ONCOLOGY NURSING -IT IS A BRANCH OF MEDICINE THAT DEALS WITH THE STUDY, DETECTION, TREATMENT AND MANAGENEMENT OF CANCER.

. 1. EPIDEMIOLOGY Cancer affects people of all ages, most cancers occur in people older than 65 years old Higher in men than in women Cancer is 2nd only to cardiovascular diseases as leading cause of death in U.S Cancer is higher in African American due to economic factors, education, access to health care In order of frequency in men are lung, prostate and colon cancer, in women are lung, breast and colorectal cancer. COMPARISON OF NORMAL AND CANCER CELLS NUCLEUS membraneenclosed organelle found in eukaryotic cell

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Normal cell CELL Smallest functional unit of organism EUKARYOTIC CELL Comprise all life kingdom Membranes bound nucleus With true nucleus PROKARYOTIC CELLS Bacteria monera Few internal structures Lacks a membrane bound nucleus

Organelles: Mitochondria Powerplant Provides energy needed by cell Ribosomes Site of protein synthesis Endoplasmic Reticulum Network of tubes carries materials to the cell Golgi apparatus Directing molecular traffic in the cell Lysosomes Digestive system of cell Digestion and removal of dead or damaged tissue of foreign substances Phagocytosis Cytoplasm Cytoskeleton Controls shape and movement Cilia and Flagella Sweeping and flaiting movement Cell membrane

Cellular composition PROTOPLASM Internal matrix heavy, thick colloid al material 5 SUBSTANCES 70 % water 25 % protein Electrolytes 2-3 % lipids 1% CHO (glycogen) FUNCTIONS: A. B.

plasma membrane Seperates intracellular contents from the extracellular environment Semi-permeable

Controls the exchange of substances in and out of cell Process information crossing the membranes such as hormone transmitters, insulin, steroids Nucleus Controls center of the cells Enclosed with a membrane

CYTOPLASM Surrounds nucleus where most work of the cell takes place Contains rest of organelles CELL MEMBRANE a biological membrane that separates the interior of all cells from the outside environment.

Inside part: Chromosomes : DNA (composed of genes) Nucleoli: contains RNA 3 FORMS OF RNA Messenger RNA Carries genetic code from nucleus to cystoplasm

Dictates sequence of amino acids

2. 3.

Transfer RNA Carries activated amino acids to ribosome Ribosomal RNA Productions of ribosome

4. 5. 6.

Size and Shape: Normal cells are homogenous Anaplastic cells : deviant from normal cell ; irregular cellular nest Benign and malignant Uncontrolled cell replication Malignant cells: no purpose

BEHAVIORAL OF CELLS Hypertrophy Enlargement of the structure due to increase workload Atrophy Shrinking of cell Hyperplasia Increase number of cells in an organ or tissue :occurs in response to stress Metaplasia Transformation of one cell type to another Dysplasia Abnormal differentiation of dividing cells resulting in changes of cells Anaplasia Cell differentiation to a more immature or embryonic form.

COMPARISON OF BENIGN AND MALIGNANT NEOPLASM CELLS CHARACTERISTIC BENIGN MALIGNAN S T GROWTH Slow, nonRapid, infiltrating infiltrating DIFFERENTIATIO Fully Immature, N differentiate poorly d differentiate d CELL TYPE Close to Abnormal original ENCAPSULATED Frequent Infrequent METASTASIS Absent Present EFFECT Can Terminal become without malignant treatment

NEOPLASIA Cancer 2nd leading cause of death in U.S Synonymous to word CANCER Neos= new, plasia = growth of tissue

Malignant Neoplasm Harmful and may metastasize to other tissue Benign Neoplasm Harmless and does not infiltrate other tissue Tumor Abnormal swelling or enlargement Carcinoma Specific cancer derived from epithelial cells Aberrant Cellular Growth Abnormal cellular growth Cancer Disease of cell (proliferation)

CLASSIFICATION OF NEOPLASM TISSUE ORIGIN Benign tumors 1. Fibroma Fibrous /connective tissue Usually small but may grow Harmless, easily removed surgically 2. Lipoma Arise with adipose tissue Rarely cause symptoms but encapsulated 3. Lelomyoma Common in women Smooth muscle origin Lodges in uterus May became malignant Malignant Tumors 1. Carcinoma Affects cervix Remained confined in one side 2. Sacroma Mesenchyma origin Blood vessels, lymphatics and nerve tissue

