Cancer

1. Cancer Concepts

2.  Exact cause: Unknown
 Predisposing factors:
•Heredity
•Stress
 Psychological
 Physical
•Unuse
•Overuse
•Abuse
•Specific

3. Theories of Cancer
 Cellular Transformation
and Derangement Theory
 Failure of the Immune
Response Theory
Normal Cell
Virus
Chemical / Physical Agent
Drugs
Hormones
Genetic Alteration
Defective Cell
Multiple cell division
Malignancy
(destruction)
Potential
Cell
Ab
Ab
Ab
Ab
Immune system
fails

4. Classification

5.  Tumor
• 1 - small
• 2-3 - medium
• 4 - large
 Node
• 0 - no involvement
• 1-3 - moderate
• 4 - extensive
 Metastasis
• 0 - no metastasis
• 1 - metastasis

8. Warning Signs of Cancer
C - change in bowel or bladder habits
A - sore that does not heal
U - unusual bleeding or discharge
T - tumor
I - indigestion or difficulty in swallowing
O - obvious change in warts or moles
N - nagging cough or hoarseness of voice
U - unexplained anemia
S - sudden weight loss

9. Comparison of Benign & Malignant Neoplasm
Characteristics Benign Malignant
Speed of growth Slow Rapid
Mode of growth Localized Infiltrating
Capsule Encapsulated No capsule
Recurrence Unusual Common
Metastasis None Common
Effect Harmless to
host
Harmful
Prognosis Very good Poor

10. LUNG CANCER

11. Description
 Refers to malignant tumor
growth within the bronchial
tissue or lung parenchyma.
 Types include:
• Squamous cell
• Adenocarcinoma
• Small cell (oat cell)
• Large cell

12. Etiology and Incidence
 Exact Cause: Unknown
 Predisposing factors
• Heredity
• Pulmonary irritants
 Poor prognosis

13. Pathophysiology
 Irritation  series of changes
 tumor
 Metastases – primary sites
 Some tumors secrete
hormones:
•ADH – reabsorption of water
•ACTH – stimulates adrenal
glands to produce steroids

14.  Symptoms may include:
• Cough
• Wheezing
• Shortness of breath
• Chest pains
• Hoarseness
• Dysphagia (compression of esophagus)
• Weight loss

15. Nursing Interventions
 Adequate oxygenation
 Prepare for surgery if tumor is small
enough to be removed
 Prepare patient for planned
treatments
• chemotherapy
• radiation therapy
 Analgesics as ordered
 Maintain nutritional status
 Provide emotional support

16. BLADDER
CANCER

17.  More common in males
 Cause: unknown
 Risks factors
1. Exposure to cigarette smoke
2. Pelvic radiation
3. Use of cyclophosphamide
4. Chronic cystitis
5. Bladder calculi
6. Schistosomiasis

18. Assessment
 Hematuria (first sign)
• Painless
• Gross
 Dysuria
 Obstruction to urine flow
 Development of fistula

19. Collaborative
Management
 Chemotherapy
• Thiotepa
• Mitomycin C
• Doxorubicin (Adriamycin)
• Cyclophosphamide (cytoxan)
• Cisplatin (Platinol)
• Methotrexate
 Radiation

20.  Surgery
• Urinary Diversion Surgeries
Ileal Conduit
Ureterostomy
Ureterosigmoidostomy
Nephrostomy

21. Ileal Conduit
 For CA Bladder
 Adult
Neurogenic
Bladder
 Insterstitial
Cystitis
 Irreparable
Trauma

22. Important!
 External
collection device
needed
 Proper fitting to
prevent urine
leak to the skin
 Skin care with
warm water and
mild soap
Complications
 Obstruction to
the urine flow via
small intestines
secondary to
edema
 Infection
 Stoma prolapse
 Calculi
 Electrolyte
imbalances

23. Ureterostomy
 Either or both
ureters are out to
the abdominal wall
 Ureteral stoma is
created
 External collection
device is needed
 Infection is a
potential hazard
 Increase fluid
intake

