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Cellular Abbe Ration

Cellular Abbe Ration

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Published by: Mademoiselle Kayetty on Jun 20, 2011
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UNDERSTANDING CANCER

OH GOD AND KING, PLEASE EXPAND MY OPPORTUNITIES AND MY IMPACT IN SUCH A WAY THAT I TOUCH MORE LIVES FOR YOUR GLORY. LET ME DO MORE FOR YOU«

OBJECTIVES
At the end of the lecture-discussion, the students would be able to: 1. Explains the theories of causation and the pathophysiological changes in cellular aberration. 2. Summarizes the nursing roles and opportunities in cancer prevention, detection, diagnosis and treatment of cancer.

3. Differentiates the modes of treatment for cancer. 4. Enumerates the case finding and early detection methods of cancer. 5. Explains the major health problems of clients with cancer. 6. Discusses the psychosocial implications in cancer. 7. Describes the process of counseling among patients.

8. Utilizes the nursing process in the care of patient with problems in cellular functioning. 9. Formulates appropriate nursing diagnosis as to priority. 10. Evaluate outcome of nursing care goals for each disease entity.

‡ Essential Concepts of Cancer
² ² ² ² ² ² What is Cancer? Normal Cell Growth vs. Cancer Cell Growth Etiology and Causative Factors Pathophysiology Classification of Tumors Effects of Cancer

‡ Nursing Process
² ² ² ² ² Assessment Laboratory & Diagnostic Tests Tumor Staging and Grading Nursing Diagnoses & Planning 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

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WHAT IS CANCER
‡ 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)
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ONCOLOGY DEFINED of medicine that deals with the study, detection, treatment and management of cancer and neoplasia
Branch

³ROOT WORDS´
‡ ‡ ‡ ‡ ‡ ‡ Neo- new Plasia- growth Plasm- substance Trophy- size +Oma- tumor Statis- location

³ROOT WORDS´
‡ ‡ ‡ ‡ ‡ A- none Ana- lack Hyper- excessive Meta- change Dys- bad, deranged

CHARACTERISTICS OF NEOPLASIA
‡ ‡ ‡ ‡ Uncontrolled growth of Abnormal cells 1. Benign 2. Malignant 3. Borderline

BENIGN
‡ ‡ ‡ ‡ ‡ Well-differentiated Slow growth Encapsulated Non-invasive Does NOT metastasize

MALIGNANT
‡ ‡ ‡ ‡ ‡ Undifferentiated Erratic and Uncontrolled Growth Expansive and Invasive Secretes abnormal proteins METASTASIZES

NOMENCLATURE OF NEOPLASIA
Tumor is named according to: 1. Parenchyma, Organ or Cell ‡ Hepatoma- liver ‡ Osteoma- bone ‡ Myoma- muscle

Tumor is named according to: 2. Pattern and Structure, either GROSS or MICROSCOPIC ‡ Fluid-filled CYST ‡ Glandular ADENO ‡ Finger-like PAPILLO ‡ Stalk POLYP

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)

BENIGN TUMORS
Suffix- ´OMAµ is used ‡ Adipose tissue - LipOMA ‡ Bone - osteOMA ‡ Muscle - myOMA ‡ Blood vessels - angiOMA ‡ Fibrous tissue - fibrOMA

MALIGNANT TUMOR
Named according to embryonic cell origin 1. Ectodermal, Endodermal, Glandular, Epithelial ‡ Use the suffix- ´CARCINOMAµ ‡ Pancreatic AdenoCarcinoma ‡ Squamos cell Carcinoma

Named according to embryonic cell origin 2. Mesodermal, connective tissue origin ‡ Use the suffix ´SARCOMA ‡ FibroSarcoma ‡ Myosarcoma ‡ AngioSarcoma

Loss of Normal Growth Control
Normal cell division
Cell Suicide or Apoptosis Cell damage² no repair

Cancer cell division

First mutation

Second mutation

Third mutation

Fourth or later mutation Uncontrolled growth

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Oncogenes

Normal cell

Normal genes regulate cell growth

Cancer cell

Oncogenes accelerate cell growth and division

Mutated/damaged oncogene

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Example of Normal Growth

Dead cells shed from outer surface

Epidermis

Cell migration

Dividing cells in basal layer

Dermis

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The Beginning of Cancerous Growth

