CAR E OF CLIE NT S

WIT H CE LL ULAR
ABE RR ATIO N
Earl Francis R. Sumile, RN
Instructor, College of Nursing
University of Santo Tomas
St ages in
Ca rcin ogenesis
 Initiation – exposure of normal cells to
carcinogens
 Promotion – cigarette smoking, alcohol
abuse or dietary components that act on
the transformed cell
 Progression – uncontrolled growth of
malignant tumor capable of metastatic
activity
Ca rcin ogenesis
Th eories
 Environment Theory – environmental
factors are implicated directly or indirectly
in cancer development
 Physical – sexual development, reproductive
patterns and sexual practices
 Chemical – tobacco, alcohol, drugs,
radiation, occupational, pollution, diet
Ca rcin ogenesis
Th eories
 Genetic Theory – inherited disorders
(deranged gene, chromosomal defect) or
altered DNA may result in changes that
render the cell vulnerable to malignant
transformation; “cancer families” tend to
inherit the same type of cancer and
develop the disease at an early age
Ca rcin ogenesis
Th eories
 Viral Theory – viruses have been isolated
and identified as the cause of cancer in
mice, rabbits and frogs but not
ascertained in human beings e.g.
cervical cancer may result from a virus
introduced into the cervix during sexual
intercourse
Ca rcin ogenesis
Th eories
 Immunological Theory – failure of the
normal immune mechanism may
predispose one to certain cancers
 e.g high incidence of tumors in early
childhood and old age – periods when
the immune system is weak
Te rminologies

 Hyperplasia – increase in the size of an

organ because of an increase in cell
number
 Hypertrophy – increase in the size of an
organ because of an increase in cell size
 Metaplasia – a reversible process in
which one adult cell type in an organ is
replaced by another adult cell type
Te rminologies
 Dysplasia – alteration in adult cells
characterized by changes in their size,
shape, and organization
 Atrophy – decrease in cell size
 Anaplasia – reversed cellular
development to a primitive cell type
 Neoplasia – abnormal cellular changes
and growth of new tissues
Warning Sig ns o f
Ca ncer
 C – hange in bowel or bladder habits
 A – sore that doesn’t heal
 U – nusual bleeding or discharge
 T – hickening or lump
 I – ndigestion or dysphagia
 O – bvious change in a wart or mole
 N – agging cough or hoarseness
Warning Sig ns o f
Ca ncer
 Unexplained weight loss
 Unexplained anemia
 Persistent headache
Ca ncer Ea rly De tectio n

 Breast Self Examination (BSE)

 Once a month, one week after menstruation
starting at menarche
St eps i n BSE
 Stand or sit in front of the mirror – note
contour changes, asymmetry, nipple
discharge, color of skin (orange peel
skin), presence of dimpling, puckering or
retraction
 Supine position with a small pillow or
folded bath towel under the shoulder of
the breast to be examined with the arm
raised over the head
St eps i n BSE

 The other hand palpates or kneads

breast in a circular motion starting from
the outside inwards
 Press the nipple to check for any
discharge
 Repeat palpation while in the shower
Ca ncer Ea rly De tectio n

 Testicular self-examination (TSE) – done

by males 15-35 years old
St eps i n TS E
 Examine for testicular tumor periodically
preferably done during a shower or bath.
 Use both hands to palpate. Carefully
examine all scrotal contents.
 Locate the epididymis; this is the cord
like structure at the back of the testis.
 The spermatic cord and vas extends
upward from the epididymis.
St eps i n TS E

 Feel each testis between the thumb and

the first two fingers of each hand.
 Note size, shape, abnormal tenderness.
 Stand infront of the mirror and look for
changes in size and shape of the
scrotum.
Ca ncer Ea rly De tectio n
 Mammography – radiologic study of the
soft tissue of the breast used to evaluate
differences in the density of tissue
especially small or poorly defined
masses or nodules; capable of detecting
breast cancers that are too small to be
palpated on physical examination.
 Xeromammography – x-ray image of the
breast recorded on paper rather than film
Ca ncer Ea rly De tectio n

 Papanicolau Smear – microscopic

examination of the cells collected from
the vaginal pool, exocervix and
endocervix
 Rectal Digital Examination – done
annually on clients over forty years old.
Ca ncer Ea rly De tectio n

