Chapter 12 Management of Patients with Oncologic Disorders Cancer A group of disorders characterized by abnormal cell proliferation, in which cells ignore growth-regulating signals in the surrounding environment 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 Copyright © 2022 Wolters Kluwer · All Rights Reserved Malignant Process Cell proliferation: o Genetically altered cells clone and proliferate abnormally o Evading normal intra/extracellular processes such as growth regulating and immune system defenses o Abnormalities in cell signaling processes lead to cancer development o Ultimately metastasis occurs Copyright © 2022 Wolters Kluwer · All Rights Reserved Characteristics of Benign and Malignant Neoplasms Cell characteristics Mode of growth Rate of growth Metastasis General effects Tissue destruction Ability to cause disease Tables 12-1 and 12-2 Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 Is the following statement true or false? Malignant tumors spread by way of blood and lymph channels to other areas of the body. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 True Rationale: Malignant tumors spread by way of blood and lymph channels to other areas of the body. Cells bear little resemblance to the normal cells of the tissue from which they arose. Copyright © 2022 Wolters Kluwer · All Rights Reserved Carcinogensis Malignant transformation Three-step process o Initiation: apoptosis o Promotion: preneoplastic/benign lesions o Progression: angiogenesis Copyright © 2022 Wolters Kluwer · All Rights Reserved Carcinogenic Agents and Factors Viruses, bacteria Physical agents: sunlight, radiation, chronic irritation Chemical agents: tobacco, asbestos Genetic, familial factors (Chart 12-1) Lifestyle factors Hormonal agents Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 Which specific agents or factors are associated with the etiology of cancer? A. Dietary and genetic factors B. Hormonal and chemical agents C. Viruses D. All of the above Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 D. All of the above Rationale: Specific agents or factors associated with the etiology of cancer include viruses and bacteria, physical factors, sunlight, radiation, chronic irritation, chemical agents, tobacco, asbestos, genetic and familial factors, diet, and hormones. Copyright © 2022 Wolters Kluwer · All Rights Reserved Prevention Primary prevention: reducing the risks of disease through health promotion and risk reduction strategies, including nutrition and exercise (Refer to Chart 12-2) Secondary prevention: screening and early detection activities that seek to identify precancerous lesions and early-stage cancer in individuals who lack signs and symptoms of cancer, including community-based screening and detection programs (Refer to Table 12-3) Tertiary prevention: efforts focus on monitoring for and preventing recurrence of the primary cancer as well as screening for development of secondary malignancies in cancer survivors or genetic mutations related to inherited cancer syndromes, environmental exposures and lifestyle factors Copyright © 2022 Wolters Kluwer · All Rights Reserved Diagnosis of Cancer Determine presence, extent of tumor Identify possible disease metastasis Evaluate functions of involved and uninvolved body systems and organs Obtain tissue and cells for analysis, including evaluation of tumor stage and grade Copyright © 2022 Wolters Kluwer · All Rights Reserved Tumor Staging and Grading Staging: determines the size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis Tumor, nodes, metastasis (TNM): Refer to Chart 123 Grading: pathologic classification of tumor cells: I– IV Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer Management Specific to type, stage, grade of cancer Cure Control Palliation Copyright © 2022 Wolters Kluwer · All Rights Reserved Surgical Treatment Diagnostic surgery Biopsy: excisional, needle, incisional Tumor removal: wide excision, local excision Prophylactic surgery Palliative surgery (Table 12-6) Reconstructive surgery Select surgical techniques (Table 12-5) Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 Which type of surgery is being done when lesions that are removed are likely to develop into cancer? A. Diagnostic B. Palliative C. Prophylactic D. Reconstructive Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 C. Prophylactic Rationale: Prophylactic or risk reduction surgery involves removing nonvital tissues or organs that are at increased risk of developing cancer. Diagnostic surgery such as a biopsy is usually performed to obtain a tissue sample for analysis of cells suspected to be malignant. Palliative surgery is performed to relieve complications of surgery. Reconstructive surgery is carried out to improve function or obtain a more desirable cosmetic