PATHOPHYSIOLOGY MALIGNANT (Cancer) Carcinogenesis

ONCOLOGY NURSING Differentiation: Poor Molecular Process involves 3 stages:

Body Defenses Against Tumor
Terms used in Oncology: Encapsulation: (-) 1. Initiation
NEO - new ● T cell System/ Cellular Immunity 2. Promotion
PLASIA - growth Cytotoxic T cells kill tumor cells Metastasis: (+)
3. Progression
PLASM - substance Prognosis: Poor
TROPHY - size ● B cell System/ Humoral immunity Treatment Modalities: Surgery, Irradiation,
-OMA - tumor B cells can produce antibody Carcinogenesis: Etiology & Predisposing
Chemotherapy, BM Transplant Factors
STATIS - location
● Phagocytic cells
A - none ● Genetics
ANA - lack Macrophages can engulf cancer CANCER CLASSIFICATION ● Immunosuppression
HYPER - excessive cell debris
META - change By the type of tissue in which the cancer ● Viral (HPV, EBV, Hepa-B)
DYS - bad, deranged originates (histological type) ● Environmental

WHAT IS ONCOLOGY? By primary site, or the location where the Physical

Branch of medicine that deals with the study, cancer first developed - Radiation, UV rays, Nuclear explosion
detection, treatment, and management of - Chronic irritation, direct trauma
cancer. Classification - Histological Type
From a histological standpoint there are Chemical
DEFINITION OF CANCER hundreds of different cancers, which are - Acids, alkalis, hydrocarbons, dye
● Cancer is a disease process whereby grouped into six major categories: - Food (high fat, low fiber) & food additives
cells proliferate abnormally, ignoring Pathophysiology of Malignant Process (nitrites)
growth-regulating signals in the Genetically mutated cells acquire various - Drugs, hormones
● Carcinoma – epithelial (glandular,
environment surrounding the cells. capabilities involving: - Smoking
squamous)
1. Proliferative Patterns
● Sarcoma – connective or supportive
● It is not a single disease with a single 2. Characteristics
(bone, adipose, etc...)
cause; it is a group of distinct diseases 3. Invasion and Metastasis ● Myeloma – plasma cells DETECTION AND PREVENTION
with different causes, manifestations, ● Leukemia – hematopoietic cells (WBC, Screening and Diagnostic Testing
treatments, and prognoses. Classification of Neoplasia RBC, lymphocytes)
Uncontrolled growth of Abnormal Cells Warning/danger signs of cancer
● Lymphoma – lymphocytes (lymph nodes)
CANCER NURSING PRACTICE ● Benign ● Mixed Types – combination of other (CAUTION US)
● Overlaps numerous nursing specialties ● Malignant categories
● Covers all age groups and is carried out ● Borderline
Change in bowel/bladder habits
in various settings such as acute care
Classification – Primary Site A sore that does not heal
institutions, outpatient centers, Neoplasia DIFFERENCES
rehabilitation facilities, home, and long- BENIGN (Tumor) The most common sites in which cancer Unusual bleeding/discharge
term care facilities. Differentiation: Well develops include:
Thickening of a lump in breast or elsewhere
● Involves the care of patients from Encapsulation: (+)
prevention to end-of-life care. Metastasis: (-) ● Skin Indigestion/dysphagia
Prognosis: Good ● Lungs Obvious change in a wart or mole
Cancer Nursing Practice - Care Trajectory Treatment Modalities: Surgery ● Female Breasts
Nagging cough/hoarseness
● Prostate
● Colon and Rectum Unexplained anemia
● Cervix and Uterus Sudden weight loss
CANCER DIAGNOSTICS
● Biopsy (most definitive)
● CT, MRI
● Tumor Marker
EARLY DETECTION OF CANCER
● Mammography
● Pap smear
● Stool for occult blood
● Sigmoidoscopy, colonoscopy
● Breast self-examination
● Testicular self-examination
● Skin inspection
Breast self-examination (BSE)
- Done 7-10 days after menses
- Postmenopausal or S/P Hysterectomy:
specific day of the month
Inspection
❖ In front of the mirror with arms at
sides, arms over head and arms at
hips (changes in shape, dimpling of
skin or any changes in the nipple)
Palpation:
❖ While in the shower/bath or lying down Classifies the cellular aspects of CA
