Ch 16: What is Cancer and Benign Breast Disorders

Cancer

is a group of diseases characterized by uncontrolled and unregulated cell growth.

What is considered a disease of aging?

Cancer, most commonly diagnosed in those over age 55. 2nd most leading cause of death and most common in men.

Biology of Cancer Development

Two major dysfunctions present in the process of cancer development are defective cell proliferation (growth) and defective cell differentiation.

Normal Cell Proliferation

• All cells are controlled by these intracellular mechanisms

  • Apoptosis (cell degeneration or death triggers proliferation)

  • Physiologic need for more cells (ex: increased WBC w/ infection)

  • Contact inhibition; cells proliferate in their respectable location.

Cancer Cell Proliferation

Cell does not respond to controlled intracellular mechanisms

• cancer cell proliferates with no control or regard for contact inhibition; invades other cells spaces

Normal Cell Differentiation

• All cells can perform all functions until differentiation

  • Maturation and stabilization of cells

  • Genes lock cells into mature state

  • Cannot dedifferentiate (cardiac cells stay cardiac cells)

Cancer Cell Differentiation

• Cancer cells become unlocked. When this lock is “unlocked,” which can occur through exposure to carcinogens (agents that cause cancer) or oncogenic viruses, genetic alterations and mutations occur.

  • Cells become malignant and dedifferentiate, invading other cells.

Carcinogens

are cancer-causing agents capable of producing cell alterations. They may be chemical, radiation, or viral.

Promoting Factors of Cancer

• Obesity

• Smoking

• Alcohol

• Diet

• Physical inactivity

• Changing a person’s lifestyle to modify these risk factors can reduce the chance of cancer development.

Metastasis

cancer spread to other parts of the body.

Begins in primary tumor → angiogenesis (its own blood source to thrive and survive) = tumor invades blood vessels and travels → invades other organs

Immune System

helps w/ detecting cancer and fighting it off

• body recognizes normal cells (self) and abnormal cells (not self)

• Cancer cells can be rejected and destroyed once detected through immunologic surveillance

• Lymphocytes constantly check for abnormal cells and destroy them.

Immunologic Escape

cancer cells evade the immune system via escaping

Carcinomas

originate from embryonal ectoderm (skin and glands) and endoderm (mucous membrane linings of the respiratory tract, GI tract, and genitourinary [GU] tract).

Sarcomas

originate from embryonal mesoderm (connective tissue, muscle, bone, fat).

Lymphomas and leukemias

originate from the hematopoietic system.

Staging

Classifying the extent and spread of disease

Stage 0

Cancer in situ (it is in original place; has not spread)

Stage IV

Metastasis; cancer has spread

Benign tumor

typically ends in -oma while malignant tumors typically end w/ carcinoma or sarcoma (Adenocarcinoma, Osteosarcoma)

TNM classification

There are 3 parameters: tumor size and invasiveness (T), presence or absence of regional spread to the lymph nodes (N), and metastasis to distant organ sites (M).

Warning Signs of Cancer: CAUTION

Change in bowel or bladder habits 

A sore that does not heal 

Unusual bleeding or discharge from any body orifice 

Thickening or a lump in the breast or elsewhere 

Indigestion or difficulty in swallowing 

Obvious change in a wart or mole 

Nagging cough or hoarseness

Early Detection and Prevention of Cancer

• Regular screenings

• Lifestyle changes

• CAUTION warning

• Breast Self-Exam

Mastalgia

Breast pain

Mastitis

inflammation of the breast tissues from a plugged duct

• occurs typically in lactating women

• cured w/ antibiotics

• encourage warm showers and massaging breasts

• breastfeed to clear the ducts!

Breast Abcess

pocket of pus in the breast; located w/ ultrasound and drained, sometimes treated w/ antibiotics.

Fibrocystic Changes

changes in breast tissue; develop as lumps that move freely and are not cancerous

Fibroadenoma

benign breast lump, round and well delineated, move freely.

Bad Breast Cancer Lumps

Painless and immovable lumps.

Trends in the death rates from cancer that affect health promotion programs include

d. lung cancer is a leading cause of death among men and women.

The nurse is caring for a female who had surgery 1 day ago to remove a breast mass. The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to

d. let her communicate about the meaning of this experience.

Surgery is used in cancer care to

all of the below

a. diagnose cancer.

b. cure or control cancer.

c. provide supportive care.

d. prevent spread of cancer.

e. assist with rehabilitation after treatment.

The most effective method of administering a chemotherapy agent that is a vesicant is to

c. use a central venous access device.

A patient on chemotherapy and radiation for head and neck cancer has a WBC count of 1.9 × 103/μL, hemoglobin of 10.8 g/dL, and a platelet count of 99 × 103/μL. Based on the CBC results, which are the most serious clinical findings?

a. Anorexia and nausea

b. Headache, mucositis, and constipation

c. Fatigue and skin redness at site of radiation

d. Temperature of 101.9°F, fatigue, and shortness of breath

The nurse, who is teaching a patient how to manage chemotherapy-induced diarrhea, determines that teaching is successful when the patient states

c. “I will decrease fried and fatty foods in my diet.”

A patient receiving treatment for cancer is having problems maintaining their weight. What is the best option that the nurse can do for the patient?

d. Suggest adding nutrition supplements with meals.

A patient who recently started chemotherapy has uncontrollable nausea, diarrhea, muscle cramps, and dizziness. Which complication of cancer is this most likely caused by?

a. Tumor lysis syndrome

Tumor Lysis Syndrome (TLS)

• Metabolic complication characterized by rapid release of intracellular components in response to chemotherapy and radiation therapy (less often).

• Massive cell destruction releases intracellular components (potassium, phosphate, DNA, RNA) that are metabolized to uric acid by liver

s/s:

• Hallmark signs: hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia.

• Weakness, muscle cramps, diarrhea, nausea, vomiting, cardiac dysrhythmia, seizure, syncope.

• Occurs within 24–48 hr after starting chemotherapy.

• May last 5–7 days.

• Metabolic abnormalities and concentrated uric acid (which crystallizes in distal tubules of kidneys) can lead to acute kidney injury.

Nursing management:

• Identify patients at risk.

• Monitor for and address abnormal electrolyte values.

• Maintain high urine output with hydration therapy.

• Decrease uric acid concentration with allopurinol.

• Implement safety precautions.

A woman has recently been diagnosed with early-stage uterine cancer. What can you do to promote effective coping strategies? (select all that apply)

a, b and c

a. maintain the patient’s hope.

b. connect the patient to a support group.

c. help the patient in setting realistic goals