Cancer Concepts

Exact cause: Unknown Predisposing factors:

Heredity Stress
Psychological Physical

Unuse Overuse Abuse

Specific

Theories of Cancer

Cellular Transformation and Derangement Theory Failure of the Immune Response Theory

Cellular Transformation and Derangement Theory

Normal Cell

Virus Chemical / Physical Agent Drugs Hormones Genetic Alteration Defective Cell
Multiple cell division

Malignancy

Failure of Immune Response Theory

Potential Cell

(d e st

ruc tio

n)
Ab

Ab Ab

Immune system fails

Ab

Classification

Tumor
1 2-3 4 small medium large no involvement moderate extensive

Node
0 1-3 4 -

Metastasis
0 1 no metastasis metastasis

Warning Signs of Cancer

C A U T I O N U S - change in bowel or bladder habits - sore that does not heal - unusual bleeding or discharge - tumor - indigestion or difficulty in swallowing - obvious change in warts or moles - nagging cough or hoarseness of voice - unexplained anemia - sudden weight loss

Comparison of Benign & Malignant Neoplasm

Characteristics
Speed of growth Mode of growth Capsule Recurrence Metastasis Effect Prognosis

Benign
Slow Localized Encapsulated Unusual None Harmless to host Very good

Malignant
Rapid Infiltrating No capsule Common Common Harmful 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. 2. 3. 4. 5. 6. Exposure to cigarette smoke Pelvic radiation Use of cyclophosphamide Chronic cystitis Bladder calculi 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 Ureterosigmoidosto my

Ileal Conduit

For CA Bladder Adult Neurogenic Bladder Insterstitial Cystitis Irreparable Trauma

Complications Important! Obstruction to External the urine flow collection via small device needed intestines Proper fitting secondary to to prevent edema urine leak to Infection the skin Stoma Skin care with prolapse warm water Calculi and mild soap Electrolyte

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 (Pyelonephriti IRRIGATE!!! s) 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 Cystitis 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

Hodgkins 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 Pain Fever Weight Loss Malaise Metastases Spleen Liver Lungs Heart

Management
Watch out for BM depression 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) Colon Cancer

Occult blood in stool Anemia Anorexia and weight loss Abdominal pain above umbilicus Palpable mass

Distal Colon / Rectal Cancer

Rectal bleeding Changed bowel habits Constipation or Diarrhea Pencil or ribbon shaped stool Tenesmus Sensation of incomplete bowel emptying

COLORECTAL CANCER

Dukes 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

Surgery Hemicolectomy (ascending and transverse) Abdomino Perineal Resection (APR) for rectosigmoid cancer
Necessitates permanent colostomy

COLLABORATIVE MANAGEMENT

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
necrosis hemorrhage

Lymph nodes
Renal veins

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