with folded towel under the breast Grade I
being examined
❖ Use the right hand to examine the left
breast and vice versa
❖ Use the pads of the 2nd, 3rd, and 4th
fingers
❖ Use small, circular motions in spiral or
in an up-and-down motion to examine
the entire breast and under the arm
(lump, hard knot, or thickened tissue)
Testicular self-examination (TSE)
Same day, every month, right after a warm
shower (scrotal skin is moist and relaxed)
❖ Gently lift each testicle, each one STAGING OF CANCER
should feel like an egg, firm but not
Classifies the clinical aspects of CA
hard and smooth without lumps
Stage 0
❖ Using both hands, place middle
fingers underside of each testicle and Stage I
thumbs on top and gently roll the
testicles (lumps, swelling, or mass)
DIAGNOSIS OF CANCER
Grading and Staging of Cancer
➢ Lymphatic (most common)
➢ Hematogenous (blood-borne,
commonly to liver and lungs)
➢ Direct spread (surrounding organs)
Grading
- based on the microscopic features of
the cells which compose a tumor and
is specific for the tumor type.
Staging
- is based on clinical, radiological and
surgical criteria, such as tumor size,
involvement of regional lymph nodes,
and presence of metastases.
- Usually has prognostic value
GRADING OF CANCER
- cells differ slightly from
normal cells
- well-differentiated
- (mild dysplasia)
Grade II - cells are more abnormal
- moderately
differentiated
- (moderate dysplasia)
Grade III - cells are very abnormal
- poorly differentiated
- (severe dysplasia)
Grade IV - cells are immature
(anaplasia)
- undifferentiated
Clinical Diagnosis of Cancer
carcinoma in situ
tumor limited to the tissue of
origin, localized tissue
growth
Stage II limited local spread
Stage III extensive local and
regional spread
Stage IV metastasis
MANAGEMENT OF CANCER
Medical and Nursing Care
Uses the T-N-M staging system
T- tumor
Cancer treatment modalities:
N- Node
M- Metastasis
SURGERY
T category describes the original (primary) tumor
❖ Prophylactic: For premalignant conditions
or strong familial history of cancer
❖ Curative : Removal of all gross and
microscopic tumors
❖ Control (cytoreductive): "debulking"
procedure to decrease cancer cells
: increase the chance of other
N category describes whether or not the cancer has
treatment will be successful
reached nearby lymph nodes
❖ Palliative: Improves quality of life during
survival time
: Decrease pain; relieves obstruction
(airway, GI, or GU)
: Relieves pressure (brain & spinal
cord)
: Prevent hemorrhage, remove
infected or ulcerated tumors or drain
abscesses
M category determines distant metastases (spread of
cancer to other parts of the body)
❖ Reconstructive or Rehabilitative:
improves quality of life by restoring
maximal function and appearance (breast
reconstruction, S/P mastectomy)
 CHEMOTHERAPY
➢ Kills cancer cells and rapidly producing
cells (skin, hair, BM, reproductive tract,
GIT)
Types of chemotherapy drugs:
● Antimetabolites - N₂ mustard
● Plant alkaloids - Vincristine & Vinblastine
● Alkylating agents - Methotrexate
● Hormones (DES)/steroids
● Antineoplastic antibiotics
Nursing Interventions for Major Side Effects
Hair: alopecia
○ Encourage patient to wear wigs,
caps
○ Hair regrows in 3-6 months after last
chemotherapy treatment
BM: depression
○ Anemia: CBR, O2 as ordered
○ Leukemia: reverse isolation, strict
handwashing, asepsis
○ Thrombocytopenia: bleeding
precaution
GIT: nausea and vomiting
● Antiemetics 4-6 hours pre- & post-chemo
as ordered
● NPO temporarily
● Bland diet post-chemo
❖ Stomatitis: oral care; ice chips or
popsicles
❖ Diarrhea: antidiarrheals; monitor VS, I/O,4.
watch for DHN
● Watch for paralytic ileus (with Vincristine)
Reproductive tract: sterility
○ Encourage sperm banking for
males
Renal damage: increase uric acid Methods of delivery BRACHYTHERAPY RADIATION
○ Allopurinol as ordered
Neuro disturbance: peripheral neuropathy 1. Internal - utilizes injection / Source: INTERNAL RADIATION (sealed or
