Oncology Concepts PDF

# Oncology Concepts ## Basic Cancer Information - Affects males and females: greatest incidence is prostate, breast, and lung - Affects all ages: 78% diagnosed >55+ years - Presentation varies from severe/acute to chronic - Clinical features - Type - Staging - Molecular characteristics...

# Oncology Concepts ## Basic Cancer Information - Affects males and females: greatest incidence is prostate, breast, and lung - Affects all ages: 78% diagnosed >55+ years - Presentation varies from severe/acute to chronic - Clinical features - Type - Staging - Molecular characteristics *Constellation of diseases involving malignant (unregulated) transformation of cells specific body system* ## Basic Cancer Continued - Cancer is the leading cause of death worldwide: lower rates in developing countries, but higher mortality. Due to health-care infrastructure unable to effectively identify cancer early or provide treatment. - Most common types of cancer globally - Lung - Breast - Colorectal - Stomach - Prostate - Carcinogen exposure varies leading to different cancer disease patterns: internal (DNA destruction, resulting in cellular mutation) or external - Cancers detected early or with slow proliferation rate associated with longer survival, must detect early (lung or pancreatic CA shows no signs until advanced) ## Vocabulary - Carcinogenesis - the initiation and promotion of cancer - Contact inhibition - normal cells stop growing/reproducing when they come into contact with other cells - Apoptosis - normal cell cycle ends with programmed cell death - Anchorage dependence - cells cannot grow and flourish in atypical patterns and environments - Dysplasia - uncontrolled or deranged growth resulting in cells of various size, shape and organization **Begins with carcinogen exposure, triggers gene mutation(s), mutated cells not detected by immune system, proliferate and progress into cancer, lack contact inhibition, do not undergo apoptosis, do not have anchorage dependence, dysplasia seen** ## Other Cancer Terms - Neoplasia - uncontrolled cell proliferation - Anaplasia - when a cell loses expected structure and function - Cancer cells replicate and expand locally into malignant tumors - Metastasis - propensity for tumors to spread (graphic bottom pg 227) ## Cancer Spread Patterns - Many CA spread in predictable patterns - Ex: prostate CA tendency spread by cell-to-cell-transfer, so advanced disease is most likely seen in spread to nearby structures like rectum, pelvic floor, lower spine or hip. - Ex: colorectal CA commonly metastasizes hematogenously, and because blood supply that is closest proximity to colon is portal circulation, the liver is common site of mets ## Risk Factors - Risk factors for cancer - Most common risk factor for cancer is exposure to a carcinogen - Carcinogens alone are unlikely cancers triggers - Influence cancer development - Environmental, hormonal, lifestyle factors; infectious disease; medications; immune status; and nutrition - Advanced age and genetic predisposition ## Cancer Continued - Primary tumor - original site - Secondary tumor - where it metastasized to ## Types and Staging - Solid tumor - arise from specific body organs that erode and evade normal body tissue - Hematological - arise from cells in hemapoietic cell line or from secondary immune organs such as lymph or spleen - Leukemia - blood cells - Lymphoma - lymphatic system - Multiple myeloma - plasma cells and immunoglobulins - Staging - TNM (T = tumor size, N = number of lymph nodes, M = presence of metastasis) ## CA staging continued (continuum I-IV) - Stage I - small tumor without obvious spread to outside organ - Stage II - invasion of tissues or involvement of local lymph nodes - Stage III - large or locally invasive tumors - Stage IV - cancers that have metastasized ## Presentation - CAUTION (C = change in bowel or bladder habits, A = sore that does not heal, U = unusual discharge or bleeding, T = thickening or lump in breast or other part of body, I = indigestion or difficulty swallowing, O = obvious change in wart or mole, N = nagging cough or hoarseness) - Constitutional signs - some providers call vague sx (fatigue, significant