Oncology Nursing

Learning Objectives
At the end of this concept, the students should be ab le to: Identify nurses role in the prevention of cancer and in health education. Discuss the pathophysiology of cancer and its clinical manifestation. Apply the nursing process to identify care of the client in the diagnosis and treatment phases of cancer Formulate plan of care for the client ith early stage and advanced cancer !alue the nurses role in providing "uality, comprehensive, individuali#ed, ethical and humane care of client ith cancer.

Intro
$ancer as recogni#ed in ancient times by s%illed observers ho gave it the name &$AN$'() *latin, $ancri,crab+

It may spell death and mutilation to others.

What is Cancer?
Dse of the cell

wherein the normal growth controlling mechanism of cells is uncontrolled or altered = SPREAD OF CANCER CELLS.

CELLULAR ABERRATIONS - Neoplasia

Alterations in cell differentiation $a, -nd leading cause of death in the ./ after

$!D.
0neoplasm1 comes from 2ree%

ord 3ne

gro th

/ynonym

4 malignant neoplasm

5hat is $ancer6
$a cells are different bec. they do not die, 7ust continue to divide 8 gro . $a cells form as a result of damaged DNA. 9roduced serious problem i.e. impaired immune 8 hematopeitic f:n 8 many others

CA is not just one dse but dses"

; <== diff. types of $A.

an!

$A are named for the organ or type of cell in 4c they start , for e:ample,

CANCER

$A cells can spread to other parts of the body through the blood 8 lymph system So e Ca tu ors" do not #or

$at%ogenesis
Cellular Trans#or ation 'erange ent T%eor! &

, conceptuali#es that N cells may be

transformed into $a cells d4t e:posure to some etiologic agents

$at%ogenesis
(ailure o# t%e I T%eor! une Response

, /o the $a cells undergo destruction. (ailure o# t%e i une response s!ste leads to inabilit! to destro! t%e ca cells"

Clic) to edit *aster te+t st!les Second level T%ird level (ourt% level (i#t% level

Clic) to edit *aster te+t st!les Second level T%ird level (ourt% level (i#t% level

Neo lastic growth

Com ression of !lood su l" Com ression of organs

Accumulation of to#ic waste roducts

$schemia and necrosis

$nterference with function

Pain. Infection, Bleeding

Host reaction Mobilization of compensatory mechanisms %aries with organ in&ol&ed 'e#. $ncreased eristalsis w( tumor o!struction of !owel) Immune responses

Ele&ated leu*oc"te count $nflammator" res onse Ele&ated tem erature and ulse

>'(?/
@ ON$O2'N' A$>I!A>ION a. 9roto,oncogene A acts as ,on s-itc% for cellular gro th, devtl gene during early embryonic devpt. @ hen proto,oncogenes are turned ON, they are then called oncogenes b. $ancer /uppressor gene A &turn o##) unneeded cellular gro th. A gene that suppresses the e:pression of an oncogene.

>'(?/
ON$O2'N' A$>I!A>ION c. Oncogene A segments of DNA that hen INA99(O9IA>'BC Activated 3 contribute to the transformation of N cell into malignant cells.

>'(?/
Neoplasia,abn cellular gro th of ne tissues gro th 8

Dypertrophy , Increase in cell si#e Dyperplasia A Increase in cell E ?etaplasia, replacement of < adult cell type by a diff. adult cell type

>'(?/
Dysplasia, $hanges in cell si#e, shape 8 organi#ation Anaplasia, reverse cellular devt. >o a more primitive or embryonic cell type ?etastases, /pread of ca cells to distant parts of the body to set up ne tumors
Oncology, ?edical specailty that deals d:, t: 8 study of cancer. 4 the

>'(?/
Adenocarcinoma, ca that arises from glandular tissues. $arcinoma A A $a that is composed of epithelial cellsF develops in tissues covering or lining organs of the body /arcoma, a $a of supporting or connective tissues $arcinogens, factors assoc. 4 ca causation

Ter inologies
<. 9roliferation A process of cell division or gro thF an inherent adaptive mechanism for replacing body cells hen old cells die or additional cell are needed. , A process 4c cells bear offspring

Ter inologies
-. Differentiation A the e:tent to 4c the replicated cells are similar to the original cellF process hereby cells are transferred into diff. 8 more speciali#ed cell types. , ANA$LASIA, lac% of cell differentiation in cancerous cells

$haracteristic
Nor al cell Das contact inhibition $ohesive d4t fibronectin 5ell regulated mitosis , undergo A9O9>O/I/ /mall nuclear, cytoplasmic ratio /%eletal muscle gro by hypertrophy NO> by hyperplasia *,+ *,+, metastasi#e Do not respond to signal of apoptosis, continuous cell division Barge nuclear, cytoplasmic ratio anaplasia Cancer cell

C.ARACTERISTIC

NOR*AL

BENI/N

*ALI/NANT

.ave li ited Speed0Rate cell o# gro-t% division1 234contact in%ibition /ro- in orderl! & -ell regulated anner" Undergo Apoptosis

SLO5 continuous or inappropriate cell gro-t%1 2-4 contact in%ibition

.ave rapid or continuous cell division12-4 contact in%ibition or variable1 depends on level o# di##erentiation

*ode o# gro-t% & Cell deat%

/ro-s b! e+pansion6 'o not respond to signal #or apoptosis or do not in#iltrate surrounding

/ro-s at perip%er! destro!ing surrounding tissue6 'o not respond to signal #or apoptosis or in#iltrate

5ell 5ell di##erentiated- Undi##erentiated 7o#ten bear Cell di##erentiate rese ble1 nor al cell little c%aracteris d cells tissue tic *etastasis 2-4 because Cells ad%ere tig%tl!6 co%esive ENCA$SULATE' Not capsulated6 *etastasi8e via blood vessels1 l! p%atic & direct bod! cavit! 1 gain access to bld & l! p% c%annels

C.ARACTERISTIC

NOR*AL

BENI/N

*ALI/NANT

/eneral e##ects

Locali8ed p%eno enon6 not %ar #ul to %ost6 pain can be present6 does not cause general e##ect unless location inter#eres vital organs bld #lo-

$arasitic6 causes generali8ed e##ects i"e" ane ia1 -ea)ness & -eig%t loss O#ten cause generali8ed e##ects i"e" ane ia1 -ea)ness & -t"loss

Tissue destructio n

unless location O#ten causes tissue inter#eres vital organs da age as tu or bld #looutgro-s t%e bld suppl! or enroac%es on bld #lo- to t%e area Unless t%e location inter#eres -0 vital #+n" /ood prognosis -%en surgicall! re oved Usuall! cause deat% unless gro-t% is controlled" $oor prognosis i# not controlled

Abilit! to cause deat%

$a cells do not spend time in 2o phase 4 resting phase

9 distinct p%ases:

/o

resting phase in 4c nondividing cells reside.

/; 2gap ;4 post,mitotic phase , DNA synthesis ceases hile (NA 8 $DON synthesis 8 cell gro th ta%e place. S p%ase DNA synthesis occurs, giving rise to - separate sets of chromosomes, <for each daughter cell <= , -= hours /< 2gap <4 pre,mitotic phase 8 is similar to DNA synthesis ceases hile (NA 8 $DON synthesis continues < - ;= %ours * p%ase mitosis or phase of cell division ="> - ; %our

 T%e duration : var! depending on t%e cell t!pe6 ver! rapidl! dividing cells can co plete t%e cell c!cle ?@ %ours 1 ot%ers can ta)e longer t%an ; !ear" Aariabilit! occurs in /o and /; p%ases" S $%ase ;= - <= %ours

/< < - ;= %ours * p%ase ="> - ; %our Tu or - s-elling t%an can be caused by a E of conditions, including inflammation 8 trauma.

*etastases

9(I?A(C ?ABI2NAN> N'O9BA/?

$'BB D'>A$D?'N>
Separate from primary neoplasm and penetrate lymphatic or blood vessels

DI//'?INA>ION Lymphatic or hematogenous dissemination A(('/> Trapped in a capillary bed '/>AGBI/D?'N> Aberrant clump of malignant cells must break through the vessel into the interstitial spaces to continue to grow 9(OBIF'(A>ION

*etastatic *ec%anis s

LB*$.ATIC S$REA' transporting tumor cells thru lymphatic circulation via Interstitial fluid or invasion. .E*ATO/ENOUS S$REA' dissemination thru bld stream that is directly r4t tumor vascularity AN/IO/ENESIS - ability of malignant cells to induce the gro th of ne capillaries from the host tissue to meet their need for nutrient 8 O-

*etastatic *ec%anis s
INAASION & *ETASTASIS , ability to allo the spread or transfer of cancerous cells from one organ or body part to another. Done thru its specific affinity to bind to molecules in specific body tissue.

+ t" es of tumors, -alignant and .enign .enign tumors / new0 nonmalignant cell growth not needed for normal growth or re lacement. sta" in one lace. 1armless growth that does not s read or in&ade other tissues.
-alignant tumors

What is Cancer

/ CANCERO2S0 new growth of cells needed for normal growth or re lacement. A!normal cellular growth

Benign

*alignant

Cell gro-t% 7 EC$ANSION ENCA$SULATE'1 surrounded b! #ibrous connective tissue No etastasis

INAASION Not encapsulated1 cell e b" %as proteins called TU*OR S$ECI(IC ANTI/ENS" Can etastasi8e

Rese bling nor al cells 'oes not cause deat% unless its location inter#eres vital #+n

undi##erentiated Causes deat% unless gro-t% is controlled

>ypes of $ancer
Sarco a Adenocarcino a Carcino a Leu)e ia L! p%o as

*ain Categories o# CA
AdenoCarcino a , begins in the s%in or in tissues that line or cover internal organs. Sarco a , begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leu)e ia , starts in blood,forming tissue i.e. the bone marro 8 causes large Es of abn bld cells to be produced 8 enter the bld.

*ain Categories o# CA
Leu)e ia A starts in blood,forming tissue i.e. the bone marro and causes large Ers of abn bld cells to be produced 8 enter the bld. L! p%o a & *!elo a , begin in the cells of the immune system CNS Ca , begin in the tissues of the brain 8 spinal cord.

 >he process of cell gro th 8 division is called the CELL CBCLE" >D' interval bet een each cell division.

