Transcript Oncology Nursing

Neoplasia
Oncology defined
• Branch of medicine that deals
with the study, detection,
treatment and management of
cancer and neoplasia
“Root words”
• Neo- new
• Plasia- growth
Neoplasia
Uncontrolled growth of Abnormal cells
• 1. Benign
• 2. Malignant
• 3. Borderline
Characteristics of Neoplasia
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BENIGN
Well-differentiated
Slow growth
Encapsulated
Non-invasive
Does NOT metastasize
Characteristics of Neoplasia
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MALIGNANT
Undifferentiated
Erratic and Uncontrolled Growth
Expansive and Invasive
Secretes abnormal proteins
METASTASIZES
leiomyomas
adenoma
adenocarcinoma
carcinoma
Nomenclature of Neoplasia
Tumor is named according to:
1. Parenchyma, Organ or Cell
• Hepatoma- liver
• Osteoma- bone
• Myoma- muscle
Nomenclature of Neoplasia
Tumor is named according to:
2. Pattern and Structure, either GROSS or
MICROSCOPIC
• Fluid-filled CYST
• Glandular ADENO
• Finger-like PAPILLO
• Stalk POLYP
BENIGN TUMORS
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Suffix- “OMA” is used
Adipose tissue- LipOMA
Bone- osteOMA
Muscle- myOMA
Blood vessels- angiOMA
Fibrous tissue- fibrOMA
MALIGNANT TUMORnomenclature
Glandular, Epithelial
• Use the suffix- “CARCINOMA”
• Pancreatic AdenoCarcinoma
• Squamos cell Carcinoma
MALIGNANT TUMOR
2. connective tissue origin
• Use the suffix “SARCOMA
• FibroSarcoma
• Myosarcoma
• AngioSarcoma
“OMA” but Malignant
– HepatOMA, lymphOMA, gliOMA, melanOMA
dysplasia
• denotes a loss of architectural organization
and a loss of cell uniformity in epithelium
• mild to moderate dysplasia is potentially
reversible
dysplasia
normal epithelium
dysplasia
• Dysplasia is a non-neoplastic proliferation.
• Dysplasia may or may not progress to cancer.
differentiation
• Well-differentiated tumors contain cells that
resemble the normal cells of origin
• poorly-differentiated or undifferentiated
tumors contain cells that do not resemble
their normal counterparts (ancillary studies
may be needed to determine the cell of origin)
well-differentiated
poorly-differentiated
• Benign tumors are composed of welldifferentiated cells.
• Malignant tumors are characterized by a
wide range of cellular differentiation.
rate of growth
• In general, well-differentiated malignant
tumors have a slower rate of growth than
poorly-differentiated malignant tumors.
• There are exceptions. Blood supply, site, and
hormonal stimulation are factors that can
affect the growth rate of tumors.
meningioma
basal cell carcinoma
melanoma
metastasis
• Distant spread of the tumor
• Methods of metastasis include: lymphatic
spread, and hematogenous spread.
metastatic ovarian carcinoma
MRI: metastatic adenocarcinoma
metastatic adenocarcinoma
Spread of Cancer
• 1. LYMPHATIC
• Most common
• 2. HEMATOGENOUS
– Blood-borne, commonly to Liver and Lungs
• 3. DIRECT SPREAD
– Surrounding organs
Spread of cancer
• Cancers commonly spread t bone,lungs liver
and brain(secondary deposits)
Cancer Diagnosis
• 1. BIOPSY
– The most definitive
• 2. CT, MRI
• 3. Tumor Markers
grading and staging
• Grading is based on the microscopic features
of the cells which compose a tumor and is
specific for the tumor type.
• Staging is based on clinical, radiological, and
surgical criteria, such as, tumor size,
involvement of regional lymph nodes, and
presence of metastases. Staging usually has
prognostic value.