 Biopsy – surgical excision of small piece

of tissue for microscopic examination
 Incisional or Partial Biopsy – only part of
neoplasm is removed and examined under
microscope
 Excisional or Total Biopsy – entire tumor is
removed and examined under microscope
Ca ncer Ea rly De tectio n
 Fine Needle Aspiration Biopsy – aspiration
of secretions from suspicious nodule and
examination under microscope
 Rush Frozen Section – incisional biopsy
done in the operating room while the patient
and the surgical staff awaits for the result
that comes back after a few minutes;
determines the type of surgery to be done.
Ca ncer Ea rly De tectio n
 Bone or Bone Marrow Biopsy – done by
means of bone marrow aspiration; uses
trocar or bone marrow needle
 Sites of Aspiration:
 Sternum
 Iliac Crest – most common
 Tibia
Ca ncer Cla ssif icatio n

 Grading
 defines the origin of the tumor and degree
to which tumor cells retain the functional and
histologic characteristics of tissue origin;
usually done by pathologist (histologic
classification)
Gr ading
 G1 – well differentiated
 G2 – moderately well differentiated
 G3 – poorly differentiated
 G4 – very poorly differentiated with high
degree of malignancy
Ca ncer Cla ssif icatio n
 Staging – determines the size of the
tumor and extent metastasis; determines
extent of the disease
 Stage 0 – in situ
 Stage I – limited to tissue of origin; localized
 Stage II – limited local spread
 Stage III – extensive local and regional
spread
 Stage IV – metastasis
St agin g

 TNM Staging – provides categorization of

primary lesion and extent of involvement
in the clinical assessment of cancer
 T – primary tumor extent
 N – lymph node involvement
 M – metastasis
T

 TX – tumor cannot be adequately

assessed
 T0 – no incidence of primary tumor
 TIS – tumor in situ
 T1, T2, T3, T4 – progressive increase in
tumor size and involvement
N

 NX – regional lymph node cannot be

assessed clinically
 N0 – regional lymph node demonstrable
abnormal
M

 MX – not assessed
 M0 – no known distant metastasis
 M1 – distant metastasis present in site
Tr eatment Goals

 Complete irradication of malignancy

 Prolong survival in the presence of
malignancy
 Relief of associated symptoms with
cancer disease process
Ca ncer Manageme nt

 Surgery
 Diagnostic – biopsy
 Radical surgery (wide resection) – remove
all tumors without disturbing the structure or
function of host extensively, useful in early
stages; if invasive – not curative
 Enbloc resection – excision of original growth
and lymph channel around are
Ca ncer Manageme nt
 Prophylactic – remove pre-cancerous lesion
while it is still harmless and non-malignant
 Palliative – retard growth of tumor; relieve
signs and symptoms of tumor; prevent
complication
Ca ncer Manageme nt

 Radiotherapy – to destroy the malignant

tumors without unduly harming
surrounding tissues
 Tumor must e radiosensitive and rapidly
dividing, poorly differentiated, embryonic and
immature, characterized by increased
metabolic activity
Ca ncer Manageme nt
 Tumor must be located in areas where they
can be treated with large doses of radiation
without causing serious injury to neighboring
tissues; tumors located deep within the body
can’t be safely irradiated
Me ans of
Ad min ist ration
 External Radiotherapy – skin mark, tatoo,
ports (X marks) to localize the are to be
exposed to external radiation
Ex ternal Ra dio therapy

 X-ray machine
 Low voltage roentgen therapy –skin
cancer
 High voltage roentgen therapy – deep
seated cancer
Ex ternal Ra dio therapy

 Radioisotopes
 Teletherapy – cobalt 60 or cesium 137;
enclosed and shielded in protective
casing “cobalt bomb”; sealed radiation
Ad va ntages o f
Te le therapy
 Eradicates and destroys deep internal
cancer without seriously damaging skin
 Fewer cases of radiation sickness
 May be incorporated into external molds
 Can be applied topically to eyes and
skin, ears, lips, mouth, scalp, larynx and
penis
Me ans of
Ad min ist ration
 Internal Radiotherapy – placement of
especially separated isotopes into the
tumor or systematic circulation
Internal Radioth erapy
 Interstitial Therapy
 placed in beads, seeds, needles, catheter
and ribbons implanted in tumor
 Eg. Cobalt 60, Iodine 125, Tantalium 182
 Intracavity Isotope Therapy
(brachytherapy)
 placed inside a body cavity; cancer of
uterus; bladder – Radium, Cobalt 60, Iridium
192
Internal Radioth erapy

