Cellular Aberrations: Types of Cancers (PDF)

NRG 301 – CARE FOR CLIENTS WITH HEALTH PROBLEMS CELLULAR ABERRATION – Types of Cancers, Breast, Cervical, 1stSemester | S.Y. 2023-2024 Transcribe by: Stanley Galaura (BS NURSING – 13F)...

NRG 301 – CARE FOR CLIENTS WITH HEALTH PROBLEMS CELLULAR ABERRATION – Types of Cancers, Breast, Cervical, 1stSemester | S.Y. 2023-2024 Transcribe by: Stanley Galaura (BS NURSING – 13F) LECTURER: Ma’am Miranda, R. Reference: Ma’am Miranda’s Video Lecture, Brunner & Suddarth Medical Surgical Nursing Disclaimer: No copyright Infringement Intended; this is for educational FORMS OF BREAST CANCER purposes only. Made by Stanley G. (Personal property & Usage). Carcinoma in-situ or DCIS (ductal carcinoma in-situ) – no spread, early-stage abnormal cells are in the lining of the CARCINOMA OF THE BREAST breast. Most common non-skin malignancy in women o Non-invasive, and may progress to invasive if not Gender – most important rx. Factor along with genetics Tx. o 1% occur in men LCIS (lobular carcinoma in-situ) – cancer cells in the Incident ↑ throughout woman lifetime lobules, has not yet spread. o Peak – 75-80 years o Not true cancer, indicative of ↑Rx. o Declines slightly after o Needs monitoring Women reach menarche younger than 11 y/o – 20%↑rx. o Conduct preventive measures to arrest o Menarche – start of menstruation progression o Early menstruation > exposed to more hormones Invasive ductal carcinoma– there is already invasion of (especially estrogen). nearby tissues, in milk ducts Late menopause - ↑rx. o Most common type of Ca. both breast Full term pregnancy at age 20 or younger – Half the Rx. o Surgery, radiation, chemo as Tx. Of nulliparous women or women over 35 at their first birth Invasive lobular carcinoma – may not form a distinct o Early pregnancy > brought changes to the lump, hard to detect since no lumps breast tissue > less susceptible to Ca. o Surgery, radiation, chemo as Tx. o Hormonal changes in pregnancy/breastfeeding Medullary carcinoma – distinct appearance in the > has protective feature against Ca. microscope, less aggressive. can be detected with lump Other rx. Factors – 1st degree relatives w/ breast Ca, o Surgery and additional Tx (chemo and atypical hyperplasia, race/ethnicity, estrogen exposure, radiation) breast density, radiation exposure Mucinous (colloid) carcinoma – cancer cells are floating o Estrogen exposure (pills or early menstruation) – in mucin Slow growing Rx. Factor, estrogen plays a role in breast cancer o Mucin – slimy substance o Breast density – larger breast, higher rx. Of breast o Better prognosis Ca. o Surgery and additional Tx. o Radiation exposure – radiation Tx. during Tubular carcinoma – cancer cells resemble small tubes in adolescents > higher Rx. Also the microscope o Diet – caffeine ↓ Rx., moderate to heavy o Tend to have good prognosis consumption of alcohol ↑Rx. o Surgery and additional Tx. as necessary ▪ Caffeine has protective effect on breast Invasive papillary carcinoma – finger-like progression of tissue the cancer cells. ▪ Alcohol is abrasive, any type of cancer o Relatively rare o Obesity – fat tissues produce estrogens, ↑level o Chemo, surgery, radiation as Tx. depends on size of estrogen, increases Rx. Of Ca. Attributed also and grade of tumor. to chronic inflammation Metaplastic carcinoma – rare and less common. o Exercise – more exercise, maintains body o Rare and less common weight, regulates hormones, estrogen is o Bad prognosis likelihood of recurrence maintained. Supports overall well-being. o Combination Tx. – surgery, radiation, chemo o Breastfeeding – longer breastfeed, greater ↓Rx., Major prognostic factors – likely predicts the prognosis of regulates hormones. the course of disease, guides health workers on how to o Environmental toxins – certain chemicals and choose Tx. pollutants damages DNA of the cells o Invasive carcinoma vs. In-situ disease – o Tobacco – not a major rx., not main contributor, ▪ Invasive - There is already