Cancer

1. Stages of Metastasis
Stage 1
Increasing tumor size, leading to tissue pressure and mechanical
expansion, may cause neoplastic invasion; however the size of the
primary tumor is not the sole predictor of metastasis. Tumors with
identical size and histologic cell type can vary markedly in metastatic
spread. As the malignant tumor grows, the cells at the center become
hypoxic, and it begins to seek its own blood supply. Neoplastic cells from
the primary tumor invade surrounding tissue and penetrate blood or
lymph vessels. Vascularisation of the tumor drastically increases its
metastatic potential.
Stage 2
Cancer cells migrate via the lymph or blood circulation or by direct
extension. The lymphatic system provides the most common pathway for
the initial spread of malignant cancer cells. There may be spread to the
lymph nodes draining the region of the primary tumor site.
Direct extension of tumors to adjacent tissues also occurs. In body
cavities, cells may spread by gravity, resulting in new growths on other
serosal surfaces.
Stage 3
Cells are established at secondary site. This may result from
entrapment due to the size of the tumor clump, adherence to cells at the
new site through specific interactions, or by binding to exposed basement
membrane. Continued growth and proliferation at the metastatic site are
also dependent on the development of its own blood supply and ability to
evade eradication by immune responses. Cells from the metastatic site
may then go to disseminate to form additional metastatic lesions.

Illustration of three
stages
of cancer cells and
metastasis
reaching
expand
through blood and
lymph vessels

2. Factors Assessing Cancer

Genetic Factor
Genetic factors affect the tendency to develop cancer.
Predisposing mutations often influence DNA repair, cell cycle
regulation and cell-death pathways.
Some cancers are due to the genes we are born with. Other
cancers are due to gene changes that happen during our lifetime.
Sporadic (acquired) cancers are due to mutations that happen as we
get older or because of age, chance or something we are exposed to
(carcinogen). Sometimes these mutations are errors that occur during
cell division. They can also be caused by something that damages the
cells DNA. Mutations can affect the structure of the gene and stop it
from working properly. The majority of cancers are sporadic (caused
by acquired gene mutations). NOT SATISFIED
Environmental Factors
Some substances in the air, water or soil may increase a persons
risk of cancer. These natural or manufactured substances are
sometimes called environmental contaminants. Environmental
contaminants may be present in the home, at work or outside
Sometimes people cant avoid being exposed to environmental
contaminants or they may not know they are being exposed to them.
People are exposed to different environmental contaminants for
varying lengths of time and at different levels. This makes it hard to
figure out how much exposure a person has had to any one substance
or chemical. Also, exposure to a combination of environmental
contaminants may increase a persons risk more than each substance
or chemical alone.

3. Nursing Care Plan During Diagnostic Procedure

FEAR/ANXIETY
May be related to:
Lack of knowledge or unfamiliarity with the diagnostic procedure
Anticipating pain or pain during the procedure

Possibly evidenced by:

Increased tension, shakiness, apprehension, restlessness, insomnia
Feelings of helplessness, hopelessness, inadequacy
Sympathetic stimulation, somatic complaints
Desired Outcomes:

Display appropriate range of feelings and lessened fear.

Appear relaxed and report anxiety is reduced to a manageable

level.

Demonstrate use of effective coping mechanisms and active

participation in during the diagnostic procedure.

Nursing Interventions
Provide

accurate

information
before,

about

during

procedure.

and
the
and

Rationale

consistent
procedure This will help the patient understand
the procedure thus reducing anxiety
after
the
and fear.

Encourage patient to share thoughts

Provides opportunity to examine

realistic fears and misconceptions

and feelings.

about diagnostic procedure

Provide safe environment and privacy

during the procedure.

Maintain

frequent

contact

with

as appropriate.

with

patient and possibly enhance coping

skills

patient. Talk with and touch patient

Stay

To provide comfort thus relaxing the

patient

Provides assurance that patient is

not alone or rejected; conveys
respect for and acceptance of the
person, fostering trust.

during

the

procedure if possible.
Permit expressions of fear without
confrontation. Give information that
feelings are normal and are to be
appropriately expressed.

Provide reliable and consistent

information and support for SO.

This will gain trust of the patient

Acceptance of feelings allows

patient to begin to deal with
situation.

Allows for better interpersonal

interaction and reduction of anxiety
and fear.

4. Factors that
Neoplasm

may

Contribute

to

the

Development

of

Solid

a. Age
The older the person he/she has had more years of potential
exposure to carcinogen.
b. Chemicals

Exposures to particular substances have been linked to specific types

of cancer. These substances are called carcinogens. Tobacco smoking causes
90% of lung cancer.It also causes cancer in the larynx, head, neck, stomach,
bladder, kidney, esophagus andpancreas. Tobacco smoke contains over fifty
known
carcinogens,
including nitrosamines and polycyclic
aromatic
hydrocarbons.[29]Tobacco is responsible for about one in three of all cancer
deaths in the developed world, and about one in five worldwide

c. Radiation
More than 80% of exposure to radiation is from natural sources,
including ionizing radiation from cosmic rays and radioactive minerals.
Sunlight and tanning beds are two sources ultraviolet radiation, a complete
carcinogens.
Radioactive materials that decay spontaneously produce ionizing
radiation, which has sufficient energy to strip away electrons from atoms
(creating two charged ions) or to break some chemical bonds. Any living
tissue in the human body can be damaged by ionizing radiation in a unique
manner. The body attempts to repair the damage, but sometimes the
damage is of a nature that cannot be repaired or it is too severe or
widespread to be repaired. Also mistakes made in the natural repair process
can lead to cancerous cells.
d. Hormones
Some hormones play a role in the development of cancer by promoting
cell proliferation. Insulin-like growth factors and their binding proteins play a
key role in cancer cell proliferation, differentiation and apoptosis, suggesting
possible involvement in carcinogenesis.

Hormones are important agents in sex-related cancers such as cancer

of the breast, endometrium, prostate, ovary, and testis, and also of thyroid
cancer and bone cancer. For example, the daughters of women who have
breast cancer have significantly higher levels of estrogen and progesterone
than the daughters of women without breast cancer. These higher hormone
levels may explain why these women have higher risk of breast cancer, even
in the absence of a breast-cancer gene.
e. Diet and Exercise
Diet, physical inactivity, and obesity are related to up to 3035% of
cancer deaths. In the United States excess body weight is associated with the
development of many types of cancer and is a factor in 1420% of all cancer
deaths. Physical inactivity is believed to contribute to cancer risk not only
through its effect on body weight but also through negative effects on
immune system and endocrine system.[36] More than half of the effect from
diet is due to overnutrition (eating too much), rather than from eating too few
vegetables or other healthful foods.
Some specific foods are linked to specific cancers. A high-salt diet is
linked to gastric cancer. Aflatoxin B1, a frequent food contaminates causes
liver cancer.
The differences in dietary practices may partly explain
differences in cancer incidence in different countries.
f. Viruses
Some viruses are strongly associated with cancer such as the hepatitis
B and C viruses, the human papilloma virus and Helicobacter Pylori. The virus
at some point infected the cell, causing genetic damage to the cells
deoxyribonucleic acid (DNA), thus leading to the development of cancer.