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

2. 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

3. 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

4. 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

5. CANCER/MALIGNANCY
Metastasize (Mets)

6. 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

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

8. 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

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

10. 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

11. 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

12. 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

13. Diagnosis and Staging

14. 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

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

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

17. 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.

18. 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

19. Chemotherapy

20. Treatment
Chemotherapy

21. 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

22. Extravasation

23. Side Effects of Chemotherapy

24. Side Effects
Myelosuppression
Neutropenia
Thrombocytopenia
Anemia

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

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

27. Thrush

28. 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

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

30. Grieving

31. 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