Breast cancer

Breast cancer is a kind of cancer that develops from breast cells. Breast cancer usually starts off in the inner lining of milk ducts or the lobules that supply them with milk. A malignant tumor can spread to other parts of the body. A breast cancer that started off in the lobules is known as lobular carcinoma, while one that developed from the ducts is called ductal carcinoma.

Predisposing factors Menarche at age <11 Menopause >50 Family history of breast cancer Nulliparity or birth of first child after 30 Hx of uterine cancer Presence of benign breast mass Obesity, DM, HPN Staging Stage 1: tumor size is up to 2cm Stage 2: up to 5cm axillary lymph node involvement Stage 3: >5cm axillary + neck lymph Stage 4: metastasis Prevention BSE >18 y/o monthly Clinical BSE annually Mammogram >18 y/o annually

Assessments Firm, nontender fixed mass Solitary, irregularly shaped mass Nipple periphery involvement Retraction of nipple, dimpling Abnormal discharge from nipple Management: Radio/chemotherapy Surgery Lumpectomy Simple mastectomy Modified radical mastectomy Radical mastectomy

Pathophysiology Etiology (unknown) Somatic mutations in the DNA Activate oncogene/deactivate tumor suppressor gene Malignant transformation of lymphoid stem cells Uncontrolled proliferation of lymphoblast in the bone marrow Lymphoblast replace the normal marrow elements s/sx such as decreased production of normal blood cells

Medications Anti estrogen- competed with estrogen in binding sites in target tissues, such as in the breast Anthracyclines- chemically similar to an antibiotic. Damage the genetic material of the cancer cells which make the cell die. Taxanes- interfere with the way cancer cells divide. Nursing management Psychological support Arm exercises Wound suction drainage DBCT

Monitoring tissue drainage, bleeding Post mastectomy exercises BSE on remaining breast.

Colorectal cancer
Colorectal cancer is commonly termed bowel cancer. It usually begins in the large intestine and, depending on its starting point, colorectal cancer is sometimes called colon cancer or rectal cancer.

Risk factors

>40 y/o Low fiber diet High in fat, protein and refined carbohydrates Obesity Hx of chronic constipation Hx of IBD Polyposis or colon polyps Family hx of colon cancer Assessments: Anemia, anorexia and wt loss Abd pain Palpable mass Occult blood/rectal bleeding Constipation/ diarrhea Pencil of ribbon shaped stool Tenesmus Sensation of incomplete bowel emptying Diagnosis Stool occult blood (+) CEA: (+) Colonoscopy Proctosigmoidoscopy Barium enema Management Surgery Hemicolectomy for ascending and transverse colon cancer Abdomino-perineal resection (APR) for rectosigmoid cancer Radiation therapy Chemotherapy Fluorouracil is the most effective drug for colorectal cancer Pathophysiology Predisposing factors Formation of polyps (intramucosal epithelial lesion) Cancer grows Cancer invades the muscularis mucosa, lymphatic structures, and vascular structures and involve regional lymph nodes and adjacent structures &distant sites

Colorectal cancer

Medications Chemotherapy is also used to improve symptoms and prolong survival in patients with stage IV colon cancer. Irinotecan, oxaliplatin, capecitabine, and 5-fluorouracil are the three most commonly used drugs. Monoclonal antibodies, including cetuximab (Erbitux), panitumumab (Vectibix), bevacizumab (Avastin), and other drugs have been used alone or in combination with chemotherapy Nursing management Psychological conditioning Mgt of bowel function Mgt of nausea and vomiting Nutritional management; increase fiber Provide teaching on radiation and chemotherapy

Lung cancer
Lung cancer is the uncontrolled growth of abnormal cells in one or both lungs. These abnormal cells do not carry out the functions of normal lung cells and do not develop into healthy lung tissue. As they grow, the abnormal cells can form tumors and interfere with the functioning of the lung, which provides oxygen to the body via the blood.

