CARE OF A CLIENT WITH CELLULAR ABBERRATIONS

(This is only an outline, READ..READ AND READ..)

The CELL CYCLE
MITOSIS refers to splitting of one cell into two
CELL CYCLE Time the interval from mitosis of a cell to its mitosis into a daughter cells
STATIONARY Period apparent rest after mitosis
FOUR PHASES OF THE CELL CYCLE
1. The Quiescent phase consisting of G1 phase in which ribonucleic acid (RNA) and protein synthesis
begin
2 .S is a period of DNA synthesis or replication
3. G2 Further RNA and more protein synthesis and the development of mitotic spindle .S to G2 Phase is
2 to 4 hrs.
4 .M or Mitosis- cells split into 2 cells or cell division.
Cell cycle is controlled by the cell nucleus, which receives signals from growth regulating protein that
stimulate or suppress cell division.
DIFFERENTIATION
All body tissue are derive from stem cells which are immature cells with no specific cell lineage
and this cells has the ability to proliferate rapidly and renew themselves as needed and to develop
specialized functions as they grow and mature.
The process of differentiation causes the cells to resemble their normal forebears and have fully
mature, specialize function and morphology
NORMAL CELL PROLIFERATION
Cellular growth take place in an orderly process that responds to the needs such as trauma, surgery, or
an inflammatory event. Once the needs is meet multiplication stops.
Normal cells recognize the presence of other cells, by means of co tact inhibition.
When cells are in close contact with each other, they normally adhere closely together. This
contact inhibits overlap of cells and disorganized growth.
In normal cells these restraints on growth are maintained under the need for new cells arise
because of cell death. Some are rapid like bone marrow, skin and gastrointestinal because the need for
all cell replacement in these areas is greater than the slower growing tissue.
Except for blood cells, normal cells do not migrate but have a designated locations.
How do cancer get started?Cancer is cause by mutations in a variety of genes responsible for controlling
the growth of cells either directly or indirectly.
Is all cancer genetic?Yes, all cancer, the uncontrolled division of a cell, is genetic because cancer is cause
by damage to genes that control cell division or cell growth. This damage is usually due to outside
influences or carcinogens damaging our genes over the course of a lifetime.


What is a Carcinogen?A carcinogen is any substance situation or exposure that can damage genetic
material (DNA). Hundreds of known carcinogen include internal factors created in the body by
metabolic processes (ex. Free radicals, hormones ), virus (e.g. hepatitis B, human papilloma virus)
chemicals (e.g .tobacco ,alcohol ,industrial asbestos ) and radiation (e.g. diagnostic radiation, ultra
violet light)

TERMS DENOTING CELLULAR CHANGES
Types of Cellular Changes
MITOSIS - formation of a new cell by cell division Ex. Normal cell growth
HYPERPLASIA - increase in cell number Ex. Breast epithelium in pregnancy
HYPERTHROPHY - increase in cell size Ex. Increase in muscle cell size with exercise
ATROPHY Decrease in cell size Ex. Decrease in muscle size with disease
METAPLASIA- replacement of one adult cell type by different adult cell type
Ex.Replacement of columnar epithelium of the respiratory tract by squamous epithelium
DYSPLASIA Change in cell size, shape and organization
Ex. Change in cervical epithelium in long standing cervicitis
ANAPLASIA Reverse cellular development to more primitive cell type, or total loss of differentiation
Ex. Irreversible change in accompanying cancer
NEOPLASIA Abnormal cellular changes Ex. Malignancies
OTHER TERMINOLOGIES
CARCINOMA malignant tumor of the ephethelial cells
SARCOMA a malignant tumor of the connective tissue cells
ADENO classified arising from glandular epithelium with the prefix adeno.
SQUAMOUS arising from squamous epithelium
BLASTOMA originate during the primitive blastula embryonic phase
TERATOMA contains all three types of embryonal tissue

