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Terms in this set (43)
•Characterized by abnormal or uncontrolled cellular proliferation, which if not treated may result in death.
-a group of 200 different and distinctive diseases that can affect any tissue, organ or organ system.
•2nd most common cause of death in US
•5year survival rate is 66%
Biology of cancer
•Defect in Cellular Proliferation
-Divide indiscriminately and haphazardly
•Defect in Cellular differentiation
An abnormal mass of tissue (or tumor) that serves no useful purpose and many harm the host organism.
•Usually harmless growth that does not spread or invade other tissue.
-Does occupy space; if located near vital structures or organs it can be harmful to host.
A harmful growth that capable of invading other tissues and spreading (metastasis) to distant organs.
-Specific Morphology &
-Encapsulated (contained within a fibrous capsule)
-Adhere Tightly Together & Non-Migratory
•Speed of Growth (Mitosis)
•Mode of Growth
-Enlargement & Expansion
-Easily Removed / Tend Not To Reoccur
-Associated with Localized Effects
-Different Morphology &
-Do Not Adhere Tightly Together & Are Very Migratory
•Speed of Growth (Mitosis)
-Variable; Often Rapid
•Mode of Growth
-Infiltration; Resulting in Cellular Damage or Destruction
-Metastasis Is Common
-Not Easily Removed / Tends To Reoccur
-Associated with Systemic Effects
Methods for Classifying Malignant Neoplasms
•Organ of Origin
-i.e. Breast, prostate or lung cancer etc.
•Tissue (or Cell) of Origin
-Epithelial Tissue: - Carcinomas
-Connective, Muscle and Bone: - Sarcomas
-Lymphatic Tissue: Lymphomas
-Plasma Cells: Myelomas
Malignant Neoplasms:Metastatic Processes
-The spread of cancerous cells from the primary tumor site to distant sites or organs.
•Mechanisms of Metastasis
-Hematogenous Spread (blood vessels)
*A mechanism by which tumor cells induce growth of new capillaries from host tissue to ensure a blood supply.
*Thought to be a self-created mechanism to transport cancerous cells to distant sites.
•Common Site of Metastasis: Secondary Tumors:
-Breast Cancer → Bone
g*, Liver & Brain
-Prostate Cancer → Bone* (especially spine & legs)
-Lung Cancer → Brain*, Bone, Liver & Pancreas
-Melanoma → GI Tract, Lung & Brain
-Colorectal Cancer → Liver*
*=most common site
Etiology of Cancer
-Factors that initiate or promote cellular changes associated with cancer.
ºViruses & Bacteria
--Physical Agents (i.e. Radiation)
--Chemical Agents (i.e. Tobacco Use)
ºGenetic / Familial Factors
Malignant Neoplasms: Grading
-Grade I: mild dysplasia, well differentiated
-Grade II: moderate dysplasia, moderately differentiated
-Grade III: severe dysplasia, poorly differentiated
-Grade IV cells immature and primitive, high grade
-Grade V; grade cannot be determined
Malignant Neoplasms: Staging
•Determines relative tumor size and the extent of disease spread in the body
-Stage 0: cancer in situ (meaning very localized)
-Stage I: localized
-Stage II: limited local spread
-Stage III: extensive local and regional spread
-Stage IV: metastasis
TNM Classification System
•Determines extent of disease involvement
•T = tumor size and invasiveness
-Tx → To → T 1, 2,3,4
•N = presence or absence of regional spread to lymph nodes
-Nx → No → N 1, 2,3,4
•M = Metastasis to distant organs
-Mx → Mo → M 1,2,3,4
-Reduce or avoid exposure to carcinogens
-Eat a balanced diet
-6-8 hours sleep per night
-Cope with stress
-Know 7 warning signs
-Do regular cancer screenings
-Practice self examinations
-Seek immediate care if cancer suspected
7 Warning Signs of Cancer: CAUTION
-Changes in bowel or bladder habits
-A sore that doesn't heal
-Unusual bleeding or discharge
-Thickening or lump
-Indigestion or difficulty swallowing
-Obvious changes in a wart or mole
-Nagging cough or hoarseness
Assessment of the Client with Cancer
•Reported Signs & Symptoms
-Fatigue -Night Sweats
•Explore for exposure to carcinogens, familial history of cancer and for the presence of other risk factors.
•A Complete Physical Examination
-Complete Blood Count with Differential
-Liver function studies
-Other Electrolytes: Mg+, PO4- & Ca++
-Coagulation Studies: PT / INR & PTT
ºCEA (carcinoembryonic antigen)
ºPSA (prostate specific antigen)
-Alkaline Phosphatase (for bone and liver abnormalities)
-Computerized Tomography (CT Scan)
-Magnetic Resonance Imaging (MRI)
-Positron Emission Tomography (PET Scan)
•Cytology Studies: Examination of Cells
-Scrapings or brushings from organs or tissues
-Body fluids or secretions.
•Biopsies: Examination of Tissue
ºFine Needle Aspiration
ºIncisional (Subtotal) Biopsy
ºExcisional (Total) Biopsy
•Biopsies are the only way to diagnose cancer definitively. Once you do that, you can plan treatment. You need to know what you are working with before you can plan treatment.
Factors Influencing Prognosis
-Type of Cancer
-Stage & Grade of Tumor (at time of diagnosis)
-Presence of Chronic Illness
Nursing Diagnoses: Cancer
-Risk for Infection
-Risk for Injury
-Impaired Skin Integrity
-Chronic Pain / Acute Pain
-Imbalanced Nutrition, Less Than Body Requirements
-Disturbed Body Image
-Risk for Loneliness
Management of Cancer
•Goals of Cancer Management
-Treatment options should be individualized to the client and based on realistic and obtainable goals.
