CELLULAR ABBERATION

Presented by:

MARIFE RHEA R. CACHOLA

Clinical Instructor, College of Nursing

CANCER
Disease

process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA MALIGNANT neoplasms Manifestations are r/t the system affected & degree of disruption Ranks third in leading cause of morbidity & mortality in the Philippines Occurs at any age but with 75% of cancers occuring after 50

normal cell divides only approximately 60 times but a single CANCER cell can divide indefinitely, hence huge mass of tissue can arise Cancer grow & metastisize thru:
Directly extending into adjacent tissues Invading nearby body cavity Invading along lymphatic vessels Traveling via lymphatic vessels to lymph nodes Traveling via blood vessels to any part of the body but usually to the lungs, liver & bones

RISK FACTORS
AGE

occurs at any age but incidence increases with age; except for ALL young Sex significant differences exist Race skin color, diet, customs Occupational asbestos, uranium cause lung cancer Health habits Family history Socio-economic status Lifestyle

Cancers According to Tissue Type

Lymphoma

organs Leukemia originating in blood-forming organs Sarcoma originating in bones, muscle, or connective tissue Carcinoma originating in epithelial cells

originating in infection-fighting

TMN Classification System

Tumors

are staged depending on size, lymph node involvement & metastasis

T primary tumor N lymph node involvement M metastasis

STAGES OF TUMORS
I:

tumor <2cm, (-) lymph node involvement, no detectable metastases II: tumor >2cm but <5cm, (-) or (+) unfixed lymph node involvement, no detectable metastases III: large tumor >5cm, tumor of any size with invasion of skin or chest wall or (+) fixed lymph node involvement in the clavicular area without evidence of metastases IV: tumor of any size, (+)/(-) lymph node involvement, distant metastases

LATE WARNING SIGNS of CANCER

Change in bowel/bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing Obvious change in wart or mole Nagging cough or hoarseness of voice Unexplained anemia Sudden unexplained weight loss
(alternating diarrhea & constipation, early morning)

Nursing Diagnoses
Impaired

dse Imbalanced Nutrition: LBR r/t anorexia, malabsorption, cachexia Pain, chronic r/t disease & tx effects Fatigue r/t physical & psychological stressors Anticipatory grieving r/t expected loss & altered role function Disturbed body image r/t changes in appearance & role functions

tissue integrity r/t effects of tx &

Hopelessness

terminally ill Powerlessness unable to do things Knowledge Deficit upon admission

Nursing Interventions
Maintaining

tissue integrity Managing stomatitis Managing malignant skin lesions Promoting nutrition Relieving pain Decreasing fatigue Improving body image & self-esteem Assisting in grieving Monitoring & managing potential complications

 Maintaining

Tissue Integrity

Avoid rubbing & use of hot or cold water, soaps, powders, lotions, cosmetics Wear loose-fitting clothes Provide aseptic wound care
Managing

stomatitis

Good oral hygiene Brush with soft-bristled toothbrush & non-abrasive toothpaste Avoid alcohol-based mouth rinses, hot & spicy foods Lubricate pts lips Adequate food & fluid intake

 Addressing

alopecia

Encourage pt to acquire a wig or hairpiece before hair loss occurs so replacement matches pts own hair Suggest use of scarves & hats
Managing Promoting

malignant skin lesions nutrition

Carefully assess & cleanse skin Consider pts preferences as well as physiologic & metabolic requirements in selecting foods Small frequent feedings

 Relieving

pain/decreasing fatigue

Identify sources of fatigue & develop ways to conserve energy Help patient plan daily activities, alternating periods of rest & activity Encourage regular, light exercise
Improving

body image & self-esteem

Encourage pt to express any (-) feelings Encourage pts who are experiencing disturbances in sexuality & sexual function to share & discuss concerns openly with their partner

 Monitoring

& managing potential complications

Use strict asepsis when handling IV lines, catheters, & other invasive equipment Avoid exposing pt to others with an active infection & to crowds Provide pts with low bacteria diet, avoid fresh fruits & vegetables Encourage pt to do coughing & DBE to prevent respiratory problems Stress proper handwashing

PRIORITY Nsg Interventions

Chemotherapy

Assess

for body image Nutrition well-balanced Caution pt on s/s Exercise Rest

BLADDER CANCER
Seen

more frequently in people ages 50-70 Affects men more than women Usually arise at the base of the bladder & involve ureteral orifices & bladder neck Predominant cause: cigarette smoking Cancers arising from the prostate, colon & rectum in men & from lower gynecologic tract in women may metastasize to the bladder

Clinical Manifestations
Gross

PAINLESS HEMATURIA most common Frequency in urination, urgency dysuria Pelvic or back pain may occur with metastasis Lab data: elevated acid phosphatase

BREAST CANCER
Starts

with genetic alteration in a single cell & may take 2 years to become palpable RF:
Prolonged exposure to hormonal stimulation early menarche (before 12), nulliparity, 1st birth after 30 years, late menopause (after 55), breast implants, oral contraceptives, hormone replacement therapy, cigarette smoking, high fat diet

