Cellular Aberrations Oncologic Nursing PDF

Cellular Aberrations Oncologic Nursing  Cancer CRAB descriptive of the crablike extension of malignant cells into healthy tissues and the deadly hold or crablike grip that the disease has upon its victims. NCM 112- ONCOLOGY Ma. Claudette L...

Cellular Aberrations Oncologic Nursing  Cancer CRAB descriptive of the crablike extension of malignant cells into healthy tissues and the deadly hold or crablike grip that the disease has upon its victims. NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  Oncology Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia Oncologist: a specialist in study and treatment of neoplastic growths NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  Oncogenes: genes derived from normal growth-controlling cellular genes which instruct the cell to behave abnormally NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  “Root words” Neo- new Plasia- growth Plasm- substance Trophy- size +Oma- tumor Statis- location NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  “Root words” A- none Ana- lack Hyper- excessive Meta- change Dys- bad, deranged NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer Neoplasm: growth of new tissues Abnormal new growth of tissue which serves no purpose and which can be highly damaging to the host Tumor: any neoplasm in which cells are permanently altered but have the capability of growth and reproduction Differentiation: refers to the extent to which the cells differ from their cells of origin and to their degree of maturity NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer Metastasis: the dissemination or spread of malignant cells from the primary tumor to distant sites by direct spread of tumor cells to body cavities or through lymphatic and blood circulation Mutation: unusual change in genetic material occurring spontaneously or by induction; the alteration change the original expression of the gene Carcinogens: agents that initiate or promote cellular transformation NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  Characteristics of Neoplasia Uncontrolled growth of Abnormal cells 1. Benign 2. Malignant 3. Borderline NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  Characteristics of Neoplasia BENIGN Well-differentiated Slow growth Encapsulated Non-invasive Does NOT metastasize NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  Characteristics of Neoplasia MALIGNANT Undifferentiated Erratic and Uncontrolled Growth Expansive and Invasive Secretes abnormal proteins METASTASIZES NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  Abnormal Cells and Cancer Cancerous cells usually become far different from the tissue from which they arise. The tumour pictured here, an ovarian teratoma, bears no resemblance to the normal tissue of the ovary. Tumours like these contain such foreign material as bone, hair, skin, or teeth. NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  Nomenclature of Neoplasia Tumor is named according to: 1. Parenchyma, Organ or Cell Hepatoma- liver Osteoma- bone Myoma- muscle NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  Nomenclature of Neoplasia Tumor is named according to: 2. Pattern and Structure, either GROSS or MICROSCOPIC Fluid-filled CYST Glandular ADENO Finger-like PAPILLO Stalk POLYP NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  Nomenclature of Neoplasia Tumor is named according to: 3. Embryonic origin Ectoderm ( usually gives rise to epithelium) Endoderm (usually gives rise to glands) Mesoderm (usually gives rise to Connective tissues) NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  BENIGN TUMORS Suffix- “OMA” is used Adipose tissue- LipOMA Bone- osteOMA Muscle- myOMA Blood vessels- angiOMA Fibrous tissue- fibrOMA NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  MALIGNANT TUMOR Named according to embryonic cell origin 1. Ectodermal, Endodermal, Glandular, Epithelial Use the suffix- “CARCINOMA” Pancreatic AdenoCarcinoma Squamos cell Carcinoma NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  MALIGNANT TUMOR Named according to embryonic cell origin 2. Mesodermal, connective tissue origin Use the suffix “SARCOMA FibroSarcoma Myosarcoma AngioSarcoma NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  “PASAWAY” 1. “OMA” but Malignant  HepatOMA, lymphOMA, gliOMA, melanOMA 2. THREE germ layers  “TERATOMA” 3. Non-neoplastic but “OMA”  Choristoma  Hamartoma NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  CANCER NURSING Review of Normal Cell Cycle 3 types of cells 1. PERMANENT cells- out of the cell cycle  Neurons, cardiac muscle cell 2. STABLE cells- Dormant/Resting (G0)  Liver, kidney 3. LABILE cells- continuously dividing  GIT cells, Skin, endometrium , Blood cells NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  CANCER NURSING Cell Cycle G0------------------G1SG2M G0- Dormant or resting G1- normal cell activities S- DNA Synthesis G2- pre-mitotic, synthesis of proteins for cellular division M- Mitotic phase (I-P-M-A-T) NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  https://youtu.be/QVCjdN xJreE?si=NRlusIpfo6dxAj bY NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER NURSING Proposed Molecular cause of CANCER: Change in the DNA structure altered DNA function Cellular aberration  cellular death  neoplastic change Genes in the DNA- “proto-oncogene” And “anti-oncogene” NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  CANCER NURSING Etiology of cancer 1. PHYSICAL AGENTS Radiation Exposure to irritants Exposure to sunlight Altitude, humidity NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER NURSING Etiology of cancer 2. CHEMICAL AGENTS Smoking Dietary ingredients Drugs NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER NURSING Etiology of cancer 3. Genetics and Family History Colon Cancer Premenopausal breast cancer NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER NURSING Etiology of cancer 4. Dietary Habits  Low-Fiber  High-fat  Processed foods  alcohol NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER NURSING Etiology of cancer 5. Viruses and Bacteria DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus RNA Viruses- HIV, HTCLV Bacterium- H. pylori NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER NURSING Etiology of cancer 6. Hormonal agents DES OCP especially estrogen NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER NURSING Etiology of cancer 7. Immune Disease AIDS NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER NURSING CARCINOGENSIS Malignant transformation IPP Initiation Promotion Progression NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER NURSING CARCINOGENSIS INITIATION Carcinogens alter the DNA of the cell Cell will either die or repair NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER NURSING CARCINOGENSIS PROMOTION Repeated exposure to carcinogens Abnormal gene will express Latent period NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER NURSING CARCINOGENESIS PROGRESSION Irreversible period Cells undergo NEOPLASTIC transformation then malignancy NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER NURSING Spread of Cancer 1. LYMPHATIC  Most common 2. HEMATOGENOUS  Blood-borne, commonly to Liver and Lungs 3. DIRECT SPREAD  Seeding of tumors NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  How Cancer Occurs NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER NURSING Body Defenses Against TUMOR 1. T cell System/ Cellular Immunity  Cytotoxic T cells kill tumor cells 2. B cell System/ Humoral immunity B cells can produce antibody 3. Phagocytic cells  Macrophages can engulf cancer cell debris NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  SCREENING 1. Male and female- Occult Blood, CXR, and DRE 2. Female- SBE, CBE, Mammography and Pap’s Smear 3. Male- DRE for prostate, Testicular self-exam NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Cancer Detection Examination GENERAL TECHNIQUES include obtaining - 1. Family & environmental history of the patient 2. Performance of a thorough Physical Examination 3. Evaluation of Laboratory Examination result (blood & urine) NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  Specialized Techniques a. Cytologic Examination Papanikilaou Test Papanicolaou Smear Pap smear. Pap test. Cervical Smear. Smear Test NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer Medical screening method primarily designed to detect premalignant and malignant processes in the ectocervix. Sample collection is done in the cervical os, during a non menstrual phase of the cycle because presence of blood interferes with an accurate interpretation Detect Infections & AbN in the endometrium. Abnormal smear – does not mean that the patient has cancer NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  GEORGIOS PAPANIKOLAOU in 1943: pioneer in cytology & early cancer detection Cervical Scrapings is the material for pap smear: The appearance of cells in the microscope is graded on a 5 point scale This multi-image surgical exhibit shows typical elements from a Pap Smear examination, a typical test for cervical cancer. This exhibit features a gynecologist's view of the vagina with a speculum placed visualizing the cervix. A second detailed cut-away view shows a curet scraping cells from the cervical opening and surfaces which will later be tested for cancer. NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  Class I – Normal Class II – Probably Normal Class III – Doubtful (maybe malignant) Class IV – Probably malignant Class V - Malignant NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer b. BIOPSY: the most definitive A surgical excision of a piece of tissue for microscopic exam to analyze presence of cancer including its stage & grade. NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  PERFORMED TO OBTAIN TISSUE SAMPLES FOR ANALYSIS OF CELLS SUSPECTED TO BE MALIGNANT Biopsy specimens are often taken from part of a lesion when the cause of a disease is uncertain or its extent or exact character is in doubt. NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  3 most common types of biopsy procedure 1. Total or excisional biopsy  For easily accessible tumors – Skin, breast, upper & lower GIT & URT  Decreases the chance of seeding  Usually performed thru endoscopy, but a surgical incision might be required 2. Subtotal or incisional biopsy core biopsy  Performed if tumor mass is too large to be removed  Tissue removed must be representative of tumor mass FOR ACCURATE DIAGNOSIS NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer 3. Needle aspiration biopsy - involves aspirating tissue fragments through a needle into an area suspected to bear a disease. ADVANTAGES:  Fast, inexpensive, easy to perform  Local anesthesia with temporary slight discomfort  Minimal disturbance of surrounding tissues  Seeding of Ca cells decreased DISADVANTAGE: Does not yield enough tissue to permit accurate diagnosis NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  NEEDLE CORE BIOPSY  Uses a specially designed needle to obtain a small core of tissue  Sufficient to permit accurate diagnosis NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  2 methods of examining biopsy specimen: Frozen section – very speedy, requires only minutes before a diagnosis is made.  Quality of tissue sections not as good as that of permanent section.  A skilled pathologist and a knowledgeable surgeon works together to use the frozen section’s radip availability to the pts great benefit Permanent paraffin section – provides best quality NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  c. x-rays X-RAYS – Rontgen rays or Roentgen ray electromagnetic radiation Primarily used for diagnostic radiography and crystallography. X-rays are a form of ionizing radiation and as such can be dangerous. Wilhelm Conrad Roentgen – one of the 1st investigators of x-ray Sometimes called RONTGEN RADIATION NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  Radiography Examination of any part of the body for diagnostic purposes by means of x-rays with the record of the findings usually impressed upon a photographic film. NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  An x-ray machine NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Bone Radiography NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Staging & Grading Cancer The diagnosis of cancer is based on: Assessment of physiologic & functional changes Result of Diagnostic Evaluation – WHICH IS GUIDED BY INFO OBTAINED THROUGH COMPLETE HISTORY & PE – knowledge of suspicious symptoms of the behavior of particular types of cancer helps in determining the most appropriate Dx test NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  Nursing Considerations  Fear OF THE PROCEDURE  Anxiety ABOUT RESULTS  Explain TEST TO BE PERFORMED  Encourage PT & FAMILY TO VOICE FEARS  Reinforce & CLARIFY INFO CONVEYED BY AP  ENCOURAGE TO COMM OPENLY & SHARE CONCERNS WITH EACH OTHER NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Patients with suspected Ca undergo extensive Dx testing to: 1. Determine the presence of tumor & the extent of the dse. 2. Identify possible spread or invasion of other body tissues 3. Evaluate the functions of involved as well as the uninvolved organs 4. Obtain tissue & cells for analysis of the cancer including its stage & grade NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  A complete diagnostic evaluation includes: 1. Staging of malignancy – determines the size of the tumor and the extent of metastasis  Descriptor of how much the cancer has spread.  