CA

Lung Cancer: Definition

• Tumors in the lung parenchyma or bronchi are referred to as bronchogenic carcinoma or lung cancer.
• Carcinogens, primarily cigarette smoke, are the main cause.
• Exposure affects the lung epithelium leading to dysplasia.
• The longer it persists, the more affected surroundings are impacted.
• It affects protein synthesis due to genetic mutations which disrupts cell cycles and promotes carcinogenicity.

Lung Cancer: Stages

• Stage 0 (in situ): Often asymptomatic, detectable through imaging or biopsy.
• Stage 1 (Localized):
  • Stage IA: Tumor size is 3 cm or less.
  • Stage IB: Tumor size is between 3 cm and 4 cm.
• Stage 2 (Locally advanced):
  • Stage IIA: Tumor size is more than 4 cm but has not spread significantly.
  • Stage IIB: Larger tumors or tumors that have spread to nearby lymph nodes.
• Stage 3 (Regional):
  • Stage IIIA: Cancer has spread to nearby lymph nodes but not beyond the mediastinum.
  • Stage IIIB: Extensive lymph node involvement or larger tumors affecting surrounding structures.
• Stage 4 (Metastatic):
  • Stage IVA: Tumors have spread outside the chest but not to distant organs.
  • Stage IVB: Multiple metastases, in one organ or spread to multiple organs.

Anatomy & Physiology: Anatomical Structure

• Lungs are in the thoracic cavity, protected by the rib cage, and positioned on either side of the heart.
• The right lung has 3 lobes (superior, middle, inferior).
• The left lung has 2 lobes (superior, inferior), to accommodate the heart.
• Each lung has 8-10 segments, separated by fissures.
• Right lung has 2 fissures (horizontal, oblique).
• Left lung has 1 fissure (oblique).

Anatomy & Physiology: Airways

• Air enters through the nose or mouth → pharynx → larynx → trachea → two primary bronchi.
• Primary bronchi branches into secondary bronchi, bronchioles, and alveoli.

Anatomy & Physiology: Gas Exchange

• Gas exchange occurs in alveoli, which are tiny sacs at the ends of bronchioles.
• Lungs contain ~300 million alveoli which provides a surface area equivalent to a tennis court.
• Oxygen diffuses from alveoli into capillaries, and carbon dioxide diffuses out for exhalation.

Anatomy & Physiology: Pleura and Respiratory Mechanics

• Lungs are covered by a double-layered pleura.
  • Visceral pleura closely envelops the lung tissue.
  • Parietal pleura lines the chest wall.
  • Pleural fluid between layers reduces friction during breathing.
• Diaphragm and intercostal muscles aid in expanding and contracting the thoracic cavity for inhalation and exhalation.

Lung Functions

• The lungs supply oxygen to the bloodstream and remove carbon dioxide.
• The lungs perform gas exchange through alveolar and capillary membranes.
• Lungs are pinkish-gray, spongy organs with three edges, surfaces, and an apex.

Lobules and Segments

• Lobules are groups of alveoli within each lobe. -The right lung contains 10 segments, the left lung contains 8 segments.

Lung Cancer :Signs & Symptoms

• Chronic Cough
• Hemoptysis
• Dyspnea
• Unexplained Weight Loss
• Chest Pain
• Hoarseness
• Fatigue
• Recurrent Respiratory Infections

Lung Cancer :Etiology

• Predisposing Factors:
  • Gender
  • Genetics
  • Race
• Precipitating Factors:
  • Carcinogens -Tobacco use -Secondhand (Passive) Smoke -Occupational Exposures -Dietary Deficits -Air Pollution
  • Ionizing Radiation

Lung Cancer: Medical Management

• Diagnostic exams include biopsy, chest x-ray, sputum cytology, CT scan, MRI, PET scan, endoscopy with esophageal ultrasound, and low dose Helical Computed Tomography.
• Treatments include surgery, chemotherapy, radiation therapy, and targeted therapy.
• Drugs:
  • Carboplatin: Disrupts DNA, RNA, and protein production by creating interstrand DNA cross-linkages, and is effective regardless of the cell cycle.
  • Cisplatin: Causes intrastrand and interstrand cross-links in DNA, blocking the production of RNA, DNA, and proteins; it stops cancerous cells from growing rapidly.
  • Paclitaxel: Disrupts cell microtubules, inhibiting cancer cell replication.
  • Ondansetron: Prevents serotonin from causing nausea and vomiting due to chemotherapy, radiation, and post-operative conditions.

Lung Cancer: Surgical Management

• Surgical options include Wedge Resection, Segmental Resection, Lobectomy, Pneumonectomy, Sleeve Resection, Open-Chest Surgery (Thoracotomy), VATS (Video-Assisted Thoracoscopic Surgery), and RATS (Robot-Assisted Thoracic Surgery).

