Cancer Concepts

 Exact cause: Unknown

 Predisposing factors:

• Heredity
• Stress
 Psychological
 Physical

• Unuse
• Overuse
• Abuse
• Specific
 Theories of Cancer

 Cellular Transformation and

Derangement Theory

 Failure of the Immune

Response Theory
 Cellular Transformation and
Derangement Theory Normal Cell

Virus
Chemical / Physical Agent
Drugs
Hormones

Genetic Alteration

Defective Cell

Multiple cell division

Malignancy
Failure of Immune Response Theory

Potential
Cell Ab
(d e s
truc t
io n)

A
bA b
Immune system
fails
Ab
Classification
 Tumor
•1 - small
• 2-3 - medium
• 4 - large
 Node
•0 - no involvement
• 1-3 - moderate
•4 - extensive
 Metastasis
•0 - no metastasis
•1 - metastasis
 Warning Signs of Cancer
C - change in bowel or bladder habits
A - sore that does not heal
U - unusual bleeding or discharge
T - tumor
I - indigestion or difficulty in swallowing
O - obvious change in warts or moles
N - nagging cough or hoarseness of voice

U - unexplained anemia
S - sudden weight loss
Comparison of Benign & Malignant Neoplasm

Characteristics Benign Malignant

Speed of growth Slow Rapid

Mode of growth Localized Infiltrating

Capsule Encapsulated No capsule

Recurrence Unusual Common

Metastasis None Common

Effect Harmless to host Harmful

Prognosis Very good Poor

LUNG CANCER
 Description
 Refers to malignant tumor
growth within the bronchial
tissue or lung parenchyma.
 Types include:
• Squamous cell
• Adenocarcinoma
• Small cell (oat cell)
• Large cell
 Etiology and Incidence
 Exact Cause: Unknown

 Predisposing factors
• Heredity
• Pulmonary irritants

 Poor prognosis
 Pathophysiology
 Irritation  series of changes
 tumor
 Metastases – primary sites
 Some tumors secrete
hormones:
• ADH – reabsorption of water
• ACTH – stimulates adrenal
glands to produce steroids
 Symptoms may include:
• Cough
• Wheezing
• Shortness of breath
• Chest pains
• Hoarseness
• Dysphagia (compression of esophagus)
• Weight loss
 Nursing Interventions
 Adequate oxygenation
 Prepare for surgery if tumor is small
enough to be removed
 Prepare patient for planned
treatments
• chemotherapy
• radiation therapy
 Analgesics as ordered
 Maintain nutritional status
 Provide emotional support
BLA DDER
CANCER
 More common in males
 Cause: unknown

 Risks factor s
1. Exposure to ci garette
smoke
2. Pel vi c radi ati on
3. Use of
cycl ophosphami de
4. Chroni c cyst iti s
As ses sment

 Hematu ria (f ir st s ign)

• Pai nl ess
• Gross
 Dysur ia
 Obs truct ion to uri ne f low

 Development of f is tula
 Collaborative
Management
 Chem ot herapy
Thi otepa
Mitomyci n C
Do xorubi ci n (Adri amyci n)
Cycl ophosphami de
(cytoxan)
Ci spl ati n (Pl ati nol)
Met hotrexate
 Radi ati on
 Surgery
•Urinary Diversion
Surgeries
Ileal Conduit

Ureterostomy

Ureterosigmoidosto

my
Ileal Conduit
 For CA
Bladder
 Adult

Neurogenic
Bladder
 Insterstitial

Cystitis
 Irreparable
Important! Compl icati ons
 External  Obstructio n

col lecti on to the uri ne

devi ce flow vi a
smal l
needed intestine s
 Proper
secondary to
fitting to edem a
prevent  Inf ect ion

uri ne le ak to  Stoma
the ski n prol apse
 Ski n care  Cal cul i
Ureterostomy
 Either or both
ureters are out
to the
abdominal wall
 Ureteral stoma
is created
 External
collection
device is
needed
 Infection is a
Nephrostomy
 To drain the
urine while
ureteral
inflammation
from trauma
or calculus is
present
Complications Important!
 Infection  DO NOT

