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Altered Cell Growth & Cancer Development NRS 108 Spring, 2008 Lola Oyedele MSN, RN CTN Majuvy L. Sulse RN, MSN, CCRN

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  • Altered Cell Growth & Cancer DevelopmentNRS 108Spring, 2008

    Lola Oyedele MSN, RN CTNMajuvy L. Sulse RN, MSN, CCRN

  • DescriptionUncontrolled growth of abnormal cellsNeoplastic disorder that can involve all body organsCancer produces serious health problems as impaired immune and hematopoetic function, altered GI tract structure and function, motor and sensory deficits and decreased respiratory functions

  • EpidemiologyIncreased incidence & mortality in malesProstateLungcolorectalIncreased incidence & death in African AmericansFemalesBreast, lungs, colorectal

  • Biology of normal cellsLimited cell division-divide & undergo mitosis-(divide only when internal body conditions and nutrition are just right to promote cell division)Show specific morphology-distinct appearance, size, shapeSmall nuclear-cytoplasmic ratioPerform specific differentiated functions-pluripotency, multipotency, totipotencyAdhere tightly togethersecrete proteins (fibronectin) that protrude from the cell surface allowing cells to bind closely and tightly together Non migratory- exception leukocytes & erythrocytesGrow in an orderly & well regulated manner-cell cycleAre contact inhibited density-dependent inhibition of cell growth

  • Cell Cycle

  • Benign CellsMalignant CellsDemonstrate continuous or inappropriate cell growth-growing too much in the wrong placeRapid or continuous growth- short generation timeShow specific morphology-strongly resembles parent tissueAnaplastic morphology- loose the specific appearance of parent cellSmall nuclear-cytoplasmic ratioLarger nuclear-cytoplasmic ratioPerform differentiated functions-perform same parent tissue functionLoss some or all differentiated functions- no useful functionAdhere tightly together-encapsulatedAdhere l o o s e l y togetherNon migratoryAble to migrate-metastasizeGrow in an orderly manner-hyperplastic expansionGrow by invasion and not contact inhibited

  • Common AlterationsHyperplasia- increase in number of cellsHypertrophy- increase in sizeMetaplasia-transformation of one type of differentiated cell into anotherDysplasia-abnormal development of an organ, tissues or cellsNeoplasia-new or continued cell growth not needed for normal development

  • CarcinogenesisProcess of transformation of normal cells to malignant cellsInitiationPromotionMalignant conversionProgressionMetastasisExtension to surrounding tissuePenetration into blood vesselsRelease of tumor cellsInvasion at arrest site

  • Malignant ConversionChromosomes derangedTranslocation & deletionAlter regulatory function of DNADistort biological info of RNAResults in altered growth & function messages

  • Factors Affecting Growth RateCell cycle timeGrowth factorRate cell lossVascularizationHormonal factors

  • Factors influencing Cancer developmentEnvironmental factorsChemicalPhysical-chronic irritation & radiationviral carcinogensDietary factorsGenetic predispositionAgeImmune function

  • WARNING SIGNSC hange in bowel/ bladder patternsA sore throat that does not healU nusual bleeding or dischargeT hickening or LumpI ndigestion or difficulty swallowingO bvious change in mole or wartN agging cough or hoarseness

  • Grading & StagingMethod used to describe tumorExtent of tumorExtent to which malignancy has increased in sizeInvolvement of regional nodesMetastatic developmentGrading-classifies the cellular aspect of cancerStaging-classifies the clinical aspects of the cancer (0-lV)

  • ClassificationSolid tumors-named for tissue type or organs from which they developSarcoma-connective tissueLipo-fat/adipose tissueHematologic CA-blood cell forming tissuesLeukemialymphomaGrade of Classification- 0-5

  • Staging (TNM classification)TumorTO=no evidenceTis=tumor insituT 1-2-3-4=degree of size & involvementNodeN1a=1 node, no metsN2a=2 node, no metsMetastasesMo= no metsM1-2-3= degree of mets including distant nodes

  • PreventionPrimaryAvoidance of known or potential carcinogensAvoidance or modification of factors associated with development of Cancer cellsSecondaryEarly detectionBreast, Colon, Prostate, Uterus, skinChemopreventionGene Alteration

  • Diagnostic StudiesBloodCytology- PAP, All body secretionsRadiology-US, RadioisotopeBiopsy- definitive means of diagnosing CA incisional, excisional, aspiration

  • Treatment & Nurses RoleTreatmentCurativeControlPalliativeRehabilitative/ReconstructiveNurses RoleAssessment-health status, cognitive level, pattern of ADLs,Data collection-level of knowledge, support systemEthical issues

  • MethodsSurgeryRadiotherapyChemotherapyImmunotherapy( Biological Therapy

  • SurgeryDescriptionDiagnostic, staging, and treatment TypesProphylacticCurativeControl-cytoreductivePalliativeReconstructive/rehabilitative

  • Nursing ManagementPre-operativePost operativeRehabilitative Care

  • Radiation TherapyDestroy cancer cells with minimal exposure to damaging effects of radiationDose calculated to destroy cancer cells and spare healthy cellsSplit courseTotal dose divided with 1-2 weeks intervals to allow changes in cell cycle & good tissue repair targets (ports) are markedDifferent ports on different days directed at different anglesSide- effects=skin changes & irritation, alopecia, fatigue, altered taste sensation

  • TeletherapryBeam radiationWash area with water and mild soap using hand rather than washcloth, rinse soap thoroughly & pat dry using soft towel or clothDont remove markings on skinUse no powders, ointments, lotions, or creams on areas unless prescribedWear soft clothing over area avoiding belts, buckles, strapsAvoid sun exposureMonitor for moist desquamationSmall frequent high protein meals

  • BrachytherapyUnsealed radiation sourcesOral/ IV routes or instillation to body cavitiesEnters body fluids eventually eliminated via excretaMost of the source is eliminated from the body within 48 hours; then the client nor excreta are radioactive or harmful

  • BrachytherapySealed-Delivers concentrated dose directly to tumor (cavity/tissues).Client emits radiation while implant is in place but excreta is not radioactivePlace client in private room with private bathPlace radiation CAUTION sign on doorOrganize nursing tasks to minimize exposure to radiation sourceVisitors limited to hour/day & at least 6 feet from source. No pregnant woman and children below 16 yrs. oldSave bed linens & dressings till source is removed

  • Exposure to RadioactivityIncrease distance =decrease exposureWear dosimeter film badge to measure radiation exposureWear lead shield to reduce transmission of radiation

  • Radio Wave Ablation/RadiowaveAblationTreatment with a heat generating probeRadiofrequency ablation RadiowaveMinimally invasive, involves no incisionUsed as alternative to lumpectomy

  • ChemotherapyIndicationsCurative-Acute Lymphocytic LeukemiaControl-disease widespreadPalliative-relief of painAdjuvant- post-op/Radiation therapyNeoadjuvant-pre-operative

  • Principles of ChemotherapyCell cycleCreates change in cell cycleInterrupts cell growth & replicationPhase specificUsed with rapidly growing large number of cellsPhase non specificActs without regard to cell cycle

  • ConsiderationsResponseChoiceCombinationsCell-kill hypothesis

  • Categories of AgentsPhase SpecificAntimetabolites-S phaseMiotic inhibitor- in phasePhase non-specificAlkylating agentsAnti-tumor antibioticsNitrisoureasHormonal agentsSteroids

  • Methods of AdministrationOralTopicalIMIVIntra-arterial-Intra-thecalPerfusionInstillation

  • Access deviceSilastic arterial catheters-single-triple lumenVADPorta cath, HickmanPICC lines

  • Cell SensitivityAll rapidly dividing cellsBone marrowAnemia, neutropenia, thrombocytopeniaGI epitheliummucositosisHair FolliclesAlopecia

  • Hematological EffectsNADIRPoint of greatest impactAnemiaExpect fatigue, plan rest, notify MDNeutropenia- teach potential for infectionThrombocytopeniaTeach potential for bleeding/ hemmorhage

  • Complications/ InterventionsPAINTeam approachAssess, askBelieveChoose from appropriate optionsDeliverEmpower, enableBarriers to pain managementLack of knowledgeFear of addictionFinancescultural

  • GI ComplicationsNausea/ vomitingAnticipate, give antiemeticsAnorexiaSmall frequent feedings, Hi protein, Hi calorieStomatitisOral hygiene, avoid hot spicy foodsDiarrheaLo-residue diet, anti-diarrhealConstipationIncrease fibers, fluidsStool softenersAlopecia

  • Biological Response ModifiersTypesAgents that modify immune systemInterferon, interluken 2Agents that have anti-tumor activityMonoclonal antibodiesTumor necroing factorOthers that suppress metastatic ability

  • InterferonAction:Produce changes in cellular enzyme needed for growth & replicationActivates natural killer cellsStimulates tumor antigenSide effects:Chills & fever- 3-6 hoursMyalgia lasting 5-10 daysNausea, anorexia, altered tasteHypotension, increased respiration & pulseRenal toxicityDepression, paranoia, cognitive impairment

  • InterlukenAction:enhances production of T cellsEnhances function of killer cellsSide effects:Increased capillary permeabilityHypotension, ascites, weight gain, pulmonary edemaSkin rash, pruritus, desquamation

  • Monoclonal AntibodiesProduced by immunizing animals with antigen, testing b cells from spleen with tumor cells, creates hybrid antibodyDelivers immunotoxin to tumorSide-effect: allergic reaction

  • Hematopoetic Growth factorsColony stimulating factors (CSFs)Stimulates production, maturation, regulation and activation of cellsG-CSF (granulocyte-Neupogen,Neulasta

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