Predisposing factors Cigarette smoking Pollution, asbestos Infections Pulmonary disorders Genetics Assessments: Persistent cough Dyspnea Bloody sputum/ hemoptysis Long-term pulmonary infection Chest pain Chills, fever, fatigue Atelectasis Bronchiectasis Diagnosis Chest x-ray Cancer markers CT-Scan/ MRI

Prevention Avoid smoking, pollution Annual chest x-ray Pathophysiology Predisposing factors Transformation of a single epithelial cell in the tracheobronchial airways Attachment of a carcinogen into a cells DNA causing damage Cellular changes, abnormal cell growth, and eventually a malignant cell Passing of damaged daughter cells causing further changes and become unstable Pulmonary epithelium undergoes malignant transformation eventually invasive carcinoma Medical Management Surgery- lobectomy or bilobectomy Radio/chemotherapy Medications Expectorants and antimicrobial agents to relieve dyspnea and infection. Analgesics given regularly to maintain pain at tolerable level. Titrate dosages to achieve pain control. Chemotherapy using cisplatin in combination with a variety of other agents and immunotherapy treatments may be indicated. Nursing intervention Supportive care to the pt undergoing surgery Provide relief/control of pain Administer medication as ordered Control nausea Provide teaching on radiation therapy and chemotherapy

Ovarian cancer
Cancer that forms in tissues of the ovary (one of a pair of female reproductive glands in which the ova, or eggs, are formed). Most ovarian cancers are either ovarian epithelial carcinomas (cancer that begins in the cells on the surface of the ovary) or malignant germ cell tumors (cancer that begins in egg cells)

Predisposing factors Unknown cause Often discovered late Over 50-70 years of age nulliparity, celibacy, infertility, long hx of menstrual irregularity

 Hx of breast, endometrial & ovarian cancer fat diet exposure to industrial chemicals such as asbestos and talc. Assessments: No early manifestation abdominal or pelvic pain feeling of fullness, bleeding palpable mass in the abd. persistent GIT complaints Ascites urinary frequency weight loss Pathophysiology Cellular shedding into the peritonealcavity Implantation on the peritoneal surface Tumor cells may block diaphragmaticlymphatics impairment of lymphatic drainage Development of ascites Local invasion on the bowel and bladder Signs and symptoms of ovarian cancer Management: Surgery: Salpingo-oophorectomy TAHBSO Radiation therapy: Intracavity radiation external beam radiation Chemotherapy: chlorambucil or melphalan. Doxorubicin, methotrexate, cyclophosphamide, 5FU, vinblastine, bleomycin, cisplatin. Medications: Chemotherapy agents (eg, cisplatin, carboplatin, paclitaxel, liposomal doxorubicin)

Antineoplastic agents (eg, etoposide, topotecan, gemcitabine, docetaxel, vinorelbine, ifosfamide, fluorouracil, melphalan, altretamine) Cytoprotective agents (eg, mesna) Antiemetics (eg, ondansetron, granisetron, palonosetron, dexamethasone) Nursing Intervention Manage dyspepsia, indigestion, flatulence, anorexia, N&V Dietary supplements I&O; fluid balance Inspect urine for bleeding Catheterize only as necessary Diagnostic tests physical exam, a pelvic exam, lab tests, ultrasound, or a biopsy blood test for elevated levels of a protein called CA-125. Imaging tests, such as ultrasound or CT scans (seen here), can help reveal an ovarian mass

Bladder Cancer
Bladder cancer refers to any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder.

Assessments:

1) Blood in urine. Bloody urine mostly occurs as intermittent or throughout the whole process of disease.. 2) Irritation of bladder. A patient would present the symptoms of frequency and urgency of micturition if a malignancy occurs in trigonum vesicae, or the lesion spreads or infection happens. 3) Urinary obstruction. The bigger tumors located in vesicae cervix and blood clots can arouse dribble urination or even urine retention. Tumor infiltration in ureterostoma causing blockage in upper urinary tract would develop lumbar pain, hydronephrosis and damage of kidney functions. 4) Metastases. Pains in bladder, urethrovaginal fistula, edema in lower extremities, etc appear when advanced-stage tumor encroaches on tissues or organs around bladder and pelvic lymph nodes. Medications and management 1. Surgery. The most proper surgery method should be chosen according to pathological diagnosis and general physical condition of a patient, and these methods including: 1) Transurethral incision of bladder tumor 2) Radical cystectomy 2. Radiotherapy and chemotherapy. Both of them can be taken as assistant therapies. Elective radiotherapy and chemotherapy before or after surgery can help to improve the cure effect and the living quality of a patient. 3. TCM(Traditional Chinese medicine). It can apply throughout the whole treatment for bladder cancer patient. No matter used singly or combined with chemotherapy or radiotherapy, it can take the effect of suppressing tumor and improving patient living quality and so on. Pathophysiology Predisposing factors Cellular genetic mutation Malignant cellular proliferation Immune system failure to destroy cancer cell Malignant cellular survival Malignant cellular deprivation of normal of nutrition and other substance for sustenance NORMAL CELL DEATH S/Sx of bladder cancer Diagnostic findings 1. Cystoscope, through which can directly find the location, size, quantity, shape and infiltration extent of cancer. Biopsy should also perform when having this examination. 2. CT scan. It can find the tumor and swelling lymph nodes in an accuracy of 80%. 3. Ultrasound B. It can detect the size, location and infiltration degree in mucosa when a patient is having full bladder, a status that the mucosa of bladder wall is fully extending.

4. Ray contrast examination. Through it can a doctor know the bladder is full or empty and the infiltration condition. Combining with pyelography and ureterography, hydronephrosis, infiltration condition of ureter can be confirmed. Nursing interventions Prevent from getting infection and improve the immunity of patient. Advise to take more fresh fruits and vegetables. Have diets with high protein, such as eggs, milk, fish and so on. Adjust the diets according to patient flavor, but spicy food or the diets are hard for digestion are forbidden. Keep the ward clean and the air fresh. Family should always support the patient to help him eliminate the negative emotions.

Cervical Cancer
Cancer that forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope). Cervical cancer is almost always caused by human papillomavirus (HPV) infection.

Preventive measures Vaccination of HPV vaccine Male circumcision Penile hygiene Use of condoms to prevent STDs Predisposing factors Age: Cervical cancer affects mostly the middle-aged

Cigarette smoking Having multiple sex- partners or having a partner A history of a sexually- transmitted disease Having seven or more number of full- term pregnancies Long -term use of oral contraceptives Assessments Abnormal vaginal bleeding Bleeding that occurs between regular menstrual periods Bleeding after sexual intercourse, douching, or a pelvic exam Menstrual periods that last longer and are heavier than before Bleeding after going through menopause Increased vaginal discharge Pelvic pain Pain during sex

Pathophysiology

Predisposing/ Precipitating factors: Etilogic Agents: Human pappiloma virus (HPV) Exposure to carcinogens Failure of immune system Carcinogens invade the cells in the cervix Genetic mutation Oncogenesis Neoplasm formation Proliferation of cancer cells

Medication

Common chemotherapy medicines used to treat cervical cancer Cisplatin. Cisplatin is the medicine most often used in chemoradiation for cervical cancer. Fluorouracil (5-FU). Mitomycin. Paclitaxel.

include:

Diagnosis Pap smears screen for precancers and cancer, but do not make a final diagnosis. A procedure called cone biopsy may also be done. CT scan of the pelvis Cystoscopy Intravenous pyelogram (IVP) MRI of the pelvis

Management: Loop electrosurgical excision procedure (LEEP) -- uses electricity to remove abnormal tissue Cryotherapy -- freezes abnormal cells Laser therapy -- uses light to burn abnormal tissue A hysterectomy (surgery to remove the uterus but not the ovaries) is not often done for cervical cancer that has not spread. It may be done in women who have repeated LEEP procedures. Nursing intervention:
Listen to the patients fears and concerns, and offer reassurance when appropriate.