invasion, more but still a chemical, might be a Rx. Factor serious, there is spread and invasion. Bad outlook and prognosis ▪ In-situ – early stages, ↑chance of cure. Page 1 of 8 Cancer – Breast, Cervical , Endometrial, Leiomyosarcoma, Ovarian, Choriocarcinoma, Prostate, Esophagus, Stomach, Liver o Distant metastases – metastases, goes beyond o Removes cancerous area + surrounding margin the breast, there is already traveling of cancer, of normal tissue bad prognosis. ▪ 2nd incision may be made – removal of o Lymph node metastases – spread in lymph lymph nodes nodes, lymph notes are systemic, poor o Aim – maintain normal breast appearance prognosis. likelihood of recurrence when surgery is over. ▪ Systemic in nature, can be Tx w/ o 5–8-week radiation after procedure – Tx. chemotherapy. remaining breast tissue o Tumor size – indicates how advance the cancer o Contraindication for lumpectomy: is. Indicates the extent of the surgery. Also ▪ Previous radiation therapy to the determines what type of Tx. applicable. big tumor = bad prognosis affected breast – radiation may affect o Locally advanced disease – there is already how the tissue heals; healing may be spread to nearby tissues, not in distant organs. difficult. ▪ ↑chance of recurrence ▪ 2 or more areas of cancer in same ▪ Needs aggressive Tx. breast, too far apart to be removed o Inflammatory carcinoma – aggressive form of through one incision. breast Ca, breasts look swollen and red ▪ Cancer not completely removed during ▪ Nature is aggressive lumpectomy. ▪ Tx. requires combination poor prognosis SIGNS & SYMPTOMS (+) Lump – painless, could be detected with monthly SBE and in clinical examination Nipple inversion – nipple goes inward, changes in position depicts underlying condition, needs to be checked Breast discharge – unusual, unexplained, bloody (+) Peau d’orange – orange-peel-like, there are pores, caused by the swelling of the lymphatic channels of the Partial/Segmental Mastectomy or quadrantectomy – breast lymphatic obstruction removal of larger section yet still o (+) inflammation spares a significant amount of breast tissue. possible 1 quadrant of the breast o Preserved breast still o Chosen if tumor is larger than the lump o Radiation after procedure 6 to 8 weeks Total mastectomy – entire breast removal, not surrounding lymph nodes. all 4 quadrant of the breast o Consider when there is a sig. Rx. Of recurrence. DIAGNOSTICS muscles are not involved in the removal Mammography – X-ray that is specific to the breast simple mastectomy Ultrasound – usage of soundwaves to create images Modified radical mastectomy – MRI – possible, provides detailed images removal of entire breast, and some Biopsy – varying biopsy, removal of small tissue samples of the lymph nodes under the arm to be examined in the microscope. Knowing if there is Ca (axillary). chest muscle is not included cells in the sample. cancer type o Done when cancer is Treatment – surgery, chemotherapy, radiotherapy spread on nearby lymph nodes TREATMENT AND MANAGEMENT o Prevents spread of cancer Lumpectomy – removal of lump, suitable for small tumors, to the lymphatics there is still preservation of the breast. o Breast-conserving therapy BS NURSING - Stanley G. Page 2 of 8 Cancer – Breast, Cervical , Endometrial, Leiomyosarcoma, Ovarian, Choriocarcinoma, Prostate, Esophagus, Stomach, Liver Subtypes of cervical cancers: o Squamous cell carcinoma – most common histologic subtype ▪ 80% of cases ▪ Present In thin flat cell ▪ HSIL as immediate precursor o Cervical adenocarcinoma - 2nd most common type (15%) ▪ Originates in granular cells in cervix o Adenosquamous carcinoma – 5% ▪ More rare ▪ ↑age - ↑at Rx. Radical mastectomy – extensive surgery, removes entire o Peak incidence for invasive cervical carcinoma breast, underlying lymph nodes, and surrounding tissues – 45 yrs. o Standard Tx. in the past, now not common. chest muscle is included NURSING INTERVENTIONS ✓ Monitor for adverse – radiation, chemo, fatigue, sore