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CARCINOGENESIS
The
process through which normal cells are transformed into malignant or cancer cells
STAGES
INITIATION
Occurs
DNA
PROMOTION
Occurs
MALIGNANT CONVERSION
Genetic
PROGRESSION
are increasingly malignant in appearance It develop into an invasive cancer with metastasis to distant body parts
Cells
CARCINOMA IN SITU
The
Specific
ONCOGENES
PROLIFERATION
Also
CYTOKINE
A
substance secreted by immune system cells It send messages to other immune cells
ANEUPLOID
Tumor
cells that do not have the normal 46 chromosomes in a human cell Aneuploid tumors often have a worse prognosis
SARCOMA
A
PHEOCHROMOCYTOMA
A
catecholamine secreting tumor of the chromaffin cells of the sympathetic nervous system Usually found in the adrenal medulla Rare
ADENOCARCINOMA
Cancer
tissues
PATHOPHYSIOLOGY
> Irritated mucosa tougher mucosa (squamous metaphasia) occurs by increasing the mucosal thickness (acanthosis or hyperplasia) or by developing a keratin layer (keratosis) > Changes @ the gene level enhance the growth of abnormal epithelial cells that become malignant white patchy lesions (leukoplakia) or red, velvety patches (erythroplasia) > Spread (metastasis) into the mucosa, muscle & bone systemic spread through the blood & lymphatic system distant metastasis to the lungs or liver
DIAGNOSIS
in situ early stage & well differentiated Moderately differentiated if progressing Poorly differentiated - Final
Carcinoma
ETIOLOGY
Risk factors: > chewing tobacco > Hardwood dust > Pipe smoking >Poor oral hygiene > Marijuana > Voice abuse > Chronic laryngitis > exposure to chemicals
Manifestation
Hoarseness
of the true vocal cord Mouth sores Lump in the neck for 3 4 weeks or longer
Lesions
DIAGNOSTIC MEASURES
LABORATORY TEST
blood count Bleeding time Urinalysis Blood chemistry reveals low protein Renal & liver function test
Complete
RADIOGRAPHIC STUDIES
X-ray Computed tomography MRI SPECT (Single photon emission computerized tomography scan) PET (Positron emission computerized tomography scan)
tumor location
BIOPSY
Confirm
the diagnosis
TUMOR STAGING
Tumor
NURSING DIAGNOSIS
Risk for aspiration Anxiety Disturbed body image Acute pain or chronic pain Imbalance nutrition : less than body requirements Impaired skin integrity Ineffective coping Impaired adjustment Deficient knowledge
MANAGEMENT
therapy Chemotherapy
throat Difficulty in swallowing Skin is red & tender Xerostomia (dry mouth)
Surgical Management
Laryngectomy
Types: > Cordal stripping > Cordectomy excission of a vocal cord >Partial or total laryngectomy
Airway
ENDOMETRIAL CANCER
A
PATHOPHYSIOLOGY
Arises
from the glandular part of the endometrium and may be preceded by endometrial overgrowth Initial growth is w/n the uterine cavity myometrium cervix
Spread outside the uterus occurs through: Lymphatic spread ovaries, pelvic, inguinal, para aortic lymph nodes By blood lungs, liver or bones By transtubal or intra abdominal spread peritoneal cavity
GRADE
Grade
11- cancers are identified by endometrial glands and well differentiated Grade 3- have a solid growth pattern 3and are poorly differentiated
Obesity Uterine
African American Native American/American Indian Multiparity Below 18 y.o. @first coital Below 18 @ first pregnancy Multiple sex partner Smoking
Infection
with herpes simplex virus Infection with human papilloma virus Infection with cytomegalovirus (CMV) HIV/AIDS Lower socio economic status Sexual partner had a previous partner who developed cervical cancer
SYMPTOMS
Post
menopausal bleeding Watery, bloody vaginal discharge Low back or abdominal pain Palpable uterine mass
DIAGNOSTIC TEST
CA 125 Tumor marker Chest X-ray XIntravenous Pylography or excretory Urography Barium enema Computed Tomography Liver & bone scans
Dilatation and curettage Endometrial biopsy Proctosigmoidoscopy Ultrasonography Endoscopic examination of the uterus
