Adult Health Cancer PDF

CANCER  Abnormal, unrestricted cell division that invades and crowds out healthy tissue  Nondiscriminatory  2nd leading cause of death in U.S.  Higher incidence among African Americans DEFINITION  Smoking and smokeless tobacco, e-cigarettes  Diet high in fat and low in fiber...

CANCER  Abnormal, unrestricted cell division that invades and crowds out healthy tissue  Nondiscriminatory  2nd leading cause of death in U.S.  Higher incidence among African Americans DEFINITION  Smoking and smokeless tobacco, e-cigarettes  Diet high in fat and low in fiber and inadequate nutrients  Obesity and inactivity  Ultraviolent radiation  Environmental and chemical carcinogens  Frequent heavy consumption of alcohol  Genetics RISK FACTORS/CARCINOGENS  Malignant  Benign  Usually rapid growth  Slow growth  Metastasizes  Localized  Outside capsule  Encapsulated  Irregular, more  Smooth, well-defined immovable edges, movable  Little resemblance to  Resembles parent tissue parent tissue  Crowds tissue  Invades tissue  Rarely reoccurs after  May recur removal  Fatal without treatment  Rarely fatal COMPARISON OF NEOPLASMS  Diffusion to other body cavities  Circulation vis blood or lymphatic system THE SPREAD OF CANCER METASTASIS  Carcinoma  Most common type  Arises out of epithelial tissue—solid form  Sarcoma  Solid form—arises out of connective tissue  Less common  Blood forming—leukemias  Lymphoid—Hodgkin’s; non-Hodgkin’s; multiple myeloma FORMS OF CANCER  Dietary  Lifestyle modifications PRIMARY PREVENTION  SBE  Clinical breast exam  Mammograms  Digital rectal exams  Pap Smear  Stop smoking  Prostate exam and/or PSA  Self skin examination SECONDARY PREVENTION  Grade  Stage ◦ GX—normal tissue  Stage 0: Cancer in situ ◦ G1—well-differentiated;  Stage 1: Tumor limited minimal deviation to tissues of origin; ◦ G2—Mod. Differentiated; localized structural changes  Stage 2: Limited local ◦ G3—poorly differentiated; spread extensive structural  Stage 3: Extensive local changes and regional spread ◦ G4—no resemblance to  Stage 4: Metastasis parent tissue CLASSIFICATION OF MALIGNANCIES  C– a 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 in swallowing  O– obvious change in wart or mole  N– nagging cough or hoarseness  White patches on tongue or inside mouth WARNING SIGNS OF CANCER  Pap smear  Biopsy  Bronchoscopy  EGD/colonoscopy/flexible sigmoidoscopy  Mammograms  GI series—UGI, BE  CT scans  PET Scan DIAGNOSTIC/SCREENING TESTS  MRI  Ultrasounds  Radioisotope studies  Lab  CEA—found in rectal/colon cancer  CA-125—elevated in ovarian cancer  PSA/acid phosphatase—prostate  CA-19-9 for pancreatic or hepatobiliary cancer  Occult blood test DIAGNOSTIC/SCREENING TESTS  Often primary  May be preventative, curative, palliative, or diagnostic  Laser, cryosurgery newest surgical techniques TREATMENT--SURGERY  Damages DNA and disrupts cell division and function of mainly cancer cells and occasionally normal cells around that site.  Can be a stand alone treatment or used as an adjunct therapy TREATMENT--RADIATION  External Beam  Patient not radioactive  Ink marks the sites—do not wash away  Sites not to be irradiated are shielded with lead  Side effects  Radiation sickness—NV, diaphoresis  Stomatitis, skin atrophy, changes in pigmentation  Alopecia, chronic dermatitis  Cystitis  Bone marrow depression  Pneumonitis TREATMENT—RADIATION-- TYPES  External Radiation  Nursing interventions  Bathe only according to procedure guidelines  No ointments, lotions, etc. on treated area  Avoid extreme heat or cold  Wear protective clothing  Hi-calorie; hi-protein diet  Increase fluids to 3000 ml/day  Antiemetics and antidiarrheals as indicated  Planned exercise with rest periods  Monitor for infection TREATMENT—RADIATION-- TYPES  Sealed Internal Radiation  Implants in close proximity to cancer for several days  Implant is main source of radioactivity  Types  Vaginal/uterus—head and chest low 45 degrees  Do not bathe below waist or change linens if possible  TED hose  ROM  VS q 4  I&O  Rash  Catheter placed  Encourage dietary intake; 3000 mL fluid  Check applicator q 4 hours  Health care providers wear lead apron and lead gloves  Wear dosimeter film badge to monitor exposure TREATMENT—RADIATION-- TYPES  Unsealed Internal Radiation  Patient is source of radioactivity  Radioactive isotope is given orally or by IV  Nursing interventions  Disposable utensils/trays  Visitor limits  Distance, time, shielding  Gloves when handling body fluids  Diversional activities  Flush toilet several times TREATMENT—RADIATION-- TYPES  Uses  Cure  Control  Or palliate  Act systemically  Affects malignant and healthy cells—especially those of GI system.  