throat, dry cough, nausea, anorexia ✓ Monitor for adverse – chemo, BMW depression, nausea, vomiting, alopecia, weight gain or weight loss, fatigue, stomatitis, anxiety, and depression ✓ Realize Dx. Of breast Ca, - devastating emotional shock ✓ Provide psych support throughout Dx. And Tx. process ✓ Involve pt. in planning and Tx. ✓ Describe surgical procedure to alleviate fear ✓ Prepare pt. for effects of chemo – alopecia, fatigue ✓ Administer antiemetics prophylactically, as directed, for pt. receiving chemo. ✓ Administer IV fluids and hyperalimentation as indicated. ✓ Help Pt. identify and use support persons or family or Risk factors (Host and Viral): community. o Multiple sex partners - ↑ Rx. Of HPV (major ✓ Suggest Pt. psych interventions – anxiety, depression, contributor) sexual problems o Male partner w/ multiple previous/current sex ✓ Teach women recommended cancer-screening partners - ↑Rx. Of HPV procedures. o Young age at first sex - ↑Rx., most exposed to HPV CERVICAL CARCINOMA o ↑ Parity – multiple pregnancies, pregnancies Cancer originates in the lower part of uterus, the cervix. affect changes in the cervix, develops changes o Usually presented to pre-cancerous changes. in cervix CIN – cervical intraepithelial neoplasia, a precancerous HPV 16o Persistent Infx. w/ ↑oncogenic Rx. HPV – HPV lesion. Classified according to degree of dysplasia. and 18 has tendency to change the cells in the cervix o Immunosuppression – unable to fight HPV infx. CIN 1 Low grade dysplasia o Certain HLA subtypes – genetic factors, LSIL or low grade squamous intraepithelial lesion leukocyte antigen has something to do with the CIN II Both high grade dysplasia immune response against HPV. and HSIL – high grade squamous intraepithelial o Use of Oral contraceptive pills – when using it for CIN III lesion too long > hormonal changes > contribute to cervical cell abnormalities CIN associated w/ productive HPV Infx. (Esp. HPV 16) o Nicotine use – smoking > weakens immunity > o HPV common reproductive Infx. HPV infx. o HPV linked to cervical cancer Most LSILS regress spontaneously w/ only a small percentage progressing to HSIL. LSIL doesn’t progress directly to invasive carcinoma. BS NURSING - Stanley G. Page 3 of 8 Cancer – Breast, Cervical , Endometrial, Leiomyosarcoma, Ovarian, Choriocarcinoma, Prostate, Esophagus, Stomach, Liver DIAGNOSTICS + SCREENING + PREVENTION TREATMENT AND MANAGEMENT Pap smear – screening, cell collection in cervix, lithotomy No screenings available position, speculum insertion until cervix found, swab the May be asymptomatic for certain period of time – cervix, sent to the lab (specimen). esp. in early stage. Cervical biopsy – can be done after pap smear, biopsy Irregular/ post-menopausal bleeding w/ excessive gets tissue sample. Detailed. leukorrhea – no bleedings in menopause, unusual o Cold cone biopsy – large area of tissue around bleeding. cervix is excised, cone shaped tissue diagnosing o Leukorrhea – abnormal vaginal discharge, o Punch biopsy – punched, like a puncher, small not normal. portion. initial assessment Uterine enlargement may be absent in early stage o Loop electrosurgical excision procedure (LEEP) – Dx is established w/ biopsy or curettage and wire loop to get tissue. both diagnostic and therapeutic/ histologic exam of the tissue local anesthesia HPV vaxx – vaxx against HPV, a preventive measure. o Definitive diagnostic Surgical removal – removal of the affected tissue o Curettage – scraping to get samples Adjunctive radiotherapy and chemotherapy – targeting Prognosis depends on stage and type to eliminate cancer cells to prevent them from spreading Treatment o Surgical removal (TAHBSO) w/ removal of TREATMENT AND MANAGEMENT tissue suspected of being involved alone or Early invasive cancer – cone biopsy in combination w/ radiotherapy. Highly invasive cancers – hysterectomy w/ lymph node o TAHBSO total abdominal hysterectomy dissection bilateral salpingo-oophorectomy – removal o Hysterectomy – removal of uterus along with of entire uterus, ovaries, fallopian, and lymph nodes, to check if there is potential cervix. spread Prognosis – depends on stage at w/c cancer has been detected. ENDOMETRIAL CARCINOMA Most common invasive cancer of female genital tract o 7% of all invasive cancer in women o Uncommon in women younger than 40 o Peak – 55-65 y/o. post menaposal women Age and variations of occurrence – due to the hormonal changes. o Cancer often develops due to prolonged exposure to endometrial lining o No balance effect of progesterone > Ca. o Endometrium – lining of uterus. Risk factors: o Age - ↑ increases, ↑ Rx. Especially after menopause, due to hormonal imbalance, LEIOMYOSARCOMA decline in progesterone (the balancer of Arises in smooth muscle cells, seen in uterus (uterine estrogen). leiomyosarcoma, common), in GI, in blood vessels o Unopposed estrogen – lining thickens Uncommon malignant neoplasm o Endometrial atrophy – lack of healthy lining Origin – de novo (develop from scratch) from o Obesity + thin physiques – contributes to myometrium or endometrial stromal precursor cells hormonal imbalance Equal common before and after menopause o HTN – associations with metabolic and hormonal Peak incidence – before and after menopause (40- changes. hypertension 60 years) o Diabetes - ↑ rx. Of adenocarcinoma, esp. Striking tendency to recur after removal uncontrolled blood sugar level. Insulin resistance o More than half eventually to metastasize > obesity > hormonal imbalance > ↑estrogen/ through bloodstream to distant organs no progesterone to balance. (lungs, bone, brain) uterine bleeding 5-year survival rate – 40% BS NURSING - Stanley G. Page 4 of 8 Cancer – Breast, Cervical , Endometrial, Leiomyosarcoma, Ovarian, Choriocarcinoma, Prostate, Esophagus, Stomach, Liver o Imaging studies (MRI) – check for metastatic osteoblastic carcinoma to the vertebrae. PROSTATE SPECIFIC ANTIGEN 40-49 years 2.5 ng/ml 50-59 years 3.5 ng/ml 60-69 years 4.5 ng/ml 70-79 6.5 ng/ml OVARIAN CARCINOMAS PSA levels – varies with age For test to be valid – at least 3 PSA measurements Originates in the ovaries over period of 1.5 to 2 years. o Accounts 3% of all Ca in females 80% of ovarian tumors are benign Mostly occur in young women (20-45 y/o.) TREATMENT AND MANAGEMENT Borderline tumors – occur slightly older age Surgery – radical prostatectomy – removal of entire Malignant tumors – common in older women prostate, suitable if cancer is confined inside the prostate. o Curative Antibiotic prophylaxis – quinolones and covers anaerobic bacteria (during biopsy). o Prevent infx. during biopsy Radiation – brachytherapy o Internal radiation, place radioactive seeds placed on tissues o Usage of radioactive pallets/seeds and the perineal template Cryotherapy – freezing to destroy CHORIOCARCINOMA Chemotherapy – drugs to kill Ca cells Very rare, very aggressive, occurs in the cell of the Hormonal therapy – for beyond systemic, systemic, placenta. blocks hormones > prevents growth of prostate. Develops in pregnancy, and in pregnancy without the Post-op effects of surgery fetus o Rx. Of anesthesia o Post-op bleeding PROSTATE CARCINOMA o Impotence– sildenafil (Viagra) tablets, Arises in the prostate alprostadil (caverject) injections into penis, Most common form of cancer in men devices such as penile prosthesis o 29% of cancer in US o Incontinence - o Over 50 y/o. Uncommon in Asia PENILE CARCINOMA Rx factors: CIS (carcinoma in-situ) – bowel disease and o Genetics Bowenoid papulosis o Diet – fatty foods, rich in lycopene suspected of o Bowenoid papulosis – pigmented, reddish preventing or delaying development. papules, red bumps. o Lifestyle (still not clear) o Has potential to transform into cancer DRE – digital rectal exam, as definitive diagnostics. Androgens – important hormone, important role in development. Most men underwent TURP – incidental finding of focal Ca, don’t progress when followed up after 10 years Older men – typically followed up