09-1.Cancer.Basics.Taped

Management of Patients with Oncologic Disorders

• Presented by Zelnez Amora, DNP, RN, CMSRN

Understanding Cancer

Definition

• Cancer: Abnormal, uncontrolled cell division resulting from damage to genes controlling growth.

• Characteristics:

  • Loss of normal functions.

  • Rapid division.

  • Invasion of surrounding cells.

Key Definitions

General Terms

• Metastasis: Abnormal cells traveling to other sites and establishing new tumors.

• Tumor: Abnormal enlargement of tissue.

• Neoplasm: Synonymous with tumor.

Types of Tumors

• Benign Neoplasms:

  • Slow growing.

  • Do not metastasize.

• Malignant Neoplasms:

  • Fast growing.

  • Typically metastasize, can lead to death.

  • Subtypes:

    • Sarcoma: Cancer in connective tissues.

    • Carcinoma: Cancer in epithelial tissues (more common).

Other Types of Cancer

• Leukemia: Cancer in blood-forming cells in bone marrow.

• Lymphoma: Cancer in lymphatic tissue.

• Glioma: Cancer in glial cells of the nervous system.

Genetic Factors in Cancer

• Oncogenes: Mutated genes that enable cancer development by disrupting cell growth and DNA repair mechanisms, often linked to environmental factors.

Precision Medicine

• Utilization of biological databases (e.g., human genome sequencing).

• Identification of unique patient characteristics (genomics, cellular assays).

• Ongoing research under the precision medicine initiative focusing on preventing and curing cancers (Collins & Varmus, 2015).

Malignant Process

• Cell Proliferation Responses:

  • Genetically altered cells proliferate abnormally.

  • Evade normal regulatory and immune processes.

  • Abnormal cell signaling leads to cancer development.

  • Resulting in metastasis.

Characteristics of Neoplasms

Comparison between Benign and Malignant Tumors

• Cell Characteristics

• Mode of Growth

• Rate of Growth

• Metastasis Potential

• General Effects

• Tissue Destruction

• Disease Causation

Carcinogenesis

• Malignant Transformation:

  • Initiation: Apoptosis of damaged cells.

  • Promotion: Formation of preneoplastic or benign lesions.

  • Progression: Involvement of angiogenesis for tumor growth.

Carcinogenic Agents and Factors

• Categories Include:

  • Viral and bacterial agents.

  • Physical agents (sunlight, radiation, chronic irritation).

  • Chemical agents (tobacco, asbestos).

  • Genetic and familial predispositions.

  • Lifestyle factors and hormonal influences.

Prevention Strategies

Types of Prevention

• Primary Prevention: Health promotion and risk reduction strategies.

• Secondary Prevention: Screening and early detection of precancerous lesions.

• Tertiary Prevention: Monitoring for cancer recurrence and development of secondary malignancies in survivors.

Diagnosis of Cancer

• Goals of Diagnosis:

  • Identify presence and extent of tumors.

  • Evaluate possible metastasis.

  • Assess functions of affected and unaffected body systems.

  • Tissue and cellular analysis for tumor staging and grading.

Tumor Staging and Grading

• Staging: Evaluates tumor size, invasion, nodal involvement, and metastasis (TNM classification).

• Grading: Pathologic classification of tumor cells (grades I-IV).

Cancer Management Approaches

• Treatment specifics depend on cancer type, stage, and grade.

• Goals include:

  • Cure

  • Control

  • Palliation

Surgical Treatment Options

• Types of Surgery:

  • Diagnostic surgeries (biopsy types).

  • Tumor removal (wide, local excisions).

  • Prophylactic and palliative surgeries.

  • Reconstructive surgery post-treatment.

Radiation Therapy

• Uses:

  • Curative, control, or palliative care.

• Types:

  • External and Internal Radiation.

• Side Effects and Reactions:

  • Management of toxicity and radiation reactions.

Nursing Care during Radiation Therapy

• Focus on healing, comfort, and quality of life.

• Assessments:

  • Skin integrity, nutritional status, overall well-being.

  • Caregiver protection measures.

Chemotherapy Overview

• Mechanism of Action: Destroys cancer cells by interfering with replication.

• May be combined with other treatments (surgery, radiation).

• Goals: curative, control, or palliative.

Chemotherapy Administration Considerations

• Monitoring dosages, the risk of extravasation, nadirs, and hypersensitivity reactions.

Chemotherapy Toxicity Profiles

• Potential toxicities include:

  • Gastrointestinal, Hematopoietic, Renal, Cardiopulmonary, Reproductive, Neurologic, Cognitive, and Fatigue.

Neutropenic Precautions

• No sick visitors.

• Avoid plants or fresh fruits/vegetables.

Nursing Management during Chemotherapy

• Assess fluid and electrolyte status.

• Monitor cognitive status.

• Mitigate risks for infection and bleeding.

• Administer medications and manage side effects (nausea, vomiting).

Hematopoietic Stem Cell Transplantation (HSCT)

• Utilized for treating various malignant and nonmalignant diseases.

• Types of HSCT:

  • Allogeneic, Autologous, Syngeneic, Myeloablative, Nonmyeloablative.

Graft-versus-Host Disease (GVHD)

• Major cause of morbidity and mortality in allogeneic transplants.

• Occurs when donor lymphocytes attack recipient tissues.

• Prevention involves immunosuppressant medications (e.g., cyclosporine).

Nursing Management during HSCT

• Care Phases:

  • Pretransplantation.

  • During treatment.

  • Post-transplantation care for recipients and donors.

Nursing Care of Cancer Patients

• Focus on maintaining tissue integrity: stomatitis, skin integrity, alopecia, malignant lesions.

Nutritional Management

• Addressing nutritional impairment and cancer-related anorexia-cachexia syndrome.

• Strategies to relieve pain and manage fatigue.

Monitoring for Complications

• Infection and septic shock.

• Risk of bleeding and hemorrhage.

Hospice Care

• Importance of early referral for comprehensive care in terminal illness.

• Focus on quality of life and palliation of symptoms, including psychosocial support.

Questions and Key Learning Areas

• Understand basic cancer terminologies, tumor staging, and differences between benign and malignant tumors.