USJR COLLEGE OF NURSING

Cancer
A term for a group of disorders in which cells grow and

multiply uncontrollably eventually forming a mass (Tumor) Characteristic Uncontrolled growth Proliferation Metastasis

3 stages

Invasion (surrounding tissue) Spread (Lymph or circulation) 2ndary site growth (lymph node or organs)

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7 signs of cancer
C - Change in bowel or bladder habits A - A sore that does not heal U - Unusual bleeding or discharge T - Thickening or lump in breast (or elsewhere) I

- Indigestion or dysphagia O - Obvious change in wart or mole N - Nagging cough or hoarseness

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Etiology
Unknown

May be due to Viruses

Epstein-Barr (Burkitts lymphoma, nasopharyngeal cancer) Herpes simplex ( carvical cancer) Cytomegalovirus Papillomavirus (Cervical cancer) Hepatitis B

Chemical carcinogens Physical stressors (sunlight, radiation, chronic irritation) Hormonal factors (estrogen, DES) Genetic factors
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Risk Factors
Internal Age Gender (M>F) Race (Black) Genetic Immunologic factor Psychological
External Chemicals Radiation Viruses Diet
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Pathophysiology
Cancer is closely linked to immune system failure (immune

surveillance) Increase incidence in Pt. Organ transplant Chemotherapy to treat primary tumor Immune deficiency (e.g. HIV) Proliferation
Benign (harmless, not invasive) or

Malignant (harmful, metastatic) Hyperplasia number of cell Metaplasia change in type of cell (reversible) Dysplasia change in structure of cell (irreversible) Anaplasia change in DNA structure of cell
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Classification

Epithelial tissue (carcinoma) most common Gland (adenocarcinoma) Connective, muscle and bone tissue (sarcoma) Brain and spinal cord (gliomas) Pigmented cells (melanomas) Plasma cell (myeloma) Lymphatic tissue (lymphomas) Leukocytes ( leukemia) Erythrocytes (erythroleukemia)

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Test
Pap smear, Pelvic exam

Who?
Women

Age

Frequency

Age 18 or Yearly when sexually active and beyond Age 18 and up Monthly and Yearly Age 16 and up Monthly

BSE TSE Sigmoidoscopy Stool occult blood

Women Men

Men & Women Age 50 and up Every 3 years Men and Women Age 50 and up Yearly

DRE

Men

Age 40 and up Yearly

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Test
Mammography

Who?
Women

Age
Age 35 and beyond

Frequency
Ages 35-40: one baseline exam Ages 41-50: every two years Ages 51 and beyond: yearly

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Treatment
Surgery
Radiation Chemotherapy Bone Marrow Transplantation Immunotherapy Biologic Response Modifiers Gene Therapy

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1. Surgery
Surgery - Surgical removal of a tumor, most commonly
used local treatment.
Preventive or prophylactic Remove precancerous lesion unusual skin growth Colorectal polyps Cervical cancer in situ Diagnostic Incisional Excisional Needle biopsy
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 Curative removing of the whole tumor as the primary

treatment

Reconstructive - performed to improve quality of life by

restoring function and appearance

Palliative
Retard growth Decrease tumor size Relieve symptoms but does not cure

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2. Radiation
Radiation - Uses a high energy radiation to destroy
Curative Radiation therapy

malignant cells with out harming surrounding tissue (local effect)

Treat solid tumor Eradicates all cancer cells and give a life expectancy same as

hose without cancer Control radiation therapy Used as an adjunct to other therapy Pre-op to tumor size Post-op to eradicate microscopic disease Palliative Radiation therapy Relieve symptoms of metastatic disease Pain, obstruction, bleeding and pathologic fractures)
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Sources
External RT (teletherapy) Use of high energy radiograph machine Betatron, linear accelerator Do not retain radioactivity after therapy Internal RT (Brachytherapy) Placing radioisotopes inside the body Sealed inside a container placed in/near the tumor Unsealed used in systemic therapy thru IV or oral

