This document provides information about caring for a client with cellular aberrations. It discusses the cell cycle, normal cell proliferation, differentiation, terms denoting cellular changes, clinical manifestations of cancer cells, modes of cancer dissemination, carcinogenesis, classifying and naming neoplasms, cancer staging systems, and the four stages of cancer cell growth.
This document provides information about caring for a client with cellular aberrations. It discusses the cell cycle, normal cell proliferation, differentiation, terms denoting cellular changes, clinical manifestations of cancer cells, modes of cancer dissemination, carcinogenesis, classifying and naming neoplasms, cancer staging systems, and the four stages of cancer cell growth.
This document provides information about caring for a client with cellular aberrations. It discusses the cell cycle, normal cell proliferation, differentiation, terms denoting cellular changes, clinical manifestations of cancer cells, modes of cancer dissemination, carcinogenesis, classifying and naming neoplasms, cancer staging systems, and the four stages of cancer cell growth.
The CELL CYCLE MITOSIS refers to splitting of one cell into two CELL CYCLE Time the interval from mitosis of a cell to its mitosis into a daughter cells STATIONARY Period apparent rest after mitosis FOUR PHASES OF THE CELL CYCLE 1. The Quiescent phase consisting of G1 phase in which ribonucleic acid (RNA) and protein synthesis begin 2 .S is a period of DNA synthesis or replication 3. G2 Further RNA and more protein synthesis and the development of mitotic spindle .S to G2 Phase is 2 to 4 hrs. 4 .M or Mitosis- cells split into 2 cells or cell division. Cell cycle is controlled by the cell nucleus, which receives signals from growth regulating protein that stimulate or suppress cell division. DIFFERENTIATION All body tissue are derive from stem cells which are immature cells with no specific cell lineage and this cells has the ability to proliferate rapidly and renew themselves as needed and to develop specialized functions as they grow and mature. The process of differentiation causes the cells to resemble their normal forebears and have fully mature, specialize function and morphology NORMAL CELL PROLIFERATION Cellular growth take place in an orderly process that responds to the needs such as trauma, surgery, or an inflammatory event. Once the needs is meet multiplication stops. Normal cells recognize the presence of other cells, by means of co tact inhibition. When cells are in close contact with each other, they normally adhere closely together. This contact inhibits overlap of cells and disorganized growth. In normal cells these restraints on growth are maintained under the need for new cells arise because of cell death. Some are rapid like bone marrow, skin and gastrointestinal because the need for all cell replacement in these areas is greater than the slower growing tissue. Except for blood cells, normal cells do not migrate but have a designated locations. How do cancer get started?Cancer is cause by mutations in a variety of genes responsible for controlling the growth of cells either directly or indirectly. Is all cancer genetic?Yes, all cancer, the uncontrolled division of a cell, is genetic because cancer is cause by damage to genes that control cell division or cell growth. This damage is usually due to outside influences or carcinogens damaging our genes over the course of a lifetime.
