Cancer

1
Cancer

• Management and Care

2
A Few Facts

• 2nd leading cause of death
• 14 deaths due to cancer
• 1/3 of deaths related to
• Nutrition problems
• Physical inactivity
• Obesity
• Other lifestyle factors

3
Early Detection

• Why is early detection so important to the
  management and care of cancer?
• What role does assessment play in early
  detection?

4
Cancer Classifications

• Carcinomas
• Adenocarcinomas
• Sarcomas
• Gliomas
• Melanomas
• Myelomas
• Lymphomas
• Leukemias
• Erythroleukemia

5
Metastasis

• Spread of cancer cells from site of origin
• Mechanisms of metastasis
• By circulation through blood and lymphatic system
• By accidental transplantation during surgery
• By spreading to adjacent organs and tissues
• What is the primary concern of metastatic
  disease?

6
Carcinogenesis

• Cell transformation from normal to cancerous.
• Malfunction of genes that control cell growth and
  division
• Three step cellular process
• Initiation
• Promotion
• Progression
• No single cause

7
Immunosurveillance

• It is theorized that the body continually
  develops cancer cells that are recognized and
  destroyed by the immune system.
• Immunosurveillance promotes antibody production,
  cellular immunity, and immunologic memory.
• Interruption in immunosurveillance can lead to
  overproduction of cancer cells and, possibly,
  tumor development.

8
Cancer Diagnosis

• Based on
• Assessment for physiologic and functional changes
• Results of diagnostic testing
• Extensive testing
• Determine presence and existence of tumor
• Identify possible metastasis or invasion
• Evaluate function of involved and uninvolved body
  systems and organs
• Obtain tissues and cells for analysis

9
Question

• What psychosocial factors are at play in cancer
  diagnosis?

10
Tumor Staging and Grading

• Needs to be done before treatment begins. Why?
• Staging determines size of tumor and existence
  of metastasis.
• TNM commonly used system
• Grading classification of tumor cells
• To identify tissue type of origin
• Grade I Grade IV

11
Cancer Management

• Contrast
• Cure
• Control
• Palliation

• Multiple Modalities
• Surgery
• Radiation Therapy
• Chemotherapy
• Targeted Therapies

12
Surgery

• Diagnostic Surgery
• Primary treatment approach
• Local excision vs. wide excision
• Prophylactic Surgery
• Palliative Surgery
• Reconstructive Surgery

• Surgical Approaches
• Video-assisted endoscopy
• Salvage surgery
• Electrosurgery
• Cryosurgery
• Chemosurgery
• Laser surgery
• Stereotactic radiosurgery

13
Question

• Compare and contrast the nursing management
  responsibilities in cancer surgery.

14
Radiation Therapy

• Ionized radiation is used to disrupt cellular
  growth
• Body cells undergoing frequent cell division are
  most sensitive
• External vs. Internal
• Radiation dose is dependent upon the sensitivity
  of target tissue and tumor size
• Risk of radiation toxicity

15
Radiation Therapy Adverse Effects

• Common Systemic effects
• Fatigue
• Malaise
• Anorexia
• Late Effects
• Fibrotic changes secondary to decreased vascular
  supply
• Irreversible

16
Question

• What is the role of the nurse in regards nursing
  management in Radiation Therapy?

17
Chemotherapy

• Antineoplastic agents used to destroy tumor cells
• Primarily used for systemic disease
• May be used alone or combined with surgery,
  radiation or both
• Actively proliferating cells are most sensitive
  to chemotherapeutic agents
• Can be classified by relationship to cell cycle
  or chemical group

18
Cell Cycle

• Phases
• G1 RNA and Protein synthesis occur
• S DNA synthesis occurs
• G2 premitotic phase DNA synthesis is complete,
  mitotic spindle forms
• Mitosis cell division occurs
• In regards to chemotherapy, why is the
  understanding of the cell cycle important?

19
Administering Chemotherapeutic Agents

• Route
• Dosage
• Special Problems
• If extravasation expected
• Immediately stop infusion
• Apply ice (unless vinca alkaloid)
• MD may aspirate infiltrated medication and inject
  neutralizing agent

20
Chemotherapy Toxicity

• Acute or Chronic
• GI
• Hemopoietic
• Renal
• Cardiopulmonary
• Reproductive
• Neurologic
• Fatigue

• What manifestations would you expect?
• What therapies may be instituted to relief the
  manifestations?
• What should be closely monitored?

21
Nursing Management In Chemotherapy

• Assessing fluid and electrolyte status
• Modifying risk for infection and bleeding
• Administering chemotherapy
• Protecting caregivers

22
Bone Marrow Transplantation

• Bone marrow or peripheral blood stem cells
• Types
• Allogenic
• Ablative vs. Nonablative
• Autologous
• Syngenic
• Goal Graft-vs-Disease Effect
• Graft-vs-Host-Disease

23
Nursing Management in BMT

• Care is complex and highly skilled
• Pretransplantation care
• Extensive assessment and evaluations
• Informed consent and patient teaching
• Care during treatment
• Monitor effects of high dose chemotherapy or
  radiation
• During cell infusion monitor VS, SpO2, assess
  for adverse effects
• Provide ongoing support and education

24
Nursing Management in BMT

• During aplastic phase
• High risk for sepsis and infection
• Administer blood products and hemopoietic growth
  factors
• Monitor for renal complications
• Post-transplantation care
• Recipient
• Ongoing assessments
• Early detection of late effects of therapy
• Donor

25
Other Modalities to Destroy Tumors

• Hyperthermia
• Targeted Therapies
• Biologic Response Modifiers (BRM)
• Gene therapy
• Agents to target growth factors
• Photodynamic Therapy
• Unproven and Unconventional Therapies

26
Nursing Interventions

• Managing stomatitis
• Maintaining skin integrity
• Helping patients cope with alopecia
• Managing malignant skin lesions
• Promoting nutrition

• Relieving pain
• Decreasing fatigue
• Improving body image and self-esteem
• Assisting in the grieving process
• Monitoring and managing complications

27
(No Transcript)
28
Cancer Rehabilitation

• Many problems are experienced as patient returns
  to work and usual activities
• Nurses play an important role
• To maximize outcomes
• The patients needs related to cancer
  rehabilitation must be evaluated early in cancer
  treatment.

29
Gerontologic Considerations

• gt 58 of cancers occur in persons older than 65
• 66 of cancer deaths occur in persons older
  than 65
• Normal physiologic changes associated with aging
  influence the patients ability to tolerate
  cancer treatment

30
Care of Patients with Advanced Cancer

• Common problems associated with cancer disease
  and treatment are experienced to a greater
  degree.
• Treatment generally palliative
• Prevention and appropriate management of problems
  can significantly increase quality of life.
• Hospice care

31
Oncologic Emergencies

• Superior Vena Cava Syndrome
• Spinal Cord Compression
• Hypercalcemia
• Pericardial effusion and Cardiac Tamponade
• Disseminated Intravascular Coagulation
• Syndrome of Inappropriate ADH
• Tumor Lysis Syndrome