Académique Documents
Professionnel Documents
Culture Documents
Terms
• 1. benign: not malignant, nonrecurrent, favorable for
recovery
• 2. malignant: tending to become progressively worse and
to cause death
• 3. remission: improvement or absence of signs of disease
• 4. idiopathic: disease of unknown origin
• 5. carcinoma: cancerous (malignant) tumor
• 6. epithelioma: tumor composed of epithelium (malignant
tumor)
• 7. fibroma: (tumor composed of fibrous tissue)
• 8. fibrosarcoma: malignant tumor composed of fibrous
tissue
• 9. leiomyoma: (benign) tumor of smooth muscle
• 10. leiomyosarcoma: malignant tumor of smooth muscle
Terms
• 11. lipoma: tumor containing fat (benign tumor)
• 12. liposarcoma: malignant tumor composed of fat
• 13. melanocarcinoma: cancerous (malignant) black tumor
• 14. melanoma: black tumor (primarily on the skin)
• 15. myoma (tumor formed of muscle)
• 16. neoplasm: new growth (of abnormal tissue or tumor)
The Cell
• the structural and functional unit of all
known living organisms
• the smallest unit of an organism that is
classified as living, and is sometimes
called the building block of life
Components
• Cell membrane- separate and protect a
cell from its surrounding environment
• Cytoskeleton - acts to organize and
maintain the cell's shape
• Genetic material
– DNA - for their long-term information
storage
– RNA - used for information transport
Cell functions
• Cell growth and metabolism
• Creation of new cells
• Protein synthesis
• Cell movement or motility
Cell Cycle
• Cell Proliferation – process by which the
cells divide and reproduce
– regulated
• Cell differentiation – transformation of cell
into specialized cells
Evolution of Cancer Cells
• all cells constantly change through growth,
degeneration, repair and adaptation
• neoplasm refers to both benign and
malignant cells
• growth control mechanism of normal cells
is not entirely understood
Evolution of Cancer Cells
Characteristics of Malignant
Cells
• Differentiation
– Mutated stem cells undergone structural
changes hindering them from functioning
normally
• Rate of Growth
– Have uncontrollable growth/cell division
– Tumor growth rate is affected by ↑cell division
& ↑ survival time of cells
• Spread
– Lack adhesion and capsule, resulting to spread
to distant body parts
Etiology (Carcinogenesis)
1.Environmental Factors
a. Physical
i.Radiation – x-rays, radium, nuclear explosion/waste,
ultraviolet
b.Chemical
•Nitrites and food additives, polycyclic hydrocarbons,
dyes, alkylating agents, salt-cured, high calorie diet
•Drugs: arsenical, stilbestrol, urethane
•Cigarette smoke
•Hormones – estrogen, hormonal replacement therapy,
oral contraceptives
Etiology
2.Genetics
a.Some cancers show familial pattern/inherited
genetic defects
3.Viral theory
a.Oncoviruses (RNA-type viruses)
b.Viruses like:
• Hepa B, C – liver Ca
• Herpes simplex II, cytomegalovirus, Human
Papilloma virus-dysplacia and cervix Ca
• HIV – Kaposis sarcoma
• Helicobacter pylori – gastric Ca
• Epstein-Barr virus – Burkitt lymphoma,
nasopharyngeal Ca, non-hodgkin & Hodgkin dse
Etiology
• 4. Immunologic factors
a.Failure of the immune system to respond to
and eradicate cancer cells
b.Immunosuppressed individuals are more
susceptible to cancer
Carcinogenesis
1 Initiation – brought by the diff causative
agents
2 Promotion – K-ras (KRAS2) located on
chromosome 12, all mammal has cellular
oncogenes
a.Proto-oncogenes
b.Suppressor genes (p53 or TP53)
3 Progression – continue to proliferate and
metastasize
Diagnosis of Cancer
• Classification and Staging
a.Tissue of Origin
b.Stages of Tumor Growth
• TNM System
• Cytologic Diagnosis of Cancer
Staging and TNM System
• describes the extent or severity of an individual’s cancer
based on the extent of the original (primary) tumor and the
extent of spread in the body.
