Cancer & Cancer Pain

CANCER & CANCER PAIN

INTRODUCTION

  • Instructor: Professor Cynthia Bivens, MSN, RN, BSDH, RDH

  • Course: NP3

PATIENT QUESTION EXAMPLE

  • Scenario: Patient with colorectal cancer receiving first dose of bevacizumab (a targeted biologic response modifier that inhibits angiogenesis).

  • Best response by the RN: "It will prevent the formation of new blood vessels that cancer cells need to grow."

  • Incorrect alternatives:

    • "It will prevent DNA in the cancer cells from replicating."

    • "It will block the folic acid needed to replicate RNA in the cancer cells."

    • "It will cross the blood-brain barrier to kill cancer cells that have traveled to the brain."

OBJECTIVES

  • Define cancer biology

  • Understand cancer statistics

  • Explore cancer diagnosis

  • Discuss cancer treatment options

  • Examine pain management in cancer

  • Identify cancer complications

  • Investigate cancer prevention methods

DEFINITION OF CANCER

  • Cancer is defined as the uncontrolled division of abnormal cells.

BIOLOGY OF CANCER

Major Dysfunctions in Cancer Development

  1. Defect in Cell Proliferation: This refers to the abnormal growth of cells, leading to tumor formation.

  2. Defect in Cell Differentiation: The process by which cells become specialized is impaired, often resulting in immature or nonfunctional cells.

Development of Cancer Stages

  • Initiation: Genetic mutations in cells are either inherited or acquired.

  • Promotion: Factors encourage proliferation of those mutated cells.

  • Progression: Tumor evolves into a more invasive form, potentially spreading to other parts of the body.

Metastasis Sites

  • Common sites for metastasis include:

    • Liver

    • Bone

    • Brain and cerebrospinal fluid

    • Lung

GENETIC LINKS IN CANCER

  • Proto-oncogenes: Normal cell genes regulating growth; mutations can activate them into oncogenes (tumor-inducing).

  • Tumor Suppressor Genes: Genes that normally suppress growth; mutations can lead to inactivation.

  • Examples:

    • BRCA1 and BRCA2: Associated with hereditary breast and ovarian cancer risk.

    • APC Gene: Associated with familial adenomatous polyposis, a precursor to colorectal cancer.

CARCINOGENS

  • Definition: Cancer-causing agents capable of producing alterations in DNA.

U.S. CANCER STATISTICS

Prevalence

  • 2nd most common cause of death in the U.S.; Leading cause for individuals aged 40-79 years.

  • Mortality statistics:

    • More than 1,600 people die every day from cancer.

    • Mortality rates for common cancers are declining.

    • Approximately 14.5 million cancer survivors in the U.S. as of recent estimates (possibly rising to 15.5 million).

Incidence

  • Higher incidence in men vs. women.

    • Prostate cancer: Most common form in men.

    • Breast cancer: Most common form in women.

  • Higher incidence and mortality rates observed in African Americans vs. Caucasians.

  • More than 200 different types of cancer, all sharing characteristics of:

    • Defective cellular proliferation

    • Defective cellular differentiation

DIAGNOSIS OF CANCER

Diagnostic Techniques

  • Biopsy:

    • Types include needle, incisional, and excisional biopsies.

  • Cytology: Study of individual cells.

  • Radiography: Imaging techniques to visualize abnormalities.

  • Endoscopy: Visual inspection of internal organs.

  • Blood/Bone Marrow Tests: Evaluating blood criteria and marrow activity.

  • Genetic and Tumor Markers: Identifying genetic predispositions and tumor presence.

Clinical Staging of Cancer

  • Stage 0: Carcinoma in situ; localized.

  • Stage I: Tumor localized to tissue of origin.

  • Stage II: Limited local spread.

  • Stage III: Extensive local and regional spread.

  • Stage IV: Metastasis to other organs.

TNM System for Cancer Staging

  • T (Primary Tumor): Staged 0-4 based on size and extent.

  • N (Regional Lymph Nodes): Staged 0-4 reflecting involvement.

  • M (Distant Metastases): Presence classified as 0 (absent) or 1 (present).

IDENTIFYING METASTASES

  • Imaging Tests:

    • PET Scan

    • CT Scan

    • MRI Scan
      These are utilized pre-therapy and post-therapy to assess cancer spread.

CANCER TREATMENTS

Treatment Modalities

  1. Medications

  2. Radiation

  3. Surgery

  4. Nutritional Interventions

    • External Beam Radiation Therapy (EBRT)

    • Brachytherapy

Medications to Remember

  • Class names suffice; specific drug emphasis designated.

Safety Alerts in Oncology

  • Occupational Hazards: Chemotherapy drugs pose potential risks to healthcare professionals; safe handling guidelines are crucial.

  • Administering Chemotherapy: Requires specific training and certification; compliance with hospital policy is mandatory, with certifications renewed every 2 years through the Oncology Nursing Society (ONS).

Routes of Administration

  • Oral

  • Subcutaneous

  • Intramuscular

  • Intravenous

  • Intra-peritoneal

  • Intravesical (bladder)

  • Intraarterial

  • Intrathecal (injection into the cerebrospinal fluid)

CHEMOTHERAPY RESPONSE FACTORS

  • Mitotic Rate: Rapid mitotic rate of origin tissue correlates with better response.

  • Tumor Size: Smaller tumors = greater probability of response to treatment.

  • Tumor Age: Younger tumors often respond better.

  • Tumor Location: Some agents may not effectively cross the blood-brain barrier, and resistant malignant cells may pass on resistance to progeny.

ALKYLATING AGENTS

  • Function: Damage DNA.

    • Example: Nitrogen mustards (e.g. Cyclophosphamide - Cytotoxan)

  • Caution: Can lead to hemorrhagic cystitis; cytoprotectant such as mesna is used to mitigate this.

PLATINUM DRUGS

  • Function: Damage RNA and/or DNA.

    • Examples:

      • Cisplatin

      • Carboplatin

      • Oxaliplatin

ANTIMETABOLITES

  • Function: Interfere with enzymes or DNA synthesis.

    • Examples:

      • Fluorouracil (5-FU)

      • Capecitabine (Xeloda)

      • Methotrexate (Folic Acid antagonist)

MITOTIC INHIBITORS

  • Function: Interfere with mitosis or DNA replication.

    • Examples:

      • Paclitaxel (Taxol)

      • Docetaxel (Taxotere)

      • Vinblastine

      • Vincristine (Oncovin)

    • Includes plant alkaloids.

SIDE EFFECTS OF CHEMOTHERAPY

  • Immunosuppression: Patients require reverse isolation due to heightened risk of infections; adherence to neutropenic precautions is critical.

  • Neutropenia: Reducing neutrophils, major players in phagocytizing microbes; ANC (Absolute Neutrophil Count) calculated as:
    extANC=extTotalWBCimesextNeutrophil%ext{ANC} = ext{Total WBC} imes ext{Neutrophil \%}

  • Alopecia: Management includes use of wigs, scarves, and hats.