What is a Carcinogen?A carcinogen is any substance situation or exposure that can damage genetic material (DNA). Hundreds of known carcinogen include internal factors created in the body by metabolic processes (ex. Free radicals, hormones ), virus (e.g. hepatitis B, human papilloma virus) chemicals (e.g .tobacco ,alcohol ,industrial asbestos ) and radiation (e.g. diagnostic radiation, ultra violet light)
TERMS DENOTING CELLULAR CHANGES Types of Cellular Changes MITOSIS - formation of a new cell by cell division Ex. Normal cell growth HYPERPLASIA - increase in cell number Ex. Breast epithelium in pregnancy HYPERTHROPHY - increase in cell size Ex. Increase in muscle cell size with exercise ATROPHY Decrease in cell size Ex. Decrease in muscle size with disease METAPLASIA- replacement of one adult cell type by different adult cell type Ex.Replacement of columnar epithelium of the respiratory tract by squamous epithelium DYSPLASIA Change in cell size, shape and organization Ex. Change in cervical epithelium in long standing cervicitis ANAPLASIA Reverse cellular development to more primitive cell type, or total loss of differentiation Ex. Irreversible change in accompanying cancer NEOPLASIA Abnormal cellular changes Ex. Malignancies OTHER TERMINOLOGIES CARCINOMA malignant tumor of the ephethelial cells SARCOMA a malignant tumor of the connective tissue cells ADENO classified arising from glandular epithelium with the prefix adeno. SQUAMOUS arising from squamous epithelium BLASTOMA originate during the primitive blastula embryonic phase TERATOMA contains all three types of embryonal tissue
DIFFERENCES BETWEEN BENIGN AND MALIGNANT NEOPLASM BENIGN MALIGNANT Rate of growth limited - may proliferate rapidly or grow slowly Spread - localized - spread (metastasize) throughout the body - fibrous capsule - No inclosing capsule Recurrence - rarely recur after removal - May recur even after treatment Shape -usually regular in shape - Irregular in shape with poorly defined border Cell characteristic - cells similar to cells of parent tissue - cells much different from parent cell (well differentiated) (poorly differentiated) Mode of growth -expansive growth -infiltrative growth General Effect -localized phenomenon --causes generalized effects such as anemia ,weakness and Weight loss
CLINICAL MANIFESTATION OF CANCER CELLS Tumors can be an obstructive problem if they occur in the trachea, ureter, gastrointestinal tract Tumors may also cause ulceration and infections of epithelial cells Intra spinal and intracranial tumors may cause symptoms of increase pressure Immunologic, hormonal, neuromuscular changes may result from a malignant process Systemic symptoms, such as fatigue, loss of appetite, and weight loss, may occur early in the disease process. MODE OF DESSIMINATION OF CANCER Direct extension into neighboring tissues (invasion characteristic) Permeation along lymphatic vessels Embolism via lymphatic vessels to the lymph nodes Embolism via blood vessels By invasion of body cavity by diffusion Invasion and Metastasis: Malignant disease processes have the ability to allow the spread of transfer of cancerous cells from one organ or body part of another by invasion and metastasis. Invasion or growth of primary tumor into the neighboring tissues occur in several ways Mechanical pressure exerted by rapidly proliferation neoplasm may force fingerlike projections of tumor cells into surrounding tissues and interstitial space. Malignant cells are thought to possess or produce destructive enzymes (protienases), such as collagenases (specific to collagen), plasminogen activators (specific to plasma), and lysosomal hydrolyses. These enzymes are thought to destroy surrounding tissues including the structural tissues of the vascular basement membrane, facilitating invasions of malignant cells.The mechanical pressure of a rapidly growing tumor may enhance this process. Lymphatic and Hematogenous Spread Most common mechanism of metastasis is the lymphatic spread. Tumor emboli enter the lymph channels by way of the interstitial fluid, which communicate with lymphatic fluid. Entering the lymphatic circulation malignant cells lodge in the lymph nodes or pass between the lymphatic and venous circulations. Hematogenous spread is the dissemination of malignant cells via the blood stream and is directly related to the vascularity of the tumor. Few malignant cells can survive the turbulence of arterial circulation, insufficient oxygenation or destructions of the body immune system. Angiogenesis Angiogenesis is the growth of new capilliaries from the host tissue by the release of growth factors and enzymes such as vascular endothelial growth factor. Large tumor emboli become traf in the microcirculation of distant sites may further metastasized to other sites. CARCINOGENESIS (Malignant Transformation) Molecular process
Classifying and Naming neoplasm Classification of Malignant lesions by Grade Grade o : Normal Tissue Grade 1 : Well differentiated, with minimal deviation from tissue of origin Grade 2 : Moderately Well differentiated, with evidence of structural changes from normal tissue of origin Grade3 : Poorly differentiated with extensive structural changes from normal tissue of origin Grade 4: Very anaplastic with no resemblance to tissue of origin
TNM Staging Classification System Tumor T0 No evidence of primary tumor Tis Carcinoma in situ T1,T2,T3,T4 Ascending degrees of tumor size and involvement Tx Tumor cant be measured or found Nodes N0 No evidence of disease in the lymph nodes N1a,N2a Disease found in regional lymph nodes, metastasis not suspected N1b,N2b,N3 disease found in regional lymph nodes, metastasis suspected Nx Regional nodes cant be assessed clinically Metastasis M0 No evidence of distance metastasis M1,M2,M3 Ascending degree of metastatic involvement Mx Metastasis cant be measured or found Ex.. a T2N1M1 breast cancer is stage 4
Four stages of cancer cell growth Initiation Promotion 1. Progression 2. Metastasis Initiation Carcinogen scape normal enzymatic mechanisms and alter the genetic structure of the DNA. These alterations are reversed by DNA repair mechanism or the changes initiate programs cellular death. Occasionally, cells escape this protective mechanism and permanent cellular mutation occurs. Promotion To become malignant the cell must enter the promotion stage. Repeat exposure to carcinogens expressions causes the expressions of abnormal cells or mutant genetic formations even after long latency periods. APOSTOSIS is the innate cellular process of program cell death. Progressions Normal cells is transform into a malignant potentials, the altered cells exhibit increase malignant behavior. INCIDENCE OF CANCER Increase in actual number of cancer deaths continue to increase because of aging and expanding population. Large disparities in cancer incidence and mortality occurs across racial and ethnic boundaries.
