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Neoplastic disorders –
1. Describe the process involved in the development of Cancer:
Most tissues contain predetermined undifferentiated stem cells, these cells
give rise to mature cells of the type of tissue where they reside. These
cells ( and all cells) are controlled by an intracellular mechanism that
determines proliferation (growth by the rapid multiplication of parts).
Normal cells respond to intracellular signals regulating equilibrium.
Cancer cells do not. Cancer cells have no regard to cellular boundaries
and divide indiscriminately. This is caused by a loss of contact in the
inhibition cells, and results in the mutation of the stem cell(called the stem
cell theory). After this occurs the cell can either kill itself (apoptosis),
recognize damage and repair itself, or survive and pass along damage
(mutated cells can become malignant). Cancer cells secrete biochemicals
that cut through the tissue and other biochemicals that stimulate growth
of blood vessels that nurture the tumor growth. IMP: CANCER CELLS
DO NOT GROW FASTER THAN REGULAR CELLS BUT DIVIDE HALF
HAZARDLY GIVING OFF MORE THAN ONE DAUGHTER CELL AT A
TIME WHICH IN TURN CAUSES THEM TO POPULATE AND AREA
QUICKER THAN A NORMAL CELL. (this is known as the pyramid
effect)
2. Differentiate between the phases of cancer:
First phase of cancer is initiation; during this phase the cell’s genetic
structure is mutated, it has potential to develop into a clone of neoplastic
cells, (this mutation is caused by exposure to a carcinogen). This cell has
not established the ability to self replicate and grow, and these mutations
may remain undetected throughout the lifetime. The second phase of
cancer is promotion; its characterized by a reversible proliferation of the
altered cells. The odds of developing cancer increases with the presence
of promoting agents like fat, obesity, cigarettes and alcohol. Lifestyle
changes in this stage will reduce the risks. The third and final stage in
cancer is the progression stage, this stage is characterized by increased
growth rate of the tumor, invasiveness of the tumor, metastasis, and the
most frequent sites for metastasis are the adrenal glands, bone, brain,
liver, and lungs.
3. Describe the classification systems of caner:
Benign/Malignant:
Benign Neoplasms are well differentiated and do not spread while
Malignant neoplasms range from well differentiated to undifferentiated
and this tumor can invade and metastasize. Normally is invasive and
spreads outward
Anatomic Site:
Carcinomas originate from embroyonal ectoderm (skin and glands) and
endoderm (mucous membrand lining of resp. tract, gi and gu tract);
Sarcomas originate from embroyonal mesoderm (connective tissue,
muscle, bone, and fat); and Lymphomas and leukemias originate from
hematopoietic systems.
Histologic grading :
this is classified by the appearance and degree of differentiation; poorly
differentiated appearance has a worse prognosis than a closely defined
one. Grade I cells differ slightly from normal cells (mild dysplasia) and
are well differentiated. Grade II cells are more abnormal (moderate
dysplasia and moderately differentiated. Grade III cells are very
abnormal (severe dysplasia) and are poorly differentiated. Grade IV cells
are immature and primitive (anaplasia) and undifferentiated, cell of
origin is difficult to determine.
Staging based on description of extent
Clinical stageing, Stage 0 is cancer in situ which means it has not
metastasized or invaded surrounding tissue. Stage 1 is localized tumor
growth. Stage II is limited local spread. Stage III is extensive local and
regional spread. Stage IV is matastasis
TNM Classifications:
Determines the anatomic extent of the disease involvement according to
the following. T would be the tumor size and invasiveness. N would be
the presence or absence of regional spread to lymph nodes. M would be
the metastasis to distant organ sites
4. Role of the nurse in the prevention, protection and care of cancer patient:
Nurses are in a position with the patients to provide and educate, they can
help the pt understand , reduce or eliminate the pts’s risk of cancer development, help
them comply with cancer management regimens, help patients cope with the effects of
cancer and related treatment. And they can help change the attitude of cancer
5. Lab values associated with cancer
• WBC 4,500-11,000
• Neutrophils 4,000-11,000
• Neutropena 1,000-1,500
• Plateletts 150,000-450,000
• Thrombocytopena below 50,000
• Hemoglobin 12-18 g/dl
• Anemia below11g/dl
6, 7, 8, differentiate b/w the types of therapy, describe the effects of each on the pt as well
as effects on normal tissue and side effects and describe complications that can occur
within each therapy
Biopsy:
Only definitve means of diagnosing cancer with help with treatment plan,
whether to cure, control, or palliation
Goals of treatment:
To cure treatment is offered to have greatest chance of disease
eradication such as surgery and radiation. To control the cancer may not
be completely eradicated but cancer may be responsive to anticancer
therapies and can be managed for a long period of time. To palliate relief
or control of symptoms aand maintenance of satisfactory quality of life,
can go on for months or years
Surgical Treatment
This is the oldest for of treatment. Can be used to eliminate or reduce risk
of ca development (preventative). Can also cure and control only the necessary diseased
tissue is removed, additional therapy is used to tread unresectable masses. Reduction of
seeding measured utilized, surgical removal of unusual sites of regional spread.
Chemotherapy
Goal is to eliminate or reduce malignant cells primary tumor and metastic
sites, is a systemic therapy, mainstay of cancer therapy for most solid
tumors and hamatologic malignanceies, administered multiple routes such
as vascular access, peripherally inserted central venous access or
implanted infusion ports. Chemo can cause schlerosis, phylbitis,
infiltration,necrosis of the vein. It can be absorbed through the skin and
inhaled during administration. Advantages is that it devievers the drug
directly to the tumor site and a higher concentration of drug with reduced
systemic toxicity. Intraarterial chemotherapy is delivered to the tumor via
arterial vessels supplying the tumor. Used for the treatment of cancers of
the head neck, bladder brain, cervix, melanomas, primary liver cancer,
metastic liver disease. Intraperitoneal chemotherapy – delivers to the
peritoneal cavity for treatment of peritoneal metastases, treatment of
primary colorectal, ovarian cancers, given via hickman or groshong
catheters for short time administration. Complications of intraperitoneal
chemo is abdomal pain, the catherter may become occluded, dislodged,
migrate or an infection my occur. Intrathecal or intraventricular chemos
involve lumbar punctures and injection of chemotherapy to subarachnoid
spaces. Used to tread ca that metastasized to the CNS (most common
breast, lung, gi tumors, leukemia and lymphoma). Can cause headache,
nausea, vomiting, fever and nuchal rigidity (neck) surgically injected
resivior place in cerebrum. Intravesical bladder chemo is the installation
of chemotherapeutic agents into the bladder via urinary catheter and
retained for 1-3 hrs. treatment of bladder cancer. Pt has already
undergone tradional surgical therapy. Benefits are reduced urinary and
sexual dysfunction. Complications can be dysuria, urinary freguency,
hematuria, bladder spasms. ALL CHEMO THERAPIES: chemotherapy
response is based on mitotic rate, size, location, and presence of resistant
tumor cells. Chemotherapeutic agent cannot distinguish between normal
and cancer cells, causes fatigue, anorxia, taste alterations, acute toxicity
occurs during and immediately after drug administration this is seen by
vomiting, nausea, allergic reactions, dysrhythmias, extravasation.
Delayed effects are mucositis, alopecia, bone marrow suppression,
delayed nausea and vomiting, skin rashes, bone marrow suppression,
altered bowel function, cumulative neurotoxicities, and can cause damage
to the heart, kidneys, liver, lungs because the normal cells are killed with
the cancerous cells