NSG 260 Cancer

• Number one leading cause of death in people under the age of 85 (US)
• Over 10 million people have cancer
• In 1970 the five year survival rate was 50%, in 2005 the five year survival rate was 74%
• 30% of people now living will have a cancer diagnosis
• 1500 people die of cancer each day, half are over age 65 and 35% are preventable with early detection.
• Incidence is increasing, with melanoma rising higher than any other cancer, but the death rate is leveling off.

• Site: Breast, Lung, Colon
• Death: Lung, Breast, Colon

• Site: Prostate, Lung, Colon
• Death: Lung, Prostate, Colon

A normal cell which, when altered by mutation, may become an oncogene and contribute to cancer

A tumor producing gene

A tumor suppressing gene

• Decreased contact inhibition
• Decreased cohesion
• Produces proteins, hormones, & other substances to enchance growth
• Tumor Angiogenic Factor (TAF) formation of blood vessels
• Not encapsulated
• Undifferentiated
• Vascularity
• Mode of growth
• Cell characteristics

Stage where a chemical, physical, or biological agent (carcinogen) or an inherited gene alters the DNA in the cell causing a mutation

• Cigarette smoke
• Asbestos
• Nitrites
• Vinyl chloride

• Radioisotopes
• Immunosuppressives (Azathioprine, Antimetabolites, Alkylating agents, Corticosteriods)
• Cytoxic agents (Cyclophosamide)
• Hormones (Diethylstilbesterol, Prenatal estrogen, Postnatal estrogen, Androgenic-anabolic steroids)

Radiation (ionizing, rocks, x-rays, UV light, sun, tanning booths, electromagnetic fields)

• Viruses (hepatitis B, Epstein Barr virus, HPV, herpes virus, HIV)
• Diet (fats, fiber, Vitamin B deficiency, charcoal grilling, food additives, obesity)

The reversible proliferation of the mutated cell

• Implantation: cancer embeds along the body organ, uses tumor angiogenesis
• Lymph system: cancer moves to local lymph nodes, but may also "skip" nodes
• Blood vessels (Hematogenesis): cancer cells enter circulation and use enzymes

• Risk factors: 20 year pack history, asbestos, uranium, COPD
• ACS screening: none

• Risk factors: Benign Prostatic Hyperplasia (BPH), African American, age
• ACS screening: Prostate-Specific Antigen (PSA) and digital exam after age 50, 45 for African Americans with positive family history

• Risk factors: Caucasian, early menarche, late menopause, fibrocystic disease, infertility, first pregnancy after age 30, maternal history of breast cancer, obesity
• ACS screening: monthly self exams starting at age 20, ages 20-39 Clinical breast Exam (CBE) every 3 years, ages 40 and up mammogram and CBE annually

• Risk factors: ulcerative colitis, familial polyposis, high fat/low fiber diet
• ACS screening: one of the following after age 50 - fecal occult exam & fecal immunochemical test (FIT) yearly, flexible sigmoidoscopy every 5 years, double-contrast barium enema every 5 years, colonoscopy every 10 years

• Risk factors: early intercourse with multiple partners, poor hygiene, STDs, cervical dysplasia
• ACS screening: screen annually 3 years after starting intercourse (no later than age 21), at age 30 with 3 negative exams are rescreened & HPV screened every 2-3 years, after age 70 with 3 negative exams may stop screening. Women with a total hysterectomy can stop having cervical screenings unless surgery was treatment for cervical cancer

• C: change in bowel/bladder habits
• A: a sore that does not heal
• U: unusual bleeding or discharge
• T: thickening or lump in breast or elsewhere
• I: indigestion or difficulty swallowing
• O: obvious change in wart or mole
• N: nagging cough or hoarseness

• Needle: aspiration (bone marrow, prostate, breast, liver, kidney)
• Incisional: portion of the lesion to make diagnosis (dermal punch)
• Excisional: remove entire tumor

Removal of a portion of the tumor

Provision of supportive care, such as feeding tubes

Removal of cancer to reduce symptoms

• Slow growing
• Clean margins
• Prevent seeding
• No local spread

Well differentiated (mild dysplasia)

