The Big “C”: CANCER
By: Diana Blum RN MSN
Metropolitan Community College
Definition

According to the American Cancer
Society:

A large group of diseases characterized by
uncontrolled growth and spread of abnormal
cells
2nd leading cause of death in USA
Metastasizing cancer
Cell
1 out of 4 Americans
will have CA at some
time in their life
Common Sites

MEN










Prostate
Lung
Colorectal
Bladder
Lymphoma
Melanoma of Skin
Oral
Kidney
Leukemia
Stomach

Women










Breast
Lung
Colorectal
Corpus Uteri
Ovarian
Lymphoma
Melanoma of Skin
Bladder
Cervical
Pancreas
Top 3 Cancers that cause Deaths

Men



Lung
Prostate
Colorectal

Women



Lung
Breast
Colorectal

Early Diagnosis Is Key for survival
Normal Cell
Single small nucleus
 Performs a specific function when it
matures
 Able to recognize other cells and identify
tissue of origin
 Reproduce in a controlled manner
 Remain in their tissue of origin except
blood cells

Neoplasm (aka TUMOR)

Cells that reproduce abnormally and in an
uncontrolled manner
Benign Tumors
Harmless
 Do not spread
 Can create pressure or obstruct organs


3 types
Fibroma: fibrous connective tissue
 Lipoma: fat tissue
 Leiomyoma: smooth muscle tissue

Malignant Tumors

Cancer cells characteristics
Change in appearance from normal
cells/origin
 Inability to properly perform function
 Not recognized by other cells
 Random disorganized uncontrolled growth
pattern
 Continue to divide when there’s no need
 Can migrate to other organs

Malignant continued


Tend to press on normal tissue and organs as
the grow
Invasive with all tissues




Regional invasion: movement into adjoining cells
Metastasis: to spread to distant sites
Most common sites are:
Treatment is more difficult with mets
4 types of Malignancies
Carcinoma: skin, glands, lining of digestive
urinary and reproductive tracts
 Sarcoma: bone, muscle, other connective
tissues
 Melanomas: pigment cells in the skin
 Leukemias and lymphomas: blood forming
tissues: lymphoid tissue, plasma cells, and
bone marrow

Malignant Transformation

4 steps




Initiation: DNA exposed to carcinogen
Promotion: sufficient exposure to agent to
encourage/enhance cell growth
Progression: accelerated growth, enhanced invasion,
altered appearance and activity
Metastasis: tumor develops blood vessels



Penetrates capillaries and form fibrin network (undetectable
by immune system)
Dissolve lining of blood vessels to invade surrounding tissue
Set up their own blood supply
Staging
Stage 1

The malignant cells are confined to the
tissue of origin. Not invasive with other
tissues
Stage 2

Limited spread of the cancer in the local
area usually near lymph nodes
Stage 3
The tumor is larger or has spread from the
local site of origin into nearby tissues
 regional lymph nodes are likely to be
involved

Stage 4

The cancer has metastasized to distant
parts of the body
THE TNM Staging System

Specifies the status of the primary
tumor, regional lymph nodes, and
distant mets
T: tumor
 N: regional nodes
 M: distant mets

TNM Continued

T=primary tumor





T0: no signs of tumor after
treatment
Tis: malignancy in epithelial
tissue but not in basement
membrane
T1: minimal size and
extension
T2, T3:progressive
increase in size and
extension
T4:large size and extension

N=regional nodes





N0:no regional nodes
involved
N1:minimal node
involvement
N2:increased involvement
of regional nodes
N3:extensive involvement
of regional nodes
M=distant mets


M0:no distant mets
M1:distant mets present
practice

You are caring for a client who has cancer. The
cancer is staged T4,N3, M1 how would you
interpret the information???

