Unit 12.1 - Cancer Care

Cancer

Abnormal cell growth.

Cellular regulation lost, resulting in:

• new tissues that serve no useful function.

• harm to the function of normal cells and organs.

• death if left untreated.

Risk Factors

External

• chemical, radiation, chronic irritation and tissue trauma (burns), viruses (HPV, Hep B & C, HIV), diet (red meat, additives/sweeteners, low-fibre).

Personal

• immunity, age, genetics.

Normal vs Cancer Cells

1. Normal cells have a distinct appearance, size, and shape (morphology); cancer cells do not look like parent cell (anaplasia).

2. Normal cells have a small nucleus; cancer cells have a large nucleus.

3. Normal cells have a particular function; cancer cells do not serve a purpose.

4. Normal cells bind closely together (tight adherence); cancer cells break off easily (loose adherence).

5. Normal cells do not wander (nonmigratory); cancer cells spread to other areas of body (migration).

6. Normal cells divide only under certain conditions - balance of proto-oncogenes (promote growth) and suppressor genes (inhibit growth); cancer cells divide even when touching other cells (contact inhibition).

7. Normal cells die at the appropriate time (apoptosis); cancer cells have an unlimited life span and ignore signals for apoptosis.

8. Normal cells have a complete set of chromosomes (euploidy); cancer cells have abnormal chromosome number or structure.

Cancer Cell Development

1. Initiation - mutation in cell’s genetic structure; proto-oncogenes change to oncogenes, and loss of suppressor gene function.

2. Promotion - growth of mutated cells.

3. Progression - continued change and growth of cancer cells; tumor develops own blood supply.

4. Metastasis - spread of cancer to another location within body.

Steps of Metastasis

1. Malignant Transformation - some normal cells have undergone malignant transofrmation and have divided enough times to form a tumorous area.

2. Tumor Vascularization - cancer cells secrete vascular endotehlial growth factor (VEGF), stimulating the blood vessels to forn new channels that grow into the tumor.

3. Blood Vessel Penetration - cancer cells have broken off from the main tumour; enzymes make holes in the blood vessels allowing for travel around the body.

4. Arrest and Invasion - cancer cells clump up in blood vessel walls and invade new tissue areas.

Grading

x = unknown

Higher number = worse

Cancer Management

Cure - eradicate the cancer.

Control - cancer can’t be completely removed bus is responsive to therapies (surgery, radiation, and/or chemotherapy).

Palliation - relief or control of symptoms and optimizations of quality of life.

Surgery Types

Prophylactic - prevent cancer development.

Diagnostic - excisional biopsy to rule out cancer.

Curative - remove all cancer.

Debulking - remove part of cancer tissue.

Palliative - provide symptom relief.

Reconstructive/Restorative - increases function or appearance.

Side Effects: changes in appearance or activity level.

Radiation Therapy

High dose radiation to a local area.

Given as a series of doses over a set of time.

Skin Care:

• Don’t remove ink markings.

• Avoid skin irritation and friction from clothing.

• Skin in radiation path is photosensitive - avoid direct sun exposure.

• Pat area dry, do not rub.

Side Effects: radiation dermatitis, altered taste, fatigue, bone marrow suppression.

Chemotherapy

Drug therapy to kill cancer cells and disrupt their cellular regulation.

Given on a regularly scheduled basis timed to maximizae cancer cell kill and minimize damage to normal cells.

Side Effects:

• Bone Marrow Suppression

  • montior blood cell counts (WBC, RBC, platelets).

  • monitor symptoms of infection

• Nausea & Vomiting

  • eat slow, keep upright, serve food at cold or room temp.

  • small frequent meals.

  • monitor weight and signs of dehydration.

• Mucositis

  • maintain oral hygiene and good nutrition.

  • treat infections.

• Alopecia

  • temporary.

  • avoid direct sunlight on scalp.

• Cognitive Function

  • decreased ability to concentrate, memory loss, difficulty learning new information.

  • can last for years after treatment.

• Peripheral Neuropathy

  • loss of sensation in limbs, impaired mobility and balance, erectile dysfunction, loss of taste, constipation.

  • can last years after therapy.

  • avoid injury.