CARE OF THE CLIENT WITH CANCER
Cellular Adaptation, Injury and Death
Cellular Adaptation
Atrophy is the wasting or decrease in
size of a normally developed organ.
results from a decrease in size of the cells
composing it.
Example is disuse of an organ
- control of cell division is regulated
by CHONs produced by suppressor genes
cyclins CHONs that promote
cells to enter &
complete cell division.
Contact inhibited
-once a normal cell is in direct
contact on all surface areas with other cells, it no
longer undergoes mitosis
Euploid- 23 pairs of chromosomes
Hypertrophy
increase in size of an organ resulting from
an increase in the size of the cells.
sometimes represents the response of an
organ to a greater workload
Hyperplasia
is an increase in the number of cells
resulting from an increased rate of cellular
division.
a response to injury when the injury has
been severe and prolonged enough to have
caused cell death.
Metaplasia
can transform into malignant cancer cells
Dysplasia
transformation of one mature cell type or
tissue into another
deranged cellular growth or a form of
hyperplasia
It results from persistent severe injury or
irritation
Characteristics of Normal Cells
Have limited cell division
Divide for: dev. of normal tissue
replaced damaged or lost
normal tissue
Undergo apoptosis programmed cell
death
Show specific morphology (size, shape
appearance)
(Continued)
Programmed Cell Death
Characteristics of Normal Cells (cont.)
Characteristics of Normal Cells (Cont.)
Nonmigratory: due to tight binding of cells
Grow in an orderly and well-regulated
manner; follow the cell cycle
COMMITMENT
- AT DAY 8, EARLY EMBRYONIC CELLS
START CHANGING TO
DIFFERENTIATED
CELLS. . . AND
COMMITS ITSELF TO A
SPECIFIC
OUTCOME . . . WHICH MEANS
TURNING OFF EARLY EMBRYONIC
GENES (PROTO-ONCOGENES) THAT
CONTROLLED OR REGULATED
EARLY RAPID GROWTH.
ONCOGENES TURNED ON PROTOONCOGENES THAT CAN CAUSE NORMAL
CELLS TO CHANGE TO CANCER CELLS
Characteristics of Cancer Cells
Have rapid or continuous cell division
Do not respond to signals for apoptosis
Show anaplastic morphology
Have a large nuclear-cytoplasmic ratio
Lose some or all differentiated functions
Adhere loosely together
(Continued)
Characteristics of Cancer Cells (Continued)
Able to migrate through embryonic cells
Grow by invasion
Are not contact inhibited
Are aneuploid more than or less than the
normal number of chromosomes
Phases of a Cell
Pathophysiology: Cell Cycle
Replication and Carcinogenesis
- G0 phase
- reproductive resting state
- actively carry out function but no
division
- normal cells spend most of their
lives in
this state
*Control of the cell cycle is regulated by CHONs
produced by suppressor genes and cyclins
>> allow the cell to move from G0 >>cell cycle
G1
- Normal cell division: Balance betweel CHONs
that promote cell division (cyclins) and CHONs
that limit cell division ( suppressor gene product)
- G1 phase
- cell takes on extra nutrients, make
more
energy and grow extra
membrane
- increase amount of cell fluid
(cytoplasm)
- S phase
- doubling of DNA through DNA
synthesis
- G2 phase
- Cell makes important CHONs for
actual cell division and for
normal
physiologic
functioning after cell
division is
complete.
- M phase
- actual mitosis (splitting of the cell
into 2 cells
Cancer Development
Oncogene activation
Chemical carcinogenesis, physical
carcinogenesis, radiation, chronic irritation, vital
carcinogenesis
Dietary factors
Personal factors, immune function, age,
and genetic risk
3-STEP CELLULAR PROCESS of CARCINOGENESIS:
1. INITIATION carcinogens alter genetic
structure of DNA.
Carcinogens substances that transforms a
cell to a cancer
cell.
2. PROMOTION repeated exposure to
carcinogen causes production of
mutant cell
populations that are anaplastic.
- initiated by promoters hormones,
drugs, chemicals
3. PROGRESSION increased malignant
behavior
of cells; invasive and
metastasize.