24. Nephrostomy
 To drain the
urine while
ureteral
inflammation
from trauma
or calculus is
present

26. Complications
 Infection
(Pyelonephritis)
 Blockage of the
catheter
Important!
 DO NOT
IRRIGATE!!!

27. Ureterosigmoidostomy
 No external
collection
device
 Passage of
flatus
includes leak
of urine
 Infection is
possible

28. PROSTATE
CANCER

29.  Most common male Ca
(gender-specific)
 Androgen – dependent
adenocarcinomas

30. Predisposing Factors
 Genetic tendency
 50 years of age
 Hormonal factors
• Late puberty
• High frequency of sexual
experience
• History of multiple sexual
partners
• High fertility

31.  Diet
• ↑fat (alters cholesterol and steroid
metabolism)
 Chemical carcinogens
• Air pollution
• Occupation-related
 industries – fertilizer, rubber, textile
 batteries containing Cadmium
 Viruses

32. Assessment
 Hesistancy
 Hematuria
 Urinary retention
 Stool changes
 Pain radiating down hips and legs
 Cytitis
 Dribbling

33.  Nocturia
 Hard, enlarged prostate
 Pain on defecation
 High level of acid
phospatase
 Elevated PSA (Prostatic
Specific Antigen)

34. Nursing Interventions
 Early detection of tumor
• Ultrasound
• MRI
• X-ray
• CT Scan
 Radiation therapy
 Endocrine therapy - DES
(diethylstilbestrol) - decreases
testosterone level
 Surgery: Prostatectomy

35. Hodgkin’s
Disease
malignant tumor of lymphatic
system

36.  Cause:
•Unknown
•Viral associations
•Autoimmunity
 Incidence:
•Young adult 15-35 years

38. Pathophysiology
Proliferation of abnormal T-Cells

Obstruction in lymphatic flow
Pain
Fever
Weight Loss
Malaise
Metastases
 Spleen
 Liver
 Lungs
 Heart

39. Management
 MOPP
•Watch out for BM
depression
 ABVD
•Causes red urine

40. Nursing Intervention
 Supportive
•N/V
•F & E
•Comfort measures

41.  Protection from infection
 Maintain Tissue Integrity
 Maintain Normal Body
Temperature
 Prevent or decrease pain
 Maintain ideal body weight
 Maintain adequate hydration
 Assist client and significant
others to cope

42. COLORECTAL
CANCER

43.  Cause: Unknown
 Predisposing Factors:
• Age above 40 years
• Predisposing Factors
  low in fiber
  high in fat, protein and refined carbohydrates
 Obesity
 History of chronic constipation
 History of IBD, familial polyposis or colon
polyps
 Family history of colon cancer
 Most Common Site: Rectosigmoid area (70%)

44. ASSESSMENT
 Ascending (Right)
Colon Cancer
• Occult blood in stool
• Anemia
• Anorexia and weight
loss
• Abdominal pain
above umbilicus
• Palpable mass
 Distal Colon / Rectal
Cancer
• Rectal bleeding
• Changed bowel
habits
• Constipation or
Diarrhea
• Pencil or ribbon –
shaped stool
• Tenesmus
• Sensation of
incomplete bowel
emptying

45. COLORECTAL CANCER
 Duke’s Classification of Colorectal Cancer
Stages:
• A: confined to bowel mucosa, 80 – 90% 5- year
survival rate
• B: invading muscle wall
• C: lymph node involvement
• D: metastases or locally unresectable tumor, less
than 5% 5 – year survival rate
 Guidelines for Early Detection of Colorectal
Cancer
• Digital rectal examination yearly after age 40
• Occult blood test yearly after age 50
• Proctosigmoidoscopy every 5 years after age 50,
following 2 negative results of yearly examination

46. COLLABORATIVE
MANAGEMENT
 Surgery
• Hemicolectomy (ascending and
transverse)
• Abdomino – Perineal Resection
(APR) for rectosigmoid cancer
Necessitates permanent colostomy
 Chemotherapy
• Fluorouracil (most effective)
 Radiotherapy
• Adjuvant treatment

47. Renal Cell
Carcinoma

49. Pathophysiology:
Tumor (anywhere in
the kidneys)
Compression on the
surrounding surface
•Ischemia
• necrosis
• hemorrhage
Metastasis
Primary sites
•Lungs
•Liver
•Lymph nodes
•Renal veins

50. Signs and Symptoms
 Abdominal pain
 Hematuria
 S/sx of shock

51. Nursing Interventions:
 Monitor closely for:
• Fluid and electrolyte status.
• I & O
• Acid-base balance
 Symptomatic
 Prepare for possible surgery
 Institute postop care