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Lecture 12

NURS 371 Lecture Notes - Lecture 12: Mastectomy, Dysfunctional Uterine Bleeding, Cryptorchidism


Department
Nursing
Course Code
NURS 371
Professor
Heather Mitchell
Lecture
12

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N371: Cancer, Breast, and Reproductive Disorders
I. Cancer
a. Types of Cancers based on Tissue of Origin
i. The process of cancer growth comes from defects in either cell
proliferation or differentiation
ii. Defects can be caused by a variety of causes (carcinogens)
iii. Carcinoma arise from epithelial tissue
iv. Adenocarcinoma arise from glandular organs.
v. Sarcoma arise from mesenchymal tissue (“softor connective tissue).
vi. Leukemia malignancies of the blood-forming cells.
vii. Lymphoma arise from the lymph tissue.
viii. Multiple myeloma arises from plasma cells and affects the bone.
b. Risk Factors for Cancer
i. Age
ii. Genetic predisposition
iii. Exposure to chemicals, viruses, tobacco, and alcohol
iv. Diet high in fat and red meat, low in fiber
v. Sun, UV light, or radiation exposure (radon)
vi. Sexual lifestyles: multiple partners, STD, HIV/AIDS
vii. Other risk factors such as poverty, obesity, and chronic diseases (GERD,
UC)
c. Classifications of Cancers
i. Anatomic site classified by tissue of origin, the anatomic site, and the
behavior of the tumor (benign or malignant)- so malignant lung
adenocarcinoma
ii. Histological grading appearance of cells and the degree of differentiation
are evaluated pathologically (the higher the grade, the poorer the
prognosis)
1. Grade I: Cells differ slightly from normal cells (mild dysplasia)
and are well differentiated (low grade).
2. Grade II: Cells are more abnormal (moderate dysplasia) and
moderately differentiated (intermediate grade).
3. Grade III: Cells are very abnormal (severe dysplasia) and poorly
differentiated (high grade).
4. Grade IV: Cells are immature and primitive (anaplasia) and
undifferentiated; cell of origin is difficult to determine (high
grade).
iii. Extent of disease based on the anatomic extent of disease (if its local or
spread) rather than on cell appearance
1. Stage 0: cancer in situ
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2. Stage I: tumor limited to the tissue of origin; localized tumor
growth
3. Stage II: limited local spread
4. Stage III: extensive local and regional spread
5. Stage IV: metastasis
iv. TNM system used to determine the anatomic extent of the disease
involvement according to three parameters: tumor size and invasiveness
(T), presence or absence of regional spread to the lymph nodes (N), and
metastasis to distant organ sites (M).
d. Metastasis
i. Cancer cells penetrate surrounding tissues
ii. Metastatic cells frequently travel thru lymph and blood
iii. When cancers mets, they are still classified by the original location (ie,
breast cancer in the bone)
e. 7 Signs of Cancer
i. Manifestations will depend on location (discussed in specific conditions)
ii. Think CAUTION
Change in bowel or bladder habits
A sore that doesn’t heal
Unusual bleeding or discharge
Thickening or lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in warts or moles
Nagging cough or hoarseness
f. Diagnostic Testing
i. Tissue biopsy
ii. CBC
iii. Tumor markers (CEA, AFP, PSA, CA-125, HCG)
iv. Genetic testing (BRCA1, BRCA2)
v. X-rays
vi. PET scans
vii. Tests specific to certain cancers: colonoscopy, pap smear
g. Prevention and Detection
i. Healthy lifestyle: exercise, sleep, balanced diet,
ii. Elimination of risk factors
iii. Identification of high risk patient
iv. Screening tests for early diagnosis (recommended guidelines)
1. Breast yearly mammogram >40, Clinical Breast Exam (CBE) every 3 yrs
in 20s
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2. Colon at 50, colonoscopy every 10 years and fecal occult blood test
every year
3. Cervix All women should begin cervical cancer screening about 3 years
after they begin having vaginal intercourse or 21 years old. Every 2
years.
4. Prostate 50, consider PSA with/without rectal exam. If higher risk, start
at 45.
5. Skin - Be aware that fair-skinned men and women aged 65 and older,
and people with atypical moles or more than 50 moles, are at greater
risk for melanoma. Look for skin abnormalities when performing
physical examinations for other reasons. (from CDC website)
h. Treatments
i. Goals: Cure, Control, Palliation
ii. Combination of treatment modalities is effective for controlling many
cancers
iii. Surgical Therapy
1. Prevention, Cure , Control, or Palliative
iv. Chemotherapy
1. Many factors affect response to treatment
2. Must be trained to administer
v. Radiation Therapy
1. Internal (brachytherapy) & external therapy
vi. Others: stem cell transplants, gene therapy, hormone therapy, biological
therapy
i. Post-Treatment Care
i. General
1. Psychosocial support
2. Pain management
ii. Chemo
1. Immunosuppression - temperature and white blood cell (WBC) count.
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control precautions (we discussed in neutropenia), meds to increase
WBC production
2. Hematology changes anemia and thrombocytopenia. Institute safety
measures, meds to stimulate production, care discussed in hematology
3. GI disturbances - antiemetics & antihistamines, high-calorie, high
protein choices, small frequent meals. Hard candies can help with
metallic taste in mouth
4. Alopecia discuss options such as wigs, hats, scarves. Should try wigs
prior to hair loss. Hair will come back but may appear different
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