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CARE OF THE CLIENT WITH CANCER

Cellular Adaptation, Injury and Death

Cellular Adaptation

Atrophy is the wasting or decrease in


size of a normally developed organ.

results from a decrease in size of the cells


composing it.

Example is disuse of an organ

- control of cell division is regulated


by CHONs produced by suppressor genes
cyclins CHONs that promote
cells to enter &
complete cell division.

Contact inhibited
-once a normal cell is in direct
contact on all surface areas with other cells, it no
longer undergoes mitosis

Euploid- 23 pairs of chromosomes

Hypertrophy

increase in size of an organ resulting from


an increase in the size of the cells.

sometimes represents the response of an


organ to a greater workload

Hyperplasia

is an increase in the number of cells


resulting from an increased rate of cellular
division.

a response to injury when the injury has


been severe and prolonged enough to have
caused cell death.

Metaplasia

can transform into malignant cancer cells

Dysplasia

transformation of one mature cell type or


tissue into another

deranged cellular growth or a form of


hyperplasia

It results from persistent severe injury or


irritation
Characteristics of Normal Cells

Have limited cell division


Divide for: dev. of normal tissue
replaced damaged or lost
normal tissue
Undergo apoptosis programmed cell

death

Show specific morphology (size, shape


appearance)
(Continued)
Programmed Cell Death
Characteristics of Normal Cells (cont.)
Characteristics of Normal Cells (Cont.)

Nonmigratory: due to tight binding of cells

Grow in an orderly and well-regulated


manner; follow the cell cycle

COMMITMENT
- AT DAY 8, EARLY EMBRYONIC CELLS
START CHANGING TO
DIFFERENTIATED
CELLS. . . AND
COMMITS ITSELF TO A
SPECIFIC
OUTCOME . . . WHICH MEANS
TURNING OFF EARLY EMBRYONIC
GENES (PROTO-ONCOGENES) THAT
CONTROLLED OR REGULATED
EARLY RAPID GROWTH.
ONCOGENES TURNED ON PROTOONCOGENES THAT CAN CAUSE NORMAL
CELLS TO CHANGE TO CANCER CELLS
Characteristics of Cancer Cells

Have rapid or continuous cell division


Do not respond to signals for apoptosis
Show anaplastic morphology
Have a large nuclear-cytoplasmic ratio
Lose some or all differentiated functions

Adhere loosely together


(Continued)
Characteristics of Cancer Cells (Continued)

Able to migrate through embryonic cells


Grow by invasion
Are not contact inhibited

Are aneuploid more than or less than the


normal number of chromosomes
Phases of a Cell
Pathophysiology: Cell Cycle
Replication and Carcinogenesis
- G0 phase
- reproductive resting state
- actively carry out function but no
division
- normal cells spend most of their
lives in
this state
*Control of the cell cycle is regulated by CHONs
produced by suppressor genes and cyclins
>> allow the cell to move from G0 >>cell cycle
G1
- Normal cell division: Balance betweel CHONs

that promote cell division (cyclins) and CHONs


that limit cell division ( suppressor gene product)
- G1 phase
- cell takes on extra nutrients, make
more
energy and grow extra
membrane
- increase amount of cell fluid
(cytoplasm)
- S phase
- doubling of DNA through DNA
synthesis
- G2 phase
- Cell makes important CHONs for
actual cell division and for
normal
physiologic
functioning after cell
division is
complete.
- M phase
- actual mitosis (splitting of the cell
into 2 cells
Cancer Development

Oncogene activation

Chemical carcinogenesis, physical


carcinogenesis, radiation, chronic irritation, vital
carcinogenesis

Dietary factors

Personal factors, immune function, age,


and genetic risk
3-STEP CELLULAR PROCESS of CARCINOGENESIS:
1. INITIATION carcinogens alter genetic
structure of DNA.
Carcinogens substances that transforms a
cell to a cancer
cell.
2. PROMOTION repeated exposure to
carcinogen causes production of
mutant cell
populations that are anaplastic.
- initiated by promoters hormones,
drugs, chemicals
3. PROGRESSION increased malignant
behavior
of cells; invasive and
metastasize.
Tumor at 1 cm size >>cells at center are
hypoxic and begin to die >>tumor makes
TAF
>> ensures tumors continued
nourishment.

