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Tumors can be classified by anatomic site, histology, or by the extent of the disease

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Classification of Cancer

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Genetic Chemical Environmental Viral or immunologic

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Origin of cancer may be

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Avoid or reduce exposure to Cigarette smoke and excessive sun Eat a balanced diet Exercise regularly Obtain adequate rest Regular health examination

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how to reduce cancer risks

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are defective cellular Proliferation (growth) and Differentiation (specialization)

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Two major dysfunctions present in the cancer process are

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-Suppress growth of tumors but Mutations render them inactive -Protooncogenes: genetic locks that keep cells functioning normally Mutations that alter their expression can activate them to function as oncogenes (tumor-inducing)

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Tumor suppressor genes Protooncogenes

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-encapsulated, similar to parent cell Metastasis is absent,Rarely recur -Able to metastasize, Infiltrative and expansive growth, Frequent recurrence, Rarely encapsulated, less like parent cell

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Benign vs. Malignant

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Give clear explanations, repeat if necessary Give written information for reinforcement Actively listen to patient's concern

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dealing with fear and anxiety in newley diagnosed patients

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-When the focus of therapy is a cure: accomplished by surgery alone or periods of systemic therapy (chemo or radiation) -When the goal of therapy is to control the cancer there is an initial course of treatment followed by maintenance therapy (multiple myeloma) -goal of treatment is to relieve or control of symptoms & maintain quality of life

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Curative therapy control therapy palliation or palliative treatment

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Cell type Location and size of tumor Extent of disease Physiologic and psychological status of the patient Expressed needs and desires of the patient

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factors that determine the type of treatment

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Surgery can be used to prevent the occurrence or re-occurrence of cancer Surgery can be used to cure and control cancer When cure or control isn't possible, surgery can be used for support and palliation Surgery is Rehabilitative when it's done to improve acceptance and coping

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benefits of Surgery for cancer patients

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widely used treatment option that involves the use of chemicals as systemic therapy for cancer The goal is to decrease number of malignant cancer cells in tumor site(s) uneffective on cells in the resting cycle

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Chemotherapy

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Rapid mitotic (growth) rate, better response Smaller & younger the tumor, the greater the response Location of tumor:Only a few chemo drugs readily cross the blood-brain barrier Presence of resistant tumor cells (pass resistance to daughter cells, which continue to proliferate and remain resistant)

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factors that determine the response of cancer to chemo

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Because of the toxicity, always check the right: dose, drug, person, schedule, & route, with 2 nurses. IV (most common route of administration) problems: limited venous access and infection

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routes to administer chemotherapy

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chemo drugs are either irritants or vesicants when IV administration is used Irritants:Damages lining of vein, but doesn't cause surrounding tissue damage Vesicants: Causes severe local tissue breakdown and necrosis

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Irritant vs. vesicant

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Because chemo is so toxic, it is frequently administered via Central vascular access devices (VAD): a long term IV that is placed into a major vein Benefits: Decreased risk of infiltration and localized infection but an increased risk of systemic infection

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Central vascular access devices (VAD)

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Delivery of drug directly into tumor site Higher concentrations of drug can be delivered with less systemic toxicity

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Regional Administration

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Chemotherapeutic agents cannot distinguish between normal and cancer cells Body's response to products of cellular destruction: Fatigue, Anorexia, Taste alterations

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Chemotherapy Effects

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Acute toxicity: Occurs during and immediately after drug administration, such as N/V, allergic reactions, cardiac dysrhythmias Chronic toxicities: Involve long-term damage to organs: Heart, kidneys, liver, & the lungs Delayed effects: mucositis, alopecia, bone marrow suppression, delayed nausea and vomiting, skin rashes, altered bowel function, cumulative neurotoxicities

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how are side effects are classified

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Drugs given in combination Dosages are carefully calculated according to body surface area Selecting drugs with different modes of action minimizes occurrences and severity of adverse side effects

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chemotherapy treatment plan

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when 3 criteria are met: Tumor burden is low Therapy is not interrupted Pt receives the intended dosage

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when is chemo effective

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There are two different types of radiation: low & high-energy ....... Low-energy beams: Expend energy quickly & penetrate a short distance Useful for skin lesions High-energy beams: Greater depth of penetration, Used for internal targets while sparing skin The dose of radiation depends on Tumor size & type and Treatment settings

