ALTERATIONS / PROBLEMS IN CELLULAR ABERRATIONS

INTRODUCTION

CANCER:

is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body.
These contrast with benign tumors, which do not spread.

PATHOPHYSIOLOGY:

 Cancer is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular
DNA

 Early detection is crucial in reducing morbidity and mortality. Clients need to be taught about:

Nine warning signs of cancer

C – Change in bladder habits or bladder function.

A – A sore that do not heal.

U – Unusual bleeding or discharge.

T – Thickening or lump in breast or other body parts.

I – Indigestion or difficulty swallowing.

O – Obvious recent change in a wart or mole.

N – Nagging cough or hoarseness.

U – Unexplained anemia.

S – Sudden weight loss.

STAGES OF CANCER

• Stage I – malignant cells are confined to the tissue of origin, with no signs of metastasis.

• Stage II – spread of cancer is limited to the local area, usually to area of lymph nodes.

• Stage III – tumor is larger, probably has invaded surrounding tissues, or both.

• Stage IV – cancer has invaded or metastasized to other parts of the body.

FOUR MODALITIES OF TREATMENT

1. Surgery

2. Radiation therapy

3. Chemotherapy

4. Biotherapy

CANCER OF THE BREAST

 Breast cancer is the most common cancer in women and is the second leading cause of death from cancer in women
in the United States.
  1. Most breast cancer begins in the lining of the milk ducts, sometimes in the lobule. Eventually it grows through the
wall of the duct and into the fatty tissue.
2. Family history accounts for approximately 7% of all breast cancers.

Types of Breast Cancer

1.  Ductal Carcinoma in Situ (DCIS)

2. Invasive Ductal Carcinoma (IDC)

3. Inflammatory Breast Cancer (IBC)

4. Metastatic Breast Cancer

Risk Factors

1. Major

2. Probable

3. Controversia

Clinical Manifestations

1. A firm lump or thickening in breast, usually painless

2. Nipple discharge
 3. Breast asymmetry

4. Nipple retraction or scaliness Late signs

 Inflammatory breast cancer may present with erythema.

7. Many small invasive breast cancers as well as noninvasive breast cancer (DCIS) do not present with a palpable mass but
are found on mammography. 6. Inflammatory breast cancer may present with erythema.

NURSING ALERT

 Pain is not usually an early warning sign of breast cancer.

DIAGNOSTIC TESTS /LABORATORY TESTS

1. Nipple Discharge Cytology

 Secretions are smeared on a slide, fixed, and submitted for cytologic examination. There is a high rate of false-
negative test results with this method.

2. Ductal Lavage

 A procedure that targets asymptomatic women at increased risk for breast cancer. Breast duct epithelial cells are
collected from the nipple for cytological analysis.

RADIOLOGY AND IMAGING

1. Mammography
2. Ultrasonography

3. Galactography

4. Magnetic Resonance Imaging

OTHER TESTS

> biopsy

1. Fine-Needle Aspiration

2. Needle Biopsy

3. Stereotactic Core Needle Biopsy

4. Excisional Biopsy

5. Sentinel Lymph Node Biopsy

 BSE is an inexpensive, risk-free method to detect cancer. When lumps are discovered at an early stage, they have a
better chance for long-term survival.

 1. Look for changes

  2. Feel for changes.

 3. Check your left breast with your right hand in the same way.

 4. If you detect any changes, lumps, or knots, notify your health care provider immediately

Diagnostic Evaluation:

 1. Mammography

 2. Biopsy or aspiration.

 3. Estrogen/progesterone

 4. Laboratory tests to detect metastasis.

 5. Additional metastatic workup

1. SURGERY

 Lumpectomy – removal of tumor and surrounding tissue

 Quadrantectomy (partial mastectomy) - removal of a breast quadrant that includes the tumor area and
possibly overlying skin

 Sentinel lymph node biopsy- removal of only a few gatekeeper lymph nodes.

 Axillary dissection - Surgical removal of the axillary lymph nodes

 Simple mastectomy - Surgical removal of the breast and few of the axillary lymph nodes close to the breast

 Potential Complications

1. Infection

2. Hematoma, seroma

3. Lymphedema

4. Paresthesia, pain of axilla and arm

5. Impaired mobility of arm

 Postoperative Management and Nursing Care

1. Dressing is removed and the wound is assessed for erythema, edema, tenderness, odor, and drainage.

2. Suction (hemovac) drain from wound is maintained.

3. Arm on affected side is observed for edema, erythema, and pain.

4. Patient teaching about drain care, exercises, surgical outcome, and BSE occurs.
5. Female relatives, especially sisters, daughters, and mother, who may need closer breast cancer surveillance are
discussed.

 BREAST RECONSTRUCTION AFTER MASTECTOMY

1. Implants

2. Flap Grafts

2. Radiation Therapy

3. Chemotherapy

4. Endocrine Therapy

5. Bone Marrow Transplant

6. Oophorectomy

7. Adrenalectomy
CANCER OF THE CERVIX

 Cancer of the cervix is a common gynecologic malignancy.

