Cancer Management and Pathophysiology

Surgical Interventions
• Preventive
• Diagnostic ( Excisional biopsy, FNAB)
• Curative (Electrosurgery, Cryosurgery, Chemosurgery, stereotactic radiosurgery)
• Reconstructive
• Palliative
• Prophylactic (family history)
Chemotherapy
 Objectives
• To destroy Ca cells w/o excessive destruction of normal cells
• To control tumor growth if cure is no longer possible
• Used as adjuvant therapy
 Contraindications
• Infection
• Recent surgery
• Impaired renal/hepatic function
• Pregnancy
• Bone marrow depression
• Recent radiation

Classification of Chemotherapeutic Agents

• Alkylating Agents - Interferes with DNA Replications
• Antimetabolites - Inhibits DNA Synthesis
• Nitrosoureas - Interfere with DNA replication and repair.
• Antitumor antibiotics - Interfere with nucleic acid synthesis and function, inhibits RNA synthesis
and DNA synthesis
• Plant Alkaloids- arrest or inhibits mitosis

Safe Handling of Chemotherapeutic Agents

1. Wear mask, gloves and back-closing gown
2. Avoid skin contact
3. Sterile/alcohol-wet cotton pledgets should be used in opening vials
4. Expel air bubbles on wet cottons
5. Vent vials to reduce pressure after mixing
6. Wipe external surface of syringes and IV bottles
7. Avoid needle stab
8. Clearly label the hanging bottle with ANTINEOPLASTIC CHEMOTHERAPY
9. Contaminated needles should be disposed in a clearly marked special container
10. Dispose half-empty ampules, vials, IV bottles in a sealed plastic bag with label
11. Handwashing should be done before and after removal of gloves
12. Trained personnel only should be involved in the use of drugs
13. Ideally preparation of drugs should be in laminar flow condition with filtered air

Nursing Intervention for Chemotherapeutic Side-effects

1. GI system – nausea, vomiting, diarrhea, constipation
Administer antiemetic
Replace fluid & electrolyte loss, low fiber diet to relieve diarrhea
High fiber diet to relieve constipation

By: Rommel Rufuz A. Lopez RN, MAN

Cancer Management and Pathophysiology

2. Integumentary system
• Pruritus, urticaria
Provide good skin care
• Stomatitis
Provide good oral care, avoid hot & spicy food
• Alopecia
• Skin pigmentation
• Nail changes
3. Hematopoietic system
• Anemia
Provide frequent rest periods
• Neutropenia
Protect from infection
• Thrombocytopenia
Protect from trauma, avoid ASA
3. Genito-urinary system
• Hemorrhagic cystitis
Provide 2-3 L of fluids/day
• Urine color changes
Reassure client that it is harmless
3. Reproductive system
• Premature menopause or amenorrhea
Reassure that menstruation will resume after chemotherapy

Radiation Therapy
• Role in Ca prevention
• Primary curative role
• Adjunct to other therapy
• Palliation
• Sources of Radiation Therapy
External radiation therapy(the higher the voltage the deeper the penetration in the
body) Skin and breast
Internal radiation therapy
Types:
• Sealed source (brachytherapy
• Unsealed source (oral, IV)
Side Effects of Radiation Therapy
Skin reactions
Infection
Hemorrhage
Fatigue
Weight loss
Stomatitis
Diarrhea
Nausea & vomiting
Headache
Hair loss

By: Rommel Rufuz A. Lopez RN, MAN

Cancer Management and Pathophysiology

Cystitis
Social isolation
Principles of Radiation Protection
1. Distance
Maintain at least a distance of 3 ft when not performing nursing procedure
2. Time
Limit contact for 5 min each time, 30 min for whole shift
3. Shielding
Use lead shield during contact with client

Teaching Guidelines Regarding Radiation Therapy

1. It is painless
2. Lie very still on a special table
3. Sometimes client may be placed in a special position
4. Each treatment lasts for few minutes
5. Sound will be heard from the machine
6. Client will be alone while procedure is ongoing
7. Personnel will be observing client through a glass window
8. No residual radioactivity after radiation therapy
9. Client may resume activities of daily living