Tumor at 1 cm size >>cells at center are
hypoxic and begin to die >>tumor makes
TAF
>> ensures tumors continued
nourishment.
SPREAD OF CANCER:
- after initial event, some mutated cells
may die
- survivors reproduce until the tumor is
1-2 mm
- angiogenesis to support growth
- # of Ca cells exceed normal cells
- invasion of surrounding tissue
- metastasis:
- hematogenous
- lymphatic
- metastasis
- hematogenous
- more typical with sarcomas
- follow venous flow that drains site
of primary tumor
- lymphatic
- more typical with carcinomas
- lodge in regional lymph nodes
that
receive drainage from tumor site
(may: die; grow into a
mass; become dormant)
>> lymph
channels >> empty into the
venous system >> blood
Three Stages of Metastatic Process
Cancer affects patient function by:
a) Growth & expansion in confined space
(pressure effects)
b) High metabolic rate ---> nutritional
deficits
c) decreased host defense mechanisms
d) Production of hormone-like substances
e) Tissue invasion ---> hemorrhage &
infection
f) Metastasis ---> tissue destruction
RISK FACTORS
ACQUIRED:
VIRUSES
RADIATION
exposure to radiations causes mutations,
inactivates enzymes, and interrupts cell division.
ENVIRONMENTAL AND DIETARY
CARCINOGENS
HORMONES
INCREASE RISK:
AGE
NUTRITIONAL STATUS
HORMONAL BALANCE
RESPONSE TO STRESS
KEY SIGNS AND SYMPTOMS
FATIGUE
CACHEXIA: ANOREXIA, TASTE PERCEPTION
ALTERED,
EARLY SATIETY, WT. LOSS, ANEMIA,
MARKED WEAKNESS
>> CHON-CALORIC MALNUTRITION
>>
HYPOALBUMINEMIA, EDEMA,
MUSCLE
WASTING AND IMMUNODEFICIENCY
>> STARVATION OF NORMAL
TISSUE
PAIN
ANEMIA, LEOKOPENIA,
THROMBOCYTOPENIA
INFECTION
Classifications of Neoplasms/ Comparison of
characteristics:
Speed of growth/ Mode of growth
Benign
Grows enlarging and expanding
Grows slowly
Continues to grow throughout life
Benign
If neoplasm arises in glandular tissues,
cells may secrete hormones
Extremely unusual when surgically
removed
Metastasis never occur
Common following surgery
Benign
Rare regression
Infiltrate tissues
Always remains localized
Malignant
Grows rapidly
Grow relentlessly
May remain in situ, but infiltrates other
Capsule
Benign
Contained w/in a fibrous capsule
Prevents infiltration
Encapsulated tumor can be removed
easily
Cells too abnormal to perform any
physiologic functions
Recurrence / Metastasis
Periods of remission
tissues
Malignant
Never contained in a capsule
Absence of capsule allows cancer cells to
invade other tissues
Surgical removal is difficult
Cell characteristics
Benign
Malignant
Cells tend to be anaplastic
Well differentiated
Mitotic figures absent or scanty
Mature cells
Anaplastic cells absent
Cells function poorly in comparison with
normal cells
Poorly differentiated
Large numbers of normal and abnormal
mitotic figures present
Malignant
Malignant tumor arising in glandular tissue
secretes hormones
Metastasis is very common
Effect of neoplasm
Not harmful unless located in an area
where it compresses tissues or obstructs vital
organs
Does not produce cachexia (weight loss,
debilitation, anemia, weakness)
Malignant
Always harmful
Causes death
Causes disfigurement, disrupted organ
function, nutritional imbalances
May result in ulcerations, sepsis,
perforations, hemorrhage, tissue slough
Prognosis
Benign
Local symptoms:
Very good
Tumor generally removed surgically
Malignant
Poor prognosis if with metastasis
unusual lumps or swelling (tumor)
hemorrhage (bleeding)
pain and/or ulceration
Compression of surrounding tissues may
cause symptoms such as jaundice.
Symptoms of metastasis (spreading):
enlarged lymph nodes
cough and hemoptysis
hepatomegaly (enlarged liver)
bone pain, fracture of affected bones
neurological symptoms.
