CELLULAR ABERRATION

Group of diseases characterized by unregulated growth of cells Affects all ages, races Second most common cause of death Probably the most feared disease

Differentiated functions similar to parent tissue Nonmigratory Adhere tightly together Grow in an orderly function

Characteristics of Malignant Cells

Neoplasia

Any new or continued cell growth not needed for normal development or for replacement of dead and damaged tissues Always abnormal

Demonstrate rapid or continuous growth Show anaplastic morphology Large nuclear-to-cytoplasmic ratio Loss of differentiated functions Adhere loosely together Able to migrate Grow by invasion

Cancer Development

Characteristics of Normal Cells

Have limited cell division Show specific morphology Small nuclear-to-cytoplasmic ratio Differentiated functions Adhere tightly together Nonmigratory Grow in an orderly and wellregulated manner

Initiation Promotion Progression

Initiation

Characteristics of Normal Early Embryonic Cells

Demonstrate rapid and continuous cell division Show anaplastic morphology Large nuclear-to-cytoplasmic ratio No differentiated functions Adhere loosely together Able to migrate

Irreversible alteration in the cells genetic structure resulting from the action of a chemical, physical, or genetic agent. Substances that can change the expression of a cells genes to the extent that the cell expresses malignant characteristics are called carcinogens.

Carcinogens Chemical - Difficult to identify (Long latency period) - Can be associated with lifestyle Ex. obesity

Biology of Abnormal Cells Characteristics of Benign Tumor Cells

Demonstrate continuous or inappropriate cell growth Show specific morphology Small nuclear-to-cytoplasmic ratio

Physical

Examples: radiation

Terminology for neoplasia describes the tissue of origin for neoplastic cells and classifies the tumor as benign or malignant

Classification ultraviolet light foreign bodies Genetic Susceptibility

Solid Tumors

Associated with organs from which they develop such as breast or lung cancer

Not considered hereditary in the true sense; more of a strong disposition

Hematological cancers

Examples: Colon cancer Breast cancer Progression

Originate from blood cell- forming tissues, such as leukemia as lymphomas Prevention

Characterized by increased growth rate of the tumor as well as by increased invasiveness and metastasis Metastasis can occur via:

Avoidance of known or potential carcinogens and avoidance or modification of the factors associated with the development of cancer cells

Detection

Vascular spread Lymphatic spread Process of implantation Promotion

Mammography Papanicolaus (Pap) Test Stool for occult blood Sigmoidoscopy; Colonoscopy Breast-Self Examination Testicular Self-Examination Skin Inspection

Warning Signs

Latency period: the time between a cells initiation and the development of an overt tumor Promoters: can enhance the development; activity of promoters is reversible Examples of promoters:

Change in bowel or bladder habit Any sore that does not heal Unusual bleeding or discharge Thickening of lump in breast or somewhere Indigestion Obvious change in wart or mole Nagging cough or hoarseness

Dietary fat, smoking, alcohol consumption Classification of Cancer

Motor and Sensory Deficits Cancer Screening Assessment Considerations for the Elderly Diagnosis

Health History Risk factors Physical exam Diagnostic tests

Can occur when cancers invade bone or compress nerves Bones most affected include vertebrae, ribs, pelvis, femur. Bone metastasis can cause pathological fractures, SC compression, hypercalcemia

Decreased Respiratory Function

Diagnostic Test; Biopsy General Consequences of Cancer Impaired Immune Function

Airway obstruction from tumors Impaired gas exchange Tumors may cause vascular or lymphatic obstruction, leading to PE and dyspnea

Most often affects those with leukemia and lymphoma, but can occur with any cancer that invades the bone marrow Tumor cells enter the bone marrow causing decreased production of health WBCs

Treatment Goals

Cure Control Palliative

Treatment Modalities

Impaired Hematopoietic Function

When cancer invades the bone marrow, clients also have a decreased number of RBCs and platelets. May be a result of the cancer or its treatments

Surgery Radiation Biologic response modifiers Chemotherapy

Surgical Intervention

Role of surgery

Altered GI Function

Prevention Diagnosis Staging

Can alter GI function and disturb clients nutritional status

Ex. obstruction from tumor, liver Impairment Treatment

Anorexia Interferes wit clients ability to meet energy requirements Altered taste sensations

