CANCER NURSING PREPARED BY: MS. SHENELL A. DELFIN, RN
Cancer - comes from the Greek word “Karkinos”; meaning crab – a graphic description of disease growth pattern.
generic term for large group of disease characterized by abnormal, seemingly unrestricted cell division.
Altered cellular metabolism with progressive and uncontrolled multiplication of cells with selective ability to invade and metastasize and cause mechanical effects of pressure, obstruction, and interruption of blood supply.
Tumor – any mass or swelling in or on the body of a plant or animal.
Neoplasm – more precise technical term for tumor and new growth.
cell growth without definite purpose in which there is uncontrolled production of cells that is therefore destructive in nature.
Danger signs of Cancer (CAUTION)
C – Change in bladder and bowel habits.
A – A sore that does not heal.
U – Unusual bleeding or discharge.
T – Thickening or lumps in breast or elsewhere.
I – Indigestion or difficulty of swallowing.
O – Obvious change in wart or mole.
N – Nagging cough or hoarseness.
Plus: unexplained loss weight and anemia.
Site of Cancer and Danger signal
Lung cancer- Dypsnea, wheezing, dry to productive cough, hemoptysis, hoarseness, chest pain, history of cigarette smoking and recurrent infection.
Colon/Rectal cancer- change in bowel habits, diarrhea or constipation, rectal bleeding, abdominal cramps and vague discomfort, signs of intestinal obstruction, palpable mass, history of low fiber diet.
Breast cancer - firm, non-tender painless lump or mass, nipple retraction or discharge, palpable mass, + mammography, in women > 50 with + history and early menarche and late menopause.
Uterine cancer- post menopausal uterine bleeding, intermenstrual bleeding, common among obese, nulliparous, prolonged estrogen therapy, postmenopausal + pap smear.
Prostate cancer - difficulty in starting urine, smaller and less forceful urine flow, urgency, hesistancy, dribbling and retention ( increase residual urine volume), frequency common in age 50 with + history
Laryngeal cancer - persistent hoarseness, cough and hemoptysis, enlarged cervical lymph nodes, dysphagia and dyspnea, common among voice abusers, smokers and alcoholics.
Bladder cancer- initially painless hematuria, flank or pelvic pain, dysuria, frequency and urgency, common in men, cigarette smokers and excessive coffee drinkers.
Metastasis – secondary growths at distant site.
Common sites for metastasis: brain, liver, lungs, spinal cord, and bone.
Factors in enabling to metastasize:
Invasiveness of cells of the neoplasm – power to overcome the local barriers to spread.
Tendency of malignant cells to separate from the parent growth.
Four mechanisms by which the neoplasm spreads:
Vascular system - cancer cells penetrate vessels and circulate until trapped. The cancer cells may penetrate the vessel wall and invade adjacent organs and tissues.
Lymphatic system- cancer cells penetrate the lymphatic system and distributed along lymphatic channels
Implantation- cancer cells implant into a body organ. Certain cells have an affinity for particular organs and body areas.
Seeding- a primary tumor sloughs off tumor cells into a body cavity, such as the peritoneal cavity.
Difference between Benign and Malignant Tumors Cause death unless removed surgically before metastasis 9. Not cause death except when located in areas producing pressure and obstruction. Produce typical cancer cachexia 8. Not produce typical cachexia Extensive tissue destruction as a result of infiltration 7. produce minimal tissue destruction Do not resemble normal tissue 6. Cells resemble those normal tissue from which they arise Tends to recur after surgical removal. 5. Do not tend to recur when removed surgically Spread via lymph stream and blood 4. Do not spread but remain localized Infiltrate surrounding tissues tumor extended in all directions. Poorly differentiated from normal tissue 3. Grow to expansion; do not infiltrate surrounding tissues Rarely encapsulated 2. Usually encapsulated Grows rapidly 1. Grows slowly Malignant Benign
Classification of malignant Tumors
Carcinoma- originates in epithelial tissue (skin and lining of body tissue)
Adenocarcinoma- originates in glandular tissue ( breast, Prostate)
Sarcoma- originates in fat, muscle, blood vessels, deep skin tissues, nerves, bones, and cartilage.