Gender and Age men common sites are prostrate,lung,colon, rectum, while in women the top 3 are lung, breast, and colon, then also uterine, cervical,and ovarian. AGE Todays life expectancy is 74.4% for men and 79.8 in women.Risk of developing cancer age - 20 =1 %,Age 50 =7%,age 60 = 10% to 16%,65 yrs =13% of the population. These are influence by variety of factors, like financial constraint of a fixed income and inadequate health insurance, limited transfortation ,established cultural ethnic and religious practice. This factors explain why older people are diagnosed with more advance cancer and do not participate in prevention and screening program. RACE AND ETHNICITY racial and ethnic minorities because of delayed diagnosis, unequal socio economic status, and unequal access to care. For socio economic factors health care insurance is unavailable or expensive for members of the minority group. GEOGRAPHIC - Genetic differences among population may contribute to international variations. Migrations from one country to another frequently results in major changes in the cancer incidence pattern. RISK FACTORS = Endogenous {age-} cancer increases with age{Genetic factors}- some exhibit a clear inheritance pattern,{ Hormonal factors } hormones influences carcinogenesis. =External { Tobacco} the single most lethal carcinogen,{Radiation} both ionizing and ultraviolet radiation can cause cancer{Nutrition }excess energy intake like obesity is associated with a higher incidence of cancer. Inactivity with obesity is associated with a higher incidence of cancer. {Infectious organism} Several virus, including sexually transmitted disease organism increases the risk of cancer. *ETIOLOGY 1. Viruses and bacteria heap b, helicobacter pylori, human papilloma virus 2. Physical agents sunlight, radiation, chronic irritation or inflammation, tobacco, etc. 3. Chemical agents hazardous chemicals, liver lungs kidney are most affected due to their role as a detoxifying chemicals 4. Genetics and familial factors genetics, shared environment, cultural and lifestyle factors 5. Dietary factors chronic absence of protective substance in the diet, fats, alcohol, salt cured or smoked meat, nitrite and nitrate containing food. Obesity 6. Hormonal agents disturbances in hormonal imbalance, oral contraceptives, and prolong estrogen therapy. WARNING SIGNS C Change in bowel habits A A sore that does not heal U Unusual bleeding/discharges T _ Thickening/ lump in the breast I _ Indigestion/ difficulty swallowing O _Obvious change in warts or mole N _ Nagging cough or Hoarseness A _ Anemia / L _ Loss of weight DIAGNOSTIC PROCEDURE: How are cancer diagnosed?
Cancer maybe diagnosed clinically or by looking at the sample of tissues suspected of being cancerous under a microscope. A clinical diagnosis is the physician best educated guess at the most likely diagnosis. A patient maybe asymptomatic or present with a signs and symptoms that suggest a diagnosis of cancer. Most s/s however are non specific and can be seen in a wide variety of illnesses. A diagnosis of cancer requires a diagnostic test and that test is the biopsy. A biopsy is a surgical procedure in which all or part of the tissues suspected of being cancerous is remove.
