Week 15 - Oncology Nursing PDF

# Week 15 - Oncology Nursing ## Cancer - The origin of the word cancer is accredited to the Greek physician Hippocrates. - Cancer is derived from the Greek word Cancri which means crab or crab-like. - Because cancer is characterized by a finger-like spreading projection into surrounding tissue that...

# Week 15 - Oncology Nursing ## Cancer - The origin of the word cancer is accredited to the Greek physician Hippocrates. - Cancer is derived from the Greek word Cancri which means crab or crab-like. - Because cancer is characterized by a finger-like spreading projection into surrounding tissue that is similar to the shape of a crab. ### Is a complex of diseases which occurs when normal cells mutate into abnormal cells that take over normal tissue, eventually harming and destroying the host. - A large group of diseases characterized by: - Uncontrolled growth and spread of abnormal cells - Proliferation - rapid reproduction by cell division - Metastasis - spread or transfer of cancer cells from one organ to another that is not directly connected. ## Oncology - Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia. ## Characteristics of Neoplasia - Uncontrolled growth of abnormal cells - **Benign** - Well-differentiated - Slow growth - Encapsulated - Non-invasive - Does NOT metastasize - Ex: Fibroid - **Malignant** - Undifferentiated / Anaplasia (Hallmark of neoplasm, meaning may be non-functional cells). - Erratic and Uncontrolled Growth - Expansive and Invasive - Secretes abnormal proteins - this happens when the cancer begins to mutate - METASTASIZES - **Borderline** - Low malignant potential - Difficult to detect clinically - **Growth Patterns** - **Benign** - Hypertrophy - inc in cell size - Hyperplasia - inc in number of cells - Metaplasia - cell type is converted into another cell type. Most common in squamous cells. Squamous cells are soft, so the conversion bec of stimulus and the changes in cells can be reversible. - Dysplasia - abnormal changes in the size, shape, organization of cells and may perceive into tissue becoming cancerous. - **Malignant** - Anaplasia - hallmark if malignant - **Key areas to distinguish if benign or malignant** - **Differentiation** - **Well-differentiated** - similar to the normal cells but not actually the normal cells. - **Undifferentiated** - the new growth is totally different from the normal cells. - **Capsulation** - refers if a cell is enclosed with capsule or not. - **Growth Rate** - is the cell grows fast or uncontrolled? - **Local invasion** - refers if the cell invades a local area or surrounding tissues? - **Metastasis** - if the cell has the capacity to travel distant body organ? ## "ROOT WORDS" - Neo - new - Plasia - growth - Plasm - substance - Trophy - size ## Tumor is named according to: - Parenchyma, Organ or Cell - Hepatoma - liver - Osteoma - bone - Myoma - muscle - Pattern and Structure, either GROSS or MICROSCOPIC - Fluid filled → CYST - Glandular → ADENO - Finger-like → PAPILLO - Stalk → POLYP - Embryonic origin - Ectoderm - Endoderm - Mesoderm ## Benign Tumors - Suffix- "OMA" is used - Adipose tissue - LipOMA - Bone - osteOMA - Muscle - myOMA - Blood vessels - angiOMA - Fibrous tissue - fibroma ## Malignant Tumor - **Named according to embryonic cell origin:** - Ectodermal, Endodermal, Glandular, Epithelial - Use the suffix- "CARCINOMA" - Pancreatic Adenocarcinoma - Squamos cell Carcinoma - **Named according to embryonic cell origin:** - Mesodermal, connective tissue origin - Use the suffix- "SARCOMA" - FibroSarcoma - MyoSarcoma - Angio Sarcoma #"PASAWAY" - hepatOMA, lymphOMA, gliOMA, melanoma ## Three germ layers - Teratoma ## Non-neoplastic but "OMA" - CHoristoma - Hamartoma ## ETIOLOGY OF CANCER - Viruses/Bacteria - Chemical carcinogens - Physical agents - Hormonal factors - Genetic factors - Dietary - Immune disease ## Cells ### The Cell Cycle - **Permanent** - goes out the cell cycle. They do not go mitosis after they reach a point of certain maturity, they are already incapable of regeneration. Ex. Neurons and cardiac muscle. - **Stable** - Px with stroke, rehabilitation but neurons will not go back to normal. Ischemia heart will not go back to normal and causes manifestation of heart damages. quiescent - multiply only when needed. They grow unless traumatized. They spend most of the time in the quiescent phase or dormant phase of the