CANCER

By: Carolina Vidal, RN

 CANCER
● Cancer is the uncontrolled growth of abnormal cells anywhere in the
body.

● Cancer can be benign and malignant.

 Benign tumors: uncontrolled growth but non-invasion
 Malignant tumors are invasive and can migrate to other organs (metastasis).
90% of cancer deaths are due to metastasis.
 NORMAL CELL
GROWTH
Shape: Regular
Nucleus: Proportionate size
Growth: In control, systematic
Death: Mortal (Apoptosis)
Maturation: Mature (cell differentiation)
Communication: Communicates
Visibility: Visible to immune cells, with ID
Blood Supply: Angiogenesis during repair
Oxygen: Requires oxygen
Energy Efficiency: Very high (95%)
Amount of ATP: 36 units of ATP
Cell environment: Alkaline
Nutrient Preferences: Fat, Ketone,Glucose
VS CANCER CELL GROWTH
Shape: Irregular
Nucleus: Larger, darker
Growth: Out of control
Maturation: Immature (Doesn’t mature)
Communication: Doesn’t communicates
Visibility: invisible to immune cells
Blood Supply: Tumor Angiogenesis Oxygen:
doesn’t like or require oxygen
Glucose: Loves, craves glucose
Energy Efficiency: Very low (5%)
Amount of ATP: 2 units of ATP
Cell environment: Acidic
Nutrient Preferences: Glucose
 Etiology and Causative Factors

1. Predisposing factors 3. Role of hormones in cancer

a.) Familial and genetic factors
b.) Racial and geographic factors
c.) Environmental and cultural
factors
d.) Age and gender
a) Oestrogen
b) Contaceptive hormones
c) Anabolic steroids
d) Hormone-dependent tumor

2. Chronic non-neoplastic (pre-

malignant) conditions
a.) Carcinoma in situ
b.) Benign tumor
c.) Miscellaneous conditions
 Etiology and Causative Factors

Carcinogenesis: mechanism of induction of tumors

3 MAJOR TYPES

• CHEMICAL • PHSICAL • INFECTIOUS

CARCINOGENESIS
- Mutagens
- Chemical carcinogenesis and
their metabolism
CARCINOGENESIS PATHOGENS (VIRAL)
(RADIATION)
- Ultraviolet radiation, -Human t-cell leukemia
Asbestos viruses, DNA viruses,
HPV
-Epstein-Barr virus, Hep-
B virus
 Etiology and Causative Factors

Tobacco related Cancers

Tobacco use also increases the risk for cancers of the mouth, lips, nasal cavity (nose) and sinuses,
larynx (voice box), pharynx (throat), esophagus (swallowng tube), stomach, pancreas, kidney,
bladder, uterus, cervix, colon/rectum, ovary (mucinous), and acute myeloid leukemia.
Induced by alcohol abuse:
• Mouth cancer
• Pharyngeal cancer
• Oesophageal cancer
• Laryngeal cancer
• Liver cancer
 PATHOPHYSIOLOGY
PRECIPITATING FACTOR
PREDISPOSING FACTOR
Diet, Exposure to carcinogens,
Age, Gender, Genes
Hx of smoking

Gene Mutation of the cellular

DNA

Activation of growth promoting Inactivation of tumor suppressor Alterations in the gene that
oncogenes genes controls apoptosis

Unregulated proliferation and

differentiation of cancer cells

Progression to cancer
 Classification of tumors
Tissue or Origin Benign Malignant
Epithelial tumors

1. Squamous epithelium Squamous cell papilloma Squamous cell carcinoma

2. Transitional epithelium Transitional cell papilloma Transitional cell carcinoma

3. Glandular epithelium Adenoma Adenocarcinoma

4. Basal cell layer skin -- Basal cell carcinoma

5. Neuroectoderm Naevus Melanoma

(melanocarcinoma)
6. Hepatocytes Liver cell adenoma Hepatoma (Hepatocellular
carcinoma)
 Classification of tumors
Tissue or Origin Benign Malignant
Non - epithelial (mesenchymal) tumors
1. Adipose tissue Lipoma liposarcoma
2. Adult fibrous tissue Fibroma Fibrosarcoma
3. Embyronic fibrous tissue Myxoma Myxosarcoma
4. Cartilage Chondroma Chondrosarcoma
5. Bone Osteoma Osteosarcoma
6. Synovium Benign synovium Synovial sarcoma

7. Smooth muscle Leiomyoma Leimyosarcoma

8. Embryonic fibrous tissue Rhabdomyoma Rhabdomysarcoma

 Classification of tumors
Tissue or Origin Benign Malignant
Non - epithelial (mesenchymal) tumors
9. Mesothelium --- Mesothelioma
10. Blood vessels Haemangioma Angiosarcoma
11. Lymph vessels Lymphagioma lymphagiomasarcoma
12. Glomus Glomus tumor --
13. Meninges Meningioma Invasive meningioma
14. Haematopoietic cells -- Leukaemias

