Objectives
After 2H of active lecture-discussion. The students will be able to: 1. 2. 3. 4. 5. Define CANCER Present their group audio-visual presentation focusing on CANCER prevention and awareness Identify the responsibilities of the nurse in CANCER care Have a preview on the different types of CANCER Include Christian Valuing in the care of clients with CANCER.
Cancer
malignant neoplasm is a class of diseases in which a group of cells display
uncontrolled growth (division beyond the normal limits) invasion (intrusion on and destruction of adjacent tissues) metastasis (spread to other locations in the body via lymph or blood).
Cancer
is not a single disease with a single cause; rather it is a group of distinct diseases with different causes, manifestations, treatments, and prognoses.
PROLIFERATIVE PATTERNS
Cancerous cells:
malignant neoplasms
demonstrate uncontrolled cell growth that follows no physiologic demand.
BENIGN Well- differentiated cells that resemble normal cells of the tissue from which the tumor originated. Tumor grows by expansion and does not infiltrate the surrounding tissues; usually encapsulated.
MALIGNANT Cells are undifferentiated and often bear little resemblance to the normal cells of the tissue from which they arose. Grows at the periphery and sends out processes that infiltrate and destroy the surrounding tissues.
Mode of growth
Rate of growth
Rate of growth is usually Rate of growth is slow. variable and depends on level of differentiation; the more anaplastic the tumor, the faster its growth. Does not metastasis. spread by Gains access to the blood and lymphatic channels and metastizes to the other areas of the
Metastasis
General effects
Is usually a localized phenomenon that does not cause generalized effects unless its location interferes with vital functions. Does not usually cause tissue damage unless its location interferes with blood flow.
Often causes generalized effects, such as anemia, weakness, and weight loss.
Tissue destruction
Often causes extensive tissue damage as the tumor outgrows its blood supply or encroaches on blood flow to the area; may also produce substances that causes cell damage.
Ability to cause death Does not usually cause Usually causes death death unless its location unless growth can be interferes with vital controlled. functions.
Metastasis: dissemination or spread of malignant cells from the primary tumor to distant sites by direct spread of tumor cells to by cavities or through lymphatic and blood circulation.
METASTATIC MECHANISMS
Lymphatic spread
Most common mechanism. Tumor emboli enter through interstitial fluid that communicates with lymphatic fluid or by invasion. After entering the lymphatic circulation, may lodge in the lymph nodes or pass between lymphatic and venous circulation.
Hematogenous spread
Malignant cells are disseminated through the blood stream. Few malignant cells survive the turbulence of arterial circulation, insufficient oxygenation, or destruction by the bodys immune system. Those that survive are able to attach to endothelium and attract fibrin, platelets and clotting factors to seal themselves form immune system vigilance.
Angiogenesis
Ability of the malignant cells to induce the growth of new capillaries from the host tissue to meet their needs for nutrients and oxygen.
Promotion
Repeated exposure to promoting agents (cocarcinogens) causes the expression of abnormal or mutant genetic mutation even after long latency periods.
Progression
Cellular changes formed during initiation and promotion now exhibit increased malignant behaviour. These cells now show a propensity to invade adjacent tissues and to metastasize.
ETIOLOGY
Physical agents
Exposure to sunlight or radiation, chronic irritation or inflammation, and tobacco use.
Chemical agents
75% are thought to be related to the environment Tobacco smoke: single most lethal carcinogen (30% of cancer deaths) Others: aromatic amines and aniline dyes; pesticides and folmaldehydes; arsenic soot, and tars; asbestos; benzene; betel nut and lime; cadmium; chromium compounds; nickel and zinc ores; wood dust; beryllium compounds; and polyvinyl chloride. Most chemicals alters DNA structure in body sites distant from chemical exposure. Most often affected: liver, lungs and kidneys
Dietary factors
35% of all environmental cancers Dietary substances associated with an increased cancer risk: Fats, alcohol, salt- cured or smoked- meats, foods containing nitrates and nitrites, and high- caloric dietary intake. Foods that lower cancer risks: High- fiber foods, cruciferous vegetables (cabbage, broccoli, cauliflower, Brussel sprouts, kohlbari), carotenoids (carrots, tomatoes, spinach, apricots, peaches, dark- green and deep- yellow vegetables) Obesity: associated with endometrial cancer, postmenopausal breast cancer, cancers of the colon, kidney, and gallbladder.