unexplained weight loss, fever of unknown etiology, night sweats) - Malignancy specific signs and symptoms - sx related to location of primary CA, location of mets, metabolic changes associated with malignancy and specific pathology of disease ## Prevention - Primary - risk factor modification, immunization, chemoprevention - Secondary - noninvasive screenings, eval family hx/genetics - Tertiary - reducing morbidity and mortality, manage side effects ## Modifying risk of CA - Limit exposure to carcinogens - Immunization = some CA believed to be triggered by viral (HPV) - Chemoprevention = administration of chemo meds in high risk pt - Find and treat early ## Tissues and Bones ## Skin Cancer - 2 groups: basal cell and nonsquamous cell carcinomas - Pathophysiology : main cause is UV rays cause it penetrates deeper and damages cell membrane - Types - actinic keratoses - precancerous lesions - Squamous cell carcinoma - cumulative exposure to UVB rays over extended time - Basal cell carcinomas - arise from basement membrane of epidermis *malignant melanoma is most dangerous- arise from melanocytes in basement membrane* ## Skin Cancer continued - Actinic Keratosis: precancerous but without treatment evolve into squamous cell carcinoma - Skin colored-reddish brown macules, pacules or plaques - Up to 2 cm usually in clusters found on sun exposed skin - Start as scaley plaques that can be exfoliated - Squamous Cell Carcinoma: from epidural squamous cells from prolonged exposure, invade dermis and spread to surrounding tissue – fast mets - Crusted plaques, larger areas can bleed, painful, can come from open wounds, burn scars and areas of chronic inflammation - Sun exposed skin (top of head and lips common areas) - Invades subq tissue and possible to mets via the lymph system - Basal Cell Carcinoma: come from basement membrane, rate to mets but damaging to surrounding tissue d/t large excision for removal - Pearly translucent skin color papules, possible rolled edges - Head, neck, trunk - Not likely to mets, but high reoccurance - Malignant Melanoma: most deadly, rapid mets, good survival if caught early ## Details are more than skin deep ## ABCDE of melanoma | | | | | | |:-----------------|:----------|:--------|:-------------|:---------------| | Symmetrical | Borders are even | One Color | Smaller than ¼ Inch | Ordinary Mole | | Asymmetrical | Borders are uneven | Multiple Colors | Larger than ¼ Inch | Changing in size, shape and color | ## Treatments - Non-melanomas: treatment depends on size and location - Malignant melanomas: removal and bx: if mets 7.5 months life expectancy rate - Complications: cosmetic, also anger, financial, emotional ## Examples of Skin Cancers - Actinic Keratosis - Squamous Cell Carcinoma - Basal Cell Carcinoma ## Examples of skin cancers - **Image of skin cancer** ## Bone cancer and fractures - Ch 53 1168-1171 - Ch 54 1176-1185 ## Bone Cancer - Classifications: benign and malignant - Pathophysiology: primary-small population age 10-30, secondary sites found as mets in older age - Manifestations: pain with activity, unrelieved by rest. Limp, swelling, redness, decrease ROM, fracture, increased Calcium - Complications: if not treated = death Let's look at the Nursing Management as a group! ## Complications of Fractures - Compartment Syndrome: caused by edema or hemorrhage with no room for escape - Neurovascular Compromise: when bone fragments pose threat to blood vessels or nerves surrounding the bone - Venous Thromboemboli (VTE): develop in large vessels d/t immobility, trauma, cardiac disease, long surgery, obesity, smoking, oral contraceptives (fat embolism is rare but occurs after ortho injury or surgery) - Rhabdomyolysis: from crush injury or ischemia- when muscles “die” myoglobin released, travels to kidneys and clogs nephrons leading to kidney injury, flank pain and tea colored urine, CK elevated- fluids to flush or dialysis - Hypovolemia: from blood/fluid loss - Malunion and Nonunion: not properly healed ## Leukemia - Several types: named for type of progenitor or stem cell from which it evolves - Acute or chronic - Either a myeloid or lymphoid stem cell - Blast cells: unknown stimulus mutates, then