15. Lymphoid tissue Pseudolymphoma Malignant lymphomas

16. Nerve sheath Neurilemmoma, Neurogenic sarcoma

neurofibroma
17. Nerve cells Ganglioneuroma Neuroblastoma
 Classification of tumors
Tissue or Origin Benign Malignant
Mixed tumors
Salivary glands Pleomorphic adenoma Malignant mixed salivary tumor

Tumors of more than one germ cell layer

Totipotent cells in gonads or Mature teratoma Immature teratoma
in embryonal rest
 The effects of cancer on social and emotional wellbeing

Common reactions to cancer 

• People with cancer (and those close to them) can experience a range
of feelings during their cancer journey. These can include:
• anger
• fear
• feeling out of control
• feeling that there is nothing they can do to help themselves or their
situation.
The effects of cancer on social and emotional wellbeing

Cancer factors

• Having cancer that has spread to other parts of the body (advanced

disease).
• Having a limited life-expectancy (poor prognosis).
• Experiencing a number of treatment related side effects.
• Having multiple side effects which affect their ability to do things they would
normally do.
• Lymphoedema (swelling from having lymph nodes removed or treated).
• Frequent or severe pain.
• Extreme or long-lasting tiredness (fatigue).
• Issues relating to body image—a person’s thoughts and/or feelings about his
or her body.
 The effects of cancer on social and emotional wellbeing

Physical factors

Cancer treatments, such as chemotherapy, radiotherapy and hormonal treatments can

have direct physical effects on the patient.
• Physical side-effects that can make social and emotional problems worse can include:
• feeling exhausted (fatigue)
• feeling sick in the stomach (nausea) and vomiting
• pain
• fertility problems (e.g. being unable to have children)
• sexual problems
• hormonal changes and menopausal symptoms
• problems with sleep.
 Nursing Assessment
WARNING SIGNALS

• C – Change in bowel/bladder habits

• A – A sore that does not heal
• U – Unusual bleeding
• T – Thickening or lump in the breast
• I – Indigestion
• O – Obvious change in warts
• N – Nagging cough and hoarseness
• Weight loss
• Frequent infections
• Skin problems
• Hair loss
• Fatigue
• Disturbance in body image/depression
 Laboratory and Diagnostic Test
• Xray, CT, ultrasonosography, and MRI to locate abnormal tissues
or tumor.

• Microscopic histologic and cytologic examination to know the

type of cell and its structural differences from the parent tissue

• Lymph nodes biopsy to determine whether metastasis has begun.

• Blood tests to check the tumor marker (Antigens, hormones,

proteins, or enzymes)

• Nuclear imaging

• Direct visualization (i.e. endoscopy, cystoscopy)

 Tumor Staging and Grading
TNM System

Tumor Size Nodal Status Metastasis

Shows whether the cancer has Indicates whether the cancer

Refers to the extent of spread to the regional lymph has spread (metastasized) to
primary tumor. nodes. the bones or other organs.
 Tumor size

TUMOR (T) DESCRIPTION

TX Primary tumor cannot be evaluated

T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor < 2cm
T2 Tumor < 2-5cm
T3 Tumor >5cm

*note: CA in situ – abnormal cell are present but do not

spread to neighboring tissue
 Lymph Node Status

Lymph node DESCRIPTION

NX Regional lymph nodes cannot be
evaluated
N0 No regional lymph node involvement
N1 3 Lymph nodes + Axillary
N2 10 Lymph nodes +
 Metastasis

Metastasis DESCRIPTION
MX Metastasis cannot be measured
M0 Cancer has not spread to other parts
of the body
M1 Cancer has spread to other parts of
the body
 AJCC System

STAGE DESCRIPTION
Stage 0 Carcinoma in situ
Higher numbers indicate more extensive disease:
Stage 1 Small and only in one area
Stage 2 Larger and has grown into nearby tissues or
Stage 3 lymphnodes

Stage 4 The cancer has spread to distant tissue or

organs
 Importance of grading and staging

 Helps the doctor plan the appropriate

treatment
 Estimates patient’s prognosis trials and
comparing the results of different trials.
 Helps health care providers and
researchers exchange information about
the patients.
 It also gives them a common terminology
for evaluating the results various
treatments.
 Nursing diagnoses & Planning

• Anxiety
- Carefully assess the client’s level of anxiety
-Establish a therapeutic relationship
-Encourage the client to express his feelings

• Disturbed body image

-Provide supportive environment
--Encourage wearing colorful head cover
 Nursing diagnoses & Planning

• Anticipatory grieving
- Use therapeutic communication skills
-Answer questions about illness

