General cancer care and management, easy PPT for nursing students

1. Guess????
WHY IS CRAB HERE!!!!!!

3. INTRODUCTION
▪ Cancer is caused by the failure of genetic mechanisms that control the growth
and proliferation of cells. In most cases, cumulative damage to multiple genes
(the "multi-hit" model) via physical and chemical agents, replication errors, etc.
contribute to oncogenesis.
▪ However, a person's inherited genetic background also may strongly contribute.
In cancer, a single transformed cell grows to become a primary tumor,
accumulates more mutations and becomes more aggressive, then metastasizes
to another tissue and forms a secondary tumor.

4. WHAT IS CANCER ????
MEANING:
▪ Derived from Latin word ‘cancrum’ meaning crab.
▪ It is a group of diseases characterised by uncontrolled cell division leading to the growth
of abnormal tissue / tumor.
▪ Cancer is a disease process that begins when an abnormal cell is transformed by the
genetic mutation of the cellular DNA
▪ ONCOLOGY: Branch of medicine that deals with the study, detection, treatment and
management of cancer.

5. TERMINOLOGIES
▪ neo+ new Neoplasia,
▪ +plasia growth Hyperplasia
▪ +plasm substance Neoplasm
▪ +trophy size Atrophy
▪ +oma tumor Carcinoma
▪ a+ none Atrophy
▪ ana+ lack Anaplasia
▪ hyper+ excessive Hypertrophy
▪ meta+ change Metaplasia
▪ dys+ bad, impaired Dysplasia

6. TERMINOLOGIES
▪ epithelial tissues (carcinoma)
▪ glandular tissues (adenocarcinomas)
▪ connective, muscle, and bone tissues (sarcomas)
▪ brain and spinal cord tissues (gliomas)
▪ pigmented cells (melanomas)
▪ plasma cells (myelomas)
▪ lymphatic tissue (lymphomas)
▪ leukocytes (leukemia)
▪ erythrocytes (erythroleukemia)

7. PATTERNS OF CANCER GROWTH
▪ Atrophy - Decrease in size of cell - muscle atrophy - pancreatic, lung cancer
▪ Hypertrophy – Increase in size of cell - retinal, iris hyper trophy-
▪ Hyperplasia - Increase in size of cell - breast cancer, endometrial, prostate cancer
▪ Metaplasia - Transformation of one cell to another - fibrous tissue into bone tissue.
▪ Dysplasia - Presence of abnormal cells within a tissue or organ - hip dysplasia
▪ Anaplasia - loss of the mature or specialized features of a cell or tissue - Adenoma
to Adenocarcinoma
▪ Neoplasia - the uncontrolled, abnormal growth of cells or tissues in the body,

8. CELL STRUCTURE
Determine the form and functions of the human body. Basic living unit of all
organisms. Are specialized to perform specific functions.
The characteristics of normal cells :
▪ Reproduce themselves exactly
▪ Stop reproducing at the right time
▪ Stick together in the right place
▪ Self destruct if they are damaged
▪ Become specialized or 'mature'

9. ▪ The cell cycle, or cell-division cycle, is a series of events that takes place in a
cell leading to its division and duplication (replication).
▪ In cells without a nucleus (prokaryotic), the cell cycle occurs via a process
termed binary fission.
▪ In cells with a nucleus (eukaryotes), the cell cycle can be divided in two brief
periods: Interphase & mitosis.
Review of cellular division

10. Phases of cell division

11. Mitosis phase:

12.  Cancer cells show uncontrolled mitotic divisionscausing unorganized growth.
 Due to uncontrolled growth and division of cells, a tumor (also called Neoplasm is
generally formed).
 They exhibit a number of alterations on cell surface, in the cytoplasm and in their
genes.
 They do not undergodifferentiation.
 They lose the ability to communicate with other cells through chemical signals.
 They also lose sensitivity to anti-growth signals from surrounding cells.
 They lose the adhesion molecules that keep them bondedto neighboring cells.
Properties of Cancer Cells