clones itself producing immature WBC known as leukemic cell (or blast), cycle continues - Bone marrow disorder: cloning process fills bone marrow, subsequently pushing into circulation - Result is leukocytosis: uncontrolled production of WBC ## Leukemia continued - Manifestations: swollen, painful lymph glands, low grade fevers, neutropenia (leukemic WBCs don't mature and do their job, number of mature infection fighting cells -neutrophils- decreases *this condition known as neutropenia*) - Diagnosis: flulike symptoms, fever, fatigue, CBC show increased WBC, anemia and thrombocytopenia, follow up with bone marrow biopsy which tells type and dictates tx - Management: systemic chemo, sometimes radiation, tx goal is remission (bone marrow produces healthy blood cells free of leukemic cells) *remission isn't cure, BMT (bone marrow transplant) is only cure, stem cell transplant - Complications: infection, myelosuppression – neutropenia, anemia, bleeding precautions ## Lymphomas - *increase risk in childhood through early adulthood, then decreases until age 55 where it increases again. Caucasian men in higher economic status, reason unknown* - *1 in 50 chance of developing* - 2 types: Hodgkin's (higher survival rate) vs Non-Hodgkin's - Reed-Sternberg cells: seen in Hodgkin's - specific giant lymphocytes associated with this disorder - cause unknown - Manifestations: PAINLESS swollen lymph node in heck, underarm or groin, low grade fever of unknown origin, unexplained wt loss, drenching night sweats, fatigue - Diagnosis: history and exam, radiological testing (CXR, CT, PET, MRI) - Management: chemo, radiation, surgery (can travel via lymph system into other lymphatic tissue) ## Endocrine System ## Thyroid Cancer *more common in females* - 4 types of thyroid cancer: papillary, follicular, medullary and anaplastic - Manifestations: nodule noted, dx by ultrasound and biopsy - Treatments: radiation or surgery, lifelong hormone or thyroid replacement meds ## Gastrointestinal System ## Read one Teach one GI Cancers - *Intro/etiology: what, who, where* - *Quick A&P: location and function of area* - *Clinical Manifestations: signs, symptoms* - *How to diagnose: tests, screenings* - *Treatment: surgery, radiation, chemo* - *Education: for pt and family* - *References: APA format* - Esophageal • 1297-1302 - Stomach • 1324-1328 - Colorectal • 1355-1364 ## Hepatic and Pancreatic System ## Liver cancer - Risks: >65, male, chronic HepB or C, long hx of ETOH, usually fatal within 6-12 months - Pathophysiology: hepatocellular carcinoma is most prevalent type of live CA, secondary liver CA is often mets from colon CA - Manifestations: often asymptomatic until liver becomes enlarged, abd pain, wt loss, anorexia, weakness, fatigue, jaundice, ascites - Management: poor prognosis d/t being diagnosed late, routine screenings, surgical if mets, transplant is only cure ## Pancreatic cancer: quick with high mortality rate, only 23% survive to 1 yr, 5% at 5 years - Risks: risk increases with age, commonly dx >60, DM, smoking, high fat diet, chronic pancreatitis - Pathophysiology: no reliable screening, s/s vague and similar to million other Gl disorders. Affects more males and more African American than Caucasians. Pancreatic tumor likely to mets to surrounding structures (stomach, duodenum, gallbladder, intestine. Metastatic tumors usually originate in lung, breast, thyroid, kidneys or skin - Manifestations: dull pain in epigastric area and back, jaundice, wt loss - Management: ERCP (combo ultrasound and CT of pancreas), combo radiation and chemo, Whipple procedure in small percentage- potentially curable ## Reproductive Cancers ## BREAST CANCER *vast majority in females* - Epidemiology - As a woman ages the risk of breast cancer increases - Early menarche and late menopause have a 30-50% increase in risk - 5-10% of breast cancers by known genetic mutations - Pathophysiology - Cells of the body grow and divide abnormally and uncontrollably, invade nearby tissue and spread via lymphatic system - Clinical manifestations - Presence of a new mass or lump: typically hard, irrgegular and painless, but can also be soft, round and tender. Sometimes changes in shape