Cancer Classification & Carcinogenesis PDF

5F-A- Cellular Aberrations- Tumors, Neoplasms CANCER CLASSIFICATION CANCER cells ignore growth-regulating signals i...

5F-A- Cellular Aberrations- Tumors, Neoplasms CANCER CLASSIFICATION CANCER cells ignore growth-regulating signals in the surrounding environment  Solid tumors are associated with the organs from which they develop  is defined as a malignant neoplastic disorder that can involve all body such as breast cancer or lung cancer while the hematological cancers organs with manifestations that vary according to the body system originate from blood forming tissue such as leukemia lymphoma and affected and the type of tumor cells. multiple myeloma  Cells lose their normal growth controlling mechanism and the growth GRADING AND STAGING of cells is uncontrolled.  These are the methods used to describe the tumor.  Cancer produces serious health problems such as impaired immune and  These methods describe the extent of the tumor, the extent to which hematopoietic or blood producing function altered gastrointestinal malignancy has increased in size, the involvement of the regional nodes structure and function motor and sensory deficits and decreased and metastatic development respiratory function ↑ Help us predict prognosis CARCINOGENESIS GRADING - classifies the cellular aspects of the cancer and is an indicator of tumor  is the malignant transformation of a normal cell into a cancer cell growth rate and speed. pathologic of cells (histologic characteristics) classification tumor  it is the ability of a carcinogen to invade normal cells I: Cells differ slightly from normal and are well-differentiated (MILD  4 steps: carcinogenesis cause mutations in the cellular DNA DYSPLASIA) o Initiation- the first exposure of a normal cell to a carcinogen II: Cells are more abnormal and are moderately differentiated Molecular process I o Promotion- is a repeated or constant exposure to (Removecarcinogenis (MODERATE DYSPLASIA) REVERSIBLE Proliferation initiated tells with expression carcinogens manifestations expansion genetic and of abnormal of information increased or III: Cells are very abnormal and are poorly differentiated (SEVERE o Progression increasingly ~ malignant Altered cells exhibit its behavior. DYSPLASIA) o Metastasis rapid proliferative growth - IV: Cells are immature (ANAPLASIA) and undifferentiated cell of origin METASTASIS is difficult to determine  the movement of the cancer cells from their original location to other sites. Benign ROUTES OF METASTASIS Grade 1 GX Grade 2 Gl  Local seeding - there is a distribution of cancer cells in the local area of Glands are small, well-formed, and Glands are larger and have more differentiated assessed Grade cannot be well the primary tumor close together Cundetermined grade) space between them (low grade)  Bloodborne metastases - tumor cells enter the blood which is the most common cause of cancer spread Malignant  Lymphatic spread - primary sites rich in lymphatics are more Grade 3 G3 Grade 4 Grade 5 susceptible to early metastatic spread Glands are further Hardly any glands, There are no glands, apart, darker, and have cancer cells have lost and sheets of cancer COMMON SITES OF METASTASIS different shapes their ability to form cells are present diff- diff.  moderately Bladder Cancer  lungs, bone, liver, Pelvic/retroperitoneal structures (intermediate grade) glands poorly (high grade) throughout the tissue  Brain Tumor  CNS undifferentiated (high grade  Breast Cancer  Bone, lungs, brain, liver STAGING - classifies the severity and clinical aspects of the cancer and degree of  Lung Cancer  Brain, liver metastasis at diagnosis  Prostate Cancer  Bone, spine, lung, liver, kidneys 0: Carcinoma in situ  Testicular Cancer Lung, bone, liver, adrenal glands, Retroperitoneal I: Tumor limited to the tissue of origin; localized tumor growth (cancer lymph nodes is localized in the pleura) ⑧ ⑧ Breast Cancer colorectal Cancer -o > - bone liver , lung , brain liver II: Limited local spread (cancer has spread to a single lung and lymph DIFFERENCE BETWEEN NORMAL AND ABNORMAL nodes) CHARACTERISTICS NORMAL CELLS ABNORMAL CELLS III: Extensive local and regional spread (tumor is extensive, spreading to Cell Division Limited; contact Rapid or continuous; not the lungs, chest