Cell Cycle G0 Phase: resting phase

Cancer - uncontrolled cellular division

• Normal Cells 1. Interphase

- grow only when they receive such - longest
signals - G1 Phase: cell growth
- would grow and mature into - s Phase: DNA synthesis
distinct cell types - G2 Phase: prep for mitosis *one-
- blast: immature (non-fx) way, irreversible
- cytes: mature (fx)
2. Mitosis
• Cancer Cells - cell division
- would grow even in the absence - Karyokinesis: nuclear division
of signals - Cytokinesis: cytoplasmic division
- would grow too rapidly to even (cytoplasm -- fluid-filled portion of
mature the cells)
- would influence normal cells
- would trick the immune system Carcinogenesis: formation/production
- may metastasize of cancer

1. Benign: do not metastasize, do not 1. Initiation: initial cell mutation

recur occurs, exposure to carcinogens
2. Malignant: metastasize, recur
 Promotion
Hypertrophy: cells increased in size
Initiation Progression Hyperplasia: cells increased in amount;
pre-malignant

2. Promotion: cancer cells Neoplasia: aka Anaplasia; automatic

stimulated divide even further; malignant
reversible
Metaplasia: one cell type is converted
3. Progression: cancer cells with one into another cells
another to survive; aggressive:
malignant; poor prognosis - Ciliated Columnar Epithelium:
located in the Respi tract to
Atrophy: cells shrink in size expectorate secretions
usually cells atrophy d/t:
- decreased o2, blood, nerve, - Simple Squamous Epithelium
nutrient supply
- aging Dysplasia: bizarre cell growth;
- prolonged immobilization - complete alteration of cells in
- decreased in use terms of size, shape, amount, color,
organization, etc;
 - has a basement membrane; pre- A: A sore does not heal
malignant
• Oral CA caused by trauma
Warning Signs of Cancer (CAUTION
US) • Melanoma: most severe form of skin
ca
C: Change in bowel or bladder habits - ABCDE (Assymetry, Border, Color,
Diameter: N is less than 5mm, Evolving)
• Colorectal CA
- RF: 60 and above U: unusual bleeding or discharge
- alteration of diarrhea/
constipation - Post-menopausal bleed
- blood in the stool - Post-coital bleed
(hematochezia, melena) - Bleeding in between periods
- change in the shape of stool - Abnormal nipple discharge
(pencil-shaped) (prolactinoma: benign pituitary gland
tumor; breast ca)
• Bladder CA - Abnormal vaginal discharge
- RF: smoking - Abnormal penile discharge
- Urinary frequency, urgency,
hesitancy, dysuria, hematuria,
obstruction
T: Thickening or lump in the breast U: unexplained anemia
or elsewhere
• colon ca
• Breast, testicular, lymph nodes ca •
S: sudden weight loss
I: Indigestion or difficulty in
swallowing • cachexia: wasting syndrome,
unintentional weight loss or
• Gastric ca muscle loss d/t underlying
• Dyphagia (head and neck ca) condition

O: obvious change in a wart or mole Tumor Staging

- identify the extent of
• In elderly: scalp, face, behind the involvement of cancer
ear, nape
• In adults: upper back TNM Staging: Tumor Node and
Metastasis
N: nagging cough or hoarseness
Number Staging
• dry, persistent cough (Lung ca) - Stage 0: carcinoma in situ;
• hoarseness (Laryngeal ca) incidental findings
- stage 1: small, hasn't spread
anywhere else - Grade 2: moderately differentiated
- Stage 2: larger, hasn't spread - Grade 3: poorly differentiated
anywhere else (local spread) - Grade 4: undifferentiated; look
- Stage 3: already spread nothing like normal cells ; malignant
regionally, extensive spread, into
surrounding tissues Management of Cancer
- Stage 4: spread into at least 1
organ (metastasize) Surgery (most common)

Most Common Metastasis Sites 1. Diagnostic: Biopsy

- Lung
- Liver • Fine Needle Aspiration
- lymph - for solid organs (breast, brain,
- Brain thyroid, liver)
- Bones
• Punch Biopsy
Tumor Grading - for deeper tissue (skin, vulva)

Levels of Differentation • Shave Biopsy

- Grade 1: well-differentiated; still - for superficial tissue sample
Closely resemble the cells of the
tissue to wc it came from
• Incisional Biopsy 5. Palliative: relieving symptoms,
- applicable for large tumor, improving quality of life
portion Radiation Therapy

