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² Assessment
² Laboratory & Diagnostic Tests
² Tumor Staging and Grading
² Nursing Diagnoses & Planning
² Implementation and Management
‡ Treatment Modalities
² Chemotherapy
‡ End-of-life Issues
WHAT IS CANCER?

CANCER is a complex of diseases which

occurs when normal cells mutate into
abnormal cells that take over normal
tissue, eventually harming and
destroying the host
WH 



A large group of diseases characterized

by:
² Uncontrolled growth and spread of abnormal
cells
² Proliferation (rapid reproduction by cell
division)
² Metastasis (spread or transfer of cancer cells
from one organ or part to another not directly
connected)


 

uranch of medicine that

deals with the study,
detection, treatment and
management of cancer and
neoplasia
 
 

 Êyperplasia ² increase in the number of cells

 Metaplasia ² conversion of one cell to another cell
 Dysplasia ² bizarre cell growth resulting in difference
in size, shape and arrangement
 Anaplasia ² cells that lack normal cellular
characteristic
 Neoplasia ² uncontrolled cell growth
 v W

 Neo- new
 Plasia- growth

 Plasm- substance

 Trophy- size

 +Oma- tumor

 Statis- location
 v W

 A- none
 Ana- lack

 Êyper- excessive

 Meta- change

 Dys- bad, deranged


H

  

 Uncontrolled growth of Abnormal cells

 1. uenign

 2. Malignant

 3. uorderline

H

  

uENIGN
 ell-differentiated

 Slow growth

 Encapsulated

 Non-invasive

 Does NOT metastasize


H

  

MALIGNANT
 Undifferentiated

 Erratic and Uncontrolled Growth

 Expansive and Invasive

 Secretes abnormal proteins

 METASTASIZES
‘ SS
N RMA‘ GR WTH
C NTR ‘
 
m  

Tumor is named according to:

1. Parenchyma, Organ or Cell
 Êepatoma- liver

 Osteoma- bone

 Myoma- muscle
 
m  

Tumor is named according to:

2. Pattern and Structure, either GROSS or
MICROSCOPIC
 !luid-filled CYST

 Glandular ADENO

 !inger-like PAPILLO

 Stalk POLYP
 
m  

Tumor is named according to:

3. Embryonic origin
 Ectoderm ( usually gives rise to
epithelium)
 Endoderm (usually gives rise to glands)

 Mesoderm (usually gives rise to

Connective tissues)
u  m

 Suffix- ´OMAµ is used

 Adipose tissue- LipOMA

 uone- osteOMA

 Muscle- myOMA

 ulood vessels- angiOMA

 !ibrous tissue- fibrOMA

    m
 Named according to embryonic cell
origin
1. Ectodermal, Endodermal, Glandular,
Epithelial
 Use the suffix- ´CARCINOMAµ

 Pancreatic AdenoCarcinoma

 Squamos cell Carcinoma

    m
 Named according to embryonic cell
origin
2. Mesodermal, connective tissue origin
 Use the suffix ´SARCOMA

 !ibroSarcoma

 Myosarcoma

 AngioSarcoma
vW 
1. ´OMAµ but Malignant
D ÊepatOMA, lymphOMA, gliOMA, melanOMA
2. TÊREE germ layers
D ´TERATOMAµ

3. Non-neoplastic but ´OMAµ

D Choristoma

D Êamatoma
 
m 


‡ Viruses
‡ Chemical carcinogens
‡ Physical stressors
‡ Êormonal factors
‡ Genetic factors


 m 
Etiology of cancer
1. PÊYSICAL AGENTS
 Radiation

 Exposure to irritants

 Exposure to sunlight

 Altitude, humidity


 m 
Etiology of cancer
2. CÊEMICAL AGENTS
 Smoking

 Dietary ingredients

 Drugs


 m 
Etiology of cancer
3. Genetics and !amily Êistory
 Colon Cancer

 Premenopausal breast cancer



 m 
Etiology of cancer
4. Dietary Êabits
 Low-!iber
 Êigh-fat
 Processed foods
 alcohol


 m 
Etiology of cancer
5. Viruses and uacteria
 DNA viruses- Êepau, Êerpes, EuV, CMV,
Papilloma Virus
 RNA Viruses- ÊIV, ÊTCLV

 uacterium- Ê. pylori


 m 
Etiology of cancer
 ·. Êormonal agents

 DES

 OCP especially estrogen



 m 
Etiology of cancer
 Î. Immune Disease

 AIDS
 uURKITT·S LYMPÊOMA - a cancer of the
lymphatic system
Classification of Cancer
Õ


 



