Altered Cell Growth and Cancer Development

1. Altered Cell Growth and Cancer Development Iggy—Chapter 27

2. Characteristics of Normal Cells • Have limited cell division • Specific morphology • Small nuclear cytoplasmic ratio • Perform specific differentiated functions • Adhere tightly together • Are non-migratory • Grow in an orderly and well-regulated manner • Are contact inhibited

3. Mitosis of Normal Cells Cell Cycle • G1 • S • G2 • M • G0 http://www.cellsalive.com/cell_cycle.htm

4. Abnormal Cells • Hypertrophy—increase in tissue size by enlarging each cell. • Hyperplasia—increase in tissue size by increasing the number of cells • Neoplasia—new cell growth not needed for normal body growth or replacement of dead or missing tissue.

5. Characteristics of Benign Cells • Continuous or inappropriate cell growth • Specific morphology • Small nuclear cytoplasmic ratio • Perform differentiated functions • Adhere tightly together • Are non-migratory • Grow in an orderly manner

6. Characteristics of Malignant Cells • Rapid or continuous cell division • Anaplastic morphology • Large nuclear cytoplasmic ratio • Lose some or all differentiated functions • Adhere loosely together • Are able to migrate • Grow by invasion • Are not contact inhibited

7. Cancer Development • Carcinogenesis/oncogenesis • Malignant transformation-changes a normal cell to a cancer cell • 4 stages • Initiation • Promotion • Progression • Metastasis

8. Metastasis • The breaking off and establishing remote tumors • Metastatic • Secondary

9. Metastasis • Extension into surrounding tissues • Penetration in blood vessels • Release of tumor cells • Invasion of tissue at site of arrest • Local seeding • Blood-borne metastasis • Lymphatic spread

10. Steps of metastasis

11. Cancer Classification • From type of cell they arise from • Biologic behaviors • Anatomical sites • Degree of differentiation • 2 major types • Solid • Hematologic

12. Cancer Grade and Stage • Grading • High grade • Low grade • Staging • Clinical • Surgical • Pathologic

13. TNM • (T) Tumor • Tx – unable to assess • T4 – larger number signifies increasing size • (N) Node • Nx – unable to assess • N3 – increased node involvement • (M) Distant Metastasis • Mx – unable to assess • M1 – no distant mets • M2 – distant mets

14. Cancer Etiology and Genetic Risk • Oncogene activation • External factors • Chemical • Physical • Radiation • Chronic irritation • Viral

15. Advancing age is the single most important risk factor for cancer • 77% of cancer is in people age 55 or older • The older a person is, the less ability their immune system retains to repair mutations that occur

16. Genetic testing for cancer • Requires a blood sample • Very expensive • Frequently not covered by insurance • Does not diagnose the presence of cancer

17. Prevention • Primary • Secondary • Chemoprevention • Gene therapy

18. Seven Warning Signs of Cancer • C – Changes in bowel or bladder • A – A sore that does not heal • U – Unusual bleeding or discharge • T – Thickening or lump in breast or elsewhere • I – Indigestion or dysphagia • O – Obvious change in wart or mole • N – Nagging cough or hoarseness

19. General Intervention for Clients with Cancer Iggy—Chapter 28

20. Common Problems • Impaired immune and hematopoietic function • Altered gastrointestinal tract structure and function • Motor and sensory deficits • Decreased respiratory function • Treatment-related consequences

21. Ways to Treat Cancer • Surgery • Radiation • Chemotherapy

22. Surgery • Prophylaxis • Diagnosis • Cure • Control (debulking) • Palliation • Therapy effectiveness • Reconstructive or rehabilitative

23. Radiation • Kills cancer cells with minimal exposure of normal cells to radiation • Cells damaged by radiation either die or become unable to divide • Works best in localized tumors

24. Penetrating capacity ofdifferent types of radiation

25. Radiation Administration • Amount of radiation delivered to a tissue is called “exposure” • Amount of radiation absorbed by the tissue is called the “dose” • Total dose depends on the tumor location and its sensitivity to radiation • Doses are given in fractionation divided over the treatment time span

26. Types of Radiation Therapy • Teletherapy – beam radiation • Brachytherapy – short or dose therapy • All types—radiation source is placed in the patient—making the patient emit radiation and be a hazard to others for a short time • Unsealed isotope—example is radioactive iodine concentrate (thyroid gland) • Sealed—Seeds (prostate Ca) short half life, usually left in place • Implants—constant in hospital several or intermittent in and out of clinic over a period of time

27. The Inverse Square Lawof Radiation Exposure • The intensity of radiation decreases with distance from the radiation source.