Moderately differentiated (moderate dysplasia)

Poorly differentiated (severe dysplasia)

Anaplastic

• Tumor, Nodes, Metastasis
• 0-4 scale used to identify the course and extent of a cancer diagnosis

• Fatigue
• Anorexia/taste changes
• Skin reactions ("baby skin" rule)

• Cough
• Dyspnea
• Pneumonitis

• Increased ICP
• Peripheral neuropathy
• Fatigue

• Constipation
• Hepatotoxicity
• N/V/A/D
• Inflammation of the mucosa

• Reproductive dysfunction
• Hemorrhagic cystitis (dysuria, hematuria, hemorrhage)

• Private room (lead lined, radiation hazard marking)
• Bedrest
• Elimination: foley catheter
• Diet: low residue

• Using tongs, place the device in a lead lined container. Do not handle directly!
• Notify safety officer

No. The radiation is contained within the device. The body fluids, while affected by the radiation, do not themselves become radioactive.

• Private room (lead lined, radiation hazard marking for 96 hours)
• Elimination: flush 3x
• Diet: use of disposable utensils
• Hospital clothes and linens

• Time: shortest time possible (ALARA)
• Distance: inverse square rule
• Shielding

• The further you get away from the source of radiation the less exposure you suffer.
• (I₁/I₂) = (D₂²/ D₁²)

Has effect on cells in the process of cellular replication and proliferation

Has effect on cells in the process of cellular replication, proliferation, and rest

Cells with a high rate of proliferation (i.e. lining of the mouth and GI tract) - kills them

• Drug effectiveness
• Synergistic effect
• Cycle specific + nonspecific drugs
• Different side effects

Appetite stimulant

• Stop the drug infusion
• Leave the needle in place
• Administer the antidote
• Remove needle
• Use hot/cold packs
• Assess site

• Only give chemo if you've been trained
• Chemo is stored separately from other meds
• Gown, gloves, goggles, and respirator mask
• Disposal of syringes, tubing, gauze, etc. in HAZARD container
• Glove when handling excreta
• Avoid giving chemo when pregnant, trying to get pregnant, or breast feeding
• Periodic health screening

• Natural substances normally produced in small amounts by the immune system
• Boost the body's response to fight tumors and foreign substances
• Fights indirectly by stimulating the immune system

• Function: Inhibits DNA protein synthesis and causes tumor antigen expression on tumors
• S/E: flu like symptoms (give Tylenol before/during administration)

• Function: Activates NK cells, lymphokine activated killing cells, and tumor infiltrating lymphocytes
• S/E: neurological, fever, chills, renal/liver dysfunction

• Function: Binds to tumor antigens and tries to destroy them, may be able to bind chemo or dyes to antibodies that will seek cancer cells
• S/E: fever, chills, vomiting (need premedicated with Tylenol, Benadryl, Merperdine)

• Function: Damages the capillaries of the tumor, activates the immune system
• S/E: capillary leak syndrome

• Function: Causes the proliferation and differentiation of granulocytes
• S/E: bone pain, fever, chills, rash, myalgias

• Function: Causes the proliferation and differentiation of granulocytes and macrophages
• S/E: bone pain, fever, chills, rash, myalgias, fluid retention

• Function: Causes the proliferation and differentiation of erythrocytes
• S/E: hypertension, fever, N/V/D, SOB, tingling sensation

• Function: Causes the proliferation and differentiation of platelets, granulocytes, and monocytes
• S/E: bone pain

• Step 1: Non-opioid + adjuvant (ASA, paracetamol, NSAIDs)
• Step 2: Opioid for mild to moderate pain + non-opiod + adjuvant (codeine)
• Step 3: Opiod for moderate to severe pain + non-opioid + adjuvant (morphine, oxycodone, fentanyl)