-Three Main Goals:
ºCure: Complete eradication of disease
ºControl: Slow disease progression
ºPalliation: Alleviating disease related symptoms
Types of Cancer Interventions
-Hematopoietic Stem Cell Transplantation
-Biologic Response Modifiers
-Surgery is the oldest form of cancer treatment
•Surgery plays many roles in the treatment of cancer:
-Cure for localized cancer
-Prevent, diagnose & stage cancer
-Palliation of cancer symptoms
-Reconstruct diseased or lost tissue or structures.
•Often combined with chemotherapy, radiation or a combination of both.
Surgical Interventions: Curative
•Goal: To eradiate the cancer
•Two Common Approaches:
1. Local Excision
-Removal of entire tumor and a small margin of normal tissue.
2. Wide (Radical) Excision
-Removal of entire tumor, lymph nodes, adjacent structures and surrounding tissue.
-May result disfigurement & altered functioning
Surgical Interventions: Preventative (Prophylactic)
•Removal of non-vital tissue or organs that are likely to develop cancer; Often a strong genetic predisposition or familial tendency.
•Goal: To prevent disease occurrence
Surgical Interventions: Palliative: Debulking
•Indicated when cure is not possible; done to relieve symptoms associated with cancer.
•Goal: To improve comfort and QOL.
Surgical Interventions: Reconstructive (Rehabilitative)
•Done to improve function, enhance appearance or both.
•Goal: Improve function, body image and QOL
•To attempt to destroy tumor by interfering with cellular functions and division.
•Goal: eliminate or reduce the number of malignant cells in primary tumor and metastatic tumor site
-Can not distinguish between cancerous and healthy cells
-Utilized more for systemic disease or localized cancers not amenable by surgery or radiation
-Often used along with surgery, radiation or both.
-Goals: Cure, control and palliation of cancer.
•Involves using two or more drugs proven effective against a tumor type.
•Goal: to kill more cancer cells with fewer side effects.
•Rationale for chemotherapy to be given in cycles
•Each cell cycle a percentage of cancerous cells are killed but some remain; repeating chemotherapy kills more cells so that remaining cancerous cells can be destroyed by the body's immune system.
•Routes of Administration
-Oral, topical, intravenous, intramuscular, subcutaneous, intra-arterial, intraperitoneal, intrathecal, or intravesical.
•IV is preferred route: Chemo is a vesicant
-Can be given via a peripheral or central access
**Venous Access Device (VAD)
ºCentral Venous Catheters (CVC)
ºSubcutaneous Infusion Ports
•Escape of a chemotherapeutic agent into surrounding subcutaneous tissue.
•Signs and Symptoms
-Absence of blood return in IV catheter
-Resistance to flow of IV fluid
-Swelling, pain, and tenderness at site
-Stop Infusion Immediately !!
-Other interventions (i.e. ice or heat) to site depend on agent
-Physician may aspirate or inject neutralizing solution
Chemotherapy Adminstration Considerations
-Chemotherapeutic agents prepared by pharmacy under a ventilation hood.
-Requires informed consent and a 2 RN check; No pregnant staff members should handle or administer these agents
-Gloves and a long-sleeve disposable gown must be worn for administration of the agent.
-Gloves must be also worn while handling of bodily fluids; usually for 48 hours after treatment as well.
-Dispose of waste in designated chemotherapy waste receptacles.
•Begins usually within 2-3 weeks after the start of chemotherapy.
-Hair loss is not permanent
-Gentle cleansing & conditioning; avoid excessive brushing
-Encourage or even assist the client with choosing a hair covering (i.e. scarf or wig); often helpful if done prior to actual hair loss.
•Small, frequent meals; high-protein & high-calorie foods
•Encourage nutritional supplements between meals
Chemotherapy: Nausea and Vomiting
•Preventative approach works best !
•Antiemetic agents (i.e. Zofran or Reglan)
Chemotherapy: Mucositis of Entire GI Tract
-Antidiarrheal agents (i.e. Lomotil)
-Frequent oral and lip care
-Soft-bristled toothbrush or toothette
-Avoid flossing and high-pressure gum cleaners
-Avoid spicy or hard foods, mouthwashes containing alcohol or glycerin, and extreme temperatures.
-NSS or room-temperature tap water rinses as needed
-Other Considerations: "magic mouthwash" (swish & spit)
Chemotherapy: Anemia (↓ RBC Counts)
•Clinical Manifestations: Fatigue & weakness
•Encourage frequent rest periods
•Supportive therapies: PRBC transfusions & Epogen or Procrit
Chemotherapy: Thrombocytopenia (↓ Platelets)
•Clinical Manifestations: Bruising, petechiae or bleeding
-Use an electric razor
-Careful venipuncture / Avoid IM injections
-Careful repositioning & handling of client
-Avoid NSAIDs like aspirin
-Avoid any rectal procedures
•Supportive therapies: Platelet transfusions & Neumega
Chemotherapy: Leukopenia (↓ WBC Count)
-At risk for infection!!!!
-Result is immunosupression
-Supportive Therapies: Neupogen or Neulasta
•Neutropenia Care Considerations
-Good hand-washing is essential !
-Aseptic technique with invasive lines and catheters
-Limit visitors to healthy adults
-No fresh flowers, fresh fruit & raw foods
-Avoid Foley catheters
↓ RBC Counts
↓ WBC Counts
↓ Platelet Counts
Chemotherapy: Reproductive Considerations
-Reliable birth control methods
-Education on possibility of sterility for both males & females
--Sperm & Egg Harvesting should be offered
-Common side effect
-Rest when fatigued, pace activities
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