Oncology

“Karnikos” Neoplasm “Cancer adheres to any part that it seizes upon in an obstinate manner like the crab.”



product of new growth



abnormal mass of tissue

The crab depicts the manner of growth of the disease.



exceeds and is uncoordinated with that of the normal tissues



persists in the same excessive manner after cessation of the stimuli which evoked that change

Cancer More than 100 neoplastic diseases that involve all body organs Uncontrolled growth of one of more cells Progression from normal tissue to invasive cancer is 5 – 20 years Driven by a series of accumulative genetic changes Terminologies Neoplasia – “new growth” Tumor – swelling originally due to inflammation Oncology – study of tumors or neoplasms



purposeless, preys on the host, autonomous

1.2 million in US are diagnosed with cancer every year Greatest increase seen in lung CA Number of CA deaths increased by 11% during past 40 years Epidemiology Geographic and Environmental Factors 

Gastric CA in Japan



Racial differences due to environmental influences

 Epidemiology Second leading cause of death in the US after heart disease Ranks fourth for males and first for females as leading cause of death Ranks second for children as cause of death, after accidents Epidemiology

Age 

Late age



Cancers of certain age groups

Heredity

 Inherited cancer syndromes (Rhabdomyosarcoma) 

Familial cancers (Breast, colon, ovary and brain)

Terminologies Do not invade adjacent structures

- grows to a large size

Benign - designated by the suffix

Do not spread to distant sites

- it obstructs important channels in the body

“-oma”

Usually not lethal

- it ulcerates or bleeds

Malignant – “sarcomas, carcinomas”

Life-threatening

- it produces endocrine disturbances

Benign Tumors

- if it forms in a critical location

Tissue of Origin

Benign

Malignant Tissue of Origin

Benign

Malignant

Composed of More Than One Neoplastic Cell Type (Mixed Tissue of Tumors) Origin Benign Composed One 1. of Salivary Parenchymal Cell glands Type A. Mesenchymal Tumors 2. Breast 1.

Lipoma

3.

Pleomor

Malignant mixed tumor of

phic adenoma

salivary gland

Fibroade

Fibrosarcoma Malignant cystosarcoma

noma

phyllodes Liposarcoma

Connective tissue and Chondroma 3. Renal Anlage derivatives Osteoma

2. Endothelial and related tissues

3.

Fibroma

Malignant

Angiosarcoma

Lymphangioma

Lymphangiosarcoma

Muscle

Benign

2.

Basal cell

3.

Glands or ducts

4.

Respiratory passages 5.

Malignant Tumors

Neuroectoderm

Basal cell carcinoma Adenoma

Leiomyosarcoma

Rhabdomyoma

Rhabdomyosarcoma

Adenocarcinoma Bronchogenic carcinoma

Nevus

Malignant melanoma

6.

Renal epithelium

Renal tubular adenoma

Renal cell carcinoma

7.

Liver cells

Liver cell adenoma

Hepatocellular carcinoma

8.

Urinary tract epithelium

Transitional cell papilloma

Transitional cell carcinoma

Leukemias Leiomyoma

Malignant

Composed of One Parenchymal Cell Type 1. Totipotential cells in Mature teratoma, dermoid Immature teratoma, gonads or in embryonic cyst B. Epithelial Tumors Squamous cellteratocarcinoma papilloma Squamous cell rests carcinoma 1. Stratified squamous

Chondrosarcoma Wilms’ tumor Osteosarcoma

Hemangioma

Blood cells

Benign vs.

Composed of More Than One Neoplastic Cell Type From More Than One Germ Layer Tissue of Origin Teratogenous

Tumor Progression Cancer is a multistep process

Initiation Carcinogen Cell

Tumor Abnormal Cell

Promotion

Carcinogen The Switc h from Norm al to Abnor mal Growt h Activa tion of

Onco genes Oncogenes encode proteins that promote cell growth Inhibi tion of Tumo r Suppr essor Gene s Tumor Suppressor Genes apply brakes to cell proliferation The Switc h from Norm al to Abnor mal Growt h Altera tion in cell cycle Dereg ulatio n of cell cycle

contr ol Apopt osis

Growth

Local Invasion

What cause s the switc h? Point mutat ions Transl ocatio ns Gene ampli ficatio n Loss of heter ozygo zity

Damage to the DNA Stage s of Tumo r Growt h Transformatio n

Metastases Angio genes is Conti nued tumor growt h requir es persis tent new blood vesse l growt h Shed ding of malig nant cells into the venou s drain age

Tumo r cells releas e solubl e factor s that requir e angio genic respo nse (angi ogen esis factor s) Metas tasis Metas tasis Detac hmen t of the tumor cells from each other Attac hmen t to matri x comp onent s Degra datio n of extra cellul

ar matri x

b et w e e n v e n o u s a n d ly m p h at ic ci rc ul at io n

Migra tion of tumor cells Mech anism s of Metas tasis Via the lymp hatic syste m  C a n c er c el ls re si d e in ly m p h n o d e s or p a ss



Ar e a s of b o d y wi th e xt e n si v e ly m p h at

ic ci rc ul at io n (e .g . br e a st ) 

M e c h a ni s m s of M et a st a si s

Via the circul atory syste m

 H e m at o g e n o u

s ro ut e: bl o o d c ar ri e s c a n c er c el l fr o m o n e si te to a n ot h er

 R el at e d to th e d e gr e e of v

a sc ul ar it y or a n gi o g e n e si s in th e tu m or 

M e c h a ni s m s of M et a st a si s

Via direct sprea d of cance r cells (seedi ng) where

there are no boun daries to stop growt h (e.g. ovary, stomach) C ar ci n o g e ni c A g e nt s Chem ical carcin ogens Radia nt energ y Onco genic viruse s Horm ones Genet ic

Immu nodef icienc y immune effector cells can eliminate cells that undergo malignant transformatio n development of tumor is a failure of immune surveillance in maintaining tissue homeostasis C h e m ic al C ar ci n o g e n s Organ specif ic Genot oxic (caus e genet

ic dama ge) Envir onme ntal expos ures Activa tion of endo geno us muta genic pathw ays (nitric oxide & oxy radica ls) Requi res accu mulat ed expos ure Gross chro moso mal chang es Chem ical Carci noge ns Two stage s of

chemi cal carcin ogen esis

e ni c a g e nt

Initiation   R e s ul ts fr o m e x p o s ur e of c el ls to a n a p pr o pr ia te d o s e of a c ar ci n o g

n in d u c e tu m or s in in iti at e d c el ls b ut ar e n o nt u m or ig e ni c b y th e m s el v e s

C a u s e s p er m a n e nt D N A d a m a g e C h e m ic al C ar ci n o g e n s

Promotion

 C a



Pr o d u c e re

v er si bl e d a m a g e to D N A C h e m ic al C ar ci n o g e n s Direct Actin g Alkyla ting Agent s - use as anticancer drugs cyclophospha mide, chlorambucil, busulfan,

melphalan and others Polyc yclic Arom atic Hydro carbo ns some of the most potent carcinogens 

Pr o d u c e d in th e c o m b u st io n of to b a cc o a s in ci g ar et te s m o

ki n g C h e m ic al C ar ci n o g e n s Arom atic Amin es and Azo Dyes 



E x er ts it s ef fe ct s in th e li v er “ T h e ul ti

m at e c ar ci n o g e n ”

 In te r m e di at e s wi th th e c yt o c hr o m e P4 5 0 o x y g e n a s e s y st e

m 

C h e m ic al C ar ci n o g e n s

Natur ally occur ring carcin ogens Aflatoxin B1 Produced by certain strains of Aspergillus flavus Found on improperly stored grains and peanuts Nitros amin es and amid es In the gastrointestin al tract

C h e m ic al C ar ci n o g e n s in th e Di et Chem ical Carci noge ns in the Diet High fat, low fiber conte nt Food additi ves such as cycla mides , nitrite s and sacch arin