Instruct patient to avoid douching and sexual intercourse 24 hours before Paps smear Stress the importance of lifelong follow-up visits to detect response to treatment. Prepare patient for chemotherapy, radiation and surgery Understand the treatment regimen and verbalize the need for adequate fluid and nutritional intake to promote tissue healing.

Endometrial Cancer
Cancer that forms in the tissue lining the uterus (the small, hollow, pear-shaped organ in a woman's pelvis in which a fetus develops). Most endometrial cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).

Risk factors Obesity Age Nulliparity ERT Late menopause

Manifestations 1. Unusual vaginal bleeding or discharge 2. Difficult or painful urination 3. Pain during intercourse 4. Pain in the pelvic area Diagnosis 1. Endometrial biopsy-The removal of tissue from the endometrium (inner lining of the uterus) by inserting a thin, flexible tube through the cervix and into the uterus. The tube is used to gently scrape a small amount of tissue from the endometrium and then remove the tissue samples.

2. Dilatation and Curettage- Surgery to remove samples of tissue or the inner lining of the uterus. The cervix is dilated and a curette is inserted into the uterus to remove tissue. Pathophysiology Predisposing factors Excessive increase estrogen Supress LH & FSH Slows Ovarians cycle Increase reformation of endometrial lining & slow regeneration Normal cells continuously growing and old cells do not die Extra cell form together TUMOR

Endometrial cancer
Management:

Surgery Surgery to remove the uterus is recommended for most women with endometrial cancer.. Radiation Radiation therapy uses powerful energy beams, such as X-rays, to kill cancer cells. Hormone therapy Medications to increase the amount of progesterone in your body. Synthetic progestin, a form of the hormone progesterone, may help stop endometrial cancer cells from growing.
Nursing management: Teaching about and providing access to regular Pap screening tests for high-risk and other women are the most important preventive interventions. When a patient requires surgery, prepare her mentally and physically for the surgery and the postoperative period. Be certain to teach the patient about vaginal discharges that may follow a surgical procedure. refrain from douching, using tampons, and coitus until healing occurs. Discuss any changes that may affect the patient's sexual function or elimination mechanisms.

Explain to the patient that she will feel fatigued and that she should gradually increase activity but should not do heavy lifting or strenuous or rough activity or sit for long periods.

Laryngeal Cancer
Laryngeal cancer may also be called cancer of the larynx or laryngeal carcinoma. Most laryngeal cancers are squamous cell carcinomas, reflecting their origin from the squamous cells which form the majority of the laryngeal epithelium. Cancer can develop in any part of the larynx, but the cure rate is affected by the location of the tumour.

Assessment:
A sore throat or cough that does not go away. Trouble or pain when swallowing. Ear pain. A lump in the neck or throat. A change or hoarseness in the voice

Diagnosis Physical exam of the throat and neck: An exam to check the throat and neck for abnormalareasThe neck will be felt for swollen lymph nodes. A history of the patients health habits and past illnesses and medical treatments will also be taken. Biopsy : The removal of cells or tissues so they can be viewed under a microscope by apathologist to check for signs of cancer. Laryngoscopy : A procedure to look at the larynx (voice box) for abnormal areas. A special tool on the laryngoscope may be used to remove samples of tissue.

Endoscopy : A procedure to look at organs and tissues inside the body, such as the throat,esophagus, and trachea to check for abnormal areas. Radiation therapy Chemotherapy

laser surgery endoscopic resection partial laryngectomy total laryngectomy Chemoprevention Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of developing cancer or to reduce the risk cancer will recur (come back). Pathophysiology Predisposing/ Precipitating factors:
Cellular genetic mutation Malignant cellular proliferation Immune system failure to destroy cancer cell Malignant cellular survival Malignant cellular deprivation of normal of nutrition and other substance for sustenance NORMAL CELL DEATH Nursing management Prepare patient for radiation, chemotherapy and surgery Teach patient to avoid cold air Instruct patient that swimming is not recommended post laryngectomy Institute alternative modes of communication Adherence to Alcohol consumption Assist the patient and the family in dealing with the psychological impact of the diagnosis of cancer, alteration of physical appearance, and possible need for altered methods of communication due to loss of voice.