Lung Cancer: Nursing Management

• Ineffective Airway Clearance is related to tumor obstruction; evidenced by chronic productive cough and wheezing.
• Impaired Gas Exchange is related to tumor growth; evidenced by a low oxygen saturation of 83%.
• Chronic Pain is related to tumor invasion; evidenced by a pain scale of 10/10 and guarding behavior.
• Risk for Infection is associated with chemotherapy medication.
• Anxiety is related to unidentified causes associated with lung cancer; evidenced by excessive worry, restlessness, tachycardia, and difficulty concentrating.

Cervical Cancer: Definition

• Cervical cancer is a significant health issue.
• Results from the uncontrolled growth of abnormal cells in the cervix, linked to persistent infection with high-risk strains of HPV.

Cervical Cancer: Key Causes and Risk Factors

• Human Papillomavirus (HPV) is the primary cause, especially high-risk strains.

Cervical Cancer:Progression

• Untreated cellular changes caused by HPV can develop into cancer.

Cervical Cancer: Classification

• Squamous Cell Carcinoma: -Originates in thin, flat cells lining the cervix, accounting for 70-90% of cases.
• Adenocarcinoma: -Originates in glandular cells in the cervical canal, accounting for 10-25% of cases.
• Adenosquamous Carcinoma:
  • Features characteristics of both squamous and glandular cell types, less common.

Cervical Cancer: Anatomy

• Location: Lower, narrow part of the uterus that connects the uterine cavity to the vagina.
• Length: Approximately 2.5 to 3 cm in non-pregnant women.
• External Os: Opening of the cervix into the vagina.
• Endocervical Canal: Passage between the external os and the internal os.
• Internal Os: Opening of the cervix into the uterine cavity.

Cervical Cancer: Layers

• Epithelium consists of the squamous epithelium (outer portion) and columnar epithelium (inner portion).
• Stroma is dense connective tissue with smooth muscle fibers.
• Blood Supply comes from the uterine and vaginal arteries, with innervation from the hypogastric plexus.
• Lymphatic Drainage occurs via pelvic lymph nodes.

Cervical Cancer: Physiological Role

• Cervix produces mucus to facilitate or block sperm entry, depending on menstrual cycle phase and dilates during labor to allow childbirth.

Cervical Cancer: Signs & Symptoms

• Abnormal vaginal bleeding
• Pelvic pain and pain during intercourse
• Unusual vaginal discharge
• Painful urination or blood in urine
• Fecal incontinence
• Leg swelling or pain
• Fatigue
• Back pain

Cervical Cancer: Etiology

• Predisposing Factors: -Age -Family history -Race
• Precipitating Factors: -Human Papillomavirus -Smoking and secondhand smoke -Sexual activity -Diethylstilbestrol exposure -HIV or other infection -Low socioeconomic status

Cervical Cancer: Medical Management

• Diagnostic exams include Pap Test (Pap Smear), HPV DNA Test, Colposcopy, Punch biopsy, Cone Biopsy, and Endocervical curettage (ECC).
• Treatments include Radiation Therapy, Chemotherapy, Chemoradiotherapy, Targeted Therapy, and Immunotherapy.
• Ondansetron is a drug that prevents nausea and vomiting caused by chemotherapy or radiation.
• Cisplatin is a platinum-based chemotherapy agent that kills cancer cells by damaging their DNA.
• Carboplatin is a platinum-based chemotherapy drug used as an alternative to Cisplatin.
• Paclitaxel is a chemotherapeutic agent that inhibits cancer cell division by stabilizing microtubules.
• Avastin (Bevacizumab) is an anti-angiogenic drug that blocks blood vessel growth in tumors, limiting their nutrients and oxygen supply.
• Erythropoietin stimulates red blood cell production, which treats anemia caused by chemotherapy or cancer.

Cervical Cancer: Surgical Management

• Treatments include Hysterectomy, Cryosurgery, Laser Ablation, Conization, and Trachelectomy.

Breast Cancer Definition

• Breast cancer is characterized by the uncontrolled growth of malignant cells within the breast tissues.
• Cancer originates primarily in the milk ducts or lobules of the breast.
• It can manifest in various forms, with the most common being invasive ductal carcinoma, where cancer cells invade nearby tissues beyond the ducts.

Breast Cancer : Anatomy and Physiology

• External Features: -Nipple: Central protruding structure for milk release. -Areola: Pigmented area surrounding the nipple containing Montgomery glands.
  • Skin: Provides a protective barrier with sweat glands, sebaceous glands, and hair follicles around the areola.
• Internal Features: -Females: Have lobes and lobules that produce milk, connected to lactiferous ducts for milk transport.
  • Males: Lacks developed lobes and lobules, with no milk-producing function.
  • Adipose Tissue: Influences breast size and shape. -Cooper's Ligaments: Provide structural support for breast tissue.
  • Vessels: Supply nutrients, and lymphatic vessels drain fluids, maintaining breast health.

