MALLARI, ALLEN J.

1.

TYPES OF CANCER

AIDS-related cancer is a group of cancers that are frequently diagnosed in people withHIV/AIDS. People who do not have HIV or AIDS can certainly develop these types of cancers, however they are only referred as HIV/AIDSrelated cancers when diagnosed in someone with HIV or AIDS. Cancers that are more prevalent among those with HIV/AIDS include: Kaposi's sarcoma Lymphoma Cervical cancer Anal cancer Oral cancer Testicular cancer Skin cancer Lung cancer

Kaposi's sarcoma, lymphoma, and invasive cervical cancer are considered to be AIDS defining illnesses, a group of conditions and diseases that indicate advanced HIV or the onset of AIDS. Anal cancer is cancer that develops in the anus, the opening of the rectum, which allows waste to pass from the large intestine to outside of the body. The anus is often confused with the rectum, which is the last several inches of the lower intestine. The rectum ultimately ends at the anus, where fecal material exits the body. Like other parts of the body, the anus is susceptible to infections and diseases, such as anal cancer. Bladder cancer is a disease that affects the bladder, an elastic organ that is responsible for storing urine that is released by the kidneys. It is the fifth most common type of cancer in the U.S. and when diagnosed in the early stages, it is highly treatable. There are several types of bladder cancer, some being more common then others. The most common type of bladder cancer is urothelial carcinoma, accounting for about 90% of bladder cancer cases. The remaining types of bladder cancer are considered rare. They include squamous cell carcinoma, adenocarcinoma, small cell carcinoma, leiomyosarcoma, lymphoma, and, melanoma. Bone cancer is a type of cancer that can affect both children and adults, although it is more common in children and teens. It is categorized based on whether the cancer originated in the bone (primary) or whether it spread from another location to the bone (secondary). Secondary bone cancer, or cancer that has spread to the bone from another part of the body, is much more common than primary bone cancer. In fact, primary bone cancer is considered rare. There are several types of primary bone cancer, including: osteosarcoma chondrosarcoma Ewing's sarcoma malignant fibrous histiocytoma

fibrosarcoma chordoma

Brain tumors are the result of uncontrolled growth of abnormal cells in the brain. They can affect children and adults, but are considered to be rare among both populations. Brain tumors can be classified as malignant (cancerous) or benign (non-cancerous). Malignant tumors tend to be more aggressive than benign types, but both are very serious and can be fatal. For educational purposes, this article references subject matter related to malignant brain tumors affecting adults only. There are over 140 different types of brain tumors that can form in the brain. Brain tumors can be classified as primary or metastatic, depending on where they arise in the body. Primary brain tumors originate in the brain and rarely spread outside of it. Metastatic tumors begin in another part of the body and spread to the brain through blood or lymphatic tissue. Some cancer types are more prone to spreading to the brain. These types includebreast cancer, kidney cancer, melanoma, and lung cancer. Breast cancer is a malignant (cancerous) growth that begins in the tissues of the breast. Cancer is a disease in which abnormal cells grow in an uncontrolled way. Breast cancer is the most common cancer in women, but it can also appear in men. In the U.S., it affects one in eight women.

The most common types of breast cancer are: ductal carcinoma (85 - 90% of all cases) lobular carcinoma (8% of all cases)

Cervical cancer is a disease that affects the cervix in the female reproductive system. The cervix is the lower portion of the uterus that connects the upper vagina to the uterus. It is about two inches in length. During childbirth, the cervix dilates, allowing the baby to travel from the uterus to the vagina. Colon cancer is a type of cancer that develops in the large intestine. Our colons are about 6 feet long and allow waste to travel from the small intestine to the rectum. Like other organs in our body, the colon is vulnerable to many diseases and conditions, like cancer. Endometrial cancer is a type of cancer that develops in the endometrium, the lining of the uterus in women. It is commonly referred to as uterine cancer, but other types of cancer do develop in the uterus, though much less often. Endometrial cancer is most often diagnosed in women who went through menopause but can be diagnosed in younger women too. It is most often found in the early stages, when the disease is most treatable.

