Oncology Notes PDF

DR/ Rania Ibrahim El-Gazar Lecturer of MSN Outline: Concepts of oncology Cell division Cancer cell Characteristics of benign and malignant neoplasms Classification of cancer Risk factors Staging and grading of cancer Warning signs of cancer Diagnosis of cancer Management of cancer  Oncology: is t...

DR/ Rania Ibrahim El-Gazar Lecturer of MSN Outline: Concepts of oncology Cell division Cancer cell Characteristics of benign and malignant neoplasms Classification of cancer Risk factors Staging and grading of cancer Warning signs of cancer Diagnosis of cancer Management of cancer  Oncology: is the branch of medicine dealing with tumors. Tumor : It meant any abnormal swelling, lump or mass Benign neoplasm or benign tumor: a tumor (solid neoplasm) that grows slowly, does not invade other tissues and does not form metastases.  What is cancer? -A term for diseases in which abnormal cells divide without control and can invade nearby tissues. -Cancer cells can also spread to other parts of the body through the blood and lymph systems. Dr. Salwa Elbadry  Normal cell division occurs in a pattern of sequential events referred to as “the cell cycle”. Mitosis, the actual growth phase, involves the cytoplasmic and nuclear separation within the cell, which results in two identical daughter cells containing the full complement of genetic information found in the parent cells.  Cells of the gastrointestinal tract, skin, hair follicles and bone marrow are cells that undergo cell division at a rapid rate. Conversely, skeletal muscle cells do not undergo cell division, these cells grow by increasing in their size (hypertrophy). Types of Genes that Cause Cancer: / regulate cell cycle 1.Proto-oncogenes 2. Tumor suppressor genes (p53,BRCA 1,2) 3. DNA repair genes.  These cells proliferate (cancer cell)  invade surrounding tissues  cancer cells infiltrate this tissue  spread to other locations via lymph and blood vessels “metastasis”.  Characteristics of cancer cell 1.Uncontrolled cell proliferation(division) 2.Resistance to apoptosis 3.Inducing angiogenesis 4.Invasion, Metastasis 5.Loss of function  Carcinogenesis (development of cancer) The process by which a normal cell is transformed into a malignant cell 1.Initiation (carcinogen invades and change DNA) 2.Promotion(prolonged exposure and cell proliferation) 3. Progression(morphology change / angiogenesis). 4.Metastasis Cancer cells are transported through the: Blood stream Lymphatic system Common sites of metastasis :  Characteristics Benign tumors Malignant tumors Cell characteristics Resembles/typical Little resemblance to normal cells normal cells / atypical Invasion Don’t invade May invade surrounding tissue surrounding tissue Rate of growth Slow Usually rapid Metastasis Does not spread by Reach blood and metastasis lymph vessels and metastasizes to other body parts  Characteristics Benign tumors Malignant tumors Recurrence Does not recur when Tends to recur when removed removed Destruction of tissues Does not cause tissue Cause extensive tissue destruction damage due to pressure (e.g. on blood supply) General effects Usually localized Anemia, weakness, weight loss Ability to cause death Rarely cause death, Cause death, unless unless located near its growth is vital functions controlled  Classification of cancer Tissue type Benign Malignant 1- Epithelial tumors - Surface Papilloma Squamous cell carcinoma - Glandular Adenoma Adenocarcinoma 2- Connective tissue tumors - Fibrous Fibroma Fibrosarcoma - Adipose Lipoma Liposarcoma - Cartilage Chondroma Chondrosarcoma - Bone Osteoma Osteosarcoma - Blood vessel Hemangioma Hemangiosarcoma - Lymph vessels Lymphangioma Lymphangiosarcoma 3- Muscle tumors - Smooth Leiomyoma Leiomyosarcoma 4- blood leukemia Tumor staging  The clinical staging classification system determines the extent of the disease process of cancer by stages: Stage 0: Cancer in situ. Stage I: Tumor limited to the tissue of origin; localized tumor growth. Stage II: grown, Limited local spread. Stage III: Extensive local and regional spread. Stage IV: Metastasis.  