cancer
TRANSCRIPT
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Cancer ConceptsCancer Concepts
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Exact cause: UnknownExact cause: Unknown Predisposing factors:Predisposing factors:
•HeredityHeredity•StressStress
PsychologicalPsychological PhysicalPhysical
•UnuseUnuse•OveruseOveruse•AbuseAbuse
•SpecificSpecific
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Theories of CancerTheories of Cancer
Cellular Transformation and Cellular Transformation and Derangement TheoryDerangement Theory
Failure of the Immune Failure of the Immune Response TheoryResponse Theory
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Normal Cell
VirusChemical / Physical Agent
DrugsHormones
Genetic Alteration
Defective Cell
Multiple cell division
Malignancy
Cellular Transformation andDerangement Theory
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PotentialCell Ab
AbAb
AbImmune system
fails
Failure of Immune Response Theory
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ClassificationClassification
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TumorTumor• 11 -- smallsmall• 2-32-3 -- mediummedium• 44 -- largelarge
NodeNode• 0 0 - - no involvementno involvement• 1-31-3 -- moderatemoderate• 44 -- extensiveextensive
MetastasisMetastasis• 00 -- no metastasisno metastasis• 11 -- metastasismetastasis
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Warning Signs of CancerWarning Signs of CancerC - change in bowel or bladder habitsA - sore that does not healU - unusual bleeding or dischargeT - tumorI - indigestion or difficulty in swallowingO - obvious change in warts or molesN - nagging cough or hoarseness of voice
U - unexplained anemiaS - sudden weight loss
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Comparison of Benign & Malignant NeoplasmComparison of Benign & Malignant Neoplasm
CharacteristicsCharacteristics BenignBenign MalignantMalignant
Speed of growthSpeed of growth SlowSlow RapidRapid
Mode of growthMode of growth LocalizedLocalized InfiltratingInfiltrating
CapsuleCapsule EncapsulatedEncapsulated No capsuleNo capsule
RecurrenceRecurrence UnusualUnusual CommonCommon
MetastasisMetastasis NoneNone CommonCommon
EffectEffect Harmless to hostHarmless to host HarmfulHarmful
PrognosisPrognosis Very goodVery good PoorPoor
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LUNG CANCERLUNG CANCER
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DescriptionDescription Refers to malignant tumor Refers to malignant tumor
growth within the bronchial growth within the bronchial tissue or lung parenchyma.tissue or lung parenchyma.
Types include:Types include:• Squamous cellSquamous cell• Adenocarcinoma Adenocarcinoma • Small cell (oat cell) Small cell (oat cell) • Large cell Large cell
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Etiology and IncidenceEtiology and Incidence
Exact Cause: UnknownExact Cause: Unknown
Predisposing factorsPredisposing factors•HeredityHeredity•Pulmonary irritantsPulmonary irritants
Poor prognosisPoor prognosis
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PathophysiologyPathophysiology Irritation Irritation series of changes series of changes
tumor tumor Metastases – primary sitesMetastases – primary sites Some tumors secrete Some tumors secrete
hormones:hormones:•ADH – reabsorption of waterADH – reabsorption of water•ACTH – stimulates adrenal ACTH – stimulates adrenal
glands to produce steroidsglands to produce steroids
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Symptoms may include:Symptoms may include:• CoughCough• WheezingWheezing• Shortness of breathShortness of breath• Chest painsChest pains• HoarsenessHoarseness• Dysphagia (compression of esophagus)Dysphagia (compression of esophagus)• Weight lossWeight loss
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Nursing InterventionsNursing Interventions
Adequate oxygenation Adequate oxygenation Prepare for surgery if tumor is small Prepare for surgery if tumor is small
enough to be removedenough to be removed Prepare patient for planned Prepare patient for planned
treatmentstreatments• chemotherapy chemotherapy • radiation therapyradiation therapy
Analgesics as orderedAnalgesics as ordered Maintain nutritional statusMaintain nutritional status Provide emotional supportProvide emotional support
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BLADDER BLADDER CANCERCANCER
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More common in malesMore common in males Cause: unknownCause: unknown
Risks factorsRisks factors1.1. Exposure to cigarette smokeExposure to cigarette smoke
2.2. Pelvic radiationPelvic radiation
3.3. Use of cyclophosphamideUse of cyclophosphamide
4.4. Chronic cystitisChronic cystitis
5.5. Bladder calculiBladder calculi
6.6. SchistosomiasisSchistosomiasis
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AssessmentAssessment
Hematuria (first sign)Hematuria (first sign)•PainlessPainless•GrossGross
DysuriaDysuria Obstruction to urine flowObstruction to urine flow Development of fistulaDevelopment of fistula