28. Side Effects of Radiation • Limited to areas of exposure • Skin changes and hair loss usually permanent • Care of patient receiving radiation includes: • Teaching • Don’t remove radiation markings • Skin care to radiated areas • No lotions or creams, use radigel provided by radiologist

29. Chemotherapy • Used for both cure and to increase survival time • Works best for systemic (mets) • May be used in combination with surgery and/or radiation (adjuvant)

30. Chemotherapy • Antimetabolites—counterfeit metabolites that fool cancer cells • Antitumor antibiotics—interrupts DNA/RNA synthesis • Alkylating agents—cross links DNA-2 strands bind together, inhibiting cell division

31. Chemotherapy, cont. • Antimitotic agents—usually made from plant sources, prevents completion of mitosis • Topoisomerase inhibitors—prevents enzyme from copying and reattaching, causing DNA breakage and cell death • Miscellaneous—doesn’t fit anywhere else • Combination

32. Total Body Surface Area • BSA, TBSA, PSA • Height and weight • Ht (cm) x wt (Kg) / 10,000 = TBSA • 5’11’’ tall and weighs 186 pounds What is his TBSA?

33. Calculating TBSA • 5’11’’ = 71 inches = 180.34 • 185# = 84.1 KG • 180.34 X 84.4 10,000 • BSA = 1.52

34. Scheduling and Administration • Schedule treatment every 3-4 weeks for the total (Course) of 6-12 months • Administration • PO or Im • Mostly given IV (CVL or pIV) • Intra-thecal • Intra-arterial • Intra-peritoneal • Intra-vesical

35. Extravasation • Irritants • Vesicants • Most important nurse action is prevention • What do you do if an extravasation happens?

36. How does chemo work? • Cancer cells divide continously • Chemo kills during cell division • Chemo kills good cells as well as bad cells • http://www.cancer.org/docroot/ETO/content/ETO_1_2X_Chemotherapy_What_It_Is_How_It_Helps.asp • http://www.cancer.org/docroot/ETO/content/ETO_1_4X_How_Does_Chemotherapy_Work.asp?sitearea=ETO

37. Side Effects of Chemotherapy • Immunosuppression • Anemia • Thrombocytopenia • Alopecia • Nausea and vomiting • Mucositis

38. Hair loss is usually temporary and does reverse Alopecia

39. Can continue for 5-7 days s/p chemotherapy Give antiemetics Avoid spicy or rich foods, strong smells, and extreme hot or cold liquids Nausea and Vomiting

40. Mucositis • Soft bristled toothbrush • Avoid toothpicks and dental floss • Avoid mouthwashes that contain alcohol • Do frequent mouth care • Give pain meds PRN

41. Immunosuppression • Nadir—lowest point in blood counts s/p chemo • Usually seen in 5-10 days • Neutropenia – WBC below 1000 • Patient is at extreme risk for infection • Major dose limiting side effect of chemotherapy

42. Anemia • Hgb below 8—transfuse • S/S fatigue and SOB

43. Thrombocytopenia • Decreased platelets • Below 50,000—bleeding precautions • Below 20,000—high risk • Transfuse with platelets • Educate and protect patient

44. Immunotherapy: Biological Response Modifiers • Stimulates the production of bone marrow • Cytokines—interferon, interleukins, epogen, G-CSF, GM-CSF

45. Hormonal Manipulation • Some hormones make homes-sensitive tumors grow more rapidly—so decreasing amount of hormone in body can cause tumor growth to slow. • Types • Agonists • Antagonists • Inhibitors

46. Gene Therapy • Experimental • Has shown limited response rates, but indicates potential for future treatment.

47. Targeted Therapy • Combination of gene therapy and biologic therapy to target specific cells • Examples: herceptin and gleevac • Most common side effect is allergic reactions

48. Oncological Emergencies • Sepsis • Disseminated intravascular coagulation • Syndrome of inappropriate antidiurectic hormone • Spinal cord compression • Hypercalcemia • Superior vena cava syndrome • Tumor lysis syndrome

49. Sepsis • Septic shock • Life threatening • 1st get blood cultures and urine culture • 2nd start antibiotics

50. DIC (70% mortality rate) • Blood clotting problem often caused by sepsis (gram negative infection) in cancer patients. • Release of clotting factors from cancer cells cause excessive abnormal clot formation in small blood vessels, which use up the clotting factors and platelets in the blood.