1 DIFFERENT CANCER TYPES

SKIN CANCERS The uncontrolled growth and division of skin cells There are two general types of skin cancer: MELANOMA AND NONMELANOMA Most co on for of cancer !ause is sun e"posure !o on sites are sun-e"posed areas such as the face# neck# $ack# forear s# and $ack of hands Pathophysiology A$nor al growth and proliferation of skin cells# resulting in the loss of their function and structure Three Common Types of Skin Cancer 1. asal Cell Carcinoma ost co on type of skin cancer co only presents as a pink# translucent# or pearly papule with over lying s all $lood vessels $leeds and sca$s easily painless and slow growing surgical re oval usually cures this type of cancer typically does not etastasi%e 2. S!"amo"s Cell Carcinoma Typically presents as a rough# scaly# fleshy nodule that&s fir 'lcerates with tu or growth and sca$s Although locali%ed# without treat ent# it can etastasi%e Also known as (O)EN&s disease when it&s confined to the epider is #alignant #elanoma *kin cancer involving the uncontrolled growth and division of elanocytes Typically presents as a dark $rown# $lue# or $lack skin lesion or ulcer that $egin in an e"isting ole $ut can etastasi%e to every organ in the $ody !ura$le if caught early# $ut is potentially fatal if untreated or detected late Dysplastic Ne$"s Syn%rome +enerally larger than ordinary oles and have irregular and indistinct $orders, Their color fre-uently is not unifor and ranges fro pink to dark $rown They usually are flat# $ut parts ay $e raised a$ove the skin surface, This suggests the person is at increased risk for elano a Diagnosis& .hysical e"a and skin $iopsy for confir ation Treatment #o%alities& /, !urettage and Desiccation !ancer cells are scraped out and $urned 'sed for s all local tu ors such as s-ua ous cell carcino a in situ 0, !ryosurgery Lesion is fro%en with li-uid nitrogen causing a $lister and sca$ for ation# which then falls off leaving a s ooth surface 1, *urgical E"cision !ancer cells are cut out along with a argin of nor al appearing tissue to ini i%e the risk of recurrence *kin is then sutured 2, !he otherapy and 3adiation Therapy 'sed when cancer cells have spread to the ly ph nodes or distant sites 5 unotherapy 5nterferon sti ulates i une syste 'sed in treat ent of elano a

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Important actions for patient's (ith skin cancer or at risk for skin cancer /, .erfor onthly self-e"a inations in addition to having routine e"a inations perfor ed $y a der atologist 0, Avoid unnecessary e"posure to sunlight# particularly $etween /6a and 0p when ultraviolet radiation peaks, 1, Avoid artificial sunlight such as tanning $eds RAIN T)#*RS A ass growth of a$nor al cells in the $rain tissue that are typically classified as either pri ary or secondary lesions .35MA37 LE*5ON* originate in the $rain and ay $e $enign or alignant *E!ONDA37 LE*5ON* are alignant and are the result of cancer etastasis fro another location in the $ody Most co on in children ages 1 to /0 and in adults ages 26 to 86 Pathophysiology A$nor al cells arise within the $rain tissue# which can e"ert pressure on the cranial nerves as the tu or enlarges 'nderlying cause is unknown Clinical #anifestations /, .ressure headaches usually worse in the orning and upon awakening 0, vo iting not preceded $y nausea 1, visual changes or loss of visual field 2, $ehavioral changes 4, he iparesis and he iplegia 9, hearing deficits 8, speech difficulties :, sei%ures Complications /, 0, 1, 2, 4, cranial nerve dysfunction sei%ures te porary or per anent $rain da age increased 5!. fro hydrocephalus death

3.

Treatment #o%alities 1. !orticosteroids# such as De"a ethasone# and Os otic diuretics such as Mannitol# to reduce cere$ral ede a 2. Anticonvulsants to prevent sei%ures 3. *urgical procedures including laser destruction of tu or tissue or place ent of shunts within the $rain to treat hydrocephalus 4. !ranioto y with tu or resection ;de$ulking< when the tu or can $e easily accessed and there&s low risk of da age to vital areas, 5. 3adiation therapy after surgical re oval of alignant tu ors

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6. 7. !he otherapy ad inistered via various routes =+a a >nife? Therapy# involving speciali%ed high dose radiation focused to the tu or that can $e perfor ed $efore or after the surgery Assess neurologic status and report even su$tle changes 2. 5 ple ent sei%ure precautions for patient safety 3. Assess 5!. ;if 5!. onitor is placed< at fre-uent intervals and report any sustained elevations to the physician 4. Assess electrolyte $alance 5. Ad inister edications as ordered $y physician, !orticosteroids# anticonvulsants and ild analgesics are typically used $ecause the $rain doesn&t have pain !hronic da age to the $ronchial ucosa results in e"cessive proliferation of the $ronchial cell# chronic infla ation# and DNA da age- all of which pro ote the develop ent of lung cancer ,"ng Cancer Categories 1. *MALL-!ELL: aggressive etastasisC occurs predo inantly in s okers 2. NON-*MALL !ELL: ore co onC further divided into s-ua ous cell# adenocarcino a# and large cell carcino a Clinical #anifestations ;Typically produces no sy pto s in the initial phase< 5. 6. 7. 5. 6. fatigue anore"ia weight loss .rovide fre-uent rest periods to ini i%e fatigue Monitor the patient for co plications of the disease process ;respiratory distress# hypercalce ia< or its treat ent ;leucopenia# increased risk of infections< Encourage close edical check up 1.