Heav y food seaso ning Smok ed or salted foods Foods conta minat ed with anato xin Alcoh ol Chem ical Carci noge ns Miscel laneo us agent s AsbestosLung CA Vinyl chlorideLiver hemangiosarc oma Chromium, nickel – Lung CA Arsenic – Skin CA

Components of insecticides

c el l C A a n d m el a n o c ar ci n o m a of th e sk in

Diethylstilbes trol R a di a nt C ar ci n o g e n s Ultrav iolet rays

 I m pl ic at e d in s q u a m o u s c el l C A, b a s al



D e p e n d s o n th e ty p e, in te n si ty a n d le n gt

h of e x p o s ur e, a n d q u a nt it y of m el a ni n o n sk in 

U V B is th e c ar ci n o g e ni c ty p e



R a di

a nt C ar ci n o g e n s Ionizi ng Radia tion formation of free radicals which can damage DNA 

El e ct ro m a g n et ic ra di at io n( xra y s, g a m m a)



P ar ti

c ul at e ra di at io n (a lp h a p ar ti cl e s, b et a p ar ti cl e s, pr ot o n s, n e ut ro n s) 

T h er a p e ut ic ra di at

io n

 Huma n Papill omavi rus Anogenital, cervical and skin cancer 



Viral Carcinogens

 Hepa DNAvi rus Hepa B virus (Hepatocellul ar cancer)

 Hepat otropi c virus Hepa C virus (Hepatocellul ar cancer)

 Herpe svirus Epstein Barr virus (Hodgkin’s lymphoma, nasopharyng eal CA)

Kapos i’s sarco ma Huma n immu nodef icienc y virus Horm ones Estro gen Proge stero ne Andro gens Warni ng Signs of Cance r From the Ameri can Cance r

Societ y

Healt h Histor y

Change in bowel or bladder habits

Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing Obvious change in wart or mole Nagging cough or hoarseness Asses smen t Healt h Histor y Physi cal Exami natio n Diagn ostic Proce dures

Perso nal and Social Histor y

Gener al infor matio n

A sore that doesn’t heal Unusual bleeding or discharge

hospitalizatio ns / surgery

-

allergy

name

- diet - age

- life-

-

style

- race

occupation

gender

Healt h Histor y

- date & place of birth marital status

Famil y Histor y

Healt h Histor y

OBGyne Histor y

Chief Comp laint Past Medic al Histor y previous medical disease previous

menarche menopause - OCP use - GP (TPAL) Physi cal

Exami natio n

h e al )

Skin 

L o ss of sk in m ar ki n g s



P er si st e nt ul c er (a n y c h a n g e in c ol or , si z e, s h a p e, el e

 Ir re g ul ar h y p er k er at ot ic ar e a s (r o u g h ar e a th at sc a b s o v er , re sc a b s or fa ils to

v at io n, s ur fa c e, s ur ro u n di n g sk in , s e n s at io n or c o n si st e n c y)

 Pr ur it u s (p re v al e nt in H

o d g ki n’ s di s e a s e) 



V ar ia ti o n in pi g m e nt at io n P h y si c al E x a m in at io n

Head and Neck 

ul ty c h e wi n g, s w al lo wi n g, or m o vi n g to n g u e or ja w

Di ffi c



Fi r m , u ni la te ra l ly m p h n o d e s in n

e c k 

P er si st e nt re d di s h or w hi ti s h p at c h

Oral cavity

 O ta lg ia

 S w el li n g or ul c er th at fa ils to h e

al , in d ur at e d ul c er , or ip sil at er al re fe rr e d ul c er Physi cal Exami natio n Oroph arynx

 D y s p h a si a, lo c al p ai n,

p ai n o n s w al lo wi n g, or re fe rr e d ot al gi a Laryn x

 P er si st e nt h o ar s e n e ss , p ai n, re fe rr e d ot al

gi a, or n e c k m a ss Naso phary nx 

Bl o o d y n a s al di sc h ar g e, o b st ru ct e d n o st ril , c o n d u ct iv e d

e af n e ss 

P h y si c al E x a m in at io n

Nose and sinus es

 Bl o o d y n a s al di sc h ar g e, n a s al o b st ru ct io

n, fa ci al p ai n, fa ci al s w el li n g, di pl o pi a Paroti d and subm andib ular gland s

 P ai nl e ss lo c al s w el li n g or h e m if a ci

al p ar al y si s Physi cal Exami natio n Chest /Lung s Change in pulmonary habits Cough Hoarseness Chest pain Rust-streaked or purulent sputum production Hemoptysis Dyspnea P h y si c al E x a m in at io n

Breas t Axilla ry lymp hade nopat hy Blood y disch arge Chan ge in conto ur of breas t Dimpl ing of skin of breas t Edem a or eryth ema of breas t skin Fixati on of a mass to pecto ral fascia or chest wall Nippl e retrac tion Painle ss lump or mass

Unilat eral nipple disch arge

s of a p p et it e

Physi cal Exami natio n



Abdo men 

St o m a c h

 C o m pl ai nt s of in di g es ti o n or e pi g as tri c di st re ss 

L os



U ni nt e nt io n al w ei g ht lo ss or a n or e xi a





 D ys p h a gi a 

M as s in a b d o m e n



Ul c er ty p e p ai n Ir o n d ef ici e n cy a n e m ia P h ys ic al E x a m in at io n

Li v er

 P ai nf ul h e p

at o m e g al y 

e al v ar ic es sc it es 







 S

 E so p h a g

Physi cal Exami natio n 

G al lb la d d er

Ja u n di c e GI bl e e di n g F e v er



c ut e or c hr o ni c c h ol e cy st iti s

 A

Li v er te n d er n es s wi th n o d ul ar e nl ar g e m e nt pl e n o m e g al y

 A





E d e m a 

A b d o m in al p ai n A n or e xi a U ni nt e nt io n al w ei g ht lo ss





Ja u n di c e

ni a

N a u se a V o m iti n g

Physi cal Exami natio n 

P a n cr e a s



 In si d u o u s o n se t of as th e



A n or e xi a



W ei g ht lo ss



G as e o u s n es s



N a u se a

C ol o n a n d re ct u m

 C h a n g e

in b o w el h a bi ts (o b st ru ct io n, di ar rh e a, re ct al bl e e di n g, te n es m u s 

Ir o nd ef ici e n cy a n e m ia

Physi cal Exami natio n

Exami natio n Genit ourinar y

Genit ourinar y 



Ki d n e y s a n d ur in ar y tr a ct 

F e m al e g e ni ta li a

 C

 V

O b st ru ct io n

 H e m at ur ia

 Ol ig ur ia Physi cal

n u s u al pi g m e nt at io n

ul v a – pr ur it u s bl e e di n g, ul c er at e d le si o n, m as s, u

er vi x – p ai nf ul in te rc o ur se , p os tc oi ta l c oi ta l or in te r m e n st ru al bl

e e di n g, or w at er y fo ul s m el li n g di sc h ar g e

n st ru al bl e e di n g or p os t m e n o p a u sa l bl e e di n g (6 m os .)

