UNDERSTANDING CANCER c) Metastasis (spread or transfer of cancer cells

form one organ or part to another not directly

Learning Outcomes: connected).
At the end of this chapter, the learner should be LOSS OF NORMAL GROWTH CONTROL
able to: NORMAL CELLS CANCER CELLS
1. Identify the Nurse’s roles in the prevention of cancer Normal Cell Division Cancer Cell Division
and in health education. Cells damage--no repair First Mutation-Later
2. Discuss the pathophysiology of cancer and its clinical Mutation
manifestations. Cell Suicide or Apoptosis Uncontrolled Growth
3. Apply the nursing process to identify care of the client ONCOGENES - Normal MUTATED/DAMAGED
in the diagnosis and treatment phases of cancer. genes regulate cell ONCOGENES -
4. Value the nurses’ role in providing quality, growth Oncogenes accelerate
comprehensive, individualized, ethical and human care cell growth and division
of clients with cancer.
THE BEGINNING OF CANCEROUS GROWTH
ESSENTIAL CONCEPTS OF CANCER: 1. Cancer cells on underlying tissue
 What is Cancer? 2. Becomes tumor (neoplasms)
 Normal Cell Growth vs. Cancer Cell Growth 3. Invasion and Metastasis
 Etiology and Causative Factors a) Cancer cells invade surrounding tissues and
 Pathophysiology blood vessels
 Classification of Tumors b) Cancer cells are transported by the circulatory
 Effects of Cancer system to distant sites
c) Cancer cells reinvade and grow at new location
NURSING PROCESS:
 Assessment ETIOLOGY/CAUSATIVE FACTORS:
 Laboratory and Diagnostic Tests  Viruses
 Tumor Staging and Grading  Chemical Carcinogens
 Nursing Diagnoses and Planning  Physical Stressors
 Implementation and Management  Hormonal Factors
TREATMENT MODALITIES:  Genetic Factors
 Chemotherapy
 Radiotherapy
END-OF-LIFE ISSUES A. VIRUSES, CHEMICALS, RADIATION =
HEREDITY, DIET, AND HORMONES
TERMINOLOGY RELATED TO ONCOLOGY/CANCER Cancerlinked virus inserts and changes for cell growth
NURSING
Oncology-Cancer
Benign Neoplasm B. POPULATION-BASED STUDIES
Neoplasia Regions of Highest Incidence:
Hyeperplasia U.K = Lung cancer
Hypertrophy China = Liver cancer
Metaplasia Australia = Skin cancer
Dysplasia Japan = Stomach Cancer
Anaplasia U.S = Colon Cancer
Metastases Canada = Leukemia
Adenocarcinoma Brazil = Cervical cancer
Carcinoma
Sarcoma C. GENES AND CANCER
Carcinogens D. VIRUSES

EXAMPLOF HUMAN CANER VIRUSES:

WHAT IS CANCER? Some Viruses Associated with Human Cancers
Cancer is a complex of diseases which occurs
when normal cells mutate into abnormal cells that take
over normal tissue, eventually harming and destroying
the host.

 A LARGE GROUP OF DISEASES

CHARACTERIZED BY:
a) Uncontrolled growth and spread of abnormal
cells
b) Proliferation (rapid reproduction by cell
division)
 PATHOPHYSIOLOGY
E. BACTERIA AND STOMACH CANCER
Ex: H. Pylori  ABNORMAL CELL FORMED BY MUTATION OF
DNA
F. TOBACCO USE AND CANCER
 CELL GROWS AND PROLIFERATES

