Altered Cell Growth & Cancer Development

NRS 108

Spring, 2008

Lola Oyedele MSN, RN CTN

Majuvy L. Sulse RN, MSN, CCRN

Description

Uncontrolled growth of abnormal cells Neoplastic disorder that can involve all body

organs Cancer produces serious health problems as

impaired immune and hematopoetic function, altered GI tract structure and function, motor and sensory deficits and decreased respiratory functions

Epidemiology

Increased incidence & mortality in males Prostate Lung colorectal

Increased incidence & death in African Americans

Females Breast, lungs, colorectal

Biology of normal cells Limited cell division-divide & undergo mitosis-(divide

only when internal body conditions and nutrition are just right to promote cell division)

Show specific morphology-distinct appearance, size, shape

Small nuclear-cytoplasmic ratio Perform specific differentiated functions-

pluripotency, multipotency, totipotency Adhere tightly together–secrete proteins (fibronectin)

that protrude from the cell surface allowing cells to bind closely and tightly together

Non migratory- exception leukocytes & erythrocytes Grow in an orderly & well regulated manner-cell cycle Are contact inhibited –density-dependent inhibition of

cell growth

Cell Cycle

Benign Cells Malignant CellsDemonstrate continuous or inappropriate cell growth-growing too much in the wrong place

Rapid or continuous growth- short generation time

Show specific morphology-strongly resembles parent tissue

Anaplastic morphology- loose the specific appearance of parent cell

Small nuclear-cytoplasmic ratio Larger nuclear-cytoplasmic ratio

Perform differentiated functions-perform same parent tissue function

Loss some or all differentiated functions- no useful function

Adhere tightly together-encapsulated

Adhere l o o s e l y together

Non migratory Able to migrate-metastasize

Grow in an orderly manner-hyperplastic expansion

Grow by invasion and not contact inhibited

Common Alterations

Hyperplasia- increase in number of cells Hypertrophy- increase in size Metaplasia-transformation of one type of differentiated

cell into another Dysplasia-abnormal development of an organ, tissues or

cells Neoplasia-new or continued cell growth not needed for

normal development

Carcinogenesis Process of transformation of normal cells to malignant

cells Initiation Promotion Malignant conversion Progression Metastasis

Extension to surrounding tissue Penetration into blood vessels Release of tumor cells Invasion at arrest site

Malignant Conversion

Chromosomes deranged Translocation & deletion Alter regulatory function of DNA Distort biological info of RNA Results in altered growth & function messages

Factors Affecting Growth Rate

Cell cycle time Growth factor Rate cell loss Vascularization Hormonal factors

Factors influencing Cancer development

Environmental factors Chemical Physical-chronic irritation & radiation viral carcinogens

Dietary factors Genetic predisposition Age Immune function

WARNING SIGNS

C hange in bowel/ bladder patternsA sore throat that does not healU nusual bleeding or discharge T hickening or Lump I ndigestion or difficulty swallowingO bvious change in mole or wartN agging cough or hoarseness

Grading & Staging

Method used to describe tumor Extent of tumor Extent to which malignancy has increased in

size Involvement of regional nodes Metastatic development

Grading-classifies the cellular aspect of cancer Staging-classifies the clinical aspects of the cancer

(0-lV)

Classification

Solid tumors-named for tissue type or organs from which they develop

Sarcoma-connective tissue Lipo-fat/adipose tissue

Hematologic CA-blood cell forming tissues Leukemia lymphoma

Grade of Classification- 0-5

Staging (TNM classification) Tumor

TO=no evidence Tis=tumor insitu T 1-2-3-4=degree of size & involvement

Node N1a=1 node, no mets N2a=2 node, no mets

Metastases Mo= no mets M1-2-3= degree of mets including distant nodes

Prevention

Primary Avoidance of known or potential carcinogens Avoidance or modification of factors associated with

development of Cancer cells Secondary

Early detection Breast, Colon, Prostate, Uterus, skin

Chemoprevention Gene Alteration

Diagnostic Studies

Blood Cytology- PAP, All body secretions Radiology-US, Radioisotope Biopsy- definitive means of diagnosing CA

incisional, excisional, aspiration

Treatment & Nurses’ Role

Treatment Curative Control Palliative Rehabilitative/Reconstructive

Nurses’ Role Assessment-health status, cognitive level, pattern of ADL’s, Data collection-level of knowledge, support system Ethical issues

Methods

Surgery Radiotherapy Chemotherapy Immunotherapy( Biological Therapy

Surgery

Description Diagnostic, staging, and treatment

Types Prophylactic Curative Control-cytoreductive Palliative Reconstructive/rehabilitative

Nursing Management

Pre-operative Post operative Rehabilitative Care

Radiation Therapy Destroy cancer cells with minimal exposure to damaging

effects of radiation Dose calculated to destroy cancer cells and spare

healthy cells Split course

Total dose divided with 1-2 weeks intervals to allow changes in cell cycle & good tissue repair

targets (ports) are marked Different ports on different days directed at different

angles Side- effects=skin changes & irritation, alopecia, fatigue,

altered taste sensation

Teletherapry

Beam radiation Wash area with water and mild soap using hand rather than

washcloth, rinse soap thoroughly & pat dry using soft towel or cloth

Don’t remove markings on skin Use no powders, ointments, lotions, or creams on areas

unless prescribed Wear soft clothing over area avoiding belts, buckles, straps Avoid sun exposure Monitor for moist desquamation Small frequent high protein meals

