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intro to oncology

intro to oncology

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  • Acte lymphocytic leukemia
  • The place where a cancer begins is called the 'primary cancer'.  Cancers may also spread into nearby body tissues.  For example, lung cancer can spread to the lining of the chest, the pleura.  Ovarian cancer can spread to the lining of the abdomen (the peritoneum).  This is called locally advanced cancer.
  • Increase consumption of fresh vegetables Increase fiber intake (breast, prostate, and colon) Increase intake of vitamin A (esophageal, laryngeal, and lung cancers) Increase intake of foods rich in vitamin C (stomach and esophageal cancers) Practice weight control (uterus, gallbladder, breast, and colon)
  • Reduce intake of dietary fat (breast, colon, and prostate) Practice moderation in consumption of salt-cured, smoked, and nitrate-cured foods( esophageal and gastric) Stop smoking cigarettes and cigars Reduce alcohol intake Avoid overexposure to the sun, wear protective clothing, and use a sunscreen to prevent skin damage from ultraviolet rays
  • CELLULAR – type of tissue CLINICAL – size of tissue
  • Gleason Grade 1 – Here, cancerous tissue is well differentiated and looks like normal prostate tissue. Glands are well packed and formed. Gleason Grade 2 – Here, well-formed large glands have more tissue between them. Gleason Grade 3 – Glands begin to look darker and show signs of randomness. They seem to be breaking away from monotony of their existence and invading surrounding tissue. Gleason Grade 4 – Majority of glands appear to be interspersed with surrounding tissue. A few recognizable glands are still present though. Gleason Grade 5 – There are no recognizable glands. Cells with distinct nuclei appear in sheets within surrounding tissue.
  • complete eradication of malignant disease ( cure) prolonged survival and containment of cancer cell growth ( control) relief of symptoms associated with the disease ( palliation)
  • Electrosurgery makes use of electrical current to destroy the tumor cells. Cryosurgery uses liquid nitrogen to freeze tissue to cause cell destruction. Chemosurgery uses combined topical chemotherapy and layer-by-layer surgical removal of abnormal tissue. Laser surgery ( l ight amplification by stimulated emission of radiation) makes use of light and energy aimed at an exact tissue location and depth to vaporize cancer cells. Stereotactic radiosurgery (SRS) is a single and highly precise administration of high-dose radiation therapy used in some types of brain and head and neck cancers. This type of radiation has such a dramatic effect on the target area that the changes are considered to be comparable to more traditional surgical approaches
  • Certain chemotherapeutic agents (cell cycle–specific drugs) destroy cells actively reproducing by means of the cell cycle. Many of these agents are specific to certain phases of the cell cycle. Most affect cells in the S phase by interfering with DNA and RNA synthesis. Others, such as the vinca or plant alkaloids, are specific to the M phase, where they halt mitotic spindle formation.
  • new bone marrow becomes functional and begins producing red blood cells, WBCs, and platelets
  • If cancer is caused due to missing or altered genes, then gene therapy involves the replacement of these genes with the healthy ones. Besides, gene therapy can also be carried out to stimulate the immune system to attack the cancer cells. Through this technology, genes can be inserted into the patient's body; which, either instruct the cancer cells to produce certain proteins for inhibiting the cancer-causing oncogenes or stimulate the tumor suppressor genes. Some other studies are also ongoing to introduce genes into the cancerous cells, which can help to make the cancerous cells more responsive to various cancer treatments , including chemotherapy and radiation therapy. Besides, researches are also being carried out to reduce the side effects of various anti-cancer drugs, by increasing the resistance of the stem cells.
  • owever, in gene therapy, genes are not directly inserted into the patient's body, but uses viruses for that purpose. The viruses, generally used for this therapy, include retroviruses, adenoviruses, herpes viruses, lentiviruses and poxviruses. Sometimes, liposome (a tiny vesicle found in a cell that stores and transports substances within a cell) is also used as a carrier in gene therapy. The viruses can be used both for the ex vivo, as well as in vivo gene therapies. The ex vivo gene therapy involves the collection of some blood or bone marrow cells from the patient. Then, the viruses with the necessary genes are introduced into the cells in a laboratory, which are then injected into the patient's body. On the other hand, in vivo gene therapy involves the direct insertion of viruses or liposomes that contain the desired gene into the patient's body.
  • However, gene therapy is not free from disadvantages. One of the most potential dangers associated with gene therapy, is the possibility of infection of the healthy cells caused by the viruses used for delivering the gene. Besides, if the genetic material is accidentally introduced into the germ cells, then the changes induced by it, would pass on to the next generation. Again, it is very important to insert the desired gene at the correct location, failure of which might result in genetic mutation and even cause cancer. More scientific researches are required to remove the drawbacks of gene therapy, so it can truly revolutionize the treatment of life-threatening diseases like cancer.
  • Breathing: When you breathe, the vocal cords relax and open. When you hold your breath, the vocal cords shut tightly. Swallowing: The larynx protects the windpipe. When you swallow, a flap called the epiglottis covers the opening of your larynx to keep food out of your lungs. The food passes through the esophagus on its way from your mouth to your stomach. Talking: The larynx produces the sound of your voice. When you talk, your vocal cords tighten and move closer together. Air from your lungs is forced between them and makes them vibrate. This makes the sound of your voice. Your tongue, lips, and teeth form this sound into words.