• Excisional Biopsy • Radiosensitive Cancer Cells:

- for small tumor, entire sensitive to radiation

• Bone Marrow Aspiration • Radioresistant Cancer Cells:

- for liquid ca difficult to kill, malignant
- preferred site: posterior iliac
crest Radiosensitive Normal Cells: highly,
- sternum: avoid for pedia less than actively dividing cells
12 y/o
- tibia: for pedia 1. hair cells: alopecia (priority: self-
- anterior iliac crest: for obese esteem, offer wigs, scarves, hats)
- self-care: brush hair, shampoo,
2. As primary treatment conditioner

3. Prophylactic: risk reduction 2. GI tract cells: stomatitis (use

warm non-alcoholic mouthwash, avoid
4. Reconstructive : cosmetic effects, rough, hot, spicy, acidic food, bland
to improve fx diet.
- Radiation Induced Enteritis sessions
(diarrhea: low fiber diet)
1. The total radiation dose is too
3. Blood Cells large to be given all at once
- Anemia
- Leukopenia (immunosupression) 2. For the normal cells to recover
- Thrombocytopenia
- Nadir: lowest point of immunity 3. For the tumor to be more
radiosensitive
4. Skin Cells: radiation-induced
dermatitis (avoid powders, perfumes, Internal: AKA Brachytherapy
chemical irritants), (avoid extreme
of temperature) - sealed: implant
- when dropped: pickup the implant
5. Reproductive Tract Cells: sterility, using long-handed forceps and place it
decreased libido in a lead lined container
- when loss: report to radiation
Radioresistant Normal Cells: soft safety team
tissues, cartilage (brain cells)
- unsealed: IV, Oral; patient is
External: AKA Teletherapy, patient is radioactive himself (even bodily fluids
not radioactive, more common, in are radioactive as well)
- private CR, flush toilet twice • Anorexia
• Cachexia
DTS Principles • Fatigue (most common)
• N/V
Distance: 6ft away; private room, • Cachexia
away from the nurse's station
Chemotherapy
Time: 30 mins per shift; cluster - administration of anti-neoplastic
activities drugs to manage cancer

Shield: lead shield, dosimeter badge Side Effects

(indicator of radiation exposure:
black) • Alopecia
• Stomatitis
Side Effects Radiation Therapy • Enteritis
• Immunosuppression
• Alopecia • Dermatitis
• Stomatitis • Decreased libido/ sterility
• Enteritis • Cachexia
• Immunosuppression • Anorexia
• Dermatitis • Cachexia
• Decreased libido/ sterility • Fatigue
• N/V (most common, give anti- Extravasation
emetics ondansetron or - infiltration of chemo agents
metoclopramide IV) - stop the infusion
• Pulmo toxicity
• Cardiac toxicity Irritants
• Nephro toxicity - localized tissue damage
• Neuro toxicity (chemo-fog)
Vesicants
- permanent tissue damage, tissue
necrosis

Breast Cancer
- most common type worldwide
- terminal lobular ducts

Risk Factors
Management
NOn-Modifiable
• Cyclophosphamide: mesna, - Gender: 99% females (BRCA 2 Gene,
encourage increased OFI Klinefelter Syndrome XXY)
- Age: 55 to 65 y/o
- Family hx - HER Gene - HER 2 Proteins
- Genetics (BRCA1, BRCA2 Gene)
2. Genetic Testing:
Modifiable: - BRCA1, BRCA2 Gene
- Smoking, Alcohol drinking
- Obesity: increased subq tissue - 3. Imaging Test:
increased hormone conversion - CT Scan: fastest, most affordable,
(estrogen) lesser s/e, radiowaves
- MRI: magnetic waves
Estrogen: - PET Scan: not only structural-fx
- nulliparity abnormality, but metabolic
- early menarche (less than 12 y/o) abnormalities as well, most expensive
- late menopause (more than 55 y/o) - UTZ: sound waves; 6-8 glasses of H2o
- oral contraceptives if pelvic UTZ

Diagnostic Tests 4. Mammography:

- xray of the breast
1. Tumor Marker Test: - avoid perfumes, deo, chemical
- CA 125 (screening test only) irritants
- Estrogen Receptor Positive (ERP) - 40 to 44 y/o is optional
- Progesterone Receptor Positive - 45 to 54 y/o is required annually
(PRP) - 55 y/o above is every other year,
biennially (every 2 years) - irregular: same day each month'
- implant, trans, male, x for
mastectomy Most common method of palpation:
circular motion (outer to inner)
Signs and Symptoms: - can be up down motion, spiral
motion
- upper outer quadrant
- Non-tender, firm, fixed, irregular Gently place a folded towel
borders underneath the shoulders for even
- Peau D' Orange: orange-peel distribution of tissues across the
- Skin: large pores near the areola chest wall
- abnormal nipple discharge
- inversion, retraction, ulceration Management:
- skin dimpling
1. Mastectomy
Breast Self Exam
• Modified Radical Mastectomy:
- pre-menopausal: 5 to 7 days after removal of breast tissues + nipple
menstrual period areola complex, axillary lymph
nodes; pectoralis major + minor
- post-menopausal: same day each muscles intact
month
• Radical Mastectomy: remove asbestos, radon)
everything
Diagnostic Tests
• Total Mastectomy: prophylactic
purpose; non-invasive, removal of 1. Imaging Test (CT, MRI, PET Scan)
breast tissues + nipple areola
complex 2. Bronchoscopic Biopsy

• Lumpectomy: benign, everything Nursing Management

intact; tumor only removed;
cosmetic effects Pre-procedure: administer lidocaine
spray to suppress gag reflex
Lung Cancer (Bronchogenic
Carcinoma) Post-procedure: assess for return
of gag reflex
Risk Factors
Signs and Symptoms
- Age: 60 y/o and above
- Family hx - nagging cough
- smoking (highest rf) - dyspnea --) fatigue
- secondhand smoking - anorexia --) cachexia
- occupational pollutants (silica dust, - n/v, dysphagia, hoarseness
- recurrent lung infections 2. Incentive Spirometry
*bronchitis* --) chronic inflammation - to prevent atelectasis to
--) mutation strengthen intercostal muscles
- 10 to 15 times per hr during waking
Management hours suck through the mouthpiece

1. Thoracotomy Cervical Cancer

- surgical incision into thoracic
cavity Risk Factors

• Lobectomy: remaining lobes will - Age: 52 y/o

just re-expand; unaffected - Family hx (genetics)
- smoking
• Wedge Resection: biopsy - recurent HPV infection (highest RF)
- HPV types: 6, 11: STI
• Pneumonectomy: removal of lungs; - HPV types 16, 18: Cervical ca
affected - risky sexual behavior
- early coitus (less than 17 y/o)
LUPA- Lobectomy Unaffected, - unprotected sex, multiple sexual
Pneumonectomy Affected partners
- multiparity
- contraceptive pills
- poor utilization pap smear, HPV Signs and Symptoms
vaccine
- asymptomatic in early stages
Diagnostic Tests - abnormal vaginal bleeding, discharge,
abdominal pain
1. Pap Smear - changes in bowel habits
- not biopsy - leg edema
- abnormal cervical lesions,
inflammation Management
- 25 years to 65 y/o
- Pap smear with HPV test q5 years 1. Hysterectomy
- HPV test only q5 years - priority: psychosocial
- Pap smear only q3 years
- avoid sexual intercourse for 24hrs 2. Conization
before pap smear - child-bearing child
- avoid douching for 2-3 days before
pap smear

2. Colposcopy
- acetic acid --) acetowhite lesions

3. Biopsy
3. Cryosurgery Risk Factors
- freezing of abnormal cells
- Age: young adult males (15 to 40 y/o,
4. Chemotherapy 17 to 45 y/o)
- family hx, personal hx
Prevention - hx of cryptorchidism (undescended
testicles) --) orchiopexy
1. Pap smear - 3 degrees less than the body
2. HPV Vaccine temperature
- Gardasil: HPV 6, 11, 16, 18 - Race: Caucasian
- Cervarix: HPV 16, 18
Diagnostic Tests
Ovarian Cancer
- most lethal 1. Tumor Marker Test:
- HCG, LDH, AFP
Endometrial Cancer
- most common gynecological cancer 2. Testicular Self Examination:
- after warm shower, same day each
Testicular Cancer month
- sperm production - gently roll and palpate using thumb
- best prognosis 95% and fingers
Signs and Symptoms Prostate Cancer
- most common in older men
- painless testicular swelling
- feelings of heaviness in scrotum
- sudden fluid collection in scrotum
- pelvic pain, abdominal pain, scrotal
pain
- low back pain (bone metastasis)
- gynecomastia

Management

1. Orchiectomy
- priority: psychosocial
- removal of testicles

2. Radiation Therapy

3. Chemotherapy

4. Hormone Replacement Therapy