TNM Cancer Staging There are many cancer staging systems, but TNM Staging is the most common to measure the extent of the spread of cancer: T" refers to the size of the tumor. "N" refers to the number and location of lymph nodes involved. "M" refers to metastasis. Primary tumor (T) T0 No evidence of primary tumor Tis Carcinoma in situ T1-4 Ascending degrees of increase in tumor size and involvement Regional lymph nodes (N) N0 No evidence of disease in lymph nodes N1-4 Ascending degrees of nodal involvement Nx Regional lymph nodes unable to be assessed clinically Distant metastasis (M) M0 No evidence of distant metastasis M1-4 Ascending degrees of metastatic involvement of the host, including distant nodes Tumor grading Cancer grades: -The grade describes the appearance of cancerous cells. - The grade of a cancer depends on what the cells look like under a microscope. Grade 1 – cancer cells that resemble normal cells and aren't growing rapidly. Grade 2 – cancer cells that don't look like normal cells and are growing faster than normal cells. Grade 3 – cancer cells that look abnormal and may grow or spread more aggressively.  What are the risk factors of cancer? 1. Age Primary prevention Secondary prevention Tertiary prevention  Primary prevention 1.Make appropriate lifestyle changes. 2.Avoid sun exposure. 3.Genetic counseling and testing regularly. 4.Use of vaccines for cancer prevention 5.Assess the home and workplace for known carcinogens. 6.Workers should be counseled regarding their risks and use of protective devices.  Secondary prevention/ early detection Performing regular screening tests.  C: Change in bladder or bowel habits.  A: A sore that not heal within a realistic period of time.  U: Unusual bleeding or discharge from any body orifice.  T: Thickening or the presence of a lump of the breast, testicle, or any part of the body.  I: Indigestion or difficulty swallowing for a prolonged period of time.  O: Obvious change in wart or mole, such as color, size, texture.  N: Nagging cough or hoarseness that is prolonged.  Tertiary prevention Prevent recurrence of disease Health counseling, Chemoprevention A.The health history. B.The physical examination. C.Studies include the following: 1.Lab inv. 2.Tumor markers or genetic markers such as BRCA-1 and BRCA-2. 3.Radiologic studies. 4.Radioisotope scans. 5.Sigmoidoscopy or colonoscopy examination.  5. Biopsy. The procedure may be a needle biopsy, an incisional biopsy, or an excisional biopsy. Management  The method of treatment depends on:  The type, stage of malignancy.  Cancer is treated by surgery, chemotherapy, radiation, or immunotherapy or by a combination of these modalities. Surgical Management Types of surgical procedures: Debulking surgery: remove bulk of tumor before chemotherapy. Curative surgery: primary site of tumor Palliative surgery: relieve obstruction Preventive : polyps removal Reconstructive rehabilitative surgery. Chemotherapy  It is the treatment of cancer with (anticancer drugs) that can destroy cancer cells by interfering with cellular functions and reproduction. Chemotherapy may be combined with surgery, radiation therapy or both to reduce tumor size preoperatively The goals of chemotherapy (cure, control, and palliation). destroy cancer cells by interfering with cellular functions and reproduction. Oral: Capsule, tablet or liquid. Intravenous (IV): Push (bolus) or infusion over a specific time period. Intramuscular. Intraperitoneal. Subcutaneous. Topical. Safety measures in handling chemotherapy Personal safety to minimize exposure via skin contact. Personal safety to minimize exposure via inhalation, ingestion. Safe disposal of antineoplastic agents, body fluids, and excreta. 1. Alopecia 2.Fatigue (anemia and wt loss) 3.Anorexia (loss of taste buds) 4.Nausea, vomiting. 5.Anemia 6.Mucositis. 7.Neutropenia (WBCS 1500/M3 OR LESS) 8.Thrombocytopenia (BELOW 50.000/MM3). 1. Integumentary system: 2.Hematopoietic system: 3.Renal system: 4.Cardiopulmonary system: 5.Reproductive system: 6.Neurologic system: 7.Fatigue. 1. risk for infection related to neutropenia. 2.Risk for bleeding related to thrombocytopenia. 3.Fatigue related to anemia. 4.Altered body image related to alopecia. …etc. 1.Prevention of infection: 2.Prevention of bleeding: 3.Fatigue related to anemia: 4.Minimize fatigue: 5.Minimize stomatitis: 6.Promotion nutrition: 7.Strengthening coping with altered body image: Management of an extravasation: 1- stop the infusion of the chemotherapy. 