 E n d o m et ri u m – p er si st e nt irr e g ul ar pr e m e

Physi cal Exami natio n Genit ourinar y 

F e m al e g

e ni ta li a

e ar ly sa ti et y, or m il d a n or e xi a, as ci te s p ai n, or a p el vi c m as s

 O v ar ie s – p er si st e nt v a g u e GI c o m pl ai nt s, a b d o m in al di sc o m fo rt, in di g es ti o n,



V a gi n a – bl e e di n g, c h a n g

es in ur in at io n p at te rn s, fo ul s m el li n g di sc h ar g e 

F al lo pi a n tu b es – a b n or m al bl e e di n g, a

b d o m in al p ai n, v a gi n al di sc h ar g e 

Genit ourinar y 

M al e g e ni ta li a

P h ys ic al E x a m in at io n



P e ni s – p ai nl es s ul c er or gr o w th or p er si st e nt di sc h ar g e (a lw a ys re tr a ct fo re sk in )

 Pr os ta te – b

o n e p ai n a n d c o nt in u o u s p ai n in lo w er b a ck , p el vi s, or u p p er th ig h s; re n al in s uf fi ci e n

cy , h e m at ur ia

 T es te s – p ai nl es s e nl ar g e m e nt of o n e te st icl e or a te st ic ul ar lu m p or n o d ul e,

fe el in g of h e a vi n es s or dr a g gi n g in lo w er a b d o m e n, c h a n g e in pr e e xi st in g h y dr o c el e



P os si bl e e x a m in at io n s

er y 3 y e ar s 

Low risk and asym ptom atic client s 

A g e s 2 04 0 – P E wi th h e al th c o u n s el in g e v





O v er a g e 4 0 – a n n u al P E M ol e m a p pi n g S e m ia n n u al d e nt al or al e x

a m in at io n High risk or symp tomat ic client s 

M or e fr e q u e nt e x a m s



S cr e e ni n g te st s

Possi ble exami natio ns for the Femal e Client

BSE mont hly for client s older than age 20 

B S E s h o ul d b e d o n e 35 d a y s af te r m e n st ru al p er io d e n d s

 P o

st m e n o p a u s al or h y st er e ct o m iz e d cli e nt s – p er fo r m B S E o n s a m e d a y e a c h m o

nt h Clinic al breas t exam 

E v er y 3 y e ar s fo r a g e s 2 04 0

natio ns for the Femal e Client Mam mogr aphy 

 

E v er y y e ar fo r a g e s o v er 4 0

Possi ble exami

di s p o s e d w o m e n

B a s el in e fo r a g e s 3 53 9 B a s el in e at a g e 2 5 fo r g e n et ic al ly pr e





E v er y 12 y e ar s fo r a g e s 4 04 9 E v er y y e ar fo r 5 0 a n d a b o

v e

e wi th se x u al a ct iv it y

Possi ble exami natio ns for the Femal e Client 

Colpo scopy for wome n with histor y of HPV Pelvic exam and Pap test 



W o m e n a g e s 1 84 0 

B as el in e o n c

W o m e n o v er 4 0 – e v er y y e ar

Endo metri al biops y at meno pause

P os si bl e e x a m in at io n s fo r th e F e m al e Cl ie nt

E v er y 13 y e ar s

Annu al fecal occult blood test for client s older than 50 Annu al DRE for client s over 40 Sigm oidos

copy for client s older than 50 every 3-5 years

fecal blood test 

Possi ble exami natio ns for the Male Client Prost ate exami natio n 

E v er y y e ar fo r cli e nt s ol d er th a n 5 0

Occul t

E v er y y e ar fo r cli e nt s ol d er th a n 5 0

DRE 

E v er y y e ar fo r cli e nt s ol d er th a n 4 0

Sigm oidos copy 

E v er y 15 y e ar s fo r cli e nt s ol d er th a n 5 0

Mont hly testic ular selfexami natio n 

Fr o m p u b er ty to a g e

4 0 

Bronc hosco py

Di a g n o st ic Pr o c e d ur e s

XRay Use of ionizi ng radiat ion to provi de imag es of tissue & bone struct ure and functi on

X-Ray Mam mogr aphy CT Scan

Contr aindic ated in pregn ancy

MRI Ultras ound

Nursi ng care

Bone Scan Lumb ar Punct ure Thora cente sis Pap Smea r

remove metallic objects, jewelry, or clothing apply lead shields instruct

patient to remain still Mam mogr aphy Diagn ose breas t cance r Contr aindic ated in pregn ancy Chara cteris tics of cance rous lesion Nursi ng care explain that compression does not harm the breast Comp uted Tomo graph y Scan Use of radiat ion

beam s to produ ce crosssectio nal views of soft tissue anato my and restru cturin g with the aid of comp uter Contr aindic ations : allergy to dye / contrast material pregnancy unstable vital signs / restlessness renal failure

Imagi ng Use of electr omag netic wave s acros s the body in differ ent plane s More sensit ive to soft tissue s Contr aindic ations claustrophobi a unstable, restless patient metallic implants

claustrophobi a

Ultras ound

Magn etic Reson ance

Use of highfrequ

ency sound wave s Highl y accur ate in distin guishi ng betwe en cystic and solid mass es Used in pelvis , abdo men, uteru s Bone Scan Involv es IV injecti on of radio active dye mater ial which is detec ted by a scann ing machi ne

Areas of conce ntrate d nucle otide uptak e may repre sent a tumor or any abnor malit y Contr aindic ated in pregn ancy Lumb ar Punct ure A spinal needl e is insert ed into the subar achno id space to exami natio n CSF to diagn ose

brain and spinal cord tumor s Contr aindic ations uncooperativ e patient increased ICP infection at the lumbar puncture site bleeding disorders Thora cente sis Pleur al tap Insert ing a needl e into the pleur al space to remo ve fluid and air

Nursi ng care explain the procedure secure informed consent instruct patient not to cough make sure CXR plates are available routine postprocedure monitoring (CXR) Pap Smea r Used to detec t cance r cell secret ions from the cervix and vagin a Can detec

t early cellul ar chang es in prem aligna nt or existi ng malig nant condit ions

bleedi ng, tumor s and obtai n biops y sampl es Flexib le fibero ptic bronc hosco pe

Scree ning: yearly for 2 negat ive exam s, then repea t every 3 yrs until age 65 Bronc hosco py Direct visual izatio n of laryn x, trach ea, and bronc hi to locali ze

Gener al anest hesia or IV sedati on Nursi ng care - NPO 6-8 hrs secure informed consent remove any dental prosthesis routine postprocedure monitoring

Upper GI Series Bariu m swall ow Visual ize upper GI tract “appl e core” defor mity Endos copy Direct visual izatio n of UGIT with a flexibl e fibero ptic scope ERCP Endoscopic Retrograde CholangioPancreatogra phy detect tumors in the pancreaticobiliary tree

jaundiced patients Colon oscop y Use of colon oscop e to direct ly visual ize colon and obtai n biops y Contr aindic ations unstable medical condition profuse rectal bleeding bowel distention suspected colon perforation Nursi ng care

informed consent bowel preparation Proct osigm oidos copy Use of a rigid proct oscop e to detec t lesion s in the rectos igmoi d colon and obtai n biops y Same princi ple in colon oscop y Diagn ostic Lapar oscop y Insuffl ation of

abdo minal cavity with C02

- Fine Needle Aspiration Biopsy (FNAB)

Insert ion of came ra throu gh umbili cal port incisi ons to visual ize the intrab domi nal organ s

- Core needle biopsy

Gener al anest hesia Biops y Acqui sition of tissue for exact histol ogic diagn osis Aspir ation biops y

Incisi on biops y Excisi on biops y Biops y Bone Marro w Brain Liver Lung Pleur al Endo metri al Thyro id Breas t Stere otacti c

Prost ate Tumo r Marke rs Carci noEm bryon ic Antig en (CEA) - NV: 0 – 2.5 ng/mL colorectal, metastatic breast, lung cancer Alpha FetoProtei n (AFP) - NV: 10 ng/mL testicular, liver cancer Prost ateSpecif ic Antig en (PSA) - NV: <4 ng/mL

primary & metastatic prostate cancer

medullary cancer of the thyroid Tumo r Marke rs

Tumo r Marke rs Huma n Chori onic Gona dotro pin (HCG) - NV: 0-1 ng/mL choriocarcino ma, testicular cancer Cance r Antig en 125 (CA 125) - NV: 34 U/mL ovarian cancer Calcit onin - NV: M=0-14 pg/mL; F=028 pg/mL

