6705558 Cancer Oncology

8/13/2019 6705558 Cancer Oncology

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CancerOncology

•http://neelabh1221.googlepages.com


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Cancer: Etiology

• Cancer is a group of diseases characterized bythe uncontrolled growth & spread ofabnormal cells.

•Incidence of some cancers are increasing !on"#odg$in%s& melanoma

• Incidence of some cancers are decreasing

'tomach& uterine cancers

• Cancer is the 2nd most common cause of deathin ('


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Cancer: Etiology

• #igher death rates among )frican

)mericans than Caucasians& especially

males r/t later diagnosis

• )ffects people of all ages

Occurs most fre*uently in the aged

+ore children ,1- yrs die of cancer than any

other disease


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Cancer: Etiology

• Lung cancer is the leading cause ofcancer"related death in men 10 3omen 240 255-

• 6reast prostate cancer ha7e greaterincidences& but better cure sur7i7al

rates

• E7ery year& 1.- million people arediagnosed 3ith cancer8 cancer 3illde7elop in 1 of 2 men and 1 of 3omen

during their li7es. It is estimated that thereare no3 more than 15 million cancersur7i7ors in the (nited 'tates alone& and&gi7en the trend to3ard aging of thepopulation& this number is e9pected togro32;


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Cancer 'ur7i7ors by )ge


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Cancer 'ur7i7ors by


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Cancer 'ur7i7ors

• 'ur7i7ing cancer used to mean ma$ing it to the >"yearmar$ or li7ing through chemotherapy& rather than thehoped"for return to normal health and daily life.

• ?he cancer sur7i7or must no3 find and adapt to @a ne3normal.A

• /-ths of cancer sur7i7ors e9perience late effects orse*uelae of cancer& its treatment& or both effects thatthreaten the sur7i7orBs physical& psychosocial& andeconomic 3ell"being.

ate treatment effectsD to9icities that are absent orsubclinical at the end of therapy but manifest months oryears later as organ inury becomes e7ident& and long"term effects as ad7erse effects that appear duringtreatment and continue beyond the end of treatment


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ate Effects and ong"?erm'e*uelae of Cancer and Cancer?reatment 1;

• Fhysiological Effects

'econd malignancies/ymphedema /eu$emia

!eurocogniti7e deficits

Cardiac dysfunction/C)


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ate Effects and ong"?erm'e*uelae of Cancer and Cancer

?reatment 1;• Fsychosocial and Economic Effects


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Cancer 'ur7i7orship: !ursing

• ?he reality is that indi7iduals 3ho ha7e sur7i7ed cancer canbe found in e7ery healthcare setting& from primary care to theemergency department8 from the labor and deli7ery unit to thestudent health clinic.

• +ost people 3ith cancer are going to come into contact 3ithnurses 3ho are not oncology nurses.

• )ll nurses need to be better e*uipped about sur7i7orshipissues so they can be proacti7e and help these patients li7eas 3ell as possible.


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Components of Cancer 'ur7i7orshipCare

• Fre7ention of recurrent and ne3 cancers& and other lateeffects

• 'ur7eillance for cancer spread& recurrence& or secondcancer

• )ssessment of medical and psychosocial late effects

• Inter7ention for conse*uences of cancer and itstreatment lymphedema& symptoms& including pain andfatigue& psychological distress e9perienced by ne3

cancer sur7i7ors and their caregi7ers& and concernsrelated to employment& insurance& and disability

• Coordination bet3een specialists and primary carepro7iders to ensure that all the sur7i7orBs health needsare met.


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Frescription for i7ing

• ?he ideal time to begin filling out A Prescription for Living is during orat the completion of the cancer patientBs treatment.

Communicate up"to"date information to the primary care teamincluding any specific short or long"term signs and symptoms thatshould be monitored in a particular cancer sur7i7or& and 3hy.

'uggestions for any recommended routine screening.

