Cancer

Nursing Care of the Patient with Cancer

Overview of Oncology

  • Definition: Oncology is the branch of medicine concerned with the diagnosis and treatment of cancer.

Key Aspects of Nursing Care for Cancer Patients

  • Requires:
      - Compassion
      - Knowledge
      - Keen assessment with attention to every detail

Cancer Statistics

  • Men (2020):
      - Prostate, lung, and colorectal cancers account for an estimated 43% of all cancers diagnosed.

  • Women (2020):
      - Breast, lung, and colorectal cancers will account for an estimated 50% of all new cancer diagnoses.

  • Global Data (2018):
      - 18.1 million new cases and 9.5 million cancer-related deaths.

  • Survival Rate:
      - 63% or more of newly diagnosed cancer patients are expected to be cured (alive in 5 years with no evidence of disease).

Definition and Pathophysiology of Cancer

  • Cancer is a group of distinct diseases with different causes, manifestations, treatments, and prognoses.

  • Characteristics:
      - Abnormal cell transformed by genetic mutation of cellular DNA
      - Proliferates without restraint
      - Invasive and metastasizes through blood and lymph

Cancer Cell Characteristics

  • Altered cell membrane

  • Presence of tumor-specific antigens on the membrane

  • Reduced fibronectin

  • Large and irregular nuclei

  • Increased fragility

  • More frequent mitotic activity

  • Higher demand for glucose and oxygen

  • May utilize anaerobic respiration pathways

Mechanisms of Cancer Spread

  • Invasion:
      - Growth into surrounding tissue facilitated by proteinases and mechanical pressure.

  • Metastasis:
      - Spread to distant sites through body cavities, lymph, or blood.

  • Local Seeding:
      - Tumors shed cells or emboli that implant onto surfaces of other organs within body cavities.

  • Angiogenesis:
      - Induction of new capillary growth to supply tumors.

  • Spread Types:
      - Lymphatic spread is most common; tumor emboli in interstitial fluid can lodge in lymph nodes.
      - Hematogenous spread—few cancer cells survive the turbulence of arterial circulation or immune destruction.

Etiology of Cancer

  • Factors contributing to cancer development include:
      - Viruses
      - Bacteria
      - Sun exposure, radiation, radon
      - Tobacco usage
      - Chemical agents
      - Genetic and familial factors
      - Dietary factors
      - Hormonal agents

Classification of Tumors

  • Benign Tumors:
      - Non-cancerous
      - Typically removable
      - Do not usually recur
      - Do not metastasize or invade other tissues

  • Malignant Tumors:
      - Cancerous
      - Can invade and damage surrounding tissues and organs
      - May metastasize through the bloodstream or lymphatic system

  • Small Cell Carcinoma:
      - Can create its own hormones, altering body chemistry.

Detection and Characteristics of Cancer

  • The smallest detectable cancer is approximately one-fourth inch in diameter, containing between 1 million to 1 billion cancer cells.

General Categories of Cancers

  • Carcinomas

  • Adenocarcinomas

  • Sarcomas

  • Leukemias and lymphomas

  • Brain cancers, nerve cancers, melanomas, and certain testicular and ovarian cancers do not fall into a general category.

Cancer Prevention

  • Pharmacological Measures:
      - Drugs like Tamoxifen (Nolvadex) FDA approved to decrease breast cancer risk in high-risk individuals.
      - NSAIDs being investigated for colorectal cancer prevention.
      - Vitamins and plant derivatives undergoing clinical trials.

  • Personal Accountability:
      - Avoid smoking and second-hand smoke
      - Maintain a balanced diet rich in fruits, vegetables, and complex carbohydrates
      - Control weight, reduce fat intake
      - Avoid sun exposure during peak hours; use sunscreen daily
      - Wear protective equipment in the workplace

Secondary Prevention Strategies

  • Emphasis on self-examination practices:
      - Skin, oral cavity, lymph nodes
      - Breasts or chest walls
      - Testicles/penis
      - Screening tests:
        - Mammogram, PSA, and others

Warning Signs of Cancer (CAUTION)

  • C – Change in bowel and bladder habits

  • A – Sore that does not heal

  • U – Unusual bleeding or discharge

  • T – Thickening or a lump in the breast or elsewhere

  • I – Indigestion or difficulty swallowing

  • O – Obvious changes in a wart or mole

  • N – Nagging cough or hoarseness

Diagnosis of Cancer

  • Steps to diagnose include:
      - History and physical examination
      - Blood and urine tests for abnormal cells
      - Tumor markers
      - Diagnostic imaging techniques—
        - X-ray (e.g., lung cancer)
        - CT (Computerized Tomography)
        - MRI (Magnetic Resonance Imaging)
        - Ultrasound
        - Radionuclide scanning
        - PET (Positron Emission Tomography)
        - SPECT (Single Photon Emission Computed Tomography)

Types of Biopsies

  • Biopsy Methods:
      - Removing a sample of tissue through techniques such as:
        - Needle biopsy
        - Endoscopic biopsy
        - Stereotactic biopsy
        - Surgical biopsy

Cancer Screening Guidelines

  • Recommended frequency based on age and risk:
      - General check-up every 3 years for ages 20-39; annually after 40 (more frequently if high risk).
      - Breast cancer: Mammogram at 40 and yearly thereafter (10 years earlier for special cases).
      - GYN cancers: Pap smear and pelvic exam for those over 21 or 3 years after first intercourse; pelvic exams continued post age 70.
      - Colorectal cancer: Colonoscopy after age 50 every 10 years.
      - Prostate cancer: Digital exam and PSA blood test annually for men aged 50 and older (unless at high risk).

