1. Cancer, Immune System, and Skin Disorders
Understanding cancer and immune system and skin disorders gives meaning to the required care.
Chapter 40
Cancer, Immune System, and Skin Disorders

2. Cancer Cells reproduce for tissue growth and repair.
Cell division and growth are sometimes out of control.
A mass or clump of cells develops. This new growth of abnormal cells is called a tumor.
Tumors are benign or malignant.
Refer to Figure 40-1 on p. 669 in the Textbook.

3. Cancer (cont’d) Benign tumors Do not spread to other body parts
Can grow to a large size, but rarely threaten life
Usually do not grow back when removed
Malignant tumors (cancer)
Invade and destroy nearby tissue
Can spread to other body parts
May be life-threatening
Sometimes grow back after removal

4. Cancer (cont’d)
Metastasis is the spread of cancer to other body parts.
Cancer cells break off the tumor and travel to other body parts.
New tumors grow in other body parts.
Cancer can occur almost anywhere.
Cancer is the second leading cause of death in the United States.
Metastasis occurs if cancer is not treated and controlled.
Review Box 40-1 on pp in the Textbook for some signs and symptoms of cancer
Review the Focus on Children and Older Persons: Cancer Box on p. 671 in the Textbook.

5. Cancer (cont’d)
The National Cancer Institute describes these risk factors:
Growing older
Most cancers occur in persons over 65 years of age.
Tobacco
Sunlight
Ionizing radiation
Certain chemicals and other substances
Some viruses and bacteria
Certain hormones
Family history of cancer
Alcohol
Poor diet, lack of physical activity, and being overweight
Tobacco includes using tobacco and being around tobacco. This risk can be avoided.
Sun, sunlamps, and tanning booths cause early aging of the skin and skin damage.
Sources of ionizing radiation include x-rays, radon gas that forms in the soil and some rocks, and radioactive fallout.
Painters, construction workers, and those in the chemical industry are at risk. Paint, pesticides, used engine oil, and other chemicals can be harmful.
Certain viruses increases the risk of some cancers.
Hormone replacement for menopause may increase the risk of breast cancer.
Certain cancers tend to occur in families.
More than 2 alcoholic drinks a day increases the risk of certain cancers.

6. Cancer (cont’d) Treatment depends on: The tumor type
Tumor site and size
If the tumor has spread
The treatment goal may be to:
Cure the cancer.
Control the disease.
Reduce symptoms for as long as possible.
Some cancers respond to one type of treatment.
Others require two or more types.
Cancer treatments also damage healthy cells and tissues.
Side effects depend on the type and extent of the treatment.

7. Cancer (cont’d) Surgery removes tumors.
It is done to cure or control cancer.
It relieves pain,
Radiation therapy (radiotherapy)
Destroys certain tumors
Shrinks a tumor before surgery
Destroys cancer cells that remain after surgery
Controls tumor growth to prevent or relieve pain
X-ray beams are aimed at the tumor. Radioactive material is sometimes implanted in or near the tumor.
Cancer cells and normal cells receive radiation. Both are destroyed.
With radiation therapy, burns, skin breakdown, and hair loss can occur at the treatment site. Special skin care measures are ordered.
Extra rest is needed for fatigue.
Review the Promoting Safety and Comfort: Radiation Therapy Box on p. 672 in the Textbook.

8. Cancer (cont’d)
Chemotherapy involves drugs that kill cells. It is used to:
Shrink a tumor before surgery
Kill cells that break off the tumor
Relieve symptoms caused by the cancer
Side effects depend on the drug used.
Hair loss (alopecia)
Gastro-intestinal irritation
Decreased blood cell production
With chemotherapy, cancer cells and normal cells are affected.
The drug usually stays in the person’s body for 3 to 7 days.
It is excreted in urine, feces, vomitus, semen, and vaginal secretions.
Safety measures are listed in Box 40-2 on p. 673 in the Textbook.

9. Cancer (cont’d)
Hormone therapy prevents cancer cells from getting or using hormones needed for their growth.
Drugs are given to prevent the production of certain hormones.
Organs or glands that produce a certain hormone are removed.
Biological therapy (immunotherapy) helps the immune system fight the cancer.
It also protects the body from the side effects of cancer treatments.
Side effects of hormone therapy include fatigue, fluid retention, weight gain, hot flashes, nausea, vomiting, appetite changes, and blood clots.
With hormone therapy, fertility is affected in men and women. Men may experience impotence and loss of sexual desire.
Side effects of biological therapy include flu-like symptoms. Bleeding, bruising, swelling, and skin rashes may occur.

10. Cancer (cont’d) Other therapies Stem cell transplants
A stem cell is a cell from which new cell types develop.
The new cells have certain functions (blood cells, brain cells, bone cells).
Some persons need high doses of chemotherapy or radiation therapy.
Such therapies kill cancer cells and blood cells in the bone marrow.
Fewer blood cells are produced.
A person is given blood-forming stem cells.
New blood cells develop from the stem cells.
Complementary and alternative medicine (CAM)
Used along with standard cancer treatments
Used instead of standard cancer treatments
Types of CAM include massage therapy, herbal products, vitamins, special diets, spiritual healing, and acupuncture.
Acupuncture helps to control pain and other symptoms.