Note& .atients should not $e placed on the operative side for at least : hours after a cranioto y Important actions in the care of a patient (ith a +rain t"mor 6. receptors,

,)N- CANCER A condition characteri%ed $y a$nor al cell growth and differentiation within the lung tissue or parenchy a * oking accounts for appro"i ately :4@ of the cases E"posure to as$estos# second hand s oke# or radon gas also increases the risk Pathophysiology (3ON!AO+EN5! !A3!5NOMA arises fro the $ronchial ucosa as a result of chronic inBury or da age to the ucosa# ost co only fro cigarette s oke or environ ental to"ins 1. chronic cough 2. he optysis 3. chest pain 4. dyspnea Aeadaches# $one pain# and Ly phadenopathy can occur secondary to etastatic disease Complications 1. 2. 3. pneu onia etastatic disease death

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Treatment #o%alities 1. *'3+5!AL 3E*E!T5ON Wedge resection or segmentectomy- re oving a s all section of the lung, The doctor ay use these types of surgery if patient has $een diagnosed with an early stage and the cancer is very s all, Lobectomy- the re oval of a lo$e of the lungs, The right lung has three lo$es and the left lung has two lo$es, oval of an entire lung and is used when your doctor $elieves that cancer is present in only one lung $ut it ay $e anywhere in that lung, !AEMOTAE3A.7 ;with or without radiation treat ent< depending on si%e and staging of tu or

*RA, CANCER A$nor al# alignant tissue growth affecting the lip and oral cavity that occurs ost co only in people who use large -uantities of to$acco and alcohol products Lip cancers ost co only affect pipe s okers and fair-skinned people who have had e"cessive sun e"posure Pathophysiology 'nregulated cellular growth and differentiation produces alignant tu ors of the lip and oral cavity Clinical #anifestations 1. a lu p in the lip# outh or gu s 2. a non-healing sore of the lips or oral cavity 3. leukoplakiaprecancerous white patches in the outh 4. altered taste sensations 5. difficulty swallowing 6. dentures that no longer fit early Complications 1. 2. 3. NOTE: .ain is typically not an anifestation of oral cancers Disfigure ent of face# head or neck ;postoperatively< dry outh and difficulty swallowing ;after radiation therapy< etastasis to the neck or other sites

Pneumonectomy- is the re

2.

Important actions in the care of a patient (ith l"ng cancer 1. Encourage s oking cessation, Discuss options of nicotine patches or chewing gu and the use of antidepressants# such as (upropion ;)ell$utrin# Dy$lan<# to facilitate s oking cessation, 2. .rovide skin care for patients receiving radiation treat ent, Avoid re oving any radiation arkings 3. Encourage ade-uate intake of highcalorie food 4. Ad inister edications ;o"ygen# opioid analgesics< as ordered $y the physician

Treatment #o%alities

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1. 2. *'3+5!AL 3E*E!T5ON: re oval of the tu or and any affected ly ph nodes 3AD5AT5ON TAE3A.7: to kill cancer cells and shrink the tu or use othguard to prevent $iting of the scope e ergency e-uip ent ust $e on the $edside

Important actions in the care of a patient (ith oral cancer 1. Advise the patient to avoid alcohol and to$acco products 2. .rovide fre-uent oral hygiene# including saline outh-washes to relieve dry outh 3. Educate the patient preoperatively a$out the ethod of co unication following surgery ;writing $oard< 4. Ad inister analgesics as ordered $y the physician for pain control 5. .ro ote reha$ilitative services# including speech therapy and learning to chew and swallow following surgery 6. Encourage regular dental e"a inations ; any oral cancers are found incidentally $y dentists< and follow up with the physician regularly ES*P.A-EA, CANCER A$nor al# alignant tissue growth within the esophagus that co only affects people with e"tensive alcohol or to$acco use and chronic gastric reflu" .eople with hiatal hernias# (arrett&s esophagus ;precancerous cells of the esophagus fro chronic reflu"<# and achalasia ;a condition in which the lower esophageal sphincter can&t rela" ade-uately to allow food to pass to the sto ach< are at higher risk for the develop ent of esophageal cancer, Mostly wo en $etween 26-86 years old ;o$esity# ascites# trau a< !ertain nutritional deficiencies ;diets low in fruits# vegeta$les# vita in A# ri$oflavin# and %inc< are also $elieved to increase the risk of esophageal cancer !o on co plication is E*O.AA+OT3A!AEAL E5*T'LA Clinical #anifestations/ ASSES#ENT 1. alnourish ent 2. respiratory distress pressure of tu or on trachea 3. etastasis N"rsing Diagnoses& /, An"iety 0, Altered Nutriton: Less than $ody re-uire ents 1, .ain 2, Anticipatory grieving 4, >nowledge Deficit Nsg #anagement& a, reduce an"iety $, pro ote opti al nutrition c, reliveing pain d, providing psychosocial support DIA-N*STC ST)DIES& /, Esophagogastroduodenoscopy ;E+D# endoscopy<C diagnostic study of choice involves the passing of a fle"i$le tu$e down the esophagus and visuali%ing the wall, , N.O at least 2-9 hours $efore the procedure, ain risks are $leeding and perforation ;if there is $iopsy< endoscopy is inserted: duodenu is th e/st to $e seen patient ay e"perience nausea# gagging or choking ;use anesthetics<

