Cellular Aberration/

Oncologic Nursing
Course Outline
The Individual Across the lifespan
A. Risk Factors Assessment
B. Chief Complaints, functional patterns,
psychosocial assessment.
C. Principles and techniques of physical
examination, deviations from normal.
D. Results and implications of diagnostic/lab
exams.
E. Pathophysiologic Mechanisms
F. Nursing Diagnosis, taxonomy pertinent to
problems/ alteration in:
G. Principles of various Modalities of
Management.
H. Principles of Management for Cellular
Aberration.
I. Pharmacologic Actions, therapeutic use, side
effects, indications/contra, Nsg resp.
J. Purposes, Indications, Nsg resp for surgical
and special procedures.
K. Perioperative Care, discharge &
documentation
L. Application of Bioethics
Terms
1. Benign: not malignant, nonrecurrent, favorable
for recovery
2. Malignant: tending to become progressively
worse and to cause death
3. Remission: improvement or absence of signs of
disease
4. Idiopathic: disease of unknown origin
5. Carcinoma: cancerous (malignant) tumor
6. Epithelioma: tumor composed of epithelium
(malignant tumor)
7. Fibroma: (tumor composed of fibrous tissue)
8. Fibrosarcoma: malignant tumor composed of
fibrous tissue
9. Leiomyoma: (benign) tumor of smooth muscle
10. Leiomyosarcoma: malignant tumor of smooth
muscle
Terms
11. Lipoma: tumor containing fat (benign
tumor)
12. Liposarcoma: malignant tumor composed
of fat
13. Melanocarcinoma: cancerous (malignant)
black tumor
14. Melanoma: black tumor (primarily on the
skin)
15. Myoma (tumor formed on muscle)
16. Neoplasm: new growth (of abnormal
tissue or tumor)
Apoptosis death of cell
There are two ways in which cells die:
They are killed by injurious agents.
They are induced to commit suicide.
Hyperplasia (HYE-per-PLAY-zha)
Enlargement of an organ or tissue because
of an increase in the number of cells in that
organ or tissue.
Hypertrophy (hye-PER-tro-fee) The
enlargement or overgrowth of an organ or
tissue due to an increase in size of its cells,
rather than the number.

Aplasia failure of a part of an organ to
develop; birth of deformity.
Metaplasia the reversible conversion of
normal tissue cells into less differentiated
cell type in response to chronic stress or
injury. With prolonged exposure, cancerous
transformation can occur
Neoplasia - (NEE-oh-PLAY-zha, NEE-oh-
plaz-um) Adj: neoplastic (NEE-oh-PLAS-tik)
Abnormal and uncontrolled cell growth
(mitosis) that often produces a tumor (a
neoplasm) that may or may not be
cancerous
Dysplasia disordered growth



The Cell
the structural and functional unit of all
known living organisms.

the smallest unit of an organism that is
classified as living, and is sometimes
called the building block of life.
Main Components
Cell membrane
Nucleus
Cytoplasm

Genetic material
DNA - for their long-term information storage
RNA - used for information transport
Cell Cycle/functions
Cell growth and metabolism
Interphase/MetabolicPhase
Creation of new cells Cell division
Protein synthesis
Cell movement or motility
Cell Cycle
Cell Proliferation process by which the
cells divide and reproduce
regulated
Cell differentiation transformation of cell
into specialized cells

The cell cycle is composed of two phases,
mitosis and interphase.
Mitosis has subphases: interphase, prophase,
metaphase, anaphase, and telophase.


Interphase has three subunits:
gap one (G1), synthesis, and gap two
(G2). Interphase is the period between nuclear
divisions.

Two types of proteins trigger decisions in the cell
cycle: Cyclin D and CDK4.
Gap 0, G0, A resting phase where the cell
has left the cycle and has stopped dividing.
Interphase, Gap 1, G1, Cells increase in
size in Gap 1.
The G1 checkpoint control mechanism
ensures that everything is ready for DNA
synthesis.
Synthesis, S, DNA replication occurs during
this phase.
Gap 2, G2, During the gap between DNA
synthesis and mitosis, the cell will continue
to grow.
G2 checkpoint control mechanism ensures
that everything is ready to enter the M
(mitosis) phase and divide.
Cell division, Mitosis, M Cell growth stops
at this stage and cellular energy is focused
on the orderly division into two daughter
cells.
A checkpoint in the middle of mitosis
(Metaphase Checkpoint) ensures that the
cell is ready to complete cell division.

Stages of Cell Cycle
G1 phase
Asparaginase,
Prednisone
S phase
Antimetabolites,
cytarabine, methotrexate
G2 phase
Antibiotic(Bleomycin)
Mitosis Vinka alkaloids
Evolution of Cancer Cells
all cells constantly change through growth,
degeneration, repair and adaptation
neoplasm refers to both benign and
malignant cells
growth control mechanism of normal cells
is not entirely understood
Evolution of Cancer Cells

Apoptosis (PCD)
Disintegration of cells into membrane-
bound particles that are then eliminated by
phagocytosis or by shedding.
Leading Sites of New Cancer Cases 2009-
ACS (Estimated Cases)
Male
Prostate 25%
Lung/Bronchus 15%
Colon/Rectum 10%
Urinary/Bladder 7%
Skin 5%
Non-Hodgkin 5%
Kidney/renal 5%
Leukemia 3%
Oral/Pharynx 3%
Pancreas 3%
Female
Breast 27%
Lung/Bronchus 14%
Colon/Rectum 10%
Uterine 6%
Non-Hodgkin 4%
Skin 4%
Thyroid 4%
Kidney/renal 3%
Ovary 3%
Pancreas 3%

Leading Sites of New Cancer Deaths 2009-
ACS
Male
Lung/bronchus 30%
Prostate 9%
Colon/rectum 9%
Pancreas 6%
Leukemia 4%
Liver/Intra-hepatic 4%
Esophagus 4%
Urinary bladder 3%
Non-Hodgkin 3%
Kidney 3%
Female
Lung/bronchus 26%
Breast 15%
Colon/rectum 9%
Pancreas 6%
Ovary 5%
Non-Hodgkin 4%
Leukemia 3%
Uterine 3%
Liver/Intra-hepatic 2%
Brain/N/S 2%

Characteristics of Malignant
Cells
Differentiation
Mutated stem cells undergo structural changes
hindering them from functioning normally
Rate of Growth
Have uncontrollable growth/cell division
Tumor growth rate is affected by cell division
& survival time of cells
Spread
Lack adhesion and capsule, resulting to spread
to distant body parts
Tumor Development
Etiology (Carcinogenesis)
1.Environmental Factors
a. Physical
i.Radiation x-rays, radium, nuclear explosion/waste,
ultraviolet
b.Chemical
Nitrites and food additives, polycyclic hydrocarbons,
dyes, alkylating agents, salt-cured, high calorie diet
Drugs: arsenical, stilbestrol, urethane
Cigarette smoke
Hormones estrogen, hormonal replacement therapy,
oral contraceptives
Etiology
2.Genetics
a.Some cancers show familial pattern/inherited
genetic defects
3.Viral theory
a.Oncoviruses (RNA-type viruses)
b.Viruses like:
Hepa B, C liver Ca
Herpes simplex II, cytomegalovirus, Human
Papilloma virus-dysplacia and cervix Ca
HIV Kaposis sarcoma
Helicobacter pylori gastric Ca
Epstein-Barr virus Burkitt lymphoma,
nasopharyngeal Ca, non-hodgkin & Hodgkin dse
Etiology
4. Immunologic factors
a.Failure of the immune system to respond to
and eradicate cancer cells
b.Immunosuppressed individuals are more
susceptible to cancer
Carcinogenesis
1. Initiation brought by the different
causative agents
2. Promotion K-ras (KRAS2) located on
chromosome 12, all mammal has cellular
oncogenes
a.Proto-oncogenes
b.Suppressor genes (p53 or TP53)
3. Progression continue to proliferate and
metastasize
Early Detection
9 warning signs of cancer
Change in bowel/bladder habits
A sore that doesn't heal
Unusual bleeding or discharge
Thickening or lump in breast
Indigestion or dysphagia
Obvious change in wart or mole
Nagging cough / hoarseness of voice
Unexplained Anemia
Sudden weight loss
Day 2

