Cancer disorder Adult health

Cancer

• Cancer is the abnormal, unrestricted division of cells, invading and crowding out healthy tissue.
• Cancer is the second leading cause of death in the United States.
• The incidence rate of cancer is higher among African Americans.

Risk Factors for Cancer

• Smoking
• Smokeless tobacco
• E-cigarettes/vaping
• Diet high in fat and low in fiber
• Inadequate nutrition
• Obesity
• Inactivity
• Ultraviolet radiation (sunlight)
• Environmental and chemical carcinogens
• Frequent, heavy consumption of alcohol
• Genetics

Cancer Tumor Types

• Benign Tumors:
  • Slow-growing
  • Localized
  • Encapsulated
  • Well-defined edges
  • Movable
  • Resemble parent tissue
  • Crowd tissue, but don't invade
  • Rarely fatal
• Malignant Tumors (Cancerous):
  • Rapid growth
  • Ability to metastasize
  • Outside of a capsule
  • Irregular shape
  • Immovable when palpated
  • Little resemblance to parent tissue
  • Invade tissue
  • May recur
  • Fatal without treatment

Spread of Cancer

• Diffusion of cancer cells to other body cavities
• Through the blood and lymphatic system

Cancer Types

• Carcinoma: Most common, arising from epithelial tissue, solid form
• Sarcoma: Less common, arising from connective tissues, less solid
  • Connective tissue includes: cartilage, blood, adipose tissue, bone
• Blood Forming Cancers: Leukemias
• Lymphoid Carcinomas: Hodgkin's, Non-Hodgkin's, Multiple Myeloma

Cancer Prevention

• Dietary:
  • Green, deep yellow, and orange vegetables (e.g., cabbage, cauliflower, Brussels sprouts, broccoli)
  • Fresh fruit
  • Onions
  • Whole grains
  • Fiber
• Lifestyle:
  • Regular checkups
  • Reduce stress
  • Regular physical activity
  • Sleep (6-8 hours/night)

Cancer Detection

• Secondary Prevention
  • Self-breast exams (controversial, still encouraged)
  • Clinical breast exams (yearly)
  • Mammograms:
    • Ages 40-44: optional or early for high risk
    • Ages 45-54: annually
    • Ages 55+: annually, may go to every two years depending on risk factors
  • Digital Rectal Exams: to check for prostate cancer (looking for enlargement or abnormalities), annual for men over 50, African American men starting at 45
  • Papsmear:
    • 21-29: every three years
    • 30-65: every five years
    • Over 65 with hysterectomy: not recommended, follow provider instructions
  • Prostate specific antigen (PSA): less than 4 is ideal, men over 50 (or high risk starting at 40-45)
  • Scrotal Self Exam: beginning at puberty, check for enlargement, thickening, pressure, or lumps
  • Skin Self Exam: use ABCDE's to evaluate moles and lesions
  • Colonoscopy: Starting at 45, every 10 years until 75
  • Flexible Sigmoidoscopy: every 5 years
  • Fecal occult blood test: annually

Cancer Classification

• Grade:
  • Grade X: Normal tissue
  • Grade 1: Well differentiated, minimal deviation from parent tissue
  • Grade 2: Moderate differentiation, structural changes
  • Grade 3: Poorly differentiated, extensive structural changes
  • Grade 4: No resemblance to parent tissue
• Stage:
  • Stage 0: In situ, localized
  • Stage 1: Limited to tissues of origin, localized
  • Stage 2: Limited local spread
  • Stage 3: Extensive local and regional spread
  • Stage 4: Metastasis to another site

Cancer Warning Signs (CAUTION + 1)

• C: Change in bowel or bladder habits
• A: A sore that does not heal
• U: Unusual bleeding or discharge
• T: Thickening or lump
• I: Indigestion or difficulty swallowing
• O: Obvious change in a wart or mole
• N: Nagging cough or hoarseness
• W: White patches on the tongue or inside the mouth

ABCDE's of Skin Cancer

• A: Asymmetry
• B: Border uneven
• C: Color (multiple colors)
• D: Diameter (larger than 6mm)
• E: Elevated, changing in size, shape, or color, growing, or new symptoms

Diagnostic and Screening Tests

• Pap smear: Cervical or vaginal scrapes
• Biopsy: Definitive diagnosis of cancer
• Bronchoscopy
• EGD
• Colonoscopy
• Flexible Sigmoidoscopy
• Mammogram
• GI series (Upper GI or barium enema)
• CT scan
• PET Scan: Radioactive tracers injected IV, highlight cancer cells, force fluids afterward
• MRI
• Ultrasound
• Radioisotope studies
• Lab Tests:
  • CA 19-9: rectal/colon cancers
  • CA 125: Elevated in ovarian cancer, pancreatic cancer
  • PSA: Prostate specific antigen, not diagnostic, elevated for other prostate issues, men over 50 (or high risk starting at 40-45)
  • Fecal occult blood: can be high in other conditions
  • Alpha-feta protein (information on page 2031)

