altered cell growth and cancer development
DESCRIPTION
Altered Cell Growth and Cancer Development. Iggy—Chapter 27. Characteristics of Normal Cells. Have limited cell division Specific morphology Small nuclear cytoplasmic ratio Perform specific differentiated functions Adhere tightly together Are non-migratory - PowerPoint PPT PresentationTRANSCRIPT
Altered Cell Growth and Cancer Development
Iggy—Chapter 27
Characteristics of Normal Cells
Have limited cell division Specific morphology Small nuclear cytoplasmic ratio Perform specific differentiated functions Adhere tightly together Are non-migratory Grow in an orderly and well-regulated
manner Are contact inhibited
Mitosis of Normal Cells
Cell Cycle G1 S G2 M G0
http://www.cellsalive.com/cell_cycle.htm
Abnormal Cells
Hypertrophy—increase in tissue size by enlarging each cell.
Hyperplasia—increase in tissue size by increasing the number of cells
Neoplasia—new cell growth not needed for normal body growth or replacement of dead or missing tissue.
Characteristics of Benign Cells
Continuous or inappropriate cell growth Specific morphology Small nuclear cytoplasmic ratio Perform differentiated functions Adhere tightly together Are non-migratory Grow in an orderly manner
Characteristics of Malignant Cells Rapid or continuous cell division Anaplastic morphology Large nuclear cytoplasmic ratio Lose some or all differentiated functions Adhere loosely together Are able to migrate Grow by invasion Are not contact inhibited
Cancer Development
Carcinogenesis/oncogenesis Malignant transformation-changes a
normal cell to a cancer cell 4 stages
– Initiation– Promotion– Progression– Metastasis
Metastasis
The breaking off and establishing remote tumors– Metastatic– Secondary
Metastasis
Extension into surrounding tissues Penetration in blood vessels Release of tumor cells Invasion of tissue at site of arrest Local seeding Blood-borne metastasis Lymphatic spread
Steps of metastasis
Cancer Classification
From type of cell they arise from Biologic behaviors Anatomical sites Degree of differentiation 2 major types
– Solid– Hematologic
Cancer Grade and Stage
Grading– High grade– Low grade
Staging– Clinical– Surgical– Pathologic
TNM (T) Tumor
– Tx – unable to assess– T4 – larger number signifies increasing size
(N) Node– Nx – unable to assess– N3 – increased node involvement
(M) Distant Metastasis – Mx – unable to assess– M1 – no distant mets– M2 – distant mets
Cancer Etiology and Genetic Risk
Oncogene activation
External factors– Chemical– Physical
RadiationChronic irritation
– Viral
Advancing age is the single most important risk factor for cancer
77% of cancer is in people age 55 or older
The older a person is, the less ability their immune system retains to repair mutations that occur
Genetic testing for cancer
Requires a blood sample Very expensive Frequently not covered by
insurance Does not diagnose the presence
of cancer
Prevention
Primary Secondary Chemoprevention Gene therapy
Seven Warning Signs of Cancer
C – Changes in bowel or bladder A – A sore that does not heal U – Unusual bleeding or discharge T – Thickening or lump in breast or elsewhere I – Indigestion or dysphagia O – Obvious change in wart or mole N – Nagging cough or hoarseness
General Intervention for Clients with Cancer
Iggy—Chapter 28
Common Problems
Impaired immune and hematopoietic function
Altered gastrointestinal tract structure and function
Motor and sensory deficits Decreased respiratory function Treatment-related consequences
Ways to Treat Cancer
Surgery Radiation Chemotherapy
Surgery
Prophylaxis Diagnosis Cure Control (debulking) Palliation Therapy effectiveness Reconstructive or rehabilitative
Radiation
Kills cancer cells with minimal exposure of normal cells to radiation
Cells damaged by radiation either die or become unable to divide
Works best in localized tumors
Penetrating capacity ofdifferent types of radiation
Radiation Administration
Amount of radiation delivered to a tissue is called “exposure”
Amount of radiation absorbed by the tissue is called the “dose”
Total dose depends on the tumor location and its sensitivity to radiation
Doses are given in fractionation divided over the treatment time span
Types of Radiation Therapy
Teletherapy – beam radiation Brachytherapy – short or dose therapy
– All types—radiation source is placed in the patient—making the patient emit radiation and be a hazard to others for a short time
Unsealed isotope—example is radioactive iodine concentrate (thyroid gland)
Sealed—Seeds (prostate Ca) short half life, usually left in place
Implants—constant in hospital several or intermittent in and out of clinic over a period of time
The Inverse Square Lawof Radiation Exposure
The intensity of radiation decreases with distance from the radiation source.
Side Effects of Radiation
Limited to areas of exposure Skin changes and hair loss usually
permanent Care of patient receiving radiation includes:
– Teaching– Don’t remove radiation markings– Skin care to radiated areas– No lotions or creams, use radigel provided by
radiologist
Chemotherapy
Used for both cure and to increase survival time
Works best for systemic (mets) May be used in combination with
surgery and/or radiation (adjuvant)
Chemotherapy
Antimetabolites—counterfeit metabolites that fool cancer cells
Antitumor antibiotics—interrupts DNA/RNA synthesis
Alkylating agents—cross links DNA-2 strands bind together, inhibiting cell division
Chemotherapy, cont.