Diagnosis of Cancer
Classification and Staging
a.Tissue of Origin
b.Stages of Tumor Growth
TNM System
Cytologic Diagnosis of Cancer
Staging and TNM System
describes the extent or severity of an
individuals cancer based on the extent
of the original (primary) tumor and the
extent of spread in the body.
(secondary)

TNM - one of the most commonly used
staging systems
Primary Tumor (T)

TX - Primary tumor cannot be evaluated

T0 - No evidence of primary tumor

Ts - Carcinoma in situ (early cancer that has
not spread to neighboring tissue)

T1, T2, T3, T4 - Size and/or extent of the
primary tumor
Regional Lymph Nodes (N)

NX - Regional lymph nodes cannot be
evaluated

N0 - No regional lymph node involvement (no
cancer found in the lymph nodes)

N1, N2, N3 - Involvement of regional lymph
nodes (number and/or extent of spread)
Distant Metastasis (M)

MX - Distant metastasis cannot be evaluated

M0 - No distant metastasis (cancer has not
spread to other parts of the body)

M1 - Distant metastasis (cancer has spread
to distant parts of the body)
example:
breast cancer T3 N2 M0
Prostate cancer T2 N0 M0
Grading and Staging of Tumors

Grading: based on the
degree of malignancy, how
alike the cells are to the
parent tissue or
differentiated

Grade 1 most
differentiated

Grade 4 least differentiated,
most malignant



Staging: general extent of
cancer and spread of disease
rather than cell appearance


Stage 1 No invasion of
other tissues, localized

Stage IV Metastasized to
distant parts


Mechanism of Metastasis
Lymphatic spread lymph node spread
Hematogenous spread
Angiogenesis(an-gee-oh-GEN-eh-sis)
Blood vessel formation or the growth of
blood vessels between a tumor and
surrounding tissue so the tumor can be
nourished.
Hematogenous Spread


Individuals age 20-40
Uterus
Pelvic examination every three years.
Cervix
Pap-testAfter three initial negative tests one year
apartat least every three years. This includes women
under the age of 20 if they are sexually active.
Testes
Self examination every month.
Consult a doctor when an abnormality is present.
*The key is to know your body so that you will
recognize the difference when it appears.
Uterus
Pelvic examination every year.
Individuals age 40 and Over:

Cervix
Pap-testAfter three initial negative tests one
year apartat least every three years.
Endometrium
Endometrial tissue sample at menopause if the
individual is at risk..
Testes
Self examination every month.
Consult a doctor when an abnormality is present.
Colon and Rectum
Manual rectal examination every year.
Proctoscopic exam.
Prostate
Digital rectal exam every year.



Hazards of smoking
Oral self-exam and annual exam of
mouth/teeth
Hazards of excess sun exposure
Pap smear
Physical exam with lab work:
20 40 y/o = q 3 years
>40 y/o = annually
Diagnostic Studies
Laboratory test, Tumor markers
Cytology
Radiologic test
Radioisotopes studies/Radioimmunoconjugates
Ultrasound
Biopsy
Endoscopy
CT-scan, PET scan, PET fusion
Fluoroscopy
MRI (uses powerful magnets and radio waves)
PET Scan
(Positron Emission Tomography )
Nuclear medicine is a branch of medical
imaging that uses small amounts of
radioactive material to diagnose or treat a
variety of diseases, including many types of
cancers, heart disease and certain other
abnormalities within the body.
Tumor Markers
Substances produced in the
body by the tumor cells
can be measured in urine,
blood and tissue sample.
Tumor Markers
Alpha-fetoprotein (AFP) - liver cancer
(hepatocellular carcinoma), testicular
cancers
Bladder tumor antigen (BTA) - bladder
cancer
CA 15-3 , CA 27.29- breast cancer
CA 125 - epithelial ovarian cancer (the
most common type of ovarian cancer
Calcitonin- medullary thyroid carcinoma
(MTC)
Tumor Markers
Carcinoembryonic antigen (CEA)-colorectal
cancer
Estrogen receptors/progesterone receptors-
breast cancer
Human chorionic gonadotropin (HCG)-
choriocarcinoma,testicular and ovarian
cancers (germ cell tumors)
Prostate-specific antigen (PSA)-prostate
cancer
Health Promotion
More fresh vegetables/Fruits
Vitamin A - esophageal, laryngeal, lung
Ca
Vit. C - stomach & esophageal
Weight control- uterus, gall bladder,
breast, colon
High fat - breast & prostate Ca
Smoking
Alcohol- Liver Ca, larynx, esophagus
Sun exposure - skin Ca

Treatment
Surgery
Chemotherapy
Radiation therapy
Biotherapy
Treatment Strategies:
- Adjuvant treatment:

Chemotherapy that is given according to
certain risk factors after the complete
excision of tumor

It aims to prevent the recurrence of the
disease.


Neoadjuvant Chemotherapy:

Chemotherapy that is given prior
to surgery

It aims at decreasing (down-
staging) the tumor to allow safe
and proper complete surgical
excision.


Multimodality treatment:

When different modalities of
treatment are used to treat cancer

like chemotherapy with
radiotherapy and/or surgery.

Chemotherapy
Antineoplastic agents are used to destroy
tumor cells by interfering with cellular
function, including replications
Principles
Based on the ability of the drug to kill cancer
cells; normal cells may also be damaged.
Effect is greatest on the rapidly dividing cells.

Different drugs act on tumor cells in different
stages of the cell growth cycle
Stages of Cell Cycle
G1 phase
Asparaginase, Prednisone

S phase
Antimetabolites,
cytarabine, methotrexate

G2 phase
Antibiotic(Bleomycin)

Mitosis Vinka alkaloids
Chemotherapy

Classification:
They can work at any point of the cell cycle
(cell-cycle specific- phase non-specific)

but some works only in specific phase of
the cycle (cell cycle phase specific).

Other chemotherapeutics act on cells
whether they are in the cell cycle or resting
and are named cell-cycle nonspecific
drugs.