Embryonal- originates in embryonic tissue.
Lymphomas- originate in lymphatic system.
Leukemias- originate in blood forming organs.
Systemic Effects of Malignant Cancer
Uncontrolled growth of cells destructive in nature
Lesion continues to grow and enlarge
No sufficient nutrition
Resulting devitilization of a portion of lesion
Ulceration and bleeding
Cancer cachexia – syndrome gradual or rapid weight loss, signs of muscular weakness, anorexia; insomnia, pain and an attitude of hopelessness
Severe terminal toxemia – accompanied by acidosis and rapid rise of waste products in blood.
Pain – distortion and destruction of tissue infiltration, compression or destruction of nerves resulting from direct extension of lesion
distortion of vessels and pain sensitive structure.
Deep coma or death – due to severe hemorrhage, brain involvement
Causes of Cancer
1. Susceptible Host
Genetic Factors – either by the effect of a specific gene or as a consequence of genetic constitution of individuals.
Age – leukemia is common to young.
Hormone – tumor growth is promoted by disturbances in hormonal balance of the body’s own hormones.
Precancerous lesions – person who develops Cancer in one tissue is more likely to develop another one than a person who has never a precancerous lesion.
Immunity – decreased immunity results to higher incidence.
Causes of Cancer
TAR – cigarette smoking causes of Bronchogenic cancer
pipe smoking leads to kidney malignancy
Polyvinyl – hepatoma
Dye, asbestos, tars, smoke, –liver, lungs and kidney cancer
Fertilizers, pesticides- skin cancer
Mining, textile, rubber industries – Lung cancer
Causes of Cancer
b. Physical heat rays, ultraviolet rays
- depletion of ozone layer leads to direct ultraviolet radiation from sun
- .electromagnetic field/ air pollution
- Nuclear power plants
- Radiation, x-ray
Nitrosamine – chemicals used as preservatives
Fatty foods, salt cured, smoke foods, preservatives, low fiber diet
Causes of Cancer
EB Virus – nasopharyngeal Cancer
Hepa B virus
HIV- Kaposis Sarcoma—pink to purple lesion
H-Pylori – (Helicobacter ) – gastric CA
Goals of Cancer Therapy
Cure – client will be diseased free and live normal expectancy.
Control – client’s cancer is not cured but controlled by therapy over long periods of time.
Palliative – maintain as high as quality for the client when cure and control are not possible.
Prophylactic —provide treatment when no tumor is detectable but when client is known to be at risk for tumor development, spread, or reoccurrence.
Common cancer diagnostic studies.
Computerized axial tomography.
Cytology studies ( bone marrow aspiration, urine and cerebrospinal fluid analysis, cell washing)
Colposcopic exam of cervix.
NEEDLE- Tissues are obtained by aspiration, a sample is removed.
INCISIONAL- Tumor mass may be too large for removal; this maybe done for staging the disease level.
EXCISIONAL- involves removal of the entire tumor.
ENDOSCOPIC BIOPSY- direct biopsy through an endoscopy of the area.
Modalities of Treatment
DIAGNOSTIC- obtains tissue samples for diagnostic purposes and to determine the methods of treatment.
STAGING- determines the extent of cancer. Presence, and location of metastatic lesions.
CURATIVE- removal of cancers that are localized to the area of origin;
PALLIATIVE- does not impair the growth or spread of the cancer but improves the quality of life of the client.
RECONSTRUCTIVE- restoration of the clients form, function, and appearance after radical surgery for cancer.
PREVENTIVE- for clients who are in high-risk category, certain surgical procedures may prevent the future development of cancer.