Horm ones - ER / PR ACTH, Insulin, PTH (“ectopic hormones”) Enzy mes Amylase (lung & ovarian tumors) SGPT, SGOT (liver cancer) Stagi ng of Cance r TNM Stagi ng Syste m T: exten t of prima ry

tumor based on size, depth of penet ration ,& invasi on of adjac ent struct ures N: Prese nce, exten t, & locati on of regio nal lymp h node involv emen t M: Prese nce or absen ce of distan t meta stase s& degre e of disse minat ion

Stagi ng of Cance r Stage 1Malig nant cells are confin ed to the tissue of origin , with no signs of meta stasis . Stage 2Tumo r is larger , proba bly has invad ed surro undin g tissue s, or both Stage 3Sprea d of the cance r is

limite d to the local area Stage 4Cance r has meta stasiz ed to other parts of the body TNM Stagi ng Syste m T0: no evide nce of prima ry tumor Tis: carcin omain-situ T1, T2, T3, T4: indica te progr essiv e degre es of tumor size

and involv emen t Tx: tumor can not be asses sed N0: regio nal LN not demo nstra bly abnor mal N1, N2, N3: indica te regio nal lymp h nodes involv emen t with increa sing degre e Nx: regio nal LN can not be asses

sed clinic ally M0: no evide nce of meta stasis M1: meta stasis prese nt

G4: very poorl y differ entiat ed Cance r Mana geme nt Surge ry

Gradi ng of Tumo r

Radia tion thera py

Gx: grade can not be asses sed

Chem other apy

G1: welldiffer entiat ed

Biolog ic thera py Surgi cal Oncol ogy

G2: mode rately welldiffer entiat ed

Oldes t treat ment for cance r

G3: poorl y differ entiat ed

Used to be the only treat

ment that could cure patie nts with cance r Roles for surge ry Prevention of cancer Diagnosis of cancer Treatment of cancer Proph ylacti c Surge ry Diagn osis Of Cance r Acqui sition of tissue for exact histol ogic diagn osis

Aspir ation biops y - Fine Needle Aspiration Biopsy (FNAB) - Core needle biopsy

genci es Palliat ion Recon struct ion and rehab ilitati on

Incisi on biops y

Radia tion Thera py

Excisi on biops y

Electr omag netic Radia tion

Treat ment Of Cance r Prima ry cance r Resid ual disea se Metas tatic Disea se Oncol ogic emer

Gamma radiation > produced intranuclearly (decay of radioactive isotopes) Roentgen > produced extranuclearl y

Photo electr ic absor ption Radia tion Thera py Brach yther apy radiation device is placed within or close to the target volume interstitial & intracavitary radiation used in the treatment of gynecologic & oral tumors Radia tion Thera py Telet herap y - uses a device located at a distance from the patient Radia tion

Thera py Rapid death by apopt osis Death while trying to divide May produ ce unusu al forms as a result of aberr ant attem pts at divisi on Cells may stay as it is, unabl e to divide , but physi ologic ally functi onal for a long perio d

May under go no altera tions or only minor ones

hy cells in the area

Radia tion Thera py

Eradi cates radioc urabl e disea se such as earlystage breas t CA follow ing lump ecto my

Energ y depos ited in cells cause a direct hit to the DNA causi ng DNA stran d break s Tumo r cells lose their capac ity to repair dama ge Affect s norm al healt

Radia tion Thera py

Contr ols the growt h and sprea d of disea se, such as adjuv ant thera py for latestage chest wall recurr ence

Acts as proph ylacti c treat ment to preve nt micro scopi c disea se, such as whole brain irradi ation with lung CA Impro ves qualit y of life in advan ced disea se, such as pain from bone meta stasis or press ure from spinal cord comp ressio n

The client under going exter nal radiat ion thera py (telet herap y)

 T h e ra di at io n o n c ol o gi st m ar ks s p e ci fi c lo c at io n s fo r ra di at io n

tr e at m e nt u si n g a s e m ip er m a n e nt ty p e of in k 

Tr e at m e nt is u s u al ly gi v e n 1 5 to 3 0 m in

ut es p er d a y, 5 d a ys p er w e e k, fo r 2 to 7 w e e ks 

T h e cli e nt d o es n ot p os e a ri sk fo r ra di at io n

e x p os ur e to ot h er p e o pl e The client under going exter nal radiat ion thera py (telet herap y) 

Cl ie nt e d u c at io n fo r e xt er n al ra di at

io n 

W as h th e m ar k e d ar e a of th e sk in wi th pl ai n w at er o nl y a n d p at sk in dr y; d o n ot u se so a p s,

d e o d or a nt s, lo ti o n s, p er fu m es , p o w d er s or m e di c at io n s o n th e si te d ur in g th e d ur at io n

of th e tr e at m e nt ; d o n ot w as of f th e tr e at m e nt si te m ar ks 

A v oi d ru b bi n g, sc ra tc hi n g, or sc ru b

bi n g th e tr e at m e nt si te ; d o n ot a p pl y e xt re m e te m p er at ur es (h e at or c ol d) to th e tr e at m e nt si

te ; if s h a vi n g, u se o nl y a n el e ct ri c ra zo r The client under going exter nal radiat ion thera py (telet herap y) 

W e ar so ft. L o os efit ti n

g cl ot hi n g o v er th e tr e at m e nt ar e a 

Pr ot e ct sk in fr o m s u n e x p os ur e d ur in g th e tr e at m e nt

a n d fo r at le as t 1 y e ar af te r th e tr e at m e nt is c o m pl et e d; w h e n g oi n g o ut d o or s, u se s u n-

bl o ck in g a g e nt s wi th s u n pr ot e ct io n fa ct or (S P F) of at le as t 1 5 

M ai nt ai n pr o p er re st , di et , a

n d fl ui d in ta k e as es se nt ia l to pr o m ot in g h e al th a n d re p ai r of n or m al ti ss u es 

H ai r lo ss m a y

o cc ur ; c h o os e a wi g, h at , or sc ar f to c o v er a n d pr ot e ct H e a d (r ef er to c ar e of cli e nt wi th al o p

e ci a la te r in c h a pt er ) The client under going brach yther apy (inter nal radiat ion) 

S o ur c e s of in te rn al ra di at io n 

I m pl a nt e d in

to af fe ct e d ti ss u e or b o d y c a vi ty 

In g es te d as a so lu ti o n



In je ct e d as a so lu ti o n in to th e bl o

o d st re a m or b o d y c a vi ty

nal radiat ion) 



Cl ie nt e d u c at io n 



The client under going brach yther apy (inter

In tr o d u c e d th ro u g h a c at h et er in to th e tu m or

A v oi d cl os e c o nt a ct wi th ot h er s u nt il tr e at m e nt is c o m pl et e d

M ai nt ai n d ai ly a ct iv iti es u nl es s c o nt ra in di c at e d, al lo wi n g fo r e xt ra re st p er io d s as n e e d e d



M ai nt ai n b al a n c e d di et ; m a y to le ra te fo o d b et te r if c o n s u m es s m al l, fr e q u e nt m e al s

The client under going brach yther apy (inter nal radiat ion)





M ai nt ai n fl ui d in ta k e to e n s ur e a d e q u at e h y dr at io n (2 -3 lit er s/ d a y)



If i m pl a nt is te m p or ar y, m ai nt ai n b e d re st to a v oi d di sl o d gi n g th e i m pl a nt E xc re te d b o d

y fl ui d s m a y b e ra di o a ct iv e; d o u bl efl u s h to il et s af te r u se 

R a di at io n th er a p y m a y le

a d to b o n e m ar ro w s u p pr es si o n The client under going brach yther apy (inter nal radiat ion) 