Antineoplastic Agents
Alkylating agents altered DNA structure
by misreading DNA code
carboplatin, cisplatin ,oxaliplatin,busulfan,
cyclophosphamide,
dacarbazine,hexamethyl,melamine,ifosfami
de

SE: bone marrow , nausea, vomiting, cystitis,
stomatitis, alopecia, gonadal suppression,
renal toxicity (cisplatin)
Nitrosureas
Similar to the alkylating agents; can cross
the blood brain barriers
LOSE CAR MUSTINE -
LOmustine SEmustine CARmustine
Streptozocin
Non-specific
SE: myelosuppression,
thrombocytopenia;nausea, vomiting
Topoisomerase 1 inhibitors
Induce breaks in DNA
topoTECAN, irinoTECAN
S-phase specific
SE:bone marrow suppression, diarrhea,
nausea, vomiting, hepatotoxicity
Antitumor Antibiotics
Interfere with DNA synthesis by binding
DNA; prevent RNA synthesis
BLEO,DACTINO,MITO,PLICAmycin
DOXO, DAUNO, IDArubicin
Non-specific
SE: cardiac toxicity (daunorubicin, doxorubicin)
Mitotic Spindle Poison
PLANT ALKALOIDS
Arrest metaphase by inhibiting spindle
formation; inhibit DNA and protein synthesis
M-phase specific
VINcristine, VINblastine, VINdesine,
VINorelbine
EtoPOSIDE, teniPOSIDE
SE: BM suppression, neuropathies, stomatitis
Mitotic Spindle Poison
TAXANES
Arrest metaphase by inhibiting tubulin
depolymerization
PACLItaxel, DOCEtaxel
SE: bradycardia, hypersensitivity rxn, BM
suppressio, alopecia, neuropathies
Hormonal agents
Bind to hormone receptors sites that alter cellular
growth e.g. Blocking of ESTROGEN
Androgens, antiandrogens, estrogens and
antiestrogen, progestins and antiprogestines,
aromatase inhibitors, lutenizing-hormone-
releasing hormones analogues, steroids
Non-specific
SE: hypercalcemia,jaundice,increased
appetite,masculinication,Na&fluid retention,
vomiting , hot flashes, vaginal dryness
Miscellaneous Agents
Unknown
Asparaginase ( Elspar) for acute
lymphoblastic leukemia (ALL) & mast cells
Procarbazine (Matulane) Hodgkin's
lymphoma & brain cancers

Side effects of Chemotherapy
GI
Nausea, vomiting
Diarrhea
Stomatitis
Hematologic
Thrombocytopenia
Leukopenia
Anemia
Integumentary
Alopecia
Side effects of Chemotherapy
Renal
Direct damage to kidney by excretion of
metabolites
Reproductive
Infertility
Neurologic
Peripheral neuropathies, hearing loss, loss of
deep tendon reflex, paralytic ileus
Problems/Interventions

Extravasations
Vesicants agents when deposited into the SQ
tissue cause necrosis and damage to tendons,
nerves, blood vessels
MYSINE, RUBICIN, VIN, nitrogen MUSTARD
Carefull selection of VEINS
No blood return, resistance to flow, swelling, pain
redness at the site :STOP immediately

Problems
Toxicity
GI: N&V
Meds: ondan, grani, dola, palono SETRON (blocks
serotonin receptors)
Metoclopramide (Reglan, Plasil) dopaminergic
blocker
Hematopoetic System
Myelosuppression
Granulocyte colony-stimulating factor (GSF)
Granulocyte-macrophage CSF (GM-CSF)
Problems
Renal System
Cisplatin, Methotrexate, mitomycin
Nephrotoxic
Excretion of Uric Acid damage the kidney
Monitor BUN, crea, serum electrolytes
Adequate hydration, alkalinization of urine,
allupurinol prevention of these side effects
Reproductive system
Sterility
Sperm bank, Use birth control
Problems
Cardiopulmonary
RUBICIN-cardiotoxicity
Monitor for cardiac ejection fraction, heart failure
Bleomycin, carMUSTINE, busulfan lung damage
Pulmonary fibrosis long-term effect
Neurologic
Taxanes and plant alkaloid
Peripheral neuropathies, loss of deep tendon
reflexes, paralytic ileus, ototoxocity (acoustic nerve
damage)
Problems
Liver Damage - hepatotoxic

Miscellaneous
Fatigue and depression
- Hair loss
Nursing diagnosis
Fear/anxiety
situational crisis
Threat to/change in health/socio-economic
status, role functioning, interaction pattern
Threat of death
Separation from family
Grieving, anticipatory
Loss of physiologic well being (loss of body
part, change in body function
Perceived potential death
Nursing Diagnosis
Situational low self-esteem
Biophysical
Psychosocial
Acute/Chronic Pain
Disease process
Side-effects of therapeutic agents
Altered nutrition, less than body requirements
Hypermetabolic state, consequences of chemo,
radiation, surgery, emotional distress, fatigue, poor
pain control
Nursing Diagnosis
Risk for fluid volume deficit
Fatigue
Risk for infection
Risk for altered mucous membrane
Risk for skin/tissue integrity
Risk for Constipation/diarrhea
Risk for Altered sexuality patterns
Knowledge deficit
Nursing Care of Client with Cancer

Diagnostic Phase
Support
Denial common
Stress signs may
be due to
something other
than cancer
Educate on effects
of delaying
treatment
Treatment Phase
Varies on type of
cancer
Side effect treatment
Neutropenia
precautions
Nutrition
Activity Intolerance
Pain control
Grieving

Terminal Phase
Hospice
Grief counseling for
both patient and
family

Special Concerns
Bleeding
Skin problems
Hair loss
Nutrition
Pain
Fatigue
Psychosocial status
Body image
Stomatitis
Anorexia
Malabsorption
Cachexia-loss of
body weight,
adipose,visceral
proteins,and
skeletal muscle
Nursing Management Pt Teaching
Thrombocytopenia
Use soft toothbrush to avoid bleeding gums
When shaving, use electric razor
Avoid constipation, enemas, rectal temps
Do not use products that contain aspirin, NSAID
Avoid IM or sc injection
Notify MD/RN if petechiae, bruising, frank or tarry
stools, change in color of urine frank blood, dark
amber, bleeding from any part of body such as
nosebleed
Nursing Management
Minimize Side Effects of Nausea and Vomiting

Serotonin receptor antagonists such as Ondasetron
(Zofran)
Granisetron (Kytril)
Dolasetron (Anzemet)

Avoid offensive odors
Small frequent feedings rather than 3 big meals
Adjust oral and fluid intake
Relaxation exercises, hypnosis, etc.
Radiation therapy
sometimes called:
radiotherapy,
x-ray therapy radiation treatment,
cobalt therapy,
electron beam therapy
(irradiation uses high energy, penetrating
waves or particles such as x rays, gamma
rays, proton rays, or neutron rays)
Radiation therapy
ionizing radiation kill cancer cells and shrink
tumors
dose to each site depends on a number of
factors
Radiation Therapy
Ionizing radiation destroys cells ability to produce
by damaging its DNA
Cellular sensitivity varies throughout cell cycles

Safety time of exposure, distance from time of
exposure, distance from source, amount of shielding
source

Stay at least 6 feet away when not giving direct

External (Teletherapy)
Source is outside body
Beam aimed at specific spot
Marked with marker
Protect area from heat or cold
High protein, high calorie, high fluid intake
(2-3 quarts)
Radiation Therapy
Internal Radiation Therapy

Internal Radiation Therapy (Brachytherapy)

Source is placed inside the body

Sealed or unsealed

Radiation is emitted


Radiation Therapy
Internal Radiation Therapy

Sealed radiation
Sealed source of radiation intracavity, interstitial

Radioisotope cannot circulate thru clients body nor contaminate
urine, blood or vomit. Body fluids NOT contaminated
Clients excretion- not radioactive

Private room properly labeled Private room properly labeled
No children under 18 or anyone pregnant
Wear film badge

Prevent dislodgment
Monitor VS every four hours
Accurate I&O usually have a usually have a foley
Active ROM
Radiation Therapy
Unsealed Source Radiation
Administered intravenously or orally
Used in systemic system
Colloid suspension into body tissue
Iodine 131 Graves disease, thyroid cancer
Strontium chloride (Metastron) for bone metastasis

