ONCOLOGY

By: EABSM

Common Terminologies
Oncogene cancer genes that alter normal genes Proto oncogenes repressed oncogene that can activated by etiologic and risk factors Anaplasia no resemblance to tissues of origin Metaplasia replacement of the original cell with another type of cell Carcinoma cancer cell composed of epithelial cells that can spread Neoplasm growth of new tissue Tumor same with neoplasm

 Tumor can be:

Benign Localized Encapsulated Hyperplasia, o functional activity Malignant Systemic Not encapsulated Anaplasia, metaplasia (o or q function of the organ involved) With metastasis (direct invasion, lymphatic, embolism, diffusion) Harmful Hardly differentiated Rapid growth

No metastasis

Fatal if it occurs in restricted area (skull) Fully differentiated Slow growth

Classification of Cancer: Squamous cell carcinoma surface epithelial Adenosarcoma glandular epithelial Fibrosarcoma fibrous connective tissue Liposarcoma adipose tissue Chondrosarcoma cartilage Osteosarcoma bone

Hemangiosarcoma blood vessels Lymphangiosarcoma lymph vessels Leiomyosarcoma smooth muscles Rhabdomyosarcoma striated muscles Glioma glial cells Neurolemic sarcoma nerve sheath Leukemia blood

Classification of Benign Neoplasia: Glandular tissue adenoma Bone osteotoma Nerve cells neuroma Fibrous tissue - fibroma

Etiology
Exact cause is still unknown Viruses cancer of the liver, burkitts lymphoma Chemical Agents tar, asphalt, arsenicals, fuels, oil Drugs chemodrugs Physical Agents radiation

 Predisposing Factors: Age (60% of cancer clients are over 65 y/o) Sex Breast cancer for females and Prostate CA for males Geographic location cancer of the stomach (Japan)

Occupation factory workers (lung cancer) Hereditary breast, ovaries and colon Diet cured and salted foods (stomach) Stress decreased immune system Precancerous lesions moles, polyps (colon and stomach)

 Early Detection: Chest xray and sputum cytology (lung cancer) Physical exam (every year for over 40 y/o) skin, lymph nodes, mouth, thyroid, breast, testes, rectum, prostate Oral Exam - annually TSE monthly following shower Digital Rectal Exam annually for 40y/o and above

 BSE every month after menstruation Breast Clinical Exam done by physician (every 3 years for 202040 y/o then yearly for over 40 y/o) Mammography once for 35-40 y/o, then yearly for over 50 y/o 35 Pap smear age 18 and all sexually active women then yearly after 3 negative results Pelvic Exam same with pap smear Endometrial tissue sampling menopause Sigmoidoscopy for 50 y/o and above annually for 2 years then every 3 years if negative Fecal Occult Blood doctors recommendation

7 Warning Signals: C hange in bowel and bladder habits A sore that does not heal U nusual bleeding or discharge T hickening or lump in breast or elsewhere I ndigestion or difficulty in swallowing O bvious change in wart or mole N agging cough or hoarseness of the voice U nexplained anemia S udden weight loss

7 SAFEGUARDS U terus annual pap smear B reast regular BSE B asic PE yearly for all adults L ung control or preferably stop smoking annual chest xray for high risk O ral annual oral exam by the doctor C olon or Rectum DE, proctosigmoidoscopy (40y/o) S kin avoid undue exposure to sunlight (10-2 PM) (10-

Factors that lead to Cancer

Smoking lung cancer Sunlight (10am to 2pm) basal/squamous cell (skin cancer) Ionizing Radiation medical and dental xrays Nutrition and diet (high fats and low fiber diet) Alcohol liver, oral and esophagus cancer Chewing of tobacco (mouth, larynx and throat) Estrogen endometrial cancer (give it with estrogen) Occupational hazards (nickel and asbestos)

Diagnostic Exam
Biopsy FNA Incision Excision CT scan MRI PET Direct Visualization Bronchoscopy Gastroscopy Proctosigmoidoscopy

Mammogram Pap smear UTZ Angiogram Lymphangiogram Blood Studies Antigen-skinAntigen-skin-testing

Staging and Grading

T Tumor T0-T4 T0N Node N0-N3 N0M Metastasis M0-M3 M0Tis carcinoma in situ (non-infiltrating) (nonX cant be assessed Normal T0, N0, M0 Stage I T1, N0, M0 Stage II T2, N1, M0 Stage III T3, N2, M0 Stage IV with metastasis

Stages of Metastatic Process

Invasion of adjacent tissue Spread of cancer cells Establishment and growth at secondary site

Effective Test must be

Specific for the type of Cancer Reliable Economical on terms and benefits Acceptable to the client (most important)

Points to Remember
Most client fear of death upon confirmation of Cancer Clients usually ignored cardinal signs of Cancer Most often cancer is detected during routine exam Questions that need to be answered: Example (Is the disease curable or not?)

Client Reaction during Diagnoses

Client will use coping strategies to q his anxiety level such as: DenialDenial Rational inquiry-seek more information inquiry Affect Reversal-make light of the situation (laughing Reversaletc.) Mutuality-share concerns and talk with other persons Mutuality Suppression-conscious forgetting Suppression Displacement or redirection-do other things redirection-

Confrontational Redefine or revise Passive acceptance Disengagement Externalization or Projection Moral masochism Compliance and cooperational

Intervention Phase
Therapeutic communications (silence, non judgemental, acceptance, active friendliness, setting limits) Strategizing how to use effective coping mechanism (client and SO) Cancer management will involve surgery, radiatioo, chemo and immunotherapy in combination.