* Although advanced cancer may cause pain, it is
often not the first symptom.
Systemic symptoms:
weight loss
poor appetite and cachexia (wasting)
excessive sweating (night sweats),
anemia
specific paraneoplastic phenomena, i.e.
specific conditions that are due to an active
cancer, such as thrombosis or hormonal changes
Clients with Cancer: Health Promotion and
Maintenance
Cancer prevention and control
Prevention, screening, and early detection
Primary prevention
(ACTIVITIES VS SMOKING, ALCOHOL,POOR
DIETARY HABITS, LIFESTYLE MODIFICATION)
Secondary prevention
(EARLY DETECTION / SCREENING
PROGRAMS)
Cancer Prevention
Cervical cancer
(PAP TEST/PELVIC EXAM)
Head and neck cancer
Skin cancer
(SKIN INSPECTION ESP. OF MOLES)
PAP smear
Digital Rectal Exam
Testicular Self Exam.
Health Restoration
Maintaining wellness during treatment
Client history
X-rays and other Imaging
Host susceptibility and prevention benefits
7 WARNING signs
Regulation
Prohibiting sale of tobacco and alcohol to
Host modification
Lifestyle changes/carcinogen exposure
and chemoprevention
Cancer
7 warning signs of Cancer
C
hange in bowel or bladder habits
A
sore that does not heal
U
nusual bleeding or discharge
T
hickening or lump in breast or
elsewhere
I
ndigestion
O
bvious change in wart or mole
N
agging cough or hoarseness
Early Detection of Cancer:
Risk Factors and Screening
Breast cancer and prostate cancer
(CBE/SBE & MAMMOGRAPHY) (PSA & DRE)
Lung cancer
Colorectal cancer
Optimize quality of life
Rehabilitation
Reconstructive surgery
Lymphedema management
Others: Exercise program to counteract
chemotherapy-related fatigue; speech
therapy; prosthetic devises
Cancer Diagnosis
Education
minors
(FECAL OCCULT
BLOOD/SIGMOIDOSCOPY/COLONOSCOPY/DRE)
Clinical manifestations
Diagnostic evaluation
Laboratory blood tests
Tumor markers - barometers for
effectiveness of Tx
CBC - for non-specific problems & Side
Effects of
Tx
Diagnostic evaluation
Grading (extent of differentiation) and
Staging (extent of spread)
Cancer Treatment
Treatment goals
Cure
Control,
Palliation
Rehabilitation
Treatment modalities:
-
Surgery
Radiation therapy
Chemotherapy
Biotherapy
Bone marrow transplant
Cancer Care: Surgical Management
Types of surgery
Diagnostic: (cytologic brushings/ tissue biopsy
with endoscopy, biopsy: needle, excisional,
incisional)
Treatment: radical/wide excision
Recurrence and metastasis: excision
Palliative: retard, decrease size, relieve sx
Reconstructive: improve QOL
Preventive
Nursing management
Cancer Care:
RadiationTherapy
USES:
PRIMARY ONLY TREATMENT USED & AIMS
TO ACHIEVE LOCAL CURE OF THE CANCER
ADJUVANT USED EITHER PRE- OR POSTOP TO AID IN CA CELL DESTRUCTION
PALLIATIVE RELIEF OF PAIN DUE TO
OBSTRUCTION, PATHOLOGIC Fx, CORD
COMPRESSION, METASTASIS
Cancer Care: Radiation Therapy
How radiation therapy works
Radiosensitivity RELATIVE
SUSCEPTIBILITY OF TISSUES TO RADIATION
High-energy ionizing radiation
DESTROYS A CELLS ABILITY TO REPRODUCE BY
DAMAGING ITS DNA, & FORMATION OF FREE
RADICALS
* Normal cells have greater ability to
repair damaged DNA than Ca cells
Time- limit to 30 mins direct care/8hr shift
Distance distance & radiation exposure
inversely related.
*Intensity of radiation decreases inversely
with the square of the distance from the source.
Ex: 2m=1/4 exp; 4m=1/16 exp
*Visitors 6 ft. from source; off limits to
<16 y.o. & pregnant women
Shielding lead shields, lead container
(pig) & long handled forceps are musts in pts
unit.
