Oncology

1. Oncology Care of the Patient with Cancer

2. Objectives • Differentiate between benign and malignant tumors • Screening procedures for cancer • General signs and symptoms of cancer • Discuss the prevalence of cancer • Identify risk factors for cancer • Treatment and nursing care of patients with cancer with cancer

3. Cancer= abnormal, uncontrolled cellular growth Benign versus malignant tumors Malignant tumor = cancerous and capable of spreading; neoplasm Benign tumor = noncancerous and nonspreading 1.3 million cases of cancer per year; 550,000 deaths Oncology branch of medicine that deals with the study of tumors Pathophysiology of Cancer Defect in cellular proliferation No contact inhibition Proliferate indiscriminately What Is Cancer?

4. How Cancer Spreads: Metastasis • Metastasis = spread of cancer cells from one part of the body to another • Blood vessels • Lymphatic system • Secondary tumors or metastases • Carcinogen = any substance that causes cancer

5. Statistics • Cancer is the second leading cause death in the United States • Men have a 1 in 2 lifetime risk of developing cancer • Women have a 1 in 3 lifetime risk developing cancer • Lung cancer is the leading cause of death in both men and women death in both men and women

6. Tumor Development

7. Normal Body Cells • Look like other cells from the tissue of origin • When mature serve a specific purpose • Reproduce in a controlled predictable manner • Stop dividing when nutrients are insufficient or space is inadequate • Remain in tissue of origin, except blood cells

8. Slow steady growth Enlarges and expands but remains localized but remains localized Resembles parent tissue Rarely recurs Usually does not cause tissue destruction in compression or obstruction Smooth, well defined edges, may be movable edges, when palpated Varied rate of growth, often rapid metastasizes Little or no resemblance to parent tissue to parent tissue Commonly recurs after removal Can cause tissue necrosis, ulceration, perforation, tissue sloughing, and can be fatal Irregular edges, more immobile when palpated Benign TumorsMalignant Tumors

9. Malignant & Benign

10. Metastasis • Process by which tumor cells are spread to distant parts of body to distant parts of body • Occurs several different ways: • Direst spread of cells by diffusion • Circulation by way of blood and lymph • Accidental transplant during procedures

11. Staging is a way of describing a cancer, such as the size of the tumor and where it has spread Staging is the most important tool doctors have to determine a patient’s prognosis The type of treatment a person receives depends on the stage of the cancer Clinical diagnostic staging Bone and liver scan Ultrasonography Computed tomography MRI Surgical Staging- Describe extent of the disease after biopsy or surgical exploration Staging

12. Grading: based on the degree of malignancy, how alike the cells are to the parent tissue or “differentiated” Grade 1 – most differentiated Grade 4 least differentiated, most malignant Staging: general extent of cancer and spread of disease rather than cell appearance Stage 1 – No invasion of other tissues, localized Stage IV – Metastasized to distant parts Grading and Staging of Tumors

13. Grading and Staging of Tumors

14. Risk Factors • The followingpromotesadditional damage to cells causing further genetic alteration • Dietary fats • Cigarette smoking • Alcohol consumption • Prolonged severe stress • Reversible proliferation of altered cells is a key concept in cancer prevention

15. Heredity Age - Inactivity and obesity Chemical Agents Tobacco Alcohol Diet Dietary fat and meat Fruits and vegetables Carotenoids Antioxidants Phytochemicals Environmental Carcinogens in the environment Ingested chemicals Environmental and industrial pollution Radiation Microorganisms Risk Factors of Cancer

16. Percentage of All Cancer Deaths Linked to Risk Factors

17. Seven Major Warning Signs of Cancer

18. The Causes of Cancer: Role of DNA • DNA basics • DNA= deoxyribonucleic acid, a chemical substance that carries genetic information • Chromosome= threadlike body in a cell nucleus that contains molecules of DNA • Gene = section of chromosome that contains the instructions for making a particular protein

19. The Causes of Cancer: Role of DNA • DNA mutations and cancer • A mutated gene no longer contains the proper code for producing its protein • Oncogene= gene involved in the transformationof a normal cell into acancer cell • Cancer promoters = compounds that accelerate cell growth

20. Dietary Guidelines for Cancer Prevention • Eat a varied plant-based diet • Eat 5–9 servings of fruits and vegetables each day • Cruciferous vegetables • Citrus fruits and berries • Dark-green leafy vegetables • Dark-yellow, orange, or red fruits or vegetables • Eat high-fiber foods • Limit consumption of meat and total fat; favor monounsaturated and omega-3 polyunsaturated fats • Limit consumption of charred, blackened, cured, and smoked meat and fish • Be moderate in consumption of alcohol