DIFFERENCES BETWEEN BENIGN AND MALIGNANT NEOPLASM
BENIGN MALIGNANT
Rate of growth
limited - may proliferate rapidly or grow slowly
Spread
- localized - spread (metastasize) throughout the body
- fibrous capsule - No inclosing capsule
Recurrence
- rarely recur after removal - May recur even after treatment
Shape
-usually regular in shape - Irregular in shape with poorly defined border
Cell characteristic
- cells similar to cells of parent tissue - cells much different from parent cell
(well differentiated) (poorly differentiated)
Mode of growth
-expansive growth -infiltrative growth
General Effect
-localized phenomenon --causes generalized effects such as anemia ,weakness and
Weight loss



CLINICAL MANIFESTATION OF CANCER CELLS
Tumors can be an obstructive problem if they occur in the trachea, ureter, gastrointestinal tract
Tumors may also cause ulceration and infections of epithelial cells
Intra spinal and intracranial tumors may cause symptoms of increase pressure
Immunologic, hormonal, neuromuscular changes may result from a malignant process
Systemic symptoms, such as fatigue, loss of appetite, and weight loss, may occur early in the
disease process.
MODE OF DESSIMINATION OF CANCER
Direct extension into neighboring tissues (invasion characteristic)
Permeation along lymphatic vessels
Embolism via lymphatic vessels to the lymph nodes
Embolism via blood vessels
By invasion of body cavity by diffusion
Invasion and Metastasis:
Malignant disease processes have the ability to allow the spread of transfer of cancerous cells
from one organ or body part of another by invasion and metastasis. Invasion or growth of primary
tumor into the neighboring tissues occur in several ways
Mechanical pressure exerted by rapidly proliferation neoplasm may force fingerlike projections
of tumor cells into surrounding tissues and interstitial space.
Malignant cells are thought to possess or produce destructive enzymes (protienases), such as
collagenases (specific to collagen), plasminogen activators (specific to plasma), and lysosomal
hydrolyses. These enzymes are thought to destroy surrounding tissues including the structural tissues of
the vascular basement membrane, facilitating invasions of malignant cells.The mechanical pressure of a
rapidly growing tumor may enhance this process.
Lymphatic and Hematogenous Spread
Most common mechanism of metastasis is the lymphatic spread. Tumor emboli enter the
lymph channels by way of the interstitial fluid, which communicate with lymphatic fluid. Entering the
lymphatic circulation malignant cells lodge in the lymph nodes or pass between the lymphatic and
venous circulations.
Hematogenous spread is the dissemination of malignant cells via the blood stream and is
directly related to the vascularity of the tumor. Few malignant cells can survive the turbulence of arterial
circulation, insufficient oxygenation or destructions of the body immune system.
Angiogenesis
Angiogenesis is the growth of new capilliaries from the host tissue by the release of growth
factors and enzymes such as vascular endothelial growth factor. Large tumor emboli become traf in the
microcirculation of distant sites may further metastasized to other sites.
CARCINOGENESIS (Malignant Transformation) Molecular process


Classifying and Naming neoplasm
Classification of Malignant lesions by Grade
Grade o : Normal Tissue
Grade 1 : Well differentiated, with minimal deviation from tissue of origin
Grade 2 : Moderately Well differentiated, with evidence of structural changes from normal tissue of
origin
Grade3 : Poorly differentiated with extensive structural changes from normal tissue of origin
Grade 4: Very anaplastic with no resemblance to tissue of origin

TNM Staging Classification System
Tumor
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1,T2,T3,T4 Ascending degrees of tumor size and involvement
Tx Tumor cant be measured or found
Nodes
N0 No evidence of disease in the lymph nodes
N1a,N2a Disease found in regional lymph nodes, metastasis not suspected
N1b,N2b,N3 disease found in regional lymph nodes, metastasis suspected
Nx Regional nodes cant be assessed clinically
Metastasis
M0 No evidence of distance metastasis
M1,M2,M3 Ascending degree of metastatic involvement
Mx Metastasis cant be measured or found
Ex.. a T2N1M1 breast cancer is stage 4