2- disconnect the Iv tubing. 3- use antidote to prevent tissue necrosis. 4- apply warm or cold compress to reduce extravasation and swelling. Radiation therapy It is the use of high-energy ionizing radiation to destroy a cancer cell’s ability to grow and multiply. Radiation therapy is used to cure or control cancer.  Teletherapy: External beam radiation by machines distance from body (80-1.00cm).  Brachytherapy: Internal radiation implantation. Need direct access to tumor. Brachytherapy types: Interstitial: Implant of solid materials as seeds Intracavitary: Used in uterine cancer. Systemic: Parenteral, IV,oral. Complications depend on radiation type, site, dose and overall health of patient. Acute side effects: During treatment to 6 months after treatment: Fatigue, malaise. Skin: erythema, dry to wet desquamation. GIT: nausea, vomiting. Oral : mucositis, change taste. Cardiovascular: thrombus formation. Pulmonary: dyspnea, productive cough. Renal: cystitis, urethritis. Chronic side effects: After 6 months of treatment: Skin: fibrosis, permanent darkening of skin. GIT: fibrosis, obstruction, ulceration, adhesion. Oral : permanent xerostomia, taste alteration. Pulmonary: fibrosis. Renal: fibrosis, nephritis. 1. Avoid lotions, ointments, or cosmetics to radiation sites unless prescribed. 2. Avoid vigorous rubbing, friction, or scratching because this can destroy skin cells. 3. Apply ointments as instructed by health professionals. 4. Avoid wearing tight-fitting clothes over the treatment field. 5. Take precautions against exposing radiation field to sunlight and extremes temperature. 6. Avoid apply adhesive or other tape to the skin. 7. Avoid shaving the skin in the treatment field. 8. Use warm water only and mild, creamy soap for bathing. 1. Use shield sheet of absorbing material between radiation source and the nurse. 2. Do not remain within (1 meter) of patient longer than required to give care. 3. Be alert for implants that may loosen from cavities; e.g. check emesis basin following mouth care for a patient with an oral implant. 4. Notify the radiation therapist of any implant that has moved out of position. 5. Use long-handled forceps and hold at arm’s length when picking up any dislodged radium needle, seeds, or tubes. 6. Discard dressings or linens used in special containers. 7. After the patient is discharged, check the room with a radiograph or survey meter to be sure that all radioactive materials have been removed. Other treatment modalities  Immunotherapy Use of biologic response modifiers to stop or slow malignancy process. Bone marrow transplantation BMT Use for hematologic cancer. Allogeneic = from donor Autologous= from patient Syngeneic= identical twin  Gene therapy Used to correct genetic defects by insertion of a desired gene into target cell. Ex: insertion of tumor suppressor gene.  Blood component therapy  Granulocyte transfusion for granulocytopenia.  Platelets transfusion Hyperthermia Additional heat to radiotherapy to destroy tumor, enhance immune system. Pain management Palliative care. Psychological care. High risk for infection related to altered immunologic response. High risk for injury related to bleeding problems. Impaired skin integrity: erythematous/wet desquamation skin reaction. Alteration of oral mucous membranes: stomatitis. Impaired tissue integrity: alopecia. Alteration in nutrition, less than body requirements, related to nausea/vomiting. Altered nutrition: less than body requirements, related to anorexia/cachexia/malabsorption. Fatigue and activity intolerance. Pain and discomfort. Grieving related to anticipatory loss; altered role functioning. Altered body image and self-esteem related to changes in appearance, function, and roles. 1. Nursing Management of Tissue Integrity in Cancer Patient. 2. Nursing Management of Nutrition in Cancer Patient. 3. Nursing Management of Pain in Cancer Patient. 4. Nursing Management of Fatigue and Weakness in Cancer Patient. 5. Nursing Management of Self-esteem and Body Image Concerns in Cancer Patient. 6. Nursing Management of Anemia in Cancer Patient. 7. Nursing Management of Thrombocytopenia/Bleeding in Cancer Patient. 8. Nursing Management of Neutropenia