Cancer

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.

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