Objectives
At the conclusion of this module, you will be able to:
- Describe
advances in the field of oncology related to the modality of chemotherapy.
- Identify
the different modalities of cancer therapy.
- Define cancer
disease staging and tumor classification.
- Identify
the basic characteristics of Carcinogenesis.
- Define the
differences between malignant and benign carcinoma.
- Describe
the phases of clinical trials in the testing of new anti-neoplastic
drugs.
- Describe
tumor response criteria and other methods by which response to
treatment is determined.
- Explain
the nursešs role in obtaining informed consent.
- Recognize
the signs and symptoms of an extravasation and infiltration of
a vesicant, and outline the appropriate nursing measures to minimize
tissue damage.
- Describe
safety precautions to minimize exposure of healthcare personnel,
family, patient, and the environment, from the potentially harmful
effects of chemotherapy.
Introduction
The American Cancer society traces its origins to 1913, when a group
of physicians and laymen met in New York City and founded the American
Society for the Control of Cancer. Their original premise at that
time, was to disseminate knowledge concerning the symptoms, treatment,
and prevention of cancer; investigate the conditions under which
the cancer occurred, and compile the statistics. The purpose of
the organization is very similar today; to conquer cancer through
balanced programs of research, education (preventative), patient
service, and rehabilitation.
Cancer is a
group of diseases characterized by the uncontrolled growth of abnormal
cells that spread from the site of origin. This spread, if uncontrolled,
invades vital organs and results, ultimately, in death. Early detection,
diagnosis, and treatment can cure many cancers while others can
be controlled for many years with a variety of treatment approaches.
Cancer is most
often treated by surgery, radiation, chemotherapy, and hormones.
Recently immunotherapy has been added to this armament. Cancer occurs
at any age, although it is sometimes referred to as a disease of
agingš, with statistics citing 66% of cancer deaths occurring after
the age of 65, it is also accountable for the death of more children
between the ages of 3 and 14 than any other disease.
More than 6
million Americans alive today have had a history of cancer; most
but not all, of the 3 million who were diagnosed five years ago
can be considered cured. "Cure" is defined as having no evidence
of recurrent cancer, while simultaneously having the same life expectancy
as a person who never had cancer.
For most forms
of cancer, five years after treatment with no signs of recurrence
is a good statistical mark for continued survival, although there
still can be an attrition rate beyond that time. In fact, for some
of the more aggressive cancers, fatal in a short period of time,
a three year survival rate may be considered a "cure". Other cancers
may require a much longer period of time without recurrence to be
considered cured. In 1991, 1 million people were diagnosed with
cancer. These statistics do not include nonmelanoma or carcinoma
in situ. Nonmelanoma cancers alone account for 600,000 new cases
annually.
At the turn
of this century very few people with major cancers had much hope
of long - term survival. More than 60 years ago, in the 1930s, less
than 1 in 5 persons with cancer was alive 5 years after cancer treatment.
In the 1940s it was 1 in 4, and in the 1960s it was 1 in 3. Today
40%, or four out of ten persons who develop cancer, will be alive
five years after treatment. The improvement from 1 in 3 to 4 out
of 10 represents 69,000 people in 1991 alone. This is an "observed"
survival rate. In terms of normal life expectancy when other causes
of death (heart disease, accidents, etc.) are taken into account,
50% of the cancer population will be alive five years after cancer
treatment. This "relative" survival rate is a more accurate measure
of success in the treatment of cancer.
Cancer is a
universal disease that affects people without regard to race, gender,
socioeconomic status, or culture. However, different forms of cancer
strike specific age, ethnic, and gender groups with varying frequency
and severity. For example, cancer morbidity and mortality increase5
rapidly with age, and it is believed by many researchers that if
you live long enough you will eventually develop some form of cancer.
Socioeconomic
factors are thought to explain ethnic differences in cancer. Both
the incidence and mortality of certain cancers are higher in African
Americans than in Caucasians. Although women are more likely to
develop cancer, men are more likely to die of the disease. The sites
in men that are associated with the greatest mortality are the lungs,
prostate, colon and rectum. In women the leading sites are the lungs,
breasts, colon and rectum.
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