Esophageal cancer develops in the esophagus, a long tube that connects your mouth to your stomach. It is generally hollow and is about ten inches long in adults. Esophageal cancer is also referred to as cancer of the esophagus. Common esophageal cancer symptoms include difficulty swallowing, persistent cough, hoarseness and weight loss. Symptoms generally do not appear until the disease has progressed.

Ewing's sarcoma is a type of bone cancer that primarily affects children and young adults. It is a rare type of cancer, affecting about 250 children in the United States each year. Ewing's sarcoma is most often diagnosed in adolescents between the ages of 10 and 20. Ewing's sarcoma affects the bone, but it can also affect the soft tissue surrounding the bone. It is most commonly found in the arms or legs but can be found elsewhere in the body, such as the pelvis, ribs, or spine.

Ocular melanoma, or melanoma of the eye, is a rare type of cancer that affects various parts of the eye, specifically the choroid, ciliary body, and the iris. Choroidal melanoma is the most common type of eye malignancy. Many people are confused by the melanoma aspect of this type of eye cancer, as melanoma is most commonly associated with skin. Melanomas develop from melanocytes, cells that contain the dark pigment (melanin) that defines our skin coloring. Melanocytes aren't exclusive to the skin -- they can be found in the hair, the eyes, and the lining of some organs.

Gastrointestinal cancer is a term that encompasses a group of cancers that affect the gastrointestinal tract. Types of gastrointestinal cancer include: esophageal cancer stomach cancer gallbladder cancer gastrointestinal stromal tumors liver cancer pancreatic cancer colon cancer rectal cancer anal cancer

Gynecologic cancer is a group of cancers that affect the tissue and organs of the female reproductive system. Each type of cancer is named after the organ it originates. Types of gynecologic cancer include: cervical cancer ovarian cancer uterine cancer vaginal cancer vulvar cancer

Head and neck cancer is cancer that originates in the head or neck region, not including thyroid or skin cancers. Several types of cancer are considered head and neck cancer: oral cancer salivary gland cancer laryngeal cancer hypopharyngeal tumors

nasopharyngeal cancer tumors of the oropharynx

The kidneys are an essential part of our urinary system. We have two kidneys, and they are located on either side of the spine in our lower back. They are about the size of a fist and bean shaped. Like other organs in our bodies, the kidneys are vulnerable to infection and disease, including cancer. There are several types of cancer that can develop in the kidney, but renal cell carcinoma is by far the most prevalent. It is estimated that 9 of 10 cases of kidney cancer are renal cell carcinomas. Other types of kidney cancer, although much less commonly, include: transitional cell carcinoma Wilms' Tumor renal sarcoma

Laryngeal cancer is a type of cancer that affects the larynx - an organ that plays an important role in breathing and communicating. It contains the vocal cords, which give us the sound needed to speak. The larynx is composed of three different parts: glottis - the part of the larynx that contains the vocal cords supraglottis - the area above the glottis subglottis - area below the glottis

Leukemia is a disease that affects blood-forming cells in the body. It is a cancerous condition characterized by an abundance of abnormal white blood cells in the body. Leukemia begins in the bone marrow and spreads to other parts of the body. Both children and adults can develop leukemia.

Liver cancer is a type of cancer in which malignant cells are found in the liver, the second largest organ in our body. The liver weighs about 2 to 6 pounds and is located in the right upper abdomen. The liver has many duties, such as detoxifying substances, secreting bile and metabolizing carbohydrates, fats and proteins. Like other organs in our body, the liver is susceptible to diseases, including cancer. There are several types of cancer that can develop in the liver of adults, including: hepatocellular carcinoma, also known as hepatoma (most common type of liver cancer) cholangiocarcinomas

Lung cancer arises when a series of mutations in normal lung cells cause them to become abnormal and grow out of control. These changes can take place anywhere from the bronchus(the windpipe), down to the small air sacs in the periphery of the lungs where oxygen exchange takes place. Lymphoma is a type of cancer that affects our lymphatic system. There are main groups of lymphoma: Hodgkin's lymphoma and non-Hodgkin's lymphoma. These two groups encompass about 30 different types of lymphoma.