Four stages of cancer cell growth
Initiation
Promotion
1. Progression
2. Metastasis
Initiation Carcinogen scape normal enzymatic mechanisms and alter the genetic structure of the DNA.
These alterations are reversed by DNA repair mechanism or the changes initiate programs cellular
death. Occasionally, cells escape this protective mechanism and permanent cellular mutation occurs.
Promotion To become malignant the cell must enter the promotion stage. Repeat exposure to
carcinogens expressions causes the expressions of abnormal cells or mutant genetic formations even
after long latency periods. APOSTOSIS is the innate cellular process of program cell death.
Progressions Normal cells is transform into a malignant potentials, the altered cells exhibit increase
malignant behavior.
INCIDENCE OF CANCER
Increase in actual number of cancer deaths continue to increase because of aging and expanding
population. Large disparities in cancer incidence and mortality occurs across racial and ethnic
boundaries.


Gender and Age men common sites are prostrate,lung,colon, rectum, while in women the top 3
are lung, breast, and colon, then also uterine, cervical,and ovarian.
AGE Todays life expectancy is 74.4% for men and 79.8 in women.Risk of developing cancer age - 20
=1 %,Age 50 =7%,age 60 = 10% to 16%,65 yrs =13% of the population.
These are influence by variety of factors, like financial constraint of a fixed income and inadequate
health insurance, limited transfortation ,established cultural ethnic and religious practice. This factors
explain why older people are diagnosed with more advance cancer and do not participate in prevention
and screening program.
RACE AND ETHNICITY racial and ethnic minorities because of delayed diagnosis, unequal socio
economic status, and unequal access to care.
For socio economic factors health care insurance is unavailable or expensive for members of
the minority group.
GEOGRAPHIC - Genetic differences among population may contribute to international variations.
Migrations from one country to another frequently results in major changes in the cancer incidence
pattern.
RISK FACTORS = Endogenous {age-} cancer increases with age{Genetic factors}- some exhibit a clear
inheritance pattern,{ Hormonal factors } hormones influences carcinogenesis.
=External { Tobacco} the single most lethal carcinogen,{Radiation} both ionizing and
ultraviolet radiation can cause cancer{Nutrition }excess energy intake like obesity is associated with a
higher incidence of cancer. Inactivity with obesity is associated with a higher incidence of cancer.
{Infectious organism} Several virus, including sexually transmitted disease
organism increases the risk of cancer.
*ETIOLOGY
1. Viruses and bacteria heap b, helicobacter pylori, human papilloma virus
2. Physical agents sunlight, radiation, chronic irritation or inflammation, tobacco, etc.
3. Chemical agents hazardous chemicals, liver lungs kidney are most affected due to their role as
a detoxifying chemicals
4. Genetics and familial factors genetics, shared environment, cultural and lifestyle factors
5. Dietary factors chronic absence of protective substance in the diet, fats, alcohol, salt cured or
smoked meat, nitrite and nitrate containing food. Obesity
6. Hormonal agents disturbances in hormonal imbalance, oral contraceptives, and prolong
estrogen therapy.
WARNING SIGNS
C Change in bowel habits
A A sore that does not heal
U Unusual bleeding/discharges
T _ Thickening/ lump in the breast
I _ Indigestion/ difficulty swallowing
O _Obvious change in warts or mole
N _ Nagging cough or Hoarseness
A _ Anemia /
L _ Loss of weight
DIAGNOSTIC PROCEDURE:
How are cancer diagnosed?


Cancer maybe diagnosed clinically or by looking at the sample of tissues suspected of being cancerous
under a microscope. A clinical diagnosis is the physician best educated guess at the most likely diagnosis.
A patient maybe asymptomatic or present with a signs and symptoms that suggest a diagnosis of cancer.
Most s/s however are non specific and can be seen in a wide variety of illnesses. A diagnosis of cancer
requires a diagnostic test and that test is the biopsy. A biopsy is a surgical procedure in which all or part
of the tissues suspected of being cancerous is remove.