Underlying tissue
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Tumors (Neoplasms)

Underlying tissue
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Invasion and Metastasis

1 Cancer cells invade surrounding tissues and blood vessels 2 Cancer cells are transported by the circulatory system to distant sites 3 Cancer cells reinvade and grow at new location

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ETIOLOGY/CAUSATIVE FACTORS
‡ ‡ ‡ ‡ ‡ Viruses Chemical carcinogens Physical stressors Hormonal factors Genetic factors

What Causes Cancer?
Some viruses or bacteria

Some chemicals Heredity Diet Hormones

Radiation

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Hereditary/Family History
Certain types of cancers run in the family such as breast cancer.

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Carcinogens
‡ A carcinogen is an agent capable of causing cancer. This may be a chemical, an environment agent, radiation and viruses. ‡ Many cancers are associated with lifestyle risk factors such as smoking, dietary factors and alcohol consumption.

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Chemical & Environmental Agents
‡ 1. Polycyclic hydrocarbons
‡ - are chemicals found in cigarette smoke, industrial agents, or in food such as smoked foods. ‡ - are also produced from animal fat in the process of broiling meats and are present in smoked meats and fish.

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2. Aflatoxin - is found in peanuts and peanut butter. 3. Benzopyrene - Produced when meat and fish are charcoal broiled or smoked (e.g. tinapa or smoked fish).. - Also produced when food is fried in fat that has been reused repeatedly. Avoid reusing cooking oil.
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4. Nitrosamines - These are powerful carcinogens used as preservatives in foods like tocino, longganisa, bacon and hotdog.  Formation of nitrosamines may be inhibited by the presence of antioxidants such as Vitamin C in the stomach. Limit eating preserved foods and eat more vegetables and fruits that are rich in dietary fiber.
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Radiation
± - Radiation can also cause cancer including ultraviolet rays from sunlight, x-rays, radioactive chemicals and other forms of radiation.

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Population-Based Studies
Regions of Highest Incidence
U.K.: Lung cancer

JAPAN: Stomach cancer

CANADA: Leukemia U.S.: Colon cancer BRAZIL: Cervical cancer
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CHINA: Liver cancer

AUSTRALIA: Skin cancer

Genes and Cancer
Viruses Chemicals Radiation

Heredity

Chromosomes are DNA molecules

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Viruses

Virus inserts and changes genes for cell growth Cancer-linked virus
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Examples of Human Cancer Viruses

Some Viruses Associated with Human Cancers

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Bacteria and Stomach Cancer

Patient¶s tissue sample

H. pylori

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Tobacco Use and Cancer
Some Cancer-Causing Chemicals in Tobacco Smoke

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High-Strength Radiation
High

Leukemia Incidence

Low Least X-ray Dose (atomic radiation)
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Most

AIDS and Kaposi¶s Sarcoma

Without disease

HIV infection
Depressed immune system

KSHV infection
Kaposi¶s sarcoma

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Heredity and Cancer
All Breast Cancer Patients

Inherited factor(s) Other factor(s)
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CANCER Lung Cancer

RISK FACTORS · Tobacco use, including cigarettes,
cigars, chewing tobacco and snuff. · Radiation exposure Second-hand smoke

Oral Cancer

· Tobacco use (cigarette, cigar, pipe,
smokeless tobacco) · Excessive alcohol use · Chronic irritation (e.g. ill-fitting dentures) Vitamin A deficiency
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Laryngeal Cancer

Tobacco use (cigarette, cigar, pipe, smokeless tobacco) · Poor nutrition · Alcohol · Weakened immune system · Occupational exposure to wood dust, paint fumes · Gender: 4-5 times more common in men Age: more than 60 years Tobacco use (cigarette, cigar, pipe, smokeless tobacco) · Occupational exposure: dyes, solvents Chronic bladder inflammation Tobacco use (cigarette, cigar, pipe, smokeless tobacco): increase risk by 40% · Obesity · Diet: well-cooked meat · Occupational exposure: asbestos, organic solvents Age: 50-70 years old

