Seizures and Cancer Therapy

Cancer Objectives and Readings

• The learner needs to be able to demonstrate critical learning elements related to cancer.

Critical Learning Elements:

• Cancer pathophysiology and classification
• Cancer preventative practices
• Care of the patient with cancer
• Specific Neoplasms: Breast, Lung, Prostate and Colorectal Cancer

Required Readings:

• The text includes a table of required readings for the content listed.
• The text book is by Tyerman(2023)

Genetic Changes Contributing to Cancer:

• Proto-oncogenes are involved in normal cell growth and division.
• When altered, proto-oncogenes can become cancer-causing genes, allowing cells to grow and survive inappropriately
• Tumor suppressor genes control cell growth and division.
• Alterations in tumor suppressor genes may allow cells to divide uncontrollably.
• DNA repair genes fix damaged DNA; mutations in these genes can lead to additional mutations, increasing cancer risk

Categories of Cancers:

• Carcinomas: Most common type, formed by epithelial cells covering body surfaces.
• They originate inside and outside surfaces of the body
• Adenocarcinomas: Form in epithelial cells that produce fluids or mucus.
• Many breast, colon, and prostate cancers are adenocarcinomas.
• Basal Cell Carcinoma: Cancer that begins in the lower or basal layer of the epidermis, the outer layer of the skin.
• Squamous Cell Carcinoma: Forms in squamous cells beneath the skin's surface, lining organs.
• Cells look flat, like fish scales under a microscope, and can be called epidermoid carcinomas.
• Transitional Cell Carcinoma: Forms in transitional epithelium/urothelium, found in bladder, ureters, kidneys.
• Soft Tissue Sarcomas: Forms in soft tissues like muscle, tendons, fat, blood vessels and tissues around joints.
• Sarcomas are cancers that from in bone an soft tissues, including, muscle, fat, blood vessels, lymph, vessels, and fibrous tissue (such as tendons and ligaments)
• Osteosarcoma: Is the most common cancer of bone.
• Common soft tissue sarcoma types include leiomyosarcoma, Kaposi sarcoma, malignant fibrous histiocytoma, liposarcoma, and dermatofibrosarcoma protuberans.
• Leukemia: Cancers start in blood-forming tissue of bone marrow without forming solid tumors.

Leukemia:

• Large abnormal numbers of WBC crowd out normal blood cells in the blood and bone marrow.
• Low levels of normal blood cells can hinder oxygen transport, bleeding control, and infection fighting.
• Leukemia is prevalent in adults over 55 and children under 15.
• Leukemia can be acute (fast-growing) or chronic (slow-growing). Treatment and prognosis depend on the affected blood cell type and whether it is acute or chronic.

What is Cancer?:

• Uncontrolled cell growth (proliferation), affecting all ages, sexes, and ethnic groups, incidence increasing with age.
• Cells die and new cells develop, but sometimes a cancer cell develops in division and continues to develop creating a tumor.
• If a cell does not die and it cannot repair itself, then it will survive, mutate, and multiply.
• Cancer DNA indicates cancer.
• Stem cells target cancer.
• 'N' cells differentiate into cells as body needs . If 'abN' then DNA is altered .

Definitions

• Hyperplasia: Increased cell division rate, resulting in more cells than die.
• Metaplasia: Cells appear normal but are not of the type usually found in a tissue or area, occurring in the wrong place
• Dysplasia: Abnormal changes in multiplying cells (shape, size, appearance) that can be a precursor to malignancy.

Development of Cancer

• Initiation: Mutation of cell DNA during replication, triggered by carcinogen exposure, with genetic markers present.
• Promotion: Altered cells replicate and continue to mutate; preventable stage.
• Progression: Tumor growth and movement when it becomes too large for its space.

Cancer Risk Factors

• Modifiable: Factors that can be Try and mitigate exposure to these risk factors.
• Genetics: Inherited cancer syndrome with genetic markers affecting multiple generations as a Non-Modifiable factor.
• Additional Non-Modifiable factors include age and biological sex.

Development of Cancer and Risk Factors

• Chemical carcinogens and immune suppressants contribute to cancer development.
• Cyclophosphamides (chemo, immune suppressant), nitrogen mustards (chemotherapy),and toxic chemicals are also contributing to cancer development.