Brachytherapy

Unsealed radiation sources Oral/ IV routes or instillation to body cavities Enters body fluids eventually eliminated via

excreta Most of the source is eliminated from the body

within 48 hours; then the client nor excreta are radioactive or harmful

Brachytherapy Sealed-Delivers concentrated dose directly to tumor

(cavity/tissues).Client emits radiation while implant is in place but excreta is not radioactive

Place client in private room with private bath Place radiation CAUTION sign on door Organize nursing tasks to minimize exposure to

radiation source Visitors limited to ½ hour/day & at least 6 feet from

source. No pregnant woman and children below 16 yrs. old

Save bed linens & dressings till source is removed

Exposure to Radioactivity

Increase distance =decrease exposure Wear dosimeter film badge to measure

radiation exposure Wear lead shield to reduce transmission of

radiation

Radio Wave Ablation/Radiowave Ablation

Treatment with a heat generating probe Radiofrequency ablation

Radiowave Minimally invasive, involves no incision Used as alternative to lumpectomy

Chemotherapy

Indications Curative-Acute Lymphocytic Leukemia Control-disease widespread Palliative-relief of pain Adjuvant- post-op/Radiation therapy Neoadjuvant-pre-operative

Principles of Chemotherapy

Cell cycle Creates change in cell cycle Interrupts cell growth & replication

Phase specific Used with rapidly growing large number of cells

Phase non specific Acts without regard to cell cycle

Considerations

Response Choice Combinations Cell-kill hypothesis

Categories of Agents

Phase Specific Antimetabolites-S phase Miotic inhibitor- in phase

Phase non-specific Alkylating agents Anti-tumor antibiotics Nitrisoureas Hormonal agents Steroids

Methods of Administration

Oral Topical IM IV Intra-arterial- Intra-thecal Perfusion Instillation

Access device

Silastic arterial catheters-single-triple lumen VAD

Porta cath, Hickman

PICC lines

Cell Sensitivity

All rapidly dividing cells Bone marrow

Anemia, neutropenia, thrombocytopenia GI epithelium

mucositosis Hair Follicles

Alopecia

Hematological Effects

NADIR Point of greatest impact

Anemia Expect fatigue, plan rest, notify MD

Neutropenia- teach potential for infection

Thrombocytopenia Teach potential for bleeding/ hemmorhage

Complications/ Interventions

PAIN Team approach

Assess, ask Believe Choose from

appropriate options

Deliver Empower, enable

Barriers to pain management Lack of knowledge Fear of addiction Finances cultural

GI Complications Nausea/ vomiting

Anticipate, give antiemetics Anorexia

Small frequent feedings, Hi protein, Hi calorie Stomatitis

Oral hygiene, avoid hot spicy foods Diarrhea

Lo-residue diet, anti-diarrheal Constipation

Increase fibers, fluids Stool softeners

Alopecia

Biological Response Modifiers

Types Agents that modify immune system

Interferon, interluken 2 Agents that have anti-tumor activity

Monoclonal antibodies Tumor necroing factor

Others that suppress metastatic ability

Interferon Action:

Produce changes in cellular enzyme needed for growth & replication

Activates natural killer cells Stimulates tumor antigen

Side effects: Chills & fever- 3-6 hours Myalgia lasting 5-10 days Nausea, anorexia, altered taste Hypotension, increased respiration & pulse Renal toxicity Depression, paranoia, cognitive impairment

Interluken

Action: enhances production of T cells Enhances function of killer cells

Side effects: Increased capillary permeability

Hypotension, ascites, weight gain, pulmonary edema

Skin rash, pruritus, desquamation

Monoclonal Antibodies

Produced by immunizing animals with antigen, testing b cells from spleen with tumor cells, creates hybrid antibody

Delivers immunotoxin to tumor Side-effect: allergic reaction

Hematopoetic Growth factors Colony stimulating factors (CSFs)

Stimulates production, maturation, regulation and activation of cells G-CSF (granulocyte-Neupogen,Neulasta) GM-CSF (granulocyte macrophage-Leukine,

Prokine) M-CSF (macrophage CSF) IL-3-multicolony stimulating factor

Hasten recovery from bone marrow depression Decrease bone marrow suppression

Erythropoetin (EPO)-Procrit, Aranesp Oprelvekin (Neumaga)

Bone Marrow Transplants

Allogeneic-donor is human leukocyte antigen matched to the recipient

Autologous-own bone marrow removed treated, stored and reinfused

Syngeneic-stem cells from an identical twin

Gene Therapy

Removal of damaged, mutated or activated oncogenes

Insertion of multiple genes to increase susceptibility to other treatment modalities

Experimental research