Sarcoma

• cancer rises from tissue
  • Muscle
  • bone 
  • CT              
• cancer that affects
  • bones
  • bladder
  • kidney
  • livr
  • parotids
  • spleen

Carcinoma

• occurs in epithelial tissue/skin/mucous membranes
• can metastasis
• E.g>:bronchial, squaomas cell,gastric carcinoma

Cancer is ...

• 2nd leading cause of death

cancer

• malignant neoplasm
• is uncontrolled growth of cells
• its cells have reproductive advantages over normal cells

cancer cells....

• have own enzymes/proteins that give ability to spread & cause growth
• has own blood supply

tumor

• abnormal mass/growth/proliferation
• independant of neighbor tissue

neoplasm

• new growth of abnormal tissue as tumor/growth

benign

• tumor that isnt cancerous and doesnt spread

malignant

• rumor that spreads> is cancerous

pre-malignant

• pre-cancerous
• capable of becoming cacerous if given time

carcinogenic

• substance/agent that produces cancer
• increases risk of developing cancer

In situ

• cancer confined to primary site
• hasnt gone past borders of original site

Primary site and secondary site

• PRIMARY: original site
• SECONDAEY: site of metastasis

Leukimeia/lymphomas

• from blood formin systems
• E.g.: acute leukemia/ lymphcytic leukemia

Melanomas

• From pitmanted cells of skin( moles)
• Highly malignant
• Any mole can be>grows bigger than pencil earaser(KEEP EYE ON!)

Gioblastoma

meningioma

'

other cancers named for:

palliative treatment of cancer

• treatment aimed at relieving symptoms

cured

theraputic treatment of cancer

• treatment given to treat the disease

Staging of malignancies

stages catagorized by numbers 1-4

1=good

4= worst

staging 1 of malignancies

• in situ- cells confined at site w/o matastasising

 staging 2 of malignancies

• spread of cancer limited to local areas( ususally to lymph nodes)

Staging 3 of malignancies

• tumor larger>prob. invaded surrounding tissues( or both)

Stage 4 malignancies

• cancer invaded/matastasized to other parts of body.

TNM method

• addresses status of
  • T: Tumor size
  • N:iNvolvment
  • M:Metastasis distance

7 warning signs of cancer

C-A-U-T-I-O-N

C-hange of bowel sounds/bladder habits

A- sore>doesnt heal>especially around mouth

U-nusual bleeding/discharge>especially vaginal

T-hickening/lumb in breast/elswhere

I-nigestion/difficuly swallowing

O-bvious change of wart/mole

N-agging cough/hoarsness

some symptoms of cancer

• Often none> if some are vague
• Fatigue
• anemia
• unexplained weight loss      FAUMAWP
• malaise
• anorexia
• weakness
• pain>late sign>site of metastasis

Type of treatment depends on

• location
• type of CA
• extent of spread
• reaction of tumor itself
• Individual patient

Individual patient consideration

• Consideration that therapies
  •  are themselves threatening
  • may harm normal cells and malignant

Radiation therapy

• treatment
  • high use of  high energy radiation
  • penetrates tumor/destroys cells
  • often done with surgery/chemotherapy

radiation therapy kills

• cells that are frequent in reprodution:
• hair(alopacia)
  •  
    • malignant cells(targeted

Reasons for radiation therapy

• Destroys tumor
• diminishes size to relieve pressure/pain

reasons for pre-op/post-op radiation

• pre-op: decreases tumor size>increases probability of removing all the cancer
• post-op: destroys stray cells & lymph nodes that cant be resected

External/Rotational radiation

• source: high voltage X-ray
• cobalt treatment
• used 4 lung/breast/brain CA
• may go 3x/wk. on outpnt. basis

Internal radiation

• Implanted radioactive isotope
• needles/rods in/near tumor

Unsealed radiation sources

• Radioactive materials in suspension
• admin. PO,IV,or into body cavity
  • E.G. gold into bladder>intracavity

characteristics to side effects of radiation are:

• common/unexpected
• cumulative
• chronic: continues after completion of therapy

Side effects of radiation therapy

• bone marrow suppression 
• radiation sickness
• alopecia
• alterations of oral mucosa
• skin reaction
• ( BRAAS )

syptoms ass. w/bone marrow depression

• ↓RBCs: anemia/lowered energy
• ↓WBCs:Leukopenia
• ↓platlet count:increased bleeding
• damage to surrounding tissues

leukopenia

• lowered resistence to infection because of lowered WBCs

symptoms of radiation sickness

• (VHAND)
• Vomitting
• headache
• anorexia
• nausea
• diarrhea

 alterations of oral mucosa

• (STAX)
• Stomatitis-mouth sores
• taste loss
• Anorexia,NV
• Xerostomia-dry mouth

Skin reactions to radiation therapy

• burns like chemical or thermal

radiation sickness....

