CELLULAR REGULATION

• Cellular regulation

  All functions carried out within a cell to maintain homeostasis, including its responses to extracellular signals (e.g., hormones, cytokines, and neurotransmitters) and the way each cell produces an intracellular response
• Cellular Reproduction and Growth

  • Replication: making a copy of a cell
  • Proliferation: production of new cells through growth and division
  • Mitosis: cell divide to develop normal tissues or to replace lost or damaged normal tissues
  • Meiosis: sex cell production
  • Differentiation: normal process occurring over many cells that allows cells to specialize in certain tasks
• Neoplasia

  Abnormal and progressive multiplication of cells, leading to the formation of a neoplasm
• Types of Neoplasm

  • Benign: non-cancerous
  • Malignant: cancerous
• Malignant neoplasm

  Abnormal growth patterns, multiple abnormal functions and the ability to disseminate to distant sites
• Consequences of Malignant Neoplasia

  • Fatigue, weight loss, pain, organ failure, and death
  • Fear, stress, and anxiety
  • Changes in family dynamics
  • Financial challenges
  • Changes in self-image and interpersonal relationships
• Individual Risk Factors

  • Exposure to environmental carcinogens such as sunlight; pollutants in the air, soil, water or food; or medical treatments such as medication or radiation
  • Poor nutrition
  • Sedentary lifestyle
  • Hormone replacement therapy
  • Age
  • Certain forms have a genetic component (skin, ovarian, breast, prostate, colon)
  • Low socioeconomic status (lack of healthcare coverage increases risk)
  • Smoking/tobacco
  • Infectious agents
• Examination Findings Commonly Associated with Neoplasia

  • Visible lesions
  • Physical asymmetry
  • Palpable masses
  • Unexplained bleeding (stool, urine, sputum)
  • Unexplained weight loss
  • Pain
  • Fatigue
  • Difficulty swallowing
• Common Diagnostic Tests

  • Radiographic tests: x-rays, MRI, CT, ultrasound, mammography, PET scan
  • Direct visualization: colonoscopy, endoscopy
  • Laboratory tests: complete blood count, chemistry panel, genetic or tumor marker tests
  • Pathology: examination of cells and tissues for a diagnosis of malignancy, tissue type, bone marrow biopsy
• Cancer Treatments

  • Surgery
  • Radiation
  • Drug therapy
• Drug Therapy Classes

  • Cytotoxic agents (largest class) (kill cells directly) (high alert)
  • Hormones and hormone antagonists
  • Biological response modifiers (immune modulating agents)
  • Targeted drugs (drugs that bind with specific targets to reduce growth)
• Chemotherapy

  • Pharmacological agents used to prevent cancer cells from multiplying, invading, or metastasizing.
  • Provides systemic treatment.
  • Usually administered by nurses who are certified in providing chemotherapy.
  • Multiple side effects require symptom management.
• Obstacles to Chemotherapy

  • Toxicity to normal cells: anticancer drugs like cytotoxic drugs lack selective toxicity
  • Cure requires 100% cell kill
  • Absence of true early detection
  • Solid tumors respond poorly to cytotoxic drugs
  • Drug resistance
  • Bone marrow suppression
• Vesicants

  Drugs that can result in tissue necrosis or formation of blisters when accidentally infused into tissue surrounding a vein.
• Extravasation

  The inadvertent infiltration of chemotherapy into the subcutaneous or subdermal tissues surrounding the intravenous or intra-arterial administration site.
• Safety & Handling

  • Specialized field (certifications)
  • Radiation safety: limit time of exposure, distance from source, shielding to avoid exposure. Waste products and patient radioactive with brachytherapy
  • National Institute for Occupational Safety and Health (NIOSH) specific handling procedures
• Radiation Therapy


  • energy used to damage and kill cancer cells
  • energy delivered to specifically targeted tissue area
  • multiple forms of delivery
  • multiple side effects require symptom management
• Targeted Therapy


  • use of molecular and genetic biology linked to cell functioning
  • prevents tumor growth and metastasis by blocking signaling processes responsible for growth and spread disease
• Biologic Therapy


