Cancer

 

Excessive multiplication of cells in part of the body

Tumour - a lump, new growth or neoplasm

Common primary sites include, kidney, prostate, breast, bone, GIT, cervix or ovary

Caused by a hyperplasia.

Loss of contact inhibition

Growth may outstrip blood supply resulting in necrosis, ulceration and subsequent infection.

 

Primary or secondary

Common primary sites include, bronchus, colon, stomach, kidney, prostate, breast, bone, cervix or ovary

Common secondary sites include,

 

Benign or malignant

Metastases

Cachexia

 

Names

oma - lump

fibroma - lump in fibrous tissue

carcinoma - malignancy originating from a surface epithelium, eg. ca bronchus.

sarcoma - tumours arising from a connective tissue, eg. fibrosarcoma

adeno - gland

haem - blood angio - vessel chondro cartilage

osteo - bone endo - lining myo- muscle

 

Cancer warning signs

Change in bowel habits Sore which does not heal

Unusual bleeding or discharge Thickening or lump somewhere, (self examination)

Difficulty in ingestion Changes in a wart or mole

Nagging cough or hoarseness

 

Diagnosis

Clinical Biopsy Cytology

Radioisotope scanning CT MRI

Ultrasound Biochemistry and haemotology

Treatment

Surgical excision Cytotoxic agents DXT Immunotherapy

 

Causes

Radiation Chemical carcinogens Smoking

Occupation Virus Diet

Heredity Hormones Other environmental factors

Age Initiators, promoters, multifactoral aspects.

 

 

Cancer

20 - 25% of deaths in the West, normally more common in old age.

Excessive multiplication of cells in part of the body, rapid and uncoordinated.

Tumour - a lump, new growth or neoplasm

Loss of contact inhibition

Growth may outstrip blood supply resulting in necrosis, ulceration and subsequent infection.

Primary or secondary

 

Benign or malignant

 

benign malignant

 

Growth rate

 

Local invasion

 

Metastases

 

Recurrence after

resection

 

Systemic effects

 

Cytology normal usually big cells with irregular nuclei, mitotic figures

 

Histology preserved form form and function changed and function

 

 

Causes

Radiation exogenous oncogenes endogenous oncogenes

Chemical carcinogens Smoking Occupation

Virus (Epstein Barr) Diet Disorder of immunity

Heredity Hormones Other environmental factors

Immunosupression Age

 

Multi-step theory of neoplasia

Initiator - causes a change in the genetic material, must be applied first

Promoter - applied at regular intervals over time removal of the promoter in

pre - malignant tissue can remove or reduce risk

Complete carcinogens - initiators and promoters

Incomplete carcinogens - initiators or promoters

 

Tumour grading

 

Histological estimate of the differentiation of neoplastic cells.

 

well differentiated moderately differentiated poorly differentiated

no differentiation or anaplastic

 

 

 

Staging of tumours

The degree of spread of a malignant neoplasm.

 

site of origin local spread lymph node metastases distant metastases

T = tumour N = regional lymph node involvement M = metastases.

eg. T1N0M0 T4N3M3

 

Hormones and cancer

Hormone producing tumours

appropriate production inappropriate production

 

Prostatic and breast tumours are to some extend dependent on the relevant gender sex hormone

 

Names

Oma - lump fibroma - lump in fibrous tissue adeno - gland

haem - blood angio- vessel chondro - cartilage

osteo - bone endo- lining myo - muscle

 

Histogenesis

carcinoma - malignancy originating from a surface epithelium, eg. ca bronchus.

sarcoma - tumours arising from a connective tissue, eg. fibrosarcoma

lymphoma - from lymphoid tissue

 

Cancer warning signs

Change in bowel habits Sore which does not heal

Unusual bleeding or discharge Thickening or lump somewhere, (self examination)

Difficulty in ingestion Changes in a wart or mole

Nagging cough or hoarseness

 

Diagnosis

Clinical Biopsy Cytology Radioisotope scanning

CT MRI Ultrasound Endoscopy

Biochemistry and haematology

 

Clinical effects

compression general malaise SOL lethargy

ulceration peripheral neuropathy haemorrhage hypercalcaemia rupture skin disorders perforation cerebral degeneration infarction anaemia hormonal metastases pain infection cachexia obstruction

 

Direct effects Paraneoplastic effects

 

Treatment

Surgical excision Cytotoxic agents DXT Immunotherapy

Endocrine-related therapy Palliative

 

Benign tumours

local expansive growth usually not life - threatening

not metastatic cells well differentiated

surrounding rim of compressed, fibrous tissue forming a capsule

eg. adenoma - gland, fibroma - fibrous tissue, lipoma - fat

myoma - muscle, angioma - blood vessel.