• TNM - one of the most commonly used staging systems
• Primary Tumor (T)
a.TX Primary tumor cannot be evaluated
b.T0 No evidence of primary tumor
c.Tis Carcinoma in situ (early cancer that has not
spread to neighboring tissue)
d.T1, T2, T3, T4 Size and/or extent of the
primary tumor
• Regional Lymph Nodes (N)
– NX Regional lymph nodes cannot be evaluated
– N0 No regional lymph node involvement (no
cancer found in the lymph nodes)
– N1, N2, N3 Involvement of regional lymph
nodes (number and/or extent of spread)
• Distant Metastasis (M)
– MX Distant metastasis cannot be evaluated
– M0 No distant metastasis (cancer has not
spread to other parts of the body)
– M1 Distant metastasis (cancer has spread to
distant parts of the body)
• example:
– breast cancer T3 N2 M0
– Prostate cancer T2 N0 M0
Grading and Staging of Tumors
• G1 phase –
Asparaginase,
Prednisone
• S phase –
Antimetabolites,
cytarabine, methotrexate
• G2 phase –
Antibiotic(Bleomycin)
• Mitosis – Vinka alkaloids
Antineoplastic Agents
• Alkylating agents – altered DNA structure
by misreading DNA code
• carboplatin,cisplatin,oxaliplatin,busulfan,cyc
lophosphamide,dacarbazine,hexamethyl,m
elamine,ifosfamide
– Non-specific
– SE: bone marrow , nausea, vomiting, cystitis,
stomatitis, alopecia, gonadal suppression,
renal toxicity (cisplatin)
Nitrosureas
• Similar to the alkylating agents; can cross
the blood brain barriers
• LOSE CAR MUSTINE -
– LOmustine SEmustine CARmustine
Streptozocin
– Non-specific
– SE: myelosuppression,
thrombocytopenia;nausea, vomiting
Topoisomerase 1 inhibitors
• Induce breaks in DNA
• topoTECAN, irinoTECAN
– S-phase specific
– SE:bone marrow suppression, diarrhea,
nausea, vomiting, hepatotoxicity
Antitumor Antibiotics
• Interfere with DNA synthesis by binding
DNA; prevent RNA synthesis
• BLEO,DACTINO,MITO,PLICAmycin
• DOXO, DAUNO, IDArubicin
– Non-specific
– SE: cardiac toxicity (daunorubicin, doxorubicin)
Mitotic Spindle Poison
• PLANT ALKALOIDS
– Arrest metaphase by inhibiting spindle
formation; inhibit DNA and protein synthesis
– M-phase specific
– VINcristine, VINblastine, VINdesine,
VINorelbine
– EtoPOSIDE, teniPOSIDE
– SE: BM suppression, neuropathies, stomatitis
Mitotic Spindle Poison
• TAXANES
– Arrest metaphase by inhibiting tubulin
depolymerization
– PACLItaxel, DOCEtaxel
• SE: bradycardia, hypersensitivity rxn, BM
suppressio, alopecia, neuropathies
Hormonal agents
• Bind to hormone receptors sites that alter cellular
growth e.g. Blocking of ESTROGEN
• Androgens, antiandrogens, estrogens and
antiestrogen, progestins and antiprogestines,
aromatase inhibitors, lutenizing-hormone-
releasing hormones analogues, steroids
– Non-specific
– SE: hypercalcemia,jaundice,increased
appetite,masculinication,Na&fluid retention,
vomiting , hot flashes, vaginal dryness
Miscellaneous Agents
• Unknown
• Asparaginase ( Elspar) – for acute
lymphoblastic leukemia (ALL) & mast cells
• Procarbazine (Matulane) – Hodgkin's
lymphoma & brain cancers
Side effects of Chemotherapy
• GI
– Nausea, vomiting
– Diarrhea
– Stomatitis
• Hematologic
– Thrombocytopenia
– Leukopenia
– Anemia 5
• Integumentary
– Alopecia
Side effects of Chemotherapy
• Renal
– Direct damage to kidney by excretion of
metabolites
• Reproductive
– Infertility
• Neurologic
– Peripheral neuropathies, hearing loss, loss of
deep tendon reflex, paralytic ileus
Administration
• ROUTES: • Dosage:
– Topical – Based on the total
– Oral body surface
– Intravenous
– Intramuscular
– Subcutaneous
– Arterial
– Intracavitary
– Intrathecal
Special Problems
• Extravasation
– Vesicants – agents when deposited into the SQ
tissue cause necrosis and damage to tendons,
nerves, blood vessels
• MYSINE, RUBICIN, VIN, nitrogen MUSTARD
– Carefull selection of VEINS
– No blood return, resistance to flow, swelling, pain
redness at the site :STOP immediately
• Apply ice unless its VINCA alkaloids
Problems
• Toxicity
– GI: N&V
• Meds: ondan, grani, dola, palono SETRON (blocks
serotonin receptors)
• Metoclopramide (Reglan, Plasil) – dopaminergic
blocker
– Hematopoetic System
• Myelosuppression
– Granulocyte colony-stimulating factor (GSF)
– Granulocyte-macrophage CSF (GM-CSF)
Problems
• Renals System