Common malignant lesions and commonly used diagnostic test
Malignancy Diagnostic test
Gynecologic cancers
Cervix Colposcopy, biopsy, pap smear
Ovary Pelvic physical exam ,urinalysis, IVP, Barium Enema
Uterus Endometrial biopsy and aspiration
Gastrointestinal
Esophagus Chest xray, CT Scan, MRI, Esophagoscopy and biopsy
Barium contrast studies
Stomach Gastic secretion analysis barium contrast studies
Carcinoembryonic antigen, gastroscopy and biopsy
colorectal Ct scan, MRI, Stool guaiac, barium enema, colonoscopy and biopsy,
Liver Liver biopsy,liver enzyme studies, alpha-fetoprotien, MRI,
City scan and angiography , ultrasound
Genitorurinary
Prostrate Digital Rectal Examination, bone scan, biopsy, urinalysis,
Prostrate specific antigen
Bladder Cytology, cystoscopy, IVP, urinalysis
kidney CT scan, Renal angiogram, sonogram, KUB, Urinalysis, IVP
Other Cancers
Breast Breast physical exam, Ultrasound, Mammography, Tissue and Lymph nodes
biopsy
Lungs Chest Xray, fiberotic bronchoscopy with biopsy and bronchial washing
Mediastinography(endoscopic examination of mediastinum and nodes)
Thoracentesis.

COMPLICATIONS OF CANCER
Malnutrition
Altered taste
Infection
oncologic emergencies

ONCOLOGIC EMERGENCIES
Obstructive Emergencies
SVC( superior vena Cava) syndrome
Spinal Cord Compression
Metabolic Emergencies
SIADH(Syndrome of Inappropriate Secretions of Anti diuretic Hormone)


Hypercalcemia
Tumor Lysis Syndrome
Septic Shock and DIC(disseminated intravascular dessimination)
Cardiac Tamponade

NURSING MANAGEMENT FOR COMPLICATIONS
SUPERIOR VENA CAVA SYNDROME - is a clinical diagnosis that describe a pattern of physical finding
resulting from obstruction of blood flow through the superior venacava. The resulting engorgement of
collateral veins in the thorax, head and neck produces the classic symptoms. Cause by compression,
thrombosis, Invasion.
Most common in lung, non-hodgkin lymphoma,and Breast cancer
Progressive shortness of breath, cough, hoarseness, chest pain and facial swelling
Edema of the neck, arms, hands, and thorax, and reported sensation of skin and
difficulty of swallowing
Possible engorge and distended, jugular and arm vein
ma
SPINAL CORD COMPRESSION- it is develop in 5 to 10% in patient with cancer, 40% in patient with bone
metastasis. Significant neurologic deterioration is associated with a worst prognosis.

Usual in lumbar, thoracic, and cervical cancer.
Back pain
Motor weakness, bowel and bladder dysfunction
Steroids- reduce swelling
External Braces may be used
Radiation/chemotherapy/surgery

SIADH-SYNDROME OF INAPPROPRIATE ANTI DIURETIC HORMONE a syndrome of hyponatremia due
to abnormal secretions of production of anti diuretic hormone.
Decreased urine output
Weight gain: > 5 lbs/day
Dilutional hyponatremia
Nausea and vomiting
Confusion and fatigue personality changes
Altered mental status

HYPERCALCEMIA of Malignancy is a paraneoplastic syndrome characterized by a serum calcium level
exceeding 10.5mg/dl.without treatment may progress to renal failure,severe dehydration, coma and
death.
Ca that involves metastases to bone.
Greater than 11 mg/dlac


Muscle weakness, fatigue, confusion
Bradycardia,
Nausea, Vomiting, loss of appetite, constipation, peptic ulcer pain
Renal failure
Management:
Hydration: NS 3-4 L/day
Loop diuretic
Biphosphonates (Zometa)- inhibits osteoclasts)
calcitonin
Weight bearing exercise, refer for physical therapy