$ommon $auses 8 /ites

;" Breast Ca

early ?enarche Bate menoupause Nulliparous or older than H= at the birth of <st child >obacco use Asbestos (adiation e:posure 9ollution

<" Lung Ca

D" Colorectal ca greater in men Familial polyposis .lcerative colitis Digh,fat,lo ,fiber diet

$ommon $auses 8 /ites

9" $rostate Ca

?ales I= years old 8 older African American *J+ Fam h: ':posure to cadmium /e:ual Gehavior

>" Cervical Ca

,<st intercourse at an early age , multiple se:ual partners , /e:ual partner ho has had multiple se:ual partner

D9! 8 AID/ Bo /ocio,economic status $igarette smo%ing

$ommon $auses 8 /ites

E" .ead & Nec) Ca

?ore common among males Alcohol 8 tobacco use 9oor oral hygiene Bong term sun e:posure Occupational e:posures,asbestos, tar, nic%el, t:tile, ood or leather or%, 8 machine tool e:perience Individuals 4 fair comple:ion *J+ fam h: ?oles *nevi+ ':posure to coal 8 tar, creosote, arsenic, radium /un e:posure bet. <<Am to H9?

F" S)in ca

/ENERAL E((ECTS O( CANCER:

Overall E##ects:
Altered #+n o# t%e involved tissue Bleeding & %e orr%age

Related Tu or Action Destruction 8 replacement parenchymal tissue by neoplastic gro th

of

$ompression of bld vessels, 4 ischemia 8 necrosis of tissue, or tumor may outgro its bld supply

Ulceration1 necrosis & Ischemia assoc. 4 rapid gro th, in#+n o# tu or area 4 subse"uent bacterial invasion Obstruction o# %ollo- ':pansive gro th of tumor 4 viscera or compression 8 invasion of tissues co unication pat%-a!s

/ENERAL E((ECTS O( CANCER:

Overall E##ects: Related Tu or Action E##usion in Impaired lymph flo from serous cavities serous cavity or erosion of tumor into the cavity Increased ris) o# Abn prod. of coagulation vascular factors by the tumor into the t%ro bosis cavity Ane ia Gleeding 8 depression of (G$ production

Bone destruction ?etastatic invasion of bony structures

/ENERAL E((ECTS O( CANCER:

Overall E##ects: Related Tu or Action

Dypercal Destruction of bone d4t cemia metastasis or prod. by the tumor of parathyroid,li%e, hormone 9ain Biberation of pain mediators by the tumor, compression, or ischemia of structures

/ENERAL E((ECTS O( CANCER:

Overall E##ects: Related Tu or Action $ache:ia, $atabolic effect of tumor on body ea%ness, metabolism along 4 selecting asting of tissues trapping of nutrients by rapidly gro ing tumor cells Inappropriate hormone production of *A$>D or ADD+ secretion by $a i.e. bronchogenic carcinoma 9rod. by the tumor of hormones or hormone,li%e substances that are not regulated by normal feedbac% mechanism

Etiologic Factor of Cancer

A. Viruses B. Chemical

carcinogens C. Physical agents D. Hormones E. Genetics

Etiologic Factor of Cancer

*@= G r0t li#e-st!le & envtl carcinogens: Gy family h:: ;=G ris) / primary relativeF ;>G , 4o affected family memberF D=G , 4 affected family member.

Etiologic Factor of Cancer

A. %iruses / rolong or fre3uent &iral infections ma" cause !rea*down of the immune s"stem or o&erwhelm the immune s"stem Eg., 1P% / cer&ical E stein4.arr &irus4 L"m homa 1e . 5 C / 1e a"tocellular Ca 1elico!acter P"lori4 gastric Ca
.u an T-cell leu)e ia0l! p%o a virus lymphoma 8 leu%emia.

*DI!+: AIDS.. lymphoma 8 a rare $A called Kaposi's sarcoma.

A. Viruses
ONCO%$R2SES
1e atitis . &irus /

rimar" li&er carcinoma 1er es sim le#0 c"tomegalo&irus0 1uman a illoma &irus / cer&ical ca0 angiogenital carcinoma E stein .arr / naso har"ngeal ca0 hodg*in6s disease

Etiologic Factor of Cancer .. Chemical Carcinogens

/ causing cell mutation or alteration in cell en7"mes 5 C1ONs causing altered cell re lication. ..8. $ndustrial Com ounds 4%in"l Cl ' lastic0 as!estos0 factories0 construction wor*s) 4Pol"c"clic aromatic h"drocar!ons 0 cigarette smo*e0 industrial agents0 smo*ed foods0 !roiling meats 5 animal fats0 refuse !urning0 auto 5 truc* emissions0 oil refineries0 air ollution) 4 Fertili7ers0 weed *illers 4 D"es 'analine d"es used in !eaut" sho s0 hair !leach)

Etiologic Factor of Cancer

.. Chemical Carcinogens ..+. Drugs 4 9o!acco 'tar nicotine)0 :;< of all causes of lung Ca are d(t smo*ing0 alcohol0 c"toto#ic drugs

Etiologic Factor of Cancer

.. Chemical Carcinogens ..=. 1ormones
/ tumor growth ma" !e hormonal !alance, romoted !" distur!ances in

4 Estrogen - Diestylbestrol (DES) / in cer&ical &aginal ca0oral

contrace ti&e0 rolonged ER9 = li&er0 endometrial 5 !reast ca. >.+) !reast ca0 rostate0 uterus ca de ends on endogenous hormone le&el for growth.

Etiologic Factor of Cancer

.. Chemical Carcinogens
..?. Foods0 Preser&ati&es / Nitrosamines(Nitrites / carcinogens used as reser&ati&es in longganisa0 !acon 0 hotdog0 smo*ed meat)= 'ru!!er !a!" ni les)

-a" !e inhi!ited !" resence of Antio#idants eg, Vit C0 &egeta!les 5 fruits

4 9alc ' olished rice0 salami0 chewing gum)

Etiologic Factor of Cancer

.. Chemical Carcinogens
..?. Foods0 Preser&ati&es /Food

Sweeteners

Aflato#in / eanuts 5 eanut !utter0 grains0 mil*0

cheese

.en7o "rene 4

roduced when meats 5 fish are charcoal !roiled '!urned art)0 reusing coo*ing oil

Etiologic Factor of Cancer

C. Ph"sical Carcinogens

Radiation / @4ra"s or radioacrti&e isoto es from sunlight(ultra&iolet ra"s. $oni7ing 4 radium0 #4ra"s 0 gamma ra"s 2ltra&iolet non4ioni7ing / sun e# osure0 tanning !eds0 germicidal lights

Etiologic Factor of Cancer

C. Ph"sical Carcinogens

Ph"sical irritation(trauma, i e smo*ing0 multi le deli&eries0 Aagged tooth0 irritation of the tongue0 Bo&eruse of an" organ(!od" art

Etiologic Factor of Cancer

D. 1ormones

Estrogen/ as re lacement thera " has !een

found to increase incidence of &aginal0 cer&ical0 uterine ca.

Etiologic Factor of Cancer

7. Endogenous %or ones hormones play a ma7or role in the etiology of several human $As.
estrogens appears to be primary stimulant for

breast cell proliferation 8 facilitates mutation or e:pression of genetic errors leading to breast $A.
prostate $A depends on androgenic stimulationF

testosterone can cause prostate $A in rats.

$ertain Dormones
Doctors may recommend hormones *estrogen
alone or estrogen along 4 progestin+ to help control problems *i.e. hot flashes, vaginal dryness, 8 thinning bones+ that may occur during menopause.

Do ever,

studies sho that menopausal hormone therapy can cause serious side effects. Dormones may K the ris% of breast $A , heart attac%, stro%e, or blood clots.

 Diethylstilbestrol

*D'/+, a form of estrogen, as given to some pregnant omen in the ./ bet. about <LM= 8 <LN<.

5omen

ho too% D'/ during pregnancy may have a slightly higher ris% of developing breast $A. >heir daughters have an Ked ris% of developing a rare type of $A of the cervi:. >he possible effects on their sons are under study.

Etiologic Factor of Cancer

and Familial factors / DNA '8;48C< are inherited)

Dhen

E. >enetics

oncogene 'hidden or re ressed genetic code for ca that e#ists in all indi&iduals; is e# osed to carcinogens0 changes in cell structure occurs0 malignant tumor de&elo s assoc. w( familial atterns.

Regardless of the cause0 se&eral ca are

Etiologic Factor of Cancer E. ) Genetic and Familial factors

Dilm6s tumor0 Retino!lastoma Pheocromoc"toma Leu*emia Colon adenocarcinoma0 .reast0 Prostate0 stomach0 lung0 colorectal Cancer

Predisposing Factor
A. )Age4 ris* increases EC;. . Older indi&iduals are more

rone to ca !ec.the" ha&e !een e# osed to carcinogens longer. $n addition0 the" ha&e de&elo ed alterations in the immune s"stem.

.. )Diet4 high fat0 high cholesterol diets increase ris*. C.) Se# E -ost common t" e of Ca in females is !reast ca. Dhereas0 in males ois rostate Ca

Predisposing Factor
D. )2r!an &s. Rural residence Common among ur!an dwellers than rural residents. Pro!a!l" d(t e# osure to carcinogens0 more stressful lifest"le and greater consum tion of reser&ati&e4cured foods among ur!an dwellers. E. )>eogra hic Distri!ution / Common t" e of Ca in Fa an is gastric ca. Dhile in the 2S is !reast ca. -a"!e d(t influence of en&t6l. factors as nat6l diet 'raw foods greatl" consist Fa anese diet)0 ethnic customs0 t" es of ollutions.

Predisposing Factor
F.) Occu ation >reat ris* among chemical factor" wor*ers0 farmers0 radi;log" de t. ersonnel >.) 1ereditar" 'G) famil" h# of Ca increases the ris* to de&elo the dse. $n adults a ro#. =?< of ca ha&e a familial !asis. Ca that ma" ha&e familial lin* include !reast0 o&arian0 colorectal0 rostate0 melanoma0 uterine0 lue*emia0 sarcomas0 5 rimar" !rain tumors.

