Cancer ConceptsCancer Concepts

Exact cause: UnknownExact cause: Unknown Predisposing factors:Predisposing factors:

•HeredityHeredity•StressStress

PsychologicalPsychological PhysicalPhysical

•UnuseUnuse•OveruseOveruse•AbuseAbuse

•SpecificSpecific

Theories of CancerTheories of Cancer

Cellular Transformation and Cellular Transformation and Derangement TheoryDerangement Theory

Failure of the Immune Failure of the Immune Response TheoryResponse Theory

Normal Cell

VirusChemical / Physical Agent

DrugsHormones

Genetic Alteration

Defective Cell

Multiple cell division

Malignancy

Cellular Transformation andDerangement Theory

PotentialCell Ab

AbAb

AbImmune system

fails

Failure of Immune Response Theory

ClassificationClassification

TumorTumor• 11 -- smallsmall• 2-32-3 -- mediummedium• 44 -- largelarge

NodeNode• 0 0 - - no involvementno involvement• 1-31-3 -- moderatemoderate• 44 -- extensiveextensive

MetastasisMetastasis• 00 -- no metastasisno metastasis• 11 -- metastasismetastasis

Warning Signs of CancerWarning Signs of CancerC - change in bowel or bladder habitsA - sore that does not healU - unusual bleeding or dischargeT - tumorI - indigestion or difficulty in swallowingO - obvious change in warts or molesN - nagging cough or hoarseness of voice

U - unexplained anemiaS - sudden weight loss

Comparison of Benign & Malignant NeoplasmComparison of Benign & Malignant Neoplasm

CharacteristicsCharacteristics BenignBenign MalignantMalignant

Speed of growthSpeed of growth SlowSlow RapidRapid

Mode of growthMode of growth LocalizedLocalized InfiltratingInfiltrating

CapsuleCapsule EncapsulatedEncapsulated No capsuleNo capsule

RecurrenceRecurrence UnusualUnusual CommonCommon

MetastasisMetastasis NoneNone CommonCommon

EffectEffect Harmless to hostHarmless to host HarmfulHarmful

PrognosisPrognosis Very goodVery good PoorPoor

LUNG CANCERLUNG CANCER

DescriptionDescription Refers to malignant tumor Refers to malignant tumor

growth within the bronchial growth within the bronchial tissue or lung parenchyma.tissue or lung parenchyma.

Types include:Types include:• Squamous cellSquamous cell• Adenocarcinoma Adenocarcinoma • Small cell (oat cell) Small cell (oat cell) • Large cell Large cell

Etiology and IncidenceEtiology and Incidence

Exact Cause: UnknownExact Cause: Unknown

Predisposing factorsPredisposing factors•HeredityHeredity•Pulmonary irritantsPulmonary irritants

Poor prognosisPoor prognosis

PathophysiologyPathophysiology Irritation Irritation series of changes series of changes

tumor tumor Metastases – primary sitesMetastases – primary sites Some tumors secrete Some tumors secrete

hormones:hormones:•ADH – reabsorption of waterADH – reabsorption of water•ACTH – stimulates adrenal ACTH – stimulates adrenal

glands to produce steroidsglands to produce steroids

Symptoms may include:Symptoms may include:• CoughCough• WheezingWheezing• Shortness of breathShortness of breath• Chest painsChest pains• HoarsenessHoarseness• Dysphagia (compression of esophagus)Dysphagia (compression of esophagus)• Weight lossWeight loss

Nursing InterventionsNursing Interventions

Adequate oxygenation Adequate oxygenation Prepare for surgery if tumor is small Prepare for surgery if tumor is small

enough to be removedenough to be removed Prepare patient for planned Prepare patient for planned

treatmentstreatments• chemotherapy chemotherapy • radiation therapyradiation therapy

Analgesics as orderedAnalgesics as ordered Maintain nutritional statusMaintain nutritional status Provide emotional supportProvide emotional support

BLADDER BLADDER CANCERCANCER

More common in malesMore common in males Cause: unknownCause: unknown

Risks factorsRisks factors1.1. Exposure to cigarette smokeExposure to cigarette smoke

2.2. Pelvic radiationPelvic radiation

3.3. Use of cyclophosphamideUse of cyclophosphamide

4.4. Chronic cystitisChronic cystitis

5.5. Bladder calculiBladder calculi

6.6. SchistosomiasisSchistosomiasis

AssessmentAssessment

Hematuria (first sign)Hematuria (first sign)•PainlessPainless•GrossGross

DysuriaDysuria Obstruction to urine flowObstruction to urine flow Development of fistulaDevelopment of fistula