CHARACTERISTICS OF NEOPLASTIC CELLS 1. Appearance: larger than normal, bigger nucleus

7 Warning Signals (CAUTION US)

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hange in bowel and bladder habits sore that does not heal nusual bleeding or discharge hickening or lump in breast or elsewhere ndigestion or difficulty in swallowing bvious change in wart or mole agging cough or hoarseness of the voice Carcinogenesis:

wide variety of cells and tissues. Process of cancer formation

Initiation exposure to carcinogens Promotion exposure to carcinogenic chemicals will promote the function of proto oncogenes Transformation conversion to malignant cell Progression malignant behavior of the cells

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nexplained anemia udden weight loss 4. 5. CLASSIFICATIONS OF TUMORS ETIOLOGY

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PATHOPHYSIOLOGY OF MALIGNANT PROCESS (INVASION AND METASTASIS) PATHO

a.

Cancer is a disease process that begins when an abnormal cells is transformed by the genetic mutation of cellular DNA. These abnormal cells form a clone and begin to proliferate abnormally, ignoring growth-regulating signals in the environment surrounding the cell. The cells acquire invasive characteristics and changes occur in the surrounding tissue. The cells infiltrate the tissue and gain access to the lymph and blood vessels, w2hich carry the cells to the other area of the body.

Viruses and bacteria Viruses are difficult to evaluate as a cause of human cancers because they are difficult to isolate. However, infectious causes are considered or suspected when specific cancers appear in clusters. DNA viruses- Hepa B, Herpes, EBV, CMV, Papilloma virus Bacterum- H. pylori Physical agents Radiation (thyroid CA) Exposure to irritants (skin CA) Exposure to sunlight (skin CA) Chemical agents About 75% of all cancers thought to be related to the environment. Smoking (Lung CA) Dietary ingredients (gastric CA) drugs Genetic and familial factors Genetic factors play a role in cancer cell development due to genetics, shared environment, cultural or lifestyle factors or chance alone. Dietary factors Dietary substances can be proactive, carcinogenic or co-carcinogenic. The risk of cancer increase with longterm ingestion of carcinogen or chronic absence of protective substances in the diet. E.g. Low-fiber, high fat, processed foods, alcohol Hormonal Agents

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c.

METASTASIS Transportation of tumor cells from one organ to part that is separated by distance from original tumor location. MECHANISM of metastasis 1. Lymphatic Spread most common mechanism of metastasis 2. Hematogenous Spread few malignant cells can survived. 3. Angiogenesis growth of new capillaries from the host tissue by release of growth factors and enzymes. VEGF (Vascular Endothelial growth factor) CHON which stimulates formation of new blood vessels bFGF (basic Fibroblast growth factor) key player for proliferation and differentiation of d.

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Tumor growth may be promoted by disturbances in hormonal balance, either by the bodys own hormone production or by administration of exogenous hormones,

and the presence of distant metastasis (M). A number is added to each letter to indicate the size or extent of the primary tumor and the extent of cancer spread.

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ASSESSMENT a. Health history b. Physical examination are used to gather information about the cancer. The doctor examines the body by looking, feeling, and listening for anything unusual. The physical exam may show the location and size of the tumor(s) and the spread of the cancer to the lymph nodes and/or to other organs. c. General assessment DETECTION AND PREVENTION OF CANCER a. Primary prevention By acquiring the knowledge and skills necessary to educate the community about cancer risk, nurses in all setting play a key role in cancer prevention. One way to reduce the risk of cancer is to help the patients avoid known carcinogens. b. Secondary prevention The evolving understanding of the role of genetics in cancer cell development has contributed in prevention and screening efforts. People with specific gene mutations have an increased susceptibility to cancer.