MANAGEMENT
used when the risk for distant spread exceeds 20% HORMONE THERAPY for stage 1 & 11 and for palliative treatment for stage 1V
CHEMOTHERAPY
SURGICAL MANAGEMENT
TOTAL ABDOMINAL HYSTERECTOMY (TAH) BILATERAL SALPINGO OOPERECTOMY RADICAL HYSTERECTOMY W/BILATERAL PELVIC LYMPH NODE DISSECTION for stage 11
PSYCHOSOCIAL PREPARATION need to discuss their concerns Provide emotional support Create a good atmosphere Include family members/S.O. in discussions Inform the client for possible side effects of medication
Client
CERVICAL CANCER
PATHOPHYSIOLOGY
Normal
1 carcinoma is confined in the cervix STAGE 11- extends beyond the cervix 11but not extend to the pelvic wall - vagina is involve
CLASSIFICATION OF CIN
MANIFESTATION
Painless
vaginal bleeding Watery, blood tinged vaginal discharge that becomes dark & foul smelling Leg pain (along the sciatic nerve) Swelling of the legs (late symptom)
SIGNS OF METASTASIS
Weight
loss Pelvic pain Painful urination Hematuria Rectal bleeding Chest pain Coughing
DIAGNOSTIC PROCEDURES
examination to view the transformation zone Colposcopy a procedure in which application of a 30% acetic acid solution is applied to the cervix Pap smear Endocervical curettage scrapping of the endocervix
Colposcopic
MANAGEMENT
NON - SURGICAL
a painless electrical current used to cut away or peel off affected tissue
Laser Therapy
A
Cryotherapy
A
prone is placed against the cervix to cause freezing of the tissues and subsequent necrosis
Radiation Therapy
For
Chemotherapy
For
SURGICAL
Conization
Used to treat clients with microinvasive cervical cancer, especially when presentation of fertility is desired Done when the lesion cannot be visualized by colposcopic examination
Hysterectomy
Done
Pelvic Exenteration
Performed
PSYCHOSOCIAL PREPARATION
Assess
the client for manifestations of depression daily Emotional support Assess the need for sexual counseling
Complications of Conization
Hemorrhage Uterine
OVARIAN CANCER
PATHOPHYSIOLOGY
Tumor
grows rapidly, spread quickly & are often bilateral metastasize by direct extension into nearby organs or through blood & lymph circulation to distant sites abdomen by seeding free floating cancer cells
RISK FACTORS
Age
over 40 y.o. Family history Diabetes Mellitus Nulliparity Above 30 y.o. @ first pregnancy
Breast
STAGE 1
Growth
is limited to ovaries
STAGE 11
Growth
STAGE 111
Tumor
involves one or both ovaries with peritoneal implants outside the pelvis or positive retroperitoneal or inguinal nodes; superficial liver metastasis but with histologically proven malignant extension to small bowel or omentum
STAGE 1V
Growth
involving one or both ovaries with distant metastasis to the lungs & liver
MANIFESTATION
Abdominal
pain or swelling Abdominal discomfort Premenstrual tension Heavy menstrual flow Abdominal mass
DIAGNOSTIC TEST
Complete blood count Urinalysis Liver studies if ascites occurs Ultrasonography Intravenous pyelography (IVP)
MANAGEMENT
NON SURGICAL
Chemotherapy
Most common agents used: - Cisplatin - Carboplatin - Paclitaxel (Taxol)
RADIATION THERAPY
Used
after surgery
SURGICAL
VULVAR CANCER
PATHOPHYSIOLOGY
Vulvar
atypia or mild dysplasia (Vulvar Intraepithelial Neoplasia) VIN 1 moderate dysplasia (VIN 11) severe dysplasia or carcinoma in Situ (VIN 111) lesions become invasive spread to the urethra, vagina, anus through the lymphatic system inguinal, femoral & deep iliac pelvic nodes
RISK FACTORS
Herpes
MANIFESTATIONS
Irritation Sore
that will not heal Bleeding (late symptom) Multifocal lesions on the labia (lesions are whitish & reddish)
DIAGNOSTIC TEST
Pap
smear Colposcopic examination of the vulva Toluidine blue test identify abnormal cells for biopsy Biopsy (Keyes Dermal Punch) a device that removes a disk of tissue
MANAGEMENT
NON SURGICAL
Laser Therapy
