Chapter 16: Cancer

• Cancer encompasses a broad range of diseases of multiple causes that can arise in any cell
of the body capable of evading regulatory controls over proliferation and differentiation.

• Two major dysfunctions present in the process of cancer are (1) defective cellular
proliferation (growth) and (2) defective cellular differentiation.

• Cancer cells usually proliferate at the same rate of the normal cells of the tissue from which
they arise. However, cancer cells divide indiscriminately and haphazardly and sometimes
produce more than two cells at the time of mitosis.

• Protooncogenes are normal cellular genes that are important regulators of normal cellular
processes. When these genes become mutated, they can begin to function as oncogenes
(tumor-inducing genes).

• Tumors can be classified as benign or malignant.

o Benign neoplasms are well-differentiated.
o Malignant neoplasms range from well-differentiated to undifferentiated.

• The stages of cancer include initiation, promotion, and progression.

o The first stage, initiation, is the occurrence of a mutation in the cell’s genetic
structure, resulting from an inherited mutation, an error that occurs during DNA
replication, or following exposure to a chemical, radiation, or viral agent.
o Promotion, the second stage in the development of cancer, is characterized by the
reversible proliferation of the altered cells.
o Progression, the final stage, is characterized by increased growth rate of the tumor,
increased invasiveness, and spread of the cancer to a distant site (metastasis).

• Since cancer cells arise from normal human cells, the immune response mounted against
cancer cells may be inadequate to effectively eradicate them.

• The process by which cancer cells evade the immune system is termed immunologic escape.

• Tumors can be classified according to anatomic site, histologic (grading), and extent of
disease (staging).
o In the anatomic classification of tumors, the tumor is identified by the tissue of
origin, the anatomic site, and the behavior of the tumor (i.e., benign or malignant).
o In histologic grading of tumors, the appearance of cells and the degree of
differentiation are evaluated pathologically. For many tumor types, four grades are
used to evaluate abnormal cells based on the degree to which the cells resemble the
tissue of origin.
o The staging classification system is based on a description of the extent of the
disease rather than on cell appearance.

• The biopsy procedure is the only definitive means of diagnosing cancer.

• The goal of cancer treatment is cure, control, or palliation.

o When cure is the goal, the treatment offered is expected to have the greatest chance
of disease eradication and may involve local therapy (i.e., surgery or radiation) alone
or in combination with or without periods of adjunctive systemic therapy (i.e.,
 chemotherapy).
o Control is the goal of the treatment plan for many cancers that cannot be completely
eradicated but are responsive to anticancer therapies and, as with other chronic
illnesses such as diabetes mellitus and heart failure, can be managed for long periods
of time with therapy.
o With palliation, relief or control of symptoms and the maintenance of a satisfactory
quality of life are the primary goals rather than cure or control of the disease process.

• Modalities for cancer treatment with all three goals include surgery, chemotherapy, radiation
therapy, and biologic and targeted therapy.

• The goal of chemotherapy is to eliminate or reduce the number of malignant cells present
in the primary tumor and metastatic tumor site(s).

• Chemotherapeutic drugs are classified in general groups according to their molecular

structure and mechanisms of action.

• Chemotherapy can be administered by multiple routes, such as central vascular access

devices, peripherally inserted central venous catheters, or implanted infusion ports.

• Regional treatment with chemotherapy involves the delivery of the drug directly to the
tumor site.

• Chemotherapy-induced side effects are the result of the destruction of normal cells,
especially those that are rapidly proliferating such as those in the bone marrow, lining of the
gastrointestinal system, and the integumentary system (skin, hair, and nails).

• Radiation is the emission and distribution of energy through space or a material medium.

• Radiation is used to treat a carefully defined area of the body to achieve local control of
disease.

• Simulation is a part of radiation treatment planning used to determine the optimal treatment
method by focusing on the geometric aspects of treatment.

• Nurses play a key role in assisting patients to cope with the psychoemotional issues
associated with receiving cancer treatment.

• Educating patients about their treatment regimen, supportive care options (e.g., antiemetics,
antidiarrheals), and what to expect during the course of treatment is important to help
decrease fear and anxiety, encourage adherence, and guide at-home self-management.

• Myelosuppression is one of the most common effects of chemotherapy, and, to a lesser

extent, it can also occur with radiation.

• Fatigue is a nearly universal symptom affecting 70% to 100% of patients with cancer.

• The intestinal mucosa is one of the most sensitive tissues to radiation and chemotherapy.

• Nausea and vomiting are common sequelae of chemotherapy and, in some instances,
radiation therapy.
• Biologic and targeted therapy can be effective alone or in combination with surgery,
radiation therapy, and chemotherapy.

• Biologic therapy consists of agents that modify the relationship between the host and the
tumor by altering the biologic response of the host to the tumor cells.

• Targeted therapy interferes with cancer growth by targeting specific cellular receptors and
pathways that are important in tumor growth.

• Capillary leak syndrome, pulmonary edema, bone marrow depression, and fatigue are
associated with biologic therapy.

• Hematopoietic stem cell transplantation is an effective, lifesaving procedure for a number

of malignant and nonmalignant diseases.
o Hematopoietic stem cell transplants are categorized as allogeneic, syngeneic, or
autologous.
o In allogeneic transplantation, stem cells are acquired from a donor who has been
determined to be human leukocyte antigen (HLA)–matched to the recipient.
o Syngeneic transplantation is a type of allogeneic transplant that involves obtaining
stem cells from one identical twin and infusing them into the other.
o In autologous transplantation patients receive their own stem cells back following
myeloablative (destroying bone marrow) chemotherapy.

• Gene therapy is an experimental therapy that involves introducing genetic material into a
person’s cell to fight a disease, such as cancer.

• Cancer patients may develop complications related to the continual growth of the
malignancy into normal tissue or to the side effects of treatment.

• Moderate to severe pain occurs in approximately 50% of patients who are receiving active
treatment for their cancer and in 80% to 90% of patients with advanced cancer.