TUMOR LYSIS SYNDROME occurs when a large number of tumors cells are destroyed. It is manifested
by severe electrolyte embalance and can lead to severe cardiac arrhythmias, acute renal failure and
death.
Rapid release of uric acid, potassium into the blood from dead tumor cells
Occurs 24 hours after chemotherapy
Hyperuricemia, hyperkalemia
Muscle weakness, twitching, seizures
Cardiac arrhythmias, arrest
Renal failure: Flank pain, oliguria, edema
MANAGEMENT - Hydration
: Administer fluids
Allopurinol as ordered
I and O, weights

SEPSIS septicemia
organisms enter the bloodstream
Clients with Ca: decrease, WBC and low immune function
Mngt:
Oxygen, fluid replacement , antibiotic, immunizations, chemotherapy induce nutropenia.
Strict hand washing and routine wearing of mask

DIC Disseminated intravascular Coagulation a direct response to the presence of specific proteins or
cancer procoagulants which maybe secreted by malignant cells.
release of thrombin (clotting factor) from cancer cells
Widespread clotting uses platelets and clotting factors
Process followed by extensive bleeding
Mngt:
Blood products
Heparin or low-molecular weight heparin

Cardiac Tamponade - execssive accumulation of blood or fluid between the pericardium and the heart,
prevents the adequate amount of blood from flowing into the heart to fill the ventricles.
Management
Emotional support
Oxygen administration
Reposition the patient to enhance circulation


Administer analgesics
Encourage relaxation technique
Administer anti- anxiety
Vaso active drugs maybe ordered


PART 2
TREATMENT MODALITIES Goal of Care
Surgery cure
Chemotherapy control
Radiation Therapy palliative relieve but does not cure
Biologic Target Therapy
SURGICAL MANAGEMENT
*Most ideal and most widely used option
Purpose of Surgery
1. Prevent
2. Diagnose or staging - biopsy
3. Cure - remove wide range of tissue surrounding the organ involve
4. Control
5. Reconstructive/Rehabilitative
6. Palliative colostomy

Chemotherapy
Used to treat systemic disease rather than localize lesions that are amenable to surgery or
radiation. Antineoplastic agents are used in an attempt to destroy tumor cells by interfering with
cellular function. Adjuvant chemotherapy refers to chemotherapy administered with either surgery or
radiotherapy.
Principles of Chemotherapy
Most chemotherapy agents cause cell death by interrupting cell growth and replication at some point of
the cell cycle.
Drugs are classified by their mechanism of action
Cell cycle phase- specific drugs drugs that act at a particular point in the cell cycle
Phase- Non specific drug drugs that act throughout the cell cycle.
Cell Population Growth; Chemotherapy is most effective when the tumor is small and growing rapidly, a
time when a relatively high proportion of cells are undergoing division. At this time tumor cells are more
sensitive to drugs that are toxic to dividing cells (Phase-specific drugs). Larger, slower growing tumor
responds better to drugs that act regardless of whether the cell is dividing (phase non specific drugs)
Cell Kill Hypothesis; Chemotherapy is thought to kill a fix percentage of the total number of cancer cells.
90 percent cell-kill and 10 percent would be killed by the body immune system
Combination chemotherapy, has a therapeutic effect superior to single agents therapy for many
cancers, since drugs that attack the tumor cells in various ways can produce maximal kill.It also
decreases the likelihood of the tumor to become resistant.


Dose Intensity; Most effective when given sufficient
Tumor Resistance to Chemotherapy; primary resistance maybe present as a result of specific genetic
trait, secondary resistance maybe acquired during treatment as a result of spontaneous genetic
alterations, MDR or multiple drug resistance can occur when several agents are used in combination
CLASSIFICATION OF CHEMOTHERAPEUTIC AGENT
Cell Cycle Phase Specific Agent
Antimetabolites ( S Phase ) interferes with synthesis of nucleic acid( DNA or RNA )
Flouracil (SFU) Gemzar
Methotrexate (Mexato)
Cladribine, Cytarabine, Floxuridine
Fluradabine, hydrxy urea
Also,Doxurobicin,5 Flouroracil,6 Mercaptopurine, Mitozantone,Topotecan,Irenotican,
Capecitadine, Germcetabine
Plant Alkaloid/Antimiotic (M Phase)- prevents mitosis/ disrupt mitosis causing cell death
Vinblastin Sulfate ( Vilban)
Vincristine Sulfate ( Oncobin)
Also Etoposide, Teniposide, Paclitaxel, Doxetaxel