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Linear accelerator

cobalt 60

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Principles in radiation exposure Time Distance Shielding lead (use film badge) Side Effects and Intervention for Radiation Therapy
Do not wash marks Skin irritation (do not refer as burns!) avoid medicated solutions use cornstarch, olive oil for itching wash with plain water only & pat dry avoid pressure to skin avoid exposing skin to heat, cold, or sunlight
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 anorexia, N&V
bland diet small frequent feedings adm. antiemetics before meals

Diarrhea give low residue, bland, CHON antidiarrheal monitor electrolytes Pancytopenia reverse isolation avoid injury (IM injection) and aspirin bed rest
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3. Chemotherapy
Chemotherapy administering anti-neoplastic drugs to
destroy cancer cell (systemic effect) Destroys fast growing cells Cancer cells, Mucosa, bone marrow, hair Purpose Curative Salvage 2nd attempt to cure if disease recur Control Therapy used to sustain tumor size or diminish symptoms to extend life is cure is not possible Palliative
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Side effects and Nursing Intervention Pancytopenia

Bed rest avoid crowds reverse isolation Avoid injury (no rectal temp., IM injection) soft bristled toothbrush electric razor avoid anti-coagulants, aspirin

Stomatitis
gargle w/ NSS or viscous lidocaine avoid lemon juice & glycerin mineral oil Mycostatin (Nystatin) popsicles avoid commercial mouthwashes avoid spicy food
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 N&V
bland diet, anti-emetic before meals

Alopecia
wigs

Sterility - temporary / permanent

sperm banking

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4
Bone Marrow transplantation
Infusion of bone marrow to a patient
Autologous Syngeneic

Allogeneic

Purpose
Cure Complete marrow recovery in 6 to 8 weeks Proliferation of marrow cells to increase blood products
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Nursing Intervention General / spinal anesthesia Antiseptic soap the night prior to harvest Site: Post Iliac Crest or sternum Withdraw 600-2500 ml Transplant should be done after chemo or radiation therapy Should be given immediately if autologous Monitor for pancytopenia
Avoid injury and aspirin

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Types of Cancers

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Bladder Cancer
Etiology Carcinogens (dye, rubber, leather, ink or paint): work related Recurrent UTI Smoking
Manifestation Gross, painless hematuria Urinary frequency Urgency Dysuria Pelvic or Back pain (metastasis)
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Treatment Intravesical (bladder) chemotherapy Chemotherapy Radiation Surgery Urinary diversions

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ileal conduit

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Nephrostomy

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Bone Tumor
Etiology Unknown Osteogenic sarcoma: < 20 yrs old Chondrosarcoma: Adult males Multiple Myeloma: 50 to 70 yrs old
Manifestations Bone pain (mild to severe) Limitation of movement Palpable fixed bone mass Pathologic fracture
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Treatment Surgery (amputation) Chemotherapy Radiation

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Brain / spinal cord Cancer

Unknown

Classification Gliomas (most common)

Arise from brains connective tissue Are fast growing, infiltrative, and difficult to excise completely

Meningiomas Arise from meninges, Slow growing and usually benign Pituitary adenomas (glandular) arise pituitary gland, usually affects endocrine function and vision Neurinomas Arise cranial nerve covering, Commonly affects CN VIII
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Manifestation depend on tumor type, location and rate of growth Brain tumor Increased ICP (headache, vomiting, papilledema) sensory and motor deficits Seizures Disturbances in smell, hearing, touch and vision Spinal Cord tumor Weakness or paralysis below site if tumor Treatment Surgery Chemotherapy Radiation
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Nursing Intervention prepare for surgery Monitor for signs of increased ICP and neurologic deficits If clients is confused, implement safety precautions Use restraints judiciously Provide assistance with mobility if pt. has paresis or paralysis Provide information on concealing devices if on chemotherapy (Wigs, etc). Place items within his visual field, scan environment Approach pt. on unaffected side Tell pt. to face the person when talking
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Breast Cancer
Unknown

Risk factors Familial history Early menarche, late menopause Nulliparous, or 1st child after 34 yrs of age High fat diet Hormonal contraceptive use Manifestation Nontender lump (left breast, upper outer quadrant) Axillary lymphadenopathy (late, metastasis) Fixed mass (late) Pain (late)
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Treatment Chemotherapy Radiation Mastectomy