Radiation therapy
Used
after surgery
SURGICAL MANAGEMENT
Vulvectomy
To
TYPES OF VULVECTOMY
Simple Vulvectomy
Removal
Skinning Vulvectomy
The
removal of superficial vulvar skin without removal of the clitoris & replacement of removed skin with split thickness graft
Radical Vulvectomy
Removal
of the entire vulva skin, labia, clitoris, subcutaneous tissues and possibly inguinal & femoral node dissection
VAGINAL CANCER
PATHOPHYSIOLOGY
Vaginal
cancer is an extension of cervical, endometrial, or vulvar cancers Spread depends on the location of the tumor Upper vaginal lesions spread in the same manner as cervical cancer Lower lesions spread similarly to vulvar cancer
Risk Factors
Repeated
Manifestations papsmear - only indication Late symptoms: - Pain - Foul smelling vaginal discharge - Painless vaginal bleeding - Pruritus - Urinary symptoms
Abnormal
Diagnostic Test
Pelvic
MANAGEMENT
Non - surgical
Laser
therapy Staining of the abnormal tissues with iodine solution Topical chemotherapy Intracavitary radiation
Complications of Radiation
Vaginal
Surgical
Partial
of gynecologic cancers Results from pelvic inflammatory disease and chronic salpingitis
Risk factors
Nulliparity Infertility
PATHOPHYSIOLOGY
Initial
lesion is confined to the lumen of the tube invades the serosa spreads intraperitonially bowel, omentum & peritoneum. Lymphatic spread is to the para aortic & retroperitoneal nodes
Manifestations
Postmenopausal
Diagnostic Examination
Pap
Management
Total
abdominal hysterectomy Bilateral Salpingo oopherectomy with omentectomy (removal of the connective tissues covering these organs) Chemotherapy (before or after surgery)
PROSTATE CANCER
ADENOCARCINOMAS
Arise
NONEPITHELIAL CARCENOMAS
TYPES: -
lymph nodes Bone marrow Bones of the pelvis Sacrum Lumbar spine
Etiology
Castrated
before
History
Manifestations
Difficulty
in urination Recurrent bladder infections Urinary retention Painless hematuria Bone pain
Screening Procedures
Digital
rectal examination (DRE) prostate that is found stony hard is suspected malignant Prostate specific antigen (PSA) a glycoprotein produced solely by the prostate
Diagnostic test
Biopsy Prostatic ultrasonography Radiographic and blood studies Computed Tomography of the pelvis and abdomen Magnetic resonance imaging Bone scan Liver function test
NURSING DIAGNOSIS
Anxiety Acute
or chronic pain Impaired urinary elimination Risk for sexual dysfunction Dysfunctional grieving Potential for metastasis
PATHOPHYSIOLOGY
Epidermoid
(squamous) carcinomas developing from the squamous cells. Tumors tend to grow slowly and can develop anywhere on the penis but most commonly occur on the foreskin or the glans. When the cancer is confined to the skin of the penis it is called carcinoma in situ (CIS). Other types of penile cancers include melanomas, basal cell cancer, and sarcomas
Manifestations
Painless,
wartlike growth or ulcer on the glans under the prepuce (foreskin) and may be mistaken for a venereal wart Reddened lesion with plaque
MANAGEMENT
biopsy Penectomy TYPES Partial Penectomy the distal portion of the corpus cavernosum and the corpus spongiosum is amputated Total Penectomy- an incision is made from Penectomythe pubic bone, which encircles the penis & extends into the perineum
Excisional
Preventive measures
Circumcision Personal
hygiene
PATHOPHYSIOLOGY
Also
known as adenocarcinoma of the kidney The healthy tissue of the kidney is damage and replaced by cancer cells
Stage 1 Tumors up to 2.5 are situated within the capsule of the kidney; the renal vein, perinephric fat, and adjacent lymph nodes have o tumor Stage 11 - Tumors are larger than 2.5 cm & extend beyond the capsule but are within Gerotas fascia; the renal vein and lymph nodes are not involved Stage 111 Tumors extend into the renal vein, lymph nodes or both Stage 1V Tumors include invasion of adjacent organs beyond Gerotas fascia or metastasize to distant tissues