Cell Cycle Phase Non specific

Alkalyting (Non Specific) binds with DNA, breaks DNA helix, preventing cell replication to cell death.
Mustargen, cytoxan,leukera,
Myleran, cisplatin
Oxaliptatin, carboplatin
Others busulfan, carboplatin,cyclopospamide, nitrosureas,

Antitumor Antibiotics (Non Specific)-binds with DNA thus inhibiting DNA synthesis
Mitomycin (Mutamycin)
Doxurobicin (Adriamycin)
Methramycin(Mitracin)
Doxurobicin HCL toxic to myocardium attach to mycardium

Hormonal Preparation decrease cell metabolism environment not favorable for growth
of cancer cells
Anti estrogen/Androgen
Tamoxifen Megace causes verilism on woman
Estrogens/ and Progestins
Diethylstebestro (DES)(Estradol)
Effect in female- heavy menses, fluid retention, breast tenderness.
In Male gynecomastia, penile atrophy

METHOD OF ADMINISTRATION
Oral,


Intramuscular,
intravenous
Intra arterial- arterial vien supplying tumor
Intraperitonial / Intracavitary
Intrathecal/ Intraventricular/ Spinal/ Ommaya Reservoir
Intravesical/ Bladder
IV COMPLICATION
Irritants damage vein,intense phlebitis, no tissue damage if infiltrated
Vesicant causes local tissue necrosis when infiltrated
NURSING RESPONSIBILITIES
Use gloves, mask and eye protection
Administer anti emetic 30 mins before chemotherapy
Render meticulous oral care, alkalinizer for mouth wash
Avoid spicy food, bulky food
Reverse isolation
Avoid raw food
Drugs are sensitive to ligth, dim the room
Cover IV bottles and tubings with carbon paper

MANAGING SIDE EFFECTS OF CHEMOTHERAPY
STOMATITIS
Self examine
Soft toothbrush/toothettes
Mouth care of 2-4 hrs
No commercial mouthwash, plain water saline solution
Rinse with viscus lidocaine before meals
KY jelly- cracked lips
Such on popsicles to provide moisture
Soft bland high protien, high caloric diet
NAUSEA AND VOMITING
Administer antiemetic 30 mins. Before chemotherapy
Withold foods/fluids 4-6 hrs before chemotherapy
Provide bland foods in small amount after treatment
DIARRHEA
Anti diarrheas (lomotil, Kaopectate)
Good perenial care
Increase fluids as tolerated
Monitor potassium, sodium chloride levels
Low residue diet, increase potassium
INTEGUMENTARY- ALOPECIA
Head coverings, caps
Scarves, turban


Wigs
Light brushing
Trim hair before treatment
Frequent linen change
Hair loss temporary, regrowth in 1 month from chemotherapy
New hair color, texture thickness
NEOROLOGIC SYSTEM
ALKALOID (Vincristine)
May cause neurologic damage
Peripheral neuropathies
Hearing loss, paralytic ileus
RESPIRATORY SYSTEM
Pneumonia
monitor for high hacking cough fever and dysnea
RENAL SYSTEM
Increase fluid, frequent bleeding metabolites
Allupurinol (Zyloprim)
REPRODUCTIVE SYSTEM
Infertility
Banking sperm
Reliable method of Contraception before treatment
FATIGUE
Accumulation metabolies from cell breakdown
Health Teaching on expected side effect
Encourage to rest
RADIATION THERAPY-radiotherapy is a treatment of disease with ionizing radiation. Normal tissues and
tumors are both affected by ionizing radiation
How does radiation Works?
Radiation therapy delivers a precised measured dose of ionizing radiation to a specific tumor
volume, with the intent to kill the cancer cells but spare the normal tissues. Radiation treatment causes
cellular damage that leads to bilogical in the DNA.. Each radiation treatment causes permanent damage
in the DNA of the tumor cells, which is then unable to divide and eventually dies. Radiation also damage
the DNA of normal cells but most of them are able to repair it and remain functional.
A local treatment modality
Deliver of high energy become sufficient to break
DNA bonds , interupting Mitosis
Cells most sensitive during G2 and M phase
Sources of Radiation Therapy
Teletherapy
administered by high energy, x ray (linear accelerator)
delivered from a machines containing radioisotopes (Cobalt 60)
External Beam Radiation