wall, abdomen and chest cavity inhibited contact inhibited IV: Distant metastasis (cancer has metastasized throughout the chest, Appearance Specific morphology Anaplastic morphology (some abdomen, neck and bones) features doesn’t have nuclei) TNM CLASSIFICATION SYSTEM (only solid tumors) (blood-related not included) Differentiated Perform specific Lose some or all differentiated  T - Refers to tumur size, extent, penetration (depth) extent primary of tumor Functions differentiated functions o TX - Primary tumor cannot be assessed functions o T0 - No evidence of primary tumor Adherence Tightly Loosely o TIS - Carcinoma in situ Tis Migration Non- migratory Migratory o T1, T2, T3, T4 - Increasing size / local extent of primary Growth Orderly and well Invasion; not contact inhibited tumor regulated manner  N - Stands for node - Indicates the number of lymph nodes with cancer Chromosomes Euploid Aneuploid regional lymph or the location of cancer involved lymph nodes absence/presence extent The and of Mode Of Growth Grows by expansion Gross at the periphery and o NX - Regional lymph nodes cannot be assessed node and does not sends out processes that o N0 - No regional lymph node metastasis infiltrate surrounding infiltrate and destroy o N1, N2, N3 - Increasing involvement of regional lymph tissues surrounding cells. nodes Rate Of Growth Slow Variable and depends on level  M - Refers to metastasis - The spread of cancer cells to other parts of of differentiation the body The absence/presence distant metastasis of Metastasis Does not spread Gains access to the blood and o MX - cannot be assessed lymphatic channels and o M0 - no distant metastasis metastasize to other areas of o M1 - distant metastasis present the body Tissues Destruction Does not usually Often causes extensive tissue SURVIVABILITY RATE cause tissue damage damage as the tumor Stage Location Survivability TNM unless its location outgrowth its blood supply to 0 Cancer in situ interferes with blood the area 1 Tumor limited to disease of 70 - 80% T1, N0, M0 flow origin Ability To Cause Does not usually Usually causes cell death apoptosis 2 Lymphatic involvement; 50 + 5% T2, N1, M0 Cell Death cause cell death Programmed cell death - limited spread Capsule Encapsulated Never contained 3 Extensive local and regional 20 + T3, N2, M0 Progression Slowly progressive Usually progressive spread PROGNOSIS Maybe fatal if tumor Fatal 4 Widespread metastasis No survival rate T4, N3, M1 is inaccessible RECURRENCE Rare Common FACTORS IN CANCER DEVELOPMENT ENVIRONMENTAL FACTORS A. Chemical carcinogen  Industrial chemicals (asbestos)  Medications  Tobacco (nicotine, tar) B. Physical carcinogen  Ionizing radiation (diagnostic and therapeutic x-rays)  UV radiation (sun, tanning beds and germicidal lights)  Chronic irritation  Tissue trauma C. Viral carcinogen  Epstein-Barr virus  Hepatitis B virus  Human papillomavirus D. Helicobacter pylori infection  Local incision- ↑ s ipriman wrmradicaexci io · Salvage - unique nini truch LIFESTYLE DIFFERENT APPROACH IN TREATING CANCER A. Obesity and Dietary Factors SURGERY - Is indicated to diagnose, stage and treat certain types of cancer.  G Surgical Remove at entit Tumor Diet  High in Preservatives Types of surgery:  risk reduction surgery Contaminants 1. Prophylactic surgery -.  Additives  It is performed in clients with existing pre-malignant condition or a  Alcohol known family history of genetic mutation that strongly predisposes  Nitrates the person to the development of cancer. It is an attempt to remove GENETICS the tissue or organ at risk and thus prevent the development of  Inherited predisposition to a specific cancer (it has been said that cancer the dna is already embedded with such specific disease and if you 2. Curative surgery will be exposed with another factor, there is a greater chance that  All that grows a microscopic tumor is removed or destroyed you will be activating this dormant dna or this dormant 3. Control (cytoreductive or debulking) surgery chromosome lying on your dna)  Is a debulking procedure that consists of removing a large portion AGE of a locally invasive tumor such as advanced ovarian cancer. Surgery  Advancing age is a significant risk factor for the development of decreases the number of cancer cells and therefore it may increase cancer