Surgery
Used in diagnosing, staging and treating the client FNA, I&E biopsy Cytology specimens Palliative relieves pain, airway obstruction. Reconstructive restore maximal function and appearance Preventive removal of target organ

Radiation Therapy
Alpha particle-fast moving helium nucleus particle(slight penetration) Beta particle-fast moving electron (moderate particlepenetration) Gamma ray-similar to light ray (high raypenetration) Sodium Iodide (131 I)-for thyroid gland I) Gold (198 Au)-effective for ascites and pleural Au)effusion

 Sodium Phosphate (32 P)-for RBC P) Destroys the ability of the cell to reproduce by damaging the DNA Range will be 2,000-5,000 centigrays (cGy) 2,000 o 5,000 cGy will o SE Normal cells and cancer cells are both affected

 The goal is to destroy malignant cells without harming normal cells by: FractionationFractionation-small frequent dose Alternating the site

Radiation Safety
Distance-the greater the distance the lesser the Distanceexposure Time-the less time spent close to radiation the Timeless exposure Shielding-use lead aprons and gloves Shielding Standards-kept as low as reasonably achievable Standards Monitoring device-film badge (measure the devicewhole exposure of the nurse)

Types
External Radiation Administered by high energy xray machine (radioisotope Cobalt for Prostate and Lung CA) Internal Radiation Via injection or orally Sealed source-radioisotope is placed into needles, beads, seeds, sourceribbons or catheter then implanted directly into the tumor. Requires a private room and bathroom Room must be lead-shield proof lead Lead container and long forcep on bedside Check linen and other materials for the presence of isotope

 Unsealed source-radioisotope is administered IV or sourceorally NaP04 (32 P) IV for polycythemia vera (131 I) PO for graves disease Potential hazard exist because its not encased Isotope maybe excreted via body fluids Flush the toilet several times after use Protect staff and visitors Marked room and kardex with RADIATION HAZARD

Chemotherapy
Use of chemicals to destroy cancer cells Interferes DNA & RNA activities associated with cell division Often used in combination with radiation therapy Cytotoxic-is an agent capable of destroying cells Cytotoxic Cytotoxic drug-alkylating and antimetabolites drug-

Goal
Destroy all malignant cells without excessive destruction of normal cell Control growth of tumor when cure is not possible Note: all rapid dividing cells (GI mucosa, hair follicles and bone marrow) are susceptible to the action of chemo and radiation therapy.

Reasons of Combining Drugs

Synergy-two or more agents works together to Synergyenhance the effect of one another Adjuvant-an additional treatment Adjuvant os malignant cell destructions, qs the SE Principle of MDT may be instituted to avoid and prevent the SE

Antineoplastic Drugs
Alkylating Agents Attack the DNA of rapidly dividing cell Nitrosurea: Carmustine (BCNU) Nitrogen Mustard: Chlorambucil (Leukeran) Cyclophosphamide (Cytoxan)

Vinca Alkaloids Interfere with mitosis (M phase) Vincristine (Oncovin) Vinblastine (Velban) Antimetabolites Inhibits protein synthesis (S phase) Azathioprine (Imuran) Fluorouracil (5-FU) Methotrexate (5(Mexate) Antibiotics Inhibit RNA Doxorubicin HCl (Adriamycin) Mithramycin (Mithracin)

 Hormone Inhibit RNA and protein synthesis in tissues that are dependent on the opposite sex Androgens, Estrogens, Progestins, Steroids (Analogue, Exogenous) Hormone Antagonist: Mitotane (Lysodren) cortisol antagonist, Tamoxifen Citrate (Nolvadex) estrogen antagonist Immune Agents Introduction of an agent to stimulate production of antibodies Bacillus Calmette-Guerin (BCG) Calmette-

Side Effects from Radiation and Chemo Therapy

Neurologic/Sensory/Perceptual Meningeal irritation CN and peripheral neuropathy Cerebellar toxicity Ototoxicity Cardiac Pericardial Effusion Arrhythmias CHF Pulmonary Pleural Effusion Pneumonitis

 GIT Stomatitis Esophagitis Pharyngitis Taste alteration Anorexia Nausea and vomiting Constipation and diarrhea Weight loss

 GUT Nephrotoxicity Hemorrhagic cystitis Hyperuricemia Urine color changes

Reproductive Loss of libido Impotence Amenorrhea Irregular menses Menopausal symptoms Azoospermia Sterility Gynecomastia

Hepatic Hepatotoxicity Integumentary Alopecia Dermatitis and ulcers Hematopoietic q bone marrow activity anemia, prone to infection and bleeding tendency Metabolic TLS and Hyperkalemia

Perceived Change in Body Image

Obvious reminder of disability need for prosthesis (breast, leg and eye) need for hardware (wheel chair, crutches) need for medication (CR therapy) extent of disability or limitation )

Type of loss
symbols of sexuality social acceptability (colostomy) ability to communicate (laryngectomy, aphasia) anatomic changes (amputation)

Terminally Ill
50% die from the disease time from diagnosis to death ranges from weeksweeks- years not all clients become terminally ill others die during initial treatment; others die from complications of treatment Endpoint: no response to treatment and progressions cannot be controlled

HOSPICE CARE
standard of care for terminally ill cancer clients symptom control pain management providing comfort and dignity 24 hour 7 day coverage services given is based on clients need not on its ability to pay

Ethical Issues
caring can be just successful as curing; when curing is not an option care is exercised during the final stage of life

Goals of Intervention
to care without functional and structural impairment if cure is not possible goals must prevent further metastasis relieve symptoms maintain high quality of life