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Oncology Nursing

Oncology Nursing

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Published by Cham Rafaela Conese

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Published by: Cham Rafaela Conese on Jun 01, 2012
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11/29/2012

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ONCOLOGY Nursing
CANCER
Epidemiology
 
2
nd
leading cause of death (US)
 
Increasing age
 
90-95% related to life-style and environmentalcarcinogens.
Pathogenesis of Cancer
 
Cellular Transformation and DerangementTheory
 – 
 
Exposure to carcinogens
 
Failure of the Immune Response Theory
 – 
 
Failure of the immune system toinability to destroy the cancer cells
Proliferative Growth Patterns
 
Four Common Nonneoplastic Growth Pattern:
 – 
 
Hyperplasia
 – 
 
Metaplasia
 – 
 
Dysplasia
 – 
 
Anaplasia
Neoplasm
 
Is an abnormal mass of tissue
 
The growth persist after cessation of the stimulithat initiated the change
 
Cancer 
 
 –
is the common term for all malignantneoplasms
 
How are cancers classified?Categories of Tumors:
 
benign tumors
 
malignant tumors
Distinction Between Malignant and Benign
 
differentiation and Anaplasia
 
Rate of growth
 
Local invasion
 
Metastases
Differentiation
 
Is the extent to which tumors cells resemblecomparable normal cells.
 – 
 
Benign
 –
well differentiated
 – 
 
Malignant
 –
poorly differentiated,anaplastic
 
Anaplasia
 –
lack of differentiation, hallmark of malignant cells
Rate of growth
 
malignant tumors grow more rapidly thanbenign tumors
 
Some grow slowly for years and then enter thephase of rapid growth
 
Hormone sensitive tissues
Local invasionBenign tumors Malignant tumors
Capsule NoneDo not penetrate thecapsuleInvasive, infiltratingDo not penetrate normaltissueDestroying normal tissuessurrounding themSurgical enucleation Surgical enucleationdifficult and impossible
Metastasis
 
lymphatic, blood vessels, and body cavities.
 
Single most important feature
 
Lung, liver, brain and bones
 
Distant spread of tumors occurs by threeroutes:
 
spread into body cavities
 
invasion of lymphatics
 
Hematogenous spreadCLASSIFICATION OF NEOPLASMSBenign neoplasia
 
Growth remain circumscribed (capsule)
 
Generally not life threatening unless they occurin a restricted area
 
Well differentiated
Classified according to the tissue involved:
 – 
 
Adenoma
 –
glandular tissue
 – 
 
Leiomyoma
 –
smooth muscle
 – 
 
Chondroma
 –
cartilaginous tissue
 – 
 
Osteoma
 –
bone osteoblast
 – 
 
Hemangioma
 –
blood vessel
 – 
 
Lymphangioma
 –
lymphatics
 – 
 
Neuroma
 –
nerve cells
 – 
 
Lipoma
 –
adipose tissue
 – 
 
Papilloma
 –
epithelial tissue
 
 – 
 
Rhabdomyoma
 –
skeletal tissue
 – 
 
Fibroma
 –
fibrous tissue
Malignant Neoplasia
 – 
 
no capsule
 – 
 
infiltrate surrounding tissue
 – 
 
produce secondary lesions
 – 
 
may metastasize
 – 
 
anaplasia
Malignant NeoplasiaTypes of malignant neoplasm:
 
Solid cancers (Tumors)
»
 
carcinoma : arises in epithelial cells
»
 
sarcoma : arises in connective tissue,muscle or bone
 
Hematological cancers
»
 
Leukemia
 –
arises in blood
»
 
Myeloma
 –
arises in bone marrow
»
 
Lymphoma
 –
arises in lymph
Tumors are classified according to the tissue involved:
 
adenocarcinoma
 –
glandular epithelial tissue
 
osteosarcoma
 –
bone osteoblasts
 
leiomyosarcoma- arising from smooth muscle
 
Hemangiosarcoma
 –
blood vessels
 
Lymphangiosarcoma
 –
lymphatics
 
Neurofibrosarcoma (neurilemic sarcoma)
 –
 nerve sheath
 
Melanoma
 –
melanocytes
Comparison of the Characteristics of Benign andMalignant NeoplasmBenign
 
Grows slowly
 
Remains localized
 
Encapsulated
 
Well differentiated mature cells; cells functionpoorly
 
Extremely unusual when surgically removed
 
Never occur
 
Not harmful to host
 
Very good prognosis
Malignant
 
Grows rapidly
 
Infiltrates surrounding tissues
 
Not encapsulated
 
Poorly differentiated (anaplastic type)
 
Common following surgery
 
Very common
 
Always harmful
 
Poor prognosis
What are the risk factors for cancer?Predisposing factors
 
geographical and environmental factors
 
men
 –
lung, colon and prostate cancer
 
women
 –
lung, breast and colon
 
in Japan, the death rate from cancer of the stomach is about seven times thatin the US
 
increased risk with exposure toasbestos, vinyl chloride and 2napthylamine
 
association of carcinomas of theoropharynx, larynx and lungs withcigarette smoking
 
age
 
cancer is most common in those olderthan 55 years old.
 