effect. Copyright © 2022 Wolters Kluwer · All Rights Reserved Radiation Therapy Curative, control, or palliative External radiation Internal radiation Radiation reactions Brachytherapy Toxicity Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Care of the Patient Undergoing Radiation Therapy Promote healing, patient comfort, quality of life Assessment o Skin o Nutritional status o Well-being Protecting caregivers Copyright © 2022 Wolters Kluwer · All Rights Reserved Chemotherapy Agents used in attempt to destroy cancer cells by interfering with cellular function, replication May be combined with surgery, radiation therapy, or both Curative, control, or palliative Cell kill and cell cycle Copyright © 2022 Wolters Kluwer · All Rights Reserved Chemotherapy Toxicity Gastrointestinal Hematopoietic Renal Cardiopulmonary Reproductive Neurologic Cognitive Fatigue Copyright © 2022 Wolters Kluwer · All Rights Reserved Chemotherapy Administration Dosage Extravasation Hypersensitivity reactions Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Management in Chemotherapy Assessing fluid, electrolyte status Assessing cognitive status Modifying risks for infection, bleeding Administering chemotherapy Preventing nausea and vomiting Managing fatigue Protecting caregivers Charts 12-4 and 12-5 Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic Stem Cell Transplantation (HSCT) Used to treat several malignant and nonmalignant diseases Types of HSCT o Allogeneic o Autologous o Syngeneic o Myeloablative o Nonmyeloablative Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Management in HSCT Implementing pretransplantation care Providing care during treatment Providing posttransplantation care o Caring for recipients o Caring for donors Copyright © 2022 Wolters Kluwer · All Rights Reserved Graft-Versus-Host Disease Major cause of morbidity and mortality in the allogeneic transplant population Occurs when the donor lymphocytes initiate an immune response against the recipient's tissues (skin, gastrointestinal tract, liver) during the beginning of engraftment To prevent GVHD, patients receive immunosuppressant drugs, such as cyclosporine May be acute (within first 100 days) or chronic (occurring after 100 days) Copyright © 2022 Wolters Kluwer · All Rights Reserved Immunotherapy The use of medications or biochemical mediators to stimulate or suppress components of the immune system to kill cancer cells Nonspecific immunotherapy boosts the immune system to enhance cancer cell destruction (bacilli Calmette-Guérin, cytokines) Monoclonal antibodies Checkpoint inhibitors Cancer vaccines CAR T-cell immunotherapy Copyright © 2022 Wolters Kluwer · All Rights Reserved Targeted Therapy The use of agents to kill or prevent the spread of cancer cells by targeting a specific part of the cell, with less negative effects on healthy cells than conventional chemotherapy Allows for personalization of cancer therapy Nursing management o Patient education o Standards of care for anticancer treatment patients o Promote self-care o Table 12-8 Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Care of Patients with Cancer #2 Maintaining tissue integrity o Stomatitis o Radiation-associated impairment of skin integrity o Alopecia o Malignant skin lesions (see Chart 12-6) Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Care of Patients with Cancer #1 Promoting nutrition o Nutritional impairment o Anorexia o Malabsorption o Cancer-related anorexia–cachexia syndrome Relieving pain (Table 12-9, Figure 12-7) Decreasing fatigue (Chart 12-8) Improving body self-image Sex Copyright © 2022 Wolters Kluwer · All Rights Reserved Monitoring and Managing Potential Complications Infection, Table 12-10 Septic shock Bleeding, thrombocytopenia Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Management for Patient Self-Care Patient education o Easily understood information o Designed for support across the cancer continuum o Describe what to expect o Chart 12-10 Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Management for Continuing and Transitional Care Nurse must assess the home environment and suggest modification for patient and caregivers Arrange for ongoing nursing visits Education Coordination of care Community resources Cancer survivorship (Table 12-12) Copyright © 2022 Wolters Kluwer · All Rights Reserved Care for the Advanced Cancer Patient Care during oncologic emergencies (Table 12-13) Pain management Promote independence Copyright © 2022 Wolters Kluwer · All Rights Reserved Hospice Should be referred in a timely fashion Comprehensive, multidisciplinary approach to care of patients with terminal illness, their families Focuses on o Quality of life o Palliation of symptoms o Psychosocial, spiritual care o Grief Copyright © 2022 Wolters Kluwer · All Rights Reserved
