cancer

Cancer Care Study Notes

INTRODUCTION

  • Cancer
    • Affects both males and females.
    • Affects all ages.
    • Presentation varies from asymptomatic to severe, and can manifest acutely or chronically.
    • Clinical features of cancer include:
    • Type
    • Staging
    • Molecular characteristics

EPIDEMIOLOGY

  • Global Impact

    • Cancer is the leading cause of death worldwide.
    • Most common types of cancer globally include:
    • Lung cancer (most prevalent in both men and women)
    • Breast cancer
    • Colorectal cancer
    • Stomach cancer
    • Prostate cancer

  • U.S. Statistics

    • Cancer is the 2nd leading cause of death in the U.S.
    • Current statistics indicate that 1 in every 4 deaths in the U.S. is attributed to cancer.
    • Demographics:
    • 78% of all cancer diagnoses occur in individuals aged 55 years and older.
    • Leading cancers based on gender are as follows:
      • Men: Prostate, Lung, Colorectal
      • Women: Breast, Lung, Colorectal

  • Risk Factors for Cancer

    • The most common risk factor for cancer is exposure to carcinogens.
    • Carcinogens alone are unlikely triggers; they influence cancer development in conjunction with other factors such as:
    • Environmental and hormonal factors
    • Lifestyle factors
    • Exposure to infectious diseases
    • Medications and immune status
    • Nutrition
    • Advanced age and genetic predisposition

THIRD-HAND SMOKE

  • Definition and Risks
    • Third-hand smoke refers to the residue from tobacco smoke that clings to clothing, bags, skin, and hair.
    • Contains toxic chemicals that become more toxic over time as chemical compounds change.
    • Children are particularly vulnerable due to their immature immune systems and developmental behaviors.
    • Poses health threats, including increased cancer risks.
    • Higher levels of third-hand smoke are found in environments with elevated smoking rates and permissive smoking policies.

WHAT IS CANCER?

  • Definition
    • Cancer is a disease characterized by abnormal mitosis (cell division) where normal checkpoints regulating mitosis are disregarded by the cell.
    • Process initiates when a single normal cell transforms into a cancer cell.
    • Causes often involve changes in one or several genes that normally control cell growth or suppress tumor formation.

PATHOPHYSIOLOGY

  • Carcinogenesis

    • Initiates with carcinogen exposure leading to single or multiple gene mutations.
    • Mutated cells evade detection by the immune system, allowing them to proliferate and develop into cancer.

  • Tumor Characteristics

    • Cancer cells replicate locally forming malignant tumors.
    • Metastasis:
    • Involves cell-to-cell transfer either through the lymphatic system or blood vessels.
    • Secondary tumors (metastatic) may be molecularly similar to the primary tumor.

EXAMPLES OF CARCINOGENS

  • IARC Carcinogen Classifications
    • The International Agency for Research on Cancer (IARC) classifies substances based on evidence of their carcinogenicity into five groups:
    • Group 1: Carcinogenic to humans (e.g., smoking, solar radiation, alcoholic beverages, processed meats)
    • Group 2A: Probably carcinogenic to humans (e.g., emissions from frying, red meat)
    • Group 2B: Possibly carcinogenic (e.g., coffee, gasoline)
    • Group 3: Not classifiable as carcinogenic
    • Group 4: Probably not carcinogenic (only one substance: caprolactam)
    • The IARC index measures the strength of evidence; substances within the same category can differ greatly in cancer risk.

TUMORS: GOOD CELLS GONE BAD?

  • Types of Tumors
    • Benign Tumors:
    • Tumor cells remain localized at the original site and do not spread.
    • Malignant Tumors:
    • Cells can break away from the tumor, spreading to surrounding tissues and forming new tumors (metastasis).

CHARACTERISTICS OF BENIGN AND MALIGNANT NEOPLASMS

  • Benign Neoplasms:

    • Cells are well differentiated.
    • Grow by expansion and are typically slow-growing.
    • Do not spread via metastasis; localized effects only.
    • Limited tissue destruction.

  • Malignant Neoplasms:

    • Cells are poorly differentiated and often undifferentiated.
    • Growth process involves invasive behavior, overcoming contact inhibition.
    • Growth rate can vary but is often rapid.
    • Metastasis occurs through vascular and lymphatic channels.
    • Generalized effects may include weight loss and anemia, with extensive tissue destruction.