Predisposing Factor
1.) Stress de ression0 grief0 anger0 aggression0 des air0 or life stresses decreases immunocom etence !ec.of affectation of h" othalam"us 5 ituitar" gland. $mmunodeficienc" ma" s ur the growth 5 roloferation of ca cells. $.) Precancerous Lesion E Pigmented moles0 !urn scars0 senile *eratosis0 lue*o la*ia0 !enign ol" s or adnoima of the colon or stomach0 fi!roc"stic dse of the !reast0 ma" undergo transformation into cancerous lesions 5 tumors.

Predisposing Factor
F.) O!esit"
Studies ha&e lin*ed o!esit" to !reast 5

colorectal ca

no clear lin* !ut research indicates it is a

factor
H. )$mmune s"stem diseases

 5hat substance hich is considered as a carcinogen that is usually found on peanuts and peanut butter6 A. Gen#opyrine G. Aflato:in $. 9olycyclic hydrocarbons D. Nitrosamines

/>A2'/ OF $A($INO2'N'/I/ <.

A reversible, carcinogen mutates or damages DNA structure of normal cell. Oncogene is turned ON >umor suppresor gene is OFF Natural Oiller $ell *NO cell+ activated to eliminate mutated cancer cell.

INI>IA>ION

/>A2'/ OF $A($INO2'N'/I/
-. 9(O?O>ION A reversible since it depends in the presence of repeated e:posure to promoting agents *cocarcinogens+ after long latency period. 'g: repeated tobacco smo%ing

 H. 9(O2('//ION A irreversible,rapid proliferation of cancer cells. *J+ morphological change and malignant behavior $a cells produces destructive en#ymes *proteinases, collagenases, lysosomal hydrolyses+ *J+ Angiogenesis due to tumor angiogenesis factor produced by cancer cells.

/>A2'/ OF $A($INO2'N'/I/
M. IN!A/ION 4 ?'>A/>A/I/ A cancer cell move from primary site to distant body sites !ia : lymphatic system, blood vessels, direct spread in the body cavity

?etastasis
<. $a moves from their original location to other sites -. (outes of metastasis a. Bocal seedingF distribution of shed ca cells occurs in the local area of the primary tumor b. Glood,borneF tumor cells enter the bld, 4c is the most common cause of ca spread c. Bymphatic spread: primary sites rich in lymphatics are more susceptible to early metastaic spread.

Ca Classi#ications
<. /olid tumorsF Assoc. 4 the organs from they develop, i.e. breast $a or lung $a 4c

-. Dematological $a: Originate from bld cell, forming tissues, i.e. lue%emias 8 lymphomas.

$AN$'( $BA//IFI$A>ION
/RA'IN/ 7 classify the cellular aspect of the cancer cells, to determine its differentiation , si#e of the tumor 8 e:istence of metastases ,necessary at the time of d: to det. >he e:tent of dse, det.prognosis 8 guide proper mngt. /rading 7 classification of tumor cells

 2(ADIN2 A classify the cellular aspect of the cancer cells, to determine its differentiation /+ A cannot be assessed

$AN$'( $BA//IFI$A>ION
/; 7 tumor cells ell differentiated, malignant but slo gro ing /< A moderately differentiated , more malignant than 2<

/D A poorly differentiated, have fe N cell ch: /9 A poorly differentiated, NO N. cell ch:, anaplastic

/>A2IN2
>N? /C/>'? > Ae:tent of >umor or si#e N A lymph node ? A distant metastasis

>: >is >o ><, >-, >H N: No N<, N?: ?o ?<,?-

$annot be assessed $arcinoma in situ No evidence of primary tumor P-cm, >umor -,I cm, >umor ; Icm $ant be assessedQ No regional lymph node metastasis King nodal involvement $ant be assessed No distant metastasis King Distant metastasis

Staging
/tage =F carcinoma in situ /tage I: >umor limited to the tissue of originF locali#ed tumor gro th /tage II: Bimited local spread /tage III: ':tensive local 8 regional spread /tage I!: metastases

 ?rs. G has breast cancer. Der physician has 7ust told her that her cancer has been staged as HT< N; *=I and ?rs. G as% the nurse hat this means. >he nurse ans er is based on the understanding that: A. >he primary tumor is -cm in diameter, she has one positive lymph node, no metastasis. G. >here are - primary tumors, one involved the lymph node and no metastasis. $. >he primary tumor is bet een - to I cm in si#e, she metastasi#e to one lymph node, no distant metastasis. D. >here is carcinoma in situ, no regional lymph node involvement, and the presence of distant metastasis cannot be assessed.

Detection and $ancer 9revention

$ri ar! $revention Secondar! $revention Tertiar! $revention

Primary Prevention
Aimed

at inter&ent. !efore athologic change has !egun0 Reduce ris* through alteration of lifest"le !eha&iors or reduce e# osure to carcinogens

Primary Prevention
A&oidance of *nown or otential carcinogens

Sto smo*ing0 s*in rotection with sun e# osure0 a&oid o&ere# osure from the sun 8;am to = m etc A&oid 1igh fat diet 5 sedentar" lifest"le0 alcoholic !e& in moderation0 e#ercises0 ro er nutrition

-odification of associated ris* factors

econdary Prevention
Earl"

detection ro&ides the o ortunit" to detect recancerous lesion or earl"4stage Ca0 to treat them rom tl".

/econdary 9revention
'arly detection, case finding
(emoval of &at ris%) tissues, or premalignant lesions.

(emoving colon polyps, moles

'arly diagnosis of malignancy 3 provides opportunity to detect precancerous lesions or early stage $a before manifestations become apparent.

Reco

ACS 2A erican Ca Societ!4 endations #or Earl! Ca 'etection in As! pto atic $eople

Ca-related c%ec)-up 3 "H yrs .for age -=,M= yrs. 8 " year for M= 8 older.

;" Breast 3 annual mammogram for M= yrs 8 K 3 $G' *clinical breast e:am+ performed by healthcare prof., 3 G/' *breast self,e:am+ mos. , "Hyrs -=,HL yrs.old 8 mos.

Reco

ACS 2A erican Ca Societ!4 endations #or Earl! Ca 'etection in As! pto atic $eople

D" Colon & Rectu 3 for I= yrs 8 older Fecal Occult Gld test *2uiac+ yearly 8 fle:ible sigmoidoscopy " I yrs. $olonoscopy "<= yrs Double,contrast barium enema "I,<= yrs D(' at the same time as sigmoidoscopy, colonoscopy or double,contrast barium enema.

Reco

ACS 2A erican Ca Societ!4 endations #or Earl! Ca 'etection in As! pto atic $eople

9" $rostate J Annuall! #ro age >= & %ig% ris) group 2strong familial predisposition,- or more affected in <st degree4 9/A Gld test D('

Reco

ACS 2A erican Ca Societ!4 endations #or Earl! Ca 'etection in As! pto atic $eople

>" Uterus Cervi+, ho are 8 have been se:ually active, M= yrs 8K 3 Annual 9ap /mear or 9elvic e:am ,after H or more consecutive satisfactory e:ams 4 normal findings, 9ap smear may be less fre"uently. ,D9! is recommended Endo etriu 7 high ris% omen, have endometrial sample tissue e:amined hen menoupause begins.

/creening 9rograms American $ancer /ociety -==H

A/E #reKuenc! <R -= to HL Cearly " mos. S H C(/

9= AN' BEARLB OL'ER

'IA/NOSTIC ECA* 9elvic e:amination and 9A9 /?'A( *for se:ually active+ Greast /elf ':amination >esticular /elf ':am G('A/> $BINI$AB 'TA? *G$'+
BREAST CLINICAL ECA* *A**O/RA$.B 'RE onl! 2 & #4

/creening 9rograms American $ancer /ociety -==H

>= AN' BEARLB OL'ER

/I2?OIDO/$O9C *m 8 f+ Fecal Occult Glood test 4 /tool 2uaiac 9rostate ':amination *m+: D(' 8 9rostate /pecific Antigen /igmoidoscopy $olonoscopy at I= then " <= yrs

econdary ! cancer "arning signs #CA$%&'(A)*

C %ange in BO5EL & BLA''ER %abits A sore t%at does not %eal U nusual bleeding T %ic)ening or LU*$ else-%ere in t%e bod! I ndigestion or di## in s-allo-ing O bvious c%ange in -arts or ole N agging coug% & .OARSENESS in voice A ne ia 2une+plained4 L oss o# -eig%t 2une+plained4

! cancer "arning signs #CA$%&'(A)*

C.AN/E in BO5EL & BLA''ER %abits or alternating

diarr%ea & constipation is t%e ost c%aracteristic ani#estation o# Colon Ca

C.AN/E in BLA''ER %abits

a! signi#! bladder or prostate Ca

econdary ! cancer "arning signs #CA$%&'(A)*

A sore t%at does not %eal

c%arac" Ca bec" t%e tu or causes i paired circulation & o+!genation in t%e area" T%is leads to tissue necrosis1 ulceration1 bleeding & in#ection"

econdary ! cancer "arning signs #CA$%&'(A)*

Unusual bleeding or disc%arge #ro t%e bod! part

a##ected b! Ca is d0t i paired circulation & o+!genation in t%e area" T%is leads to tissue necrosis1 ulceration1 bleeding & in#ection" - In#ection causes unusual disc%arge"

econdary ! cancer "arning signs #CA$%&'(A)*

T%ic)ening

or

LU*$

else-%ere in t%e bod! a! signi#! abnor al cellular gro-t%

econdary ! cancer "arning signs #CA$%&'(A)*

Indigestion s-allo-ing

or

di##"

in

usual initial ani#estation o# /astric Ca

econdary ! cancer "arning signs #CA$%&'(A)*

Obvious c%ange in -arts or ole1 li)e sudden gro-t% in si8e o# -art or ole1 uneven coloring1 c%ange in t%e te+ture a! signi#! trans#or ation into cancerous lesion"

econdary ! cancer "arning signs #CA$%&'(A)*

Nagging coug% .OARSENESS in

& voice

signi#ies Ca o# t%e Lar!n+ or lungs

econdary ! cancer "arning signs #CA$%&'(A)*

Ane ia

Une+plained

d0t

t%e ## #actors: Ca cells ta)e up (e #aster t%an t%e nor al cells6 bleeding contributes to ane ia6 Ca cells tend to destro! nor al RBCs"

econdary ! cancer "arning signs #CA$%&'(A)*

Loss o# -eig%t 2une+plained4

a!be related to ane ia & c%ange in bo-el & bladder %abit 2 alnutrition & de%!dration4

