This document provides an overview of cancer and nursing care for clients with cancer. It defines cancer, reviews risk factors and pathophysiology, and discusses diagnostic tests and various treatment options including surgery, chemotherapy, radiation therapy, biotherapy, and complementary therapies. The document is intended to outline learning outcomes for understanding cancer and the nursing care of clients diagnosed with cancer.

1. NURSING CARE OF CLIENT WITH
CANCER
Abdelrahman Alkilani- 15906012
Submitted to:
Dr. Maragatham Kannan, Associate professor.

2. LEARNING OUTCOME
By the end of this seminar, you will be able to:
 Define cancer
 Review the incidence and mortality rate of cancer
 Identify the risk factors of cancer
 Review the pathophysiology of cancer
 Explain the theories of carcinogenesis
 Define neoplasm
 Differentiate between benign and malignant neoplasm
 Discuss tumor invasion and metastasis
 Discuss physiologic and psychologic effects of cancer

3. LEARNING OUTCOME
 Describe the needed diagnostic tests of cancer
 Discuss the different types of cancer treatment.
 Discuss the nursing care provided for patients with
cancer

4. DEFINITION
 Cancer is a group complex diseases with various
manifestations depending on which body system is
affected and the type of tumor cells involved.
 It results when normal cells mutate into abnormal,
deviant cells that the perpetuate within the body.

5. INCIDENCE AND MORTALITY
 Cancer is the third leading cause of death in the
Emirate of Abu Dhabi. It is second among nationals
and the third among expatriates. It accounts for
16% of total deaths.
 1589 new cancer cases were reported to Abu Dhabi
Central Cancer Registry in 2013.
 There were around 390 deaths caused by cancer in
2013.

6. RISK FACTORS
 Age:
 Long-term exposure to high dose of promotional agents.
 Alter immune response
 Free radicals tend to accumulate in the cells over time
 Hormonal changes:
 Increase risk of breast and uterine cancers in post menopause.
 Increase risk of prostate cancer in older men due to breakdown of
testosterone into carcinogenic forms.
 Stress:
 High levels of epinephrine and cortisol cause fatigue and
impaired immunologic surveillance.

7. RISK FACTORS
 Heredity
 Gender (Females with breast cancer)
 Poverty (Stress, diet, not doing screening tests)
 Diet (Some preserved food considered genotoxic)
 Occupation (healthcare providers exposure to x-ray)
 Infection
 Tobacco, alcohol, recreational drug use.

8. PATHOPHYSIOLOGY
 The cell cycle is 4 phases; G1, S, G2, and M.
 It is regulated by cyclin (regulate the speed) and
checkpoints (Ensure that the cell cycle proceeds the
correct order).
 Malfunction of any of the regulators can result in the rapid
proliferation of immature cell.

9. PATHOPHYSIOLOGY
Differentiation:
 A normal process occurring in many cell cycles that
allow cells to specialize in certain tasks.
 Alterations in cell can occur if adverse conditions
occur in body tissues during differentiation
 Types of unproductive cell alterations:
 Hyperplasia ( ↑ #cells)
 Metaplasia (change of cell type)
 Dysplasia
 Anaplasia

10. Type Definition DNA control Reversibility
Hyperplasia Increase in the number or
density of normal cells
under normal
DNA control
Reversible after the
elimination of the
irritating factor.
Metaplasia Differentiation to a cell type
not normally found in that
location in the body.
under normal
DNA control
Reversible after the
elimination of the
irritating factor
Dysplasia Abnormal variation in size,
shape, appearance, and
arrangement
Loss of DNA
control over
differentiation
Reversible after the
elimination of the
irritating factor.
Anaplasia Is the regression of a cell to
an immature or
undifferentiated cell type
Not under DNA
control
Not reversible
• The degree of anaplasia determines the potential risk for cancer
PATHOPHYSIOLOGY
Types of unproductive cell alterations:

11. ETIOLOGY
Carcinogens
 External: chemicals, radiation, and viruses
 Internal: hormones, immune conditions, inherited
mutation.
Theories of carcinogenesis
 Cellular mutation
 Oncogenes
 Tumor suppressor genes

12. THEORIES OF CARCINOGENESIS
1. Cellular mutation
 Carcinogens cause mutations in cellular DNA.
 Three stages of carcinogenic process:
 Initiation stage:
 permanent damage in cellular DNA in a result to exposure to
carcinogen.
 Promotion stage:
 may last for years
 Includes conditions, such as smoking, that act repeatedly on
the already affected cells
 Progression stage:
 Inherited changes acquired during the cell replication develop
into a cancer.

