CANCER/NEO-PLASM/NEW GROWTH

1. Cancer is also called neoplasm
2. Cancer is also defined as abnormal growth in the tissue either slow (benign) & or fast (malignant)
3. Cancer is the new growth, a tumor which is either cancerous or non-cancerous
4. Abnormal mass that is referred as a neoplasm or new growth. The cells of the neoplasm serve the no useful purpose and use nutrients and oxygen
5. Nursing involvement in the care of the patient education, assessment, monitoring, and treatment support and require knowledge of both the bio-medical and physiological components of the cancerous care.

Difference between the Benign & Malignant

	Benign	Malignant
1	Increase in size slowly	Increases in size rapidly
2	Growth is limited as a capsule	Growth is unlimited
	shaped
3	Do not spread towards neighboring	Spread towards neighboring tissue or
	tissue or organ	organ
4	Do not spread to a lymphatic system	Spread to a lymphatic system
5	No tendency to re-occur, even after	Tendency to re-occur, even after
	surgery	surgery
6	Benign is the opposite of the	Malignant is the opposite of the Benign
	malignant
7	Benign may re-occur if surgeon	Malignant possess the property of the
	can’t get successive result	anaplasia
8	It can be treated with the medicines	It cannot be treated with the medicines

Anaplasia= loss of distinctive characteristics of a cell associated with proliferate activity as in cancer.

Metastasis (Secondary Malignant)

1. Secondary malignant is also called Metastasis
2. Secondary Malignant is defined as the transfer of a disease from one part of the organ to the part throughout the blood vessels and lymph.
3. Metastasis may occurs due to the primary Malignant

No:	Tissue types	Benign	Malignant
A.	Epithelial
i	Surface skin	Popilloma	Squamous cell carcinoma
ii	Glandular	Adenoma	Adino-carcinoma

i	Fibrous	Fibroma	Fibro-carcinoma
ii	Adipose	Lipoma	Lipo-carcinoma
iii	Cartilage	Chondroma	Chondro-carcinoma
iv	Bone	Oestoma	Oesteo-carcinoma

Common sites of Metastasis are lungs, liver, brain and bone.

1. Connective
2. Muscular

i	Smooth	Leiomyoma	Leiomyo-sarcoma
ii	Striated	Rhambdomyoma	Rhabdo-sarcoma

1. Nerve

i	Nerve	Neuroma	Neuro-blastoma
ii	Gliel	Glioma	Glio-blastoma
iii	Nerve sheath	Neurilemmoma	Neirilemmal-sarcoma
iv	Menings	Meningioma	Meningeal-sarcoma

1. Hematological

i	Granulocytic	Myelocytic leukemia
ii	Erythrocytic	Erythrocytic leukemia
iii	Lymphocytic	Lymphocytic leukemia
iv	Monocytic	Monocytic leukemia
v	Plasma cell	Multiple myeloma

1. Endothelial

i	Blood vessel	Hemangioma	Hemangio-sarcoma
ii	Lymph vessel	Lymphangioma	Lymphagio-sarcoma
iii	Lymph tissue	Lymphogioma	Lympho-sarcoma

Treatment of the neo-plasm:

At present three methods have proved their values in the treatment of the neo-plasm

1. Chemo-therapy
2. Radio-therapy
3. Surgery

The hope for cure of neo-plasm especially for malignant depends on the chemotherapy. In general, it can be said that as yet no drugs have been discovered to cure malignant tumor however, cancer chemotherapy may or may not offer some help to patients for home surgery and radiation are no longer beneficial. Chemotherapeutic agents at the time of surgery may reduce or slow up the appearance of secondary growth. In some patients pain and other symptoms are relieved for the time.

Chemotherapeutic agents are especially used for the lymphomea and leukemia, diffuse tumor usually not amenable to surgical therapy.

The rational for administrating chemotherapeutic drug is that they are capable and destroying young rapidly multiplying cells. It is believed that these drugs interfere with the manufacturing of nucleic acid that is necessary for the building of genetic structures in the cells. As a result cellular growth and building reproduction inhabited.

Specific agents used as chemotherapy

1. Poly-functional alkyl ting agents:

These poison destroy both cells either tumor cells or normal. It is believed that tumor cells are more sensitive to toxicity than normal cells, as a result cell growth and division is hindered.

The chief disadvantage of most of these drugs is destructive effect on the bone marrow, which is the body’s chief source of new born blood cells other side effect is vomiting, nausea and Stomatitis.

1. Antimetabolytes:

e.g.: Folic acid, purine antagonistic

These are the synthetic substance, similar to those that nourish the normal cells during its growth and development.

1. Steroids compounds:
2. ACTH: control on cortisol (kidney).
3. Castration: control on secretion on prostate gland.

These drugs changes the endocrine environment because tumor arising in organs usually under hormonal influences such as prostate and breast.

The patient receiving the type of therapy will be need to be observed by toxicity signs such as fluid retention, increases libido (the vital force or impulse which brings about purposeful action) and hirutism (excessive hair ness) as well as nausea and vomiting.

1. Miscellaneous drugs:

Antibiotics drugs such as Actynomycin-D, Mytomycin-C and Streptomycin.

Note:

None of above drug can cure Malignancy. They are efforts to make the physiology of the host cells less favorable for the growth of the cancer.

These drugs may be given orally, IV, IM depending on the drug and Carcinoma.