PATHOPHYSIOLOGY CONT'D

  • Hallmark Signs of Cancer:
    • Uncontrolled cellular growth
    • Lack of contact inhibition
    • Failure to undergo apoptosis
    • Loss of anchorage dependence
    • Dysplasia: Presence of abnormal cells which may be pre-cancerous
    • Neoplasia: Formation or presence of new abnormal growth
    • Anaplasia: Loss of differentiation and specialization of cells, common in malignant tumors

CARCINOGENESIS STAGES

  • Stages of Carcinogenesis:
    • Initiation: Exposure to a carcinogen resulting in DNA mutation
    • Promotion: Repeated exposure leads to expression of mutation
    • Progression: Altered cells exhibit malignant behavior and initiate angiogenesis (formation of new blood vessels)

TYPES OF CANCER

  • Divided into two main categories:
    • Solid Tumors
    • Hematological Malignancies
    • Subcategories include:
      • Leukemia
      • Lymphoma
      • Multiple Myeloma
    • Further classified by organ/system of origin.

STAGING

  • Purpose of Staging

    • Helps to determine tumor size, extent of disease, and overall burden.
    • Aids in planning patient assessment and treatment strategies.

  • Staging Criteria for Solid Tumors:

    • Tumor size (T)
    • Lymph node involvement (N)
    • Presence of metastases (M)

  • Cancer Staging Continuum:

    • Stage I: Small tumor without spread beyond the organ.
    • Stage II: Invasion into tissues or local lymph nodes involved.
    • Stage III: Large or locally invasive tumors.
    • Stage IV: Cancers that have metastasized.

GRADING

  • Classification of Tumor Cells:
    • Grade I: Cells slightly differ from normal; well differentiated.
    • Grade II: More abnormal and moderately differentiated.
    • Grade III: Very abnormal and poorly differentiated.
    • Grade IV: Immature, primitive cells that are undifferentiated; difficult to determine origin.

CLASSIFICATIONS OF CANCER

  • Various types based on tissue origin:
    • Carcinoma/Adenocarcinoma: Epithelial tissue
    • Sarcoma: Connective tissue
    • Lymphoma: Lymphoid tissue
    • Leukemia: Blood-forming tissue (WBCs)
    • Multiple Myeloma: Plasma cells
    • Neuroblastoma: Nerve cells
    • Meningeal Sarcoma: Meninges

CLINICAL PRESENTATION

  • Types of Symptoms
    • Symptoms can be categorized as CAUTION symptoms which are vague and related to many disease processes:
    • C: Change in bowel or bladder habits.
    • A: A sore that does not heal.
    • U: Unusual bleeding or discharge.
    • T: Thickening or lump in breast or any part of the body.
    • I: Indigestion or difficulty swallowing.
    • O: Obvious change in a wart or mole.
    • N: Nagging cough or hoarseness.

PREVENTION

  • Primary Prevention

    • Aims to reduce cancer risk in healthy individuals through:
    • Risk factor modification
    • Health promotion
    • Immunizations
    • Chemoprevention: Use of medication, vitamins or supplements to prevent cancer in high-risk individuals.

  • Secondary Prevention

    • Early diagnosis and intervention through:
    • Noninvasive screening tests
    • Evaluation of family history for genetic syndromes
    • Activities for early detection.

  • Tertiary Prevention

    • Focuses on monitoring for and preventing recurrence of primary cancers, screening for secondary cancers, and reducing morbidity and mortality.

Prevention and Screening Methods

  • Healthy lifestyle practices can reduce cancer risks:

    • Avoid tobacco products
    • Limit sun exposure
    • Consume a diet rich in fiber, fruits, and vegetables.
    • Maintain healthy weight
    • Protect against known carcinogens.

  • Screening Methods

    • Breast self-exams/mammography, PAP test
    • Prostate screening & PSA tests
    • Testicular self-exams
    • Regular doctor visits
    • Knowledge of risk factors and family history.

DIAGNOSING CANCER

  • Initial Assessment Triggers

    • Presentations of CAUTION signs, constitutional symptoms of vague nature, or unexpected symptoms of unknown etiology.