Oral cancer
Cancer that forms in tissues of the oral cavity (the mouth) or the oropharynx (the part of the throat at the back of the mouth).

Risk factors
Tobacco: Tobacco use causes most oral cancers. Heavy alcohol use HPV infection Sun: Cancer of the lip can be caused by exposure to the sun. A personal history of oral cancer: People who have had oral cancer are at increased risk of developing another oral cancer. Smoking increases this risk. Diet: Some studies suggest that not eating enough fruits and vegetables may increase the chance of getting oral cancer. Betel nut use: Chewing betel nut causes oral cancer.

Assessment White or red patches in the mouth A mouth sore that won't heal Bleeding Loose teeth Problems or pain with swallowing A lump in the neck Bad breath Diagnosis CT Scan MRI Toluidine blue stain Fluorescence staining Exfoliative cytology Brush biopsy

Pathophysiology Predisposing/ Precipitating factors: Cellular genetic mutation Malignant cellular proliferation Immune system failure to destroy cancer cell Malignant cellular survival Malignant cellular deprivation of normal of nutrition and other substance for sustenance Oral Cancer Management

Surgical:
Primary tumor resection Maxillectomy Glossectomy Mohs' micrographic surgery Laryngectomy Neck dissection

Radiation therapy Chemotherapy

Nursing management Assess airway patency and respiratory status every hour until stable., Monitor the side effects of chemoherapy Maintain semi-Fowlers position, supporting arms. Encourage to turn, cough, and deep breathe every 2 to 4 hours. Teach the importance of activity, turning, coughing, and deep breathing. Avoidance of smoking , drinking alcohol Consult with dietitian to assess calorie needs and plan appropriate enteral feeding. Assess response to enteral feedings. Allow adequate time for communication efforts. Support the clients physically, emotionally. Keep emergency call system in reach at all times and answer

Uterine Cancer
Cancer that forms in tissues of the uterus (the small, hollow, pear-shaped organ in a woman's pelvis in which a fetus develops). Two types of uterine cancer are endometrial cancer (cancer that begins in cells lining the uterus) and uterine sarcoma (a rare cancer that begins in muscle or other tissues in the uterus).

Risk factors Obesity Age Nulliparity ERT Late menopause

Manifestations 1. Unusual vaginal bleeding or discharge 2. Difficult or painful urination 3. Pain during intercourse 4. Pain in the pelvic area Diagnosis 1. uterine biopsy-The removal of tissue from the uterus by inserting a thin, flexible tube through the cervix and into the uterus. The tube is used to gently scrape a small amount of tissue from the uterus and then remove the tissue samples. 2. Dilatation and Curettage- Surgery to remove samples of tissue or the lining of the uterus. The cervix is dilated and a curette is inserted into the uterus to remove tissue. Pathophysiology Precipitating Factors Excessive increase estrogen Supressing the LH & FSH Slows Ovarians cycle Increased reformation of endometrial lining & slow regeneration Normal cells continuously growing and old cells do not die Extra cell form together TUMOR

Uterine cancer
Management

Surgery Surgery to remove the uterus is recommended for most women with uterine cancer Radiation Radiation therapy uses powerful energy beams, such as X-rays, to kill cancer cells. Hormone therapy Medications to increase the amount of progesterone in your body. Synthetic progestin, a form of the hormone progesterone, may help stop Uterine cancer cells from growing.
Chemotherapy

Nursing management Teaching about and providing access to regular Pap screening tests for high-risk and other women are the most important preventive interventions. When a patient requires surgery, prepare her mentally and physically for the surgery and the postoperative period. Be certain to teach the patient about vaginal discharges that may follow a surgical procedure. refrain from douching, using tampons, and coitus until healing occurs. Discuss any changes that may affect the patient's sexual function or elimination mechanisms. Explain to the patient that she will feel fatigued and that she should gradually increase activity but should not do heavy lifting or strenuous or rough activity or sit for long periods.