Cancer Basics

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Foreword xv
Acknowledgments xvii
Section I. Foundations 1
Chapter 1. Biology of Cancer 3
Introduction 3
Models of Cancer Development 3
Structure and Function of DNA and Chromosomes 5
Self-Sufficiency in Growth Signals 9
Tumor Suppressor Genes 12
Sustained Angiogenesis 15
Tissue Invasion and Metastasis 15
Conclusion 16
References 16
Chapter 2. Staging and Performance Status 19
Introduction 19
Types of Cancer 19
Confirming a Diagnosis of Cancer 20
Nursing Implications of Cancer Staging and Performance Status 26
Conclusion 27
References 27
Chapter 3. Cancer Epidemiology and Prevention 35
Introduction 35
Epidemiologic Terms and Concepts 35
Risk Factors and Risk Assessment 40
Primary Cancer Prevention 47
Conclusion 52
References 52
Chapter 4. Genetic Risk for Developing Cancer 55
Introduction 55
The Genetic Basis of Cancer 55
Indications for Genetic Assessment 57
Standards for Genetic Testing 57
Provision of Cancer Genetic Education and Counseling 58
Common Cancer Genetic Predisposition Syndromes 68
Nursing Implications 75
Conclusion 76
References 76
Chapter 5. Cancer Detection Measures 81
Introduction 81
Principles of Secondary Cancer Prevention 81
Lung Cancer 84
Breast Cancer 85
Cervical Cancer 91
Endometrial and Ovarian Cancers 95
Colorectal Cancer 99
Oral Cancers 105
Testicular Cancer 106
Prostate Cancer 108
Skin Cancer 110
Nursing Implications 113
Conclusion 115
References 115
Chapter 6. Cultural Differences in Cancer Care 119
Introduction 119
Evidence-Based Cultural Care 119
Culturally Competent Nursing Care in Oncology 121
Conclusion 131
References 132
Section II. Treatment Options 137
Chapter 7. Pharmacogenomics 139
Introduction 139
History 139
Pharmacogenetics and Pharmacogenomics 140
Pharmacodynamics and Pharmacokinetics 141
P450 Cytochromes 141
Non-CYP Metabolizers 142
Drug Transport Genes 144
Nursing Implications 145
Conclusion 146
References 146
Chapter 8. Surgery 149
Introduction 149
Cancer Surgery Rationale 150
Staging 151
Types of Cancer Operations 151
Perioperative Nursing Considerations 154
Selected Cancers in Surgical Oncology 156
Conclusion 169
References 169
Chapter 9. Radiation Therapy 173
Introduction 173
The Science Behind Radiation Therapy 173
Clinical Uses of Radiation Therapy 175
External Beam Radiation Therapy 175
Internal Radiation Therapy: Radioactive Source Therapy 180
Radiation Safety 182
Side Effects 183
The Nursing Role in Radiation Oncology 185
Conclusion 185
References 191
Chapter 10. Chemotherapy 195
Introduction 195
Chemotherapy and the Cell Cycle 195
Mechanism of Action 197
Response to Chemotherapy 203
Chemotherapy Treatment Approaches 207
Routes of Chemotherapy 209
Administration 211
Conclusion 214
References 214
Chapter 11. Biologics and Targeted Therapies 217
Introduction 217
Historical Perspective 217
Immune System 218
Definition and Classification of Biologic Therapy 219
Maximum Tolerated Dose Versus Optimal Biologic Dose 220
Cytokines 220
Hematopoietic Growth Factors 220
Interferons 230
Interleukins 231
Monoclonal Antibodies 232
Hematologic Monoclonal Antibodies 234
Solid Tumor Monoclonal Antibodies 240
Small Molecules—Tyrosine Kinase Inhibitors 246
Tyrosine Kinase Inhibitors for Hematologic Malignancies 246
Tyrosine Kinase Inhibitors for Solid Tumors 250
Proteasome Inhibitors 253
Immunomodulatory Agents 254
Histone Deacetylase Inhibitors 256
Vaccines 257
Conclusion 260
References 261
Chapter 12. Hormonal Therapy 269
Introduction 269
Breast Cancer 277
Endometrial Cancer 278
Ovarian Cancer 279
Prostate Cancer 280
Side Effects of Hormonal Therapy 282
The Role of Supplements in Hormone-Sensitive Cancers 282
Treatments on the Horizon 282
Conclusion 284
References 284
Chapter 13. Clinical Trials 287
Introduction 287
Definition 287
A Brief History of Clinical Trials 288
Types of Cancer Clinical Trials 291
Phases of Cancer Clinical Trials 291
Elements of a Clinical Trial Protocol 293
Ethical, Legal, and Regulatory Issues 294
Conduct of Cancer Clinical Trials in the Oncology Setting 297
Nursing Implications 298
Conclusion 298
References 301
Chapter 14. Complementary and Alternative Medicine 303
Introduction 303
Definitions 304
Economics of Complementary and Alternative Medicine Use 305
Ethical and Legal Issues in Complementary and Alternative Medicine Use 311
Evidence Base 311
Defining Professional Duty 312
Nondisclosure 312
Children 312
Reporting Adverse Effects 312
Nursing Implications 313
Conclusion 314
References 314
Chapter 15. Transplantation 317
Introduction 317
Hematopoietic and Immunologic Concepts of Transplantation 317
Evolution of Transplantation 319
Types of Transplant 320
Transplant Program Standards 320
Preparing for Transplantation 322
Acute Side Effects 326
Late Complications 333
Long-Term Issues 336