Radiation, Viral/Bacterial Infections in Cancer Development:

• Ionizing radiation (e.g., uranium exposure) and UV radiation (sunlight) can alter cells, increasing cancer risk.
• Viral/Bacterial factors: Epstein-Barr, HIV, Hepatitis B/C, HPV (hemopapaloinion virus) are all contributing factors to cancer.

Genetics, Oncogenes, Tumor Suppressor Genes and DNA Repair Genes:

• Oncogenes promote cell division; when mutated, division can become abnormal.
• Tumor suppressor genes suppress cell division; when mutated, they fail to suppress division.
• DNA repair genes fix DNA mutations; when mutated, they cannot repair DNA.

Genetics- Gene mutation

• Genetics- Gene mutation EX, women with BRCA1 and BRCA2 gene mutations have up to an 85% chance of developing breast cancer in their lifetime
• Inherited Genes or inherited lifestyle Cancers that are not caused by a inherited genetic mutation can sometimes appear to run in families.

Immune System and Cancer Role:

• Distinguishes normal from abnormal cells, recognizing and destroying foreign entities.
• In cancer, cells arise from the body's own cells
• Cytotoxic T-cells slow tumor growth.
• Natural killer cells lyse cancer cells.
• Macrophages respond to and destroy tumor markers.
• B-lymphocytes create antibodies.

Tumor Markers

• Tumor cells produce antigens or markers that appear.
• They can be be found in blood, urine, tumor tissue, or other tissues
• They can be utilized as a diagnostic tool to indicate cancer.
• They can also be used as a baseline marker as well as a tool to monitor treatment response, and a sign of recurrence.
• Some examples are CA 125 for ovarian cancer, PSA for prostate cancer, and AFP for testicular cancer .

Cancer and Immune System Evasion:

• Suppress T cells
• Immune system develops a tolerance to the bad neighbors- basically lets it do its thing
• Block recognition by the T-cells- Immune system no longer recognizes anything.
• Escape the immune surveillance

Cancer Signs and Symptoms:

• Symptoms can be due to other occurrences in a a persons life
• Fatigue, bowel or bladder habit changes, persistent indigestion or discomfort
• Lump or thickening, cough or trouble breathing, muscle or joint pain
• Weight changes, difficulty swallowing, fevers or night sweats.
• Skin changes, hoarseness, unexplained bleeding or bruising

Cancer Diagnosis:

• Diagnose cancer utilizing these methods.
• Lab Tests: Cytology, Hematology, Chemistry, Tumor markers.
• Diagnostic Tests: Scope (gastroscopy, sigmoidoscopy, colonoscopy, etc), CT/MRI, mammogram, radio-isotope scans, genetic markers, and bone marrow biopsy
• Biopsy types include needle, incisional (punch, tissue sample, skin lesion), and excisional (removal of tumors)

Cancer Classification Systems and Biopsy

• Biopsies help with grading and classification of cancer.
• Classification system (grading is how a cell looks) According to the WHO classification:
• Grade I: low proliferative potential & able to cure with surgical resection
• Grade II: usually have diffuse infiltrative and low proliferative potential, but with a probability of low recurrence rate, some of them have risk of progression to high grade
• Grade III: mostly known as anaplastic tumors and have malign histologic features, with a high recurrence rate, frequently needing chemotheraphy and radiotherapy
• Grade IV: obviously malign tumors, which are necrotic and have capability of fast recurrence, most of them show diffuse spreading in CNS

Cancer Biopsy

• How abnormal cells look under a microscope
• How quickly the tumor is likely to progress
• Definitive diagnostic test
• helps with staging (how much and where)

Biopsies and Stages

• Biopsies help with staging (how much and where)
• Stage 0: Cancer in situ
• Stage 1: Tumor is limited to the tissue of origin and is characterized by localized tumor growth
• Stage 2: Limited local spread
• Stage 3: Extensive local and regional spread
• Stage 4: Metastasis and / or Lumbar puncture

Nurses Role at Time of Diagnosis:

• Remember patients need for support and communication
• Be prepared to re-answer people over and over again, due to pts only hearing they have Cancer
• DO: Communication, Support and Listening
• Do Not: Say "everything will be okay”, be impatient or rush through your teaching session
• Be sure to tell the patient the reality of their condition.