0, (A35'M *)ALLO) with fluoroscopyF visuali%es the tu or ' +5* F uses radipa-ue li-uid co only uses (ariu ; the outh# pharyn"# esophagus# and sto ach,< (ariu - tastless# odorless# nongranular# co pletely insolu$le ;non a$osor$a$le<# in thick or thin a-ueous suspension for the puropose of studying upper +5 patient swallows $ariu patient is su$Bected for florouscopy i agesG"ray ;variations of '+5*< dou$le contrast studies F $ariu the !O0 is added through water to see finer details of the esophagus and sto ach enteroclysis F very detailed visuali%ation of the intestines preparations: N.O 9-: hours prior to (* withhold edications advise not to s oke $efore the procedure as it will increase gastric otility increase OE5 after procedure to prevent constipation ad inister la"ative $efore to prevent constipation or give ene a until the nurse sees that the stools are in nor al color

Treatment #o%alities /, *'3+5!AL 3EMOHAL of the cancerous portion of the esophagus ;E*O.AA+E!TOM7<: treat ent of choice 0, *'3+5!AL 3EMOHAL of the cancerous portion of esophagus and sto ach ;E*O.AA+O+A*T3O*TOM7<: for ore advanced tu ors 0, 3AD5AT5ON TAE3A.7 AND !AEMOTAE3A.7: ay $e used prior to surgery and for palliative easures 1, LA*E3 TAE3A.7: use of high intensity light $ea to kill cancer cells 2, .AOTOD7NAM5! TAE3A.7: a type of laser therapy in which cancer cells a$sor$ cancer-killing drugs when e"posed to a special wavelength of light 4, Endoscopic Lu en 3estoration Techni-ues Esophageal Dilation Esophageal *tents Important actions in the care of a patient (ith ES*P.A-EA, cancer /, .lace the patient in se i-Eowler&s or high-fowler&s position to facilitate respiration and to prevent aspiration 0, Monitor for respiratory distress 1, .rovide fre-uent oral hygiene ;dysphagia can cause saliva accu ulation< 2, Monitor nutritional status, Encourage the intake of high protein li-uids and ad inister vita in and ineral replace ents as ordered, 4, Ad inister analgesics as ordered $y the physician,
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-ASTRIC CANCER A$nor al# alignant tissue growth of the cells lining the sto ach !o only affects people with Helicobacter Pylori infection# chronic gastritis# s oking history# a diet high in salted# pickled# or s oked ;nitrates< food and low in fruits and vegeta$les# advanced age# ale gender# and a fa ily history of gastric cancer Pathophysiology Clinical #anifestations EA3L7: /, anore"ia 0, nausea 1, vague sto ach disco fort 2, $loated sensation with eals 4, eructation ;$elching< 9, indigestion 8, pyrosis ;heart$urn< LATE: /, elena 0, weight loss 1, sto ach pain 2, ascites ;accu ulation of fluid within the a$do en< NOTE: .ain is typically not an early anifestation of gastric cancer Complications /, weight loss 0, develop ent of ascites 1, etastasis 2, ane ia 4, achlorhydria 9, pernicious ane ia ;if gastrecto y is perfor ed< N"rsing Diagnoses& An"iety Altered Nutriton: Less than $ody re-uire ents .ain Anticipatory grieving >nowledge Deficit Nsg #anagement& reduce an"iety pro ote opti al nutrition reliveing pain providing psychosocial support 'nregulated cellular growth and differentiation causes tu or develop ent within the gastric ucosa ;inner lining< As the tu or grows# it e"tends outward to other layers of the sto ach Diagnostic e"a s: Endoscopy '+5*G (ariu *wallow !T *can ;if etastasis occurs<

Treatment #o%alities /, *'3+5!AL 3EMOHAL of part of sto ach and near$y ly ph nodes ;*'(TOTAL +A*T3E!TOM7< 0, *'3+5!AL 3EMOHAL of entire sto ach # near$y ly ph nodes# and portions of the esophagus and s all intestine ;TOTAL +A*T3E!TOM7< (illroth 5 F perfor ed if there is a sufficient portion of the upper duodenu re aining F --the re aining portion of the sto ach is reattached to the duodenu $efore the $ile duct and the duct of the pancreas, (illroth 55 -if the sto ach cannot $e reattached to the duodenu --a surgical procedure which connects the sto ach to the BeBunu ;the iddle portion of the s all intestine< 1, 2, 3adiation Therapy and !he otherapy Eradication of Aelico$acter .ylori 0, aintain a high-fat# high protein ;fat delays gastric e ptying<

Con%itions res"lting from Total -astrectomy /, Dumping syndrome- food and li-uid passing too -uickly into the s all intestine# which causes: Initial manifestations: D5A33AEA ;due to hyperintestinal otility< D5A.AO3E* 5*# D3O)*5NE** cra py a$do inal pain nausea tachycardia palpitations hypoglyce ia occurs with late du ping syndro e ;within 0 hours of eating< N'3*5N+ 5NTE3HENT5ON*: aintain patient on supine position after eals withhold fluids during eals

Pernicious anemia- non-a$sorption of Hita in (/0 fro the digestive tract due to lack of intrinsic factor# which results in an ade-uate production of red $lood cells Assess ent: fatigue# $eefy red tongue or glossitis# peripheral neuropathy ;tingling< D" : *!A5LL5N+&s TE*T ;should reveal ore than 26@ of ingested vit (/0< Nsg 5nt: H5T (/0 is lifeti e replace ent ;teach<# if severe (ED3E*T