11. Cancer (cont’d) Persons with cancer have many needs, including:
Pain relief or control
Rest and exercise
Fluids and nutrition
Preventing skin breakdown
Preventing bowel problems
Dealing with treatment side effects
Psychological and social needs
Spiritual needs
Sexual needs
Psychological and social needs are great. Anger, fear, and depression are common.
Some surgeries are disfiguring. The person may feel unwhole, unattractive, or unclean.
The person and family need support.
Spiritual needs are important. To many people, spiritual needs are just as important as physical needs.
Persons dying of cancer often receive hospice care. Support is given to the person and family.
Review the Focus on Communication: The Person’s Needs Box on p. 674 in the Textbook.

12. Immune System Disorders
The immune system
Protects the body from microbes, cancer cells, and other harmful substances
Defends against threats inside and outside the body
Immune system disorders occur from problems with the immune response.
The response may be inappropriate, too strong, or lacking.
Review the Body Structure and Function Review: The Immune System Box on p. 674 in the Textbook.

13. Immune System Disorders (cont’d)
Autoimmune disorders can occur.
The immune system attacks the body’s own normal cells, tissues, or organs.
One of the following may occur.
One or more types of body tissues are destroyed.
An organ grows abnormally.
There is a change in how an organ functions.
Common autoimmune disorders include
Graves’ disease (the most common form of hyperthyroidism)
Lupus (an inflammatory disease that affects the blood cells, joints, skin, kidneys, lungs, heart, or brain)
Multiple sclerosis
Rheumatoid arthritis
Type 1 diabetes
Organs and tissues commonly affected are: red blood cells, blood vessels, connective tissue, the endocrine glands (thyroid gland, pancreas), muscles, joints, and skin.
In Graves’ disease, the immune system attacks the thyroid gland.

14. Immune System Disorders (cont’d)
Signs and symptoms depend on the type of disease.
Fatigue, dizziness, not feeling well, and fever are common.
Most autoimmune disorders are chronic.
Treatment depends on the:
Type of disorder
Tissues and organs affected
Treatment is aimed at:
Reducing symptoms
Controlling the autoimmune response
Maintaining the body’s ability to fight disease

15. Immune System Disorders (cont’d)
Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV).
HIV attacks the immune system.
HIV is spread through body fluids (blood, semen, vaginal secretions, and breast milk).
HIV is transmitted mainly by:
Unprotected anal, vaginal, or oral sex with an infected person
“Unprotected” means without a new latex or polyurethane condom.
Needle and syringe sharing among IV drug users
HIV-infected mothers
AIDS destroys the body’s ability to fight infections and certain cancers. Some infections are life threatening.
HIV is not spread by saliva, tears, sweat, sneezing, coughing, insects, or casual contact.
The virus enters the bloodstream through the rectum, vagina, penis, mouth, or skin breaks.
The virus can enter the bloodstream through mucous membrane breaks (mouth, vagina, rectum).
The virus is carried in contaminated blood left in needles or syringes. Needle sticks are a threat to the health team.
Babies can become infected during pregnancy, shortly after birth, and through breast-feeding.

16. Immune System Disorders (cont’d)
HIV cannot:
Live outside the body
Be spread by casual, everyday contact
Be transmitted by food prepared by the infected person
Some HIV-infected persons have symptoms within a few months.
Others are symptom-free for more than 10 years. (They carry the virus and can spread it to others.)
The person with AIDS can develop other health problems.
The immune system is damaged.
Box 40-3 on p. 675 in the Textbook lists the signs and symptoms of AIDS.

17. Immune System Disorders (cont’d)
The person with AIDS is at risk for:
Pneumonia
Tuberculosis
Kaposi’s sarcoma (a cancer)
Nervous system damage
Many new drugs
Help slow the spread of HIV in the body
Reduce complications
Prolong life
You may care for persons with AIDS or those who are HIV carriers.
Protect yourself and others.
Follow Standard Precautions and the Bloodborne Pathogen Standard.
Memory loss, loss of coordination, paralysis, mental health disorders, and dementia signal nervous system damage.
AIDS has no vaccine and no cure at present. It is a life-threatening disease.
A person may have the HIV virus but no symptoms. In some persons, HIV or AIDS is not yet diagnosed.
Review the Focus on Children and Older Persons: Acquired Immunodeficiency Syndrome Box on p. 676 in the Textbook.

18. Varicella Zoster & Herpes Zoster
Chicken Pox
Shingles

19. Skin Disorders Shingles (herpes zoster)
Shingles is caused by the same virus that causes chickenpox.
The virus lies dormant (inactive) in nerve tissue.
The virus can become active years later.
Persons at risk include those who:
Are over 50 years of age
Have had chickenpox
Have weakened immune systems
The doctor orders anti-viral drugs and drugs for pain relief.
A vaccine is now available to prevent shingles.
Other skin disorders are discussed in Chapters 21, 33, 34, and 51.
At first, the person has a burning or tingling pain, numbness, or itching in an area on one side of the body or one side of the face.
After a few days or a week, a rash with fluid-filled blisters appears. Pain is mild to intense. Itching is a common complaint.
For many healthy people, the blisters heal and pain is gone in 3 to 5 weeks.
Shingles lesions are infections until they crust over.
Avoid contact with an infected person if you: are pregnant and have not had chicken pox; are pregnant and have not had the vaccine to prevent shingles; have a weakened immune systems.