Antimitotic agents—usually made from plant sources, prevents completion of mitosis
Topoisomerase inhibitors—prevents enzyme from copying and reattaching, causing DNA breakage and cell death
Miscellaneous—doesn’t fit anywhere else Combination
Total Body Surface Area
BSA, TBSA, PSA Height and weight Ht (cm) x wt (Kg) / 10,000 = TBSA
5’11’’ tall and weighs 186 pounds What is his TBSA?
Calculating TBSA
5’11’’ = 71 inches = 180.34 185# = 84.1 KG
180.34 X 84.4 10,000
BSA = 1.52
Scheduling and Administration
Schedule treatment every 3-4 weeks for the total (Course) of 6-12 months
Administration– PO or Im– Mostly given IV (CVL or pIV)– Intra-thecal– Intra-arterial– Intra-peritoneal– Intra-vesical
Extravasation
Irritants Vesicants Most important
nurse action is prevention
What do you do if an extravasation happens?
How does chemo work?
Cancer cells divide continously Chemo kills during cell division Chemo kills good cells as well as bad
cells– http://www.cancer.org/docroot/ETO/content/E
TO_1_2X_Chemotherapy_What_It_Is_How_It_Helps.asp
– http://www.cancer.org/docroot/ETO/content/ETO_1_4X_How_Does_Chemotherapy_Work.asp?sitearea=ETO
Side Effects of Chemotherapy
Immunosuppression Anemia Thrombocytopenia Alopecia Nausea and vomiting Mucositis
Alopecia
Hair loss is usually temporary and does reverse
Nausea and Vomiting Can continue for 5-7
days s/p chemotherapy
Give antiemetics Avoid spicy or rich
foods, strong smells, and extreme hot or cold liquids
Mucositis
Soft bristled toothbrush
Avoid toothpicks and dental floss
Avoid mouthwashes that contain alcohol
Do frequent mouth care
Give pain meds PRN
Immunosuppression
Nadir—lowest point in blood counts s/p chemo– Usually seen in 5-10 days
Neutropenia – WBC below 1000
Patient is at extreme risk for infection
Major dose limiting side effect of chemotherapy
Anemia
Hgb below 8—transfuse
S/S fatigue and SOB
Thrombocytopenia Decreased platelets Below 50,000—
bleeding precautions Below 20,000—high
risk Transfuse with
platelets Educate and protect
patient
Immunotherapy: Biological Response Modifiers
Stimulates the production of bone marrow
Cytokines—interferon, interleukins, epogen, G-CSF, GM-CSF
Hormonal Manipulation
Some hormones make homes-sensitive tumors grow more rapidly—so decreasing amount of hormone in body can cause tumor growth to slow.
Types– Agonists– Antagonists– Inhibitors
Gene Therapy
Experimental Has shown limited response rates, but
indicates potential for future treatment.
Targeted Therapy
Combination of gene therapy and biologic therapy to target specific cells– Examples: herceptin and gleevac
Most common side effect is allergic reactions
Oncological Emergencies Sepsis Disseminated intravascular coagulation Syndrome of inappropriate antidiurectic
hormone Spinal cord compression Hypercalcemia Superior vena cava syndrome Tumor lysis syndrome
Sepsis
Septic shock Life threatening
– 1st get blood cultures and urine culture– 2nd start antibiotics
DIC (70% mortality rate)
Blood clotting problem often caused by sepsis (gram negative infection) in cancer patients.
Release of clotting factors from cancer cells cause excessive abnormal clot formation in small blood vessels, which use up the clotting factors and platelets in the blood.
DIC, cont.
This leads to extensive bleeding. Clots are still there which can block
blood vessels and decrease blood flow to major organs.
Early treatment is to treat the cause and give anticoagulants
Late treatment is to control the bleeding and give cryoprecitated clotting factors
SIADH
Water is reabsorbed to excess by the kidneys and put into the systemic circulation
Increase in water causes a decrease in sodium levels (hyponatremia) and increased fluid retention
SIADH, cont.
May lead to seizures, coma, and death Treatment—
– Increase sodium intake– Restrict fluids (often 500 cc – 1 L/24h)– Drug therapy (demeclocycline)– Monitor serum sodium levels– Reduce or eliminate underlying cause
Spinal Cord Compression
Tumor directly enters the spinal cord or vertebrae
Collapse from tumor degradation of vertebrae bone
Early recognition is the key to treatment
Spinal Cord Compression, cont.
Treatment includes high dose corticosteroids to reduce swelling, radiation may be used to shrink tumor, surgery is an option, back or neck braces may be used to support the spinal column and decrease pressure on the spinal cord.
Hypercalcemia
Most often seen with bone mets Bone cancer causes release of calcium
into the bloodstream Decreased mobility and dehydration
worsen hypercalcemia Treatment includes hydration, monitor
serum calcium levels, and drugs to reduce calcium.
Superior Vena Cava Syndrome
SVC compressed or obstructed by tumor growth
Blockage of blood flow in the venous system of neck and upper trunk
S/S: facial swelling, distention of jugular veins, edema of hands and arms, dyspnea
Treatment: high dose radiation, possible surgical stint
Compression of the superior vena cava
Tumor Lysis Syndrome
Rapid destruction of tumor cells, releasing cell contents into the bloodstream faster than the body can eliminate them.
Best treatment: Prevention through– Hydration—(3000-5000 ml/24h) dilutes K+
level and increases kidney filtration rate– Diuretics– Drugs—allopurinol
Tumor Lysis
Treatment Failure
50% of people diagnosed with cancer are cured
Others live 5 years or longer Some have treatment failure and die Dying process is usually long, lasting
weeks or months. Care of the terminally ill patient.
Good bye, all done… study hard….