N"tritional Consi%erations after a Total -astrectomy

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/, 0, 1, 2, Eat s all# fre-uent eals !onsu e dry# low fi$er# low car$ohydrate# high fat# and high protein food Drink li-uids $etween eals rather than with eals Avoid dairy products or consu e low-lactose dairy products 1, 2, 4, 9, 8, Important actions in the care of a patient (ith gastric cancer /, Ensure patency of nasogastric tu$e ;to deco press the re aining portion of the sto ach so that the suture line can $e rested<, Assess gastric aspirate and report any fecal odor fro the aspirate, 0, Ad inister tu$e feedings as ordered $y the physician PANCREATIC CANCER Pancreas 0/4-04 c ;9-/6 inch< elongated organ in the a$do en, -- posterior to the sto ach and in close association with the duodenu , /, e"ocrine ;secreting pancreatic Buice containing digestive en%y es< and endocrine ;producing several i portant hor ones# including insulin# glucagon# and so atostatin<, .rovide care of chest tu$es ;if total gastrecto y is perfor ed< Assess vital signs at fre-uent intervals# especially $lood pressure and heart rate, Monitor intake and output Educate the patient a$out anti-du ping diet ;s all and fre-uent low-car$ohydrate eals< Ad inister analgesics and vita in and ineral supple ents ;Hita in (/0# folate# iron# calciu # vita in D< as ordered $y the physician,

NOTE: The gastric aspirate post-operatively should $e $right red at first with gradual darkening within the first 02 hours after surgery to a yellow-green color within 19 to 2: hours, Other potential causes include advanced age# ale gender# history of dia$etes and chronic pancreatitis ;fre-uently related to alcohol a$use<# and a high fat diet,

0,

Pathophysiology 'nregulated cellular growth and differentiation produces tu ors that arise fro the lining of the pancreatic ducts Tu ors grow and $lock the ducts of the pancreas# which can cause fi$rosis and o$struction of the pancreas Often invades the sto ach# duodenu # $ile ducts# colon# spleen Clinical #anifestations /, painless Baundice F cancer of the head of pancreas ;due to $ile o$struction< 0, weight loss 1, anore"ia# nausea 2, severe a$do inal pain that ay radiate to the $ack ;cancer of the $ody of pancreas< 4, diarrhea# steatorrhea 9, clay-colored stools or tea-colored urine ;due to $iliary o$struction< 8, a right upper guardant ass ay $e present in later stages Complications 2, 4, 9, hyperglyce ia etastasis death II 3econstruction consists of attaching the pancreas to the BeBunu ;pancreaticoBeBunosto y< II attaching the co on $ile duct to the BeBunu ;choledochoBeBunosto y< to allow digestive Buices and $ile to flow into the gastrointestinal tract II and attaching the sto ach to the BeBunu ;gastroBeBunosto y< to allow food to pass through, 3adiation and !he otherapy .har acologic Agents Analgesics# pancreatic en%y es# vita in supple ents# and anti-hyperglyce ic agents ;insulin< in patients .alliative Measure Analgesics# radiation therapy to shrink tu or# nerve $locks# and *y pathecto y ;destruction of nerves<

5t is often descri$ed as having three regions: a head# $ody and tail, The pancreatic head a$uts the second part of the duodenu , The $ody of the pancreas lies at the level of L0 on the spine, The tail of the pancreas e"tends towards the spleen, A$nor a l# alignant tissue growth ost co only involving the lining of the pancreatic ducts that occurs predo inantly with s okers /, ascites 0, peritonitis 1, Baundice

Treatment #o%alities /, *'3+E37: )hipple&s Operation ;pancreaticoduodenecto y< A surgical procedure that involves the re oval of head of the pancreas# the duodenu # the gall$ladder# the end of the co on $ile duct and possi$ly part of the sto ach head of the pancreas and the duodenu share the sa e arterial $lood supply# and these arteries run through the head of the pancreas# so that $oth organs ust $e re oved, To re ove only the head of the pancreas would co pro ise $lood flow to the duodenu , 0, 1,

2, re oval of the distal half of the sto ach ;antrecto y<# the gall $ladder ;cholecystecto y<# the distal portion of the co on $ile duct ;choledochecto y<# the head of the pancreas# duodenu # pro"i al BeBunu # and regional ly ph nodes, A connection $etween the end of the $ile duct and the re aining of the pancreas with s all $owel is perfor ed to allow $ile and en%y es to enter the intestines

N"tritional Consi%erations after a 1hipple's *peration Trial-and-error approach to food is reco ended as fatty food ay cause loose stools and a$do inal cra ping A etallic taste ay $e e"perienced for the first few weeks and the patient ay re-uire insulin Important actions in the care of a patient (ith pancreatic cancer
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/, Ad inister edications ;anti-hyperglyce ic agents if dia$etes is present# analgesics for co fort easures as well as pancreatic en%y es# $ile salts# and Hita in > to correct deficiencies< as ordered $y the physician, Encourage s all# fre-uent# low-fat eals after surgery ;fatty food ay cause diarrhea and a$do inal cra ping< .erfor soapless $athing and ad inister anti-pruritic agents to relieve itching fro Baundice, ( - Tu our invading through the intestinal wall ! - )ith ly ph node;s< involve ent D - )ith distant etastasis Diagnostic e"a s: /, stool for occult $lood positive 0, !olonoscopy and sig oidoscopy reveals ass 1, (ariu ene a a, to detect polyps# tu ors and other lesions $, ay take /4-16 inutes c, sa e preparations as $ariu swallow d, la"ative $efore for clearer visuali%ation e, assess for allergy f, no need for la"atives since ediu is eli inated after the procedure# $ut can still $e taken since $ariu causes constipation 2, digital rectal e"a inations indicates a palpa$le ass Clinical #anifestations ;usually produces no sy pto s initially< /, A change in nor al $owel ha$its of at least /6 days& duration 0, rectal $leeding 1, $loody stools ;guaiac positive or grossly $loody< 2, persistent spas s of the $owel 4, weight loss 9, a$do inal pain 8, $loating ay occur as the condition progresses Complications 1, 2, 9, 8, :, K, etastasis death 3eco end a diet high in fruits and vegeta$les# and restriction of saturated fats 5nstruct the patient to avoid or li it use of alcohol and to$acco products Encourage folic acid and calciu supple ents ;unless contraindicated< to prevent co plications fro colon cancer 3eco end colon cancer screening for the patient&s fa ily

