Oncology Nursing - LECTURE NOTES PDF

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LECTURE NOTES...

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ONCOLOGY NURSING  CANCER NURSING/ ONCOLOGY NURSING/ NEOPLASTIC DISORDERS/ CELLULAR ABERRATION/ ONCOLOGICAL DISORDERS/ ABNORMAL CELL GROWTH.

I. Background Cancer 

Is a scary word



A diagnosis of cancer is frightening to most people although reaction depend on the particular diagnosis, location, stage, reatment, effects on bodily function and prognosis.

II. Pathophysiology  The cell is the basic structural unit in plants and animals. Differentiated cells work together to perform specific functions. Cell regeneration occurs through cell division and reproduction. Abnormal changes in cells develop for many reasons. These abnormal cells reproduce in the same way as normal cells, but they do not have the regulatory mechanisms to control growth. Thus, abnormal cell growth proliferates in an uncontrolled and unrestricted way.

III.Definition  Is a neoplastic disorder by abnormal, unrelated cell proliferation  Invades healthy tissues & compete with normal cells for O2, nutrients & space  Can involve all body organs with manifestations that vary according to the body system affected & type of tumor cells  Produces serious health problems such as impaired immune & hematopoetic (blood-producing) function, altered GI structure and function, motor and sensory deficits and decreased respiratory function.

IV.Cell biology  Cancer cells synthesize proteins and glucose more rapidly than do normal cells  Nuclei of cancer cells are abnormally large  Adhesiveness of cancer cells attracts greater number of growth factors.

V.Tumors (neoplasms)  New growths of abnormal tissues are called neoplasms or tumors.  The first part of the tumor’s name indicates the particular cell or tissue.  The suffix –oma indicates it is a tumor.

Four Main Tumor Classifications according to the tissue type are: 1. Carcinomas – cancers originating from the epithelial cells 2. Lymphomas – cancers originating from organs that fights infection 3. Leukemia's – cancers originating from organs that form blood 4. Sarcomas – cancers originating from connective tissues such as bone or muscle Tumors are classified according to their cell of origin and whether their growth is benign (not invasive or spreading) or malignant (invasive or spreading).

Characteristics of Benign and Malignant tumors CHARACTERISTICS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Speed of Growth Mode of Growth Capsule When palpated Mostly found in Cell characteristics Extend of destruction compression and destruction Metastasis Effect of neoplasm Prognosis

BENIGN TUMORS 1. 2. 3. 4. 5. 6.

Slow, steady rate Remains localized Encapsulated Smooth, easily defined, movable Less profuse blood supply Cells resemble the cells of the tissue origin

7. Only destroy normal tissue by compression or obstruction of normal tissue 8. Rare 9. Never occur 10. Rarely fatal (not harmful) 11. Very good MALIGNANT TUMORS 1. Rapid rate, can be unpredictable 2. Invades surrounding tissue & metastasize to other tissues 3. Not encapsulated or rarely encapsulated 4. Have irregular borders and are immovable 5. Greater than normal blood supply 6. Cells cannot be readily identified as to tissue of origin 7. Invade normal tissue and compete with normal cells for O2, nutrients; also destroy

by compression and destruction 8. More common 9. Very common 10. Fatal if not treated (harmful) 11. Poor

FOUR PRIMARY MECHANISMS BY WHICH THE NEOPLASMS SPREAD 1.

Vascular system – cancer cells penetrate vessels and circulate until trapped; may penetrate the vessel wall and invade adjacent organs & tissues.

2. Lymphatic system – cancer cells penetrate the lymphatic system & are distributed along lymphatic channels 3. Implantation – cancer cells implant into a body organ certain cells have an affinity for particular organs and body areas. 4. Seeding – a primary tumor sloughs off tumor cells into a body cavity, such as the peritoneal cavity

HOW CANCER METASTASIZES (SPREADING)? Cancer cells travel from primary site to more distant site through: - blood vessels - lymphatic system or by external means

Primary Site  is the area where is where malignant cells first form Secondary Site or metastatic sites  are regions to which cancer cells have spread

Common Sites of Metastasis BREAST CANCER  bone  lung LUNG CANCER  brain COLORECTAL CANCER  liver PROSTATE CANCER  bone  spine and legs BRAIN TUMORS  central nervous system

V. Etiology

 Damage to cellular deoxyribonucleic acis (DNA), causes cancer cells to develop. In many cases, the body repairs such damage; in cancer cells, The DNA remains damaged. Inherited cancers occur when the damage  DNA passes to the next generation. In many instances, however, certain factors and agents contribute to the development of cancer. These factors called carcinogens A.