 Dhich of the following is associated with

the role of secondar" cancer re&entionI A. Pre&ention of secondar" malignancies .. Pre&ention of genetic cancer inheritance C. Detection and screening for earl" diagnosis D. A&oidance of smo*ing and sun e# osure

Tertiary
Health counseling Decrease reoccurrence of cancer Support groups

CANCER 'ETECTION ECA*S

$C>OBO2I$ 'TA?/ or 9A9 /?'A( GIO9/C .B>(A/O.ND BAGO(A>O(C GBOOD >'/> 4 />.DI'/

D'?A>OBO2I$ *$G$+ 8 5G$ differential >.?O( ?A(O'( ID'N>IFI$A>ION

CANCER 'ETECTION ECA*S

CBTOLO/IC ECA*S or $A$ S*EAR , Obtain from tumors that tend to shed cells from their surface. ,'g, 2I> through endoscopy (espi tract through laryngoscopy or bronchoscopy 2.> through colposcopy of the cervi: 8 vagina Gladder through cystoscopy 9elvic 8 Abdominal cavity through laparoscopy
$A$ S*EAR 7 detects Cervical Ca

RESULT
CLASS ; NOR*AL CLASS < CLASS D

$A$ s ear

IN(LA**ATION 2Rpt a#ter D

os4

*IL' to *O'ERATE 'BS$LASIA 2Rpt -0in D -)s $ROBABLB *ALI/NANT 2BIO$SB4 *ALI/NANT

CLASS 9 CLASS >

CANCER 'ETECTION ECA*S

BIO$SB , obtaining tissues by needle aspiration or incision of tumor A" Needle Biops! A aspiration of tumor cells 4 needle 8 syringe B" E+cisional biops! A removing the entire tumor, hen the tumor is small C" Incisional or subtotal biops!- only a part of the tumor hen the tumor is large

 GIO9/C FNAG

$O(' N''DB' GIO9/C

CANCER 'ETECTION ECA*S

ULTRASOUN'1 *RI1 RA'IOLO/IC TEST1 CAT or CT1 EN'OSCO$IC ECA*S

 I*A/IN/ TEST

mammography ?(I A no radiation $> /$AN .B>(/ONO2(A9DC !I/.ABIUA>ION 3 ,oscopy N.$B'A( /$AN A introduction of radioactive dye ff by imaging of tissues that have concentrated the radioisotopes, H%ot spots) indicate malignancy

CANCER 'ETECTION ECA*S

LABORATORB BLOO' TEST 0 STU'IES
- .E*ATOLO/IC 2CBC4 & 5BC di##erential
.e oglobin & .ct L in Ane ia indic" alignan! Lue)oc!tes M in Lue)e ia 2I ature 5BCs4 & L! p%o as L Lue)e ia 2 ature 5BCs4 & etastatic dse to Bone *arro $latelets - M in C*L & .odg)inNs1 L ALL & A*L & *ultiple *!elo a & Bone *arro- 'epression -

CANCER 'ETECTION ECA*S

LABORATORB BLOO' TEST 0 STU'IES
TU*OR *AROER I'ENTI(ICATION A($ - M in lung1 testicular1 prostate1 colon1
gastric & c%oriocarcino a CEA - M in colorectal1 breast1 lung1 sto ac%1 pancreatic & prostate Ca .C/ - M in c%oriocarcino a1 ger cell testicular ca1 ectopic production in lung1 liver1 gstric1 pancreatic1 & colon Ca $rostatic Acid $%osp%atase - M in etatstatic prostate Ca & p-rostate Ca

Tu or *ar)er

Nor al Aalue

Condition at -0c levels a! be altered

Alp%a (eto $rotein ?;=ng0 l Lung1 $ancreatic1 2A($4 Colon1 /astric CA ;<> ?D> units Ovarian 1 $ancreatic

Carcinoe br!onic = 7 Colorectal1 Breast1 Antigen 2CEA4 <">ng0 l Lung1 sto ac%1 $ancreatic $rostate Speci#ic =-9ng0 l $rostate Antigen 2$SA4 $rostatic Acid $%osp%atase ="<E 7 ="@D U0L *etastatic $rostate Ca

 URINE Gence,Vones 9rotein Adetects ?ultiple ?yeloma OCCULT BLOO' A 2I bleed

 9he nurse is caring for a client with a

diagnosis of cancer of the rostate. 9he nurse anal"7es the la!orator" &alues and notes that the Serum Acid hos hatase titer is ele&ated. 9he nurse determines that this la!orator" test in most often useful in determining, A. 9he diagnosis of rostate cancer .. Com lications associated with cancer C. Progression or regression of the cancer D. 9he li*elihood of associated !one cancer

 9he atient6s a aniculaou smear ' a smear) result

is Class $$$0 which of the following inter retation is correctI A. $ts normal and does not need an" further inter&ention .. 9here is resence of inflammation and the atient needs to re eat the test after = months C. 9here is ro!a!l" malignanc" and needs !io s" D. 9here is mild to moderate d"s lasia and re etition of test is needed within = wee*s.

Pathophysiologic +asis of ,alignant (eoplasia

Predis osing Factors(tiologic Factors
Ca Cell $roli#eration
'isrupts N cell gro-t% & inter#ere -0 tissue #+n $ressure Obstruction $ain E##ussion Ulceration Aascular T%o bosis1 E bolis 1 T%ro bop%lebitis

*alignant cells produce en8! es1 Anore+ia & Cac%e+ia %or ones & ot%er substances S!ndro e 2paraneoplastic Tissue 5asting Severe 5eig%t S!ndro e4 Ane ia Loss .!percalce ia Severe 'ebilitation Ede a 'IC

Ca Cell Proliferation Pressure - d t Ksi#e of neoplastic gro th !bstruction - as tumor cont. to gro"#$
hollo# organs % &essels become com'ressed % obstructed i.e. eso'hagus$ brochi$ ureters$ bld &essels$ lym'hatic system distentuion o) organs &essels$ lac* o) !+ to tissues % organs % release o) 'ain mediators by the tumor - ,ate Sign

Pain ( d t 'ressure on ner&e endings$

Ca Cell Proliferation

E))usion- lym'hatic )lo# is obstructed$ there

may be e))usion in serous ca&ities eg. Plueral ca&ity ('lueral e))usion)$ abdominat ca&ity(ascites)

-lceration .ecrosis

( as the tumor erodes bld &essels % 'ressure on tissue causes ischemia tissue damage % bleeding in)/n

Vascular 0hombosis$ Embolism$

0hrombo'hlebitis (

'roduce abn coagulation )actors that cause M clotting 2pul onar! e bolis li#e-t%reatening4"

,alignant cells produce en-ymes.hormones / other su0stances1paraneoplastic yndrome)

interefere w( R.C roductuion 4 Fe u ta*e is E that de osited in the li&er 4 .ld loss that results from !leeding leads to anemia Hy'ercalcemia ( 9umors of the !one0 s3uamous lung Ca 5 !reast ca roduce Parath"roid4li*e hormone that Kes or accelerates bone brea%do n 8 release of $a - also results from metastasis of the bones , 'nhanced by immobili#ation 8 dehydration

1nemia / Ca cells roduce chemicals that

,alignant cells produce en-ymes.hormones / other su0stances1paraneoplastic yndrome)

Edema -

Tu or ta)es up Na1 .<O retention as) alnutrition & is not i ediatel! re#lected as -eig%t loss

D2C ( 3ore li*ely to occur in Ca o) the

lungs$ 'ancteas$ stomach$ 'rostate - 'reci'itated by the release o) tissue thrombo'lastin or endothelial in4ury

Anore2ia / Cache2ia 0issue 5asting$yndrome Se&ere 5eight ,oss$

Se&ere Debilitation

6inal outcome o) unrestrained Ca cell gro#th 3alignant neo'lasm de'ri&e . cells nutrition Produce alteration in en7yme system nec. )or .

metabolism stored )at is lost$ tissue lose .itrogen ( (-) nitro bal.) 0umors re&ert to anaerobic metabolism consume glucose8 de'lete glycogen stores in the li&er % con&ert glucose to lactate. CH!. de'letion$ serum albumin le&el L

Anore2ia / Cache2ia 0issue 5asting$yndrome Se&ere 5eight ,oss$

Se&ere Debilitation

Tu or

ta)es up Na1 .<O retention as) alnutrition & is not i ediatel! re#lected as -eig%t loss Ca cells produce Anore+igenic substances t%at act in t%e satiet! center o# t%e %!pot%ala us1 causing anore+ia Taste sensation di inis%es o altered & a! %ave taste aversion to eatung1 particularl! eateat taste bitter a ong Ca clients"

>('A>?'N>
/OALS O( TREAT*ENT CURE

CONTROL $ALLIATION A'PUAANT T.ERA$B

T+ *odalities #or Ca
;" <" D" 9" >" . SUR/ERB RA'IATION T.ERA$B C.E*OT.ERA$B I**UNOT.ERA$B BONE *ARRO5 TRANS$LANT $hoice of >: depends on the type of tumor, e:tent of the dse 8 the clients co,morbid condition *eg. $ardiac dse+, performance status 8 ishes.

;" SUR/ERB
9.(9O/'/: >ypes <.$rop%!la+is0$reventive ,performed

to &premalignant) conditions or &at ris%) tissue or organ is removed to prevent $a devt

, removal of precancerous lesions or benign tumors *eg.pts 4 familial polyposis 8

ulcerative colitis undergo subtotal colectomies to prevent colon $a+

<"'iagnosis 2biops!4
A provides proof of $a. Done by cytologic specimen collection 8 biopsy

FNAG $ore needle Incisional ':cisional

D" Curative A result to

cure rate of -NW , H=W . (emoval of an entire tumor 8 surrounding lymph nodes. . Bocali#ed to the organ of origin 8 regional lymph nodes are potentially curable by surgery.

9" Reconstructive ,
may follo curative surgery to improve function 8 enhances cosmetic appearance , >o improve clients "uality of life.

