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Cancer Pathophysiology
Abnormal cells DNA Oncogenes Abnormal growth Cells become invasive Metastasis
Cancer is classified by tissues or blood cells in which it originates: Glandular tissues (adenocarcinoma) Connective, muscle, bone tissue (sarcoma) Tissue of the brain and spinal cord (gliomas) Pigment cell (Melanoma) Plasma cell (myeloma) Lymphatic tissue (lymphomas) Leukocytes (leukemia)
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Environmental
Viruses Chemicals Sunlight Radiation Tobacco use
Environmental
Lung cancer Aspirin and other NSAIDs Tamoxifen SERMs Finasteride
Genetic Susceptibility
About 5-10% of cancers have familial tendency Examples of cancers that show familial inheritance are: retinoblastomas, breast, ovarian, endometrial, colorectal, stomach, prostate, and lung cancer BRCA-1 (and 2) gene
Host Susceptibility
Immune system Carcinogens
Host Susceptibility
New, additional cause of cancer is prior treatment with chemo or radiation therapy for a prior malignancy Can cause leukemias (latency period 2-5 yrs) or solid tumors (10-20 years) Prognosis for these are usually poor
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Staging Cancer
TNM
T: extent primary tumor N: Lymph node involvement M: Metastasis
Malignant Tumors
Breast Cancer
70% occur in women over age of 70 BRCA1 & 2 gene Other risks
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Breast assessment
Symptoms that may indicate breast cancer Breast lump * Breast pain * Change in the size or shape of the breast * Swelling of the arm (lymphoedema) * Dimpling of the breast skin * Involution or inversion of the nipple * Axillary lymphadenopathy * Nipple discharge or bleeding * Ulceration of the breast skin * Bone or abdominal pain / jaundice Symptoms requiring specialist referral Lumps * All new discrete breast lumps * A new lump in pre-existing nodularity Asymmetrical nodularity persisting after menstruation * Breast abscess * Persistently refilling or recurrent cysts * Axillary lymphadenopathy * Breast pain * Pain associated with a lump * Persistent unilateral pain in a postmenopausal woman Nipple discharge * All women aged over 50 years * Women aged below 50 years with: * Bilateral discharge sufficient to stain clothes * Blood-stained nipple discharge * Persistent discharge from a single duct Family history
1:7 women will develop in lifetime in OC If already had breast cancer, 3-4x more likely to develop it again Detection
Mammogram (5-17% missed cancers) Digital mammogram MRI (finds 2x cancers vs mammo+ US) Positron Emission Tomography scanradioactive sugar injected. Self Breast Exam (SBE)
Breast Cancer
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Breast Cancer
Breast cancer in men-approximately 1690 new cases will be diagnosed in men this year. 100x more common in women than men
Malignant Melanoma
Melanoma is a malignancy of pigment-producing cells (melanocytes) Melanoma accounts for only 4% of all skin cancers
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70% arise from pre-existing mole Risks: excessive sunlight exposure, increased nevi (moles), tendency to freckle from the sun, family history, red hair, fair skin, blue eyes, susceptibility to sunburn, celtic or scandinavian ancestry (Melanoma rare in african-americans)
Malignant Melanoma
Malignant Melanoma
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Colon Cancer
Colonoscopy versus Virtual Colonoscopy 1:20 will have colon cancer in lifetime Approximately 150,000 new cases each yr in USA Early detection critical; 5 yr survival rate is 92%.
Colon Cancer
Higher risk in smokers Diets high in vegetables & fruits lower risk Right-sided (ascending colon) tumors present with anemia, fatigue. Lesions can grow large without obstructive symptoms as stool liquid in ascending colon Left sided (descending colon) tumors present with obstructive symptoms Aspirin and Calcium (1500 mg) may lower risk
Growth of polyp: takes approximately 5 yrs to grow 1/2 inch, takes approximately 5-10 years for these to become malignant
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Diagnosis
Self exam Stool guaiac Rectal exam & sigmoidoscopy Blood studies Tissue Biopsy Pap smear Digital exam PSA
Nursing Diagnosis
Anxiety r/t lack of knowledge Dx & Tx Disturbed self concept r/t Ineffective individual coping Sexual dysfunction r/t Knowledge deficit Altered Nutrition r/t intake, N & V, anorexia Potential for injury r/t susceptibility At risk for infection
Nursing Diagnosis
Pain r/t dx and tx
Impaired physical mobility r/t Activity intolerance r/t malnutrition & tx
Noncompliance Collaborative: hemorrhage, infection, bladder neck obstruction, many of the above Etc.. Etc. Etc.