13.  Cancer arises from a loss of normal growth control.
 Cancer is a geneticdisease: Inherited cancer, Sporadic cancer
 Cancer typically involves a change in geneexpression/function: Qualitative change,
Quantitative change
 Loss of limitations on the number of celldivisions
 Ability to grow in culture (medium) –normal cells do not grow well in culture.
 In laboratory cultures, normal cells divide only when attached toa surface.
 Angiogenesis –secrete substances that cause blood vessels togrow towards tumor.
Properties of Cancer Cells

14. Normal vs cancer cell

15. Normal vs cancer cell

18. Invasion and metastasis:
▪ Mechanical pressure exerted by rapidly proliferating neoplasms force finger like
projections of tumor cells into surrounding tissue and interstitial spaces
▪ Malignant cells are less adherent and break off from primary tumor and invade
adjacent structures
▪ Malignant cells are thought to possess or produce specific destructive enzymes
(proteinases), such as collagenases (specific to collagen), plasminogen activators
(specific to plasma), and lysosomal hydrolyses

19. Invasion and metastasis

20. Lymphatic spread
▪ Tumor emboli enter the lymph
channels by way of the
interstitial fluid, which
communicates with lymphatic
fluid.
▪ Malignant cells penetrate
lymphatic vessels by invasion.
▪ Malignant cells either lodge in
the lymph nodes or pass
between the lymphatic and
venous circulations.

21. Haematogenous spread
▪ Dissemination of malignant cells via the
bloodstream and is directly related to the
vascularity of the tumor.
▪ Malignant cells attach to endothelium
and attract fibrin, platelets, and clotting
factors to seal themselves from immune
system surveillance.
▪ Malignant cells to enter the basement
membrane and secrete lysosomal
enzymes

22. Cancer
▪ Disease process that begins when a cell is transformed by genetic mutation of
cellular DNA
▪ Metastasis: Abnormal cells invade surrounding tissue and gain access to lymph
and blood vessels carrying them to other areas of the body
▪ Malignant cancer cells: cells or processes that are characteristic of cancer
▪ Benign cancer cells: cells that are not cancerous

23. Epidemiology
▪ Second leading cause of death in the US
▪ 1 in 4 deaths is caused by cancer
▪ Leading causes of cancer death in men
1) Lung
2) Prostate
3) colorectal

24. Epidemiology
▪ Leading causes of cancer death in women
1) Lung
2) Breast
3) Colorectal
▪ 78% of cancer diagnoses are people >55 years of age
▪ Overall, incidence is higher in men than women
▪ Racial & geographical disparities

25. Carcinogensis
▪ Malignant transformation
▪ Three-step process
▪ Initiation: apoptosis
▪ Promotion: preneoplastic/benign lesions
▪ Progression:
▪ altered cells exhibit increasingly malignant behavior
▪ angiogenesis

26. CAUSES OF CANCER?
▪ VIRUSES AND BACTERIA
▪ PHYSICAL AGENTS
▪ CHEMICAL AGENTS
▪ GENETIC FACTORS
▪ HEREDITY
▪ DIETARY FACTORS
▪ HORMONAL FACTORS

27. Etiology:
Nutrition
Chemical
Tobacco
Pollution
Virus
Bacteria
Parasites
Physical
Age
Sex
Genetic factors
Hormones
Habits
Agent factor
Biologic factor
Host factor
Environmental
factor

28. Etiology - Agent factor:
• Nutritional: High fat diet is related to breast and colon cancer, high fiber diet to intestinal
cancer, smoked fish to stomach cancer and beef consumption is related to bowel cancer.
Alcohol can cause esophageal and liver cancer.
• Chemical: Exposure to chemical substances such as arsenic, cadmium, chromium,
asbestos, aniline, benzol and coal tar are related to cancers involving various
sites/organs.
• Tobacco: Tobacco use in various forms of its usage, e.g. Smoking and betel chewing causes
cancers of the lung, pharynx, mouth, esophagus, bladder, pancreas and probably kidney.

