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Cancer

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by

Nikki Leach

on 14 January 2015

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Transcript of Cancer

Colorectal Cancer
Other Facts

Anatomy
Nearly all colon cancers begin as polyps- benign precancerous lesions of the large intestine.
Pathophysiology
Manifestations depend on location and type of tumor, size, and complications.
Manifestations
Barium enema may detect the presence and location of a tumor.
Diagnostic Tests
Treatment of choice is surgical removal of the tumor, adjacent colon, and regional lymph nodes.
Surgical Treatment
Radiation and chemotherapy often are used in conjunction with surgery to treat colorectal cancers.

Pre- or Post- operative radiation is used for the reduction of recurrence of rectal tumors in the pelvic area.
Other Treatments
Nursing care is aimed at providing emotional support, teaching, and addressing client’s surgical needs.
Nursing Care
Cancer of the Digestive System
Radiation
Chemotherapy
Other Treatments
Depends on stage of disease and treatment planned.
Nursing Care
Aside from skin, stomach cancer is the most common.
Other Facts
Top connected to esophagus
Anatomy
Usually develops in the distal portion.
Pathophysiology
Poor Appetite
Early Satiety (feeling full)
Anorexia
Indigestion
Persistent Vomiting
Manifestations
Fecal Occult Sample
Diagnostic Tests
Before metastases develops, results in partial/total gastrectomy.
Surgical Treatment
A biopsy is done on the oral lesion to determine if it is benign or malignant.
Diagnostic Tests
Loosening of teeth
Dentures that no longer fit properly
Manifestations
Oral cancer can develop anywhere in the oral mucosa including the lips, tongue, or pharynx.

Most oral cancers are squamous cell carcinomas. An estimated 35,000 new cases of oral cancer are diagnosed annually in the United States. The incidence is twice as high in men than women, particularly in men over 40.

Tobacco and alcohol damage cells lining the mouth and oropharynx. These damaged cells grow rapidly to repair the damage, increasing the risk for malignancy.
Pathophysiology
Anatomy
The greatest risk factor is tobacco use, both smoking and smokeless tobacco.
Risk Factors
Oral cancer and treatment can affect airway clearance, food intake and nutrition, communication, and body image.
Nursing Care
Treatment and prognosis vary depending on the stage of the tumor.
Other Treatments
Advanced cancers may require extensive surgery such as Radical Neck Dissection.
Surgical Treatment
Esophageal Cancer
Anatomy
It's not clear what causes esophageal cancer.
Other Facts
Teach clients the importance of limiting risk factors (i.e. smoking cessation, limiting alcohol consumption etc) and provide referrals to support groups as needed.
Nursing Care
Chemotherapy
Radiation Therapy
Other Treatments
Surgery to remove very small tumors.

