CANCER CANCER

KRISHNA B. BALSARZA, RN
MAN-NURSING SERVICE
C - cancer derives from the Greek word karkinoma meaning crab
which is used to describe appendage-like projections extending
from tumors
A - abnormal cells divide in an uncontrolled way
N - normal cell suddenly turns into a rouge cell and start dividing
continuously without check, leading to the development of solid
lumps
C - condition wherein cells mutate and increase number, with
changes in their morphology and without any function.

E - estimates that it is the second leading cause of death

R - results from abnormal cellular DNA

 TUMOR CLASSIFICATION
MALIGNANT
grows rapidly
not encapsulated
invade local structures and
tissues
poorly differentiated
high mitotic index
spread distantly
BENIGN
grows slowly
well-defined capsule
not invasive
well differentiated
low mitotic index
do not metastasize
 FACTORS AFFECTING CANCER
Age and Hormonal Diet
Status Chemicals
Family history Smoking
Genetic Predisposition Radiation
Infection
Role of Free Radicals
 BREAST CANCER
Family History
High-fat
Diet
Obesity after Menopause
Early Menarche, Late Menopause
Alcohol Consumption
Postmenopausal Estrogen and Progestin
First Child after Age 30
 OVARIAN CANCER
Multiple Sexual Partner
Having Sex at Early Age
Exposure to Human Papilloma Virus
Smoking
 COLORECTAL CANCER
Family History
Low Fiber Diet
History of Rectal Polyps

ESOPHAGEAL CANCER
Heavy Alcohol Consumption
Smoking
 CERVICAL CANCER
Multiple Sexual Partner
Having Sex at Early Age
Exposure to Human Papilloma Virus
Smoking
STOMACH CANCER
Family History
Diet Heavy in Smoked, Pickled or Salted Foods
 LUNG CANCER
Cigarette Smoking
Asbestos, Arsenic, and Radon Exposure
Secondhand SmokeTB
SKIN CANCER
Excessive Exposure to UV Radiation (Sun)
Fair Complexion
Work With Coal, Tar, Pitch or Creosote
Multiple or Atypical Nevi
 TESTICULAR CANCER
Undescended Testicles
Consumption of Hormones by Mothers during Pregnancy
PROSTATE CANCER
Increasing Of Age
Family History
Diet High in Animal Fat
 WARNING SIGNS FOR CANCER
C hanges in bladder or bowel habits
A sore that does not heal
U - nusual bleeding or discharges
T hickening or lumps
I ndigestion or difficulty swallowing
O bvious changes in warts, mole or the skin
N aging cough or hoarseness of voice
U nexplained anemia
S udden loss of weight
CLINICAL MANIFESTATIONS
1. PARANEOPLASTIC SYNDROME
2. PAIN
3. FATIGUE
4. CACHEXIA
5. ANEMIA
6. LEUKOPENIA & THROMBOCYTOPENIA
7. INFECTION
 Types of Associated Tumor
Proposed Mechanism
PARANEOPLASTIC SYNDROME
Syndrome Type
Syndrome of Inappropriate
Small Cell Lung Ca Production and release of ADH by tumor
ADH
Some are caused by the elaboration of hormone by
Small Cell Lung Ca, Bronchial Production and release of ACTH by
cancer
Cushing's Syndrome cells
Carcinoid Ca tumor
Result
Hypercalcemia
from the
Squamosproduction
Cell Cancers of Lung,of circulating factors
Production and release that
of polypeptide
produce hematopoietic,
Head, Neck, Ovary
neuroloficfactorand dermatologic
with close relationship to PTH