0, 1,

C*,*N CANCER A$nor al# alignant tissue growth that affects the cells lining the colon 3isk factors include presence of precancerous colon polyps# advanced age ;over age 46<# history of infla atory disorders of the colon ;!rohn&s or ulcerative colitis<# a low-fi$er and high-fat diet low in fruits and vegeta$les# history of s oking and oderate consu ption of alcohol# and a positive fa ily history of colon cancer, Pathophysiology 'nregulated cellular growth and differentiation in the lining of the colon produces tu ors that can cause o$structions as they grow D"kes2 system DukesJ classification# first proposed $y Dr !uth$ert E, Dukes in /K10# identifies the stages as:L/KM A - Tu our confined to the intestinal wall /, intestinal o$struction 0, ane ia Treatment #o%alities /, *'3+5!AL 3E*E!T5ON ;!OLE!TOM7< of the affected portion of the colon is preferred treat ent Total Colectomy: re oval of entire colon and its $lood supply Right Hemicolectomy: re oval of last part of s all $owel# the ascending colon# hepatic fle"ure# and s all portion of the transverse colon Left Hemicolectomy: re oval of descending colon and adBoining portion of sig oid colon# splenic fle"ure# and a portion of the transverse colon 0, 3adiation Therapy and !he otherapy $e used in conBunction with surgery ay

,ADDER CANCER A condition characteri%ed $y tu or for ation within the $ladder, Most are transitional cell carcino as that occur in the transitional cells that line the $ladder wall# although tu or ay arise fro the s-ua ous cells in the $ladder wall Risk Factors /, 0, 1, 2, 4, 9, 8, :, s oking advanced age ale gender white chronic $ladder infla ation fa ily history e"posure to certain che icals used in anufacturing industry ;ru$$er# te"tiles# dyes# leather< long ter use of certain drugs such as cyclophospha ide ;!yto"an<

Complications associate% (ith s"rgical proce%"res "se% in the treatment of colon cancer /, diarrhea 0, irregular $owel ove ents 1, $ladder dysfunction ;in ales who have undergone surgery involving the rectu < Important actions in the care of a patient (ith colon cancer /, Educate the patient a$out osto y care $efore resection, !onsult an enterosto al nurse preoperatively so that the patient preparation can $egin as early as possi$le, 5nfor patient that colosto y drainage can $e regulated through safe dietary odifications and a regular irrigation schedule 0, .rovide an opportunity for the patient to speak with so eone with an osto y $efore surgery 1, 5f colosto y is perfor ed# provide colosto y care# including irrigations as ordered $y the physician, !onvey acceptance of osto y to pro ote the patient&s positive self-i age, 2, Monitor vital signs and intake and output fre-uently in early postoperative course 4, Monitor for co plications of the disease process ;o$struction# ane ia< or its treat ent

DIA-N*STIC ST)DIES& N cystoscopy - a fle"i$le tu$e $earing a ca era and various instru ents is introduced into the $ladder through the urethra, Clinical #anifestations ;usually produces no sy pto s initially< /, painless and inter ittent he aturia ;initial sign< 0, dysuria 1, pelvic pain 2, urinary fre-uency or urgency 4, decreased urinary flow ay occur as the disease progresses Complications /, 0, ane ia urinary incontinence
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1, 2, hydronephrosis ;due to o$struction that prevents urine fro the $ladder etastatic disease ureteral entering /, 0, 1, Transurethral Resection: te porary he aturia or dysuria for first few postoperative days %egmental Cystectomy: increased urinary fre-uency Radical Cystectomy: induction of enopause for wo enC infertility and possi$le infertility in enC en ay want to $ank their sper prior to surgery

Treatment #o%alities /, *'3+E37: T3AN*'3ETA3AL 3E*E!T5ON of the tu or via the use of cystoscope# a s all wire loop for re oving the tu or and an electrical current for $urning any re aining cancer cells ;E'L+'3AT5ON< 0, 3e oval of the $ladder ;!7*TE!TOM7< Segmental ;re oval of only the area of the $ladder with cancer cells present< Ra%ical ; re oval of entire $ladder# part of the urethra# and so e ly ph nodes as well as possi$ly the ovaries# fallopian tu$es# and a portion of the vagina in wo en and prostrate gland# se inal vesicles# and part of the vas deferens in en<, (ladder reconstruction is perfor ed with radical cystecto y 3adiation Therapy May involve an internal or e"ternal sourceC ost co only used following surgery to destroy re aining cancer cells !he otherapy May $e intravesical ;instillation of che otherapeutic agents into the $ladder through a catheter< or syste ic 'sed $efore or after surgery to shrink tu or si%e and possi$le spare the $ladder# or to destroy any re aining cancer cells (iologic Therapy 'se of i une sti ulant (acillus !al ette-+uerin to inhi$it develop ent and growth of new $ladder tu ors