29. Smoking
▪ Thought to be the single most lethal chemical carcinogen
▪ Accounts for about one third of cancer deaths
▪ Strongly associated with cancers of the
▪ lung
▪ head and neck
▪ Esophagus
▪ stomach, pancreas
▪ Cervix
▪ kidney, and bladder
▪ acute myeloblastic leukemia

30. Virus: Hepatitis B and C are usually related to hepato-cellular carcinoma. HIV infection is a
risk factor for Kaposi’s sarcoma. Human papilloma virus is a risk factor for cancer of
cervix.
Parasites:Schistosomiasis in Middle East is associated with risk of bladder cancer.
Physical: Factors such as sunlight heat and ionizing radiation are related to cancer such as
basal cell cancer, oral cancer and leukemia.
Etiology - Biological factor:

31. Eiology - Host factor:
Sex:Males are more often affected than females except for cancers of the reproductive
organs.
Age:Elderly people are often affected than younger age groups. Some cancers have bimodal
occurrence like Hodgkin’s disease, kidney cancer and leukemia which are common in
young adults and elderly persons.
Habits:Habits of chewing pan, zarda and tobacco are associated with orophayngeal cancer.
Excessive sex with multiple partners is associated with cancer of cervix. Smoking and
alcoholism are associated with lung cancer. Poor personal hygiene increases the chance of
occurrence of cancer of the cervix.

32. Cont…
Genetics:
Genetic factors such as translocation of chromosomes are found in certain forms of
cancers such as in myeloid leukemia. Mongols are more likely to develop cancer than
normal children.
Defective gene present on the long arm of chromosome13 predisposes to familial
retinoblastoma.
There is a familial tendency in the occurrence of breast cancer.
Hormones: Over use of estrogen can lead to cancer of the body of the uterus.

33. Environmental Factors :
Air pollution: due to hydrocarbons emitted by automobiles
predisposes to lung cancer.

34. WARNING SIGNALS OF CANCER

35. Prevention and control of cancer
Pre-modial Prevention:
Measures in this concentrate on modification or elimination of risk factors among
population group in which they have not yet developed eg. people can be made aware
about protecting from carcinogenic exposures and danger signs of cancer by health
education.
Women can be educated about warnings signs of cancer of cervix such as bleeding after
menopause or bleeding in between menstrual period. Young girls in particular and women in
general should be taught menstrual and genital hygiene for prevention of cancer cervix.

36. Cont…
Educating children and adolescents to develop healthy habit and lifestyle, educating
about hazards of smoking and alcohol, benefits of exercise, healthy diet and personal
hygiene.
Parents and teachers should be role model for children in the family school and colleges.
Tobacco free society should be aimed at school and colleges.

37. Cont…
Primary Prevention:
High Risk strategy:
This is aimed at bringing preventive care to those people who are at special risk of
getting cancer.
High risk individuals should be educated regarding the association or risk factor with
cancer smoking, use of tobacco, alcohol, eating beef, smoked fish, exposure to
carcinogens history of breast cancer in immediate family members poor perineal
hygienic practices etc. are related different types of cancers.

38. Cont…
Nurses can teach the following to high risk groups :
Toquit smoking and stop chewing tobacco.
Alcohol intake should be restricted
Tohave only one faithful married partner.
Family history breast cancer.
Change dietary habits.
Women should have marriage at appropriate age.
Practice good personal hygiene and perinel hygiene
Women should have pap smear test for screening cervical cancer
Individuals who have the above risk factors should be referred for screening for cancer.

39. warning signals of cancer:

40. Cont…
Health education to people regarding the following:
Maintaining personal and genital hygiene.
Exercise regularly to reduce the risk of obesity and early menarche
Breast Self Examination (BSE) - encourages women to perform BSE every month, a week
after menstruation. Women after menopause also should perform BSE every month
Testicular Self Examination should be performed by men regularly to detect any lump in the
testis.
To prevent certain specific cancer vaccines are available. Cancer vaccines are either
intended to treat existing cancer or to prevent the development of cancer

41. Cont…
Avoid exposure to radiation: Special efforts should be made to reduce the radiation
amount received by each individual to a minimum without reducing the benefits.
Specific Protection
Avoiding X-ray and radiation exposures by wearing protecting devices and rotation of
workers if harmful effects are found after every two monthly examination
Industrial workers should wear protective devices apron lead gloves and respirators
Educate to use fruit, vegetables at least 500 g/day, legumes and whole grain cereals and
avoid foods, junk foods and avoid coloring agents.
Fatty foods should be avoided and obesity should be prevented to prevent breast cancer.