Cancer Treatments

• Types of Surgery:
  • Preventative: e.g., double mastectomy for high-risk breast cancer
  • Curative: Complete removal of cancer, e.g., early breast cancer
  • Palliative: Manage pain or symptoms when cancer is not curable
  • Diagnostic: Evaluate changes in the body
• Radiation Therapy:
  • Damages cancer cells, disrupting cell division and function
  • Can be a standalone treatment or used in combination with other therapies
  • Types:
    • External Beam: Ink marks on skin (do not wash), targeted beam to tumor area
    • Sealed Internal Radiation (Brachytherapy): Implant with radioactive source near tumor for days, patient not radioactive
• CHEMOTHERAPY: Use of drugs to kill cancer cells, administered intravenously or orally

Side Effects of Radiation Therapy (and other treatments)

• Radiation Sickness: Nausea, vomiting, diaphoresis
• Stomatitis: Mouth sores (soft foods, cool water rinses, no commercial mouthwash)
• Skin Atrophy: Changes in pigmentation
• Alopecia: Temporary hair loss
• Cystitis: Urinary tract inflammation
• Bone Marrow Depression: Monitor for bleeding, infection, and anemia.
• Pneumonitis: Lung inflammation
• Chronic dermatitis
• (Other specific side effects are detailed in the prior information, these below are just adding those specific parts)*
• Chemo brain: mental fogginess, difficulty concentrating, memory issues
• Leukopenia/Neutropenia: low WBC counts due to chemo, protective isolation
• Thrombocytopenia: low platelet count, risk of bleeding, soft toothbrushes, avoid invasive procedures.
• Anemia: low red blood cells, rest, medication/transfusions
• Tumor Lysis Syndrome: rapid breakdown of malignant cells, medical emergency, lab monitoring, hydration, medication.
• Targeted Therapy (Biotherapy): interfere with cancer cell signaling, prevent growth, examples: interferons, interleukins, TNF, colony stimulating factors.
• Bone Marrow Transplant (Stem Cell Transplant): autologous or allogeneic or syngeneic from donors, marrow harvest (bone/peripheral blood), germ-free environment/reduced infection risk. Recovery risks include rejection symptoms, like rash, nausea, vomiting etc.
• Peripheral Stem Cell Transplant Recovery: recovery process, risks of rejection (especially allogenic), specific symptoms of rejection are detailed in the text

Skin Care During External Beam Radiation

• Keep skin dry. Pat dry; don't rub.
• Avoid lotions, powders, creams, sunlight, heat, cold with precautions
• No soaking in bathtubs according to procedure guidelines.
• Mild shampoo and gentle washing.
• Wear protective clothing when outside.
• High calorie, high protein diet.
• Increase fluids to 3000 mL/day.
• Antiemetics/antidiarrheals as needed.
• Planned exercise with planned rest periods.
• Frequent monitoring for infection.

Sealed Internal Radiation

• Positioning and duration determined by radiologist
• Lead container and long forceps nearby
• Types:
  • Vaginal/Uterine: Head/chest less than 45 degrees, legs straight, strict bed rest, vagina packed, threads attached to a leg, counted every 4 hours
  • Head and Neck: Head of bed elevated, monitor airway, check vomit, alternative communication methods

Unsealed Internal Radiation

• Patient becomes source of radioactivity.
• Disposable utensils, trays, and special waste disposal methods.
• Visitors limited to <10 minutes, no children under 18 or pregnant women.
• Staff in lead aprons and gloves, flush toilets.
• Diet high in protein, calories, vitamins, and minerals.
• Monitor for radiation sickness.
• Minimize staff time in the room.

Radioactive Iodine 131 & Thyroid Cancer

• Targets thyroid gland to destroy tissue.
• Private room with limited visitors.
• Patient confined to room, all items removed/approved by radiation safety officer.
• No pregnant/breastfeeding personnel.
• All linen, clothes in labeled laundry bags.
• No housekeeping services allowed.
• Only nursing staff enters for specific tasks.

Colony Stimulating Factors

• Medications like filgrastim (Neupogen) and pegfilgrastim (Neulasta) increase neutrophil production.
• Administered subcutaneously or intravenously.

Emotional Support & Psychological Considerations

• Extensive emotional support for patients and families
• Anxiety/depression are normal responses
• Therapeutic communication; validate feelings
• Encourage expression of grief
• Focus on the present, avoid dwelling on future
• Acknowledge nonverbal cues

Support and Referrals

• Support groups
• Hospice/rehab/support groups (for terminal patients)
• Encourage return to normal activities at own pace
• Self-help groups

Caring for Cancer Patients: The "Cancer" Pneumonic

C: Comfort A: Alteration in Body Image N: Nutrition C: Chemo E: Evaluation of Med Responses R: Respite for Caregivers R: Radiation

Study Resources

• Review ATI Adult Med Surge, cancer chapters.