Radioisotopes do circulate through the body fluids. Sweat,
blood, urine, and vomit contains radioactive isotopes

Body fluids are contaminated special care special care
Flush at least three times
Disposable equipment
Wear shoe covers, protective equipment
Dosimeter- device used to measure an individual's
exposure to a hazardous environment
Radiation Safety Standards
Distance
distance & radiation
exposure is inversely related

Time 30 minutes per 8 hour shift

Shielding lead shield

Wear film badge or dosimeter
do not share

Private room & bath

Shields, lead container,
& long-handled forceps
in client room

If source is dislodged
use forceps to pick
up and place in the lead
container

Notify radiation safety
officer
Client with Implant
Remember Sealed radiation
Sealed source of radiation intracavity, interstitial

Radioisotope cannot circulate thru clients body nor
contaminate urine, blood or vomit
Body Fluids NOT Contaminated

Clients excretion- not radioactive

Implant in abdominal cavity

Confined to bed

Indwelling catheter inserted and low fiber diet

No bowel movement before the device is removed in 2-3
days
Internal Radiation with Unsealed Sources
Remember that Unsealed Source Radiation is;
Administered intravenously or orally

Used in systemic system

Radioisotopes do circulate through the body
fluids. Sweat, blood, urine, and vomit contains
radioactive isotopes

Body fluids are contaminated special care
Internal Radiation with Unsealed Sources
Private room and bath

Precautions on all secretions
Wear gloves if handling body fluids
Emesis after ingesting oral isotope cover with
absorbent pad and notify radiation safety officer
Use of disposable utensils
Covering floor areas with chux, papers
Flush toilet at least 3 times after each use

Limited visitor and staff contact
Nursing Management
Provide Education

Skin care within the treatment field
Keep skin dry
Wash with mild soap, rinse well, pat dry
Use cool water, not hot
Do not remove lines or ink marks
Protect skin from exposure to sunlight, chlorinated
swimming pools, extreme temp

Minimize side effects
Biotherapy




immunotherapy, biotherapy, or
biological response modifier therapy
uses the body's immune system, either
directly or indirectly, to fight cancer or to
lessen the side effects that may be caused
by some cancer treatments.

They alter the interaction between the
body's immune defenses and cancer cells
to boost, direct, or restore the body's ability
to fight the disease.
Classification:
Cytokines - interferons, interleukins,
Colony-stimulating factors,
Monoclonal antibodies,
Vaccines,
Gene therapy, and nonspecific
immunomodulating agents
Common Biological Therapy
1. Cytokines
IL-2 or Interleukin-2- leukemia,
lymphoma, and brain, colorectal, ovarian,
breast, and prostate cancer
Interferon alpha FDA has approved IL
2 for the treatment of metastatic kidney
cancer and metastatic melanoma.
Colony-stimulating factors
encourage bone marrow stem cells to
divide and develop into white blood cells,
platelets, and red blood cells.




Biotherapy
boost marrow function: the hematopoietic growth factors

Monoclonal antibodies (mAb) are
antibodies that are identical because they
were produced by one type of immune
cell, all clones of a single parent cell
enhance a patient's immune response to the
cancer.
MOABs can be programmed to act against cell
growth factors,
MOABs may be linked to anticancer drugs,
radioisotopes (radioactive substances),
Examples of MOABs
1. Rituxan or Rituximab - treats non-
Hodgkin's lymphoma.
2. Herceptin or Trastuzumab - treats
breast cancer.

Cancer vaccines are another form of
biological therapy
Example:
BCG or Bacillus Calmette-Gurin- treats
bladder tumors or bladder cancer.

Gene therapy
- is an experimental treatment that
involves introducing genetic material into a
person's cells to fight disease.

scientists inject cancer cells with genes
that cause the cancer cells to produce
cytokines and stimulate the immune
system.
Nonspecific immunomodulating
agents
are substances that stimulate or indirectly
augment the immune system.
Often cause secondary responses such as
increased production of cytokines and
immunoglobulins.

used in cancer treatment are bacillus
Calmette-Guerin (BCG) and levamisole .
Medical Emergencies- continued
Neutropenia decreased WBC
Thrombocytopenia- decreased platelets

Neutropenia =A reduced white blood cell count
lowers resistance to infection
may cause delay in patient receiving chemotherapy

Thrombocytopenia (low platelet count)
Platelets - prevent bleeding by causing coagulation
Decreased platelets s/s
Bruising easily
Nosebleeds
Excessive bleeding from cuts, wounds, gums (brushing
teeth), blood in urine/stool
Medical Emergencies- continued

Thrombocytopenia

Platelet count normal 150,000-400,000mm

When platelet count is less than 20,000 pt has risk of
hemorrhage

Chemo is withheld until platelets increase to >100,000

HEMATOLOGY
BLOOD
Primary function is to maintain a constant
environment for the other living tissues in
the body
Hematology/hematologist

Liquid Portion - Plasma

Formed elements
RBCs
WBCs
Platelets (thrombocytes)

BLOOD
Human body contains 4-6 liters of blood
Accounts for 8 % of body weight
PLASMA
Holds the formed elements
Clear, straw colored liquid
Carries nutrients, electrolyes (salts),
hormones and waste products
Plasma proteins
Blood clotting factors
Albumin
Globulins
Antibodies
Serum
Plasma without blood clotting element -
fibrinogen
HEMATOPOIESIS
RED BLOOD CELLS
Erythropoiesis
Shape-biconcave (resembles a caved-in
disk)
Carry oxygen to the cells
Hemoglobin: protein
Oxyhemoglobin
Transport CO
2
away from the cells to the
lungs
Live for about 120 days
Worn out cells are destoyed, mainly by spleen
and liver
Figure 194
Recycling RBCs
Figure 196a
4 Basic Blood Types
Figure 196b
Cross-Reaction
LEUKOCYTES (WBCs)
Less numerous than RBCs
Immune response to protect body against
infection
Directly attack foreign matter
Make antibodies
5 types in two primary groups
Granulocytes have a grainy appearance
Neutrophils
Eosinophils
Basophils
Agranulocytes
Lymphpocytes
Monocytes
Figure 199
Types of WBCs
Neutrophil Action
Very active, first to attack bacteria
Engulf pathogens
Digest pathogens
Release prostaglandins and
leukotrienes
Form pus
Eosinophil Actions
Are sensitive to allergens
Control inflammation with enzymes that
counteract inflammatory effects of
neutrophils and mast cells
Basophil Actions
Release histamine:
dilates blood vessels
Release heparin:
prevents blood clotting
Macrophage Actions
Engulf large particles and pathogens
Secrete substances that attract immune
system cells and fibroblasts to injured
area
Lymphocyte Actions
Types of lymphocytes include
B cells,
T cells, and
Natural Killer cells.
T cells
T cells (T lymphocytes) work primarily
by producing proteins called cytokines.
Cytokines allow immune system cells to
communicate
cytotoxic T cells, release pore-forming
proteins that directly attack infected,
foreign, or cancerous cells.
helper T cells, regulate the immune
response by releasing cytokines to
signal other immune system defenders.

B cells

Synthesize antibodies
B cells (B lymphocytes) mature into
plasma cells that secrete proteins
called antibodies (immunoglobulins).
Antibodies recognize and attach to
foreign substances known as antigens,

Natural Killer Cells (NK)
Detect and destroy abnormal tissue
cells (cancers)
(NK cells) produce powerful cytokines
and pore-forming proteins that bind to
and kill many foreign invaders, infected
cells, and tumor cells.
attack quickly, upon their first encounter
with their targets.