Pathophysiology and Etiology

 Most common between ages 35 and 55.

 Early sexual activity, multiple sexual partners, and history of STDs, especially HPV and HSV, are major risk factors.

 Incidence is higher in lower socioeconomic status and in blacks.

 Decreased mortality in United States, but most frequent malignancy among women in developing countries.

 Early disease is usually asymptomatic although patient may notice watery, vaginal discharge.

 Initial symptoms include postcoital bleeding, irregular vaginal bleeding or spotting between periods or after
menopause, and malodorous discharge.

 As disease progresses, bleeding becomes more constant and is accompanied by pain that radiates to buttocks and
legs.

 Weight loss, anemia, and fever signal advanced disease.

Diagnostic Evaluation

1. Pap smear – routine screening measure; abnormal results warrant further diagnostic tests

such as colposcopy and biopsy or conization.

Management

1. Radiotherapy

2. Chemotherapy

3. Surgery

a. Simple hysterectomy for stage IA.

b. Radical hysterectomy and bilateral lymph node resections

OVARIAN CANCER

 Ovarian cancer is a gynecologic malignancy, with high mortality because of advanced disease by time of diagnosis. It
is the leading cause of morbidity of gynecologic cancers.

Pathophysiology and Etiology

1. One out of 70 women will develop ovarian cancer.

2. Cause is unknown but about 10% of cases are associated with family history of breast, endometrial, colon, or ovarian
cancer.

3. High-fat diet; smoking; alcohol use; environmental pollutants; and personal history of breast, colon, or endometrial
cancer are also risk factors.

4. There is also higher incidence in nulliparous women or women with low parity.
Clinical Manifestations

1. No early manifestations.

2. First manifestations – (vague) abdominal discomfort, indigestion, flatulence, anorexia, pelvic pressure, weight gain or
loss, ovarian enlargement.

3. Late manifestations – abdominal pain, ascites, pleural effusion, intestinal obstruction.

Diagnostic Evaluation

1. Pelvic examination to detect enlargement, nodularity, immobility of the ovaries.

2. Pelvic sonography

Management

 Surgery

 Chemotherapy

 Radiation therapy is not usually valuable.

 Hormonal therapy

Prostate Cancer
 Cancer of the prostate is the leading cause of cancer and second-leading cause of cancer death among American men
and is the most common carcinoma in men over age 65
Pathophysiology and Etiology

1. The incidence of prostate cancer is 30% higher in black men.

2. The majority of prostate cancers arise from the peripheral zone of the gland; therefore, most prostatic cancers are
palpable on rectal examination.

3. Prostate cancer can spread by local extension, by lymphatics, or by way of the bloodstream.

4. 4. The etiology of prostate cancer is unknown; there is an increased risk for persons with a family history of the
disease.

5. 5. The influences of dietary fat intake, serum testosterone levels, vasectomy, and industrial exposure to carcinogens
are under investigation.

Clinical Manifestations

1. Most early-stage prostate cancers are asymptomatic.

2. Symptoms due to obstruction of urinary flow:

a. Hesitancy and straining on voiding, frequency, nocturia.

b. Diminution in size and force of urinary stream.

3. Symptoms due to metastasis:

 a. Pain in lumbosacral area radiating to hips and down legs (from bone metastases), Perineal and rectal
discomfort, Anemia, weight loss, weakness, nausea, oliguria (from uremia), Hematuria (from urethral or
bladder invasion, or both), Lower extremity edema—occurs when pelvic node metastases compromise
venous return.

Diagnostic Evaluation

1. Digital rectal examination

2. Needle biopsy (through anterior rectal wall or through perineum)

3. Transrectal ultrasonography

4. PSA

Management

1. Conservative Measures

No treatment may be indicated in men over age 70 because prostate cancer may be slow growing and it is
expected that many men will die from other causes.

2. Surgical Interventions

a. Radical prostatectomy removal of entire prostate gland, prostatic capsule, and seminal vesicles; may include
pelvic lymphadenectomy.

b. Cryosurgery of the prostate freezes prostate tissue, killing tumor cells without removing the gland.

CANCER OF THE LUNG (BRONCHOGENIC CANCER)

 Bronchogenic cancer
  refers to an epithelial cancer which arises within the wall or epithelial lining of the bronchus. The lung is also a
common site of metastasis by way of the venous circulation or lymphatic spread.

Pathophysiology and Etiology

Predisposing Factors

1. Cigarette smoking

2. Occupational exposure

Clinical Manifestations

 Usually occur late and are related to size and

location of tumor, extent of spread, and

involvement of other structures.

1. Cough, especially a new type or changing cough, results from bronchial irritation.

2. Dyspnea, wheezing (suggests partial bronchial obstruction).

3. Chest pain (poorly localized and aching)

4. Excessive sputum production, repeated upper respiratory infections

5. Hemoptysis

6. Malaise, fever, weight loss, fatigue, anorexia

7. Paraneoplastic syndrome – metabolic or neurologic disturbances related to the secretion of substances by the
neoplasm
 8. Symptoms of metastasis – bone pain; abdominal discomfort, nausea and vomiting from liver involvement;
pancytopenia from bone marrow involvement; headache from CNS metastasis

9. Usual sites of metastasis – lymph nodes, bones, liver

Diagnostic Evaluation

1. CT scan of upper chest and abdomen and whole body positron-emission tomography (PET) scan are indicated ion
most candidates for surgical resection.