as well the chance that other therapies will be successful IMMUNE FUNCTION 4. Palliative surgery - to reliefJ umptom , make po. comfortable , promote QOL  The incidence of cancer is also higher with immunosuppressed  is performed to improve the quality of life during the survival time. · individuals such as those with acquired immunodeficiency It is performed to reduce pain, relieve obstructions in the syndrome (AIDS) and organ transplantations who are taking gastrointestinal or urinary tract, relieve pressure on the brain or immunosuppressive medications because their immune system has spinal cord, prevent hemorrhage and remove infected or ulcerated been severely compromised allowing opportunistic pathogens from tumors or drain abscess the environment to invade and cause malformations in the cells. 5. Reconstructive or rehabilitative surgery  Avoiding these known potential carcinogens, or modification of the  Is performed to improve the quality of life by maximal function and factors associated with the development of cancer are ways to appearance like those of breast reduction or breast reconstruction prevent the development of the disease after a mastectomy Adverse effects of surgery: - GENERALIZED SIGNS AND SYMPTOMS OF CANCER 1. Loss or loss of function of a specific body part. C - change in bowel or bladder habits sign of colorectal a common cancer 2. Reduced function as a result of organ loss A - any sore that does not heal (u should advise the person to have it checked skin/mouth skin oral cancer could be the 3. Scarring or disfigurement immediately) If located on the , cancer or cause vagina prostate from the bladder rectum could mean cervical 4. Grieving about altered body image or imposed change in lifestyle U - unusual bleeding or discharge bleeding or Any , , , colorectal cancer 5. Pain, infection, bleeding, thromboembolism T - thickening or lump in breast or elsewhere (it signifies that this is a tumor, u just A have to check if it is malignant or benign) Alumpon the breastcan be sign lump a of. cancer on a a test I - indigestion (which is an early sign of gastric cancer, which is also a common s/s CHEMOTHERAPY of other GI diseases) symptom esophagus can be a of stomach , throat , , or month cancer G, ↳ Phase RNA & protein  Kills or inhibits the reproduction of both the neoplastic cells and the O - obvious change in wart or mole (meaning there is proliferation of the cells and Synthesis occurs normal cells  S phase the characteristics of the cell in that certain wart or mole esp. for those who are ↳ DNA synthesis The effects are systemic because chemotherapy is usually occurs highly susceptible to skin cancer) Most sign common of skin cancer G2 Phase administered systemically. N - nagging cough or hoarseness (which is associated with any respiratory cancer) ↳ Premiotic phase DNA synthesis is  complete Normal cells most profoundly affected include those of the skin, A cough that lasts for a weeks or longer > - lung or throat cancer Mitosis Mitotic spindle form hair, lining of the gastrointestinal tract, spermatocytes, and DIAGNOSTIC EXAM FOR CANCER ↳> Duplicated chromosomes hematopoietic cells. separate dy cell division Cancer that is diagnosed at an early stage (stage I or II) before I had the chance to occurs  Combined with other therapies to increase therapeutic response grow big or spread to other areas of the body has more chances to be treated and to minimize immunosuppression. Combination of successfully. The diagram and study by cancer research UK shows that TEN YEAR chemotherapy is planned by the doctor so that medications with SURVIVAL for all cancer types in the UK is better if the disease is diagnosed at an overlapping toxicities or the time during which bone marrow early stage. So here are the different diagnostic examination and even a cell activity and white blood cell counts are at their lowest are not assessment for early detection of cancer: administered at or near the same time to minimize severe  Mammography immunosuppression  Papanicolaou (pap) test  May be combined with other treatments such as surgery and  Rectal exams and stools for occult blood radiation  Sigmoidoscopy, colonoscopy  Common side effects are:  Breast Self-examination and clinical breast examination - Fatigue. Due to the destruction of both neoplastic cells and normal cells  Testicular self-examination - Alopecia. Due to the effects of the chemotherapeutic drug in the  Skin inspection hair - Nausea and vomiting. effect of the chemotherapeutic drug into Biopsy the GI tract  Confirmatory tests to diagnose cancer - Mucositis  It provides histological proof of malignancy - Skin changes  Involves surgical incision to obtain a small piece of tissue sample for - Myelosuppression (neutropenia, anemia, and microscopic examination thrombocytopenia). The last three are due to the suppression of Types ↓ My Fire Made nion on : , the reproduction of a certain blood component so when you A. Needle Aspiration Biopsy - Aspiration of cells with the use of a fine needle biopsy examine the CBC of your patient, it is expected that the patient will -Remove mals of too large B. Incisional Biopsy - Removal of a wedge of suspected tissue from a large mass be manifesting neutropenia, anemia, and thrombocytopenia. -> For small issue nemore C. Excisional Biopsy - Complete removal of the entire lesion D. Staging - Multiple needle or incisional biopsies in tissues where metastasis is a adjurant therapy RADIATION THERAPY Read ~ neo suspected or likely  Destroyed cancer cells with minimal exposure of the normal cells to the damaging effects of radiation. The damaged cells die of become TISSUE EXAMINATION unable to divide A. Frozen Section 30 results hour  Frozen section mins to 1 - Effective on tissues directly within the path of the radiation beam  Speedy diagnosis because it only takes minutes to perform this test B. Permanent Paraffin Section TYPES OF RADIATION THERAPY USED TO TREAT CANCER:  Takes about 24 hours to be completed A. External beam radiation (teletherapy) commonly used most  Provides clearer details than the frozen section  The actual source of radiation is external to the client. Nursing Interventions  The client is not radioactive. No need for the patient to be isolated  Ensure informed consent has been obtained when he is in a teletherapy  Prepare the client for the diagnostic procedure B. Internal radiation (brachytherapy) Example of temporary implantation - high close includes localized or systemic radionuclide administration  Provide post procedure instructions depending on the type and location permanent-low geninfraction elization ↳  The radiation source comes into direct, continuous contact with of the procedure tumor tissues for a specific time. Other diagnostic Test to assess cancer:  Patient is radioactive. The radiation source is within the client which  Bone marrow Aspiration means the client emits radiation and can pose a hazard to others so  Chest Radiograph they need to be isolated  CBC B.1 Unsealed radiation source  Computer Tomography Scans  Administration is via the oral or IV route or by instillation into body  Cytologic studies Evaluation of tumor markers cavities  Liver Function Studies  The source is not confined completely into one body area and it  MRI enters body fluids and eventually is eliminated via various excreta  Proctoscopic Examination which are radioactive and harmful to others.  Radiographic Studies  Most of the source is eliminated from the body within 48 hours then  RadiostopeScanning neither the client nor the excreta is radioactive or harmful  Tumor Markers B.2 Sealed Radiation Source Procedure:  a sealed, temporary or permanent radiation source (solid implant) 1. Harvest is implanted within the tumor target tissues.  The client is radioactive but the excreta are not radioactive. The 2. Conditioning client emits radiation while the implant is in place but the excreta are not radioactive so even though the waste material of the patient 3. Transplantation is not radioactive but the client itself is radioactive so they still need to be isolated and their room should be with a led so a s to prevent 4. Engraftment the emission of radiation into the outside sources. 