Cellular Aberrations Lecture Notes PDF

Cellular Aberrations By: Evangeline Go RN MAN Cell Cycle Identical Daughter Cells Two identical daughter cells Parent Cell 4  The Cell Cycle Checkpoints...

Cellular Aberrations By: Evangeline Go RN MAN Cell Cycle Identical Daughter Cells Two identical daughter cells Parent Cell 4  The Cell Cycle Checkpoints G1-to-S checkpoint Cell Cycle G2-to-M checkpoint Checkpoints Metaphase checkpoint 5 Carcinogenesis  Three-step process 1. Initiation – initiators (carcinogens), such as chemicals, physical factors, and biologic agents escape normal enzymatic mechanisms and alter the genetic structure of the cellular DNA 2. Promotion – repeated exposure to promoting agents causes the expression of abnormal or mutant genetics information 3. Progression – the altered cells exhibit increased malignant behavior; they now have the propensity for invasion and metastasis Oncology defined Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia  “Root words”  Neo- new  Plasia- growth  Plasm- substance  Trophy- size  +Oma- tumor  Statis- location “Root words”  A- none  Ana- lack  Hyper- excessive  Meta- change  Dys- bad, deranged CARE OF PATIENTS WITH CANCER  Cancer is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA.  This abnormal cell forms a clone and begins to proliferate abnormally, ignoring growth-regulating signals in the environment surrounding the cell. The cells acquire invasive characteristics, and changes occur in surrounding tissues. The cells infiltrate these tissues and gain access to lymph and blood vessels, which carry the cells to other areas of the body. CARE OF PATIENTS WITH CANCER REMEMBER THAT CANCER CELLS:  Have uncontrollable growth  when we mention carcinoma, the tumor usually arises from surface or glandular epithelium  sarcoma: arises from the connective tissues.  lymphoma and myeloma start in the cells of the immune system. CARE OF PATIENTS WITH CANCER Cellularorigin  Carcinoma: originates in epithelial tissue  Adenocarcinoma: originates in the glandular tissue (breast, prostate)  Sarcoma: originates in fat, muscle blood vessels, nerves, bones CARE OF PATIENTS WITH CANCER 7 warning signs of cancer  C- Change in bowel or bladder  A lesion that does not heal  U- Unusual bleeding or discharge  T- Thickening or lump formation  I - Indigestion or difficulty swallowing  O- Obvious changes in wart or mole  N- Nagging cough or persistent hoarseness  U- Unexplained anemia  S- Sudden loss of weight CARE OF PATIENTS WITH CANCER  Other definitions and characteristics of cancer are:  Benign Neoplasm – Slow-growing, localized, and encapsulated with well-defined borders. Not cancerous.  Malignant neoplasm – Aggressive form that invades and destroys tissues. having cells or processes that are characteristic of cancer  Metastasis – Cells travel through the blood or lymphatic system and invade other tissue and organs to form a secondary tumor CARE OF PATIENTS WITH CANCER  TUMOR GRADING  Examined the tumor through biopsy under a microscope.  Abnormality of the cells determines the grade of the cancer.  Increasing abnormality increases the grade, from 1–4.  Grade 1 – Cells slightly abnormal and well differentiated  Grade 2 – Cell more abnormal and moderately differentiated  Grade 3 – Cells very abnormal and poorly differentiated  Grade 4 – Cell’s immature and undifferentiated  CANCER STAGING  Staging is the classification of the extent of the disease. There are several types of staging methods. The tumor, node, metastases (TNM) system classifies cancer by tumor size (T), the degree of regional spread or node involvement (N), and distant metastasis (M).  TUMOR (T)  To – No evidence of tumor  Tis - Carcinoma in situ (limited to surface cells)  T1-T4 – amount of tumor has been grown or increasing tumor size  NODE (N)  N0 - No lymph node involvement N1-4 Increasing degrees of lymph node involvement  Nx Lymph node involvement cannot be assessed  CANCER STAGING  METASTASES (M)  M0 No evidence of distant metastases  M1 Evidence of distant metastases CARE OF PATIENTS WITH CANCER  CARE OF PATIENTS WITH CANCER PATHOPHYSIOLOGY Cancer cells differ from normal cells in size, structure, function, and growth rate. These malignant cells lack the normal controls of growth seen in healthy cells, and grow uncontrollably. This uncontrolled growth allows the cancer cells to invade adjacent