>" $alliation A done for

relief of distressing /4s or for retardation of metastasis. 'g. if tumor is causing pain, obstruction, DOG.
. Also an attempt to improve clients "uality of life '2. (educe pain by interrupting nerve path aya or implanting pain control pumps

>" $alliation
(educe pain by interrupting nerve path ay or implanting pain control pumps (elieve air ay obstruction (elieve Obstruction in 2I> 8 2.> (elieve 9ressure in the brain 8 spinal cord 9revent hemorrhage (emove infected 8 ulcerating tumors Drain abscesses

E"'ebul)ing 0 C!toreductive Surger! A removing

part of tumor, $AN> $.(' but dec. number of $a cells 8 enhances effect ith other therapies.

 lymph nodes, ad7acent involved structures, 8 surrounding tissue that may be at high ris% for metastasis *lu pecto !+ Salvage surger! e:tensive surgical approach to treat local recurrence after a less e:tensive approach * astecto !1 radiation+

 Electro surger! ma%es use of electric current to destroy tumor cells Cr!osurger! uses li"uid nitrogen to free#e tissue to cause cell destruction C%e osurger! uses combined topical chemotherapy 8 layer by layer surgical removal of abnormal tissue

 Laser surger! uses light 8 energy aimed at an e:act tissue location 8 depth to vapori#e cancer cells Stereotactic surger! a single highly precise administration of high dose radiation therapy

>he $ell $ycle

<" RA'IATION T.ERA$B

.se of high,energy ioni#ing radiation that destroy a cells ability to reproduce by damaging its DNA (> %ills $a cells hile sparing N cells from e:cessive cell death T!pes: , E+ternal RT2Telet%erap!1 'CT4 - Internal RT a. Sealed b" Unsealed

<" RA'IATION T.ERA$B

$auses damage to cells during phases of cell division (adiosensitive phases : end of 2< phase, mitosis phase, 2- phase. (ole of O- A ma:imi#es %illing effect of (>. O:ygenated cells are more sensitive to the destructive effects of (>. (adiosensitivity, the relative sensitivity of tissues to radiation depends on the individual cell 8 the charac. of the tissue itself

<" Radiation T%erap!

>herapeutic uses: 9rimary curative modality A for basal cell $a of s%in, /tage I 8 II Dodg%ins, /tage - $ervical $a

Ad7uvant A (> J surgery or $hemotherapy J (> 9alliative

<" Radiation T%erap!

$ri ar! Curative *odalit! A for basal cell $a of s%in, /tage I 8 II Dodg%ins, /tage - $ervical $a Only t: used 8 aims to achieve local cure of the $a

<" Radiation T%erap!

Adjuvant A (> J surgery or $hemotherapy J (> , can be done preop or postop to aid in destruction of ca cells. , $an be used in con7unction 4 chemot: to enhance destruction of ca cells

<" Radiation T%erap!

$alliative A can be used to relieve pain caused by obstruction, pathologic fractures, spinal cord compression 8 metastases

A" E+ternal RT0 telet%erap!

Administered through a high,energy T,ray or gamma T,ray machine

E+ternal Radiation
Delivery is dependent on the tumor depth, amt of energy content >he higher the energy, the deeper the penetration

OILOAOLTA/E T.ERA$B *superficial lesions+ LINEAR ACCELERATORS & BETATRON *AC.INES /A**A RABS *beneath the s%in surface sparing the s%in+ IORT *precisely targeted areas+

E+ternal RT0 telet%erap!

.ses Geam radiation A $obalt X= *megavoltage gamma rays+, Binear accelerator *uses electrons4 protons+, betatron or a machine containing radioisotope+. /tandard fractionation of dose is <R=, -R= rad *radiation absorbed dose+ per dayF <=,-= min inside the room

 R=,<== cm distance from the body ?onitor client via closed circuit >!, voice contact4 intercom

RA'IATIONQQQ
$BI'N> DO'/ NO> '?I> (ADIA>ION, No Need for I/OBA>ION. /%in,sparing effect. ?a:.effect occurs at tumor deep in the body not on the s%in surface (apidly dividing cells are affected, eg :alopecia, radiation enteritis type of s4s 4 /4' depends on location 8 dose of radiation received

(sg 3esponsi0ility4

5in Care

9 / adiodermatitis can occur =4J w*s

ost R9 ' first sign, er"thema) 1 / &oid sun(heat e# osure0 chlorinated ools0 !elts0 !uc*les D / o use water onl" or with mild soa 2 / n washing0 1ANDS are used0 not washcloth 1 / &oid owders0 lotion0 creams0 unless rescri!ed

(sg 3esponsi0ility4

5in Care

0 / or PA9 irradiated area with soft

towel0 not Ru! 2 / nform ,Radiation mar*ings are not remo&ed ! / !ser&e moist DESK2A-A9$ON 's*in wee ing) . / o !uc*les or !elts0 wear soft clothing

B" Internal RT0 Brac%!t%erap!

(adiation source comes into direct, continuous contact 4 tumor tissues. Administered 4in or near the tumor or into the systemic circulation

B" Internal RT0 Brac%!t%erap!

< t!pes: Sealed 2brac%!t%erap!4 Unsealed Radiation Source

B" Internal RT0 Brac%!t%erap!

< t!pes: Sealed 2brac%!t%erap!4 A radioisotope
placed 4in or near tumor. >he radioactive material is enclosed in a sealed container .sed for both intracavity 8 interstitial t: (adioisotope cannot circulate through the clients body nor can it contaminate the clients urine, s eat, blood or vomitus. NO> (ADIOA$>I!'.

B" Internal RT0 Brac%!t%erap!

< t!pes: Sealed 2brac%!t%erap!4
(adiation e:posure can result from direct contact 4 the sealed isotope i.e. touching the container 4 bare hands or from lengthy e:posure to the sealed radioisotope.

B" Internal RT0 Brac%!t%erap!

< t!pes: Sealed 2brac%!t%erap!4 A Intracavit!,$a of uterus 8 cervi:, placed in the body cavity for -M,MR hrs *$esium <HN or radium --X+

B" Internal RT0 Brac%!t%erap!

< t!pes: Sealed 2brac%!t%erap!4 Interstitial,placed in needles, beads, seeds, ribbons, or catheters, 4c are then implanted directly into the tumor mammosite (> *breast+, afers *brain+, cesium, radon, iridium *Iridium <L-,iodine <-I,cesuim <HN,gold <LR or radium ---+

/ealed (adiation /ource GODC FB.ID/ A(' NO> (ADIOA$>I!'

Nursing $are:
/ A hielding : lead apron, >ime: N,H= min4shift,
!,H=m,<hr4day 'istance: N:Hft ,<m a ay from client, !, X ft a ay

' A nsure 9(I!A>' (OO? 8 G'D('/> *-M, N- hrs+ A A void touching sealed radioisotopes
use BON2,DANDB'D forceps 8 place in $ON>AIN'( B'AD

B A inens are chec%ed 8 saved inside the room

Nursing $are:
' A nsure that pregnant nurses, 8 P<X are not allo ed in the room D A osimeter film badge are orn, yrs old

upto <.-I ('? *(adiation 'mitting ?eter+ allo ed

D A oor is placed ith: &caution: radioactive material) sign. ( A otate nsg staff, < patient in one shift > A eflon foley catheter is used

B" Internal RT0 Brac%!t%erap!

< t!pes:Unsealed Radiation Source

(outes: I!, 9O, instillation direct into the body cavity (adioisotopes circulates through the clients body. (ADIO A$>I!'YYY ':. Iodine <H< in 2raves Dse 8 thyroid $a, Alrontium $l RL I! for relief of painful bony metastases.

Systemic theory, All body fluids are RADIOACTIVE! Nsg Care: lush toilet t!ice "reatest dan#er from body fluids$ %&' () hours

 A cer&ical radiation im lant is laced in

the client for treatment of cer&ical cancer. Dhat acti&it" order is most a ro riate for this clientI A. Out of !ed in a chair onl" .. .ed rest C. Am!ulate to the !athroom onl" D. Out of !ed ad li!

 Dhich of the following client statements indicates to the nurse

that discharge teaching a!out radiation thera " has !een successfulI A. B$ should gargle with Listerine mouthwash e&er" da"L. .. B$ should ha&e low4 rotein foods and cold drin*sL. C. B$6ll use a hard4!ristle tooth!rush to !rush m" teethL. D. B$ need to drin* lots of fluids and a&oid smo*ingL.

D" C%e ot%erap! >oAL, C2RE0CON9ROL0 PALL$A9$ON

OF -AN$FES9. S"stemic effect0 most sensiti&e to Chemo are ra idl" growing tumor. Dose , mg( s3. m of 9.SA total !od" surface area Course, e&er" =4? w*s for J to <-: Affects also Ra idl" di&iding cells 'mucous mam!rane0 !ld cells0 hair follicles0 s*in cells)

Chemotherapy 1as fraction cell4*ill. Onl" certain M of Ca cells

are *illed w( each course of t#. 9herefore must !e gi&en in a series. -a" !e cell4c"cle s ecific 'CCS) or cell4c"cle non s ecific 'CCNS) 4 CCS0 destro" Ca cells at s ecific stage in the cell di&ision 4CCNS0 ma" destro" Ca cells at an" stage of cell di&ision Com!ination Chemot# o roduces lesser S(E.

