RGV College: An Overview of Cancer

Cancer: An Overview

I. Cancer Statistics and Epidemiology

• Lifetime Risk of Cancer: Approximately $1$ in $2$ men and $1$ in $3$ women will develop cancer in their lifetime.

• Most Common Sites of Cancer:

  • Men: Prostate, lung, colon, and rectum.

  • Women: Breast, lung, colon, and rectum.

• Leading Cause of Death: Cancer is the second leading cause of death in the U.S., following heart disease.

• Top Cancer Incidences by Sex and Combined:

  • Male: Prostate cancer.

  • Female: Breast cancer.

  • Both combined: Lung cancer.

• Prevalence and Age: Cancer is more prevalent in the older generation.

• Racial and Ethnic Disparities:

  • African Americans have a higher incidence of cancer than Anglos.

  • Asians have the lowest cancer rates among all populations.

  • Cervical Cancer: Higher incidence in Vietnamese women, followed by Hispanic-American women.

  • Breast Cancer: African-American women are less likely to get breast cancer than white women but are more likely to die from it.

  • Native Americans: Have the lowest cancer rates in the USA but higher mortality rates if they develop cancer.

II. Cancer Prevention Strategies

• Dietary Recommendations:

  • Limit intake of saturated fat and added sugars.

  • Consume vegetables from the cabbage family.

  • Eat fruits and vegetables high in beta-carotene.

  • Ensure high sources of Vitamin C daily.

  • Include daily high portions of lean protein.

  • Opt for low-fat dairy products.

  • Consume high grains (whole grains).

  • Eat more beans.

  • Avoid processed meats such as salt-cured, smoked, or nitrite-cured meats.

• Primary Prevention (preventing cancer from starting):

  • Smoking cessation.

  • Maintain a healthy diet.

  • Avoid excessive exposure to the sun.

  • Avoid using smokeless tobacco.

  • Avoid excessive alcohol consumption.

  • Exercise regularly.

  • Ensure adequate rest.

  • Undergo regular medical exams.

• Secondary Prevention (early detection and intervention):

  • General: Learn and practice self-examination.

  • Men:

    • Testicular self-examination (TSE).

    • Prostate-specific antigen (PSA) testing for men over $50$.

  • Women:

    • Pap test for cervical cancer screening.

    • Breast self-examination (BSE).

    • Mammogram biannually after age $40$.

III. Cellular Basis of Cancer

• Normal Cell Function:

  • Cells are the basic structure of tissues.

  • Cells reproduce steadily at a controlled rate.

  • Cells divide by splitting DNA and being replicated using RNA.

• Mutations and Cancer Development:

  • During cell division, errors in the genetic code can occur; these errors are called mutations.

  • As mutations accumulate, the likelihood of cancer development increases.

  • The process by which normal cells transform into cancer cells is via mutations.

• Causes of Cancer: May be caused by external and internal factors.

• Pathological Progression of Cellular Changes:

  • Hypertrophy: Increase in cell size.

  • $\rightarrow$ Hyperplasia: Increase in number of cells.

  • $\rightarrow$ Metaplasia: Change in cell type.

  • $\rightarrow$ Dysplasia: Disordered cell growth.

  • $\rightarrow$ Anaplasia: Loss of differentiation (characteristic of malignancy).

IV. Terminology and Characteristics of Cancer Cells

• Neoplasm: A new growth; characterized by abnormal or uncontrolled growth.

• Benign: Not recurrent or progressive; indicates a non-cancerous growth.

• Malignant: Abnormal cell growth with a loss of normal role and function; cancerous.

• Tumor: A growth; can be local (affecting local tissue and surrounding areas) or invasive (affecting local tissue and different surrounding areas).

• Metastasis: The process by which tumor cells spread from the primary site to a secondary site.

• Differentiated Cells: Cells that are recognizable from normal cells in size, shape, and color.

• Undifferentiated Cells: Cells that are unrecognizable from normal size, shape, color; often associated with higher malignancy grades.

• Immunosurveillance: The immune system's recognition and destruction of newly developed abnormal cells.

• Angiogenesis: The formation of new blood vessels to supply the growing tumor or growth.

• Oncogene: Genes responsible for causing cell differentiation.

• P53: A cellular gene that causes preprogrammed cell death in cases of erroneous nuclear mutation; known as a tumor suppressor gene expression.

• Apoptosis: Preprogrammed cell death due to the normal cell cycle or premature mutation problems.

• Characteristics of Malignant Cells:

  • Rapid growth.

  • Irregular shape.

  • Rarely contained within a capsule.

  • Capable of metastasis.

  • Little resemblance to parent tissue (undifferentiated).