·

Bladder Cancer

·

Renal Cancer ·

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Cervical Cancer

· Tobacco use (cigarette, cigar, pipe, smokeless tobacco) · Human papillomavirus infection · Chlamydia infection · Diet: low in fruits and vegetables Family history of cervical cancer

Esophageal Cancer Breast Cancer

· Tobacco use (cigarette, cigar, pipe, smokeless tobacco) · Gender: 3 times more common in men · Alcohol Diet: low in fruits and vegetables · Early menarche/late menopause · Age-changes in hormone levels throughout life, such as age at first menstruation, number of pregnancies, and age at menopause · High fat diet · Obesity · Physical inactivity · Some studies have also shown a connection between alcohol consumption and an increased risk of breast cancer Women with a mother or sister who have had breast cancer are more likely to develop the disease

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Prostate Cancer

· While all men are at risk, several factors can increase the chances of developing the disease, such as advancing age, race and diet · Race: more common among AfricanAmerican men than among white men · High fat diet Men with a father or brother who has had prostate cancer are more likely to get prostate cancer themselves · Certain types of viral hepatitis · Cirrhosis of the liver Long-term exposure to aflatoxin (carcinogenic substance produced by a fungus that often contaminates peanuts, wheat, soybeans, corn and rice)

Liver Cancer

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Skin Cancer

· Unprotected exposure to strong sunlight · Fair complexion Occupational exposure · · · · · Personal/family history of polyps High fat diet and/or low fiber diet History of ulcerative colitis Age: >50 years

Colonic Cancer

Uterine/Endo metrial Cancer

Estrogen replacement therapy · Early menarche/late menopausal
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Heredity Can Affect Many Types of Cancer

Inherited Conditions That Increase Risk for Cancer

Back

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When you develop cancer your normal cells turn into cancer cells. Cancer cells have different DNA than healthy cells. One of the first steps in a healthy cell becoming a cancer cell is the change of the proto-oncogens to oncogenes. In cancer cells the cell grows and divides very quickly. The second step to becoming a cancer cell is the tumor suppressor genes get turned off. The last step to becoming a Cancer cell is the DNA repair genes gets turned off.

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PATHOPHYSIOLOGY
ABNORMAL CELL FORMED BY MUTATION OF DNA CELL GROWS AND PROLIFERATES METASTASIS OCCURS WHEN ABN. CELLS INVADE OTHER TISSUE,THROUGH LYMPH AND BLOOD
² Cancer development linked to immune system failure ² Example of clients susceptible to developing cancer

Classification of Cancer
According to Behavior of Tumor: ‡ Benign - tumors that cannot spread by invasion or metastasis; hence, they only grow locally ‡ Malignant - tumors that are capable of spreading by invasion and metastasis. By definition, the term ³cancer´ applies only to malignant tumors

Malignant versus Benign Tumors
Benign (not cancer) tumor cells grow only locally and cannot spread by invasion or metastasis Malignant (cancer) cells invade neighboring tissues, enter blood vessels, and metastasize to different sites

Time
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Why Cancer Is Potentially Dangerous
Brain

Melanoma cells travel through bloodstream Liver Melanoma (initial tumor)

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Patterns of cell Proliferation
‡ Hyperplasia ‡ Dysplasia ‡ Metaplasia ‡ Anaplasia ‡ Neoplasia

Hyperplasia
‡ tissue growth based on an excessive rate of cell division, leading to a larger than usual number of cells; the process of hyperplasia is potentially reversible; can be a normal tissue response to an irritating stimulus. An example is a callus

Normal

Hyperplasia

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Dysplasia
‡ Bizarre cell growth differing in size, shape and cell arrangement

Normal

Hyperplasia

Mild dysplasia
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Carcinoma in Situ

Normal

Hyperplasia

Mild dysplasia

Carcinoma in situ (severe dysplasia)

Cancer (invasive)

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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. Spread ² tumor cells spread through lymph or circulation or by direct expansion Establishment and growth ² tumor cells are established and grow in secondary site: lymph nodes or in organs from venous circulation

