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Chapter 16 Cancer Nursing
Chapter 16 Cancer Nursing
Cancer encompasses a broad range of diseases of multiple causes that can arise in any
cell of the body capable of evading regulatory controls over proliferation and
differentiation.
Two major dysfunctions present in the process of cancer are (1) defective
cellular proliferation (growth) and (2) defective cellular differentiation.
Cancer cells usually proliferate at the same rate of the normal cells of the tissue from
which they arise. However, cancer cells divide indiscriminately and haphazardly and
sometimes produce more than two cells at the time of mitosis.
Protooncogenes are normal cellular genes that are important regulators of normal
cellular processes. When these genes become mutated, they can begin to function
as oncogenes (tumor-inducing genes).
Since cancer cells arise from normal human cells, the immune response mounted against
cancer cells may be inadequate to effectively eradicate them.
The process by which cancer cells evade the immune system is termed immunologic
escape.
Tumors can be classified according to anatomic site, histologic (grading), and extent
of disease (staging).
o In the anatomic classification of tumors, the tumor is identified by the tissue of
origin, the anatomic site, and the behavior of the tumor (i.e., benign or malignant).
o In histologic grading of tumors, the appearance of cells and the degree of
differentiation are evaluated pathologically. For many tumor types, four
grades are used to evaluate abnormal cells based on the degree to which the
cells resemble the tissue of origin.
o The staging classification system is based on a description of the extent of the
disease rather than on cell appearance.
Modalities for cancer treatment with all three goals include surgery,
chemotherapy, radiation therapy, and biologic and targeted therapy.
The goal of chemotherapy is to eliminate or reduce the number of malignant cells
present in the primary tumor and metastatic tumor site(s).
Regional treatment with chemotherapy involves the delivery of the drug directly to the
tumor site.
Chemotherapy-induced side effects are the result of the destruction of normal cells,
especially those that are rapidly proliferating such as those in the bone marrow, lining
of the gastrointestinal system, and the integumentary system (skin, hair, and nails).
Radiation is the emission and distribution of energy through space or a material medium.
Radiation is used to treat a carefully defined area of the body to achieve local control of
disease.
Nurses play a key role in assisting patients to cope with the psychoemotional
issues associated with receiving cancer treatment.
Educating patients about their treatment regimen, supportive care options (e.g.,
antiemetics, antidiarrheals), and what to expect during the course of treatment is
important to help decrease fear and anxiety, encourage adherence, and guide at-
home self-management.
Fatigue is a nearly universal symptom affecting 70% to 100% of patients with cancer.
The intestinal mucosa is one of the most sensitive tissues to radiation and chemotherapy.
Nausea and vomiting are common sequelae of chemotherapy and, in some instances,
radiation therapy.