Lymphoma develops in the lymphatic system, part of the immune system that helps filter out bacteria and fight disease. Most of us are familiar with the term lymph nodes, and they can become swollen in normal situations at any time in our lives usually when we are sick or have an infection. When the cells in the lymph nodes begin to multiply rapidly, become malignant, and the developing condition is lymphoma.

Melanoma is a potentially dangerous type of skin cancer. It is diagnosed less frequently than other types of skin cancer (nonmelanoma skin cancer), but has the ability to spread very quickly. Melanoma most often begins on the skin but can develop on the other parts of the body, such as under fingernails, toenails and the eyeball.

Mesothelioma is a type of cancer that is primarily caused by exposure to certain types of asbestos, a material once used in building construction. The disease can affect the lungs, the abdomen, or the heart. There are three types of mesothelioma: Pleural: Pleural mesothelioma affects the pleura - the lining of the lungs. It is the most common type of mesothelioma. Peritoneal: Peritoneal mesothelioma affects the peritoneum - the lining of the abdomen. Pericardial: Pericardial mesothelioma affects the pericardium, the membrane that surrounds the heart. It is the least common type, affecting about 5 percent of people with the disease.

Oral cancer is a type of head and neck cancer that affects the mouth. It can form in the lining of the cheeks, gums, roof of the mouth, tongue, and lips. Oral Cancer Risk Factors The primary risk factor for developing oral cancer is tobacco use. Smoking cigarettes, cigars, and pipes all increase your risk of oral cancer. Smokeless tobacco, often called "dip" or "chew," also heighten the risk. Alcohol consumption is another habit that is strongly associated with the development of oral cancer. Ovarian cancer is a disease that affects ovarian tissue in the female reproductive system. The ovaries are responsible for producing eggs (ova) and are also a production site for the hormones estrogen and progesterone. Causes and Risk Factors of Ovarian Cancer Unfortunately, we cannot pinpoint exactly what causes ovarian cancer, but researchers have identified several known risk factors for it. We know that ovarian cancer most often is diagnosed in women who: are post-menopausal. are Caucasian. have a family history of colon cancer, breast, or ovarian cancer. were previously diagnosed with breast cancer. suffer from obesity. used Clomid (a fertility drug) for longer than one year use(d) estrogen replacement therapy who have not given birth.

have a a known inherited mutation of BRCA 1 or 2 gene conformed through genetic testing

Pancreatic cancer is a type of cancer that affects the pancreas, an organ that lies behind the stomach and in front of the spine. The pancreas is responsible for producing hormones like insulin and glucagon, which help control our blood sugar levels. It also produces enzymes that help breakdown protein and carbohydrates during digestion. Like other organs in the body, the pancreas is vulnerable to cancer. There are several types of pancreatic cancer, however the most common is adenocarcinoma. This type of cancer affects cells that produce digestive enzymes. Much less common types of pancreatic cancer include islet cell carcinoma, pancreatic blastoma, and pseudopapillary neoplasms.

Since cancer is the uncontrolled and abnormal growth of cells in a certain area of the body, prostate cancer is simply the uncontrolled and abnormal growth of cells in the prostate. Some men have BPH (benign prostatic hyperplasia). This is often confused with prostate cancer. With BPH, prostate cells multiply faster than they should. This causes the prostate to enlarge and the patient to develop difficulty urinating. With prostate cancer, the cells not only multiply faster, but also behave abnormally by spreading outside of the prostate if not caught in time. BPH is not cancer, but can show some of the same symptoms. Rectal cancer is a type of cancer that develops in the rectum, the last six inches of our large intestine. Like other organs in our body, the rectum is vulnerable to many diseases and conditions, such as cancer. Causes and Risk Factors of Rectal Cancer We can't exactly pinpoint what causes rectal cancer, but we know what may increase our risk of developing it. Risk factors for rectal cancer include: being older than 50 family or personal history of colon cancer (a person does not need a family history of colon cancer to have rectal cancer; it is most commonly diagnosed in those without a family history.) personal history of polyps(small growths in the colon) smoking