Venous syndromes
Thrombosis Pancreatic, Lung, Other Cancer

May
Nonbacterial be the earliest
Thrombocytic indication
Other Advanced Cancers
Production of Procoagulation factors
that a person has cancer
Endocarditis
Treatment
Eaton-Lambert Syndrome
involves
Small Cell Lung Ca
concurrent treatment og the
Autoimmune producon of antibodies to
underlying
Myasthenia Gravis
cancer
Thymoma
and suppression motor of the
end-plate mediator
structures
causing the syndrome Possibly caused by producttion of growth
Acanthosis Nigricans Gastric Carcinoma
factors by tumor cells
 PAIN
occurs in a large fraction of
those individuals who are
terminallly ill with cancer
influenced by fear, anxiety, sleep
loss, fatigue and overalll physical
deterioration
occur at the site of the primary
tumor or can result from a
distant metastatic lesion
 FATIGUE
studies of muscle function suggest that some individuals with
cancer may lose portions of muscle function needed to perform
normal physical activies

described as tiredness, weakness, lack of energy, exhaustion,

lethargy, inability to concentrate, depression, sleepines, boredom, lack
of motivation and decreased mental status

can be caused by the cancer itself or by the stress associated with

the diagnosis of cancer
 CACHEXIA
severe form of malnutrition associated with cancer and result
in wasting, emaciation and quality of life

constellation of symptoms including anorexia, weight loss,

early satiety, anemia , asthenia, taste alterations and altered
protein, lipid and carbohydrate metabolism
 ANEMIA
mechanisms that cause anemia includes chronic bleeding,
severe malnutrition, cytotoxic chemotherapy, malignancy in
blood forming organs

defects in erythropoietin and shortened duration of red

blood cells
 LEUKOPENIA / NEUTROPENIA /
THROMBOCYTOPENIA
Direct tumor invasion of the bone marrow causes both
leukopenia and thrombocytopenia

Availability of hematopoietic growth factors like GCSF

(Granulocyte Colony-Stimulating Factor), Erythropoietin,
which stimulates red blood cell production and IL-11 which
stimulates platelet production has shortened the period of
myelosuppresion.
 INFECTION
cause of complications and death in person with
malignant disease
persons with cancer have debility with advance disease
and immunosuppression from the underlying cancer and
treatment
 GASTROINTESTINAL TRACT
Both chemotherapy and radiation therapy may cause a
decreased cell turnover thereby leading to oral ulcers,
malabsorption and diarrhea

Disruption of barrier defenses also increases the risk for

infection
 TUMOR STAGING
In situ, meaning early cancer that is present only in the layer of
cells in which it began.

Regional, meaning the cancer has spread to nearby lymph nodes,

organs, or tissues.

Unknown, meaning there is not enough information to designate

a stage or know where an advanced cancer originated.
 INVASION AND METASTASIS
Metastasis is the spread of cancer cells from the site of the
original tumor to distant tisses and organs through the
body.
 LYMPHATIC SPREAD
Tumor emboli enter the lymph channels by way
of the interstitial fluid, which communicates
withlymphatic fluid.
Malignant cells penetrate lymphatic vessels by
invasion.
Malignant cells either lodge in the lymph nodes
or pass between the lymphatic and venous
circulations.
 HEMATOGENOUS SPREAD
Dissemination of malignant cells via the
bloodstream and is directly related to the
vascularity of the tumor.
Malignant cells attach to endothelium and attract
fibrin, platelets, and clotting factors to seal
themselves from immune system surveillance.
Malignant cells to enter the basement
membraneand secrete lysosomal enzymes.
 IMAGING PROCEDURES
CT SCAN
ULTRASOUND
PET SCAN
MRI
NUCLEAR SCAN
X-RAYS
 TUMOR MARKERS
Are antigens that are expressed on the surface of the tumor cells or
substances released from normal cells in response to the presence of tumor
Are substances, mostly proteins, that are produced by the body or by the
tumor itself in response to cancer.
The value of a marker depends on:
sensitivity
specificity
proportionality
feasibility
 OBTAINING TISSUE BIOPSY
PROCEDURE PURPOSE EXAMPLE

complete removal, usually with margin of

Excisional full resection
normal tissue

lymph node biopsy, muscle

Incisional removal of portion of lesion
mass biopsy
performed with direct vision, or guided wit needle biopsy of prostate or
Core Needle
ultrasound or CT Scan liver mass

Fine Needle obtains dissociated cells for cytology study

thyroid, breast mass
Aspiration but does not preserve tissue structure

Exfolliative brushings from lung or colon

cells shed from surface
Cytology endoscopy
 TREATMENT
CHEMOTHERAPY
BIOTHERAPY
SURGERY
RADIOTHERAPY
BONE MARROW TRANSPLANTATION
 Chemotherapy
It is a systemic treatment that enables drugs
to reach the site of the tumor as well as
distant sites.

