Cellular Adaptation
Contact inhibited
-once a normal cell is in direct
contact on all surface areas with other cells, it no
longer undergoes mitosis
Hypertrophy
Hyperplasia
Metaplasia
Dysplasia
death
COMMITMENT
- AT DAY 8, EARLY EMBRYONIC CELLS
START CHANGING TO
DIFFERENTIATED
CELLS. . . AND
COMMITS ITSELF TO A
SPECIFIC
OUTCOME . . . WHICH MEANS
TURNING OFF EARLY EMBRYONIC
GENES (PROTO-ONCOGENES) THAT
CONTROLLED OR REGULATED
EARLY RAPID GROWTH.
ONCOGENES TURNED ON PROTOONCOGENES THAT CAN CAUSE NORMAL
CELLS TO CHANGE TO CANCER CELLS
Characteristics of Cancer Cells
Oncogene activation
Dietary factors
SPREAD OF CANCER:
- after initial event, some mutated cells
may die
- survivors reproduce until the tumor is
1-2 mm
- angiogenesis to support growth
ACQUIRED:
VIRUSES
RADIATION
HORMONES
INCREASE RISK:
AGE
NUTRITIONAL STATUS
HORMONAL BALANCE
RESPONSE TO STRESS
FATIGUE
ANEMIA, LEOKOPENIA,
THROMBOCYTOPENIA
INFECTION
Classifications of Neoplasms/ Comparison of
characteristics:
Speed of growth/ Mode of growth
Benign
Grows slowly
Continues to grow throughout life
Benign
Benign
Rare regression
Infiltrate tissues
Capsule
Benign
Contained w/in a fibrous capsule
Prevents infiltration
Encapsulated tumor can be removed
easily
Periods of remission
tissues
Malignant
Never contained in a capsule
Benign
Malignant
Well differentiated
Mitotic figures absent or scanty
Mature cells
Anaplastic cells absent
Malignant
Malignant
Always harmful
Causes death
Benign
Local symptoms:
Very good
Tumor generally removed surgically
Malignant
Poor prognosis if with metastasis
Systemic symptoms:
weight loss
poor appetite and cachexia (wasting)
excessive sweating (night sweats),
anemia
specific paraneoplastic phenomena, i.e.
specific conditions that are due to an active
cancer, such as thrombosis or hormonal changes
Clients with Cancer: Health Promotion and
Maintenance
Primary prevention
(ACTIVITIES VS SMOKING, ALCOHOL,POOR
DIETARY HABITS, LIFESTYLE MODIFICATION)
Secondary prevention
(EARLY DETECTION / SCREENING
PROGRAMS)
Cancer Prevention
Cervical cancer
(PAP TEST/PELVIC EXAM)
Skin cancer
(SKIN INSPECTION ESP. OF MOLES)
PAP smear
Digital Rectal Exam
Testicular Self Exam.
Health Restoration
Client history
Lung cancer
Colorectal cancer
Education
minors
(FECAL OCCULT
BLOOD/SIGMOIDOSCOPY/COLONOSCOPY/DRE)
Clinical manifestations
Diagnostic evaluation
Laboratory blood tests
Tumor markers - barometers for
effectiveness of Tx
CBC - for non-specific problems & Side
Effects of
Tx
Diagnostic evaluation
Treatment goals
Cure
Control,
Palliation
Rehabilitation
Treatment modalities:
-
Surgery
Radiation therapy
Chemotherapy
Biotherapy
Bone marrow transplant
Types of surgery
Diagnostic: (cytologic brushings/ tissue biopsy
with endoscopy, biopsy: needle, excisional,
incisional)
Treatment: radical/wide excision
Recurrence and metastasis: excision
Palliative: retard, decrease size, relieve sx
Reconstructive: improve QOL
Preventive
Nursing management
Cancer Care:
RadiationTherapy
USES:
Radiosensitivity RELATIVE
SUSCEPTIBILITY OF TISSUES TO RADIATION
Fractionation dosing:
- Unsealed source
oral/injection/instillation into
body cavity for systemic
treatment;
direct contact with
body tissue.
* radioisotope circulates
throughout
the body. Clients urine, sweat,
blood & vomitus contain
radioisotope
* eliminated from the body in 48
hrs
- Afterloading device empty applicator is
implanted during surgery
and loaded
when treatment is
done.
Safety standards
Patient education
B. CELL-CYCLE NON-SPECIFIC
ANTIMETABOLITES counterfeit
metabolites
TOPOISOMERASE INHIBITOR
CANCER CHEMOTHERAPY
Chemotherapy: Nursing Management
Administration
Verification of agent, dose, schedule
Safe preparation, handling, and disposal
Routes of administration
Intravenous, regional, oral, etc.
Adverse reactions
Vaccines
Clinical trials
Myelosuppression
thrombocytopenia
* must be >100,000/mm3 for chemotx to
be done
anemia
Gastrointestinal effects
Anorexia
Stomatitis
Integumentary effects
Alopecia
Skin reactions
Infection
Pain
Cardiac tamponade
Cancer Care:
Psychosocial Aspects
Nipple tenderness
Nipple retraction
Diagnosis:
Breast Biopsy
Mammography
Common sites of metastasis:
bones, lungs, brain, liver
Management:
1. Chemotherapy
2. Radiation
3. Hormonal manipulation with
estrogen in
postmenopausal
women. (Tamoxifen)
4. Surgery:
a. Mastectomy
b. Oophorectomy
c. Adrenalectomy
The most effective chemotherapy regimens for
breast cancer that has spread include:
- cyclophosphamide
CYTOXAN
- docetaxel
TAXOTERE
- doxorubicin
ADRIAMYCIN
- epirubicin
ELLENCE
- gemcitabine
GEMZAR
- paclitaxel
TAXOL
vinorelbine.
Lumpectomy
- Tumor excised and removed; lymph node
dissection
Simple Mastectomy
- Breast tissue and nipples removed; lymph nodes
left intact
Pre-op period:
assess self esteem and body image
support denial
breast reconstruction and prosthesis
Post- op period:
infection
CERVICAL CANCER
lymph edema
Prevention:
abstinence
limiting number of partners
using a condom
Abnormal vaginal
bleeding between periods, after intercourse, or
after menopause
rectum