Modalities of Treatment
II. Radiation Therapy – Used in high doses to kill cancer cells
Destroy or contain tumor cells without producing excessive destruction of surrounding normal tissues.
Remission of disease – regression of tumor --- reduction of pain
Supportive treatment – in conjunction with surgery or chemicals.
Palliative – relieves severe pain.
Modalities of Treatment
RADIATION SAFETY PRECAUTIONS:
Private room and bath
Plan care so minimal time is spent in the room
When prolonged care is required, use a lead shield or wear a lead apron
Wear monitoring device to measure exposure
Mark on the room and in the kardex the pregnant women, infants and young children should not come in contact with the client during treatment.
Check all linens and materials removed from the bed for presence of foreign bodies that could be a source of radioactivity
Keep long-handled forceps and lead container in the room of a client with an implant in place.
Modalities of Treatment
III. Chemotherapy – Used as single treatment or in combination with surgery and radiation, early and advanced diseases.
Major problem of chemotherapeutic agents is that they lack specificity thus affecting normal as well as malignant cells.
Classes of drugs
Cytotoxic drug – kills or injures cancer cells in dosage that are insufficient to kill normal cells.
Hormones and enzymes – alters the climate or environment by the cancer cell so that its growth is depressed or prevented.
PROBLEMS OF CHEMOTHERAPY
Bone marrow depression: increased bleeding, anemia, decreased resistance to infection.
GI: anorexia, N/V, diarrhea, and constipation
Tissue irritation, necrosis, ulceration from infusion therapy.
Nursing Intervention in chemotherapy
Asses client for symptoms of bone marrow depression
Prevent exposure of client to people with communicable diseases.
Before therapy, establish a baseline regarding intake and output, bowel habits, oral hygiene, psychological status and family relationships.
Inform client of side effects and nursing management to reduce resulting comfort.
Monitor intake and output; maintain adequate hydration to prevent urinary complications.
Inform client that alopecia, if it occurs, is usually transient.
Check for possible drug interaction with chemotherapeutic agents.
10 STEPS in cancer prevention:
Increase intake of fresh vegetables
Increase fiber intake; reduces risk of breast, prostate, and colon cancer.
Increase intake of vitamin A; reduces risk for laryngeal, esophageal, and lung cancer.
Increase intake of foods rich in vitamin C; may protect against stomach and esophageal cancer.
Keep weight in normal range; obesity is associated with cancer of uterus, gall bladder, breast, and colon.
Reduce amount of intake of dietary fat; fat is associated with increased risk of breast, colon, prostate cancer.
Reduced intake of salt-cured, smoked, and nitrate-cured food.
No cigarette smoking; smoking increases the risk of lung cancer.
Reduced alcohol intake; alcohol is associated with increased risk of liver cancer.
Avoid overexposure to sunlight; associated with risk of skin cancer.
1. PAP SMEAR TEST - for sexually active women and/or women over age 18, it is recommended that pap smear be done annually.
2. DIGITAL RECTAL EXAM- men and women annually after age 40.
3. PROCTOSIGMOIDOSCOPY - after age 50, should be done every 3-5 years in both men and women.
4. Check for occult blood in stool ; done after age 50 on an annual basis.
5. MAMMOGRAPHY- baseline between 35-40, then again between ages 40-49, then yearly after age 50.
6. BSE- conducted monthly.
7. PELVIC EXAMINATION- every 3 years from ages 20-40, yearly after age 40.
8. TSE- monthly from age 20- 40.
BRAIN DRAIN????? We will have a break after this exercises..
Identify if it is BENIGN or MALIGNANT Neoplasm.
____________ grows rapidly.
____________ poorly differentiated.
____________ metastasis never occur.
____________ never contained within a capsule.
____________ good prognosis once removed.
____________ recurrence is common.
____________ grows slowly.
____________ always harmful to host.
____________ it infiltrates the surrounding tissues.