21. SOURCE: National Cancer Institute

22. Levels of Disease Prevention • Primary Prevention • Avoidance of causative agent • Secondary Prevention • Early detection, screening • Tertiary Prevention • Treatment, symptom control, rehabilitation

23. PrimaryPreventionAvoidance of causative agent • Alteration in lifestyle behaviors to eliminate or reduce exposure to carcinogens • Avoid smoking. Tobacco is linked with lung, oropharyngeal, bladder, pancreatic, cervical, kidney cancer • Risk is related to:“Pack Years” – number of packs of cigarettes smoked per day multiplied by the number of years a person has smoked • Example – Patient smoked 1 pack per day for 30 years • 1x 30 = 30 pack years

24. Primary Prevention – continuedAvoidance of causative agent • (1) Abstain from smoking • Major single cause of cancer death in US • Most preventable cause of premature death • (2) Dietary • Eat variety of foods, with emphasis on plant sources • Limit consumption of red meat, especially high in fat and processed

25. Primary Prevention – continuedAvoidance of causative agent • (3) Adopt a physically active lifestyle • Moderate activity – 30 minutes or more 5x or more days of the week • Vigorous activity – 45 minutes or more further decrease risk of breast and colon cancer • (4) Maintain a healthy weight throughout lifetime • Overweight increase risk of cancer – breast, colon, endometrium, kidney, etc.

26. PrimaryPrevention – continuedAvoidance of causative agent • (5)Alcoholic beverage – limit consumption • Alcohol increases risk of cancers of mouth, pharynx, larynx, esophagus, liver, breast, colon • (6) Sunlight & Ultraviolet Exposure • UV exposure can increase skin cancer risk • Actinic keratosis – small (<1/4 inch) rough or scaly spots. Found on face, ears, back of hands, arms. Can turn into squamous cell carcinoma • Two types of UV (a) UVA and (B) UVB • Both cause damage of DNA of skin • Artificial sources of UV – sunlamps, tanning booths- may increase source of skin cancer

27. Preventing Cancer • Avoid tobacco • Control diet and weight • Exercise regularly • Protect skin from sun • Avoid environmental and occupational carcinogens • Be aware of warning signs, and get recommended screening tests

28. Preventing Cancer

29. Secondary PreventionEarly detection, screening • Secondary Prevention – early detection • Methods • 1) Inspection • 2) Palpation • 3) Use of tests or procedures – screening recommendations • Women – Self breast exam monthly Over 40 – mammogram • Men – Prostate – rectal exam 40 years old yearly • Both Men & Woman – Colon & Rectum at 50 baseline colonoscopy and follow up colonoscopy q10years

30. Tertiary Prevention Treatment, symptom control, rehabilitation • Tertiary prevention – reducing morbidity by • Prompt, effective treatment • Symptom control • Rehabilitation • Reconstructive surgery after breast cancer • Surgery to reverse a temporary colostomy after colon cancer treatment • Strategies to maintain quality of life

31. Diagnosis of Cancer • Health history • Identification of risk factors • Physical exam • Diagnostic procedures

32. Clinical Manifestations of Cancer • Depends on size and site • Local Effects • Benign – obstruct lumen of tubular structure such as ureters, trachea, or intestinal tract • Intraspinal or intracranial – pressure within the close space • Malignant • Destroy or infiltrate surrounding tissues • Obstruction • Hemorrhage • Ulceration • Secondary infection

33. Systemic Effects

34. Clinical Signs • Cachexia– sign of advanced cancer • Anorexia • Early satiety & early filling • Weight loss • Anemia • Pain – 75% of pt will experience pain. Incidence and severity depends on site

35. Diagnostic Tests • Labs • CBC, H/H, WBC • Blood or serum Calcium increases • Hypercalcemia is often associated with malignant disease. Causes of elevated serum-calcium levels in the absence of bony metastases; • (a) parathyroid-hormone production by the tumor • (b) osteolytic factors made by the tumor (dissolution of bone, especially the loss of calcium from bone) • © coexistent primary hyperparathyroidism • Acid phosphataseincreases • an enzyme that works under acid conditions and is made in the liver, spleen, bone marrow and the prostate gland. • Abnormally high serum levels of the enzyme may, for example, indicate prostate disease (infection, injury, or Cancer).

