Documente Academic
Documente Profesional
Documente Cultură
OH GOD AND KING, PLEASE EXPAND MY OPPORTUNITIES AND MY IMPACT IN SUCH A WAY THAT I TOUCH MORE LIVES FOR YOUR GLORY. LET ME DO MORE FOR YOU
OBJECTIVES
At the end of the lecture-discussion, the students would be able to: 1. Explains the theories of causation and the pathophysiological changes in cellular aberration. 2. Summarizes the nursing roles and opportunities in cancer prevention, detection, diagnosis and treatment of cancer.
3. Differentiates the modes of treatment for cancer. 4. Enumerates the case finding and early detection methods of cancer. 5. Explains the major health problems of clients with cancer. 6. Discusses the psychosocial implications in cancer. 7. Describes the process of counseling among patients.
8. Utilizes the nursing process in the care of patient with problems in cellular functioning. 9. Formulates appropriate nursing diagnosis as to priority. 10. Evaluate outcome of nursing care goals for each disease entity.
Nursing Process
Assessment Laboratory & Diagnostic Tests Tumor Staging and Grading Nursing Diagnoses & Planning Implementation and Management
Treatment Modalities
Chemotherapy
End-of-life Issues
What Is Cancer?
CANCER is a complex of diseases which occurs when normal cells mutate into abnormal cells that take over normal tissue, eventually harming and destroying the host
WHAT IS CANCER
A large group of diseases characterized by:
Uncontrolled growth and spread of abnormal cells Proliferation (rapid reproduction by cell division) Metastasis (spread or transfer of cancer cells from one organ or part to another not directly connected)
Back
ONCOLOGY DEFINED of medicine that deals with the study, detection, treatment and management of cancer and neoplasia
Branch
ROOT WORDS
Neo- new Plasia- growth Plasm- substance Trophy- size +Oma- tumor Statis- location
ROOT WORDS
A- none Ana- lack Hyper- excessive Meta- change Dys- bad, deranged
CHARACTERISTICS OF NEOPLASIA
Uncontrolled growth of Abnormal cells 1. Benign 2. Malignant 3. Borderline
BENIGN
Well-differentiated Slow growth Encapsulated Non-invasive Does NOT metastasize
MALIGNANT
Undifferentiated Erratic and Uncontrolled Growth Expansive and Invasive Secretes abnormal proteins METASTASIZES
NOMENCLATURE OF NEOPLASIA
Tumor is named according to: 1. Parenchyma, Organ or Cell Hepatoma- liver Osteoma- bone Myoma- muscle
Tumor is named according to: 2. Pattern and Structure, either GROSS or MICROSCOPIC Fluid-filled CYST Glandular ADENO Finger-like PAPILLO Stalk POLYP
Tumor is named according to: 3. Embryonic origin Ectoderm ( usually gives rise to epithelium) Endoderm (usually gives rise to glands) Mesoderm (usually gives rise to Connective tissues)
BENIGN TUMORS
Suffix- OMA is used Adipose tissue - LipOMA Bone - osteOMA Muscle - myOMA Blood vessels - angiOMA Fibrous tissue - fibrOMA
MALIGNANT TUMOR
Named according to embryonic cell origin 1. Ectodermal, Endodermal, Glandular, Epithelial Use the suffix- CARCINOMA Pancreatic AdenoCarcinoma Squamos cell Carcinoma
Named according to embryonic cell origin 2. Mesodermal, connective tissue origin Use the suffix SARCOMA FibroSarcoma Myosarcoma AngioSarcoma
First mutation
Second mutation
Third mutation
Oncogenes
Normal cell
Cancer cell
Mutated/damaged oncogene
Epidermis
Cell migration
Dermis
Underlying tissue
R
Tumors (Neoplasms)
Underlying tissue
R
1 Cancer cells invade surrounding tissues and blood vessels 2 Cancer cells are transported by the circulatory system to distant sites 3 Cancer cells reinvade and grow at new location
Back
ETIOLOGY/CAUSATIVE FACTORS
Viruses Chemical carcinogens Physical stressors Hormonal factors Genetic factors
Radiation
Hereditary/Family History
Certain types of cancers run in the family such as breast cancer.
Carcinogens
A carcinogen is an agent capable of causing cancer. This may be a chemical, an environment agent, radiation and viruses. Many cancers are associated with lifestyle risk factors such as smoking, dietary factors and alcohol consumption.
2. Aflatoxin - is found in peanuts and peanut butter. 3. Benzopyrene - Produced when meat and fish are charcoal broiled or smoked (e.g. tinapa or smoked fish).. - Also produced when food is fried in fat that has been reused repeatedly. Avoid reusing cooking oil.