 Protective

Factors: regular vigorous exercise (dec body fat), pregnancy before age 30, breastfeeding Clinical Manifestations:
Lesions nontender, fixed, hard & with irregular borders; most often occur in upper outer quadrant, left breast Pain usually absent except in later stages Some women may have no symptoms & no palpable lump but have abnormal mammogram Dimpling, orange-peel skin (peau d orange), asymmetry & elevation of affected breast, nipple retraction, lesions fixed to chest wall, ulceration & metastasis

Self Breast Examinations

Done

monthly, a week after menstruation since breasts are less tender at this time Best position: lying down with pillow under shoulder of breast being examined MAMMOGRAPHY
Reveals non-palpable lesions Baseline: ages 35-40; q2 years at 40-50 y/o if w/o predisposition; yearly for hi risk women; after age 50, yearly Avoid use of deodorants, lotions or powder PT exam

CANCER of the CERVIX

Occurs

most commonly in women ages 3045 but even as early as 18 y/o RF: multiple sex partners, smoking, chronic cervical infection HPV, STDs Most often asymtomatic; dark, foul smelling vaginal discharge; post-coital bleeding PAPANICOLAOU Smear
Reveals presence of malignant cells Instruct pt to avoid douching & sexual intercourse 24H PT test

COLORECTAL CANCER (Dukes Disease)

May

start as benign polyp & become malignant & spread RF: age of 85 up, family hx of colon cancer or polyps, high fat low fiber diet most common presenting symptom: change in bowel habits Passage of blood in stools Lab data: Ba enema, sigmoidoscopy/colonoscopy, fecal occult blood

Right-sided lesions: dull abdominal pain, melena

Left-sided lesions: obstruction, abdominal pain & cramping, narrowing stools, constipation, distention, bright red blood in stool
Rectal lesions: tenesmus, rectal pain, bloody stool

Cancer of the Esophagus

Malignant

tumor in the esophagus r/t alcoholism & smoking RF: males, 50s, GERD Initial Manifestation: dysphagia 1st with solid foods then liquids Lab data: Ba Swallow

LARYNGEAL CANCER
RF:

male gender, age 50-70 years, tobacco use, alcohol use, vocal straining, chronic laryngitis, industrial exposure to carcinogens Early manifestation: hoarseness Pain & burning in the throat when drinking hot liquids & citrus juices, tickling sensation Lump felt in the neck Late symptoms: dysphagia, dyspnea, persistent hoarseness of voice

LUNG CANCER (Bronchogenic Ca)

Development

tract

of neoplasm in the respiratory

Squamous cell slow-growing Large cell & small oat fast growing
RF:

tobacco smoke, second-hand smoke, environmental pollution, asbestos, COPD, PTB Initial manifestations: chronic, nagging cough

OVARIAN CANCER
Usually

at 50s Oral contraceptives protective effect RF: high fat diet, nulliparity, smoking, alcohol, infertility Initially asymptomatic; vague abdominal pain like indigestion, flatulence, fullness after a light meal

diagnosed in advanced stage; peaks

PROSTATE CANCER
Most

common cancer in MEN Usually aymptomatic Stony, hard fixed lesion Dysuria, decreased size & force of urinary stream Hematuria, painful ejaculation Lab data: elevated PSA, acid phosphatase

SKIN CANCER
Malignant

primary tumor of the skin mainly caused by prolonged exposure to the sun or other carcinogenic agents Initial manifestations:
Squamous cell carcinoma small red nodular lesions that begin as erythematous macule or plaque
Lab

data: skin biopsy

TESTICULAR CANCER
Most

common cancer in men 15-35 years Malignancy in testes usually a/w cryptorchidism Initial manifestation: mass or lump, painless swelling & enlargement of testes, accompanied by sensation of heaviness in the scrotum Lab data: elevated HCG, AFP

TESTICULAR SELF-EXAM
Done

once a month while having a warm bath or standing in front of the mirror after bath (so testicles will sag) Cancer of the testes spongy on palpation Normal: SMOOTH testicles; unequal, left is lower

LYMPHOMA
Hodgkins Epstein barr virus Reed Sternberg cells are present Non-Hodgkins Helicobacter pylori infection

Cause: UK; malignancy of lymph nodes Painless enlargement of lymph nodes (cervical/sentinel)

Fever without chills, fatigue

Tx: chemo

SCREENING TESTS
TSE:

males, 13 Pap Smear: females, 18 BSE: females, 20 Mammogram: females; baseline: 35-40 DRE: males, 40 yearly to dx prostate cancer Stool for guaiac: M/F, 50 up

a. b. c. d.

Among the following diagnostic results, which is most suggestive of colorectal cancer? Painless hematuria Presence of occult blood in the stool Increased levels of acid phosphatase Indigestion

A client with nagging cough makes an appointment to see the physician after reading that this symptom is one of the warning signs of cancer? a. persistent nausea b. rash c. indigestion d. chronic pain

A client with a family history of cancer asks the nurse what the single most important risk factor for cancer is. Which of the following risk factors should the nurse discuss? a. family history b. lifestyle choices c. age d. hormonal events