Cellular Aberration: Oncology Nursing

• The module focuses on cellular aberration in the context of client care related to oxygenation and flu.

Introduction to Cellular Aberration

• Cancer comprises various diseases with differing causes, manifestations, treatments, and prognoses.
• The disease initiates when a cell undergoes transformation due to genetic mutations in its DNA.
• Oncology Nursing addresses the varied and complex needs of cancer nursing.

Overview of Cellular Aberration

• Cells reproduce, react to stimuli, and can move via mechanisms like amoeboid motion or cilia.
• Cellular activities include protein synthesis, energy production, maintaining a stable internal environment, and ingestion/assimilation of external materials.
• Cancer cells can dedifferentiate, losing specialized structural and functional capabilities.
• Aging cells shrink, experience slower protein synthesis, Golgi complexes break down, and immune cell function decreases despite their increased numbers.

Normal Cell Characteristics

• Age: Epithelial cells renew in 1-2 days, red blood cells last 120 days, and nerve cells can last 100 years.
• Normal cells exhibit cell division and apoptosis, maintain proper morphology and function, adhere tightly, are non-migratory, grow in a regulated manner, and are euploid.

Cellular Division

• Interphase: Cell grows, conducts normal functions, and prepares for division.
• Prophase: Chromosomes condense, and spindle fibers emerge.
• Metaphase: Chromosomes align at the cell's center
• Anaphase: Sister chromatids separate and migrate to opposite poles.
• Telophase: Nuclear envelopes reform around the separated chromosome sets.

Cell Cycle Phases

• G0: Cells rest or remain quiescent, not actively dividing
• G1: RNA and protein synthesis occurs.
• S: DNA synthesis occurs.
• G2: The premitotic phase involves the completion of DNA synthesis and the formation of the mitotic spindle.
• M: Mitosis occurs, chromosomes separate, and cell division takes place.

Cellular Adaptation Examples

• Hypertrophy (increase in cell size)
• Atrophy (decrease in cell size)
• Metaplasia (change in cell type)
• Dysplasia (abnormal cell development)
• Cancer is new tissue growth from abnormal cells with the ability to invade and destroy other tissues; derived from the latin word which means crablike.

Mitotic Division

• Normal cells maintain a balance between new cell growth and old cell death.
• Cancer cells experience uncontrolled cell growth or lose the ability to undergo programmed cell death.

Growth Patterns

• Growth rate in normal cells is equal to the rate of cell death.
• Cancer cells display uncontrolled growth.
• Cancer cells have numerous dividing cells, large and variable nuclei, small cytoplasmic volume relative to nuclei, and variation in cell size and shape.
• Cancer cells lose specialized features (are undifferentiated), have disorganized arrangement and display a poorly defined tumor boundary.
• Normal cells can regenerate, with replacement cells derived from progenitor or undifferentiated stem cells.
• Cancer cells cannot undergo normal cell proliferation or differentiation.
• Changes in cancer cell function include altered contact inhibition, loss of cohesiveness/adhesion, impaired cell-to-cell communication, altered tissue antigens, and enzymes that promote invasion/metastasis.

Major Causes of Cell Injury

• Hypoxia (lack of oxygen)
• Toxins
• Microbes (direct viral or indirect effects)
• Inflammation and immune reactions
• Genetic or metabolic disturbances.

Cancer Facts

• Occurrences worldwide and in the Philippines

Definitions

• Carcinogens agents that initiate or promote malignant transformation.
• Complete Carcinogens are agents that both initiates and promotes cancer development
• Carcinogenesis the multi-step malignant transformation including initiation, promotion, and progression
• Neoplasia is cancerous cells with uncontrolled cell growth without physiological demand.
• A Neoplasm is the abnormal growth of cells or tissue, either benign or malignant.
• A Tumor is an uncontrollable cell mass, which can be cancerous or noncancerous.
• Oncology is the field or study of cancer.