Important actions in the care of a patient (ith +la%%er cancer /, Educate the patient preoperatively a$out need for $ladder reconstruction after radical !ystecto y, .atients will need assistance in coping with $ody i age changes as well as care of the new urinary outlet device, 0, .ro ote s oking cessation 1, E phasi%e the i portance of close screening with cystoscopies every 1 to 9 onths ;K6@ of superficial $ladder tu ors recur< CER3ICA, CANCER A alignant condition of the cervi" that typically occurs in wo en ages 16 to 44 *trongly associated with the hu an papillo a virus# $ut other risk factors include early onset of intercourse# ultiple se"ual partners# history of se"ually trans itted diseases# and pregnancy at a young age SCREENIN/< .apanicolaou test# or pap s ear - suggestd neoplasia ;pre alignant changes in the cervi"< $efore a cancer has developed# allowing for further workup, (5O.*7: follows !lass 5 F nor al pap s ear !lass 55 F atypical cells !lass 555- oderate dysplasia !lass 5H F *-ua ous cell !arcino a A.H test - detects the presence of hu an papillo avirus infection in the cervi", 5t is ore sensitive than the pap s ear ;less likely to produce false negative results<# Clinical #anifestations ;!o only produces no sy pto s and only detected on routine pap&s s ear tests< /, vaginal $leeding after intercourse# $etween enstrual periods or after enopause 0, watery# $loody or alodorous vaginal discharge 1, pelvic pain ;late< Treatment #o%alities /, !ON5DAT5ON OE TAE !E3H5O: coneshaped piece of diseased cervi" is re oved with a scalpel 0, LA*E3 *'3+E37: narrow $ea of intense light is used to destroy cancerous or precancerous lesions 1, LOO. ELE!T3O*'3+5!AL EO!5*5ON .3O!ED'3E: a wire loop is used to pass an electrical current and re ove cancerous cells 2, !37O*'3+E37: uses free%ing to destroy cancerous and precancerous cells 4, A7*TE3E!TOM7: re oval of cervi" and uterus# radiation# and che otherapy ay $e used in advanced cases NOTE: A pap test is the single ost i portant screening tool in the evaluation for cervical cancer Important actions in the care of a patient (ith cer$ical cancer /, Encourage regular pap tests

1,

2,

4,

Common types of "rinary %i$ersions 1 !ephrostomy Tubes Tu$e is placed percutaneously ;through the skin< into the renal pelvis to allow for an uno$structed urinary drainage syste May $e te porary or per anent " Ileal Conduit *eg ent of s all intestine is re oved and used to attach a ureter to a sto a in the lower a$do en to allow urine drainage into a s all collection $ag ;urosto y< urine is then collected in an osto y pouch $och or Indiana Pouch 'rine reservoir is created internally $y using a portion of the ileu or a co $ination of the ter inal ileu and ascending colon Need for an e"ternal osto y pouch is eli inated 3e-uires regular catheteri%ation of the sto a

Neo+la%%er A surgical techni-ue in which a portion of the $owel is used to create a co pletely new $ladder# which is directly attached to the urethra for nor al outflow of urine Other conditions that ay re-uire urinary diversions include urethral stictures# congenital ano alies# chronic pyelonephritis# neurogenic $ladder# and ureteral or $ladder trau a, Complications associate% (ith the s"rgical treatments "se% for +la%%er cancer

jonimariepatnugot,rn

8
0, Educate the patient regarding preventive easures, Advise the patient to practice safer se" $y using condo s and li iting the nu $er of se" partners Encourage routine edical follow-up and co pliance with any treat ent regi en Trans&rethral !eedle ,blation uses low-level radiofre-uency energy delivered through two needles to destroy e"cess prostate tissue *'3+E37 Transurethral Resection of the Prostate involves the insertion of an instru ent through the urethra to re ove the prostate tissue that&s o$structing the flow of urine

1,

*3ARIAN CANCER A alignant condition affecting the ovaries !o on risk factors include positive fa ily history# advanced age ;age 96 and older<# and nulliparity or late age of first pregnancy Pathophysiology 'ncontrolled cellular growth and proliferation of the cells within the ovaries resulting in tu or for ation As the tu or grows# it ay e"ert pressure on the near$y organs and interfere with their function Clinical #anifestations ;Most wo en re ain asy pto atic until the disease is advanced< /, a$do inal pain 0, swelling ;ascites< 1, pressure sensation in pelvis 2, urinary fre-uency 4, constipation or diarrhea 9, a$nor al vaginal $leeding 8, weight loss :, pelvic and $ack pain K, pain with intercourse ;dyspareunia< NOTE: !linical sign in post enopausal wo en that warrants a alignancy work-up are palpa$le ovaries Treatment #o%alities /, Typically a co $ination of surgery and che otherapy, *urgery ay include total hysterecto y# oophorecto y# or salpingecto y, Important actions in the care of a patient (ith o$arian cancer /, .ro ote good nutritional intake of protein-rich food 0, E phasi%e the i portance of close edical follow-up 1, Discuss the option of attending support groups ENI-N PR*STATIC .YPERP,ASIA Non-cancerous hyperplasia ;enlarge ent< of the prostate gland due to the a$nor al growth of $enign prostate cells The enlarged prostate gland ay result in o$struction of the urethra# and su$se-uently# the flow of urine Clinical #anifestations /, difficulty starting urine strea 0, s aller and weaker urinary strea 1, urinary fre-uency 2, nocturia 4, leakage and dri$$ling of urine Treatment #o%alities /, .AA3MA!OLO+5! A+ENT* Einasteride ;.roscar< to inhi$it production of hor one dihydrotestosterone Alpha $lockers such as Ta sulosin ;Elo a"<# Tera%osin ;Aytrin<# Do"a%osin ;!ardura< to rela" the s ooth uscle of the prostate and i prove urine flow 0, NON-*'3+5!AL .3O!ED'3E* Trans&rethral 'icro(a)e Therapy *T&'T+ or ther otherapy uses icrowaves to heat and destroy e"cess prostate tissue