– Cisplatin, Methotrexate, mitomycin –
Nephrotoxic
– Excretion of Uric Acid damage the kidney
• Monitor BUN, crea, serum electrolytes
• Adequate hydration, alkalinization of urine,
allupurinol – prevention of these side effects
• Reproductive system
– Sterility
• Sperm bank, Use birth control
Problems
• Cardiopulmonary
– RUBICIN-cardiotoxicity
– Monitor for cardiac ejection fraction, heart failure
– Bleomycin, carMUSTINE, busulfan – lung damage
– Pulmonary fibrosis – long-term effect
• Neurologic
– Taxanes and plant alkaloid
– Peripheral neuropathies, loss of deep tendon
reflexes, paralytic ileus, ototoxocity(acoustic nerve
damage)
Problems
• Miscellaneous
– Fatigue and depression
Nursing diagnosis
• Fear/anxiety
– situational crisis
– Threat to/change in health/socio-economic
status, role functioning, interaction pattern
– Threat of death
– Separation from family
• Grieving, anticipatory
– Loss of physiologic well being (loss of body
part, change in body function
– Perceived potential death
Nursing Diagnosis
• Situational low self-esteem
– Biophysical
– Psychosocial
• Acute/Chronic Pain
– Disease process
– Side-effects of therapeutic agents
• Altered nutrition, less than body requirements
– Hypermetabolic state, consequences of chemo,
radiation, surgery, emotional distress, fatigue, poor
pain control
Nursing Diagnosis
• Risk for fluid volume deficit
• Fatigue
• Risk for infection
• Risk for altered mucous membrane
• Risk for skin/tissue integrity
• Risk for Constipation/diarrhea
• Risk for Altered sexuality patterns
• Knowledge deficit
Nursing Management
• Assess fluid & electrolytes
• Modify risk for infection & bleeding
• Administer chemotherapy
• Protect caregivers
Nursing Management – Pt Teaching
• Thrombocytopenia
• Use soft toothbrush to avoid bleeding gums
• When shaving, use electric razor
• Avoid constipation, enemas, rectal temps
• Do not use products that contain aspirin, NSAID
• Avoid IM or sc injection
• Notify MD/RN if petechiae, bruising, frank or tarry
stools, change in color of urine – frank blood, dark
amber, bleeding from any part of body such as
nosebleed
Nursing Management
• External
– Source is outside body
– Beam aimed at specific spot
– Marked with marker
– Protect area from heat or cold
– High protein, high calorie, high fluid
intake (2-3 quarts)
Radiation Therapy
Internal Radiation Therapy
• Sealed or unsealed
• Radiation is emitted
Radiation Therapy
Internal Radiation Therapy
• Sealed radiation
• Sealed source of radiation – intracavity, interstitial
• Prevent dislodgment
• Monitor VS every four hours
• Accurate I&O– usually have a usually have a foley
• Active ROM
Radiation Therapy
Unsealed Source Radiation
• Administered intravenously or orally
• Used in systemic system
– Colloid suspension into body tissue
– Iodine 131 – Graves disease, thyroid cancer
– Strontium chloride (Metastron) for bone metastasis
• Confined to bed
• Provide Education
• Myelosuppression
– reduction of bone marrow to produce blood cells.
– any or all of the three main types of blood cells that are normally produced
in the bone marrow are decreased in number and/or may take a prolonged
period of time to return to "normal levels“
• Thrombocytopenia
• Formed elements
– RBC’s
– WBC’s
– Platelets (thrombocytes)
BLOOD
• Human body contains 4-6 liters of blood
– Accounts for 8 % of body weight
PLASMA
• Holds the formed elements
– Clear, straw colored liquid
• Carries nutrients, electrolyes (salts),
hormones and waste products
• Plasma proteins
– Blood clotting factors
– Albumin
– Globulins
• Antibodies
• Serum
– Plasma without blood clotting element -
fibrinogen
HEMATOPOIESIS
RED BLOOD CELLS
• Erythropoiesis
• Shape-biconcave (resembles a caved-in
disk)
• Carry oxygen to the cells
– Hemoglobin: protein
– Oxyhemoglobin
• Transport CO2 away from the cells – to the
lungs
• Live for about 120 days
– Worn out cells are destoyed, mainly by spleen
and liver
Recycling RBCs
Figure 19–4
BLOOD TYPES
• 4 Blood types
– A, B, AB, O
– Depending on type of proteins (antigens)
located on surface of the RBC’s
• Harmful to transfuse blood from a donor of
one blood group into a recipient who has
blood from another blood group.