N ur si n g m a n a g e m e nt of cli e nt re

c ei vi n g in te rn al ra di at io n 

E x p os ur e to s m al l a m o u nt s of ra di at io n is p os si bl e d ur in g cl os e

c o nt a ct wi th p er so n s re c ei vi n g in te rn al ra di at io n; u n d er st a n d th e pr in ci pl es of pr ot e ct io n fr o

m e x p os ur e to ra di at io n: ti m e, di st a n c e, a n d s hi el di n g 

Time: minimize time spent in close proximity to the radiation sources; a common standard is to limit contact time to 30 minutes total per 8-hour shift;

minimum distance of 6 feet used when possible 

Distance: maintain the maximum distance possible from the radiation source



Shielding: use lead shields and other precautio ns to reduce exposure to radiation



Pl a c e cli e nt in pr iv at

The client under going brach yther apy (inter nal radiat ion)

e ro o m 

In st ru ct vi si to rs to m ai nt ai n at le as t a di st a n c e of 6 fe et fr o m th e cli e nt a n d li m it vi si ts

to 1 0 to 3 0 m in ut es 

E n s ur e pr o p er h a n dl in g a n d di s p os al of b o d y fl ui d s, as s ur in g th e c

o nt ai n er s ar e m ar k e d a p pr o pr ia te ly 

E n s ur e pr o p er h a n dl in g of b e d li n e n s a n d cl ot

hi n g The client under going brach yther apy (inter nal radiat ion)

 In th e e v e nt of a di sl o d g e i m pl a nt , u se lo n gh a n dl e d fo rc e

p s a n d pl a c e th e i m pl a nt in to a le a d c o nt ai n er ; n e v e r di re ct ly to u c h th e i m pl a nt



D o n ot al lo w pr e g n a nt w o m e n to c o m e in to a n y c o nt a ct wi th ra di at io n so ur c es ; sc re e n vi si

to rs a n d st af f fo r pr e g n a n cy 

If w or ki n g ro ut in el y n e ar ra di at io n so ur c es , w e ar a m o ni to ri

n g d e vi c e to m e as ur e e x p os ur e 

Radia tionprote ction meas ures Alpha partic les

E d u c at e cli e nt in al l sa fe ty m e as ur es





Tr a v el at gr e at s p e e d, p o or p e n et ra ti o n Li m it e d th er a p e ut ic u s e

Beta partic les 

P h o s p h

or u s3 2 or Yt tri u m 9 0 

C a n b e s hi el d e d b y th ic k pl a st ic or b y th e b o d y’ s s ur fa c e



R a di at io npr ot e ct io n m e a s ur e s

y, th e th ic k er th e a b s or bi n g m at er ia l re q ui re d

Gam ma partic les 



U n st a bl e p ar ti cl e s T h e hi g h er th e e n er g





L e a d A d v er s e Ef fe ct s

May be acute or imme diate – after

6 mos. post expos ure May be late or chron ic – after 1 year post expos ure Reflec t cell dama ge and accu mulat ion of toxic effect s of tissue destr uction

indivi dual differ ences SiteSpecif ic Adver se Effect s Head and neck 





Sitespecif ic Depe ndent on volum e, dose fracti onati on, total dose and



St o m at iti s X er o st o m ia T o ot h d e c a y a n d c ar ie s T a

st e c h a n g e s

 O st e or a di o n e cr o si s ( m a n di bl e)

 H y p o pi tu it ar is m (r ef le ct d e cr e a s

e d s e cr et io n s of c or ti s ol , th yr o xi n e, a n d s e x h or m o n e s) SiteSpecif ic Adver se Effect s

a gi ti s 

C o u g h

 R a di at io n p n e u m o ni ti s 

R a di at io n fi br o si s

Abdo men 

Chest

 E s o p h

s e a a n d v o m iti n g



G a st rit is N a u

SiteSpecif ic Adver se Effect s

gi n al st e n o si s 

O v ar ia n fa il ur e



T e st ic ul ar d y sf u n ct io n

Pelvis 

Di ar rh e a



C y st iti s



Er e ct il e d y sf u n ct io n

 V a

SiteSpecif ic Adver se Effect s Brain 

C er e br al e

d e m a (s te ro id th er a p y in di c at e d) 



Al o p e ci a C h a n g e s in h ai r te xt ur e a n d c ol or

 S c

al p pr ur it u s Chem other apy Chem other apy Induc tion chem other apy Adjuv ant chem other apy Neoa djuva nt chem other apy Types of chem other apy Adjuv ant – micro meta stase s

Neoa djuva nt – shrink sa tumor prior surgic al remo val

syner gizes the thera peutic action s of other cytot oxic drugs

Prima ry thera py – treats a locali zed tumor when there’ s an altern ative, less effect ive

Proph ylacti c – to preve nt micro meta stase s

Induc tion – treats a cance r for which there is no altern ative treat ment Comb inatio n– enha nces or

Prima ry Chem other apy Neopl asms in w/c CTX is the prima ry thera peutic moda lity for locali zed tumor s Large cell lymphoma

Lymphoblasti c lymphoma Hodgkin’s disease Wilm’s tumor Embryonal rhabdomyosa rcoma Small cell lung cancer - CNS lymphomas Neoa djuva nt Chem other apy Neopl asms in w/c prima ry CTX can allow less mutil ating surge ry - Anal carcinoma Bladder carcinoma

Breast cancer Esophageal cancer Laryngeal cancer Osteogenic sarcoma - Soft tissue sarcoma Basic Conce pts in Chem other apy Destr oy cance r cells by interf ering with their repro ductio n Act at specif ic points in the cell cycle Affect any rapidl

y dividi ng cell within the body, thus havin g the poten tial for toxicit y devel opme nt in healt hy, functi onal tissue (bone marro w, hair follicl es, GI muco sa) To reduc e possi bility of toxicit y and drug resist ance, combi natio n thera py is often used

Availa ble in oral, paren teral and topica l prepa ration s Basic Conce pts in Chem other apy Patter n of neutr openi a after chem other apy

 M in i m al n e ut ro p e ni a 47 d a y s af te

r tr e at m e nt

 N a di r (p er io d of m a xi m u m n e ut ro p e ni a) 8 to 1 2 d a y s af te r tr e at m e nt

 R et

ur n of n or m al n u m b er of n e ut ro p hi ls 1 4 to 1 8 d a y s af te r tr e at m e nt Chem other apeut ic Drugs Alkyla ting agent s

- cell cycle nonspecific

Nitrogen mustards

- form highly reactive carbonium ions which react w/ DNA, proteins, & other essential cellular substances

> Chlorambucil > Cyclophospha mide > Ifosfamide

replace hydrogen atoms w/ alkyl radicals, causing cross-linking & abnormal base pairing in the DNA molecule renders DNA molecule defective & unable to carry on normal cellular metabolic & reproductive functions Chem other apy Alkyla ting agent s

> Mechloretha mine > Melphalan Nitrosureas > Carmustine > Lomustine > Streptozocin > Busulfan > Carboplatin > Cisplatin

> Thiotepa Chem other apeut ic Drugs Antibi otics - cell cycle specific; inhibit RNA & protein synthesis or rapidly dividing cells Produ ced by the bacte rial speci es Strep tomy ces Dacti nomy cin, Daun orubi cin, Doxor ubicin ,& Plica mycin - use complex mechanisms to combine w/ DNA base

pairs, thus interfering w/ DNA, RNA, & protein synthesis Chem other apeut ic Drugs Bleo mycin causes DNA strand scission and fragmentatio n Mito mycin inhibits DNA replication by causing cross-links to form between complementa ry strands of the molecule Chem other apeut ic Drugs Antim etabo lites - cell cycle specific inhibition of S phase

Folic acid analo g Blocks the action of the enzyme dihydrofolate reductase which inhibits production of coenzyme needed for synthesis of thymidylic acid – precursor for nucleic acid replication Pyrim idine & purin e analo gs block enzymes needed during the synthesis of DNA & RNA Chem other apeut ic Drugs Antim etabo lites Cytarabine