1,

Important actions in the care of a patient (ith P. /, 5nstruct the patient to urinate upon earliest urge to do so, 0, 5nstruct the patient to avoid alcohol or e"cessive fluid consu ption# particularly in the evening 1, Encourage low-fat diet and encourage the consu ption of fruits and vegeta$les 2, 5nstruct the patient to avoid over-thecounter cough and cold edications that contain decongestants ; ay worsen sy pto s of (.A< PR*STATE CANCER A slowly progressive# alignant condition affecting the prostate gland The ost co on type of cancer in ales in the 'nited *tates each year Pathophysiology A alignant tu or develops in the tissues of the prostate gland# typically in the outer portion As the tu or enlarges# it ay cause o$struction of the urinary flow Risk Factors /, 0, 1, 2, $lacks en age 44 and older en with fa ily history of prostate cancer possi$ly high fat diet ; ay increase production of testosterone<

DIA-N*STIC SCREENINDigital rectal e"a ination - where the e"a iner inserts a gloved# lu$ricated finger into the rectu to check the si%e# shape# and te"ture of the prostate, Areas which are irregular# hard or lu py need further evaluation# since they ay contain cancer, A .*A screening testay detect these s all cancers that would never $eco e life threatening, The .*A test easures the $lood level of prostate-specific antigen# an en%y e produced $y the prostate, *pecifically# .*A is a serine protease si ilar to kallikrein, 5ts nor al function is to li-uify gelatinous se en after eBaculation# allowing sper ata%oa to ore easily Pswi P through the uterine cervi", A5+AE3 .*AQ A5+AE3 !AAN!E OE TE*T !AN!E3 Two co levels: III are enlarge ent of the prostate ;$enign prostatic hypertrophy ;(.A<< II infection in the prostate ;prostatitis<, 5t can also $e raised for 02 hours after eBaculation and several days after catheteri%ation, .*A levels are
jonimariepatnugot,rn

on causes of high .*A

9
lowered in en who use edications used to treat (.A or $aldness, These edications# finasteride ; arketed as .roscar or .ropecia< and dutasteride ; arketed as Avodart<# ay decrease the .*A levels $y 46@ or ore, Clinical #anifestations /, elevated seru prostate-specific antigen levels 0, sy pto s of (.A ;urinary fre-uency# difficulty starting a strea # weak urine flow# dysuria# dri$$ling< /, erectile dysfunction 0, urinary incontinence Treatment #o%alities /, .AA3MA!OLO+5! A+ENT* Ta sulosin ;Elo a"<# Tera%osin ;Aytrin<# Do"a%osin ;!ardura< to ini i%e sy pto s of prostate enlarge ent 0, *'3+E37 Transurethral Resection of the Prostate involves the insertion of an instru ent through the urethra to re ove the prostate tissue that&s o$structing the flow of urine Radical Prostatectomy involves the co plete re oval of the prostate gland and se inal vesicles 3adiation Therapy via e"ternal $ea or $y i planted radioactive seeds ;(3A!A7TAE3A.7< Aor onal Therapy Luteini%ingAor one-releasing hor one agonists such as Leuprolide ;Lupron Depot< Anti-androgens such as Eluta ide and (icaluta ide Orchiecto y ;surgical re oval of testicles< ay $e perfor ed to eli inate the pri ary source of ale hor ones 1, 2, 4, 9, 8, $lood in urine or se en painful eBaculation difficulty having an erection a$nor al prostate ass noted on digital rectal e"a $one pain# fatigue and yalgias can occur in late stage of the disease which indicates etastasis

Complications

1, recurrence 2, etastasis !o only affects white 14

ales ages /4 to

Clinical #anifestations /, scrotal ass or nodule in a testicle 0, heavy sensation in the scrotu 1, pain or disco fort in the affected testis or in the scrotu 2, dull# aching sensation in the a$do en or groin 4, a$rupt accu ulation of fluid within the scrotu Complications /, 0, infertility ;only if $oth testicles are re oved as a eans of treat ent< etastatic disease

1,

2,

Screening g"i%elines for Testic"lar cancer /, perfor ance of onthly self-testicular e"a inations $eginning at age /4 0, clinical testicular self e"a ination $y a health care provider perfor ed annually Testic"lar Self E4amination /, 5nstruct the patient to perfor an e"a ination following a war $ath or shower ;rela"es the scrotu < 0, 5nstruct the patient to use his thu $ and fingers to palpate each testicle thoroughly for lu ps, 1, Tell the patient to visually inspect the scrotu for any color changes or asy etry 2, 5nstruct the patient to report any suspicious nodules to the physician pro ptly Treatment #o%alities /, *'3+E37 Radical Inguinal -rchiectomy- one or $oth testes are re oved through an incision ade in the groin 0, E"ternal (ea 3adiation 1, !he otherapy Important actions in the care of a patient (ith prostate cancer /, E phasi%e the i portance of close edical follow-up and perfor ance of onthly testicular e"a inations 0, .ro ote good nutritional ha$its# including consu ption of protein-rich food# fruits and vegeta$les RENA, CANCER A condition in which cancerous cells develop within the kidney Most co on type in adults is renal cell carcino a# which $egins within renal tu$ules Transitional cell carcino a involves the develop ent of a tu or in the renal pelvis )il &s Tu or is the ost co on for of renal cancer in children Pathophysiology 'nregulated cell growth and proliferation occurs ;co only in the lining of the renal tu$ules<# for ing a tu or
jonimariepatnugot,rn