PLATELETS
Also called thrombocytes
Helps the body to form clots
Rush to the sight of an injury
Adhere to the blood vessel wall
Clotting process
Vascular constriction to stop blood flow
Platelet plug formation
Local blood coagulation
Prothrombin
Platelet Counts
150,000 to 500,000 per microliter
Thrombocytopenia:
abnormally low platelet count
Thrombocytosis:
abnormally high platelet count
4 Colony-Stimulating
Factors (CSFs)
Hormones that regulate blood cell
populations:
1. M-CSF:
stimulates monocyte production
2. G-CSF:
stimulates granulocyte production
neutrophils, eosinophils, and basophils
4 Colony-Stimulating
Factors (CSFs)
3. GM-CSF:
stimulates granulocyte and monocyte
production
4. Multi-CSF:
accelerates production of granulocytes,
monocytes, platelets, and RBCs
WELLNESS & ILLNESS
CBC most common blood test

Inspection for pallor
Anemia ?

Checks for enlargement
Liver hepatomegaly
Spleen splenomegaly
FETUSES, INFANTS, CHILDREN
RH factor
Erythroblastosis fetalis
RhoGAM

InheritedProblems
Sickle cell anemia

Thalasemia

Hemophilia


SICKLE CELL ANEMIA
Vaso-Occlusive Crisis
ADULTS/SENIORS
Adults
Anemias
Iron deficiency
Pernicious (Vitamin B12 deficiency)
Aplastic
Idiopathic
IDIOPATHIC THROMBOCYTOPENIC
PURPURA
Seniors
Polycythemia vera

GENERAL TERMS
Ecchymosis
Blood under skin from trauma
Changes colors, fades away
Hematoma
Thrombosis
Thrombus
Clot
Embolus
Clot that dislodges and travels through
bloodstream

WBC Disorders
Leukopenia:
abnormally low WBC count
Leukocytosis:
abnormally high WBC count
Leukemia:
extremely high WBC count
CANCERS OF HEMATOPOIETIC
SYSTEM
Arise in the bone marrow
Leukemia is the most common
Proliferation of abnormal WBCs in blood
Different types
Childhood about 85% cure rate with chemo
Lymphomas
Affects tissues of Lymphatic system
Hodgkins
Non-Hodgkin type
Multiple myeloma
Affects plasma cells
TESTS & PROCEDURES
3 Major blood tests
CBC
RBC, WBC, Platelets, Hgb and HCT
CBC with Diff (differential)
Includes breakdown of WBCs
Peripheral blood smear
Size, appearance, abnormally shaped cells
Others
Bone marrow aspiration/biopsy
Clotting factors
PT & PTT
Coombs test

PHARMACEUTICAL AGENTS
Thrombolytic agents
Break down clots that have formed
Antithrombolytic agents
Anticoagulants
Prevent clots from forming
Warfarin, Heparin, Aspirin
Coagulants
Promote clotting
Growth factors
Stimulate growth of certain cells
Blood Transfusion
BONE MARROW TRANSPLANT
Donor Types
Autologous - self to self
Syngeneic - from genetically identical twin
Allogeneic:
Matched sibling
Matched family member
Matched unrelated
Partially matched and haploidentical
Indications
High dose chemotherapy (dose - response
curve)
Allogeneic effect (graft-versus- tumour
effect)
Replacement of abnormal stem cells
(aplastic anaemia, thalassaemia, sickle cell
disease, gene therapy etc)
Immunological effect (autoimmune disease,
? solid organ transplants)
Common Uses of BMTs
AUTOLOGOUS TRANSPLANT

Multiple myeloma
Non-Hodgkin lymphoma
Hodgkin disease
Acute myeloid leukemia
(AML)


ALLOGENEIC TRANSPLANT

AML
Non-Hodgkin lymphoma
Hodgkin disease
Acute lymphoblastic leukemia
(ALL)
Chronic myeloid leukemia
(CML)
Chronic Lymphocytic Leukemia
(CLL)
Aplastic Anemia
Myelodysplastic syndromes
Multiple myeloma
Thalassemia major
Sickle cell anemia


RISKS OF BONE MARROW
TRANSPLANT
Short term
Sepsis, Acute graft-versus-host disease, multi-organ
failure or toxic death

Longer term
Chronic graft-versus-host disease (lung, gut, liver, skin)
Relapse
Infection
Endocrine
Ocular
RISKS OF BONE MARROW
TRANSPLANT
Short term
Sepsis, VOD, AGVHD, multi-organ failure or toxic
death

Longer term
Chronic graft-versus-host disease (lung, gut, liver,
skin)
Relapse
Infection
Endocrine
Ocular

References:
http://www.cancer.gov/cancertopics/what-is-cancer
National Cancer Institute

Brunner & Suddarth's Medical-Surgical Nursing,
Smeltzer et al, LWW 2008
Pathophysiology 7
th
edition, Port, 2002
E. Donnall Thomas - Fred Hutchinson Cancer
Research Center Seattle, WA, USA
Breast Cancer


Breast cancer - Etiology
menopause after age 55 are at an increased
risk of breast cancer.
No children=increased risk of breast cancer.
taking menopausal hormone therapy with
estrogen plus progestin after menopause also
appear to have an increased risk of breast
cancer.
Large, well-designed studies have shown no
link between abortion or miscarriage and
breast cancer.
Breast cancer - Etiology
Race: Breast cancer is diagnosed more often
in white women than Latina, Asian, or African
American women.
Radiation therapy to the chest
Older women whose mammograms (breast x-
rays) show more dense tissue are at
increased risk of breast cancer.
Symptoms
A change in how the breast or nipple feels
A lump or thickening in or near the breast or in
the underarm area
Nipple tenderness
A change in how the breast or nipple looks
A change in the size or shape of the breast
A nipple turned inward into the breast
The skin of the breast, areola, or nipple may be
scaly, red, or swollen. It may have ridges or
pitting so that it looks like the skin of an orange.
Nipple discharge (fluid)
Staging
Stage I
The cancer is no larger than 2 centimeters -
approximately about 1 inch- and has not spread outside
the breast.
Stage II
Stage II is divided into stages IIA and IIB.

Stage IIA is defined by either of the following:
1) The cancer is no larger than 2 centimeters but has
spread to the lymph nodes under the arm, the auxiliary
lymph nodes.
2) The cancer is between 2 and 5 centimeters -from 1
to 2 inches, but has not spread to the lymph nodes
under the arm.
Staging
Stage IIB is defined by either of the following:

1) The cancer is between 2 and 5 centimeters -from 1
to 2 inches-and has spread to the lymph nodes
under the arm.

2) The cancer is larger than 5 centimeters - larger than
2 inches- but has not spread to the lymph nodes
under the arm.
Commonly diagnosed types of
breast cancer are:


DCIS (Ductal Carcinoma In Situ)

DCIS is the most commonly diagnosed non-
invasive breast cancer.
The cancer is confined to the ducts of the breast,
thus being referred as non-invasive.
Rarely does it spread outside the ducts. If it stays
within the ducts, the five year survival rate is
almost 100%. There are different forms of DCIS.


LCIS (Lobular Carcinoma In Situ)

LCIS is not usually classified as cancer.
It is a condition indicating a sudden
increase of cells in the lobules.
indicate a higher chance of developing
breast cancer.
The good news is a great majority of LCIS
cases never develop into cancer. Patients
are monitored closely and may be given
hormone therapy to prevent cancer.