36. Diagnostic Tests • Tumor markers • PSAprostate specific antigen(0.4ng/ml) increases • CEA–carcino embryonic antigen • Most commonly ordered when a patient has a cancer of the GI system-colon, rectum, stomach, esophagus, liver, or pancreas • Once treatment for the cancer has begun, CEA tests have a valuable role in monitoring the patient's progress. A decreasing CEA level means therapy is effective in fighting the cancer. A stable or increasing CEA level may mean the treatment is not working, and/or that the tumor is growing. • AFP –Alpha-fetoprotein • Used to detect tumors that mark cancers of the liver, testes, ovaries • The higher the AFP level in patients with cancer, the bigger the tumor. AFP decreases when your body responds to anti-cancer therapy. If AFP does not return to normal within about one month after cancer therapy, some of the tumor may still be present.

37. Common Cancers: Lung Cancer • Leading cause of cancer death • Chief risk factor = smoking • Estimated causes about 3000 lung cancer deaths per year • Symptoms = persistent cough, chest pain • Treatment = combination of surgery, radiation, chemotherapy • Survival rate = 15% after five years

38. Common Cancers: Colon and Rectal Cancer • Second leading cause of cancer death • Risk factors • Age • Preexisting polyps • Heredity • Inactivity and obesity • Diets high in red meat, smoked foods, simple sugars • Excessive alcohol consumption • Smoking

39. Common Cancers: Colon and Rectal Cancer • Symptoms • Bleeding from the rectum • Change in bowel habits • Testing • Stool blood test • Sigmoidoscopy or colonoscopy • Treatment • Surgery is primary method of treatment

40. Common Cancers: Breast Cancer • Most common cancer in women and second to lung cancer in the number of cancer deaths among women • Causes/risk factors • Heredity • Long-term exposure to high blood levels of estrogen • Early onset of menstruation • Late onset of menopause • No children or first child after age 30 • Obesity • Current use of Hormone Replacement Therapy HRT • Alcohol use • Inactivity • Diet low in vegetables and fiber

41. Common Cancers: Breast Cancer • Early detection • Mammography (low-dose X ray) after age 40 • Clinical breast exams • Breast awareness and self-examinations • Diagnosis • Ultrasonography = imaging method using high-pitched sound • Biopsy = removal and examination of a small piece of body tissue • Treatment • Surgery (lumpectomy, mastectomy) • Chemotherapy or radiation, social support

42. Common Cancers: Prostate Cancer • Most common cancer in men and second to lung cancer in the number of cancer deaths among men • Risk factors • Age • African American ethnicity • Heredity • Lifestyle factors • Diets high in calories, dairy products, and animal fat and low in plant foods • Obesity and inactivity • History of STDs

43. Common Cancers: Prostate Cancer • Detection and diagnosis • Rectal exam • PSA (prostate-specific antigen) blood test • Ultrasound • Biopsy • Treatment • Surgery • Radioactive seeds • Survival rate = 98% at 5 years

44. Cancers of the Female Reproductive Tract • Cervical cancer • Linked to infection with HPV (genital warts) • Detected with the Pap test = scraping of cells from the cervix for examination • Abnormal cells are monitored over time; if they progress toward malignancy, they are removed

45. Cancers of the Female Reproductive Tract • Uterine or endometrial Cancer • Risk factors similar to those for breast cancer • Usually detected by pelvic examination • Treatment = surgery, possibly combined with radiation and chemotherapy • Survival rate = 96% at 5 years

46. Cancers of the Female Reproductive Tract • Ovarian cancer • Risk factors similar to breast and endometrial cancer • Anything that lowers the lifetime number of ovulation cycles reduces risk • Usually has no symptoms and is difficult to detect • Treatment = surgery • Survival rate is low due to late detection • Other female reproductive tract cancers • Clear cell cancer of vagina or cervix is more common among daughters of women who took DES during pregnancy

47. Skin Cancers • Most common type of cancer when cases of the highly curable forms are included • Primary risk factor is exposure to ultraviolet (UV) radiation • UVA = longer wavelength; damages connective tissue, leads to premature aging of the skin, causes skin cancer • UVB = shorter wavelength; causes sunburn, damages eyes and immune system, causes skin cancer

48. Skin Cancers • Basal cell carcinoma = cancer of the deepest layers of the skin • Squamous cell carcinoma = cancer of the surface layers of the skin • Melanoma = a malignant tumor of the skin that arises from pigmented cells, usually a mole; the most dangerous form of skin cancer

49. ABCD Test for Melanoma

50. Preventing Skin Cancer • Cover to protect skin -Wear long-sleeved shirts, long pants, hats • Use sunscreen - a broad-spectrum sunscreen with a high SPF (30+) • Apply sunscreen 30 minutes before sun exposure, 15–30 minutes after exposure begins, and frequently after that; apply extra if you are using DEET • Avoid sun exposure between 10 AM and 4 PM • Wear sunglasses that block UV • Check UV index • Avoid tanning salons