Lumpectomy (tumor and some lymph node) Simple mastectomy (breast with out lymph node) Modified radical mastectomy (breast, lymph nodes with out

muscle) replaced radical mastectomy Radical mastectomy (all)

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Nursing Intervention Post-op Promote healing and prevent infection Elevate arm, wall climbing Avoid injury to affected side Avoid swimming and table tennis

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Cervical Cancer
Etiology Unknown Promiscuity Viral infections (HPV, herpes) Manifestations Asymptomatic Abnormal pap smear finding Vaginal discharge Spotting Chronic cervical erosion Postcoital pain Pain (pelvic, late, metastasis)
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Treatment Radiation Chemotherapy Hysterectomy

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Colon cancer
Etiology Familial history Chronic inflammatory disease (ulcerative colitis) Polyps Low-fiber diet
Manifestations Change in bowel habits Hematochesia Unexplained anemia, anorexia, weight loss and fatigue Right sided abdominal pain, melena Pain in back or legs (late)
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Treatment Chemotherapy Radiation Resection with anastomosis Colostomy or ileostomy Temporary or permanent Assess stoma

Pinkish Apply skin barrier Sex is not contraindicated

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Esophageal cancer
Etiology Chronic irritation Alcohol and tobacco ingestion
Manifestations Asymptomatic (early), late when symptoms appear Dysphagia and painful swallowing Feeling of mass in throat

Treatment Radiation Chemotherapy Esophagectomy

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Nursing Intervention Small, frequent feeding Soft, non irritating foods Watch for aspiration Difficulty of breathing

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Gastric Cancer
Etiology Diet
Smoked foods Lack of fruits and vegetables

Chronic stomach inflammation Pernicious anemia Achlorhydria Gastric ulcer H. Pylori infection

Manifestation Indigestion, dyspepsia Anorexia, Weight loss Abdominal pain (epigastric) constipation
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Treatment Radical surgery Subtotal gastrectomy Total gastrectomy

Take Vit. B12 lifetime

Chemotherapy

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Wilms Tumor (NEPHROBLASTOMA)

Most common renal neoplasm in children.
May be associated with congenital anomalies:
aniridia ( congenital absence of iris) hypospadias cryptorchidism.

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Manifestations Swelling or non tender mass in the abdomen; confined to one side or midline. Anorexia & vomiting - Wt. Loss Fever Fatigue/Malaise Hematuria Hypertension occasionally occurs
Treatment Surgery (nephrectomy) Radiation Chemotherapy
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Nursing Intervention Do not palpate the abdomen Handle and bathe carefully Monitor BP I&O

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Kidney cancer
Etiology Tobacco use Industrial chemicals (rubber, ink, paraffin etc.) Manifestation Asymptomatic (early) Classic triad Hematuria Pain Mass in flank
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Treatment Radical nephrectomy Radiation Hormone Therapy Chemotherapy

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Laryngeal Cancer

Familial tendency Smoking Vocal straining Alcohol ingestion

Manifestation Hoarseness (1st sign) Pain radiating to ear when drinking hot or acidic drinks Late signs Dysphagia, weight loss Dyspnea Cough, hemoptysis Foul breath
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Treatment Partial laryngectomy Total laryngectomy

Alternate communication, airway obstruction, tacheostomy,

dilators Soft diet Clean stoma twice a day Avoid water, fumes and powder

Radial neck dissection Chemotherapy Radiation

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Liver cancer
Etiology Hep. B Anabolic steroid use Alcoholism
Manifestation Weakness, fatigue, weight loss Hepatomegaly, liver (right upper quadrant) mass on palpation Jaundice Ascites Increase Bleeding tendency
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Treatment Always fatal even with treatment Chemotherapy Surgery Transplantation

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Lung cancer
Smoking Occupational exposure Asbestos Coal dust

Manifestations Cough (persistent) Hemoptysis Dyspnea Hoarseness Chest pain Pleural effusion Weight loss and fatigue
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Treatment Chemotherapy Radiation Lobectomy Pneumonectomy

