Cancer Concepts

 Exact cause: Unknown

 Predisposing factors:

• Heredity
• Stress
 Psychological
 Physical

• Unuse
• Overuse
• Abuse
• Specific
 Normal Cell
Theories of Cancer
Potential
Cellular Transformation A
b
Virus
Chemical

C
/ Physical Agent
ell
Drugs
and Derangement Theory
Hormones A
b A
b
Immune system
Genetic
fails Alteration
A
b
 Failure of the Immune
Response Theory
Defective Cell

Multiple cell division

Malignancy
Classification
 Tumor
•1 - small
• 2-3 - medium
• 4 - large
 Node
•0 - no involvement
• 1-3 - moderate
•4 - extensive
 Metastasis
•0 - no metastasis
•1 - metastasis
 Warning Signs of Cancer
C - change in bowel or bladder habits
A - sore that does not heal
U - unusual bleeding or discharge
T - tumor
I - indigestion or difficulty in swallowing
O - obvious change in warts or moles
N - nagging cough or hoarseness of voice

U - unexplained anemia
S - sudden weight loss
Comparison of Benign & Malignant Neoplasm

Characteristics Benign Malignant

Speed of growth Slow Rapid

Mode of growth Localized Infiltrating

Capsule Encapsulated No capsule

Recurrence Unusual Common

Metastasis None Common

Effect Harmless to Harmful

host
Prognosis Very good Poor
LUNG CANCER
 Description
 Refers to malignant tumor
growth within the bronchial
tissue or lung parenchyma.
 Types include:
• Squamous cell
• Adenocarcinoma
• Small cell (oat cell)
• Large cell
 Etiology and Incidence
 Exact Cause: Unknown

 Predisposing factors
• Heredity
• Pulmonary irritants

 Poor prognosis
 Pathophysiology
 Irritation  series of changes 
tumor
 Metastases – primary sites
 Some tumors secrete hormones:
• ADH – reabsorption of water
• ACTH – stimulates adrenal
glands to produce steroids
 Symptoms may include:
• Cough
• Wheezing
• Shortness of breath
• Chest pains
• Hoarseness
• Dysphagia (compression of esophagus)
• Weight loss
 Nursing Interventions
 Adequate oxygenation
 Prepare for surgery if tumor is small
enough to be removed
 Prepare patient for planned
treatments
• chemotherapy
• radiation therapy
 Analgesics as ordered
 Maintain nutritional status
 Provide emotional support
BLADDER
CANCER
 More common in males
 Cause: unknown

 Risks factors
1. Exposure to cigarette smoke
2. Pelvic radiation
3. Use of cyclophosphamide
4. Chronic cystitis
5. Bladder calculi
6. Schistosomiasis
Assessment

 Hematuria (first sign)

• Painless
• Gross
 Dysuria
 Obstruction to urine flow
 Development of fistula
 Collaborative
Management
 Chemotherapy
• Thiotepa
• Mitomycin C
• Doxorubicin (Adriamycin)
• Cyclophosphamide (cytoxan)
• Cisplatin (Platinol)
• Methotrexate
 Radiation
 Surgery
• Urinary Diversion Surgeries
Ileal Conduit

Ureterostomy

Ureterosigmoidostomy

Nephrostomy
Ileal Conduit
 For CA Bladder
 Adult Neurogenic

Bladder
 Insterstitial

Cystitis
 Irreparable

Trauma
Important! Complications
 External  Obstruction to

collection device the urine flow via

small intestines
needed
secondary to
 Proper fitting to
edema
prevent urine  Infection
leak to the skin  Stoma prolapse
 Skin care with  Calculi
warm water and  Electrolyte
mild soap imbalances
Ureterostomy
 Either or both ureters
are out to the
abdominal wall
 Ureteral stoma is
created
 External collection
device is needed
 Infection is a
potential hazard
 Increase fluid intake
Nephrostomy
 To drain the
urine while
ureteral
inflammation
from trauma
or calculus is
present
Complications Important!
 Infection  DO NOT
(Pyelonephritis) IRRIGATE!!!
 Blockage of the

catheter
Ureterosigmoidostomy
 No external
collection
device
 Passage of
flatus includes
leak of urine
 Infection is
possible
PROSTATE
CANCER
 Most common male Ca
(gender-specific)
 Androgen – dependent

adenocarcinomas
 Predisposing Factors
 Genetic tendency
 50 years of age
 Hormonal factors
• Late puberty
• High frequency of sexual
experience
• History of multiple sexual partners
• High fertility
 Diet
• ↑fat (alters cholesterol and steroid
metabolism)
 