Floxuridine Fluorouracil Mercapturine Methotrexate Thioguanine Chem other apeut ic Drugs Natur al or semis ynthe tic produ cts deriv ed from differ ent plants Etopo side semisynthetic derivative of podophylloto xin, derived from root of May-apple plant affect G2 phase pf cell cycle

causes cell lysis at high dose prevents cells from entering mitosis stage & inhibit DNA synthesis Chem other apeut ic Drugs Vincri stine & Vinbl astine Vinca alkaloids from periwinkle plant arrest cell activity at the M phase (metaphase) inhibiting mitosis Horm ones Inhibit RNA & protein synthesis that are dependent on sex hormone for development

Side effect s of chem other apeut ic agent s >.Bon e marro w suppr essio n Decre ased WBC count (imm unosu ppres sion) Decre ased platelet count (thrombocyto penia) Decre ased hemoglobin and hematocrit (anemia) Gastr ointestinal effects: anorexia, nausea, vomiting, and diarrhea Side effect s of

chem other apeut ic agent s

ss ) 

 St o m at iti s (i nf la m m at io n of th e m o ut h) a n d m u c o si to si s 

Al o p e ci a (h ai r lo

F at ig u e

 X er o st o m ia (d ry m o ut h) 

O th er si d e ef fe ct s s p e ci fi c to c h e m ot h er a p e ut

ic a g e nt

s, peopl e with infecti ons, and small childr en when WBC is low

Immu nosup pressi on

 Cl ie nt e d u c at io n fo r i m m u n o s u p pr e ss io n

Use meticulous personal hygiene to avoid infection Immu nosup pressi on Wash hands before and after eating, after toileting, and after contact with other people and pets

R isk for infecti on is high when WBC count is low A void crowd

Consume a low-bacteria diet; avoid undercooked meat and raw fruits and vegetables Be aware of signs and symptoms of infection and report them immediately to primary care provider

Nursi ng mana geme nt of immu nosup pressi on

Nursi ng mana geme nt of immu nosup pressi on

Monit or labor atory value s: CBC with differ ential , platel ets, BUN, liver enzy mes

WBC suppr essio n, maln utritio n anf prese nce of disea se increa se the risk of infecti on

Asses s for infecti on; monit or vital signs for early indica tion of infecti on: fever, tachy cardia , and tachy pnea

Utilize neutr openi c preca utions (lowbacte ria diet, no fresh plants or flower s in room, no pets, no visitor s with infecti

ons) when WBC level falls below prede termi ned level (such as 2,000 mm3)

o p e n i a •

Thro mboc ytope nia 

C l i e n t e d u c a t i o n f o r t h r o m b o c y t

Mo nit or sto ols an d uri ne for ble edi ng

•

For sh avi ng, us e ele ctri c raz or onl y

•

Av oid co nta ct sp ort s an d oth er act ivit ies tha

t ma y ca us e tra um a •

If tra um a do es oc cur , ap ply ice to are a an d se ek me dic al as sis tan ce

Thro mboc ytope nia •

A v o i d d e n

t a l w o r k o r o t h e r i n v a s i v e p r o c e d u r e s •

I n f o r m a l l h e

a l t h c a r e p r o v i d e r s o f c h e m o t h e r a p y a n d / o r r a d i a t i o n

t r e a t m e n t s •

A v o i d

o d u c t s •

t o o t h b r u s h e s

S a f e t y

a s p i r i n

p r e c a u t i o n s

a n d

f o r

a s p i r i n c o n t a i n i n g

o r a l

p r

t

h y g i e n e ; u s e s o f

a n d d o n o t f l o s s Nursi ng mana geme nt of throm bocyt openi a •

T h e r e i s a h

i g h r i s k f o r s p o n t a n e o u s h e m o r r h a g e w h e n p l a t e l e t c o u n t i s <

2 0 , 0 0 0 ; p r e c a u t i o n s a r e n e c e s s a r y f o r p l a t e l e t c o u n t < 5 0 , 0

0 0 •

A s s e s s f o r b l e e d i n g , m o n i t o r s t o o l s a n d u r i n e f o r o c c u l t

b l o o d Nursi ng mana geme nt of throm bocyt openi a

•

A s s e s s s k i n f o r e c c h y m o s e s , p e t e c h i a e , a

n d t r a u m a •

E d u c a t e c li e n t a b o u t b l e e d i n g s a f e t y p r e c a u t i o n s

•

Stom atitis

A v o i d i n t r a m u s c u l a r i n j e c t i o n s a n d li m i t v e n i p u n c t u r e s

and muco sitosi s

i s •

 C l i e n t e d u c a t i o n f o r s t o m a t i t i s a n d m u c o s i t o s

•

U se a so ft to ot h br u s h; m o ut h s w a b s m a y b e n e e d e d d ur in g a c ut e e pi so d e A v

oi d m o ut h w as h es c o nt ai ni n g al c o h ol ; d o n ot u se le m o n gl yc er in s w a b s or d e nt al fl os s

Stom atitis and muco sitosi s

•

C o n s i d e r u s i n g c h l o r h e x i d i n e m o u t h w a s h ( P e r i d e x )

t o d e c r e a s e r i s k o f h e m o r r h a g e a n d p r o t e c t g u m s f r o m t r a u m a

•

A s s e s s d a il y f o r l e s i o n s , i n f e c t i o n , b l e e d i n g , o r i r r i t a t i

o n Stom atitis and muco sitosi s

•

F or x er o st o m ia , a p pl y lu br ic at in g a n d m oi st ur izi n g a g e nt s to pr ot e ct th

e m u c o u s m e m br a n e s fr o m tr a u m a a n d in fe ct io n •

M a y c o n si d er u si n g “ ar tif ici al s

al iv a ” a n d h ar d c a n d y or m in ts to h el p wi th dr y n e ss Stom atitis and muco sitosi s

•

s y m p t o m s o f o r a l i n f e c t i o n a n d t o

.Avoid smoking and alcohol, which can further irritate oral mucosa T e a c h

r i m a r y h e a l t h c a r e

s i g n s a n d

r e p o r t t o p

p r o v i d e r •

D r i n k c o o l li q u i d s , a n d a v o i d

o r a l m u c o u s m e m b r a n e s e v e r y 4 h o u r s

h o t a n d i r r i t a t i n g f o o d s Stom atitis and muco sitosi s •

 Nu rsi ng ma na ge me nt of sto ma titi s •

A s s e s s

T e a c h a n d i m p l e m e n t p r o

p e r o r a l c a r e Inade quate nutriti on and fluid and electr olyte imbal ance 

Cl ie nt e d u c at io n fo r m ai nt ai ni n g a d e q u at e n

ut rit io n, fl ui d a n d el e ct ro ly te b al a n c e •

E a t f r e q u e n t s m a ll , l o w f a t m e a l s

•

A v o i d s p i c y a n d f a t t y f o o d s

•

A v o i d e x t r e m e l y h o t f o o d s

Inade quate nutriti on

and fluid and electr olyte imbal ance •

•

cr ib e d • P er fo r m or al h y gi e n e b ef or e a n d af te r m e al s M ai nt ai n fl ui d in ta k e as pr es

•

T a k e n ut rit io n al s u p pl e m e nt s as pr es cr ib e d (v it a m in s, li q ui d n ut rit io n) M ai nt ai

n a d ai ly jo ur n al of fo o d a n d fl ui d in ta k e Inade quate nutriti on and fluid and electr olyte imbal ance 

N u r s i n g m a n a g e m

e n t

t e i m b a l a n c e s

o f i n a d e q u a t e n u t r i t i o n a n d f l u i d a n d e l e c t r o l y