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Multiple Myeloma
Etiology Unknown
Manifestation Severe bone pain pancytopenia (bone marrow replaced by plasma cells) Weight loss Treatment Chemotherapy Radiation Avoid fracture
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Oral cancer
Etiology Alcohol and tobacco use (chewing)
Manifestation Asymptomatic (early) Painless sore/mass that does not heal Painless indurated, ulcer with raised lesion Dysphagia, dysarthria (late)

Treatment Chemotherapy Radiation Resectional surgery

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Ovarian Cancer
Etiology Familial history DES use by mother or in utero
Manifestation Pelvic pain/backache (early) Irregular menses (meno or metrorrhagia) Dyspepsia Breast tenderness Treatment Radiation Chemotherapy TAHBSO
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Pancreatic Cancer
Etiology Chemicals High fat diet Smoking Chronic pancreatitis
Manifestation Anorexia, weight loss Abdominal pain (epigastric) Jaundice Diarrhea, steatorrhea Palpable epigastric mass
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Treatment Chemotherapy Radiation Surgery (palliative, depend on type)

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Penile Cancer
Etiology Uncircumcised
Manifestation Painless, wart like growth on glans or caronal sulcas Treatment Chemotherapy Radical prostatectomy Orchiectomy
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Prostate Cancer
Etiology Familial tendency High Alcohol and fat intake Exposure to chemicals
Fertilizer and rubber industry

Manifestations Hematuria Hard, fixed nodule on DRE

Urine obstruction (oliguria, urgency, dribbling etc.)

Treatment Radiation Hormone therapy chemotherapy

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Skin cancer
Etiology Sun exposure
Manifestation Small, elevated, multicolored nodule with irregular border Large, flat, darkly pigmented area with irregular margin Treatment

Surgical excision Cryotherapy Curettage and electrocautery Radiation Chemotherapy

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Testicular cancer
Etiology Cryptorchidism, undescended testes Epididymitis (reproductive tract infection) Local trauma Manifestation Painless enlargement of scrotum Palpable, firm testicualr mass Scrotal heaviness Pain (back and abdomen) Weight loss and weakness Elevated AFP and HCG levels
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Treatment Orchiectomy Radiation Chemotherapy

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Thyroid Cancer
Etiology Neck radiation exposure
Manifestation Respiratory distress Hard, painless Lump in throat Dysphagia Treatment Surgery (Thyroidectomy) Chemotherapy Radiation
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Uterine (endometrial) cancer

Etiology Obesity DM Hypertension Nulliparity, infertility Polycystic ovary disease Uterine polyps
Manifestation Irregular vaginal bleeding Postmenopausal bleeding Abnormal pap smear (25%)
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Treatment Chemotherapy Hysterectomy TAHBSO Radiation (internal or external)

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Vulvular cancer
Etiology Unknown Herpes HPV
Manifestation Pruritus (early) Vulvar bleeding Foul smelling discharge Pain Vulvar mass and ulceration
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Treatment Radiation Radical vulvectomy

Perform irrigation to promote hygiene, comfort and healing

Chemotherapy
Laser therapy

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Interventions for all cancer

Relieve pain and discomfort Maintain skin integrity Maintain oral mucosa integrity Prevent injury Prevent infection Promote rest Ensure adequate food and water intake Enhance body image Provide intervention relatd to treatment
Chemo, radiation, surgery, etc

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Grading of Tumors
Gx Grade cannot be assessed
G1 Well differentiated G2

Moderately well differentiated G3 and G4 Poorly to very poorly differentiated

STAGES OF TUMOR GROWTH

TMN Classification System

T- primary tumor
Tx- tumor cannot be adequately assessed T0- no evidence of primary tumor TIS- carcinoma in situ T1, T2, T3, T4- progressive increase in tumor size and involvement N- regional lymph node Nx- regional lymph node cannot be assessed clinically N0- regional lymph nodes demonstrably normal N1, N2, N3, N4- increasing degrees of demonstrable abnormalities of regional lymph nodes M- distant metastasis Mx- not assessed M0- no (known) distant metastasis M1, M2, M3- ascending degrees of distant metastasis, including metastasis to distant lymph nodes

THANK YOU AND GOODLUCK!!!

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