– People with type O blood are universal donors
– People with type AB are universal recipients
– Type and cross – match to determine type
4 Basic Blood Types
Figure 19–6a
Cross-Reaction
Figure 19–6b
LEUKOCYTES (WBCs)
• Less numerous than RBCs
• Immune response to protect body against
infection
– Directly attack foreign matter
– Make antibodies
• 5 types in two primary groups
– Granulocytes – have a grainy appearance
• Neutrophils
• Eosinophils
• Basophils
– Agranulocytes
• Lymphpocytes
• Monocytes
Types of WBCs
Figure 19–9
Neutrophil Action
• Very active, first to attack bacteria
• Engulf pathogens
• Digest pathogens
• Release prostaglandins and
leukotrienes
• Form pus
Eosinophil Actions
• Are sensitive to allergens
• Control inflammation with enzymes that
counteract inflammatory effects of
neutrophils and mast cells
Basophil Actions
• Release histamine:
– dilates blood vessels
• Release heparin:
– prevents blood clotting
Macrophage Actions
• Engulf large particles and pathogens
• Secrete substances that attract immune
system cells and fibroblasts to injured
area
Lymphocyte Actions
• Are part of the body’s specific defense
system
T cells
• Cell-mediated immunity
• Attack foreign cells directly
B cells
• Humoral immunity
• Differentiate into plasma cells
• Synthesize antibodies
Natural Killer Cells (NK)
• Detect and destroy abnormal tissue
cells (cancers)
PLATELETS
• Also called thrombocytes
• Helps the body to form clots
– Rush to the sight of an injury
– Adhere to the blood vessel wall
• Clotting process
– Vascular constriction – to stop blood flow
– Platelet plug formation
– Local blood coagulation
– Prothrombin
Platelet Counts
• 150,000 to 500,000 per microliter
• Thrombocytopenia:
– abnormally low platelet count
• Thrombocytosis:
– abnormally high platelet count
4 Colony-Stimulating
Factors (CSFs)
• Hormones that regulate blood cell
populations:
1. M-CSF:
• stimulates monocyte production
2. G-CSF:
• stimulates granulocyte production
• neutrophils, eosinophils, and basophils
4 Colony-Stimulating
Factors (CSFs)
3. GM-CSF:
• stimulates granulocyte and monocyte
production
4. Multi-CSF:
• accelerates production of granulocytes,
monocytes, platelets, and RBCs
WELLNESS & ILLNESS
• CBC – most common blood test
• InheritedProblems
– Sickle cell anemia
– Thalasemia
– Hemophilia
SICKLE CELL ANEMIA
• Vaso-Occlusive Crisis
ADULTS/SENIORS
• Adults
– Anemias
• Iron deficiency
• Pernicious (Vitamin B12 deficiency)
• Aplastic
– Idiopathic
• IDIOPATHIC THROMBOCYTOPENIC
PURPURA
• Seniors
– Polycythemia vera
GENERAL TERMS
• Ecchymosis
– Blood under skin from trauma
• Changes colors, fades away
• Hematoma
• Thrombosis
– Thrombus
• Clot
– Embolus
• Clot that dislodges and travels through
bloodstream
WBC Disorders
• Leukopenia:
– abnormally low WBC count
• Leukocytosis:
– abnormally high WBC count
• Leukemia:
– extremely high WBC count
CANCERS OF HEMATOPOIETIC
SYSTEM
• Arise in the bone marrow
• Leukemia is the most common
– Proliferation of abnormal WBC’s in blood
– Different types
– Childhood – about 85% cure rate with chemo
• Lymphomas
– Affects tissues of Lymphatic system
• Hodgkin’s
• Non-Hodgkin type
• Multiple myeloma
– Affects plasma cells
TESTS & PROCEDURES
• 3 Major blood tests
– CBC
• RBC, WBC, Platelets, Hgb and HCT
– CBC with Diff (differential)
• Includes breakdown of WBC’s
– Peripheral blood smear
• Size, appearance, abnormally shaped cells
• Others
– Bone marrow aspiration/biopsy
– Pheresis
– Clotting factors
• PT & PTT
– Coomb’s test
PHARMACEUTICAL AGENTS
• Thrombolytic agents
– Break down clots that have formed
• Antithrombolytic agents
– Anticoagulants
• Prevent clots from forming
• Warfarin, Heparin, Aspirin
• Coagulants
– Promote clotting
• Growth factors
– Stimulate growth of certain cells
Blood Transfusion
Blood Types
• categorized according to antigens on red blood cells
• Type A: A antigens
• Type B: B antigens
• Type O: no antigens (universal donor)
• Type AB: A and B antigens (universal recipient)
• Longer term
Chronic graft-versus-host disease (lung, gut, liver, skin)
Relapse
Infection
Endocrine
Ocular
RISKS OF BONE MARROW
TRANSPLANT
Short term (TRM)
Sepsis, VOD, AGVHD, multi-organ failure or toxic
death
Longer term
Chronic graft-versus-host disease (lung, gut, liver,
skin)
Relapse
Infection
Endocrine
Ocular
References:
• http://www.cancer.gov/cancertopics/what-is-cancer
• National Cancer Institute