SPREAD OF CANCER:
- after initial event, some mutated cells
may die
- survivors reproduce until the tumor is
1-2 mm
- angiogenesis to support growth

- # of Ca cells exceed normal cells


- invasion of surrounding tissue
- metastasis:
- hematogenous
- lymphatic
- metastasis
- hematogenous
- more typical with sarcomas
- follow venous flow that drains site
of primary tumor
- lymphatic
- more typical with carcinomas
- lodge in regional lymph nodes
that

receive drainage from tumor site


(may: die; grow into a
mass; become dormant)
>> lymph
channels >> empty into the
venous system >> blood
Three Stages of Metastatic Process
Cancer affects patient function by:

a) Growth & expansion in confined space


(pressure effects)
b) High metabolic rate ---> nutritional
deficits
c) decreased host defense mechanisms
d) Production of hormone-like substances
e) Tissue invasion ---> hemorrhage &
infection
f) Metastasis ---> tissue destruction
RISK FACTORS

ACQUIRED:

VIRUSES

RADIATION

exposure to radiations causes mutations,


inactivates enzymes, and interrupts cell division.

ENVIRONMENTAL AND DIETARY


CARCINOGENS

HORMONES
INCREASE RISK:
AGE
NUTRITIONAL STATUS
HORMONAL BALANCE
RESPONSE TO STRESS

KEY SIGNS AND SYMPTOMS

FATIGUE

CACHEXIA: ANOREXIA, TASTE PERCEPTION


ALTERED,
EARLY SATIETY, WT. LOSS, ANEMIA,
MARKED WEAKNESS
>> CHON-CALORIC MALNUTRITION
>>
HYPOALBUMINEMIA, EDEMA,
MUSCLE
WASTING AND IMMUNODEFICIENCY
>> STARVATION OF NORMAL
TISSUE
PAIN

ANEMIA, LEOKOPENIA,
THROMBOCYTOPENIA
INFECTION
Classifications of Neoplasms/ Comparison of
characteristics:
Speed of growth/ Mode of growth

Benign

Grows enlarging and expanding

Grows slowly
Continues to grow throughout life

Benign

If neoplasm arises in glandular tissues,


cells may secrete hormones

Extremely unusual when surgically


removed
Metastasis never occur

Common following surgery

Benign

Rare regression

Infiltrate tissues

Always remains localized


Malignant
Grows rapidly
Grow relentlessly

May remain in situ, but infiltrates other

Capsule
Benign
Contained w/in a fibrous capsule
Prevents infiltration
Encapsulated tumor can be removed

easily

Cells too abnormal to perform any


physiologic functions
Recurrence / Metastasis

Periods of remission

tissues

Malignant
Never contained in a capsule

Absence of capsule allows cancer cells to


invade other tissues

Surgical removal is difficult


Cell characteristics

Benign

Malignant

Cells tend to be anaplastic

Well differentiated
Mitotic figures absent or scanty
Mature cells
Anaplastic cells absent

Cells function poorly in comparison with


normal cells
Poorly differentiated

Large numbers of normal and abnormal


mitotic figures present

Malignant

Malignant tumor arising in glandular tissue


secretes hormones
Metastasis is very common
Effect of neoplasm
Not harmful unless located in an area
where it compresses tissues or obstructs vital
organs
Does not produce cachexia (weight loss,
debilitation, anemia, weakness)

Malignant
Always harmful
Causes death

Causes disfigurement, disrupted organ


function, nutritional imbalances

May result in ulcerations, sepsis,


perforations, hemorrhage, tissue slough
Prognosis

Benign

Local symptoms:

Very good
Tumor generally removed surgically
Malignant
Poor prognosis if with metastasis

unusual lumps or swelling (tumor)


hemorrhage (bleeding)
pain and/or ulceration
Compression of surrounding tissues may
cause symptoms such as jaundice.

Symptoms of metastasis (spreading):

enlarged lymph nodes


cough and hemoptysis
hepatomegaly (enlarged liver)
bone pain, fracture of affected bones
neurological symptoms.