Renal cell carcinoma is the most common type of kidney cancer, accounting for up to 90% of cases of the disease. In renal cell carcinoma, malignant cells are believed to arise from the tubules of the kidney. The primary function of the kidney is to filter waste from our blood. About 50 gallons of blood enter our kidneys every day. They also process approximately two quarts of extra water. The wastes that are filtered, and the extra water, turn into urine. The urine then travels down tubes, called ureters and is stored in the bladder until excretion (urination).

Skin cancer is a cancer of the cells in the outermost layer of skin, called the epidermis. The epidermis itself has three layers: an upper and middle layer made up of squamous cells, and a bottom layer made up of melanocytes and basal cells. Different types of skin cancer affect each of these types of cells, including the following most common forms: Basal Cell Carcinoma Squamous Cell Carcinoma Melanoma Testicular cancer is a type of cancer that develops in the testicle(s) of men. It is considered to be uncommon, with about 8,000 men diagnosed each year. The good news is that this type of cancer is highly treatable and curable. Causes and Risk Factors of Testicular Cancer Although researchers cannot pinpoint exactly what causes testicular cancer, they have identified several known risk factors for the disease. A risk factor is something that increases the likelihood that you may develop a disease, but is not a guarantee you will get it. Risk factors include: having had an undescended testicle, although if this is corrected early in life, the risk is reduced having had abnormal development of the testicles having a personal or family history of testicular cancer being diagnosed with Klinefelter's syndrome being infected with HIV being Caucasian

Uterine cancer is a type of cancer that affects the uterus in the female reproductive system. Cancer most commonly develops in the endometrium of the uterus, resulting in endometrial cancer, the most prevalent type of uterine cancer. Much less commonly, cancer develops in the muscles and other tissues that support the uterus. When this occurs, it is called a uterine sarcoma. Less than 5% of uterine cancers are sarcomas.

Vaginal cancer is a rare type of cancer that forms in the vaginal tissue in women. Not to be confused with the vulva, the vagina is the narrow, elastic canal that extends from the cervix to the outside of the body. It is about 2 to 4 inches long. It is also referred to as the birth canal.

Vulvar cancer is a rare type of cancer that affects vulva of women. Not to be confused with thevagina, the vulva encompasses the labia majora and labia minora, folds of skin that protect the vaginal and urethral openings. There are several types of vulvar cancer, but squamous cell vulvar carninoma is most common. It accounts for more than 90% of diagnosed cases. Melanoma of the vulva is the second most common and represents about 5% of women with vulvar cancer. Other types include Paget's Disease of the vulva, vulvar adenocarcinoma, and basal cell carcinoma, but these are much less common.