structures and then destroy surrounding tissues and organs. Malignant cells may also metastasize to other areas of the body through the cardiovascular or lymphatic systems. This uncontrolled growth and spread of cancer cells can eventually interfere with one or more of a person's vital organs or functions and possibly lead to death. The primary sites of cancer metastasis are the bone, the lymph nodes, the liver, the lungs, and the brain  CARE OF PATIENTS WITH CANCER There are two broad categories of genes that are affected: Oncogenes – these are cancer causing genes. They may be normal genes which are expressed at inappropriately high levels in patients with cancers or they may be altered or changed normal genes due to mutation. In both cases these genes lead to cancerous changes in the tissues. Tumor suppressor genes – these genes normally inhibit cell division and prevent survival of cells that have damaged DNA. In patients with cancer these tumor suppressor genes are often disabled. This is caused by cancer-promoting genetic changes. Typically, changes in many genes are required to transform a normal cell into a cancer cell. CARE OF PATIENTS WITH CANCER Carcinoma of the breast  Full term pregnancy at ages younger than 20 years have half the risk of nulliparous women or women over age 35 at their first birth  Other risk factors: first-degree relatives with breast cancer, atypical hyperplasia, race/ethnicity, estrogen exposure, breast density, radiation exposure Carcinoma of the breast: Risk factors  Diet – coffee decreases risk and moderate to heavy consumption of alcohol increases risk  Obesity  Exercise  Breastfeeding – the longer you breastfeed, the greater the reduction risk  Environmental toxins  Tobacco  Major risk factors for the development are hormonal and genetic Carcinoma of the breast  Carcinoma in-situ or DCIS (ductal carcinoma in-situ)  LCIS (lobular carcinoma in-situ)  Invasive ductal carcinoma in-situ  Invasive lobular carcinoma in-situ  Medullary carcinoma  Mucinous (colloid) carcinoma  Tubular carcinoma BREAST CANCER  Classified as invasive when it penetrates the tissue surrounding the mammary duct and grows in an irregular pattern  Metastasis occurs via lymph nodes  Common sites of metastasis are the bone, lungs brain, liver and skin  Diagnosis is made by breast biopsy through a needle aspiration or by surgical removal of the tumor Carcinoma of the breast  Major prognostic factors: 1. Invasive carcinoma vs in-situ disease 2. Distant metastases 3. Lymph node metastases 4. Tumor size 5. Locally advanced disease  Staging Stage T: Primary Lymph Node M: distant 5-year survival Cancer (LNs) metastases (%) 0 DCIS or LCIS None Absent 92 I Invasive None Absent 87 carcinoma 2cm 1 to 3 positive Absent 5cm 1 to 3 positive Absent 46 Any size >4 positive Absent With skin or 0 to 10 positive Absent chest wall involvement o IV Any size Negative or Present 13 carcinoma positive LNs Carcinoma of the breast- Findings  Presence of lump  Nipple inversion  Breast discharges  Changes in the skin – “peau d’orange”  Diagnostics: mammography, UTZ, MRI (possibly), biopsy NIPPLE RETRACTION ASYMMETRY DIMPLING PEAU D’ ORANGE INTERVENTIONS Nonsurgical Chemotherapy Radiationtherapy Hormonal manipulation Surgical Carcinoma of the breast  Lumpectomy  Partialor Segmental Mastectomy or Quadrantectomy  Total Mastectomy  Modified Radical Mastectomy  Radical Mastectomy () Lumpectomy  This is also referred to as breast-conserving therapy.  The surgeon removes the cancerous area and a surrounding margin of normal tissue.  A second incision may be made in order to remove the lymph nodes.  This treatment aims to maintain a normal breast appearance when the surgery is over. During a partial or segmental mastectomy or quadrantectomy, the surgeon removes more breast tissue than with a lumpectomy. With a simple or total mastectomy, the entire breast is removed, but no lymph nodes are removed in this procedure The surgeon removes all of the breast tissue along with the nipple in a modified radical mastectomy. Lymph nodes in the armpit are also removed. The chest muscles are left intact. Radical mastectomy The surgeon removes all of the breast tissue along with the nipple, lymph nodes in the armpit, and chest wall muscles under the breast. MONITORING AND MANAGING POTENTIAL COMPLICATIONS 1. Lymphedema Lymphedema can occur any time after an axillary 2. Hematoma Formation Hematoma formation may occur after either mastectomy or breast conservation. 