* Although advanced cancer may cause pain, it is


often not the first symptom.

Systemic symptoms:

weight loss
poor appetite and cachexia (wasting)
excessive sweating (night sweats),
anemia
specific paraneoplastic phenomena, i.e.
specific conditions that are due to an active
cancer, such as thrombosis or hormonal changes
Clients with Cancer: Health Promotion and
Maintenance

Cancer prevention and control


Prevention, screening, and early detection

Primary prevention
(ACTIVITIES VS SMOKING, ALCOHOL,POOR
DIETARY HABITS, LIFESTYLE MODIFICATION)

Secondary prevention
(EARLY DETECTION / SCREENING
PROGRAMS)
Cancer Prevention

Cervical cancer
(PAP TEST/PELVIC EXAM)

Head and neck cancer

Skin cancer
(SKIN INSPECTION ESP. OF MOLES)
PAP smear
Digital Rectal Exam
Testicular Self Exam.
Health Restoration

Maintaining wellness during treatment

Client history

X-rays and other Imaging

Host susceptibility and prevention benefits


7 WARNING signs
Regulation
Prohibiting sale of tobacco and alcohol to
Host modification

Lifestyle changes/carcinogen exposure


and chemoprevention
Cancer

7 warning signs of Cancer


C
hange in bowel or bladder habits
A
sore that does not heal
U
nusual bleeding or discharge
T
hickening or lump in breast or
elsewhere
I
ndigestion
O
bvious change in wart or mole
N
agging cough or hoarseness
Early Detection of Cancer:
Risk Factors and Screening

Breast cancer and prostate cancer


(CBE/SBE & MAMMOGRAPHY) (PSA & DRE)

Lung cancer
Colorectal cancer

Optimize quality of life


Rehabilitation
Reconstructive surgery
Lymphedema management

Others: Exercise program to counteract


chemotherapy-related fatigue; speech
therapy; prosthetic devises
Cancer Diagnosis

Education

minors

(FECAL OCCULT
BLOOD/SIGMOIDOSCOPY/COLONOSCOPY/DRE)

Clinical manifestations
Diagnostic evaluation
Laboratory blood tests
Tumor markers - barometers for
effectiveness of Tx
CBC - for non-specific problems & Side
Effects of
Tx
Diagnostic evaluation

Grading (extent of differentiation) and


Staging (extent of spread)
Cancer Treatment

Treatment goals
Cure
Control,
Palliation
Rehabilitation
Treatment modalities:
-

Surgery
Radiation therapy
Chemotherapy
Biotherapy
Bone marrow transplant

Cancer Care: Surgical Management

Types of surgery
Diagnostic: (cytologic brushings/ tissue biopsy
with endoscopy, biopsy: needle, excisional,
incisional)
Treatment: radical/wide excision
Recurrence and metastasis: excision
Palliative: retard, decrease size, relieve sx
Reconstructive: improve QOL
Preventive

Nursing management
Cancer Care:
RadiationTherapy
USES:

PRIMARY ONLY TREATMENT USED & AIMS


TO ACHIEVE LOCAL CURE OF THE CANCER

ADJUVANT USED EITHER PRE- OR POSTOP TO AID IN CA CELL DESTRUCTION

PALLIATIVE RELIEF OF PAIN DUE TO


OBSTRUCTION, PATHOLOGIC Fx, CORD
COMPRESSION, METASTASIS
Cancer Care: Radiation Therapy

How radiation therapy works

Radiosensitivity RELATIVE
SUSCEPTIBILITY OF TISSUES TO RADIATION

High-energy ionizing radiation


DESTROYS A CELLS ABILITY TO REPRODUCE BY
DAMAGING ITS DNA, & FORMATION OF FREE
RADICALS
* Normal cells have greater ability to
repair damaged DNA than Ca cells

Time- limit to 30 mins direct care/8hr shift


Distance distance & radiation exposure
inversely related.
*Intensity of radiation decreases inversely
with the square of the distance from the source.
Ex: 2m=1/4 exp; 4m=1/16 exp
*Visitors 6 ft. from source; off limits to
<16 y.o. & pregnant women