Primary Tumor (T) TX T0 Tis

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T1, T2, T3, T4

Primary tumor cannot be evaluated No evidence of primary tumor Carcinoma in situ (CIS; abnormal cells are present but have not spread to neighboring tissue; although not cancer, CIS may become cancer and is sometimes called preinvasive cancer) Size and/or extent of the primary tumor

Regional Lymph Nodes (N) NX N0 N1, N2, N3

Regional lymph nodes cannot be evaluated No regional lymph node involvement Involvement of regional lymph nodes (number of lymph nodes and/or extent of spread)

Distant Metastasis (M) MX M0 M1

Distant metastasis cannot be evaluated No distant metastasis Distant metastasis is present

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DIAGNOSTIC EVALUATION a. staging and grading STAGING Finding extent or severity of an individuals cancer

STAGES Stage I Stage II

Roman Numeral Staging

TYPES: Clinical Staging based on PE, imaging test and endoscopic procedures Pathologic staging- microscopic examination Stage II Stage IV

localized Spread into surrounding tissue, but not beyond the location of origin regional , spread to nearby area distant, have metastasized

CANCER GRADING Reflects how abnormal cells look under microscope GX G1 G2 G3 G4 Grade cannot be assessed Well differentiated Moderately differentiated Poorly differentiated Undifferentiated

STAGING SYSTEM TNM is based on the extent of the tumor (T), the extent of spread to the lymph nodes(N),

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imaging and radiologic examination Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. such as x-ray radiography, ultrasound, computed tomography (CT), nuclear medicine, positron emission tomography(PET) and magnetic resonance imaging (MRI)) to diagnose or treat diseases.

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DISORDERS a. Lung cancer Cause: smoking Types: adenocarcinoma (common), small cell (fatal) s/sx: chronic cough, wheezing, dyspnea, repeated unresolved URTI, chest/shoulder pain, hemoptysis, hoarseness, dysphagia, head and neck edema Dx: Chest X-ray, Sputum cytology, Computed tomography (Ct) scan, Bronchoscopy, needle biopsy, tissue biopsy, thoracentesis Tx: Surgery, radiation, Chemotherapy, Laser therapy Intervention: position the patient on the surgical side to promote drainage and lung reexpansion. Bone cancer Bone cancer is a malignant (cancerous) tumor of the bone that destroys normal bone tissue (1). TYPES: Osteosarcoma is the most common primary malignant bone cancer. It most commonly affects males between 10 and 25 years old but can less commonly affect older adults. It often occurs in the long bones of the arms and legs at areas of rapid growth around the knees and shoulders of children. This type of cancer is often very aggressive with risk of spread to the lungs. The five-year survival rate is about 65%. Ewing's sarcoma is the most aggressive bone tumor and affects younger people between 4-15 years of age. It is more common in males and is very rare in people over 30 years of age. It most commonly occurs in the middle of the long bones of the arms and legs. The threeyear survival rate is about 65%, but this rate is much lower if there has been spread to the lungs or other tissues of the body.

b.

Chondrosarcoma is the second most common bone tumor and accounts for about 25% of all malignant bone tumors. These tumors arise from the cartilage cells and can either be very aggressive or relatively slow growing. Unlike many other bone tumors, chondrosarcoma is most common in people over 40 years of age. It is slightly more common in males and can potentially spread to the lungs and lymph nodes. Chondrosarcoma most commonly affects the bones of the pelvis and hips. The five-year survival for the aggressive form is about 30%, but the survival rate for slowgrowing tumors is 90%. Fibrosarcoma is much more rare than the other bone tumors. It is most common in people 35-55 years of age. It most commonly affects the soft tissues of the leg behind the knee. It is slightly more common in males than females. Chordoma is a very rare tumor with an average survival of about six years after diagnosis. It occurs in adults over 30 years of age and is about twice as common in males as females. It most commonly affects either the lower or upper end of the spinal column.

DX: X-rays, which can show the location, size, and shape of a bone tumor. A bone scan, which is a test in which a small amount of radioactive material isinjected into a blood vessel and travels through the bloodstream; it then collects in the bones and is detected by a scanner. A computed tomography (CT or CAT) scan, which is a series of detailed pictures of areas inside the body, taken from different angles, that are created by a computer linked to an x-ray machine. A magnetic resonance imaging (MRI) procedure, which uses a powerful magnet linked to a computer to create detailed pictures of areas inside the body without using xrays. A positron emission tomography (PET) scan, in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside

the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body. An angiogram, which is an x-ray of blood vessels. Biopsy (removal of a tissue sample from the bone tumor) to determine whether cancer is present. The surgeon may perform a needle biopsy or an incisional biopsy. During aneedle biopsy, the surgeon makes a small hole in the bone and removes a sample of tissue from the tumor with a needle-like instrument. Blood tests to determine the level of an enzyme called alkaline phosphatase. A large amount of this enzyme is present in the blood when the cells that form bone tissue are very activewhen children are growing, when a broken bone is mending, or when a disease or tumor causes production of abnormal bone tissue. TX Surgery is the usual treatment for bone cancer. Chemotherapy is the use of anticancer drugs to kill cancer cells. Radiation therapy, also called radiotherapy, involves the use of high-energy xrays to kill cancer cells. Cryosurgery is the use of liquid nitrogen to freeze and kill cancer cells.

Firm, painless smooth testicular mass Testicular heaviness In severe case; urethral obstruction, abdominal mass, cough, hemoptysis, SOB, weight loss, fatigue , pallor and lethargy Self-examination and testicular palpation Transillumination UTZ, abdominal CT scan Surgical excision and biopsy

DX

TX Surgery, radiation, chemotherapy INTERVENTION If the patient receives vinblastine, assess for neurotoxicity If the patient receives cisplatin, check for ototoxicity.

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Cervical cancer The 3rd most common cancer of the female reproductive system. CAUSES Human papillomavirus (HPV) Intercourse at young age Multiple sexual patners And herpes virus 2 S/SX EARLY STAGE Normal vaginal bleeding, Persistent vaginal discharge, Postcoital pain ADVANCE STAGE Pelvic pain, vaginal leakage of urine and stool from fistula, anorexia, weight loss and anemia.

c.

Breast s/sx: non tender fixed lump (tail of spence), dimpling, bleeding Stage I (<2cm) Stage II (>2<5cm + Nodes) Stage III (>5cm + nodes) Stage IV (metastasis) Intervention: chemo and radiation, surgery Lumpectomy, segmental mastectomy (lobe), simple mastectomy (entire breast), MRM, RM, URBAN Follow post-op nursing management testicular cancer Malignant tumor which ranks first in cancer deaths among men ages 20 to 35. CAUSES: Idiopathic Higher in men with cryptorchidism. Exposure to certain chemicals, infection with immunodeficiency virus Family history S/SX

DX Cytologic examination 9pap test) cystography, MRI, CT scan, bone scan Loop electrosurgical examination procedure, cryosurgery, laser destruction, conization, and radiation therapy.

TX

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Prostate cancer BPH cancer of the prostate s/sx: asymptomatic Dx: elevation of CEA, PSA, AP Intervention: Prostatectomy Follow post-op procedure of prostatectomy TESTICULAR CA (curable) CRYPTORCHIDISM

 10. ONCOLOGIC EMERGENCIES a. SEPTIC SHOCK RISK FACTORS Neutropenia, ANC less than 500 Patients who are neutropenic longer than 7 days are most susceptible Patients with HIV and concomitant neutropenia Prolonged hospitalization Elderly patients Patients with co-morbid conditions such as diabetes and pulmonary diseases CLINICAL MANIFESTATIONS Fever greater than 100.1 F (37.8 C) Warm, flushed, dry skin Hypotension Tachycardia Tachypnea Decreased level of consciousness Decreased urine output DIAGNOSTIC EVALUATION Vital signs Culture blood, urine, stool, sputum, central and peripheral IV lines, and any open wounds to determine source and type of infection Chest X-ray to detect underlying pneumonia CT scans as necessary Arterial blood gas analysisdecreased pH reflects acidosis BUN and creatinine- elevated due to decreased circulating blood volume CBC with differential- elevated WBC MANAGEMENT Antibiotics are started immediately; broad spectrum antibiotics are given until organism is identified. IV fluids and plasma expanders are used to restore circulating volume. Colony-stimulating factors are administered to increased neutrophil count. Vasopressors are administered to support blood pressure.

Oxygen is administered as needed to prevent tissue hypoxia. Vital sign, respiratory status, urine output and any signs of bleeding are monitored carefully. Complications are treated aggressively.

b.