3. Infection NURSING INTERVENTIONS 1. Monitor for adverse effects of radiation therapy such as fatigue, sore throat, dry cough, nausea, anorexia. 2. Monitor for adverse effects of chemotherapy; bone marrow suppression, nausea and vomiting, alopecia, weight gain or loss, fatigue, stomatitis, anxiety, and depression. 3. Realize that a diagnosis of breast cancer is a devastating emotional shock to the woman. 4. Provide psychological support to the patient throughout the diagnostic and treatment process. 5. Involve the patient in planning and treatment. NURSING INTERVENTIONS 6. Describe surgical procedures to alleviate fear. 7. Prepare the patient for the effects of chemotherapy, and plan ahead for alopecia, fatigue. 8. Administer antiemetics prophylactically, as directed, for patients receiving chemotherapy. 9. Administer I.V. fluids and hyperalimentation as indicated. 10.Help patient identify and use support persons or family or community. 11.Suggest to the patient the psychological interventions may be necessary for anxiety, depression, or sexual problems. 12.Teach all women the recommended cancer-screening procedures. BREAST SELF-EXAMINATION  Performing Breast Self-Examination (BSE) Perform 7 to 10 days after menses Postmenopausal clients or clients who have had a hysterectomy should select a specific day of the month and perform BSE monthly on that day CANCER OF THE LUNGS  Lung cancer is the abnormal, uncontrolled cell growth in lung tissues, resulting in a tumor. A tumor in the lung may be primary when it develops in lung tissue. It may be secondary when it spreads (metastasizes) from cancer in other areas of the body, such as the liver, brain, or kidneys. There are two major categories of lung cancer—small cell and non-small cell.  Repetitive exposure to inhaled irritants increases a person’s risk for lung cancer. Cigarette smoke, occupational exposures, air pollution containing benzopyrenes, and hydrocarbons have all been shown to increase risk.  1. Small cell: Oat cell—fast-growing, early metastasis  2. Non-small cell:  Adenocarcinoma—moderate growth rate, early metastasis  Squamous cell—slow-growing, late metastasis  Large cell—fast-growing, early metastasis CARE OF PATIENTS WITH CANCER OF THE LUNGS CARE OF PATIENTS WITH CANCER OF THE LUNGS CARE OF PATIENTS WITH CANCER OF THE LUNGS Nursing Diagnosis  Risk for infection  Impaired Gas Exchange related to ventilation- perfusion imbalance  Altered Nutrition: Less Than Body Requirements  Risk for Ineffective Therapeutic Regimen Management  Risk for Impaired Skin Integrity.  Anticipatory Grieving CANCER OF THE LIVER  Liver cancer is cancer that begins in the cells of your liver. Your liver is a football-sized organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach.  Several types of cancer can form in the liver. The most common type of liver cancer is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Other types of liver cancer, such as intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common. Risk factors include: chronic infection of hepatitis b or c virus; liver cirrhosis; inherited liver diseases such as hemochromatosis and Wilson’s disease; diabetes; nonalcoholic fatty liver disease; exposure to aflatoxins; and excessive alcohol consumption. CARE OF PATIENTS WITH CANCER OF THE LIVER PATHOPHYSIOLOGY  Liver cancer happens when liver cells develop changes (mutations) in their DNA. A cell's DNA is the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of cancerous cells.  Sometimes the cause of liver cancer is known, such as with chronic hepatitis infections. But sometimes liver cancer happens in people with no underlying diseases and it's not clear what causes it. CARE OF PATIENTS WITH CANCER OF THE LIVER CARE OF PATIENTS WITH CANCER OF THE LIVER Complications  Acute graft rejection post liver transplantation  Liver failure or kidney failure (due to impaired blood flow to the kidneys) CARE OF PATIENTS WITH CANCER OF THE STOMACH  Stomach cancer usually begins in the mucus- producing cells that line the stomach. This type of cancer is called adenocarcinoma.  For the past several decades, rates of cancer in the main part of the stomach (stomach body) have been falling worldwide. During the same period, cancer in the area where the top part of the stomach (cardia) meets the lower end of the swallowing tube (esophagus) has become much more common. This area of the stomach is called the gastroesophageal junction. CARE OF PATIENTS WITH CANCER OF THE STOMACH RISK FACTORS  Factors that increase your risk of stomach cancer located in the stomach body include:  A diet high in salty and smoked foods  A diet low in fruits and vegetables  Family history of stomach cancer  Infection with Helicobacter pylori  Long-term stomach inflammation  Pernicious anemia  Smoking  Stomach polyps CARE OF PATIENTS WITH CANCER OF THE STOMACH STAGES OF STOMACH CANCER The stages of adenocarcinoma of the stomach or esophagus include: Stage I. At this stage, the tumor is limited to the top layer of tissue that lines the inside of the esophagus or stomach. Cancer cells also may have spread to a limited number of nearby lymph nodes. Stage II. The cancer at this stage has spread deeper, growing into a deeper muscle layer of the esophagus or stomach wall. Cancer may also have spread to more of the lymph nodes. Stage III. At this stage, the cancer may have grown through all the layers of the esophagus or stomach and spread to nearby structures. Or it may be a smaller cancer that has spread more extensively to the lymph nodes. Stage IV. This stage indicates that the cancer has spread to distant areas of the body. CARE OF PATIENTS WITH CANCER OF THE STOMACH PATHOPHYSIOLOGY  In general, cancer begins when an error (mutation) occurs in a cell's DNA. The mutation causes the cell to grow and divide at a rapid rate and to continue living when a normal cell would die. The accumulating cancerous cells form a tumor that can invade nearby structures. And cancer cells can break off from the tumor to spread throughout the body. Gastroesophageal junction cancer is associated with having gastrointestinal reflux disease (GERD) and, less strongly, with obesity and smoking. GERD is a condition caused by frequent backflow of stomach acid into the esophagus. There is a strong correlation between a diet high in smoked and salted foods and stomach cancer located in the main part of the stomach. As the use of refrigeration for preserving foods has increased around the world, the rates of stomach cancer have declined. CARE OF PATIENTS WITH CANCER OF THE STOMACH CARE OF PATIENTS WITH CANCER OF THE STOMACH NURSING DIAGNOSIS Risk for infection Impaired Gas Exchange related to ventilation- perfusion imbalance Acute Pain Altered Nutrition: Less Than Body Requirements Risk for Ineffective Therapeutic Regimen Management Risk for Impaired Skin Integrity. Anticipatory Grieving CARE OF PATIENTS WITH CANCER OF THE COLON COLON CANCER  Colon cancer is a type of cancer that begins in the large intestine (colon). The colon is the final part of the digestive tract  Colon cancer typically affects older adults, though it can happen at any age. It usually begins as small, noncancerous (benign) clumps of cells called polyps that form on the inside of the colon. Over time some of these polyps can become colon cancers.  Polyps may be small and produce few, if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying and removing polyps before they turn into cancer.  If colon cancer develops, many treatments are available to help control it, including surgery, radiation therapy and drug treatments, such as chemotherapy, targeted therapy and immunotherapy.  Colon cancer is sometimes called colorectal cancer, which is a term that combines colon cancer and rectal cancer, which begins in the rectum.  Adenocarcinoma is the most common type of colon cancer and may spread by direct extension through the walls of the intestine or through the lymphatic or circulatory system. Metastasis is most often to the liver. CARE OF PATIENTS WITH CANCER OF THE COLON CARE OF PATIENTS WITH CANCER OF THE COLON RISK FACTORS  Factors that may increase your risk of colon cancer include: Older age. Colon cancer can be diagnosed at any age, but a majority of people with colon cancer are older than 50.  African-American race. Inflammatory intestinal conditions. Inherited syndromes that increase colon cancer risk.  Family history of colon cancer. Low-fiber, high-fat diet. Diabetes. Obesity.  