Complications associate% (ith s"rgeries performe% for prostate cancer /, 'rinary incontinence 0, rectal inBury 1, i potence 2, infertility ;due to potential ina$ility to produce sper < Important actions in the care of a patient (ith prostate cancer /, Assess the urinary catheter for patency due to its tendency to clot with $lood, 5rrigation ay $e necessary 0, Monitor intake and output as well as urine characteristics, 'rine will $e pinkish red in the i ediate postoperative period $ut should $e clear 1 to 2 days after surgery 1, Ad inister analgesics and antispas odic agents for $ladder spas s 2, .ro ote $owel regi en to ini i%e straining and da age to surgical site due to close pro"i ity of prostate gland 4, 5nstruct the patient to avoid se"ual activity and heavy lifting for three weeks# to use stool softeners# to get ade-uate hydration# and to notify the physician if $lood in urine recurs, 9, 5 ple ent che otherapy precautions when handling patient waste if radioactive seed i plants have $een placed TESTIC),AR CANCER A alignant condition that affects the cells within a testis,

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(egins ost co only within the renal tu$ules in renal cell carcino a# $ut ay also occur at the site where the kidney Boins with the ureter ;renal pelvis<# as occurs in transitional cell carcino a, /, 0, 1, 2, 4, 9, 8, :, K, Advanced age ;ages 46 to 86< $lack race ale gender history of s oking ;cigarettes# cigars pipes< hypertension chronic dialysis e"posure to certain che icals ;as$estos# cad iu < genetic predisposition high-fat diet and o$esity 5nvasive ;or infiltrating< cancers have started to $reak through nor al $reast tissue $arriers and invade surrounding areas, 3isk Eactors: Age *e" Aeredity Alcohol O$esity - +aining weight after enopause can increase a wo anJs risk Aor ones - .ersistently increased $lood levels of estrogen /, increased levels of the androgens androstenedione and testosterone ;which can $e directly converted $y aro atase to the estrogens estrone and estradiol# respectively<, 0, 5ncreased $lood levels of progesterone are associated with a decreased risk of $reast cancer in pre enopausal wo en,L19M 1, not having children# 2, delaying first child$irth 4, not $reastfeeding 9, early enarche ;the first enstrual period< 8, late enopause :, nulliparity Environ ental causes To$acco Deodorants ii, alu inu -containing underar antiperspirants Screening /, O-ray a ography odality of choice for screening of early $reast cancer 0, (reast M35 1, (reast self-e"a Diagnostic E4am& /, (iopsy Staging *tage 6 - !arcino a in situ *tage / The tu our easures less than 0c across, The ly ph glands in the ar pit ;a"illa< are not affected *tage 0 The tu our easures 0F4c across# Ly ph glands in the ar pit are affected# or $oth, *tage 1 The tu our is larger than 4c across# May $e attached to surrounding structures such as the uscle or skin, Ly ph glands are usually affected *tage 2 F Distant etastasis ;M< Assesment& /, 0, 1, 2, TREAT#ENT /, *urgery I lu pecto y ;re oval of the lu p only< I astecto y i, *5M.LE MA*TE!TOM7 F re oval of the $reast only# ly ph nodes $iopsied ii, 3AD5!AL MA*TE!TOM7 F re oval of the $reast# uscle layer down to chest wall and a"illary ly ph nodes i, Nursing interventions: provide routine pre-op and post Fop care
jonimariepatnugot,rn

Risk Factors

Clinical #anifestations /, inter ittent he aturia 0, flank pain 1, unintentional weight loss 2, fever 4, palpa$le ass of the kidney ay $e present as the condition progresses Complications /, 0, 1, hypercalce ia polycythe ia ;e"cessive red $lood cell production due to release of erythropoietin< etastatic disease

Treatment #o%alities /, *'3+E37 !ephrectomy: re oval of the entire kidney and possi$ly its associated adrenal gland, May $e perfor ed laparoscopically !ephron-%paring %urgery: involves re oving only the tu or as opposed to the entire kidney 0, A3TE35AL EM(OL5DAT5ON *u$stance is inBected into the renal artery in order to deprive the tu or cells of o"ygen and other nutrients May $e perfor ed prior to surgery or to relieve pain and $leeding in a non-surgical candidate 1, 3AD5AT5ON TAE3A.7 Typically used to relieve pain related to etastasis 2, !AEMOTAE3A.7 'sually used for treat ent of etastasis 4, 5MM'NOTAE3A.7 (iological response odifiers ;interferon# interleukin-0< ay $e used in so e instances Important actions in the care of a patient (ith +la%%er cancer 0, Encourage s oking cessation 1, Encourage weight loss and aintenance of healthy weight 2, E phasi%e the i portance of close edical follow-up 4, Encourage e"ercise to decrease $lood pressure 9, Monitor the patient for co plications# including hypercalce ia and polycythe ia and notify the physician if any occur, REAST CANCER uncontrolled growth of $reast cells, / in : wo en will get it, Non-invasive ;or Pin situP< cancers confine the selves to the ducts or lo$ules and do not spread to the surrounding tissues in the $reast or other parts of the $ody,

.alpation of lu p ;usually first sy pto < - upper outer -uadrant *kin $reast $eing di pled Nipple discharge Asy etry of the $reast

11
ii, iii, iv, v, vi, elevate ar on post operative side on pillow F to ini i%e ede a do not use ar on affected side# do not take (.# 5H&s or inBection onitor for $leeding# check unaffected side 3OM F a$duction will $e the last ove ent Teach necessary lifestyle changes vii,

0, 3adiation therapy 1, !he otherapy 2, Aor onal treat ent I Ta o"ifen is typically given to pre enopausal wo en to inhi$it the estrogen receptors I Aro atase inhi$itors are typically given to post enopausal wo en to lower the a ount of estrogen in their syste s

jonimariepatnugot,rn