Common malignant lesions and commonly used diagnostic test Malignancy Diagnostic test Gynecologic cancers Cervix Colposcopy, biopsy, pap smear Ovary Pelvic physical exam ,urinalysis, IVP, Barium Enema Uterus Endometrial biopsy and aspiration Gastrointestinal Esophagus Chest xray, CT Scan, MRI, Esophagoscopy and biopsy Barium contrast studies Stomach Gastic secretion analysis barium contrast studies Carcinoembryonic antigen, gastroscopy and biopsy colorectal Ct scan, MRI, Stool guaiac, barium enema, colonoscopy and biopsy, Liver Liver biopsy,liver enzyme studies, alpha-fetoprotien, MRI, City scan and angiography , ultrasound Genitorurinary Prostrate Digital Rectal Examination, bone scan, biopsy, urinalysis, Prostrate specific antigen Bladder Cytology, cystoscopy, IVP, urinalysis kidney CT scan, Renal angiogram, sonogram, KUB, Urinalysis, IVP Other Cancers Breast Breast physical exam, Ultrasound, Mammography, Tissue and Lymph nodes biopsy Lungs Chest Xray, fiberotic bronchoscopy with biopsy and bronchial washing Mediastinography(endoscopic examination of mediastinum and nodes) Thoracentesis.
COMPLICATIONS OF CANCER Malnutrition Altered taste Infection oncologic emergencies
ONCOLOGIC EMERGENCIES Obstructive Emergencies SVC( superior vena Cava) syndrome Spinal Cord Compression Metabolic Emergencies SIADH(Syndrome of Inappropriate Secretions of Anti diuretic Hormone)
NURSING MANAGEMENT FOR COMPLICATIONS SUPERIOR VENA CAVA SYNDROME - is a clinical diagnosis that describe a pattern of physical finding resulting from obstruction of blood flow through the superior venacava. The resulting engorgement of collateral veins in the thorax, head and neck produces the classic symptoms. Cause by compression, thrombosis, Invasion. Most common in lung, non-hodgkin lymphoma,and Breast cancer Progressive shortness of breath, cough, hoarseness, chest pain and facial swelling Edema of the neck, arms, hands, and thorax, and reported sensation of skin and difficulty of swallowing Possible engorge and distended, jugular and arm vein ma SPINAL CORD COMPRESSION- it is develop in 5 to 10% in patient with cancer, 40% in patient with bone metastasis. Significant neurologic deterioration is associated with a worst prognosis.
Usual in lumbar, thoracic, and cervical cancer. Back pain Motor weakness, bowel and bladder dysfunction Steroids- reduce swelling External Braces may be used Radiation/chemotherapy/surgery
SIADH-SYNDROME OF INAPPROPRIATE ANTI DIURETIC HORMONE a syndrome of hyponatremia due to abnormal secretions of production of anti diuretic hormone. Decreased urine output Weight gain: > 5 lbs/day Dilutional hyponatremia Nausea and vomiting Confusion and fatigue personality changes Altered mental status
HYPERCALCEMIA of Malignancy is a paraneoplastic syndrome characterized by a serum calcium level exceeding 10.5mg/dl.without treatment may progress to renal failure,severe dehydration, coma and death. Ca that involves metastases to bone. Greater than 11 mg/dlac
TUMOR LYSIS SYNDROME occurs when a large number of tumors cells are destroyed. It is manifested by severe electrolyte embalance and can lead to severe cardiac arrhythmias, acute renal failure and death. Rapid release of uric acid, potassium into the blood from dead tumor cells Occurs 24 hours after chemotherapy Hyperuricemia, hyperkalemia Muscle weakness, twitching, seizures Cardiac arrhythmias, arrest Renal failure: Flank pain, oliguria, edema MANAGEMENT - Hydration : Administer fluids Allopurinol as ordered I and O, weights
SEPSIS septicemia organisms enter the bloodstream Clients with Ca: decrease, WBC and low immune function Mngt: Oxygen, fluid replacement , antibiotic, immunizations, chemotherapy induce nutropenia. Strict hand washing and routine wearing of mask
DIC Disseminated intravascular Coagulation a direct response to the presence of specific proteins or cancer procoagulants which maybe secreted by malignant cells. release of thrombin (clotting factor) from cancer cells Widespread clotting uses platelets and clotting factors Process followed by extensive bleeding Mngt: Blood products Heparin or low-molecular weight heparin