²

²

Cancer Tends to Involve Multiple Mutations
Benign tumor cells grow only locally and cannot spread by invasion or metastasis Malignant cells invade neighboring tissues, enter blood vessels, and metastasize to different sites

Time Mutation Cells inactivates proliferate suppressor gene Mutations inactivate DNA repair genes Proto-oncogenes mutate to oncogenes More mutations, more genetic instability, metastatic disease

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Mutations and Cancer
Genes Implicated in Cancer

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Cancer Tends to Corrupt Surrounding Environment
Growth factors = proliferation
Invasive

Matrix Proteases Fibroblasts, adipocytes Blood vessel Cytokines

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Cytokines, proteases = migration & invasion

Classification of Tumors
‡
²

CARCINOMAS: EPITHELIAL TISSUE
BODY SURFACES, LINING OF BODY CAVITIES ETC: (ADENOCARCINOMA)

‡
²

SARCOMAS: CONNECTIVE TISSUE
STRIATED MUSCLE, BONE, ETC (OSTEOSARCOMA)

‡
²

LYMPHOMAS AND LEUKEMIAS
HEMATOPOIETIC SYSTEM

‡
²

NERVOUS TISSUE TUMORS
EX. NERVE CELLS-NEUROBLASTOMA

‡
²

MYELOMA
Develops in the plasma cells of bone marrow

Different Kinds of Cancer

Some common carcinomas:
Lung Breast (women)

Leukemias:
Bloodstream

Lymphomas:
Lymph nodes

Colon Bladder Prostate (men)

Some common sarcomas:
Fat Bone Muscle
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Naming Cancers
Cancer Prefixes Point to Location
Prefix adenochondroerythrohepatolipolymphomelanomyelomyoosteoMeaning gland cartilage red blood cell liver fat lymphocyte pigment cell bone marrow muscle bone
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hemangio- blood vessels

Women, Tobacco & Lung Cancer
³ Women who smoke like men, die like men.´
U.S. Surgeon General David Satcher

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Effects of Cancer
‡ Disruption of Function- can be due to obstruction or pressure ‡ Hematologic Alterations: can impair function of blood cells ‡ Hemorrhage: tumor erosion, bleeding, severe anemia ‡ Anorexia-Cachexia Syndrome: wasted appearance of client

Effects of Cancer
‡ Paraneoplastic Syndromes: ectopic sites with excess hormone production
² ² ² Parathyroid hormone hypercalcemia secretion of insulin hypoglycemia Antidiuretic hormone (ADH) fluid retention, HTN & peripheral edema

‡

Adrenocorticotropic hormone (ACTH): cause excessive secretion of cortisone (ie: fluid retention, glucose levels)

Effects of Cancer
‡ Pain: major concern of clients and families associated with cancer ‡ Physical Stress: body tries to respond and destroy neoplasm ‡ Psychological Stress

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STAGES IN CARCINOGENESIS
‡ Carcinogenesis is the process during which normal genes are damaged so that cells lose normal control mechanisms of growth and proliferate out of control. When the genes of a single cell are altered by a carcinogenic event, the offspring of the single cell continue to mutate and divide, producing even more virulent mutant clones. ‡ Initiation ² exposure of normal cells to carcinogens ‡ Promotion ² cigarette smoking, alcohol abuse or dietary components that act on the transformed cell ‡ Progression ² uncontrollable growth of malignant tumor capable of metastatic activity

CLASSIFICATION
‡ GRADING
defines the origin of the tumor and degree to which tumor cells retain the functional and histologic characteristics of tissue origin

‡ Grade X : Grade cannot be determined ‡ Grade I : Cells differ slightly from normal cells and are well differentiated (Mild Dysplasia) ‡ Grade II: Cells are abnormal and are moderately differentiated (Moderate Dysplasia) ‡ Grade III: Cells are very abnormal and are poorly differentiated (Severe Dysplasia) ‡ Grade IV: Cells are immature (Anaplasia) and undifferentiated, cell of origin is difficult to determine.

