Cancer

 

Excessive multiplication of cells in part of the body

Tumour - a lump, new growth or neoplasm

Common primary sites include, kidney, prostate, breast, bone, GIT, cervix or ovary

Caused by a hyperplasia.

Loss of contact inhibition

Growth may outstrip blood supply resulting in necrosis, ulceration and subsequent infection.

 

Primary or secondary

Common primary sites include, bronchus, colon, stomach, kidney, prostate, breast, bone, cervix or ovary

Common secondary sites include,

 

Benign or malignant

Metastases

Cachexia

 

Names

oma                - lump

fibroma           - lump in fibrous tissue

carcinoma      - malignancy originating from a surface epithelium, eg. ca bronchus.

sarcoma         - tumours arising from a connective tissue,  eg. fibrosarcoma

adeno             - gland           

haem  - blood                        angio - vessel                       chondro – cartilage

osteo  - bone                         endo   - lining                         myo- muscle

 

Cancer warning signs

Change in bowel habits                                Sore which does not heal

Unusual bleeding or discharge                    Thickening or lump somewhere, (self examination)

Difficulty in ingestion                         Changes in a wart or mole

Nagging cough or hoarseness

 

Diagnosis

Clinical                                               Biopsy                                    Cytology

Radioisotope scanning                    CT                                           MRI

Ultrasound                                          Biochemistry and haemotology

Treatment

Surgical excision                               Cytotoxic agents                   DXT                Immunotherapy

 

Causes

Radiation                                           Chemical carcinogens         Smoking

Occupation                                        Virus                                       Diet

Heredity                                              Hormones                              Other environmental factors

Age                                                     Initiators, promoters, multifactoral aspects.

 

 

Cancer

20 - 25% of deaths in the West, normally more common in old age.

Excessive multiplication of cells in part of the body, rapid and uncoordinated.

Tumour - a lump, new growth or neoplasm

Loss of contact inhibition

Growth may outstrip blood supply resulting in necrosis, ulceration and subsequent infection.

Primary or secondary

 

Benign or malignant

 

                                                benign                                               malignant

 

Growth rate

 

Local invasion

 

Metastases

 

Recurrence after

resection

 

Systemic effects

 

Cytology                     normal                                    usually big cells with irregular                                                                                                                      nuclei, mitotic figures

 

Histology                    preserved form                      form and function changed                                                                           and function              

 

 

Causes

Radiation                                           exogenous oncogenes         endogenous oncogenes

Chemical carcinogens                     Smoking                                 Occupation

Virus (Epstein Barr)                          Diet                                         Disorder of immunity

Heredity                                              Hormones                              Other environmental factors

Immunosupression                            Age    

 

Multi-step theory of neoplasia

Initiator          - causes a change in the genetic material, must be applied first

Promoter      - applied at regular intervals over time removal of the promoter in

                           pre - malignant tissue can  remove or reduce risk

Complete carcinogens   - initiators and promoters

Incomplete carcinogens - initiators or promoters

 

Tumour grading

 

Histological estimate of the differentiation of neoplastic cells.

 

well differentiated                  moderately differentiated                 poorly differentiated             

no differentiation or anaplastic

 

 

 

Staging of tumours

The degree of spread of a malignant neoplasm.

 

site of origin               local spread               lymph node metastases       distant metastases

T = tumour      N = regional lymph node involvement         M = metastases.

eg.       T1N0M0      T4N3M3

 

Hormones and cancer

Hormone producing tumours

appropriate production                     inappropriate production

 

Prostatic and breast tumours are to some extend dependent on the relevant gender sex hormone

 

Names

Oma    - lump                          fibroma - lump in fibrous tissue                   adeno - gland

haem - blood                        angio- vessel                                                 chondro - cartilage

osteo  - bone                         endo- lining                                                    myo - muscle

 

Histogenesis

carcinoma    - malignancy originating from a surface epithelium, eg. ca bronchus.

sarcoma        - tumours arising from a connective tissue, eg. fibrosarcoma

lymphoma    - from lymphoid tissue

 

Cancer warning signs

Change in bowel habits                                Sore which does not heal

Unusual bleeding or discharge                    Thickening or lump somewhere, (self examination)

Difficulty in ingestion                         Changes in a wart or mole

Nagging cough or hoarseness

 

Diagnosis

Clinical                       Biopsy                        Cytology                     Radioisotope scanning

CT                               MRI                             Ultrasound                  Endoscopy

Biochemistry and haematology

 

Clinical effects

compression                          general malaise                                SOL                            lethargy

ulceration                               peripheral neuropathy                       haemorrhage         hypercalcaemia rupture                                    skin disorders            perforation cerebral degeneration  infarction anaemia                            hormonal metastases                       pain                             infection cachexia                             obstruction

 

Direct effects                                     Paraneoplastic effects

 

Treatment

Surgical excision                   Cytotoxic agents                               DXT                Immunotherapy

Endocrine-related therapy   Palliative

 

Benign tumours

local expansive growth                                                         usually not life - threatening

not metastatic                                                                        cells well differentiated

surrounding rim of compressed, fibrous tissue forming a capsule

eg. adenoma - gland,  fibroma - fibrous tissue,  lipoma - fat

myoma - muscle,  angioma - blood vessel.

 

Malignant tumours

destructive and invasive growth                              usually fatal without treatment

sooner or later metastatic                                        less well differentiated cells

transgression of normal boundaries

 

Spread

local infiltration           lymphatic spread                   blood              body cavity spread                CSF

 

 

 

Nursing measures

 

Teaching patient and family

explanations about care                   encourage self care activities         

encourage family in patient care                 recognise when nursing care becomes necessary

 

Prevent effects of immobility

prevent pressure sores                                maximise mobility as condition allows

 

Maintenance of personal hygiene

attention to skin, hair and clothing may improve self-esteem

pay attention to smells from body exudates, draining wounds and dressings

clean bed linen                                              fulfil self card defects

 

Maintaining elimination

constipation likely, resulting from opiates, anorexia and immobility

fluids and dietary fibre                                  mobility where possible

use of stool softener                         enemas and laxatives as indicated

 

Maintaining nutrition

cathexia may occur                                       tumour growth uses a lot of protein

malignant tissue is metabolically active     encourage family/group eating

pay attention to protein and calories, consider supplements

blend food if indicated                                  TPN may be indicated if available

good nutrition promotes immuno-competence and wound healing       

 

Promotion of comfort

treat pain                    facilitate sleep and rest periods                  optimise nursing positions

 

Identify patient fears

irrational fears may be allayed

 

Be realistic

don`t lie to patients               avoid unrealistic false hope, eg during remission

 

Plan home care

Marie Curie cancer care                  hospice                      MDT                care of family and others

 

Pain

Aspirin                        aspirin and codeine              opiates                       anxiety makes pain worse

give regularly not PRN          phenothiazines          tricyclics

 

 

 

 

 

 

 

 

 

 

 

Group work 1.  Cancer

 

 

Group 1.

 

What percentage of people in the West die from malignant disease?

 

What are the differences between malignant and benign tumours?

 

List some aetiological factors in cancer

 

 

Group 2

 

What theories of cancer aetiology have you heard of?

 

How are cancers staged and graded?

 

List some names of cancers - what do the suffixes mean?

 

 

Group 3.

 

What are some "warning signs" of cancer?

 

How are cancers diagnosed?

 

What are the clinical effects of cancer?

 

 

Group 4.

 

How are cancers treated?

 

List some characteristics of benign tumours

 

List some characteristics of malignant tumours