Oncology Nursing Cancer, any of more than 100 diseases characterized by excessive, uncontrolled growth of abnormal cells, which

invade and destroy other tissues. Cancer develops in almost any organ or tissue of the body, but certain types of cancer are more lethal than others. Most type of cancer are more common in people over 50 years old Cancer are usually develop gradually over many years Causes of cancer is not known Certain lifestyle lowers the risk of developing cancer such as : Bot smoking, eating a healthy diet and exercise- reduce the risk by more than 60 % Diet low in fat and high in fiber

For reasons not well understood, cancer rates vary by: Gender: male develops more cancer than females Race: African American develop more cancer than any other ethnic group in USA Geographic region: people living in USA are three times likely to develop than those living in Egypt. Cancer may be a result of: Environmental: work related exposure to chemical or industrial carcinogens Nutritional: high fat and low fibre in diet (colorectal camcer) Behavioural: weak personality Hereditary factor: families with history of cancer 4 basic underlying cause of health problems: 1. Cellular aberration: deviation the structure and growth of the cell 2. Break in the body defences and barrier: health problems arises when the there is a disruption or damage in the first line of body defences caused by inflammation and wounds. 3. physical-chemical insult: illness occurs when there is an alteration in the normal body functioning or direct injury to the tissue and organs.

4. Degenerative process: health problems arise when there is an inadequate supply of nutritive materials or stimulation. An absence of physical neural stimulation. Examples: DM, BURNS, OPEN FRACTURE, PARALYSIS, DIARRHEA, ISCHEMIA, VEHECULAR ACCIDENT, CVA, LYMPHOMA, ELECTROLYTE IMBALANCE, FALL. CELL STRUCTURE AND FUNCTION: 1. CELL MEMBRANE- every cell is enclosed in a membrane. The membrane is a double layer of lipids (lipid bilayer) but id made quite complex by the presence of numerous proteins that are important to cell activity. These proteins include receptors, pores, and enzymes. The membrane is responsible for the controlled entry and exit of ions like Sodium, Potassium, and Calcium. 2. Cytosol- the cytosol (cytoplasm) is the soup within which all other cell organelles reside and where most of the cellular metabolism occurs. Though mostly of water, the cytosol is full of proteins that control cell metabolism including signal transduction pathways, glycolysis intracellular receptors, and transcription factors. 3. Endoplasmic Reticulum- responsible for the reproduction of hormones and other secretory product, is a vast amount of membrane called endoplasmic reticulum or ER for short . Some areas of the endoplasmic reticulum look smooth and some appear rough. The rough ER appears rough due to the presence of the ribosomes on the membrane surface. Smooth and rough ER have different functions . Smooth ER is important in the synthesis of lipids and membrane proteins. Rough ER is important in the synthesis of other proteins. 4. Mitochondria- provide the energy a cell needs to move, divide, produce secretory products, in contract- they are the power centers of the cell. 5. Golgi complex- proteins to be exported are passed to the golgi apparatus, sometimes called a Golgi body or golgi complex, for further processing, packaging, and transport to a variety of other cellular locations. 6. Lysosomes- contain hydrolytic enzymes that are necessary for intracellular digestion. Often referred to as the garbage disposal system of the cell. 7. Ribosomes- the ribosome is a large complex composed of many molecules, including RNAs and proteins and are responsible for processing the genetic instructions carried by Mrna 8. centoromes- also called the microtubule organizing center is an area in the cell where the microtubules are produced. 9. Nucleus- The most obvious organelle in any eukaryotic cell. It is a membrane-bound organelle and is surrounded by a double membrane. It communicates with the surrounding cytosol via numerous nuclear pores. Within the nucleus is the DNA responsible for providing the cell with its unique characteristics

10. DNA- genetic key to life. Deoxyribose in nuclei that is an acid. Deoxyribose is a sugar that is not sweet. 11. Genes- units or parts of chromosomes that determine the character and activities of cells and transmit inherited traits. Is a segment of DNA molecules consisting of chain about 1000 pairs of nucleotide joined in a precise sequence. 12. Chromosomes- small bodies found in nuclei of cells.

