1. Epidemiology, Etiology, Terms
1. Cancer is the second most common cause of death in the USA
2. Sites in men associated with greatest mortality: lung, colon, rectum and prostate
3. Sites in women with greatest mortality: breast, lung, colon, and rectum
4. Familial risk for certain cancers: lung, stomach, breast, colon, rectum and uterus
5. Etiology
1. Generally unknown but may be caused by interacting factors
2. Theories include predisposing factors:
1. constant irritation
2. history of cancer
3. environmental carcinogens
4. radiation
3. Cancer terminology
1. primary site of neoplasmis its site of origin
2. secondary sites represent metastasis
3. types of neoplasms: benign and malignant
4. four types of malignant neoplasms
1. carcinomas: usually solid tumors arising from epithelial cell
2. sarcomas: from muscle, bone, fat and other connective tissue
3. lymphomas: originate in the lymphatic system
4. leukemias: originate in the blood system
   
2. Diagnostics  and Staging
1. History and physical exam - depends on location of tumor
2. Biopsy: obtaining tissue for histological examination
3. Imaging: CT scan, MRI
4. Tumor markers: biochemicals made and released by tumor cells
5. Staging and grading
1. Staging: describe and classify extent of a malignancy when it is diagnosed
2. Grading: describe the degree of malignancy according to the type of tumor cell
   
3. Treatment in General
1. Objective: to remove all traces of the cancerous tissue
2. Treatment plan based on stage and grade of tumor
3. Surgery: specific to site of malignancy
4. Chemotherapy - see Lesson 6 (Pharmacological and Parenteral Therapies) for information about chemotherapy
5. Radiation therapy - see Lesson 7 (Reduction of Risk Potential) for more information about radiation therapy
4. Metastatic Disease
1. Spread of malignancy beyond the primary site; means of metastasis:
1. Tumor invades adjacent tissue
2. Tumor sheds cells into body cavities
3. Tumor cells spread via the lymphatic system or blood stream
2. Major cause of death from cancer
1. Most common sites:
1. to lung from primary sites in colon, rectum, breast, renal system, testes and bone
2. to liver from primary sites in lung, colon, rectum, breast and renal system
3. to CNS from primary sites in lung and breast
4. to bone from primary sites in lung, breast, renal system and prostate
   
5. Cancer Pain Management
1. Although clients with cancer may experience pain at any time during their disease, pain is usually a late symptom of cancer
2. Use a variety of pain relief measures. (See Lesson 5: Basic Care and Comfort for information regarding nonpharmacologic pain relief measures.)
   
6. Acquired Immune Deficiency Syndrome (AIDS)
1. Definition/etiology
1. Infection with human immunodeficiency virus (HIV) resulting in a dysfunction of cell-mediated immunity
2. Characterized by recurrent, opportunistic infections or unusual malignancies
3. Methods of transmission
1. parenteral
2. sexual
3. perinatal
4. Incubation period ranges from six months to ten years
5. Antibodies can generally be detected in blood within two weeks to three months after infection with virus
   
2. Findings
1. Most common manifestations
1. Kaposi's sarcoma
1. malignant tumor of the endothelium lining the heart, blood vessels, lymphatic system, and serous cavities
2. most benign form limited to the skin particularly the lower extremities
3. characterized by diffuse cutaneous lesions
2. pneumocystis carinii pneumonia (PCP)
1. etiology: opportunistic protozoa
2. characterized by low-grade fever, nonproductive cough, shortness of breath
3. may progress to respiratory failure
   
2. Other findings
1. fatigue, shortness of breath
2. weight loss, nausea and vomiting, diarrhea
3. cough
4. chest pain
5. fever, night sweats
6. mental changes
7. infections
1. protozoal infections: toxoplasmosis, giardiasis
2. fungal infections: candidiasis, histoplasmosis
3. viral infections: cytomegalovirus, herpes, Epstein-Barr
4. bacterial: salmonellosis, mycobacterium tuberculosi
   
3. Diagnostics
1. History and physical exam
2. Bronchoscopy for PCP (pneumocystis carinii pneumonia)
3. Enzyme-linked immunoabsorbent assay (ELISA)
4. Polymerase chain reaction (PCR)
5. CBC: decreased WBC, decreased lymphocytes, anemia, thrombocytopenia
6. Tissue biopsy for Kaposi's
7. T4 lymphocyte count
   
4. Management
1. Objective: to detect and treat opportunistic infections and any sign of Kaposi's sarcoma and to prevent complications
2. No known cure at present
3. Pharmacologic
1. antiviral agents: azidothymidine (Zidovudine)
2. pneumocystis: trimethoprim/sulfomethoxazole (Septra), pentamidine (NebuPent)
3. Kaposi's: vinblastine (Velsar), Vincristine (Oncovin),interferon Alph-2A (Roferon-A)
   
5. Nursing care of HIV-positive client
1. Initiate standard precautions
2. Use postural drainage and percussion only when secretions are present and coughing does not adequately clear lungs (illustration 1  illustration 2)
3. Administer oxygen as ordered
4. Provide restful environment
5. Monitor for signs of dehydration
6. Maintain diet high in calories and protein, low in residue
7. Encourage fluids
8. Provide supplemental feedings as ordered
9. Administer medications as ordered
10. Provide skin care as indicated
11. Weigh client daily
12. Care of the client on mechanical ventilation
13. Assess how much the disease has impaired cognition. (See Lesson 3: Health Promotion and Maintenance for assessment of the neurological system.)
14. Provide emotional support
15. Care of the cancer client undergoing chemotherapy. (See Lesson 6: Pharmacological and Parenteral Therapies for information about chemotherapy.)
16. Maintain body-substance isolation according to CDC guidelines for HIV. (Information about Standard Precautions can be found in Lesson 2: Safety and Infection Control.)
17. Care of the client on TPN
18. Teach client
1. avoid persons with known infections
2. safe sex guidelines
3. energy conservation techniques
4. need to wear disease identification jewelry
5. to report infections immediately to physician
6. not to donate blood, serum or semen
7. not to share toothbrushes, razors, or other items that may draw blood
   

• Radiation has local effects; chemotherapy is more systemic.
• Only certified nurses may administer chemotherapeutic agents.
• Ionizing radiation will damage both normal and cancerous cells, and cause side effects.
• Clients who receive external radiation are not radioactive at any time.
• Clients receiving internal radiation are not radioactive: the implant or injection is.
• If the source of radiation is metabolized, the client's secretions and excretions may be radioactive for a time, based on the half-life of the isotope.

Anaplasia
Carcinogenesis
Dysplasia
Hyperplasia
Metastasis
Neoplasia