‡ uenign - tumors that cannot spread by
invasion or metastasis; hence, they only
grow locally
‡ Malignant - tumors that are capable of
spreading by invasion and metastasis.
uy definition, the term ´cancerµ
Patterns of cell Proliferation
‡ Êyperplasia
‡ Dysplasia
‡ Metaplasia
‡ Anaplasia
‡ Neoplasia
Patterns of cell Proliferation
‡Metaplasia
‡ conversion of one type of cell in a tissue to
another type not normal for that tissue
‡Anaplasia
‡ change in the DNA cell structure and orientation
to one another, characterized by loss of
differentiation and a return to a more primitive
form.
Neoplasia
‡ uncontrolled cell growth, either benign or
malignant
Metastasis
‡ Metastasis: 3 stages
² Invasion ² neoplastic cells from primary
tumor invade into surrounding tissue with
penetration of blood or lymph.
² Spread ² tumor cells spread through lymph
or circulation or by direct expansion
² Establishment and growth ² tumor cells
are established and grow in secondary
site: lymph nodes or in organs from venous
circulation


 m 
Spread of Cancer
 1. LYMPÊATIC
Most common

 2. ÊEMATOGENOUS
D ulood-borne, commonly to Liver and Lungs
 3. DIRECT SPREAD
D Seeding of tumors