Staff should wear film badges or
dosimeters.
- Precautionary measures for sealed & unsealed
Treatment considerations
- Certain normal cells are more sensitive to
radiation & may incur permanent damage.
- SE related to total dose of radiation
- Gray (Gy) unit dose of radiation
- Rad radiation absorbed dose
1 Gy = 100 rad; 1 cGy (centigray)
= 1 rad
Curative Tx = >dose = >SE
- Fractionation dosing
Fractionation dosing:
> To reduce SE,
> To allow normal cells to repair
themselves & increase
susceptibility
of the cell to radiation.
> Vulnerable during late G2 & early M
phase of cell cycle.
NURSING MANAGEMENT
- Unsealed source
oral/injection/instillation into
body cavity for systemic
treatment;
direct contact with
body tissue.
* radioisotope circulates
throughout
the body. Clients urine, sweat,
blood & vomitus contain
radioisotope
* eliminated from the body in 48
hrs
- Afterloading device empty applicator is
implanted during surgery
and loaded
when treatment is
done.
Safety standards
Patient education
Minimize side effects
*SKIN CARE
CLIENT EDUCATION
WASH AREA WITH WATER ALONE OR MILD
SOAP & WATER
USE HAND RATHER THAN WASHCLOTH
FOR WASHING
DO NOT REMOVE MARKINGS
DRY THE SKIN USING PATTING NOT
RUBBING MOTION
NO powder, lotions, ointment & creams to
affected area
Wear soft clothing over affected area
Avoid using anything that rubs on the
affected area
Avoid exposing irradiated area to the sun
Avoid heat exposure
Cancer Care: Chemotherapy
TYPES:
ADJUVANT eliminates any remaining
submicroscopic cells after surgery & RT.
NEOADJUVANT pre-op use of CT to
reduce bulk & lower stage of
tumor
making it amenable to
surgery
"Most chemotherapeutic agents damage
DNA or interfere with DNA synthesis thereby
killing all rapidly dividing cells, both normal and
neoplastic
Some Principles of Cancer Chemotherapy
1. Cure probably requires complete
eradication
of tumor cells
2. Drug kills a constant PROPORTION of tumor
cells rather than a constant NUMBER of
cells (first order kinetics).
therefore number of cells before therapy
determines the number of cells surviving therapy
therefore early treatment when tumors are
small ---> better clinical result
How chemotherapy works
- PHASES OF THE CELL-CYCLE
- ACTIVELY DIVIDING CELLS ARE MORE
SENSITIVE TO RADIATION.
- DIRECTLY OR INDIRECTLY DISRUPTS
REPRODUCTION OF CELLS BY
ALTERING
ESSENTIAL BIOCHEMICAL
PROCESSES.
- SINGLE AGENT VS COMBINATION
CHEMOTHERAPY
Classification of chemotherapeutic agent A.
CELLCYCLE- SPECIFIC
- ANTIMETABOLITES (5FU, CYTOSAR)S
phase
- ANTIMITOTICS: (Mitotic spindle
poisons)
- VINCA ALKALOIDS (ONCOVIN,
VELBAN) M
phase
- TAXANES (PACLITAXEL (TAXOL))
M phase
- TOPOISOMERASE INHIBITORS
- EPIPODOPHYLLOTOXINS
(ETOPOSIDE(VP16) M phase
Variable category:
- L-ASPARAGINASE, HYDROXYUREA
3. Tumors usually detected clinically
late in course of disease.
Chemotherapy should be prolonged to
increased cure rate
B. CELL-CYCLE NON-SPECIFIC
In clinical practice, nearly all neoplastic
diseases are treated with multiple drugs
- ALKYLATING (MYLERAN, PLATINOL)
- ANTITUMOR ANTIBIOTICS
(LEUKERAN, ADRIAMYCIN,
MITOMYCIN)
- HORMONES:
STEROIDS
ESTROGENS
ANTI-ESTROGEN
(TAMOXIFEN)
PROGESTINS
NITROSOUREAS (CARMUSTINE
4. Adverse effects are decreased by
giving combinations of drugs with
different side-effects
5. Intermittent high doses are more
effective
6. Adjuvant therapy (chemotherapy after
surgery/radiation) is given to eliminate
metastases
7. Drugs have a narrow therapeutic index
therefore treatment is a balance between
toxic effects and efficacy
growing cells, which are most sensitive,
are killed.