V. Types of Malignant Tumors

• Carcinoma:

  • Malignant tumors composed of epithelial cells.

  • Tend to metastasize.

  • Originate from embryonal ectoderm (skin and glands) and endoderm (mucus membrane linings of the respiratory, GI, and GU tracts).

• Sarcoma:

  • Malignant tumors of connective tissues.

  • Originate from embryonal mesoderm.

  • Often painless (e.g., Kaposi's Sarcoma).

• Lymphoma and Leukemia:

  • Malignant tumors that originate from the hematopoietic system (blood).

VI. Metastasis: Spread of Cancer

• Definition: The process by which tumor cells spread from the primary site to a secondary site.

• Secondary Tumors: Once cancer cells move to another area, secondary tumors may grow there.

• Naming Convention: The cancer is always named for the tissue of origin, regardless of where it metastasized.

• Mechanisms of Metastasis:

  • Direct spread of tumor cells by diffusion to other body cavities.

  • Circulation via blood and lymphatic channels.

VII. Cancer Staging and Classification Systems

• Clinical Staging:

  • Stage 0: Carcinoma in situ (tumor in place, not invasive).

  • Stage I: Tumor limited to the tissue of origin.

  • Stage II: Limited local spread.

  • Stage III: Extensive local and regional spread.

  • Stage IV: Metastasis to distant sites.

• TNM Classification System:

  • T (Tumor): Measures tumor size.

    • $\text{Tx}$-Tumor cannot be adequately assessed.

    • $\text{T0}$-No evidence of primary tumor.

    • $\text{Tis}$-Carcinoma in situ.

    • $\text{T1-T4}$-Size and extent of the primary tumor (increasing numbers indicate larger size/extent).

  • N (Nodes): Describes the degree of regional spread to the lymph nodes.

    • $\text{Nx}$-Regional lymph nodes cannot be assessed.

    • $\text{N0}$-No regional lymph node metastasis.

    • $\text{N1-N4}$-Degree of regional lymph node involvement (number and location of lymph nodes; increasing numbers indicate more involvement).

  • M (Metastasis): Indicates presence of distant metastasis.

    • $\text{Mx}$-Distant metastasis cannot be evaluated.

    • $\text{M0}$-No distant metastasis.

    • $\text{M1-M4}$-Distant metastasis present; specify site(s) (increasing numbers indicate more widespread metastasis).

  • Histopathology Grading (G): Assesses the differentiation of cells.

    • $\text{Gx}$-Grade cannot be assessed (undetermined grade).

    • $\text{G1}$-Well-differentiated grade (low grade, cells look similar to normal).

    • $\text{G2}$-Moderately differentiated (intermediate grade).

    • $\text{G3}$-Poorly differentiated (high grade).

    • $\text{G4}$-Undifferentiated (high grade, cells look very abnormal).

• Bethesda System (for Pap smear results of cervical cytology):

  • Negative: Normal (formerly Class I).

  • Probably negative: May indicate infection, atypical squamous cells, or reactive changes (formerly Class II).

  • Suspicious, but not conclusive for malignancy: Low-grade squamous intraepithelial lesion (formerly Class III).

  • More suspicious, strongly suggestive of malignancy: High-grade squamous intraepithelial lesion (formerly Class IV).

  • Conclusive for malignancy: Invasive squamous cell carcinoma (formerly Class V).

• Gleason Score: Mentioned as a classification system (details not provided in transcript, typically for prostate cancer).

VIII. Diagnostic Studies

• Biopsy:

  • Removal of a small piece of living tissue for microscopic examination.

  • Used to confirm/establish diagnosis, prognosis, or follow disease course.

  • Only definitive way to determine the presence of malignant cells.

• Endoscopy: Visual examination of internal organs or cavities.

• Diagnostic Imaging:

  • Radioisotope studies.

  • Computed Tomography (CT).

  • Ultrasound.

  • Magnetic Resonance Imaging (MRI).

  • Positron Emission Tomography (PET) scan.

• Lab Values/Tumor Markers:

  • $\text{PSA}$ (Prostate-Specific Antigen): Prostate cancer.

  • $\text{CA-125}$: Ovarian (gynecological) and pancreatic cancers; also breast, colorectal, uterine, cervical, liver, lung.

  • $\text{CA-19-9}$: Pancreatic and hepatobiliary cancers; also colorectal, liver, stomach, and biliary tree cancers.

  • $\text{AFP}$ (Alpha-fetoprotein): Ovaries and testes cancers.

  • $\text{Bence-Jones Proteins}$: Multiple myeloma or Chronic Lymphocytic Leukemia (CLL).

