Cancer

Jeseca Mae J. Toledo

How Cancers Develop and Spread
Cancer develops only in cells with damaged
genes (mutations).
Mutations can be inherited or caused by
exposure to:
Low-dose radiation
Drugs
Toxic chemicals
Infection with certain viruses can cause
mutations.
Lifestyle plays a major role in cancer
prevention.
How Cancers Develop and Spread
(continued)
Cells that begin to grow abnormally but
are not yet cancer cells, may form benign
tumors.
Benign tumors are surrounded by a fibrous
capsule, and they do not spread or invade
surrounding tissues.
Benign tumors are usually not life-threatening
unless they interfere with vital processes.
Cancer Detection
Cancer screening is an examination to detect
cancer before a person has symptoms.
American Cancer Society recommends
screening for early detection, particularly for
high-risk people or people with symptoms.
Visual examination
Self-examination
Clinical (physician) examination
Laboratory testing
Scans (MRI, CAT)
Lung Cancer
Tobacco smoking is the leading cause of various
cancers.
30% of cancer deaths, including 87% of lung
cancer deaths, are attributed to tobacco use.
Smoking cigarettes is most common cause.
Women are more susceptible to lung cancer than
men
Lung Cancer (continued)
Signs and symptoms
In the early stages, signs and symptoms may
be difficult to detect.
Cigarette smokers may have chronic
cough or chronic bronchitis
Risk factors and prevention
Risk increases with:
The number of cigarettes smoked/day
The number of years a person smokes
How deeply the smoker inhales
Smoking high-tar or unfiltered cigarettes
Lung Cancer (continued)
Quitting tobacco use reduces lung
cancer risk, but it never returns to that of
a nonsmoker.
Passive smoking may increase
nonsmokers risk of lung cancer.
Environmental tobacco smoke is
associated with 20% to 30% increase
in lung cancer risk.
Asbestos and radon exposure also
increase risk.
Breast Cancer
Breast cancer occurs primarily in women.
Signs and symptoms involve changes in breast tissue:
Risk factors
Family history
Women with mothers, sisters, or daughters
who have breast cancer
Age
Rare before age 20
Risk increases throughout the 20s
Rises dramatically during the 30s through
mid-70s (majority or cases occur in women
40 and over)
Drops significantly after mid-70s
Cervical Cancer
A causal association exists between infection
with human papillomavirus (HPV) and
cervical cancer.
Causes genital warts
Is sexually transmitted
Risk of infection increases with an
increased number of sexual partners
and/or non-monogamous partners
Women who became sexually active
before age 17 have higher risk
Skin Cancer
Related to exposure to ultraviolet (UV)
radiation from the sun as well as tanning
beds.
Three types of UV radiation: UVA, UVB,
and UVC.
All types are harmful and have potential
to cause skin cancer.
UVA is associated with sunburn, skin
cancer formation, and premature aging
effects.
Skin Cancer (continued)
Artificial UV sources may also generate
UVC rays
UVC is potent cancer-causing radiation
Earths atmosphere filters natural UVC
Prevention
Limit sun exposure
Use sunscreens
Where protective clothing when exposed to
sunlight
Avoid artificial sources of UV light (i.e.,
tanning beds).
Skin Cancer (continued)
If you are high risk for malignant melanoma,
check skin regularly for skin legions that:
Are asymmetrical (A)
Have irregular borders (B)
Have multiple colors (C)
Have a diameter greater than pencil eraser (D)
Prevention
Limit sun exposure
Use sunscreens
Where protective clothing when exposed to sunlight
Avoid artificial sources of UV light (i.e., tanning beds)
Reducing Cancer Risk
Eat a diet low in fat and red meats, especially
high-fat and processed meats.
Eat a variety of fruits and vegetables daily.
Men should conduct monthly testicular self-
examinations.
Know warning signs of cancer and see your
health care provider immediately if you detect
any.
Reducing Cancer Risk (continued)
Sexually active people should use condoms to
avoid contacting HPV.
Women should consult with their health care
providers about risks of using oral
contraceptives or hormone replacement
therapy.
Exercise most days of the week.
When in the sun, takes steps to limit UV
radiation exposure.
Reducing Cancer Risk (continued)
Dont smoke or chew tobacco.
Avoid secondhand smoke.
Dont drink excessive amounts of alcohol.
Avoid unnecessary exposure to ionizing
radiation, such as x-rays and UV light.
Dont lie in the sun or tanning beds.
Avoid direct sun exposure between 10 a.m. and
4 p.m.
Avoid exposure to toxic chemicals and fumes.
Avoid asbestos dust and radon gas.
Avoid eating cured or smoked meats.
Cancer Treatments
Types of Treatment
Surgery
Radiation Therapy
Chemotherapy
Hormone Therapy

