CARE OF THE CLIENTS WITH ONCOLOGICAL DISORDERS
Epidemiology, Etiology, Terms
Disorders Disorders that can involve all body organs with manifestations that vary according 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. Consta Constant nt irri irritat tatio ion n b. Hist Histor ory y of canc cancer ers s c. Envir Environm onment ental al carc carcin inoge ogens ns d. Radi adiati ation
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. Metaplasi Metaplasia a refers refers to the the conver conversion sion 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. Dyspla Dysplasi sia a refers refers to to a change change in in size, shape, or arrangement of normal cell into bizarre cells; may precede an irreversible neoplastic change c. Anapl Anaplasi asia a involv involves es a chang change e in the 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 Neoplasia refers refers to the abnormal abnormal benign or malignant cell growth 1. Benign Benign neopla neoplasm sm:: usual usually ly harmless, does not infiltrate other tissues
TREATMENT IN GENERAL
2. Malign Malignant ant neop neoplas lasm: m: alwa always ys 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
GRADING – describe the degree of malignancy according according to the type of tumor cell
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
CANCER TERMINOLOGY
Primary site of neoplasm is its site of origin Secondary sites represent metastasis Types of neoplasms: benign and malignant
FACTORS THA TH AT INFLUENCE INF LUENCE CANCER DEVELOPMENT
Four types of malignant neoplasms:
Chemical carcinogen –industrial chemicals, drugs, and tobacco
a. Carcino Carcinomas: mas: usually usually solid solid tumor tumors s arising from epithelial cells
b. Sarcoma Sarcomas: s: from from muscl muscle, e, bone, bone, fat, and other connective tissues
Physical carcinogen –radiation (diagnostics, (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
c. Lymphom ymphomas: as: ori origin ginate ate in in the lymphatic system d. Leukem Leukemias: ias: oprigina opriginate te in the blood blood system STAGING and GRADING –are methods used to describe the tumor
STAGING –describe and classify extent of a malignancy when it is diagnosed
FACTORS THA TH AT INFLUENCE INF LUENCE CANCER DEVELOPMENT
Obesity and dietary factors – preservatives, 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
Sigmoidoscopy Sigmoidoscopy and colonoscopy
BSE
TSE
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
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
Consume salt-cured, smoked, and nitrite-cured 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.
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
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 EARLY DETECTION
AVOIDANCE of known or potential carcinogens and avoidance or modification modification of the factors associated with the development of cancer cells
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 microscopic examination
Mild or moderate pain may be treated with salicylates, acetaminophen, NSAIDS
Severe pain is treated with opioids
BIOPSY/TYPES
Needle-aspiration Needle-aspiration of cells
Incisional-removal of suspected tissue from a larger mass
Monitor vital signs and for side effects of medication
Excisional-complete removal of the entire lesion
Monitor for effectiveness of medications
Provide non-pharmacological techniques of pain control, i.e. relaxation, biofeedback, massage, heat/cold application
OTHER DIAGNOSTIC TESTS
Bone marrow examination
Chest radiograph
Computed tomography
Pap’s smear
Liver function tests
MRI
Protoscopic examination
Mammography
Radioisotope scanning
REMINDER “DO NOT UNDER-MEDICATE THE CANCER CLIENT WHO IS IN PAIN”
SURGERY-indicated to diagnose, stage, and treat cancer
Prophylactic-an 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, 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
PAIN CONTROL Causes of Pain
Bone destruction
Obstruction of an organ
Compression Compression of peripheral nerves
Infiltration, distention of tissues
Inflammation, necrosis
INTERVENTIONS
Asses the client’s pain
Reconstructive or rehabilative-improve quality of life by restoring maximal function and appearance, i.e. breast reconstruction after mastectomy
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
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
ROUTES OF ADMINISTRATION
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 Antimetabolites :5-fluorouracil, :5-fluorouracil, floxuridine: inhibit DNA synthesis; most effective against rapidly growing tumors enzymes necessary for cell function and replication
Intravenous (peripheral or central nervous access) •
Oral
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Intraarterial
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Intraperitoneal
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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, Nausea/vomiting, stomatitis, alterations in taste, anorexia anorexia
Diarrhea, constipation
Alopecia, dermatitis, pruritus, paresthesia, rash, bruising
Hemorrhagic cystitis
Cardiomyopathy
Fatigue, dyspnea, fever, chills
Sterility, amenorrhea
Depression, anxiety
Myelosuppression
NURSING INTERVENTIONS
Monitor lab studies as ordered
Monitor IV site for extravasation
Maintain strict asepsis
Use soft-bristle toothbrush
Avoid use of razors
SPACIAL NURSING CONSIDERATIONS
Administer Administer antiemetic agents as ordered and prophylactically before chemotherapy
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Contact dermatitis
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Nausea and vomiting
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Diarrhea
Give antihistamines as ordered
Exposure to chemotherapeutic agents can lead to adverse reactions
Withhold food and liquids for 4 to 6 hours before treatment Between treatments, give small, frequent, bland meals
Give antidiarrheals as ordered
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
Exposure during pregnancy can lead to •
increased risk of fetal abnormalities
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ectopic pregnancies
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spontaneous abortions
