Oncologic Nursing Overview PDF

Oncologic Nursing Oncology: Overview TUMOR – NEOPLASM Benign Malignant = CANCER Theories 1. Cellular differentiation theory 2. Failure of the immune response theory  Cellular differentiation theory – Benign Growth Patterns Hypertrophy – inc in the size of the cells Hyperplas...

Oncologic Nursing Oncology: Overview TUMOR – NEOPLASM Benign Malignant = CANCER Theories 1. Cellular differentiation theory 2. Failure of the immune response theory  Cellular differentiation theory – Benign Growth Patterns Hypertrophy – inc in the size of the cells Hyperplasia – inc in the number of cells Metaplasia – a change of one cell type to another cell type Normal fontanelle (cartilage (chondrocytes) 🡪 bone (osteocyte) Dysplasia – abnormal changes in the cells - Precursor of cancer Anaplasia – loss of cellular organization Benign and Malignant Tumor Characteristics Benign Malignant Differentiation Well differentiated, structure Some lack of differentiation maybe typical of tissue of with anaplasia, structure is origin often atypical Rate of growth Usually progressive and slow, Erratic and may be slow to may come to standstill or rapid, mitotic figure maybe regress, mitotic figures are numerous and abnormal rare and normal Local invasion Usually cohesive and Locally invasive infiltrating expansile, well demarcated surrounding normal tissues, masses that do not invade or sometime maybe seemingly infiltrate surrounding tissues cohesive and expansile Metastasis Absent Present Failure of the immune response theory – Kaposi’s sarcoma in HIV – AIDS patients Tumor terminology – Suffix : -OMA Classification of human tumors Tumor type Cell tissue of origin Benign Tumors Malignant tumors Mesenchymal cells Fibroblast Fibroma Fibrosarcoma Fat cells Lipoma Liposarcoma Bone cells Osteoma Osteosarcoma Epithelial tumors Squamous epithelium Epithelioma Squamous cell carcinoma Glandular or ductal Adenoma Adenocarcinoma epithelium Internal organs Liver cell Liver cell adenoma Liver cell carcinoma Germ cell tumors Embryonic cells Teratoma Embryonal carcinoma Carcinogenesis – Initiation – exposure to initiating agents (carcinogens) – Promotion – carcinogens cause unregulated accelerated growth in previously initiated cells: reversible – Progression – tumor cells acquire malignant characteristics Acquired (environmental) NORMAL CELL DNA damaging agents Successful DNA repair Chemicals DNA damage Radiation viruses Failure of DNA repair Inherited mutations in: Genes affecting DNA repair Genes affecting cell growth and Mutation in the genome of apoptosis somatic cells Activation of growth Inactivation of tumor Alterations in genes that promoting oncogenes suppressor genes regulate apoptosis Unregulated cell proliferation Decreased apoptosis Clonal expansion Angiogenesis Escape from immunity Additional mutation Tumor progression Malignant neoplasm Invasion and metastasis – Secondary cancer Primary cancer Characteristic of cancer cells – Altered cell differentiation Characteristics of cancer cells – Appearance changes – Cancer cells vary in size and shape (Pleomorphism) – Abnormal nuclei or multiple nuclei – Abnormal number of chromosomes (Aneuploidy)) – Abnormal chromosome arrangement – The more undifferentiated, the more aggressive malignant cells Characteristics of cancer cells – Altered metabolism – Production of surface enzymes that aid in invasion and metastasis – Higher rate of anaerobic glycolysis – Production of abnormal growth factor – Inappropriately secrete hormone or hormone like substance resulting in paraneoplastic syndrome Characteristic of cancer cells – Tumor specific antigens(antigen – protein that stimulate Ab formation) – Proteins marking the cancer cells as “non – self ” Characteristics of cancer cells – Altered Cellular function – Normal control mechanisms fail to stop proliferation of cancer cells – Loss of contact inhibition – Cancer cells are less genetically stable -> increasing malignant mutations – METASTASIS – hallmark of cancer Tumor Growth – Cell cycle Go or Resting phase – cells perform all functions other than proliferation, non dividing cells are not considered to be in the cell cycle Tumor growth – Cell – cycle time : the amount of time required for a cell to move from one mitosis to another. The sum of M,G1, S and G2. – The length of Go phase is the major factor in determining the cell cycle time Tumor Growth – Doubling time: the length of time it takes for a tumor to double its volume. – Average doubling time for solid tumor is 2 months. Vary in different types of tumor – A tumor is clinically undetectable until it has doubled 30 times and contained 1 billion cells, at this point is approximately 1 cm in size and equals 1 gram in weight Tumor growth – Growth fraction: the ratio of the total number of cells to the number of dividing cells. Tumor with large growth factors increase their tumor volume more quickly. As tumor volume increases, growth factor decreases as a result of hypoxia, decreased nutrient availability and toxins Carcinogenic Factors – Heredity – Hormonal factors – Bacteria and parasites – Oncogenic viruses – Immune system deficiency – Environmental factors – Chemicals – Radiation Route of spread – Lymphatics – Blood vessels – hematogenous spread – Direct seeding – invasion of surrounding Most common cancer in the Philippines – According to World Health Organization (WHO), cancer accounts for nearly 10 million deaths or nearly one in six deaths in 2020. – The most common cancers are breast, lung, colon and rectum, and prostate cancers. Around one-third of deaths from cancer are due to tobacco use, high body mass index, alcohol consumption, low fruit and vegetable intake, and lack of physical activity. – In the Philippines, there are 141, 021 total cancer cases with 86,337 total cancer-related deaths in 2018. Among the top 10 most common cancers are breast, cervix uteri, colorectum, Corpus Uteri, leukemia, liver, lung, ovary, prostate, and thyroid cancer. Breast cancer has the highest incidence at 17.6% and lung cancer has the highest mortality rate at 17.9%. (February 2023)  USA _ National Cancer Institute 2023 Cancer Type Estimated New Cases Estimated Deaths Bladder 82,290 16,710 Breast (Female – Male) 297,790 – 2,800 43,170 – 530 Colon and Rectal (Combined) 153,020 52,550 Endometrial 66,200 13,030 Kidney (Renal Cell and Renal 81,800 14,890 Pelvis) Leukemia (All Types) 59,610 23,710 Liver and Intrahepatic Bile Duct 41,210 29,380 Lung (Including Bronchus) 238,340 127,070 Melanoma 97,610 7,990 Non-Hodgkin Lymphoma 80,550 20,180 Pancreatic 64,050 50,550 Prostate 288,300 34,700 Thyroid 43,720 2,120 Levels of Care – Primary level of care – prevention/ promotion – Secondary level of care – screening, diagnosis and treatment – Tertiary level of care - palliative Prevention, Screening and Detection – Identify risk factors Prevention, Screening and Detection – Warning signs of cancer – C – changes in bladder/bowel habits – A – a sore that does not heal – U – unusual bleeding or discharge – T – thickening or lump in the breast or elsewhere – I – indigestion & difficulty of swallowing – O – obvious changes in warts and moles – N – nagging cough and hoarseness – U – unexplained anemia – S – severe wt loss Prevention, Screening and Detection – Lung Cancer – 40 y/o – annual CXR – Breast cancer – BSE (Breast self exam) after menses – clinical breast exam every 3 years (