• ?he Institute of +edicineBs recommendation to introduce cancersur7i7orship care planning has also spurred legislation. In Jebruary of2554& a bill 3as introduced in the #ouse of Gepresentati7es toaddress this issue. ?he Comprehensi7e Cancer Care Impro7ement

)ct of 2554 #ouse Gesolution 154K 3ould amend title LMIII

+edicare of the 'ocial 'ecurity )ct to pro7ide for co7erage ofcomprehensi7e care planning ser7ices for indi7iduals diagnosed 3ithcancer. It 3ould also ma$e grants a7ailable to establish ne3 palliati7ecare and symptom management programs for cancer patients andimpro7e the *uality of graduate& postgraduate& and continuingprofessional education of physicians& nurses and other healthcarepro7iders in palliati7e care and symptom management for cancer

patients.


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Comprehensi7e Cancer Care

Impro7ement• 'hift the paradigm of cancer sur7i7orship care from an illness focus to

a 3ellness and disease"pre7ention focus

• ?o 7ie3 cancer sur7i7orship as a chronic condition rather than anacute one

• ) second goal that emerged from this meeting 3as to de7elop& incollaboration 3ith patients and families& a ointly crafted e7idence"based 3ellness plan as part of a comprehensi7e cancer sur7i7or careplan

• Jinally& 3ith 'igma ?heta ?au International& the #onor 'ociety of

!ursing& the group plans to de7elop and prioritize a multinationalresearch agenda related to cancer sur7i7orship and translate thefindings into clinical practice and policy


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• !urses must anticipate and identify potential problemsso that they can be addressed

Cancer sur7i7ors often belie7e that their symptoms& such aspersistent pain& are una7oidable outcomes of their cancer or

treatment that they simply must learn to li7e 3ith Fatients hesitant to raise nonmedical concerns

• #a7enBt made the connection bet3een their current symptomsand their cancer.

• +ay not be a3are of the full range of possible se*uelae

• Cancer sur7i7ors should be encouraged to report allsymptoms to their healthcare pro7iders.


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•


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Cancer: Cellular Froliferation

• ?he rate of normal cellular proliferation is different for

each body tissue type

• Gapid D HI lining& hair follicles& bone marro3

• !o proliferation D myocardium& neurons& cartilage


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!ormal Cellular Hro3th• imited cell di7ision r/t physiological

demand

• Getain distinct recognizable

appearance& size shape

• Ferform specific differentiated

functions ma$e bile& conduct impulses&

carry #gb

• )dhere tightly together gro3 in aorderly 3ell"regulated manner

Contact inhibited

• !onmigratory


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Cellular Hro3th

• +ay precede de7elopment

of cancer:

• #ypertrophy Increase in

size of cells 3ithout celldi7ision

• #yperplasia Increase in

the number of cells r/t

increased cell di7ision


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Cellular Hro3th

• +etaplasia

Ge7ersible transformation

of 1 cell type into another

6one

Intestine


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Cellular Hro3th

•


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!eoplastic Cellular Froliferation

• )ll cancer cells ha7e the same cellularcharacteristics

• Cancer cells respond differently to

the intracellular signals not morerapid but indiscriminate

haphazard di7iding continuous

gro3th

Fyramid effect

Jollo3s no physiologic demand


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!eoplastic Characteristics

• Cell membranes Contain less fibronectin are

less cohesi7e do not stic$ to

neighboring cells

• Cancer cells are not inhibitedby contact gro3 on top of orbet3een normal cells

• 6rea$ off easily metastasize


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• Cell membranes

Contain tumor"specific antigens CE) F') 3hichde7elop as the cancer cells mature

Characteristic of fetal/embryonic appearance function

• +ay produce hormones r/t embryonic tissues


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• Chromosomal abnormalities

• Increased rate of mitosis

gro3th

Increased bodily demand for

o9ygen glucose

If supply inade*uate& use

anaerobic metabolism


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Carcinogenesis: Initiation

• Cancers are not thought to be the result of

a single e7ent.