5. Post transplantation- signs of myelosuppression, infection, bleeding Removal of sealed radiation sources - The client is no longer radioactive after removal. COMPLICATIONS: These are some complications that can arise during the bone - Inform the client that cancer is not contagious. marrow transplantation. As mentioned above during post transplantation - Inform the client to follow the HCP’s prescription regarding resumption of period, the client remains without any natural immunity until the donor stem sexual intercourse if the implant was cervical or vaginal. cells begin to proliferate and the start of engraftment. - Advise the client who had a cervical or vaginal implant to notify the HCP if any A. Failure to engraft of the following occurs: severe diarrhea, frequent urination, urethral burning  The client recipient will die unless another transplantation is for more than 24 hours, hematuria, heavy vaginal bleeding, extreme fatigue, attempted and successful. If the transplanted stem cells fail to abdominal pain, fever, and other signs of infection. engraft, the client will die unless another transplantation is attempted and becomes successful. SIDE EFFECTS OF RADIATION THERAPY B. Graft-versus-host disease in allogenic transplants 1. Local skin changes and irritation  Although the recipient cannot recognize the donated stem cells as 2. Alopecia foreign or non-self because of the total immunosuppression, 3. Fatigue Incompetent cells of the donor recognize the recipient’s cells as 4. Altered taste sensation foreign and mount an immune response against them. Donor cells will be the one to attack the recipient's cell. Different Treatment Guides for Patient with Radiation Therapy ~  Managed by administration of immunosuppressive agents to avoid 1. Client Education guide: Radiation Therapy for Cancer suppressing the new immune system to such an extent that the  Wash the irritated area gently each day with warm water alone or client becomes MORE susceptible to infection or the transplanted with mild soap and water cells stop engrafting.  Use the hand rather than a washcloth to wash the area C. Hepatic veno-occlusive disease  Rinse soap thoroughly from the skin  Occlusion of the hepatic venules by thrombosis or phlebitis.  Take care not to remove the markings that indicate exactly where  Signs and symptoms: the beam of radiation =is to be focused ➔ RUQ abdominal pain  Dry the irritated area with patting motions rather than rubbing ➔ Jaundice - because of the occlusion of the hepatocytes causing a motions; use a clean, soft towel or cloth yellow discoloration into the skin  Use mo powders, ointments, lotions, opr creams on the skin at the ➔ Ascites radiation site unless they are prescribed by the radiologist ➔ weight gain due to the ascites  Wear soft clothing over the skin at the radiation site ➔ and hepatomegaly  Avoid wearing belts, buckles, straps, or any type of clothing that  Tx: Early detection is critical because there is no known way to open binds or rubs the skin at the radiation site. the hepatic valves/ vessels. The client will be treated w/:  Avoid exposure of the irritated area to the sun ➔ fluid administration  Avoid heat exposure. ➔ and supportive therapy 2. Care of The Clients with A Sealed Radiation Implant ~  Place the client in a private room with a private bath  Place a radiation precaution sign on the client’s door # - to CANCER-refer book /  Organize nursing tasks to minimize exposure to the radiation source DIFFERENT TYPES OF CANCER nursing assignments to a client with a radiation implant should be v LEUKEMIA rotated.  Group of hematological malignancies involving abnormal  Limit time to a 30 min per care provider per shift OVERPRODUCTION of leukocytes usually at an immature stage in  Wear a dosimeter film badge to measure radiation exposure the bone marrow.  Lead shielding may be used to reduce exposure to radiation.  Leukemia is classified with lymphocytic involvement and the  The nurse should never care for more than 1 client with a radiation duration of the symptom. implant at 1 time  Do not allow a pregnant nurse to take care for the client CLASSIFICATION OF LEUKEMIA  Do not allow children younger than 16 years or a pregnant woman 1. Acute Lymphocytic Leukemia to visit the client  Mostly lymphoblasts present in the bone marrow.  Limit visitors to 30 min per day, visitors should be at least 6 feet  Age of onset: younger than 15 years old. from the source 2. Acute Myelogenous Leukemia  Save bed linens and dressings until the source is removed. The  Mostly myeloblasts present in bone marrow. dispose of the linens and dressings in the usual manner  Age of onset: between 15-39 years old.  