IDC (Infiltrating Ductal Carcinoma) or
( Invasive Ductal Carcinoma)

accounts for 80 to 85% of all breast cancer
diagnoses.
IDC is indicative that the cancer has
broken through the ducts and has invaded
neighboring fatty tissues.

IFC (Infiltrating Lobular Carcinoma) or
Invasive Lobular Carcinoma

This is a very difficult form of breast cancer.
It initially develops in the lobules (milk
ducts) but spreads to other parts of the
body.
ILC is responsible for 10-15% of breast
cancer cases.

Mucinous Carcinoma ( colloid carcinoma )

formed from mucus producing cancer cells.
. a better prognosis than many invasive breast cancer
types.

Medullary Carcinoma:
account for about 5% of breast cancer cases.
It is invasive and forms a distinct boundary between
healthy and tumor tissue.
It is often hard to tell the difference between this type and
invasive ductal carcinoma.

Tubular Carcinoma

Named after the shape of the cell under a microscope,
tubular carcinoma is a type of invasive breast cancer. It
has a better prognosis than most common invasive breast
cancers.


Inflammatory Breast Cancer

usually detected at advanced stages.
it causes the skin to have an orange peel
appearance and it may become reddened.
it may be mistaken for mastitis.
Inflammatory breast cancer accounts for 1-
4% of breast cancer cases.


Symptoms

Breast lump
Nipple discharge
Retracted nipple
Red/inflamed nipple
Breast enlargement
Breast shrinkage
Breast becomes hard
Bone pain
Back pain


Examination
Breast Lump
Nipple discharge
Skin changes on breast
Hardened breast
Enlarged lymph glands:
Above clavicles (collar bone)
In armpits
Sides of center bone in chest
(mediastinal lymph nodes
might be enlarged inside the
chest, to the right and left of
the midline)



Diagnostics
Imaging:
Mammograms Mammography: Screening for
Breast Cancer
Ultrasound
TVS
CT Scan
MRI to check for spread to the brain
Mammography: Screening for Breast Cancer
Diagnostic Tests:
- Needle aspiration (FNAB)
Mammatome test -- special type of needle
biopsy with special X-Ray techniques to localize
deep lumps
Open surgical biopsy -- when a lump is
removed and sent to the lab for analysis
Lymph node dissection -- multiple lymph
nodes are removed to check for the spread of
cancer
Sentinel lymph node dissection -- only a few
lymph nodes need to be biopsied


Risk Factors
Family history of breast cancer in mother,
sister, daughter, or if two or more close
relatives have the disease
Risk increases as women get older
Previous endometrial (uterine) cancer
Previous breast cancer, atypical changes,
and previous breast disease
Carrier of BRCA1 or BRCA2 genes
(especially prominent in Ashkenazi Jews);
however, only 5-10% of all breast cancers
may be due to genetic defects or changes.
Menstrual periods started before the age of 12
Menopause ended after age 50
No children
Estrogen hormone replacement therapy
Alcohol, high fat in diet, increased fiber diet,
smoking, obesity, and having previous ovarian or
Colon Cancer
African-Americans and Hispanics may have a
worse prognosis than whites.


Treatment
Breast cancer treatment depends on three major
factors:
If the woman has reached menopause
The extent to which the breast cancer has spread
The cell type of the breast cancer
The extent of the spread of the cancer is defined
accordingly:
Where it is localized in the breast
The rate of the cancer's spread to the lymph nodes
The spread of the cancer to deep muscles in the
breast
The spread of the cancer to the other breast
The spread of the cancer to the other organs, i.e., bone
or brain
Lumpectomy -- removal of the lump and local tissue
around it. This may include the removal of some of the
lymph nodes via radiation treatment.
Segmental (partial) mastectomy with or without
radiation treatment -- removal of the cancer, some of
the tissue surrounding it, the lining covering the muscles
underneath the cancer, as well as the lymph nodes under
the arm
Total mastectomy - removing the entire breast and
axillary (under the arms) lymph nodes.
Modified radical mastectomy - removal of breast,
muscles below it, and lymph glands in axillary armpit area
Ovarian ablation -- making ovaries inactive so they do
not produce hormones that enhance breast cancer
growth.
MRM/RM
Medications

Hormonal therapy -- Tamoxifen
CMF (Cytoxan, Methotrexate, 5-FU)
and other agents of chemotherapy
Bone marrow transplant
Stem cell transplant
Biological therapies


Post-op Instructions: Mastectomy

Diet ; there are no restrictions.
Activity
You may use your arm normally, although no
heavy lifting or vigorous sports activities until
advised by your surgeon. No special exercises
are required during the immediate post-operative
period.
Medications
Post-op Instructions: Mastectomy

Wound Care
The bandages will be removed at your first follow-
up appointment.
If no drains are present, you may shower in 24
hours after the outer gauze dressings have been
removed. Do not remove paper tapes (steri-
strips).
When to Contact Your Physician
Call for advice if signs of wound infection such as:
redness, swelling, heat, increased tenderness,
drainage, red streaks and fever of 101F or
greater.
Continue to use both hands as you did before the
mastectomy.
Towel drying with both hands after bathing will
help you increase your range of motion.

When blow-drying and styling your hair, it may be
more comfortable initially to support the affected
arm on a telephone book or other prop until range
of motion and strength have been restored.

To fasten a bra, begin by fastening it in front and
then turning it around. Progress to reaching
behind your back to fasten it, first with straps off,
then with straps on your shoulders.

When putting on a blouse, shirt or sweater, put
the affected arm in first. When undressing, take
the affected arm out last. To remove slip-on
clothing, draw it over your head first, and then
slide it off your arms.
When closing a zipper at the back of a garment,
use a zipper pulley.
When cooking, do the stirring with your affected
arm..
Plan your marketing to eliminate heavy lifting or
carrying.
General household activities you may use as
exercises to increase your range of motion
include sweeping; making the bed; mopping;
polishing mirrors, silver, etc.; turning doorknobs
and keys; folding laundry; washing walls and
windows; vacuuming, and reaching up to high
shelves.
When watering plants, use both hands to hold the
watering can. As your strength increases, try
using your affected arm,
Gardening offers many opportunities to help you
increase your range of motion, such as raking,
hoeing, cutting and planting. Caution: Wear
gloves to avoid cuts or injuries to your hands or
fingers, because your affected arm is more
susceptible to infection after surgery.

Colo-rectal Cancer
Colon cancer is cancer that starts in the
large intestine (colon) or the rectum (end of
the colon).

Other types of colon cancer such as
lymphoma, carcinoid tumors,
melanoma, and sarcomas are rare.
You have a higher risk for colon cancer if
you have:
Cancer elsewhere in the body
Colorectal polyps
Crohn's disease
Family history of colon cancer
Personal history of breast cancer
Ulcerative colitis

Symptoms
Many cases of colon cancer have no symptoms.

The following symptoms, however, may indicate
colon cancer:
Abdominal pain and tenderness in the lower
abdomen
Blood in the stool
Diarrhea, constipation, or other change in bowel
habits
Intestinal obstruction
Narrow stools
Unexplained anemia
Weight loss with no known reason

Exams and Tests
With proper screening, colon cancer can be
detected BEFORE symptoms develop, when it is
most curable.
physical exam - rarely shows any problems,
A rectal exam - rectal cancer, but not colon
cancer.
Imaging tests to diagnose colorectal cancer
include:
Colonoscopy
fecal occult blood test (FOBT)
Sigmoidoscopy
CBC
staging.