  • Age. Cancer of the larynx occurs most often in people over the age of 55. Gender. Men are four times more likely than women to get cancer of the larynx. Race. African Americans are more likely than whites to be diagnosed with cancer of the larynx. Smoking. Smokers are far more likely than nonsmokers to get cancer of the larynx. The risk is even higher for smokers who drink alcohol heavily. People who stop smoking can greatly decrease their risk of cancer of the larynx, as well as cancer of the lung, mouth, pancreas, bladder, and esophagus. Also, quitting smoking reduces the chance that someone with cancer of the larynx will get a second cancer in the head and neck region. (Cancer of the larynx is part of a group of cancers called head and neck cancers.) Alcohol. People who drink alcohol are more likely to develop laryngeal cancer than people who don't drink. The risk increases with the amount of alcohol that is consumed. The risk also increases if the person drinks alcohol and also smokes tobacco. A personal history of head and neck cancer. Almost one in four people who have had head and neck cancer will develop a second primary head and neck cancer. Occupation. Workers exposed to sulfuric acid mist or nickel have an increased risk of laryngeal cancer. Also, working with asbestos can increase the risk of this disease. Asbestos workers should follow work and safety rules to avoid inhaling asbestos fibers.

Cell abberation Cell abberation Presentation Transcript

  • CELL ABBERATION Maria Hazel Torres Organo-Rosario, RN,MAN Clinical Instructor College of Nursing23/09/12 cancer 1
  • GRADING SYSTEMATTENDANCE10%QUIZZES 40%MIDTERM/FINAL EXAM50% 100% 23/09/12 cancer 2
  • CELL CYCLE • G0 • Interphase –G1 –S –G2 • Mitosis23/09/12 cancer 3
  • 23/09/12 cancer 4
  • 23/09/12 cancer 5
  • DIFFERENTIATION• Cells develop specific structures and functions in order to specialize in certain tasks23/09/12 cancer 6
  • How the cancer cells grow?23/09/12 cancer 7
  • A normal cell divides only approximately 60 times but a single CANCER cell can divide indefinitely.23/09/12 cancer 8
  • 23/09/12 cancer 9
  • CELLULAR ADAPATION • Hypertrophy • Atrophy • Hyperplasia • Metaplasia • Dysplasia • Anaplasia23/09/12 cancer 10
  • CANCER• abnormal cell is transformed by the genetic mutation of the cellular DNA• can involve all body organs• Manifestations are r/t the system affected & degree of disruption23/09/12 cancer 11
  • NEOPLASIA• Abnormal cell growth or tumor –Benign –Malignant23/09/12 cancer 12
  • benign malignantDifferentiation Well Lack of differentiated differentiation with anaplasiaRate of growth Progressive and Erratic and slow slow to rapidLocal invasion Cohesive and well Locally invasive, demarcated infiltratingMetastasis None Frequently present 23/09/12 cancer 13
  • Benign means not cancer23/09/12 cancer 14
  • The characteristics of normal cells•  Reproduce themselves exactly        • Stop reproducing at the right time        • Stick together in the right place        • Self destruct if they are damaged        • Become specialised23/09/12 cancer 15
  • How cancer cells are different• dont die if they move to another part of the body• dont stop reproducing         • dont obey signals from other cells         • dont stick together          • dont specialise23/09/12 cancer 16
  • Cancer cells dont stick together23/09/12 cancer 17
  • iNCIDENCE • Ranks 2nd to CVD as the leading cause of death • 1:4 deaths is due to cancer • Ranks third in leading cause of morbidity & mortality in the Philippines • Occurs at any age but with 75% of cancers occuring after 5023/09/12 cancer 18
  • Cells lose their Normal growth-controlling mechanisms & the growth of cell is uncontrolled Develops from a mutation in a single cell Grows w/o the control that char. Normal cell growthCA cells fail to mature into the type of Normal cell from w/c it originates metastasis23/09/12 cancer 19
  • RISK FACTORS• Environmental – Chemical – Physical – Viral -oncovirus• Immunologic• Dietary• Genetic• Hormonal• Socioeconomic23/09/12 cancer 20
  • RISK FACTORS• Age• Gender• location• Race• Occupation• Obesity• stress23/09/12 cancer 21
  • CARCINOGENESIS Cells transformation from normal to cancerous - No SINGLE CAUSE23/09/12 cancer 22
  • CARCINOGENESIS• Initiation• Promotion• progression23/09/12 cancer 23
  • metastasis23/09/12 cancer 24
  • • Cancer grow & metastisize thru: – Directly extending into adjacent tissues – Invading nearby body cavity – Invading along lymphatic vessels – Traveling via lymphatic vessels to lymph nodes – Traveling via blood vessels to any part of the body but usually to the lungs, liver & bones23/09/12 cancer 25
  • 23/09/12 cancer 26
  • Malignant tumours are made up of cancer cells• Usually grow faster than benign tumors          • Spread into and destroy surrounding tissues          • Spread to other parts of the body23/09/12 cancer 27
  • Primary vs Secondary23/09/12 cancer 28
  • 23/09/12 cancer 29
  • Cancers According to Tissue Type • Lymphoma – infection-fighting organs • Leukemia –blood-forming organs • Sarcoma –bones, muscle, or connective tissue • Carcinoma –epithelial cells23/09/12 cancer 30
  • Benign• Adenoma – glandular tissue• Leiomyoma – smooth muscle• Chondroma – cartilaginous tissue• Hemangioma – blood vessels• Lymphagioma – lymphatics• Neurofibroma – nerve sheath• Lipoma – adipose tissue23/09/12 cancer 31