Chemotherapy
Route, mostl" $%0 %AD &enous access de&ice

'im lanted Parth4A4Cath)0central lines through P$CC4 eri herall" inserted central cath)

others, oral0 intraca&itar" eg , intrathecal

for CNS tumors 'LP)0 intra eritoneal0 intra&esical Regional / to ical0 intra4arterial %esicants / with e#tra&asation the chemo drug causes tissue necrosis

 1d4u&ant Chemothera'y ( .eoad4u&ant Chemothera'y /

Categories,
8. Cell c"cle S ecific / A-0 %P

Su!classification,
Antimeta!olites %inca Al*aloids E i odo h"lloto#ins 9a#anes -iscellaneous

 1d4u&ant Chemothera'y ( .eoad4u&ant Chemothera'y /

Categories,
+. Non Cell c"cle S ecific / AL0

Su!classification,
Al*"lating

agents Antitumor Anti!iotics 1ormonal 9#

Antimetabolites, retards / phase

Nsg Consideration
?onitor Depatic Functions, hyperuricemia, cerebellar dysfunction $ounsel about Alopecia, use of sun screen ?onitor for e:travasation

E+a ple
X,?ercaptopurine I, Fluorouracil ?ethotre:ate $ytarabine *Ara, $,$ytosar+ X,>hioguanine*X,>2+ Fludarabine*Fludara+ 9entostatin*Nipent+

Antidote: ?ethotre:ate A Beucovorin *Floninic Acid+

!inca Al%aloids 4 9lant Al%aloids prevents ?itosis phase

E+a ple Aincristine 2Oncovin41 Ainblastine 2Aelban4 Ainorelbine 2Navelbine4 *onitor s0s o# neuroto+icit! J c%ec) re#le+es1 otor & sensor! #unction Avoid E+travasation J I# it occur: stop ad inistration /ive Allopurinol #or %!perurice ia

'pipododophylloto:ins
E+a ple Etoposide 2A$-;E4 Teniposide 2A*-<E1 Au on4

>a:anes
E+a ple $aclita+el 2Ta+ol4

 ?iscellaneous
E+a ple LAspaaginase .!dro+!urea 2.!drea4

 CELL CBCLE NON S$ECI(IC

 Al%ylating Agents A
E+a ple Busul#an 2*!leran4 Carboplatin 2$araplatin4 C%lora bucil Cisplatin 2C''$1$latinol-AR4 C!clop%osp%a id e 2C!to+an4 I#os#a ide 2I#e+4 *ec%lorat%a ine .Cl 2*ustargen4 T%iotepa4 Side E##ect -sterilit! -neuro1oto1 nep%roto+ic -%e orr%agic c!stitis - %!perurice ia Nsg R -Assses tingling1 %earing loss1 incoordination -inc O(I -*esna 7 #or c!stitis

 Antitumor Antibiotics
E+a ple C%lora bucil 2lue)eran4 Bleo !cin 2bleno+ane4 'aunorubicin 2Cerubidine4 'o+urubicin 2Adria !cin4 'actino !cin Idarubicin 2Ida !cin4 *ito !cin C *ito+ant%rone $lica !cin Side e##ect -$ul onar! to+icit! -Cardioto+ic -%!perurice ia Nsg R -C%ec) RR -EC/1 *onitor CR --it% IA( e+travasation: cold co press -Inc O(i

C0I:C.E*OTC
Infection A tumor drugs are immunosuppressive (ecent surgery, drugs may retard healing process Impaired (enal4hepatic f:n, drugs are nephroto:ic 8 hepatoto:ic (ecent (adiation >:,also immunosuppressive 9regnancy,may cause congenital defect Gone ?arro Depression, may aggravate conddition, the 5G$ levels must be 4in normal limit.

Side E##ects Gone ?arro /uppression: Anemia, Neutropenia

>hrombocytopenia,

A: 'rythropoietin N: nadir stage: Antibiotics, (everse isolation, fre".rest periods Filgrastim *granulocyte $/F+, protect from inf:n, avoid A/A,trauma >: platelet transfusion, Oprelve%in *plt 2F+ 2ive antiemetic M,X before $hemo $O?9AUIN' Gicarbonate or al%aline mouth ash Ice chips, soft diet, Appettite /tim: ?agestrol acetate F4' replacement, lo fiber diet

2I>: n4v, /tomatitis, Anore:ia, diarrhea,constipat ion

Side E##ects
Integu entar! S!s: Alopecia1 $ruritus1 to atitis1 S)in pig entation1 Nail C%anges (enal /ystem: .ric Acid stones, Demorrhagic cystitis Occurs <-D -)s a#ter $s!c%ological preparation Use o# -igs1 %ats1 scar#2reassure its te porar!41 good s)in care1 oral care1 avoid %ot0spic! #ood Inc OFI -,H B of fluids4day Allopurinol

(epro: infertility, sterility /perm ban%, reassure that menstruation 9remature menopause resumes after chemot: or amenorha Neuropathy /afety measures, protective foot ear, analgesics for pain, (O? e:ercise as tolerated

Adverse (eactions
<. .!persensitivit! R+n Anaphylactic r:n , /top Drug admin ,?aintain I! lineof =.LW Na$l ,Oeep Open Air ay ,?odified trendlenberg, unless $4I ,Notify Ap ,?onitor !/ til stable ,Admin. 'pinephrine, aminophylline, diphenhydramine 8 corticosteroids

Adverse (eactions
<. E+travasation , /top Drug admin ,Beave the needle in place 8 attemptb to aspirate any residual drug from tubing, needle 8 site ,Administer antidote as prescribed.>hen remove the needle , Apply arm or cold compress as indicated ,Document the appearance of the site before 8 after chemot:

9" I

unot%erap!

Giologic response modifiers Interleu%ins Interferons

 >he nurse and parents are planning for the discharge of a child ith leu%emia ho is receiving dactinomycin *actinomycin D+ and vincristine *Oncovin+. 5hich of the follo ing ould the nurse e:pect to teach the parents to do6 A. 'ncourage increased fluid inta%e. G. ?onitor the childs heart rate. $. Oeep the child out of the sun. D. Observe the child for dro siness. .

 5hich of the follo ing interventions ould be included in the plan of care for patient receiving chemotherapy ho develops thrombocytopenia6 A. Instructing the client to use mild, protein,based shampoo every H to I days G. 'ncouraging fre"uent hand ashing and overall hygiene measures. $. Instructing the client to s ish and s allo ith an antacid before meals. D. Observing the clients s%in fre"uently for ecchymoses and petechiae.

Bone *arro- & $erip%eral Blood Ste Cell Transplantation" Stem Cell Transplantation Transplantation of blood forming stem cells enables pts! to receive high doses of chemotherapy" radiation" or both! The high doses destroy both #A cells $ normal blood cells in the bone marrow!

>" Bone *arro- Transplant

>ype of donor: a. Allogenic b. /yngenic c. Autologous $rocedure: <. Darvest A frm iliac crest I==,<,=== ml of marro -. $onditioning the pt. 2ive immunosuppressant

H. >ransplantation A I! central line, over H= min or I! push

Bone *arro- Transplant

M. 'ngraftment after -,I %sA Nadir can occur. Occurs hen plt, (G$, 5G$ are increasing I. 9ost,transplant ?onitor for Infection, Gleeding $hec% complications: Failure to engraft 2raft vs Dost dse !enooclusive disease

CANCER TREAT*ENT
Bone *arro- & $erip%eral Blood Ste Cell Transplantation"

Stem Cell Transplantation Transplantation of blood forming stem cells enables pts! to receive high doses of chemotherapy" radiation" or both! The high doses destroy both #A cells $ normal blood cells in the bone marrow!

E" .or onal T%erap!

$onsist of admn of drugs designed to alter the hormonal envt. of $A cells negatively. ':: >amo:ifen

Side e##ects:

eight gain, hot flashes, nausea, 8 changes in fertility. In omen, hormone therapy may ma%e menstrual periods stop or become irregular 8 may cause vaginal dryness.

E" .or onal T+

/lucocorticoids $rednisone 2'eltasone *et%!lprednisolone 2Solu-*edrol1 *edrol4 'e+a et%asone 2decadron4 Estrogens C%lorotrianesine 2Tace4 'iet%l!stilbestrol 2'ES4 Estradiol 2Estrace4 Antiestrogens Ta o+i#en 2Nolvade+4 $rogestins 'epo-$rovera *egestrol Acetate 2*egace4 Leuprolide 2Lupron4 Nitrosoureas Car ustine 2BCNU4 Lo ustine 2CCNU4 Strepto8ocin 2Sanosar4

After teaching a child ith leu%emia scheduled for a bone marro aspiration about the procedure, the nurse determines that the teaching has been successful hen the child identifies hich of the follo ing as the puncture site6 A. (ight lateral side of the right rist G. Distal end of the thigh $. ?iddle of the chest D. Gac% of the hipbone

G('A/> $A

*a! develop an!ti e a#ter pubert! F=G occur in -o en older t%an >= E+act cause re ain elusive >G -speci#ic genes called BRCA; & BRCA<1 -0c con#ir s t%at t%e dse can be in%erited #ro personNs ot%er or #at%er" T%ose -%o in%erit t%e genes %ave an @=G c%ance o# developing Breast CA About %al# o# all develop in upper outer Kuadrant classified as invasive hen it penetrates the tissue surrounding the mammary duct 8 gro s in an irregular pattern.

/tages of Greast $a
/tage I, tumor si#e upto - cm /tage II,I cm 4 ma:illary node involvement /tage III,;Icm, 4 a:illary 8 nec% lymphnode involvent /tage I!, metatasis to distant organ *liver, lungs, bone 8 brain+

Classi#ication of Greast $a
$lassified by tissue of origin 8 the location of the lesion Lobular A in the lobes Intraductal A most common form, 4in the ducts P <W originate in the nonepithelial connective tissue In#la ator! Ca gro s rapidly 8 causes the overlying s%in to become edematous, inflamed, 8 indurated $agetNs dse- is a gro th of $A cells 4in the breast ducts beneath the nipple

$lassification of Greast $a
Breast Ca are also classi#ied as:
.

Invasive, 4c ma%es up L=W of all Greast $a, brea%through the duct alls 8 encrouch on other breast tissue Noninvasive, tumor remain confine in the duct in 4c they originated

$lassification of Greast $a 9hase < A hyperplasia, an e:cessive proliferation of normal cells 9hase - A atypical hyperplasia, e:cessive proliferation of abnormal cells 9hase H A cells 4in the duct

Breast Ca
S0S: (ir 1nontnder1 non obile ass Solitar!1 irregularl! s%aped ass Ad%erence to uscle or s)in causing di pling Involve nt o# upper outer Kuadrant or cntral poretion o# t%e breast Ass! tr! o# t%e breast Horange peel s)inI Retraction o# t%e nipple Abn disc%arge #ro t%e nipple

Breast Ca
$recipitating (actors: (a il! %+ 2BRCA;1 BRCA<4 Earl! enarc%e and late enopause $revious %istor! o# t%e breast1 uterus1 ovaries Nulliparit! Obesit! T Ta o+i#en <= g0da! #or > !ears to decrease incidence #or %ig% ris)

T+: Breast Ca
Lu

pecto ! $artial *astecto ! Total *astecto ! *odi#ied Radical *astecto ! 2%alstead4 7 re oves t%e entire breast1 a+illar! l!u p% nodes1 & t%e lining t%at covers t%e c%est uscles" - It preserves t%e pectoral uscles - I# l! p%nodes contain CA cells1 radiation2preop sterili8e9s t%e area4 & c%e ot+ #ollo-" C%e ot%erap! 7 c!clop%osp%a ide1 e9t%rotre+ate1 do+orubicin & #luoroucil .or one T%erap!

