Professional Documents
Culture Documents
Cancer
I. Cancer is unregulated growth of cells; Carcinogens are
agents capable of producing cellular alterations.
II. Complications of Cancer, Radiation and Chemotherapy
A. Hematopoietic System (Nadir)
o Very low in RBC, WBC & platelets = Nadir
o Lowest point someone can be @ once we have
damaged good & bad cells
1. Anemia- reduction in RBC’s
a) Gas Exchange Impairment
b) Dyspnea- Shortness of Breath
c) Activity Intolerance
d) Low WBC, impaired immune system
e) Platelets, No clotting, would bleed/may bleed to death
− Nursing care for depressed red cells:
o Give O2
o Alternate Rest and Activity (RBC, normal 4-6 million -
Low RBC = low Hgb)
o CSF- Colony Stimulating Factor
Procrit and epogen (exogenous erythropoietin) -
stimulate the bone marrow to produce RBC’s
Iron, Administer Blood
o End up having to back up off the treatment, we try to
manage the symptoms, cause we don’t want to have to
back off
2. Leukopenia/ granulocytopenia/ neutropenia- WBC
− Penia = decreased
− At risk for infection (High Risk)
− 5,000 – 10,000 = normal level
− May give granulocytes
− Nursing care for depressed white cells:
o No Flowers
o No Catheter – can introduce bacteria
o Reverse or protective isolation
o S/Sx of infection (Assess very carefully for infection)
o Sputum
o Urine – Should be clear yellow
o Assess puncture sites for any sign or warmth or redness
o Breath sounds
o Temperature ± 101.0 normally, for these patients 99.2
or 99.4
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18.Second Malignancies
− Had cancer years later on down the road they develop
another kind of malignance in response to first chemo
treatment
− * CEA
− * Lifelong monitoring
19.Death
− Hospice care
− Cancer Kills
− Not qualified until 6 Months Left
III. Theories of the Etiology of Cancer (there are many--these
are only 2)
A. Cellular Transformation and Derangement (crazy cells,
altered cell growth)
1. Theory: Can occur from the cells changing into Cancer
Cells
2. Agents: Some Drugs can cause cancer or Sun damage =
skin cancer
o Kaposis sarcoma tumor that people with HIV get
o Hep B can cause Liver cancer
o Factories = cancer
o Asbestos = type of lung cancer
o Birth Control pills lead to cancer
o Smoking = lung cancer
B. Immune Response Failure (The old gray mare she ain’t what
she used to be)
1. Theory: The immune system surveys what is you and
what isn’t you and whatever isn’t you the body is trained to
attack!
o We are living longer so we see more cancer
2. Immune response can be repressed by:
− Immunosupressors: Transplant patients
− Aging
− Smoking and alcohol
− Poor nutrition (good protein intake)
− Chronic steroids
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− Stress
IV. Basic Principles
A. Differentiation is process where cells diversify and acquire
specific structural and functional characteristics and mature. *
Cancer cells lack differentiation!!!
B. Cell cycle
− life of the cell
− Normal cells- go through normal cell life
− Cancer cells- Do not go through normal cell life, do weird
strange things, don’t follow the rules
C. Contact inhibition
− Normal cells have
− Cancer cells do not
− * When crowding occurs production of cells slow down, not
in the case of cancer cells they just keep growing.
D. Benign (spreads locally)
− not recurrent or aggressive; does not metastasize; does
not cause systemic symptoms or death unless it interferes
with vital functions due to location, i.e. brain tumor
(acoustic neuroma)
E. Malignant (spreads far away)
− undifferentiated, immature cells; invade, erode, & spread
1. Implantation- Local spreading
2. Cells can travel by vascular system
3. Lymphatic system
F. TNM Classification System (Tumor, Node, Metastasis)
− Also see chapter on breast cancer
− T--tumor size (describes primary tumor)
o T O (no evidence of tumor)
o T IS (in situ)
o T 1 (< or equal to 2 cm)
o T2 (> 2 but not > 5 cm)
o T3 (> 5 cm)
o T4 (extension to chest wall, inflammation)
− N--degree of spread to nodes
o N 0 (no evidence of lymph node involvement)
o N 1-4 (ascending degree of node involvement)
o N X (regional lymph nodes unable to be assessed
clinically)
− M—metastasis
o M 0 (no evidence of distant metastasis)
o M 1 - 4 (ascending degree of metastasis)
G. 3 Stages of cancer cell growth
1. Initiation--something causes cell’s genetic structure to
change
a. Chemical Carcinogens--Drugs, Chemicals, Diet
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b. Physical Carcinogens
i. Ionizing radiation--secondary cancer from
radiation to primary cancer
ii. UV radiation--short rays of sun worse
iii. Foreign bodies—asbestos
iv. Certain DNA and RNA viruses--oncogenic--can
transform cells i.e., HIV ------>Kaposi's Sarcoma
Hep B------->Liver cancer
2. Promotion
− 2 mutations are required for cancer to develop in a
cell; Proliferationof cells with first mutation leads to a
population of cells where a 2nd mutation can occur.
Some promoters are specific to specific cancers--
Alcohol---->GI tract cancer
Smoking--->Lung cancer
Some carcinogens can initiate and promote
cancer—ex: smoke
3. Progression
− includes increased growth rate, invasiveness &
metastasis. As tumor increases in size, it develops
own blood supply--tumor angiogenesis.
