Chapter 6: Pathophysiology of Cancer

Cancer Pathophysiology and Causes

• Loss of normal cell regulation
• Abnormal cell growth
• Invasion of surrounding tissue
• Metastasis

Causes of Cancer

• Viruses and bacteria
• Physical agents
• Chemical agents
• Genetics/Family History
• Dietary factors
• Hormones

Cancer Prevention

• No specific information provided

How Cancer Spreads

• No specific information provided

Cancer Diagnosis

• Determine presence of tumor
• Identify metastasis
• Evaluate function of involved body parts/organs
• Obtain tissue sample

Staging and Grading

• Staging: determines size of tumor and extent of disease
• Grading: refers to classification of tumor cells

Management of Cancer

• 3-pronged approach:
  • Surgery
  • Radiation
  • Chemotherapy

Management with Surgery

• Types:
  • Diagnostic
  • Primary Treatment
  • Prophylactic
  • Palliative
• Post-op nursing care:
  • Assess for complications
  • Educate client

Management with Radiation

• External:
  • Delivered by x-ray
  • Site permanently marked
  • Site may become irritated
  • Considerations:
    • Assess for redness, cracking
    • Moisturize skin
    • Avoid skin irritants
    • Use lukewarm water
    • Avoid sun exposure, heat/cold to the site
• Internal:
  • Delivered through implant
  • Placed in OR
  • Temporary or Permanent
  • Precautions:
    • Time, Distance, Shielding
    • Limit contact with high-risk groups

Side Effects of Radiation

• Alopecia: hair loss
• Stomatitis: inflamed oral and GI mucosa
• Xerostomia: excessive dry mouth
• Thrombocytopenia: low platelet count

Thrombocytopenic Precautions

• Skin assessment
• Monitor labs
• Monitor for bleeding
• Avoid invasive procedures
• Patient education

Management with Chemotherapy

• Systemic treatment
• Can be combined with other treatments
• Can be administered by various routes
• Side effects:
  • GI effects: N/V, anorexia, diarrhea, constipation
  • Reproductive system effects: sterility, loss of libido, impotence
  • Myelosuppression: leukopenia, neutropenia, thrombocytopenia, anemia
  • Tumor lysis syndrome

Tumor Lysis Syndrome

• Pathophysiology: malignant tumor cells burst due to chemotherapy
• Treatment: aggressive hydration, sodium bicarbonate IV, kayexelate/patiromer, insulin/dextrose, allopurinol, rasburicase
• Nursing considerations: strict I&O and weights, assessment of electrolyte disturbances

Alternative Treatments

• Targeted therapies
• Immunotherapy
• Stem cell transplants

Graft Versus Host Disease

• Occurs with allogenic or syngeneic transplants
• Clinical manifestations:
  • NVD
  • Mucositis
  • Liver failure
  • Red rash on palms of hands and soles of feet
  • RUQ pain and abdominal pain
• Treatment: immunosuppressive drugs

End of Life Care

• Focus on quality of life, palliation of symptoms, psychosocial and spiritual support, and empathy
• Hospice care: facilitates symptom management, approaches death with dignity, and provides support to families

Cancer-Related Pain

• Associated with cancer
• May be acute or chronic
• Pain assessment review:
  • Every shift, before intervention, and after intervention
  • COLDSPA
• Pain management:
  • Nonpharmacological
  • Pharmacological:
    • Medication form
    • Opioids and non-opioids
    • Various routes and methods

Note: The rest of the text is related to Rheumatic Disorders and Musculoskeletal Disorders, which is a separate topic.### Musculoskeletal Disorders

• Osteoporosis:
  • Risk factors: Figure 41-8, p. 1195
  • Clinical manifestations: Kyphosis, decreased height, low back pain
  • Treatment: Increase Ca and Vitamin D, medications (Alendronate, Calcitonin, Teriparatide), bowel elimination, resistance/impact (weight-bearing) exercises, fracture management

Paget Disease

• Definition: Abnormal bone destruction and regrowth
• Diagnosis: Serum test for ALP
• Clinical manifestations: Usually asymptomatic, skeletal deformities, bowed legs, enlarged skull, pain, warm skin, fractures
• Treatment: Medications (Acetaminophen/NSAIDS, Calcitonin), walking aids, shoe lifts, PT, fracture management

Osteomyelitis

• Definition: Infection of the bone usually caused by staph aureus
• Clinical manifestations: Swelling, redness, warmth, pain, fever, leukocytosis, positive (+) cultures, sepsis
• Treatment: Antibiotics, surgical debridement if needed, relieve pain, immobilize, elevate, analgesics, activity restriction, sterile dressing changes, diet high in protein and vitamin C, prevention is key

Bone Cancers

• Primary: Benign and malignant bone tumors
• Secondary: Metastatic bone disease
• Diagnosis: CT, bone scans, biopsy, MRI
• Clinical manifestations: Swelling, pain, pathologic fractures, hypercalcemia
• Treatment: Surgical removal/amputation, radiation, chemotherapy, palliative care, nursing management: pain relief, safety, monitor for complications

Musculoskeletal Trauma

• Strains, Sprains, and Contusions:
  • Treatment: RICE (Rest, Ice, Compression, Elevation) and monitor neurovascular status
• Joint Dislocation:
  • Definition: Occurs when articular surfaces of bones are no longer in anatomic alignment
  • Clinical manifestations: Acute pain, change in contour of joint, shortening of affected limb, loss of normal mobility
  • Treatment: Immobilize, dislocation reduced, ROM
• Fractures:
  • Definition: Break in continuity of bone
  • Clinical manifestations: Pain, loss of function, deformity, shortening of affected limb, crepitus, swelling/discoloration
  • Treatment: Provide emergency care, immobilize, assess pain, temperature, color, sensation, capillary refill, bone will be reduced (closed or open - ORIF)

Fractures - Nursing Management

• Teaching related to treatment regimen
• Relieve pain
• Improve physical mobility
• Maintain adequate neurovascular function
• Assess the 5 P's
• Monitor for complications: fat embolism, delayed union, malunion, nonunion, sepsis, peripheral nerve damage, hemorrhage, DVT/PE, compartment syndrome