Spinal cord Compression -is the result of tumor compression on the spinal cord or thecal sac or in the epidural space. It is associated with vertebral metastasis. CLINICAL MANIFESTATIONS Local inflammation, edema, venous statis and impaired blood supply to nervous tissue Local or radicular back or neck pain along the dermatomal areas innervated by the affected nerve root Pain exacerbated by movement, supine recumbent position, coughing, sneezing, or the valsalva maneuver Neurologic dysfunction and related motor and sensory deficits. Motor loss ranging from subtle weakness to flaccid paralysis Bladder and or bowel dysfunction. DIAGNOSTIC Percussion tenderness at the level of compression Abnormal reflexes Sensory and motor abnormalities MRI, myelogram, spinal cord, X-rays, bone scans, and CT scan MEDICAL MANAGEMENT Treatment is usually palliative because it is associated with metastatic disease. Treatment goals are to relieve pain and preserve or restore neurologic function. Corticosteroids are the initial treatment can be instituted; reduce inflammation and swelling at site, increase neurologic function and relieve pain. Radiation Therapy to the tumor on spinal column is the most common treatment. Surgery (laminectomy) is considered when tumors are

not radiosensitive or located in an area that has been previously radiated. It is also indicated with spinal instability. NURSING INTERVENTION Perform ongoing assessment of neurologic function to identify existing and progressing dysfunction. Control pain with pharmacologic and nonpharmacologic measures Prevent complications of immobility resulting from pain and decreased function Maintain muscle tone by assisting with range-of-motion exercises in collaboration with physical and occupational therapists Institute intermittent urinary catheterization and bowel training program for patients with bladder/bowel dysfunction

Chemotherapy for chemosensitive cancers Anticoagulant or thrombolytic therapy for intraluminal thrombosis Surgery Supportive measures such as oxygen therapy, corticosteroids and diuretics.

c.

Superior Vena Cava Syndrome CLINICAL MANIFESTATION Progressive shortness of breath (dyspnea) cough, hoarseness, chest pain and facial swelling. Edema of the neck, arms, hands, and thorax and reported sensation of skin tightness and difficulty of swallowing. Possibly engorged and distended jugular, temporal and arm veins. Dilated thoracic vessels causing prominent venous patterns on the chest wall. Increased intracranial pressure, associated visual disturbances, headache, and altered mental status. DIAGNOSTIC Clinical findings Chest X-ray Thoracic computed tomography (CT) scan Thoracic magnetic resonance imaging (MRI) MEDICAL MANAGEMENT RADIATION Therapy to shrink tumor size and relieve symptoms

NURSING INTERVENTIONS Identify patients risk for SVCS Monitor and report clinical manifestations of SVCS Monitor cardiopulmonary and neurologic status Avoid upper extremity venipunctures and blood pressure management Facilitate breathing by positioning the patient properly. Promote energy conservation to minimize shortness of breath. Monitor patients fluid status and administer fluids cautiously to minimize edema.

d.

Hypercalcemia CLINICAL MANIFESTATIONS Fatigue, weakness, confusion, decreased level of responsiveness, hyporeflexia, nausea, vomiting, constipation, polyuria, polydipsia, dehydration and dsyrhythmias. DIAGNOSTOIC Serum calcium level exceeding 11mg/dL (2.,74 mmol/L) NURSING INTERVENTION Identify patients at risk for hypercalcemia and assess for signs and symtoms of hypercalcemia Educate patients and family interventions and early detection can prevent fatality

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Teach at risk patients to recognize and report signs and symptoms of hypercalcemia Encourage patients to recognize 2-3L of fluid daily unless contraindicated by existing renal or cardiac disease Explain the use of dietary and pharmacologic interventions such as stool softeners and laxatives for constipation. Advise patients to maintain nutritional intake without restricting Discuss antiemetic therapy if nausea and vomiting occur Pericardial Effusion and Cardiac Tamponade CLINICAL MANIFESTATION Neck vein distention during inspiration Pulsus paradoxus Distant heart sounds, rubs and gallops, cardiac dullness Compensatory tachycardia Increased venous and vascular pressures DIAGNOSTIC ECG Chest X-rays CT scan MEDICAL MANAGEMENT Pericardiocentesis Radiation Therapy or antineoplastic agents depending on how sensitive the primary tumor is to these treatments. NURSING INTERVENTIONS Monitor VS and O2 saturation Assess fpr pulsus paradoxus Monitor ECG tracing Assess heart sounds and lung sounds, neck vein filling, LOC, RR , skin color and temperature. Monitor I and O Elevate the HOB to ease breathing Provide frequent oral hygiene

f.