Systemic effects
Paraneoplastic syndromes: syndromes: - Anemia - Erythrocytosis - Hypercalcemia - Liver dysfunction
-
Manifestations
Flank pain Gross hematuria Palpable renal mass Renal bruit heard during auscultation Hematuria late sign
Muscle wasting Weakness Poor nutritional status Weight loss Breast enlargement
Diagnostic Assessment
Urinalysis Surgical exploration IV Urogram with Nephrograms Sonography CT Magnetic resonance imaging
MANAGEMENT
NON SURGICAL
Radiofrequency Chemotherapy
ablation
SURGICAL
Nephrectomy
GASTRIC CARCINOMA
GASTRIC CARCINOMA
A
malignant neoplasm in the stomach Mostly Adenocarcinoma It develops in the mucosal cells that form the innermost lining of any portion or all of the stomach Other types include: lymphomas and sarcomas
PATHOPHYSIOLOGY
Result
from atrophic gastritis or intestinal metaplasia Gastric cancers spread by direct extension through the gastric wall and into regional lymphatics The intramural lymphatics readily allow horizontal spread within the gastric wall Extramural lymphatics carry tumor deposits to lymph nodes.
Direct
invasion to the extramural lymphatics carry tumor lymph nodes. Hematogenous spread via the portal vein the liver and via the systemic circulation lungs and bones Peritoneal seeding of cancer cells from the gastric serosa omentum, peritoneum, ovary, & pelvic cul-de-sac cul-de For the advance gastric cancer, there is invasion of the stomach muscle or beyond
Etiology
Infection
with H. pylori Pernicious anemia Gastric polyps Chronic atropic gastritis Achlorhydria absence of secretion of hydrochloric acid
Ingestion
of pickled foods Salted fish, meat Nitrates from processed foods High consumption of salt Genetic factor Gastric surgery like Billroth 11 procedure Smoking, drinking alcoholic beverage
MANIFESTATIONS
Enlarged lymph nodes Weakness and fatigue Progressive weight loss Distant metastasis
Laboratory Assessment
hematocrit and hemoglobin values Stool positive for occult blood Hypoalbuminemia Elevated carcinogenic antigen
Low
Radiographic Assessment
Double
(EGD)
ultrasound (EUS)
MANAGEMENT
NON SURGICAL
Chemotherapy Radiation
SURGICAL
Total
Nursing Interventions
Auscultate
the lungs Monitor for the return of bowel sounds Inspect the operative site for signs of infection or bleeding Nutrition therapy
ENDOCRINAL NEOPLASM
PAPILLARY CARCINOMA
common type of thyroid cancer Occurs most often in younger women
Most
FOLLICULAR CARCINOMAS
About
25% of all thyroid cancers Occur most often in older clients Cancer invades blood vessels and spread to bones and lung tissue = dyspnea & dysphagia
MEDULLARY CARCINOMA
Accounts
cancers Most common in clients older than 50 years of age This tumor often occurs as part of multiple endocrine neoplasia (MEN) type 11
ANAPLASTIC CARCINOMA
A
rapid growing, aggressive tumor that directly invades nearby structures Manifestations: - Stridor - Hoarseness - Dysphagia
Management
Total
BRAIN TUMORS
Arise
anywhere within the brain structures and are named according to the cell or tissue from which they originate
PATHOPHYSIOLOGY
Regardless of origin, the tumor expands and invades, infiltrates, compresses, and displaces normal brain tissue
Cerebral edema / brain tissue inflammation Increased intracranial pressure Focal neurologic deficit Obstruction of the flow of the CSF Pituitary dysfunction
COMPLICATIONS
Ischemia Hemorrhage Seizure Hydrocephalus
CLASSIFICATION
1st Classified as: Benign Malignant
LOCATION OF TUMORS
2nd classification is based on their location: SUPRATENTORIAL above the tentorium cerebelli INFRATENTORIAL- beneath the INFRATENTORIALtentorium, the area of the brainstem structures and cerebellum
3rd Classification
Depends
are responsible for nerve impulse conduction Neuroglial cells provide support, nourishment, and protection for neurons