 

Malignant tumours

destructive and invasive growth usually fatal without treatment

sooner or later metastatic less well differentiated cells

transgression of normal boundaries

 

Spread

local infiltration lymphatic spread blood body cavity spread CSF

 

 

Nursing measures

 

Teaching patient and family

explanations about care encourage self care activities

encourage family in patient care recognise when nursing care becomes necessary

 

Prevent effects of immobility

prevent pressure sores maximise mobility as condition allows

 

Maintenance of personal hygiene

attention to skin, hair and clothing may improve self-esteem

pay attention to smells from body exudates, draining wounds and dressings

clean bed linen fulfil self card defects

 

Maintaining elimination

constipation likely, resulting from opiates, anorexia and immobility

fluids and dietary fibre mobility where possible

use of stool softener enemas and laxatives as indicated

 

Maintaining nutrition

cathexia may occur tumour growth uses a lot of protein

malignant tissue is metabolically active encourage family/group eating

pay attention to protein and calories, consider supplements

blend food if indicated TPN may be indicated if available

good nutrition promotes immuno-competence and wound healing

 

Promotion of comfort

treat pain facilitate sleep and rest periods optimise nursing positions

 

Identify patient fears

irrational fears may be allayed

 

Be realistic

don`t lie to patients avoid unrealistic false hope, eg during remission

 

Plan home care

Marie Curie cancer care hospice MDT care of family and others

 

Pain

Aspirin aspirin and codeine opiates anxiety makes pain worse

give regularly not PRN phenothiazines tricyclics

 

 

 

 

Neoplasia

 

 

Aetiology of cancer

 

Neoplasms and mutations

 

Chemical carcinogens

 

Tobacco smoke as a carcinogen

 

Direct and indirect carcinogens

 

Initiation and promotion

 

Free radicals

 

Radiation

 

DNA repair

 

Oncogenic viruses

 

Cancer and immunity

 

Cancer and hormones

 

Cancer and age

 

Genetic factors

 

 

 

Cancer prevention

 

Never use tobacco

 

Limit alcohol intake

 

Have a good diet; avoid `junk` foods

 

Eat enough antioxidants to neutralise free radicals

 

Combat and prevent obesity

Be physically active

 

Avoid too much ultraviolet radiation

 

Avoid carcinogens

 

Vaccination

 

Eradicate Helicobacter pylori,

 

Treat chronic oesophageal regurgitation

 

Promote immune function

 

 

 

Epidemiology and incidence of cancer

 

 

 

 

 

 

 

 

Naming and classifying cancers

 

Carcinoma

 

Sarcoma

 

Bone marrow derived cells

Leukaemias - haemopoietic cells

Lymphomas - lymphocytes

Myeloma - plasma cells from B lymphocytes.

 

Other categories of malignancies

Melanoma - melanocytes

Gliomas - glial cells

Teratoma and seminoma - ovaries or testis.

 

 

Hypertrophy and hyperplasia

 

 

 

Benign and malignant neoplasms

 

Metaplasia - metaplastic tissue

 

 

Invasion and metastasis

 

Carcinoma in situ

 

Primary and secondary tumours

 

Loss of cell to cell adhesion

 

Metastasis of malignant cells

 

Cancer staging

 

Cancer grading

Cytological and histological appearance

An indicator of how aggressive a malignancy is

Low grade tumours - well differentiated, slower growth rates, less invasive, less metastasis

High grade tumours - poorly differentiated cells, anaplastic, rapid rates of growth, invasion and metastasis

Moderately differentiated - intermediate grade and level of aggressiveness.

 

Tumour markers

Prostate-specific antigen (PSA)

Carcino-embryonic antigen (CEA) in colorectal cancer

CA-125 in ovarian cancer.

 

 

Clinical features of neoplasms

 

Direct effects

Bulky tumours - compressive and obstructive effects, compress blood or lymphatic vessels causing areas of necrosis, airways, GI tract

Kidney tumours - obstruct the flow of urine

Intracranial tumours - compress the brain

Peripheral tumours - nerve compression

Penetrate blood vessel - haemorrhage.

Ulceration and fungation

GI pain, haemorrhage perforation, obstruction

Periosteum or endosteum - pain, pathological fractures

Lethargy and general malaise caused by metabolic effects, hormonal changes or secondary infections

Anaemia, hypercoagulable state

 

 

 

Paraneoplastic syndromes

Fever

Weight loss, cachexia

Hypercalcaemia

Endocrine disorders

Finger clubbing

Skin rashes

Peripheral neuropathy

Cerebral degeneration

 

 

 

Early warning signs of cancer

 

Unusual bleeding or discharge

 

A sore which does not heal

 

Change in bowel or bladder habits

 

Thickening of tissue or a lump in breast or elsewhere

 

Nagging cough/hoarseness

 

Obvious change in a wart or mole

 

Indigestion/difficulty in swallowing

 

 

Diagnosis of malignancy

 

 

Screening

 

 

Principles of cancer management

 

Local excision

 

Chemotherapy

 

Radiotherapy

 

Endocrine related treatment

 

Immunotherapy

 

Palliative treatment

 

Teaching patient and family

 

Prevent effects of immobility

 

Maintenance of personal hygiene

 

Maintaining elimination

 

Maintaining nutrition

 

Promotion of comfort

 

Identify patient fears

 

Be realistic

 

Plan home care

 

Pain