Tumor Staging, Grading & Ploidy

  • Staging:
      - TNM (Tumor, Node involvement, Metastasis).

  • Grading:
      - Ranges from I (well differentiated) to IV (undifferentiated).

  • Ploidy:
      - Classifies tumor chromosomes as normal or abnormal.

Cancer Grading System

  • Nottingham Histologic Grading:
      - Grade 3-5: Cancer cells similar to normal cells.
      - Grade 6-7: Intermediate, likely aggressive growth.
      - Grades 8-9: More likely aggressive growth.

Staging Details

  • Stage 0: Carcinoma in situ

  • Stage I: Primary site, no spread
      - IA: Small amount of cancer
      - IB: Larger amount in tissues

  • Stage II: Spread to nearby areas
      - IIA: Spread beyond primary site
      - IIB: Spread to surrounding tissue

  • Stage III: Extensive spread in nearby areas

  • Stage IV: Involves distant organs
      - IVA: Spread to organs close to pelvic area
      - IVB: Spread to distant organs (e.g., lungs)

Nurse's Role in Cancer Diagnosis

  • Clarify misconceptions and allay fears of the patient.

  • Comfort during diagnostic procedures.

  • Assess outcomes from diagnostic tests.

  • Provide support to family members.

Management of Cancer

  • Surgical Options:
      - Treatment, prophylactic, palliative, reconstructive.

  • Nonsurgical Options:
      - Radiation, chemotherapy, bone marrow transplantation, hyperthermia, biological response modifiers.

Radiation Therapy

  • Purpose:
      - To damage cancer cells during cell division phases.

  • Typical Schedule:
      - Once daily for 5 days for 2-8 weeks, allowing time for cancer reoxygenation.

  • Methods:
      - External and internal (e.g., brachytherapy) radiation.

External Radiation Care

  • Treats superficial lesions and deeper structures.

  • Skin Care Protocol:
      - Inspect for redness and inquire about changes in sensation.
      - Avoid lotions, ointments, powders, or soaps.
      - Do not wash off skin markings for radiation.

Internal Radiation (Brachytherapy)

  • High doses localized via various methods (implants, needles, seeds, beads).

  • Necessitates patient protection, including potential isolation.

Radiation Safety Measures

  • Radiation exposure is directly proportional to the length of time exposed, the distance from the source, and the use of lead shielding.

  • Healthcare workers should wear radiation badges for monitoring.

  • Maintain a distance of 6 feet from the radiation source whenever possible.

Radiofrequency Ablation (RFA)

  • A technology under study that employs high-energy radio waves to destroy tumor cells.

Chemotherapy Overview

  • Purpose:
      - Systemic treatment aimed at destroying the maximum number of cancer cells while minimizing irreversible damage to normal cells.

  • Effect:
      - Targets rapidly dividing cells, leading to their death, leaving remaining cells to be eradicated by the body's immune system.

Chemotherapy Administration Protocol

  • Guidelines:
      - Established by the Oncology Nursing Society (ONS).
      - The nurse preparing the dose cannot administer it; another nurse must verify MD orders and IV contents.

Cell Cycle and Chemotherapy Timing

  • Cell Cycle Phases:
      - G0: dormant
      - G1: RNA and protein synthesis
      - S: DNA synthesis and mitotic spindle formation

  • Drugs may be cell cycle specific, phase specific, or nonspecific.

  • Combination therapies are often employed.

Types of Chemotherapy

  • Categories:
      - Antimetabolites, antitumor antibiotics, nitrosureas, alkylating agents, plant alkaloids, hormonal agents.

Cancer Treatment Principles

  • Strategies:
      - Single drug therapy and combination drug therapy.
      - Combination therapy advantages include increased efficacy and decreased drug resistance.
      - Drugs generally exhibit different mechanisms of action and spectra of clinical toxicities, enabling the administration of full doses.
      - Biological response modifiers are proteins that modify the body’s response to cancer.

Calculating Chemotherapy Dosages

  • Calculation Method:
      - Based on the patient’s weight (kg) and BSA (body surface area) determined by height and weight.
      - Double-check calculations and MD orders.

Administration Routes for Chemotherapy

  • Oral (pills)

  • Topical ointments

  • Intravenous (IV)

Chemotherapy Side Effects

  • Gastrointestinal: Nausea and vomiting, stomatitis, anorexia, mucositis, diarrhea.