(40) CARE OF CLIENTS WITH
CANCER OF THE STOMACH
STOMACH CANCER:
- Usually begins in the mucus-
producing cells that line the stomach.
This type of cancer is called
adenocarcinoma.
STAGES OF STOMACH CANCER:
The stages of adenocarcinoma of the
stomach or esophagus include:
a.) Stage I. At this stage, the tumor is
limited to the top layer of tissue that lines
the inside of the esophagus or stomach.
Cancer cells also may have spread to a
limited number of nearby lymph nodes.
b.) Stage II. The cancer at this stage has
spread deeper, growing into a deeper
muscle layer of the esophagus or
stomach wall. Cancer may also have
spread to more of the lymph nodes.
c.) Stage III. At this stage, the cancer may
have grown through all the layers of the
esophagus or stomach and spread to
nearby structures. Or it may be a smaller
cancer that has spread more extensively
to the lymph nodes.
d.) Stage IV. This stage indicates that the
cancer has spread to distant areas of the
body.
RISK FACTORS:
- Increase your risk of stomach cancer
located in the stomach body include:
 A diet high in salty and smoked foods
 Family history of stomach cancer
 Smoking
Subjective Cues:
 Feeling bloated after eating
 Feeling full after eating small
amounts of food
 Severe, persistent heartburn
 Stomach pain
 Unexplained, persistent nausea
PATHOPHYSIOLOGY:
- Gastroesophageal junction
cancer is associated with having
gastrointestinal reflux disease
(GERD) and, less strongly, with
obesity and smoking.
- GERD is a condition caused by
frequent backflow of stomach acid
into the esophagus.
- There is a strong correlation
between a diet high in smoked and
salted foods and stomach cancer
located in the main part of the
stomach.
Laboratory / Diagnostic
Examination for stomach cancer:
 Biopsy will show cell type:
 CT scan or MRI shows mass
Medication:
Targeted drugs used to treat
stomach cancer include:
 Trastuzumab (Herceptin) for
stomach cancer cells that
produce too much HER2
 Ramucirumab (Cyramza) for
advanced stomach cancer that
hasn't responded to other
treatments
 (41) CARE OF CLIENTS WITH
CANCER OF THE COLON
COLON CANCER:
- A type of cancer that begins in the
large intestine (colon). The colon is the
final part of the digestive
Tract.
- Affects older adults, though it can
happen at any age. It usually begins as
small, noncancerous (benign) clumps of
cells called polyps that form on the inside
of the colon. Over time some of these
polyps can become colon cancers.
- If colon cancer develops, many
treatments are available to help control
it, including surgery, radiation therapy
and
drug treatments, such as chemotherapy.
- Colon cancer is sometimes called
colorectal cancer, which is a term that
combines colon cancer and rectal cancer,
which begins in the rectum.
- Adenocarcinoma is the most
common type of colon cancer and may
spread by direct extension through the
walls of
the intestine or through the lymphatic or
circulatory system.
RISK FACTORs:
 Inflammatory intestinal conditions.
 Family history of colon cancer.
 Alcohol.
Duke’s Classification of Colorectal
Cancer:
a.) Stage A: confined to bowel mucosa,
80-90 % 5 years survival rate
b.) Stage B: invading muscle wall
c.) Stage C; Lymph node involvement
d.) Stage D: Metastases or locally
unresectable tumor, less than 5% , 5
years survival rate.
PATHOPHYSIOLOGY:
- Doctors aren't certain what
causes most colon cancers.
- In general, colon cancer begins
when healthy cells in the colon
develop changes (mutations) in their
DNA. A cell's DNA contains a set of
instructions that tell a cell what to
do.
Subjective Cues:
 Persistent abdominal
discomfort, such as cramps, gas
or pain
 A feeling that your bowel
doesn't empty completely
Laboratory / Diagnostic
Examination for colon cancer:
 Biopsy is confirmative for
cancer.
 Colonoscopy or sigmoidoscopy
Medication:
 Chemotherapy before surgery to
shrink some tumors, or after
surgery:
 - cyclophosphamide
 - methotrexate
 - fluorouracil
 - doxorubicin
 - epirubincin
 - vincristine
 - paclitaxel
 - docetaxel
 (42) CARE OF CLIENTS WITH
CANCER OF THE BREAST
Subjective Cues:
BREAST CANCER:
 Fatigue
- Studies show that by age 80, about 1  Loss of appetite
in 8 women will have breast cancer.  Generalized weakness

