Diagnosis, Staging &Chemotherapy for Cancer Cheryl A. Yarde RN, MSN Clinical Assistant Professor

Benign Vs. Malignant What is the difference between a benign tumor and a malignant t tumor? Malignant tumors are ambitious. They have two goals in life: To survive To conquer new territory

Benign vs. Malignant Benign Malignant Well differentiated Tumor does not infiltrate surrounding tissue Growth is slow Does not spread Undifferentiated Invades and infiltrates Rate of growth is variable Spreads to other areas of the body- metastasizes

Benign vs. Malignant Benign Malignant Does not cause generalized effects Cause localized effects Does not usually cause tissue damage Does not usually cause death unless location interferes with vital function Can Cause anemia, weakness, Systemic inflammation, weight loss Causes extensive tissue damage Eventually causes death unless growth can be controlled

CANCER/MALIGNANCY Metastasize (Mets)

Carcinogenesis Process of transforming normal cells into cancer cells Every phase of this process is affected by multiple gene mutations Some gene mutations- inherited 90% acquired mutations in specific cells

Genetics Examples of some Cancers influenced by genetics: Breast Ovarian Colorectal Prostate Ca Retinoblastoma Familial melanoma syndrome

Family History Family history assessment for specific Oncology disorders: H/O of maternal and paternal sides Three generations- parent, sibling, child Clusters of Ca that occur at young ages Multiple cancers in one individual Two or more close relatives with the same cancer

Family history Referral for genetic testing Need support if genetic testing is positive Need to know options Support groups

Factors inducing carcinogenesis Viruses: HPV, HepB, Epstein Barr Bacteria: H. plylori Physical agents: sunlight, radiation, tobacco, asbestos Hazardous Chemicals: Alter DNA structure Tobacco smoke, passive smoke, cigars, pipes, chewing tobacco Workplace chemicals Asbestos

Carcinogens Tobacco smoke – single most lethal chemical carcinogen Accounts for 1/3 of all cancer deaths Lung Head and neck Esophagus Stomach Pancreas Kidney AML Second hand smoke- Non - smokers who live with smokers have a 20%-30% greater risk of developing lung cancer

Factors inducing carcinogenesis Lifestyle factors: Diet - long term ingestion of carcinogens: Fats, alcohol, salt cured or smoked meats, nitrate containing foods, red and processed meats Obesity Insufficient physical activity

Diagnosis and Staging

Diagnosis of Cancer Determining presence/Type of malignancy Obtain tissue, cells for analysis: Biopsy Fine needle aspiration **The only way to confirm whether a tumor is cancerous or benign is with a biopsy/ fine needle aspiration

Diagnosis of Cancer Staging: Size of tumor local invasion Lymph node involvement Distant mets

*Staging Done prior to treatment Provides baseline data Treatment options and prognosis are based on staging

Staging Stage I-IV stage 1 is localized cancer, further local spread will take it to stage 2; stage 2 also usually includes spread to the nearest lymph nodes; stage 3 usually indicates more extensive lymph node involvement and stage 4 always indicates distant spread.

Grading Determine the type of tumor the tissue originated from Differentiation does the tumor cells retain the function and histologic characteristics of the tissue of origin- differentiation Helps with prognosis Grade l: well differentiated Resembles the tissue of origin Grade lV Poorly differentiated More aggressive, less responsive to treatment

Chemotherapy

Treatment Chemotherapy

Chemotherapy What is chemotherapy? Administration of chemotherapy Drugs used for cancer treatment Used to kill tumor cells by interfering w/cellular functions and reproduction Kills rapidly dividing cells Administration of chemotherapy

Extravasation

Side Effects of Chemotherapy

Side Effects Myelosuppression Neutropenia Thrombocytopenia Anemia

GI Effects Nausea & Vomiting (N/V): Most common side effect 25

GI Effects Oral cavity & GI tract * 5-14 days Stomatitis: Mouth Mucositis Oral cavity & GI tract *

Thrush

Fatigue Cancer fatigue is distressing Rest helps but does not make it go away A little activity may be exhausting Interferes w/family, work, recreation, and social life 28

Psychosocial distress Actual/potential losses Fear Symptoms Changes in family and social roles Financial issues Loss of control

Grieving

Alopecia Destruction of hair follicles by chemotherapy or radiation to head and neck Hair loss usually temporary w/chemotherapy usually permanent in response to radiation