Nucleotides Purine base: thymine-adenine ( obligatory base pair or the Watson-crick base pairing scheme) Pyramidine base: guanine- cytosine (obligatory base pair) Normal human body: 46 chromosomes/ 23 pairs 22 pairs autosomes ,1 pair of sex chromosomes Trisomy 21- Downs syndrome/ mongolism ( 47 chromosomes) Trisomy 13/ Trisomy D - Pataus syndrome (extra chromosome in the 13th-15th pair). Characterized by cleft lip and palate, microcephaly, abnormality in the forehead, nose and eyes, polydactyly, mental disturbance Trisomy 18/ Trisomy E Edwards syndrome. Occurs in children with parents 30 years old. Low birth weight, abnormality in the face with low seat malformed ears, heart defects, mental disturbance. Klinefelters syndrome (male hypogonadism ) extra chromosomes at the sex chromosome. Characterized by sterility on attaining adulthood. Enlarged breast. CELL DIVISION -is a process by which a cell , called the parent cell divides inbto two or more cells, called daughter cells. - is usually a small segment of a larger cell cycle . this type of cell division is known s mitosis and leaves the daughter cell capable of dividing again. Mitosis- is the process by which the diploid nucleus (having two sets of homologous chromosmes) of a somatic cell divides to produce two daughter nuclei, both of which are still diploid. -vital for growth -repair -replacement for worn out cells

-asexual reproduction -the daughter cell produces same number of chromosomes from the parent cell. Diploid cells. Phases: Interphase- this is the longest period of the complete cell cycle during which the DNA replicates, the centioles divide and proteins are active produced.. Prophase- during this first mitotic stage, the nucleolus fades and the chromatin ( replicated DNA and associated proteins) condenses into chromosomes. Each replicated chromosomes comprises two chromatids. Both with the same genetic information. Microtubules of the cytoskeleton, responsible for cell shape, motility and attachment to other cells during interphase. Disassemble. And the building blocks of these microtubules are use to glow the mitotic spindle from the region of the centrioles.. Metaphase- tension applied by the spindle fibers aligns all chromosomes in one plnae at the cneter of the cell. Anaphase- spindle fibers are shortened and kinectichores repartee, and the chromosomes in one plane at the center of the cell. Telophase- the daughter chromosomes arrive at the poles and the spindle fibers that have pulled them apart disappear. Cytokinese- the spindle fibers are attach to chromosomes begin breaking down until only that portion of overlaps is left. It is in the region that a contractile ring cleaves the cell into two daughter cells. Microtubules then organize into a new cytoskeleton for the return to interphase. . the division of the cytoplasm. Meiosis- specialized type of a cell division that occurs during the formation of gametes. A cell division that occurs only in the primitive sex cells during the process of their becoming matured sex cells. The process by which the diploid nucleus ( having two sets of homologous chromosomes) of a somatic cell divides to produce two daughter nuclei, both of which are still diploid. Phases: meisos 1- refers to the first two division and is often called the reduction division. It is here that the chromosomes complement is reduced from diploid to haploid. Primary sex cells simply a mitotic division of each of the haploid cells produced in meiosis. Meiosis 2- is quite simply a mitotic division of each of the haploid cells produced in meiosis 1. Comparison between mitosis and meiosis: Mitosis - occurs in any of the cells of the body except for sex cells. -Daughter cell has the same numbers of chromosmes with parent cell diploid.

Meiosis occurs only in the formation of sex cells -The daughter cell have half the number of chromosmes with the parent cell (haploid)

PATTERN OF CELL GROWTH 1. Hyperplasia an increase in the number of cells of a tissue - proliferative process during the period of rapid growth and epithelial and bone marrow regeneration. 2. Metaplasia - when the matureceklls is converted to another type by means of outside stimulus ( irritation, inflammation, chemical exposure) - eventually this may progress to dysplasia. 3. Dysplasia - bizarre cell growth resulting in the cells that deiffer in sixe, shape or arrangement from other celss - result from the continuous environmental stimulation 4. Anaplasia - is a lower degree of differentiation of dysplastic cell -they are poorly differentiated , irregularly shaped and disorganized. -they are nearly always malignant 5. Neoplasia - uncontrollable cell growth that follows no physiologic demand -could either be benign or malignant ONCOLOGY NURSING Is an area of practise that covers all age groups, and nursing specialties and is carried out In a variety of health care setting, including the home, community, avcute care institutions and rehabilitation center.

In order to accomplish the desired outcomes the nurses provides realistic care using the NCP as the basis of her care. PHYSICAL EMOTIONAL SOCAIL CULTURAL SPIRITUAL UPHEAVALS TO SUPPORT THE PATIENT AND HIS FAMILY

Cancer

- is not a single disease with a single cause but rather it is a group of distinct diseases with a different causes, manifestation, treatment, and prognosis -is a disease process that begins when the abnormal cells arise from the normal body cells as a result of some poorly understood mechanism of change. - characterized by excessive, uncontrolled growth of abnormal cells, which onvade and destroy other tissue

DEFINITIONS OF TERMS: ONCOLOGY -scince of tumor - substance that stimulates tumor formation, such as cigarette smoking

ONCOGENIC/ CARCINOGENIC ONCOGENE MUTATION

- a gene possessing the ability to promote growth of a malignant tumor. - a change in the characteristics of an animal or other organism as a result of changes in genes and hereditary factors - more presice technical term for tumor and new growth