Future Directions 339
Conclusion 339
References 340
Section III. Symptom Management 343
Chapter 16. Alopecia 345
Introduction 345
Risk Factors 346
Definition and Pathophysiology 346
Assessment 347
Prevention and Treatment 347
Patient Education 348
The Impact of Alopecia: Understanding What Hair Means 349
Conclusion 350
References 350
Chapter 17. Cardiac and Pulmonary Toxicity 353
Introduction 353
Risk Factors 353
Preventive Measures 354
Pathophysiology 355
Diagnosis 357
Treatment 357
Oncologic Emergency: Superior Vena Cava Syndrome 358
Oncologic Emergency: Cardiac Tamponade 358
Conclusion 359
References 359
Chapter 18. Cognitive Changes 361
Introduction 361
Risk Factors 361
Pathophysiology 363
Assessment 366
Symptom Management 367
Conclusion 367
References 367
Chapter 19. Dermatologic Complications 371
Introduction 371
Basic Rationale 371
Side Effects 371
Conclusion 379
References 379
Chapter 20. Gastrointestinal Symptoms 383
Introduction 383
Xerostomia 383
Mucositis 386
Dysphagia 392
Nausea and Vomiting 395
Constipation 403
Diarrhea 407
Conclusion 414
References 414
Chapter 21. Genitourinary Symptoms 421
Introduction 421
Overview of Urinary Incontinence 421
Assessment 422
Pathophysiology of Urinary Incontinence After Prostatectomy 422
Postprostatectomy Urinary Incontinence 422
Urinary Incontinence in Patients With Other Cancers 423
Consequences of Urinary Incontinence 424
Pelvic Floor Muscle Exercises 425
Nursing Interventions 427
Future Research 428
Conclusion 428
References 428
Chapter 22. Hematologic Issues 433
Introduction 433
Neutropenia 433
Anemia 438
Thrombocytopenia 441
Conclusion 445
References 445
Chapter 23. Hepatic Toxicities 449
Introduction 449
Liver Anatomy, Pathology, and Physiology 449
Liver Laboratory Parameters 452
Clinical Findings 454
Tumors 458
Surgery 459
Chemotherapy and Targeted Therapy 460
Liver-Directed Therapies 463
Graft-Versus-Host Disease and Sinusoidal Obstruction Syndrome 468
Conclusion 470
References 470
Chapter 24. Hypersensitivity 473
Introduction 473
Risk Factors 473
Pathophysiology 475
Diagnosis 478
Treatment and Nursing Implications 481
Prognosis 483
Conclusion 484
References 484
Chapter 25. Pain 485
Introduction 485
Definition of Pain 485
Etiology 485
Pathophysiology 486
Pain Assessment 486
Pain Management 490
Non-Narcotic Analgesics 491
Opioids 492
Adjuvant Analgesics 497
Interventional Strategies for Pain Management 500
Complementary and Alternative Medicine Therapies 503
Conclusion 504
References 505
Chapter 26. Peripheral Neuropathy 511
Introduction 511
Risk Factors 511
Pathophysiology 512
Assessment 512
Prevention and Treatment 515
Nursing Implications 518
Patient Education 518
Conclusion 520
References 520
Section IV. Issues for Cancer Survivors and Their Families 523
Chapter 27. Sexual and Reproductive Issues 525
Introduction 525
Integrating the Components of Sexuality 527
Effects of Cancer Treatment on Sexuality 528
Overcoming Physical Handicaps 529
Issues Related to Infertility After Cancer Treatment 532
Parenthood During or After Cancer Treatment 533
Relational Issues 535
Including Sexuality Assessment in Nursing Practice 536
Conclusion 537
References 538
Chapter 28. Developmental Life Stage Issues 541
Introduction 541
Early Adulthood (Ages 20–39) 542
Middle Adulthood (Ages 40–59) 543
Young-Old (Ages 60–75) 545
Old-Old (Age 75 and Older) 546
Conclusion 548
References 548
Chapter 29. Psychosocial Issues 551
Introduction 551
Conceptualizing Psychosocial Aspects 552
Traumatic Events on the Cancer Trajectory 553
Cancer and Post-Traumatic Stress Disorder 553
The Psychosocial Impact Along the Cancer Trajectory 554
Nursing Management of Psychosocial Aspects 557
Supportive Psychotherapy and Supportive Social Networks 562
Mitigating and Compounding Distress 563
Conclusion 565
References 565
Chapter 30. Caring for the Adult Childhood Cancer Survivor 569
Introduction 569
The Childhood Cancer Survivor Study 570
Common Adverse Medical Outcomes Associated With Treatment for Childhood Cancer 571
Depression, Post-Traumatic Stress, and Quality of Life in Adult Childhood Cancer Survivors 575
Risk-Based Follow-Up Care of Adult Childhood Cancer Survivors 578
Models of Care for Adult Survivors of Childhood Cancer 578
Transition of Care 580
Risk-Based Guidelines Interventions 581
Conclusion 582
References 582
Chapter 31. Ethical Issues 587
Introduction 587
Nurse’s Role 588
Diagnosis—Truth-Telling, Prognosis, Treatment Options, Hope 589
Caregiver Burden, Moral Distress, and Impact on Treatment Decisions 590
Advance Care Planning 592
Role of Ethics Consultants and Ethics Committees 595
Futility 598
Pediatric Issues 601
Treating Vulnerable Populations 604
Rehabilitation for Patients With a Terminal Cancer Diagnosis 605
Conclusion 605
References 606
Index 609
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