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11

Chapter 17Care of the Patient with Cancer

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OncologyOncology Branch of medicine that deals with the Branch of medicine that deals with the

study of tumorsstudy of tumors Lung cancer is the leading cause of Lung cancer is the leading cause of

cancercancer--related death in both men and related death in both men and womenwomen More children 14 years of age and More children 14 years of age and

younger die of cancer than of any other younger die of cancer than of any other diseasedisease

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What types of diet may place a What types of diet may place a person at higher risk for person at higher risk for cancer? cancer?

1 2 3 4

44%

11%

22%22%

1.1. Diet high in fatsDiet high in fats2.2. High fiber diet High fiber diet 3.3. Diet with lots of vegetables Diet with lots of vegetables 4.4. Diet high in carbohydratesDiet high in carbohydrates

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Development, Prevention, Development, Prevention, and Detection of Cancerand Detection of Cancer CarcinogenesisCarcinogenesis The process by which normal cells are The process by which normal cells are

transformed into cancer cellstransformed into cancer cells Various factors are possible origins of cancerVarious factors are possible origins of cancer

CarcinogensCarcinogens Substances known to increase the risk for the Substances known to increase the risk for the

development of cancerdevelopment of cancer

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Development, Prevention, Development, Prevention, and Detection of Cancerand Detection of Cancer

Carcinogenesis and the prevention of Carcinogenesis and the prevention of cancer cancer (continued)(continued) Risk factorsRisk factors SmokingSmoking 87% of people who develop lung cancer are smokers87% of people who develop lung cancer are smokers

Dietary habitsDietary habits Play a role in development of colon, rectum, and Play a role in development of colon, rectum, and

breast cancerbreast cancer

Exposure to radiationExposure to radiation Ultraviolet rays are a factor in the development of Ultraviolet rays are a factor in the development of

basal and squamous cell skin cancers and melanomabasal and squamous cell skin cancers and melanoma

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Hereditary CancersHereditary Cancers About 90% of cancers are NOT inheritedAbout 90% of cancers are NOT inherited Genetic susceptibilityGenetic susceptibility Incidence of breast cancer is higher in Incidence of breast cancer is higher in

women with a family history of this diseasewomen with a family history of this disease

Cancer risk assessment and cancer Cancer risk assessment and cancer genetic counselinggenetic counseling First step toward identifying hereditary First step toward identifying hereditary

cancer predispositioncancer predisposition

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Cancer Prevention and Cancer Prevention and Early DetectionEarly Detection Planned periodic examination and Planned periodic examination and

recognition of cancerrecognition of cancer’’s warning signss warning signs Colorectal testsColorectal tests Prostate cancer detectionProstate cancer detection Pelvic examination with Pap smear for Pelvic examination with Pap smear for

womenwomen Breast cancer detection (selfBreast cancer detection (self--exams)exams) Skin examinationsSkin examinations

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CancerCancer’’s seven warning s seven warning signssigns 1. Changes in bowel or bladder habits1. Changes in bowel or bladder habits 2. A sore that does not heal.2. A sore that does not heal. 3. Unusual bleeding or discharge.3. Unusual bleeding or discharge. 4. Thickening or lump in breast or 4. Thickening or lump in breast or

elsewhere.elsewhere. 5. Indigestion or difficulty eating. 5. Indigestion or difficulty eating. 6. Obvious changes in warts or molds.6. Obvious changes in warts or molds. 7. Nagging cough or hoarseness. 7. Nagging cough or hoarseness.

