cancer lecture, spring 2012
TRANSCRIPT
OncOlOgy nursing
What is Cancer ?
• An alteration in cell growth
• A common health problem in the United states and Canada
• A disease that can effect anyone
• One of the most feared diagnoses
Neoplasms
Tumor Growth
Tumor Cell Division
Incidence and Mortality
• Annual newly diagnoses of 1.5 million people • Occurs in 1 of every 3 persons living in North
America • More than 10 million Americans with a history
of cancer are still alive, with nearly 5 million considered cured
(American Cancer Society[ACS]2008)
Features of Normal Cell Growth
• Limited Cell Division
• Apoptosis
• Specific Morphology
• A small nuclear-to-cytoplasmic ratio
• Differential Function
• Tight Adherence
• Non-migratory
• Orderly & well-regulated cell growth
Features of Cancer Cells: Benign
• Continuous or inappropriate cell growth
• Specific morphologic features
• Small nuclear-to-cytoplasmic ratio
• Many differentiated functions
• Tight adherence
• No migration
• Growth- Expansion
• Normal chromosomes(eupliod)
• Low mitotic index
Features of Cancer Cells: Malignant
• Rapid or continuous cell division
• Anaplastic appearance • Large nuclear-to-
cytoplasmic ratio
• No differentiated function
• Loose adherence
• Migration
• Growth –Invasion
• Abnormal chromosomes (aneuploid)
• High mitotic index
Cancer Development (Carcinogenesis/ Oncogenesis)
• Malignant transformation –The process of changing a normal cell
into a cancerous cell • Initiation • Promotion • Progression • Metastasis
Metastasis
• Metastasis occurs through a progression of steps: – Extension into surrounding tissues – Blood vessel penetration – Release of tumor cells – Invasion – Local seeding – Blood borne metastasis – Lymphatic spread
Steps of Metastasis
Metastasis
Cancer Classification
• Grading Iggy pg 406 – I - low grade malignant , slow growing – II- moderately differentiated from normal cell – III- poorly differentiated, able to tell tissue of
origin – IV- no normal cell differentiation tissue of origin
impossible to determine • Staging Iggy pg 407
– TNM (tumor, node, metastasis) – Useful for treatment options and prognosis determination
Caution: Seven Warning Signs of Cancer
• Change in bowel or bladder habits
• A sore that doesn’t heal
• Unusual bleeding or discharge
• Thickening/lump in the breast or elsewhere
• Indigestion or difficulty swallowing
• Obvious change in a wart or mole
• Nagging cough or hoarseness
Diagnostic tests
• CBC
• Chemistry
• Protein tumor markers (PSA, CEA)
• X-ray
• MRI
• CT
• Ultrasound
• Nuclear Imaging
• Biopsy
• Endoscopy
• Laparoscopy
Treatment and Management
• Goal is: survival prolongment and/or improvement of quality of life – surgery
– radiation – chemotherapy – hormonal manipulation – immune therapy – photodynamic therapy – gene manipulation – target therapy
Types of Surgeries Iggy pg 417
• Diagnostic- biopsy
• Prophylactic- removal of at risk tissue
• Curative- removal of all cancerous tissue
• Cytoreductive (“debulking”)- removing part of the tumor and leaving a known amount of gross tumor
• Palliative- focused on improving quality of life and not focused on cure
• Reconstructive- increase function, enhanced appearance or both
Radiation Therapy • Purpose is to destroy the cancer cells with minimal
exposure to normal cells
• Side Effects: limited to tissue exposed to the radiation (varies according to site)
-hair loss, altered taste, fatigue, tissue - fibrosis, scarring, direct skin becomes dry/broken down/red
( *** Iggy Chart 24-2 skin protection during radiation
therapy*** AND **chart 24-1 precautions for sealed implants***) pg 420
Chemotherapy
• The treatment of cancer with chemical agents
– Cure
– Increase survival time
• Damages the DNA and interferes with cell division
– Better for rapid growing cancers
Chemotherapy Side effects
• Effects all cells not just cancer cells
• Side Effects: Neutropenia, thrombocytopenia, alopecia, N/V, mucositis, anxiety, sleep disturbances, cognitive changes, altered bowel elimination.
