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CancersJulie Mann, NP

N145

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What is Cancer

Uncontrolled cellular proliferation that knows no limits and serves no

purpose.

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the cell Cycle

Cells reproduce at an inherit rateRespond to environmental changes in the body by

sending messengers called growth signals

Growth signals reach the nucleus and proteins called

transcription factors turn on and off genes that promote

cell proliferation

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Cancer & the Cell Cycle

CA cells do not respond to normal cues about cellularreproduction

CA cells:

Have autonomyGo through anaplasiaHave immortality

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Characteristics of CA cells

unregulated growth

low differentiatiated

genetic instability

independent of growth factors

low cell to cell adhesion

no density-dependent inhibition

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Gene and Chromosome Abnormalities

MutationProto-oncogenes

Oncogenes

Tumor Suppressor genes

DNA repair genes Alterations of pro-growth and antigrowth signals

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Tumor Markers

Def: substances produced by CA cells that are found on

tumor plasma membranes or in blood, spinal fluid, or

urine.

Examples: hormones, enzymes, genes, antigens, andantibodies

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Viral and bacterial cause of CA

Initial acute infection not associated with CA

Chronic infection can lead to CA

Examples:

Viral: HPVBacterial: Helicobacter Pylori

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Environmental Risk Factors

Tobacco useDietAlcohol ConsumptionSexual and Reproductive behaviorAir pollutionOccupational hazardsUltraviolet radiation

Ionizing radiationHormonesOral contraceptivesEstrogens

Progestogen and Androgens

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Tumor Spread

Local spread by direct invasion of contiguous organs

Metastasis to distant organs by lymphatics and veins

Metastasis by implantation

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Mechanism of Local Spread

Cellular multiplication

Mechanical pressure

Release of lytic enzymes

Decreased cell to cell adhesion Increased motility of individual tumor cells

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Cancer Warning Signs

Change in Bowel/Bladder Habits

2. A Sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere

Indigestion or difficulty swallowing Obvious change in wart or mole Nagging cough or hoarseness

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Tumor Staging

TNM SystemT: tumor spread

N: node involvement

M: presence of distant metastasis

Grading System I-IV

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Case #1 Colin is a 30 year old caucasian male whopresents to a clinic with c/o frequent diarrheaand constipation and change in bowl pattern.He recently traveled to the Caribbean islandsand a fellow travel also is having bowl problems.He has not seen doesnt have a primary carephysician and hasnt sought medical care forover 5 years prior to today.

What might be going on with Colin?

What would you anticipate might be ordered?

C li h i t f f th di l

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Colin, who isnt a fan of the medical

community since his mom died of

breast CA 5 years ago, sees severalPrimary care doctors and a holistic

healer before one of the Doctors orders

a colonoscopy and a CT of his abdomen.During this time Colin thinks he

developed either a tropical illness, as

his friend did, or picked up a tape worm.

Several months has past and he has

lost about 20 lbs and is pale and

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The CT results indicate a mass in his

colon and small masses in his liver.

He has surgery to remove the tumor in

the colon and the liver is evaluated for

possible removal of the tumors.

However the tumors were so numerous

in his liver that removal wasnt possible.

What stage do you think his CA was at?

What do you think his prognosis was?

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Age > 50 years old

family history of CA

Crohn Disease & Ulcerative Colitis

familial adenomatous polyposis of the colon

Poor diet

Risk Factors

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bleeding

change in bowel habits

diarrhea or constipation

sense of urgency or incomplete emptying of thebowel

pain (a late symptoms)

Symptoms

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Case #2

Mary is a 60 year old post menopausal female

with a pmh of smoking 30 pack years. Shepresents to her GYN for her annual exam andher MD notices her left nipple is retracted andshe feels a lump under her areola.

What puts her at risk for breast CA?

What tests would be ordered?

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Breast CA

Fibroadenoma

Carcinoma of the BreastSusceptible genes

BRCA 1

BRCA 2

Classification

Ductal carcinoma

Lobular carcinoma

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Lung CA

TypesBronchogenic carcinoma

Squamous cell carcinoma

Large cell carcinoma

Small cell carcinomaAdenocarcinoma

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Smoking and Lung CA

Risk is related to:Amount smoked

Age of smoking onset

Product smoked (tar, nicotine, filters)

Depth of inhalationGender

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Case #4

Lenny is a 64 year old a.a. man who presents

with c/o frequency and difficulty starting to void.On digital rectal exam his prostate is fixed andnodular.

What is causing his symptoms?

What would your nursing plan of care include?

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Prostate CA

exact cause is unclear

androgens are believed to play a role

risk factors: age, race, heredity, high fat diet

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Clinical manifestations

urgency

frequency

nocturia

hesitancy

dysuria

hematuria

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Metastasis

Bone (low back pain)

vertebral column, ribs, & pelvis

lung

bladder

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Clinical Manifestations

Anorexia

Cachexia

Fatigue

Sleep Disorders

Anemia

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Clinical Manifestations

Altered Tissue Integrity

compression and erosion of blood vessels

development of effusions

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Please also review

Uterine CA

Bladder CA

Lymphoma (hodgkins and nonhodgkins)

Leukemia (both acute and chronic forms)