 Chemical carcinogens
• Air pollution
• Occupation-related
 industries – fertilizer, rubber, textile

 batteries containing Cadmium

 Viruses
 Assessment
 Hesistancy
 Hematuria
 Urinary retention
 Stool changes
 Pain radiating down hips and legs
 Cytitis
 Dribbling
 Nocturia
 Hard, enlarged prostate

 Pain on defecation

 High level of acid

phospatase
 Elevated PSA (Prostatic

Specific Antigen)
 Nursing Interventions
 Early detection of tumor
• Ultrasound
• MRI
• X-ray
• CT Scan
 Radiation therapy
 Endocrine therapy - DES
(diethylstilbestrol) - decreases
testosterone level
 Surgery: Prostatectomy
 Hodgkin’s
Disease
malignant tumor of lymphatic
system
 Cause:
• Unknown
• Viral associations
• Autoimmunity

 Incidence:
• Young adult 15-35 years
 Pathophysiology
Proliferation of abnormal T-Cells

Obstruction in lymphatic flow

Metastases
Pain
 Spleen
Fever
 Liver
Weight Loss
 Lungs
Malaise
 Heart
 Management
 MOPP
• Watch out for BM
depression
 ABVD
• Causes red urine
 Nursing Intervention
 Supportive
•N/V
•F & E
•Comfort measures
 Protection from infection
 Maintain Tissue Integrity

 Maintain Normal Body

Temperature
 Prevent or decrease pain

 Maintain ideal body weight

 Maintain adequate hydration

 Assist client and significant

others to cope
COLORECTAL
CANCER
 Cause: Unknown
 Predisposing Factors:
• Age above 40 years
• Predisposing Factors
  low in fiber
  high in fat, protein and refined carbohydrates
 Obesity
 History of chronic constipation
 History of IBD, familial polyposis or colon polyps
 Family history of colon cancer
 Most Common Site: Rectosigmoid area (70%)
 ASSESSMENT
 Ascending (Right)  Distal Colon / Rectal
Colon Cancer Cancer
• Occult blood in stool • Rectal bleeding
• Anemia • Changed bowel
habits
• Anorexia and weight • Constipation or
loss Diarrhea
• Abdominal pain • Pencil or ribbon –
above umbilicus shaped stool
• Palpable mass • Tenesmus
• Sensation of
incomplete bowel
emptying
 COLORECTAL CANCER
 Duke’s Classification of Colorectal Cancer
Stages:
• A: confined to bowel mucosa, 80 – 90% 5- year
survival rate
• B: invading muscle wall
• C: lymph node involvement
• D: metastases or locally unresectable tumor, less
than 5% 5 – year survival rate
 Guidelines for Early Detection of Colorectal Cancer
• Digital rectal examination yearly after age 40
• Occult blood test yearly after age 50
• Proctosigmoidoscopy every 5 years after age 50,
following 2 negative results of yearly examination
 COLLABORATIVE
MANAGEMENT
 Surgery
• Hemicolectomy (ascending and
transverse)
• Abdomino – Perineal Resection (APR)
for rectosigmoid cancer
Necessitates permanent colostomy
 Chemotherapy
• Fluorouracil (most effective)
 Radiotherapy
• Adjuvant treatment
Renal Cell
Carcinoma
 Pathophysiology:
Tumor (anywhere in
the kidneys) Metastasis

Compression on the
surrounding surface Primary sites
•Lungs
•Liver
•Ischemia
•Lymph nodes
• necrosis
•Renal veins
• hemorrhage
 Signs and Symptoms
 Abdominal pain
 Hematuria
 S/sx of shock
 Nursing Interventions:
 Monitor closely for:
• Fluid and electrolyte status.
• I&O
• Acid-base balance
 Symptomatic
 Prepare for possible surgery
 Institute postop care