Client dose does not emit radiation
Nursing Responsibilities
Skin care, do not expose to sunligth, avoid pressure to site,avoid soap cream, lotion and oils
External Radiation
Placement of specially, bead prepaed radioesotopes directly into the tumor or intosystemic
circulation wire, needle Bead
Internal Radiation (2 types)
Sealed Source
radio sotopes enclosed in a container(seeds, Ribbon)
Clients emit radiations whie inplant is in place
Radium seed, Radon seed,Ceseum
Unsealed Source
Radioisotopes circulated in the body
Contaminated body fluidsUrine saliva,sweet,feces
RAI 131, RA 135, Ragold 192, Raphos 132
Internal Radiation
Sealed Implant- intracavitary, intra lesions, intratumor
Unsealed implant PO,intra arterial Infusion, Intrathecal Infusion
RADIATION SICKNESS/ REACTION
LOCAL SYSTEMIC
Erythema Bone Marrow Depression
Dryness Anemia
Skin /hour Leukopenia
blister-exact symptoms of 1st degree burn thrombocytopenia
sterility
NURSING RESPONSIBILITY

Sealed Radiotherapy
Hang caution sign on the door
Organize task to minimize exposure
No pregnant and below 16.
Linen must remain room until implant is remove
Dislodge radium, pick with long forcep, and put in lead container or inform radiology
department
If unable to locate; prohibits visitor
As long us implant is removed no more radiation

Unsealed Radiotherapy Home teaching
Wash hands after bathroom, flush toilet several times
Wash laundry differently
Drink plenty of water

NURSING RESPONSIBILITIES


Anemia
Adequate rest period
Monitor hemoglobin/hematocrit
Administer O2 as needed
Leukopenia
Wash hands before contact with client
NO fresh fruits, vegetables, raw foods
NO flowers, pets, visitors with infection, crowd
Client wears mask in public area
Bathe daily; moisturizer to prevent dry skin
Monitor for signs of infection: fever: notify MD
Bone Marrow Suppression/Thrombocytopenia (<100,000/mm3)
Protect client from physical injury
Electric shaver only
Avoid aspirin, NSAIDs, IM inj, rectal temp., suppository
Monitor blood counts, stool and urine
High fiber diet, inc fluids
Assess and teach increased bleeding (epistaxis, petechiae, ecchymosis)
Teaching: avoid bump/bruising skin

BIOLOGIC THERAPY
With direct antitumor effects
Restore, augment, modulate
host immune system Mechanism

Target therapy Targets specific cellular receptors,Kills cancer cells w/o damaging normal cells
Tyrosine Kinase inhibitors
Angiogenesis Inhibitor
Proteasome Inhibitor
Monoclonal Antibodies

BONE MARROW TRANSPLANTATION OR Hematopoietic stem cell transplant
What is bone marrow?
Bone marrow is the soft, spongy tissue found inside bones. It is the medium for development and
storage of about 95 percent of the bodys blood cells.
What is bone marrow transplantation (BMT)?
Bone marrow transplantation is a special therapy for patients with cancer or other diseases that affect
the bone marrow. A bone marrow transplant involves taking cells that are normally found in the bone
marrow (stem cells) and giving them back to the patient. The goal of BMT is to transfuse healthy bone
marrow cells into a person after his/her own unhealthy bone marrow has been eliminated.