2. NURSING MANAGEMENT FOR CANCER Nursing Management in Cancer Surgery The patient undergoing surgery for cancer requires general peri-operative nursing care, as described in Unit 4, along with speciccare related to the patients age, organ impairment, nutritionaldecits, disorders of coagulation, and altered immunity that may increase the risk for postoperative complications. Combiningother treatment methods, such as radiation and chemotherapy, with surgery also contributes to postoperative complications,such as infection, impaired wound healing, altered pulmonary orrenal function, and the development of deep vein thrombosis. Inthese situations, the nurse completes a thorough preoperative as-sessment for all factors that may affect patients undergoing sur-gical procedures.The patient undergoing surgery for the diagnosis or treatmentof cancer is often anxious about the surgical procedure, possiblendings, postoperative limitations, changes in normal body func-tions, and prognosis. The patient and family require time and as-sistance to deal with the possible changes and outcomes resultingfrom the surgery.The nurse provides education and emotional support by as-sessing patient and family needs and exploring with the patientand family their fears and coping mechanisms, encouraging themto take an active role in decision making when possible. Whenthe patient or family asks about the results of diagnostic testing and surgical procedures, the nurses response is guided by the in-formation the physician previously conveyed to them. The pa-tient and family may also ask the nurse to explain and clarify information that the physician initially provided but that they didnot grasp because they were anxious at the time. It is importantfor the nurse to communicate frequently with the physician andother health care team members to be certain that the informa-tion provided is consistent. After surgery, the nurse assesses the patients responses to thesurgery and monitors for possible complications, such as infection,bleeding, thrombophlebitis, wound dehiscence, uid and elec-trolyte imbalance, and organ dysfunction. The nurse also providesfor patient comfort. Postoperative teaching addresses wound care,activity, nutrition, and medication information.Plans for discharge, follow-up and home care, and treatmentare initiated as early as possible to ensure continuity of care fromhospital to home or from a cancer referral center to the patientslocal hospital and health care provider. Nursing Management in Radiation Therapy The patient receiving radiation therapy and the family often havequestions and concerns about its safety. To answer questions andallay fears about the effects of radiation on others, on the tumor,and on the patients normal tissues and organs, the nurse can ex-plain the procedure for delivering radiation and describe theequipment, the duration of the procedure (often minutes only),the possible need for immobilizing the patient during the procedure, and the absence of new sensations, including pain, duringthe procedure. If a radioactive implant is used, the nurse informsthe patient and family about the restrictions placed on visitorsand health care personnel and other radiation precautions. Pa-tients also need to understand their own role before, during, andafter the procedure. See Chapter 47 for further discussion of ra -diation treatment for gynecologic cancers. PROTECTING THE SKIN AND ORAL MUCOSA The nurse assesses the patients skin, nutritional status, and gen-eral feeling of well-being. The skin and oral mucosa are assessedfrequently for changes (particularly if radiation therapy is directedto these areas). The skin is protected from irritation, and the pa-tient is instructed to avoid using ointments, lotions, or powderson the area.Gentle oral hygiene is essential to remove debris, prevent irri-tation, and promote healing. If systemic symptoms, such as weak-ness and fatigue, occur, the patient may need assistance withactivities of daily living and personal hygiene. Additionally, thenurse offers reassurance by explaining that these symptoms are aresult of the treatment and do not represent deterioration or pro-gression of the disease. PROTECTING THE CAREGIVERS When a patient has a radioactive implant in place, nurses andother health care providers need to protect themselves as well asthe patient from the effects of radiation. Specic instructions areusually provided by the radiation safety ofcer from the x-ray de-partment. The instructions identify the maximum time that canbe spent safely in the patients room, the shielding equipment tobe used, and special precautions and actions to be taken if the im-plant is dislodged. The nurse should explain the rationale for theseprecautions to keep the patient from feeling unduly isolated. Nursing Management in Chemotherapy