Collaborative ManagementCollaborative Management

ChemotherapyChemotherapy

ThiotepaThiotepa

Mitomycin CMitomycin C

Doxorubicin (Adriamycin)Doxorubicin (Adriamycin)

Cyclophosphamide (cytoxan)Cyclophosphamide (cytoxan)

Cisplatin (Platinol)Cisplatin (Platinol)

MethotrexateMethotrexate RadiationRadiation

SurgerySurgery•Urinary Diversion SurgeriesUrinary Diversion Surgeries

Ileal ConduitIleal ConduitUreterostomyUreterostomyUreterosigmoidostomyUreterosigmoidostomyNephrostomyNephrostomy

Ileal ConduitIleal Conduit For CA BladderFor CA Bladder Adult Adult

Neurogenic Neurogenic BladderBladder

Insterstitial Insterstitial CystitisCystitis

Irreparable Irreparable TraumaTrauma

Important!Important! External External

collection collection device neededdevice needed

Proper fitting Proper fitting to prevent to prevent urine leak to urine leak to the skinthe skin

Skin care with Skin care with warm water warm water and mild soapand mild soap

ComplicationsComplications Obstruction to Obstruction to

the urine flow the urine flow via small via small intestines intestines secondary to secondary to edemaedema

InfectionInfection Stoma prolapseStoma prolapse CalculiCalculi Electrolyte Electrolyte

imbalancesimbalances

UreterostomyUreterostomy Either or both Either or both

ureters are out to ureters are out to the abdominal wallthe abdominal wall

Ureteral stoma is Ureteral stoma is createdcreated

External collection External collection device is neededdevice is needed

Infection is a Infection is a potential hazardpotential hazard

Increase fluid Increase fluid intakeintake

NephrostomyNephrostomy

To drain the To drain the urine while urine while ureteral ureteral inflammation inflammation from trauma or from trauma or calculus is calculus is presentpresent

ComplicationsComplications Infection Infection

(Pyelonephritis(Pyelonephritis))

Blockage of Blockage of the catheterthe catheter

Important!Important! DO NOT DO NOT

IRRIGATE!!!IRRIGATE!!!

UreterosigmoidostomyUreterosigmoidostomy

No external No external collection collection devicedevice

Passage of Passage of flatus includes flatus includes leak of urineleak of urine

Infection is Infection is possiblepossible

PROSTATE PROSTATE CANCERCANCER

Most common male Ca Most common male Ca (gender-specific)(gender-specific)

Androgen – dependent Androgen – dependent adenocarcinomasadenocarcinomas

Predisposing FactorsPredisposing Factors

Genetic tendencyGenetic tendency 50 years of age50 years of age Hormonal factorsHormonal factors

•Late pubertyLate puberty•High frequency of sexual High frequency of sexual

experienceexperience•History of multiple sexual partnersHistory of multiple sexual partners•High fertilityHigh fertility

DietDiet• ↑↑fat (alters cholesterol and steroid fat (alters cholesterol and steroid

metabolism)metabolism)   Chemical carcinogensChemical carcinogens

• Air pollutionAir pollution• Occupation-relatedOccupation-related

industries – fertilizer, rubber, industries – fertilizer, rubber, textiletextile

batteries containing Cadmiumbatteries containing Cadmium

VirusesViruses

AssessmentAssessment

HesistancyHesistancy HematuriaHematuria Urinary retentionUrinary retention Stool changesStool changes Pain radiating down hips and legsPain radiating down hips and legs Cytitis Cytitis DribblingDribbling

NocturiaNocturia Hard, enlarged prostateHard, enlarged prostate Pain on defecationPain on defecation High level of acid High level of acid

phospatasephospatase Elevated PSA (Prostatic Elevated PSA (Prostatic

Specific Antigen)Specific Antigen)

Nursing InterventionsNursing Interventions Early detection of tumorEarly detection of tumor

• UltrasoundUltrasound• MRIMRI• X-rayX-ray• CT ScanCT Scan

Radiation therapyRadiation therapy Endocrine therapy - DES (diethylstilbestrol) Endocrine therapy - DES (diethylstilbestrol)

decreases testosterone level)decreases testosterone level) Surgery: ProstatectomySurgery: Prostatectomy

Hodgkin’s Hodgkin’s Disease Disease

malignant tumor of lymphatic malignant tumor of lymphatic systemsystem

Cause: Cause: •UnknownUnknown•Viral associationsViral associations•AutoimmunityAutoimmunity