42. Secondary Prevention:
Cancer Registration: It provides a baseline data regarding magnitude of the cancer problem
and for planning and implementing the required services they are of two types
Hospital Based Registries: It includes all out patient as well as in patients on treatment in
the hospital. It should be done as per “WHO handbook for standardized cancer registers”
Population Based Registries: It should include situation in a given geographical area. The
optimum size of base population recommended for cancer registry is from 2-7million
such data can provide significant information about incident of cancer and causes of
cancer time trends common cancer for planning and evaluation of operational activities
related to all cancer control activities.

43. Cont…
Early Detection of cases:
This is done by cancer screening at a stage where the lesion is localized.
Treatment:
Treatment of cancer include the following methods:
Surgery
Chemotherapy
Radiotherapy
Immunotherapy

44. Tertiary Prevention:
Tertiary prevention aims at disability limitation and rehabilitation
Disability limitation:
This is done by intensive treatment to prevent development of disability patient may develop
disability due to pain, decreased vitality, loss of weight, fatigue, and discomfort in advance
stage of cancer.
Rehabilitation:
Patients who have undergone surgery are rehabilitated. After amputation of leg they are given
prostheses and physiotherapy in order to train them to walk with prostheses.
Rehabilitation also includes management of psychological problem of the patient and
management of the social spiritual and family problem.

45. ▪ GradeX
▪ Grade cannot be determined
▪ GradeI
▪ Cells differ slightly from normal cells and are
well differentiated (Mild Dysplasia)
▪ GradeII
▪ Cells are abnormal and are moderately
differentiated (Moderate Dysplasia)

46. ▪ GradeIII
▪ Cells are very abnormal and are poorly
differentiated (Severe Dysplasia)
▪ GradeIV
▪ Cells are immature (Anaplasia) and
undifferentiated, cell of origin is difficult to
determine.

47. T
The extent of the primary tumor
N
The absence or presence of regional
lymph node metastasis.
M
The absence or presence of
distant metastatsis.

48. PRIMARY TUMOR (T)
TX: primary tumor cannot be assessed.
T0: no evidence of primary tumor.
Tis: carcinoma in situ
T1, T2, T3, T4: increasing size and/ or local
extent of the primary tumor.

49. REGIONAL LYMPH NODES (N)
NX: regional lymph nodes cannot be assessed.
N0: no regional lymph node metastasis.
N1, N2, N3: increasing involvement of regional
lymph nodes.

50. DISTANT METASTASIS (M)
MX: distant metastasis cannot be assessed.
M0: no metastasis
M1: distant metastasis

51. BIOPSY
Types: Needle Incisional
Excisional Staging

52. MAMMOGRAPHY
PAPANICOLAOU’S (PAP) TEST
STOOLS FOR OCCULT BLOOD
SIGMOIDOSCOPY
COLONOSPCOPY
SKIN INSPECTION

53. ONCOFETAL ANTIGENS
Carcinoembryonic
Antigen (CEA) Alpha-
feto Protein

54. HORMONES
ADH
Calcitonin
Catecholamines
HCG
PTH

55. ▪ ISOENZYMES
▪Neurospecific enolase (NSE)
▪Prostatic acid phosphatase (PAP)

56. ▪ Prostate-specific antigen (PSA)
TISSUE-SPECIFIC ANTIGENS

58. INTERNAL RADIATION
THERAPY
(BRACHYTHERAPY)
EXTERNAL RADIATION
THERAPY
(TELETHERAPY)

59. SOURCES
 implanted into the affected tissue or body cavity
 ingested as a solution
 Injected as a solution into the bloodstream or body
cavity
 introduced through a catheter into the tumor
SIDE EFFECTS
 fatigue
 anorexia
 immunosuppression