Chemo Brain TREATMENT—CHEMOTHERAPY  Can cause leukopenia  If neutrophils < 500 need reverse isolation or protective precautions  Stomatitis – white plaques, lesions, ulcers  Soft toothbrush  Skin - rashes  TCDB  Thrombocytopenia  Alopecia  NVD  Assess for s/s infection  T >100.4, chills  Neutropenia  condition characterized by abnormally low blood levels of infection-fighting neutrophils, a specific kind of white blood cell. Neutropenia increases the risk of bacterial and fungal infections. The most common reason that cancer patients experience neutropenia is as a side effect of chemotherapy.  Some s/s: Fever, sore throat, cough, redness, swelling, etc  Treatment: colony stimulating factors (SQ or IV)  Filgrastim, lenograstim, pegfilgrastim  Nursing interventions  Prevent infection, promote nutrition, prevent skin breakdown, promote hygiene, promote oral hygiene CANCER  Hemoglobin levels below 10 are considered anemia  Plenty of rest is required  Plan activities with lots of rest  Epoetin alfa (Epogen, Procrit)  May require packed RBCs ANEMIA WITH CHEMOTHERAPY  Oncologic emergency with rapid lysis of malignant cells  Result of chemotherapy usually but can be with radiation  24 hours to 7 days after treatment  Causes  Hyperkalemia  Hyperphosphatemia  Hyperuricemia  Secondary  Hypocalcemia  Causes increased risk for renal failure and cardiac issues.  Manifestation include: N/V, anorexia, diarrhea, muscle weakness, cramping.  Late s/s tetany, paresthesia, seizures, anuria, cardiac arrest. TUMOR LYSIS SYNDROME  Nursing Interventions  24-48 hours prior to treatment have the client begin hydrating  Allopurinol before and during chemo to keep urine alkaline  Discuss medications containing phosphorus, potassium with provider  Monitor lab TUMOR LYSIS SYNDROME  Uses immunotherapy, human growth factors, and biologic response modifiers  Types  Interferons—can exert antitumor effect by activating a variety of responses.  Interleukins—help coordinate the inflammatory and immune responses of the body, particularly the lymphocyte.  Tumor Necrosis factor—produced by WBC; kills tumor by necrosis without harming healthy cells  Colony stimulating factors—hematopoietic factors that stimulate the growth of young blood cells in marrow—G-CSF—granulocytes; Epoeitin—RBCs, filgrastim TREATMENT—TARGETED THERAPY/BIOTHERAPY  Uses  Cancers of blood-forming and lymphatic tissues and advance or resistant solid tumors  Replacing diseased or damaged bone marrow  Types  Autologous—patient’s own marrow  Allogenic—compatible tissue from donor or sibling  Syngeneic—identical twins  Related  Unrelated TREATMENT—BONE MARROW TRANSPLANT  Pre-transplant treatment  Chemo and/or radiation  Germ free environment  Infusion of stem cells via central line; can take up to 4 hours  Recovery is shorter with peripheral transplant  May experience rejection (allogenic sources only)—skin rash and peeling, NVD, liver dysfunction, photophobia, dry/burning eyes TREATMENT—BONE MARROW TRANSPLANTATION  Know patient’s understanding  Anxiety and depression very common  May see illness as punishment  May react with anger  Goes through stages of grieving  Encourage expression of feelings/emotions  Support groups  Stress progress and events of the day rather than referring to the future optimistically  Be aware of nonverbal communication EMOTIONAL SUPPORT  Want to return to as normal activities as possible as soon as possible  Encourage independence as long as possible  Refer to and encourage participation in self- help groups REHAB  Review ATI AMS cancer chapters