Certain cancers are particularlycommon in children younger than 15years of age
 
Tumors of hematopoietic system(leukemias and lymphomas)
 
Neuroblastomas
 
Wilms tumor
 
Retinoblastomas
 
Sarcomas of bone and skeletal muscle
 
heredity
 
acquired preneoplastic disorder
 
certain clinical condition are associated withan increased risk of developing cancers:
»
 
cirrhosis of the liver
 –
Hepatocellularcarcinoma
»
 
atrophic gastritis of pernicious anemia
 –
 stomach cancer
»
 
chronic ulcerative colitis
 –
carcinoma of the colon
»
 
leukoplakia of the oral and genitalmucosa
 –
squamous cell carcinoma
 
 
CARCINOGENIC AGENTS1. Carcinogenic chemicals
 
alkylating agents
 –
cyclophosphamideand busulfan
 
aromatic hydrocarbons
 –
cigarettesmoke
 
Azo dyes-beta napthylamine
 –
bladdercancer (rubber industries)
 
Naturally occurring carcinogens
 –
aflatoxin B1,produced by Aspergillus flavus
 
Nitrosamines and amides
 –
gastric cancer
 
Miscellaneous agent
 –
asbestos, vinyl chlorideand metals such as nickels
 
Hormones such as estrogen
 –
endometrialcancer
2. Radiation carcinogen (ionizing Radiation)
 
Electromagnetic and particulate radiations arecarcinogenic
 
Miners of radioactive ores
 –
lung carcinoma
 
Survivors of atomic bomb in Japan
 –
leukemia
 
Therapeutic radiation in the neck
 –
laterdeveloped thyroid cancer
 
Ultraviolet rays
 
Natural radiation especially UVB, derived fromthe sun can cause skin cancer
 
Particularly common in Australia and NewZealand.
3. Viral and microbial carcinogenesis
 
HPV
 
Epstein Barr virus (EBV
 
Hepatitis B virus (HBV)
»
 
EBV
 
Burkitt lymphoma
 
Nasopharynbgeal carcinoma
 
B-cell lymphoma
 
Some forms of Hodgkin disease
»
 
HPV
 
Squamous cell cancer of the uterinecevix ( HPV type 16 and 18)
 
Genital warts (HPV 6 and 11)
»
 
Hepatitis B. virus
 
Hepatocellular carcinoma
 
HCV also associated with hepatic cancer
»
 
RNA oncogenic virus
 
Human T-cell lymphotrophic virus type1
 
Strong tropism with CD4 T cells
 
Cause leukemia/lymphoma
»
 
Helicobacter pylori
 
Peptic ulcer
 
Gastric lymphoma
 
Gastric carcinoma
Signs and Symptoms of Cancer
 
C
 –
change in bowel or bladder habits
 
A
 –
 
a sore that doesn’t heal
 
U
 –
unusual bleeding or discharge
 
T
 –
thickening or lump in tissue
 
I
 –
indigestion or difficulty swallowing
 
O
 –
obvious change in wart or mole
 
N
 –
nagging cough or hoarseness
Staging and Grading of Neoplasia
 
TNM system
T - designates a primary tumorN - designates lymph node involvementM - designates metastasis
 
Numbers 0 to 4 designate degree of involvement
 
Laboratory Diagnosis of CancerFine Needle Biopsy
 
Involves aspiration of cells and fluids fromtumors or masses that occur in readily palpablesites
 
The aspirated cells are smeared, stained andexamined
Cytologic (papanicolaou) smears
 
Involve examination of cancer cells that arereadily shed
 
Exfoliative cytology is used most commonly inthe diagnosis of dysplasia, carcinoma in situ,and invasive cancer of the uterine cervix tumorsof the stomach, bronchus and urinary bladder
Tumor markers
 
Tumor derived or associated molecules that canbe detected in blood or other body fluids
 
They are not primary method of diagnosis butrather adjuncts to the diagnosis
 
They may also be value in determining theresponse to therapy

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