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cancer nursing role

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prevention and early detection

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cancer facts

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Certain cancers are more common today because of longer life expectancies and environmental factors. A cancer cell is only a health threat if it can divide Widespread metastatic disease can develop from one cancer cell The smallest detectable tumor is about 1cm in diameter and contains 1 billion cells.

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benign tumor cells

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normal cells growing in the wrong place or at the wrong time (moles, uterine fibroid tumors, skin tags, endometriosis, and nasal polyps)

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malignant tumor cells

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cancer cells divide nearly continuously, have an unlimited life span, migrate easily through blood vessels and tissue

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carcinogenesis and what it depends on

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Exposure to carcinogens When a normal cell is exposed to any carcinogen (initiator), the normal cell's DNA can be damaged or undergo mutation Immune function Genetic predisposition

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carcinogens definition

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substances that change the activity of a cell's genes so that the cell becomes a cancer cell

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chemical carcinogens

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DNA damage occurs) - tobacco and ETOH (preventable carcinogenesis)

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physical carcinogens

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DNA damage occurs)- radiation (ionizing and ultraviolet) and chronic irritation; Ionizing radiation - found naturally (rocks and soil) and also x-rays; UV radiation - from the sun, tanning beds, and germicidal lights (do not penetrate deeply, therefore, cause skin cancers) Chronic irritation - undergo frequent cell division and are at increased risk for spontaneous DNA mutation (GERD)

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viral carcinogens

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viruses infect cells and break the DNA chain and insert their own genetic material into the human DNA chain, mutating the normal cell's DNA

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4 steps to normal to cancer

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Initiation (carcinogens) Promotion (hormones, drugs, or a wide variety of chemicals) Progression (develop own blood supply) Metastasis

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cancer risk factors

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Age, genetic predisposition, immune function, exposure to carcinogens (chemical, physical, viral), diet (↑in fat, red meat, and ↓in fiber), sexual lifestyle (multiple partners, STDs, HIV/AIDS), poverty, obesity, and chronic GERD

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metastasis definition

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cancer cells move from the primary location by breaking off by local seeding - shedding of cancer cells in the local area of the primary tumor.

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bloodborne mets

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most common) tumor cells release into the blood

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lymphatic mets

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primary sites that are rich in lymphatics have earlier metastatic spread

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cancer grading

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classifies cellular aspects of the cancer Lowest rating given to those cells that closely resemble normal cells Highest rating given to cancer cells that barely resemble normal cells Aggressive, and spread rapidly

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cancer staging

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classifies clinical aspects of the cancer Determines the exact location of the cancer and its degree of metastasis Cancer stage also influences the selection of therapy TNM (tumor, node, metastasis) system to describe the anatomic extent of cancers

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genetic risk

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- proto-oncogenes, precursors of oncogenes, are passed on from generation to generation Genetic Predisposition -BRCA-1 and BRCA-2 gene Ethnicity and Genetic Predisposition but also Behavior and Socioeconomic factors

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CAUTION warning signs

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C A U T I O Nagging cough or hoarsness

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personal factors that contribute to cancer

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Exposure to carcinogens Immune function - protects the body from foreign invaders and non-self cells (ex. - cancer cells); Cell-mediated immunity protects against cancer Older adults, transplant patients, HIV/AIDS Age - lifelong accumulation of DNA mutations Advanced age is the single most important risk factor for cancer.

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cancer primary prevention

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strategies to prevent the actual occurrence of cancer; example = mastectomy Chemoprevention - prevention of cancer development; example = Tamoxifen post breast cancer

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secondary prevention

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the use of screening strategies to detect cancer early; does not reduce the incidence but may reduce cancer deaths

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types of prevention

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Sunscreen- primary Colonoscopy Skin inspection PSA/DRE Smoking cessation class- primary Mammogram

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cancer interventions (4)

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Surgery Radiation Chemotherapy Alternative Therapies

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disease related consequences

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Cancer destroys normal tissue, decreasing function in that tissue or organ Cancer in nonvital tissues or organs may lead to death by metastasizing into vital organs Untreated cancer may lead to: Impaired Immune and Hematopoietic Function

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Impaired Immune and Hematopoietic Function

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Leukemia, Lymphoma, or any cancer that invades the bone marrow Reduces the production of healthy WBCs, RBCs, and platelets May be caused by the cancer or the treatment

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altered GI structure and function