13. THEORIES OF CARCINOGENESIS
2. Oncogenes
 Genes that promote cell proliferation and are
capable of triggering cancerous characteristics.
 Can be classified according to their overall function.
i.e. BRCA-1 and BRCA-2 are associated with
breast cancer.
 A decrease in body’s immune may allow the
expression of oncogenes

14. THEORIES OF CARCINOGENESIS
2. Oncogenes

15. THEORIES OF CARCINOGENESIS
3. Tumor suppressor genes
 Normally suppress oncogenes
 Become inactive by deletion or mutation.
 Inherited cancers have been associated with tumor
suppressor genes.

16. NEOPLASM
 A neoplasm is a mass of new tissue that grows
independently of its surrounding structures and has
no physiological purpose.
 They are classified as benign or malignant on the
basis of their potential to damage the body and on
their growth characteristics.

17. NEOPLASM
Benign Malignant
Localized, stop growing when they
reach the boundaries of another
tissue
Invasive, invades and destroys
surrounding tissues
Cohesive Not cohesive
Form a solid mass, well-defined
borders
Irregular shape, does not stop at
tissue borders.
Slow growth Rapid growth
Encapsulated Metastasizes to distant sites
Easily removed Not always easy to remove
Doesn’t recur Can recur
Typically harmless, but can be
destructive if they crowd
surrounding tissue
i.e. Benign meningioma can
increase ICP

18. TUMOR INVASION AND METASTASIS
 Invasion: the ability of cancer cells to invade
adjunct tissues
1. The pressure of growing tumor can cause atrophy
and necrosis to adjunct tissues.
2. Many cancer cells release enzymes that lyse cell
membranes of normal tissues.
3. Cancer cells are easily separate from neoplasm
and moves into surrounding tissues.
4. Motile cells are attracted by chemical signals
produced by activity within normal cells

19. TUMOR INVASION AND METASTASIS
 Metastasis: travelling of
malignant cells from the
primary tumor to invade other
tissues and organs of the body
and form a secondary tumor.

20. TUMOR INVASION AND METASTASIS
 Mechanism of metastasis:
 Blood- or lymph- borne through the following
steps:
1. Intravasation of malignant cells through blood or
lymphatic vessel walls and into the circulation
2. Survival of the malignant cells in the blood (from
detection of immune system).
3. Extravasation from the circulation and
implantation in a new tissue
 Body cavities:
 From the wall of the organ to the nearby cavity
 Example: from colon cancer to the peritoneal
cavity form a tumor in mesenteric epithelium.

21. METASTASIS
 Factors may alter the immune response and
enhance the establishment of metastasis:
 Increased age
 Depression
 Accumulated stress
 Pregnancy
 Chemotherapy treatment for the primary cancer

22. PHYSIOLOGIC AND PSYCHOLOGIC EFFECTS OF
CANCER
1. Disruption of function
 By obstruction of pressure.
 Ex. Tumor in the bowel can stop intestinal motility.
2. Hematologic alteration
 Can impair the normal function of blood cells
 Ex. In leukemia, immature leukocytes cause compromised
immunity.
 Ex. Gastrointestinal tumor disrupt the absorption of vitamin
B12 and iron
3. Infection
 Ex. Invading bowel or bladder walls cause fistula and
infections
 Ex. Infection from necrosis

23. PHYSIOLOGIC AND PSYCHOLOGIC EFFECTS OF
CANCER
4. Hemorrhage
 Ex. Tumor erosion through blood vessels
5. Anorexia-Cachexia syndrome
 Unexplained rapid weight loss
6. Paraneoplastic syndromes
 Indirect effects of cancer
 May be early warning signs of cancer or indicate
complications
 Ex. Increased some hormones in breast, ovarian, or
renal cancers

24. PHYSIOLOGIC AND PSYCHOLOGIC EFFECTS OF
CANCER
7. Pain
 Acute and chronic
 Caused by pressure, necrosis, or side effects of the
therapies.
8. Physical stress
 Immune system needs high energy to destroy the
neoplasm.
 Continued immune process cause fatigue, weight loss,
anemia, or dehydration.
9. Psychologic stress
 Ex. Fear, grief, hopeless, or anger

25. CANCER IDENTIFICATION
1. Classification: Naming of the tumor
 Incorporates the Latin stem identifying the tissue from which the
tumor arises
 Hematopoietic malignancies are usually named by the type of
immature blood cell that predominates.
 Ex. Myelocytic leukemia: immature form of the granuloyte is
predominate.
 Other names incorporate of discoverer. (Hodgken’s disease)
Tissue origin Name Example
Epithelial tissue Carcinoma Adenocarcinoma: a glandular malignancy arising
from epithelial tissue
Supportive tissue Sarcoma Fibrosarcoma: a cancer of fibrous connective tissue
Germ tissue Seminoma