T+: Breast Ca
Lu

pecto ! $artial *astecto ! Total *astecto ! *odi#ied Radical *astecto ! 7 re oves t%e entire breast1 a+illar! l!u p% nodes1 & t%e lining t%at covers t%e c%est uscles" - It preserves t%e pectoral uscles - I# l! p%nodes contain CA cells1 radiation2preop sterili8e9s t%e area4 & c%e ot+ #ollo-" C%e ot%erap! 7 c!clop%osp%a ide1 e9t%rotre+ate1 do+orubicin & #luoroucil .or one T%erap!

>ail of spence

Outer .pper "uadrant

Assess ent: *ass #elt during BSE usuall! at upper outer Kuadrant or beneat% t%e nipple" (ir 1 (i+ed1 irregular nonencapsulated ass Nipple retraction Breast As! etr! Blood! or clear nipple disc%arges S)in di pling1 retraction and ulceration $eauN dN orange s)in

$ICTURES

return

 '+

*a ograp%! (NAB *gt C%e o1 RT1 Surger! Lu pecto ! Si ple *astecto ! *odi#ied Radical *astecto ! .alsted R *

 $ost-op

Care B - od! i age 7 pro ote sel#-estee R - educe & prevent in#ection 1 l! p%ede a No B$1 IA(1 bld e+traction
E

Elevate -it% < pillo-s Avoid cuts0 trau a over a##ected ar

- ncourage deep breat%ing & coug%ing1 A - ssess operative site & drainage J ;==-<==cc0da! S - %ould obili8ed a##ected ar $ D-9 'ABS T - o c%ec) Bleeding U t%e bac) o# pt"

$re-op Care

$s!c%osocial support Teac% ar e+ercises to prevent l! p%ede a In#or about -ound suction drainage1 eg"%e ovac1 Pac)son-$ratt 'BCT e+ercises to prvent postop co pli

$ROSTATE CA

A##ecting *en1 'eat% rates %ig%er t-ice in Blac)s @>G 1 post" /land

$ROSTATE CA

/ro-s slo-l!1 -%en pri ar! lesions spread be!ond t%e prostate gland1 t%e! invade t%e prostatic capsule & t%en spread along t%e ejaculator! duct in t%e space bet" T%e se inal vesicles or perivesicular #ascia

LUN/ CA
In

nor al lungs1 t%e epit%eliu protects t%e tissue belo- it" .o-ever1 -%en e+pose to irritants or carcinogens1 t%e epit%eliu continuall! replaces itsel# until t%e cell develop c%ro oso al c%anges & beco e d!splastic 2alt"in si8e1 s%ape & org"4 cell donNt #+n -ell as protectors1 so underl!ing tissue gets e+poased to irritants & carcinogens"

'!splastic

Bung Ca
Etiolog!: V; s o)ing E+posure to carcinogens S0s : C%ronic coug%1 '!spnea1 $leural e##usion 1 %e opt!sis T!pes: Adenocarcino a SKua ous Cell carcino a S all Cell 2oat cell4 carcno a Large cell carcino a 7 can cause SAC s!ndro e : t+ -it% Radiation T%erap!

LUN/ CA
(ate of 2ro th ;" Adenocarcino a - *oderate <" SKua ous - sloD" Large 7 #ast 9" S all 7 ver! #ast W C!tologic sputu reliable" anal!sis 7 @=G

LUN/ CA : T+
Surger!1

Radiation1 C%e ot+ 2relapse F-;9 os"4 Ot%ert t+: - 2efitinib 7 a drug t%at bloc)s gro-t%n #actor receptor activit!1 -as approved #or adcvanced nons all cell lung CA" Ad n as onot%+ -%en c%e ot+ #ail"

*gt6 lung Ca

Improve breathing: high,fo lers, O-, Gronchodilators Improve Nutritional status: inc $DON 8 calorie, /FF (> for obstruction /urgery: Bobectomy, 9neumonectomy 9re,op: No $>> for 9neumonectomy 9ost,op: $are ith $>>, assess $>> drain

.O'/OINNS 'SE
9ainless, progressive enlargement of the lymphnodes, spleen 8 other lymphoid tissue. Digher incidence in male, slightly more common in hites, 8 Occur most commonly in t o age groups : HI 8 older than I=

.O'/OINNS 'SE
$ause is un%no n, it probably involves a virus. ?any pts 4 the dse have had infectious mononucleosis, so an indirect relationship may e:ist bet een 'pstein,Garr virus 8 Dodg%ins dse. Another possible factor is occupational e:posure to herbicides 8 other chemicals.

.O'/OINNS 'SE
'nlargement of the lymphnodes, spleen 8 other lymphoid tissues results from proliferation of lymphocytes, histocytes 8 rarely eosinophils. 9t. also have distinct chromosome abnormalities in their lymph nodes 'nlarged abn histocyte, REE'STERNBER/ CELL, to confirm the d:

.O'/OINNS 'SE
$hemot:, radiation or both Autologous bone marro or peripheral stem cell transplantation Immunot:, use in con7unction 4 $hemot:, radiation C%e ot+: ?O99 * ?echlorethamine, Oncovine*vincristine=, 9rocarba#ine, 9rednisone+ ,or combi. Of do:orubicin, bleomycin, vinblastine, dacarba#ine.

*ULTI$LE *BELO*A
Disseminated $a of marro plasma that infiltrates bone to produce lesions throughout the flat bones, vertebrae, s%ull, pelvis, ribs. Bate stages infiltrates: liver, spleen, lymphnodes, luns, adrenal glands, %idneys, s%in 8 2.I. tract $ommon in ?'N I=,R=

*ULTI$LE *BELO*A
9oor prognosis by the time its d:, the vertebrae, s%ull, pelvis, ribs, clavicle 8 sternum are infiltrated 8 s%eletal destruction is idespread. I=W die 4in H mos. L=8W in - years ?ay prolong life to H,I years 4 t:

*ULTI$LE *BELO*A
Not Ono n cause Bin%ed to genetic factors, viral 8 occupational e:posure to chemicals 8 radiation

*ULTI$LE *BELO*A
In normal cell activity, stem cells 4in the bone marro can self,replicate or differentiate *mature into specific types+. >he lymphoid stem cell can differentiate into > lymphocytes, 4c participates in cell mediated immunity or G lymphocytes, 4c participates in humoral immunity. G lymphocytes eventually become plasma cells that produce 8 release Ig2 Ig2 is the most common Ig in humans

*ULTI$LE *BELO*A
An un%no n factor that stimulates the G lytmphocytes to turn into malignant plasma cells, that produce huge amyts. Og Ig2, IgA or Gence Vone proteins Chis leads to hyperviscosity syndrome commonly seen in myeloma patients.

*ALI/NANT *ELANO*A
$ommon sites are: Dead, nec% in men, legs in omen, and bac%s of people e:posed to e:cessive sunlight N=W arise from a pree:isting nevus *circumscribed malformation of the s%in+ or ?OB'.

*ALI/NANT *ELANO*A
>T : surgical resection H,I cm margin. Deep 9rimary lesion, chemot: dacarba#ine Immunot: G$2 vaccine ?etastatic, dacarba#ine (adiation t: 2ene >: 4

Leu)e ia
Is

a malignant e:acerbation in the E of leu%ocytes, usually at an immature stage, in the bone marro . affects the bone marro , causing anemia, leucopenia, thrombocytopenia 8 decline in immunity.

Beu%emia
(is%

factors: !iral Immunological 'nvironmental factors ':posures to radiation, chemical and medications.

Classi#ication o# Leu)e ia:

<. ACUTE LB*$.OCBTIC LEUOE*IA ?ostly lymphoblast present in G? Age of onset is less than <I years old -. ACUTE *BELO/ENOUS LEUOE*IA ?ostly myeloblast Age of onset is bet een <I,HL years old H. C.RONIC *BELO/ENOUS LEUOE*IA ?ostly granulocyte present in G? Age of onset is after I= years old M. C.RONIC LB*$.OCBTIC LEUOE*IA ?ostly lymphocytes present in G? Age of onset is after I= yrs old.

Leu)e ia

D: test: G?A ?gt: /trict aseptic techni"ue (everse Isolation Bo bacteria diet No fresh flo ers Oral hygiene

Assess

bleeding Nutrition: /FF, Inc $DON 8 calorie Inc (est periods Gone ?arro >ransplant $hemotherapy

LUEOE*IA1 ACUTE

':act cause is un%no nF ho ever M=,I=W of pts have mutations in their chromosomes. Do n syndrome, trisomy <H 8 other hereditary disorders have a higher incidence 4

9eople

LUEOE*IA1 ACUTE

Immature hematopoeitic cells undergo an abn transformation , giving rise to lue%emic cells cells multiply 8 accumulate , cro ding out other types of cells ding prevents prod. of normal (G$, 5G$ 8 platelets, leading to 9ancytopenia, reduction in the E of all cellullar elements of the blood.

Bue%emic $ro

LUEOE*IA1 ACUTE
2roup

of malignant disorders charac. Gy abn proliferation 8 maturation of lymphocytes 8 nonlymphocytic cells, leading to suppression of normal cells. If untreated is fatal, usually result of complications for lue%emic cell infiltration of bone marro or vital organs. < t!pes: ALL & A*L

LUEOE*IA1 ACUTE
< t!pes: ALL & A*L

ALL , R=W of childhood leu%emia1s ,t: leads to remission in R<W of children, ho survive in ave. of I yrs ,XIW in adults, survive ave. of - yrs $hildren bet. -,R ho receive intensive t: have the best survival rate

LUEOE*IA1 ACUTE
< t!pes: ALL & A*L

A*L A one of the most common in

adults. , Ave. survival is < year after the d:, even 4 aggressive t: ,remission lasting -,<,= mos. Occur in I=W of children , pts. D: reveals sudden onset of high fever 8 abn bleeding i.e. bruising after minor trauma, nosebleeds, gingival bleeding 8 purpura. Fatigue 8 nights s eats may also occur.