Takes into account the size of a tumor,  How deep the tumor has penetrated,  Invasion of adjacent organs,  Involvement of lymph nodes it has metastasized to  Its spread to distant organs. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer   Staging of cancer is important because the stage at diagnosis is the most powerful predictor of survival.  Treatments are often changed based on the stage. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer 2. Grading of malignancy –refers to the classification of tumor cells  Seeks to define the origin of the tumor and the degree to which the tumor cells retain the functional & histologic characteristics of the tissue of origin  Assigned a numeric value from I – IV  Low numeric grades reflects – WELL DIFF TUMORS WITH MINIMAL DEVIATION FROM NORMAL CELLS  high numeric grades reflects – POORLY DIFF TUMORS & TEND TO BE MORE AGGRESSIVE & LESS REPONSIVE TO TREATMENT NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  TNM SYSTEM Developed & maintained by the International Union Against Cancer & the American Joint Committee for Cancer Staging Used to achieve consensus on one globally recognized standard Aid the medical staff in staging the tumor helping to plan the treatment. Gives an indication of prognosis. Assist in the evaluation of the results of treatment. Enable facilities around the world to collate information more productively. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Used for solid tumors Hema & CNS Ca & Malignant Melanoma uses other staging system BEC TNM CANNOT DESCRIBE IT APPROPRIATELY WITHIN THE TNM SYS, A Ca CAN ALSO BE designated as recurrent - MEANING THAT IT HAS APPEARED AGAIN AFTER BEING IN REMISSION OR AFTER ALL VISIBLE TUMOR HAS BEEN ELIMINATED.  The Recurrence can either be  Local - appearing in the same location as the original  Distant – which appeared in a different part of the body. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Staging & Grading of Cancer The degree of DIFFERENTIATION Grade 1- Low grade Grade 4- high grade NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER STAGING 1. Uses the T-N-M staging system T- tumor N- Node M- Metastasis 2. Stage 1 to Stage 4 NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Modalities of Treatment of Cancer OBJECTIVES of TREATMENT OF PATIENTS WITH CANCER 1. To completely remove or destroy the malignant neoplasm early 2. To prevent further metastases 3. To relieve symptoms 4. To preserve the pts life for as long as possible NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Treatment should be based on REALISTIC & ACHIEVABLE GOALS The following are the range of possible treatment goals 1. Cure – COMPLETE ERADICATION OF THE DSE 2. Control – SURVIVAL OF PT, CONTAINMENT OF Ca CELL GROWTH 3. Palliation – RELIEF OF Sx ASSO WITH THE DSE Open communication is paramount – to reassess Tx plan when complications develop & dse progresses The HCT, Pt & pts family must have a clear understanding regarding treatment options and goals. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Most Common types of cancer treatment: 1. Surgery- cure, control, palliate 2. Chemotherapy 3. Radiation therapy 4. Immunotherapy 5. Bone Marrow Transplant NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  I. SURGERY  SURGICAL REMOVAL OF THE ENTIRE Ca - remains the ideal & most frequently used treatment method  Multidisciplinary approach  Post op rehab plan “REMOVING ALL THE Ca CELLS” is not often realistic because of DISTANT MICROMETASTASIS BY THE TIME Tx IS AVAILED – substantiating multidisciplinary approach Skin & testicular cancer – considered curable if treated surgicall in the VERY EARLY STAGES  Surgery can be very successful in treating some kinds of cancer BUT IT IS NOT AN OPTION FOR ALL. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer SURGERY as primary treatment Goal: to remove entire tumor ( debulking) and any involved surrounding tissue including regional lymph nodes Two Common Surgical Approaches: 1. Local excision: when the mass is small and tissue margins are safety accessible 2. Radical excision: removal of the primary tumor, surrounding tissues and lymph nodes NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Diagnostic Surgery Performed to obtain a biopsy (excision of a piece of tissue from a suspicious growth) to analyze the tissues and cells of the suggested malignancy. It is imperative that the biopsy be a representative of the tumor mass so that the pathologist can provide an accurate diagnosis NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Biopsy Methods 1. Excisional method: for easily accessible tumors of the skin.  Breast, upper lower GIT, URT  Provides the pathologist with the entire specimen and decreases the chances of cellular seeding of tumor 2. Incisional method: used if the tumor is too large to be removed; required to determine the anatomic extent or stage of the tumor NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer 3. Needle biopsy: used to sample suspicious masses that are easily accessible, such as growths in the breast, lung, liver and kidney Fast, inexpensive, easy to perform, generally requires only local anesthesis Patient experiences minimal and temporary physical discomfort Seeding or disseminating cancer cells is kept to a minimum. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Prophylactic Surgery Removal of nonvital organs that are likely to develop cancer Removal of pre cancerous lesions while still harmless & nonmalignant. Factors CONSIDERED when electing Prophylactic Surgery 1. Family history & genetic predisposition 2. Presence or absence of Sx 3. Potential risks & benefits 4. Ability to detect Ca at an early stage 5. Acceptance of the post op outcome Controversy about adequate justification still exists. Unknown long term physiologic & psychological effects. Offered selectively & discussed thoroughly with pt & family NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer Common Prophylactic Surgery Colectomy – excision of the colon Mastectomy – removal of the breast Oophorectomy – excision of one or two ovaries NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Palliative Surgery MAJOR GOAL: High quality of life defined by pt & family  Promote comfort  Promote a satisfying & productive life FOR AS LONG AS POSSIBLE Relieves the manifestations/complications of cancer when cure is no longer possible like: ulcerations, obstructions, hemorrhage, pain & malignant effusions Tumors dependent on hormones like estrogen or progesterone Ovaries, testes are removed to retard the growth of the tumor. Ex. Oophorectomy Honest communication – Xfalse hope & disappointment NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Radical Surgery the removal of the entire tumor without disturbing the function or structure of the host extensively. Examples:  Cancers of the Colon  Rectum  Breast  Cervix NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Reconstructive Surgery usually follows radical or curative surgery  Attempts to improve function  Obtain a more desirable cosmetic effect  Indicated for breast, head & neck, skin cancers NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Reconstructive Surgery to confirm or rule out the possibility of malignancy; WHICH CAN BE DONE THROUGH BIOPSY NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  SEVERAL OTHER TYPES OF SURGICAL INTERVENTIONS 1. Electrosurgery 2. Cryosurgery 3. Chemosurgery 4. Laser Surgery 5. Stereotactic Radiosurgery (SRS) NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Electrosurgery Unit NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer Laparoscopic Electrosurgery Monopolar laparoscopic electrosurgery involves the insertion of optical and surgical instruments into the abdomen through small incisions, providing the surgeon access to the peritoneal cavity and a view of the surgical site. Due to a limited field of vision during minimally invasive surgery, surgeons can see only approximately 10% of the live electrode (the area inside the square), thus any burns outside the surgeon's field of view can go undetected until days after surgery by which time serious burns may have caused severe infection. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  What is cryosurgery (also called cryoablation)? Cryoablation is a treatment for prostate cancer that uses small probes, called cryoprobes, inserted into the prostate gland in order to destroy the prostate cancer. The probes are placed precisely into the prostate using ultrasound guidance, and temperature sensors placed into and around the prostate are used to be certain that proper freezing of the tissue is obtained. The entire prostate is frozen to -40°C, while the urethra is protected by a special warming catheter. The procedure is performed under spinal anesthesia, so the patient has no pain during the procedure. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Cryosurgery for Prostate Cancer Cryoablation therapy offers: a minimally invasive procedure favorable success rate and complication rates a short recuperation period procedure can be repeated if the first cryoablation has failed radiation therapy or radical prostatectomy is still an option if the procedure fails less than half the cost of the traditional treatment The disadvantages are: men will have a suprapubic urinary catheter for 2-3 weeks after the procedure, similar to prostate surgery most patients treated with cryosurgery on both sides of the prostate will have impotence initially after the procedure, but it can be treated and may improve over time NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Cryosurgery NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Cryosurgery NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Chemosurgery Also called chemical peels Chemical peels (often called chemosurgery) use a chemical solution, applied by a trained healthcare professional to remove the top layers of damaged skin. New cells formed during healing produce a tighter, more youthful-looking skin. Chemical peels have proven successful in restoring wrinkled, sun-damaged and blemished skin, and may be applied to the entire face, or specific areas such as the mouth or forehead. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Chemosurgery NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer What is Laser Spine Surgery? If you suffer from agonizing back or neck pain as a result of a herniated disc, PLDD (Percutaneous Laser Disc Decompression) offers quick relief without surgery. minimally invasive laser treatment performed on an outpatient basis using only local anesthesia. During the procedure, a laser beam vaporizes a tiny portion of the disc, decompressing it. Patients typically get off the table and go home. There is no hospital stay, no long recovery period, and PLDD costs thousands of dollars less than surgery. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer Laser Surgery NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Laser surgery NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer What is stereotactic radiosurgery? Stereotactic radiosurgery is a non-surgical treatment using very focused beams of radiation on small and previously inaccessible tumors or lesions deep within the body. Because the radiation beams enter the body from many different angles and all focus directly on the tumor or lesion, the surrounding healthy cells and important structures (blood vessels, nerves, etc.) are spared. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Stereotactic Radiosurgery NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer How Stereotactic Radiosurgery is Performed A stereotactic frame is temporarily affixed to the patient's head for the treatment, using only local anesthesia. The patient then undergoes the appropriate imaging studies necessary to define the exact location and shape of the lesion. Depending on the type of lesion, these studies may include digital angiography, CT, MRI, or PET (positron emission tomography) scanning. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer Endoscopic surgery uses scopes going through small incisions or natural body openings in order to diagnose and treat disease. Another popular term is minimally invasive surgery (MIS), which emphasizes that diagnosis and treatments can be done with reduced body cavity invasion. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer Video-assisted endoscopic surgery NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Terminologies for Endoscopic Surgery Some terms refer to the body region being examined or treated: 1. Laparoscopy (laparoscopic surgery) 2. Arthroscopy (arthroscopic surgery) 3. Thoracoscopy (thoracoscopic surgery) 4. Rhinoscopy 5. Otoscopy 6. Cystoscopy 7. Endosurgery 8. Minimal access surgery 9. Less invasive surgery 10. Endoscopic microsurgery 11. Video assisted surgery 12. Videoendoscopic surgery 13. Telescopic surgery NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Video assisted endoscopic surgery  HAS REPLACED SURGERIES ASSO WITH LONG INCISION & EXTENDED RECOVERY PERIOD  NOW USED FOR MANY THORACIC & ABDOMINAL SURGERIES NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Salvage Surgery  Uses an extensive surgical approach to treat the local recurrence of Ca after a less extensive primary approach is used.  Ex. Primary lumpectomy ------ Mastectomy NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  II. RADIATION THERAPY Uses ionizing radiation — in the form of a special kind of x-ray, gamma rays or electrons — to interrupt cell growth. Controls malignant disease when a tumor cannot be removed surgically or when local nodal metastasis is present. No pain during therapy. Indicated for Hodgkin’s disease, testicular seminomas, localized cancers of the head & NCM 112- neck…. Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  cont. Radiation Therapy A prophylaxis to prevent leukemic infiltration to the brain or spinal cord. Can be used by itself or in combination with other treatment methods PALLIATIVE RT – relieve the Sx of metastatic dse ESP WHEN THE Ca HAS SPREAD TO THE BRAIN, BONE OR SOFT TISSUE. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Uses of Radiation Therapy 1. Curative as in localized cancer of the head, neck, uterus, cervix 2. To control malignant disease when tumor cannot be removed surgically or when local nodal metastasis is present; prophylactically to prevent leukemia infiltration to the brain or spinal cord. 3. Palliative irradiation is frequently used to relieve the symptoms of metastatic disease, especially when it has spread to brain, bone or soft tissue NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer IONIZATION:is a physical production of positive and negative ions capable of conducting electricity. IONIZING RADIATION: radiation of sufficient energy to disrupt the electronic balance of the atom. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Types of Ionizing Radiation 1. Alpha particles: produce tremendous tissue destruction within a short distance 2. Beta particles: produce ionization which has destructive properties 3. Gamma rays and x-rays: are capable of completely penetrating the body, they affect tumor tissue more rapidly than normal tissue NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Types of Radiation Therapy 1. External Radiation – deliver intense treatment with pinpoint accuracy THROUGH EXTERNAL BEAM RADIATION  Treatment comes from external machines like: LINEAR ACCELERATORS COBALT MACHINES ORTHOVOLTAGE X-RAY MACHINES  X-rays  Gamma rays  IORT  Given 5/7 for 5-7 weeks NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  External Radiation Therapy 1. Kilovoltage therapy: deliver the maximum radiation dose to superficial lesions such as lesions of the skin and breast or bony metastasis 2. Gamma ray therapy: (Cobalt 60 min) deliver the radiation dose to deeper body structures and spare the skin from possible adverse effect 3. Megavoltage therapy: linear accelerators (therapy machines) deliver their dosage to deeper structures and witout harming the skin and also create less scattering of radiation within the body tissues 4. Particle beam therapy: Cyclotrons (neutron-beam therapy) – for late stage malignant disease: tumor that are large, anoxic, necrotic and resistant to treatment NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer 2. Internal Radiation – USES IMPLANTS WHICH MAY BE PERMANENT OR TEMPORARY  Brachytherapy – delivers a high dose of radiation to a localized area  Involves placing radioactive substances near or into cancerous cells  Also LIMITS THE AMOUNT OF RADIATION HEALTHY CELLS RECEIVE, THUS REDUCING DAMAGE TO NORMAL CELLS  Implanted by needles, seeds, beads , catheters into body cavities NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  SEEDS – ARE VERY SMALL PCS OF RADIOACTIVE SUBSTANCES USED FOR Ca Tx.  Low dose rate – where seeds give off radiation slowly  Tx is given over days  High dose rate radiation – where seeds give off radiation quickly  Tx lasts 5-10 mins only Intracavitary Radioisotopes – used to treat gynecologic Ca as well as prostate, pancreatic Ca RI are inserted with specially positioned applicators  Bed rest  Log rolled  IC  Low residue diets & anti diarrheal agents NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer Radiation Treatment for Prostate Cancer: Types of Radiation Therapy Internal Radiation or Prostate Cancer brachytherapy External Radiation Treatment for Prostate Cancer NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer Nursing Considerations in Radiotherapy Preparatory measures:  Remove dressings from the site & cleanse the skin  Instruct the patient not to remove or wash away any marks the radiologist places on the skin Contact with HCT is guided by principles of time, distance & shielding. Precautionary measures - contact with HCT is guided by principles of time, distance & shielding.  Time – the less time spent close to a radiating source, the less the exposure to radiation.  