Shielding lead shields, lead container


(pig) & long handled forceps are musts in pts
unit.
Staff should wear film badges or
dosimeters.
- Precautionary measures for sealed & unsealed
Treatment considerations
- Certain normal cells are more sensitive to
radiation & may incur permanent damage.
- SE related to total dose of radiation
- Gray (Gy) unit dose of radiation
- Rad radiation absorbed dose
1 Gy = 100 rad; 1 cGy (centigray)
= 1 rad
Curative Tx = >dose = >SE
- Fractionation dosing

Fractionation dosing:

> To reduce SE,


> To allow normal cells to repair
themselves & increase
susceptibility
of the cell to radiation.
> Vulnerable during late G2 & early M
phase of cell cycle.
NURSING MANAGEMENT

- Unsealed source
oral/injection/instillation into
body cavity for systemic
treatment;
direct contact with
body tissue.
* radioisotope circulates
throughout
the body. Clients urine, sweat,
blood & vomitus contain
radioisotope
* eliminated from the body in 48
hrs
- Afterloading device empty applicator is
implanted during surgery
and loaded
when treatment is
done.

Safety standards

Patient education

Minimize side effects


*SKIN CARE
CLIENT EDUCATION

WASH AREA WITH WATER ALONE OR MILD


SOAP & WATER

USE HAND RATHER THAN WASHCLOTH


FOR WASHING

DO NOT REMOVE MARKINGS

DRY THE SKIN USING PATTING NOT


RUBBING MOTION

NO powder, lotions, ointment & creams to


affected area

Wear soft clothing over affected area

Avoid using anything that rubs on the


affected area

Avoid exposing irradiated area to the sun

Avoid heat exposure

Cancer Care: Chemotherapy


TYPES:

ADJUVANT eliminates any remaining


submicroscopic cells after surgery & RT.

NEOADJUVANT pre-op use of CT to


reduce bulk & lower stage of
tumor
making it amenable to
surgery

"Most chemotherapeutic agents damage


DNA or interfere with DNA synthesis thereby
killing all rapidly dividing cells, both normal and
neoplastic
Some Principles of Cancer Chemotherapy

1. Cure probably requires complete


eradication
of tumor cells
2. Drug kills a constant PROPORTION of tumor
cells rather than a constant NUMBER of
cells (first order kinetics).

therefore number of cells before therapy


determines the number of cells surviving therapy

therefore early treatment when tumors are


small ---> better clinical result

How chemotherapy works


- PHASES OF THE CELL-CYCLE
- ACTIVELY DIVIDING CELLS ARE MORE
SENSITIVE TO RADIATION.
- DIRECTLY OR INDIRECTLY DISRUPTS
REPRODUCTION OF CELLS BY
ALTERING
ESSENTIAL BIOCHEMICAL
PROCESSES.
- SINGLE AGENT VS COMBINATION
CHEMOTHERAPY
Classification of chemotherapeutic agent A.
CELLCYCLE- SPECIFIC
- ANTIMETABOLITES (5FU, CYTOSAR)S
phase
- ANTIMITOTICS: (Mitotic spindle
poisons)
- VINCA ALKALOIDS (ONCOVIN,
VELBAN) M
phase
- TAXANES (PACLITAXEL (TAXOL))
M phase
- TOPOISOMERASE INHIBITORS
- EPIPODOPHYLLOTOXINS
(ETOPOSIDE(VP16) M phase
Variable category:
- L-ASPARAGINASE, HYDROXYUREA

3. Tumors usually detected clinically


late in course of disease.

Chemotherapy should be prolonged to


increased cure rate

B. CELL-CYCLE NON-SPECIFIC

In clinical practice, nearly all neoplastic


diseases are treated with multiple drugs

- ALKYLATING (MYLERAN, PLATINOL)


- ANTITUMOR ANTIBIOTICS
(LEUKERAN, ADRIAMYCIN,
MITOMYCIN)
- HORMONES:
STEROIDS
ESTROGENS
ANTI-ESTROGEN
(TAMOXIFEN)
PROGESTINS
NITROSOUREAS (CARMUSTINE

4. Adverse effects are decreased by


giving combinations of drugs with
different side-effects

5. Intermittent high doses are more


effective
6. Adjuvant therapy (chemotherapy after
surgery/radiation) is given to eliminate
metastases

