Cancer Nursing

Incidence & Mortality • USA – 1, 399,790 new cases in 2006 – (- basal & squamous cell skin cancers) – remove them from the statistics • 1 in every 4 deaths – cancer cause • 1500 people die each day • Lung cancer - #1 cause of cancer death ••Primary – death quickly Metastasis – sometimes can get rid of cancer 5 year survival rate improving • African Americans highest mortality rate – no good access to healthcare – no insurance

Death: #1 Heart Disease #2 Lung Cancer

Incidence of Cancer • Incidence: # cases/yr • Prevalence: # cases at any one time • Men (Prostate CA) * • Female (Breast CA) * • 5-year survival rate for all cancers combined is 65% (11% gain over 20 yrs)

Terminology • Carcinogen – cancer causing • Neoplasms – mass, tumor – needs O2/blood • Benign tumor – localized growth, encapsulate, well defined growth – Meningioma; lipoma (fatty tumor) • Malignant tumor – capability to invade other areas of the body metastasis à distant from primary site • Metastasis - spreading • Carcinoma – skin (80-90% of all cancer cases) • Sarcoma - connective tissue bones and ligaments • Lymphoma -lymph • Leukemia - blood

Risk Factors Heredity – breast, colon Age – usually after 55 years of age Gender Poverty Stress – continuous stress brings on hormones (depression) Diet – high fat, low fiber (30 % are caused by diet) Occupation – exposed to chemicals, X-Ray, Farmers, Asbestos Infection –HPV virus, HIV Alcohol – high risk for oral, esophagus, bladder cancer Obesity Sun exposure – high (10-2 pm stay out of the sun) risk group 25-29 Caucasian Tobacco Recreational Drug Use – coccaine, heroin

Risk Factors Known Carcinogens – Viruses •HCMV, EBV,HPV – Drugs •Chemotherapeutic •Heroin & Cocaine – Hormones •Gonadotropic • Estrogen – Chemical Agents – Radiation

Pathophysiology Differentiation • Hyperplasia – increase density • Metaplasia - replaces • Dysplasia – abnormal, shape, appearance, size

Causes of Cancer • Most are “idiopathic” (don’t know why) • Theories – Cellular mutation – related to DNA, carcinoma’s – Oncogenes – capability of triggering cancer processes – Tumor suppressor genes – regulated of cell growth, but they get mutated by the DNA

• Benign • Local • Well defined borders ** • Pushes organs away • Slow growth • Encapsulated • Easily removed – surgical – Thyroid (usually benign) put on synthroid mediation • Does not recur

• Malignant • Invasive • Does not stop at tissue border • Rapid growth • Metastasizes to sites • Not always easy to remove • Can recur

Benign vs Malignant Characteristics of Malignant Cells • Loss of regulation of mitotic rate • Loss of cell specialization – not a parent cell anymore • Loss of contact inhibition – don’t respect other cellular boundaries they invade other cells • “Immortality” – don’t stop growing they don’t do cell suicide • Irreversibility • Altered cell structure • Simplified metabolic activity – they can grow • Translatability – break away to other sites • Promote survival – cell takes nutrient from the host (angiogenesis)

• Infections – sepsis à tissue become necrotic (bone à bone marrow immunity problems à infection) – Fistula between noncompatible organs – Necrosis_ septicemia – Organs of immunity • Anemia – Tumor erosion ® anemia – Cytokines from infection and tumor suppress marrow function

Anorexia-Cachexia Syndrome – wasting away appearance can be the first symptom, usally late in the game; syndrome – late stage, can be related to treatment, cytokines – altered taste/smell, catabolize own tissue

Paraneoplastic Syndromes – rare disorders, start secreting hormones • Endocrine Breast, ovarian, renal _ ectopic parathyroid = increase CA Lung _ ectopic secretion of insulin = _blood glucose

Diagnosis of Cancer • Cancer is diagnosed by a biopsy which is reviewed be a pathologist. – Get Biopsy, tissue or cells (can be outpatient) • Types of Biopsy: – Needle biopsy (fine needle, needle core) - portion – Incisional – part removal – Excisional – entire removal – Endoscopy - scope – Laparoscopy – go in the GI Tract