  • Malignant• Adenocarcinoma – epithelial cells• Carcinoma – epithelial surface• Sarcoma – connective tissue• Osteosarcoma – bone osteoblasts• Angiosarcoma – blood vessels• Lymphagiosarcoma – lymphatics• Neurofibrosarcoma – nerve sheath• Liposarcoma – adipose tissue23/09/12 cancer 32
  • LATE WARNING SIGNS of CANCER Change in bowel/bladder habits (alternating diarrhea & constipation, early morning) A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing Obvious change in wart or mole Nagging cough or hoarseness of voice Unexplained anemia Sudden unexplained weight loss23/09/12 cancer 33
  • BEST DEFENSE? IMMUNOSURVEILLANCE - Promotes antibody production, cellular immunity & immunologic memory23/09/12 cancer 34
  • PREVENTION• Avoidance of known or potential carcinogens• Avoidance or modification of the factors associated with development of CA cells 23/09/12 cancer 35
  • DETECTION and PREVENTION23/09/12 cancer 36
  • PRIMARY• Education –Avoid known carcinogens –Adopting healthy lifestyle23/09/12 cancer 37
  • SECONDARY• individualized education and recommendations for continued surveillance and care in high-risk populations• Public awareness23/09/12 cancer 38
  • GENERAL PREVENTION• Increase consumption of fresh vegetables• Increase fiber intake• Increase intake of vitamin A• Increase intake of foods rich in vitamin C• Practice weight control23/09/12 cancer 39
  • GENERAL PREVENTION• Reduce intake of dietary fat• Practice moderation in consumption of salt- cured, smoked, and nitrate-cured foods• Stop smoking cigarettes and cigars• Reduce alcohol intake• Avoid overexposure to the sun, wear protective clothing, and use a sunscreen to prevent skin damage from ultraviolet rays23/09/12 cancer 40
  • EARLY CANCER DETECTION• Breast CA• Colon and rectal CA• Uterine CA• Prostate CA23/09/12 cancer 41
  • EARLY DETECTION Enables more effective treatment and better prognosis for the patient23/09/12 cancer 42
  • 23/09/12 cancer 43
  • 23/09/12 cancer 44
  • BREAST• Age 20, routine BSE• 20-39, BE by health care provider every 3 years• 40 and older, yearly mammogram & BE by health provider23/09/12 cancer 45
  • 23/09/12 cancer 46
  • COLON & RECTAL• 50 & older, yearly FOBT• DRE & sigmoidoscopy, every 5 years• Colonoscopy w/ barium, every 10 yrs23/09/12 cancer 47
  • UTERINE• Sexually active females & any female over 18 yrs, PAPSmear• Endometrial tissue sample-menopause23/09/12 cancer 48
  • PROSTATE Age 50, yearly DRE Age 50, yearly PSA test23/09/12 cancer 49
  • NURSING INTERVENTIONS• Relieve fear and anxiety –Explain –Reinforce –Clarify –Encourage communication23/09/12 cancer 50
  • TMN Classification System• Tumors are staged depending on size, lymph node involvement & metastasis T – primary tumor N – lymph node involvement M – metastasis23/09/12 cancer 51
  • T-extent of tumor• TX –cannot be assesses• T0 – no evidence• Tis – carcinoma in situ• T1, T2, T3, T4 – increasing size and/or local extent of primary tumor23/09/12 cancer 52
  • N- lymph node• NX – cannot be assessed• N0 – no metastasis• N1, N2, N3 – increasing involvement23/09/12 cancer 53
  • M-Metastasis• GX-cannot be assessed• G1-well differentiated• G2-moderately• G3-poorly• G4-undifferentiated23/09/12 cancer 54
  • STAGES OF TUMORS• I: tumor <2cm, (-) lymph node involvement, no detectable metastases• II: tumor >2cm but <5cm, (-) or (+) unfixed lymph node involvement, no detectable metastases• III: large tumor >5cm, tumor of any size with invasion of skin or chest wall or (+) fixed lymph node involvement without evidence of metastases• IV: tumor of any size, (+)/(-) lymph node involvement, distant metastases23/09/12 cancer 55
  • Grading & Staging• A method used to describe the tumor• Grading – CELLULAR aspect of CA• Staging – CLINICAL aspect of CA23/09/12 cancer 56
  • 23/09/12 cancer 57
  • 23/09/12 cancer 58
  • TUMOR MARKER• Protein substances• Oncofetal antigens• Hormones• Isoenzymes• Tissue specific proteins• Host response tumor markers23/09/12 cancer 59
  • 23/09/12 cancer 60
  • 23/09/12 cancer 61
  • TUMOR MARKER ID• Analysis of substances found in blood or other body fluids that are made by the tumor or by the body in response to the tumor• Breast, colon, lung, ovarian, testicular, prostate cancer23/09/12 cancer 62
  • MAMMOGRAPHY• low-dose amplitude-X-rays• NO: Deodorant, talcum powder or lotion23/09/12 cancer 63
  • mammography
  • SIGMOIDOSCOPY• Large intestines23/09/12 cancer 65
  • COLONOSCOPY• Colon and distal part of the small bowel23/09/12 cancer 66
  • Digital Rectal Exam• simple test to check the prostate23/09/12 cancer 67
  • Barium enema• radiological examination of the rectum and the entire colon23/09/12 cancer 68
  • 23/09/12 cancer 69
  • 23/09/12 cancer 70
  • PapSmear23/09/12 cancer 71
  • PSA23/09/12 cancer 72
  • IMAGING TESTS23/09/12 cancer 73
  • Magnetic Resonance Imaging• Use of magnetic fields and radiofrequency signals to create sectioned images of various body structures• Neurologic, pelvic, abdominal, thoracic cancers23/09/12 cancer 74
  • CT Scan• Use of narrow beam x-ray to scan successive layers of tissue for a cross- sectional view• Neurologic, pelvic, skeletal, abdominal, thoracic cancers23/09/12 cancer 75
  • Fluoroscopy• Use of x-rays that identify contrasts in body tissue densities; may involve the use of contrast agents• Skeletal, lung, gastrointestinal cancers23/09/12 cancer 76