adverse effects are seen in non-neoplastic
cells eg. hair follicles, bone marrow
drugs may act only at specific stages of
the cell cycle
Cancer Care: Chemotherapy
ANTIMETABOLITES counterfeit
metabolites
ANTITUMOR ANTIBIOTICS damage
cells DNA
& interrupt DNA or RNA
synthesis
ALKYLATING AGENTS crosslink DNA
making two strands bind tightly
together >> inhibits DNA
synthesis >>
inhibits cell division
ANTIMITOTIC interfere with formation of
microtubules >> inhibits cell division
TOPOISOMERASE INHIBITOR
Topoisomerase - enzyme needed for DNA
synthesis & cell
division
Causes DNA breakage and cell death
CANCER CHEMOTHERAPY
CANCER CHEMOTHERAPY
Chemotherapy: Nursing Management
Administration
Verification of agent, dose, schedule
Safe preparation, handling, and disposal
Routes of administration
Intravenous, regional, oral, etc.
Adverse reactions
Hypersensitivity reaction and
extravasation
Safe preparation, handling, and disposal
NURSING CARE FOR HYPERSENSITIVITY:
1.
2.
3.
4.
5.
6.
7.
stop drug adm
maintain IV access with 0,9% saline
maintain airway
supine position with feet elevated
notify MD
monitor VS every 2 mins until stable
administer epinephrine, aminophylline,
Benadryl, steroid as Rx
NURSING CARE FOR EXTRAVASATION:
1. STOP drug administration
2. leave needle in place & attempt to aspirate
any
residual drug from the tubing, needle &
site.
3. administer antidote, if appropriate, then
remove
needle
4. do not apply direct manual pressure to the site
5. apply warm (for vinca) or cold compresses as
indicated
6. observe site for pain, erythema, swelling,
induration, & necrosis
7. document appearance of site before & after
chemotx
If extravasation occurs:
stop the infusion
aspirate remaining drug from needle
ice pack (for 20min/hr for 24-48 hrs.) or
pour NSS
Cancer Care: Biotherapy
Hematopoietic growth factors (STIMULATE
BM RECOVERY AFTER CHEMOTX. EX: GM-CSF,
ERYTHROPOIETIN)
Biologic response modifiers (BRMs)(ALTER HOSTS BIOLOGIC RESPONSE TO TUMOR.
EX:INTERFERONS)
Interferons (IFN) and interleukins (IL)
( ANTIVIRAL, IMMUNOMODULATORY,
ANTIPROLIFERATIVE)
Monoclonal antibodies (MoAbs)
(SPECIFIC ANTIBODIES DIRECTED VS. SINGLE
ANTIGENIC DETERMINANTS ON THE CELL
SURFACE)
Vaccines
Anti-angiogenesis agents- (PREVENT THE
GROWTH OF BLOOD VESSELS INSIDE A TUMOUR,
STARVING IT OF BLOOD)
Emerging targeted therapies
Bone Marrow Peripheral Stem Cell
Transplant
Cancer Care:
Other Treatment Modalities
Bone marrow transplantation
- Autologous
- Allogeneic- relative;
Syngeneic identical twin
*500 1,000 ml of marrow
from the iliac crest
Clinical trials
Complementary and alternative
approaches
Bone Marrow Transplant
Cancer and Treatment Side Effects: Nursing
Management
Myelosuppression
Neutropenia: NC < 1000/mm3
NC = WBC X neutrophils (%)
FEVER: oral temp >38C in 24 hrs; T >38.5C
* INFECTION PRECAUTIONS
thrombocytopenia
* must be >100,000/mm3 for chemotx to
be done
anemia
Gastrointestinal effects
Nausea and vomiting
* premedication with serotonin
antagonists (ex
Ondansetron)
Anorexia
Stomatitis
Diarrhea and constipation
Cancer and Treatment Side Effects: Nursing
Management (cont.)