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Pathophysiology of CancerPathophysiology of Cancer

Cell mechanisms and growthCell mechanisms and growth Normal cellsNormal cells When cells are destroyed, cells of the same type When cells are destroyed, cells of the same type

reproduce until the correct number have been reproduce until the correct number have been replenishedreplenished

Cancer cellsCancer cells Instead of limiting their growth to meet specific Instead of limiting their growth to meet specific

needs, they continue to reproduce in a disorderly needs, they continue to reproduce in a disorderly and unrestricted mannerand unrestricted manner

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Grading and Staging of Tumors Grading and Staging of Tumors Stage I: Tumor limited to the Stage I: Tumor limited to the tissue origintissue originStage II: Limited local spreadStage II: Limited local spreadStage III: Extensive local and Stage III: Extensive local and regional spreadregional spreadStage IV: MetastasisStage IV: Metastasis

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Diagnosis of CancerDiagnosis of Cancer

Biopsy Biopsy Incisional, excisional, needle aspirationIncisional, excisional, needle aspiration

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Types of biopsy.

(From Belcher, A. E. [1992]. Cancer nursing. St. Louis: Mosby.)

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Diagnosis of CancerDiagnosis of Cancer Laboratory testsLaboratory tests

Carcinoembryonic antigen (CEA)Carcinoembryonic antigen (CEA)PSA and CAPSA and CA--125125Stool examination for bloodStool examination for blood

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Cancer TherapiesCancer Therapies

SurgerySurgery PreventivePreventive DiagnosticDiagnostic CurativeCurative

Palliative Palliative Radiation therapyRadiation therapy External radiation therapyExternal radiation therapy Internal radiation therapyInternal radiation therapy

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Cancer TherapiesCancer Therapies

ChemotherapyChemotherapy Side effectsSide effects LeukopeniaLeukopenia AnemiaAnemia ThrombocytopeniaThrombocytopenia AlopeciaAlopecia StomatitisStomatitis Nausea, vomiting, and diarrheaNausea, vomiting, and diarrhea Tumor lysis syndromeTumor lysis syndrome

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Cancer TherapiesCancer Therapies Bone marrow transplantationBone marrow transplantation Process of replacing diseased or damaged Process of replacing diseased or damaged

bone marrow with normally functioning bone bone marrow with normally functioning bone marrowmarrow

Peripheral stem cell transplantationPeripheral stem cell transplantation This procedure is based on the fact that This procedure is based on the fact that

peripheral or circulating stem cells are peripheral or circulating stem cells are capable of repopulating the bone marrowcapable of repopulating the bone marrow

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Advanced CancerAdvanced Cancer Pain managementPain management OpioidsOpioids Morphine, hydromorphone, fentanyl, methadoneMorphine, hydromorphone, fentanyl, methadone SustainedSustained--release morphinerelease morphine MS Contin, Roxanol SRMS Contin, Roxanol SR

AdministrationAdministration IV drips and epidurallyIV drips and epidurally Avoids peaks and valleysAvoids peaks and valleys

Patient selfPatient self--controlcontrol Distraction, massage, relaxation, biofeedback, Distraction, massage, relaxation, biofeedback,

hypnosis, and imageryhypnosis, and imagery

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Advanced CancerAdvanced Cancer

Pain management Pain management Patients should not be subjected to Patients should not be subjected to

severe suffering from potentially severe suffering from potentially controllable paincontrollable pain Fear of addiction should not be a factor Fear of addiction should not be a factor

when considering pain relief for the when considering pain relief for the terminally illterminally ill

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Advanced CancerAdvanced Cancer

Nutritional therapyNutritional therapy ProblemsProblems MalnutritionMalnutrition Anorexia Anorexia Altered taste sensationAltered taste sensation Nausea/vomitingNausea/vomiting DiarrheaDiarrhea StomatitisStomatitis MucositisMucositis

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Advanced CancerAdvanced Cancer Terminal prognosisTerminal prognosis Most patients with advanced cancer know Most patients with advanced cancer know

they are dyingthey are dying Honesty and openness are the best Honesty and openness are the best

approachesapproaches Spiritual activities may provide mental and Spiritual activities may provide mental and

emotional strengthemotional strength Social worker assists the patient and family Social worker assists the patient and family

in planning for home carein planning for home care Hospice services can be arrangedHospice services can be arranged——efforts efforts

are directed toward relief from pain and are directed toward relief from pain and other problemsother problems