Hormonal agents
Disturbances in hormonal balance either by the bodys own (endogenous) hormone production or by administration of exogenous hormones. Endogenous: cancers of the breast, prostate and uterus Oral contraceptives and prolonged estrogen replacement therapy: hepatocellular, endometrial, and breast cancers. Hormonal changes with reproduction are also associated with cancer incidence. Increased numbers of pregnancies are associated with a decreased incidence of breast, endometrial and ovarian cancers.
1. Cervical cancer
Colorectal cancer
family history (immediate relatives) low fiber diet history of rectal polyps
3.
Esophageal Cancer
heavy alcohol consumption Smoking
3.
Lung Cancer
cigarette smoking asbestos, arsenic, and radon exposure secondhand smoke TB
Skin Cancer
excessive exposure to UV radiation (sun) fair complexion work with coal, tar, pitch or creosote multiple or atypical nevi (males)
6.
Stomach Cancer
family history diet heavy in smoked, pickled or salted foods
6.
Testicular Cancer
undescended testicles consumption of hormones by mothers during pregnancy
6.
Prostate Cancer
increasing of age family history diet high in animal fat
Cancer Classification
1.Solid Tumors : Associated with the organs from which they developed, such as breast or lung cancer 2.Hematological Cancers : Originate from blood-cell forming tissues, such as the leukemias and the lymphomas
Grading
Grading: refers to classification of tumor cells. Seek to define the type of tissue from which the tumor originated and the degree to which the tumor cells retain the functional and histologic characteristics of the tissue of origin. Can be obtained through cytology (examination of cells from tissue scrapings, body fluids, secretions or washings), biopsy or surgical excision.
GRADING
GradeX : Grade cannot be determined GradeI : Cells differ slightly from normal cells and are well differentiated (Mild Dysplasia) GradeII : Cells are abnormal and are moderately differentiated ( Moderate Dysplasia) GradeIII : Cells are very abnormal and are poorly differentiated ( Severe Dysplasia) GradeIV : Cells are immature (anaplasia) and undifferentiated, cell of origin is difficult to
Staging
Staging: determines the size of the tumor and the existence of the metastasis. TNM system:
T: The Extent of the primary tumor N: The absence or presence of regional lymph node metastasis. M: The absence or presence of distant metastatsis.
Cancer is also curable if detected and treated early. The principal role of an oncology nurse as a provider of information and education in the prevention and early detection of cancer requires a basic understanding of the etiology and epidemiology of the disease.
4. Limiting alcohol consumption 5. Hepa B virus infant vaccination 6. Control of STDs 7. Changing risk behaviors 8. Teaching skills for early detection programs 9. Promoting participation in early detection programs
Recommendations of the American Cancer Society for early cancer detection 1. For detection of breast cancer
Monthly BSEs Women at age 40 should have a yearly mammogram and breast examination by a health care provider
Cancer Screening
-refers to detection of disease through tests, exams, and other procedures An ocology nurse should have good hx taking skills. She should be able to note down all possible clinical as well as behavioral clues through PE
DIAGNOSTIC TESTS
Biopsy - is the definitive means of diagnosing cancer and provides histological proof of malignancy. - involves the surgical incision of a small piece of tissue of microscopic examination Types: a. Needle : Aspiration of Cells b. Incisional : Removal of a wedge of suspected tissue from a larger mass c. Excisional : Complete removal of the entire lesion d. Staging : Multiple needle or incisional biopsies in tissues where metastasis is suspected or likely.