• starts 7-10 days after therapy/cont. for several weeks
• severity/symptoms depend on dose of radiation/location of tumor

Surgery for cancer

• removal of the cancer
• oldest and most frequent method

Surgery for cancer works well:

• with tumors that are
  • easily removed
  • detected early
  • have not metastasized

Surgery of cancer is done frequently:

• after radiation treatment

surgery of cancer currently uses:

• laser rather than scalpel when possible

Nursing care for surgery with cancer

• Pre-op teaching
• dealing with possible deformities
• grief counciling
• possible complications

 chemotherapy

• uses a variety of drugs to slow/stop the malignant process
• Can be curative or palliative

Many chemotherapy drugs are:

• available/ can be used alone
• used in combo with surgery and/or radiation

Side effects of chemotherapy

nursing care of chemo therapy

• assess for
  • signs of
    • allergic reaction
    • malnutrition & dehydration
  • electrolyte imbalance
• Monitor
  • for bleeding & infection
  • kidney function

immunology treatments

• biologic response modifiers
• newer method

immunology treatments do what?

• Stimulate bodys immune system>so can more effectively combat CA cells

kinds of immunology treatments

1. Nonspecific immunotherapy
2. monoclonal antibody immunotherapy
3. cytokines

neutropenic isolation

protecting patient from everyone else>(when immuno suppressed)

bone marrow transplant

• replaces pre-procedural bone marrow
•  high dose radiation & chemotherapy
  • leaves patient immunocompromised
    • @ risk for infection/bleeding

Bone M. transplant takes effect when?

• 2-4 weeks until new bonoe marrow becomes established and functioning

Ptn. must take what with marrow transplant?

• immunosuppresant drugs to prevent host vs. graft desease
• to avoid T-lymphocytes creating immune respose to fight foreign cells

marrow transplant comes from:

Autologous marrow transplant

allogenic marrow transplant

• from unrelated but compatible donor

singeneic marrow transplant

• from identical twin donor

stem cell marrow transplant

• hematopoietic stem cells stimulated& collected by apheresis
• reinfused after chemo and radiation

Nursng. management for cancer ptnt.

Pain

• #1 on list
• may be pnts. biggest fear
• assure pain meds will be available
• teach alternate methods of pain control

Characteristics of benign tumors

• slow/steady growth rate
• remains encapsulated/localized
• smooth easily defined borders
• movable
• uses blood around it>not own
• cells resemble normal cells
• destroys surrounding tissue by compression/obstruction
• easily removed
• not fatal

Characteristics of malignant tumors

• rapid growth
• not encapsulated
• invades surrounding tissue & matastasizes
• has iregular borders
• cant move
• has own blood supply
• cells abnormal
• compete with normal cells 4 O_2, nutrients
• destroys healthy cells by compression and obstruction
• fatal
• may recur after removal
• progress= variable

X-ray to diagnos cancer

• Xray of
  • chest for lung tumor
  • upper GI or barium enema for digestive

Biopsy to diagnos cancer

• Surgical removal of small piece of tissue
  • 4 microscope examination
  • looks for tissue abnormalities
• most important procedure in diagnosing CA
• done by incision or need aspiration

indifferentiated cells

mammography

CT scan to diagnos cancer

• To determine
  • size    
  • density   >   of cancer
  • location 

MRI to diagnos cancer

• to see tumors hidden by bone

Endoscopic procedures to diagnos cancer

• Colonoscopy
• bronchoscopy

other ways to diagnost cancer

• lab tests
• cytology studies>pap tests/bronchial cells/ascites fluid

Cardiac function S&S ass. w/death

• Initial increase in HR>followed by drop in HR & BP

Skin: S&S ass. w/death

• pale
• looks like wax
• cold to touch
• cyanosis

Pulmonary function: S&S ass. w/death

• Moist breath sounds
• death rattle
• apnea in periods>gets longer and longer

Senses:S&S of death

Kidneys:s&s ass. w/death

Dimineshed out put:< 20cc/hour.

GI function: S&S ass. w/death

• Peristalsis slows
• Little/no bowl movements

Musculoskeletal:S&S ass/w.death

• Incontinence
• jaw/facial muscles relaxed
• mouth breathing
• toungue falls back causing death rattle

Stages of grieving

1. denial/isolation
2. anger
3. bargaining
4. depression
5. acceptance

other physical S&S of death

• Chest pain
• GI distress
• headache

Nursing response to denial & isolation

• Be non-judgmental
• dont take accusations personal
• be a good listener

Nrsing response to anger

• dont take anger personal
• put self in their position
• recognize behavior as part of process
• allow a break from this person

Nrursing response to bargaining

• promises may be associated w/guilt
• allow person to express feelings & talk them out
• Do not minimize feeling by being to realistic

Nursing response to depression

• limit # of visitors
• non-verbal signs of affection-silence-hand holding
• let person know its ok not to talk

advanced directives

• end of life decisions
  • living will
  • durable power of attorny

living will

• not really medically associated
• personal affairs

Durable power of attorney

•  appoints someone to be incharge for decisions of medical affairs
• dont need layer or court
• need witnessed signature
• make sure everyone has appropriate copy

ACT that states all hosptals required by law have to provide info. on advance directives to ptnts?

main focuses of hospice

• keep ptnts free of pain
• ptnts will
  • die w/comfort & dignity
  • not feel abandoned
  • not lose personal ID
  • retain control
• all ptnts. induviduals w/thoughts,feelings,values