R
4. Nitrosamines - These are powerful carcinogens used as preservatives in foods like tocino, longganisa, bacon and hotdog. Formation of nitrosamines may be inhibited by the presence of antioxidants such as Vitamin C in the stomach. Limit eating preserved foods and eat more vegetables and fruits that are rich in dietary fiber.
R
Radiation
- Radiation can also cause cancer including ultraviolet rays from sunlight, x-rays, radioactive chemicals and other forms of radiation.
Population-Based Studies
Regions of Highest Incidence
U.K.: Lung cancer
Heredity
Viruses
Virus inserts and changes genes for cell growth Cancer-linked virus
R
H. pylori
High-Strength Radiation
High
Leukemia Incidence
Most
Without disease
HIV infection
Depressed immune system
KSHV infection
Kaposis sarcoma
Oral Cancer
Laryngeal Cancer
Tobacco use (cigarette, cigar, pipe, smokeless tobacco) Poor nutrition Alcohol Weakened immune system Occupational exposure to wood dust, paint fumes Gender: 4-5 times more common in men Age: more than 60 years Tobacco use (cigarette, cigar, pipe, smokeless tobacco) Occupational exposure: dyes, solvents Chronic bladder inflammation Tobacco use (cigarette, cigar, pipe, smokeless tobacco): increase risk by 40% Obesity Diet: well-cooked meat Occupational exposure: asbestos, organic solvents Age: 50-70 years old
Bladder Cancer
Renal Cancer
Cervical Cancer
Tobacco use (cigarette, cigar, pipe, smokeless tobacco) Human papillomavirus infection Chlamydia infection Diet: low in fruits and vegetables Family history of cervical cancer
Tobacco use (cigarette, cigar, pipe, smokeless tobacco) Gender: 3 times more common in men Alcohol Diet: low in fruits and vegetables Early menarche/late menopause Age-changes in hormone levels throughout life, such as age at first menstruation, number of pregnancies, and age at menopause High fat diet Obesity Physical inactivity Some studies have also shown a connection between alcohol consumption and an increased risk of breast cancer Women with a mother or sister who have had breast cancer are more likely to develop the disease
Prostate Cancer
While all men are at risk, several factors can increase the chances of developing the disease, such as advancing age, race and diet Race: more common among AfricanAmerican men than among white men High fat diet Men with a father or brother who has had prostate cancer are more likely to get prostate cancer themselves Certain types of viral hepatitis Cirrhosis of the liver Long-term exposure to aflatoxin (carcinogenic substance produced by a fungus that often contaminates peanuts, wheat, soybeans, corn and rice)
Liver Cancer
Skin Cancer
Unprotected exposure to strong sunlight Fair complexion Occupational exposure Personal/family history of polyps High fat diet and/or low fiber diet History of ulcerative colitis Age: >50 years
Colonic Cancer
Back
When you develop cancer your normal cells turn into cancer cells. Cancer cells have different DNA than healthy cells. One of the first steps in a healthy cell becoming a cancer cell is the change of the proto-oncogens to oncogenes. In cancer cells the cell grows and divides very quickly. The second step to becoming a cancer cell is the tumor suppressor genes get turned off. The last step to becoming a Cancer cell is the DNA repair genes gets turned off.
PATHOPHYSIOLOGY
ABNORMAL CELL FORMED BY MUTATION OF DNA CELL GROWS AND PROLIFERATES METASTASIS OCCURS WHEN ABN. CELLS INVADE OTHER TISSUE,THROUGH LYMPH AND BLOOD
Cancer development linked to immune system failure Example of clients susceptible to developing cancer
Classification of Cancer
According to Behavior of Tumor: Benign - tumors that cannot spread by invasion or metastasis; hence, they only grow locally Malignant - tumors that are capable of spreading by invasion and metastasis. By definition, the term cancer applies only to malignant tumors
Time
R
Hyperplasia
tissue growth based on an excessive rate of cell division, leading to a larger than usual number of cells; the process of hyperplasia is potentially reversible; can be a normal tissue response to an irritating stimulus. An example is a callus
Normal
Hyperplasia
Dysplasia
Bizarre cell growth differing in size, shape and cell arrangement
Normal
Hyperplasia
Mild dysplasia
R
Carcinoma in Situ
Normal
Hyperplasia
Mild dysplasia
Cancer (invasive)
Anaplasia
change in the DNA cell structure and orientation to one another, characterized by loss of differentiation and a return to a more primitive form.