) combination of negati7e e7ents andmissed opportunities are probablyre*uired rapid& haphazard e7ent

• Cause of cancer still un$no3n& butcarcinogens are possible origins

'ubstances $no3n to increase the ris$for the de7elopment of cancer

+any are deto9ified by enzymes e9creted

If these mechanisms fail& thencarcinogens enter the cell damagethe


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Cancer: Carcinogens

• Smoking " 'mo$eless tobacco "


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Carcinogenesis: Fromotion

• Ge7ersible proliferation of altered cells increased li$elihood of additional

mutations

Fromoting factors: obesity8 dietary fat8

cigarette smo$ing8 alcohol

consumption8 prolonged& se7ere

stress

=ithdra3al of factors reduced ris$

for de7elopment of specific cancers

Latent period = 1-! yrs = initiation

" promotion stages r#t mitotic rate

of tissue of origin


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Carcinogenesis: Frogression

• Increased gro3th rate of tumor gro3th

Gapid gro3th of primary tumor

)ngiogenesis creates blood supply

• Increased rate of metastasis

Hro3th penetrates lymph 7ascular 7essels

Cells transported to other organs


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)ngiogenesis• )ngiogenesis gro3th

of ne3 capillaries r/trelease of gro3thfactors enzymes

Creates a 7ascularnet3or$ that enables

hematogenous spread 'ome cancer

treatments target thisprocess


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6enign !eoplasms

• 6enign neoplasms

'lo3 steady gro3th

Gemains localized

(sually contained 3ithin a

capsule 'mooth& 3ell"defined& mo7able

3hen palpated

=ell"differentiated cells that

resemble parent tissue

Cro3ds normal tissue

Garely recurs after remo7al

Garely fatal

•$enign tumor%

parotid gland

+ li t ! l


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+alignant !eoplasms• +alignant !eoplasms

Gate of gro3th 7aries& usually rapid

+etastasizes

Garely contained 3ithin a capsule

Irregular& more immobile 3hen palpated

ittle resemblance to parent tissue +ay be 3ell"differentiated to undifferentiated

In7ades normal tissue

+ay recur after remo7al

Jatal 3ithout treatment

6asal Cell Carcinoma

+elanoma


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+etastasis• +etastasis: )bility to spread or transfer

cancer cells E9tension into surrounding tissues "

'ecrete enzymes that open upsurrounding tissue

ymphatic spread most common

#ematogenous spread can attach toendothelium attract fibrin platelets clot themsel7es to basement membraneto protect from immune system

?ransplantation or direct transport of

tumor cells from one site to another.?ransplantation may occur accidentallyduring surgery or other procedures 3hencancer cells are AcarriedN on instrumentsor glo7es


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Hrading 'taging of ?umors

• ?umors are classified according to the parent tissuetype location 3ithin the body.

• Carcinoma" malignant tumors composed of

embryonic epithelial cells& 3hich ha7e a tendency to

metastasize

• Sarcoma refers to malignant tumors of embryonic

connectie tissues& such as muscle or bone&

usually presenting as a painless s3elling. +ay affectbones& bladder& $idneys& li7er& lungs& parotids& and

spleen

• Lymphomas & leukemias originate fromhemato oietic s stem


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Cancer: Clinical 'taging

• Classified 'tage 1"- by the e9tent of disease e9istence of metastasis

Stage !% Cancer in situ

Stage ': ?he tumor is small& local& and detected early

Stage '': ?he tumor is some3hat larger and has started to

spread to nearby lymph nodes

Stage ''': ?he tumor has spread e9tensi7ely to nearby

lymph nodes

Stage 'V: Cancer has metastasized to other parts of the

body and is generally in an ad7anced stage.


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?!+ ?umor& !odes&+etastasis 'taging 'ystem

• (sed to indicate tumor si(e )*+& spread to

lymph nodes ),+ and e.tent of

metastasis )/+% Each is rated 5"-

• 'ee te9ts for specific classification criteria

• ?his system is used to direct treatment&

predict prognosis& and contribute to cancerresearch by ensuring reliable comparison of

different patients


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ifestyle Changes to Geduce Gis$

• 'top smo$ing cigarettes use ofsmo$eless tobacco

• imit e9posure to ultra7iolet radiation

Includes tanning beds sunlamps

• imit e9posure to en7ironmental chemical carcinogens

Gubber& chlorine& coal& asbestos& 7inylchloride& dyes& leather processing

• imit hea7y consumption of alcohol


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Joods that Geduce Cancer Gis$