cell cycle but can be stimulated to enter the cell cycle when needed. - **Labile** - Ex. The liver and kidney continuously divides and replace the cells that have a limited life span. Ex. Skin, Endometrium, and blood cells. Skin - when we shower, we scrub some skin off and it just replaces. ## Cell Cycle Time - Amount of time required for a cell to move from one mitosis to another mitosis. ## Doubling Time - is the length of time it takes for a tumor to double its volume. ## The Cell Cycle - **Labile cell** - **Mitosis** - **Permanent cell** - **Go** - **Inter- phase** - **Stable cell** - **The Cell Cycle and the Checkpoints** - 1. Cell Growth Checkpoint - 2. DNA Synthesis Checkpoint - 3. Cell Growth Checkpoint - 4. DNA Synthesis Checkpoint ## Theories - **cellular transformation & derangement theory** - Normal cells may be transformed to cancer cells due to some etiologic agents, and that DNA mutates spontaneously during mitosis or a result to exposure to chemical, viruses, radiation, or other environmental hazards. Specifically other malignant transformation results from a combination of activation of oncogenes or inactivation of tumor suppressor genes. ## 7 Fundamental Changes in Malignancy: 1. **Self-sufficiency in growth signals** - Tumor now can proliferate without external stimuli. In normal cells, they stop at certain point when reaching maturity, the ability to proliferate without external stimuli usually results from oncogene activation where cells has the capability to promote autonomous regulation of cell growth and repair. Many cancer cells develop cell growth sufficiency by acquiring the capability to produce the necessary growth factors to which they respond. 2. **Insensitivity to growth inhibitory signals** - Alterations in the tumor suppressor genes resulting to failure to inhibit tumor cell growth. Key event in many cancers. - **Tumor suppressor genes** - **gate keepers** - Genes that directly control the growth of tumor by inhibiting cell proliferation and or promoting cell death. - **care takers** - Do not directly regulate cell proliferation but control the rate of mutation. Therefore, mutation caretaker genes lead to genetic instability that directly promotes growth and conversion of a normal to neoplastic cell. 3. **Evasion of apoptosis (p53)** 4. **Defects in DNA repair (BRCA1&2)** - DNA of normal cell is susceptible to damage by environmental agents and to alterations resulting to errors that occur spontaneously during DNA replication. Alteration then error in development of cell components. Individuals born with an inherited mutation of DNA repair genes are at a significantly increase risk of developing Cancer. IF DNA repair does not occur frankly, malignant transformation of cell can occur. 5. **Limitless replication potential** - **Lengthening time of telomeres** - **Telomeres** - structures at end of each chromosome, this normally shortens with each cell division. In normal aging process, the function of cells decreases and dies (programmed cell death), in malignancy the telomeres lengthens and replicated. - **Enzyme telomerase** - Prevents the shortening of telomeres and enabling the cells to self-replicate extensively. If telomeres continue to lengthen, it can lead to - unlimited replication of malignant cells and attain immortality. 6. **Sustained angiogenesis (VEGF)** - Formed tumors stimulate the formation of vascular supply, which is essential for continued tumor growth and metastasis. Tumor growth produced angiogenic factors such as: vascular endothelial growth factor (VEGF) to stimulate and sustain BV growth. 7. **Ability to invade and metastasize** - Ability to break loose from the group and go with the blood stream or lymphatic system and produce secondary tumor at distant location. ## What makes them invade and metastasize? - **Tumor-specific antigen on cell membrane (CEA/PSA)** - This tumor specific antigen ang isa sa magandang nakita. Kaya meron tayong tumor markers tayong tinatawag. - Example antigen: carcinoembryonic antigen, Alpha-fetoprotein, prostate specific antigen. - Scenario: You are suspecting that the patient is having prostate cancer. Kukunan natin ng dugo si patient at kapag mataas PSA baka merong cancer. Because PSA is the tumor marker for prostate cancer. - **Less FIBRONECTIN in cell membrane - less cohesive and do not readily adhere to adjacent cells** - Ano ang nagbibigay ng