3/9/2017. Chapter 56. Care of the Patient with Cancer. Cancer Rates in the US. Carcinogenesis

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1 Chapter 56 Care of the Patient with Cancer All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Cancer Rates in the US 1 in 2 men and 1 in 3 women will develop cancer in their lifetime Most common sites in men are prostate, lung, colon, and rectum Most common sites in women are breast, lung, colon, and rectum Cancer is the second leading cause of death in the US All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 2 Carcinogenesis The process by which normal cells are transformed into cancer cells Cancer may be caused by external and internal factors All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 3 1

2 Cancer Prevention Primary prevention Smoking cessation Eat a healthy diet Avoid excessive exposure to the sun Avoid using smokeless tobacco Avoid excessive alcohol consumption Exercise regularly Adequate rest Regular medical exams All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 4 Detection of Cancer Identify causes of cancer Learn and practice self-examination PSA for men over 50 Mammogram for women over 40 All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 5 Risk Factors for Cancer Smoking Smokeless tobacco Diet UV exposure Environmental carcinogens Chemical carcinogens Heavy alcohol use Heredity Age All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 6 2

3 Preventive Behaviors for Men Testicular self-examination (TSE) PSA after age 50 All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 7 Preventive Behaviors for Women Pap test Breast self-examination Mammogram biannually after age 40 All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 8 Warning Signs of Cancer CAUTION All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 9 3

4 Cancer Terminology Neoplasm a new growth Abnormal or uncontrolled growth Benign not recurrent or progressive Malignant abnormal cell growth with a loss of normal role and function Tumor a growth; may be local or invasive Metastasis the process by which tumor cells spread from the primary site to a secondary site Immunosurveillance the immune system s recognition and destruction of newly developed abnormal cells All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 10 Characteristics of Malignant Cells Rapid growth Irregular Rarely contained within a capsule Capable of metastasis Little resemblance to parent tissue All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 11 Types of Malignancies Carcinoma malignant tumors composed of epithelial cells Sarcoma malignant tumors of connective tissues Lymphoma and leukemia malignant tumors that originate from the hematopoietic system All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 12 4

5 Pathophysiology of Cancer Cells are the basic structure of tissues Cell reproduce steadily at a controlled rate Cells divide by splitting DNA, and being replicated using RNA As the cells divide, sometimes errors in the genetic code occur These errors are referred to as mutations As mutations occur, the likelihood of cancer development increases All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 13 Metastasis Metastasis is the process by which tumor cells spread from the primary site to a secondary site Once cancer cells have moved to another area of the body, secondary tumors may grow in that area However, the cancer is still named for the tissue of origin All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 14 Metastasis cont d Metastasis can occur by Direct spread of tumor cells by diffusion to other body cavities Circulation by way of blood and lymphatic channels All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 15 5

6 Cancer Classification Systems Clinical staging TNM classification system Bethesda system All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 16 Clinical Staging Stage O: Tumor in situ Stage I: Tumor limited to the tissue of origin Stage II: Limited local spread Stage III: Extensive local and regional spread Stage IV: Metastasis All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 17 TNM Staging System T: Tumor size N: Degree of regional spread to the lymph nodes M: Metastasis All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 18 6

7 Bethesda System The results of the Bethesda system as determined by a Pap smear Negative: Normal (formerly class I) Probably negative: May indicate infection, atypical squamous cells, or reactive changes (formerly class II) Suspicious, but not conclusive for malignancy: Low-grade squamous intraepithelial lesion (formerly class III) More suspicious, strongly suggestive of malignancy: Highgrade squamous intraepithelial lesion (formerly class IV) Conclusive for malignancy: Invasive squamous cell carcinoma (formerly class V) All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 19 Diagnostic Tests Used to Identify Cancer Biopsy Endoscopy Diagnostic imaging Radioisotope studies CT Ultrasound MRI PET scan Lab values All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 20 Biopsy The removal of a small piece of living tissue from an organ or other part of the body for microscopic examination Used to confirm or establish a diagnosis, establish prognosis, or follow the course of a disease The only definitive way to determine the presence of malignant cells All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 21 7

8 Surgery Nursing Interventions Provide patient education Relieve anxiety Assess nutritional status Provide preoperative care Provide postoperative care Community resources All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 22 Radiation Nursing Interventions Provide patient education Keep skin dry Place Radiation in Use sign on patient s door Encourage ROM exercises Assess skin regularly Monitor I&O Monitor nutritional status All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 23 Chemotherapy Nursing Interventions Provide patient education Monitor nutritional status Administer antiemetics Monitor hydration status All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 24 8

9 Chemotherapeutic Agents Alkylating agents Antitumor antibiotics Antimetabolites Hormonal agents Vinca alkaloids All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 25 Tumor Lysis Syndrome An oncologic emergency with rapid lysis of malignant cells The syndrome develops when chemotherapy or irradiation causes the destruction (or lysis) of a large number of rapidly dividing malignant cells This results in hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 26 Tumor Lysis Syndrome cont d Clinical Manifestations Early clinical manifestations include Nausea Vomiting Anorexia Diarrhea Muscle weakness Cramping Clinical Manifestations Later signs and symptoms may include Tetany Paresthesias Seizures Anuria Cardiac arrest All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 27 9

10 Tumor Lysis Syndrome cont d Diagnostic Tests and Medical Management Diagnosed by assessment and lab values Medical management Hydration Diuretics Allopurinol Sodium bicarbonate Calcium gluconate All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 28 Tumor Lysis Syndrome cont d Nursing Interventions Administer medications Monitor for signs and symptoms of tumor lysis syndrome and electrolyte abnormalities Promote anxiety relief Treat pain Prevent further complications All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 29 Tumor Lysis Syndrome cont d Prognosis Typically resolves in 7 days once treatment is initiated All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved

11 Pain Relief Guidelines for Advanced Cancer Opioids NSAIDs Analgesics Acupuncture Biofeedback Guided imagery Massage Distraction All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved