Prepared by:
Fig. 15-2
Defect in Cellular Proliferation
Pyramid effect
Each cell division creates two or more
offspring cells
• Continuous tumor growth
Defect in Cellular Differentiation
Protooncogenes
Normal cellular genes that are
important regulators on normal
cellular processes
Mutations that alter their expression
can activate them to act as oncogenes
(tumor-inducing)
Defect in Cellular Differentiation
Initiation
Mutation of genetic structure
Has potential to develop into clone of
neoplastic cells
Process of Cancer Development
Fig. 15-3
Development of Cancer
Promotion
Characterized by the reversible
proliferation of altered cells
Activities of promotion (e.g. obesity,
smoking, alcohol) are reversible
Latent period
• Initial genetic alteration to clinical
evidence of cancer
Development of Cancer
Progression
Characterized by increased growth
rate of tumor as well as its invasiveness
and metastasis
Metastasis = spread of cancer from
primary (initial) site to distant site
Development of Cancer
Progression
• Metastasis process begins with rapid
growth of primary tumor
Tumor angiogenesis - formation of
blood vessels within the tumor; critical
for tumor survival
Role of Immune System
Clinical Staging
0: cancer in situ
1: tumor limited to tissue of origin
2: limited local spread
3: extensive local and regional spread
4: metastasis
Classification of Cancer
Goals
Cure
Control
Palliation
Collaborative Care of Cancer
Surgical therapy
to cure or control
Slow cancers are most amenable
Margin of normal tissue must
surround tumor
Collaborative Care of Cancer
Radiation therapy
Emission and distribution of energy through
space or material medium
Energy produced breaks bonds in DNA,
leading to death at time of reproduction
Affects both cancer as well as normal cells
Normal tissues are usually able to recover
Collaborative Care of Cancer
Radiation therapy
Teletherapy
• Given via external beam from a
machine
• Most common
Brachytherapy
• Radioactive material implanted in or
close to the tumor
• Patient is radioactive
Precautions: time, distance, shielding
Nursing Management:
Patients Undergoing Radiation
Fatigue
Possibly due to accumulation of
metabolites from cell destruction
Rest before activity
Get assistance with activity
Maintain nutritional status
Nursing Management:
Patients Undergoing Radiation
Anorexia
Monitor carefully to avoid weight loss
• Weigh twice weekly
Small, frequent, high-protein, high-
calorie meals
Supplements
Nursing Management:
Patients Undergoing Radiation
Bone Marrow Suppression
If bone marrow is within treatment
field
Kills RBCs, WBCs, platelets
Not as significant as with
chemotherapy
Monitor blood counts
May need transfusion for anemia
Nursing Management:
Patients Undergoing Radiation
Skin Reactions
Occurs within treatment field
Lubricate dry skin with nonirritating
lotion or solution (no metal, alcohol,
perfume, or additives)
Wet desquamation must be kept clean
and protected from further damage
Nursing Management:
Patients Undergoing Radiation
Skin Reactions
Prevention of infection
Facilitate wound healing
Protect irritated skin from extremes in
temperature
Avoid constricting garments, harsh
chemicals, and deodorants
See Table 15-12
Nursing Management:
Patients Undergoing Radiation
Oral, Oropharynx, and Esophageal
Reactions
Teach patients to examine oral cavity
Dental work before initiation of
radiation therapy
Saliva substitutes for dry mouth
Oral care (brushing and flossing unless
contra-indicated)
Nursing Management:
Patients Undergoing Radiation
Oral, Oropharynx, and Esophageal
Reactions
Pain relief
Frequent feedings of soft,
nonirritating, high-protein, high-
calorie foods
Avoidance of extremes in temperature,
alcohol, and tobacco
Nursing Management:
Patients Undergoing Radiation
Pulmonary Effects – pneumonitis (cough,
SOB, fever, night sweats)
Treatment
• Bronchodilators
• Expectorants/cough suppressants
• Bed rest
• Oxygen
Nursing Management:
Patients Undergoing Radiation
Gastrointestinal Effects – ↓ secretion of
HCl, mucus, pepsin → N&V, diarrhea
Prophylactic administration of
antiemetics
Assess for S/S of alkalosis and
dehydration
I&O
nonirritating diet
Antidiarrheal medications
Nursing Management:
Patients Undergoing Radiation
Reproductive Effects
Risk of infertility
Inform patient on expected sexual side
effects
Consider harvesting sperm or ova
Refer to counseling if needed
Nursing Management:
Patients Undergoing Radiation
Coping
Assist in planning for transportation,
nutrition, and emotional support
Patient teaching of symptom
management to maintain highest
possible quality of life
Chemotherapy
Goal is to reduce number of cancer cells
in the tumor site(s)
Several factors determine response of
cancer cells
Cancer cells can escape death by
staying in the G0 phase
Main problem is presence of drug-
resistant resting and noncycling cells
Chemotherapy
Effect on cells
Cell cycle non-specific
Cell cycle phase-specific
Chemotherapy
Methods of Administration
Oral
IM
IV
Many agents are vesicants, causing severe tissue
breakdown and necrosis if infiltration occurs
S/S infiltration: pain, redness, swelling, vesicles
Central vascular access devices permit frequent,
continuous, or intermittent administration
• Can be used to administer additional fluids
• Major types
Silastic right atrial catheters
Implanted infusion ports
Infusion pumps
Chemotherapy
Methods of Administration
Intrathecal – into subarachnoid space via lumbar
puncture
Alkylating Agents
Antimetabolites
Anti-tumor antibiotics
Plant Alkaloids
Nitrosoureas
Corticosteroids
Hormone Therapy
Chemotherapy
Regional Administration
Delivery of drug directly into the tumor
site
Acute toxicity
Vomiting
Allergic reactions
Arrhythmias
Delayed effects
Mucositis
Alopecia
Bone marrow suppression
Chemotherapy
Effects on Normal Tissues
Chronic toxicities
Damage to
• Heart
• Kidney
• Liver
• Lungs
Chemotherapy
Treatment Plan
Rapidly dividing cells are most sensitive
(tumor cells, hair, GI, reproductive, &
blood cells)
Effects are systemic and therefore kill
primary and metastatic cancer cells
Carefully calculated according to body
weight or body surface area
Drugs usually given in combination
Chemotherapy
Treatment Plan
Selection of principles of combination
chemotherapy
Drugs used are effective against cancer
being treated
Synergistic effect occurs when
combined
Includes cell cycle phase-specific and
cell cycle nonspecific drugs with
different mechanisms of action
Chemotherapy
Treatment Plan
Combination of drugs with different
toxic side effects
Continue to be available
Exhibit caring attitude
Listen actively to fears and concerns
Provide relief from distressing symptoms
Maintain relationship based on trust and
confidence
Cancer
Psychologic Support
Use touch to exhibit caring
Assist patient in setting realistic short-
term goals
Assist in maintaining usual lifestyle
patterns
Maintain hope, which can vary
Provides control over what is
occurring
Basis of positive attitude