• Megetables from the cabbage family 6roccoli& cauliflo3er& 6russels

sprouts& all types of cabbage and$ale

• Megetables and fruits high in betacarotene

Carrots& peaches& apricots&s*uash& broccoli

• Gich sources of 7itamin C

Hrapefruit& oranges& cantaloupe&stra3berries& red and greenpeppers& broccoli& tomatoes


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Joods to Geduce Cancer Gis$

• ?he !ational Cancer Institute

has recommended including

at least > ser7ings of fruits

7egetables in the daily diet

• ean meat& fish& s$inned

poultry

• o3 fat dairy products&

including 3hite cheese rather

than yello3

• #igh fiber

• )7oid salt cured& smo$ed& or

nitrite cured foods


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Cancer%s 'e7en =arning 'ignals

• C)(?IO!

• Changes in bo3el or bladder habits

• ) sore that does not heal

• (nusual bleeding or discharge

• ?hic$ening or lump in breast or else3here

• Indigestion or difficulty in s3allo3ing

• Ob7ious changes in 3arts or moles

•!agging cough or hoarseness


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Early


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Colorectal ?ests +en and=omen • #ematest stool for blood

e7ery year after age >5

• Froctosigmoidoscopy&

preferably fle9ible& e7ery

> years after age >5

• Colonoscopy * 15 yrs is

gold standard for

colorectal cancerdetection


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Frostate Cancer


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Cer7ical Cancer 'creening

• Fel7ic e9amination for 3omen must

include a Fapanicolaou Fap smear test

annually after age 1K or at age first

se9ually acti7e


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6reast Cancer


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Cancer


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Cancer:


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Cancer:


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Cancer: aboratory ?ests• )l$aline Fhosphatase 6lood e7el

Ele7ated 3ith metastasis to bone

or li7er

• 'erum calcitonin le7el

Ele7ated 3ith cancer of thyroid&breast& lung

• Carcinoembryonic antigen CE)

Ele7ated 3ith cancer )!


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Cancer: aboratory ?ests

• F') Frostate cancer

• C)"12> 'ignals recurrence of o7arian

cancer


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Cancer: aboratory ?ests

• Occult 6lood 'tool ?esting


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Cancer +anagement: 'urgery

• (sed to remo7e a cancerous lesion.• Hoal is to remo7e all malignant cells 3hich may

include remo7al of the tumor& surrounding tissue&

and regional lymph nodescure or control cancer

so is managed li$e a chronic illness

• +ay be used in conunction 3ith chemotherapy and

radiation.

• Geconstructi7e surgery may be needed to impro7e

body functions appearance after radical

surgeries.


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Cancer 'urgery

• ocal e9cisions 'mall mass

Gemo7al of mass

small margin of normaltissue

• '$in cancers

C '


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Cancer 'urgery

• =ide radical e9cisions Gemo7al of primary

tumor& lymph nodes&

adacent tissues R ris$

for tumor spread

Can result in

disfigurement altered

functioning 6(? chances

for cure or control are

good


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Frophylactic 'urgery

• Gemo7al of non7ital tissue or organs li$elyto de7elop cancer r/t genetic disposition

genetic mar$ers& symptoms

Colectomy +astectomy Oopherectomy

• Geduced or lost function

Falliati7e 'urgery


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Falliati7e 'urgery

• Falliati7e surgery to relie7e or reduce

uncomfortable symptoms D procedure to relie7eobstruction& ulceration& hemorrhage& pain


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Geconstructi7e 'urgery

• +ay follo3 curati7e orradical surgery to

impro7e function or

more desirable

cosmetic effect

• Often done in stages


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Cancer: !ursing Fostoperati7e

• Education support Geinforce information pro7ided by physician

Increased an9iety

• Fromote nutrition

• Fro7ide routine post operati7e care

Increased incidence of infection& impaired healing& altered

pulmonary or renal function&

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6705558 Cancer Oncology

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