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La Consolacion University Philippines

(formerly University of Regina Carmeli)
Graduate School Department

Name: Allan M. Manaloto, RN Professor: Dr. Amelia M. Sta Maria
Subject: Advanced Pathophysiology Date: November 09, 2013

Learning Objectives:
I. Identify/ Recognize factors that can increase risk for cancer development.
II. Differentiate the differences between malignant and benign tumor.
III. Determine and demonstrate correct knowledge on early detection for cancer.
IV. Identify what are the Nursing roles/ responsibilities in health promotion to control
risks, and in dealing with cancer patient.

I. I N T R O D U C T I O N
Cancer is not a single disease with a single cause; rather, it is a group of
distinct diseases with different causes, manifestations, treatments, and prognoses.
Many people associate cancer with pain and death, Nurses need to identify their
own reactions to cancer. Nurses must be prepared to support patient and families
through a wide range of physical, emotional, cultural, social, and spiritual crises.
Our responsibilities include: a.) support idea that cancer is a chronic illness with
acute exacerbation (not synonymous with pain and death), b.) identify patient and at
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higher risk of cancer, c.) participate in primary and secondary prevention effort, d.)
plan appropriate intervention with patient and family.

Most cancer occur in people more than 65 y/o (but all ages affect cancer).
Incidence higher in men than women and in industrialized nations. Below is the
table for the causes of death in the Philippines, as per DOH PH.
5-Year Average (2004-2008) & 2009
5-Year Average
Number Rate Number Rate
1. Diseases of the Heart 82,290 94.5 100,908 109.4
2. Diseases of the Vascular System 55,999 64.3 65,489 71.0
3. Malignant Neoplasms 43,185 49.6 47,732 51.8
4. Pneumonia 35,756 41.1 42,642 46.2
5. Accidents** 34,704 39.9 35,990 39.0
6. Tuberculosis, all forms 25,376 29.2 25,470 27.6
7. Chronic lower respiratory diseases 20,830 24.0 22,755 24.7
8. Diabetes Mellitus 19,805 22.7 22,345 24.2
9.Nephritis, nephrotic syndrome and nephrosis 11,612 13.4 13,799 15.0
10. Certain conditions originating in the perinatal
12,590 14.5 11,514 12.5
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Note: Excludes ill-defined and unknown causes of mortality
* reference year
** External causes of Mortality

A. Predisposing factors:
Age: about 60%- 70% of Cancer cases are over 65/o
Sex: Breast Ca for Females; Prostate cancer for males.
Occupation: Factory workers (lung Ca)
Hereditary(5-10% of CA): Breast, ovary, colon CA
Diet: cured and salted foods (stomach); High fats and low fiber diet;
Stress: decreased immune system
Precancerous lesion: Moles, polyps
Lifestyle: Tobacco and alcohol use (mouth, throat, esophagus, liver), poor diet,
lack of physical activity (kidney, uterus, colon), obese (colon)
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Others: Ionizing radiation, sunlight (too much exposure UV light), chemicals and
substances (asbestos, cadmium, nickel).
Cancer: any malignant tumor or neoplasm, and is not used to refer to benign
growths. Cancerous cells are described as Malignant neoplasm.
Tumor: any swelling, ex. That caused by inflammation, but is now generally
reserved for a new growth, or Neoplasm. Not all tumors/ Neoplasms are cancer.

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Anaplasia: hallmark of malignant cell, loss of differentiation, nuclear irregularity,
and loss of normal cell structure.
Carcinoma in Situ: (CIS) pre-invasive epithelial tumors of glandular/ squamous
cell origin.
Invasion: growth of primary tumor into the surrounding host tissues.
Metastasis: dissemination/ spread of malignant cells from primary tumor to distant

B. Early Detection
Chest xray and sputum cytology (lung cancer).
Physical exam (every year for over 40 y/o) skin,lymph nodes, mouth, thyroid,
breast, testes,rectum, prostate/.
Oral Exam annually.
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TSE monthly following shower.
Digital Rectal Exam: annually for 40y/o and above.
Sigmoidoscopy: for 50 y/o and above annually for 2 years then every 3 years if
Fecal Occult Blood: doctors recommendation.
BSE: every month after menstruation.
Breast Clinical Exam: done by physician (every3 years for 20-40 y/o then yearly
for over 40y/o).
Mammography: once for 35-40 y/o, thenyearly for over 50 y/o.
Pap smear: age 18 and all sexually activewomen then yearly after 3
negative results.
Pelvic Exam: same with pap smear.
Endometrial tissue sampling: menopause.

