Foundation Chapter 34 - Oncology - Taylor Lpn

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Cancer

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A disease resulting from the uncontrolled growth of abnormal cells, which causes malignant cellular tumors.

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A disease resulting from the uncontrolled growth of abnormal cells, which causes malignant cellular tumors.

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Cancer

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Cancer Facts

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1 in 3 Americans will develop cancer.
2nd leading cause of death in U.S.
A group of more than 200 diseases that can attack any tissue or organ in the body. 66% of people diagnosed with cancer will be alive in 5 years.

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Survival Rates are influenced by

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The type of cancer.
The progression of the disease at diagnosis.
The clients response to the treatment.

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Neoplasms

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any abnormal growth of new tissue

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any abnormal growth of new tissue

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Neoplasms

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Benign Neoplasms

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Not Progressive and favorable for recovery. Not cancerous and usually harmless. Grow slowly, are encapsulated, well defined, do not spread to other tissues.

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Malignant Neoplasms

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Becoming progressively worse and often result in death. Form irregularly shaped masses with fingerlike projections. Usually multiply quickly and spread to distant body parts through the blood stream and lymph system.

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Metastasis

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Spread of cancer cells to distant areas of the body by way of the lymph system or bloodstream.

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Spread of cancer cells to distant areas of the body by way of the lymph system or bloodstream.

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Metastasis

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Four main classifications of cancer

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Lymphomas
Leukemias
Sarcomas
Carcinomas

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Lymphomas

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Cancers occurring in infection-fighting organs such as lymphatic tissue

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Cancers occurring in infection-fighting organs such as lymphatic tissue

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Lymphomas

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Leukemias

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Cancers occurring in blood forming organs such as spleen and in bone marrow.

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Cancers occurring in blood forming organs such as spleen and in bone marrow.

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Leukemias

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Sarcomas

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Cancers occurring in connective tissue, such as bone.

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Cancers occurring in connective tissue, such as bone.

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Sarcomas

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Carcinomas

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Cancers occurring in epithelial tissue such as the skin.

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Cancers occurring in epithelial tissue such as the skin.

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Carcinomas

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Risk Factors for cancer

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Environmental, Lifestyle, Genetic, Viral

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Tumor Markers

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Substance found in the serum that indicates the possible presence of malignancy

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Substance found in the serum that indicates the possible presence of malignancy

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Tumor Markers

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Staging of Tumors

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TNM Classifications
T - anatomical size of primary tumor
N - extent of lymph node involvement
M - the presence or absence of metastasis

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Differentiation

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Acquisition of characteristics or functions different from those of the original

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Acquisition of characteristics or functions different from those of the original

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Differentiation

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Well differentiated cells

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Tumor cells that retain many of the identifiable tissue characteristics of the original cell.

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Tumor cells that retain many of the identifiable tissue characteristics of the original cell.

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Well differentiated cells

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Undifferentiated Cells

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Tumor cells having little similarity to the tissue of origin.

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Tumor cells having little similarity to the tissue of origin.

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Undifferentiated Cells

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Grading of Tumors

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Stages I, II, III, IV
The higher the grade the worse the prognosis. A grade I tumor is the most differentiated. A grade IV tumor is the most undifferentiated. Tumors containing poorly differentiated cells are more aggressive in growth and may display uncharacteristic behaviors leading to a poor prognosis.

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Treatment Modalities for cancer

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Surgery, Chemotherapy, radiation, biotherapy, photodynamic therapy, hormone therapy, targeted cancer therapy, bone marrow transplantation (BMT).

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Surgery for Cancer

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Oldest form of cancer treatment. Remains the most common form of treatment. Classified as curative, palliative or reconstructive.

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Curative Surgery

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The goal is to heal or restore to health; involves excising all of the tumor, surrounding tissue and regional lymph nodes. Most often has curative results when performed in early stages of cervical, breast, or skin cancer.

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Palliative Surgery

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70% show metastasis at diagnosis so cure isn't always possible. Usually performed to relieve obstruction or pain.

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Reconstructive Surgery

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Performed to reestablish function or to rebuild for cosmetic effect.

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Radiation therapy or radiotherapy

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Uses high-energy ionizing radiation to kill cancer. Ionizing radiation penetrates tissue cells and deposits energy within them. This intense energy causes breakage in chromosomes within the cell thus preventing the ability of the cell to replicate. Goal is to eradicate malignant cells without causing harm to healthy tissues. Better vascularized better oxygenated cells and those that divide rapidly are most sensitive to radiation.

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Antineoplastic

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Drugs used in chemotherapy that inhibit the growth and reproduction of of malignant cells.

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Drugs used in chemotherapy that inhibit the growth and reproduction of of malignant cells.

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Antineoplastic

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Classifications of chemotherapy drugs

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cell-cycle specific (CCS)
cell-cycle nonspecific (CCNS)

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Cell-cycle specific drugs

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attack cancer cells when the cells enter a certain phase of reproduction. Most effective against rapidly growing tumors."Schedule Dependent" drugs because they produce a greater cell kill when given in multiple, repeated doses.