 m 
uody Defenses Against TUMOR
 1. T cell System/ Cellular Immunity
D Cytotoxic T cells kill tumor cells
 2. u cell System/ Êumoral immunity
Du cells can produce antibody
 3. Phagocytic cells
D Macrophages can engulf cancer cell debris
Classification of Tumors
‡ CARCINOMAS: EPITÊELIAL TISSUE
² uODY SUR!ACES, LINING O! uODY CAVITIES ETC:
(ADENOCARCINOMA)
‡ SARCOMAS: CONNECTIVE TISSUE
² STRIATED MUSCLE, uONE, ETC (OSTEOSARCOMA)
‡ LYMPÊOMAS AND LEUKEMIAS
² ÊEMATOPOIETIC SYSTEM
‡ NERVOUS TISSUE TUMORS
² EX. NERVE CELLS-NEUROuLASTOMA
‡ MYELOMA
² Develops in the plasma cells of bone marrow
Effects of Cancer
‡ Disruption of !unction- can be due to obstruction or
pressure
‡ Êematologic Alterations: can impair function of
blood cells
‡ Êemorrhage: tumor erosion, bleeding, severe
anemia
‡ Anorexia-Cachexia Syndrome: wasted appearance
of client
Effects of Cancer
‡ Paraneoplastic Syndromes: ectopic sites with
excess hormone production
² ȸ Parathyroid hormoneȹ hypercalcemia
² ȸ secretion of insulinȹ hypoglycemia
² ȸ Antidiuretic hormone (ADÊ) ȹ fluid
retention, ÊTN & peripheral edema
‡ ȸ Adrenocorticotropic hormone (ACTÊ): cause
excessive secretion of cortisone (ie: fluid
retention, ȸ glucose levels)
Effects of Cancer
‡ Pain: major concern of clients and families
associated with cancer
‡ Physical Stress: body tries to respond and
destroy neoplasm
ASSESSMENT
‡ Nursing Êistory
² Êealth Êistory ² chief complaint and history of
present illness (onset, course, duration,
location, precipitating and alleviating factors)
² Cancer signs: CAUTION US!
WARNING SIGNS
CANCER
CAUTION US!
² Change in bowel or bladder habits
² A sore that does not heal
² Unusual bleeding or discharge
² Thickenings or lumps
² Indigestion or difficulty in swallowing
² Obvious change in a wart or mole
² Nagging or persistent cough or hoarseness
² Unexplained anemia
² Sudden unexplained weight loss
Change in bowel or bladder habits
² A person with colon cancer may have diarrhea
or constipation, or he may notice that the
stool has become smaller in diameter
² A person with bladder or kidney cancer
A sore that does not heal
² Small, scaly patches on the skin that bleed or
do not heal may be a sign of skin cancer
² A sore in the mouth that does not heal can
indicate oral cancer
‡ Unusual bleeding or discharge
² ulood in the stool is often the first sign of
colon cancer
² Similarly, blood in the urine is usually the first
sign of bladder or kidney cancer
² Postmenopausal bleeding (bleeding after
menopause) may be a sign of uterine cancer
‡ Thickenings or lumps
² Enlargement of the lymph nodes or glands
(such as the thyroid gland) can be an early
sign of cancer
² ureast and testicular cancers may also
present as a lump
‡ Indigestion or difficulty in swallowing
² Cancers of the digestive system, including
those of the esophagus, stomach, and
pancreas, may cause indigestion, heartburn,
or difficulty swallowing
‡ Obvious change in a wart or mole
² Moles or other skin lesions that change in
shape, size, or color should be reported
‡ Nagging or persistent cough or hoarseness
² Cancers of the respiratory tract, including lung
cancer and laryngeal cancer, may cause a
cough that does not go away or a hoarse
(rough) voice
‡ Unexplained anemia
‡ Sudden unexplained weight loss
OHYSICA‘ ASSESSMENT
‡ Inspection ² skin and mucus membranes for
lesions, bleeding, petechiae, and irritation
² Assess stools, urine, sputum, vomitus for acute
or occult bleeding
² Scalp noting hair texture and hair loss
‡ Palpation
² Abdomen for any masses, bulges or
abnormalities
² Lymph nodes for enlargement
‡ Auscultation ² of lung sounds, heart sounds
and bowel sounds
Laboratory & Diagnostic Tests
‡ Cancer detection examination
‡ Laboratory tests
² Complete blood cell count (CuC)
² Tumor markers ² identify substance (specific
proteins) in the blood that are made by the
tumor
‡ PSA (Prostatic-specific antigen): prostate
cancer
‡ CEA (Carcinoembryonic antigen): colon cancer
‡ Alkaline Phosphatase: bone metastasis
² uiopsy
Diagnostic Tests
‡ Determine location of cancer:
² X-rays
² Computed tomography
² Ultrasounds
² Magnetic resonance imaging
² Nuclear imaging
² Angiography
‡ Diagnosis of cell type:
² ɷTissue samples: from biopsies,
shedded cells (e.g. Papanicolaou (PAP)
smear), & washings
² ɷ Cytologic Examination: tissue
examined under microscope
‡ Direct Visualization:
² ɷ Sigmoidoscopy
² ɷ Cystoscopy
² ɷ Endoscopy
² ɷ uronchoscopy
² ɷ Exploratory surgery; lymph node
biopsies to determine metastases
Tumor Staging and Grading
‡ Staging determines size of tumor and
existence of metastasis
‡ Grading classifies tumor cells by type of
tissue
‡ The TNM system is based on the extent of
the tumor (T), the extent of spread to the
lymph nodes (N), and the presence of
metastasis (M).
Primary Tumor (T)
TX - Primary tumor cannot be evaluated
T0 - No evidence of primary tumor
Tis - Carcinoma in situ (early cancer that has not spread
to neighboring tissue)
T1, T2, T3, T4 - Size and/or extent of the primary tumor
Regional Lymph Nodes (N)
NX - Regional lymph nodes cannot be evaluated
N0 - No regional lymph node involvement (no cancer
found in the lymph nodes)
N1, N2, N3 - Involvement of regional lymph nodes
(number and/or extent of spread)
Distant Metastasis (M)
MX - Distant metastasis cannot be evaluated
M0 - No distant metastasis (cancer has not
spread to other parts of the body)
M1 - Distant metastasis (cancer has spread to
distant parts of the body)
NURSING DIAGNOSES
‡ Acute or chronic pain
‡ Impaired skin integrity
‡ Impaired oral mucous membrane
‡ Risk for injury
‡ Risk for infection
‡ !atigue
‡ Imbalanced nutrition: less than body
requirements
NURSING DIAGNOSES
‡ Risk for imbalanced fluid volume
‡ Anxiety
‡ Disturbed body image
‡ Deficient knowledge
‡ Ineffective coping
‡ Social isolation
OUTCOME IDENTI!ICATION
1. Pain relief
2. Integrity of skin and oral mucosa
3. Absence of injury and infection
4. !atigue relief
5. Maintenance of nutritional intake and
fluid and electrolyte balance
·. Improved body image
Î. Absence of complications
OUTCOME IDENTI!ICATION
1. Knowledge of prevention and cancer
treatment
2. Effective coping through recovery and
grieving process
3. Optimal social interaction
IMPLEMENTATION/MANAGE MENT
‡ Prevention and detection
² Primary Prevention
‡ Reducing modifiable risk factors in the
external and internal environment
² Secondary Prevention
‡ Recognizing early signs and symptoms and
seeking prompt treatment
‡ Prompt intervention to halt cancerous
process