- Ten percent of all breast cancers are

inherited. Laboratory/Diagnostic
Examination for breast cancer:
- Two major genes have been
identified— BRCA1 and BRCA2.  CT scan to check for metastasis.
 MRI of breast.
- The cause of breast cancer is  Biopsy is confirmative for
unknown. cancer.
- Some medications, like estrogen, Medication:
seem to increase the risk of breast cancer.
Exposure to radiation also increases the  Chemotherapy before surgery to
risk. shrink some tumors, or after
surgery:
- cyclophosphamide
- methotrexate
PATHOPHYSIOLOGY: - fluorouracil
- doxorubicin
- Breast cancer occurs when some - epirubincin
breast cells begin to grow abnormally. - vincristine
These cells divide more - paclitaxel
rapidly than healthy cells do and continue - docetaxel
to accumulate, forming a lump or mass.
 Hormonal therapy:
- Breast cancer most often begins with - tamoxifen
cells in the milk-producing ducts - anastrozole
(invasive ductal carcinoma).
 Administer analgesics for
- Breast cancer most often begins with pain control:
cells in the milk-producing ducts - morphine, fentanyl
(invasive ductal carcinoma). May
also begin in the glandular tissue called
lobules (invasive lobular carcinoma) or in  Hormone replacement
other cells or tissue within the breast. Therapy
 (43) CARE OF CLIENTS WITH
CANCER OF THE OVARIES
OVARIAN CANCER:
- A type of cancer that begins in the
ovaries. The female reproductive system
contains two ovaries, one
on each side of the uterus. The ovaries —
each about the size of an almond —
produce eggs (ova) as well as the
hormones estrogen and progesterone.
- Often goes undetected until it has
spread within the pelvis and abdomen. At
this late stage, ovarian cancer
is more difficult to treat. Early-stage
ovarian cancer, in which the disease is
confined to the ovary, is more likely to be
treated successfully.
- Surgery and chemotherapy are
generally used to treat ovarian cancer.
RISK FACTORS:
 Ovarian cancer can occur at any age
but is most common in women ages
50 to 60 years.
 Inherited gene mutations. A small
percentage of ovarian cancers are
caused by gene mutations you inherit
from your parents. The genes known
to increase the risk of ovarian cancer
are called breast cancer..
 Lynch syndrome, are known to
increase the risk of ovarian cancer.
 Age when menstruation started and
ended. Beginning menstruation at an
early age or starting menopause at a
later
 age, or both, may increase the risk of
ovarian cancer.
TYPES OF OVARIAN CANCER
The type of cell where the cancer begins
determines the type of ovarian cancer you
have. Ovarian cancer types include:
- Epithelial tumors, which begin in
the thin layer of tissue that covers
the outside of the ovaries. About 90
percent of ovarian cancers are
epithelial tumors.
- Stromal tumors, which begin in the
ovarian tissue that contains
hormone-producing cells. These
tumors are usually
diagnosed at an earlier stage than
other ovarian tumors. About 7
percent of ovarian tumors are
stromal.
- Germ cell tumors, which begin in
the egg-producing cells. These rare
ovarian cancers tend to occur in
younger women.
PATHOPHYSIOLOGY:
- In general, cancer begins when a
cell develops errors (mutations) in its
DNA. The mutations tell the cell to
grow and multiply quickly, creating
a mass (tumor) of abnormal cells.
Subjective Cues:
 Generalized weakness
 Discomfort in the pelvis area
 Quickly feeling full when eating
Laboratory/Diagnostic
Examination for ovarian cancer:
 CT scan to check for
Metastasis
 cancer antigen (CA) 125 test.
Medication:
 Chemotherapy before surgery to
shrink some tumors, or after
surgery
 Hormonal therapy:
- tamoxifen
 (44) CARE OF CLIENTS WITH
CANCER OF THE CERVIX AND UTERUS
CERVICAL CANCER:
- A type of cancer that occurs in the
cells of the cervix — the lower part of the
uterus that connects to
the vagina.
- Various strains of the human
papillomavirus (HPV), a sexually
transmitted infection, play a role in
causing most cervical cancer.
- Various strains of the human
papillomavirus (HPV), a sexually
transmitted infection, play a role in
causing most cervical cancer.
- You can reduce your risk of
developing cervical cancer by having
screening tests and receiving a vaccine
that protects against HPV infection.
TYPES OF CERVICAL CANCER:
Type of cervical cancer that you have
helps determine your prognosis and
treatment. The main types of cervical
cancer are:
1. Squamous cell carcinoma. This type of
cervical cancer begins in the thin, flat
cells (squamous cells) lining the outer
part of the cervix, which projects into the
vagina. Most cervical cancers are
squamous cell carcinomas.
2. Adenocarcinoma. This type of cervical
cancer begins in the column-shaped
glandular cells that line the cervical
canal.
3. Sometimes, both types of cells are
involved in cervical cancer. Very rarely,
cancer occurs in other cells in the cervix.
RISK FACTORS:
 Early sexual activity. Having sex at
an early age increases your risk of
HPV.
(44) CARE OF CLIENTS
CANCER OF THE
 Other sexually transmitted
infections (STIs). Having other
STIs — such as chlamydia,
gonorrhea, syphilis and
HIV/AIDS — increases your
risk of HPV.
PATHOPHYSIOLOGY:
- Cervical cancer begins when
healthy cells in the cervix develop
changes (mutations) in their DNA. A
cell's DNA contains the instructions
that tell a cell what to do.
- The accumulating abnormal
cells form a mass (tumor). Cancer
cells invade nearby tissues and can
break off from a tumor to spread
(metastasize) elsewhere in the body.
- HPV is very common, and most
people with the virus never develop
cancer. This means other factors —
such as your environment or your
lifestyle choices —also determine
whether you'll develop cervical
cancer.
Subjective Cues:
 Discomfort in the pelvis area
 Generalized weakness
Laboratory/Diagnostic
Examination for cervical cancer:
 HPV DNA test. The HPV DNA
test involves testing cells
collected from the cervix for
infection with any of the types of
HPV that are most likely to lead
to cervical cancer.
 Endo-cervical curettage
Medication:
 Chemotherapy before surgery
to shrink some tumors, or after
surgery.
WITH
PROSTATE