Therapies can be used alone or in
combination

Surgery
Removal of cancerous tissue from the
body
Local treatment
Can also be used for: diagnosis,
staging, relief of side effects, or to
ease pain
Side Effects of Surgery
Depends on type of surgery & overall
health of person
Most common side effect is Pain
Other side effects include: bleeding,
constipation, fatigue, wound care, and
management of drains

Surgical Treatments
Cervical
Cryosurgery, laser surgery, conization,
hysterectomy
Feel less womanly, incision, bleeding

Breast
Lumpectomy, mastectomy
Feel less womanly, balance,
numbness/tingling, drains, lymphadema

Surgical Treatments
Colon
Colectomy, resection
Altered bowel function, colostomy

Lung
Resection, lobectomy, pneumonectomy
Chest tube, respirator, short of breath
Surgical Treatments
Prostate
Prostatectomy, orchiectomy
Impotence, incontinence, libido
Radiation Therapy
High energy x-rays
to kill cancer cells
Local treatment
Given externally or
internally
Skin may be
marked by tattoos
to direct beams
Daily treatments
Side Effects of Radiation
Side effects depend on targeted area
Skin irritation
Hair loss
Digestive problems
Fatigue
Urinary & Bladder problems
Sexual/Fertility problems
Bleeding/Infection*

*Risks associated with implanted radiation source

Skin Changes
May start a few weeks after radiation
begins & last a few weeks after
radiation ends
Redness
Itching
Dry, Peeling
Sores, ulcers
Swollen

Management of Skin Changes
Clinical
May hold treatment
Prescribe special
creams
May prescribe
medications for pain,
itching, or infection

At Home
Use mild soap with lukewarm
water
Do not rub or scratch area
Loose clothing, soft fabrics
Sun protection
Sitz baths
Check with Provider before
using any skin products
Hair Loss
Also called alopecia
Only happens on the part of body being
treated
Hair loss starts 2 to 3 weeks after first
treatment
Hair may grow back 3 to 6 months after
treatment is over
New hair may not look or feel the way it did
before
Management of Hair Loss
Clinical
Prescription for wig
Look Good, Feel
Better
At Home
Cut hair short or shave
head
Buy a wig (before loss)
Wash hair gently
Avoid harsh products
Protect scalp
Stay warm
Digestive Changes
Changes depend on amount of radiation
and concurrent chemotherapy
Diarrhea
Mouth/Throat changes
Nausea & Vomiting
Diarrhea
Frequent bowel
movements which may
be soft, formed, loose,
or watery
Can occur at any time
Radiation to the
abdomen or pelvis
may cause diarrhea
Management of Diarrhea
Clinical
I.V. Fluids
Electrolyte
replacement
Imodium or other
anti-diarrheal
medications

At Home
Drink 8 to 12 cups of
clear liquids per day
Eat 5 or 6 small meals
and snacks
Eat foods that are low
in fiber, fat, and lactose
Avoid spicy foods
Mouth & Throat Changes
Radiation to head or neck can cause:

Dry mouth and throat
Difficulty swallowing
Mouth sores
Loss or changes in taste
Tooth decay
Infections

Some side effects my last for months or years
after treatment ends

Management of Changes to
Mouth/Throat
Clinical
Dental exam
Prescribe special
mouthwash for pain
or infection
At Home
Avoid tobacco, alcohol
Eat moist, soft foods
that are cool or room
temperature
Eat 5-6 small meals
high in calories &
protein
Drink 6-8 cups of fluid
each day

Nausea & Vomiting
Nausea and vomiting may occur 30 minutes
to many hours after radiation therapy session
ends

Patients are likely to feel better on days off
from radiation

Those receiving radiation to the abdomen &
certain parts of the brain are at risk
Management of Nausea & Vomiting
Clinical
I.V. fluids
Electrolyte
replacement
Prescribe anti-
nausea meds
At Home
Eat bland, easy-to-
digest foods and
drinks
Eat small meals and
snacks (5-6 meals a
day)
Have foods and drinks
that are warm or cool
Fatigue
Feeling weak, weary, worn out, heavy, or slow

Possible Causes:
Anemia
Anxiety
Depression
Infection
Lack of activity
Medicines

Fatigue may last even after therapy is over
Management of Fatigue
Clinical
Assess for
underlying cause
Treat patient for
anemia, anxiety,
depression or
infection as
indicated

At Home
Try to sleep at least 8
hours each night
Plan time to rest
Exercise
Adjust work schedule
Let others help at
home
Urinary & Bladder Changes
Frequency, burning or pain
Trouble starting or
emptying bladder
Incontinence
Blood in urine
Spasms
Starts 3-5 weeks after
therapy begins
Most problems go away 2-
8 weeks after therapy is
over.

Management of Urinary Changes
Clinical
Urine sample to
rule out infection
Prescribe meds to
help with spasms,
burning or pain
Refer to a therapist
for exercises to
improve bladder
control
At Home
Drink 6-8 cups of
fluid each day
Avoid coffee, black
tea, alcohol, spices,
and all tobacco
products
Continence pads
Sexual & Fertility Changes
Radiation to pelvic
area
Can cause sexual
changes: loss of
interest in or ability
to have sex
It can also affect
fertility

Management
Patients should talk to their Provider:

Fertility: Before starting radiation, let your doctor know if
you think you might want to father children in the future.

Impotence: The doctor can let you know whether you are
likely to become impotent and how long it might last. Your
doctor can prescribe medicine or other treatments that
may help.


Sex: Ask if it is okay for you to have sex during radiation
therapy. Most men can have sex, but it is a good idea to
ask and be sure.


Appetite Changes
Causes include:
Nausea
Mouth and throat problems
Changes in taste
Feeling depressed or tired

Appetite loss may last for a day, a few weeks,
or even months.

Management for Loss of Appetite
Clinical
Prescribe vitamins or
nutrition
supplements
Prescribe
medications that
increase appetite
receive nutrition
through an IV
At Home
Eat 5 to 6 small meals
each day
Drink milkshakes,
smoothies, juice, or
soup
Use plastic forks and
spoons
Increase your appetite
by doing something
active




Chemotherapy
Variety of drugs used to
kill cancer cells

Systemic treatment:
damages healthy cells
along with cancer cells

Given orally, IV, or by
injection into various
sites
Hormonal Therapy
May improve
prognosis more than
chemotherapy
If taken by mouth,
must be taken
everyday
Usually given for 5-
10 years
In Stage IV disease,
can control cancer for
many years
Dementia
Jeseca Mae J. Toledo
Dementia
A mental disorder that involves multiple
cognitive deficits, primarily memory
impairment, and at least one of the following
cognitive disturbances:
-aphasia use of word
-apraxia muscle movement
-agnosia loss ability to recognize objects
-executive functioning
Diagnostic Criteria: Symptoms of
Dementia

loss of memory
deterioration of language function
loss of executive function

Stages
Mild: Forgetfulness
Moderate: Confusion with progressive memory
loss
Severe: Personality and emotional changes
Delirium vs Dementia
(summary)
General rules of thumb:
Delirium Dementia
acute chronic
reversible irreversible
physiological structural
primary attention primary memory
deficits deficits
Delirium and dementia can coexist; in fact
delirium is very common in demented
patients
Nursing Intervention
Promote clients safety and protecting from injury
Promoting adequate sleep, proper nutrition and
hygiene, and activity
Structuring environment and routine
Providing emotional support
Promoting interaction and involvement