Cardiac Tamponade - execssive accumulation of blood or fluid between the pericardium and the heart, prevents the adequate amount of blood from flowing into the heart to fill the ventricles. Management Emotional support Oxygen administration Reposition the patient to enhance circulation
Administer analgesics Encourage relaxation technique Administer anti- anxiety Vaso active drugs maybe ordered
PART 2 TREATMENT MODALITIES Goal of Care Surgery cure Chemotherapy control Radiation Therapy palliative relieve but does not cure Biologic Target Therapy SURGICAL MANAGEMENT *Most ideal and most widely used option Purpose of Surgery 1. Prevent 2. Diagnose or staging - biopsy 3. Cure - remove wide range of tissue surrounding the organ involve 4. Control 5. Reconstructive/Rehabilitative 6. Palliative colostomy
Chemotherapy Used to treat systemic disease rather than localize lesions that are amenable to surgery or radiation. Antineoplastic agents are used in an attempt to destroy tumor cells by interfering with cellular function. Adjuvant chemotherapy refers to chemotherapy administered with either surgery or radiotherapy. Principles of Chemotherapy Most chemotherapy agents cause cell death by interrupting cell growth and replication at some point of the cell cycle. Drugs are classified by their mechanism of action Cell cycle phase- specific drugs drugs that act at a particular point in the cell cycle Phase- Non specific drug drugs that act throughout the cell cycle. Cell Population Growth; Chemotherapy is most effective when the tumor is small and growing rapidly, a time when a relatively high proportion of cells are undergoing division. At this time tumor cells are more sensitive to drugs that are toxic to dividing cells (Phase-specific drugs). Larger, slower growing tumor responds better to drugs that act regardless of whether the cell is dividing (phase non specific drugs) Cell Kill Hypothesis; Chemotherapy is thought to kill a fix percentage of the total number of cancer cells. 90 percent cell-kill and 10 percent would be killed by the body immune system Combination chemotherapy, has a therapeutic effect superior to single agents therapy for many cancers, since drugs that attack the tumor cells in various ways can produce maximal kill.It also decreases the likelihood of the tumor to become resistant.
Dose Intensity; Most effective when given sufficient Tumor Resistance to Chemotherapy; primary resistance maybe present as a result of specific genetic trait, secondary resistance maybe acquired during treatment as a result of spontaneous genetic alterations, MDR or multiple drug resistance can occur when several agents are used in combination CLASSIFICATION OF CHEMOTHERAPEUTIC AGENT Cell Cycle Phase Specific Agent Antimetabolites ( S Phase ) interferes with synthesis of nucleic acid( DNA or RNA ) Flouracil (SFU) Gemzar Methotrexate (Mexato) Cladribine, Cytarabine, Floxuridine Fluradabine, hydrxy urea Also,Doxurobicin,5 Flouroracil,6 Mercaptopurine, Mitozantone,Topotecan,Irenotican, Capecitadine, Germcetabine Plant Alkaloid/Antimiotic (M Phase)- prevents mitosis/ disrupt mitosis causing cell death Vinblastin Sulfate ( Vilban) Vincristine Sulfate ( Oncobin) Also Etoposide, Teniposide, Paclitaxel, Doxetaxel
Cell Cycle Phase Non specific
Alkalyting (Non Specific) binds with DNA, breaks DNA helix, preventing cell replication to cell death. Mustargen, cytoxan,leukera, Myleran, cisplatin Oxaliptatin, carboplatin Others busulfan, carboplatin,cyclopospamide, nitrosureas,
Antitumor Antibiotics (Non Specific)-binds with DNA thus inhibiting DNA synthesis Mitomycin (Mutamycin) Doxurobicin (Adriamycin) Methramycin(Mitracin) Doxurobicin HCL toxic to myocardium attach to mycardium
Hormonal Preparation decrease cell metabolism environment not favorable for growth of cancer cells Anti estrogen/Androgen Tamoxifen Megace causes verilism on woman Estrogens/ and Progestins Diethylstebestro (DES)(Estradol) Effect in female- heavy menses, fluid retention, breast tenderness. In Male gynecomastia, penile atrophy
METHOD OF ADMINISTRATION Oral,