Tumor Markers
protein substances found in the blood or body fluids derived from the tumor itself
Tumor Markers
a. Oncofetal antigens
Normally present in fetal tissue;may indicate an anaplastic process in tumor cells
Ex:
Carcinoembryonic Antigen (CEA) Alpha-feto protein
Tumor Markers
b. Hormones
ADH Calcitonin Catecholamines HCG PTH
Tumor Markers
c. Isoenzymes
increased when a tissue is experiencing rapid and excessive growth as a result of a tumor
Neurospecific enolase (NSE) Prostatic acid phosphatase (PAP)
Management of Cancer
Radiation therapy
Used to kill a tumor, reduce tumor size, relieve obstruction or decrease pain Causes lethal injury to DNA Classification:
Internal radiation therapy (brachytherapy) External radiation therapy (teletherapy)
Brachytherapy
a. Sources
Implanted into the affected tissue or body cavity Ingested as a solution Injected as a solution into the bloodstream or body cavity Introduced through a catheter into the tumor Fatigue Anorexia Immunosuppression
a. Side effects:
Brachytherapy
c. Client education
Avoid close contact with others until the treatment is completed Maintain daily activities unless contraindicated Rest Maintain a balanced diet Maintain fluid intake If implant is temporary, the client should be on bed rest Excreted body fluids may be radioactive; double flush toilets after use
Brachytherapy
d. Nursing management
Minimize time spent in close proximity to the radiation sources Limit contact time to 30 mins per 8H shift Minimum distance should be 6 ft Use lead shields Place the client in a private room Limit visits to 10-30 minutes Ensure proper handling and disposal of body fluids Pregnant women and children are not allowed inside the clients room
Teletherapy
Treatment is usaully given 15-30 minutes per day, 5x per week, for 2-7 weeks Client does not pose a risk of radiation exposure to other people Side effects:
Tissue damage to target area (erythema, sloughing, and hemorrhage) Ulcerations of oral mucous membranes Nausea, vomiting, and diarrhea Radiation pneumonia Fatigue Alopecia Immunosuppression
Teletherapy
Client education
Wash marked area of the skin with plain water only and pat dry. Do not use soaps, deodorants, lotions, perfumes, powders, or medications on the site during the duration of the treatment. Do not wash off the treatment site marks Avoid rubbing, scratching, or scrubbing the treatment site. Do not apply extreme temperatures to the treatment site. If shaving is necessary, use electric razor. Wear soft, loose-fitting clothing over the treatment area Protect skin from sun exposure during the treatment and for at least 1 year after the treatment is completed. When going outdoors, use sun blocking agents with SPF of at least 15. Maintain proper rest, diet, and fluid intake Hair loss may occur. Choose a wig, hat or scarf to cover and protect the head.
Chemotherapy
Involves the administration of cytotoxic medications and chemicals to promote death of tumor cells. Route of adminstration:
IV Oral Intrathecal Topical Intra-arterial Intracavity Intravesical
a. Alkylating agents
b. Antimetabolites
Interfere with metabolites or nucleic acids necessary for RNA and DNA synthesis
5-fluorouracil (5-FU) Methotrexate
c. Cytotoxic antibiotics
e. Plant alkaloids
Vinca alkaloids are phase-specific, inhibiting cell division Etoposide acts during all cell-cycle phases, interfering with DNA and cell division at metaphase
Nursing implications for the administration of chemotherapy IV routes may be obtained by subclavian catheters,
implanted ports, or peripherally inserted catheters. Extravasation is the major complication of IV chemotherapy. Extreme care must be used when administering vesicant agents WARNING: NEVER TEST VEIN PATENCY WITH CHEMOTHERAPEUTIC AGENTS. Monitor client closely for anaphylactic reactions or serious side effects. Discontinue infusion according to protocol if reaction occur Use caution when preparing, administering, or disposing chemotherapeutic agents
Thrombocytopenia
Use electric razor when shaving Avoid contact sports If trauma occurs, apply ice and seek medical assistance Avoid dental work or other invasive procedures Avoid aspirin and aspirin-containing products
Surgery
Primary treatment Prophylactic Palliative Reconstructive
Types of Cancer
Testicular Cancer
Arises from germinal epithelium from the spermproducing germ cells or from nongerminal epithelium from other structures in testicles. Testicular Cancer most often occurs between the ages of 15 and 40 Metastasis occurs to the lung, liver, bone and adrenal glands. Prevention : Routine Testicular Examination
Assessment
Painless testicular swelling occurs. Dragging sensation is evident in the scrotum. Palpable lymphadenopathy, abdominal masses, and gynecomastia may indicate metastasis. Late signs include back or bone pain and respiratory symptoms.