 Systematic Therapy
 Intravenous
 Eg. Na phosphate (32 P) – polycythemia
vera, myelogenous leukemia
Internal Radioth erapy

Modes of Administration
 Sealed – completely enclosed by non-
radioactive material – therefore cannot
circulate through patient’s body
 Unsealed – given by IV, mouth or instillation
directly into body cavity, not enclosed in
radioactive containers
 External hazard – due to emission of gamma or
beta rays from the patient’s body
 Internal hazard – due to radio active contamination
of one or all or patient’s body fluid
To xic Ef fects of
Ra diatio n
 Radiation Sickness
 Early: nausea or vomiting
 Late: purpura, bleeding, petechiae, diarrhea,
stomatitis
Ra diatio n Sic kness

Nursing Interventions:
 Bedrest
 Small frequent feedings
 Increased calories, increased protein diet
 Adequate fluid intake
 Administer vitamins, sedatives,
antihistamine, antiemetics
 Monitor intake and output
To xic Ef fects of
Ra diatio n
 Skin Reaction
 Over damaged; heals slowly; pigmentation;
desquamation; erythema; subcutaneous
fibrosis
Sk in Re actio n
Nursing Interventions:
 Inspect skin integrity
 Apply lanolin, petroleum jelly or cod liver oil to
affected area
 Avoid ointments, powder, lotion or any irritant
 Wash with water only, no soaps
 Avoid constricting clothes – loose for adequate
air circulation
 Avoid extremes of temperatures
To xic Ef fects of
Ra diatio n
 Bone marrow depression
 Deficiency of essential blood component
leading to anemia, leukopenia,
thrombocytopenia
Bo ne Marrow
De pre ssio n
Nursing Assessment:
 Weakness, pallor, easy fatigability
 Susceptibility to infection
 Bleeding
Bo ne Marrow
De pre ssio n
Nursing Interventions:
 Vital signs especially temperature
 CBC monitoring
 Observe signs and symptoms of infection
 Good oral hygiene-prevent gum
bleeding; use soft-bristle toothbrush or
non-sting mouthwash
To xic Ef fects of
Ra diatio n
 Increased susceptibility to cancer in
irradiated areas – may develop skin lung,
bone cancer 20 or more years after
therapy
 Birth defects due to genetic mutation – if
gonads are exposed during 2nd to 6th
week of gestation
Ba sic F actors i n
Ra diatio n Pr otectio n
 Distance
 Greater distance from source, less exposure
 At least 3 feet; use of inverse square law –
doubling distance reduces exposure by 1 or
4
 Time
 Less time spent close to pt, less exposure
Ba sic F actors i n
Ra diatio n Pr otectio n
 Shielding
 Use appropriate materials to halt and absorb
rays of radiant energy
 Lead shield – x-ray and gamma rays
 Glass, lucite and aluminum – screens beta
rays, alpha particles – no shield
 Rubber gloves – stop alpha and usually beta
rays
Ca ncer Manageme nt