Reposition and encourage the patients to cough and take deep breath every 32 hours. Disseminated Intravascular Coagulation CLINICAL MANIFESTATION CHRONIC DIC: Few or no observable symptoms or easy bruising, prolonged bleeding from venipuncture and injection sites, bleeding of the gums and slow GI bleeding ACUTE DIC: lifethreatening hemorrhage and infarction, clinical symptoms of this syndrome are varied and depend on the organ system involved in thrombus and infraction or bleeding episodes. DIAGNOSTIC Prolonged PT, PTT, TT Decreased fibrinogen level, platelet level, in clotting factors,hemoglobin and hematocrit Positive protamine sulfate precipitation test MEDICAL MANAGEMENT Chemotherapy, biologic response modifier therapy, radiation therapy, or surgery is used to treat the underlying cancer Antibiotic therapy is used for sepsis Anticoagulant such as heparin or antithrombin PPP decrease the stimulation of coagulation NURSING INTERVENTIONS Monitor VS Measure and document I and O Assess skin color and temperature; lung and heart and bowel sounds; LOC; headache; visual disturbances, chest pain, decreased urine output and abdominal tenderness Review laboratory results Prevent bleeding

Assist the patient to turn, cough and take deep breaths every 2 hours.

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Syndrome of Inappropriate Secretion of Antidiuretic hormone (SIADH) CLINICAL MANIFESTATION Serum sodium level lower than 120 mEq/L (120 mmol/L) symptoms of hyponatremia including personality changes, irritability, nausea, anorexia, vomiting, weight gain, fatigue, headache, lethargy, and confusion. Serum sodium levels lower than 110 mEq/L (110 mmol/L) seizure, abnormal reflexes, papilledema, coma, death. DIAGNOSTIC Decreased serum sodium level Increased urine osmolality Increased urinary sodium level Decreased BUN , creatinine and serum albumin levels Abnormal water load test results MEDICAL MANAGEMENT Fluid intake range limited to 500-1000 ml/day to increase the serum sodium level and decrease fluid overload. NURSING INTERVENTIONS Maintain I and O measurement Assess LOC, lung and heart sounds, VS, daily weight, and urine specify gravity. Monitor laboratory results Minimize the patient activity Reorient the patient Tumor Lysis Syndrome CLINICAL MANIFESTATION Neurologic: fatigue, weakness, memory loss, altered mental status, muscle cramps, tetany, paresthesias, seizures

Cardiac: elevated blood pressure, shortened QT complexes, widened QRS waves, dysrhythmias, cardiac arrest GI: anorexia, nausea, vomiting, abdominal cramps, diarrhea Renal: flank pain, oliguria, anuria, renal failure, acidic urine pH DIAGNOSTIC Electrolyte imbalances identified by laboratory test results MEDICAL MANAGEMENT To prevent renal failureand restore electrolyte balance, aggressive fluid hydration is initiated 48 hours before and after initiation of cytotoxic therapy.Diuretic theraoy Allopurinol therapy Administration of cationexchange resin, hypertonic dextrose, phosphate-binding gels. NURSING INTERVENTIONS Identify at risk patients Institute essential preventive measures Asses patient for s/sx of electrolyte imbalances Assess urine ph to confirm alkalization Monitor serum electrolyte and uric acid levels for evidence of fluid volume overload

11. GENERAL MANAGEMENT a. Surgical Used in diagnosing, staging and treating the client Primary treatment- involves the removal of a malignant tumor and a margin of adjacent normal tissue. Local excision is the simple excision of a tumor and a small margin of normal tissue. Wide excision includes the removal of the primary tumor, regional lymph nodes and neighboring structures. Adjuvant treatment- involves the removal of tissues to decrease the risk

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of cancer recurrence. It includes debulking procedures. Debulking surgery is the removal of the bulk of the tumor; should be performed before the start of chemotherapy whenever possible. Salvage treatment- involves the use of an extensive surgical approach to treat a local recurrence after implementing a less extensive primary approach. Palliative treatment- is surgery that attempts to relieve the complications of cancer. Reconstructive/rehabilitative surgery- is the repair defects from precious radical surgical resection; can be performed early or delayed. Preventive/prophylactic surgery- is the removal of lesions that. If left in the body, are at risk of developing into cancer. An example is polyps in the rectum or mastectomy in women who are high in risk. c.

