Cellular Aberrations

NCM 106

Care of Clients with Cancer

Pathophysiology
Normal Cell Growth The Cell Cycle Characteristic of malignant cells

Psychophysiologic Effects of Cancer

Disruption of Function Hematologic Alterations Infection Hemorrhage Anorexia-Cachexia Syndrome Paraneoplastic Syndromes Physical & Psychological Stress

Etiology

Nursing Care of Clients with Cellular Aberration

A. Assessment of Risk C. Planning for Health Factors Restoration B. Nursing Diagnoses A. Surgery and Planning B. Radiation therapy
A. Screening and Early Detection B. Cancer Prevention & Control C. Chemotherapy D. Immunotherapy E. Bone marrow transplantation

Contd
D. Implementation c. Complementary Therapies a. Pharmacological - Botanical agents Therapy - Nutritional Supplements b. Nutrition and Diet - Mind-Body modalities Therapy Energy healing - ACS Dietary - Spiritual approaches Guidelines to Prevent Cancer - Miscellaneous Therapies Specific Disease Conditions

Cells

The Cell Cycle

Cell cycling is carefully controlled so that organ maintain its function Cells that die are replaced, no extra cells are produced

Divided into intervals or steps represented by G for gap, M for mitosis and S synthesis Go

G1

G2

The Cell Cycle

G0 Phase
Resting state

G1 Phase
RNA and CHON synthesis proliferation activity- short G1

Signals beginning of G1 phase when triggered activity- lengthened G1 by immediate Restriction point committed to environment S phase
Initiate DNA synthesis

S Phase
Synthesis of both DNA G2 Phase and CHON of new chromosomes occurs Biochemical processes and some RNA synthesis 6-8 hrs. interval Only small percentage Little is known, lasts few hours of cells fraction () predictor M Phase of long-term survival
Actual cell division Daughter cells Less than an hour few hours

Cell Characteristics Activity

CANCER
A disease whereby cells mutate into abnormal cells that proliferate abnormally

Malignant Neoplasm

CANCER
Tumor Neoplasm

Tumor
Neoplasm

mass, lump, or swelling

Greek neos- new, plasis molding

abnormal tissue mass with no useful purpose benign can be fatal if near vital tube or organ malignant invades other tissues and may metastasize distant organs Oncology deals with diagnosis, treatment, and study of cancer Carcinogen- any substance or agent that tends to produce a cancer Carcinogenesis - process of cancer development

Altered Cell Differentiation

Differentiation- normal cell transformation can occur at any point Effects of altered differentiation
changes in appearance CA cells vary in shape and size presence of tumor-specific antigens diagnostic tool Loss of normal function CA mass occupies space and draws nutrition and sustenance from host

Incidence
affects every age group, most deaths occur in people older than 65 years old highest incidence: prostate CA

Highest in males:
prostate CA lung CA colorectal CA

Highest in females
breast CA lung CA colorectal CA

ETIOLOGY

Viruses
Genetic & Familial Idiopathic

Chemicals
Physical Agents

Hormonal
Carcinogenesis

Dietary

Carcinogens
Drugs Viruses Tobacco Overwhelm the Alcohol
immune system

Chemicals cell mutation

Industrial compounds Vinyl chloride (asbestos ,plastics) Polycyclic hydrocarbons (burning, auto & truck emissions, air pollution) Fertilizers, dyes

Carcinogens
Foods, preservatives
Nitrites (meat) talc (gum) nitrosomines (rubber nipples) mold in grains, nuts, cheese

Carcinogens
Genetics Physical Agents
Radiation Physical Exposure to Oncogene carcinogens irritation/trauma
Overuse of body organ

Hormones
Estrogen
Cell changes

Vaginal and Malignancy cervical adenocarcinoma

PATHOGENESIS OF CANCER
Cellular Transformation Theory
Cell transformation due to exposure

Failure of Immune Response Theory

All possess CA cells Inability to destroy CA cells

EFFECTS OF CANCER

 Disruption of Function
FATIGUE + sleep disturbances, treatment, nutritional status PHYSICAL STRESS

 Pain
+ 60-80 % of cases + from pressure, obstruction, invasion, stretching of visceral surfaces, tissue destruction, inflammation Ex: stretched liver RUQ dull pain compressed nerve endings 1st priority Tx control pain rapidly 2nd priority prevent recurrence

 Anorexia-Cachexia
most common causes of death
Cachexia- severe form of malnutrition leading to wasting, extensive loss of adipose tissue, emaciation multi-factorial process of hormones and proinflammatory cytokines, TNF, interferons decrease food intake

 Hematologic Alterations
chronic bleeding, Fe-defficiency, therapy, blood-forming organs malignancy
cytokine-release suppresses erythropoietin in BM r- HuEPO (recomb. Human erythropoietin) improve myelosuppression

leukopenia and thrombocytopenia

direct tumor invasion of BM Thrombocytopenia results from chemotherapy or BM involvement

Infection
most significant complications and death fall in granulocytes and lymphocytes
high-risk reduced immunologic functions debility immunosuppression from radiotherapy and chemotherapy

 Paraneoplastic Syndromes
effects of hormones and other substances released by tissue 10% of malignancy may be earliest symptoms of unknown cancer represent life-threatening problems mimic progression and interfere with treatment

American Cancer Societys Seven Warning Signs of Cancer Change in bowel or bladder habits 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

ASSESSMENT
RISK FACTORS

Age Gender Heredity

-mutations in germline cells

ASSESSMENT
Diet & Obesity
Xenobiotics transported to blood & react with molecules causing cell damage
Defenses: - detoxification enzymes - antioxidant systems

ASSESSMENT
Occupation
Lung CA- Exposure to asbestos Bladder CA dyes, rubber, paint, benzidines Leukemia benzol inhalation by shoemakers, rubber cement workers and explosives

ASSESSMENT
Socio-economic status Stress Sun exposure/Radiation

ASSESSMENT
Tobacco Use
Alcohol

Drugs