Interventions
- Prepare the client for radiation therapy or unlateral orcheictomy as prescribed . - Discuss reproduction, sexuality and fertility information and options with the client For Post Op: - Monitor for signs of bleeding and wound infection. - Monitor Intake and output - Notify the physician if chills, fever, increasing pain or tenderness at the incision site, or drainage of the incision occurs. - Instruct the client to perform a monthly testicular selfexamination on the remaining testicle.
Cervical Cancer
Pre-invasive cancer is limited to the cervix Invasive cancer is in the cervix and other pelvic structures. Metastasis usually is confined to the pelvis, but distant metastasis occurs through lymphatic spread. Pre malignant changes are described on a continuum from dysplasia , which is the earliest premalignant change.
Precipitating Factors
1. 2. 3. 4. 5. 6. Low socioeconomic groups Early first marriage Early and frequent intercourse Multiple sex partners High parity Poor hygiene
Assessment
Painless vaginal bleeding postmenstrually and postcoitally Foul-smelling or serosanguineous vaginal discharge Pelvic, lower back, leg or groin pain Anorexia and weight loss Leakage of urine and feces from the vagina Dysuria Hematuria Cytological changes on Papanicolaous Test
Interventions
Nonsurgical Chemotherapy Cryosurgery External Radiation Internal Radiation Implants (Intracavitary) Laser Therapy Surgical Hysterectomy Pelvic Exenteration
POST OP CARE
ESTROGEN replacement immediate post op if the ovaries were removed No vaginal entry, douching, or intercourse for 4-6 weeks Avoid bending knees
Ovarian Cancer
Ovarian cancer grows rapidly , spreads fast and is often bilateral. Metastasis occurs by direct spread to the organs in the pelvis, by distal spread through lymphatic drainage or by peritoneal seeding Prognosis is usually poor because the tumor usually is detected late. An exploratory laparotomy is performed to diagnose and stage the tumor.
Assessment
1. 2. 3. 4. Abdominal discomfort or swelling Gastrointestinal disturbances Dysfunctional vaginal bleeding Abdominal mass
Interventions
1. External radiation is used if the tumor is invaded other organs. 2. Chemotherapy is used postoperatively for all stages of ovarian cancer. 3. Intraperitoneal chemotherapy involves the instillation of chemotherapy into the abdominal cavity. 4. Immunotherapy alters the immunological response of the ovary and promotes tumor resistance. 5. Total abdominal hysterectomy and bilateral salpingo-oophorectomy may be necessary.
Endometrial Cancer
Is a slow growing tumor associated with the menopausal years. Metastasis occurs through the lymphatic system to the ovaries and pelvis; via the blood to the lungs, liver and bone; or intraabdominally to the peritoneal cavity.