Primary tumor is large in size with extension that
extensively involves the lymph nodes and distant
mets are present.
Risk Factors


No single cause identified
Carcinogens exposure




(chemicals, radiation, viruses)
Cigarettes, asbestos, nitrates
Steroids, estrogens, tar, soot, asphalt, arsenic,
corticosteroids, alkylating agents
Heredity and hormones also play factor


Familial cancers=appear at a high rate than expected.
No single gene pinpointed
Heredity:predictable patterns of inheritance found on
a single gene
7 warning signs of Cancer
C: change in bowel or bladder
 A: a sore that does not heal
 U: unusual bleeding or discharge
 T: Thickening or lump in a breast or
elsewhere
 I: Indigestion or difficulty swallowing
 O: Obvious change in a wart or mole
 N: Nagging cough or hoarseness

Prevention and Detection
Health promotion
 Avoid Carcinogens
 ID high risk people

Health Promotion
Low fat, low cal, no added preservative,
high fiber diet with at least 5 fruits and
veggies daily
 Avoid Alcohol
 Avoid salt cured, smoked, or nitrate
preserved foods
 Balance activity and rest with stress
management

Avoid carcinogens
Avoid over exposure from the sun
 Do not smoke
 Avoid second hand smoke
 Wear a mask at work

ID High risk people
This helps researchers recognize factors
that contribute to cancers
 See doctor at least every 6 months

Diagnosis



H&P
Physical Exam
Diagnostic Tests






Biopsy: the removal of cells cut from a sample
Smear: blood cells under microscope to check for leukemia
CT Scan: used fto detect head and neck Ca, joints and soft
tissue
MRI: detects CNS , spinal, neck, bones, joints, lung, kindey, etc.
PET(positron Emission Tomography): used to detect solid
tumors in the brain and breast and to assess cancer treatment
Lab: Alpha fetoprotein , Ca50, Ca 125, PSA, etc. (see page 327)
Treatments

Surgery:

Done for:
 diagnosis
 Symptom relief
 maintain function
 Reconstruction
 Possible cure
Surgery continued
Preop/postop care varies
 The recommended treatment is based on
the cancers: type, location, and mets

Radiotherapy

Uses ionizing radiation

Dose: 1 gray equals 100 rads
Used to treat malignant cells
 Has delayed and immediate effects

Delayed: altered DNA which impairs the cells
ability to reproduce
 Immediate: cell death due to damage of cell
membrane

Caregiver Safety with radiation
The less time spent near the source the
less exposure
 Unless direct care being given stay 6 ft
away from the source
 Effective shielding depends on type of
rays (the denser the material the more
protection)

External radiation

PROCEDURE



Source is outside the body
Special xray machine provides treatment
# of treatments depends on the doctor


Example: 5 times a week for 2-8 weeks
PATIENT PREP



Treatment simulation to determine exact dosage
needed and schedule
The skin is marked with permanent, waterproof ink,
by the radiologist for the exact site
Instruct client not to remove markings without
permission
Internal Radiation (Brachytherapy)

PROCEDURE

Sources

Iodine, phosphorus, radium, iridium, radon, cesium

Instruct client that they pose a threat unitl the
source is removed unless permanently
implanted small beads used

2 TYPES


Sealed
Unsealed
Sealed



Source is sealed in a container and inserted into
the body (CESIUM)
Sources may be placed in threads, beads,
needles, seeds, or molds
To protect visitors from exposure the client
needs:





To be placed in isolation
Have a sign on the door indicating radiation
No pregnant women or kids under 18 allowed in room
Limit time with visitors
Have organized schedule for cares
Between scrotum and
anus
Intracavity such
As bladder
Staff to wear film badges to monitor exposure
 Recognize that Sealed sources can become
dislodged

 Portable
lead shields provides minimal protection
Immediately notify MD if source becomes
dislodged.

Do not touch source with bare hands
Unsealed

Body fluids may be contaminated

Must wear gloves when working with patient
Contaminated fluids, dressings, etc may
require additional precautions depending
on the agency.
 Disposable utensils are recommended
 Equipment being removed from room must
be checked for radiation level first

Radiation side effects



Normal cells may be harmed (hair follicles, bone
marrow, lining of gi tractand urinary tract)
Anemia-deficiency of RBC
Low WBCs


Bruising/Bleeding( low platelets)





Take 2-6 wks to recover
Takes 2-6 wks to recover
Alopecia (hair loss)
Anorexia
Dry mouth
Harms reproductive cells
See chart 25-8 on page 404
Nursing Implications