  • Colony-stimulating factors
  • Gene therapy
  • Monoclonal antibodies
  • Nonspecific immunomodulating agents
  • Angiogenesis
  • Vaccines
• Neoplasia 


  abnormal and progressive multiplication of cells, leading to the formation of a neoplasm
• Steps of Metastasis

  A) malignant

  B) blood

  C) broken

  D) enter

  E) around

  F) clump

  G) new

  
• Staging Cancer: Stage 0

  • abnormal cells that could grow into cancer are present but have not spread to nearby tissue - this is called carcinoma situ, referred to as pre-cancer
• Staging Cancer: Stage 1

  • cancer is present but has not spread
  • called early-stage cancer
• Staging Cancer: Stage 2-3

  • cancer is present and has spread into nearby tissue
  • stage 3: the cancer has spread further, and the tumor is larger
• Staging Cancer: Stage 4

  • the cancer has spread to distant parts of the body
  • called advanced metastatic cancer
• Clinical Management: Primary Prevention

  • smoking cessation
  • avoiding excessive sun exposure
  • regular physical activity
  • balanced diet
  • prophylactic surgery
• Clinical Management: Secondary Prevention (screening)

  • mammogram
  • prostate - specific antigen (PSA)
  • colonoscopy
  • guaiac test for occult blood
• Clinical Management: Tertiary Prevention

  • stop the cancer from getting worse
  • follow up to assess for metastasis
  • chemo prevention to prevent metastasis
  • depends on type of cancer and co-morbidities
• Bone Marrow Suppression: Neutropenia

  reduction in circulating neutrophils = infections. (fevers, cultures)

  • treatments: colony stimulating factors: granulocyte colony stimulating factor, Filgrastim: Neupogen
  • increased risk of infections - neutropenic isolation
• Bone Marrow Suppression: Thrombocytopenia 


  reduction in circulating platelets = bleeding

  • treatments: platelet infusion and/or Oprelvekin (Interleukin 11)
  • avoid:
  • anticoagulants/antiplatelet medications
  • IM, SQ injections
  • BP cuff can cause bleeding @ the site
• Bone Marrow Suppression: Anemia


  reducing the circulating RBCs

  • treatment: PRBC transfusion and/or Epoetin alpha (Erythropoietin)
• Other Side effects of Chemotherapeutic drugs

  A) bleeding

  B) stomatitis

  C) alopecia

  D) cachexia

  E) diarrhea

  F) toxicity

  G) first

  H) reduced

  I) N/V

  J) hyperuricimia

  
• Proper PPE for Handling Chemo

  • gown and 2 pairs of gloves - worn within 48 hours of drug admin
  • face shield - is splashing likely
  • wash hands with soap and water after removal of gloves or immediately after contact with bodily fluids or chemo drug
  • linen - PPE should be worn while handling if contaminated with medication spill of bodily fluids
• Hormonal Therapy

  • used to treat hormonally responsive cancers (breast, prostate, uterine)
  • hormones act as agonists or antagonists to block specific receptors with target tissues
• Bone Marrow & Stem Cell Transplantation

  • replaces diseased or destroyed cells from the bone marrow with normal healthy cells
  • cells must be a close match (autologous or allogenic)
  • multiple complication can occur
• Sepsis & Disseminated Intravascular Coagulation(DIC)

  • infections high risk
  • notify provider right away of signs (even 1 degree increase in fever)
  • sepsis can trigger DIC:
  • extensive/abnormal clotting which depletes clotting factors and platelets resulting in bleeding from many site ranging from oozing to hemorrhage (high mortality rate)
• Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

  results in increased water retention (FVE).

  • hyponatremia = seizures/ coma
• Spinal cord compression


  tumor that invade spinal cord or vertebrae collapse from tumor degradation of bone.

  • back pain, loss of sensation, weakness, urinary retention
• Superior Vena Cava Syndrome 


  compression of SVC is painful and can be life threatening

  • early s/s: edema of face, especially around the eyes and reports of head fullness
• Tumor Lysis Syndrome

  • large numbers of tumor cells destroyed rapidly, results in intracellular contents being released into bloodstream faster than the body can eliminate them
  • collaborative management: prevention, hydration, drug therapy