  • Diagnostic Evaluation

    • Dependent upon suspected cancer subtype, possible disease location, and expected disease extent.
    • May include:
    • Laboratory tests
    • Imaging
    • Biopsy
    • Endoscopic procedures

NURSING MANAGEMENT

  • Involves care for patients with cancer across various medical subspecialties.
  • Can affect any organ system and managed in diverse clinical settings.

TREATMENT

  • May involve single therapy or multimodality approaches.
  • Types of Therapies:
    • Neoadjuvant therapy: Treatment prior to main treatment to shrink a tumor.
    • Adjuvant therapy: Treatment applied after initial treatment.

Major Treatment Modalities

  • Surgery
    • Includes diagnostic, biopsy, tumor removal, debulking, prophylactic, palliative, and reconstructive surgeries.
  • Radiation Therapy
    • Approximately 60% of all cancer patients will receive radiation therapy which typically results in cancer cells being more damaged than normal tissues.

Types of Radiation

  • Low-energy beams:
    • Quick energy expenditure, up to short penetration. Useful for treating skin lesions.
  • High-energy beams:
    • Greater depth of penetration, suited for internal targets while sparing skin.
    • Dosage depends on tumor size, type, and treatment setting.

IMPAIRED SKIN INTEGRITY

  • Protocols for managing erythematous areas include:
    • Avoid disrupting blisters
    • Limit frequent washing
    • Report blistering and use prescribed creams.
    • Apply non-adhesive absorbent dressings if weeping; use moisture-permeable dressings on non-infected areas.

INTERNAL RADIATION THERAPY

  • Brachytherapy:

    • Involve insertion of radioactive materials near or into the tumor.
    • Minimal exposure to healthy tissue but the patient emits radioactivity.

  • Nursing Protocol:

    • Private room, limit time spent with the patient, avoid pregnant staff, ensure patient comfort to mitigate feelings of isolation.

CHEMOTHERAPY

  • Mechanism of Action:
    • Systemic therapy aimed at destroying tumor cells by disrupting cellular functions, including replication.
    • The cell kill theory suggests that a consistent percentage of cells are killed with each dose, but it also affects normal cells.

Routes of Administration

  • Can include oral, intramuscular (IM), intravenous (IV), intracavitary, intrathecal, and others.
  • Importance of using central line access for long-term chemotherapy to minimize complications.

Factors Determining Response to Chemotherapy

  • Response depends on:
    • Mitotic rate of the tissue
    • Size of the tumor
    • Age of the tumor
    • Location concerning drug permeability (e.g., blood-brain barrier)
    • Presence of resistant tumor cells.

CHEMOTHERAPY SIDE EFFECTS

  • Adverse reactions can be broadly grouped:
    • Myelosuppression
    • Nadir phase occurs approximately 7-14 days post-treatment when blood counts are lowest.
    • Neutropenia: ANC < 1500 increases infection risk.
    • Thrombocytopenia and anemia are also significant concerns.

Additional Side Effects of Chemotherapy

  • Non-specific and drug-specific effects like fatigue, nausea, vomiting, stomatitis, etc.
  • Management:
    • Adhere to protocols during administration (e.g., precautions for irritants vs. vesicants)
    • Monitor and manage oral care, nutrition.

NUTRITIONAL CHANGES IN CANCER CARE

  • Common Issues:
    • Anorexia, nausea, malabsorption, and cachexia are prevalent.
    • Strategies include small appealing meals and therapeutic support for nutrition.
  • Expected outcomes include maintaining weight loss below 10%, encouraging fluid intake, and ensuring dietary adherence.

PAIN MANAGEMENT

  • Cancer pain should be assessed primarily based on patient reports.
  • A range of pharmacological choices exist for pain management, complemented by non-pharmacological techniques like relaxation therapy.

PSYCHOLOGICAL SUPPORT

  • Provide a supportive environment to maintain quality of life.
  • Actions include active listening, alleviating distressing symptoms, and fostering trusting relationships.

ALTERED BODY IMAGE

  • Addressing patient feelings towards their body image and self-esteem is crucial
  • Encourage participation in self-care and support through alterations in appearance due to treatment.