At cellular level, they exert their lethal action

by targeting processes that prevent cell
growth and replication. These mechanisms
include disrupting production of essential
enzymes; inhibiting DNA, RNA and protein
synthesis; preventing cell mitosis

Most effective in treating tumors that have a

high growth fraction because of their ability
to kill rapidly diving cells
 CHEMOTHERAPY PROTOCOL
Colon CA,/Colorectal CA -
FOLFOX, FOLFIRI, MFOLFOX

Burkitts Lymphoma CODOX

AML/CML/ALL
DOXOROBICIN, CYTARABINE

Breast CA PACLITAXEL,
CARBOPLATIN
Most chemotherapeutic drugs suppress bone marrow
function and formation of blood leading to
NEUTROPENIA, THROMBOCYTOPENIA and
ANEMIA.

Hematopoietic growth factors like GCSF (Granulocyte

Colony-Stimulating Factor), Erythropoietin
 ANOREXIA, NAUSEA AND
VOMITING
this symptom is due to the
stimulation of the chemoreceptor
trigger one in the medulla that
stimulates vomiting.

Seronotin (5-HT3) receptor

antagonists (Ondansetron,
Granisetron, Dolasetron,
Palonosetron)
3.DIARRHEA chemotherapy can cause temporary lactose
intolerance or increase in gastric motility.

Patients are advised to eat, small frequent feedings and small

residue meals, to refrain from eating spicy or greasy foods and
to avoid extreme temperatures in food or beverages.

4.HAIR LOSS results from impaired proliferation of the hair

follicles and is a side effect of a number of cancer drugs.
 BIOTHERAPY
Involves the use of immunotherapy and biologic
response modifiers as a means of changing the
persons own immune response to cancer. The major
mechanism by which biotherapy exerts its effects are
modification of host responses, direct destruction of
cancer cells by suppressing tumor growth or killing
the tumor cell and modification of tumor cell biology.
 SURGERY
First line of treatment for solid tumors.

Used for diagnosis, staging of cancer, tumor

removal and palliation when cure cannot be
achieved.

Type of surgery to be used is determined by

the extent of the disease, the location and
structures involved, the tumor growth and
invasiveness, the surgical risk to the patient
and the quality of life the patient will
experience after the surgery

It can be primary, curative treatment for

cancers
 RADIOTHERAPY
The goal of radiation is to achieve regional local control of the
cancerous growth without permanently damaging the surrounding
tissues.

Can be delivered by either external beam radiation machines that

have sources of radiation located some distance from the patient
(TELETHERAPY) or by short-distance therapy (BRACHYTHERAPY)
in which a sealed radioactive source is placed close to or directly in the
tumor site.
 TELETHERAPY
is commonly delivered by a linear accelerator or a
cobalt-60 machine. It produces ionizing radiation
through a process in which electrons are accelerated a
very high rate, strike a target and produce high
energy x-rays. Photon energy generates a rectangular
energy beam capable of penetrating deep within the
tumor tissue.
 BRACHYTHERAPY
SEALED UNSEALED
involves the insertion of injected intravenously or
sealed radioactive sources administered by mouth.
into a body cavity or directly Iodine- 131, given by mouth is
into body tissues. Most used in the treatment of
commonly, they are packed thyroid cancer. Strontium-89,
into needles, beads, seeds,
ribbons, or catheters which is given to control bone pain
are then implanted directly due to multiple skeletal
into the tumor metastasis
 Bone Marrow Transplantation
Involves high dose chemotherapy and radiation
therapy that are either marrow ablatie or marrow
suppressive followed by hematopoietic rescue.
Utilizes stem cells obtained from bone marrow
Transplantation techniques can identify source of
the marrow or peripheral stem cells as
ALLOGENIC, in which recipient receives stem cells
from another person whose Human Leukocyte
Antigen (HLA) matches; Syngeneic from identical
twins; Autologous in which the recipients own
bone marrow or stem cells are used.
 BURKITT'S
LYMPHOMA
 Patient Information
Patients Name : D.L. S. A. C.