Other equipment can be removed from the room at any time 3. Chronic Lymphocytic Leukemia 3. Sealed Radiation Implant that Dislodges ~  Lymphocytes are abundant in the bone marrow 1. Encourage the client to lie still  Age of onset: after 50 years. 2. Use long-handled forceps to retrieve the radioactive source 4. Chronic Myelogenous Leukemia 3. Deposit the radioactive source in a lead container  Granulocytes are abundant in the bone marrow. 4. Contact the radiation oncologist  Age of onset: in the fourth decade. 5. Document the occurrence and the actions taken The 2 major types of leukemia as mentioned are your lymphocytic or the BONE MARROW TRANSPLANTATION involvement of abnormal cells from the lymphoid pathway and myelocytic or  Most commonly used in the treatment of leukemia and lymphoma, myelogenous involving the abnormal cells from the myeloid pathway. A but are also used to treat other cancers like neuroblastoma and leukemia may also be acute with a sudden onset or chronic with a slow onset multiple myeloma and persistent symptoms over a period of years  A procedure that replace stem cells that have been destroyed by  Affects the bone marrow causing anemia, leukopenia, the high doses of chemotherapy and/or radiation therapy. production of immature cells, thrombocytopenia, and a decline in  Goal of treatment: To rid the client of all leukemic or malignant cells immunity through treatment with high doses of chemotherapy and whole  Cause: usually unknown; appears to involve genetically damaged body irradiation. cells leading to transformation of cells from a NORMAL state to a Note: Because these treatments are damaging to the bone marrow cells. MALIGNANT state. Without the replacement of blood-forming stem cell function through  Risk factors: genetic, viral, immunological, and environmental transplantation, the client will die of infection or hemorrhage. factors like exposure to radiation, chemicals and medications such as previous chemotherapy Types of donor stem cells: 1. allogenic: donor is a sibling, parent or a person who is not related to the client ASSESSMENT with a similar tissue type or another person who is not related to the client or 1. Anorexia, fatigue, weakness, weight loss this is due to the destruction of the unrelated donor cells or the cell formation in the bone marrow 2. Syngenic: stem cells are from an identical twin. 2. Anemia 3. Autologous: 3. Overt bleeding  The most common type of Donation 4. Ecchymoses, petechiae  Client receives his or her own stem cells. These stem cells are 5. Prolonged bleeding after minor abrasions or lacerations this is due to the harvested during disease remission and are stored frozen to be re- thrombocytopenia present in a patient who has leukemia infused later on. 6. Elevated temperature because there is no longer a competent WBC that will  Provide soft foods that are cool to warm to avoid oral mucosa fight against infection damage. 7. Enlarged lymph nodes, spleen, liver. Remember that the spleen is the ground  Avoid injection if possible to prevent trauma to the skin and wherein the dead RBC or the graveyard for your RBCs so there is an enlargement bleeding; apply firm and gentle pressure to a needle-stick site for at because these immature RBCs will be disposed into the spleen. least 5 minutes or longer If needed. 8. Palpitations, tachycardia, orthostatic hypotension  Pad rails and sharp containers of the bed and furniture. 9. Pallor and dyspnea on exertion which is also a symptom of anemia  Avoid rectal suppositories, enemas and thermometers. 10. Headache  If the female client is menstruating, count the number of pads or 11. Bone pain and joint swelling tampons used. This is also part of our monitoring if a hemorrhage is 12. Normal, elevated, or reduced WBC count present. 13. Decreased hgb and hct levels  Instruct the client to use only an electric razor for shaving. 14. Decreased platelet count  Discourage the client from engaging in activities involving the use of 15. Upon Positive bone marrow biopsy identifying there is a positive leukemic sharp objectives; contact sports also need to be avoided. blast-phase cells  Instruct the client to avoid using NSAIDs and products that contain aspirin. Because it may aggravate bleeding. INFECTION A patient with leukemia is highly prone or susceptible to infection. FATIGUE AND NUTRITION  Can occur through auto contamination or cross-contamination. NURSING MANAGEMENT  WBC count may be extremely low during the period of greatest  Assist the client in selecting a well-balanced diet bone marrow depression, known as the NADIR.  