To produce metastases, tumor cells must detach from the primary tumor and enter the circulation, survive in the circulation to rest in the capillary bed, adhere to capillary basement membrane, gain entrance into the organ parenchyma, respond to growth factors, proliferate and induce angiogenesis, and evade host defenses.
Diagnostic surgery (biopsy)
The removal of all or part of a suspected lesion for examination and testing - It provides evidence for the presence of cancer - Other forms of therapy are seldom initiated without this confirmation of cancer - The extent of a biopsy varies from a fine needle aspiration to an open incision exploratory surgery
Treatment goals
Three Main Medical Goals -- Curative -- Control -- Palliative Most common treatments -- Surgery -- Radiation -- Chemotherapy -- Immunotherapy/Biotherapy
Chemotherapy
Treatment of cancer with chemical agents - Used to cure and increase survival time - Adjuvant therapy = Chemotherapy + surgery or radiation - Cytotoxic effects exerted on healthy cells and cancer cells
Radiation therapy
Used by > 50% of cancer patients - May be primary treatment - Hodgkin's - Early-stage breast cancer - Laryngeal - Prostate - Vaginal - Cervical
Cachexia
What assessment data will the nurse anticipate with advanced gastrointestinal cancer? A. Vaginal bleeding. B. Cachexia. C. Nagging cough. D. Painful urination.
"It's important that you connect with a support group as you are trying to stop smoking."
What strategy will the nurse teach a client to reduce the incidence of cancer? A. "Be sure to get a colonoscopy every 10 years." B. "It's important that you connect with a support group as you are trying to stop smoking." C. "You do need to have a clinical breast exam every year, but be familiar with your breast tissue." D. "Tell the health care provider if you notice any bleeding in your stool."
"Radiation stops the cancer cells from reproducing by damaging the cellular DNA."
What will the nurse teach the client about radiation therapy? A."Radiation is often given in a single dose." B."Radiation stops the cancer cells from reproducing by damaging the cellular DNA." C."The marks that are place on the skin to guide radiation should be washed off." D."Radiation is only used when curative therapy is the goal."
Biological response modifiers.
Which cancer treatment strategy uses the body's own immune system to fight cancer? A.Biological response modifiers. B.Chemotherapy. C.Hematopoietic stem cell transplantation. D.Brachytherapy.
"Sometimes it is subtle, but all cancer produces symptoms."
Which client statement about cancer symptoms requires additional education? a. "A sore that doesn't heal can be a sign of cancer." b. "Sometimes it is subtle, but all cancer produces symptoms." c. "Cancer can cause you to gain or lose weight." d. "I know I should check my breast for dimpling of the skin."
Assisting a client undergoing a mammography.
Which nursing action demonstrates secondary prevention of cancer? A. Teaching a class on smoking cessation. B. Administering the HPV vaccine. C. Assisting a client undergoing a mammography. D. Encouraging the teenage client to apply sunscreen.