• Risk of infection
-Monitor VS
-Monitor WBC’s
-Protect skin and mucus membrane from
injuries
 Nursing diagnoses & Planning

• Imbalanced nutrition: less than body

requirement
- Assess current eating pattern
-Teach the principles of maintaining good
nutrition

• Impaired tissue integrity

-Carefully assess and evaluate the type of
tissue impairment present.
-Observe for systemic signs of infection
 Nursing diagnoses & Planning

• Acute pain
- Use relaxation techniques
- Administer medications as prescribed
https://www.studocu.com/en-us/document/cal
ifornia-state-university-bakersfield/nursing/lec
ture-notes/module-7-cancer-lecture-notes-ch-
15/3345131/view
 Implementation and Management

Cancer treatment is specific to type, stage & grade of

cancer & depending on severity, there are a range or
treatment goals:

• Cure – complete eradication of malignant disease

• Control – containment of cell growth & prolonged
survival
• Palliation – relief of symptoms associated with
disease & improvement of life
 Treatment Modalities

Diagnostic Surgery / Biopsy – performed to obtain tissue sample

for histological analysis; often from tumor itself, but also nearby
nodes to look for s/s of metastasis

• Excisional – for small, easily accessible tumors; can often

remove whole tumor & surrounding marginal tissue to
prevent seeding of leftover cells; pathologist can then
stage & grade.
• Incisional – performed if the tumor mass is too large to
remove; a wedge of tissue is removed for analysis; must
be a representative segment so pathologist can provide
accurate diagnosis.
 Treatment Modalities

• Needle Biopsy – performed to sample suspicious masses

that are easily & safely accessible; outpatient
procedure
 Treatment Modalities

• Tumor Removal / Surgery as primary treatment :

-Local Excision - when tumor is small; removal of mass &
small margin of normal tissue that is easily
accessible; usually outpatient.

• Wide Excision (radical) – removal of mass, lymph nodes,

adjacent involved structure, & surrounding tissues
that may be at high risk for tumor spread
 Often results in disfigurement & altered function
 Often require rehabilitation &/or reconstructive procedures
o Benefits of minimally invasive surgeries
(endoscopic/laparoscopic) – ↓ trauma, ↓ risk of infection,
↓ blood loss, ↓ time under anesthesia, ↓ post-op pain,
↓ time w/ limited mobility,  recovery time
 Treatment Modalities

• Prophylactic Surgery – removing nonvital tissues or

organs that are at increased risk of developing cancer
 Strong family hx
 Positive genetic screening (i.e. BRCA1 or BRCA 2 gene)
 Abnormal physical findings
 Hx of cancer in similar or same location (i.e. other breast)

• Palliative Surgery – when surgical cure is not possible,

the goal of surgery may be to relieve symptoms, make
the patient more comfortable, & promote a better quality
of life.
 Treatment Modalities

• Reconstructive Surgery – may follow curative or radical

surgeries in an attempt to improve function or obtain more
desirable cosmetic effect
 Nurse should assess patient’s needs & the impact of altered
function & body image may have on quality of life
 Nurse should provide & encourage expression of emotions
regarding these issues

Nursing Management for Surgery:

a) Postoperatively – nurse observes for patient response,
infection, bleeding, thrombophlebitis, wound
dehiscence, F&E imbalance, & organ dysfunction
b) Nurse provides patient comfort, pain management, activity,
nutrition, & information
 Treatment Modalities

c) Plans for discharge, follow-up care, wound care, subsequent

treatment
d) Patient & family encouraged to use community resources for
support & information
 Treatment Modalities

Radiation Therapy – directly alters the DNA w/in cells of both

malignant & normal tissue as well as indirectly damage
DNA by creating free radicals
 Is most effective to sensitive tissues that undergo frequent cell
division such as bone marrow, lymphatic tissue,
GI tissue, hair, gonads
 Therapy is localized to specific tissue
 Radiation sensitivity is enhanced in small tumors that are
rapidly dividing
 Dose depends on sensitivity, size, tissue tolerance of
surrounding tissues, & critical adjacent structures
 A lethal dose is one calibrated to kill 95% of tumor cells while
preserving normal tissue
 Treatment Modalities

External Radiation (EBRT) – more common; using

computerized software are able to shape invisible beam of
highly charged electrons that penetrate body & target w/
pinpoint accuracy.
 The dose of radiation that reaches the surrounding normal
tissues is reduced to much less
toxicity than older forms of radiation

Internal Radiation (Brachy Therapy) – delivers dose of

radiation to localized area; implanted by needles, rods,
seeds, beads, ribbons, or catheters into body cavities
 Can be delivered as temporary or permanent implant
 High dose for short time OR lower dose for longer time
 Treatment Modalities