Supportive interventions Reconstruction

Goals of Surgery

Cure Control Palliative Supportive Surgical Procedures

For a period of time, the client emits radiation and can pose a hazard to others

Nursing Considerations

Local excision Wide excision Debulking

Private room and bath Caution sign on door Wear dosimeter film badge Avoid if pregnant; under 16 years old Limit each visitor to 30 minutes per day and keep at least 6 ft from source Never touch the radioactive source with bare hands

Radiation Therapy

Side Effects

Purpose

Destroy malignant cells with minimal exposure of the normal cells to the celldamaging actions of the radiation.

Skin and hair changes Altered taste Fatigue Damage to normal tissues Long term effects

Goals

Chemotherapy

Cure Control Palliative

External Radiation (Teletherapy)

Instrumental in the treatment of cancer because the effect are exerted systemically and provide the opportunity to kill metastatic cancer cells that may escape local treatment. Systemic effect; affects healthy and cancerous cells Combination therapy is usually use

Radiation source is external to the client and remote from the tumor site Client never emits radiation and poses no hazard to anyone else Location is determined prior to therapy and exact positioning must be maintained

Administration Precautions

Know about the drug you are administering Vein selection Administer vesicant drugs first Monitor for extravasation

Internal Therapy (Brachytherapy)

Administration Precautions Consists of the implantation or insertion of radioactive materials directly into the tumor or in close proximity to the tumor Provides a high absorbed dose

Types of catheters

Right atrial catheters

PICC lines Implanted ports

Regional administration Intraarterial

Caused by stimulation of chemoreceptors trigger zones in the brain Primarily associated with chemotherapy Occurs during drug administration and for 1 -2 days afterward; some drugs up to 7 days Assessment of client Interventions

Intraperitoneal Intrathecal Immunotherapy: Biologic Response Modifiers

Mucositis

Defined as agents or approaches that modify the clients biologic responses to tumor cells with a beneficial result

Presence of sores in mucous membranes Clients undergoing chemo may have mucositis of the entire GI tract, esp the mouth Mucous membrane cells are killed more rapidly than they are replaced, resulting in the formation of sores

Stomatitis Three categories

Direct anti-tumor effects Restore, augment, or modulate immune system Biologic effects

Good, frequent oral hygiene Avoid trauma to mucosa Frequent rinsing with water or saline Avoid commercial mouthwashes

Nutrition Side Effects: BRMs

General symptoms of mild inflammatory reactions Fluid shifts and capillary leaks

Nursing Care of Clients Being Treated For Cancer Alopecia

Malnutrition can occur secondary to anorexia, altered taste sensation, nausea, diarrhea, stomatitis Malnutrition characterized by fat and muscle depletion Assessment Intervention

Pain Management

Temporary with chemo; permanent but localized in radiation therapy Interventions to reduce hair loss Interventions for altered body image

Nausea and Vomiting

Associated with some cancers and possible effects of treatment ALWAYS ask the patient if they are having pain Pharmaceutical interventions Oral route preferred NSAIDS, Opioids

Sexual Function

Sexual dysfunction may be manifested as temporary or permanent sterility, disruption in the menstrual cycle, temporary or permanent impotence, or chromosomal damage Use birth control during chemo and radiation and for up to 2 years after treatment

Monitor vital signs Assessment for sources of infection Prevent complications

Wound care Activity as tolerated

Bone Marrow Suppression

Avoid invasive lines Monitor WBCs Low bacteria diet No fresh flowers or potted plants in room

Results in decreased numbers of circulating leukocytes, erythrocytes, and platelets. Decreased leukocyte numbers cause immunosuppression Decreased erythrocytes and platelets cause hypoxia, fatigue, and increased bleeding tendency

Thrombocytopenia: Nursing Care

Handle client gently Use lift sheets when moving client Avoid injections and venipunctures Apply ice to areas of trauma Use an electric razor Avoid rectal trauma No rectal temps or enemas Assessment

urine and stool for occult blood IV sites

Avoid mouth trauma

soft-bristled toothbrush no flossing Immunosuppression: Nursing Care

Good handwashing Limit number of personnel entering room