Cancer- are mutated stem cells that have undergone structural changes so that they are unable to perform their normal functions
Anatomy and physiology of a cell
- Nucleus RNA/CHON synthesis= cell metabolism= give antimetabolites- to destroy cell metabolism and RNA/CHON synthesis
- MTX, 6 MP = antidote- 5 FU= antogonistic- dec folic acid= anemia
Chromatin threadlike material for DNA synthesis= cell replication/multiplication= give alkylating agent= destroy cell
multiplication/replication
- 1. Cytoxan, Cisplatin= hemo cystitis= inc fluid intake, frequent emptying of the bladder
- 2. Plant alkaloid- Vincristine, Vinplastin/ oncovin nephrotoxicity= constipation and paresthesia=s/e
Classification:
1. Benign- grow slowly, not life threatening/glandular adenoma,bone osteoma,nerve cell neuroma,fibroma
2. Malignant- infiltrate surrounding tissue, invade other tissues and produce secondary lesions/adenocarcinoma,
carcinoma,sarcoma,melanoma
Side effects
Nursing considerations
Cyclophosphamide/Cytoxan
Check CBC
Extra fluids to flush system
Monitor for infection
Avoid IM injection when platelet is low
Report hematuria, force fluids
Monitor for infection
Give antiemetics
Antimetabolites
Fluorouracil ( 5-FU )
Methotrexate/MTX
Mercaptopurine/6 MP
Cytarabine
Hydroxyurea/Hydrea
Antibiotics-antineoplastics
Doxorubirin/Adriamycin
Bleomycin/Blenoxane
Dactinomycin/
Actinomycin D
Vinca Alkaloids- interfere with
cell division
Vincristine/Oncovin
Vinblastine/Velban
Implementation:
A. Radiotherapy
1. External radiation( cobalt)
Leave markings intact on skin
Avoid creams or lotions, deodorants, perfumes ( vit A and D ointment permitted)
Use lukewarm water to cleanse the area
Assess skin for redness, cracking
Administer antiemetics for nausea, analgesics for pain
Observe skin, mucous membrane,and hair follicles for side effects
No hot water bags, bottles,tape, dont expose area to cold or sunlight
Internal radiation ( cesium, radium, gold
Wear cotton clothing
Internal radiation ( cesium, radium, gold
a. Sealed source- mechanically positioned source of radioactive material placed in body cavity or tumor
Cardinal sx: palpable mole in the thyroid, painless LN enlargement, pain during swallowing and breathing
TX: UR RAI 131 all body fluids are radioactive, 2-3x flushing the toilet ,C
LARYNX CA
Risk Factors:3 Fs father, forty, frequent smoking and alcohol intake, straining of voice
Cardinal sx: hoarseness of voice, dyspnea, dysphagia
TX: U- laryngectomy R
ESOPHAGUS CA
Risk Factors: Smoking, Alcoholic, Male
Cardinal sx: dysphagia, or difficulty in swallowing
TX: URC
Exogenous estrogen use/Premarin
CANCER OF THE STOMACH
-Cause by excessive intake of highly salted or smoked foods, diet low in quantity of vegetable and fruits, helicobacter pylori
infection, achlorhydria, atrophic gastritis
-RISK Factors: highly colored smoked food/salty food, alcohol, ELLISON_SOLINGER syndrome ( pancreas secrete Gastrinsecreting tumor), blood type A, diet low in vegs and fruits
-Cardinal sx: indigestion/dyspepsia
-TX: Billroth I and II
RENAL CA= Wilms tumor, Renal cell ca
Risk Factors:
Renal cell ca occurs bet 50-70 years old
Exposure to contrast medium and gasoline
Nephroblastoma occurs at 2-4 y/0/Wilms
Asbestos exposure
Lalaki common/ male
Cardinal sx: RCC= Palpable mass
Painless hematuria
Pain in the flanks
Wilms= abdominal enlargement, NO palpation and biopsy
narcotic, anti emetic, antacid, surgery- rem of pancreas/ whipples
CANCER OF THE COLON/RECTUM
-Risk Factors:Family hx of ca, age 50 and above, Turgots syndrome ( polyps at rectal and GI ), Hx of bowel inflam disease/
ulcerative colitis, Excessive red meat and fat intake, Resected colorectal ca
-ADENOCARCINOMA is the most common type of colon cancer
- men and women 50-60 years old
- Cardinal SX: alteraltion bowel pattern, stool characteristic ( PENCIL LIKE), chronic bleeding and anemia
-caused by diverticulitis, chronic ulcerative colitis, familial polyposis
-S/S alternating diarrhea, constipation, lower abdominal cramps, abdominal distension, weakness, pallor, anorexia, weight loss,
dyspnea
-dx. Test- barium enema, sigmoidoscopy, digital rectal exam
LUNG CA
Risk Factors: cigarette smoking, exposure to chemicals, pulmonary irritation and environmental pollution
Cardinal sx: nagging cough, dyspnea, impaired gases-diminished BS, hemoptysis
TX: URC
Risk Factors: Cigarette smoking
Chemicals
Common in men
Cytoxan
Cardinal Sx: painless hematuria
TX: U- cystectomy= post urinary diversion Ileal conduit
PANCREATIC TUMOR
Risk Factors:
Pancreatitis- autodigestion of pancreas
Alcohol
Nutritional def
Chemicals
Rate of moratality is very high
Excessive fats
Age above 60
Smoking
Cardinal sx: indigestion,trauma
S/S- weight loss, vague upper or mid-abdominal discomfort, abnormal glucose tolerance test, jaundice, clay colored stools, dark
urine
- Whipple procedure- removal of head of the pancreas, distal portion of the common bile duct, the duodenum and part of the