Precipitating Factors
1. 2. 3. 4. 5. 6. History of uterine polyps Nulliparity Polycystic ovary disease Estrogen stimulation Late menopause Family history
Assessment
- Postmenopausal bleeding - Watery, serosanguineous discharge - Low back, pelvic, or abdominal pain - Enlarged uterus in advanced stages
Interventions
Nonsurgical interventions 1. External radiation or internal radiation is used alone or in combination with surgery, depending on the stage of cancer. 2. Chemotherapy is used to treat advanced or recurrent disease. 3. Progestational therapy with medication such as medroxyprogesterone (Depo-Provera) or megestrol acetate (Megace) is used for estrogen dependent tumors. 4. Tamoxifen (Novaldex), an antiestrogen, also maybe prescribed. Surgical interventions Total abdominal hysterectomy and bilateral salpingooophorectomy
Breast Cancer
Breast cancer is classified as invasive when it penetrates the tissue surrounding the mammary duct and grows in an irregular pattern. Metastasis occurs via lymph nodes. Common sites of metastasis are the bones, lungs; metastasis also occurs to the brain and liver. Diagnosis is made by breast biopsy through a needle aspiration or by surgical removal of the tumor with microscopic examination for malignant cells. Prevention : Monthly BSE
Precipitating Factors
Family history Early menarche and late menopause Previous cancer of the breast, uterus or ovaries Nulliparity Obesity High dose radiation exposure to chest High fat diet
Assessment
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Mass felt during BSE Mass usually felt in the upper outer quadrant or beneath the nipple. A fixed, irregular noncapsulated mass A painless mass except in late stages Nipple retraction or elevation Asymmetry, with affected breast being higher Bloody or clear nipple discharge Skin dimpling, retraction, or ulceration Skin edema or peau d orange skin Axillary lymphadenopathy Lymphedema of the affected arm Symptoms of bone and lungs metastasis Presence of the lesions on mammography
Nonsurgical Interventions
1. Chemotherapy 2. Radiation therapy 3. Hormonal manipulation via the use of medication in postmenopausal women or other medications such as tamoxifen (Novadex) for estrogen receptor positive tumors
Surgical Interventions
1. Surgical breast procedures with possible breast reconstruction 2. Oophorectomy for estrogen receptor positive tumors 3. Ablative therapy with adrenalectomy or chemical ablation, which blocks the production of cortisol, androstenedione, and aldosterone.
Gastric Cancer
Gastric cancer is a malignant growth in the stomach.
Risk Factors
Diet high in complex carbohydrates , grains and salt, and low in fresh, green leafy vegetables and fresh fruit Smoking Alcohol ingestion The use of nitrates History of gastric ulcers
Assessment
1. 2. 3. 4. 5. 6. 7. 8. 9. Fatigue Anorexia and weight loss Nausea and vomiting Indigestion and epigastric discomfort A sensation of pressure in the stomach Dysphagia Anemia Ascites Palpable mass
Interventions
1. 2. 3. 4. 5. 6. 7. Monitor vital signs. Monitor hemoglobin and hematocrit and administer blood transfusions as prescribed. Monitor weight. Assess nutritional status; encourage small, bland, easily digestible meals with vitamin and mineral supplements. Administer pain medications as prescribed. Prepare the client for chemotherapy or radiation as prescribed. Prepare the client for surgical resection of the tumor as prescribed.
Surgical Interventions
Subtotal Gastrectomy Billroth I - also called gastroduodenostomy - partial gastrectomy, with remaining segment anastomosed to the duodenum Billroth II - also called gastrojejunostomy - partial gastrectomy, with remaining segment anastomosed to the jejunum. Total Gastrectomy - Also called esophagojejunostomy - removal of the stomach with attachment of the esophagus to the jejunum or duodenum.
Pancreatic Cancer
Is the most common neoplasm affecting the pancreas. The occurrence of pancreatic cancer has been linked to diabetes mellitus, alcohol use, history of previous pancreatitis, smoking, ingestion of high fat diet, and exposure to environmental chemicals. Symptoms usually do not occur until the tumor is large; therefore the prognosis is poor.
