NCM 104 Cellular Aberration Lecture 2007
NCM 104 Cellular Aberration Lecture 2007
NCM 104 Cellular Aberration Lecture 2007
CANCER
• Essential Concepts of Cancer
– What is Cancer?
– Normal Cell Growth vs. Cancer Cell Growth
– Etiology and Causative Factors
– Pathophysiology
– Classification of Tumors
– Effects of Cancer
• 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?
Cell damage—
no repair
Cancer
cell division
Oncogenes
Cancer cell accelerate
cell growth
and division
Mutated/damaged oncogene
Example of Normal Growth
Dead cells
shed from
outer surface
Epidermis
Cell migration
Dividing cells
in basal layer
Dermis
The Beginning of Cancerous Growth
Underlying tissue
Tumors (Neoplasms)
Underlying tissue
Invasion and Metastasis
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
Back at new location
ETIOLOGY/CAUSATIVE
FACTORS
• Viruses
• Chemical carcinogens
• Physical stressors
• Hormonal factors
• Genetic factors
What Causes Cancer?
Some viruses or bacteria
Heredity
Diet
Hormones
Population-Based Studies
Regions of Highest Incidence
U.K.:
Lung
cancer
JAPAN:
Stomach
cancer CANADA:
Leukemia
U.S.:
CHINA: Colon
Liver cancer
cancer
BRAZIL:
Cervical
AUSTRALIA: cancer
Skin
cancer
Genes and Cancer
Viruses
Chemicals Radiation
Heredity
Chromosomes
are DNA
molecules
Viruses
Virus inserts
and changes
genes for
cell growth
Cancer-linked virus
Examples of Human Cancer Viruses
Patient’s H. pylori
tissue sample
Tobacco Use and Cancer
Some Cancer-Causing Chemicals in Tobacco Smoke
High-Strength Radiation
Hoch
Leukemia
Incidence
Low
Least Most
X-ray Dose
(atomic radiation)
AIDS and Kaposi’s Sarcoma
Without
disease
HIV infection
Depressed
immune
system
KSHV infection
Kaposi’s
sarcoma
Heredity and Cancer
Inherited factor(s)
Other factor(s)
Heredity Can Affect Many Types of Cancer
Back
PATHOPHYSIOLOGY
ABNORMAL CELL FORMED BY MUTATION OF DNA
Time
Why Cancer Is Potentially Dangerous
Brain
Melanoma
cells travel
through
bloodstream
Liver
Melanoma
(initial tumor)
Patterns of cell Proliferation
• Hyperplasia
• Dysplasia
• Metaplasia
• Anaplasia
• Neoplasia
Hyperplasia
Normal Hyperplasia
Dysplasia
• Bizarre cell growth differing in size,
shape and cell arrangement
Time
Mutation Cells Mutations Proto-oncogenes More mutations,
inactivates proliferate inactivate mutate to more genetic
suppressor DNA repair oncogenes instability,
gene genes metastatic
disease
Mutations and Cancer
Matrix
Proteases
Fibroblasts,
adipocytes Cytokines
Blood vessel
Leukemias:
Some common
carcinomas: Bloodstream
Lung Lymphomas:
Lymph nodes
Breast (women)
Colon
Some common
Bladder sarcomas:
Prostate (men) Fat
Bone
Muscle
Naming Cancers
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
ASSESSMENT
• Nursing History
– Health History – chief complaint and history
of present illness (onset, course, duration,
location, precipitating and alleviating
factors)
Normal
Pap smear
Abnormal
Pap smear
Breast Cancer Screening
Prostate and Ovarian Cancer Screening
Colon Cancer Screening
Biopsy
Pathology
Proteomic profile
Patient’s
tissue sample or
blood sample Genomic profile
Microscopic Appearance of Cancer Cells
Back
Tumor Staging and Grading
• Staging determines size of tumor and
existence of metastasis
• Grading classifies tumor cells by type of
tissue
• The TNM system is based on the extent of
the tumor (T), the extent of spread to
the lymph nodes (N), and the presence of
metastasis (M).
Primary Tumor (T)
TX Primary tumor cannot be evaluated
T0 No evidence of primary tumor
Tis Carcinoma in situ (early cancer that has not spread to neighboring
tissue)
T1, T2, T3, T4 Size and/or extent of the primary tumor
Regional Lymph Nodes (N)
NX Regional lymph nodes cannot be evaluated
N0 No regional lymph node involvement (no cancer found in the
lymph nodes)
N1, N2, N3 Involvement of regional lymph nodes (number and/or extent of
spread)
Distant Metastasis (M)
MX Distant metastasis cannot be evaluated
M0 No distant metastasis (cancer has not spread to other parts of the
body)
M1 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
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
Cancer viruses
or bacteria
Avoid Tobacco
10x
Lung
Cancer
Risk
5x
0 15 30
Non-smoker
Cigarettes Smoked per Day
Protect Yourself From Excessive Sunlight
Limit Alcohol and Tobacco
Combination of Alcohol and Cigarettes
Increases Risk for Cancer of the Esophagus
40x
30x
Risk
Increase
20x
10x
Alcoholic Drinks
Consumed per Day
AND
Packs of Cigarettes
Consumed per Day
Diet: Limit Fats and Calories
Correlation Between Meat Consumption and
Colon Cancer Rates in Different Countries
40
30
Number of Cases
(per 100,000
people)
20
10
Cervical
Cancer
Risk
Low
Noninfected Women
women infected
with HPV
Avoid Carcinogens at Work
Incidence of
Most Cancers
Back
TREATMENT MODALITIES
• Aimed towards:
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 client’s fatigue and
increase his activity level
7. Promote measures that ensure adequate
nutritional intake
• High protein, high calorie diet
8. Ensure adequate fluid and electrolyte balance
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.
Care of Clients Receiving
Chemotherapy
• Alkylating agents:
– Action: create defects in tumor DNA
– Ex: Nitrogen Mustard, Cisplatin
– Toxic Effects: reversible renal tubular
necrosis
Classes of Chemotherapy Drugs
• Antimetabolites:
– Action: phase specific
– Ex: Methotrexate; 5 fluorouracil
– Toxic Effects: nausea, vomiting, stomatitis,
diarrhea, alopecia, leukopenia
Classes of Chemotherapy Drugs
• Antitumor Antibiotics:
– Action: non- phase specific; interfere with
DNA
– Ex: Actinomycin D, Bleomycin, adriamycin
(doxorubicin)
– Toxic Effect: damage to cardiac muscle
Classes of Chemotherapy Drugs
• Miotic inhibitors:
– Action: Prevent cell division during M phase
of cell division
– Ex: Vincristine, Vinblastine
– Toxic Effects: affects neurotransmission,
alopecia, bone marrow depression
Classes of Chemotherapy Drugs
• Hormones:
– Action: stage specific G1
– Ex: Corticosteroids
• 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) & long-
term therapy
Chemotherapy Administration