Bronchogenic carcinoma (Lung Cancer)

Risk factors:
Tobacco smoking (most common)
Secondary smoking
Radon gas inhalation
Occupational (industrial workers eg. Asbestos, nickel and radiation)
Genetics
Inhaled carcinogen
↓
Affects the epithithelial cell in the tracheobronchial airway
↓
Binds and affects the DNA
↓
Damaged DNA passed during mitosis
↓
Cellular damage and abnormal cell growth
↓
Malignant
↓
Invasive carcinoma (commonly seen at previous scarring TB and fibrosis on the lungs)
↓
Metastasis (Bone)

By: Rommel Rufuz A. Lopez RN, MAN

Cancer Management and Pathophysiology

Gastric Cancer
Risk factors:
Diet (smoke meat, pickled food, low fiber diet)
Helicobacter pylori (Chronic gastritis)
Pernicious anemia and gastric ulcer
Smoking
Genetics
Continous exposure to irritants/ precipitating factors
↓
Affects the epithelial cells
↓
Formation of adenocercinoma anywhere in the stomach
↓
Infiltrates at the surrounding mucosa
↓
Penetrates at wall of stomach and adjacent organs
↓
Metastsis trough lymph nodes

Colon Cancer
Risk Factors:
Hereditary
Increase in age (85 yrs. Old above)
Previous clients with IBD (Inflammatory Bowel Disease) and Polyps
Risk factors
↓
Epithelial cells in the intestines
↓
Mutates to become adenocarcinoma
↓
Hyperplasia
↓
Benign Polyps
↓
Malignant
↓
Invades and destroy normal tissues, and extends to surrounding structures
↓
Metastasis (Liver)

By: Rommel Rufuz A. Lopez RN, MAN

Cancer Management and Pathophysiology

Prostate cancer
Risk factors:
Male and Age (40 yrs old above)
Race (African American) and Hereditary
Diet (Low fiber and high fat diet)
Starts at the urothelial lining of the prostatic urethra
↓
epithelial cells
↓
Binds and affects the DNA
↓
Damaged DNA passed during mitosis
↓
Cellular damage and abnormal cell growth
↓
Dysplasia
↓
Adenocarcinoma Peripheral Zone of Prostate
↓
Stroma Cells (Sorrounding Prostate Tissue
↓
Hyperplasia
↓
Tumor
↓
Malignant
↓
Invades and destroy normal tissues, and extends to surrounding structures
↓
Metastasis (Liver)

By: Rommel Rufuz A. Lopez RN, MAN

Cancer Management and Pathophysiology

Breast Cancer
Risk Factors:
Menarche at 11 yrs old
Menopause at >50 yrs old
Obesity, HPN, DM
Presence of Benign Mass
Giving birth at 30 years old above
Hereditary
Stromal cells and epithelial cells
↓
Binds and affects the DNA
↓
Damaged DNA passed during mitosis
↓
Cellular damage and abnormal cell growth
↓
Dysplasia
↓
Epithelial tumor at lining ducts or lobules
↓
Malignant
↓
Invades and destroy normal tissues, and extends to surrounding structures
↓
Metastasis (bone or lung)

Cervical Cancer
Risk Factors:
Women and Multiple Pregnancies
HPV (Human Papilloma Virus), HIV infection and Chlamydia infection
Multiple sex partners, Smoking
Hormonal therapy (DES)
Hereditary

Risk Factors
↓
premalignant lesion in the area of the cervix called a squamocolumnar junction (lining of cervix)
↓
Dysplasia (Premaligant lesion)
↓
Squamous cell (outer surface) cancer and Adenocarcinoma(passageway connects cervix to uterus)
↓
Hyperplasia
↓
Malignant
↓
Invasive carcinoma (Cervical stroma)

By: Rommel Rufuz A. Lopez RN, MAN