Cellular Proliferation

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Cellular Proliferation

• Mary Ellen Santucci DNSc, RN
• Nursing II
• Rutgers University

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Characteristics of Neoplasia

• Benign vs. Malignant
• Metastatic Process
• Staging and Grading

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Benign vs. Malignant

• Benign
• Well differentiated cells that resemble normal
  cells of the same tissue
• Tumor grows by expansion, usually encapsulated
  and slow growing
• Does not spread by metastasis
• Usually localized

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Malignant

• Cells are undifferentiated and bear little or no
  resemblance to normal cells
• Grows at the periphery and sends out processes to
  infiltrate and destroy surrounding tissue
• Produces substances causing tissue damage
• Metastasizes, growth rates is variable

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Metastatic Process

• Lymphatic Spread
• Hematogenous Spread
• Angiogenesis

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Staging and Grading

• Staging determines the size of the tumor and the
  existence of metastasis. TNM system is often used
• T extent of primary tumor
• N lymph node involvement
• M extent of metastasis
• See page 272 Chart 15-2

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Grading

• Grading refers to the classification of the tumor
  cells
• Defines the type of tissue
• Obtained by
• Cytology
• Biopsy
• Surgical Incision
• See page 272 Chart 15-2

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Neoplasia and Adaptation

• Host Susceptibility
• Environmental Factors
• Health Practices
• Psychosocial Factors
• Maintaining Oxygen Transport

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Host Susceptibility

• Viruses and Bacteria
• Epstein-Barr Virus
• Herpes Simples II
• Hepatitis B
• HIV
• Helicobacter pylori

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Environmental Factors

• Physical Agents
• Exposure to sunlight or radiation
• Chronic irritation or inflammation
• Tobacco use
• Chemical Agents
• Zinc
• Nickel
• Tars
• Industrial agents

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Health Practices

• Nutrition
• Obesity
• Physical Activity
• Regular Medical Check ups

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Psychosocial factors

• Stress and the Immune System
• Stress and Hormonal Levels
• Family Factors

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Maintain Oxygen Transport

• Circulatory System
• Pulmonary System
• Tissue Perfusion

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Assessment of the Client with Neoplasia

• Subjective Data
• History
• Risk Factors
• Behavioral Risk Factors
• Hormonal Risk factors
• Inherited Risk factors

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Objective Data

• Anemia
• Fatigue
• Cachexia
• Lumps
• Bruising
• Bleeding
• Pain

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Diagnostic Evaluations

• Screening Tests
• Genetic Screening
• CAT scans, MRI, Bone Scan
• Biopsy
• Plasma Markers

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Factors Affecting Prognosis

• Stage and Grade at Time of Diagnosis
• Type of Cancer
• Age
• Prescence of Chronic Illness
• Psychosocial Support

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Management and Interventions

• Nursing Care
• Psychological Needs
• Therapeutic regimens
• Surgical Intervention
• Radiation therapy
• Chemotherapy
• Immunotherapy
• Pain

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Nursing Care

• Infection
• Impaired Skin Integrity
• Altered Oral Mucous Membranes
• Impaired Tissue Integrity (alopecia)
• Altered Nutrition
• Pain
• Grieving
• Body Image
• Bleeding

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Psychological Needs

• Fear
• Grief
• Body Image Disturbance
• Pain and depression
• Death

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Therapeutic Regimens

• Surgical Intervention
• Biopsy
• Removal of Tissue
• Causes Pain and Deformity

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Radiation Therapy

• Used to damage dividing cellsstimulate
  apoptosis halt cell cycle
• Injures and leads to death of normal cells
• Causes bone marrow depression
• Causes skin desquamation

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Chemotherapy

• Multiple Actions on cells to stop progression
  through cell cycle
• May involve combination therapy and may
  selectively or nonselectively act
• Injures and kills normal cells
• Anorexia and nausea
• Bone Marrow Depression

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Immunotherapy

• Activate host immune system to better recognize
  and destroy tumor cells
• Specifically blocks enzymes and growth factors
  required for metastasis
• Allows evaluation of treatment
• Causes flu-like symptoms

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Cancer Pain

• See Table 15-9 page 300
• 3 Step approach
• Nonopoid analgesics
• Weak Opoids
• Strong Opoids

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Supportive care

• Hospice
• Activities of Daily Living
• Pain
• Nutrition
• Elimination
• Coping
• Spiritual Concerns
• Financial Concerns

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Nursing Care of a Client with a Tumor

• Oncologic Emergencies
• Superior Vena Cava Syndrome
• Spinal Cord Compression
• Hypercalcemia
• Pericardial Effusion and Cardiac Tamponade
• Intractable Pain
• Pathologic Fractures

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Nursing Care of a Client with Leukemia

• Multiple drug chemotherapy
• Antibiotics
• Transfusions
• Bone Marrow Transplant
• Immunotherapy
• May be conservative for chronic leukemia