Etiology of Cancer

• Ecologic Factors, including host factors (age, gender, genetics, immune function, viruses), agents (physical/chemical), and environmental factors (work environments, socio-economic class, pollutants.
• Occupational factors like exposure to asbestos, silica, arsenic, radiation, diesel exhaust, etc.
• Predisposing Factors - genetic, radiation, chemical exposure, familial history, immune system dysfunction, and lifestyle practices.
• Industrial Carcinogens - asbestos, naphthylamine, nickel, arsenic, vinyl chloride
• Chemical Agents - tar, crude oil, asphalt, paraffin, hydrocarbons, azo dyes, smoke, and air pollution

Cancer Nomenclature by Tissue Type

• Melanoma: Derived from plasma cells produced by B-cell lymphocytes.
• Lymphoma: Arises from lymphocytes, categorized into Hodgkin and Non-Hodgkin types.
• Leukemia: Originates in hematopoietic cells in bone marrow.
• Carcinoma: originates from the epithelial tissue
• Sarcoma: originates from the mesenchymal tissue.

Stages of Cancer Cell Growth

• Initiation: DNA mutations caused by carcinogens, which may be reversed or lead to apoptosis.
• Promotion: Repeated exposure to promoting agents that causes initiated cells to proliferate with amplified abnormal genetic info.
• Progression: Altered cells show increasingly malignant behavior.
• Metastasis: Cancer cells spread from the primary tumor to distant sites.

Phases of Cancer Invasion

• Invasion
• Spread
• Establishment and Growth

Characteristics of Malignant Cells

• Rapid cell division and growth due to loss of mitosis regulation.
• No contact Inhibition results in invasion of cells into surrounding tissue.
• Loss of Differentiation where cells lose specialized function for simpler type
• Metastasis is the ability of cancer cells to move to distant areas and cause a lesion.
• Cell structure: differences are evident between normal and malignant cells regarding cell membrane, cytoplasm or cell shape

Cancer Cell Adaptations

• Self Survival: Develops ectopic sites to produce need hormones; Develops connective tissue to support growth and its own blood supply.

Cancer Cell Proliferation

• Cell Proliferation can cause Pressure, Obstruction and Pain
• Cancer cell can also cause: effusions, ulceration in necrosis, vascular thrombosis, embolisms, thrombophlebitis

Signs and Symptoms of Cancer

• Paraneoplastic Syndrome caused by enzymes and hormones like Anemia, Hypercalcemia and DIC
• Digestive Tract, Endocrine, Neurologic and Skin Syndromes
• Polymyositis and Hypertrophic osteoarthropathy
• Anorexia-Cachexia Syndrome

Warning Signs of Cancer (CAUTION)

• Change in bowel or bladder habits
• A sore that does not heal
• Unusual bleeding or discharge
• Thickening or lump in the breast or elsewhere
• Indigestion or difficulty in swallowing
• Obvious change in a wart or mole
• Nagging cough or hoarseness
• Sudden weight loss

Tumor Staging and Grading

• Cancer Staging describes tumor size, invasion, lymph node involvement and metastasis
• Primary tumor (T), Regional lymph nodes (N), Distant metastasis (M)
• Grading classifies tumor cells.

Cancer Stages

• Stage 0 Cancer is still in a site without any spreading
• Stage 1 Cancer is small without any spreading
• Stage 2 Cancer is large, without any spreading
• Stage 3 Cancer is Larger and has spread to tissues and lymph nodes
• Stage 4 - Cancer has spead outside of where it started

Cancer Grades

• Grade 1 - Cancer cells that resemble normal cells and are not rapidly growing
• Grade 2 - Cancer cells that don't look like normal cells and growing faster than normal cells
• Grade 3 - Cancer cells that look abnormal and grow more aggressively

Diagnostics

• Tissue Sampling
• Imaging techniques
• Laboratory Studies
• Complete Blood Count, assessing Neutrophils, Eosinophils, Basophils, Lymphocytes, Leukocytes, RBC, Hemoglobin, Hematocrit, and Platelet counts.
• Liver Function Tests (LFT)- levels of AST, ALT, ALP, Bilirubin

Liver Function Tests (LFTs)

• AST (aspartate amino transferase) is an enzyme of the liver, heart, muscles. HIgh levels indicate liver damage
• ALT (alanine aminotransferase) is a liver enzyme. Increased levels suggest liver diseee like cirrhosis
• ALP (alkaline phosphatase) is found in the liver, bones, and bile ducts. Elevated levels indicate liver disease
• Bilirubin - a yellow pigment made by the breakdown of red blood cells. High bilirubin is liver and bile ducts.