Therapies
Surgery & lymph node staging chemotherapy radiation hormonal palliative treatment
teaching
pre-op post-op
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Management of Cancer-Surgery
Diagnostic-Biopsy Primary Treatment Prophylactic surgery Pallative-
Radiation Therapy
Goal: palliative, cure, or control of cancer. Types: electromagnetic, particulate (alpha, beta, electron neutrons) External (beam) or internal delivery (implant) Safety interventions: Time, Distance, Shielding
Radiation Therapy
Cells that undergo frequent cell division are most effected by radiation Slower growing tissues are nearly resistant
Types of Radiation
External-amount of energy determine how deep radiation can treat externally Internal-high dose to a localized area; Implant (needles, seeds, beads into vagina, abdomen, pleura, breast)
Radiation Therapy
Ionizing radiation used to interrupt cell growth. High-energy particles Normal cells can tolerate a specified dose of radiation before complications occur. Cancers are most radiosensitive because they divide rapidly, are well-oxygenated, and poorly differentiated.
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Radiation Therapy
Ionizing radiation Pallative radiation can relieve symptoms
Radiation Safety-Implant
Teach patient:
Stay 3 feet minimum away from others for 1-3 days after discharge Minimize time with other individuals Wash hands with plenty of soap and water after void. Rinse bathroom sink and tub thoroughly after each use
Radiation Safety-Implant
Absorbent pads cover floor around toilet. Cover telephone, overbed table with plastic, hampers marked radioactive No pregnant staff member may care for patient Film badges worn by all staff entering room (at chest level) Verbal contact every 2 hours via telephone or call system (or per hospital policy) Double glove for handling urinals, bedpans, emesis basins or any contact body fluids. Instruct flush toilet 3 times with each use. Disposable food trays. Lead shield to be used if implants
Radiation Therapy
If implant, protect caregivers Encourage rest periods throughout day Encourage adequate protein and calorie intake
Chemotherapy
Destroys tumor cells by interrupting cellular functions and reproduction. Each time tumor exposed to chemo, percentage of tumor cells (20-90%) are destroyed.
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Chemotherapy
Chemo attacks rapidly dividing cells, cancer cells are rapidly dividing cells Other cells that divide rapidly Chemotherapy drugs remain in urine, stool, saliva, blood, emesis up to 48 hours after administration completed
Therapeutic communication
sexuality impotence
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Mucositis/Stomatitis
cancersourceRN.com the chemotherapy made my mouth and throat so raw I could not talk or swallow my own saliva. The constant pain in my throat was like being stuck with a fiery hot poker. Thank goodness for Morphine-a cancer patient suffering from stomatitis
Mucositis/Stomatitis
Signs & symptoms include taste changes, oral pain, ulceration, edema, bleeding, dry mouth, infection,altered nutritional status 40% of people with cancer will develop oral complications Can occur 2-14 days from the time of chemo administration, varies with type of chemo
Nursing Care-Mucositis
Nursing care includes: assessment-normal mucosa is pink, moist, clean, intact (Use flashlight if needed), assess for erythema, edema, signs of candidiasis (white patches), ulcers, exudate, discolored lesions, pallor. Check for altered texture and shininess, amount of saliva, coating, bad odors, cracks, fissures, blisters
Nursing Care-Mucositis
Teach to avoid spicy food, alcohol based OTC mouthwashes, good oral hygiene including flossing, brushing, rinsing, moisturizing.Toothpastes with sodium bicarb aid in dissolving mucus, reduce acidity of inflammation. Rinse agents: water, saline, salt&soda, 1/2 strength H2O2 or Peridex mouthwash. At risk for dental caries as can have 95% decline in salivation
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