The nurse has an important role in assessing and managing many of the problems experienced by the patient undergoing chemother-apy.Because of the systemic effects on normal as well as malig-nant cells, these problems are often widespread, affecting many body systems. ASSESSING FLUID AND ELECTROLYTE STATUS Anorexia, nausea, vomiting, altered taste, and diarrhea put thepatient at risk for nutritional and uid and electrolyte distur-bances. Changes in the mucosa of the gastrointestinal tract may lead to irritation of the oral cavity and intestinal tract, furtherthreatening the patients nutritional status. Therefore, it is im-portant for the nurse to assess the patients nutritional and uidand electrolyte status frequently and to use creative ways to encourage an adequate uid and dietary intake. MODIFYING RISKS FOR INFECTION AND BLEEDING Suppression of the bone marrow and immune system is an ex-pected consequence of chemotherapy and frequently serves as aguide in determining appropriate chemotherapy dosage. How-ever, this effect also increases the risk for anemia, infection, andbleeding disorders. Therefore, nursing assessment and care focuson identifying and modifying factors that further increase the pa-tients risk. Aseptic technique and gentle handling are indicatedto prevent infection and trauma. Laboratory test results, particu-larly blood cell counts, are monitored closely. Untoward changesin blood test results and signs of infection and bleeding must bereported promptly. The patient and family members are in-structed about measures to prevent these problems at home (seePlan of Nursing Care for more information) Nursing Management in BoneMarrow Transplantation Nursing care of patients undergoing BMT is complex and demandsa high level of skill. Transplantation nursing can be extremely re- warding yet extremely stressful. The success of BMT is greatly in-uenced by nursing care throughout the transplantation process. IMPLEMENTING PRETRANSPLANTATION CARE All patients must undergo extensive pretransplantation evalua-tions to assess the current clinical status of the disease. Nutritionalassessments, extensive physical examinations and organ functiontests, and psychological evaluations are conducted. Blood work includes assessing past antigen exposure (for example, to hepatitisvirus, cytomegalovirus, herpes simplex virus, HIV, and syphilis).The patients social support systems and nancial and insuranceresources are also evaluated. Informed consent and patient teach-ing about the procedure and pretransplantation and posttrans-plantation care are vital. PROVIDING CARE DURING TREATMENT Skilled nursing care is required during the treatment phase of BMT when high-dose chemotherapy (conditioning regimen) andtotal body irradiation are administered. The acute toxicities of nausea, diarrhea, mucositis, and hemorrhagic cystitis require closemonitoring and constant attention by the nurse.Nursing management during the bone marrow or stem cell in-fusions consists of monitoring the patients vital signs and blood oxygen saturation; assessing for adverse effects, such as fever, chills,shortness of breath, chest pain, cutaneous reactions, nausea, vom-iting, hypotension or hypertension, tachycardia, anxiety, and tastechanges; and providing ongoing support and patient teaching.Throughout the period of bone marrow aplasia until engraft-ment of the new marrow occurs, patients are at high risk for dyingof sepsis and bleeding. Patients require support with blood prod-ucts and hemopoietic growth factors. Potential infection may bebacterial, viral, fungal, or protozoan in origin. Renal complica-tions arise from the nephrotoxic chemotherapy agentsused in theconditioning regimen or those used to treat infection (ampho-tericin B, aminoglycosides). Tumor lysis syndrome and acutetubular necrosis are also risks after BMT.GVHD requires skillful nursing assessment to detect early ef-fects on the skin, liver, and gastrointestinal tract. VOD resultingfrom the conditioning regimens used in BMT can result in uidretention, jaundice, abdominal pain, ascites, tender and enlargedliver, and encephalopathy. Pulmonary complications, such aspulmonary edema, interstitial pneumonia, and other pneumo-nias, often complicate the recovery after BMT.

3.

GERIATRIC ASSESSMENT

The geriatric assessment differs from a standard medical evaluation in three general ways: (1) it focuses on elderly individuals with complex problems, (2) it emphasizes functional status and quality of life, and (3) it frequently takes advantage of an interdisciplinary team of providers. Whereas the standard medical evaluation works reasonably well in most other populations, it tends to miss some of the most prevalent problems faced by the elder patient. These challenges, often referred to as the "Five I's of Geriatrics", include intellectual impairment, immobility, instability, incontinence and iatrogenic disorders. The geriatric assessment effectively addresses these and many other areas of geriatric care that are crucial to the successful treatment and prevention of disease and disability in older people. Performing a comprehensive assessment is an ambitious undertaking. Below is a list of the areas geriatric providers may choose to assess: Current symptoms and illnesses and their functional impact. Current medications, their indications and effects. Relevant past illnesses. Recent and impending life changes. Objective measure of overall personal and social functionality. Current and future living environment and its appropriateness to function and prognosis. Family situation and availability. Current caregiver network including its deficiencies and potential. Objective measure of cognitive status. Objective assessment of mobility and balance. Rehabilitative status and prognosis if ill or disabled. Current emotional health and substance abuse. Nutritional status and needs. Disease risk factors, screening status, and health promotion activities.