•

As se ss for ad eq uat e hy dr ati on; for du rat ion of tre at me nt, en co ur ag e dai ly flui d int ak e of 2 to 3

lite rs unl es s co ntr ain dic ate d

•

•

Ad mi nis ter ant ie me tic s pri or to ch em oth era py We igh cli ent ro uti nel y, mo nit or for we igh t los s

Inade quate nutriti

on and fluid and electr olyte imbal ance

•

M o ni to r la b v al u es in di c at iv e of n ut rit io n al st at u s (h e m o gl o bi n, h e m at o cr

it, al b u m in , pr e al b u m in ) •

M o ni to r fo r di ar rh e a or c o n st ip at io n, a n d n a u se a or v o m iti

n g •

E n c o ur a g e a d e q u at e n ut rit io n al in ta k e wi th m e al s th at ar e se rv e d at tr a ct iv el y, a n

d e n vi ro n m e nt fr e e of n o xi o u s st i m ul i (b e d p a n, ur in al , o d or s) Fatig ue 

N ur si n g m a n a

g e m e nt of fa ti g u e •

A ss ur e cli e nt th at fa ti g u e is a n or m al re s p o n se to c h e m ot h er a p y a n

d th at it d o es n ot in di c at e pr o gr es si o n of di se as e •

E n c o ur a g e cli e nt to c o nt in u e d ai ly a ct iv

iti es as m u c h as p os si bl e, al lo wi n g fo r re st p er io d s in b et w e e n •

A ss is t cli e nt in se lfc ar e n e e

d s w h e n in di c at e d •

Al lo w fo r p er io d s of re st ; cl u st er a ct iv iti es

Alope cia 

N u r s i n g m a n

a g e m e n t o f c l i e n t e x p e r i e n c i n g a l o p e c i a ( h a i r l o s s )

•

C h e m ot h er a p y a n d ra di at io n th er a p y m a y c a u se h ai r lo ss ; th e h ai r lo ss is te m p or ar y a

n d wi ll gr o w b a ck , u s u al ly b e gi n ni n g a b o ut a m o nt h af te r c o m pl et io n of th e c h e m ot h

er a p y; th e cli e nt s h o ul d k n o w th at th e te xt ur e a n d c ol or of th e n e w h ai r gr o w th m a y b e di

ff er e nt ; h ai r lo ss d ur in g ra di at io n th er a p y to th e h e a d m a y b e p er m a n e nt Alope cia •

E n c o

ur a g e th e cli e nt to c h o os e a wi g b ef or e h ai r lo ss o cc ur s in or d er to m at c h te xt ur e a n d h ai r c

ol or •

C ar e of h ai r a n d sc al p in cl u d es w as hi n g h ai r t w o to th re e ti m es a w e e k wi th a m il d s

h a m p o o; p at h ai r dr y, a n d d o n ot u se a bl o w dr y er •

Al lo w cli e nt to e x pr es s fe el in g s c o n c

er ni n g al te re d b o d y i m a g e Nursi ng implic ations for the admi nistra tion of chem other apy

 In tr a v e n o u s ro ut es m a y b e o bt

ai n e d b y s u b cl a vi a n c at h et er s, i m pl a nt e d p or ts , or p er ip h er al ly in se rt e d c at h et er s

 E xt r a v a s a ti o n th e le a ki n g of c h e m ot h er a p e ut ic a g e nt s in to th e s ur ro u n di n g ti ss u

e, is th e m oj or c o m pl ic at io n of in tr a v e n o u s c h e m ot h er a p y; e xt re m e c ar e m u st b e u se d

w h e n a d m in is te ri n g v es ic a nt a g e nt s (c h e m ic al s c a u si n g d a m a g e to ti ss u e o n c o

nt a ct ) Nursi ng implic ations for the admi nistra tion of chem other apy P h y s i c i a n s a n d n u r s e s h o u l d b e s p

e c i a ll y t r a i n e d

t i c a g e n t

t o

p a t e n c y m u s t b e

h a n d l e a n d a d m i n i s t e r c h e m o t h e r a p e u

V e i n

a s s u r e d b e f o r e a d m i n i s t

e r i n g c h e m o t h e r a p e u t i c a g e n t s W a r n i n g : n e v e r t e s t v e i n

p a t e n c y w i t h c h e m o t h e r a p e u t i c a g e n t s Nursi ng implic ations for the admi nistra tion of chem other apy

 I f

e x t r a v a s a t i o n o c c u r s , d e p e n d i n g o n t h e c h e m o t h e r a p

e u t i c a g e n t , i n t e r v e n t i o n s m a y i n c l u d e t h e i n j e c t i o

n o f a n a n t i d o t e , t h e a p p l i c a t i o n o f a c o l d c o m p r e s

s , o r t h e a p p l i c a t i o n o f a w a r m c o m p r e s s Nursi ng implic ations for the admi nistra tion of

chem other apy 

A s s e s s r e s p i r a t o r y a n d c a r d i a c

E K G ,

g n s 

a s s e s s f o r h e a r t f a i l u r e , a n d

s t a t u s ;

m o n i t o r

m o n i t o r

v i t a l s i

M o n i t o r c l i e n t c l o s e l y f o r a n a p h y l a c t i c r e a c t i o

n s o r s e r i o u s s i d e e f f e c t s ; d i s c o n t i n u e i n f u s i o n a c

c o r d i n g t o p r o t o c o l i f r e a c t i o n s o c c u r Nursi ng implic ations for the admi nistra tion of chem

other apy 

M o n i t o r i n t r a v e n o u s s i t e c l o s e l y d u r i n g a d m i n i s t

r a t i o n ; o b s e r v e f o r p a i n a n d o t h e r s y m p t o m s o f i n f i

l t r a t i o n 

P r o v i d e a c a l m , q u i e t e n v i r o n m e n t f o r t h e

c l i e n t d u r i n g a d m i n i s t r a t i o n Nursi ng implic ations for the admi nistra tion of chem other apy U s e c a ut io n

w h e n pr e p ar in g, a d m in is te ri n g, or di s p o si n g of c h e m ot h er a p e ut ic a g e nt s; fo ll o w pr a

ct ic e g ui d el in e s a n d pr ot e ct iv e st a n d ar d s fo r s af e h a n dl in g of c h e m ot h er a p e ut ic a

g e nt s pr o vi d e d b y th e O cc u p at io n al S af et y a n d H e al th A d m in is tr at io n ( O S H A) a n d O

n c ol o g y N ur si n g S o ci et y The client under going a bone marro w trans plant (BMT)

 B M T is u s e d in th e tr e at m e nt of le u k e

m ia s, u s u al ly in c o nj u n ct io n wi th ra di at io n or c h e m ot h er a p y

 Au tol og ou s BM T: the cli ent is inf us ed wit

h ow n bo ne ma rro w ha rve ste d du rin g re mi ssi on of dis ea se

 All og eni c BM T: the cli ent is inf us ed wit h do no r bo ne ma rro w ha rve ste d

fro m a he alt hy ind ivi du al The client under going a bone marro w trans plant (BMT) T h e b o n e m ar ro w is u s u al ly h ar v e st e d fr o m th

e ili a c cr e st s, th e n fr o z e n a n d st or e d u nt il tr a n sf u si o n B ef or e re c ei vi n g th e B M T, th

e cli e nt m u st fir st u n d er g o a p h a s e of i m m u n o s u p pr e ss iv e th er a p y to d e st ro y th e i m

m u n e s y st e m ; in fe ct io n, bl e e di n g, a n d d e at h ar e m aj or c o m pl ic at io n s th at c a n o cc ur d

ur in g th is c o n di ti o ni n g p h a s e

b o n e m ar ro w is tr a n sf u s e d in tr a v e n o u sl y th ro u g h a c e nt ra l li n e

The client under going a bone marro w trans plant (BMT)