Side effects of the chemotherapeutic drugs:

1. Stomatitis
2. Neuro toxicity
3. Hepatic toxicity
4. Ocular toxicity
5. Diarrhea
6. Nephro toxicity
7. Bladder toxicity
8. Oto toxicity
9. Endocrinal changes
10. Pulmonary toxicity
11. Cardio toxicity

General Nursing & Medical care of the onco-patient (Cancerous-patient):

• To control the Carcinoma growth by surgery, radiation and chemotherapy
• Combats on local and systemic infection
• Correct existing enema and electrolytic imbalance
• Give the patient psychological support by the explaining the treatment by re-assurance, listen and observe the patient anxiety
• Administrator vitamin-B as prescribed and blood transmission is needed
• Give sedatives, anti-emetics, anti-histamines (allergic)
• Offer small frequent feeding of high caloric
• Increase fluid intake

1. Report patient’s reaction response
2. Control on diarrhea
3. Remove constipation by giving low residue or balanced diet
4. Give enema if required as suppository if needed
5. Take care of skin especially of perineal area
6. Apply oil or cream to radiation site.
7. Protect skin from sun-light, heat, injury and tight clothing
8. Advice for blood CP
9. Protect the patient from the infection
10. Evaluate the quality, intensity duration of pain as well as patient response to pain
11. Promote the general comfort of patient by turning, moving and rest
12. Administer drug as prescribed
13. Use specific drug for nausea and vomiting
14. Apply cold or hot compression if needed
15. Apply local anesthetic to relieve the pain
16. Prepare for alcohol injection to block narrow path
17. Control on the odor and remove odor
18. Encourage for good personal hygiene
19. Give normal saline irrigation to external areas if required
20. If administrator prescribed vaginal irrigation, when discharge of vaginal secretion of the patient
21. Keep perineal area shaved
22. Observe for increasing pulse rate
23. Observe the amount and color of the blood if bleeding
24. Apply digital pressure if site is accessible
25. Apply vaginal or rectum packing if required
26. Care the bladder frequently and incontinence
27. Maintain I/O chart
28. Insert catheter if all other measures fails
29. Encourage patient for fluid & regular meal for constipation
30. Reduce edema by ROM (range of motion)
31. Evaluate edematic extremity
32. Prevent the patient from bed sore by providing stimulation circulation
33. Assess the patient to cope with his/her situation
34. Develop a supportive relationship with patient (Psychotherapy)
35. Encourage the patient to make decision
36. Listen the patient attentively and answer the patient frequently and politely
37. Provide a daily schedule to the patient
38. Encourage the patient to be active
39. Maintain the patient optimal physical, mentally and emotionally satisfaction
40. Maintain a cheerful and optimistic attitude
41. Encourage for verbalization
42. Do little more for the patient
43. Include the family in the patient’s care.

Side effects of the chemotherapeutic drugs:

1. Stomatitis
2. Neuro-toxicity
3. Hepatic-toxicity
4. Ocular toxicity
5. Diarrhea
6. Nephro toxicity
7. Bladder toxicity
8. Oto toxicity
9. Hormonal changes
10. Pulmonary toxicity
11. Cardio toxicity

Cases of Neoplasm as re Registered in United Kingdom in 1985:
MALE			FEMALE.
	Lung	24%		Lung	19%
	Skin	12%		Skin	09%
	Prostate	09%		Cervix	03%
	Bladder	06%		Ovary	04%
	Colon	06%		Colon	07%
	Stomach	06%		Stomach	04%
	Rectum	05%		Rectum	03%
	Pancreas	03%		Pancreas	02%
	Esophagus	02%		Breast	19%
	Leukemia	02%		Uterus	03%
	Others	25%		Other	37%

1. Esophageal Carcinoma Definition:

Carcinoma of the esophagus is unique in its geographic distribution. Both benign & malignant tumor occurs in the esophagus. Benign tumor are usually leimyomas, and extremely rare & usually asymptomatic. They require no intervention unless symptoms necessitate local excision. Malignant tumors of the esophagus are not common but they assume increased importance because of their virulence.

Location of esophagus:

Esophagus lies behind the trachea to which it adopts and in front of the vertebral column. Passing through the thorax it pierces the diaphragm to enter in abdomen where it communicates with the stomach. Its size is 9-10 inches.

Causes:
© Exact cause is idiopathic,
© Pre-disposing factors are: © Taking alcohol
© Usage of tobacco and opium © Excessive usage of beverages
© Induced caustic esophagus sphincter © Ultra-violet radiations

1. Tumor
2. Dysphagia
3. Odynophagia (typically)
4. Heart burn
5. Anorexia
6. Weight loss
7. Feeling mass in throat
8. Painful swallowing
9. Regurgitation
10. Hiccup
11. Chest pain
12. Supera-clavicular lymphodenopathy

Complication:

1. Hemorrhage
2. Esophageal perforation
3. Esophageal obstruction

Investigations:

1. Chest X-ray
2. CT scan
3. Barium esophagography
4. Bronchoscopy
5. Biopsy
6. MRI
7. Blood CP

Medical treatment:

1. Poly-functional alkyl ting agents:
2. Antimetabolytes:
3. e.g.: Folic acid, purine antagonistic
4. ACTH
5. Castration
6. Miscellaneous drugs:
7. Antibiotics drugs such as Actinomycin-D, Mytomycin

Surgical treatment:

1. Surgical, the resection of the esophagus provides the most rapid durable relief of the Dysphagia, the standard surgical Management including partial removal of the esophagus.
2. Esophagectomy
3. Esophagogastrotomy
4. Esophagoenterostomy

Radio-therapy:

1. The radiotherapy may be given for a short time to provide relief to pain. Nursing Management:
2. Please revise the general Nursing Management of the Neoplasm.