Esophagectomy:
Surgery to remove a portion of the esophagus.
Surgical Treatments
Using a scope to examine your esophagus (
endoscopy
). During endoscopy, your doctor passes a hollow tube equipped with a lens (
endoscope
) down your throat and into your esophagus. Using the endoscope, your doctor examines your esophagus, looking for cancer or areas of irritation.
Diagnostic Tests
Presenting signs and symptoms of esophageal cancer include the following:
Manifestations
Esophageal cancer is cancer that occurs in the esophagus.
Pathophysiology
QUESTIONS
1. All of the following are symptoms of oral cancer EXCEPT for which one of the following?
Visible or palpable masses of the lips, cheek, or tongue
Slightly raised irregular red patches that bleed easily when scraped.
A sore or lesion in the mouth that doesn’t heal.
Irregular white patches on the lips, gums, tongue, tonsil, or oral mucosa
Swollen lymph nodes
Blood tinged sputum
A CT scan and MRI can be done to stage the cancer.
Small mirrors placed at the back of your mouth to look at the throat, base of the tongue, and part of the larynx
Indirect Pharyngoscopy & Laryngoscopy:
A flexible fiber-optic scope (endoscope) goes through the mouth or nose to look at areas that can’t easily be seen. Including the region behind the nose and the larynx.
Direct Pharyngoscopy & Laryngoscopy:
Chest X-Ray
PET Scan
Barium Swallow
Radical Neck Dissection
is a potentially disfiguring procedure.
Lymph nodes and most of the neck muscles are removed.
A tracheostomy is performed for this procedure, which can be temporary or permanent.
Eliminating risk factors is vital.
Early lesions without cancerous cells may heal when exposure to risk factors are eliminated.
Early cancers may be treated with radiation therapy, resection of tumor, or both.
Chemotherapy treatment is an adjunct treatment when the tumor has metastasized to other areas.
Assess airway patency and respiratory status.
Place in Fowler’s position and assist with turning and coughing.
Maintain adequate hydration, offer soft bland foods.
Monitor weight daily.
Provide emotional support especially if the patient has had a radical surgery of the head and neck, as this can affect the body image.
Alcohol consumption and prolonged sunlight exposure are also risk factors.
Tobacco is not the only thing that can cause oral cancer, in Southeast Asia and South Asia people who chew on betel quid and gutka also have an increased risk for oral cancer.
The American Cancer Society states that cancers of the oral cavity and oropharynx take years to develop and are not normally found in young people.
Most people are over the age of 55 when these cancers are found.
Oral Cancer
Bottom connected to small intestine
Holds up to 4L of food/fluids
Mechanical digestion occurs in stomach
There are 4 types of specialized cells:
Parietal Cells- Secrete HCL Acid/ IntrinsicFactor
Chief Cells- Produce Pepsin
Mucous Cells- Produce Alkaline Mucus
Enteroendocrine Cells- Secrete Hormones
Stomach empties completely within 4-6 hrs after meals.
1/2 occur in antrum or pyloric region.
Lesions are spread by direct extensions to tissues surrounding stomach
Due to rich blood/lymph supply, metastasis and lymph involvement occur early.
Metastatic lesions are usually found in the liver, lungs, ovaries, and peritoneum.
Ulcer Pain after Eating
Unintentional Weight Loss
Cachetic (Thin/Malnourished)
Swelling/Fluid Build-Up in Abdomen
Symptoms usually don't occur until late stages of stomach cancer.
Upper Endoscopy (EGD)
Endoscopic Ultrasound
Biopsy
CBC
Liver Function Test
X-Ray
MRI
Upper GI Series
CT Scan
PET Scan
Total gastrectomy is rare due to impact on digestion/nutrition.
However, extensive gastric cancer may require it.
Anastomosis connects esophagus to duodenum or jejenum
Partial- distal half to 2/3
Complications of Surgery
Dumping Syndrome
Occurs within 5-30 minutes after meals.
Managed by planning dietary intake.
Smaller amounts, consume food and fluids separately, increased proteins and fats, decreased carbs, and rest in recumbent/semi-recumbent position 30-60 minutes after meals.
Increased risk for nutritional deficiencies
50% experience significant weight loss
Palliative Care- advanced disease processes.
Targets specific genes, proteins, or the tissue environment.
It blocks the growth and spread of cancer cells while damage is limited to healthy cells.
Most common drugs used:
Herceptin
Gleevec
Sutent
Target Therapy
Feeding tube may be required.
Priority Nursing Diagnosis:
Imbalanced Nutrition r/t Anorexia and Difficulty Eating.
TPN may be required.
If completing home health: Dressing Changes & Tube Feedings
Offer grief counseling, support groups, and hospice services as appropriate.
Expected Outcomes:
Maintain Weight
High Calorie, High Protein Diet
Pain Management <3 on 0-10 scale
Maintain Patent Airway
Verbalize Feelings
Planning & Implementation:
Daily Weight
Maintain NG Tube Placement
Maintain IV Fluids/ TPN
Diet Teaching
Assess Respiratory Status
Assist to deep breath, cough, and inspirometry Q2 hours.
Diets rich in smoked foods, salted meat/fish, and pickled vegetables, and decreased in fresh vegetables equals increased risk for stomach cancer.
Highest among Asian Americans, followed by African American, Native Americans, and Hispanics.
1 in 5 diagnosis are made in the early stage.
Incidence higher in men than women
Chronic H. Pylori gastritis = major risk factor
5 year survival rate is 10% for gastric carcinoma
Esophageal cancer can occur anywhere along the esophagus, it occurs most often in the lower portion of the esophagus.
Dysphagia- most common symptom. Initially for solids, eventually progresses to include liquids.
Weight Loss-
Second most common.
Bleeding
Epigastric or Retrosternal Pain
Bone Pain with metastatic disease.
Hoarseness
Persistent Cough
Collecting a sample of tissue for testing (
biopsy
). Your doctor may use a special scope passed down your throat into your esophagus (
endoscope
) to collect a sample of suspicious tissue (
biopsy