‡

STAGING
»² determines the size of the tumor and extent metastasis; determines extent of the disease

‡ Stage 0 ² carcinoma in situ; cancer in place ‡ Stage I ² tumor limited to the tissue of origin; localized tumor growth ‡ Stage II ² limited local spread ‡ Stage III ² extensive local and regional spread ‡ Stage IV- metastasis

ASSESSMENT
‡ Nursing History
² Health History ² chief complaint and history of present illness (onset, course, duration, location, precipitating and alleviating factors) Cancer signs: CAUTION US!

²

Warning Signs of Cancer
‡ CAUTION US!
² ² ² ² ² ² ² ² ² ² Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharges Thickenings or lumps Indigestion or difficulty in swallowing Obvious change in a wart or mole Nagging or persistent cough or hoarseness Unexplained anemia Sudden unexplained weight loss Persistent headache

Warning Signs of Cancer
‡ 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 may have urinary frequency and urgency

Warning Signs of 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

Warning Signs of Cancer
‡ Unusual bleeding or discharge
² Blood 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

Warning Signs of 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 Breast and testicular cancers may also present as a lump

Warning Signs of Cancer
‡ 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

Warning Signs of Cancer
‡ Obvious change in a wart or mole
² Moles or other skin lesions that change in shape, size, or color should be reported

Warning Signs of Cancer
‡ 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

Warning Signs of Cancer
‡ Unexplained anemia ‡ Sudden unexplained weight loss ‡ Persistent headache

Physical Assessment
‡
² ²

Inspection ² skin and mucus membranes for lesions, bleeding, petechiae, and irritation
Assess stools, urine, sputum, vomitus for acute or occult bleeding Scalp noting hair texture and hair loss

‡
² ²

Palpation
Abdomen for any masses, bulges or abnormalities Lymph nodes for enlargement

‡

Auscultation ² of lung sounds, heart sounds and bowel sounds
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Laboratory & Diagnostic Tests
‡ Cancer detection examination ‡ Laboratory tests
² ² Complete blood cell count (CBC) 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

Biopsy

Biopsy
‡ is the definitive means of diagnosing cancer and provides histological proof of malignancy. It involves the surgical incision of a small piece of tissue of microscopic examination

‡ Types: ‡ Needle: Aspiration of Cells ‡ Incisional: Removal of a wedge of suspected tissue from a larger mass ‡ Excisional: Complete removal of the entire lesion ‡ Staging: Multiple needle or incisional biopsies in tissues where metastasis is suspected or likely.

Diagnostic Tests
‡ Determine location of cancer:
² ² ² ² ² ² X-rays Computed tomography Ultrasounds Magnetic resonance imaging Nuclear imaging Angiography

‡ Diagnosis of cell type:
² Tissue samples: from biopsies, shedded cells (e.g. Papanicolaou (PAP) smear), & washings ² Cytologic Examination: tissue examined under microscope

‡ Direct Visualization:
² ² ² ² ² Sigmoidoscopy Cystoscopy Endoscopy Bronchoscopy Exploratory surgery; lymph node biopsies to determine metastases

Cancer Detection and Diagnosis

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Early Cancer May Not Have Any Symptoms

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Cervical Cancer Screening

Normal Pap smear

Abnormal Pap smear

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Breast Cancer Screening

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Prostate and Ovarian Cancer Screening

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Colon Cancer Screening

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Biopsy

Pathology

Proteomic profile

Patient¶s tissue sample or blood sample

Genomic profile
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Microscopic Appearance of Cancer Cells

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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 T0 Tis T1, T2, T3, T4 NX N0 N1, N2, N3 Primary tumor cannot be evaluated No evidence of primary tumor Carcinoma in situ (early cancer that has not spread to neighboring tissue) Size and/or extent of the primary tumor Regional lymph nodes cannot be evaluated No regional lymph node involvement (no cancer found in the lymph nodes) Involvement of regional lymph nodes (number and/or extent of spread) Distant metastasis cannot be evaluated No distant metastasis (cancer has not spread to other parts of the body) Distant metastasis (cancer has spread to distant parts of the body)

Regional Lymph Nodes (N)

Distant Metastasis (M) MX M0 M1

NURSING DIAGNOSES
‡ ‡ ‡ ‡ ‡ ‡ ‡ Acute or chronic pain Impaired skin integrity Impaired oral mucous membrane Risk for injury Risk for infection Fatigue Imbalanced nutrition: less than body requirements