Intramuscular, intravenous Intra arterial- arterial vien supplying tumor Intraperitonial / Intracavitary Intrathecal/ Intraventricular/ Spinal/ Ommaya Reservoir Intravesical/ Bladder IV COMPLICATION Irritants damage vein,intense phlebitis, no tissue damage if infiltrated Vesicant causes local tissue necrosis when infiltrated NURSING RESPONSIBILITIES Use gloves, mask and eye protection Administer anti emetic 30 mins before chemotherapy Render meticulous oral care, alkalinizer for mouth wash Avoid spicy food, bulky food Reverse isolation Avoid raw food Drugs are sensitive to ligth, dim the room Cover IV bottles and tubings with carbon paper
MANAGING SIDE EFFECTS OF CHEMOTHERAPY STOMATITIS Self examine Soft toothbrush/toothettes Mouth care of 2-4 hrs No commercial mouthwash, plain water saline solution Rinse with viscus lidocaine before meals KY jelly- cracked lips Such on popsicles to provide moisture Soft bland high protien, high caloric diet NAUSEA AND VOMITING Administer antiemetic 30 mins. Before chemotherapy Withold foods/fluids 4-6 hrs before chemotherapy Provide bland foods in small amount after treatment DIARRHEA Anti diarrheas (lomotil, Kaopectate) Good perenial care Increase fluids as tolerated Monitor potassium, sodium chloride levels Low residue diet, increase potassium INTEGUMENTARY- ALOPECIA Head coverings, caps Scarves, turban
Wigs Light brushing Trim hair before treatment Frequent linen change Hair loss temporary, regrowth in 1 month from chemotherapy New hair color, texture thickness NEOROLOGIC SYSTEM ALKALOID (Vincristine) May cause neurologic damage Peripheral neuropathies Hearing loss, paralytic ileus RESPIRATORY SYSTEM Pneumonia monitor for high hacking cough fever and dysnea RENAL SYSTEM Increase fluid, frequent bleeding metabolites Allupurinol (Zyloprim) REPRODUCTIVE SYSTEM Infertility Banking sperm Reliable method of Contraception before treatment FATIGUE Accumulation metabolies from cell breakdown Health Teaching on expected side effect Encourage to rest RADIATION THERAPY-radiotherapy is a treatment of disease with ionizing radiation. Normal tissues and tumors are both affected by ionizing radiation How does radiation Works? Radiation therapy delivers a precised measured dose of ionizing radiation to a specific tumor volume, with the intent to kill the cancer cells but spare the normal tissues. Radiation treatment causes cellular damage that leads to bilogical in the DNA.. Each radiation treatment causes permanent damage in the DNA of the tumor cells, which is then unable to divide and eventually dies. Radiation also damage the DNA of normal cells but most of them are able to repair it and remain functional. A local treatment modality Deliver of high energy become sufficient to break DNA bonds , interupting Mitosis Cells most sensitive during G2 and M phase Sources of Radiation Therapy Teletherapy administered by high energy, x ray (linear accelerator) delivered from a machines containing radioisotopes (Cobalt 60) External Beam Radiation
Client dose does not emit radiation Nursing Responsibilities Skin care, do not expose to sunligth, avoid pressure to site,avoid soap cream, lotion and oils External Radiation Placement of specially, bead prepaed radioesotopes directly into the tumor or intosystemic circulation wire, needle Bead Internal Radiation (2 types) Sealed Source radio sotopes enclosed in a container(seeds, Ribbon) Clients emit radiations whie inplant is in place Radium seed, Radon seed,Ceseum Unsealed Source Radioisotopes circulated in the body Contaminated body fluidsUrine saliva,sweet,feces RAI 131, RA 135, Ragold 192, Raphos 132 Internal Radiation Sealed Implant- intracavitary, intra lesions, intratumor Unsealed implant PO,intra arterial Infusion, Intrathecal Infusion RADIATION SICKNESS/ REACTION LOCAL SYSTEMIC Erythema Bone Marrow Depression Dryness Anemia Skin /hour Leukopenia blister-exact symptoms of 1st degree burn thrombocytopenia sterility NURSING RESPONSIBILITY
Sealed Radiotherapy Hang caution sign on the door Organize task to minimize exposure No pregnant and below 16. Linen must remain room until implant is remove Dislodge radium, pick with long forcep, and put in lead container or inform radiology department If unable to locate; prohibits visitor As long us implant is removed no more radiation