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Obstruct or compress reducing ability to absorb nutrients or eliminate wastes Increase metabolic rate and the need for protein, carbohydrates, and fat Liver Cancer - reduced function leads to malnutrition and death Anorexia/Cachexia Nursing Implications : ask about appetite, taste, difficulty eating, swallowing, indigestion, bowel elimination

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motor and sensory deficits

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Bone and Brain Ca or when compression of nerves occurs Bone metastases can cause fractures, spinal cord compression, which reduces mobility; and hypercalcemia Sensory changes -spinal cord damaged by tumor pressure or if nerves are compressed Brain Ca- sensory, motor, and cognitive functions are severely impaired Pain may accompany cancer Nursing Implications : PT, OT, analgesics, limit activity, monitor Ca level, warn about cold and heat with sensory impairment

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decreased respiratory function

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Tumors in the airway cause obstruction Lung Ca - lung capacity is decreased Pulmonary edema and dyspnea - when tumors press on blood and lymph vessels, blocking blood flow Nursing Implications : oxygen, rest periods, diuretics

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treatment related consequences

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Treatment prolongs survival time and improves quality of life Treatment depends upon specific type of cancer, whether metastasis has occurred, and the health of the patient Surgery Radiation (XRT) Chemotherapy Hormonal Manipulation Immunotherapy Gene Therapy Targeted Therapy

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surgery types for cancer

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Prophylaxis - removal of benign mole, mastectomy, hysterectomy Diagnosis - (needle, incisional, excisional, and staging) - proof of cancer Biopsy - definitive diagnosis; tumor marker assays (CEA, CA 125, AFP, PSA) screen for certain cancers Cure - all visible and microscopic tumor is removed Control - debulking - removing part of the tumor to decrease the number of cancer cells; increases the chances that other therapies can be successful Palliation - improve QOL during the survival time, relieve pain, obstruction, or difficulty swallowing Second Look - assess the disease status; no symptoms of tumor; determines whether a specific therapy should be continued or discontinued Reconstructive - increases function and/or enhances appearance (breast reconstruction, revision of scars) Nursing implications : loss of a body part, scarring, disfigurement; anxiety and grieving

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radiation purpose and types

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Purpose - to destroy cancer cells with minimal exposure of the normal cells to the damaging actions of radiation Cells die or else are unable to divide Dose is determined by: the size and location of the tumor, XRT sensitivity of the tumor, and surrounding normal tissues XRT delivery Teletherapy Brachytherapy

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Teletherapy (beam XRT)

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means distant treatment; external radiation; client not radioactive and poses no hazard to anyone

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Brachytherapy

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short or close therapy; uses radioactive isotopes; XRT source comes into direct and continuous contact; provides a high dose of XRT in tumor tissues and limited dose in surrounding normal tissues (same tissue effects as teletherapy); XRT source is within the client, therefore the client emits XRT for a period of time and is a hazard to others

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radiation side effects

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Limited to tissue exposed to XRT Normal tissue most sensitive to external XRT are bone marrow cells, skin mucous membranes, hair follicles, and gonadal (reproductive) tissues; some changes are permanent Systemic side effects from external beam XRT - fatigue (may be debilitating) and altered taste sensation XRT damage to normal tissue starts the inflammatory process that causes tissue fibrosis and scarring (uterine XRT may affect the colon years later) Nursing Implications : anxiety, skin care, reproductive issues

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chemotherapy points

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Used to cure and to increase survival time Systemic effects - useful at killing metastatic cancer cells (also kills normal cells) Damages DNA and interferes with cell division The tumors that are most sensitive are the ones that have a rapid growth Those that divide rapidly - Skin, hair, intestinal tissues, spermatocytes, and blood forming cells Given on a regular basis and are timed to maximize cancer cell kill and minimize damage to normal cells (every 3-4 weeks for 6-12 times

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extravasation and vesicant definition

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Many routes for chemo administration - Usually IV Intracavitary - Intraperitoneal - ovarian; Intrathecal - brain (describes the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord, drugs can be injected into the fluid); Intravesical - bladder Extravasation - drug leaks into the surrounding tissue Vesicant - chemicals that cause tissue damage

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chemo SE/nursing implications

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Alopecia - may be whole body, temporary, regrowth begins 1 month after chemotherapy completed; new hair may differ in color, thickness, and texture N/V - watch out for dehydration and electrolyte imbalance Mucositis/Stomatitis - interferes with eating; mouth assessment, oral hygiene, soft-bristled toothbrushes, avoid alcohol based mouthwashes; swish and spit with a local anesthetic Life threatening - Bone marrow suppression (pancytopenia) -biologic response modifiers (BRMs) stimulate bone marrow production of immune system cells, reducing the risk of infection, good hand washing, and aseptic technique