Naming Cancer and Metastasis:

• Naming cancer the prefix is the tissue/area of the cancer
• Carcinoma= ectoderm and endoderm
• Sarcoma= connective tissue
• Lymphoma and leukemia= blood
• Metastasis is the same name as primary cancer site EX, breast cancer that spreads to the lung and forms a metastatic tumor

Components of Metastasis

• Components of Metastasis include, Invasion, Transportation and Metastatic growth

TNM System and Grading

• TNM system can be used T- extent of the Tumor (size/number/location) N- extent of the spread of lymph nodes M- presence of metastases
• What happens after we know the stage and grade?

Cancer Treatment Options and Types:

• Depends on types, where it is and where is has spread
• Surgery
• -First: Diagnose staging & grading
• Remove tumor and some surrounding healthy tissue to cure cancer
• Surgery is ineffective is metastasis, and requires follow up with radiation
• Examples include, Mastectomy (cure), Lumpectomy (diagnose), Resection (cure)& Debulking (palliative)
• Radiation- Shrink tumor, kill cancer cells in a localized area, killer tumor cells/limits N cell damage.
• Low dose radiation clears cells and stops them from growing
• Radiation was discovered by accident releasing free radicals to damages the cells and free radicals damage DNA
• It uses high-energy radiation to shrink tumors and kill cancer cells via X-rays/gamma rays/charged particles

Radiation and Chemotherapy

• Radiation therapy side effects can depend on the location of cancer and may include Digestive discomfort, fatigue, poor appetite and skin changes
• Chemo success depends on Size, type, location, age, stage, grade, resistance
• Chemo was discovered on accident with mustard gas
• And, the goal of it is to reduce the number of cancer cells available for replication making It cell specific / destroying during replication esp fast-growing cells.
• Chemo is Cell non-specific destroying during replication and resting phases or cellular replication causing damage in primary and metastatic sites and to healthy cells.

Chemo and Rapid Growing Cells

• Chemo: Rapid growing cells, it is single cycle combination
• Route: PO, IV ,IM, inter-cavity, Intra-thecal, Intra-arterial, Intra-peritoneal, Intra-ventricular, Intra-vesical &SC

Chemo Complications:

• Effects of decreased Number of cells, Complications from mode of delivery
• Cheoo damages Several blood cells that divide rapidly, leading to low counts of WBC, RBC and Platelets.
• Hair follicles have cells that can be affected by chemo, leading to hair loss, also called alopecia
• Cells lining your stomach can also be affected by chemo.
• Causes vomiting and diarrhea and may be associated with nausea/mucousitits
• Nadir- lowest point of cell counat
• Bone marrow suppression and increased susceptibility to infection (NEUTROPENIA), Gl cells damage (stomatitis, mucousitis), N and V and esophagitis, diarrhea, anorexia, altered taste, integumentary cells damage(alopecia), RBCs damage (anemia), reproductive dysfunction and hepatotoxicity.

Severe Nausea:

• Ondansetron/Also known as zofran/Take before chemotherapy
• Mouth to anus as chemo attacks the fast multiplying cells of the GI tract
• You must have really excellent oral cares to decrease the risk of infection. And you must make sure oral care so that is to rinsing your mouth 5-6 times a day and brushing your teeth with a soft toothbrush.
• Dietary modifications: eat moist or soft foods. Avoid foods that require a lot of chewing. Avoid spicy, salty, acidic, and hot foods
• Pain control- suck on ice chips or ice pops and use pain medications as advised by your doctor.
• Systemic: Chemo/hormones/monoclonal antibodies
• Biotherapy: Stop or slow the growth of cancer cells (slowing down growth = slow down spread)
• Make it easier for your immune system to destroy cancer cells/Keep cancer from spreading to other parts of your body
• , Immunomodulators, interferon, vaccines, monoclonal antibodies

Biologic Therapy and Donor cells

• What is Biologic therapy Immunotherapy: Cytokines, Monoclonal antibodies, Vaccines & Gene therapy
• Targeted Therapy Monoclonal antibodies: Small molecule inhibitors, Differentiation agents
• Donor Cells, Bone marrow:Allogenic /Donor, Autologous
• Peripheral stem cells:chemotherapy first to create Creating the ability to get rid of as many cancer cells as you can and then use this to get rid of the rest.
• Gene therapy: Investigational

Melanoma and CAM

• Melanoma and Brain tumor:Goals is to correct defective gene
• Basically blood is drawn from a melanoma cancer patient and the WBC are isolated. -Then new genes are inserted into the cells, creating T-receptors that which can recognize and destroy the cancer, once they are reinjected into the body.
• Complementary and Alternative Medicine CAM

