Cancer

• Cancer


  Not a single disease with a single cause; rather, it is a group of distinct diseases with different causes, manifestations, treatments and prognoses
• Cancer nursing practice


  • Covers all age groups and nursing specialties
  • Carried out in a variety of health care settings, including the home, community, acute care institutions, outpatient centers, rehabilitation, and long-term facilities
• Oncology nursing


  The scope, responsibilities, and goals are as diverse and complex as those of any nursing specialty
• Although cancer affects people of all ages, most cancers occur in people older than 65 years
• Overall, the incidence of cancer is higher in men than in women and higher in industrialized sectors and nations
• More than 1.4 million Americans are diagnosed each year with cancer, affecting one of various body sites
• Cancer is second only to cardiovascular disease as a leading cause of death in the United States
• Leading causes of cancer death in the United States, in order of frequency

  • Lung prostate
  • Colorectal cancer in men
  • Lung
  • Breast
  • Colorectal cancer in women
• Pathophysiology of the malignant process

  1. An abnormal cell is transformed by the genetic mutation of the cellular DNA

  2. Abnormal cell forms a clone and begins to proliferate abnormally, ignoring growth-regulating signals in the environment surrounding the cell

  3. The cells acquire invasive characteristics, and changes occur in surrounding tissues

  4. Cells infiltrate these tissues and gain access to lymph and blood vessels, which carry the cells to other areas of the body
• Stages of normal cells becoming cancer cells

  • Normal
  • Hyperplasia
  • Dysplasia
  • Cancer
• Hyperplasia


  An increase in the number of cells in an organ or tissue. These cells appear normal under a microscope. They are not cancer, but may become cancer
• Metaplasia


  The reversible substitution of one type of fully differentiated cell for another within a given tissue; it is seen most commonly in epithelial tissues
• Dysplasia


  The presence of cells of an abnormal type within a tissue, which may signify a stage preceding the development of cancer
• Anaplasia


  "To form backward" – implies dedifferentiation (or loss of the structural and functional differentiation) of normal cells
• Neoplasia


  • The uncontrolled abnormal growth of cells or tissues in the body, and the abnormal growth itself is called a neoplasm or tumor
  • Can be benign or malignant
• Invasion


  Refers to the growth of the primary tumor into the surrounding host tissues, occurs in several ways
• Metastasis


  The dissemination or spread of malignant cells from the primary tumor to distant sites by direct spread of tumor cells to body cavities or through lymphatic and blood circulation
• Primary prevention


  • Concerned with reducing the risks of disease through health promotion strategies
  • Help patients avoid carcinogens
  • Encourage patients to make dietary and lifestyle changes (smoking, cessation, decreased caloric intake, increased physical activity) that studies show influence the risk for cancer
• Secondary prevention


  Promote screening and early detection activities such as breast and testicular self-examination and Papanicolaou (Pap) tests
• Characteristics of Benign and Malignant Neoplasms

  • Cell characteristics
  • Mode of growth
  • Rate of growth
  • Metastasis
  • General effects
  • Tissue destruction
  • Ability to cause death
• ACS Recommendations for Individual Choices

  • Maintain a healthy weight throughout life
  • Adopt a physically active lifestyle
  • Consume a healthy diet, with an emphasis on plant sources
  • If you drink alcoholic beverages, limit consumption
• ACS Recommendations for Community Action

  • Public, private, and community organizations should work to create social and physical environments that support the adoption and maintenance of healthful nutrition and physical activity behaviors
  • Increase access to healthful foods in schools, worksites, and communities
  • Provide safe, enjoyable, and accessible environments for physical activity in schools, and for transportation and recreation in communities
• ACS Recommendations for the Early Detection of cancer in Average-Risk Asymptomatic People

  • Breast: Breast self-examination, Clinical breast examination, Mammography
  • Colorectal: Fecal occult blood test, Flexible sigmoidoscopy, Contrast barium enema, Colonoscopy
  • Prostate: Digital rectal examination, Prostate specific antigen test
• Cancer screening recommendations