Diagnostics: o PSA levels - ↑than cut-off > presence of cancer ▪ Cut off point – 4ng/ml o Transrectal needle biopsy BS NURSING - Stanley G. Page 5 of 8 Cancer – Breast, Cervical , Endometrial, Leiomyosarcoma, Ovarian, Choriocarcinoma, Prostate, Esophagus, Stomach, Liver Strong association w/ HPV infx. (HPV 16) o Hemorrhage and sepsis – tumor ulceration Bown disease – occurs in genital region (both men o First Sx. – aspiration of food via TEF. and women), usually over age 35 Adenocarcinoma o Men – occur in skin of shaft of penis o Arises in background of Barrett esophagus and o Solitary, thickened, gray-white, opaque long-standing GERD plaque o Other Rx. Factors – tobacco use, obesity, prior o Transforms into infiltrating squamous cell radiation therapy, diet poor in fresh fruits and carcinoma (10% of patients). vegies Bowenoid papulosis – presence of multiple rather o Some H pylori serotypes – associated with than solitary reddish-brown papules. decreased, causing gastric atrophy, reducing o Sexually active young adults acid reflux. Invasive carcinoma o Occasionally discovered in GERD evaluation or o Circumcision – shedding foreskin, reduced surveillance of Barret esophagus rx. o Pain and dysphagia, wt. loss, hematemesis, o HPV 16 and HPV 18 – most common chest pain, vomit o Cigarette smoking – elevates rx. o Sx. appear → tumor usually spread to o Found in pt. between 40-70 submucosal lymphatic vessels o Diagnosis time → already in advance stage ESOPHAGUS o Overall, 5 yr survival – less than 5% Squamous cell carcinoma – squamous since it lines the esophagus More common worldwide Rx. Factors: o Alcohol – ethanol > metabolize into acetaldehyde (a carcinogen) > damages esophageal tissues o Tobacco use – damages cell lining o Poverty – limited access to resource o Caustic esophageal injury – ingestion of Early stages of esophageal cancer is often treated corrosive substances > damage to esophageal with surgery tissues > Increase Rx. Of Cancer Combination of chemotherapy and radiotherapy is o Achalasia – impaired motility in the esophagus given prior to surgery to optimize the benefit of > stagnation of food and fluids > lining is surgical therapy exposed, esp. when food contents is o chemotherapy is usually given at the same carcinogenic time as radiation therapy o Plummer-vinson syndrome – rear, triad Sx Most common chemotherapy used for this purpose (dysphagia, iron deficiency anemia, upper is a combination of cisplatin and flurouracil (5-FU) esophageal webs) Surgery for esophageal cancer involves removal of o Frequent drink of very hot beverages – injury of the part of esophagus that is involved with cancer esophagus and joining the uninvolved part with stomach. Other rx. Factors: o Lymph nodes in the area are also removed. o Nutritional deficiencies – deficiency > Cancer is in the upper part of the esophagus the compromises esophagus tissue > tissue not stomach may be pulled up to the chest to healthy > carcinogenic exposure/susceptible compensate for the loss of length in the esophagus. o Polycyclic hydrocarbons Cancer is in the lower part of the esophagus; surgeon o Nitrosamines can remove lower part of the esophagus and upper o Other mutagenic compounds (fungus on part of the stomach and join the two ends together. contaminated foods, HPV) Surgery may cure some of the patients with Manifestations esophageal cancer, however in many patients the o Insidious onset cancer may come back after the surgery. o Dysphagia, odynophagia (painful swelling), Surgery not an option treatment: obstruction o High position of the esophageal cancer o Diet from solid to liquid foods due to obstruction o Poor general condition of the patient o Extreme wt. loss and debilitation – due to obstruction BS NURSING - Stanley G. Page 6 of 8 Cancer – Breast, Cervical , Endometrial, Leiomyosarcoma, Ovarian, Choriocarcinoma, Prostate, Esophagus, Stomach, Liver ▪ Patients are generally treated with o Complete blood count (CBC) test used to a combination of