Distance – Do not work any closer to a source of radiation than is absolutely necessary  Shielding – use lead shield NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer Safety Precautions TO MINIMIZE EXPOSURE OF PERSONNEL TO RADIATION The pt should be in a private room Posting of appropriate notices about radiation safety Wearing dosimeter badges No pregnant staff member assigned Prohibiting visits from children & pregnant women Limit visits to 30’ daily Visitors maintain 6 ft distance from radiation source Administered orally – thyroid carcinomas NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Radiation Dosage: dependent on the sensitivity of the target tissues to radiation and the tumor size Lethal Tumor Dose: defined as that dose that will eradicate 95% of the tumor yet preserve normal tissue NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Sources of Radiation 1. RADIUM: radioactive material 2. RADON: dense radioactive gas 3. RADIONUCLIDES: element that has been bombarded in a nuclear reactor with radioactive particles NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  SIDE EFFECTS – experienced in areas being treated  Tiredness, lack of energy, fatigue Most common Sx, but the hardest to describe & the easiest to everlook Can be caused by the dse itself or the Tx Lowered blood counts Lack of sleep Poor appetite  Rest  Combat fatigue with appropriate EXERCISE  Prioritize activities  Consult a doctor  Eat a healthy diet NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer   N&V  Hair loss  Stomach or abdomen  In areas being treated treatment only  Usually occurs 1-2 hours after  Cover head with Tx hat, scarf or turban  Eat small meals, bland esp when in the food prn sun or during cold  Avoid fried foods weather.  Drink cool liquids between  Low blood counts meals  RT reduce the  amount of WBC  Diarrhea  Fatigue may be a Sx  Lower abdomen treatment of low blood count  Avoid dairy products, high fiber foods  Avoid spicy foods & caffeine NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer   Mouth problems  Skin problems  Head or neck  Irritation in area being treatment treated  Mouth or throat pain  Appear red & sore  Lack of salive  Dry and may itch  Sores near or around  Darker than other dentures skin  Difficulty eating  Treat skin very  Drink plenty of gently water & other  Use lukewarm liquids – wash out water & mild soap mouth & relieve  Avoid tight itchy dryness clothes  Moist soft foods  Ask before using  Practice good care any creams for the teeth  No rubbing & scratching  Cover sensitive area before going NCM 112- Ma. Claudette L. Orense RN MN, out ONCOLOGY Lecturer   Loss of appetite  Abdominal area bec of N&V  Anxiety, depression & grief  Vague, uneasy & unpleasant feelings of potential harm NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer Radiation toxicity or effects of radiation in cells 1. Alteration in skin integrity which include alopecia, erythema, shedding of skin (desquamation) 2. Alteration in oral mucosal membranes, which include stomatitis, dryness of the mouth (xerostomia), change and lose of taste, decreased salivation 3. GI disturbances: chest pain, dysphagia, anorexia, nausea and vomiting, diarrhea 4. Bone marrow cells proliferate rapidly, and if bone marrow producing sites includes anemia, leucopenia, thrombocytopenia 5. Increased risk of infection and bleeding until blood cells count return to normal. Chronic anemia may occur NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer 6. Systemic side effect: fatigue, malaise, headache nausea, vomiting (temporary and subside with the cessation of treatments)\ 7. Late effects of radiation therapy: chronic effects producing fibrotic changes secondary to decreased vascular supply. Can be most severe when they involve vital organs as lungs, heart, CNS and bladder 8. Increased susceptibility to cancer in irradiated areas. Cancer sometimes develop at the site of irradiation 20 or more years following radiotherapy especially the skin, lungs and bone. 9. Birth defects due to irradiation-congenital defects occur especially if the woman’s reproductive organs are exposed to radiation during the 2nd to 6th weeks of gestation. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Chemotherapy Use of medicines or antineoplastic agents to attack cancer cells. Chemotherapeutic drugs work by impairing mitosis effectively targeting fast-dividing cells. Scientists have yet to identify specific features of malignant and immune cells that would make them uniquely targetable. Hair growth and intestinal epithelium are severely affected Causes fear because the side effects can be severe. Used when the cancer has metastasized – treats systemic disease rather than localized lesions Used in combination treatments NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer  ADMINISTRATION OF CHEMO AGENTS May be administered in the  Hospital  Clinic  Home setting ROUTES can be  Topical, Oral  IV, IM, SQ  Arterial, intracavitary, intrathecal  Depend on the type of agent to be used SPECIAL PROBLEMS  Extravasation  Toxicity NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CLASSIFICATION OF CHEMOTHERAPEUTIC DRUGS ALKYLATING AGENTS – acts by chemically modifying DNA within the cell to disrupt cell growth & division  Common side effects:  BM suppression N & V  Cystitis, stomatitis  Alopecia  Examples:  Carboplatin, chlorambucil, cyclophosphamide NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  ANTIMETABOLITES – stops normal cellular development & division  Nausea, vomiting, diarrhea  BMS, renal toxicity  Ex: 5-FU, cytarbine, edatrexate fludarabine NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  NITROSUREAS – similar to AA, crosses BBB  Thrombocytopenia  Ex: Carmustin, Lomustine, Semustine TOPOISOMERASE I INHIBITORS – induces breaks in the DNA strand; prevents cells from dividing  BMS, N, V, diarrhea, hepatotoxicity b.Topotecan, irinotecan NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  ANTITUMOR ANTIBIOTICS – prevents DNA & RNA synthesis  BMS, N, V, anorexia, cardiac toxicity  Bleomycin, dactinomycin, doxorubicin MITOTIC SPINDLE POISONS arrests metaphase by inhibiting mitotic tubular formation  BMS, neuropathies  Vinblastine, vincristine NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  HORMONAL AGENTS – alter cell growth by binding to hormone receptor sites  Hypercalcemia, jaundice, increased appetite, Na & fluid retention  Ex. Androgens & antiandrogens, steroids MISC AGENTS  Anorexia,altered glucose metabolism, anaphylaxis  Asparaginase, procarbazine NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Toxic Effects of Chemotherapy 1. Gastrointestinal System 1. Nausea and Vomiting: 24 hrs after due to stimulation of the vomiting centers of the brain Mgt: 1. Use of phenothiazines, sedatives, steroids and histamines 2. Relaxation technique 3. Alterations in patient’s diet 2. Stomatitis, anorexia, diarrhea: inflammation of mucosal lining of entire GIT NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer 2. Hematopoietic System: chemotherapeutic agents depress bone marrow function resulting in decreased production of blood cells (myelosuppression) and increase the risk of infection and bleeding a. Leukopenia (WBC) b. Thrombocytopenia (platelets) c. Anemia (RBC) Mgt: frequent monitoring of blood cell count, patient must be protected from infection and injury NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer 3. Renal System:chemotherapeutic agents can be harmful to the kidneys because of direct effect of the drugs during their excretion and the accumulation of end products after cell lysis. : rapid lysis after chemotherapy results in increased urinary excretion of uric acid, which can lead to renal damage. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer 4. Cardiopulmonary System - antitumor antibiotics (daunorubicin and doxorubicin) causes cardiac toxicities - ECG and signs of CHF must be monitored closely - Bleomycin and Busukfan cause toxic effects on lung function = Monitor patient closely for changes in pulmonary function NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer 4. Reproductive System: testicular and ovarian function can be affected by chemotherapeutic agents resulting in possible sterility 5. Neurologic System: the plant alkaloids, esp. Vincristine cause neurologic damage with repeated doses NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Nursing Considerations & management: Special care must be taken to ensure IV line is in place. Assess fluid & electrolyte status Modify risks for infection & bleeding NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer SAFETY IN ADMINISTERING CHEMOTHERAPY Use of biologic safety cabinet for the preparation Wear surgical gloves when handling antineoplastic agents & secretions Wear disposable long sleeved gowns Dispose of all equipment in a leak proof, puncture proof containers Dispose all waste as hazardous NCMmaterial 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  CANCER IMMUNOTHERAPY Biologic Response Modifiers (BRMS) is the use of the immune system to reject cancer. The main premise is stimulating the patient's immune system to attack the malignant tumor cells that are responsible for the disease. This can be either through immunization of the patient, in which case the patient's own immune system is trained to recognize tumor cells as targets to be destroyed, or through the administration of therapeutic antibodies as drugs, in which case the patient's immune system is recruited to destroy tumor cells by the therapeutic antibodies. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Goal: to immunize patient against own tumors NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer Advantages of Immunotherapy 1. Attacks only cancer cells 2. Does not damage normal cells 3. Can be continued for long periods with fewer hazardous side effects than chemotherapy 4. Can be injected subcutaneously, infused intravenously, or applied topically or intradermally as for skin cancer NCM 112- ONCOLOGY Ma. Claudette L. Orense RN MN, Lecturer   Since the immune system responds to the environmental factors it encounters on the basis of discrimination between self and non-self,  many kinds of tumor cells that arise as a result of the onset of cancer are more or less tolerated by the patient's own immune system since the tumor cells are essentially the patient's own cells that are growing, dividing and spreading without proper regulatory control. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Types of Immunotherapy 1. Active Immunotherapy: antigens are injected to stimulate development of antibodies against tumor cells by patient’s own humoral immune a. Active specific immunotherapy: a vaccine of specific tumor antigen stimulates the immune response administered intradermally - autologous vaccine is prepared from patient’s own tumor and reinoculated b. Active Nonspecific immunotherapy: - encourages hose immune response by use of an unrelated agent - BCG vaccine, Corynebacterium parvum: 2 agents NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer 2. Passive Immunotherapy: involves transfer of antibodies from an individual who has been cured of cancer to someone with the same cancer - Antisera from cured patient with same type of tumor, administered IV or subcutaneously NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer 3. Adoptive Immunotherapy: patient accepts passive immunity to inhibit tumor growth from systemic transfer of immunocompetent cells by administration of immunostimulant extracts from human white cells called transfer factor NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Side effects of Immunotherapy Malaise Chills Nausea and vomiting Diarrhea Local reaction at site of injection such as pruritus, scabbing NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Nursing Care/Implementation: Goal: Decrease discomfort associated with side effect of therapy 1. Know type of immunotherapy being used, adverse and desirable effects of therapy 2. Administer fluids to decrease fluid symptoms 3. Encourage rest 4. Administer acetaminophen as ordered 5. Administer antiemetics, as ordered 6. Monitor for respiratory distress 7. Administer analgesics as ordered NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer Goal: Health Teaching 1. Comfort measures to decrease side effects of therapy 2. Expected and side effects of therapy 3. Investigational nature of therapy 4. Care of administration site 5. Answer questions honestly NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer   Antibodies are a key component of the adaptive immune response, playing a central role in both in the recognition of foreign antigens and the stimulation of an immune response to them.  It is not surprising therefore, that many immunotherapeutic approaches involve the use of antibodies. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer Type of Antibody Drug For the Tx of: Alemtuzumab Campath Chronic lymphocytic leukemia Bevacizumab Avastin colorectal cancer Cetuximab Erbitux colorectal cancer Gemtuzumab ozogamicin Mylotarg acute myelogenous leukemia Ibritumomab tiuxetan Zevalin non-Hodgkin lymphoma Panitumumab Vectibix colorectal cancer Rituximab Rituxan, Mabthera non-Hodgkin lymphoma Trastuzumab Herceptin breast cancer NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer 1. Alemtuzumab  indicated for the treatment of Chronic lymphocytic leukemia(CLL), the most frequent form of leukaemia in Western countries.  Initiates its cytotoxic effect by complement fixation and antibody-dependent cell- mediated cytotoxicity mechanisms.  