Integumentary effects
Alopecia
Skin reactions
Reproductive system effects
Sterility
Loss of libido
Impotence
Oncologic Emergencies: Nursing Management
Infection
Pain
Hypercalcemia- due to bone resorption
TX: hydration, calcitonin, oral
glucocorticoids
Tumor lysis syndrome rapid release of IC
potassium, phosphorus & nucleic acid into
circulation due to
destruction of large # of
malignant cells.
TX: hydration, Allupurinol, NaHCO3, D
50%
Syndrome of inappropriate antidiuretic
hormone when hypoNa is severe (<120 meq/L)
TX: hypertonic saline, declomycin,
lithium
Oncologic Emergencies: Nursing Management
(cont.)
Disseminated intravascular coagulationwidespread clotting that consumes all clotting
factors >>> bleeding
Spinal cord compression- due to direct
pressure on or compromise of vascular supply to
SC. SX: back pain
Superior vena cava syndrome- from int. &
ext. obstruction of the SVC decreasing venous
return to the heart compromising CO. Sec to lung
Ca small cell 65%
Cardiac tamponade
Cancer Care:
Psychosocial Aspects
Support for client and family
Promoting positive self-concept
Promoting coping
Recurrent disease and progression
Terminal illness
After discussing the difference between
benign and malignant tumors with a client, the
nurse would know that the client
understood the discussion when the client says
a. A benign tumor does not invade other
tissue.
b. Malignant tissue is not found far from
the
original site of the tumor.
c.The control of growth is impaired only
in
malignant tissue.
d.Malignant tumors do not respond well
to
chemotherapy.
After discussing the difference between
benign and malignant tumors with a client, the
nurse would know that the client
understood the discussion when the client says
a. A benign tumor does not invade other
tissue.
b. Malignant tissue is not found far from
the
original site of the tumor.
c.The control of growth is impaired only
in
malignant tissue.
d.Malignant tumors do not respond well
to
chemotherapy.
A client who has been diagnosed with
breast carcinoma wants to know the meaning of
a cancer cure. The nurses most
accurate response is that
a. It is disease-free survival for 5 years
and indicates a
low probability of disease
recurrence.
b. It is a statistical analysis of the
number of all individuals at risk who do not show
signs of a
particular form of cancer.
c. It is the number of people living 5
years with ongoing medical treatment.
d. It is a lay term that implies a
permanent cure if you
make it through 5
years.
A client who has been diagnosed with
breast carcinoma wants to know the meaning of
a cancer cure. The nurses most
accurate response is that
a. It is disease-free survival for 5 years
and indicates a
low probability of disease
recurrence.
b. It is a statistical analysis of the
number of all individuals at risk who do not show
signs of a
particular form of cancer.
c. It is the number of people living 5
years with ongoing medical treatment.
d. It is a lay term that implies a
permanent cure if you
make it through 5
years.
In the assessmeant of a client with
suspected stomach cancer, the question that
would
be most helpful to this clients history is
a. Do you have much exposure to the
sun?
b. Have you ever taken steroids?
c. How much food such as bacon and hot
dogs do you eat?
d. How long have you been overweight?
In the assessmeant of a client with
suspected stomach cancer, the question that
would
be most helpful to this clients history is
a. Do you have much exposure to the
sun?
b. Have you ever taken steroids?
c. How much food such as bacon and hot
dogs do you eat?
d. How long have you been overweight?
The nurse caring for a client who has an
implanted radiation source should reduce
self-exposure by incorporating the
strategy of
a. limiting the time spent close to the
client to 30
minutes per 8-hour shift.
b. wearing a lead-shielded apron
whenever
entering the clients room.
c. remaining 6 feet away from the client
except
for essential care.
d. wearing a radiation meter or film
badge to
measure exposure.
The nurse caring for a client who has an
implanted radiation source should reduce
self-exposure by incorporating the
strategy of
a. limiting the time spent close to the
client to 30
minutes per 8-hour shift.
b. wearing a lead-shielded apron
whenever
entering the clients room.
c. remaining 6 feet away from the client
except
for essential care.
d. wearing a radiation meter or film
badge to
measure exposure.