Toxicity – usually associated w/ area being eradicated

- s/s show up ~2 weeks after initiation of therapy
- s/s occur when normal cell in area are damaged & cell death
exceeds cell regeneration
- Tissues most affected are rapidly proliferating ones (skin, GI,
bone marrow

Depending on site of radiation:

- Altered skin integrity is common:
• Alopecia – hair loss
• Dermatitis – erythema, dry, flaky to moist & oozing
ulcerations (therapy might have to be interrupted)
 Treatment Modalities

-Altered Oral Mucosa can occur:

• Stomatitis – inflammation of mouth
• Xerostomia – dryness of mouth
• Mucositis – inflammation of lining of GI tract

-Blood may be affected: (increases risk of infection & bleeding)

• Anemia
• Leukopenia
• Thrombocytopenia
 Treatment Modalities

Nursing Management of Radiation:

• Bed rest
• Private room for 72 hours
• Log-roll to prevent dislodging / displacement of any
intracavity radiation delivery device
• Urinary catheter to ensure bladder remains empty
• Low-residue (low fiber) diet & anti-diarrheal agents to
prevent BM during therapy that could displace radioisotopes
• Visitors & personnel limit time & proximity
• Focused assessment on area irradiated
• Assess nutrition
• Assess well-being
• Weakness, fatigue – explain s/s of treatment & don’t mean
deterioration
 Chemotheraphy

Chemotherapy – antineoplastic drugs that attempt to destroy

cancer cells by interfering w/ cellular functions, including DNA
replication & repair.

 Used primarily to treat systemic disease than localized

lesions treatable by surgery or radiation
 Repeated doses necessary over prolonged period to achieve
regression of tumor
 Goal = eradication of enough of the cancer so that remaining
malignant cells can be destroyed by body’s own immune
system
 Chemotheraphy

Extravasation – chemo drugs have the potential to cause serious

damage if they leak from their vessel or IV tubing
into surrounding tissues
Hypersensitivity reactions – repeated exposure to chemo agents
increase likelihood of a reaction/
Toxicity :
GI – n/v are most common & may persist for 24-48 hours w/
delayed n/v up to a week after chemo administration.
Hematopoietic – myelosuppression resulting in decreased WBC
(leukopenia), granulocytes (neutropenia),
RBCs (anemia), & platelets (thrombocytopenia)
Renal – some chemo agents can damage kidneys b/c impair
water secretion leading to syndrome
Reproductive – chemo often results in sterility
 Chemotheraphy

Neurological – can affect central, peripheral, and cranial nerves

Cognitive Impairment – “chemo brain,” a decline in information
handling process of attention & concentration,
executive function, information processing speed, language,
visual-spatial skill, psychomotor ability, learning, &
memory
Fatigue – greatly affects quality of life & can last for months after
treatment
 Nursing Management of Chemotherapy
1. E&F imbalances – monitor nutritional intake, F&E status, I & O
on ongoing basis & devise creative ways to encourage
adequate intake
2. Cognitive Status – reassessed routinely & patient & family
should be informed that cognitive impairment is a possibility
3. Administering Chemo – chemo agents are associated w/
hypersensitivity reactions (HSR)
a) Inform patients & family of importance of adhering to
prescribed therapy
b) Prevent extravasation by teaching s/s to report, monitoring
closely, & following policy
c) Extravasation may be occurring if: can’t get blood return on IV
catheter, resistance to flow on IV fluid,
or burning, pain, swelling, redness at site
d) Have extravasation kit ready
 End of life issues

End-of-life issues are often complex moral, ethical, or

legal dilemmas, or a combination of these, regarding a
patient's vital physiologic functions, medical-surgical
prognosis, quality of life, and personal values and
beliefs. End-of-life issues facing patients, family, and
caregivers include the following:

• Resuscitation status
• Withholding and withdrawing medical therapies
• Palliative Care
• Coma, vegetative state, and brain death
 End of life issues

Resuscitation status

Code status do not resuscitate (DNR) is the

predetermined decision to decline  cardiopulmonary
resuscitation, including defibrillation and
pharmacologic cardioversion in case cardiopulmonary
arrest.
 End of life issues

Withholding and Withdrawing Medical Therapies

Withholding support is not initiating a treatment

because it is not beneficial for the patient, whereas
withdrawing support is the discontinuation of a
treatment (but not a discontinuation of care).
 End of life issues

Palliative Care

The goal of palliative care is to “prevent and relieve

suffering, and to support the best possible quality of life
for patients and their families, regardless of their stage
of disease or the need for other therapies, in
accordance with their values and preferences.
 End of life issues

Coma, Vegetative State, and Brain Death

These conditions involve unconsciousness and

absent self-awareness but are distinct in terms of
neurologic function and recovery. 
THANK YOU!