NEOPLASM

TUMOR/ NEOPLASM - is a mass of a new tissue that persist and grows unrestrained by normal limits of growth. Little similarity to the cells of origin/ closely resembles their own cells. Could either be: Benign tumors : non cancerous/ non malignant : expansive- cells growth from their centers and push tissue aside without invading them

Malignant tumors: dangerous to life and cancerous Infiltrative if the exterior of the cells grows into adjacent tissues creating death and destruction

Benign tumors 1. grows slowly and is often limited 2. is encapsulated 3. does not infiltrated adjacent tissue and remains localized 4. reproduces its parents tissue well 5. discloses few and regular mitosis 6. does not recur after removal 7.does not result in the clients death 8. movable

Malignant tumors Grows rapidly and is usually limited in size Is not capsulated Infiltrates adjacent tissue and spreads to distant ones Does not reproduce its parent tissue well Disclose many and often irregular mitosis Tends to reoccur after removal Results in clients death by sapping his strength or interfering with the vital functions immovable

BENIGN NEOPLASM: primarily localized growth. These cells grows in such manner that they tend to push normal cells surrounding them. Therefore these cells are encapsulated. Examples: 1. PAPILLOMAS- Arise from epithelial tissue and are cauliflower- like projections that erupts form skin or mucuos membranes. Hard papillomas (warts)- Verruca Vulgaris Polyps are growths that projects from mucuous membrane but do not arise from epithelium 2. ADENOMAS- glandular tumors and maybe noted in relation to prostate or breast Cystadenoma- is a tumor become a cyst , commonly found in the breast and vary, contain thick, viscid fluid or clear, thin fluid 3. FIBROMAS- composed of fibrous connective tissues and invades skin and mucous membrane. 4. LIPOMAS are large but not serious tumor masses, found in butocks, shoulders, a neck 5. MYOMAS muscle tumors affecting smoothe muscles such as uterus, termed as LEIOMYOMA. Leiomyosarcoma-,alignant tumot 6. PIGMENTED NEVI- are small, drak spots that occur on the face and in the neck. They may be covered with coarse hair. Nevi means mole or birthmark

MALIGNANT NEOPLASM-grows more rapidly than benign -difficult to separate malignant neoplasm from their surrounding tissues -has a particular property thata makes it truly life threatening -has the ability to metastasize to other parts of the body METASTASIS Cells can break away from the parent tumor ( primary tumor) Enters circulation and floats everywhere (when the cells lodge) they form and obtain blood supply and commence proliferation at the new site (secondary tumor) METASTASIS ( floating and growing in the new location) FUNCTIONAL QUALITIES (MALIGNANT TUMOR) 1. invasion 2. formation of metastasis Examples: 1. Gliomas arise from the supporting tissue of CNS( brain and retina) 2. Neoroblastomas composed of undeveloped nerve celss commonly found in children olny 3. Malignant melanomas associated with pigmented nerve of the skin. Moles that are quiescent through life becomes more active, spreads to lungs, kidneys, and other organs. 4. Malignat lymphomas made up of lymphoid cells that occurs in the spleen and bowel and lymph nodes. Three main types of cancer : 1. epithelial cells t. (Carcinoma) skin, lungs, stomach, and blood vessels -90% 2. Connective cells T. (sarcoma) muscle , bones, cartilages and fats- 2% 3. Blood cells (leukemia) and lymphatic system( lymphoma) -8%

Factors affecting the development of cancer 1. cigarette smoking -smoking is responsible for 87% og lung CA and about 30%of all CA deaths. -those who smoke 2 or more packs a day have lung CA moratality rate 15-25 times greater than non smoker -secondhand smoke causes 300 deths from lung CA 2. nutrition -risk or colon CA, breast, uterine, -CA increases risk in obese people high fat dites may contribute to development of breast, colon and prostate -hihg fiber foods help reduce risk -vit.a and c reduces risk for CA in larynx, esophagus, stomach and lungs 3. Sunlight -almost all of more than 800 causes of non melanoma skin cancer developed each year in US -sun exposure is also a major factor in the development of melanoma and the incidence increase in the people wjo live near the equator 4. alcohol -oral CA and cancers in the larynx, throat, esophagus, and liver occur more frequently among heavy drinkers of alcohol 5. smokeless Tobacco -use of chewing tobacco or snuff increases risk for cancer in the mouth, larynx., throat, an esophagus 6. radiation -excessive exposure to ionizing radiation can increase the risk for cancer. Excessive radon exposure 7. occupational hazards

- exposure to a number of industrial agents (nickel, chromate,asbestos,vinyl chloride) increases the risk of various cancers. Cancer develops on exposed extremities and its incidence correlates with the amount of exposure.