chemotherapy measure the concentration of white blood cells, and radiation red blood cells, and platelets. o Several chemotherapy drugs that are active o Upper GI series, or barium swallow, the patient in esophageal cancer. These include drinks a thick, chalky liquid (barium) that coats fluorouracil (5- FU), cisplatin, mitomycin, the esophagus and stomach and makes it easier bleomycin, doxorubicin, methotrexate, to detect abnormal areas on x-ray. paclitaxel, vinorelbine, topotecan, and ▪ Double-contrast barium swallow, air is irinotecan blown into the esophagus and stomach ▪ Most commonly used drugs are to help the liquid coat the wall of the cisplatin and flurouracil. organs more thoroughly Palliative Tx. o PDT o Stent placement o Pain control ADENOCARCINOMA IN STOMACH Most common malignancy of the stomach o over 90% of all gastric cancers Incidence varies markedly with geography o 20-fold higher in Japan, Chile, Costa Rica, and Eastern Europe compared to North America, Northern Europe, Africa and Southeast Asia Factors that decrease risk: intake of green, leafy GASTROINTESTINAL STROMAL TUMOR (GIST) vegetables, and citrus fruits GIST most common mesenchymal tumor of the Factors that increase risk: N-nitroso compounds and abdomen smoking used for food preservation o More than half occur in the stomach Other rx. Factors: o Slightly more common in males o Age and gender are risk factors and the disease o Peak age of diagnosis in the stomach is is more common in men over the age of 55 approximately 60 years o Medical conditions that increase the risk for the Fewer than 10% occurring in individuals 40 years of disease- pernicious anemia (vitamin B-12 age deficiency), chronic inflammation of the Sx at presentation – may be r/t mass effects stomach (atrophic gastritis), and intestinal Mucosal ulceration can cause blood loss polyps (noncancerous growths) Discovered through - incidental finding during o Genetic (hereditary) risk factors - hereditary radiologic imaging, endoscopy, or abdominal nonpolyposis colon cancer (HNPCC) syndrome surgery performed for other reasons and LiFraumeni syndrome (conditions that result GIST of the small intestine is more aggressive than in a predisposition to cancer), and a family those arising in the stomach history of gastrointestinal cancer. Treatment and management o People with type A blood also have an o Surgery increased risk for stomach cancer. o Chemo Signs and symptoms: o Radiation o Abdominal discomfort or pain o Supportive care o Blood in stool o Bloating (especially after eating) o Diarrhea or constipation o Fatigue Diagnostics: o Fecal occult blood test is used to detect microscopic blood in the stool, which may indicate stomach or other gastrointestinal (GI) cancers (e.g., colorectal cancer). BS NURSING - Stanley G. Page 7 of 8 Cancer – Breast, Cervical , Endometrial, Leiomyosarcoma, Ovarian, Choriocarcinoma, Prostate, Esophagus, Stomach, Liver HEPATOCELLULAR CARCINOMA (HCC) About 82% occur in developing countries with high rates of chronic HBV infection, such as in southeast Asia and African countries Male:Female = 2.4:1 Other Rx. Factors: o drugs, chemicals and medications o Aflatoxin B1 – from the fungus Aspergillus flavus o Hemochromatosis o Cirrhosis Signs and symptoms: o (+) ill-defined upper abdominal pain o Malaise o Fatigue o Weight loss o Sometimes, awareness of abdominal mass or abdominal fullness o Enlarged liver can be felt by palpation o Jaundice o Fever o GIT or esophageal variceal bleeding Laboratory and diagnostics: o Elevated serum alpha-fetoprotein (50%) o CEA o Glypican-3 tissue staining o Imaging studies o Biopsy Treatment and Management: o Chemotherapy o Radiation therapy o Resection o Liver transplantation o Supportive care: ▪ Analgesics as needed ▪ Measure abdominal girth (ascites), ▪ intake and output ▪ weight (edema) ▪ watch out for bleeding ▪ dietary restrictions ▪ meticulous skin care ▪ neurologic assessment ▪ psychosocial care BS NURSING - Stanley G. Page 8 of 8