abilidad na kumalat? They have less FIBRONECTIN in their cell membrane which makes them less cohesive or mas less ang pagdirikit and do not readily adhere to adjacent cells. Ganito yan, kapag nagtatayo tayo ng bahay may mga hollow blocks diba? Para magdikit ang hollow blocks need natin semento diba. Etong mga cancer cells na ito para silang hollow blocks na walang semento, kaya onting push mo lang diyan magwawatak watak yan. Kaya kapag ang isang cancer cell mo eh humiwalay yan sa dating kasama niyang cancer cell at lumipat pwesto dahil sa LESS FIBRONECTIN. Kaya mas dadami, mas kakalat, dumagdag na naman lalo ang cancer cells mo, panibagong tumor na naman yan. Sana gets niyo. ## Acquired DNA damaging cells or Inherited GENE mutations - Eto ang patho ng cancer, iisa lang patho ng cancer. Mag-iiba lang yan sa signs and symptoms and the organ involve. - Magsisimula yan sa Acquired DNA damaging cells or Inherited GENE mutations. Etong inherited, yan yung non-modifiable. So, for example, nakita mo dun sa case mo na may history sa pamilya ng cancer, inherited mutation yun. Etong acquired naman yung, maninigarilyo, pagkain ng hotdog, isaw, eto yung modifiable. Kasi machachange mo naman ang lifestyle niyan. - Then if your cells are expose to these 2 problems, it will damage the DNA. Failure of DNA repair, kasi pangit nga ang genes mo. - **3 significant events** - **Activation of growth promoting oncogenes ** - si on switch ito, paparamihin - **Inactivation of tumor suppressor genes** - Which is the off switch, diba kapag na achieve mo na yung number na need mo dapat ma activate na si tumor suppressor genes. In this case, since you have gene mutation or acquired DNA damaging agents, nasira etong TSG, hindi maka "off". - **Alteration in genes regulating Apoptosis** - Yung P53 nasira, so unregulated ang cell proliferation so dami nang dami ang cells. And decrease ang apoptosis. - **Clonal expansion** - or rapid proliferation of cancer cells. - **Angiogenesis**-gagawa na sila sariling blood supply. - **Escape community** - kasi sila ay bingi sa signals na pampatigil. - **Additional mutations**- pagtumagal at di agad naayos. ## Tumor progression - Malignant neoplasm - Invasion and metastasis ## How Cancer Spreads? - **Lymphatic** - Most common route. Drainage system of the body. - **Hematogenous** - Through blood, pumasok sa blood vessel. - **Direct Spread** - Example: Pancreatic cancer, and pinakamalapit is lungs kasi nasa ibabaw lang ni Pancreas yan eh kaya mabilis kumalat din sa lungs mo yung cancer. ## Metastatic Cascade 1. Blood vessel arises from somewhere else supplying the tumor cells. 2. From the primary tumor, cancer cells duplicate rapidly by clonal expansion. 3. Some tumor will break from the original site causing intravasation to the blood stream. 4. WBC will interact with the tumor cells, but because they do not know the tumor cells - agglutination will happen leading to formation of tumor cells Embolus. 5. They will adhere to the side of Blood vessels, from there they will continue to grow and make their own blood supply, another energy, and nutrients. 6. Some tumor in the blood vessel will leave the area again thru Extravasation, causing metastatic deposits causing secondary tumor and angiogenesis. ## General Promotive and Preventive Nursing MNGT 1. **Lifestyle modification** - Stress reduction - Healthy living options 2. **Avoid environmental toxins** 3. **Early detection (screening)** - Decrease cancer morbidity and mortality 4. **Nutritional management** - Manage malnutrition as a side effect - Have foods and drinks that are easy to consume, fill refrigerators with assortment of healthy foods. 5. **Screening** - Detect cancer at an earlier stage - Reduces the chance to die from cancer. ## General Warning Signs of Cancer - **C-change in bowel/bladder habits** - Dati ok yung pag-tae ko bat ngayon hindi? Dati ok yung pag-ihi ko ngayon iba na? - **A-sore that does not heal** - **U-nusual bleeding or discharges** - Pang isang buwan na ang sugat ko bat di pa rin gumagaling? Yung hindi ka pa buntis tas may lumalabas na sa iyong suso hala! 0_0 - **T-hickening or lump in the breast or elsewhere** - **I-ndigestion or difficulty in swallowing** - **Obvious change in warts or moles** - Pag nagbago itsura, kulay, size ng mole mo baka ito ay nagiging cancer - **N-agging cough and hoarseness** - **U-nexplained anemia** - **Sudden weight loss**