Neoplasia
uncontrolled cell growth, either benign or malignant
Metastasis
Metastasis: 3 stages
Invasion neoplastic cells from primary tumor invade into surrounding tissue with penetration of blood or lymph. Spread tumor cells spread through lymph or circulation or by direct expansion Establishment and growth tumor cells are established and grow in secondary site: lymph nodes or in organs from venous circulation
Time Mutation Cells inactivates proliferate suppressor gene Mutations inactivate DNA repair genes Proto-oncogenes mutate to oncogenes More mutations, more genetic instability, metastatic disease
Back
Classification of Tumors
MYELOMA
Develops in the plasma cells of bone marrow
Leukemias:
Bloodstream
Lymphomas:
Lymph nodes
Naming Cancers
Cancer Prefixes Point to Location
Prefix adenochondroerythrohepatolipolymphomelanomyelomyoosteoMeaning gland cartilage red blood cell liver fat lymphocyte pigment cell bone marrow muscle bone
R
Back
Effects of Cancer
Disruption of Function- can be due to obstruction or pressure Hematologic Alterations: can impair function of blood cells Hemorrhage: tumor erosion, bleeding, severe anemia Anorexia-Cachexia Syndrome: wasted appearance of client
Effects of Cancer
Paraneoplastic Syndromes: ectopic sites with excess hormone production
Parathyroid hormone hypercalcemia secretion of insulin hypoglycemia Antidiuretic hormone (ADH) fluid retention, HTN & peripheral edema
Adrenocorticotropic hormone (ACTH): cause excessive secretion of cortisone (ie: fluid retention, glucose levels)
Effects of Cancer
Pain: major concern of clients and families associated with cancer Physical Stress: body tries to respond and destroy neoplasm Psychological Stress
Back
STAGES IN CARCINOGENESIS
Carcinogenesis is the process during which normal genes are damaged so that cells lose normal control mechanisms of growth and proliferate out of control. When the genes of a single cell are altered by a carcinogenic event, the offspring of the single cell continue to mutate and divide, producing even more virulent mutant clones. Initiation exposure of normal cells to carcinogens Promotion cigarette smoking, alcohol abuse or dietary components that act on the transformed cell Progression uncontrollable growth of malignant tumor capable of metastatic activity
CLASSIFICATION
GRADING
defines the origin of the tumor and degree to which tumor cells retain the functional and histologic characteristics of tissue origin
Grade X : Grade cannot be determined Grade I : Cells differ slightly from normal cells and are well differentiated (Mild Dysplasia) Grade II: Cells are abnormal and are moderately differentiated (Moderate Dysplasia) Grade III: Cells are very abnormal and are poorly differentiated (Severe Dysplasia) Grade IV: Cells are immature (Anaplasia) and undifferentiated, cell of origin is difficult to determine.
STAGING
determines the size of the tumor and extent metastasis; determines extent of the disease
Stage 0 carcinoma in situ; cancer in place Stage I tumor limited to the tissue of origin; localized tumor growth Stage II limited local spread Stage III extensive local and regional spread Stage IV- metastasis
ASSESSMENT
Nursing History
Health History chief complaint and history of present illness (onset, course, duration, location, precipitating and alleviating factors) Cancer signs: CAUTION US!
Physical Assessment
Inspection skin and mucus membranes for lesions, bleeding, petechiae, and irritation
Assess stools, urine, sputum, vomitus for acute or occult bleeding Scalp noting hair texture and hair loss
Palpation
Abdomen for any masses, bulges or abnormalities Lymph nodes for enlargement
Biopsy
Biopsy
is the definitive means of diagnosing cancer and provides histological proof of malignancy. It involves the surgical incision of a small piece of tissue of microscopic examination
Types: Needle: Aspiration of Cells Incisional: Removal of a wedge of suspected tissue from a larger mass Excisional: Complete removal of the entire lesion Staging: Multiple needle or incisional biopsies in tissues where metastasis is suspected or likely.