60. CLIENT EDUCATION
 Avoid close contact with others until the treatment is
completed
 Maintain daily activities unless contraindicated
 Rest
 Maintain a balanced diet and fluid intake
 If implant is temporary, the client should be on bed
rest
 Excreted body fluids may be radioactive; double flush
toilets after use

61. NURSING MANAGEMENT
 Minimize time spent in close proximity to the radiation
sources
 Minimum distance should be 6 feet
 Use lead shields
 Place the client in a private room
 Ensure proper handling and disposal of body fluids
 Pregnant women and children are not
allowed inside the client’s room

62. SIDE EFFECTS
 Tissue damage to target area
 Ulcerations of oral mucous membranes
 Nausea, vomiting, and diarrhea
 Radiation pneumonia
 Fatigue
 Alopecia
 Immunosuppression

64. CLIENT EDUCATION
 Wash marked area of the skin with plain water only and pat
dry. Do not wash off the treatment site marks
 Avoid rubbing, scratching, or scrubbing the treatment site.
Do not apply extreme temperatures to the treatment site. If
shaving is necessary, use electric razor.
 Wear soft, loose-fitting clothing over the treatment area

65. CLIENT EDUCATION
 Protect skin from sun exposure during the
treatment and for at least 1 year after the treatment
is completed.
 Maintain proper rest, diet, and fluid intake
 Hair loss may occur.

66. ROUTE OF ADMINISTRATION
 IV
 Oral
 Intrathecal
 Topical
 Intra-arterial
 Intracavity
 Intravesical

67. ALKYLATING AGENTS
Cyclophosphamide
(Cytoxan) Busulfan
(Myleran)
Mecholorethamine
(Mustargen)

68. ANTIMETABOLITES
5-fluorouracil (5-FU)
Methotrexate

69. CYTOTOXIC ANTIBIOTICS
Bleomycin (Blenoxane)
Doxorubicin (Adriamycin)

70. ▪ HORMONES AND HORMONE ANTAGONISTS
▪ Diethylstilbestrol (DES)
▪ Tamoxifen (Nolvadex)
Prednisone

71. PLANT ALKALOIDS
Vinca alkaloids
Etoposide

72.  IV routes may be obtained by subclavian catheters, implanted ports, or peripherally
inserted catheters.
 Extravasation is the major complication of IV chemotherapy.
 WARNING: NEVER TEST VEIN PATENCY WITH CHEMOTHERAPEUTIC
AGENTS.
 Monitor client closely for anaphylactic reactions or serious side effects. Discontinue
infusion according to protocol if reaction occur
 Use caution when preparing, administering, or disposing chemotherapeutic agents

74. Bone marrow suppression leads to:
a. LEUKOPENIA
 Avoid crowds, people with infections, and small
children when WBC count is low
 Avoid undercooked meat and raw fruits and
vegetables

75. Bone marrow suppression leads to:
b. THROMBOCYTOPENIA
 Use electric razor when shaving
 Avoid contact sports
 If trauma occurs, apply ice and seek medical assistance
 Avoid dental work or other invasive procedures.
 Avoid aspirin and aspirin-containing products

76. GI effects
 Client education
a. Eat small, frequent, low-fat meals
b. Avoid spicy and fatty foods
c. Avoid extremely hot foods
 Administer antiemetics prior to chemotherapy
 Weigh client routinely

77. Stomatitis and mucositosis
 Client education
a. Use a soft toothbrush. Mouth swabs may be needed during an
acute episode
b. Avoid mouthwashes containing alcohol. Do not use lemon
glycerin swabs or dental floss
c. Consider using chlorhexidine mouthwash to decrease risk of
haemorrhage and protect gums from trauma

78. Stomatitis and mucositosis
 Client education
d. For xerostomia, apply lubricating and moisturizing agents to protect the
mucous membranes from trauma and infection
e. Consider using “artificial saliva” and hard candy or mints
f. Avoid smoking and alcohol
g. Drink cool liquids, and avoid hot and irritating foods

79. Alopecia (hair loss)
a. Encourage the client to choose a wig before hair loss occurs
b. Care of hair and scalp includes washing hair two to three
times a week with mild shampoo. Pat hair dry and avoid the
use of blow dryer.