• Assessment: nutritional status
• Interventions: avoid judgmental statements, administer antiemetics, teach to eat slowly, bland/lukewarm/high calorie/high protein/small/frequent feedings, stimulate salivation, remove unpleasant sights/smells, relaxation techniques, avoid gas producing foods, teach to increase protein rich foods
• Note: High protein foods - double strength milke (1 cup = 14g), yogurt (10g), eggs (6g), cottage cheese (1/2 cup = 15g), beef (3oz = 21g), tuna (6oz = 44.5g)

• Assessment: oral mucousa daily for ulcers, candida, herpes, xerostomia (dry-mouth), stomatitis, and fit of dentures
• Interventions: use toothettes, mouthwashes of baking soda/saline q2h, topical anesthetics or oncology mouthwash, avoid irritating foods, apply artificial saliva/petroleum jelly to lips

• Assessment: body image, alopecia, post surgical, weight loss
• Interventions: provide support, select wig (chemo - hair grows back but may be different), use gentle products on hair, makeup tips, educate about special clothing and prosthetics

• Assessment: signs of infection
• Interventions: maintain personal hygeine, monitor for signs of infection, avoid crowds, avoid dental work when WBCs are low, no immunizations w/o doctor approval
• Note: Neutropenic precautions - private room, handwashing, screen visitors, no fresh fruit/vegetables/flowers/plants, no stagnant water, Neupogen/Neulasta, report fever of 100.4 to doctor

• Assessment: overt or covert bleeding (GI bleeding), platelet counts
• Interventions: avoid IM/SC injections (hold pressure for 5 minutes, use small bore needles), BPs infrequently, provide safe environment, use soft toothettes, no flossing, no toothpicks, avoid straining on stool, rectal, or vaginal trauma (gentle lubricated secual intercourse), use electric razors, avoid tight clothing, avoid ASA NSAIDS, avoid anticoagulants, use of Neumega

• Assessment: fatigue level, keep log, usually begins during first week (over 70% of patients on chemo are anemic)
• Interventions: sleep and naps, mild exercise, use of Procrit and Aranesp (lasts 3x longer than Procrit)

• Men: 4.7 - 6.1 million
• Women: 4.2 - 5.4 million

5,000 - 10,000

150,000 - 350,000 (below 20,000: spontaneous bleeding)

• Men: 14-18
• Women: 12-16

• Men: 42-52
• Women: 36-48

• Carcinoembryonic antigen
• Disappears during last 3 months of fetal life
• Elevated with GI cancer, also with breast, liver, and lung cancer

• Alpha Fetoprotein
• Produced by fetal liver
• Elevated with liver cancer, also with Hodgkin's lymphoma and renal cancer

Elevated with ovarian cancer

Elevated with biliary and pancreatic cancer, also lung cancer and cystic fibrosis

Elevated with metastatic breast cancer

• Prostatic Specific Antigen
• Elevated with prostate cancer

• Symptoms: fever, blood work
• Treatment: antibiotics, antipyretics

• Symptoms: SAIDH, insulin, hypercalcemia, ACTH
• Treatment: manage symptoms, treat tumor

• Symptoms: hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia
• Treatment:hydration to increase urine production and treat electrolyte imbalances

• Symptoms: bone problems, A/N/V, renal stones (hematuria, flank pain)
• Treatment: calcitonin, mithramycin, monitor cardiac status

• Symptoms: facial edema, cough, distension of neck and chest veins
• Treatment: palliative radiation

• Symptoms: bleeding from 3 separate sites (clotting/bleeding at the same time), increased PTT & PT, decreased platelet count
• Treatment: heparin, platelets, fresh frozen plasma (FFP)

• Symptoms: intense back pain, motor weakness, dysfunction, parathesia
• Treatment: palliative radiation

Surveillance - altered cells are made but usually destroyed by the immune system

• Purpose: to replenish healthy marrow after high dose chemo or radiation is given to destroy cancer cells
• Nursing implications: reverse isolation precautions, sterile drinking water, mouth care q2h, takes 2-4 weeks for marrow to start working

• Purpose: to replenish healthy undifferentiated cells back into the body after high dose chemo or radiation is given to destroy cancer cells
• Nursing implications: reverse isolation precautions, sterile drinking water, mouth care q2h