Cancers: Julie Mann, Np N145

Cancers Julie Mann, NP N145

What is Cancer



Uncontrolled cellular proliferation that knows no limits and serves no purpose.

the cell Cycle

 Cells

reproduce at an inherit rate  Respond to environmental changes in the body by sending messengers called growth signals  Growth signals reach the nucleus and proteins called transcription factors turn on and off genes that promote cell proliferation

Cancer & the Cell Cycle

 CA

cells do not respond to normal cues about cellular reproduction  CA cells:  Have autonomy Go through anaplasia Have immortality

Characteristics of CA cells • unregulated • low

differentiatiated

• genetic

instability

• independent • low • no

growth

of growth factors

cell to cell adhesion

density-dependent inhibition

Tumor Classification

• Benign

Tumors

• Malignant

Tumors

Gene and Chromosome Abnormalities

 Mutation  Proto-oncogenes  Oncogenes  Tumor

Suppressor genes  DNA repair genes 

Alterations of pro-growth and antigrowth signals

Tumor Markers

 Def:

substances produced by CA cells that are found on tumor plasma membranes or in blood, spinal fluid, or urine.  Examples: hormones, enzymes, genes, antigens, and antibodies

Viral and bacterial cause of CA

Initial acute infection not associated with CA  Chronic infection can lead to CA 



Examples:  Viral:

HPV  Bacterial: Helicobacter Pylori

Environmental Risk Factors  Tobacco

use

 Diet  Alcohol

Consumption  Sexual and Reproductive behavior  Air pollution  Occupational hazards  Ultraviolet radiation  Ionizing radiation  Hormones Oral contraceptives Estrogens Progestogen and Androgens

Tumor Spread

Local spread by direct invasion of contiguous organs • Metastasis to distant organs by lymphatics and veins • Metastasis by implantation •

Mechanism of Local Spread

 Cellular

multiplication  Mechanical pressure  Release of lytic enzymes  Decreased cell to cell adhesion  Increased motility of individual tumor cells

Cancer Warning Signs Change in Bowel/Bladder Habits 2. A Sore that does not heal • Unusual bleeding or discharge • Thickening or lump in breast or elsewhere • Indigestion or difficulty swallowing • Obvious change in wart or mole • Nagging cough or hoarseness •

Tumor Staging



TNM System  T:

tumor spread  N: node involvement  M: presence of distant metastasis

Grading System I-IV

Case #1 • Colin

is a 30 year old caucasian male who presents to a clinic with c/o frequent diarrhea and constipation and change in bowl pattern. He recently traveled to the Caribbean islands and a fellow travel also is having bowl problems. He has not seen doesn’t have a primary care physician and hasn’t sought medical care for over 5 years prior to today.

• What

might be going on with Colin?

• What

would you anticipate might be ordered?

• Colin,

who isn’t a fan of the medical community since his mom died of breast CA 5 years ago, sees several Primary care doctors and a holistic healer before one of the Doctors orders a colonoscopy and a CT of his abdomen. During this time Colin thinks he developed either a tropical illness, as his friend did, or picked up a tape worm. Several months has past and he has lost about 20 lbs and is pale and

• The

CT results indicate a mass in his colon and small masses in his liver.

• He

has surgery to remove the tumor in the colon and the liver is evaluated for possible removal of the tumors. However the tumors were so numerous in his liver that removal wasn’t possible.

• What

stage do you think his CA was at?

• What

do you think his prognosis was?

Risk Factors • Age

> 50 years old

• family

history of CA

• Crohn

Disease & Ulcerative Colitis

• familial • Poor

adenomatous polyposis of the colon

diet

Symptoms • bleeding • change

in bowel habits

• diarrhea • sense

or constipation

of urgency or incomplete emptying of the

bowel • pain

(a late symptoms)

Case #2 • Mary

is a 60 year old post menopausal female with a pmh of smoking 30 pack years. She presents to her GYN for her annual exam and her MD notices her left nipple is retracted and she feels a lump under her areola.

• What

puts her at risk for breast CA?

• What

tests would be ordered?

Breast CA  Fibroadenoma  Carcinoma

of the Breast Susceptible genes BRCA 1 BRCA 2 Classification • Ductal carcinoma • Lobular carcinoma

Case #3

• John

is a 72 year old man with a pmh significant for smoking (120 pack/years)

Lung CA  Types

Bronchogenic

carcinoma Squamous cell carcinoma Large cell carcinoma Small cell carcinoma Adenocarcinoma

Smoking and Lung CA  Risk

is related to: Amount smoked Age of smoking onset Product smoked (tar, nicotine, filters) Depth of inhalation Gender

Case #4 • Lenny

is a 64 year old a.a. man who presents with c/o frequency and difficulty starting to void. On digital rectal exam his prostate is fixed and nodular.

• What

is causing his symptoms?

• What

would your nursing plan of care include?

Prostate CA • exact

cause is unclear

• androgens • risk

are believed to play a role

factors:

• age,

race, heredity, high fat diet

Clinical manifestations • urgency • frequency • nocturia • hesitancy • dysuria • hematuria

Metastasis • Bone

(low back pain)

• vertebral • lung • bladder

column, ribs, & pelvis

Clinical Manifestations • Anorexia • Cachexia • Fatigue • Sleep

Disorders

• Anemia

Clinical Manifestations

• Altered

Tissue Integrity

• compression • development

and erosion of blood vessels of effusions

Please also review • Uterine

CA

• Bladder

CA

• Lymphoma • Leukemia

(hodgkins and nonhodgkins)

(both acute and chronic forms)