Teach pt to avoid exposure to sun, trauma,
harsh chemicals, soaps
Teach pt to leave markings alone and to not use
lotion during treatment
New hair may be different texture and color
Wig is okay to wear
Encourage dental care
Small frequent feedings



Monitor I/O
Increase fluid intake
Encourage C &DB
Chemotherapy

Use of chemical agents to treat
(Antineoplastics)

Destroy rapidly dividing cells
Curative in some cases
 Decreases symptoms in others

Antineoplastics (see Box 25-2)



Cell cycle phase specific- only works in a certain
phase
Cell cycle phase non specific-works in all stages
and phases
5 types




Cytotoxic agents: Taxol, ifex, adriamycin, folex
Hormones and Hormone antagonists: femara, emcyt,
evista
Biologic response modifiers: interferons, interleukins
Angiogenesis inhibitors: brand new and being studied
Chemo continued
Administered by doctor or certified nurse
 Given inpt or outpt
 Routes : po, iv, intracavity, or intrathecal

Intra cavity installed into cavity like bladder
 Intrathecal is given in subarachnoid space


Perfusion:technique where drug is injected
into artery supplying the tumor
Side Effects (see table 25-9)


Act on normal cells as well
Same as radiation




Bone marrow supression- most dangerous
N/V
alopecia
Client is also at risk for toxic effects




to heart (adriamycin)-causes heart failure
lung (Blenoxane)-pulmonary fibrosis and
inflammation
nerve tissue (Velbane, Oncovin)- numbness, tingling,
loss of deep tendon reflexes.
kidney, bladder
Biotherapy

Agents work by affecting biological
processes including
hematopoietic growth factors
(eyrthropoietin(production of RBC), numega,
colony stimulating factors)
 Biologic response modifiers (not first line
treatment; still being studied), and
 Monoclonal antibodies (specific for proteins
on surface of cancer cell)

Transplants and hormone therapy


Bone marrow- used with leukemia/lymphoma
Stem cell- bone marrow depression

Both are done to restore blood manufacturing
cells

Hormone therapy-used to supress natural
hormone secretion, block hormone actions, or
provide supplemental hormones
Nursing Assessment- diagnostic
phase

Health History


Chief complaint, past medical hx, family history,
system review (lumps, lesions, pain, fatigue, easy
bruising, ha, hemoptysis, vision disturbance, loss of
appetite, etc.(see pg 325)
Examination




Vs, ht, wt, inspect face, scalp, mouth for lesions
Ascultate lungs, and look at respiratory effort
Inspect breasts for symmetry, dimpling, lumps
Palpate abd, scrotum, etc
Nursing DX- diagnostic phase
Ineffective Coping r/t fear of diagnosis
 Goal: acceptance of need for medical
evaluation and treatment
 Aeb patient seeks medical tx and
evaluation

Interventions- diagnostic phase

Ineffective coping:encourage to learn the
warning signs

stress that medical evaluation is needed for
correct diagnosis
Anxiety: remain hopeful, don’t give false
reassurance, don’t use clichés, recognize
the pts feelings
 Explain procedures

Treatment phase- assessment
Obtain complete drug profile
 Review systems to check for those related
to tx
 Assess pt knowledge
 Explore pt adaptations
 Physical exam: note general appearance,
LOC, posture, gait, emotional state, head
to toe assess

Treatment phase- Nursing DX

Anxiety related to effects and outcomes of
tx

Goal : reduce anxiety aeb patient states
anxiety is reduced and demonstrates a
relaxed manner
Risk for injury
 Ineffective coping
 Anxiety
 Risk for infection
 Imbalanced nutrition< less than body
requirements

Recovery and rehab
Periodic check ups
 Rehab restores pt to highest level of
functioning possible

Terminal illness
2nd leading cause of death
 Oncology clinical nurse is great resource
for the patient

Oncological emergencies




Hypercalcemia
Syndrome of inappropriate antidiuretic hormone
(fluid does not come off)
Disseminated intravascular coagulation (DIC)
Superior Vena Cava Syndrome (redness/edema
of face, tachycardia, distended neck veins)


Teach client not to bend forward
Spinal cord compression secondary to tumor