  • Ultrasonography• High-frequency sound waves echoing off body tissues are converted electronically into images• to assess tissues deep within the body• Abdominal and pelvic cancers23/09/12 cancer 77
  • Endoscopy• Direct visualization of a body cavity or passageway by insertion of an endoscope into a body cavity or opening• allows tissue biopsy, fluid aspiration and excision of small tumors• Bronchial, gastrointestinal cancers23/09/12 cancer 78
  • Nuclear Medicine Imaging• Uses intravenous injection or ingestion of radioisotope substances followed by imaging of tissues that have concentrated the radioisotopes• Bone, liver, kidney, spleen, brain, thyroid cancers23/09/12 cancer 79
  • Positron Emission Tomography• Computed cross-sectional images of increased concentration of radioisotopes in malignant cells• Provide information about biologic activity of malignant cells• help distinguish between benign and malignant processes and responses to treatment23/09/12 cancer 80
  • PETScan• Lung, colon, liver, pancreatic, breast, esophagus cancers; Hodgkin’s and non-Hodgkin’s23/09/12 cancer 81
  • Radioimmunoconjugate• Monoclonal antibodies are labeled with a radioisotope and injected intravenously into the patient• the antibodies that aggregate at the tumor site are visualized with scanners• Colorectal, breast, ovarian, head and neck cancers; lymphoma23/09/12 cancer 82
  • MANAGEMENT23/09/12 cancer 83
  • GOALS •cure •control •palliation23/09/12 cancer 84
  • TREATMENT• Surgery• Chemotherapy• Radiation Therapy• Biologic Response Modifier• Bone Marrow Transplantation23/09/12 cancer 85
  • SURGERY• Diagnose, stage & treat –Prophylactic Sx –Curative Sx –Control (cytoreductive) Sx –Palliative Sx –Reconstructive Sx23/09/12 cancer 86
  • DIAGNOSTIC SURGERY• BIOPSY – Excisional • Remove the entire tumor and surrounding marginal tissues – Incisional • wedge of tissue from the tumor is removed – Needle Method • sample suspicious masses that are easily accessible23/09/12 cancer 87
  • Excisional biopsy23/09/12 cancer 88
  • Incisional biopsy23/09/12 cancer 89
  • Needle biopsy23/09/12 cancer 90
  • Primary Treatment• Local and wide excisions• Salvage surgery• Electrosurgery• Cryosurgery• Chemosurgery• Laser surgery –light amplification• Stereotactic radiosurgery23/09/12 cancer 91
  • PROPHYLACTIC SURGERY• removing nonvital tissues or organs that are likely to develop cancer23/09/12 cancer 92
  • Factors to consider:• Family history and genetic predisposition• Presence or absence of symptoms• Potential risks and benefits• Ability to detect cancer at an early stage• Patient’s acceptance of the postoperative outcome23/09/12 cancer 93
  • PALLIATIVE SURGERY• make the patient as comfortable as possible and to promote a satisfying and productive life for as long as possible• attempt to relieve complications of cancer, such as ulcerations, obstructions, hemorrhage, pain, and malignant effusions• GOAL: HIGH QUALITY OF LIFE23/09/12 cancer 94
  • Reconstructive Sx• may follow curative or radical surgery and• is carried out in an attempt to improve function or obtain a morecdesirable cosmetic effec23/09/12 cancer 95
  • NURSING INTERVENTIONS• Perioperative NI• assesses the patient’s responses to the surgery• monitor for possible complications• Provision of comfort• Postoperative teaching addresses wound care, activity, nutrition, and medication information23/09/12 cancer 96
  • S/E of Surgery• Loss of function of a body part• Reduced function• Scarring• grieving23/09/12 cancer 97
  • CHEMOTHERAPY• Kills or inhibits reproduction of neoplastic cells• Systemic effect: Normal & CA cells• Combination chemotherapy – avoid meds during nadirs• NADIRS – time during w/c bone marrow activiy & WBC are low)23/09/12 cancer 98
  • Chemotherapy• GOALS: cure, control, palliation• Coordinated with the cell cycle• For each tx: 20-99% are destroyed23/09/12 cancer 99
  • Growth Fractions• Actively proliferating cells within a tumor• Most sensitive23/09/12 cancer 100
  • Non dividing cells• Least sensitive• Must be destroyed to eradicate cancer completely• Repeated doses @ active cell division23/09/12 cancer 101
  • Cell cycle time• time required for one tissue cell to divide and reproduce two identical daughter cells –G1 phase –S phase –G2 phase –Mitosis23/09/12 cancer 102
  • Classifications• cell cycle–specific drugs• cell cycle–nonspecific agents23/09/12 cancer 103
  • Chemotherapeutic Agents• Topical• Oral• Intravenous• intramuscular• Subcutaneous• Arterial• intracavitary• intrathecal routes23/09/12 cancer 104
  • DOSAGE• patient’s total body surface area• previous response to chemotherapy or radiation therapy• major organ function23/09/12 cancer 105
  • ALKYLATING AGENTS• busulfan, carboplatin, chlorambucil,• cisplatin, cyclophosphamide,• dacarbazine,• hexamethyl melamine, ifosfamide,• melphalan, nitrogen mustard, thiotepa23/09/12 cancer 106
  • Alkylating Agents• Alter DNA structure by misreading DNA code, initiating breaks in the DNA molecule, cross-linking DNA strands• Cell cycle non-specific23/09/12 cancer 107
  • Alkylating Agents• Bone marrow suppression• nausea, vomiting, cystitis (cyclophosphamide, ifosfamide)• Stomatitis• alopecia• gonadal suppression• Renal toxicity (cisplatin)23/09/12 cancer 108
  • Nitrosureas• carmustine (BCNU)• Lomustine (CCNU)• semustine (methyl CCNU)• streptozocin23/09/12 cancer 109