Environmental factors

a. Virus – the cell changes that a virus incorporates into the genetic information may cause cancerous cell “oncovirus or oncogenic viruses ( e.g. Epstein-barr virus, Hep B virus and human papillomavirus).

b. Physical agents – prolonged exposure to sunlight, radiation and pollutants, chronic irritation/inflammation, tissue trauma. Electromagnetic fields from microwaves, power lines and cellular phones are other possible carcinogens, although study results related to such factors are conflicting. c. Chemical agents – produce toxic effects by altering DNA structure in body sites distant from chemical exposure (e.g. dyes, asbestos, tars, smoke (cigarettes), coal dust most often affect liver, lungs and kidneys. d. Genetic and familial factors – DNA damage occur in cells where chromosomal patterns are abnormal (e.g. leukemia) e. Dietary factors – are an important variable. Foods high in fats and oils from animal sources and those smoked or preserved with salts, alcohol or nitrates are associated with an increased cancer risk. f. Hormonal agents – tumor growth is promoted by disturbances in hormonal balance of body’s own (endogenous) hormones or administration of exogenous hormones (e.g. prolonged estrogen replacement, oral contraceptives). g. Idiopathic factors – many cancers such as breast, colon, rectal, lymphatic, bone marrow & pancreas cancers arise spontaneously from unknown causes. h. AGE -advancing age is a significant risk factor for the development of a cancer i. Immune function – incidences of cancer are higher in immunosuppressed individuals, organ transplant recipients who are taking immunosuppressive medication and individuals with acquired immune-deficiency syndrome (AIDS). VI. Prevention A. Primary prevention  ↑ intake of fresh vegetables (especially those of the cabbage family or cruciferous vegetables such as broccoli, cabbage and cauliflower.  ↑ fiber intake: like fruits and vegetables reduces risk of breast, prostate and colon cancer.  ↑ intake of vitamin A: like yellow fruits and vegetables reduces risk of laryngeal, esophangeal and lung cancer.  intake of vitamin C: rich in citrus and fruits; may protect against stomach and esophangeal cancer and fight infections.  ↑ intake of vitamin E: antioxidant  Keep weight in normal range: Obesity is associated with cancer of uterus, gall bladder, breast and colon  ↓ amount of intake of dietary fat: Fat is associated with increased risk of breast, colon, and prostate cancer.

 ↓ intake of salt-cured, smoked and nitrate foods. These are linked to stomach and esophangeal cancers.  No cigarette smoking: smoking increases the risk of lung cancer  ↓ alcohol intake: associated with increased risk of liver cancer  Avoid exposure to sunlight: associated with risk of skin cancer. Use sunscreen with SPF of 15 or greater.  Exercise regularly.  Practice safely in the workplace to avoid exposure to chemicals and radiation.

Secondary Prevention  Pap (Papanicolaou’s)Test: for sexually active women or/women over age 18, it is recommended that a Pap test be done annually. And Women taking contraceptive pills.  Digital Rectal Examination (DRE): men and women usually after age 40.  Proctosigmoidoscopy, Sigmoidoscopy, Colonoscopy: after age 50, should be done every 3-5 years both men and women  Check for occult blood in stool (Guaiac test): done after age 50 on annual basis  Mammography: baseline between ages 35-40, then again between ages 40-49, then yearly after 50.  Breast Self-Examination (BSE) conducted monthly: perform 7-10 days after menses.  Postmenopausal clients or clients who have had hysterectomy should select a specific day of the month and perform BSE monthly on that day  .Testicular Self-Examination (TSE): monthly from age 20 to 40, yearly after age 40  Skin inspection

VII. Assessment  Cancer is insidious (slow growing). It initially may cause no symptoms or signs or it may be vague. This factor underscores the importance of educating clients about prevention and selfexamination so that cancer can be diagnosed as early as possible....