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C. The Seven Warning Signs of Cancer

The American Cancer Society uses the word C-A-U-T-I-O-N to help recognize the
seven early signs of cancer:
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in the breast, testicles, or elsewhere
Indigestion or difficulty swallowing
Obvious change in the size, color, shape, or thickness of a wart, mole, or mouth
Nagging cough or hoarseness
The following symptoms may also signal the presence of some types of cancer:
Persistent headaches
Unexplained loss of weight or loss of appetite
Chronic pain in bones or any other areas of the body
Persistent fatigue, nausea, or vomiting
Persistent low-grade fever, either constant or intermittent
Repeated infection

D. Diagnostic Exam
I. Scans (e.g., magnetic resonance imaging [MRI], CT, gallium) and ultrasound: May
be done for diagnostic purposes, identification of metastasis, and evaluation of
response to treatment.
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II. Biopsy (fine-needle aspiration [FNA], needle core, incisional/excisional): Done to
differentiate diagnosis and delineate treatment and may be taken from bone
marrow, skin, organ, and so forth. Example: Bone marrow is done in
myeloproliferative diseases for diagnosis; in solid tumors for staging.
III. Direct Visualization: Bronchoscopy, Colonoscopy,
IV. Mammogram, Pap smear, Angiogram
V. Tumor markers: specific proteins which indicate malignancy
a. PSA (Prostatic-specific antigen): prostate cancer
b. CEA (Carcinoembryonic antigen): colon cancer
c. Alkaline Phosphatase: bone metastasis

E. Nursing Diagnoses for Clients with Cancer
I. Anxiety
1. Therapeutic interactions with client and family; community resources
such as American Cancer Society, I Can Cope
2. Availability of community resources for terminally ill (Hospice care in-
patient, home care)
II. Disturbed Body Image
1. Includes loss of body parts (e.g. amputations); appearance changes
(skin, hair); altered functions (e.g. colostomy); cachexic appearance, loss of
energy, ability to be productive
2. Fear of rejection, stigma
III. Anticipatory Grieving
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1. Facing death and making preparations for death: will be consideration
2. Offer realistic hope that cancer treatment may be successful
IV. Risk for Infection
V. Risk for Injury
1. Organ obstruction
2. Pathological fractures
VI. Altered Nutrition: less than body requirements
1. Consultation with dietician, lab evaluation of nutritional status
2. Managing problems with eating: anorexia, nausea and vomiting
3. May involve use of parenteral nutrition
VII. Impaired Tissue Integrity
1. Oral, pharyngeal, esophageal tissues (due to chemotherapy, bleeding due
to low platelet counts, fungal infections such as thrush)
2. Teach inspection, frequent oral hygiene, specific non-irritating products,
thrush control.

Nursing role includes health promotion to lower the controllable risks:
1. Routine medical check-up and screenings
2. Client awareness to act if symptoms of cancer occur
3. Screening examination recommendations by American Cancer Society;
specifics are made according to age and frequencies
a. Breast Cancer: self-breast exam, breast examination by health care
professionals, screening mammogram
b. Colon and Rectal Cancer: fecal occult blood, flexible sigmoidoscopy,
c. Cervical, Uterine Cancer: Papanicolaou (Pap) test
d. Prostate Cancer: digital rectal exam, Prostate-specific antigen test

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While scientists have made great strides in understanding the causes of
cancer and developing treatments, there will always be a risk for developing cancer.
The likelihood of developing cancer is related to our individual sensitivity and our
dose/response curve. As individuals, we can try to be aware of the risks of exposure
to suspected carcinogens and take appropriate actions to reduce our exposure. As
a nurse, the primary action we can give to every individual (w/ or without cancer
risk) is to give them proper information (Health teachings) on cancer, while for our
clients who has the condition, support to the client as well as the family is an
integral part.

Understanding Pathophysiology, 3
Edition (S. Huether & K. McCance)
Brunner and Suddarths Textbook of MSN, 11
Hurst Reviews (Pathophysiology Review)