26. CANCER IDENTIFICATION
2. Grading: describing tumor aggressiveness
 Evaluates the amount of differentiation of the cell and
estimates the rate of growth based on mitotic rate
 The most differentiated is the least malignant (grade 1)
 The least differentiated is the most aggressively malignant
(grade 4)

27. CANCER IDENTIFICATION
3. Staging: spread within or beyond the tissue of
origin
 Is used to classify solid tumors and refers to the relative
size of tumor and extent of the disease.
 TNM staging classification system
 T (tumor): relative tumor size, depth of invasion, and surface
spread
 N (nodes): presence and extent of lymph node involvement
 M (metastasis): presence or absence of distant metastasis

28. DIAGNOSIS
1. Diagnostic tests:
 X-ray, CT, ultrasonography, and MRI to locate abnormal
tissues or tumor.
 Microscopic histologic and cytologic examination to
know the type of cell and its structural differences from
the parent tissue.
 Lymph nodes biopsy to determine whether metastasis
has begun.
 Blood tests to check the tumor markers (Antigens,
hormones, proteins, or enzymes)
 Nuclear imaging
 Direct visualization (i.e. endoscopy, cystoscopy)

29. TREATMENT
 The goals of treatment are aimed to cure, control,
or palliation of symptoms.
 Treatment can be through:
1. Surgery
2. Chemotherapy
3. Radiation therapy
4. Biotherapy
5. Photodynamic therapy
6. Bone marrow and stem cell transplants
7. Complementary therapies

30. TREATMENT- SURGERY
1. Prophylactic surgery:
 Aims to remove tissue or organs that are likely to
develop cancer
 Ex. Mastectomy can be done for a woman with a strong
history of breast cancer, positive findings of BRCA-1
and BRCA-2, and abnormal findings of mammography.
2. Diagnostic surgery:
 Aims to ensure histologic diagnosis and staging of
cancer.
 Ex. Biopsy, endoscopy, laparoscopy, and open surgical
exploration.

31. TREATMENT- SURGERY
3. Treatment surgery:
 Aims to remove the entire tumor and involved
surrounding tissue and lymph nodes as much as
possible and feasible.
4. Palliative surgery:
 If the tumor is in a nonresectable location or deeply
invasive with metastasis.
 Aims to allow the involved organs to function as long as
possible, to relieve pain and provide comfort, or to
bypass an obstruction.

32. TREATMENT- SURGERY
5. Reconstruction surgery:
 Aims to achieve more desirable functional and cosmetic
effect after surgeries.
 Ex. TRAM flap after mastectomy

33. TREATMENT- CHEMOTHERAPY
 Chemotherapy: the use of cytotoxic medications to
cure some cancers, decrease tumor size, or to
prevent or treat suspected metastasis.
 It works by:
 Disrupting the cell cycle in various phases by
interrupting cell metabolism and replication.
 Interfering with the ability of the malignant cell to
synthesize vital enzymes and chemicals.

34. TREATMENT- CHEMOTHERAPY
 The cell-kill hypothesis:
 The chemotherapy kills fixed percentage of cells and
leaves some behind.
 The patient will receive several doses till the remains
cells become small enough that body’s immune system
can finish the job.

35. TREATMENT- CHEMOTHERAPY
Classes of chemotherapy drugs:
Based on the effects of the agent on the cell:
1. Cell cycle-specific
2. Cell cycle- nonspecific
Based on pharmacologic properties:
1. Alkylating agents
2. Antimetabolites
3. Antitumor antibiotics
4. Mitotic inhibitors
5. Hormones and hormones antagonists
6. Miscellaneous agents

36. Chemotherapy Effect on cell Action Example
Alkylating agents Not-phase specific Create defects in tumor
DNA
cyclophosphamide for
lymphomas & leukemias
Antimetabolites Phase specific
works on S phase
It combine with, or
replace the key
enzymes at the
regulatory site
5-fluoroiracil (5-FU) for
colon, rectal, breast, and
gastric carcinomas
Antitumor
antibiotics
Not- phase specific Break or damage DNA
and interfere with DNA
repair
Adriamycin for Acute
lymphoblastic leukemia
Mitotic inhibitors Phase specific
works on M phase
Prevent cell division
during M-phase
vincristine for Hodgkin’s and
non-Hodgkin’s lymphomas
Hormones works on G1 binds to intracellular
receptors which alter
cellular growth.
Main hormones are
corticosteroids
Hormone
antagonists
Not- phase specific Work with hormone-
binding tumor by
blocking the hormone’s
receptor site of the
tumor and prevent it
from receiving normal
hormonal growth
stimulation.
Raloxifene blocks estrogen
in the breast

37. TREATMENT- RADIATION THERAPY
 Delivering ionized radiations of gamma and x-rays in
one of two ways:
 Teletherapy: external radiation
 Brachytherapy: internal radiation
 Placing the radioactive material directly into or adjunct to the
tumor
 High dose to the tumor and lower dose to the normal
tissues

38. TREATMENT- RADIATION THERAPY
 Radiation kills cells by causing lethal injury to DNA,
especially cells in fast growth.
 The goal of the radiation therapy is to achieve
maximum tumor control with a minimum of damage
to normal tissue.