GLIOMAS
Are
malignant tumors. Arise from the neuroglial cells of the brain and brainstem
Types of glioma
a. Astrocytoma
may be found anywhere within the cerebral hemispheres The most common
b. Oligodendrogliomas
Located
c. Glioblastoma
Highly
d. Ependymomas
Arise
from the lining of the ventricles and are difficult to treat surgically
MENINGIOMAS
Arise
from the coverings of the brain (the meninges) Most common benign tumor
PITUITARY TUMORS
cause endocrine dysfunction Most common type of pituitary tumor is the adenoma Adenomas are subdivided into chromophobe, secretory, nonsecretory adenomas
May
disturbances Hypopituitary signs (loss of body hair, diabetes DI, sterility, visual field defects, and headache)
ACOUSTIC NEUROMAS
Arise
from the sheath of Schwann cells in the peripheral portion of cranial nerve VIII Also referred to as cerebellar pontine angle (CPA)
loss or vertigo
METASTATIC TUMORS
called as secondary tumors Metastatic cells from the lungs, breast, colon, pancreas, and kidney
Also
Genetic
Electromagnetic
CLINICAL MANIFESTATIONS
Headache Nausea
and Vomiting Visual symptoms Seizures Changes in mentation or personality Papilledema (swelling of the optic disk)
Diagnostic Test
Computed Tomography Magnetic Resonance Imaging Skull films Electroencephalogr aphy (EEG)
Lumbar puncture Myelography Brain scan Positron emission tomography (PET) Laboratory test
MANAGEMENT
NONSURGICAL
Radiation therapy Drug therapy Chemotherapy Other drugs (Analgesics, Dexamethasone, Phenytoin,Histamine blockers, Metoclopramide) Radiosurgery Gamma Knife
SURGICAL MANAGEMENT
Craniotomy
Increased
Intracranial pressure Hematomas (Subdural hematoma, Epidural hematoma, Subarachnoid hemorrhage) Hypovolemic shock Hydrocephalus
Wound infection Meningitis Fluid and Electrolyte Imbalances (dehydration, Hyponatremia) Seizures Cerebrospinal fluid (CSF) leak Cerebral edema
POST OP CARE
Positioning Monitoring
the dressing Monitoring laboratory values Ventilating the client Drug therapy
SKIN TUMORS
Skin cancer
, the uncontrolled growth of skin cells, is one of the most commonly diagnosed forms of cancer. Several different types of skin cancer exist.
is the most common type of skin cancer. It is a slow growing cancer that normally appears in patients aged 40 or over. usually occurs on areas of the body or scalp that are regularly exposed to the sun. People with light skin, hair, and eye color are at greater risk of developing basal cell skin cancer, as are those who have been overexposed to xrays. rays.
Manifestations
A skin lesion that has a pearl-like or waxy pearlappearance and is flat or slightly raised The lesion could be white or light pink, fleshfleshcolored, or brown, and may contain blood vessels that are visible either in the lesion or nearby skin. A sore that wont heal or a lesion that looks like a scar, but is not related to a skin injury. injury.
Occurs in the middle layer of the epidermis, or epidermis, skin. More aggressive than basal cell carcinoma. It often begins after age 50 Occur in normal skin or in a burned or injured area.
Melanoma
is not as common, but more deadly than other skin cancer forms. Four types of melanoma exist, and they vary according to the location on the body where they are likely to occur, the age group they affect, and the groups of people most likely affected.
Preventive Measures
Avoiding the suns strongest rays, basically from 10 a.m. to 4 p.m. Use a sunscreen daily that has a sun protection factor (SPF) of 15 or higher. Wearing sunglasses and wide-brimmed hats. wideSpending time outdoors, but in the shade
Sun exposure Ultraviolet radiation has the potential to greatly damage their skin cells. Synthetic tanning devices like tanning beds Exposure to toxins Reactions to chemicals Intolerance to certain medication.
Treatment
SARCOMAS