Stage 0: Very early cancer on the innermost layer
of the intestine
Stage I: Cancer is in the inner layers of the colon
Stage II: Cancer has spread through the muscle
wall of the colon
Stage III: Cancer has spread to the lymph nodes
Stage IV: Cancer that has spread to other organs

Treatment
Treatment depends partly on the stage of the
cancer.

In general, treatments may include:
Chemotherapy
Surgery
Radiation therapy

For patients with stage IV disease that has
spread to the liver, various treatments &
may include:
Burning the cancer (ablation)
Cutting out the cancer
Delivering chemotherapy or radiation
directly into the liver

Although radiation therapy is occasionally used in
patients with colon cancer, it is usually used in
combination with chemotherapy for patients with
stage III rectal cancer.
Prostatic & Testicular CA
A testicular tumour is a lump created by the
abnormal and uncontrolled growth of cells.
system).
Testicular cancer can spread to the lymph
nodes (part of the lymph system) or form
tumours in the lungs or other organs.
The spread of cancer is called metastasis.

Types of testicular cancer

:seminoma and non-seminoma.
Seminomas are made up of a single kind of
testicular cell,
non-seminomas (eg teratomas) are made
up of more than one type of cell.
Lymphoma is the most common type of
testicular cancer in men over 50.
Signs & Symptoms

a lump, irregularity or swelling in one
testicle.
a pulling sensation or feeling of unusual
heaviness in the scrotum
a dull ache in the groin or lower abdomen
pain or discomfort (which may come and
go) in the testicle or scrotum
tenderness or enlargement of tissue in the
breast area
a sudden collection of fluid in the scrotum
(called a hydrocele)

S/S
A few men with testicular cancer may
experience lower back pain,
stomach pain or
a cough as their first symptoms.
Causes
Unknown
Other factors :
having a brother or father who had
testicular cancer
fertility problems
being from a wealthy social group
History of sexually transmitted diseases
having a rare complication of mumps called
orchitis (painful swelling of the testicles)
Diagnosis
Physical Examination
Ultrasound
Incision/Excision Biopsy
CT scans
a chest X-ray
blood tests to assess levels of tumour
marker proteins in the blood
Treatment
Surgery (Orchidectomy)

Chemotherapy

Radiotherapy

Warning Signs of Skin Cancer
melanoma, basal cell carcinoma, and
squamous cell carcinomastart as
precancerous lesions.
These precancerous lesions are changes in
skin that are not cancer but could become
cancer over time.
An estimated 40% to 50% of fair-skinned
people who live to be 65 will develop at
least one skin cancer.
stage 1 - cancer is only in the testicle
stage 2 - cancer has spread to the lymph
nodes in the abdomen
stage 3 - there are cancer cells in the lymph
nodes in the chest or above the collarbone
stage 4 - cancer has spread to other
organs, often the lungs


Skin CANCER
Know Your ABCDEs: 'A' is for
Asymmetry
Asymmetry means one half of a mole
does not match the other half.
Normal moles are symmetrical. When
checking your moles or freckles, draw
an imaginary line through the middle
and compare the two halves. If they do
not look the same on both sides, have it
checked by a dermatologist.
B' is for Border
If the border or edges of the mole are
ragged, blurred, or irregular, have it
checked by a dermatologist.
Melanoma lesions often have uneven
borders.
'C' is for Color
A mole that does not have the same color
throughout or that has shades of tan,
brown, black, blue, white, or red is
suspicious.
Normal moles are usually a single shade of
color.
D' is for Diameter
A mole is suspicious if the diameter is
larger than the eraser of a pencil.

Benign moles are usually less than 6
millimeters in diameter.
'E' is for Elevation
If a portion of the mole appears elevated, or
raised from the skin,
Melanoma lesions often grow in size or
change in height rapidly.
A mole that is evolvingshrinking, growing
larger, changing color, begins to itch or
bleedshould also be checked.
Hodgkins Disease
Hodgkin's lymphoma is a cancer of the
lymphatic system, which is part of your
immune system.

cells in the lymphatic system grow
abnormally and may spread beyond the
lymphatic system.

it compromises your body's ability to fight
infection
Lymphatic system


Normal/Abnormal Lymph Nodes

Your body's lymphatic system is part of
your immune system, which protects you
against infection and disease. It includes
your spleen, thymus, bone marrow, lymph
nodes and lymph channels, as well as your
tonsils and adenoids.

Symptoms

Many initial signs and symptoms may be similar
to those of
the flu, such as fever, fatigue and night sweats.
tumors develop.
Painless swelling of lymph nodes in your
neck, armpits or groin
Persistent fatigue
Fever and chills
Night sweats
Unexplained weight loss as much as 10
percent or more of your body weight
Loss of appetite
Itching

Causes
The exact cause of Hodgkin's disease is
unknown.
Abnormal B cells
B cells normally work with T cells, which
derive from the thymus, to fight infection.

T cells kill foreign invaders directly.
B cells become plasma cells, which in turn
produce antibodies that neutralize foreign
invaders.

cancerous cells are called Reed-Sternberg
cells, after the two pathologists who first
discovered them.
Instead of undergoing the normal cell cycle
of life and death, these Reed-Sternberg
cells don't die, and they continue to
produce abnormal B cells in a malignant
process.

Risk Factors
1. Age. People between the ages of 15 and 40,
as well as those older than 55,
2. Family history.
3. Sex. Males are slightly more likely to
develop Hodgkin's.
4. Past Epstein-Barr infection. such as
infectious mononucleosis,
5. Compromised immune system:
HIV/AIDS
organ transplant requiring medications to
suppress your immune response,

Diagnosis/Tests
Biopsy
X-ray
Computerized tomography (CT) scan
Magnetic resonance imaging (MRI)
Gallium scan, which uses a radioactive
substance given intravenously that indicates
areas in your body where Hodgkin's disease
may be present
Positron emission tomography (PET) scan
Bone marrow biopsy
Blood tests
Ex-lap - If the disease is predominantly in
abdomen,
Staging
Stage I. The cancer is limited to one lymph
node region or a single organ.
Stage II. the cancer is in two different lymph
nodes, but is limited to a section of the body
either above or below the diaphragm.
Stage III. to lymph nodes both above and
below the diaphragm, but hasn't spread from
the lymph nodes to other organs,
Stage IV. affects not only the lymph nodes
but also other parts of your body, such as the
bone marrow or your liver.

A,B,E,S
The letter A means NO significant symptoms as
a result of the cancer.
The letter B means significant signs and
symptoms, such as a persistent fever greater
than 100 F with no other known cause,
unintended weight loss of more than 10 percent
of your body weight or severe night sweats.
The letter E stands for extranodal, cancer has
spread beyond your lymph nodes.
The letter S designates a cancer that has spread
into your spleen.
The letters B, E and S indicate potentially more
serious disease.
Treatment
The goal of treatment - destroy as many
malignant cells as possible and bring the
disease into remission.
95 percent of people with stage I or stage
II survive for 5 years or more with proper
treatment.
RADIATION
CHEMOTHERAPY
BONE MARROW TRANSPLANT
(AUTOLOGOUS)
Chemotherapy regimens
ABVD, which consists of doxorubicin (Adriamycin ),
bleomycin, vinblastine and dacarbazine
BEACOPP, which consists of bleomycin, etoposide,
Adriamycin, cyclophosphamide, vincristine (Oncovin),
procarbazine and prednisone
COPP/ABVD, which consists of cyclophosphamide,
Oncovin, procarbazine, prednisone, Adriamycin, bleomycin,
vinblastine and dacarbazine
Stanford V, which consists of Adriamycin, vinblastine,
mechlorethamine, etoposide, vincristine, bleomycin and
prednisone
MOPP, which consists of mechlorethamine, Oncovin,
procarbazine and prednisone