(Pyelonephriti IRRIGATE!!!
s)
 Blockage of

the catheter
Ureterosigmoidostomy
 No external
collection
device
 Passage of

flatus
includes leak
of urine
 Infection is

possible
PROSTATE
CANC ER
 Most comm on mal e Ca
(gender -s pecif ic)
 Androgen – dependent
adenocarci nomas
 Predisposing Factors
 Genet ic tendency
 50 y ears o f age

 Hor monal f act ors

• Late puberty
• High frequency of sexual
experi ence
• History of multi pl e sexu al
partners
• High fertil ity
 Diet
• ↑fat (alters cholesterol and
steroid metabolism)
 
 Chemical carcinogens
• Air pollution
• Occupation-related
 industries – fertilizer, rubber,

textile
 batteries containing

Cadmium
 Assessment
 Hesistancy
 Hematuria
 Urinary retention
 Stool changes
 Pain radiating down hips and legs
 Cytitis
 Dribbling
 Nocturia
 Hard, enlarged prostate

 Pain on defecation

 High level of acid

phospatase
 Elevated PSA (Prostatic

Specific Antigen)
 Nursing Interventions
 Early detection of tumor
• Ultrasound
• MRI
• X-ray
• CT Scan
 Radiation therapy
 Endocrine therapy - DES
(diethylstilbestrol) decreases
testosterone level)
 Surgery: Prostatectomy
 Hodgkin’s
Disease
malignant tumor of lymphatic
system
 Ca use :
• Unknow n
• Vi ral associ ati ons
• Auto imm uni ty

 Incid ence:
• Young adul t 15- 35
 Pathophysiology
Proliferation of abnormal T-Cells

Obstruction in lymphatic flow

Metastases
Pain
 Spleen
Fever
 Liver
Weight Loss
 Lungs
Malaise
 Heart
 Management
 MO PP
• Watch out for BM
depressi on
 ABVD
• Causes re d ur ine
 Nursing Intervention
 Support ive
•N/ V
•F & E
•Co mfort me asu res
 Protection from infection
 Maintain Tissue Integrity

 Maintain Normal Body

Temperature
 Prevent or decrease pain

 Maintain ideal body weight

 Maintain adequate hydration

 Assist client and significant

others to cope
COLORECTAL
CANCER
 Cause: Unknown
 Predisposing Factors:
• Age above 40 years
• Predisposing Factors
 √ low in fiber
 √ high in fat, protein and refined

carbohydrates
 Obesity

 History of chronic constipation

 History of IBD, familial polyposis or colon

polyps
 Family history of colon cancer

 Most Common Site: Rectosigmoid area

(70%)
 ASSESSMENT
 Ascending (Right)  Distal Colon / Rectal
Colon Cancer Cancer
• Occult blood in • Rectal bleeding
stool • Changed bowel
habits
• Anemia
• Constipation or
• Anorexia and Diarrhea
weight loss • Pencil or ribbon –
• Abdominal pain shaped stool
above umbilicus • Tenesmus
• Palpable mass • Sensation of
incomplete bowel
emptying
COLORECTAL CANCER
 Duke’s Classification of Colorectal Cancer
Stages:
• A: confined to bowel mucosa, 80 – 90% 5-
year survival rate
• B: invading muscle wall
• C: lymph node involvement
• D: metastases or locally unresectable tumor,
less than 5% 5 – year survival rate
 Guidelines for Early Detection of Colorectal
Cancer
• Digital rectal examination yearly after age 40
• Occult blood test yearly after age 50
• Proctosigmoidoscopy every 5 years after age
50, following 2 negative results of yearly
 COLLABORATIVE
MANAGEMENT
 Surgery
• Hemicolectomy (ascending and
transverse)
• Abdomino – Perineal Resection
(APR) for rectosigmoid cancer
Necessitates permanent colostomy
 Chemotherapy
• Fluorouracil (most effective)
 Radiotherapy
• Adjuvant treatment
Renal Ce ll
Ca r cinoma
 Pathophysiology:
Tumor (anywhere in
the kidneys) Metastasis

Compression on the
surrounding surface Primary sites
•Lungs
•Liver
•Ischemia
•Lymph nodes
• necrosis
•Renal veins
• hemorrhage
 Signs and Symptoms
 Abdominal pain
 Hematuria
 S/sx of shock
 Nursing Interventions:
 Monitor closely for:
• Fluid and electrolyte status.
• I&O
• Acid-base balance
 Symptomatic
 Prepare for possible surgery
 Institute postop care