Age : 52

Gender : Female

Birth date : March 11, 1964

 Short History of the Present
Illness
The patient is a 52 year old female, non-
hypertensive, nondiabetic who came in due to
fever. History stated 1 week prior to consult
when the patient had fever (Tmax 38.2),
temporary relieved by Parcetamol. Patient
sought consult revealing low platelet count. In
the interim, there was persistent of fever with
associated pain on both lower extremities and
malaise. No headache, dizziness, difficulty of
breathing, abdominal pain, vomiting or
bladder and bowel changes. Persistence of
symptoms prompted consult for further
management and evaluation.
 Family History: (+) Diabetes and Hypertension

Personal and Social History: Non-smoker, non-

alcoholic beverage drinker

Menstrual History: Menarche at 13 years of age,

regular mensses lasting 3 days, takes up 3-4
days. Menopausal at 50 years of age.

OB History: G2P2 (2-0-0-2) G1, 1998, G2 2000

Preterm via normal spontaneous delivery
Pertinent Physical Examination
Findings
Patient is awake, alert not in distress with
stable vital signs. Patient had pink palpebral
conjunctiva with anicteric sclearae. She has
moist oral mucosa. Symmetric chest rise
with clear breath sounds, normal rate and
regular rhythm is noted. Patient has soft
abdomen, non distended, nontender. Patient
is in full pulses, no edema and presence of
bruises are noted on bilateral lower
extremities.
 CBC - June 29, 2016
Hemoglobin : 8.2
Hematocrit : 23.4
RBC : 2.88
WBC : 4,060
Neutrophils : 21
Lymphocyte : 53
Eosinophils : 2
Monocyte : 10
Stabs : 12
Myelocyte : 2
Platelet Count : 3,000
MCV : 81
MCH : 29
MCHC : 35
RDW : 13.5
 Creatinine : 0.88

Uric Acid : 7.20

Blood Urea Nitrogen : 16

Sodium : 134

Potassium : 3.5
 FLOW CYTOMETRY REPORT
(Comprehensive Leukemia Panel)

Interpretation: Abnormal. This phenotype

is consistent with CD10-Positive, Mature
B-Cell Lymphoproliferative Disorder.
 CHEST AND NECK CT SCAN
Revealed confluent lymph nodes (levels 2
and 3) measuring 1.8x2.4x4.9cm
 BONE MARROW BIOPSY

Result: Histopath results showed mature B cell

lymphoproliferative disorder with primary consideration
of Burkitt Lymphona vs Diffuse Large B Cell Lymphoma.
Hence Bone Marrow specimen was sent for
immunohistochemical staining.
 RISK FOR BLEEDING
related to rupture of obstructive blood
vessels
evidenced by bruises on bilateral lower
extremities
Platelet Count of 3,000
 PAIN
related to destruction of nerve tissue
evidenced by reports of pain
both lumbar pain and lower extremities, with
pain score of 7/10, (+) facial grimace, (+)
guarding

Desired Outcome: Report maximal pain

relief/control with minimal interference with
ADLs
Altered Nutrition: Less Than Body
Requirements
related to effects chemotherapy
evidenced by inadequate food intake, altered
taste sensation, loss of interest in food,
perceived/actual inability to ingest food, nausea,
gastric irritation, taste distortions, nausea

Desired Outcome: Demonstrate stable

weight/progressive weight gain toward goal with
normalization of laboratory values and be free of
signs of malnutrition.
 FATIGUE
related to Decreased metabolic energy
production

Desired Outcome: Perform ADLs and

participate in desired activities at level of
ability.
 Altered Oral Mucous Membrane
related to antimetabolites
Dehydration, malnutrition, NPO restrictions for
more than 24 hr

Desired Outcomes

Display intact mucous membranes,

which are pink, moist, and free of
inflammation/ulcerations.
You cannot always save lives,
but you can always love them

- CANCER UNIT 1 / BMT In-Patient Unit