Assessment
Nausea and vomiting Jaundice Unexplained weight loss Clay-colored stools Glucose intolerance Abdominal pain
Interventions
1. Radiation 2. Chemotherapy 3. Whipples procedure, which involves a pancreaticoduodenectomy with removal of the distal third of the stomach, pancreaticojejunostomy, gastrojejunostomy and choledochojejunostomy 4. Postoperative care measures are similar to care of a client with pancreatiitis and the client following gastric surgery.
Intestinal Tumors
Intestinal tumors are malignant lesions that develop as polyps in the colon or rectum. Complications include bowel perforation with peritonitis, abscess and fistula formation, hemorrhage and complete intestinal obstruction. Metastasis occurs via the circulatory or lymphatic system or by direct extension to other areas in the colon or other organs.
Assessment
1. 2. 3. 4. 5. Blood in the stools Anorexia, vomiting and weight loss Malaise Anemia Abnormal stools
a. b. c. Ascending colon tumor : Diarrhea Descending colon tumor : Constipation or some diarrhea, or flat ribbonlike stool resulting from partial obstruction Rectal tumor : Alternating constipation and diarrhea
6. 7. 8.
Guarding or abdominal distention Abdominal mass (late sign) Cachexia (late sign)
Interventions
1. Monitor for signs of complications, which include bowel perforation with peritonitis, abscess or fistula formation, hemorrhage and complete intestinal obstruction. Monitor for signs of bowel perforation, which include low blood pressure, rapid and weak pulse, distended abdomen and elevated temperature. Note that an early sign of intestinal obstruction is increased in peristaltic activity, which produces an increased in bowel sound; as the obstruction progresses, hypoactive sounds are heard Prepare for radiation preoperatively to facilitate surgical resection, and postoperatively to decrease the risk of recurrence or to reduce pain , hemorrhage, bowel obstruction, or metastasis. Chemotherapy is used postoperatively to assist in the control of symptoms and the spread of the disease.
2. 3.
4.
5.
Colon Cancer
Colon cancer is cancer of the large intestine (colon), the lower part of your digestive system Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps become colon cancers.
Assessment:
A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool for more than a couple of weeks Rectal bleeding or blood in your stool Persistent abdominal discomfort, such as cramps, gas or pain Abdominal pain with a bowel movement A feeling that your bowel doesn't empty completely Weakness or fatigue Unexplained weight loss
Risk factors:
Age. A personal history of colorectal cancer or polyps. Inflammatory intestinal conditions. Inherited disorders that affect the colon. Family history of colon cancer and colon polyps. Diet low in fiber and high in fat and calories. A sedentary lifestyle. Diabetes. Obesity. Smoking. Alcohol. Radiation therapy for cancer.
Lung Cancer
Is a malignant tumor of the lung that may be primary or metastatic. The lungs are the common target of metastasis. Bronchiogenic carcinoma spreads through direct extension and lymphatic dissemination. The four major types of lung cancer include small cell (oat cell), epidermal (squamous cell), adenocarcinoma, and large cell anaplastic carcinoma.
Diagnosis
Diagnosis is made by a chest x-ray, which will show a lesion or mass, and bronhoscopy and sputum studies, which will demonstrate a positive cytological study for cancer cells.
Causes
Cigarette smoking Exposure to environmental pollutants Exposure to occupational pollutants
Assessment
dyspnea (shortness of breath) hemoptysis (coughing up blood) chronic coughing or change in regular coughing pattern wheezing chest pain or pain in the abdomen cachexia (weight loss), fatigue and loss of appetite dysphonia (hoarse voice) clubbing of the fingernails (uncommon) dysphagia (difficulty swallowing).
Interventions
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Monitor vital signs. Monitor breathing patterns and breath sounds and for signs of respiratory impairment. Assess for tracheal deviation Administer analgesics as prescribed for pain management. Place in Fowlers position for ease in breathing. Administer oxygen as prescribed and humidification to moisten and loosen secretions. Monitor pulse oximetry. Provide respiratory treatments as prescribed. Administer bronchodilators and corticosteroids as prescribed to decrease bronchospasm , inflammation and edema. Provide a high-calorie, high protein, high vitamin diet. Provide activity as tolerated , rest periods and active and passive rangeof-motion exercises. Monitor for bleeding, infection and electrolyte imbalances.