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Collaborative ManagementCollaborative Management
ChemotherapyChemotherapy
ThiotepaThiotepa
Mitomycin CMitomycin C
Doxorubicin (Adriamycin)Doxorubicin (Adriamycin)
Cyclophosphamide (cytoxan)Cyclophosphamide (cytoxan)
Cisplatin (Platinol)Cisplatin (Platinol)
MethotrexateMethotrexate RadiationRadiation
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SurgerySurgery•Urinary Diversion SurgeriesUrinary Diversion Surgeries
Ileal ConduitIleal ConduitUreterostomyUreterostomyUreterosigmoidostomyUreterosigmoidostomyNephrostomyNephrostomy
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Ileal ConduitIleal Conduit For CA BladderFor CA Bladder Adult Adult
Neurogenic Neurogenic BladderBladder
Insterstitial Insterstitial CystitisCystitis
Irreparable Irreparable TraumaTrauma
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Important!Important! External External
collection collection device neededdevice needed
Proper fitting Proper fitting to prevent to prevent urine leak to urine leak to the skinthe skin
Skin care with Skin care with warm water warm water and mild soapand mild soap
ComplicationsComplications Obstruction to Obstruction to
the urine flow the urine flow via small via small intestines intestines secondary to secondary to edemaedema
InfectionInfection Stoma prolapseStoma prolapse CalculiCalculi Electrolyte Electrolyte
imbalancesimbalances
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UreterostomyUreterostomy Either or both Either or both
ureters are out to ureters are out to the abdominal wallthe abdominal wall
Ureteral stoma is Ureteral stoma is createdcreated
External collection External collection device is neededdevice is needed
Infection is a Infection is a potential hazardpotential hazard
Increase fluid Increase fluid intakeintake
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NephrostomyNephrostomy
To drain the To drain the urine while urine while ureteral ureteral inflammation inflammation from trauma or from trauma or calculus is calculus is presentpresent
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ComplicationsComplications Infection Infection
(Pyelonephritis(Pyelonephritis))
Blockage of Blockage of the catheterthe catheter
Important!Important! DO NOT DO NOT
IRRIGATE!!!IRRIGATE!!!
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UreterosigmoidostomyUreterosigmoidostomy
No external No external collection collection devicedevice
Passage of Passage of flatus includes flatus includes leak of urineleak of urine
Infection is Infection is possiblepossible
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PROSTATE PROSTATE CANCERCANCER
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Most common male Ca Most common male Ca (gender-specific)(gender-specific)
Androgen – dependent Androgen – dependent adenocarcinomasadenocarcinomas
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Predisposing FactorsPredisposing Factors
Genetic tendencyGenetic tendency 50 years of age50 years of age Hormonal factorsHormonal factors
•Late pubertyLate puberty•High frequency of sexual High frequency of sexual
experienceexperience•History of multiple sexual partnersHistory of multiple sexual partners•High fertilityHigh fertility
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DietDiet• ↑↑fat (alters cholesterol and steroid fat (alters cholesterol and steroid
metabolism)metabolism) Chemical carcinogensChemical carcinogens
• Air pollutionAir pollution• Occupation-relatedOccupation-related
industries – fertilizer, rubber, industries – fertilizer, rubber, textiletextile
batteries containing Cadmiumbatteries containing Cadmium
VirusesViruses
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AssessmentAssessment
HesistancyHesistancy HematuriaHematuria Urinary retentionUrinary retention Stool changesStool changes Pain radiating down hips and legsPain radiating down hips and legs Cytitis Cytitis DribblingDribbling
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NocturiaNocturia Hard, enlarged prostateHard, enlarged prostate Pain on defecationPain on defecation High level of acid High level of acid
phospatasephospatase Elevated PSA (Prostatic Elevated PSA (Prostatic
Specific Antigen)Specific Antigen)
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Nursing InterventionsNursing Interventions Early detection of tumorEarly detection of tumor
• UltrasoundUltrasound• MRIMRI• X-rayX-ray• CT ScanCT Scan
Radiation therapyRadiation therapy Endocrine therapy - DES (diethylstilbestrol) Endocrine therapy - DES (diethylstilbestrol)
decreases testosterone level)decreases testosterone level) Surgery: ProstatectomySurgery: Prostatectomy
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Hodgkin’s Hodgkin’s Disease Disease
malignant tumor of lymphatic malignant tumor of lymphatic systemsystem
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Cause: Cause: •UnknownUnknown•Viral associationsViral associations•AutoimmunityAutoimmunity