Incidence:Incidence:•Young adult 15-35 yearsYoung adult 15-35 years

PathophysiologyPathophysiology

Proliferation of abnormal T-CellsProliferation of abnormal T-Cells

Obstruction in lymphatic flowObstruction in lymphatic flow

PainPain

FeverFever

Weight LossWeight Loss

MalaiseMalaise

MetastasesMetastases SpleenSpleen LiverLiver LungsLungs HeartHeart

ManagementManagement

MOPPMOPP•Watch out for BM Watch out for BM depressiondepression

ABVDABVD•Causes red urineCauses red urine

Nursing Intervention Nursing Intervention

SupportiveSupportive•N/VN/V•F & EF & E•Comfort measuresComfort measures

Protection from infectionProtection from infection Maintain Tissue IntegrityMaintain Tissue Integrity Maintain Normal Body Maintain Normal Body

TemperatureTemperature Prevent or decrease painPrevent or decrease pain Maintain ideal body weightMaintain ideal body weight Maintain adequate hydrationMaintain adequate hydration Assist client and significant Assist client and significant

others to copeothers to cope

COLORECTAL COLORECTAL CANCERCANCER

Cause: UnknownCause: Unknown Predisposing Factors:Predisposing Factors:

• Age above 40 yearsAge above 40 years• Predisposing FactorsPredisposing Factors

low in fiberlow in fiber high in fat, protein and refined carbohydrateshigh in fat, protein and refined carbohydrates ObesityObesity History of chronic constipationHistory of chronic constipation History of IBD, familial polyposis or colon History of IBD, familial polyposis or colon

polypspolyps Family history of colon cancerFamily history of colon cancer

Most Common Site: Rectosigmoid area (70%)Most Common Site: Rectosigmoid area (70%)

ASSESSMENTASSESSMENT

Ascending (Right) Ascending (Right) Colon CancerColon Cancer• Occult blood in Occult blood in

stoolstool• Anemia Anemia • Anorexia and Anorexia and

weight lossweight loss• Abdominal pain Abdominal pain

above umbilicusabove umbilicus• Palpable massPalpable mass

Distal Colon / Rectal Distal Colon / Rectal CancerCancer• Rectal bleedingRectal bleeding• Changed bowel Changed bowel

habitshabits• Constipation or Constipation or

DiarrheaDiarrhea• Pencil or ribbon – Pencil or ribbon –

shaped stoolshaped stool• TenesmusTenesmus• Sensation of Sensation of

incomplete bowel incomplete bowel emptying emptying

COLORECTAL CANCERCOLORECTAL CANCER

Duke’s Classification of Colorectal CancerDuke’s Classification of Colorectal CancerStages:Stages:• A: confined to bowel mucosa, 80 – 90% 5- year A: confined to bowel mucosa, 80 – 90% 5- year

survival ratesurvival rate• B: invading muscle wallB: invading muscle wall• C: lymph node involvement C: lymph node involvement • D: metastases or locally unresectable tumor, D: metastases or locally unresectable tumor,

less than 5% 5 – year survival rateless than 5% 5 – year survival rate Guidelines for Early Detection of Colorectal Guidelines for Early Detection of Colorectal

CancerCancer• Digital rectal examination yearly after age 40Digital rectal examination yearly after age 40• Occult blood test yearly after age 50Occult blood test yearly after age 50• Proctosigmoidoscopy every 5 years after age Proctosigmoidoscopy every 5 years after age

50, following 2 negative results of yearly 50, following 2 negative results of yearly examinationexamination

COLLABORATIVE COLLABORATIVE MANAGEMENTMANAGEMENT

Surgery Surgery • Hemicolectomy (ascending and Hemicolectomy (ascending and

transverse)transverse)• Abdomino – Perineal Resection Abdomino – Perineal Resection

(APR) for rectosigmoid cancer(APR) for rectosigmoid cancerNecessitates permanent colostomyNecessitates permanent colostomy

ChemotherapyChemotherapy• Fluorouracil (most effective)Fluorouracil (most effective)

Radiotherapy Radiotherapy • Adjuvant treatmentAdjuvant treatment

Renal Cell Renal Cell CarcinomaCarcinoma

Pathophysiology:Pathophysiology:

Tumor (anywhere in the kidneys)

Compression on the surrounding surface

•Ischemia

• necrosis

• hemorrhage

Metastasis

Primary sites

•Lungs

•Liver

•Lymph nodes

•Renal veins

Signs and SymptomsSigns and Symptoms

Abdominal painAbdominal pain HematuriaHematuria S/sx of shockS/sx of shock

Nursing Interventions:Nursing Interventions:

Monitor closely for:Monitor closely for:• Fluid and electrolyte status.Fluid and electrolyte status.• I & OI & O• Acid-base balanceAcid-base balance

SymptomaticSymptomatic Prepare for possible surgeryPrepare for possible surgery Institute postop careInstitute postop care