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hormone antagonist

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Bind to a specific hormone receptor; if a tumor needs a certain hormone to grow and the hormone can enter or activate the cell only thru a receptor, hormone antagonists can slow down tumor growth

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hormone inhibitor

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New class of drugs used for hormonal therapy with breast cancer to reduce estrogen levels by inhibiting aromatase an enzyme that leads to the production of estrogen

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hormonal manipulation side effects

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Masculinizing effects in women (antiestrogen) Feminine manifestations in men (antiandrogen) Nursing Implications : education, body image

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immunotherapy

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Biologic Response Modifiers (BRMs) Cancer Treatment Stimulate the immune system to recognize cancer cells and take action to eliminate or destroy the cells Cancer Support Induce more rapid recovery of the bone marrow after suppression by chemotherapy Less risk for infection Can tolerate appropriate dose of chemotherapy Nursing Implications : flu like symptoms, skin rashes, dryness, itching, and peeling

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oncologic emergencies

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sepsis DIC Superior vena cava syndrome Syndrome of Inappropriate Antidiuretic hormone Spinal cord compression Hypercalcemia Tumor lysis syndrome

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sepsis

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Increased risk for infection because of neutropenia

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DIC

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Triggered by Ca; caused by sepsis, by the release of thrombin or thromboplastin from Ca cells , abnormal extensive clotting occurs thru out the small blood vessels, using up the existing clotting factors and platelets, followed by extensive bleeding Treatment plan - prevention of sepsis

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superior vena cava syndrom

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Compressed or obstructed by tumor growth (lymphomas and lung cancer); Treatment - high dose XRT, stent or angioplasty vena cava

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SIADH

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Ca is the most common cause, some tumors actually make and secrete ADH and some stimulate the brain to make and secrete ADH; water is reabsorbed to excess by the kidney and put into systemic circulation leading to hyponatremia (muscle cramps to seizures, coma, and death); Treatment - restrict water and increase Na

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spinal cord compression

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Tumor enters the spinal column or when the vertebrae collapse from tumor degradation of the bone (back pain, numbness, tingling, paralysis) Treatment - palliative - steroids, XRT, and surgery

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hypercalcemia

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Bone metastasis - cancer in bone causes the bone to release Ca+ into the bloodstream; some tumors secrete parathyroid hormone, causing bone to release Ca+ (muscle weakness, loss of DTRs, ECG changes) Treatment: oral hydration, NS, drugs to lower serum Ca+, and dialysis

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tumor lysis syndrome

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Large #s of tumor cells are destroyed rapidly, their intracellular contents (K+ and purines) are released into the bloodstream (hyperkalemia and acute renal failure due to uric acid build up) Treatment: hydration to dilute K+ and increase GFR

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benign breast disorders

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Fibroadenoma Fibrocystic Breast Disease Supportive measures - mild analgesics, limit salt intake before menses (decrease swelling); well padded support bra; ice or heat; and promote BSE Ductal Ectasia Difficult to distinguish from breast cancer Intraductal Papilloma R/O breast Ca Nursing Implications : fear, anxiety - emotional support Large - Breasted Women Fungal infections under their breasts; backaches Small - Breasted Women Breast augmentation - CBE and BSE can be easily performed because the prosthesis is behind the breast tissue; mammogram may be somewhat more uncomfortable Gynecomastia Symptom not a disease; evaluate for breast Ca Nursing Implications:

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breast cancer facts

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Most commonly diagnosed invasive cancer in women and second only to lung cancer as a cause of cancer deaths` Early diagnosis to reduce mortality Primary risk factor - advancing age 25 y.o. - 1 in 20,000 75 y.o. - 1 in 11 5% of breast cancers are hereditary BRCA1 and BRCA2 gene mutations - 40-89% risk for developing breast cancer

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breast cancer health promotion

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BSE Barriers Psychological factors Knowledge Confidence CBE Barriers Psychological factors Fear of results Knowledge Mammography Barriers Cost and access Fear of XRT Fear of results Concern about pain Knowledge

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high risk women

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Cancer Surveillance Patient preference Surveillance - screening for cancer BSE, CBE, and Mammogram - start earlier and more frequent Prophylactic Mastectomy Chemoprevention Nursing Implications :

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