  • $\text{CA 15-3}$: Breast, lung, ovarian, bladder, gastrointestinal cancers.

  • $\text{CEA}$ (Carcinoembryonic antigen): Colorectal cancers; also breast, lung, gastric, kidney, thyroid, head and neck, cervical, ovarian, liver, lymphoma, melanoma.

  • $\text{HCG}$ (Human Chorionic Gonadotropin): Gestational trophoblastic neoplasia, germ cell, testicular cancers.

IX. Cancer Treatment Modalities

• Surgery: (Implied as a treatment modality by pre- and post-operative care topics).

• Radiation Therapy:

  • Nursing Interventions:

    • Provide patient education.

    • Keep skin dry.

    • Place a "Radiation in Use" sign on the patient's door.

    • Encourage Range of Motion (ROM) exercises.

    • Assess skin regularly.

    • Monitor Intake and Output (I&O).

    • Monitor nutritional status.

• Chemotherapy:

  • Categories of Agents: Alkylating agents, antitumor antibiotics, antimetabolites, hormonal agents, Vinca alkaloids.

  • Nursing Interventions:

    • Provide patient education.

    • Monitor nutritional status.

    • Administer antiemetics to manage nausea and vomiting.

    • Monitor hydration status.

• Complementary Therapies: A holistic approach to support the body.

  • Proper Nutrition: To boost immune response.

  • Proper Oxygenation: To decrease Reactive Oxygen Species (ROS).

  • Detoxification: To eliminate toxins from the body.

  • Antimicrobial agents: To eliminate antigens and assist the immune system.

  • Emotional effects on biological aspects: Utilizing meditation, prayer, relaxation, and frequency therapies.

• Biologic Therapy (formerly Immunotherapy):

  • Defined as treatment with agents derived from biologic sources or affecting biologic responses.

  • Utilizes Biologic Response Modifiers (BRMs), such as Colony-Stimulating Factors (CSFs), filgrastim, erythropoietin, Granulocyte-Macrophage Colony-Stimulating Factors (GM-CSFs), to:

    • Increase, restore, or modify the host's defenses against the tumor (e.g., interleukins, bacille Calmette-Guérin (BCG) vaccine).

    • Modify the biologic features of the tumor (e.g., interferons alpha, beta, and gamma).

X. Oncologic Emergency: Tumor Lysis Syndrome (TLS)

• Definition: An oncologic emergency characterized by rapid lysis (destruction) of malignant cells.

• Cause: Develops when chemotherapy or irradiation causes massive destruction of a large number of rapidly dividing malignant cells.

• Results in Electrolyte Imbalances: Hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia.

• Clinical Manifestations:

  • Early: Nausea, vomiting, anorexia, diarrhea, muscle weakness, cramping.

  • Later: Tetany, paresthesias, seizures, anuria, cardiac arrest.

• Diagnostic Tests and Medical Management:

  • Diagnosis: Made by assessment and lab values.

  • Medical Management: Hydration, diuretics, allopurinol (to reduce uric acid), sodium bicarbonate (to correct acidosis), calcium gluconate (to treat hypocalcemia).

• Nursing Interventions:

  • Administer medications as ordered.

  • Monitor for signs and symptoms of TLS and electrolyte abnormalities.

  • Promote anxiety relief.

  • Treat pain.

  • Prevent further complications.

• Prognosis: Typically resolves in $7$ days once treatment is initiated.

XI. Pain Management in Cancer

• Pharmacological Interventions: Opioids, NSAIDs (Nonsteroidal Anti-Inflammatory Drugs), other analgesics.

• Non-Pharmacological Interventions: Acupuncture, biofeedback, guided imagery, massage, distraction.

XII. Nursing Role in Cancer Care

• Patient-Centered Approach: Address fears, anxiety, dread, and hopelessness associated with a cancer diagnosis.

• Holistic Care: Use sensitivity across social, psychological, physical, and spiritual dimensions.

• Promote Well-being:

  • Use creativity to alleviate frustration, anxiety, and fear.

  • Promote self-care.

  • Assist in personal affairs such as case management, coping mechanisms, hospice care, or at-home care.

  • Provide effective pain management.

• Philosophical Underpinnings of Nursing Role:

  • Life is sacred and must be protected, fought for, and cherished.

  • Nursing cares for others and brings comfort in daily activities.

  • Nurses are agents of change in saving lives, increasing quality of life, and dignifying life transitions.

  • The human being is more than just a physical body, encompassing intricate preprogrammed DNA codes, cellular messages for adaptation, and detailed biochemical pathways.

  • Human personalities develop through environmental, biological, emotional, and spiritual factors.

  • Nurses are