  • Nitrosureas• Similar to the alkylating agents• cross the blood–brain barrier• Cell cycle non-specific23/09/12 cancer 110
  • Nitrosureas• Delayed and cumulative myelosuppression• thrombocytopenia• Nausea• vomiting23/09/12 cancer 111
  • Topoisomerase I Inhibitors• Irinotecan• topotecan23/09/12 cancer 112
  • Topoisomerase I Inhibitors• Induce breaks in the DNA strand by binding to enzyme topoisomerase I• Preventing cells from dividing• Cell cycle specific23/09/12 cancer 113
  • Topoisomerase I Inhibitors• Bone marrow suppression• Diarrhea• Nausea• vomiting• hepatotoxicity23/09/12 cancer 114
  • Antimetabolites• 5-azacytadine• cytarabine• edatrexate fludarabine• 5-fluorouracil (5-FU)• FUDR• Gemcitabine• hydroxyurea• Leustatin• 6-mercaptopurine,• methotrexate, pentostatin,• 6-thioguanine23/09/12 cancer 115
  • Antimetabolites• Interfere with the biosynthesis of metabolites or nucleic acids necessary for RNA and DNA synthesis• Cell specific – S phase23/09/12 cancer 116
  • antimetabolites• Nausea• Vomiting• diarrhea• bone marrow suppression• Proctitis• Stomatitis• renal toxicity (methotrexate)• hepatotoxicity23/09/12 cancer 117
  • Antitumor antibiotics• Bleomycin• dactinomycin• Daunorubicin• Doxorubicin (Adriamycin)• idarubicin• Mitomycin• mitoxantrone• plicamycin23/09/12 cancer 118
  • Antitumor antibiotics• Interfere with DNA synthesis by binding DNA; prevent RNA synthesis• Cell cycle non specific23/09/12 cancer 119
  • Antitumor antibiotics• Bone marrow suppression• nausea, vomiting• alopecia• Anorexia• cardiac toxicity (daunorubicin, doxorubicin)23/09/12 cancer 120
  • Mitotic Spindle Poisons• Plant alkaloids: etoposide, teniposide, vinblastine, vincristine (VCR), vindesine, vinorelbine• Taxanes: paclitaxel, docetaxel23/09/12 cancer 121
  • Mitotic Spindle Poisons• Arrest metaphase by inhibiting mitotic tubular formation (spindle)• inhibit DNA and protein synthesis• TAXATENES –Arrest metaphase by inhibiting tubulin depolymerization• Cell specific –M phase23/09/12 cancer 122
  • Mitotic Spindle Poisons• Bone marrow suppression (mild with VCR)• Neuropathies (VCR)• stomatitis23/09/12 cancer 123
  • Mitotic Spindle Poisons• Bradycardia• hypersensitivity reactions• bone marrow suppression• Alopecia• neuropathies23/09/12 cancer 124
  • Hormonal Agents• androgens and antiandrogens• estrogens and antiestrogens• progestins and antiprogestins• aromatase inhibitors• Luteinizing hormone–releasing hormone analogs• steroids23/09/12 cancer 125
  • Hormonal Agents• Bind to hormone receptor sites that alter cellular growth• block binding of estrogens to receptor sites (antiestrogens)• inhibit RNA synthesis• Suppress aromatase of P450 system, which decreases estrogen level• Cell cycle non-specific23/09/12 cancer 126
  • Hormonal Agents• Hypercalcemia• jaundice, increased appetite• masculinization, feminization• Sodium and fluid retention• nausea, vomiting• hot flashes• Vaginal dryness23/09/12 cancer 127
  • Chemo: Problems23/09/12 cancer 128
  • EXTRAVASATION• Vesicants - those agents that, if deposited into the subcutaneous tissue (extravasation), cause tissue necrosis and damage to underlying tendons, nerves, and blood vessels• dactrinomycin., daunorubicin, doxorubicin (Adriamycin), nitrogen mustard, mitomycin, vinblastine, vincristine, and vindesine23/09/12 cancer 129
  • extravasation• Absence of blood return from the intravenous catheter• Resistance to flow of intravenous fluid• Swelling, pain, or redness at the site23/09/12 cancer 130
  • Nursing Interventions• STOP immediately!• Ice packs on the site (except for vinca alkaloids)• Aspirate any infiltrated medication from the tissues and inject neutralizing solution into the area – sodium thiosulfate, hyaluronidase, and sodium bicarbonate23/09/12 cancer 131
  • Nursing Interventions• right atrial Silastic catheters or venous access devices –Possible complications: infection and thrombosis23/09/12 cancer 132
  • 23/09/12 cancer 133
  • TOXICITY• At risk: Cells with rapid growth rates23/09/12 cancer 134
  • GIT• n/v – most common, 24 hrs post• Serotonin blockers - ondansetron, granisetron, and dolasetron• dopaminergic blockers - metoclopramide (Reglan)• Sedatives• Corticosteroids• histamines23/09/12 cancer 135
  • GIT• Delayed n/v -48 to 72 hrs –Antiemetics –SFF –Bland foods –Comfort foods23/09/12 cancer 136
  • GIT• Stomatitis and anorexia• Mucositis –antimetabolies, antitumor antibiotics• Diarrhea- Irinotecan23/09/12 cancer 137
  • Hematopoietic System• myelosuppression (depression of bone marrow function) –Leukopenia –Anemia –thrombocytopenia23/09/12 cancer 138
  • Hematopoietic System• colony-stimulating factors (granulocyte colony-stimulating factor [G-CSF]• granulocyte-macrophage• colony-stimulating factor [GM-CSF]• erythropoietin [EPO])23/09/12 cancer 139
  • Renal System• Cisplatin, methotrexate, mitomycin• Tumor lysis syndrome – hyperkalemia, hyperphosphatemia, hypocalcemia• Hydration, monitoring, alluporinol23/09/12 cancer 140
  • Cardiopulmonary• Antitumor antibiotics (daunorubicin and doxorubicin)-CARDIAC –total dosage reaches 550 mg/m2• Bleomycin, carmustine (BCNU), and busulfan –PULMO –Bleomycin -not to exceed 400 units• PULMONARY FIBROSIS23/09/12 cancer 141
  • Reproductive System• Normal ovulation, early menopause, or permanent sterility• temporary or permanent azoospermia (absence of spermatozoa)• Banking of sperm before tx23/09/12 cancer 142