Incidence:Incidence:•Young adult 15-35 yearsYoung adult 15-35 years
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PathophysiologyPathophysiology
Proliferation of abnormal T-CellsProliferation of abnormal T-Cells
Obstruction in lymphatic flowObstruction in lymphatic flow
PainPain
FeverFever
Weight LossWeight Loss
MalaiseMalaise
MetastasesMetastases SpleenSpleen LiverLiver LungsLungs HeartHeart
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ManagementManagement
MOPPMOPP•Watch out for BM Watch out for BM depressiondepression
ABVDABVD•Causes red urineCauses red urine
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Nursing Intervention Nursing Intervention
SupportiveSupportive•N/VN/V•F & EF & E•Comfort measuresComfort measures
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Protection from infectionProtection from infection Maintain Tissue IntegrityMaintain Tissue Integrity Maintain Normal Body Maintain Normal Body
TemperatureTemperature Prevent or decrease painPrevent or decrease pain Maintain ideal body weightMaintain ideal body weight Maintain adequate hydrationMaintain adequate hydration Assist client and significant Assist client and significant
others to copeothers to cope
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COLORECTAL COLORECTAL CANCERCANCER
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Cause: UnknownCause: Unknown Predisposing Factors:Predisposing Factors:
• Age above 40 yearsAge above 40 years• Predisposing FactorsPredisposing Factors
low in fiberlow in fiber high in fat, protein and refined carbohydrateshigh in fat, protein and refined carbohydrates ObesityObesity History of chronic constipationHistory of chronic constipation History of IBD, familial polyposis or colon History of IBD, familial polyposis or colon
polypspolyps Family history of colon cancerFamily history of colon cancer
Most Common Site: Rectosigmoid area (70%)Most Common Site: Rectosigmoid area (70%)
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ASSESSMENTASSESSMENT
Ascending (Right) Ascending (Right) Colon CancerColon Cancer• Occult blood in Occult blood in
stoolstool• Anemia Anemia • Anorexia and Anorexia and
weight lossweight loss• Abdominal pain Abdominal pain
above umbilicusabove umbilicus• Palpable massPalpable mass
Distal Colon / Rectal Distal Colon / Rectal CancerCancer• Rectal bleedingRectal bleeding• Changed bowel Changed bowel
habitshabits• Constipation or Constipation or
DiarrheaDiarrhea• Pencil or ribbon – Pencil or ribbon –
shaped stoolshaped stool• TenesmusTenesmus• Sensation of Sensation of
incomplete bowel incomplete bowel emptying emptying
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COLORECTAL CANCERCOLORECTAL CANCER
Duke’s Classification of Colorectal CancerDuke’s Classification of Colorectal CancerStages:Stages:• A: confined to bowel mucosa, 80 – 90% 5- year A: confined to bowel mucosa, 80 – 90% 5- year
survival ratesurvival rate• B: invading muscle wallB: invading muscle wall• C: lymph node involvement C: lymph node involvement • D: metastases or locally unresectable tumor, D: metastases or locally unresectable tumor,
less than 5% 5 – year survival rateless than 5% 5 – year survival rate Guidelines for Early Detection of Colorectal Guidelines for Early Detection of Colorectal
CancerCancer• Digital rectal examination yearly after age 40Digital rectal examination yearly after age 40• Occult blood test yearly after age 50Occult blood test yearly after age 50• Proctosigmoidoscopy every 5 years after age Proctosigmoidoscopy every 5 years after age
50, following 2 negative results of yearly 50, following 2 negative results of yearly examinationexamination
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COLLABORATIVE COLLABORATIVE MANAGEMENTMANAGEMENT
Surgery Surgery • Hemicolectomy (ascending and Hemicolectomy (ascending and
transverse)transverse)• Abdomino – Perineal Resection Abdomino – Perineal Resection
(APR) for rectosigmoid cancer(APR) for rectosigmoid cancerNecessitates permanent colostomyNecessitates permanent colostomy
ChemotherapyChemotherapy• Fluorouracil (most effective)Fluorouracil (most effective)
Radiotherapy Radiotherapy • Adjuvant treatmentAdjuvant treatment
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Renal Cell Renal Cell CarcinomaCarcinoma
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Pathophysiology:Pathophysiology:
Tumor (anywhere in the kidneys)
Compression on the surrounding surface
•Ischemia
• necrosis
• hemorrhage
Metastasis
Primary sites
•Lungs
•Liver
•Lymph nodes
•Renal veins
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Signs and SymptomsSigns and Symptoms
Abdominal painAbdominal pain HematuriaHematuria S/sx of shockS/sx of shock
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Nursing Interventions:Nursing Interventions:
Monitor closely for:Monitor closely for:• Fluid and electrolyte status.Fluid and electrolyte status.• I & OI & O• Acid-base balanceAcid-base balance
SymptomaticSymptomatic Prepare for possible surgeryPrepare for possible surgery Institute postop careInstitute postop care