Diagnostic Tests
Determine location of cancer:
X-rays Computed tomography Ultrasounds Magnetic resonance imaging Nuclear imaging Angiography
Direct Visualization:
Sigmoidoscopy Cystoscopy Endoscopy Bronchoscopy Exploratory surgery; lymph node biopsies to determine metastases
Biopsy
Pathology
Proteomic profile
Genomic profile
R
Back
Primary Tumor (T) TX T0 Tis T1, T2, T3, T4 NX N0 N1, N2, N3 Primary tumor cannot be evaluated No evidence of primary tumor Carcinoma in situ (early cancer that has not spread to neighboring tissue) Size and/or extent of the primary tumor Regional lymph nodes cannot be evaluated No regional lymph node involvement (no cancer found in the lymph nodes) Involvement of regional lymph nodes (number and/or extent of spread) Distant metastasis cannot be evaluated No distant metastasis (cancer has not spread to other parts of the body) Distant metastasis (cancer has spread to distant parts of the body)
NURSING DIAGNOSES
Acute or chronic pain Impaired skin integrity Impaired oral mucous membrane Risk for injury Risk for infection Fatigue Imbalanced nutrition: less than body requirements
NURSING DIAGNOSES
Risk for imbalanced fluid volume Anxiety Disturbed body image Deficient knowledge Ineffective coping Social isolation
OUTCOME IDENTIFICATION
1. 2. 3. 4. 5. Pain relief Integrity of skin and oral mucosa Absence of injury and infection Fatigue relief Maintenance of nutritional intake and fluid and electrolyte balance 6. Improved body image 7. Absence of complications
OUTCOME IDENTIFICATION
8. Knowledge of prevention and cancer treatment 9. Effective coping through recovery and grieving process 10.Optimal social interaction
Back
IMPLEMENTATION/MANAGEME NT
Prevention and detection
Primary Prevention
Reducing modifiable risk factors in the external and internal environment
Secondary Prevention
Recognizing early signs and symptoms and seeking prompt treatment Prompt intervention to halt cancerous process
Cancer Prevention
Carcinogenic chemicals Carcinogenic radiation
Avoid Tobacco
Lung Cancer Risk Increases with Cigarette Consumption
15x
Non-smoker
30
Risk Increase
AND
Packs of Cigarettes Consumed per Day
R
30
20
10
80
100
200
300
R
High
Industrial Pollution
1930
1950 Year
1970
1990
Back
TREATMENT MODALITIES
Aimed towards:
CURE - free of disease after treatment normal life Control - Goal for chronic cancers Palliative Care: Quality of life maintained at highest level for the longest possible time
Chemotherapy use of antineoplastic drugs to promote tumor cell death, by interfering with cellular functions and reproduction
Radiotherapy directing high-energy ionizing radiation to destroy malignant tumor cells without harming surrounding tissues
Teletherapy (external): radiation delivered in uniform dose to tumor Brachytherapy: delivers high dose to tumor and less to other tissues; radiation source is placed in tumor or next to it
Immunotherapy use of chemical or microbial agents to induce mobilization of immune defenses. Biologic response modifiers (BRMs) use of agents that alters immunologic relationship between tumor and host in a beneficial way
Bone marrow peripheral stem cell transplantation aspirating bone marrow cells from compatible donor and infusing them into the recipient Gene therapy transfer of genetic materials into the clients DNA
Back
NURSING MANAGEMENT
1. Promote measures that relieve pain and discomfort.
Pharmacologic and non-pharmacologic interventions
2. Promote measures to maintain intact skin integrity 3. Promote measures that maintain oral mucosa 4. Promote measures to prevent injury from abnormal bleeding
Monitor platelet count; avoid aspiring products,etc
NURSING MANAGEMENT
5. Promote measures that identify and prevent infection
Monitor WBC count; encourage frequent handwashing and overall cleanliness
6. Help decrease the clients fatigue and increase his activity level 7. Promote measures that ensure adequate nutritional intake
High protein, high calorie diet
NURSING MANAGEMENT
9. Promote measures to enhance body image.
Take an honest gentle, caring approach; encourage client to express and verbalize feelings
10. Promote measures that address preventing complications of cancer therapy 11. Instruct client and family about the disease process and treatments; provide necessary information for self-care. 12. Help client and family cope effectively 13. Promote measures to reduce social isolation.
Hormone Antagonist:
Action: block hormones on hormone- binding tumors ie: breast, prostate, endometrium; cause tumor regression Ex: Tamoxifen (breast); Flutamide (prostate) Toxic Effects: altered secondary sex characteristics
Effects of Chemotherapy
Tissues: (fast growing) frequently affected Examples: mucous membranes, hair cells, bone marrow, specific organs with specific agents, reproductive organs (all are fetal toxic; impair ability to reproduce)
Chemotherapy Administration
Routes of administration:
Oral Body cavity (intraperitoneal or intrapleural) Intravenous
Use of vascular access devices because of threat of extravasation (leakage into tissues) & longterm therapy
Chemotherapy Administration
Types of vascular access devices:
PICC lines: (peripherally inserted central catheters) Tunneled catheters: (Hickman, Groshong) Surgically implanted ports: (accessed with 90o angle needle- Huber needles)
REFERENCE
National Cancer Institute Brunner and Suddarths Medical Surgical Nursing