Alemtuzumab therapy is also indicated for T-prolymphocytic leukaemia (TPPL), for which no standard treatment exists. a highly aggressive tumor, with a median survival of 7.5 months. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer 2. Bevacizumab  Indicated for colon cancer;  but has been applied to numerous other cancers in small scale studies, especially renal cell carcinoma.  Results obtained showed  increased the duration of survival,  progression-free survival NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  3. Cetuximab Indicated for the treatment of colorectal cancer NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  4. Gemtuzumab ozogamicin  It is indicated for the treatment of acute myeloid leukaemia (AML).  The patient group most likely to benefit from gemtuzumab is young adults, and trials have reported high complete responses (85%), when combined with intensive chemotherapy. There are minimal side- effects associated with Gemtuzumab therapy. NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer 5. Rituximab The exact mode of action of rituximab is also unclear, but it has been found to have a general regulatory effect on the cell cycle and on immune-receptor expression. 6. Trastuzumab is clinically used for the treatment of breast cancer. 7. Ibritumomab tiuxetan Its use has been investigated, primarily in the treatment of follicular lymphoma.[ NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Endocrine Therapy Endocrine therapy does not cure but it can control dissemination of disease. Types of Endocrine therapy: 1. Endocrine ablation: surgical removal of endocrine glands  Bilateral adrenaloopherectomy: both adrenal glands and ovaries may be resected to prevent recurrence, control soft tissue metastasis or relieve bone pain from metastatic breast cancer  Bilateral orchiectomy and adrenalectomy: both testes may be removed following prostatectomy for advance cancer of the prostate to eliminate androgens of testicular origins  Hypophysectomy: enucleation of pituitary gland may be indicated in patients with recurrent or progressive breast or prostatic cancer to eliminate stimulating hormones produced by the pituitary NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer 2. Hormonal Therapy: hormones administered orally or IM can alter cell metabolism by changing the systemic hormonal environment of the body 1. Adrogens: for women with breast CA 2. Corticosteroids: to suppress estrogen production 3. Estrogens: to men with prostatic CA; women with breast CA 4. Progesterone: inhibits proliferation of endometrium 3. Anti-estrogen therapy: to patient’s with medical contraindications to endocrine ablation NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Actions of Hormones in Chemotherapy 1. Change of hormonal balance and slow growth rate of certain tumors 2. Useful in treatment of neoplasm involving reproductive organ Adverse Effects 1. Emergence of characteristics of the opposite sex 2. Edema 3. Change in libido 4. Irritability 5. Uterine bleeding NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  GENERAL Promotive & Preventive Nursing Management 1. Lifestyle Modification 2. Nutritional management 3. Screening 4. Early detection NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Nursing Assessment Utilize the ACS 9 Warning Signals CAUTIONAL C- Change in bowel/bladder habits A- A sore that does not heal U- Unusual bleeding T- Thickening or lump in the breast I- Indigestion O- Obvious change in warts N- Nagging cough and hoarseness A-an unexplained anemia L-loss of weight NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer Nursing Assessment Weight loss Frequent infection Skin problems Pain Hair Loss Fatigue Disturbance in body image/ depression NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Nursing Intervention MAINTAIN TISSUE INTEGRITY Handle skin gently Do NOT rub affected area Lotion may be applied Wash skin only with SOAP and Water NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Nursing Intervention MANAGEMENT OF STOMATITIS Use soft-bristled toothbrush Oral rinses with saline gargles/ tap water Avoid ALCOHOL-based rinses NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer Nursing Intervention  MANAGEMENT OF ALOPECIA Alopecia begins within 2 weeks of therapy  Regrowth within 8 weeks of termination  Encourage to acquire wig before hair loss occurs  Encourage use of attractive scarves and hats  Provide information that hair loss is temporary BUT anticipate change in texture and color NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer Nursing Intervention  PROMOTE NUTRITION  Serve food in ways to make it appealing  Consider patient’s preferences  Provide small frequent meals  Avoids giving fluids while eating  Oral hygiene PRIOR to mealtime  Vitamin supplements NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Nursing Intervention  RELIEVE PAIN  Mild pain- NSAIDS Moderate pain- Weak opoids  Severe pain- Morphine  Administer analgesics round the clock with additional dose for breakthrough pain NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Nursing Intervention  DECREASE FATIGUE  Plan daily activities to allow alternating rest periods  Light exercise is encouraged  Small frequent meals NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Nursing Intervention  IMPROVE BODY IMAGE  Therapeutic communication is essential  Encourage independence in self-care and decision making  Offer cosmetic material like make-up and wigs NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Nursing Intervention  ASSIST IN THE GRIEVING PROCESS  Some cancers are curable  Grieving can be due to loss of health, income, sexuality, and body image  Answer and clarify information about cancer and treatment options  Identify resource people  Refer to support groups NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Nursing Intervention  MANAGE COMPLICATION: INFECTION  Fever is the most important sign (38.3)  Administer prescribed antibiotics X 2weeks  Maintain aseptic technique  Avoid exposure to crowds  Avoid giving fresh fruits and veggie  Handwashing  Avoid frequent invasive procedures NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Nursing Intervention  MANAGE COMPLICATION: Septic shock  Monitor VS, BP, temp  Administer IV antibiotics  Administer supplemental O2 NCM 112- Ma. Claudette L. Orense RN MN, ONCOLOGY Lecturer  Nursing Intervention  MANAGE COMPLICATION: Bleeding  Thrombocytopenia (