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types of radiation

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Radiation Therapy can be Delivered externally (teletherapy) or internally (brachytherapy) and can be used as a the:Primary therapy Adjuvant (along w/chemo) or neoadjuvant (use of chemo before radiation) Prophylaxis (preventative) Disease control Palliation (provide symptom relief)

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Radiation therapy

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only allow 30 min/ 8hrs exposure w/internal radiation Wear a lead shield for protection & a film badge to monitor exposure Patients need to be educated & prepared for time and distance restrictions on health care providers

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protection from internal radiation

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Allogeneic: Infused bone marrow acquired from donor matched to recipient Autologous: Patients receive their own stem cells Syngeneic: Stem cells are obtained from one identical twin and infused into other twin Identical twins

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Stem cell transplant types

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Assist in planning, transportation, nutrition, emotional support Teach symptom management to maintain quality of life Offer community resources

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how to assist the patient in coping with the side effects of treatment

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Bone marrow suppression Fatigue GI disturbances Integumentary (desquamation) and mucosal reactions Pulmonary effects Cardiovascular effects Reproductive effects

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side effects from chemotherapy and radiation

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Skin reactions: Desquamation (shedding of the outer layers of the skin) dry: should be lubricated with nonirritating lotion or solution wet: must be kept clean and protected from further damage (infection)

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intervention for Dry/wet desquamation

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Increased risk for leukemias and other secondary malignancies ex Multiple myeloma and Non-Hodgkin's lymphoma

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Late Effects of Radiation and Chemotherapy

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Fat and muscle depletion Altered taste sensation Supplement nutrition when 5% weight loss is noted Monitor albumin and prealbumin levels Enteral or parenteral nutrition may be required

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complications of cancer: Malnutrition

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primary cause of death in cancer patients Common sites of infection are the lungs, genitourinary tract system, mouth, rectum, peritoneal cavity, & the blood

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complications of cancer: infection

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Patient report should always be believed and accepted as primary source for assessment data Drug therapy should be used to control pain Non-pharmacologic interventions including relaxation therapy and imagery should be used

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Management of Cancer Pain

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Emphasis placed on maintaining optimal quality of life Positive attitude of patient, family, and health care providers can have a positive impact on the patient's quality of life May also influence prognosis

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Psychological Support

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Educate health care workers about needs of cancer survivors Teach survivors to look for late effects Promote healthy behaviors

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how can nurses can help cancer survivors

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:(1) defective cellular proliferation (growth) and (2) defective cellular differentiation.

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Two major dysfunctions present in the process of cancer are:

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__produce more than two cells at the time of mitosis.

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cancer cells divide indiscriminately and haphazardly and sometimes__

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__cells become capable of performing only specific functions.

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Through differentiation__

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__normal cellular genes that are important regulators of normal cellular processes that keep them in their mature, functioning state.

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Protooncogenes are__

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__they can begin to function as oncogenes (tumor-inducing genes).

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When protooncogenes are mutated__

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__benign or malignant.

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• Tumors can be classified as__

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__well-differentiated.

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o Benign neoplasms are __

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__well-differentiated to undifferentiated.

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o Malignant neoplasms range from__

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__initiation, promotion, and progression.

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• The stages of cancer include__

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__mutation in the cell's genetic structure resulting from an inherited mutation, an error that occurs during DNA replication, or following exposure to a chemical, radiation, or viral agent.

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o The first stage, initiation, is a __

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__the reversible proliferation of the altered cells.

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o Promotion, the second stage in the development of cancer, is characterized by __

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__increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (metastasis).

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o Progression, the final stage, is characterized by __

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__a multistep process in which tumor cells travel to distant sites via lymphatic and hematogenous routes.

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• Metastasis is __

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__lungs, bone, brain, liver, and adrenal glands.

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The most frequent sites of metastasis are __

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__the immune response that is mounted against cancer cells may be inadequate to effectively eradicate them.

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• Since cancer cells arise from normal human cells__

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__called tumor-associated antigens, as a result of malignant transformation.

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• Cancer cells may display altered cell surface antigens__

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__response of the immune system to tumor-associated antigens.

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Immunologic surveillance is __

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__immunologic escape.