 Af te r i m m u n o s u p pr e ss io n, th e



Si d e ef fe ct s of b

o n e m ar ro w tr a n s pl a nt : 

di n g re la te d to th ro m b o cy to p e ni a

M al n ut rit io n



Bl e e



The client under going a bone marro w trans plant (BMT)

 In fe ct io n re la te d to i m m u n os u p pr es si o n

nt (BM T)



Nur sing ma nag em ent of clie nt und erg oin ga bon e mar row tran spla

M o n i t o r

f o r

g r a f t v e r s u s h o s t

t h e

P r o v i d e p

l b e h o s p i t a l i z e d

r o o m

f o r

d i s e a s e 

r i v a t e

h o s p i t a l i z e d c l i e n t ; c l i e n t w i l

6 t o



t h s i g n i f i c a n t o t h e r s

8

b y

w e e k s

u s i n g

E n c o u r a g e

t e l e p h o n e ,

c o n t a c t w i

c o m p u t e r ,

s a n d o t h e r m e a n s o f c o m m u n i c a t i o n t o r e d u c e f e e l i n g

o f i s o l a t i o n Biolog ic Thera py Cance r treat ment that produ ces antitumor effect s prima rily throu gh the action of natur al host defen se mech anism s or the admi nistra tion of

natur al mam malia n subst ances Biolog ic Thera py Stimu late immu ne defen se mech anism s Cause the tumor to appe ar more “forei gn” comp ared to norm al tissue s Immu ne cells secret e two major classe s of solubl e

protei n Antibody Cytokines Antib ody Two pairs of differ ent polyp eptid e chain s (heav y& light chain s) Two recog nition sites capab le of combi ning with the immu nizing antig en Media te cell destr uction by phag

ocyto sis

ing cells

Cytot oxic T Lymp hocyt e (CTL)

Interf erons

Natur al Killer cells (NK) Cytok ines Produ ced by lymp hocyt es (lymp hokin es) or mono cytes (mon okine s) acting as true horm ones – acting on other cells at a distan ce from the secret

Tumo r Necro sis Facto r (TNF) Interl eukin s118 Oncol ogic Emer genci es: Diagn osis and Mana geme nt Spinal cord comp ressio n 

O c c u r s s e c o n d a

r y t o p r e s s u r e f r o m e x p a n d i n g t u m o r s

 E a r l y s y m p t o m s i n

c l u d e b a c k a n d l e g p a i n , c o l d n e s s , n u m b n e s s , t i n g li n g , p a r

e s t h e s i a ; p r o g r e s s i o n l e a d s t o b o w e l a n d b l a d d e r d y s f u n c

t i o n , w e a k n e s s , a n d p a r a l y s i s 

E a r l y d e t e c t i o n i s e s s e n t i

a l : i n v e s t i g a t e a ll c o m p l a i n t s o f b a c k p a i n o r n e u r o l o g i c a

l c h a n g e s

sio n an d pr ev en t irr ev ers ibl e pa ra ple gia ; ma y rec eiv e cor tic ost er oid to re du ce cor d ed em a

Spinal cord comp ressio n 

Tr ea tm en t is ai me d at re du cin g tu mo r siz e by ra dia tio n an d/o r sur ge ry to reli ev e co mp res



Nu rsi ng int er ve nti on s inc lud e ea

rly rec og niti on of sy mp to ms , mo nit ori ng vit al sig ns, ne ur olo gic al ch ec ks, an d me dic ati on ad mi nis tra tio n Super ior vena cava syndr ome 

C o m pr

e ss io n or o b st ru ct io n of th e s u p er io r v e n a c a v a (S V C) 

U s u al ly a ss o ci at e d wi th c a n c

er of lu n g s a n d ly m p h o m a s 

Si g n s a n d s y m pt o m s ar e th e re s ul t of bl o c k a g e of v e

n o u s ci rc ul at io n of h e a d, n e c k, a n d u p p er tr u n k Super ior vena cava syndr ome

 E ar ly si g n s a n d s y m

pt o m s ar e p er io rb it al e d e m a a n d fa ci al e d e m a 

S y m pt o m s pr o gr e ss to e d e m a of n e c

k, ar m s, a n d h a n d s; di ffi c ul ty s w al lo wi n g; s h or tn e ss of br e at h 

L at e si g n s a n d s y m pt o

m s ar e c y a n o si s, al te re d m e nt al st at u s, h e a d a c h e, a n d h y p ot e n si o n Super ior vena cava syndr ome





D e at h m a y o cc ur if c o m pr e ss io n is n ot re li e v e d Tr e at m e nt in cl u d e s hi g hd o s e ra di at

io n to s hr in k tu m or a n d re li e v e s y m pt o m s

 N ur si n g in te rv e nt io n s in cl u d e m o ni to ri n g

vi ta l si g n s, pr o vi di n g o x y g e n s u p p or t, pr e p ar in g fo r tr a c h e o st o m y if n e c e ss ar y,

in iti at in g s ei z ur e pr e c a ut io n s, a n d a d m in is te ri n g c or ti c o st er oi d s to re d u c e e d e m a

Disse minat ed intrav ascul ar coagu lopat hy (DIC) 

S e v er e di s or d er of c o a g ul at io n, of te n tri g g er e d b y s e p si s, w h er e b

y a b n or m al cl ot fo r m at io n o cc ur s in th e m ic ro v a sc ul at ur e; th is pr o c e ss d e pl et e s th e cl ot ti n

g fa ct or s a n d pl at el et s, al lo wi n g e xt e n si v e bl e e di n g to o cc ur ; ti ss u e h y p o xi a o cc ur s a

s a re s ul t of th e bl o c k a g e of bl o o d v e ss el s fr o m th e cl ot s Disse minat ed intrav ascul ar coagu lopat hy (DIC) Si g n s a

n d s y m pt o m s ar e re la te d to d e cr e a s e d bl o o d fl o w to m aj or or g a n s (t a c h y c ar di a, ol ig

ur ia , d y s p n e a) a n d d e pl et e d cl ot ti n g fa ct or s (a b n or m al bl e e di n g a n d h e m or rh a g e)

Disse minat ed intrav ascul ar coagu lopat hy (DIC)

 Tr e at m e nt in cl u d e s a nt ic o a g ul a nt s to d e cr e a s e st i m ul at io n of c o

a g ul at io n a n d tr a n sf u si o n of o n e or m or e of th e fo ll o wi n g: fr e s h fr o z e n pl a s m a (F F P)

, cr y o pr e ci pi ta te , pl at el et s, a n d p a c k e d re d bl o o d c el ls (R B C s) Disse minat ed intrav ascul ar coagu lopat hy (DIC)

 N ur si n g in te rv e nt io n s in cl u d e a ss e ss in g cli e nt , m o ni to ri n g fo r bl e e di n g, a p pl yi n g pr e

ss ur e dr e ss in g s to v e ni p u n ct ur e si te s, a n d pr e v e nt in g ri sk of s e p si s 

M or ta lit y fo r cli e nt

s e x p er ie n ci n g DI C is gr e at er th a n 7 0 p er c e nt d e s pi te a g gr e ss iv e tr e at m e nt Cardi ac tamp onade

Perica rdial effusi on secon dary to meta stase s or esoph ageal cance r can lead to comp ressio n of heart, restri cting heart move ment and result ing in cardia c tamp onade Cardi ac tamp onade Signs and symp toms are relate d to cardio genic shock

or circul atory collap se: anxie ty, cyano sis, dyspn ea, hypot ensio n, tachy cardia , tachy pnea, impai red level of consc iousn ess, and increa sed centr al venou s press ure Cardi ac tamp onade Perica rdioce ntesis is perfor med to

remo ve fluid from perica rdial sa Nursi ng interv entio ns includ e admi nister ing oxyge n, maint aining intrav enous line, monit oring vital signs, hemo dyna mic monit oring, and the admi nistra tion of vasop ressor agent s