A major concern with chemotherapy is the
possibility of long-term side effects and
complications,
heart damage, lung damage, liver damage
and secondary cancers, such as leukemia.
Skin Cancer
melanoma,basal cell carcinoma,
squamous cell carcinomastart as
precancerous lesions..
An estimated 40% to 50% of fair-skinned
people who live to be 65 will develop at
least one skin cancer.
The Warning Signs of Skin
Cancer

Actinic Keratosis (Solar Keratosis)
The small, scaly patches caused by too
much sun exposure commonly occur on the
head, neck, or hands, but can be found
elsewhere.
Actinic Cheilitis (Farmer's Lip)

Scaly patches or persistent dryness and
cracking of the lips
swelling of the lip,
loss of the sharp border between the lip
and skin, and prominent lip lines.
may evolve into invasive squamous cell
carcinoma if not treated.
cutaneous horn
appears as a funnel-shaped growth that
extends from a red base on the skin.
It is composed of compacted keratin (the
same protein in nails).
Squamous cell carcinoma is often found at
the base. It usually occurs in fair-skinned
elderly adults with a history of significant
sun exposure.
A mole (nevus
is a benign growth on the skin.
The surface is typically smooth. Normal
moles are round or oval and no larger than
a pencil eraser.
Most moles develop in youth or young
adulthood. It's unusual to acquire a mole in
the adult years.
Dysplastic Nevi (Atypical Moles)

found in sun-exposed or sun-protected
areas of the body.
Atypical moles are larger (one-quarter inch
across or larger) and more irregular in
shape, with notched or fading borders.
They may be flat or raised or the surface
smooth or rough. They are typically of
mixed color, including pink, red, tan, and
brown.
Know Your ABCDEs
: 'A' is for Asymmetry
Asymmetry means one half of a mole does
not match the other half.
Normal moles are symmetrical.
When checking your moles or freckles,
draw an imaginary line through the middle
and compare the two halves.
B' is for Border
If the border or edges of the mole are
ragged, blurred, or irregular, have it
checked by a dermatologist.
Melanoma lesions often have uneven
borders.
'C' is for Color
A mole that does not have the same color
throughout or that has shades of tan,
brown, black, blue, white, or red is
suspicious.
Normal moles are usually a single shade of
color.
'D' is for Diameter
A mole is suspicious if the diameter is
larger than the eraser of a pencil.
Benign moles are usually less than 6
millimeters in diameter.
'E' is for Elevation
If a portion of the mole appears elevated, or
raised from the skin,
Melanoma lesions often grow in size or
change in height rapidly.
A mole that is evolvingshrinking, growing
larger, changing color, begins to itch or
bleed
Tips for Screening Moles for
Cancer
Examine your skin after a shower while skin is
wet.
But check your entire body for moles or
suspicious spots once a month.
Start at your head and work your way down.
Check the "hidden" areas: between fingers and
toes, the groin, soles of the feet, the backs of the
knees. Check your scalp and neck for moles.
risk is greatest for people who
have:

Fair skin or light-colored eyes
An abundance of large and irregularly-
shaped moles
A family history of skin cancer
A history of excessive sun exposure or
blistering sunburns
Lived at high altitudes or with year-round
sunshine
Received radiation treatments

Melanoma
it's the most serious and potentially deadly.
A common location for melanoma in men is on
the back, and in women, the lower leg.
S/S include a change in the appearance of a
mole or pigmented area.
Squamous Cell Carcinoma
a firm red nodule,
a scaly growth that bleeds or develops a
crust, or a sore that doesn't heal.
often occurs on the nose, forehead, ears,
lower lip, hands, and other sun-exposed
areas of the body & curable if treated early.
Bowen disease
squamous cell carcinoma "in situ, in earliest
form
It is a type of skin cancer that spreads outward
on the surface of the body.
scaly, reddish patches that may be crusted; it
may be mistaken for rashes, eczema, fungus, or
psoriasis.
Basal cell carcinoma
is the most common and easiest-to-treat
spreads slowly, it occurs mostly in adults. pearly
white or waxy bump, often with visible blood
vessels, on the ears, neck, or face.
can also appear as a flat, scaly, flesh-colored or
brown patch on the back or chest, or more
rarely, a white, waxy scar.
Kaposi's sarcoma
, mainly seen in people with weakened immune
systems;
Merkel cell carcinoma, usually found on sun-
exposed areas on the head, neck, arms and legs
but often spreads to other parts of the body;
sebaceous gland carcinoma, an aggressive
cancer originating in the oil glands in the skin.
Health Teachings
Limit sun exposure between 10am 4pm
While outdoors, apply sunscreen liberally (don't
forget the lips and ears!),
wear a hat and sunglasses, and cover up with
clothing.
And remember, if you notice changes consult
your doctor
CNS Neoplasm
Gliomas, metastases, meningiomas, pituitary
adenomas, and acoustic neuromas account for
95% of all brain tumors
Manifestations
depend on the cause of the symptoms: an
increase in ICP, direct compression of
essential gray or white matter, shifting of
intracranial contents, or secondary cerebral
ischemia.
Symptoms may be nonspecific and include
headache, altered mental status, ataxia,
nausea, vomiting, weakness, and gait
disturbance.
may manifest as focal seizures, fixed visual
changes, speech deficits, or focused
sensory abnormalities.
Management
Management varies greatly depending on
tumor location, tissue type, and comorbid
conditions.
surgical resection, tumor removal or
debulking, installation of a ventricular shunt,
initiation of radiation treatment, and
chemotherapy.

Corticosteroids may dramatically reduce
signs and symptoms related to cerebral
edema.
Spinal Cord Tumors

Spinal Cord Tumors
A spinal tumor is a growth of cells (mass) in or
surrounding the spinal cord.

Any type of tumor may occur in the spine,
including:
Leukemia
Lymphoma
Myeloma

Signs & Symptoms
Abnormal sensations, loss of sensation:
Especially in the legs (may be in the knee or ankle, with or
without shooting pain down the leg)
May worsen
Back pain:
Gets worse over time
In any area -- middle or low back are most common
Is usually severe and not relieved by pain medication
Is worse when lying down
Is worse with strain, cough, sneeze
May extend to the hip, leg, or feet (or arms), or all extremities
May stay in the spine
Cold sensation of the legs, cool fingers or hands, or
coolness of other areas

Fecal incontinence
urinary incontinence
Muscle contractions or spasms
(fasciculations)
Muscle function loss
Muscle weakness (decreased muscle
strength not due to exercise):
Causes falls
Especially in the legs
Makes walking difficult
May get worse (progressive

Spinal tumors can occur:
Inside the cord (intramedullary)

In the membranes (meninges) covering
the spinal cord (extramedullary -
intradural)

Between the meninges and bones of the
spine (extradural)
These tests may confirm spinal
tumor:
Antidiuretic hormone (ADH) test
Cerebrospinal fluid (CSF) examination
Cytology (cell studies) of CSF
Myelogram
Spinal CT
Spine MRI or lumbosacral spine MRI
Spine x-ray

Treatment include:

Corticosteroids (dexamethasone) may be
given to reduce inflammation and swelling.
Surgery may be needed to relieve
compression on the spinal cord.
Radiation therapy may be used with, or
instead of, surgery.
Chemotherapy has not been proven effective
against most spinal tumors, but it may be
recommended in some cases.
Physical therapy may be needed to improve
muscle strength and the ability to function
independently.