LUEOE*IA1 ACUTE : T+
/ystemic $hemot:,eradicate lue%emic cells 8 induce remission. .se hen fe er than IW of blast cells in the bone marro 8 peripheral blood are normal. T+ a! also include: Antibiotic, antifungal 8 antiviral $olony,stimulating factors i.e. filgrastim to spur the fgro th of granulocytes, (G$s 8 9latelets >ransfusion of 9latelets to prevent bleeding 8 (G$s to prevent anemia.

LUEOE*IA1 ACUTE : T+
D Stage T+ o# ALL:

Induction A usually vincristine, prednisone, 8 angthracycline 4 or 4o asparaginase for adults. -. Consolidation A high doses of chemot: designed to eliminate remaining lue%emic cells H. *aintenance A lo er dose of chemot: for upto - yrs. >he goal is to eliminate stray lue%emic cells that have evaded other agents used in the induction 8 consolidation phase.
<.

LUEOE*IA1 ACUTE : T+
< Stage T+ o# A*L:
;"

Induction A angthracycline

cytarabine

<"

$ostre ission A intensification, maintenance chemot:, or bone marro transplantation

LUEOE*IA1 C.RONIC

?ost benign 8 slo est progressing form of leu%emia Occur most commonly in elderly people 8 more than one half of the cases are ?ale <4H of ne adult cases recent account

LUEOE*IA1 C.RONIC

Although the cause is un%no n, hereditary factors are suspected. 2enerali#ed, progressive dse. It causes proliferation 8 accumulation of relatively mature loo%ing but immunologically inefficient lymphocytes . After these cells infiltrate , clinical signs appear

LUEOE*IA1 C.RONIC *BELOI'

charac. Gy myeloproliferation in the bone marro , peripheral blood 8 body tissues. $ommon in the middle age but may affect any age group . Affects both se:es IN ./, M,H== cases are d: annually, accounting for about -=W of all case of lue%emia

LUEOE*IA1 C.RONIC *BELOI'

$aused by e:cessive devt. Of neoplastic granulocytes in the bone marro . >he neoplastic granulocytes circulates into the peripheral circulation, infiltrating to the liver 8 spleen >hese cells contains a distinct abnormality, the 9hiladelphia $hromosome, in 4c a long arm of $hromosome -translocates to chromosome L.

LUEOE*IA1 C.RONIC *BELOI'

$aused by e:cessive devt. Of neoplastic (adiation e:posure may cause the abnormality Other suspected causes: !eloproli#erative dses or unidenti#ied virus"

LUEOE*IA1 C.RONIC *BELOI'

Clinical Course: ;" C%ronic p%ase1 charac. Gy anemia 8 bleeding abnormalities <" Ter inal or Blastic p%ase1 4c myeloblasts, the most primitive granulocyte precursors, proliferate rapidly. ,deadly dse. Ave. survival time H,M years after the onset of the chronic phase 8 H, X mos. After onset of the terminal phase.

T!pe & Etiolog! a" Bladder Cancer -. (ecurrent .>I -. $arcinogens Z or%place -. /mo%ing b. Cervial Ca - un)no-n -Assoc ith multiple se: partners, viral infection in cervi:

S0s 2ross 9ainless Dematuria .rinary Fre"uency Dysuria Giopsy for diagnosis AbN 9ap smear 'arly: vaginal discharge, spotting, erosion of cervi: Bate: pain at bac% 8 legs

Treat ent , Intravesical chemotherapy -(adiation therapy -ileal conduit after cystectomy 9re,invasive: simple hysterectomy Invasive */tage < 8 up+(adiation >. Dysterectomy (adical trachelectomy

c" $rostate Ca ,depends to level of Androgen, after I= yo,

Asymtomatic Dard,pea si#e nodule in D(' Inc 9/A levels Dematuria

Dormones: Diethylstelbesterol >.(9 (adiation >

d. L! p%o a -.odg)inNs 'isease ,)(eed sternberg cell) ,viral infection

E< $ervical node enlargement Night s eats, loss of apetite 'nlarged nodes, liver 8 spleen Dec plt, 5G$

':tensive ':t. (> $hemo

Oncologic E ergencies
:. 2n)ection % Pain
. $nfection4arise from nuetro enia. . client with ad&anced Ca ha&e ain . Se&ere $nfection 5 Pain can interferes w( the erson6s a!ilit" to enAo" 3ualit" life. . PA$N -N>9 is the riorit" in the care of ts w( ad&anced Ca

Oncologic E ergencies
+. 0umor ,ysis Syndrome
Destruction of large M of malignant cells ma" ra idl" release $C H0 1PO? 5 nucleic acid into the circulation. Electrol"te im!al. 5 ARF ma" occur Clients w( malignancies that are &er" res onsi&e to t# are at higher ris*0 es . if large tumor !urden 'l"m homas0 lue*emias 5 sm.cell carcinoma

Oncologic E ergencies
+. 0umor ,ysis Syndrome S S; 5ea*ness$ nausea$ Diarrhea$ 6laccid
'aralysis$ ECG changes$ muscle cram's or t#itching$oliguria$ hy'otension$ edema % altered mental status

Oncologic E ergencies
+. 0umor ,ysis Syndrome
2nter&entions; 2V hydration 1llo'urinol to decrease uric acid conc. .aHC!< # 2V hydration to 'romote )ecal e/cretion o) e/cess HP!= ,o#ering o) serum > le&els # medications$ retention enemas$ 2V ?"@ de/trose

Oncologic E ergencies
=. Se'sis % disseminated intra&ascular coagulation (D2C)
charac. ." the de&t. Of e#tensi&e0 a!n clots in the microcirculation 'sm !ld &essels). 9he wides read clotting de letes the gen. circulation w( w( clotting factors 5 latelets0 leading to e#tensi&e !leeding in diff. sites of the !od" client w( an oncological disorder is at increased ris* for inf#nN D$C is caused !" se sis or gram '4) inf#n0 release of clotting factors from Ca cells0 or !lood transfusion

Oncologic E ergencies
=. Se'sis % disseminated intra&ascular coagulation (D2C)
Clots o!structing the circulation decrease !ld flow to maAor organs causing, Pain0 stro*e4li*e manifest0 D"s nea0 tach"cardia0 oliguria0 !owel necrosis -ost commonl" assoc. w( lue*emia0 adenocarcinomas of the lung0 ancreas0 stomach 5 rostate. D# findings are PROLON> P9 5 AP99 5 &er" low latelet 5 rolong clotting time

Oncologic E ergencies
=. Se'sis % D2C
$nter&entions, Ase tic techni3ue 'correction of the !asic ro!lem i.e. inf#n) Administer anti!iotics $% 5 !ld roducts as rescri!edN a. Anticoagulants !. Cr"o reci itate0 clotting factors when D$C rogresses 5 hemorrhage is the rimar" ro!lem. c. $% 1e arin if manifest of throm!osis 'although contro&ersial) . -onitor for S(S of !leeding

9" S!ndro e o# inappropriate antidiuretic %or one Increase ADD or abn production of ADD $aused by sm.lung $a, inf:, pulmonary disorders, emotional stress, $N/ disorders 8 some drugs including antineoplastic agents li%e $yto:an *$ychlosphosphanamide+, Oncovin*!incristine+, !elban*!inblastin+, 9latinol,AS* $isplatin+

9" S!ndro e o# inappropriate antidiuretic %or one S0s: ater into:ication : eight gain, edema, decreased .O, N4!, anore:ia personality changes, confusion, irritability, headache, muscle ea%ness, lethargy, and e:treme muscle ea%ness. serum Na: <<= m'"4B, sei#ures, coma

9" S!ndro e o# inappropriate antidiuretic %or one

Interventions

fluid restriction, forced diuresis or e:cretion *DI.('>I$/+ increased Na inta%e as prescribed. Dypertonic :HWNa$l /oln if severe to prevent pulmo edema Administer demeclocycline *Declomycin+. Bithane*lithium+, .rea ?onitor serum Na levels, I 8 O

>" Spinal cord co pression a tumor directly enters the spinal cord or hen the vertebral column collapses from tumor entry. $aused by pressure on or compromise of vascular supply to the spinal cord ?ay result to irreversible damage 4 paralysis 8 loss of bo el 8 bladde control

>" Spinal cord co pression S0S: bac% pain then paresthesias, motor ea%ness, autonomic dysfunction of bladder 8 bo el Interventions 9repare the pt for radiation 84or chemotherapy /urgery Baminectomy (ecognition for /$$ is a mustY $omplete 9aralysis 4 in <-,MR hours /teroids may be given to reduce inflamm 8 s elling around the spinal cord.

E" Superior Aena Cava S!ndro e

/!$

is compressed or obstructed by internal or e:ternal tumor gro th. .sually secondary to luing $a or lymphoma

E" SAC S!ndro e

S0S : 'dema of the face, eyes *late: arms 8 hands+ 'rythema of the upper body, 8 epista:is 'ngorged nec% veins 3 dysnea >ightness of the shirt or blouse collar */to%es1 sign+. Dyspnea

Interventions
9rompt

e:ternal beam radiation therapy to the mediastinal area. /teroid therapy

F" .!percalce ia
late ani#estation o# e+tensive alignanc! -0 bone etastasis" 'ecreased p%!sical obilit! -orsens d0t bone resorption 2de inerali8ation4" Seru Calciu level is W;; g0dl Usuall! occur in solid tu ors li)e breast1lung1 %ead1 nec)1 & renal Ca" XAlso occur in %e atologic Ca li)e ultiple !elo a1 lue)e ia Severe .!percalce ia ! lead to Renal #ailure1 co a1 c ardiac arrest & deat%

.!percalce ia
S0S: con#usion1 restlessness severe : uscle -ea)ness1 di inis%ed deep tendon re#le+es1 paral!tic ileus1 Interventions *onitor seru Ca level" 1 .!dration Ad inister Calcitonin 2 *iacalcin4 & oral glucocorticoids are given to lo-er S"calcui $repare #or 'ial!sis

8. Cardiac Tamponand
(luid collects in t%e pericardial sac 2pericardial e##ussion4" It leads to cardiac ta ponade Interventions: $ericardiocentesis to dra- o## t%e #luid

>D' 'ND
'What we see depends mainly on what we look for.'
- Sir John Lubbock