    H
W

TREATMENT MODALITIES
‡ Aimed towards:
² CURE - free of disease after treatment
ȹ normal life
² Control - Goal for chronic cancers
² Palliative Care: Quality of life maintained
at highest level for the longest possible
time
‡ Surgery ² surgical removal of tumors; most
commonly used treatment
‡ Preventive or prophylactic
‡ Diagnostic surgery
‡ Curative surgery
‡ Reconstructive surgery
‡ Palliative surgery
‡ Chemotherapy ² use of antineoplastic drugs to
promote tumor cell death, by interfering with
cellular functions and reproduction
‡ Radiotherapy ² directing high-energy ionizing
radiation to destroy malignant tumor cells
without harming surrounding tissues
Types:
² Teletherapy (external): radiation delivered in
uniform dose to tumor; Teletherapy is external
beam irradiation and uses a device located at a
distance from the patient. It produces X-rays of
varying energies and is administered by
machines a distance from the body 31½ to 39
inches (80 to 100 cm).
² urachytherapy: delivers high dose to tumor
and less to other tissues; radiation source
is placed in tumor or next to it; In
brachytherapy, the radiation device is
placed within or close to the target tissue.
Radiation is delivered in a high dose to a
small tissue volume with less radiation to
adjacent normal tissue, but requires direct
tumor access.
‡ Immunotherapy ² use of chemical or
microbial agents to induce mobilization
of immune defenses.
‡ uiologic response modifiers (uRMs) ²
use of agents that alters immunologic
relationship between tumor and host in
a beneficial way
‡ uone marrow peripheral stem cell
transplantation ² aspirating bone
marrow cells from compatible donor and
infusing them into the recipient
‡ Gene therapy ² transfer of genetic
materials into the client·s DNA
NURSING MANAGEMENT
1. Promote measures that relieve pain and
discomfort.
‡ Pharmacologic and non-pharmacologic
interventions
2. Promote measures to maintain intact skin
integrity
3. Promote measures that maintain oral mucosa
4. Promote measures to prevent injury from
abnormal bleeding
‡ Monitor platelet count; avoid aspiring products,
etc
NURSING MANAGEMENT
1. Promote measures that identify and prevent
infection
‡ Monitor uC count; encourage frequent
handwashing and overall cleanliness
2. Êelp decrease the client·s fatigue and increase
his activity level
3. Promote measures that ensure adequate
nutritional intake
‡ Êigh protein, high calorie diet
4. Ensure adequate fluid and electrolyte balance
NURSING MANAGEMENT
1. Promote measures to enhance body image.
‡ Take an honest gentle, caring approach;
encourage client to express and verbalize
feelings
2. Promote measures that address preventing
complications of cancer therapy
3. Instruct client and family about the disease
process and treatments; provide necessary
information for self-care.
4. Êelp client and family cope effectively
5. Promote measures to reduce social isolation.
Care of Clients Receiving Chemotherapy
‡ Classes of Chemotherapy Drugs:
‡ Alkylating agents:
² Action: create defects in tumor DNA
² Ex: Nitrogen Mustard, Cisplatin
² Toxic Effects: reversible renal tubular
necrosis
Classes of Chemotherapy Drugs
‡ Antimetabolites:
² Action: phase specific
² Ex: Methotrexate; 5 fluorouracil
² Toxic Effects: nausea, vomiting,
stomatitis, diarrhea, alopecia,
leukopenia
Classes of Chemotherapy Drugs
‡ Antitumor Antibiotics:
² Action: non- phase specific; interfere
with DNA
² Ex: Actinomycin D, uleomycin,
adriamycin (doxorubicin)
² Toxic Effect: damage to cardiac muscle
Classes of Chemotherapy Drugs
‡ Miotic inhibitors:
² Action: Prevent cell division during M
phase of cell division
² Ex: Vincristine, Vinblastine
² Toxic Effects: affects neurotransmission,
alopecia, bone marrow depression
Classes of Chemotherapy Drugs
‡ Êormones:
² Action: stage specific G1
² Ex: Corticosteroids
‡ Êormone Antagonist:
² Action: block hormones on hormone- binding
tumors ie: breast, prostate, endometrium;
cause tumor regression
² Ex: Tamoxifen (breast); !lutamide (prostate)
² Toxic Effects: altered secondary sex
characteristics
Effects of Chemotherapy
‡ Tissues: (fast growing) frequently
affected
‡ Examples: mucous membranes, hair
cells, bone marrow, specific organs with
specific agents, reproductive organs (all
are fetal toxic; impair ability to
reproduce)
Chemotherapy Administration
‡ Routes of administration:
² Oral
² uody cavity (intraperitoneal or intrapleural)
² Intravenous
‡ Use of vascular access devices because of
threat
of extravasation (leakage into tissues) &
long term
therapy
Chemotherapy Administration
‡ Types of vascular access devices:
² PICC lines: (peripherally inserted central
catheters)
² Tunneled catheters: (Êickman,
Groshong)
² Surgically implanted ports: (accessed
with 90o angle needle- Êuber needles)
Nursing care of clients receiving chemotherapy
‡ Assess and manage:
² Toxic effects of drugs (report to physician)
² Side effects of drugs: manage nausea and
vomiting, inflammation and ulceration of
mucous membranes, hair loss, anorexia,
nausea and vomiting with specific nursing
and medical interventions
Nursing care of clientsreceiving
chemotherapy
‡ Monitor lab results (drugs withheld if blood
counts seriously low); blood and blood
product administration
‡ Assess for dehydration, oncologic
emergencies
‡ Teach regarding fatigue,
immunosuppression precautions
‡ Provide emotional and spiritual support to
clients and families