OU Neurology
STROKE
Jeseca Mae J. Toledo

OU Neurology
Stroke
A stroke is a sudden loss of brain function
resulting from a disruption of the blood
supply to a part of the brain

OU Neurology
What can go wrong???
Disruption of blood flow to the brain
Plaque build up of cholesterol in interior of
blood vessel
Foreign debris
blood clot
bubble of fluid
air
Broken vessel

OU Neurology
Two general type of STROKE :
Ischemic and hemorrhagic stroke
Ischemic
Stroke







Clot occluding
artery
Intracerebral
Hemorrhage







Bleeding
into brain
Subarachnoid
Hemorrhage







Bleeding
around brain
Focal Brain Dysfunction
Diffuse Brain Dysfunction
85% 10% 5%

OU Neurology
Ischemic STROKE
Blockage of blood flow to brain
Progressive Thrombus -- growing
Plaque deposit similar to process in heart with
coronary artery disease
Cerebral Emboli --Clot from somewhere else --
floating debris
Blood clot
Air bubble
Bubble of amniotic fluid
Bone marrow from
a fracture

OU Neurology
Hemorrhagic STROKE
Aneurysm weakened area in artery
Congenital
Younger population younger than 40 years
Complain of worst headache in my life
Spontaneous Hypertensive Bleed
Due to BP > 200/100
Malformed Artery
50% younger than 30 years


OU Neurology
Transient Ischemic Attack
One Free Spin
Looks like a stroke but,symptoms improve in
1-24 hours
Temporary disruption of blood flow to the
brain Like Unstable Angina of the brain
Warning sign (15% of strokes have TIA first)
Mimicked by low blood sugar (> blood sugar
signs and symptoms go away)
1 in 20 patients will have a true stroke in 3
months

OU Neurology
Can STROKES be prevented?
Modifiable risk factors
High BP
Cigarette smoking
Alcohol intake
Uncontrolled Heart disease
Atrial fibrillation
(creates mini clots)
Uncontrolled Diabetes
Carotid congestion


OU Neurology
High blood cholesterol
Sedentary lifestyle
Obesity
Seasons spring and fall
Stress

OU Neurology
Risk Factors Unable to Control
Age
Gender
more women than men
Prior strokes
Heredity
Sickle Cell Disease
Causes clot formation and
strokes even in children

OU Neurology
Signs and Symptoms of STROKE
Hemorrhagic
Sudden and dramatic
Violent explosive headache
worst headache of my life
Visual disturbance
Flashing lights, aura
Nausea and vomiting
Neck and back pain
Due to blood in sub-arachnoid space
Sensitivity to light
Weakness on one side
Can present like a migraine headache

OU Neurology
Signs and Symptoms of STROKE
Ischemic Stroke
Harder to detect
Weakness in one side
Facial drooping
Numbness and tingling
Language disturbance
Visual disturbance

OU Neurology
Left Brain Stroke
Right side paralysis
Speech and language disturbance
Behavioral changes
Swallowing problems

OU Neurology
Right Brain Damage
Left side paralysis
Spatial perception
Where your limbs
are in relation to the room
Coordination problems
Perception
Recognition of familiar
objects

OU Neurology
Primary Stroke Care
180 minute window of time
Time is tissue
The longer the brain is without
oxygen and glucose the more
brain cells die

Goal is to restore blood flow as
soon as possible

Treatment is a system beginning with early
recognition and continuing through rehabilitation