or nipple changes (inversion, thickening, drainage) - Management - Diagnostic tests include mammography, ultrasonography, MRI, and biopsy - Laboratory data include a CBC with platelets, liver function tests, and a chest x-ray, biopsy lymph if think spread - Treatment - Surgery, chemotherapy, and radiation - Surgery alternatives - Breast conservation therapy (lumpectomy), or total mastectomy - Treatment for in situ lesions - Lobular carcinoma in situ is not precursor for invasive breast cancer and treatment not recommended - Ductal carcinoma in situ (DCIS) has surgical treatment - Treatment for intermediate-stage and advanced-stage cancers (operable) - Preoperative neoadjuvant chemotherapy - Treatment for locally advanced/inoperable cancers - Neoadjuvant chemotherapy and possible mastectomy - Treatment for local recurrence and systemic metastases - Tumor not initially operable, chemotherapy considered ## OVARIAN _CANCER_ *suspected hormonal influence, hx of breast feeding, pregnancy, oral contraceptive use, and use of progesterone alone as HRT act as protectors* - Epidemiology - 5th most common cancer found in women - 70-75% of cases not discovered until late stages: patients and providers dismiss symptoms - Pathophysiology - Cells grow and divide abnormally and uncontrollably - Cells can invade nearby tissues and spread to other areas through the bloodstream and lymphatic system - Clinical manifestations - Bloating, pelvic or abdominal pain, early satiety or problems with eating, and urinary urgency or frequency - Management - No recommended screening tests - Biochemical marker CA 125 - Surgical management consists of surgical staging and debulking of the tumor - Chemotherapy ## UTERINE _CANCER_ - Epidemiology - Most common gynecological cancer in the U.S. - Occurs in postmenopausal women - Highest incidence between age 55-65, when dx early 88% survival rate - Pathophysiology - Cells grow and divide abnormally and uncontrollably - Cells can invade nearby tissues and spread through the bloodstream and lymphatic system - Clinical manifestations - Post menopausal vaginal bleeding, premenopausal with heavy, irregular bleeding -Management - Diagnosis through biopsy, pelvic ultrasound, surgical dilation and curettage - Surgical removal of the uterus, fallopian tubes, and ovaries - Chemotherapy ## CERVICAL _CANCER_ - Epidemiology - 13th most common cancer in women - Highest incidence in women age 50-79, those who have not had pap in >5 yrs - HPV: nearly 100% are positive for HPV - Pathophysiology - Slow-developing disease - Begins With early cervical dysplasia - Clinical manifestations - No recognizable symptoms: vaginal bleeding most common sx - Most dysplasia is not visible to a trained provider - Management - Almost all cervical cancers are preventable with adequate routine screening - Chemoradiation is routine in women with higher-stage disease after radical surgery ## PROSTATE _CANCER_ - Epidemiology - Cause of 9% of cancer-related deaths of males - Most common cancer in men - Pathophysiology - Slow-growing cancer - May metastasize to lymph nodes And spread to lungs and other organs - May be curable when localized - Clinical manifestations - Trouble urinating or a weak stream of urine - Management - PSA test for detection of early prostate cancer - Treatment - Radiation, cryotherapy, ablative hormone therapy, chemotherapy, and surgery - Radiation is an option to avoid surgery - Treatment (cont’d) - Radiation - Cryotherapy and ablative hormone therapy - Chemotherapy - Surgical management - Radical prostatectomy ## TESTICULAR _CANCER_: can occur at any age, but most common between 15-35 - Epidemiology - Survival rate after treated for testicular cancer is good - Pathophysiology - Localized or metastasized to other locations - Tumors on right side may spread to right side of the lymph nodes - Tumors on left side may spread to back of the abdomen - Clinical manifestations - Painless mass; some pain possible, swelling, or hardness in the scrotum -Management - Physical assessment, ultrasonography, and lab tests - Surgery for seminomas followed by radiation and/or chemotherapy - Nonseminomas grow quickly and not responsive to radiation