Provide small, frequent meals (high calorie, high protein, high  Common sites of infection are: skin, respiratory tract and GI tract carbohydrate) that require little chewing to reduce energy  Infection is a major cause of death in the immunosuppressed client. expenditure at mealtimes  Allow adequate rest periods during care. NURSING MANAGEMENT  Do not perform activities unless they are essential; assist the client This is to prevent the occurrence of infection or management if there is already in scheduling important or pleasurable activities during periods of presence of infection. highest energy.  Frequent and thorough hand washing  Administer blood products for anemia as prescribed.  Staff and visitors who are sick should NOT be allowed to visit the client. Additional Interventions:  Strict aseptic technique for ALL procedures.  Chemotherapy: w/ administration of chemotherapeutics  Separate client’s supplies from other clients. Frequently used - IV Cytosine Arabinoside (7 days) materials should be kept in the client’s room only. - Daunorubicin (first 3 days)  Limit the number of staff and visitors to the client’s room to reduce - Induction therapy  aimed at achieving a rapid, complete risk of cross contamination. remission of all manifestations of the disease  Patient should be in a private room with doors closed at all times. If - Consolidation therapy  administered early in remission with the possible, it should have a high-efficiency particulate air filtration or aim of curing a laminar airflow system. We will also be placing the patient in a - Maintenance therapy  may be prescribed for months or years reverse isolation in which those who will come in and see the client following a successful induction and consolidation therapy and the will have to wear a mask. aim is to maintain remission  Fresh or raw fruits and vegetables (low bacteria), fresh flowers, live  Administer antibiotic, antibacterial, antiviral, and antifungal plants, stagnant water is not allowed inside the patient’s room. medications as prescribed  Client’s room should be cleaned daily  Administer colony-stimulating factors as prescribed (this is to boost  Assist the client in daily bathing using an antimicrobial soap. the immune system of the patient)  Initiate bowel program to prevent constipation and prevent rectal  Administer blood components as prescribed (to address trauma. thrombocytopenia, anemia, and neutropenia)  Avoid any unnecessary invasive procedures such as injections,  Maintain infection and bleeding precautions insertion of rectal thermometers and urinary catheterization.  Prepare the client for transplantation if indicated (so bone marrow  Change wound dressings daily and inspect the wound for redness, transplantation) swelling or drainage.  Instruct the client in appropriate home care measures  Assess the urine for cloudiness and other characteristics of  Provide psychosocial support and support services for home care infection.  Assess skin and oral mucous membranes for signs of infection.  Auscultate lung sounds, and encourage the client to cough and deep ~LYMPHOMA: HODGKIN’S DISEASE breath. Lymphoma is classified as (depending on the cell type):  Monitor temperature, pulse, respirations, and blood pressure.  Hodgkin’s  Notify physician immediately for s/sx of infection and prepare to  Non- Hodgkin’s J classification obtain specimens for culture and sensitivity either from the blood,  Characterized by abnormal proliferation of lymphocytes open lesions, urine, and sputum; chest radiograph may also be  Hodgkin’s Disease - It is a malignancy of the lymph nodes that prescribed. originates in a single lymph node or a chain of nodes  Administer prescribed antibiotics, antifungal and antiviral medications.  