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Cell-Cycle non-specific drugs

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Drugs that can destroy cancer cells in any phase of the cell cycle and are used for large tumors that have fewer dividing cells. Not schedule dependent but dose dependent. The number of cells destroyed is determined by the amount of drug given.

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Routes of administration for Chemotherapy

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Oral & IV are most common. A few are given topically, subcutaneously or intramuscularly. New methods include intrathecal injection and intracavity instillation.

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Extravasation

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Leakage of fluid from the vein into surrounding tissue during infusion

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Leakage of fluid from the vein into surrounding tissue during infusion

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Extravasation

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Vesicants

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Agent that may produce blisters and tissue necrosis

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Agent that may produce blisters and tissue necrosis

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Vesicant

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Signs of Extravasation

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Pain or burning at the site or along the vein. Absent or sluggish blood return. Redness 6 to 12 hours later. Swelling. Diffuse hardening.

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Oncology

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The study of tumors

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Biologic response modifiers (BRMs)

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Agents that stimulate the body's natural immune system to control and destroy malignant cells. Side effects less severe than in chemo. Side effects include fever, malaise, myalgia, headache, anaphyactic reaction

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Photo dynamic therapy (PDT)

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90% effective for esophageal cancer and early stage lung cancer. Client is injected with a light-activated drug that targets cancerous cells. 24 - 48 hours later a low power laser light is directed to cancerous tissue. The light stimulates the drug to destroy cancer cells but not health tissues. Few side effect include local swelling, nausea, fever and constipation

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Hormone Therapy

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Some cancerous cells need estrogen, progesterone or testosterone to grow. The goal of hormone therapy is to deprive the cancerous cells of these hormones.

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oophorectomy

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removal of the ovaries

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Orchiectomy

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removal of the testicles

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Targeted Cancer Therapy

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The goal of targeted cancer therapy is to stop growth and spread of cancer cells by preventing normal cells from changing into cancerous cells at the molecular or cellular level. Causes less harm to healthy cells than other treatments.

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Bone Marrow Transplantation (BMT)

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Used in cancers that respond to high doses of chemo or radiation. Treatment involves aspirating and storing bone marrow, exposing the client to high dose chemo or radiation, then reinfusing marrow.

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Symptom Management: Bone Marrow Dysfunction

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Low white count increases risk of infection. Stict hand hygiene and asepsis. Monitor for blood loss.

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Symptom Management: Nutritional Alterations

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Cachexia, Anorexia, Nausea & Vomiting, Altered Taste Sensation, Mucosal Inflammation, Dysphagia.

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Hallmarks of malnutrition

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Weight loss greater than 10%
Serum Albumin level less than 3.4 g/dl

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Cachexia

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A state of malnutrition and protein (muscle) wasting. Cytokines are secreted by the tumor in an attempt to cannibalize the body, and secreted by the immune system to fight the tumor. Cytokines make the body digest muscle for energy instead of using stored fat for this purpose. Occurs in conjunction with lung, pancreatic, stomach, bowel and prostate cancer but rarely with breast cancer.

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Anorexia

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the loss of appetite

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Symptom Management: Nausea and Vomiting

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Usually occurs 3 - 4 hours after chemotherapy and may last up to 72 hours. Antiemetics. Small, frequent feedings of complex carbs may be beneficial. Liquids are given 30 to 60 before meals. Cool, bland foods are more easily tolerated. Frequent mouth care is needed.

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Symptom Management: Altered Taste Sensation

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Altered because cancer cells release substances that simulate bitter taste buds, causing a bitter or metallic taste in the mouth. Some no longer enjoy red meat and have an aversion to sweets.

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Stomatitis

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inflammation of the mucous membrane of the oral cavity - occurs in half of cancer clients receiving treatment.

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Symptom Management: Mucosal Inflammation/Stomatitis

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Usually occurs 7 - 14 days after chemo and lasts 2 to 3 weeks. To minimize stomatitis asses for early signs - edema, ulceration, erythema, excessive saliva, and infection. Avoid rough, chewy foods and acidic foods. Use straws. Popsicles help pain. Avoid commercial mouthwash containing alcohol, and lemon or glycerine swabs. Remove dentures at night. Viscous Xylocaine rinses are used for pain. Remove dentures at night.

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Symptom Management: Dysphagia

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Difficulty swallowing. Occurs in clients with esophageal cancers or in those receiving radiotherapy. Artificial saliva is ordered for severe dryness.

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Symptom Management: Pain

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60 - 90% with malignancy experience pain. Usually doesnt occur until the advanced stages of the disease. Most common causes are metastatic bone disease, venous or lymphatic obstruction, or nerve compression.

