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					Cellular Aberrations

Cancer
 Is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA  Cell proliferate  Cell have invasive characteristics  They infiltrate thru the lymphatic circulation and blood vessel (metastasis)

Proliferative pattern
 Hyperplasia- increase in the number of cell of a tissue; most common associated with rapid body growth  Metaplasia- conversion of one type of mature cell into another type of cell  Dysplasia-bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same type of tissue

 Anaplasia- cells that lack normal cellular characteristics and differ in shape and organization with respect to their cells of origin usually, anaplastic cells are malignant  Neoplasia- uncontrolled cell gowth that follow no physiologic demand

Characteristics of malignant cells
 Malignant cell  Has special protein on the membrane that differentiate benign cell from a malignant cell of the same tissue – Tumor-specific antigen (TSA)

Etiology
 Virus and bacteria – incorporate themselves in the genetic structure and alter the future generation of the cell.  Eg. Epstein-barr virus can cause: Burkitt’s lymphoma, nasopharyngeal CA, some type of non-Hodgkin's lymphoma and Hodgkin's disease

         

Physical agents- such as: Sunlight or radiation Chronic irritation or inflammation Tobacco use Chemical agents- 75% of cancer are due to this, such as: Tobacco Alcohol Asbestos Uranium Viruses

 Genetic and familial factors – abnormal chromosomal pattern  Accounts to 5%-10% of cancer are due to this factor  Eg. Retinoblastoma, nephroblastoma  Dietary factor- long term ingestion of carcinogen, eg. Alcohol, salt-cured or smoke meat, food containing nitrates and nitrites, high calorie intake.  Counteract by taking proactive substance : high fiber food, vegetable (cruciferous eg. Cabbage, broccoli, cauliflower; carotenoids eg. Carrots, tomatoe, spinach, peaches, dark-green and deepyellow vegetables)

 Hormonal factor- hormonal imbalances either endogenous or exogenous source of hormone  Oral contraceptive and prolong estrogen replacement therapy can cause hepatocellular, endometrial and breast cancer however, decreased the incidence of ovarian and endometrial cancer to some as well

 Eg. Diethylstilbestrol (DES) causes vaginal carcinoma

C hange in bowel or bladder habits - colorectal
A sore that does not heal on the skin or in the mouth – skin or oral U nusual bleeding or discharge - colorectal, prostate, bladder or cervical

T hickening of breast tissue or a new lump - breast or testicular cancer. I ndigestion or trouble swallowing - mouth, throat, esophagus or stomach. O bvious changes to moles or warts - skin cancer.
N agging cough or hoarseness - lung or throat cancer.

U nexplained anemia – leukemia
S udden weight loss

Characteristic of Benign and Malignant Neoplasm Characteristics
Cell Characteristics

Benign
Well differentiated that resemble normal cell By expansion and usually encapsulated

Malignant
Undifferentiated and bear little resemblance to the normal tissue At the periphery & send out processes that infiltrate and destroy other tissue Variable; depends on the level of differentiation; more anaplastic the rapid growth
Gain access to blood and lymph channels

Mode of growth

Rate of growth

low

Metastasis

Does not spread by metastasis

Characteristic of Benign and Malignant Neoplasm Characteristics
General effects

Benign
Localized effect not unless location interfere vital function eg. BPH

Malignant
Often cause generalized effect such as anemia, weakness, wt. loss

Tissue destruction

Does not cause Often cause tissue damage extensive tissue unless location damage interfere blood flow Does not cause death unless location interfere with vital function Usually cause death unless growth are controlled

Ability to cause death

Carcenogenesis
 MALIGNANT TRANSFORMATION  3 process  Initiation – initiator like chemical, physical, biologic factor that escape the normal enzymatic mechanism –alter the genetic structure in the DNA  Promotion – repeated exposure to promoting agents causes expression of abnormal or mutant genetic information  Progression- exhibit increased malignant behavior

Staging and grading tumor
 Staging – determines the size of the tumor and the existence of metastasis  TNM used to refer to this system  T- extent of the primary tumor  N- lymph node involvement  M – extent of metastasis  Grading – refers to the classification of tumor cells, can be obtain thru cytology, biopsy, or surgical excision