Cancer Grading
The degree of DIFFERENTIATION
• Grade 1- Low grade
• Grade 4- high grade
Cancer Staging
1. Uses the T-N-M staging system
• T- tumor
• N- Node
• M- Metastasis
GENERAL MEDICAL
MANAGEMENT
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1. Surgery- cure, control, palliate
2. Chemotherapy
3. Radiation therapy
4. Immunotherapy
5. Bone Marrow Transplant
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GENERAL Promotive and
Preventive
1. Lifestyle Modification
2. Nutritional management
3. Screening
4. Early detection
SCREENING
• 1. Male and female- Occult Blood, CXR, and
DRE
• 2. Female-, Mammography and Pap’s Smear
• 3. Male- DRE for prostate, Testicular self-exam
Cancer –causes
Etiology of cancer
1. PHYSICAL AGENTS
• Radiation
• Exposure to irritants
• Exposure to sunlight
• Altitude, humidity
Etiology of cancer
2. CHEMICAL AGENTS
• Smoking
• Dietary ingredients
• Drugs
Etiology of cancer
3. Genetics and Family History
• Colon Cancer
• Premenopausal breast cancer
Etiology of cancer
4. Dietary Habits
 Low-Fiber
 High-fat
 Processed foods
 alcohol
Etiology of cancer
5. Viruses and Bacteria
• DNA viruses- Hep, Herpes, EBV, CMV,
Papilloma Virus
• RNA Viruses- HIV,
• Bacterium- H. pylori
Etiology of cancer
• 6. Hormonal agents
OCP especially estrogen
Etiology of cancer
• 7. Immune Disease
• AIDS
Proposed Molecular cause of
CANCER:
• Change in the DNA structure altered DNA
function Cellular aberration
 neoplastic change
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CARCINOGENSIS
Malignant transformation
IPP
Initiation
Promotion
Progression
CARCINOGENSIS
• INITIATION
• Carcinogens alter the DNA of the cell
• Cell will either die or repair
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CARCINOGENSIS
PROMOTION
Repeated exposure to carcinogens
Abnormal gene will express
Latent period
CARCINOGENSIS
• PROGRESSION
• Irreversible period
• Cells undergo NEOPLASTIC transformation
then malignancy
Colon cancer
COLON CANCER
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Risk factors
1. Increasing age
2. Family history
3. Previous colon CA or polyps
4. History of IBD
5. High fat, High protein, LOW fiber
6. Breast Ca and Genital Ca
COLON CANCER
• Sigmoid colon is the most common site
• Predominantly adenocarcinoma
• If early 90% survival
COLON CANCER
• PATHOPHYSIOLOGY
• Benign neoplasm DNA alteration
malignant transformation malignant
neoplasm  cancer growth and invasion 
metastasis (liver)
COLON CANCER
ASSESSMENT FINDINGS
1. Change in bowel habits- Most common
• 2. Blood in the stool
• 3. Anemia
• 4. Anorexia and weight loss
• 5. Fatigue
• 6. Rectal lesions- tenesmus, alternating D and C
Colon cancer
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Diagnostic findings
1. Fecal occult blood
2. Sigmoidoscopy and colonoscopy
3. BIOPSY
4. CEA- carcino-embryonic antigen
Colon cancer
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Complications of colorectal CA
1. Obstruction
2. Hemorrhage
3. Peritonitis
4. Sepsis
Colon cancer
• MEDICAL MANAGEMENT
• 1. Chemotherapy- 5-FU
• 2. Radiation therapy
Colon cancer
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SURGICAL MANAGEMENT
Surgery is the primary treatment
Based on location and tumor size
Resection, anastomosis, and colostomy
(temporary or permanent)
Colon cancer
NURSING INTERVENTION
Pre-Operative care
• 1. Provide HIGH protein, HIGH calorie and
LOW residue diet
• 2.Provide information about post-op care and
stoma care
• 3. Administer antibiotics 1 day prior
Breast Cancer
• The most common cancer in FEMALES
• Numerous etiologies implicated
Breast Cancer
RISK FACTORS
• 1. Genetics- BRCA1 And BRCA 2
• 2. Increasing age ( > 50yo)
• 3. Family History of breast cancer
• 4. Early menarche and late menopause
• 5. Nulliparity
• 6. Late age at pregnancy
Breast Cancer
RISK FACTORS
• 7. Obesity
• 8. Hormonal replacement
• 9. Alcohol
• 10. Exposure to radiation
Breast Cancer
PROTECTIVE FACTORS
• 1. Exercise
• 2. Breast feeding
• 3. Pregnancy before 30 yo
Breast Cancer
ASSESSMENT FINDINGS
• 1. MASS- the most common location is the
upper outer quadrant
• 2. Mass is NON-tender. Fixed, hard with
irregular borders
• 3. Skin dimpling
• 4. Nipple retraction
• 5. Peau d’ orange
Breast Cancer
• LABORATORY FINDINGS
• 1. Biopsy procedures
• 2. Mammography
Breast Cancer
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Breast cancer Staging
TNM staging
I - < 2cm
II - 2 to 5 cm, (+) LN
III - > 5 cm, (+) LN
IV- metastasis
Breast Cancer
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MEDICAL MANAGEMENT
1. Chemotherapy
2. Tamoxifen therapy
3. Radiation therapy
Breast Cancer
• SURGICAL MANAGEMENT
1. Radical mastectomy
2. Modified radical mastectomy
3. Lumpectomy
4. Quadrantectomy
Thank you…