 METASTASIS OCCURS WHEN ABN. CELLS

INVADE OTHER TISSUE,THROUGH LYMPH
AND BLOOD

 Cancer development linked to immune

system failure
 Example of clients susceptible to developing
cancer

CLASSIFICATION OF CANCER
A. ACCORDING TO BEHAVIOR OF TUMOR
a) BENIGN - tumor that cannot spread by
invasion or metastasis; hence, they only grow
locally.
b) MALIGNANT - tumors that are capable of
spreading by invasion and metastasis. By
G. HIGH-STRENGTH RADITION definition, the term “cancer” applies only to
malignant tumors.
H. AIS AND KAOSI’S SARCOMA
Wihout dse = HIV infexn
Depressed Immune System = KSHV infx Malignant versus Benign Tumors
Leading to KAPOSI’S SARCOMA
 Benign (not cancer) tumor cells grow
I. HEREDITY AND CANER only locally and cannot spread by invasion or
HEREDITY CAN AFFECT MANY TYPES OF CANCER: metastasis.
Inherited Conditions That Increase Risk for
Cancer  Malignant (cancer) cells invade neighboring
tissues, enter blood vessels, and metastasize
to different sites.

Why Cancer Is Potentially Dangerous

It can affect the brain, liver, melanoma(initial
tumor), melano cells travel through bloodstream.

Patterns of cell Proliferation

a. Hyperplasia - tissue growth based on an
excessive rate of cell division, leading to a larger
than usual number of cells; the process of
J. CHEMICA L CARCINOGENS hyperplasia is potentially reversible; can be a
1. Industrial Compounds normal tissue response to an irritating stimulus. An
2. Drugs example is a callus
3. Hormones
4. Foods
5. Polyciclic hydreocarbons

K. HORMONES
Estrogenas replacement therapy has been found
to increase incidence of:
Vaginal, cervical, and uterine cancers

L. PHYSICAL AGENTS
Radiation
Physical Irritation/Trauma
 b. Dysplasia - Bizarre cell growth differing in size, Mutations and Cancer
shape and cell arrangement.
Genes Implicated in Cancer

Carcinoma in Situ

Cancer Tends to Corrupt Surrounding

Environment

Hyperplasia Mild Carcino Cancer

dysplasia
ma in situ (invasive)
(severe
c. Metaplasia - conversion of one type of cell in a
tissue to another type not normal for that tissue.

d. Anaplasia - change in the DNA cell structure and

orientation to one another, characterized by loss of
differentiation and a return to a more primitive
form.

e. Neoplasia - uncontrolled cell growth, either

benign or malignant

METASTASIS: 3 STAGES

 Invasion – neoplastic cells from primary tumor

invade into surrounding tissue with penetration of Classification of Tumors
blood or lymph.
 CARCINOMAS: EPITHELIAL TISSUE
 Spread – tumor cells spread through lymph or  BODY SURFACES, LINING OF BODY CAVITIES
circulation or by direct expansion. ETC: (ADENOCARCINOMA)

 Establishment and growth – tumor cells are  SARCOMAS: CONNECTIVE TISSUE

established and grow in secondary site: lymph  STRIATED MUSCLE, BONE, ETC (OSTEOSARCOMA)
nodes or in organs from venous circulation
 LYMPHOMAS AND LEUKEMIAS
Cancer Tends to Involve Multiple Mutations  HEMATOPOIETIC SYSTEM

Malignant cells invade  NERVOUS TISSUE TUMORS

neighboring tissues, enter
Benign tumor blood vessels, and metastasize  EX. NERVE CELLS-NEUROBLASTOMA
cells to different sites
grow only locally and
cannot spread by  MYELOMA
invasion or metastasis  Develops in the plasma cells of bone marrow

Time More
Mutati Ce Mutati Prot
on inactivates lls ons inactivate o-oncogenes mutations,
more genetic
suppressor proliferate DNA repair
genes
mutate to instability,
gene oncogenes metastatic
disease
Different Kinds of Cancer Effects of Cancer

 Paraneoplastic Syndromes: ectopic sites with

excess hormone production

 ↑ Parathyroid hormone→ hypercalcemia

 ↑ secretion of insulin→ hypoglycemia
 ↑ Antidiuretic hormone (ADH) → fluid
retention, HTN & peripheral edema

 ↑ Adrenocorticotropic hormone (ACTH):

cause excessive secretion of cortisone (ie:
fluid retention, ↑ glucose levels)

Effects of Cancer

Pain: major concern of clients and families associated

Naming Cancers with cancer.