NURSING DIAGNOSES
‡ ‡ ‡ ‡ ‡ ‡ Risk for imbalanced fluid volume Anxiety Disturbed body image Deficient knowledge Ineffective coping Social isolation

OUTCOME IDENTIFICATION
1. 2. 3. 4. 5. Pain relief Integrity of skin and oral mucosa Absence of injury and infection Fatigue relief Maintenance of nutritional intake and fluid and electrolyte balance 6. Improved body image 7. Absence of complications

OUTCOME IDENTIFICATION
8. Knowledge of prevention and cancer treatment 9. Effective coping through recovery and grieving process 10.Optimal social interaction

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IMPLEMENTATION/MANAGEME NT
‡ 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

Cancer Prevention
Carcinogenic chemicals Carcinogenic radiation

Cancer viruses or bacteria

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Avoid Tobacco
Lung Cancer Risk Increases with Cigarette Consumption
15x

10x Lung Cancer Risk 5x

Non-smoker

0

15 Cigarettes Smoked per Day

30

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Protect Yourself From Excessive Sunlight

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Limit Alcohol and Tobacco
Combination of Alcohol and Cigarettes Increases Risk for Cancer of the Esophagus
40x 30x 20x 10x

Risk Increase

Alcoholic Drinks Consumed per Day

AND
Packs of Cigarettes Consumed per Day
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Diet: Limit Fats and Calories
Correlation Between Meat Consumption and Colon Cancer Rates in Different Countries
40

Number of Cases (per 100,000 people)

30

20

10

0

80

100

200

300
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Grams (per person per day)

Diet: Consume Fruits and Vegetables

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Avoid Cancer Viruses
HPV Infection Increases Risk for Cervical Cancer

High

Cervical Cancer Risk

Low Noninfected women Women infected with HPV
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Avoid Carcinogens at Work
Some Carcinogens in the Workplace

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Industrial Pollution

Incidence of Most Cancers

1930

1950 Year

1970

1990

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TREATMENT MODALITIES
‡ Aimed towards:
² CURE - free of disease after treatment 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
² Teletherapy (external): radiation delivered in uniform dose to tumor ² Brachytherapy: delivers high dose to tumor and less to other tissues; radiation source is placed in tumor or next to it

‡ Immunotherapy ² use of chemical or microbial agents to induce mobilization of immune defenses. ‡ Biologic response modifiers (BRMs) ² use of agents that alters immunologic relationship between tumor and host in a beneficial way

‡ Bone 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
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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
5. Promote measures that identify and prevent infection
‡ Monitor WBC count; encourage frequent handwashing and overall cleanliness

6. Help decrease the client·s fatigue and increase his activity level 7. Promote measures that ensure adequate nutritional intake
‡ High protein, high calorie diet

8. Ensure adequate fluid and electrolyte balance

NURSING MANAGEMENT
9. Promote measures to enhance body image.
‡ Take an honest gentle, caring approach; encourage client to express and verbalize feelings

10. Promote measures that address preventing complications of cancer therapy 11. Instruct client and family about the disease process and treatments; provide necessary information for self-care. 12. Help client and family cope effectively 13. 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, Bleomycin, 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
‡ Hormones:
² Action: stage specific G1 ² Ex: Corticosteroids

‡ Hormone Antagonist:
² Action: block hormones on hormone- binding tumors ie: breast, prostate, endometrium; cause tumor regression ² Ex: Tamoxifen (breast); Flutamide (prostate) ² Toxic Effects: altered secondary sex characteristics

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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 Body cavity (intraperitoneal or intrapleural) ² Intravenous
‡ Use of vascular access devices because of threat of extravasation (leakage into tissues) & longterm therapy

Chemotherapy Administration
‡ Types of vascular access devices:
² PICC lines: (peripherally inserted central catheters) ² Tunneled catheters: (Hickman, Groshong) ² Surgically implanted ports: (accessed with 90o angle needle- Huber 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 clients receiving 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
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REFERENCE
‡ National Cancer Institute ‡ Brunner and Suddarth·s Medical Surgical Nursing

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