Complimentary and Alternative Medicine

• Acupuncture
• Ayurverdic Medicine
• Bodywork and Movement Therapy
• Biofeedback
• CBT
• Chiropractic Therapy
• Dietary Medicine
• Energy Medicine
• Guided Imagery
• Herbal Medicine
• Homeopathy
• Hypnosis
• Magnet Therapy
• Massage Therapy
• Meditation
• Naturopathy
• Neural Therapy
• Physical Medicine
• Praywr and Spirituality
• TCM

Use of CAM

• People use CAM therapy to:
• Help cope with the side effects of cancer treatments, such as nausea, pain, and fatigue
• Comfort themselves and ease the worries of cancer treatment and related stress
• Feel that they are doing something to help with their own care
• Try to treat or cure their cancer
• The 3 goals of CAM cure, control & Palliation Hematology: The lab: WBC value will be low the body is a target for infection WBC is destroyed, So think tubes, lines, dressings (if they are red that may be a issue)

Infections

• infection? How long have tubes been in for? fever of 100.5 °F (38 °C) or higher
• chills
• cough or sore throat
• diarrhea
• ear pain, headache or sinus pain, or a stiff or sore neck
• skin rash
• sores or white coating in the mouth or on the tongue
• swelling or redness, especially where a catheter or line enters the body
• urine that is bloody or cloudy, or pain with urination other values to think about is low RBC, and Hgb along with Hematocrit as well Platelets as well along with Neutrophils
• Other elements are highs Urea Creatinine

Assessments to do:

• CNS
• CVS-Shock
• Respiratory
• GI
• Nutrition
• GU
• Infection- neutropenia
• Endocrine- SIADH
• Pain
• Psychosocial

DO and Nursing

• Always think ABC diagnose and treat cancer along with supportive measurements and meds
• And, if treatment doesn't work we need to move to end of life supportive care for the patient
• MAID- need to make this referral no matter your belief. Support patients in their choices.
• NOW how will I know or validate what I did worked?
• Evaluation of Bloodwork
• biopsy
• Ultrasound
• Followup
• How is the patient doing after all this?
• Who is all part of the cancer TEAM for one patient?
• Oncology, Social work, OT ,PT ,Nutrition Clinical psychology Palliative care, Pain clinic, Support groups Pharmacy and MAID

As a nurse what will I teach? Early recognition- what to watch for Immunizations and to Stop smoking along with avoid excessive sun exposure/ sunscreen Eat a healthy diet and to Exercise most days of the week Along with; to Maintain a healthy weight If you choose to drink, also to drink alcohol in moderation Furthermore ; Schedule cancer screening exam and such 10 WARNING SIGNS, are to Report any C- change in bowel or bladder habits , A- a sore that does not heal U- unusual bleeding or discharge from any orifice in the body., T- thickening or a lump in the breast or elsewhere I- indigestion or difficulty in swallowing and any O- obvious change in wart or mole lastly any N- nagging cough or hoarseness

Good nursing diagnoses:

• Anticipatory Grieving
• Altered Nutrition
• Fatigue
• Altered Mucosal Membrane
• Altered family process
• Knowledge Deficit- the more I know the better I will be able to handle things.

Breast, Colon, and other types of Cancer

• Breast cancer
• Screening- mammogram Breast cancer can happen in men but is rare. In men it is usually found near the nipple and is a hard nontender mass, with more frequent involvement of lymph nodes. Colon Cancer
• colo-rectal cancer, Increasing in rates because we are not having enough fiber in our diet and we have a more seditary lifestyle
• Screening for includes
• Sigmoidoscopy/Colonoscopy
• Skin cancer Self-exam: includes examining the body front and back in mirror, the right and left sides, arms raised also to Bend elbows look carefully at forearms, back of upper arms, and palms. . Examine back of neck and scalp with a hand mirror. Part hair and lift. the back and buttocks with a hand mirror REMEMBER A-B-C-D-E
• Prostrate cancer is recommended Starting at age 50 Prostate specific antigen blood test (PSA) Digital rectal exam (DRE) TURP- transurethral resection of the prostate
• Cervical cancer Is a must : Screening PAP test need to be regular

This quiz covers the diagnosis, characteristics, and potential causes of seizures, also systemic cancer therapy. Questions cover altered states during seizure, refractory epilepsy, warning sensations, and diagnostic steps. It also includes cancer treatment using monoclonal antibodies and chemotherapy.