CARE OF PATIENTS WITH CANCER

Learning Outcome

1. Explain known carcinogens, carcinogenesis, and identify risk factors for cancer.
2. Compare the mechanisms and characteristics of normal cells with malignant cells.
3. Describe the physical and psychologic effects of cancer.
4. Describe and compare laboratory and diagnostic tests for cancer.
5. Discuss the role of chemotherapy in cancer treatment and classify chemotherapeutic
agents.
6. Compare and contrast the role of surgery, radiation therapy, and biotherapy in the
treatment of cancer.
7. Explain causes and discuss the nursing interventions for common oncologic
emergencies.
8. Design an appropriate care plan for patients with cancer and their families regarding
cancer diagnosis, treatment, and coping strategies.

KEY TERMS

Anaplasia Incidence
Benign Leukemia Palliative Care
Biopsy Leukopenia Paraneoplastic syndrome
Brachytherapy Lymphoma Prognosis
Carcinogenesis Malignant Promoters
Carcinoma Melanoma Sarcoma
Cachexia Mesenchyme Thrombocytopenia
Cancer Metastasis TNM staging
Cell differentiation Mutation Transformation
Cytology Neoplasm Tumor
Cytotoxic Oma, carcin/o Tumor markers
Deoxyribonucleic Acid Occult Blood Tumor suppressor gene
(DNA) Oncogenes Vesicants
Encapsulated
Hematoma

INTRODUCTION

CANCER
 A group – complex diseases characterized – uncontrolled growth & spread of
abnormal cells
(American Cancer Society, ACS,2013)

 Cancer is a neoplastic disorder that can involve all body organs with
manifestations that vary according to the body system affected and type of
tumor cells.
 Cells lose their normal growth-controlling mechanism, and the growth of cells
is uncontrolled.

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  Cancer produces serious health problems such as impaired immune and
hematopoietic (blood-producing) function, altered gastrointestinal tract
structure and function, motor and sensory deficits, and decreased respiratory
function.

ONCOLOGY
 The study – cancer
 Greek word oncoma meaning “bulk”

Risk Factors

i. Genetics & Heredity

 Genetics – study of genes

 Heredity
 Is how genes are passed from generation to generation.

ii. Age

 75% of cancer diagnoses occur after age 55.

 Free radicals tend

iii. Gender

iv. Poverty

v. Stress

vi. Diet

v. Occupation

vi. Infection

vii. Tabacco use

i. Alcohol use
ii. Recreational drug use
iii. Obesity
iv. Sun exposure

Pathophysiology

i. Normal Cell Growth

- Functions of DNA
ii. The Cell Cycle
iii. Differentiation
 Hyperplasia
 Metaplasia

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  Dysplasia
 Anaplasia

Theories of carcinogenesis
 Factors that cause cancer are both external & internal.
 Causal factors may act together or in sequence to initiate or promote carcinogenesis,
a process by which normal cells are transformed into cancer cells.

Etiology of cancer:

i) First,Damaged DNA, whether inherited / from external sources, sets up the

necessary initial step for cancer to occur.
ii) Second, impairment – human immune system, from whatever cause, lessens its
ability to destroy abnormal cells.

A. CELLULAR MUTATION
B. ONCOGENES
C. TUMOR SUPPRESSOR GENES

Known Carcinogens

i. Viruses (Refer -Box 14-3)

ii. Drugs & Hormones
iii. Chemical Agents
iv. Physical Agents

Types of Neoplasms

 A neoplasm is a mass – new tissues independently of its surrounding structures and

has no physiologic purpose.
i. Benign Neoplasms
ii. Malignant Neoplasms

Characteristics of Malignant Cells

A. Loss of regulation of the rate of mitosis

B. Loss of specialization & differentiation
C. Loss of contact inhibition
D. Progressive acquisition of a cancerous phenotype
E. Irreversibility
F. Altered cell structure
G. Simplified metabolic activities
H. Transplantability

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 I. Ability to promote their own survival

TUMOR INVASION & METASTASIS

I) INVASION
i. Ability to cause pressure atrophy
ii. Ability to disrupt the basement membrane of normal cells
iii. Motility
iv. Response to chemical signals from adjacent tissues

II) METASTASIS
o One or more mechanisms including embolism – body / lymph, or spread by
way of body cavities.
o Ability to metastasize – requires
i. Intravasation – malignant cells through blood or lymphatic vessel walls &
into – circulation.
ii. Survival – malignant cells – blood (To survive, the cells must escape –
notice – body’s immune surveillance; only 1:1000 cells does)
iii. Extravasation from the circulation and implantation in – new tissue.

