ONCOLOGY: Nursing Management in Cancer Patient Cancer is a disease process whereby cells proliferate abnormally, ignoring growth regulating

signals in the environment surrounding the cells. PATHOPHYSIOLOGY OF THE MALIGNANT PROCESS Via genetic mutation of the cellular DNA a normal cell was transformed into an abnormal cell

Unhealthy diet and low fruit and vegetable intake Lack of physical activity Alcohol use Sexually transmitted HIV-infection Urban hair pollution Indoor smoke from household use of solid fuels

Cancer is the leading cause of death worldwide and counted to 7.6 million deaths (around 13% of all deaths) in 2008. The main types of cancer are: Lung cancer (1.37 million deaths) Stomach cancer (736,000 deaths) Liver cancer (695,000 deaths) Colorectal cancer (608,000 deaths) Breast cancer (458,000 deaths) Cervical cancer (275,000 deaths)

Abnormal cell forms a clone and begins to proliferate abnormally by ignoring growthregulating signals in the environment surrounding the cells

Cells acquire invasive characteristics that affect the surrounding tissues NORMAL CELL GROWTH: The Cell Cycle Cells infiltrate these tissues and gain access to lymph and blood vessels The cell cycle is a critical process that a cell undergoes in order to copy itself exactly. Most cancers have mutations in the signals that regulate the cell's cycle of growth and division. Normal cell division is required for the generation of new cells during development and for the replacement of old cells as they die. INTERPHASE- period between cell division for at least 90% of the cell 1st Part of Interphase: G1 (for first gap) Modifying and Avoiding Risk Factors Tobacco use Being obese or over weight

Cells was carried to other areas of the body (metastasis)

CANCER

There is rapid growth and metabolic activity including synthesis of RNA and proteins

2nd Part of Interphase: S Phase (DNA synthesis) The cell growth continues and the DNA replicated

lead to lesions on the surface or lining of the organ itself Malignant Neoplasm Basically cancer and the most severe of the three because it invade surrounding organs and tissues and also spread to other parts of the body through metastasis During this process the cell break of the neoplasm and travel through the blood vessels to other parts of the body Characteristics of malignant neoplasms include:

3rd Part of Interphase: G2 (for second gap) The cell continues to grow and prepare for cell division

MITISIS or Cell Division is referred as the M phase. Cells that do not divide for long periods do not replicate their DNA and considered to be in G0.

In normal cells, tumor suppressor genes act as braking signals during G1 to stop or slow the cell cycle before S phase. DNA repair genes are active throughout the cell cycle, particularly during G2 after DNA replication and before the chromosomes prepare for mitosis. NEOPLASM-it is a term used to describe an abnormal growth of cells within the body and is usually associated with cancers. THREE TYPES OF NEOPLASM Benign Neoplasm A tumor that does not metastasize or spread to other cells, tissues or organs It is the safest neoplasm because it is non-progressive and does not invade other parts of the body Pre-malignant Neoplasm Referred to as CARCINOMA IN SITU It does not spread to other organs and tissues that surrounds it but it can be cancerous if left untreated Usually grow within the organ where the initial abnormal growth began and

More rapid increase in size Less differentiation (or lack of differentiation, called anaplasia) Tendency to invade surrounding tissues Ability to metastasize to distant tissues

Cytologic features of malignant neoplasms include: Increased nuclear size (with increased nuclear/cytoplasmic ratio--N/C ratio). Variation in nuclear or cell size (pleomorphism). Lack of differentiation (anaplasia). Increased nuclear DNA content with subsequent dark staining on H and E slides (hyperchromatism). Prominent nucleoli or irregular chomatin distribution within nuclei.

Mitoses (especially irregular or bizarre mitoses).

The cellular changes formed during initiation and promotion now exhibit increased malignant behavior

All of these features are "atypical" microscopic findings. Atypia implies a change for the worse from normal. Spread of Malignant Neoplasms

NURSING DIAGNOSES Based on the assessment data, nursing diagnoses of the patient with cancer may include the following: Impaired oral mucous membrane Impaired tissue integrity Impaired tissue integrity: alopecia Impaired tissue integrity: malignant skin lesions Imbalanced nutrition, less than body requirements Anorexia Malabsorption Cachexia Chronic pain Fatigue Disturbed body image Anticipatory grieving

By direct extension (invasion) into surrounding tissues. Through lymph channels to lymph nodes (lymphatic spread)--typical of carcinomas. Via the bloodstream (hematogenous spread)--typical of carcinomas or sarcomas. Within body cavities (seeding)--typical of neoplasms impinging upon body cavities, such as the peritoneal cavity.

CARCINOGENESIS Initiation (the first step) - initiators (carcinogens), such as chemicals, physical factors, and biologic agents, escape normal enzymatic mechanisms and alter the genetic structure of the cellular DNA Promotion There is a repeated exposure to promoting agents (co-carcinogens) causes the expression of abnormal or mutant genetic information even after long latency periods Latency periods for the promotion of cellular mutations vary with the type of agent and the dosage of the promoter as well as the innate characteristics of the target cell Progression is the third step of cellular carcinogenesis