TNM classification system
     Primary tumor (T) TX primary tumor cannot be assessed TO no evidence of primary tumor Tis carcinoma in situ T1,T2,T3,T4 incraseing in size & local local extent of tumor

TNM classification system
 Regional Lymph Nodes (N)  NX regional lymph nodes cannot be assessed  NO no regional lymph node metastasis  N1,N2,N3 increasing involvement of regional lymph nodes

TNM classification system
 Distant Metastasis (M)  MX distant metastasis cannot be assessed  MO no distant metastasis  M1 distant metastasis

Diagnostic Test:
 Tumor marker identification- analysis of substances found in blood or other body fluids that are made by the tumor or by the body in response to tumor.  Use in Breast, colon, lung, ovarian, testicular, prostate cancer  MRI – use magnetic field and radiofrequency signals to create sectioned images of various body structures  Use in neurologic, pelvic, abdominal, thoracic cancer

MRI

 CT scan – use narrow beam x-ray to scan successive layers of tissue for cross-sectional view  Use in neurologic, pelvic, abdominal, thoracic cancer

CT Scan

 Flouroscopy – uses x-ray that identify the contrast in body tissue densities; may involve the use of contrast media  Use in skeletal, lung , GIT cancer

John Y. Connolly, MD performing fluoroscopy

Fluoroscopy

 UTZ- use high-frequency sound waves echoing off body tissue are converted to electronic images use to assess deep tissues of the body  Use in abdominal and pelvic cancers

UTZ

 Endoscopy  Nuclear medicine imaging  Positron Emission Tomography (PET scan)  Radioimmunoconjugates

Modalities of treatment: cure, control, & palliative treatment
 Surgery: removal of the entire cancer, ideal treatment for cancer.  Reasons for surgery:  Diagnostic – definitive measure in identifying cellular characteristics that influence the decision to treat  Biopsy – to obtain a tissue sample to determine if malignant or benign.
 Excisional-use for accessible to tumor like breast, upper & lower GIT, upper RT. The surgeon can remove the whole tissue & examine

 Incisional- wedge resection, if the tumor is too large a part will be taken for examination  Needle biopsy – use for accessible tumor to get a sample of a fragment tissue and if the physician wants a little disturbance on the tissue to avoid proliferation

 Primary treatment Surgery– goal is to removal of the entire tumor and any involving surrounding tissue and regional lymph nodes  Local excision- when mass is small  Wide excision-radical or en bloc dissection, include removal of the primary tumor & surrounding tissue & lymph nodes  Salvage surgery – lumpectomy instead of removal of the entire breast

 Others:  Electrosurgery- use of electrical current to destroy tumor cell  Cryosurgery – use of liquid nitrogen in freezing tumor cell  Chemosurgery-layer-by-layer removal of the cancer tissue by applying topical chemical  Laser surgery-(Light Amplification by stimulated emission of radiation) use light vaporize cancer  Stereotactic radiosurgery (SRS) high-dose radiation use in brain and neck cancer

 Prophylactic surgery- removal of non vital tissue that are likely to develop cancer like oophorectomy in hysterectomy  Palliative surgery- when cure is not possible, to relieve ulceration, obstruction, hemorrhage, pain. Eg. Colostomy for colon cancer, nerve block for pain in case of bone cancer  Reconstructive Surgery – following radical surgery in attempt to improve function or obtain cosmetic effect.

 Chemotherpy  Immunotherapy/gene therapy  Biologic response modifier

Radiation Therapy • The use of radiation to treat a medical condition. • Use ionizing radiation to interrupt cellular growth • There are different types of radiation that can be used but they are usually either photons or electrons • Use for Hodgkin's testicular, thyroid, head & neck, cervical CA

Types
• External- a. Kilovoltage, b. Gamma rays c. High linear transfer radiation d. Intraoperative radiation therapy

• Internal or implant or brachytherapy – Sealed – Unsealed

Quick Facts About Radiation Therapy
1. Radiation treatments are painless. 2. External radiation treatment does not make you radioactive. 3. You need to allow 30 minutes for each treatment session 4. Get plenty of rest and to eat a well-balanced diet 5. Skin in the treated area may become sensitive and easily irritated. 6. Side effects of radiation treatment are usually temporary and they vary depending on the area of the body that is being treated.