Smoking. Alcohol. Radiation therapy for cancer. CARE OF PATIENTS WITH CANCER OF THE COLON  Duke’s Classification of Colorectal Cancer  Stage A: confined to bowel mucosa, 80-90 % 5 years survival rate  Stage B: invading muscle wall  Stage C; Lymph node involvement  Stage D: Metastases or locally unresectable tumor, less than 5% , 5 years survival rate. CARE OF PATIENTS WITH CANCER OF THE COLON CARE OF PATIENTS WITH CANCER OF THE COLON CARE OF PATIENTS WITH CANCER OF THE COLON NURSING DIAGNOSIS  Risk for infection  Impaired Gas Exchange related to ventilation- perfusion imbalance  Acute pain  Altered Nutrition: Less Than Body Requirement  Risk for Ineffective Therapeutic Regimen Management  Risk for Impaired Skin Integrity.  Anticipatory Grieving CARE OF PATIENTS WITH CANCER OF THE OVARIES  Ovarian cancer is a type of cancer that begins in the ovaries. The female reproductive system contains two ovaries, one on each side of the uterus. The ovaries — each about the size of an almond — produce eggs (ova) as well as the hormones estrogen and progesterone.  Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully. Surgery and chemotherapy are generally used to treat ovarian cancer CARE OF PATIENTS WITH CANCER OF THE OVARIES RISK FACTORS  Factors that can increase your risk of ovarian cancer include:  Older age. Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years.  Inherited gene mutations. A small percentage of ovarian cancers are caused by gene mutations you inherit from your  parents. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast  cancer gene 2 (BRCA2). These genes also increase the risk of breast cancer.  Other gene mutations, including those associated with Lynch syndrome, are known to increase the risk of ovarian  cancer.  Family history of ovarian cancer. People with two or more close relatives with ovarian cancer have an increased risk  of the disease.  Estrogen hormone replacement therapy, especially with long-term use and in large doses.  Age when menstruation started and ended. Beginning menstruation at an early age or starting menopause at a later age, or both, may increase the risk of ovarian cancer. CARE OF PATIENTS WITH CANCER OF THE OVARIES TYPES OF OVARIAN CANCER  The type of cell where the cancer begins determines the type of ovarian cancer you have. Ovarian cancer types include:  Epithelial tumors, which begin in the thin layer of tissue that covers the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors.  Stromal tumors, which begin in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed at an earlier stage than other ovarian tumors. About 7 percent of ovarian tumors are stromal.  Germ cell tumors, which begin in the egg-producing cells. These rare ovarian cancers tend to occur in younger women. CARE OF PATIENTS WITH CANCER OF THE OVARIES PATHOPHYSIOLOGY  It's not clear what causes ovarian cancer, though doctors have identified factors that can increase the risk of the disease. In general, cancer begins when a cell develops errors (mutations) in its DNA. The mutations tell the cell to grow and multiply quickly, creating a mass (tumor) of abnormal cells. The abnormal cells continue living when healthy cells would die. They can invade nearby tissues and break off from an initial tumor to spread elsewhere in the body (metastasize). CARE OF PATIENTS WITH CANCER OF THE OVARIES CARE OF PATIENTS WITH CANCER OF THE OVARIES Nursing Diagnosis  Risk for Ineffective Airway Clearance  Risk for infection  Acute pain  Impaired skin integrity related to Surgical removal of skin/tissue; altered circulation, presence of edema, drainage; changes in skin elasticity, sensation; tissue destruction -(radiation)  Altered Nutrition: Less Than Body Requirements  Anticipatory Grieving  Situational low self-esteem related to Biophysical factors: disfiguring surgical procedure CARE OF PATIENTS WITH CANCER OF THE CERVIX AND UTERUS CERVICAL CANCER  Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina.  Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer.  When exposed to HPV, the body's immune system typically prevents the virus from doing harm. In a small percentage of people, however, the virus survives for years, contributing to the process that causes some cervical cells to become cancer cells.  You can reduce your risk of developing cervical cancer by having screening tests and receiving a vaccine that protects against HPV infection. CARE OF PATIENTS WITH CANCER OF THE CERVIX AND UTERUS TYPES OF CERVICAL CANCER  The type of cervical cancer that you have helps determine your prognosis and treatment. The main types of cervical cancer are:  Squamous cell carcinoma. This type of cervical cancer begins in the thin, flat cells (squamous cells) lining the outer part of the cervix, which projects into the vagina. Most cervical cancers are squamous cell carcinomas.  Adenocarcinoma. This type of cervical cancer begins in the column-shaped glandular cells that line the cervical canal.  Sometimes, both types of cells are involved in cervical cancer. Very rarely, cancer occurs in other cells in the cervix. CARE OF PATIENTS WITH CANCER OF THE CERVIX AND UTERUS RISK FACTORS:  Risk factors for cervical cancer include:  Many sexual partners. The greater your number of sexual partners — and the greater your partner's number of sexual partners — the greater your chance of acquiring HPV.  Early sexual activity. Having sex at an early age increases your risk of HPV. Other sexually transmitted infections (STIs). Having other STIs — such as chlamydia, gonorrhea, syphilis and  HIV/AIDS — increases your risk of HPV. A weakened immune system. You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV. Smoking. Smoking is associated with squamous cell cervical cancer. Exposure to miscarriage prevention drug. If your mother took a drug called diethylstilbestrol (DES) while pregnant in CARE OF PATIENTS WITH CANCER OF THE CERVIX AND UTERUS PATHOPHYSIOLOGY  Cervical cancer begins when healthy cells in the cervix develop changes (mutations) in their DNA. A cell's DNA contains the instructions that tell a cell what to do.  Healthy cells grow and multiply at a set rate, eventually dying at a set time. The mutations tell the cells to grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from a tumor to spread (metastasize) elsewhere in the body.  It isn't clear what causes cervical cancer, but it's certain that HPV plays a role. HPV is very common, and most people with the virus never develop cancer. This means other factors — such as your environment or your lifestyle choices — also determine whether you'll develop cervical cancer. CARE OF PATIENTS WITH CANCER OF THE CERVIX AND UTERUS CARE OF PATIENTS WITH CANCER OF THE CERVIX AND UTERUS LEUKEMIAS Leukemia  Neoplastic proliferation of WBC  Leukocytosis (increased level of WBC in the circulation)  Hematopoiesis is characterized by rapid, continuous turnover of cells  Unregulated proliferation of WBCs in the BM- the common feature of Leukemias 100 Incidence  2004 – estimated 33,440 new cases diagnosed  10x likelier to occur on adulthood than in childhood  Overall incidence: M>F  More often in the older adult, with more than half the cases occurring in the 6th decade  CML: seen more frequently in adults and accounting for a small proportion of the overall leukemias  ALL: makes up the smallest proportion of leukemias, and is most frequently seen among pediatric patients Risk Factors  Diagnostic and ionizing radiation  Cigarette smoke  Electromagnetic fields or high power lines  Alkylating agents is associated with secondary AML  Viruses – T and B cell lymphoma  Types of Leukemia  Acute leukemia  Abruptin onset, often occurring in few weeks  WBC development is halted at the blast phase  Progressesvery rapidly  Death occurs within weeks to months without aggressive treatment  Chronic leukemia  Evolve over a period of months to years  Majority of the WBC is mature  Progresses more slowly  The disease trajectory can extend to years 103 ACUTE MYELOID LEUKEMIA (AML)  Results from defect in the hematopoietic stem cell that dfferentiates into all myeloid cells, Monocytes and granulocytes  All age groups are affected  60 y/o peak incidence  Patients who are older or who have more undifferentiated form of AML tend to have Worst prognosis 104 ACUTE MYELOID LEUKEMIA (AML)  Patient survive an average of less than 1 year with treatment  Death usually a result of infection or hemorrhage 105 ACUTE MYELOID LEUKEMIA (AML) Clinical manifestation:  Fever and infection  Weakness and fatigue  Bleeding tendencies pain from enlarged liver and spleen  Bone pain due to expansion of the marrow 106 ACUTE MYELOID LEUKEMIA (AML) Assessment findings:  Decrease erythrocytes and platelets  Causing Ecchymosis and Petechiae  Most common sites for bleeding:  GI  Pulmonary  Intracranial 107 ACUTE MYELOID LEUKEMIA (AML) Medical Management:  Overall objective of Treatment:  To achieve a complete remission in which there is no detectable evidence of residual leukemia remaining in the bone marrow  Induction therapy- aggressive administration of chemotherapy (daunorubicin, cytarabine, mitoxantrone, idarubicin) 108 ACUTE MYELOID LEUKEMIA (AML)  Consolidation therapy (Postremission therapy)  Eliminate any residual leukemic cells that are not clinically detectable, thereby diminishing the chance for recurrence.  