  • Neurologic System• taxanes and plant alkaloids, vincristine• Peripheral neuropathies, loss of deep tendon reflexes, and paralytic ileus23/09/12 cancer 143
  • General Nursing Care• Assess F&E status• Modify risk for infection & bleeding – Avoiding contact with people who have known or recent infection or recent vaccination – Private room – Aseptic technique – Stool softeners23/09/12 cancer 144
  • • Use of electric razor• Personal hygiene• Ambulation –skin breakdown• Avoid fresh fruits, raw meat, fish, and vegetables• remove fresh flowers and potted plants23/09/12 cancer 145
  • • Each day: change drinking water, denture cleaning fluids, and respiratory equipment containing water• Assess intravenous sites every day for evidence of infection• NO IM injections, IFC23/09/12 cancer 146
  • Erythematous areas• Avoid the use of soaps, cosmetics, perfumes, powders, lotions and ointments, deodorants• Use only lukewarm water to bathe the area• Avoid rubbing or scratching the area.• Avoid shaving the area with a straight edged razor23/09/12 cancer 147
  • Erythematous areas• Avoid applying hot-water bottles, heating pads, ice, and adhesive tape to the area• Avoid exposing the area to sunlight or cold weather• Avoid tight clothing in the area• Use cotton clothing• Apply vitamin A&D ointment to the area23/09/12 cancer 148
  • stomatitis• Avoid commercial mouthwashes• Brush with soft toothbrush; use nonabrasive toothpaste after meals and bedtime• Use normal saline mouth rinses every 2 h while awake; every 6 h at night.• Use soft toothbrush• Remove dentures except for meals; be certain dentures fit well• Apply lip lubricant• Avoid foods that are spicy or hard to chew and those with extremes of temperature23/09/12 cancer 149
  • alopecia• Prevent or minimize hair loss through the following:• Use scalp hypothermia and scalp tourniquets• Cut long hair before treatment• Use mild shampoo and conditioner, gently pat dry, and avoid excessive shampooing• Avoid electric curlers, curling irons, ryers, clips, barrettes, hair sprays, hair dyes, and permanent waves• Avoid excessive combing or brushing; use wide- toothed comb.23/09/12 cancer 150
  • alopecia• Prevent trauma to scalp. –Lubricate scalp with vitamin A&D ointment to decrease itching. –Have patient use sunscreen or wear hat when in the sun23/09/12 cancer 151
  • alopecia• Purchase wig or hairpiece before hair loss• Begin to wear wig before hair loss• Wear hat, scarf, or turban23/09/12 cancer 152
  • nutrition• Adequate fluid intake• SFF• High calorie, high CHON diet• Relaxed, quiet env’t during mealtime• Cold foods if desired• Wine if possible• Frequent oral hygiene23/09/12 cancer 153
  • fatigue• Rest periods• Inc night time sleep hrs• Reduce job workload• Relaxation technique23/09/12 cancer 154
  • RADIATION THERAPY23/09/12 cancer 155
  • RADIATION• Destroys CA cells w/ minimal exposure of Normal cells to the damaging effects• Teletherapy & brachytherapy23/09/12 cancer 156
  • Teletherapy• Beam radiation• Actual radiation source is external• Does not emit radiation & does not pose hazad to anyone else23/09/12 cancer 157
  • Brachytherapy• Direct, continuous contact with tumor• Radiation source is w/in the client• Client emits radiation and poses hazard to others• Sealed or unsealed23/09/12 cancer 158
  • S/E of Radiation• Skin changes and irritation, alopecia, fatigue, altered taste sensation• Vary according to the site of tx23/09/12 cancer 159
  • BONE MARROW TRANSPLANTATION23/09/12 cancer 160
  • • For treatment of leukemia for clients who have closely matched donors and who are experiencing temporary remission with chemotherapy• GOAL: rid the client of all leukemic or other malignant cells through treatment with high doses of chemotherapy & whole-body irradiation
  • TYPES OF DONOR MARROW• ALLOGENIC• SYNGENEIC• AUTOLOGOUS
  • ALLOGENIC• from a donor other than the patient): –either a related donor (ie, family member) – a matched unrelated donor (national bone marrow registry, cord blood registry)23/09/12 cancer 163
  • • Autologous (from patient)• Syngeneic (from an identical twin)23/09/12 cancer 164
  • PROCEDURE• HARVEST• CONDITIONING• TRANSPLANTATION• ENGRAFTMENT
  • HARVESTING• Large amts under GA• Peripheral Blood Stem Transplant –uses apheresis of the donor to collect stem cells for reinfusion23/09/12 cancer 166
  • HARVESTING• ALLOGENIC –Human leukocyte antigen matched donor• ADV: transplanted cells should not be immunologically tolerant of the patient’s malignancy and should cause a lethal graft-versus-disease effect to the malignant cells23/09/12 cancer 167
  • HARVESTING• AUTOLOGOUS –Frozen (cryopreserved) –80-190 oC• ALLOGENIC –treated to remove "T-cells" (T cell depletion)23/09/12 cancer 168
  • ENGRAFTMENT• establishment of the new bone marrow• harvested donor marrow is infused intravenously into the recipient and travels to sites in the body where it produces bone marrow• COMPLETE: 2-4 wks/longer23/09/12 cancer 169
  • COMPLICATIONS• Failure to engraft• Graft-versus-host disease (GVHD)• Veno-occlusive disease
  • GENE THERAPY23/09/12 cancer 171
  • •insertion, alteration, or removal of genes•first conducted on September 14, 199023/09/12 cancer 172
  • • mainly involves the modification of genetic material (DNA and genes)• plays a key role in determining the traits and characteristics of individuals23/09/12 cancer 173
  • GOALS• destroying or preventing the growth of cancerous cells• improving the ability of the normal cells to fight against the cancerous cells23/09/12 cancer 174