V. Prevention and Early Detection Very Important--Major role
for nursing
A. Seven Warning Signs
a. C-- Change in bowel or bladder habits
b. A--A sore that does not heal
c. U--Unusual bleeding or discharge
d. T--Thickening or lump in breast or elsewhere
e. I--Indigestion or difficulty swallowing
f. O--Obvious change in wart or mole
g. N--Nagging cough or hoarseness
B. Education
1. Diet high in vegetables, fruits, whole grains, vitamins A and
C; Limit salt-cured, smoked, nitrite-cured foods, alcohol,
fats
2. Avoid smoking, obesity, sunlight
3. Regular Physical Exam (Yearly after age 40)
4. Screening for all
a. Skin inspection for changes
b. Annual rectal exam after age 40
c. Annual stool for occult blood after age 50
d. Annual oral exam
5. Screening for women:
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2. Prophylactic
3. Curative--if believed can get it all
4. Palliative--done to help if benefit outweighs risk
(debulking) (male less in size , makes things better but
won’t cure
a) To reduce pain
b) To relieve obstructions (GI, GU, Resp, spinal cord,
etc.)
c) To prevent hemorrhage
d) To remove infected and ulcerating tumors or drain
abscesses
5. Reconstructive
− restoration of form and function to improve quality of
life
B. Radiation Therapy (RT)
1. Goal: destroy cancer cells with minimized damage to other
tissues; Destroys cancer cell's replication by
damaging DNA. Cells that divide rapidly are more
radiosensitive. Also, normal cells are more capable
of repairing the DNA damage done by radiation.
2. Types of Radiation
a) External RT—Teletherapy
− Mark the site with a permanent marker, teach clients
not to scrub it off, it needs to stay on
− People go in- Radiation beams shot into them at
certain level and depth
− Not at risk to anyone else
− Special making so radiation Therapist knows where
to shot them
− Can leave after therapy
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− EXTRAVASATION MANAGEMENT:
(Infiltration)
i. Stop Drug Infusion
ii. Take all fluid down disconnect IV line-
Leave Iv Cath in
iii. Syringe/Aspirate on IV Cath try to
aspirate back as much fluid as you can
iv. Find out antidote- Bicarbonate
v. Inject/Deliver antidote in cath, will go into
the tissue
vi. D/C cath
vii. Apply cold compress to vasoconstrict
Typically, unless it’s a vincadrug = warm
compress
viii. Elevate Extremity to stop swelling
ix. Check ups – asses very often &
document findings, VERY OFTEN (maybe
every 0 minutes) If possible take a
picture of it right after it happens
− If not a vescant can put in a peripheral line
− Flush line to check patency
− Can give a vesicant through a PICC, but not
a PIC
2. Central Vascular Access
a) Central venous catheter
− Central line
− PICC – subclavian or juglar central
line, have to be flushed periodically,
o NS & then Heparin behind it,
must do site care
o @ risk for infection
o use sterile technique
b)Implanted Venous Port--Venous Access
Device (VAD)
− Example is a Port-a-Cath or Bard
Implanted Port on chest or Omaya
Reservoir under scalp (Mediport)
3. Other less common routes
− Topical, oral, SQ, IM, or
− Intrathecal (lumbar puncture to get to
brain and spinal cord)
− Intraarterial (into an artery that feeds
a tumor)
− Intrapleural (into intrapleural space of
lungs)
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− Intraperitoneal
− Intravesicle (bladder empties first,
then must retain 1 - 3 hours)
4. Outpatient Chemo Administration
− Nurse must teach client:
o SE to expect
o Safe Storage
o How to handle equipment
o Double flushing, cleaning toilet with
Clorox
o Washing contaminated linens once by
themselves & then with other things
D. Bone Marrow Transplantation (BMT)--goal is cure.
− 3 Types of Bone Marrow Donors:
a) Autologous – Self, saved & stored, can take out own
BM b/f treatment & if cancer isn’t in BM, they can then
put back in their own healthy BM
b) Syngeneic – Twin, someone just like them
c) Allogenic – Parent, Brother, Sister & Family Member
− 2nd response
2. Granulocytes
a. Neutrophils
− Phagocytic
− 50-70% of WBCs
− 1st response
b. Basophils
− Release histamine and heparin in allergic
response < 2 % of WBCs
c. Eosinophils
− Neutralize histamine
− Defend against parasites
− 2-4 % of WBCs
E. Biologic Response Modifiers
− Biotherapy, obtained through genetic engineering
a) Purpose is to strengthen and manipulate the immune
system.
b) Examples of Biologic Response Modifiers:
1. Monoclonal antibodies (MoAbs)--used
diagnostically to identify tumor cells, as a
delivery agent of radioisotopes to tumor site,
and to deliver immunotoxins to tumor site
2. Interferons (IFN)--small proteins with cellular
activity in three areas: antiviral
immunomodulatory, and antiproliferative
3. Interleukins--produced by lymphocytes and
function to promote normal hematopoiesis.
Responsible forgrowth of T cells. Side effects
as well as desirable effects. (Ex: capillary leak
syndrome leading to edema.)
4. Colony stimulating factors (CSF)--do not
treat cancer but help with negative effects of
treatment
A. Erythropoietin (EPO)--FDA approved;
affects erythrocyte production; Also
used in clients with anemia in end
stage renal failure.
o Procrit or Epogen
B. Neupogen – makes WBC
o Neumega makes platelets
5. Tumor necrosis factor (TNF)