  • Breast cancer screening:
  • Asymptomatic women aged >40 years should continue to receive a clinical breast examination as part of a periodic health examination, preferably annually

  Colorectal cancer screening:

  • Men and women aged >50 years should begin:
  • Annual fecal occult blood test (FOBT) or fecal immunochemical test (FIT)
  • Flexible sigmoidoscopy every 5 years
  • FOBT and flexible sigmoidoscopy every 5 years
  • Double-contrast barium enema (DCBE) every 5 years
  • Colonoscopy every 10 years

  Prostate cancer screening:

  • Men aged >50 years should be offered annual digital rectal examination (DRE) and prostate specific antigen (PSA) test

  Cervical cancer screening:

  • Women aged >18 years should begin Pap test 3 years after starting vaginal intercourse, but no later than age 21
  • Conventional Pap test annually or liquid-based Pap test every 2 years
  • At age 30+, women with normal results may get screened every 2-3 years with Pap test alone or every 3 years with Pap test plus HPV DNA test
  • Women aged >70 years with 10+ years of normal Pap tests may stop screening

  Endometrial cancer screening:

  • At menopause, women should be informed of endometrial cancer risks and symptoms and encouraged to report any unexpected bleeding

  General cancer screening:

  • Men and women aged <20 years should have a cancer-related checkup including examination of thyroid, testes, ovaries, lymph nodes, oral cavity, and skin, as well as health counselling
• Diagnosis of cancer


  Determine presence and extent of tumor

  1. Identify possible spread (metastasis) or invasion of other tissues
  2. Evaluate function of involved and uninvolved body systems and organs
  3. Obtain tissue and cells for analysis, including tumor stage and grade
• The diagnostic evaluation includes a review of systems, physical examination, imaging studies, laboratory tests, and surgical/pathology reports
• Knowledge of suspicious symptoms and cancer behavior assists in determining relevant diagnostic tests
• Patients undergoing extensive testing may be fearful and anxious about procedures and results
• Nurses help


  Relieve patient's fear and anxiety by explaining tests, sensations, and patient's role
• A complete diagnostic evaluation includes identifying the stage and grade of the tumor prior to treatment
• Treatment options and prognosis are based on staging and grading
• Diagnostic aids used to detect cancer

  • Tumor and marker identification

  Genetic profiling

  Mammography

  Magnetic Resonance Imaging (MRI)

  Computed Tomography (CT)

  Fluoroscopy

  Ultrasonography (Ultrasound)

  Endoscopy

  Nuclear medicine imaging

  Positron emission tomography (PET)

  PET fusion

  Radioimmunoconjugates
• TNM classification system


  1. Extent of primary tumor
  2. Absence/presence and extent of regional lymph node metastasis
  3. Absence/presence of distant metastasis
• TNM components


  • Tx: Primary tumor cannot be assessed

  T0: No evidence of primary tumor

  Tis: Carcinoma in situ

  T1, T2, T3, T4: Increasing size and/or local extent of primary tumor

  Nx: Regional lymph nodes cannot be assessed

  N0: No regional lymph node metastasis

  N1, N2, N3: Increasing involvement of regional lymph nodes

  Mx: Distant metastasis cannot be assessed

  M0: No distant metastasis

  M1: Distant metastasis
• Cancer treatment goals


  • Cure: Complete eradication of malignant disease

  Control: Prolonged survival and containment of cancer cell growth

  Palliation: Relief of symptoms associated with the disease
• HIV


  Human Immunodeficiency Virus

  
• AIDS


  Acquired Immunodeficiency Syndrome
• HIV and AIDS remains a critical public health issue in all communities across the country and around the world
• Important aspects of care for people with HIV Infection and AIDS

  • Prevention
  • Early detection
  • Treatment (ongoing)

  
• US FDA approved the first antiretroviral agent

  1987