). The tissue sample is sent to a laboratory to look for cancer cells.
Esophagogastrectomy:
Surgery to remove part of your esophagus and the upper portion of your stomach.
Acupuncture
Guided imagery
Massage
Relaxation Techniques
Alternate Medicine:
Combined Chemotherapy & Radiation Therapy
Assess airway patency and respiratory status.
Maintain hydration to help promote airway clearance and loosen respiratory secretions
Monitor daily weight and food and nutrient intake
Provide materials to facilitate communication if client is unable to speak clearly.
Examples: dry-erase board, chalkboard, etc.
Encourage client to express feelings regarding body image changes and provide emotional support.
The esophagus is a long, hollow tube that runs from your throat to your stomach.
Your esophagus carries food you swallow to your stomach to be digested.
Esophageal cancer isn't common in the United States. In other areas of the world, such as Asia and parts of Africa, esophageal cancer is much more common.
It's thought that chronic irritation of your esophagus may contribute to the DNA changes that cause esophageal cancer.
Esophageal cancer occurs when cells in your esophagus develop errors (
mutations
) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells form a tumor in the esophagus that can grow to invade nearby structures and spread to other parts of the body.
More men than women get esophageal cancer.
Factors that cause irritation in the cells of your esophagus and increase your risk of esophageal cancer include:
Having bile reflux
Drinking very hot liquids
Eating few fruits and vegetables
Being obese
Precancerous changes in the esophagus cells
Smoking
Having gastroesophageal reflux disease (GERD)
Drinking alcohol
Undergoing radiation to chest/upper abdomen
Having difficulty swallowing because of an esophageal sphincter that won't relax (achalasia)
Stomach Cancer
Tumor typically grows undetected in the rectum or sigmoid colon.
Usually by the time symptoms have occurred, the disease has often already spread into the deeper layers of the bowel tissue and adjacent organs.
Colorectal cancer spreads by direct extension to involve the entire bowel wall. May extend into neighboring structures such as the liver or genitourinary tract.
Metastasis to regional lymph nodes is common. Cancerous cells may also spread through the lymphatic or circulatory system to the liver, lungs, brain, bones, and kidneys.
Specific cause is unknown.
Bowel tumors tend to grow slowly.
5 to 15 years of growing may occur from the first malignant cells until symptoms occur.
Medical attention is usually sought when they have bleeding with defecation, or changes in bowel habits.
Advanced disease symptoms tend to include pain, anorexia, weight loss, and a palpable abdominal or rectal mass may be present. Anemia from occult bleeding may be a symptom, as well.
Primary complication is bowel obstruction due to tumor growth. Bowel wall perforation and tumor spread to adjacent organs may also occur.
Sigmoidoscopy or colonoscopy is done to detect and visualize tumors and to collect tissue for biopsy.
Tumors typically appear as raised, red, centrally ulcerated, bleeding lesions
Complete blood count (CBC) is done to evaluate for anemia.
Carcinoembryonic antigen (protein found in colorectal cancers) levels are measured. CEA levels are used primarily to predict prognosis and to detect tumor recurrence after surgery.
Chest x-ray is obtained to detect tumor metastasis to the lung. CT scans, MRI, or ultrasound examinations may identify involvement of other organs.
Small, localized tumors may be removed by laser endoscopy, which eliminates the need for abdominal surgery.
Most clients undergo a colectomy- removal of the affected part of the colon- with anastomosis of remaining bowel.
Most tumors of the ascending, transverse, descending, and sigmoid colon can be removed by the colectomy.
The anal sphincter is preserved and colostomy is avoided whenever possible.
Rectum tumors usually require an abdominoperineal resection.
This is when the sigmoid colon, rectum, and anus are removed through abdominal and perineal incisions.
Afterwards, a permanent colostomy is created
Chemotherapeutic agents are also used post-operatively.
Recommend decreased fat intake, refined sugar, and red meats.
Increase fiber, fresh fruits, and vegetables in the diet.
Regular health exams and screening procedures after the age of 50 need to be stressed.
Monitor pain levels and effectiveness of analgesia and other comfort measures.
Emotional and psychologic responses to the disease and treatment measures need to be assessed.
Colorectal cancer is often a silent disease and treatment at an early stage has a high cure rate.
Colorectal Cancer- 3rd most commonly occurring cancer and 2nd leading cause of cancer deaths in the US.
Risk factors are:
People over 50
History of colorectal cancer
Polyps of rectum or colon
Inflammatory bowel disease
Smoking, alcohol consumption
Physical inactivity
Obesity
High-saturated-fat, low-fiber diet.
Oral, Esophageal, Stomach, and Colorectal
By: Nikki, Katy, Abby, and Ronni
A. blood tinged sputum
B. dentures that fit properly
C. swollen lymph nodes
D. a lesion in the mouth
that doesn't heal.
2. Which of the following is an alternative medical treatment for esophageal cancer?
A. Hypnotherapy
B. Radiation
C. Biofeedback
D. Acupuncture
3. Which of the following is the PRIORITY nursing diagnosis for stomach cancer?
A. Imbalanced Nutrition r/t anorexia
and difficulty eating.
B. Risk for Ineffective Airway Clearance
r/t upper abdominal surgery.
C. Anticipatory Grieving r/t diagnosis
of cancer.
D. Acute Pain r/t surgical incision and
manipulation of abdominal organs.
4. In colorectal cancer, bowel tumors tend to grow slowly. How many years of growing may occur until first symptoms appear?
A. 6-9 Years
B. 8-12 Years
C. 5-15 Years
D. 3-7 Years
B
Dentures That Fit Properly
D
Acupuncture
A
Imbalanced Nutrition r/t anorexia
and difficulty eating.
C
5-15 Years
Full transcript