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Question1. In approximately 500 words, describe the routhes and mechanisms of the spread of lung cancer. Metastasis is a term referring to the process by which cancer cells spread from the primary site to a distant site characterised by increased proliferation and invasiveness of the tumour cells (Engelking & cady,2008). It occurs in the final stage of cancer development and is least responsive to cancer treatment, contributing to the most common cause of death in cancer patients (Stafford,Vaidya,& Welch,2008). Therefore, it is considered to be a lethal, serious problem (Brooks,Lomax-Browne, Carter,Kinch,&Hall,,2010). The progression of tumour cell is attributed to genetic instability and mutation, by which the property of tumour cell becomes more and more malignant, eventually enabliing the tumour cells to dissociate from the primary site and spread(Shevd&Welch,2003). Metastasis is a cascade of events comprising a series of sequential steps (McCance&Barnette,2006). The first step is angiogenesis, the formation of new blood network surrounding the primary tumour cells (Weber,2008). When tumour cells undergo hypoxia, they secrete specific factors to stimulate angiogenesis (Otrock,Hatoum,Awada,Ishak,&Shamseddine,2009). The newly formed blood vessels serve to nourish tumour cells until they grow large enough to penetrate the wall of blood or lymph vessel to leave the primary site (Brooks et al.,2010) and it is thought that the incompletely matured blood vessels facilitate the penetration with higher permeability resulted from its relatively thin vessel wall (McCance&Barnette,2006). Also it is supposed that the diminished cell to cell adhesion within tumour cells permits the disaggregation and dissemination of tumour cells (Brooks et al,2010). The disaggregated tumour cells enter the circulation system, travelling throughout the body as a single cell or a group of cells and attach to the tissue of secondary site (Chambers,Groom,&McDonald,2002). However, not all the circulating tumour cells survive and succeed the attachment process (Stafford et al.,2008). Once the detached fragments of tumour cells enter the blood stream or lymphatic channel, they encounter the host defence of the body such as macrophages or natural killers (Engelking,2008). In addition to the host defences, the tumour cells can also be destroyed by the mechanical trauma including the turbulence of blood flow and shear forces (McCance&Barnette,2006). So the tumour cells must escape the immune system of the body and survive the local environment to reach the target cell (Brooks et al.,2010). According to Nash,Turner,,Scully,and Kakkar(2002), the tumour cells travelling as a single cell are more likely to be killed than those moving as a collective group. The clumps of tumour cells combine with platelets and leukocytes, which results in a physical shield surrounding the tumour cells that protects them from the immune destruction and physical threats (Nash et al.,2002). Tumour cells that have completed all the steps described as above finally reach the target organ (Engelking,2008). They invade the tissue barrier within the secondary site organ to penetrate and proliferate for colonization (Weber,2008). The mechanisms required for the growth and development of metastatic cells at the secondary site are similar to those of primary tumour, such as angiogenesis and invasion (McCance,2006). Yet not all tumour cells succeed settling down (Chambers et al.,2002). They may undergo apoptosis by the immune system of the secondary site or remain as dormant until activated in the future (Brooks et al.,2010). Question2. In approximately 600 words, Describe the evidence-based nursing management of three signs and/or symptoms that Mrs.Parker is experiencing. Although there are many symptoms and signs Mrs. Parker experiences, I chose two physical signs and one psychological symptom that are pain, ineffective breathing pattern, and...
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