• See Iggy Chart 24-4 pg 426 – Care of patients with Neutropenia
Nursing Care – Patient Centered Care
• Infection Control
• Nausea and Vomiting – From the Chemo agents
• Mucositis
• Changes in cognitive function
• Peripheral neuropathy
• Alopecia
Anticancer Drugs by Classification
• Alkylating Agents – Cause changes in the DNA strands preventing the
cancer cells from dividing
• Antitumor Antibiotics – Inhibit Protein and RNA synthesis and bind to DNA
causing fragmentation.
• Miotic Inhibitors – Inhibit cell division by disrupting the microtubules
Anti-Cancer Drugs by Classification
• Antimetabolites – Disrupt metabolic process and can inhibit
enzymes synthesis.
• Plant Alkaloids – Derived from natural products that cause a
blocking in the cell division at the “M” Phase.
Anti-Cancer Drugs by Classification
• Hormonal & Anti-hormonal Agents – Hormones help regulate body mechanisms such
as growth, metabolism, and reproduction. – Many anti-hormone agents have been developed
to interfere with the interaction between the hormone molecule and its receptor site, which stimulates cell growth and proliferation.
• Biologic Response Modifiers – A class of pharmacologic agents that enhance the
body’s immune system.
Nutrition
• Cancer can cause devastating weight loss and malnutrition
• Nutrition therapy maximizes drug therapy, alleviates side effects of disease and treatments, improves quality of life
Nutritional deficit causes
• Anorexia
• Taste changes
• Cachexia- extreme body wasting
• Wasting Syndrome
• Diarrhea
• Nausea
• Xerostomia- severe dryness of the mouth
• Stomatitis
• Fatigue
Common Nursing Diagnosis (Just a few)
• Risk for nutritional imbalance, less than body requirements related to GI side effects of chemotherapy
• Risk for nutritional imbalance, less than body requirements r/t anorexia and fatigue
• Risk for impaired oral mucous membrane related to the side effects of chemotherapy or radiation therapy
• Risk for infection related to bone marrow suppression
Common Nursing Diagnosis
• Disturbed body image related to hair thinning or hair loss
• Risk for impaired skin integrity related to diarrhea caused by chemotherapy
• Risk for chronic pain related to disease process, injury or surgical procedure
• Risk for Impaired physical mobility related to pain and/or fatigue
• Interrupted family process related to situational crisis
OncOlOgical EmErgEnciEs
Oncologic Emergencies
• Sepsis and disseminated intravascular coagulation - DIC
• Collaborative management includes:
– Prevention (the best measure) – IV antibiotic therapy – Anticoagulants, cryoprecipitated clotting factors
Hypercalcemia
• Occurs most often in patients with bone metastasis
• Fatigue, loss of appetite, nausea and vomiting,
constipation, polyuria, severe muscle weakness, loss of deep tendon reflexes, paralytic ileus, dehydration, electrocardiographic changes
Hypercalcemia (Cont’d)
• Collaborative management includes: – Oral hydration – Normal saline IV – Drug therapy – Dialysis
Superior Vena Cava Syndrome
• SVC compressed or obstructed by tumor or formation of clots
• Painful, life-threatening emergency
• Manifestation – edema of face, around
eyes, chest/trunk can progress to arms, hands, dyspnea, stokes sign
Tumor Lysis Syndrome
• When a lg # of tumor cells are destroyed rapidly
• Their intracellular contents (ie. K+ and purines) are released into bloodstream faster than body can eliminate them
• Can lead to hyperkalemia, hyperuricemia (liver converting purines into uric acid-crystals build up in kidneys) and can cause – CRF: tx may require kayexalate or dialysis, insulin drips,
drugs that increase excretion of purines such as: Aolprim and Zyloprim.
Tumor Lysis Syndrome
Prevention and Detection of Cancer • Reduce or avoid exposure to known or
suspected carcinogens and cancer promoting agents
• Eat a balanced diet Reduce the amount of fat and preservatives including smoked and salt cured meats
• Participate in a regular exercise
• Obtain adequate, consistent periods of rest
• Have a health examination on a regular basis
• Eliminate, reduce, or change the perceptions of stressors
• Enjoy consistent periods of relaxation and leisure
• Know the seven warning signs of cancer (i.e. CAUTION)
• Learn to practice self examinations
• Seek immediate care as needed
The End- Questions?