antibodies and the new tyrosine kinase inhibitors e.g. imatinib mesylate (Gleevec or Glivec), which directly targets a molecular abnormality in certain types of cancer (chronic myelogenous leukemia, gastrointestinal stromal tumors). These are examples of targeted therapies. In addition, some drugs that modulate tumor cell behaviour without directly attacking those cells may be used. Hormone treatments fall into this category. Radiation therapy Range will be 2,000-5,000 centigrays (cGy) 5,000 cGy will SE Normal cells and cancer cells are both affected The goal is to destroy malignant cells without harming normal cells by: Fractionation-small frequent dose Alternating the site Alpha particle-fast moving helium nucleus (slight penetration) Beta particle-fast moving electron (moderate penetration) Gamma ray-similar to light ray (high penetration) Sodium Iodide (131 I)-for thyroid gland Gold (198 Au)-effective for ascites and pleural effusion Sodium Phosphate (32 P)-for RBC Destroys the ability of the cell to reproduce by damaging the DNA

NURSING MANAGEMENT Provide education and emotional support Assess patients responses to the surgery Monitor for possible complications such as infection, bleeding, fluid and electrolyte imbalance and organ dysfunction Plan for discharge, follow up and home care b. Chemotherapy

Radiation Safety Distance - the greater the distance the lesser the exposure Time - the less time spent close to radiation the less exposure (max of 30 min per shift) Shielding - use lead aprons and gloves Standards - kept as low as reasonably achievable Monitoring device - film badge (measure the whole exposure of the nurse)

Use of chemicals to destroy cancer cells Interferes DNA & RNA activities associated with cell division Often used in combination with radiation therapy

Cytotoxic - is an agent capable of destroying cells Cytotoxic drug - alkylating and antimetabolites TYPES: The majority of chemotherapeutic drugs can be divided in to alkylating agents, antimetabolites, anthracyclines, plant alkaloids, topoisomerase inhibitors, and other antitumour agents.[11] All of these drugs affect cell division or DNA synthesis and function in some way. Some newer agents do not directly interfere with DNA. These include monoclonal

Types of RADIATION External Radiation Administered by high energy xray machine (radioisotope Cobalt for Prostate and Lung CA) Internal Radiation Via injection or orally

Internal Radiation UNSEALED SOURCE Radioisotope is administered IV or orally NaP04 (32 P) IV for polycythemia vera (131 I) PO for Graves disease Potential hazard exist because its not encased Isotope maybe excreted via body fluids Flush the toilet several times after use Protect staff and visitors Marked room and kardex with RADIATION HAZARD

regards the donor's bone marrow cells as invaders and launches a destructive attack against them. Such an attack negates any benefits offered by the transplant. Autologous( from p-atient) Syngeneic (from identical twin)

SEALED SOURCE Radioisotope is placed into needles, beads, seeds, ribbons or catheter then implanted directly into the tumor. Requires a private room and bathroom Room must be lead-shield proof Lead container and long forcep on bedside Check linen and other materials for the presence of isotope

d.

Bone marrow transplantation A bone marrow transplant is used to rebuild the body's capacity to produce these blood cells and bring their numbers to normal levels. Illnesses that may be treated with a bone marrow transplant include both cancerous and noncancerous diseases. TYPES of BMT based on source of donor cells: Allogenic (from a donor other than the patient) Allogeneic transplants are more complicated because of proteins called human lymphocyte antigen s (HLA) that are on the surface of bone marrow cells. If the donor and the recipient have very dissimilar antigens, the recipient's immune system

RISKS Bone marrow transplants are accompanied by serious and lifethreatening risks. Furthermore, they are not always an absolute assurance of a cure for the underlying ailment; a disease may recur in the future. Approximately 30% of people receiving allogeneic transplants do not survive. Autologous transplants have a much better survival rate nearly 90%but are not appropriate for all types of ailments requiring a bone marrow transplant. Furthermore, they have a higher failure rate with certain diseases, specifically leukemia.