39. TREATMENT- BIOTHERAPY
 It modifies the biologic processes that result in
malignant cells, primarily through enhancing the
person’s own immune responses.
 Stimulating immune system
 Ex. Alpha interferon (IFN-α) increases immune response
 Supporting immune system
 Monoclonal antibodies

40. TREATMENT- PHOTODYNAMIC THERAPY
 Is a method of treating certain kinds of superficial tumors
(surface of the bladder, peritoneal cavity, chest wall,
pleura, head or neck, etc.)
 Light treatment is started 3 days after the drug injection
and administered for 3 days

41. TREATMENT- BONE MARROW AND PERIPHERAL
BLOOD STEM CELL TRANSPLANTATIONS
 BMT is an accepted treatment to stimulate a
nonfunctioning marrow or to replace marrow.

42. TREATMENT- BONE MARROW AND PERIPHERAL
BLOOD STEM CELL TRANSPLANTATIONS
 PBSCT is the process of removing circulation stem cells
from the peripheral blood through apheresis and
returning these cells to the patient after dose-intensive
chemotherapy.

43. TREATMENT- COMPLEMENTARY THERAPIES
 Refer to therapies that clients choose as a complement
to medical treatment.
 It categorized into:
 Botanical agents (Herbs)
 Nutritional supplements (Chemical compounds includes
vitamins, minerals, enzymes, amino acids, proteins)
 Dietary regimens (Ingestion of only natural substances)
 Mind-body modalities (Relaxation, imagery)
 Energy healing (Therapeutic touch)
 Spiritual approaches
 Miscellaneous therapies (Aromatherapy to relieve nausea)

44. NURSING CARE
Nursing diagnosis and interventions
 Anxiety
 Carefully assess the client’s level of anxiety
 Establish a therapeutic relationship
 Encourage the client to express his feelings
 Identify resources in the community
 Disturbed body image
 Provide supportive environment
 Teach strategies for minimizing physical changes, such as providing
skin care during radiation therapy
 Encourage wearing colorful head cover

45. NURSING CARE
 Anticipatory grieving
 Use therapeutic communication skills
 Answer questions about illness
 Risk of infection
 Monitor vital signs
 Monitor WBCs
 Protect skin and mucus membrane from injuries
 Encourage high protein diet
 Imbalanced nutrition: less than body requirement
 Assess current eating pattern
 Teach the principles of maintaining good nutrition

46. NURSING CARE
 Impaired tissue integrity
 Carefully assess and evaluate the type of tissue impairment
present. Identify possible sources such as chemotherapy.
 Observe for systemic signs of infection
 Monitor for the dry mouth and lubricate it with moisturizing
agent
 Acute pain
 Use relaxation techniques
 Administer medications as prescribed

47. SUMMARY
 Cancer is a group complex diseases with various
manifestations depending on which body system is
affected and the type of tumor cells involved.
 There are 4 phases of cell cycle and is regulated
by cyclin and checkpoints.
 Malfunction of any of the regulators can result in the
rapid proliferation of immature cell.
 Theories of carcinogenesis are cellular mutation,
oncogenes, and tumor suppressor genes.
 A neoplasm is a mass of new tissue that grows
independently of its surrounding structures and has
no physiological purpose. Benign or malignant

48. SUMMARY
 Invasion is the ability of cancer cells to invade
adjunct tissues
 Metastasis is travelling of malignant cells from the
primary tumor to invade other tissues and organs of
the body and form a secondary tumor.
 Cancer identification consists of classification,
grading, and staging.
 Treatment can be through surgery, chemotherapy,
radiation therapy, biotherapy, photodynamic
therapy, bone marrow and stem cell transplants, or
complementary therapies
 Nursing has an important role in the care of cancer
patient.

49. CONCLUSION
 All patient suffers from any type of cancers should
have an extra attention
 The nurse should be knowledgeable about different
types of treatment, so he can provide optimal care

50. REFERENCES
 LeMone, P., & Burke, K. M. (2008). Medical-surgical
nursing: Critical thinking in client care. Upper
Saddle River, NJ: Pearson/Prentice Hall.