7. Drugs have a narrow therapeutic index


therefore treatment is a balance between
toxic effects and efficacy

growing cells, which are most sensitive,


are killed.

adverse effects are seen in non-neoplastic


cells eg. hair follicles, bone marrow

drugs may act only at specific stages of


the cell cycle

Cancer Care: Chemotherapy

ANTIMETABOLITES counterfeit
metabolites

ANTITUMOR ANTIBIOTICS damage


cells DNA
& interrupt DNA or RNA
synthesis

ALKYLATING AGENTS crosslink DNA


making two strands bind tightly
together >> inhibits DNA
synthesis >>
inhibits cell division

ANTIMITOTIC interfere with formation of


microtubules >> inhibits cell division

TOPOISOMERASE INHIBITOR

Topoisomerase - enzyme needed for DNA


synthesis & cell
division

Causes DNA breakage and cell death


CANCER CHEMOTHERAPY

CANCER CHEMOTHERAPY
Chemotherapy: Nursing Management

Administration
Verification of agent, dose, schedule
Safe preparation, handling, and disposal
Routes of administration
Intravenous, regional, oral, etc.

Adverse reactions

Hypersensitivity reaction and


extravasation

Safe preparation, handling, and disposal


NURSING CARE FOR HYPERSENSITIVITY:
1.
2.
3.
4.
5.
6.
7.

stop drug adm


maintain IV access with 0,9% saline
maintain airway
supine position with feet elevated
notify MD
monitor VS every 2 mins until stable
administer epinephrine, aminophylline,
Benadryl, steroid as Rx
NURSING CARE FOR EXTRAVASATION:
1. STOP drug administration
2. leave needle in place & attempt to aspirate
any
residual drug from the tubing, needle &
site.
3. administer antidote, if appropriate, then
remove
needle
4. do not apply direct manual pressure to the site
5. apply warm (for vinca) or cold compresses as
indicated
6. observe site for pain, erythema, swelling,
induration, & necrosis
7. document appearance of site before & after
chemotx
If extravasation occurs:

stop the infusion


aspirate remaining drug from needle

ice pack (for 20min/hr for 24-48 hrs.) or


pour NSS
Cancer Care: Biotherapy

Hematopoietic growth factors (STIMULATE


BM RECOVERY AFTER CHEMOTX. EX: GM-CSF,
ERYTHROPOIETIN)

Biologic response modifiers (BRMs)(ALTER HOSTS BIOLOGIC RESPONSE TO TUMOR.


EX:INTERFERONS)

Interferons (IFN) and interleukins (IL)


( ANTIVIRAL, IMMUNOMODULATORY,
ANTIPROLIFERATIVE)

Monoclonal antibodies (MoAbs)


(SPECIFIC ANTIBODIES DIRECTED VS. SINGLE
ANTIGENIC DETERMINANTS ON THE CELL
SURFACE)

Vaccines

Anti-angiogenesis agents- (PREVENT THE


GROWTH OF BLOOD VESSELS INSIDE A TUMOUR,
STARVING IT OF BLOOD)

Emerging targeted therapies


Bone Marrow Peripheral Stem Cell
Transplant
Cancer Care:
Other Treatment Modalities

Bone marrow transplantation


- Autologous
- Allogeneic- relative;
Syngeneic identical twin
*500 1,000 ml of marrow
from the iliac crest

Clinical trials

Complementary and alternative


approaches
Bone Marrow Transplant
Cancer and Treatment Side Effects: Nursing
Management

Myelosuppression

Neutropenia: NC < 1000/mm3


NC = WBC X neutrophils (%)
FEVER: oral temp >38C in 24 hrs; T >38.5C
* INFECTION PRECAUTIONS

thrombocytopenia
* must be >100,000/mm3 for chemotx to
be done

anemia

Gastrointestinal effects

Nausea and vomiting


* premedication with serotonin
antagonists (ex
Ondansetron)

Anorexia

Stomatitis

Diarrhea and constipation


Cancer and Treatment Side Effects: Nursing
Management (cont.)