Physical Stress: body tries to respond and destroy

neoplasm.

Psychological Stress

ASSESSMENT

Nursing History
 Health History – chief complaint and history of
present illness (onset, course, duration, location,
precipitating and alleviating factors)

 Cancer signs: CAUTION US!

WARNING SIGNS OF CANCER

CAUTION US!
 Change in bowel or bladder habits
Women, Tobacco & Lung Cancer  A sore that does not heal
 Unusual bleeding or discharge
“ Women who smoke like men,  Thickenings or lumps
die like men.”  Indigestion or difficulty in swallowing
 Obvious change in a wart or mole
U.S. Surgeon General David Satcher  Nagging or persistent cough or hoarseness
 Unexplained anemia
 Sudden unexplained weight loss
Effects of Cancer

 Disruption of Function- can be due to a. Change in bowel or bladder habits

obstruction or pressure  A person with colon cancer may have diarrhea or
constipation, or he may notice that the stool has
 Hematologic Alterations: can impair function of become smaller in diameter.
blood cells  A person with bladder or kidney cancer may have
urinary frequency and urgency.
 Hemorrhage: tumor erosion, bleeding, severe
anemia b. A sore that does not heal
 Small, scaly patches on the skin that bleed or do
 Anorexia-Cachexia Syndrome: wasted not heal may be a sign of skin cancer
appearance of client  A sore in the mouth that does not heal can indicate
oral cancer

c. Unusual bleeding or discharge

 Blood in the stool is often the first sign of colon Determine location of cancer:
cancer  X-rays
 Similarly, blood in the urine is usually the first sign  Computed tomography
of bladder or kidney cancer  Ultrasounds
 Postmenopausal bleeding (bleeding after  Magnetic resonance imaging
menopause) may be a sign of uterine cancer  Nuclear imaging
 Angiography
d. Thickenings or lumps
 Enlargement of the lymph nodes or glands (such as
the thyroid gland) can be an early sign of cancer Diagnosis of cell type:
 Breast and testicular cancers may also present as a ▪Tissue samples: from biopsies, shedded cells (e.g.
lump Papanicolaou (PAP) smear), & washings

e. Indigestion or difficulty in swallowing ▪ Cytologic Examination: tissue examined under

 Cancers of the digestive system, including those of microscope
the esophagus, stomach, and pancreas, may cause
indigestion, heartburn, or difficulty swallowing. Direct Visualization:
▪ Sigmoidoscopy
f. Obvious change in a wart or mole ▪ Cystoscopy
 Moles or other skin lesions that change in shape, ▪ Endoscopy
size, or color should be reported. ▪ Bronchoscopy
▪ Exploratory surgery; lymph node biopsies to determine
g. Nagging or persistent cough or hoarseness metastases
 Cancers of the respiratory tract, including lung
cancer and laryngeal cancer, may cause a cough
that does not go away or a hoarse (rough) voice. Cancer Detection and Diagnosis
Early Cancer May Not Have Any Symptoms
h. Unexplained anemia Cervical Cancer Screening (pap smear)
Breast Cancer Screening
i. Sudden unexplained weight loss

PHYSICAL ASSESSMENT
 Inspection – skin and mucus membranes for
lesions, bleeding, petechiae, and irritation
Assess stools, urine, sputum, vomitus
for acute or occult bleeding
Scalp noting hair texture and hair loss

 Palpation
Abdomen for any masses, bulges or
abnormalities
Lymph nodes for enlargement

 Auscultation – of lung sounds, heart sounds and

bowel sounds

Laboratory & Diagnostic Tests

 Cancer detection examination
 Laboratory tests
 Complete blood cell count (CBC)
 Tumor markers – identify substance (specific
proteins) in the blood that are made by the tumor
 PSA (Prostatic-specific antigen): prostate
cancer
 CEA (Carcinoembryonic antigen): colon cancer
 Alkaline Phosphatase: bone metastasis
 Biopsy