Altered Cell Growth & Cancer Development
NRS 108
Spring, 2008
Lola Oyedele MSN, RN CTN
Majuvy L. Sulse RN, MSN, CCRN
Description
Uncontrolled growth of abnormal cells Neoplastic disorder that can involve all body
organs Cancer produces serious health problems as
impaired immune and hematopoetic function, altered GI tract structure and function, motor and sensory deficits and decreased respiratory functions
Epidemiology
Increased incidence & mortality in males Prostate Lung colorectal
Increased incidence & death in African Americans
Females Breast, lungs, colorectal
Biology of normal cells Limited 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, shape
Small nuclear-cytoplasmic ratio Perform specific differentiated functions-
pluripotency, multipotency, totipotency Adhere tightly together–secrete proteins (fibronectin)
that protrude from the cell surface allowing cells to bind closely and tightly together
Non migratory- exception leukocytes & erythrocytes Grow in an orderly & well regulated manner-cell cycle Are contact inhibited –density-dependent inhibition of
cell growth
Cell Cycle
Benign Cells Malignant CellsDemonstrate continuous or inappropriate cell growth-growing too much in the wrong place
Rapid or continuous growth- short generation time
Show specific morphology-strongly resembles parent tissue
Anaplastic morphology- loose the specific appearance of parent cell
Small nuclear-cytoplasmic ratio Larger nuclear-cytoplasmic ratio
Perform differentiated functions-perform same parent tissue function
Loss some or all differentiated functions- no useful function
Adhere tightly together-encapsulated
Adhere l o o s e l y together
Non migratory Able to migrate-metastasize
Grow in an orderly manner-hyperplastic expansion
Grow by invasion and not contact inhibited
Common Alterations
Hyperplasia- increase in number of cells Hypertrophy- increase in size Metaplasia-transformation of one type of differentiated
cell into another Dysplasia-abnormal development of an organ, tissues or
cells Neoplasia-new or continued cell growth not needed for
normal development
Carcinogenesis Process of transformation of normal cells to malignant
cells Initiation Promotion Malignant conversion Progression Metastasis
Extension to surrounding tissue Penetration into blood vessels Release of tumor cells Invasion at arrest site
Malignant Conversion
Chromosomes deranged Translocation & deletion Alter regulatory function of DNA Distort biological info of RNA Results in altered growth & function messages
Factors Affecting Growth Rate
Cell cycle time Growth factor Rate cell loss Vascularization Hormonal factors
Factors influencing Cancer development
Environmental factors Chemical Physical-chronic irritation & radiation viral carcinogens
Dietary factors Genetic predisposition Age Immune function
WARNING SIGNS
C hange in bowel/ bladder patternsA sore throat that does not healU nusual bleeding or discharge T hickening or Lump I ndigestion or difficulty swallowingO bvious change in mole or wartN agging cough or hoarseness
Grading & Staging
Method used to describe tumor Extent of tumor Extent to which malignancy has increased in
size Involvement of regional nodes Metastatic development
Grading-classifies the cellular aspect of cancer Staging-classifies the clinical aspects of the cancer
(0-lV)
Classification
Solid tumors-named for tissue type or organs from which they develop
Sarcoma-connective tissue Lipo-fat/adipose tissue
Hematologic CA-blood cell forming tissues Leukemia lymphoma
Grade of Classification- 0-5
Staging (TNM classification) Tumor
TO=no evidence Tis=tumor insitu T 1-2-3-4=degree of size & involvement
Node N1a=1 node, no mets N2a=2 node, no mets
Metastases Mo= no mets M1-2-3= degree of mets including distant nodes
Prevention
Primary Avoidance of known or potential carcinogens Avoidance or modification of factors associated with
development of Cancer cells Secondary
Early detection Breast, Colon, Prostate, Uterus, skin
Chemoprevention Gene Alteration
Diagnostic Studies
Blood Cytology- PAP, All body secretions Radiology-US, Radioisotope Biopsy- definitive means of diagnosing CA
incisional, excisional, aspiration
Treatment & Nurses’ Role
Treatment Curative Control Palliative Rehabilitative/Reconstructive
Nurses’ Role Assessment-health status, cognitive level, pattern of ADL’s, Data collection-level of knowledge, support system Ethical issues
Methods
Surgery Radiotherapy Chemotherapy Immunotherapy( Biological Therapy
Surgery
Description Diagnostic, staging, and treatment
Types Prophylactic Curative Control-cytoreductive Palliative Reconstructive/rehabilitative
Nursing Management
Pre-operative Post operative Rehabilitative Care
Radiation Therapy Destroy cancer cells with minimal exposure to damaging
effects of radiation Dose calculated to destroy cancer cells and spare
healthy cells Split course
Total dose divided with 1-2 weeks intervals to allow changes in cell cycle & good tissue repair
targets (ports) are marked Different ports on different days directed at different