Integumentary effects
Alopecia
Skin reactions

Reproductive system effects


Sterility
Loss of libido
Impotence
Oncologic Emergencies: Nursing Management

Infection
Pain

Hypercalcemia- due to bone resorption


TX: hydration, calcitonin, oral
glucocorticoids

Tumor lysis syndrome rapid release of IC


potassium, phosphorus & nucleic acid into
circulation due to
destruction of large # of
malignant cells.
TX: hydration, Allupurinol, NaHCO3, D
50%

Syndrome of inappropriate antidiuretic


hormone when hypoNa is severe (<120 meq/L)
TX: hypertonic saline, declomycin,
lithium
Oncologic Emergencies: Nursing Management
(cont.)

Disseminated intravascular coagulationwidespread clotting that consumes all clotting


factors >>> bleeding

Spinal cord compression- due to direct


pressure on or compromise of vascular supply to
SC. SX: back pain

Superior vena cava syndrome- from int. &


ext. obstruction of the SVC decreasing venous
return to the heart compromising CO. Sec to lung
Ca small cell 65%

Cardiac tamponade
Cancer Care:
Psychosocial Aspects

Support for client and family


Promoting positive self-concept
Promoting coping
Recurrent disease and progression
Terminal illness

After discussing the difference between


benign and malignant tumors with a client, the
nurse would know that the client
understood the discussion when the client says
a. A benign tumor does not invade other
tissue.
b. Malignant tissue is not found far from
the
original site of the tumor.
c.The control of growth is impaired only
in
malignant tissue.
d.Malignant tumors do not respond well
to
chemotherapy.

After discussing the difference between


benign and malignant tumors with a client, the
nurse would know that the client
understood the discussion when the client says
a. A benign tumor does not invade other
tissue.
b. Malignant tissue is not found far from
the
original site of the tumor.
c.The control of growth is impaired only
in
malignant tissue.
d.Malignant tumors do not respond well
to
chemotherapy.

A client who has been diagnosed with


breast carcinoma wants to know the meaning of
a cancer cure. The nurses most
accurate response is that
a. It is disease-free survival for 5 years
and indicates a
low probability of disease
recurrence.
b. It is a statistical analysis of the
number of all individuals at risk who do not show
signs of a
particular form of cancer.
c. It is the number of people living 5
years with ongoing medical treatment.
d. It is a lay term that implies a
permanent cure if you
make it through 5
years.

A client who has been diagnosed with


breast carcinoma wants to know the meaning of
a cancer cure. The nurses most
accurate response is that
a. It is disease-free survival for 5 years
and indicates a
low probability of disease
recurrence.
b. It is a statistical analysis of the
number of all individuals at risk who do not show
signs of a
particular form of cancer.
c. It is the number of people living 5
years with ongoing medical treatment.
d. It is a lay term that implies a
permanent cure if you
make it through 5
years.

In the assessmeant of a client with


suspected stomach cancer, the question that
would
be most helpful to this clients history is
a. Do you have much exposure to the
sun?
b. Have you ever taken steroids?
c. How much food such as bacon and hot
dogs do you eat?
d. How long have you been overweight?

In the assessmeant of a client with


suspected stomach cancer, the question that
would
be most helpful to this clients history is
a. Do you have much exposure to the
sun?
b. Have you ever taken steroids?
c. How much food such as bacon and hot
dogs do you eat?
d. How long have you been overweight?

The nurse caring for a client who has an


implanted radiation source should reduce
self-exposure by incorporating the
strategy of

a. limiting the time spent close to the


client to 30
minutes per 8-hour shift.
b. wearing a lead-shielded apron
whenever
entering the clients room.
c. remaining 6 feet away from the client
except
for essential care.
d. wearing a radiation meter or film
badge to
measure exposure.

The nurse caring for a client who has an


implanted radiation source should reduce
self-exposure by incorporating the
strategy of
a. limiting the time spent close to the
client to 30
minutes per 8-hour shift.
b. wearing a lead-shielded apron
whenever
entering the clients room.
c. remaining 6 feet away from the client
except
for essential care.
d. wearing a radiation meter or film
badge to
measure exposure.