BMT has been used successfully to treat diseases such as leukemias, lymphomas, aplastic anemia,
immune deficiency disorders and some solid tumor cancers since 1968.
The blood cells that produce other blood cells are called stem cells. The most primitive of the stem cells
is called the pluripotent stem cell, which is different than other blood cells with regard to the following
properties:

Renewal It is able to reproduce another cell identical to itself.

Differentiation It is able to generate one or more subsets of more mature cells.
It is the stem cells that are needed in bone marrow transplantation and they can be collected in one of
three ways:
Types of bone marrow transplant
Interfere with cancer cells ability to metastasize

1. ALLOGENEIC transplant stem cells come from a donor within the same species, a related donor
or a match unrelated donor or placenta blood.
2. AUTOLOGOUS transplant The stem cell donor is the patient
3. SYNGENEIC transplant The stem cell donor is the patient identical twin

Allogenic BMT (AlloBMT) used primarily for diseases of the bone marrow, depends on the availability
of a human leukocyte antigen- match donor. It may involve either ablative (high dose) or non ablative
(lower) dose
In ablative AlloBMT the recipient must under go ablative dose of chemotherapy and total
irradiation to destroy all existing bone marrow and malignant disease.
Nonablative AlloBMT the chemotherapy dose are lower and are aimed at suppressing the
recipients immune system to allow engraftment of donor bone marrow or PBSCs
Autologous BMT (AuBMT) is considered for patients with disease of the bone marrow who do not have
a suitable donor for AlloBMT, and for patients who have healthy bone marrow but require bone
marrow ablative doses of chemotheraphy to cure an aggressive malignancy.
Syngeneic transplant - is less incidence of GVHD( gragh versus host disease), even an identical twin is
available for marrow donation, anoher match sibling or even an unrelated donor maybe the most
suitable donor to combat an aggresive malignancy.
Cancer treatment terms you should know
Combined modality therapy a term used to describe when physicians choose more than one therapy
in treating a patient, such as a combination of radiation therapy and chemotherapy.
Adjuvant therapy a term used to describe when physicians choose more than one therapy in treating
a patient. However, the term adjuvant therapy is more specifically used to describe treatment given
after the primary cancer treatment is completed to improve the chance of a cure. For example, if the
physician wants to treat cancer cells that may be present, he or she may prescribe one or more
additional treatments.


Neoadjuvant therapy a term used to describe when physicians choose to use more than one therapy
in treating a patient. However, the term neoadjuvant therapy is more specifically used to describe
cancer treatment given before the primary therapy both to kill any cancer cells and contribute to the
effectiveness of the primary therapy.
Cryotherapy- treatment by the application of extreme cold as in cryosurgery (Use of extreme cold to
destroy tissue)
SPECIFIC MANAGEMENT FOR SOME COMMON CANCER
Hodzkin Lymphoma Chemo , radiotherapy
Leukemia Chemo
Non Hodzkin chemo, radio
KCs local Cryotherapy, radio
KCssystemic Chemo
Bladder Cystectomy
Bone Limb sparing surgery, amputation
Brain Chemo..,radio..,Surgery
Breast chemo.., radio.., hormonal, Surgery(mastectomy and lumpectomy)
Modified Radical Mastectomy(whole Breast)
Breast sparing procedure(wedge resection, partial mastectomy, and
lumpectectomy)
Colorectal chemo.., surgery
Endocrine chemo.., surgery
Gastric surgery
Gallbladder chemo
Pancreas whipples procedure
Prostrate prostatectomy
Lung chemo..,radio..
Testes Radical inguinal orchiectomy


ELEMENTS OF PALLIATIVE CARE
Distress from Physical Symptoms assess the patients understanding on
Cause of the symptoms
Goal for relief
Current side effect
Consider patient goal
What is important for the patient
How can we help the patient live well
Psychological and Spiritual Assessment
How the patient cope with the stressful situation
Who does the patient turn for support?
Discuss the Prognosis
Support System



Reference