Oncology

CARE OF THE CLIENTS WITH ONCOLOGICAL DISORDERS

Epidemiology, Etiology, Terms  Disorders that can involve all body organs with manifestations that vary according to the body system affected and type of tumor cells  Cells lose their normal growth controlling mechanisms and the growth of cells is uncontrolled.  Cancer produces serious health problems such as impaired immune and hematopoietic function, altered GIT structure and function, sensory deficits and decreased respiratory function. CANCER  Cancer is the second most common cause of death in the USA  Sites in men associated with the greatest mortality: lung, colon, rectum, and prostate  Sites in women with the greatest mortality: breast, lung, colon, and rectum  Familiar risk for certain cancers: lung, stomach, breast, colon, rectum, and uterus ETIOLOGY  Generally unknown but may be caused by interacting factors  Theories include predisposing factors a. Constant irritation b. History of cancers c. Environmental carcinogens d. Radiation

METASTASIS  LOCAL SEEDING –distribution of shed cancer cells occur in the local area of the primary tumor  BLOOD BORNE –tumor cells enter the blood, which is the most common cause of cancer spread  LYMPHATIC SPREAD –primary sites rich in lymphatics are more susceptible to early metastatic spread NEOPLASMS  Hyperplasia involves an increase in the number of cell in a tissue; may be a normal or an abnormal cellular response a. Metaplasia refers to the conversion of one type of cell in a tissue to another type not normal to that tissue. It results from an outside stimulus affecting parent stem cells and may be reversible or progress to dysplasia b. Dysplasia refers to a change in size, shape, or arrangement of normal cell into bizarre cells; may precede an irreversible neoplastic change c. Anaplasia involves a change in the structure of cells and in their orientation to one another, characterized by a loss of differentiation and a return to a more primitive form. The resulting poorly differentiated, irregularly shaped cells are nearly always malignant

d. Neoplasia refers to the abnormal benign or malignant cell growth 1. Benign neoplasm: usually harmless, does not infiltrate other tissues 2. Malignant neoplasm: always harmful, may spread or metastasize to tissues far from the original site CANCER CLASSIFICATION  SOLID TUMORS –associated with organs from which they develop such as breast cancer or lung cancer  HEMATOLOGICAL CANCER –originate from the blood cell-forming tissue, such as leukemia, lymphomas, and multiple myeloma CANCER TERMINOLOGY  Primary site of neoplasm is its site of origin  Secondary sites represent metastasis  Types of neoplasms: benign and malignant  Four types of malignant neoplasms: a. Carcinomas: usually solid tumors arising from epithelial cells b. Sarcomas: from muscle, bone, fat, and other connective tissues c. Lymphomas: originate in the lymphatic system d. Leukemias: opriginate in the blood system STAGING and GRADING –are methods used to describe the tumor  STAGING –describe and classify extent of a malignancy when it is diagnosed

 GRADING – describe the degree of malignancy according to the type of tumor cell TREATMENT IN GENERAL  Objective: to remove all traces of the cancerous tissue  Treatment plan based on the stage and grade of tumor  Surgery: specific to site of malignancy MOST COMMON SITES:  To lung from primary site in colon, rectum, breast, renal system, testes, and bone  To liver from primary sites in lung, colon, rectum, breast, and renal system  To CNS from primary sites in lung and breast  To bone from pituitary sites in lung, breast, renal system, and prostate FACTORS THAT INFLUENCE CANCER DEVELOPMENT  Chemical carcinogen –industrial chemicals, drugs, and tobacco  Physical carcinogen –radiation (diagnostics, sun, ultraviolet)  Viral –viruses capable of causing cancer are known as oncoviruses such as Epstein-Barr, heap B, and human papillomavirus  H. pylori –is associated with increased risk of gastric cancer FACTORS THAT INFLUENCE CANCER DEVELOPMENT  Obesity and dietary factors – preservatives, additives, and nitrates

 Genetic predisposition

 Mammography

 Age

 Pap’s test

 Immune function –higher in immunosuppressed persons, such as AIDS px., organ transplant taking immunosuppressive meds.

 Stools for occult blood

NUTRITIONAL GUIDELINES TO REDUCE THE RISK OF MANY TYPES OF CANCER  Avid obesity  Decrease total dietary fat intake  Eat more high-fiber foods, such as whole grain, cereals, fruits, and vegetables  Include foods rich in vitamins A and C in the daily diet  Include cruciferous vegetables (e.g. cabbage, broccoli, bruselle’s sprouts, kohirabi, cauliflower) in the diet  Consume alcoholic beverages only in moderation  Consume salt-cured, smoked, and nitrite-cured foods only in moderation OTHER ACCEPTED RISK-REDUCTION MEASURES INCLUDE  Avoid tobacco use  Avoid excessive sun exposure, particularly between 10 a.m. and 3 p.m.  Avoid exposure to industrial agents known to increase cancer risk CANCER PAIN MANAGEMENT  Although clients with cancer may experience pain at any time during their disease, pain is usually a late symptom of cancer EARLY DETECTION

 Sigmoidoscopy and colonoscopy  BSE  TSE  Skin infection CAUTION  Change in the bladder and bowel habits  Any sore that does not heal  Unusual bleeding or discharge  Thickening or lump in breast or elsewhere  Obvious change in wart or mole  Nagging cough or hoarseness PREVENTION  AVOIDANCE of known or potential carcinogens and avoidance or modification of the factors associated with the development of cancer cells BREAST SELF EXAMINATION  PERFORM 7 TO 10 DAYS AFTER MENSTRUATION  Postmenopausal clients should select a specific day of the month and perform BSE monthly on that day TESTICULAR SELF EXAMINATION  Performed on the same day of each month  Best time is right after shower DIAGNOSTIC TESTS/BIOPSY

 Definitive means of diagnostic cancer and provides histological proof of malignancy

 Collaborate with the other health team to develop a pain management program

 Involves the surgical incision of a small piece of tissue for microscopic examination

 Mild or moderate pain may be treated with salicylates, acetaminophen, NSAIDS

BIOPSY/TYPES  Needle-aspiration of cells  Incisional-removal of suspected tissue from a larger mass  Excisional-complete removal of the entire lesion OTHER DIAGNOSTIC TESTS  Bone marrow examination  Chest radiograph  Computed tomography

 Severe pain is treated with opioids  Monitor vital signs and for side effects of medication  Monitor for effectiveness of medications  Provide non-pharmacological techniques of pain control, i.e. relaxation, biofeedback, massage, heat/cold application REMINDER “DO NOT UNDER-MEDICATE THE CANCER CLIENT WHO IS IN PAIN”

 Pap’s smear  Liver function tests  MRI  Protoscopic examination  Mammography  Radioisotope scanning PAIN CONTROL Causes of Pain  Bone destruction  Obstruction of an organ  Compression of peripheral nerves  Infiltration, distention of tissues  Inflammation, necrosis INTERVENTIONS  Asses the client’s pain

SURGERY-indicated to diagnose, stage, and treat cancer  Prophylactic-an attempt to remove the tissue or organ at risk and thus prevent the development of cancer  Curative-all gross and microscopic tumor is removed or destroyed  Control/debulking-removing a large portion of a local tumor such as ovarian cancer  Palliative-performed to reduce pain, relieve airway obstruction, relieve obstruction in the GI or urinary tract, relieve pressure in the brain or spinal Cord  Palliative-performed to improve quality of life during the survival time

 Reconstructive or rehabilative-improve quality of life by restoring maximal function and appearance, i.e. breast reconstruction after mastectomy SIDE EFFECTS OF SURGERY  Loss or loss of function of a specific body part  Reduced function as a result of organ loss  Scarring or disfigurement  Grieving about the altered body image or imposed change of lifestyle

 Plant alkaloids: vincristine: bind to substances needed to form mitotic spindle, thus preventing cell division  Hormone and hormone inhibitors: alters the endocrine environment to make it less conducive to cell growth; used in cancers of the breast, prostate, and other reproductive organs ROUTES OF ADMINISTRATION  Intravenous (peripheral or central nervous access)

CHEMOTHERAPY  Kills or inhibits the reproduction of neoplastic cells and kills the normal cells  Highly toxic agents that attack all rapidly dividing cells , both normal and malignant  Most agents modify or interfere with DNA synthesis ANTINEOPLASTICS (CYTOTOXIC, ANTIPROLIFERATIVE AGENTS)  Alkalyting agents (cytoxan): produce breaks in DNA molecule and crosslinking of strands thus interfering with DNA replication; most effective in hematologic malignancies  Antitumor antibiotics (biomycin): bind directly with DNA changing its configuration and inhibiting replication  Antimetabolites :5-fluorouracil, floxuridine: inhibit DNA synthesis; most effective against rapidly growing tumors enzymes necessary for cell function and replication

•

Oral

•

Intraarterial

•

Intraperitoneal

•

Intrapleural

Use  To cure, control or palliate results of neoplasm  May be used as an adjunct to surgery and radiation ADVERSE EFFECTS: RESULTS FROM THE DAMAGE TO NORMAL CELLS  Nausea/vomiting, stomatitis, alterations in taste, anorexia  Diarrhea, constipation  Alopecia, dermatitis, pruritus, paresthesia, rash, bruising  Hemorrhagic cystitis  Cardiomyopathy  Fatigue, dyspnea, fever, chills  Sterility, amenorrhea  Depression, anxiety

 Myelosuppression

 Use soft-bristle toothbrush

NURSING INTERVENTIONS

 Avoid use of razors

 Monitor lab studies as ordered  Monitor IV site for extravasation  Maintain strict asepsis  Administer antiemetic agents as ordered and prophylactically before chemotherapy

SPACIAL NURSING CONSIDERATIONS  Exposure to chemotherapeutic agents can lead to adverse reactions •

Contact dermatitis

•

Nausea and vomiting

•

Diarrhea

 Give antihistamines as ordered  Withhold food and liquids for 4 to 6 hours before treatment

 Exposure during pregnancy can lead to •

increased risk of fetal abnormalities

 Between treatments, give small, frequent, bland meals

•

ectopic pregnancies

 Give antidiarrheals as ordered

•

spontaneous abortions

 Monitor signs of dehydration and encourage fluids as tolerated  Provide frequent oral hygiene, lubricate lips as indicated  For stomatitis, use topical anesthetics before eating and as indicated  Apply lotion to skin as indicated; avoid harsh, drying soaps  Provide a restful environment, emotional support, and anxiolytics as ordered TEACH CLIENT  Medications and side effects  Alopecia is temporary  Avoid bruising, aspirin products, and persons with infection  Conserve energy  Recognize signs of bleeding, anemia, infection