80. ▪ It is a type of biological therapy that helps the immune system to act better
against cancerous cells.
▪ Immune cells are sometimes found in and around tumors cells, which are called
tumor-infiltrating lymphocytes or TILs, and are signs that the immune system is
responding to the tumor.
▪ It is not common as Surgery, chemotherapy and radiation therapy.
▪ Common side effects of immunotherapy include skin changes (rashes, itchiness,
sore, redness), swelling, pain, flu-like symptoms, etc.

81. ▪ There are various types of Immunotherapy.
Some of them are:
▪ Immune checkpoints inhibitor.
▪ T-cell transfer therapy.
▪ Monoclonal antibodies.
▪ Treatment vaccines.
▪ Immune system modulators.

82. Slows or stops the growth of cancer that uses hormones to grow.
▪ Hormone therapy falls into two broad groups
Those that block the body’s ability to produce hormones
Those that interfere with how hormones behave in the body.
▪ Hormonal therapy can be mainly given through oral, injections, or surgery ( removing
organ producing hormone).
▪ Ex: Luteinizing hormone-releasing hormone (LHRH) or gonadotropin-releasing hormone
(GnRH) agonists and antagonists — prevent your body's cells from receiving messages
to make testosterone. As a result, your testicles stop producing testosterone.

83. ▪ Restore blood-forming stem cells in people who have had theirs destroyed by the very
high doses of chemotherapy or radiation therapy that are used to treat certain cancers.
▪ They directly don't help to treat cancer but help to form the blood-forming stem cells
which fight against cancer cells.
▪ The blood-forming stem cells that are used in transplants can come from the bone
marrow, bloodstream, or umbilical cord. Transplants can be autologous, allogeneic, and
syngeneic.
▪ Stem cell transplants are most often used to help people with leukemia and lymphoma.

84. Surgical removal of the entire cancer remains the ideal
and most frequently used treatment method.
Primary treatment
Prophylactic
Palliative Reconstructive

85. ▪ Surgery is often the first line of choice for solid tumors, whenever possible.
▪ Surgery may/may not be combined with other modalities.
▪ The size, type, location of tumor and factors such as age, comorbid conditions of a
patient are key determinant factors in choosing surgery.
▪ In some cases where primary tumor has not metastasized surgery may be
considered as curative therapy.

86. COMMON TYPES OF SURGICAL INTERVENTION IN ONCOLOGY
TYPES OF SURGICAL
INTERVENTION IN
ONCOLOGY
•A. Primary Tumor resection
•B. Resection of Metastases
•C. Cytoreduction
•D. Palliative surgery
•E. Reconstructive surgery
•F. Diagnostic surgery

87. ▪ Primary Tumor resection: If a primary tumor has not metastasized, surgery may
be curative. Establishing a complete margin of normal tissue around the primary
tumor (as in breast cancer surgery) is critical for the success of primary tumor
resection and prevention of recurrence.
▪ Resection of metastases: When cancer has metastasized to regional lymph nodes,
nonsurgical modalities may be the best initial treatments, as in locally advanced
lung cancer or head and neck cancer. Single metastases, especially those in the
lungs or liver, can sometimes be resected with a reasonable rate of cure.

88. ▪ Cytoreduction: Cytoreduction (surgical resection to reduce tumor burden) is
often an option when removal of all tumor tissue is impossible, as in most cases
of ovarian cancer.
▪ Palliative surgery: When cure is not possible, the goals of treatment are to
make the patient as comfortable as possible and to promote a satisfying and
productive life for as long as possible. Palliative surgery is performed in an
attempt to relieve complications of cancer, such as ulcerations, obstructions,
hemorrhage, pain, and malignant effusions.

89. ▪ Reconstructive surgery: Reconstructive surgery may improve a patient’s
comfort or quality of life after tumor resection (e.g., breast reconstruction
after mastectomy).
▪ Diagnostic surgery: Diagnostic surgery, such as a biopsy, is usually performed
to obtain a tissue sample for analysis of cells suspected to be malignant. In
most instances, the biopsy is taken from the actual tumor

90. THANK YOU