  • GERM LINE GT• involves insertion of functional genes into the germ or reproductive cells (sperm and egg) of the body23/09/12 cancer 175
  • SOMATIC GT• therapeutic genes are introduced into the somatic cells23/09/12 cancer 176
  • INSERTION• Thru liposome• Thru viruses: –Retroviruses –Adenoviruses –herpes viruses –Lentiviruses –poxviruses23/09/12 cancer 177
  • INSERTION• EX vivo –collection of some blood or bone marrow cells from the patient –viruses with the necessary genes are introduced into the cells in a laboratory, which are then injected into the patients body23/09/12 cancer 178
  • COMPLICATION• Infection• Cancer• Gene mutation23/09/12 cancer 179
  • INSERTION• IN vivo –direct insertion of viruses or liposomes that contain the desired gene into the patients body23/09/12 cancer 180
  • IMMUNOTHERAPY23/09/12 cancer 181
  • NURSING DIAGNOSIS23/09/12 cancer 182
  • Nursing Diagnoses• Impaired tissue integrity r/t effects of tx & dse• Imbalanced Nutrition: LBR r/t anorexia, malabsorption, cachexia• Pain, chronic r/t disease & tx effects• Fatigue r/t physical & psychological stressors• Anticipatory grieving r/t expected loss & altered role function• Disturbed body image r/t changes in appearance & role functions 23/09/12 cancer 183
  • •Hopelessness – terminally ill•Powerlessness – unable to do things•Knowledge Deficit – upon admission23/09/12 cancer 184
  • NURSING INTERVENTIONS23/09/12 cancer 185
  • Nursing Interventions • Maintaining tissue integrity • Managing stomatitis • Managing malignant skin lesions • Promoting nutrition • Relieving pain • Decreasing fatigue • Improving body image & self-esteem • Assisting in grieving • Monitoring & managing potential complications23/09/12 cancer 186
  • GAS EXCHANGE AND RESPIRATORY SYSTEM23/09/12 cancer 187
  • LARYNGEAL CANCER23/09/12 cancer 188
  • Larynx• an organ at the front of your neck. It is also called the voice box.• It is about 2 inches long and 2 inches wide• The larynx plays a role in breathing, swallowing, and talking• acts like a valve over the windpipe23/09/12 cancer 189
  • RISK FACTORS• CAUSE: UK• Age - over the age of 55• Gender – 4x greater in male• Race – African Americans than whites• Smoking• Alcohol• Personal Hx of neck and head CA• Occupation - sulfuric acid mist or nickel, asbestos• Virus and low in Vit A• GERD• Familial tendency• Straining of voice• Weakened immune system23/09/12 cancer 190
  • RISK FACTORSA. CARCINOGENS Tobacco Combined effects of alcohol and tobacco abuse Asbestos Second-hand smoke Paint fumes Wood dust Cement dust Chemicals Tar products Mustard gas Leather and metals 23/09/12 cancer 191
  • Clinical Manifestations• Hoarseness or other voice changes• A lump in the neck• A sore throat or feeling that something is stuck in your throat• A cough that does not go away• Problems breathing• Bad breath• An earache• Weight loss23/09/12 cancer 192
  • CLINICAL MANIFESTATIONSSUBJECTIVEa. Sore throat / coughb. Dyspneac. Dysphagiad. Weaknesse. Unilateral nasal obstruction or dischargef. Paing. Hoarseness of voice23/09/12 cancer 193
  • CLINICAL MANIFESTATIONSOBJECTIVE a. Persistent hoarseness b. Foul breath c. Persistent ulceration d. Cervical lymph adenopathy e. Unexplained weight loss23/09/12 cancer 194
  • Diagnosis• Physical exam• Indirect laryngoscopy -small, long- handled mirror to check for abnormal areas and to see if your vocal cords move as they should• Direct laryngoscopy - thin, lighted tube called a laryngoscope through your nose or mouth• CT scan• Biopsy23/09/12 cancer 195
  • Treatment• The choice of treatment depends on a number of factors –general health –where in the larynx the cancer began –the size of the tumor –whether the cancer has spread.23/09/12 cancer 196
  • • Radiation therapy (also called radiotherapy) uses high-energy x- rays to kill cancer cells. –Radiation therapy is local therapy. –It affects cells only in the treated area. –Treatments are usually given 5 days a week for 5 to 8 weeks.23/09/12 cancer 197
  • Combination of treatment• Radiation therapy alone• Radiation therapy combined with surgery –before or after surgery• Radiation therapy combined with chemotherapy - may be used before, during, or after chemotherapy.23/09/12 cancer 198
  • SURGERY• When patients need surgery, the type of operation depends mainly on the size and exact location of the tumor23/09/12 cancer 199
  • • Total laryngectomy: The surgeon removes the entire larynx.• Partial laryngectomy (hemilaryngectomy): The surgeon removes part of the larynx. – Supraglottic laryngectomy: The surgeon takes out the supraglottis, the top part of the larynx. – Cordectomy: The surgeon removes one or both vocal cords.23/09/12 cancer 200
  • • Lymph node dissection• Thyroidectomy or thyrotomy23/09/12 cancer 201
  • 23/09/12 cancer 202
  • Chemotherapy• Before surgery or radiation therapy• After surgery or radiation therapy• Instead of surgery23/09/12 cancer 203
  • Implementation• Radiation therapy• Dry mouth – Drinking lots of fluids can help. – Some patients find artificial saliva helpful. – It comes in a spray or squeeze bottle.• Sore throat or mouth – special rinses to numb your throat and mouth and help relieve the soreness.• Delayed healing after dental care.23/09/12 cancer 204