The nursing action that has the highest
priority for a 32-year-old client with an implanted
radiation source should focus on
a. promotion of activity.
b. prevention of skin problems related to
radiation.
c. assessment of the clients reaction to
the
diagnosis and treatment.
d. safeguarding the client and other
persons
from unnecessary radiation
exposure.
The nursing action that has the highest
priority for a 32-year-old client with an implanted
radiation source should focus on
a. promotion of activity.
b. prevention of skin problems related to
radiation.
c. assessment of the clients reaction to
the
diagnosis and treatment.
d. safeguarding the client and other
persons
from unnecessary radiation
exposure.
When explaining the treatment to a client
who is receiving interleukin-2 (IL-2) as part of the
therapeutic plan for the management of a
malignant melanoma, the nurse
would emphasize the ability of this agent
to
a. increase oxygenation to cells that are
not
malignant.
b. physically dissolve the tumor mass.
c. strengthen immune response.
d. replace damaged and diseased cells
from bone marrow.
When explaining the treatment to a client
who is receiving interleukin-2 (IL-2) as part of the
therapeutic plan for the management of a
malignant melanoma, the nurse
would emphasize the ability of this agent
to
a. increase oxygenation to cells that are
not
malignant.
b. physically dissolve the tumor mass.
c. strengthen immune response.
d. replace damaged and diseased cells
from bone marrow.
When there is extravasation of vincristine
(Oncovin), a vinca alkaloid, the nurse should
initially
a.
leave the cannula in place and
aspirate.
b. apply manual pressure to delay further
circulation.
c. apply cold compresses to the site.
d. call the physician immediately.
When there is extravasation of vincristine
(Oncovin), a vinca alkaloid, the nurse should
initially
a.
leave the cannula in place and
aspirate.
b. apply manual pressure to delay further
circulation.
c. apply cold compresses to the site.
d. call the physician immediately.
When a client undergoing systemic
chemotherapy reaches the nadir of treatment,
immediate care by the nurse should be
directed toward
a. enhancing the effects of chemotherapy
by
encouraging mild activity.
b. protecting the client from infection and
bleeding.
c. improving the mental state of the client
by
using mental imagery.
d. assisting the client to eat an adequate
amount of food to maintain nutrition.
When a client undergoing systemic
chemotherapy reaches the nadir of treatment,
immediate care by the nurse should be
directed toward
a. enhancing the effects of chemotherapy
by
encouraging mild activity.
b. protecting the client from infection and
bleeding.
c. improving the mental state of the client
by
using mental imagery.
d. assisting the client to eat an adequate
amount of food to maintain nutrition.
RISK FACTORS OF BREAST CANCER
Age:. Most cases of breast cancer occur in
women over 60. This disease is not common
before menopause.
Personal history of breast cancer:
Family history: A woman's risk of breast
cancer is higher if her mother, sister, or daughter
had breast cancer. The risk is higher if her family
member got breast cancer before age 40.
Certain breast changes: Some women
have cells in the breast that look abnormal under
a microscope. Having certain types of abnormal
cells (atypical hyperplasia and lobular carcinoma
in situ [LCIS]) increases the risk of breast cancer.
RISK FACTORS TO BREAST CANCER (CONT)
Gene changes: These genes include
BRCA1, BRCA2, and others. Tests can sometimes
show the presence of specific gene changes in
families with many women who have had breast
cancer.
Reproductive and menstrual history:
first menstrual period before age 12 are at
an increased risk of breast cancer.
menopause after age 55 are at an
increased risk of breast cancer.
never had children
menopausal hormone therapy with
estrogen plus progestin after menopause
RISK FACTORS TO BREAST CANCER
Race: more often in white women than
Latina, Asian, or African American women.
Radiation therapy to the chest: Women
who had radiation therapy to the chest (including
breasts) before age 30 This includes women
treated with radiation for Hodgkin's lymphoma.
Studies show that the younger a woman was
when she received radiation treatment, the
higher her risk of breast cancer later in life.
Breast density: Breast tissue may be
dense or fatty. Older women whose
mammograms (breast x-rays) show more dense
tissue are at increased risk of breast cancer.