The nursing action that has the highest


priority for a 32-year-old client with an implanted
radiation source should focus on
a. promotion of activity.
b. prevention of skin problems related to
radiation.
c. assessment of the clients reaction to
the
diagnosis and treatment.
d. safeguarding the client and other
persons
from unnecessary radiation
exposure.

The nursing action that has the highest


priority for a 32-year-old client with an implanted
radiation source should focus on
a. promotion of activity.
b. prevention of skin problems related to
radiation.
c. assessment of the clients reaction to
the
diagnosis and treatment.
d. safeguarding the client and other
persons
from unnecessary radiation
exposure.

When explaining the treatment to a client


who is receiving interleukin-2 (IL-2) as part of the
therapeutic plan for the management of a
malignant melanoma, the nurse
would emphasize the ability of this agent
to
a. increase oxygenation to cells that are
not
malignant.
b. physically dissolve the tumor mass.
c. strengthen immune response.
d. replace damaged and diseased cells
from bone marrow.

When explaining the treatment to a client


who is receiving interleukin-2 (IL-2) as part of the
therapeutic plan for the management of a
malignant melanoma, the nurse
would emphasize the ability of this agent
to
a. increase oxygenation to cells that are
not
malignant.
b. physically dissolve the tumor mass.
c. strengthen immune response.
d. replace damaged and diseased cells
from bone marrow.

When there is extravasation of vincristine


(Oncovin), a vinca alkaloid, the nurse should
initially
a.
leave the cannula in place and
aspirate.
b. apply manual pressure to delay further
circulation.
c. apply cold compresses to the site.
d. call the physician immediately.

When there is extravasation of vincristine


(Oncovin), a vinca alkaloid, the nurse should
initially
a.
leave the cannula in place and
aspirate.
b. apply manual pressure to delay further
circulation.
c. apply cold compresses to the site.
d. call the physician immediately.

When a client undergoing systemic


chemotherapy reaches the nadir of treatment,
immediate care by the nurse should be
directed toward
a. enhancing the effects of chemotherapy
by
encouraging mild activity.
b. protecting the client from infection and
bleeding.
c. improving the mental state of the client
by
using mental imagery.
d. assisting the client to eat an adequate
amount of food to maintain nutrition.

When a client undergoing systemic


chemotherapy reaches the nadir of treatment,
immediate care by the nurse should be
directed toward
a. enhancing the effects of chemotherapy
by
encouraging mild activity.
b. protecting the client from infection and
bleeding.
c. improving the mental state of the client
by
using mental imagery.
d. assisting the client to eat an adequate
amount of food to maintain nutrition.

RISK FACTORS OF BREAST CANCER

Age:. Most cases of breast cancer occur in


women over 60. This disease is not common
before menopause.

Personal history of breast cancer:

Family history: A woman's risk of breast


cancer is higher if her mother, sister, or daughter
had breast cancer. The risk is higher if her family
member got breast cancer before age 40.

Certain breast changes: Some women


have cells in the breast that look abnormal under
a microscope. Having certain types of abnormal
cells (atypical hyperplasia and lobular carcinoma
in situ [LCIS]) increases the risk of breast cancer.
RISK FACTORS TO BREAST CANCER (CONT)

Gene changes: These genes include


BRCA1, BRCA2, and others. Tests can sometimes
show the presence of specific gene changes in
families with many women who have had breast
cancer.

Reproductive and menstrual history:

first menstrual period before age 12 are at


an increased risk of breast cancer.

menopause after age 55 are at an


increased risk of breast cancer.

never had children

menopausal hormone therapy with


estrogen plus progestin after menopause
RISK FACTORS TO BREAST CANCER

Race: more often in white women than


Latina, Asian, or African American women.

Radiation therapy to the chest: Women


who had radiation therapy to the chest (including
breasts) before age 30 This includes women
treated with radiation for Hodgkin's lymphoma.
Studies show that the younger a woman was
when she received radiation treatment, the
higher her risk of breast cancer later in life.

Breast density: Breast tissue may be


dense or fatty. Older women whose
mammograms (breast x-rays) show more dense
tissue are at increased risk of breast cancer.
RISK FACTORS TO BREAST CANCER (CONT)

Taking DES (diethylstilbestrol) during


pregnancy:

Being overweight or obese after


menopause: The chance of getting breast cancer
after menopause is higher in women who are
overweight or obese.