  • • Tooth decay – Good mouth care – a soft toothbrush, or a toothbrush that has a spongy tip instead of bristles. – A mouthwash made with diluted peroxide, salt water, baking soda, or a combination can keep your mouth fresh and help protect your teeth from decay. – It may also be helpful to use fluoride toothpaste or rinse.• Changes in sense of taste and smell – During radiation therapy, food may taste or smell different.23/09/12 cancer 205
  • • Fatigue. – During radiation therapy, you may become very tired, especially in the later weeks of treatment. – Resting is important, but doctors usually advise their patients to stay as active as they can.• Changes in voice quality – Your voice may be weak at the end of the day. – Voice changes and the feeling of a lump in your throat may come from swelling in the larynx caused by the radiation.23/09/12 cancer 206
  • • Skin changes in treated area – Good skin care is important at this time. – Try to expose this area to the air but protect it from the sun. – Avoid wearing clothes that rub, and do not shave the treated area. – You should not put anything on skin before radiation treatments. – never use lotion or cream without doctors advice.23/09/12 cancer 207
  • Implementation• Surgery• Pain• Low energy• Swelling in the throat – wont be able to eat, drink, or swallow. – IV – Feeding tube23/09/12 cancer 208
  • • Increased mucus production –the lungs and windpipe produce a lot of mucus, also called sputum –Suction PRN23/09/12 cancer 209
  • Implementation• High CHON and Calorie diet• soft, bland foods• Thick soups, puddings, and milkshakes often are easier to swallow23/09/12 cancer 210
  • Rehabilitation• Stoma Care• Communication –partial laryngectomy, you will be able to talk in the usual way –total laryngectomy, pt. must learn to speak in a new way23/09/12 cancer 211
  • 23/09/12 cancer 212
  • Communication• Keep pads of paper and pens or pencils• Use a typewriter, computer, or other electronic device• Instruct the pt to carry a small dictionary or a picture book and point to the words you need23/09/12 cancer 213
  • • Do –Give the person plenty of time to speak –Ask them to repeat if you don’t understand –Watch a person’s lips if you are finding it hard to understand23/09/12 cancer 214
  • • Don’t –Hurry them; pressure affects ability to communicate –Pretend you understand if you don’t—it will be obvious –Avoid eye contact during the conversation23/09/12 cancer 215
  • TECHNIQUES OF ALARYNGEAL COMMUNICATION1. ESOPHAGEAL SPEECH2. ELECTRIC LARYNX3. TRACHEOESOPHAGEAL PUNCTURE23/09/12 cancer 216
  • Esophageal speech• teach how to force air into the top of your esophagus and then push it out again• The puff of air is like a burp• It vibrates the walls of the throat, making sound for the new voice• The tongue, lips, and teeth form words as the sound passes through the mouth23/09/12 cancer 217
  • Esophageal speech• speech sounds low pitched and gruff, but it usually sounds more like a natural voice than speech made by a mechanical larynx23/09/12 cancer 218
  • Tracheoesophageal puncture• surgeon makes an opening between the trachea and the esophagus• opening is made at the time of initial surgery or later• small plastic or silicone valve fits into this opening• valve keeps food out of the trachea23/09/12 cancer 219
  • 23/09/12 cancer 220
  • • After TEP, patients can cover their stoma with a finger and force air into the esophagus through the valve.• The air produces sound by making the walls of the throat vibrate.• The sound is a lot like natural speech23/09/12 cancer 221
  • Mechanical speech• powered by batteries (electrolarynx) or by air (pneumatic larynx)• small flashlight• It makes a humming sound. hold the device against the neck, and the sound travels through your neck to the mouth• a flexible plastic tube that carries sound into your mouth from a hand-held device23/09/12 cancer 222
  • 23/09/12 cancer 223
  • • pneumatic larynx –held over the stoma and uses air from the lungs instead of batteries to make it vibrate –The sound it makes travels to the mouth through a plastic tube.23/09/12 cancer 224
  • 23/09/12 cancer 225
  • NURSING1. DIAGNOSES DEFICIENT KNOWLEDGE2. ANXIETY AND DEPRESSION3. INEFFECTIVE AIRWAY CLEARANCE4. IMPAIRED VERBAL COMMUNICATION5. IMBALANCED NUTRITION6. DISTURBED BODY IMAGE AND LOW SELF-ESTEEM7. SELF-CARE DEFICIT 23/09/12 cancer 226
  • NURSING CARE1. PROVIDE TIME TO DISCUSS THE DIAGNOSIS AND THE RAMIFICATION OF SURGERY2. ASSIST AND ENCOURAGE EXPRESSION OF FEELINGS3. ANSWER AS THOROUGHLY AND HONESTLY TO QUESTIONS4. VISIT AND DISCUSS REHABILITATION PROCESS5. INSTRUCT AS TO THE METHOD OF COMMUNICATION THAT WILL BE USED AFTER SURGERY23/09/12 cancer 227
  • 6. OBSERVE FOR OBSTRUCTION OF AIRWAY7. OBSERVE FOR SIGNS OF HEMORRHAGE8. PROVIDE SUCTION APPARATUS AND CATHETERS9. PROVIDE HUMIDITY10. EXPECT AND ACCEPT A PERIOD OF MOURNING11. ENCOURAGE INVOLVEMENT IN SPEECH THERAPY12. TEACH NECESSARY TO HANDLE BODY FUNCTIONING ALTERATION23/09/12 cancer 228
  • 13. TEACH CLIENT TO AVOID ACTIVITIES THAT PERMIT WATER OR IRRITATING SUBSTANCES TO ENTER THE TRACHEA14. SUCTION LARYNGECTOMY TUBE PRN15. AVOID WEARING CLOTHES WITH CONSTRICTIVE COLLARS OR NECKLINE16. MAKE CLIENT UNDERSTAND THAT CERTAIN ACTIVITIES ARE IMPOSSIBLE23/09/12 cancer 229
  • have a nice day…23/09/12 cancer 230
  • Assignment• LUNG CANCER• TUMORS OF THE MEDIATINUM• CARDIAC TUMORS• LEOCOCYTOSIS LEUKEMIA23/09/12 cancer 231
  • Bring out ¼ sheet of paper…23/09/12 cancer 232