Laryngeal Cancer
Laryngeal cancer is a malignant tumor of the larynx. Laryngeal cancer presents as malignant ulcerations with underlying infiltration. Metastasis to the lungs is common. Diagnosis is made by laryngoscopy and biopsy showing a positive cytological study for cancer cells.
Causes
Cigarette smoking Exposure to environmental pollutants Exposure to radiation Voice strain
Assessment
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Persistent hoarseness and sore throat Painless neck mass A feeling of a lump in the throat Burning sensation in the throat Dysphasia Change in voice quality Dyspnea Weakness and weightloss Hemopytysis Foul breath odor
Interventions
Place in Fowlers position to promote optimal air exchange. Monitor respiratory status. Monitor for signs of aspiration of food and fluids. Administer oxygen as prescribed. Provide respiratory treatments as prescribed. Provide activity as tolerated. Provide a high-calorie, high-protein, high-vitamin diet. Provide nutritional support via total parenteral nutrition, nasogastric tube feedings, gastrostomy or jejunostomy tube as prescribed. Administer analgesics as prescribed for pain.
Prostate Cancer
This slow-growing cancer of the prostate gland is usually a Androgen dependent type of carcinoma. The risks increases in men with each decade after age 50. Prostate cancer can spread via direct invasion of surrounding tissuesor by metastasis, through the bloodstream and lymphatics, to the bony pelvis and spine. Bone metastasis is a concern.
Assessment
1. 2. 3. 4. 5. 6. Asymptomatic Hard, pea-sized nodule palpated on rectal examination. Hematuria Late symptoms such as weightloss, urinary obstruction, and pain radiating form the lumbosacral area down the leg. Prostatic-specific antigen test is not necessarily an indicator of malignancy and use is routine to monitor the clients response to therapy Spread and mestastasis is indicated by elevated serum acid and phosphatase.
Risk Factors:
Age. Race or ethnicity. Family history. High-fat diet High testosterone levels. Occupations exposed to harmful chemicals
Interventions
Non-surgical 1. Prepare the client for hormone manipulation therapy as prescribed. 2. Prepare the client for radiation therapy, which may be prescribed alone or along with surgery and may be prescribed preoperatively or post-operatively to reduce the lesion and limit metastasis. 3. Prepare the client for the administration of chemotherapy in cases of hormone-resistant tumors. Surgical 1. TURP 2. Suprapubic Prostatectomy 3. Retropubic Prostatectomy 4. Perineal Prostatectomy
Skin Cancer
Is a malignant lesion of the skin, which may or may not metastasize. Causes include chronic friction and irritation to a skin area and exposure to ultraviolet rays . Diagnosis : Is confirmed by a skin biopsy that is positive for cancer cells.
Assessment
a. Change in color, size, or shape of pre existing lesions b. Pruritus c. Local Soreness Appearance of Skin Cancer Lesions: - A waxy nodule - An irregular, circular, bordered lesions with hues of tan, black, or blue - A small, red, nodular lesion - An oozing, bleeding, crusting lesion
Nursing Interventions
a. b. c. d. e. f. g. Instruct the client regarding preventive measures. Instruct the client to monitor for lesions that do not heal or that change characteristics. Instruct the client to have moles or lesions removed that are subject ot chronic irritation. Instruct the client to avoid contact with chemical irritants. Intsruct the client to wear layered clothing and use sun screening lotions with an appropriate skin protection factor when outdoors. Instruct the client to avoid sun exposure between 11 am to 3 pm. Assist with surgical excision of the lesion as prescribed.