Lack of physical activity: Being active may


help reduce risk by preventing weight gain and
obesity.

Drinking alcohol: Studies suggest that the


more alcohol a woman drinks, the greater her risk
of breast cancer.
Common symptoms of breast cancer include:

A change in how the breast or nipple feels

A lump or thickening in or near the breast


or in the underarm area

Nipple tenderness

A change in how the breast or nipple looks

A change in the size or shape of the breast

A nipple turned inward into the breast

The skin of the breast, areola, or nipple


may be scaly, red, or swollen. It may have ridges
or pitting so that it looks like the skin of an
orange.

Nipple discharge (fluid)


Clinical Manifestations

Painless, non-tender, hard, irregularly


shaped, non-mobile masses (upper outer
quadrant or beneath the nipple)

Nipple retraction

Late: Nipple discharge, induration and


dimpling

Breast asymmetry, palpable lymph and


axillary nodes

Heat and erythema of breast

Skin edema- invasion and obstruction of


dermal lymphatics
Assessment:
1. - asymptomatic

lump on the upper outer quadrant

2. late signs: (malignant)

irregular shaped mass


fixed nodules and adheres to chest wall
asymmetry of the breast
peau de orange
increase venous prominence

Diagnosis:
Breast Biopsy
Mammography
Common sites of metastasis:
bones, lungs, brain, liver
Management:
1. Chemotherapy
2. Radiation
3. Hormonal manipulation with
estrogen in
postmenopausal
women. (Tamoxifen)

4. Surgery:
a. Mastectomy
b. Oophorectomy
c. Adrenalectomy
The most effective chemotherapy regimens for
breast cancer that has spread include:
- cyclophosphamide
CYTOXAN
- docetaxel
TAXOTERE
- doxorubicin
ADRIAMYCIN
- epirubicin
ELLENCE
- gemcitabine
GEMZAR
- paclitaxel
TAXOL
vinorelbine.

For women who are still menstruating,


tamoxifen
is usually the first hormone-blocking drug

For postmenopausal women who have


estrogen receptor-positive breast cancer,
aromatase inhibitors (such as anastrozole
, letrozole, and exemestane) converts some
hormones to estrogen
Surgical Treatment

Lumpectomy
- Tumor excised and removed; lymph node
dissection

Simple Mastectomy
- Breast tissue and nipples removed; lymph nodes
left intact

Modified Radical Mastectomy


- Breast tissue, nipple, lymph nodes removed,
muscle left intact

Halsted Radical mastectomy


- Breast tissue, nipple, underlying muscles and
lymph nodes removed
Nursing Management

Pre-op period:
assess self esteem and body image
support denial
breast reconstruction and prosthesis

Post- op period:

give analgesic round the clock

perform deep breathing exercises


arm precautions and position
- care of drains
Prevent complications:
bleeding
atelectasis

infection
CERVICAL CANCER

lymph edema

Almost all cervical cancers are caused by


HPV (human papillomavirus).

HPV is a common virus that is spread


through sexual intercourse

Other Risk factors for cervical cancer include:

Having sex at an early age


Multiple sexual partners
Sexual partners who have multiple
partners or who participate in high-risk sexual
activities

Women whose mothers took the drug DES


(diethylstilbestrol) during pregnancy in the early
1970s to prevent miscarriage

Long-term use of birth control pills (more


than 5 years)

Weakened immune system

Infections with genital herpes or chronic


chlamydia infections

Poor economic status (may not be able


to afford regular Pap smears)

Prevention:
abstinence
limiting number of partners
using a condom

yearly Pap smears


Symptoms that may occur can include:

Continuous vaginal discharge, which may


be pale, watery, pink, brown, bloody, or foulsmelling

Abnormal vaginal
bleeding between periods, after intercourse, or
after menopause

Periods become heavier and last longer


than usual
Surgical treatment

Early cervical Ca hysterectomy

If still childbearing Trachelectomy


( internal cervical opening is left behind)

rectum

Pelvic Exenteration TAHBSO, bladder,

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