Oncology

1. Oncology Understanding Medical Surgical Nursing 4th ed., Ch 11 OBJECTIVES: 1. Explain the differences between benign & malignant tumors. 2. List risk factors for the development of cancer. 3. State 7 warning signs of CA. 4. Define terms used to name & classify CA. 5. List the most common sites of CA in men & women. 6. List nursing responsibilities in the care of patients having diagnostic tests to detect possible CA. 7. Explain the nursing care of clients undergoing each type of CA therapy: surgery, radiation, chemotherapy, biologic response modifiers.

2. Health Statistics American Cancer Society: www.cancer.org Males: over ½ Prostate, lung, & colorectal Women: ~½ breast, lung, & colorectal Children (0-14yrs) Colorectal CA is the 3rd most common CA in both men & women.

3. Health Statistics • U.S. 2014 • Deaths • CA is the 2nd leading cause of death in the US, exceeded only by heart disease. • Breast, Prostate, Lung, & Colorectal CA’s account for ½ of all deaths, men & women.

4. Older Adult Considerations • More cases of CA • CA î with aging • S&S of CA may be misdiagnosed

5. Cancer (CA) Large group of diseases characterized by uncontrolled growth & spread of abnormal cells. (American Cancer Society) http://www.youtube.com/watch?v=bKEptX-fwP0 Neoplasms or Tumors Cells that reproduce abnormally & in an uncontrolled manner.

6. Normal Cell Growth Uniform shape Cell cohesiveness Controlled growth Well differentiated Programmed cell death (apoptosis)

7. Cancer Pathophysiology • CA cells divide & multiply, in an abnormal manner. http://www.youtube.com/watch?v=A1Fkdt-2veM • Mutation of Cellular Genes • Abnormal Cell Growth • No Cell Division Limit • Lack of Contact Inhibition

8. Cancer Cell Growth • Abnormal appearance • Lack of cohesiveness • Rapid, disorderly division • Poorly differentiated • No apoptosis

9. Benign Tumors • Slow, steady growth • Remains localized • Usually contained within a capsule • Smooth, well-defined; movable when palpated • Resembles parent tissue • Crowds normal tissue • Rarely recurs after removal • Rarely fatal

10. Malignant Tumors • http://www.youtube.com/watch?v=LEpTTolebqo • Rate of growth varies – usually rapid • Metastasizes • Rarely contained within a capsule • Irregular; more immobile when palpated • Little resemblance to parent tissue • May recur after removal • Fatal without treatment

11. Metastasis • Process by which tumor cells are spread to distant parts of body; used to describe movement of CA cells from primary to secondary site.http://www.youtube.com/watch?v=rrMq8uA_6iA • Invade Blood or Lymph Vessels • Move by Mechanical Means • Lodge & Grow in New Location

12. Carcinogenesis • The process by which normal cells are transformed into CA cells. • Etiology: • Carcinogen Exposure • Initiation • Promotion

13. Carcinogenesis • Initiation • Carcinogens: CA causing agents • Repair itself • Permanently ∆’ed, don’t cause CA • Transformed & produce new line of CA cells

14. Promotion Process by which CA promoters aid in alternation or injury to DNA.

15. Progression The expression of malignant mutation acquiring more aggressive characteristics over time.

16. Cancer Types http://www.youtube.com/watch?v=mqx-R_sjM7g • Carcinoma • Sarcoma • Melanoma • Leukemia • Lymphoma

17. Most Common Cancers • Men • Prostate • Lung • Colon • Women • Breast • Lung • Colon

18. Skin Cancer Malignant lesion of skin; may or may not metastasize • Types: basal cell, squamous cell, malignant melanoma • Assessment: change in color, size, shape of preexisting lesion; pruritus; local soreness • Interventions • Instruct in preventive measures (limiting exposure to sun, use of sunscreens) • Instruct to monitor lesions for changes, nonhealing lesions; report to primary health care provider immediately • Assist with surgical excision of lesion as prescribed

19. Leukemia • Malignant exacerbation in number of leukocytes, usually at immature stage, in bone marrow • Data collection • Normal, elevated, or reduced white blood cell count; decreased H/H; thrombocytopenia; positive bone marrow biopsy; anorexia; fatigue; bleeding; fever; lymphadenopathy; splenomegaly; bone pain, swelling

20. Lymphoma: Hodgkin’s Disease • Malignancy of lymph nodes; originates in single lymph node or single chain of nodes • Data collection • Presence of Reed-Sternberg cells in nodes • Fever; malaise; night sweats; anorexia; anemia & thrombocytopenia; enlarged lymph glands, including nodes, spleen, liver

21. Hodgin’s disease cont’d • characterized by painless, progressive enlargement of lymphoid tissue • Interventions • Provide care before & after external radiation as prescribed • Provide care before & after chemotherapy as prescribed • Monitor for signs of infection, bleeding • Follow bleeding precautions

22. Non-Hodgkin’s lymphoma (NHL) Any of a heterogeneous group of malignant tumors involving lymphoid tissue.

23. Lung Cancer • Malignant tumor of lung; may be primary or metastatic • Causes • Cigarette smoking; exposure to environmental pollutants; exposure to occupational pollutants • Data collection • Cough; dyspnea; hoarseness; hemoptysis; chest pain; anorexia; wt loss; weakness • Interventions • Place in Fowler’s position • Administer oxygen as prescribed

24. Lung CA • Small-cell lung CA: hormonal cells • Non-small lung CA: • -squamous-cell: larger airways • -adenocarcinomas: (large-cell carcinomas), in secretory portion • -bronchoalveolar carcinomas: small air sacs, or alveoli