70% of patient with AML experience a relapse  BMT  PBSCT  Cure AML in 25%-50% of patient who are at high risk for relapse or had relapse 109 ACUTE MYELOID LEUKEMIA (AML) Recent advances: Anti-CD33 antibody- potent antitumor antibiotic, calicheamicin Gemtuzumab Ozogamicin (Mylotarg) Supportive therapy 110 ACUTE MYELOID LEUKEMIA (AML) Complications: Tumor Lysis Syndrome- increased uric acid levels. 111 CHRONIC MYELOID LEUKEMIA (CML)  Arises from the mutation of the myeloid stem cell  In 90-95% of patient with CML, a section of the DNA is found to be missing from Chromosome 22 translocated onto chromosome 9  Specific Location: changes is on the BCR gene of chromosome 22 and the ABL gene of chromosome 9 112 CHRONIC MYELOID LEUKEMIA (CML)  This is uncommon in people younger than 20 y/o  Incidence increases with age (median age, 40-50 y/o)  Overall median life expectancy is 3-5 years 113 CHRONIC MYELOID LEUKEMIA (CML) Clinical Manifestations:  WBC count commonly exceeds 100,000/mm3  Enlarged, tender spleen  Malaise  Anorexia ,Weight loss  SOB, Confusion  3 stages of CML  Chronic  Accelerated or Blast crisis 114 CHRONIC MYELOID LEUKEMIA (CML) Medical Management:  Imatinib mesylate (Gleevec) A tyrosine kinase inhibitor  Works by blocking signals within the leukemic cells that express the BCR-ABL protein  Preventing a series of chemical reactions that cause the cell to grow and divide  Useful in the chronic phase of illness  Interferon alpha  For conversion of the malignant stem cell to normal in the chronic phase 115 CHRONIC MYELOID LEUKEMIA (CML)  Chemotherapeutic agent (Hydroxyurea (Hydrea) or Busulfan (Myleran) BM suppression  BMT  PBSCT 116 ACUTE LYMPHOCYTIC LEUKEMIA (ALL)  Results from uncontrolled proliferation of immature cells (Lymphoblast) derived from the Lymphoid stem cell  The most common in young children  Boys affected more than girls  Peak incidence is 4 y/o  After age 15 y/o, ALL is relatively uncommon 117 ACUTE LYMPHOCYTIC LEUKEMIA (ALL)  Increasing age appears to be associated in diminish survival  >80% of children survive at least 5 years  Even relapse occurs, resumption of Induction therapy can often achieve a second complete remission  BMT may be successful even after 2nd relapse 118 ACUTE LYMPHOCYTIC LEUKEMIA (ALL) Clinical Manifestations:  Enlarged liver or spleen  Fever  Pale, Bruises  Ulcerated lips and mouth  HA  Vomiting (because of meningeal involvement) 119 ACUTE LYMPHOCYTIC LEUKEMIA (ALL) Medical Management:  Complete Remission- expected outcome of treatment  Corticosteroids  Chemotherapy  Intrathecal chemotherapy  Infections are common 120 CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)  Common malignancy in older adults  2/3 of all patients older than 60 years of age upon diagnosis  Average survival time for patients with CLL- 14 years (early stage) to 2.5 years (late stage)  CLL typically derives from a malignant clone of B Lymphocyte  The antigenCD52 is prevalent on the surface of many of these leukemic B cells. 121 CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) Clinical Manifestations:  Diagnosed incidentally during routine physical examination or during the course of treatment of another disease  Lymphadenopathy  Splenomegaly  Fever  Infection  Unintentional weight loss 122 CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) Medical Management:  NO requirement for Early stages  Later stages  Chemotherapy with Corticosteroid and Chlorambucil (Leukeran)  Rituximab (Monoclonal antibody)  Alemtuzumab (Campath)  Targets the CD52 antigen commonly found on CLL cells 123 CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) Nursing Management:  Managing Mucositis  Improving Nutritional intake  Easing pain and discomfort  Decreasing fatigue and deconditioning  Maintaining fluid and electrolyte balance  Improving self care managing anxiety and grief  Encouraging spiritual well-being 124