• It is common for your skin to become red during radiation therapy. This redness is a temporary side effect of radiation treatment. • Changes in your skin usually occur two to three weeks into treatment and may last one to two weeks after last treatment. • The amount of skin redness or irritation depends on the part of the body being treated and the dose of radiation.

Most common types of skin reactions:
1. 2. 3. 4. 5. 6. 7. 8. 9. Erythema Alterations in pigmentation Alopecia Dry desquamation Ulceration Loss of perspiration Changes in superficial blood vessels Edema Scarring

1. Wash the skin gently using only lukewarm water & pat dry with a clean towel 2. The skin should NOT be rubbed or shaved. 3. Use only mild soaps for cleansing. 4. AVOID skin lotions, creams, powders and perfumes. 5. DO NOT remove skin markings

Helpful Hints for Skin Care
• Apply moisturizers to the skin as directed by your nurse. • Do not use moisturizers within two hours before your radiation treatment. • Moisturizers work best when applied just after bathing , while the skin is still damp. • Continue to moisturize your skin for at least a month after treatments are completed, and then as needed. • Protect the skin in and around the treatment area from extremely hot or cold temperatures, especially in the summer and winter. • Use soft, lightweight clothing to cover the treated area.

• If the area being treated is exposed to the sun, apply sunscreen routinely to the treatment site whenever you are outdoors for more than 10 minutes during the summer or winter. • Do not use heating pad, hot water bottle, or ice pack on the treatment area, unless instructed by your doctor.

• Always protect the treated area form chemicals

• Bathe for only a short period of time, just long enough to cleanse yourself. Soap and water can cause you skin to become drier. • Do not use deodorant soaps, which can dry skin. Use moisturizing soaps (such as unscented Dove) that do not contain perfume or fragrances. • Use warm water, rather than hot, to prevent your skin from becoming dry. • After bathing, pat the skin dry rather than rubbing it, especially at the treatment site.

• Eat a balanced diet. • Drink at least eight glasses of fluids daily unless your doctor has restricted the amount of fluids you can drink to another medical condition. • Check the skin at the treatment site daily. Report any changes to your nurse or doctor. • You may take your prescribed pain medication as directed. If you experience discomfort and have no pain medication prescribed, you may take an over-thecounter pain relief medication.

Alkaline Phosphatase Test-APT
 This test measures the amount of the enzyme alkaline phosphatase in your blood.

 This enzyme is present in most tissues but is especially concentrated in the liver and bones particularly in osteoblasts that reflects osteoblastic activity  The amount of alkaline phosphatase in your blood is measured to help diagnose liver and bone disease

 What does the test result mean?  In most labs the normal alkaline phosphatase range for adults is 39 to 117 units per liter (U/L).  Increased: liver or bone diseases  Decreased: anemia or glandular disorder

Chemotherapeutic drugs
 Alkylating Agents – e.g. Carboplatin, Cisplatin  Nitrosureas – e.g. Carmustine, Lomustine  Antimetabolites – 5-FU, Cytarabine  Antitumor antibiotics – Doxorubicin (Adriamycin)

 Mitotic Spindle Poisons – e.g. Vincristine, Docetaxel  Hormonal Agents – e.g. Steroids, estrogen, progesterone

Nursing Consideration
C – cbc, platelets monitor A – antiemetics before drug N – nephrotoxicity-indesirable effect C – counseling regarding reproduction E – encourage handwashing, avoid crowds  R – recommend a wig for alopecia     

Nursing Diagnosis
 Pain  Altered nutrition r/t anorexia, vomiting  Electrolyte imbalance r/t vomiting,diarrhea  Impaired tissue integrity r/t stomatitis  Impaired physical mobility r/t neurologic impairments

 Knowledge deficit r/t disease process  Ineffective breathing patterns r/t cough, shortness of breath  Sleep pattern disturbance r/t cancer therapies  Fatigue  Body image disturbance


				
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