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Agency for Health Care Policy and Research guidelines for caner pain

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1. Cancer pain can be managed effectively through simple mean in up to 90% of cancer patients.
2. Main pain assessment is the client self report.
3. Simplest dosage schedules and least invasive pain management modalities are used first.
4. Morphine is most commonly used opiod for moderate to sever pain in cancer pts.
5.Prevent pain is goal instead of treating pain

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Symptom Management: Fatigue

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Occurs as direct result of cancer treatment or because of anemia, chronic pain, stress, depression, insufficient rest or inadequate nutritional intake.

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Symptom Management: Alopecia

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The thinning or loss of hair. Can be induced by cancer treatments. Begins 2 - 3 weeks after initial treatment. Drug induced alopecia is not permanent. Threat to body image.

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Symptom Management: Odors

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Usually associated with drainage, exudates, or incontinence. Embarrasing to client.

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Dyspnea and cancer

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Half of clients with terminal cancer experience dyspnea (difficulty breathing). Causes include fluid accumulation in chest, infection, fibrosis, anemia.

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Symptom Management: Dyspnea

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Lungs are Auscultated every 4 hours.
O2 is ordered. Fluid can be drained by thoracentesis. High-Fowler positioning. Monitor O2 sats. Avoid pulling curtain or closing door because air flow is decreased and anxiety can increase.

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Symptom Management: Bowel Dysfunction - Constipation

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results from decreased motility of colon, chemo, opiodes and inactivity. Early sign of vincristine toxicity. Fluid consumption is encouraged. Stool softeners daily. High fiber diet, prune juice, bran.

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Symptom Management: Bowel Dysfunction - diarrhea

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Causes: radiation, chemo, antibiotics, tube feedings, hyperosmolar supplements, stress & fecal impaction. A low-residue, lactose-free diet is encouraged. Bananas and sports drinks replace lost electrolytes. Avoid coffee, warm liquids. Antidiarheal medications are used. Sitz baths.

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Symptom Management: Pathological Fractures

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Major problems in cancers that metastasize to the bone. Cancer weaken the bones so that they can break during normal activities. Extreme care must be given not to break bones.

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Symptom Management: Ascites

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Fluid accumulation in the abdomen. Causes abdominal swelling and difficulty breathing. Measure girth daily, auscultate abdomen, percussion, palpation.

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Symptom Management: Sexual Alterations

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Chemo drugs can interfere with sexual function and reproduction. Birth control is practiced during treatment and for 1 or 2 years after. Encourage partners to express feelings and concerns to each other.

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Medical Emergencies associated with 20% of advanced stage cancers.

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Hypercalcemia
Spinal Cord Compression
Superior Vena Cava Syndrome
Cardiac Tamponade

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ACS

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American Cancer Society

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AHCPR

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Agency for Health Care Policy and Research

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BCG

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bacillus Calmette-Guerin

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BMT

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bone marrow transplantation

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CCNS

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cell-cycle nonspecific

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CCS

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cell-cycle specific

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CNS

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central nervous system

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CT

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computed tomography

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DNA

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deoxyribonucleic acid

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EPA

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Environmental Protection Agency

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TENS

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Transcutaneous electrical nerve stimulation

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TNM

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tumor, node, metastasis

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Risk factors for Breast Cancer

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Family Hx. Immediate female relatives. High fat diet. Obesity after menopause. Early menarche, late menopause. Alcohol Consumption. Postmenopausal estrogen & Progestin. First child after 30.

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Risk factors for Lung Cancer

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Cigarette Smoking. Asbestos, arsenic and radon exposure, secondhand smoke, tuberculosis.

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Risk factors for Skin Cancer

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Excessive exposure to UV radiation (sun, indoor tanning), Fair complexion, work with coal, tar, pitch or creosote, multiple or atypical nevi (males)

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Risk factor for prostate Cancer

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Increasing Age.
Family Hx
Diet high in animal fat

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Risk factor for Stomach Cancer

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Family Hx.
Diet heavy in smoked, pickled or salted foods

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Risk factor for Cervical Cancer

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Multiple Sexual Partners
Having sex at early age
Exposure to HPV
Smoking

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Risk factor for Colorectal Cancer

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Family Hx (immediate relatives)
Low-fiber diet
Hx of rectal polyps

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Risk factor for Esophageal Cancer

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Heavy Alcohol Consumption
Smoking

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Risk factor for Testicular Cancer

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Undescended testicles
Consumption of hormones by mother during pregnancy

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Dietary Guidelines to reduce the risk of cancer

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Choose most foods from plant sources. Limit high-fat foods from animals. Be physically active and achieve and maintain a healthy weight. Limit or eliminate consumption of alcoholic beverages.

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Client Teaching: External Radiation

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Do not wash off the skin markings used to designate reference points for treatment. Client is alone in room during treatment. Client must be still. Lasts 1 - 3 minutes. Usually painless.
Skin Care important.

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Abdominal Cancer can cause ____________.

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Ascites - fluid accumulation in the abdomen.

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Smokeless tobacco leads to what type of Cancer?

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oral cavity, esophagus, pharynx and larynx.

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Survival Rates Influenced by?

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Type of cancer most influences survival rate. Also Progression of disease at diagnosis, Clients response to treatment.