CARE OF CLIENTS WITH CELLULAR ABERRATION

Stages in Carcinogenesis
 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

Carcinogenesis Theories
 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

Carcinogenesis Theories
 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

Carcinogenesis Theories
 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

Carcinogenesis Theories
 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

Terminologies
 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

Terminologies
 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 Signs of Cancer

      
C hange in bowel or bladder habits A sore that doesnt 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 Signs of Cancer

 Unexplained weight loss  Unexplained anemia  Persistent headache

Cancer Early Detection

 Breast Self Examination (BSE)
 Once a month, one week after menstruation starting at menarche

Steps in 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

Steps in 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

Cancer Early Detection

 Testicular self-examination (TSE) done selfby males 15-35 years old 15-

Steps in TSE
 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.

Steps in TSE
 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.

Cancer Early Detection

 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

Cancer Early Detection

 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.

Cancer Early Detection

 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

Cancer Early Detection

 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.

Cancer Early Detection

 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

Cancer Classification
 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)

Grading
    G1 well differentiated G2 moderately well differentiated G3 poorly differentiated G4 very poorly differentiated with high degree of malignancy

Cancer Classification
 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    

Staging
 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

Treatment Goals
 Complete irradication of malignancy  Prolong survival in the presence of malignancy  Relief of associated symptoms with cancer disease process

Cancer Management
 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

Cancer Management
 Prophylactic remove pre-cancerous lesion prewhile it is still harmless and non-malignant non Palliative retard growth of tumor; relieve signs and symptoms of tumor; prevent complication

Cancer Management
 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

Cancer Management
 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 cant be safely irradiated

Means of Administration
 External Radiotherapy skin mark, tatoo, ports (X marks) to localize the are to be exposed to external radiation

External Radiotherapy
 X-ray machine  Low voltage roentgen therapy skin cancer  High voltage roentgen therapy deep seated cancer

External Radiotherapy
 Radioisotopes  Teletherapy cobalt 60 or cesium 137; enclosed and shielded in protective casing cobalt bomb; sealed radiation

Advantages of Teletherapy
 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

Means of Administration
 Internal Radiotherapy placement of especially separated isotopes into the tumor or systematic circulation

Internal Radiotherapy
 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 Radiotherapy
 Systematic Therapy
 Intravenous  Eg. Na phosphate (32 P) polycythemia vera, myelogenous leukemia

Internal Radiotherapy
Modes of Administration
 Sealed completely enclosed by nonnonradioactive material therefore cannot circulate through patients 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 patients body  Internal hazard due to radio active contamination of one or all or patients body fluid

Toxic Effects of Radiation

 Radiation Sickness
 Early: nausea or vomiting  Late: purpura, bleeding, petechiae, diarrhea, stomatitis

Radiation Sickness
Nursing Interventions:  Bedrest  Small frequent feedings  Increased calories, increased protein diet  Adequate fluid intake  Administer vitamins, sedatives, antihistamine, antiemetics  Monitor intake and output

Toxic Effects of Radiation

 Skin Reaction
 Over damaged; heals slowly; pigmentation; desquamation; erythema; subcutaneous fibrosis

Skin Reaction
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

Toxic Effects of Radiation

 Bone marrow depression
 Deficiency of essential blood component leading to anemia, leukopenia, thrombocytopenia

Bone Marrow Depression

Nursing Assessment:  Weakness, pallor, easy fatigability  Susceptibility to infection  Bleeding

Bone Marrow Depression

Nursing Interventions:  Vital signs especially temperature  CBC monitoring  Observe signs and symptoms of infection  Good oral hygiene-prevent gum bleeding; hygieneuse soft-bristle toothbrush or non-sting softnonmouthwash

Toxic Effects of Radiation

 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

Basic Factors in Radiation Protection

 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

Basic Factors in Radiation Protection

 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

Cancer Management
 Chemotherapy
 Use of combination chemotherapeutic agents to cure or palliate cancer or as an adjuvant therapy

Factors in Effectiveness of Chemotherapy

   
Size of tumor Type of cancer Accessibility of tumor General health of client

Classification of Chemotherapeutic Drugs

 Alkylating agents alter DNA structure by preventing DNA replication and transcription of RNA (hindering cell growth and division)
 Eg. Cytoxan, Myeleran, Leukeran,, Mustargen, Platinol

Classification of Chemotherapeutic Drugs

 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, CytosanFloxuriding (FUDR)

Classification of Chemotherapeutic Drugs

 Plant alkaloids make body less favorable for growth of Ca cells
 Eg. Vincristin (Oncovin), Vinblastine (Velban)

Classification of Chemotherapeutic Drugs

 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

Classification of Chemotherapeutic Drugs

 Antitumor antibiotics affect RNA to make environment less favorable for Ca growth
 E. Adriamycin, Blenoxane, Cosmegen, Cerubidine, Mithramycin, Mutamycin, Novantrone

Classification of Chemotherapeutic Drugs

 Nitrosources similar to alkylating agents; can cross blood-brain barrier blood(used in brain affectations)
 Eg. Semustine, Lomustine, Carmustine

 Misc. drugs
 Interferon natural glucoprotein antiviral effect

Contraindications for Chemotherapy

 Infection those receiving immunosuppressive drugs  Recent surgery- interferes with wound healing surgery 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

Methods of Administration
 Oral pill or liquid  Subcutaneous injection
 through automatic syringe or subcutaneous injection pump

 Intravenous
 Non-vesicants do little damage to soft tissues Non Eg. 5-FU, Methotrexate 5 Vesicants cause soft tissue necrosis
 Eg. Nitrogen mustard, Vinblastine, Vincristine

Methods of Administration
 Irritants produces burning or minor inflammation without necrosis

 Intra-arterial perfusion implantable or Intraportable infusion pump  Intrathecal administration

 ommaya reservoir mushroom shaped self sealing silicone dome with catheter attached to lateral ventricles reservoir-burrhole on scalp flap reservoir-

Methods of Administration
 Vascular access graft
 Use of dacron graft into the vein

 Intraperitoneal
 Tenchoff catherter into abdominal cavity  Eg. Cancer of liver, ovary, colon and rectum

Side Effects and Nursing Interventions

 GI system
 Nausea and vomiting
 Antiemetics 4-6 hrs and proophylactically 4(Metocholopramide, Plasil or Tigan)  NPO 4-6 hrs before chemotherapy 4 Bland foods in small amounts after treatment

Side Effects and Nursing Interventions

 Diarrhea
   

Antidiarrheal drugs Clearliquid if tolerated Good perineal care Monitor K, Na and Cl levels

Side Effects and Nursing Interventions

 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

Side Effects and Nursing Interventions

 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

Side Effects and Nursing Interventions

 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

Side Effects and Nursing Interventions

 Hemorrhagic cystitis
 Increase fluid to 3L per day

Side Effects and Nursing Interventions

 Integumentary
 Alopecia temporary
   

Scalp tourniquets Scalp hypothermia ice pack Wig during treatment Hair grows back 6 mos after chemotherapy