Physiologycal Functions

• Hormonal Regulation in Females occurs during puberty and pregnancy; estrogen and progesterone promote breast growth and development.
• Lactation: Prolactin stimulates milk production in lobules and Oxytocin triggers the let-down reflex, releasing milk through ducts and the nipple.
• Males: Have minimal hormonal influence.

Breast Cancer: Signs & Symptoms

• Stage 0: Ductal Carcinoma In Situ -Often asymptomatic -Lump or abnormal mammogram findings
• Stage 1 -A lump in the breast -Abnormal nipple discharge (including blood) -Changes in breast shape or size -Skin texture changes (e.g., dimpling or color changes)
• Stage 2
  • lump in the breast or underarm -Changes in breast shape or size
  • Dimpling or puckering the skin -Inverted nipple
  • Nipple discharge
• Stage 4 Bone pain, joint swelling Respiratory issues (e.g., chronic cough, shortness of breath) Jaundice if liver is involved Neurological symptoms if it spreads to the brain (e.g., headaches, memory loss)

Breast Cancer: Etiology

• Predisposing Factors: -Genetics
  • Sex
  • Age -Race Menstrual History
  • Dense Breast Tissue
• Precipitating Factors: -Sedentary Lifestyle -Radiation Exposure -Diabetes Mellitus -Obesity -Alcoholism -Contraceptives

Breast Cancer: Medical Management

• Anastrozole: inhibits aromatase, which converts androgens into estrogens
• Cyclophosphamide: interferes directly with the replication of rapidly dividing cells by cross-linking DNA strands and inhibiting protein synthesis in both cancerous and normal rapidly dividing cells.
• Everolimus: blocks the mammalian target of rapamycin, which inhibits cell growth.
• Tamoxifen: binds to estrogen receptors, which blocks estrogen and prevents cancer.

Breast Cancer: Surgical Management

• Lumpectomy (Breast-Conserving Surgery)
• Mastectomy (Simple or Total)
• Modified Radical Mastectomy
• Sentinel Lymph Node Biopsy (SLNB)

Breast Cancer: Nursing Management

• Anxiety is related to the diagnosis of cancer as evidenced by concern and worries.
• Disturbed Body Image Loss (Mastectomy/ chemptherapy): patient expresses discomfort about self appearance.
• Acute Pain related to tumor pressure
• Fatigue is related to organ dysfunction as evidenced by expressed tiredness.
• High risk for impaired or loss of skin integrity

Colorectal Cancer : Definition

• Colorectal Cancer (CRC) affects the colon or rectum and is one of the most fatal if left untreated . It's defined as uncontrolled cell growth resulting in tumor formation, either begin or malignant.

Colorectal Cancer :Origin/Risk Factors

• Common in older individuals but can result from genetic predisposition in younger people.
• It generally originates from polyps, non-cancerous growths in the colon and rectum

Colorectal Cancer: Types of Polyps

• Adenomatous Polyps (Tubular Adenoma): Round and small, slow to develop over years. It's most common.
• Hyperplastic Polyps: Carries a low risk of becoming cancerous.
• Inflammatory Polyps: forms during chronic Inflammation
• Sessile Serrated Polyps smaller, found on the upper colon
• Villous Adenomas (Tubulovillous Adenomas): carries High malignancy risk.

Colorectal Cancer : Adenoma-Carcinoma Sequence

• Cells infiltrate the bowel and and travels cancerous parts vis blood
• Transforming adenomas into cancer occurs throughout several years due to abnormal cellular mutation .

Colorectal Cancer : Signs & Symptoms

• Change in Bowel Habits (Constipation or Diarrhea)
• Blood in the Stool (Melena or Hematochezia)
• Abdominal Discomfort (Cramp and Pain)
• Lumbar Pain (Lower Back Pain)
• Anemia/ Persistent Bloating/ Unexpected Weight Loss / Fatigue
• Nausea and Vomiting

Colorectal Cancer : Etiology

• Predisposing factors: Age, Ethnicity, Family History
• Precipitating Factors: Sedentary Lifestyle, Tobacco use, Diet (Processed, Grilled Meat), Inflammatory Bowel Disease

Colorectal Cancer : Medical Management

• 5-Fluorouracil: specific to the S phase of the cell cycle during cell division
• Capecitabine: inhibits synthesis, RNA prcoessiong, and protein synthesis.
• Irinotecan: binds topoisomerase which creates breaks that inhibt the re-ligation of breaking protein strands
• Diagnostic exam: Colonoscopy, Right Hemicolectomy, Carcinoembryonic Antigen

Colorectal Cancer: Surgical Management

• Surgical options include Right Hemicolectomy, Local and Endoscopic mucosal resection, Polypectomy, Colectomy (Partial or Total).

Colorectal Cancer: Nursing Management

• Acute Pain and Risk for bleeding are side effects of acute related tumor invasiton
• Imbalanced Nutrition can be related to impaired gastrointestinal function by weight-loss or Fatigue
• Fatigue related to cancer managemnt may lead to exhaustion and difficulty eating
• Risk for Infection as result if neutropenia

CA - Seminar in Nursing