 Chemotherapy
 Use of combination chemotherapeutic
agents to cure or palliate cancer or as an
adjuvant therapy
Factors i n
Ef fectiveness o f
Ch emo thera py
 Size of tumor
 Type of cancer
 Accessibility of tumor
 General health of client
Cla ssific atio n o f
Ch emo thera peutic
Dr ugs
 Alkylating agents – alter DNA structure
by preventing DNA replication and
transcription of RNA (hindering cell
growth and division)
 Eg. Cytoxan, Myeleran, Leukeran,,
Mustargen, Platinol
Cla ssific atio n o f
Ch emo thera peutic
Dr ugs
 Antimetabolites – foster CA cell death by
interfering cell metabolism, interfere with
the biosynthesis of nucleic acids
necessary for RNA and DNA synthesis
 Eg. Methotrexate (MTX), 5 FU Fluoracil,
Thioguan, Purinethol, Cytosan-U,
Floxuriding (FUDR)
Cla ssific atio n o f
Ch emo thera peutic
Dr ugs
 Plant alkaloids – make body less
favorable for growth of Ca cells
 Eg. Vincristin (Oncovin), Vinblastine
(Velban)
Cla ssific atio n o f
Ch emo thera peutic
Dr ugs
 Steroids and sex hormones – alter the
endocrine environment to make it less
conducive to growth of cancer cells
 Eg. Diethylstilbesterol, Androgen, Estrogen,
Antiestrogen, Progestin, Anticortical
Compounds, Antiadrenal
Cla ssific atio n o f
Ch emo thera peutic
Dr ugs
 Antitumor antibiotics – affect RNA to
make environment less favorable for Ca
growth
 E. Adriamycin, Blenoxane, Cosmegen,
Cerubidine, Mithramycin, Mutamycin,
Novantrone
Cla ssific atio n o f
Ch emo thera peutic
Dr ugs
 Nitrosources – similar to alkylating
agents; can cross blood-brain barrier
(used in brain affectations)
 Eg. Semustine, Lomustine, Carmustine
 Misc. drugs
 Interferon – natural glucoprotein – antiviral
effect
Co ntr ain dic atio ns fo r
Ch emo thera py
 Infection – those receiving immunosuppressive
drugs
 Recent surgery- interferes with wound healing
 Impaired renal or hepatic function –
metabolized in liver and excreted through
kidneys
 Recent Radiotherapy – suppresses bone
marrow cell production
 Pregnancy – first 3 months
 Bone marrow depression
Me thods of
Ad min ist ration
 Oral – pill or liquid
 Subcutaneous injection
 through automatic syringe or subcutaneous
injection pump
 Intravenous
 Non-vesicants – do little damage to soft tissues
 Eg. 5-FU, Methotrexate
 Vesicants – cause soft tissue necrosis
 Eg. Nitrogen mustard, Vinblastine, Vincristine
Me thods of
Ad min ist ration
 Irritants – produces burning or minor inflammation
without necrosis
 Intra-arterial perfusion – implantable or
portable infusion pump
 Intrathecal administration
 ommaya reservoir – mushroom shaped self sealing
silicone dome with catheter attached to lateral
ventricles reservoir-burrhole on scalp flap
Me thods of
Ad min ist ration
 Vascular access graft
 Use of dacron graft into the vein
 Intraperitoneal
 Tenchoff catherter into abdominal cavity
 Eg. Cancer of liver, ovary, colon and rectum
Sid e Ef fects and
Nu rsin g I nterve ntions
 GI system
 Nausea and vomiting
 Antiemetics 4-6 hrs and proophylactically
(Metocholopramide, Plasil or Tigan)
 NPO 4-6 hrs before chemotherapy
 Bland foods in small amounts after treatment
Sid e Ef fects and
Nu rsin g I nterve ntions
 Diarrhea
 Antidiarrheal drugs
 Clearliquid if tolerated
 Good perineal care
 Monitor K, Na and Cl levels
Sid e Ef fects and
Nu rsin g I nterve ntions
 Stomatitis
 Good oral hygiene – avoid commercial mouth
wash
 Viscous lidocaine before meals
 Gargling rinse with water and diluted hydrogen
peroxide after meals
 KY jelly to cracked lips
 Suck popsicles
Sid e Ef fects and
Nu rsin g I nterve ntions
 Hematologic system
 Thrombocytopenia – epistaxix, petechiae,
ecchymosis
 Avoid bumps or bruise of skin
 Protect from physical injury
 Avoid aspirin and aspirin products
 Avoid IM injection
 Monitor blood count
Sid e Ef fects and
Nu rsin g I nterve ntions
 Leukopenia
 Hand washing, reverse isolation
 Note signs and symptoms of respiratory infection
 Avoid crowd or persons with infection
 Anemia
 Adequate rest period
 H and H monitoring
 O2 PRN
Sid e Ef fects and
Nu rsin g I nterve ntions
 Hemorrhagic cystitis
 Increase fluid to 3L per day
Sid e Ef fects and
Nu rsin g I nterve ntions
 Integumentary
 Alopecia – temporary
 Scalp tourniquets
 Scalp hypothermia – ice pack
 Wig during treatment
 Hair grows back 6 mos after chemotherapy