Metastasis occurs to other adjacent lymph structures and  Instruct the client to avoid crowds and those with infections. eventually invades nonlymphoid tissue  Instruct the client to avoid activities that expose the client to  Involves lymph nodes (especially in the neck), tonsils, spleen, and infection, such as changing a pet’s litter box or working with house bone marrow. Characterized by the presence of Reed-Stenberg plants in the garden. cells in the nodes upon biopsy  Instruct clients that neither they or not their household contacts  Reed – Sternberg cells – hallmark for Hodgkin’s lymphoma should receive immunization with live virus such as measles,  Cause: rubella, polio, varicella, shingles, and some influenza including the  Viral infections (previous infection of Epstein Barr virus) H1N1 vaccine.  Clients treated with combination therapy for Hodgkin’s disease have a greater risk of developing acute leukemia and non-Hodgkin’s BLEEDING lymphoma, among other secondary malignancies A patient with leukemia is also at risk for bleeding, this is due to  Usually this is the most treatable type of cancer thrombocytopenia due to the production of immature platelet count.  Prognosis: depends on the stage of the disease  During nadir, the platelet count may be extremely low. Causing the patient to be at risk for bleeding. Assessment  The client is at risk for bleeding when the platelet count falls below 1. Fever 50,000mm3, and spontaneous bleeding frequently occurs when the 2. Malaise, fatigue, weakness platelet count is lower than 20,000 mmm3. 3. Night sweats NURSING MANAGEMENT - 4. Loss of appetite and significant weight loss 5. Anemia and thrombocytopenia  Clients with a platelet count of 20,000 mm3 and below may need 6. Lymphadenopathy (aka enlarged lymph node) (painless, rubbery, movable platelet transfusion as ordered. enlargement of lymph node) especially in the neck, spleen and liver  For clients with anemia and fatigue, transfusion of PRBC may be 7. Positive biopsy of lymph nodes, with cervical nodes, most often affected first ordered 8. Presence of Reed- Sternberg cells in the nodes  Monitor laboratory values. 9. Positive CT scan of the liver and spleen  Assess the client for s/sx of bleeding such as petechiae, examine all body fluids and excrement for the presence of blood. Intervention  Handle the client gently; use caution when taking blood pressures 1. For earlier stages (stage 1 and 2), without mediastinal node involvement, the to prevent skin injury. treatment of choice is extensive external radiation of the involved lymph node  Monitor for s/sx of internal hemorrhage (pain, rapid and weak regions pulse, increased abdominal guarding, change in mental status). 2. For extensive stage, use a combination of radiation, and multiagent chemotherapy  MOPP regimen: Mustargen, Oncovin, Procarbazine, Prednisone  3. Monitor for side effects related to chemotherapy or radiation therapy 3. Prepare the client for unilateral orchiectomy as prescribed 4. Monitor for signs of infection and bleeding 4. Prepare client for retroperitoneal lymph node dissection, if prescribed, to 5. Maintain infection and bleeding precaution stage the disease and reduce tumor volume so that chemotherapy and radiation 6. Discuss sterility with the client receiving chemotherapy and/or radiation, and therapy are more effective inform the client of fertility options such as sperm banking 5. Discuss the reproduction, sexuality, and fertility information and options with the client 6. Identify reproductive options such as sperm storage, donor insemination, and MULTIPLE MYELOMA adoption  A malignant proliferation of plasma cells within the bone.  Excessive numbers of abnormal plasma cells invade the bone Post-operative intervention marrow and ultimately destroy bone; invasion of the lymph nodes, 1. Monitor for signs and symptoms of bleeding and wound infection; antibiotics spleen and liver occurs may be administered to prevent wound infection  The abnormal plasma cells produce an abnormal antibody 2. Monitor intake and output (myeloma protein or the Bence Jones protein) found in the blood 3. Provide and explain pain management methods; to reduce swelling in the and urine first 48 hours, apply ice pack with an intervening protective layer of cloth  Multiple myeloma causes decreased production of immunoglobulin 4. Notify the physician if chills, fever, increasing pain or tenderness at the and antibodies and increased levels of uric acid and calcium, which incision site or drainage from the incision occurs can lead to kidney failure 5. After orchiectomy, instruct the client to avoid heavy lifting