25. Multiple Myeloma • Malignant proliferation of plasma cells, tumors within bone • Data collection • Bone, skeletal pain, especially in ribs, spine, pelvis • Osteoporosis • Recurrent infections; fatigue; anemia; thrombocytopenia; granulocytopenia; elevated uric acid & calcium serum levels

26. Risk factors • Smoking • Exposure to radiation • Exposure to environmental & chemical carcinogens • Smokeless tobacco • Frequent heavy consumption of alcohol

27. Risk factors • Dietary habits • Pickled, smoked, charbroiled • High-fat, low-fiber diets • High-fat diets • Diet low in vitamins A, C, & E

28. Risk Factors • Oncoviruses • Irritants • Hormones • Altered Immunity

29. Hereditary Cancers • ~ 90% of cancers are not inherited • Genetic Susceptibility: • Postmenopausal breast CA • Lung CA – Smokers • Leukemia – identical twin • Neuroblastoma – siblings • Colon CA – breast CA

30. American Cancer Society • Cancer’s 7 Warning Signals: CAUTION • Change in bowel or bladder habits • A sore that does not heal • Unusual bleeding or discharge • Thickening lump in breast or elsewhere • Indigestion or swallowing difficulties • Obvious ∆ in warts or moles • Nagging cough or hoarseness

31. Prevention • Early Detection • Regular Screening • Genetic Testing • Healthy Lifestyle

32. Breast Self-Examination (BSE) • Performing BSE • 7 to 10 days after menses • If postmenopausal or posthysterectomy, select specific day of month, perform regularly • Client instructions • In shower or bath, examine breasts • Use pads of second, third, and fourth fingers to press firmly on every part of breasts, using right hand to examine left breast and vice versa • Use small circular motions in a spiral or up and down motion so that entire breast is examined, checking for any lump, knot, thickening of tissue

33. Breast Self-Examination (BSE) (continued) • Look at breasts in mirror, raising arms over head to determine any changes in size, dimpling of skin, changes in nipple, asymmetry; repeat with hands on hips • Lying down, feel breasts as when in shower or bath; when examining right breast, place right hand behind your head and vice versa for left breast • Any changes noted should be reported immediately to health care provider

34. Testicular Self-Examination (TSE) • Performing testicular self-examination • Select day of month; perform on that day every month • Client instructions • In shower, gently lift each testicle; each one should feel like an egg: firm but not hard, smooth with no lumps • Using both hands, place middle fingers on underside of each testicle, thumbs on top; gently roll testicle between thumb and fingers to feel for swelling, lumps, or mass • Any changes noted should be reported immediately to health care provider

35. Prevention • Protectant Foods • Folic Acid • Omega-3 Fatty Acids • Fruits & Vegetables • Vaccines

36. Diagnosis of CA • Biopsy: sample of tissue for pathological examination. • Incisional bx: removal of a portion of tissue for examination. http://www.youtube.com/watch?v=nbdmmukko4s • Excisional bx: removal of complete lesion, with little or no margin of surrounding normal tissue removed. http://www.youtube.com/watch?v=QcjGCBO83DQ

37. Diagnosis of Cancer • Needle aspiration bx: aspiration of fluid or tissue by means of needle. http://www.youtube.com/watch?v=H1x_dTKAU34 • Endoscopy: directly visualize an internal structure through a body cavity or through a small incision; can also obtain cells or tissue. http://www.youtube.com/watch?v=Tz2ktVJVWcI

38. Diagnostic Imaging • Bone scanning • Tomography • Computed tomography (CT) scan • Radioisotope studies • Cytological studies

39. Diagnostic Imaging • Ultrasound testing • Magnetic resonance imaging (MRI) • Positron Emission Tomograph (PET) • http://www.youtube.com/watch?v=d9iOxMFmPlA

40. Laboratory Tests • Alkaline phosphatase • Serum calcium • Serum calcitionin • Carcinoembryonic antigen (CEA) • PSA & CA-125 • Stool examination

41. Staging http://www.youtube.com/watch?v=X8MEoi4Tqho • Tumor • Nodes • Metastasis • Indicate tumor size, spread to lymph nodes, & extent of metastasis. • Direct tx, predict prognosis, & contribute to CA research.

42. T* Subclasses • T×: tumor can’t be adequately assessed • To: no evidence of primary tumor • Tis: carcinoma in situ • T1, T2, T3, T4: progressive î in tumor size & involvement regional lymph

43. Nt Subclasses • N×: regional lymph nodes cannot be assessed • No: no regional lymph nodes cannot be assessed • N1, N2, N3: î involvement regional lymph nodes

44. M‡ Subclasses • M×: not assessed • Mo: no (known) distant metastasis • M1: distant metastasis present, specify site(s)

45. Grading • Histopathology • G1: well differentiated • G2: mod well-differentiated • G3: poorly differentiated • G4: undifferentiated

46. Staging Classification for CA Stage 1: malignant cell confined Stage 2: limited spread, local area, nearby lymph nodes. Stage 3: larger or spread to nearby tissues or both; regional lymph node likely involved. Stage 4: metastasized to distant parts of body.

47. Therapeutic Interventions • Surgery • Radiation Therapy • Chemotherapy

48. Cancer Therapies • Surgery removal of all malignant cells; may include removal of tumor, surrounding tissue & regional lymph nodes. • Preventive, Diagnostic, Curative • Palliative: relieve or reduce intensity of uncomfortable symptoms. [not a cure] • Reconstructive

49. Laser Surgery • Laser beam vaporizes tissue with little bleeding & low risk of infection. http://www.youtube.com/watch?v=BHHvzNm7oR0 • ophthalmology • gynecology • urology • neurosurgery • otolaryngology

50. Nursing Interventions • Monitor VSs • Monitor labs • Monitor client’s wt. • Monitor I&O • Monitor for bleeding, S&S of infection • Psychosocial issue