Tumor Markers

• Cancer Screening and MOnitoring like AFP (alpha-fetoprotein <10 ng/dL), CEA (Carcino Embryonic Antigen <5 ng/mL), CA 125 (Cancer Antigen <35 U/mL)
• Monitoring ovarian cancer
• Prostate-Specific Antigen (PSA <4.0 ng/mL increased in prostate cancer
• PAP (Prostate Acid Phosphate) used in detecting advanced prostate cancer

Hormones

• Human Growth Hormone- Somatitropin (0.4-10 ng/mL) Stimulates growth and cell regeneration. Excess could cause gigantism while deficiency leads to dwarfism
• Human Chorionic Gonadotropin Hormone- (Non-Pregnant; <5mIU/mL) Used as a tumor in the testicles.

Blood Cell Production Procedures

• Erythropoietin (5-36 MU/mU)
• Stimulate the red blood cell production in the one marrow.

Diagnostic Procedures

• Fecal Occult Blood (Test)- screening for Colorectal cancer
• Bone Marrow Aspiration used to diagnose leukemia.
• Barium Swallow - used to evaluate the esophagus tract
• Barium Enema - visualizes the colon and rectum
• Upper G.I Series - fluoroscopic X-ray of Duodeum
• Breast Self Examination - Self checks
• Mammography - used to capture breast tissue of cancer and abnormalities
  • Surveillance Mammography
  • Normal localization

Medical Treatment and Cancer Therapy

• Chemotherapy uses cytotoxic drugs to kill rapidly dividing cancer cells. Doxorubicin, Cisplantin, Fluoruracil (5-FU) , Methotrexate,
• Radiotherapy uses high-energy Radiation to damage cancer cells
• Biotherapy echnances the body as the immune
• Local Incision
• Wide Incisio
• Radical Excision
• Salvage Surgery
• Electrosurgery and Cripsurgery
• Chemosurgery - uses one layer at a time
• Stereotactic Radiosurgery Purpose:
• Prophylactic Surgery - Prevent Cancer From Reoccurring by removing tissues.
• Prophylactic Mastectomy used to prevent breast cancer.
• Oophorectomy
• Colectomy
• Curative Surgey
• Lobectomy - used to remove Stage Lng Cancer.
• Radical Mastectomy- For localized Prstate Cancer.
• Palliative Surgery - relieve system and pain such as a cutting nerves for pain
• Reconstructive Surgery used to regain appearance and function
• Neurologic Toxicity damage to the systems
• Tumor Lysis Syndrome and Cyclophosphamide

Prechemotheraphy Assessment

• Counsellig
• Patient information

Classes of Therapeutic Agents

• Topoisomerage inhibitors
• Plant Alkaloids
• Corticosteroids

Combination Chemotherapy

• Used to more than one chemotheraph
• Solid Tumors Leukemias and Lymphomas
• Medical Errors in Chemotherapy

Route Of Administration

• High drug administration that lower the levels and risk.
• Administered though -Intravesical -Inter Peritoneal -Topical -IntraHepatic -IntraOsseous

Systematic Medications affects whole body. CANCER is FATAL

• Oral Chemotherapy SUBCUTANEOUS AND INTRAMUSCULAR Chemotherapy :
• INTRAVENOUS Chemotherapy - Smallest amount

Complications for Adminstration Techniques

• Considerations - Pharmacology levels
• Degree of Vesicant
• Site type

Intravenous Drug and Sequence

• Exfoliant
• Inflammitant
• Neutral

Biotheraph

• Immunotherapy uses Cytokine
• Interferons Interleukins
• Gene toxicity.

Symptom Management

• CARDIOMYOPATHY
• GASTROINTESTINAL SYSTEM
• EFFECT DIARRHEA
• REANL TUBE