stomach
- complication = hypoallergenic shock- oliguria
CANCER OF THE LIVER- common site for metastasis
Risk factors: Metastasis from other organ,Alcohol and Aflatoxins ( green bread), Cirrhosis and Hep B and C, Africans, Asians,
americans, Oral contraceptive pills
Cardinal Sx: indigestion, dyspepsia
- S/S- enlargement of the liver, hemorrhage, necrosis are common, metastasis to the lungs
- highly in men
LEUKEMIA- most common cancer in childhood
- proliferation of abnormal white blood cells that do not mature beyond the blast phase
- in the bone marrow, blast cells crowd out healthy white blood cells, red blood cells, and platelets, leading to bone marrow
depression
- symptoms reflect bone marrow failure and associated involvement of other organs
Types:
- ALL- lymphocyte, acute onset, 75 % chance of survival, WBC 10,000/mm3 less than-2-9 y/o
-ANLL- includes granulocytic and monocytic types
S/S- Acute myeloid leukemias
Lymphadenopathy
- AUER rods
Excessive weight loss
found only
Unusual bleeding/ epistaxis
Knee and joint pain
Enlarged abdomen
Malaise
Infection signs, fever, sore throat, stomatitis
Anemias, severe
ALL = Genetics
Exposure to Benzene or gasoline
Nagasaki or HIrushima bomb exposure/ MISO soup
Excessive alkylating agents
T- lymphoma virus
Ionizing radiation
Caucasian children
Cardinal sx: unusual bleeding or d/c
BREAST CANCER- leading cause of death 40-44 y/o for women
Risk Factors:
Advancing maternal age
Breast ca hx
Cigarette smoking and oral intake of contraceptive pills
Diet increase in fats
Early menarche and late menopause
First child after 35 years old or nulliparity
Cardinal sx: palpation-lump- upper outer quadrant- common site- first symptom
- skin of breast dimpled, nipple discharges, asymmetry of the breast,
BREAST SELF-EXAMINATION
- after period best time
- HOW- lie down and put a pillow under your R shoulder. Place your R arm behind your head
- use the finger pads of your 3 middle fingers on your L HAND TO FEEL FOR LUMPS OR THICKENING.Your finger
pads are the top thirds of each finger
-Press firmly enough to know your breast feels. A firm ridge in the lower curve of each breast is normal
- Move around the breast in a set way; CIRCLE, UP AND DOWN, OR THE WEDGE. Do it the same way at each time
CANCER OF THE CERVIX- detected by Pap smear
- class I normal pap smear
- class II atypical cells
- class III moderate dysplasia
- class IV severe dysplasia, cancer in situ
- class V squamous cell carcinoma, invasive cancer
Preinvasive conditions maybe treated by cryosurgery, laser surgery, cervical conization, or hysterectomy
Invasive conditions- treated with radium and hysterectomy
CANCER OF THE UTERUS
- cardinal symptom- abnormal uterine bleeding either pre or post-menopause
CANCER OF THE OVARY
- ETIOLOGY: UNKNOWN
- ovarian mass during palpation
- now, examine your L breast using R finger pads using same procedure
- if you find changes, see your doctor immediately
Risk Factors:
Ovarian dysfunction/ amenorrhea
Vague abdl sx, n/v
Age, above 50
Race , whites
Incidence, inc with + hx
Alcohol
Nulliparity
Cardinal Sx: Amenorrhea, Abdl enlargement, Ascites, Abdominal bloating
TX: U- oophorectomy= ERT
ENDOMETRIAL CA
Risk Factors:
Multiple use of Tamoxifen
Cardinal sx:bleeding irreg
Early menarche
Nulliparity
tx: u- TAHBSO
Obesity
Post menopausal
Age 55 above
Urban living
Sex: F/ sex multiple
BONE CA
Risk Factors: inherited genes ( osteo, sarcomas), radiation tx. (Radium = bone demineralization) Pagets dis., secondar cause of cancer
Cardinal sx: Bone fx, Occassional fatique- intermittent, pain worsens at nite, Nocturnal pain, Edema/swelling/lump
Tx: URCHIB
LUNG CA
Risk Factors: cigarette smoking, exposure to chemicals, pulmonary irritation and environmental pollution
Cardinal sx: nagging cough, dyspnea, impaired gases-diminished BS, hemoptysis
TX: URC
Risk Factors: Cigarette smoking
Chemicals
Common in men
Cytoxan
Cardinal Sx: painless hematuria
TX: U- cystectomy= post urinary diversion Ileal conduit
PROSTATE CA
Risk Factors: Family hx
Cardinal SX : frequency
African American
residual urine
Men
eval of uria flow decrease
Age over 65
hesitancy
STDs/ smoking
nocturia
TX: U = Horse +R+C
small urinary stream
Hormonal manipulation
Orchiectomy, bilateral, over 70 no tx
Radical prostatectomy, counselling cause impotence
SILDENAFIL/ Viagra, Saw Palmetto Berry- CI in estrogen producing tumors
Extrenal beam/interstitial radiation
TESTICULAR CA
Risk Factors: 15-39 y/o
undescended testicles
TSE- HS
Cardinal sx: 4 Ls: Lump, pea sized
Loaded heavines radiation to scrotum and groin
Leg pain
Large/obese
TX: U- inguinal orchiectomy
R- lymphatics
Cisplatin/Platinol
HODGKIN CA- malignant ca in the lymphatics
Risk Factors: cause unknown, young males, Epstein Barr virus
Cardinal SX: supraclavicular node, painless, nigth sweats, flu like sx
TX: U -splenectomy= LN dissection/ biopsy 4 Reed-Sternberg cells
R com of alkylating and plant alkaloids= MOPP
C