RISK FACTORS TO BREAST CANCER (CONT)
Taking DES (diethylstilbestrol) during
pregnancy:
Being overweight or obese after
menopause: The chance of getting breast cancer
after menopause is higher in women who are
overweight or obese.
Lack of physical activity: Being active may
help reduce risk by preventing weight gain and
obesity.
Drinking alcohol: Studies suggest that the
more alcohol a woman drinks, the greater her risk
of breast cancer.
Common symptoms of breast cancer include:
A change in how the breast or nipple feels
A lump or thickening in or near the breast
or in the underarm area
Nipple tenderness
A change in how the breast or nipple looks
A change in the size or shape of the breast
A nipple turned inward into the breast
The skin of the breast, areola, or nipple
may be scaly, red, or swollen. It may have ridges
or pitting so that it looks like the skin of an
orange.
Nipple discharge (fluid)
Clinical Manifestations
Painless, non-tender, hard, irregularly
shaped, non-mobile masses (upper outer
quadrant or beneath the nipple)
Nipple retraction
Late: Nipple discharge, induration and
dimpling
Breast asymmetry, palpable lymph and
axillary nodes
Heat and erythema of breast
Skin edema- invasion and obstruction of
dermal lymphatics
Assessment:
1. - asymptomatic
lump on the upper outer quadrant
2. late signs: (malignant)
irregular shaped mass
fixed nodules and adheres to chest wall
asymmetry of the breast
peau de orange
increase venous prominence
Diagnosis:
Breast Biopsy
Mammography
Common sites of metastasis:
bones, lungs, brain, liver
Management:
1. Chemotherapy
2. Radiation
3. Hormonal manipulation with
estrogen in
postmenopausal
women. (Tamoxifen)
4. Surgery:
a. Mastectomy
b. Oophorectomy
c. Adrenalectomy
The most effective chemotherapy regimens for
breast cancer that has spread include:
- cyclophosphamide
CYTOXAN
- docetaxel
TAXOTERE
- doxorubicin
ADRIAMYCIN
- epirubicin
ELLENCE
- gemcitabine
GEMZAR
- paclitaxel
TAXOL
vinorelbine.
For women who are still menstruating,
tamoxifen
is usually the first hormone-blocking drug
For postmenopausal women who have
estrogen receptor-positive breast cancer,
aromatase inhibitors (such as anastrozole
, letrozole, and exemestane) converts some
hormones to estrogen
Surgical Treatment
Lumpectomy
- Tumor excised and removed; lymph node
dissection
Simple Mastectomy
- Breast tissue and nipples removed; lymph nodes
left intact
Modified Radical Mastectomy
- Breast tissue, nipple, lymph nodes removed,
muscle left intact
Halsted Radical mastectomy
- Breast tissue, nipple, underlying muscles and
lymph nodes removed
Nursing Management
Pre-op period:
assess self esteem and body image
support denial
breast reconstruction and prosthesis
Post- op period:
give analgesic round the clock
perform deep breathing exercises
arm precautions and position
- care of drains
Prevent complications:
bleeding
atelectasis
infection
CERVICAL CANCER
lymph edema
Almost all cervical cancers are caused by
HPV (human papillomavirus).
HPV is a common virus that is spread
through sexual intercourse
Other Risk factors for cervical cancer include:
Having sex at an early age
Multiple sexual partners
Sexual partners who have multiple
partners or who participate in high-risk sexual
activities
Women whose mothers took the drug DES
(diethylstilbestrol) during pregnancy in the early
1970s to prevent miscarriage
Long-term use of birth control pills (more
than 5 years)
Weakened immune system
Infections with genital herpes or chronic
chlamydia infections
Poor economic status (may not be able
to afford regular Pap smears)
Prevention:
abstinence
limiting number of partners
using a condom
yearly Pap smears
Symptoms that may occur can include:
Continuous vaginal discharge, which may
be pale, watery, pink, brown, bloody, or foulsmelling
Abnormal vaginal
bleeding between periods, after intercourse, or
after menopause
Periods become heavier and last longer
than usual
Surgical treatment
Early cervical Ca hysterectomy
If still childbearing Trachelectomy
( internal cervical opening is left behind)
rectum
Pelvic Exenteration TAHBSO, bladder,