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• The process by which cancer cells evade the immune system is termed __

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__anatomic site, histologic grading, and extent of disease (staging).

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• Tumors can be classified according to__

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__by the tissue of origin, the anatomic site, and the behavior of the tumor (i.e., benign or malignant).

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• In the anatomic classification of tumors, the tumor is identified by__

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__, the appearance of cells and the degree of differentiation are evaluated pathologically.

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• In histologic grading of tumors__

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__a description of the extent of the disease rather than on cell appearance.

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• The staging classification system is based on __

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__five stages, from in situ to metastasis.

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o The clinical staging classification system uses __

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__tumor size and invasiveness (T), presence or absence of regional spread to the lymph nodes (N), and metastasis to distant organ sites (M).

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o The TNM classification system uses three parameters__

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__the only definitive means of diagnosing cancer.

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o The biopsy procedure is __

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__cure, control, or palliation.

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• The goal of cancer treatment is __

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__ treatment is offered that is expected to have the greatest chance of disease eradication and may involve local therapy (i.e., surgery or radiation) alone or in combination with or without periods of adjunctive systemic therapy (i.e., chemotherapy).

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o When cure is the goal__

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__that cannot be completely eradicated but are responsive to anticancer therapies and can be maintained for long periods with therapy.

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o Control is the goal of the treatment plan for many cancers __

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__relief or control of symptoms and the maintenance of a satisfactory quality of life are the primary goals rather than cure or control of the disease process.

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o With palliation__

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__surgery, chemotherapy, radiation therapy, and biologic and targeted therapy.

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• Modalities for cancer treatment with all three goals include __

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__cell cycle phase-nonspecific and cell cycle phase-specific drugs.

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• The two major categories of chemotherapeutic drugs are__

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__on the cells during all phases of the cell cycle.

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o Cell cycle phase-nonspecific drugs have their effect__

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__during specific phases of the cell cycle.

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o Cell cycle phase-specific drugs exert their most significant effects __

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__intravenous, through central vascular access devices, peripherally inserted central venous catheters, or implanted infusion ports. The use of these means reduces the risk of extravasation.

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The most common delivery of chemotherapy is__

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__directly to the tumor site.

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• Regional treatment with chemotherapy involves the delivery of the drug __

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__intraarterial, intraperitoneal, intravesical bladder, and intrathecal or intraventricular.

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The most common methods of regional chemotherapy are__

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__the destruction of normal cells, especially those that are rapidly proliferating such as those in the bone marrow, lining of the gastrointestinal system, and the integumentary system (skin, hair, and nails).

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• Chemotherapy-induced side effects are the result of __

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__acute, delayed, or chronic

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• The general and drug-specific adverse effects of chemotherapy drugs are classified as__

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__the most common form of radiation treatment delivery. With this technique, the patient is exposed to radiation from a megavoltage treatment machine.

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• Teletherapy or external beam radiation is __

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__the implantation or insertion of radioactive materials directly into the tumor (interstitial) or in close proximity adjacent to the tumor (intracavitary or intraluminal).

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• Brachytherapy, or internal radiation treatment, consists of __

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__one of the most common effects of chemotherapy and, to a lesser extent, with radiation. It can result in life-threatening effects, including infection and hemorrhage.

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o Myelosuppression is __

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__affecting 70% to 100% of patients with cancer.

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o Fatigue is a nearly universal symptom __

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__the most sensitive tissues to radiation and chemotherapy. These injuries result in diarrhea, mucositis, anorexia, nausea, and vomiting.

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o The intestinal mucosa is one of__

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__long-term sequelae months to years after the cessation of therapy that can affect every body system.

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• Chemotherapy and radiation can produce __

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__secondary malignancies, such as leukemia, angiosarcoma, and skin cancer.

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• The cancer survivor is at risk for developing __

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__agents that modify the relationship between the host and the tumor by altering the biologic response of the host to the tumor cells

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• Biologic therapy consists of __

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__interferes with cancer growth by targeting specific cellular receptors and pathways that are important in tumor growth.

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• Targeted therapy__

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__biologic therapy

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• Bone marrow depression and fatigue are associated with __

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__is when the number and size of the pores in the capillaries increases, causing leaking into tissue.

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Capillary leak syndrome __

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