OU Neurology
Seven Ds of STROKE Care
Detection of STROKE symptoms
Dispatch of EMS/ MET Team
Delivery to a facility prepared to manage STROKE
Door to treatment rapid diagnosis and decision
making
Data CT Scan
Decision Ischemic or Hemorrhagic, does the patient
meet the criteria to receive thrombolytic drugs
Drug thrombolytics when appropriate

OU Neurology
Use a FAST STROKE Assessment
Modification of Cincinnati Pre-Hospital
Stroke Screen
Face
Arm
Speech
Time of onset

OU Neurology
FACE
Look for Facial Droop
Have the patient smile or show his/her teeth
NORMAL Both sides of the
face move equally
ABNORMAL One side of
the patients face droops
or does not move

OU Neurology
ARMS
Motor Weakness: Look for arm drift by asking
the patient to close eyes and lift arms
NORMAL- arms remain
extended equally or drift
downward equally
ABNORMAL One arm
drifts down compared
to the other


OU Neurology
Problem with gripping hands
Many elderly have arthritis in hands
Hurts to grip hands
May mimic weakness


OU Neurology
SPEECH
Ask the patient to say You cant teach an
old dog new tricks
Lots of ts, ks and cs
NORMAL Phrase repeated clearly and
plainly
ABNORMAL Words slurred, abnormal or
unable to speak

OU Neurology
Abnormal Speech
Slurring of speech
Unable to think of words
Inappropriate words
Expressive aphasia unable to speak words
Area of brain where words are created is damaged
Receptive aphasia unable to understand
words
Area where words are interpreted is damaged

OU Neurology
TIME OF ONSET
The window of opportunity to effectively
treat STROKE is 3 hours (180 minutes)
May be extended to 4 hours in some cases
Need to know last known well.
Difficult when
Patient lives alone
Woke up with symptoms


OU Neurology
180 minutes
Dont think of as 3 hours, but 180 minutes
Time gets eaten up fast
Short scene time
Take transport time into consideration


OU Neurology
Clinical Manifestation
A stroke causes a wide variety of
neurologic deficits, depending on the
location of the lesion (which vessel is
obstructed), the size of the area of
inadequate perfusion, and the amount of
collateral (secondary or accessory) blood
flow. The damaged brain cannot be
restored.

OU Neurology
Motor Loss
Communication Loss
Dysarthria (difficulty in speaking), as demonstrated by poorly intelligible
speech caused by paralysis of the muscles responsible for producing
speech
Dysphasia or aphasia (defective speech or loss of speech), which is
mainly expressive or receptive
Perceptual Disturbances - Homonymous hemianopia (loss of half of
the visual field) may occur from stroke and may be temporary or
permanent. Sensory losses from stroke may take the form of slight
impairment of touch or be more severe with loss of proprioception
(inability to perceive position and motion of body parts) as well as
difficulty in interpreting visual, tactile, and auditory.
Impairment of Mental Activity and Physiological Effects.
Bladder Dysfunction.


OU Neurology
Management of a Patient with Stroke
Patent airway and circulation to the brain are maintained
Adequate oxygenation of blood to the brain is necessary to minimize
cerebral damage. The blood pressure and cardiac output must be
maintained to sustain cerebral blood flow, and hydration (intravenous fluids)
must be ensured to reduce blood viscosity and improve cerebral blood flow.
The patient is places in a lateral or semiprone position with the head of the
bed slightly elevated to lower cerebral venous pressure.


OU Neurology
Endotracheal intubation and mechanical ventilation are necessary
for patients with massive stroke because respiratory arrest is usually
the life-threatening factor in this situation.
The patient is monitored for complications (aspiration, atelectasis,
pneumonia), which may be due to loss of airway reflexes,
immobility, or hypoventilation.
The heart is examined for abnormalities in size, rhythm, and signs of
congestive failure


OU Neurology
Thank You!