○ Skin, hand and foot care implantation of radioactive isotopes unsealed)
Skin: erythema, redness, irritation and proximal to cancer sites for specified
sloughing of tissue
period of time ● For a period of time, the patient emits
- Assist in bathing the patient radiation and poses a hazard to others
- Force fluids
- Avoid lotion, talcum powder; may use ➔ Sealed: within a container; don’t
cornstarch or olive oil contaminate with body fluids Unsealed radiation source:
➔ Unsealed: e.g Phosphorus 32
➔ Administered PO, IV, or instillation into
BM depression: same as in chemotherapy 2. External - uses electromagnetic body cavities
GIT disturbance: Dysgeusia (foul, salty, rancid, or metallic waves (e.g Cobalt) ➔ It enters the body fluids, eliminated via
taste sensation persists in the mouth) various excreta (radioactive & harmful
- decrease taste sensation especially TELETHERAPY / BEAM RADIATION to others especially the 1st 48 hrs)
with internal implant
- Oral care; avoid hot and cold foods Sealed radiation source:
Source: EXTERNAL RADIATION
RADIATION ● Patient does not emit radiation and does ➔ Temporary or permanent solid implant
not pose a hazard to others within tumor target tissues
❖ Uses ionizing radiation to kill cancer ➔ The patient emits radiation while the
cells and rapidly growing cells, and ➢ Wash area with water and mild soap, implant is in place, but the excreta is not
inhibit their growth radioactive
using the hand then a washcloth, rinse
and pat dry with soft towel ➔ Place the patient in a private room with
Types of energy:
private bath
1. Alpha rays: don’t penetrate skin tissue
2. Beta rays : penetrate skin (internal DON’T REMOVE RADIATION MARKINGS ➔ Place a caution sign on the patient’s
radiation) FROM THE SKIN door
3. Gamma rays: penetrate skin deeper, ➔ Organize nursing tasks to minimize
underlying tissues (external radiation) ➢ No powder, ointment, lotion or cream exposure to radiation source
on area unless ordered ➔ Nursing staff assignments should be
Factors affecting delivery rotated; a nurse should never care for
➢ Wear soft clothing over the area; avoid more than 1 patient with radiation
1. Half-life - time required for the ½ of the constrictive garments implant at a time; avoid assigning a
radioisotope to decay pregnant nurse
2. Time - less time, less exposure ➢ Avoid sun & heat exposure
➔ Limit time to 30 minutes per care
3. Distance - the farther the source, the provider/shift
lesser the exposure ➢ Watch for weeping of skin (moist
➔ Wear a dosimeter film badge to measure
Shielding desquamation) & if noted, cleanse the
radiation exposure
- Alpha and beta rays can be blocked by area with warm water & pat dry, apply
➔ Wear a lead shield
gloves antibiotic or steroid cream as ordered
➔ Do not allow children <16 y.o. or
- Gamma rays can be blocked by thick, & expose the site to air
pregnant women to visit the patient
lead gown and concrete ➔ Limit visitors to 30 minutes /day, at least
6 feet from the patient
➔ Save bed linens & dressings until the
source is removed then dispose
 ➔ Other equipment can be removed from
the room at any time

Dislodged sealed radiation source

➔ Do not touch it with bare hands; use

long-handled forceps to place the source
in a lead container kept in the patient’s
room and notify the physician
➔ If unable to locate the radiation source,
ban visitors from entering patient’s room
and notify the physician

Removal of sealed radiation source

➔ Patient is no longer radioactive

➔ Inform the patient that sexual partner
cannot “catch” CA
➔ Patient may resume sexual intercourse
after 7-10 days for cervical or vaginal
implant
➔ Perform povidone-iodine douche as
ordered for cervical implant
➔ Administer fleet enema as ordered
➔ Notify the physician if N/V/D, frequent
urination, vaginal or rectal bleeding,
hematuria, foul-smelling vaginal
discharge, abdominal pain/distention or
fever occurs