2. Cytologic examination of sputum/chest fluids for malignant cells.

3. Fiber-optic bronchoscopy for observation of location and extent of tumor; for biopsy.

4. PET scan sensitive in detecting small nodules and metastatic lesions.

5. Lymph node biopsy; mediastinoscopy to establish lymphatic spread; to plan treatment.

6. Pulmonary function tests (PFTs) combined with split-function perfusion scan to determine if patient will have
adequate pulmonary reserve to withstand surgical procedure.

7. Laboratory testing, including complete blood count, metabolic panel, calcium level, liver function test.

Management

a. Surgical resection.

b. Radiation therapy.

c. Chemotherapy.

d. Immunotherapy
Nursing Interventions

1. Improving Breathing Patterns

2. Improving Nutritional Status

3. Controlling Pain

4. Minimizing Anxiety

CANCER OF THE THYROID

 Cancer of the thyroid is a malignant neoplasm of the gland in front of the neck.

Pathophysiology and Etiology

 Thyroid cancer occurs when cells in your thyroid undergo genetic changes (mutations).

Clinical Manifestations

1. On palpation of the thyroid, there may be a firm, irregular, fixed, painless mass or nodule.

2. The occurrence of signs and symptoms of hyperthyroidism is rare.

Diagnostic Evaluation
 1. A thyroid scan

2. FNA biopsy.

3. Surgical exploration.

Management

1. Surgery

2. Thyroid replacement.

a. Thyroid hormone is administered to suppress secretion of TSH.

b. Such treatment is continued indefinitely and requires annual checkups.

3. For unresectable cancer, patient is referred for treatment with chemotherapy, or radiation therapy.

LIVER CANCER

Liver Cancer

 Is a cancer that begins in the cells of your liver.

Pathophysiology:

 Primary liver cancer (hepatocellular carcinoma) tends to occur in livers damaged by birth defects, alcohol abuse, or chronic
infection with diseases such as hepatitis B and C, hemochromatosis (a hereditary disease associated with too much iron in
the liver), and cirrhosis.
Some of the most common symptoms of liver cancer are:

 Weight loss (without trying)

 Loss of appetite.

 Feeling very full after a small meal.

 Nausea or vomiting.

 An enlarged liver, felt as fullness under the ribs on the right side.

 An enlarged spleen, felt as fullness under the ribs on the left side

Diagnostic Evaluation

 Increased levels of serum bilirubin, alkaline phosphatase, and liver enzymes.

 Alpha Fetoprotein (AFP) test

 Ultrasonography and CT along with MRI

 Positron Emission Tomography (PET)

 Percutaneous needle biopsy or biopsy assisted by ultrasonography or CT scan may be done.

 Laparoscopy with liver biopsy may be performed.

Management

1. Nonsurgical Treatment

These therapies may prolong survival and improve the patient's quality of life by reducing pain, but the overall effect is
palliative.

2. Surgery

COLORECTAL CANCER

 Colorectal cancer refers to malignancies of the colon and rectum.

Pathophysiology and Etiology

 Colorectal lesions occur most frequently in the rectum and sigmoid areas

Pathophysiology and Etiology

1. Risk factors include:

a. Age: risk increases sharply after age 40 with 90% of cases occurring in people over age 50.

b. Previous history of resected colorectal cancer.

c. Family history of colorectal cancer is

 d. Polyposis syndromes:

Clinical Manifestations

Colorectal cancer is often asymptomatic. If present,

symptomatology varies according to the location of

the lesion and the extent of involvement.

1. Right-sided lesions change in bowel habits, usually diarrhea; vague abdominal discomfort; black, tarry stools; anemia;
weakness; weight loss; palpable mass in right lower quadrant.

1. Right-sided lesions

 Change in bowel habits: usually diarrhea, black, tarry stools

 vague abdominal discomfort

 anemia

 weakness

 weight loss

 palpable mass in right lower quadrant

2. Left-sided lesions
  change in bowel habits: often increasing constipation with bouts of diarrhea due to partial obstruction

 bright, streaked, red blood in stool

 cramping pain

 weight loss

 Anemia

 palpable mass.

3. Rectal lesions

 change in bowel habits with possibly urgent need to defecate, alternating constipation and diarrhea, and narrowed
caliber of stool; bright red blood in stool, feeling of incomplete evacuation; rectal fullness progressing to dull
constant ache

Diagnostic Evaluation

1. Fecal occult blood test (FOBT) – often reveals evidence of carcinoma when the patient is otherwise asymptomatic.

2. Barium enema – useful in detecting smaller tumors.

3. Colonoscopy with biopsy

Management

1. Blood Replacement

Administration of whole blood or packed red blood cells

If severe anemia exists.

2. Surgical Resection

 Laparotomy with wide segmental bowel resection of tumor

 Transanal excision