PROSTATE CANCER:
- Cancer that occurs in the prostate —
a small walnut-shaped gland in men that
produces the seminal
fluid that nourishes and transports
sperm.
- Prostate cancer is one of the most
common types of cancer in men. Usually,
prostate cancer grows slowly and is
initially confined to the prostate gland,
where it may not cause serious harm.
- Some types of prostate cancer grow
slowly and may need minimal or even no
treatment, other types are aggressive and
can spread quickly.
Risk factors:
- Age. 65 and above
- Race. African American
- Family history.
- Obesity.
  Trouble urinating
  Discomfort in the pelvic area
  Bone pain
Laboratory/Diagnostic
Examination for prostate cancer:
 Digital rectal exam
 Prostate specific antigen test
 Biopsy is confirmative for cancer.
 Ultrasonography to further delineate
the mass.
 CT scan to check for metastasis
 MRI and Positive emission
tomography scan
Medication:
 Chemotherapy before surgery to
shrink some tumors, or after surgery
 Hormonal therapy
 Administer analgesics for pain
control: morphine, fentanyl
 Biological therapy (immunotherapy)

PATHOPHYSIOLOGY:

- Doctors know that prostate cancer

begins when some cells in your prostate
become abnormal.

- Mutations in the
abnormal cells' DNA cause the cells to
grow and divide more rapidly than
normal cells do.

- The abnormal cells continue living,

when other cells would die. The
accumulating abnormal cells form a
tumor that can grow to invade nearby
tissue. Some abnormal cells can also
break off and spread (metastasize) to
other parts of the body.

Subjective Cues:

  Fatigue
  Loss of appetite
  Generalized weakness