Various Cancers & sites of Metastases (refer Table 14-3)

Primary Tumor Common Metastatic Sites

Bronchogenic (lung)
Breast
Colon
Prostate
Malignant melanoma

Physiologic & Psychologic Effects of Cancer

 Nursing care for pt. with cancer is related to – effects of cancer disease & - side
effects – cancer treatment.
 The pathophysiologic effects of cancer vary with – type & location of – cancer.

PATHOPHYSIOLOGY LINKAGE

Cancer Manifestation

 Ascites
 Malaise / Fatigue
 Anorexia, Nausea, Vomiting

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  Pain

i. Disruption of Function
ii. Hematologic Alterations
iii. Infection
iv. Hemorrhage
v. Anorexia-Cachexia Syndrome
vi. Paraneoplastic Syndrome
vii. Pain
 Types of cancer pain
 Causes of cancer pain

viii. Physical Stress

ix. Psychologic Stress

DIAGNOSIS

i. Histologic examination – tissue

ii. Prostatic-specific antigen (PSA) antigen

Classification

Standardize diagnosis & treatment

i. Classification - Naming of tumor

ii. Grading - describing its aggressiveness -
iii. Staging - Spread within / beyond – tissue of origin

i. Classification - Naming of tumor (refer Table 14-5; pg-347)

 Tumors – classified & named by – tissue / cell of origin.

Eg;
 A carcinoma arises from – epithelial tissue; adjectives – added to further specify
– location.
 A glandular malignancy arising from epithelial tissue – classified as an
adenocarcinoma.
 A tumor arising from supportive tissues is – a sarcoma; the specific type of tissue
is added as a prefix. Eg; a cancer of fibrous connective tissue – called
fibrosarcoma, & smooth muscle cancer is – leiomyosarcoma.
 A tumor from seminal / germ tissue – called – seminoma.
 Myelocytic leukemia , named for – immature form of – granulocyte that is
predominant in – malignancy.

ii. Grading & Staging (refer Table 14-6; pg- 347)

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  Grading evaluates – amount of differentiation ( level of functional maturity) of –
cell & estimates – rate of growth based on – mitotic rate.
 The least malignant & better prognosis – classified as grade 1
 The least differentiated & most aggressively malignant cells – classified as grade
4

TNM staging classification system

 Staging – used to classify solid tumors & refers to – relative size of – tumor & extent
of – disease.
 TNM classification:
 T stands for – relative tumor size, depth – invasion, & surface spread.
 N indicates – presence & extent – lymph node involvement.
 M denotes – presence / absence of distant metastases.

I. Cytologic Examination
 Malignant tissue to be identified by name, grade, & stage, must first be subjected
to histologic & cytologic examination by microscope.
 Specimens – collected by 3 methods:
i. Exfoliation from an epithelial surface : eg; pap smear
ii. Aspiration of fluid from body cavities / blood: eg; pleural fluid, CSF
iii. Needle aspiration of solid tumors: eg; breast, lung / prostate
iv. Specimens from biopsied tissues / tumors & collected body secretions ; -
sputum / urine

II. TUMOR MARKERS (refer Table 14-7; pg- 348)

 A protein molecule detectable in serum / other body fluids
 Tumor marker tests – most useful for monitoring – pt.’s response – therapy & for
detecting residual disease.
 Tumor markers include – following;
i. Antigens
ii. Hormones
iii. Proteins
iv. Enzyme
v.

III. Oncologic Imaging

i. X-RAY imaging
ii. Computed tomography (CT)
iii. Ultrasonography
iv. Magnetic resonance imaging (MRI)
v. Nuclear Imaging
vi. Angiography
vii. Direct visualization : Colonoscopy,…

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IV. LABORATORY TESTS ( Refer -Table 14-6 pg; 349 -350)
 Cancer Diagnosis

V. PSYCHOLOGIC SUPPORT DURING DIAGNOSIS