angles Side- effects=skin changes & irritation, alopecia, fatigue,
altered taste sensation
Teletherapry
Beam radiation Wash area with water and mild soap using hand rather than
washcloth, rinse soap thoroughly & pat dry using soft towel or cloth
Don’t remove markings on skin Use no powders, ointments, lotions, or creams on areas
unless prescribed Wear soft clothing over area avoiding belts, buckles, straps Avoid sun exposure Monitor for moist desquamation Small frequent high protein meals
Brachytherapy
Unsealed radiation sources Oral/ IV routes or instillation to body cavities Enters body fluids eventually eliminated via
excreta Most of the source is eliminated from the body
within 48 hours; then the client nor excreta are radioactive or harmful
Brachytherapy Sealed-Delivers concentrated dose directly to tumor
(cavity/tissues).Client emits radiation while implant is in place but excreta is not radioactive
Place client in private room with private bath Place radiation CAUTION sign on door Organize nursing tasks to minimize exposure to
radiation source Visitors limited to ½ hour/day & at least 6 feet from
source. No pregnant woman and children below 16 yrs. old
Save bed linens & dressings till source is removed
Exposure to Radioactivity
Increase distance =decrease exposure Wear dosimeter film badge to measure
radiation exposure Wear lead shield to reduce transmission of
radiation
Radio Wave Ablation/Radiowave Ablation
Treatment with a heat generating probe Radiofrequency ablation
Radiowave Minimally invasive, involves no incision Used as alternative to lumpectomy
Chemotherapy
Indications Curative-Acute Lymphocytic Leukemia Control-disease widespread Palliative-relief of pain Adjuvant- post-op/Radiation therapy Neoadjuvant-pre-operative
Principles of Chemotherapy
Cell cycle Creates change in cell cycle Interrupts cell growth & replication
Phase specific Used with rapidly growing large number of cells
Phase non specific Acts without regard to cell cycle
Considerations
Response Choice Combinations Cell-kill hypothesis
Categories of Agents
Phase Specific Antimetabolites-S phase Miotic inhibitor- in phase
Phase non-specific Alkylating agents Anti-tumor antibiotics Nitrisoureas Hormonal agents Steroids
Methods of Administration
Oral Topical IM IV Intra-arterial- Intra-thecal Perfusion Instillation
Access device
Silastic arterial catheters-single-triple lumen VAD
Porta cath, Hickman
PICC lines
Cell Sensitivity
All rapidly dividing cells Bone marrow
Anemia, neutropenia, thrombocytopenia GI epithelium
mucositosis Hair Follicles
Alopecia
Hematological Effects
NADIR Point of greatest impact
Anemia Expect fatigue, plan rest, notify MD
Neutropenia- teach potential for infection
Thrombocytopenia Teach potential for bleeding/ hemmorhage
Complications/ Interventions
PAIN Team approach
Assess, ask Believe Choose from
appropriate options
Deliver Empower, enable
Barriers to pain management Lack of knowledge Fear of addiction Finances cultural
GI Complications Nausea/ vomiting
Anticipate, give antiemetics Anorexia
Small frequent feedings, Hi protein, Hi calorie Stomatitis
Oral hygiene, avoid hot spicy foods Diarrhea
Lo-residue diet, anti-diarrheal Constipation
Increase fibers, fluids Stool softeners
Alopecia
Biological Response Modifiers
Types Agents that modify immune system
Interferon, interluken 2 Agents that have anti-tumor activity
Monoclonal antibodies Tumor necroing factor
Others that suppress metastatic ability
Interferon Action:
Produce changes in cellular enzyme needed for growth & replication
Activates natural killer cells Stimulates tumor antigen
Side effects: Chills & fever- 3-6 hours Myalgia lasting 5-10 days Nausea, anorexia, altered taste Hypotension, increased respiration & pulse Renal toxicity Depression, paranoia, cognitive impairment
Interluken
Action: enhances production of T cells Enhances function of killer cells
Side effects: Increased capillary permeability
Hypotension, ascites, weight gain, pulmonary edema
Skin rash, pruritus, desquamation
Monoclonal Antibodies
Produced by immunizing animals with antigen, testing b cells from spleen with tumor cells, creates hybrid antibody
Delivers immunotoxin to tumor Side-effect: allergic reaction
Hematopoetic Growth factors Colony stimulating factors (CSFs)
Stimulates production, maturation, regulation and activation of cells G-CSF (granulocyte-Neupogen,Neulasta) GM-CSF (granulocyte macrophage-Leukine,
Prokine) M-CSF (macrophage CSF) IL-3-multicolony stimulating factor
Hasten recovery from bone marrow depression Decrease bone marrow suppression
Erythropoetin (EPO)-Procrit, Aranesp Oprelvekin (Neumaga)
Bone Marrow Transplants
Allogeneic-donor is human leukocyte antigen matched to the recipient
Autologous-own bone marrow removed treated, stored and reinfused
Syngeneic-stem cells from an identical twin
Gene Therapy
Removal of damaged, mutated or activated oncogenes
Insertion of multiple genes to increase susceptibility to other treatment modalities
Experimental research