Cancer cells

Abnormal cells that serve no useful function and are harmful to normal body tissue.

Primary Tumor

Site at which cancer cells originated, even if they are found in another area.

Metastasis

Movement of cancer cells from primary lesion to other parts of the body.

Benign Cancer Cells

Local, well-defined border, slow growing, encapsulated, pushes other tissues out of the way, easily removed and may not occur.

Dx: for Cancer

Biopsy, CXR, cytology

Malignant Cancer Cells

Rapid growing, invasive, invades or destroys surrounding tissues, metastasize to distant sites, not always easy to remove and can recur.

Metastasis

Invades surrounding tissue

spreads via lymphatic system: lymph can carry cancer cells throughout the body

 hematological spread: most common way for cancer to spread throughout the body via blood vessels.

Bone, Lung, Liver, Brain

Lung Metastasis

Brain, Bone, Liver, Lymph Nodes, Pancreas

Colorectal Cancer

Liver, Lymph Nodes, Adjacent Structures

Prostate Metastasis

Bone & Pelvic area

Brain Metastasis

CNS

Renal Tumors

Evolve from the Kidney

Solid Tumors

 Develop in specific tissue: Breast & Lung

Osteo Tumors

originate from the Bone

Hematologic Cancers

Originate from blood-forming tissues: Leukemia & Lymphomas

Tumor Staging

T = extent of primary tumor

N = Number of lymph nodes involved

M = extent of Metastasis (is it closer to or further from primary tumor?)

Tumor Grading

Grade 1 = well-differentiated tumor, closely resembles tissue of origin in structure/function. This can designate breast, lung, etc..

Grade 2 =

Grade 3 =

Grade 4 = does not clearly resemble the tissue of origin in structure/function, poorly differentiated or undifferentiated

Oncogenes

Genes that tell cells to divide, i.e., hair,skin,blood, liver. Heart & brain cells do NOT divide.

When oncogenes overexpress viruses can occur.

Etiology of Cancer

Viruses/Bacteria: HPV

Physical Agents: sun, X-rays

Chemical agents: smoking, asbestos, ETOH

Genetics

Dietary factors: high-fiber, low-fat

Hormones: estrogen, progesterone

Weakened Immune System

Primary Prevention of Cancer

Public education re: sunscreen, smoking, asbestos, limiting ETOH, safe sex, removal of moles/polyps/breasts, vaccines & chemoprevention

Secondary Prevention of Cancer

Includes detection & screening:

 yearly mammogram over 40 yrs

Colonoscopy at 50 yrs and every 10 yrs

Year Prostate Specific Antigen over 50 yrs

Pap smears

Fecal Occult Blood tests

7 Warning Signs of Cancer

(CAUTION)

C - Change in bowel or bladder

A - A sore that does not heal

U - Unusual bleeding or discharge

T - Thickening or lump

I - Indigestion or trouble swallowing

O - Obvious changes to moles/warts

N - nagging cough or hoarseness

COUGH is 1ST SIGN OF CANCER

Testing for Cancer

CBC, LFT (liver function test), CEA (carcinoembryonic antigen), AFP (alpha-fetoprotein)

Bone marrow, CT, MRI, mammogram

Guaic sool (hemacult), colonscopy

Cancer Treatment Options

Surgery, Radiation, Chemotherapy, Adjuvant Therapy, Hormonal Manipulation, Immunotherapy: Biologic Response Modifiers (BRMs) (platelets)

Types of Surgery

for Cancer

Prophylactic: breast

Diagnosis & staging

Curative:  colon

Cancer control/cytoreductive: debulking the tumor

Palliative: comfort

Secondary: to see if 1st surgery was successful

Reconstructive/Rehabilitative: breast implants/ball in testes

SEs: pain, body image, anger

Role of Radiation

Kills cancer cells, makes them stop dividing.

External/Teletherapy:  X-rays

Internal/Brachytherapy: surgical implants (seeds)

SEs of Radiation

Erythema (local) >

 desquamation (dk. red to purple) >

dry desquamation (peeling, shedding, pruritis) >

Wet desquamation (edema blisters)

Nursing care for External Radiation

Avoid frequent washing (or washing off of markings), scratching, use electric razors.

Don't disrupt blisters. No lo;tions,soaps, deodorants, powder. No hot or cold. If weeping, gauze dressing.

Alkylating Chemo Agents

Directly damage DNA to prevent cell reproduction.

All phases of cell cycle.

SE: N/V, alopecia, sterility

ASE: hemorrhagic cystitis, myelosuppression, cardiotoxicity, neurotoxicity

Antimetabolites

Interferes with DNA and RNA growth by substituting for normal building blocks of RNA and DNA.

Cell damage during S phase.

SE: N/V, diarrhea, stomatitis, leukopenia, alopecia

ASE: myselosuppression (anemia), renal failure

Interfere with enzymes involved in DNA replication. Work in the S phase.

SE: N/V, alopecia, red urine, hyperuricemia, stomatitis

ASE: cardiotoxicity, allergic reaction, myselosuppression, extravasation

(kills tissue could lose joint movement)

Adriamycin (vesicant)- check HR. Lifetime limit. Allergic reaction.

Hormonal Agents

Block estrogen/cause hormonal symptoms

SE: hot flashes, vaginal bleeding, bone pain, peripheral edema, weight gain

ASE: hypercalcemia, hepatic dysfunction.

Tamoxifen citrate

Biologic Response Modifiers (BRMs)

Cytokines: interferons & interleukins

SE: Fever, chills, rigors & flu-like, peripheral neuropathy, orthostatic hypotension, skin rashes

Stay hydrated!! Lots of fluids!!!

(for melanomas)

Common Undesirable Effects of

Chemotherapy

Bone marrow suppression, alopecia, N/V, fear and anxiety, stomatitis (mouth care vital!)

Decreased platelets, Decreased WBCs = high risk of infection

Extravasation

Vesicant drugs: adriamycin, vincristine, nitrogen mustard

Can cause tissue necrosis, damage to tendons, paresthesia, blood vessels.

Use Central line, blood for blood return, watch for swelling, pain redness at site

Lab Alerts for Cancer

CBC

1) Hgb/Hct:  Low RBCs (< 8)

2) Neutropenia: Low WBC

3) Platelets low

CBC Normal Values

Hemoglobin: 13.2-16.2 gm/dL (male)

12.0-15.2 gm/dL (female)

Hematocrit: 40-52% (male)

37-46% (female)

WBC: 4.1-10.9x10³ /uL

Neutrophils: 45-73%

Platelets: 140-450x10³/uL

(140,000 - 450,000)