Leukemia
A malignant exacerbation in the number of leukocytes, usually at an immature stage, in the bone marrow. May be acute, with a sudden onset and short duration, or chronic, with a slow onset and persistent symptoms over a period of years. Leukemia affects the bone marrow causing anemia, leukopenia, the production of immature cells, thrombocytopenia and a decline in immunity. The Cause is unknown and appears to involve gene damage of cells, leading to the transformation of cells from a normal state to a malignant state.
Risk Factors : Genetic Viral Immunological Environmental factors Exposure to radiation Medications
Classification of Leukemia
Acute Lymphocytic Leukemia mostly lymphoblasts , age of onset is less than 15 years. Acute Myelogenous Leukemia mostly myeloblasts present in bone marrow, age of onset is between 15 and 39 years Chronic Myelogenous Leukemia mostly granulocytes present in bone marrow, age of onset is after 50 years Chronic Lymphocytic Leukemia mostly lymphocytes present in bone marrow, age of onset is after 50 years
Assessment
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Anorexia, fatigue, weakness, weight loss Anemia Bleeding (nosebleeds, gum bleeding, rectal bleeding, increased menstrual flow) Petechiae Prolonged bleeding after minor abrasions or lacerations Elevated Temperature Lymphadenopathy and splenomegaly Palpitations, tachycardia, orthostatic hypotension Pallor, dyspnea on exertion Headache Bone pain and joint swelling Normal, elevated or reduced white blood cell count Decreased hemoglobin and hematocrit levels Decreased platelet Positive bone marrow biopsy identifying leukemic blast phase cells
Hodgkins Disease
Is a malignancy of the lymph nodes that originates in a single lymph node or a single chain of nodes. The disease usually involves lymph nodes, tonsils, spleen, and bone marrow and is characterized by the presence of the Reed-Sternberg cell in the nodes. Possible causes include viral infections and previous exposure to alkylating chemical agents.
Assessment
1. 2. 3. 4. 5. 6. 7. 8. 9. Fever Malaise, fatigue, and weakness Night sweats Loss of appetite and significant weight loss Anemia and thrombocytopenia Enlarged lymph nodes, spleen and liver Positive biopsy of lymph nodes, with cervical nodes most often affected first Presence of Reed-Sternberg cells in nodes Positive computed tomography scan of the liver and spleen
Nursing Interventions
1. 2. 3. 4. 5. 6. For Stages I and II without mediastinal node involvement, the treatment of choice is extensive external radiation of the involved lymph node regions. With more extensive disease, radiation along with multi agent chemotherapy is used. Monitor for side effects related to chemotherapy or radiation therapy. Monitor for signs of infection and bleeding. Maintain infections and bleeding precautions. Discuss the possibility of sterility with the male client receiving radiation, and inform the client of options related to sperm banks
Multiple Myeloma
A malignant proliferation of plasma cells and tumors within the bone. An excessive number of abnormal, plasma cells invade the bone marrow, develop into tumors , and ultimately destroy bone; invasion of the lymph node, spleen, and liver occurs. The abnormal plasma cells produce an abnormal antibody (myeloma protein or Bence Jones protein) that is found in the blood and urine.
Assessment
1. 2. 3. 4. 5. Bone pain, especially in the pelvis, spine and ribs Weakness and fatigue Recurrent infections Anemia Bence Jones proteinuria and elevated total serum protein level 6. Osteoporosis 7. Thrombocytopenia and Granulocytopenia 8. Elevated calcium and uric acid levels 9. Renal failure 10. Spinal cord compression and paraplegia
Interventions
Monitor for signs of bleeding, infection, and skeletal fractures. Encourage fluids up to 3 to 4 L a day to offset potential problems associated with hypercalcemia, hyperuricemia and proteinuria. Encourage ambulation to prevent renal problems and to slow down bone resorption. Provide skeletal support during moving, turning and ambulating to prevent pathological fractures Provide a hazard free enviroment. Instruct the client in home care measures and the signs and symptoms of infection.