Unsealed Radiotherapy Home teaching Wash hands after bathroom, flush toilet several times Wash laundry differently Drink plenty of water
NURSING RESPONSIBILITIES
Anemia Adequate rest period Monitor hemoglobin/hematocrit Administer O2 as needed Leukopenia Wash hands before contact with client NO fresh fruits, vegetables, raw foods NO flowers, pets, visitors with infection, crowd Client wears mask in public area Bathe daily; moisturizer to prevent dry skin Monitor for signs of infection: fever: notify MD Bone Marrow Suppression/Thrombocytopenia (<100,000/mm3) Protect client from physical injury Electric shaver only Avoid aspirin, NSAIDs, IM inj, rectal temp., suppository Monitor blood counts, stool and urine High fiber diet, inc fluids Assess and teach increased bleeding (epistaxis, petechiae, ecchymosis) Teaching: avoid bump/bruising skin
BIOLOGIC THERAPY With direct antitumor effects Restore, augment, modulate host immune system Mechanism
Target therapy Targets specific cellular receptors,Kills cancer cells w/o damaging normal cells Tyrosine Kinase inhibitors Angiogenesis Inhibitor Proteasome Inhibitor Monoclonal Antibodies
BONE MARROW TRANSPLANTATION OR Hematopoietic stem cell transplant What is bone marrow? Bone marrow is the soft, spongy tissue found inside bones. It is the medium for development and storage of about 95 percent of the bodys blood cells. What is bone marrow transplantation (BMT)? Bone marrow transplantation is a special therapy for patients with cancer or other diseases that affect the bone marrow. A bone marrow transplant involves taking cells that are normally found in the bone marrow (stem cells) and giving them back to the patient. The goal of BMT is to transfuse healthy bone marrow cells into a person after his/her own unhealthy bone marrow has been eliminated.
BMT has been used successfully to treat diseases such as leukemias, lymphomas, aplastic anemia, immune deficiency disorders and some solid tumor cancers since 1968. The blood cells that produce other blood cells are called stem cells. The most primitive of the stem cells is called the pluripotent stem cell, which is different than other blood cells with regard to the following properties:
Renewal It is able to reproduce another cell identical to itself.
Differentiation It is able to generate one or more subsets of more mature cells. It is the stem cells that are needed in bone marrow transplantation and they can be collected in one of three ways: Types of bone marrow transplant Interfere with cancer cells ability to metastasize
1. ALLOGENEIC transplant stem cells come from a donor within the same species, a related donor or a match unrelated donor or placenta blood. 2. AUTOLOGOUS transplant The stem cell donor is the patient 3. SYNGENEIC transplant The stem cell donor is the patient identical twin
Allogenic BMT (AlloBMT) used primarily for diseases of the bone marrow, depends on the availability of a human leukocyte antigen- match donor. It may involve either ablative (high dose) or non ablative (lower) dose In ablative AlloBMT the recipient must under go ablative dose of chemotherapy and total irradiation to destroy all existing bone marrow and malignant disease. Nonablative AlloBMT the chemotherapy dose are lower and are aimed at suppressing the recipients immune system to allow engraftment of donor bone marrow or PBSCs Autologous BMT (AuBMT) is considered for patients with disease of the bone marrow who do not have a suitable donor for AlloBMT, and for patients who have healthy bone marrow but require bone marrow ablative doses of chemotheraphy to cure an aggressive malignancy. Syngeneic transplant - is less incidence of GVHD( gragh versus host disease), even an identical twin is available for marrow donation, anoher match sibling or even an unrelated donor maybe the most suitable donor to combat an aggresive malignancy. Cancer treatment terms you should know Combined modality therapy a term used to describe when physicians choose more than one therapy in treating a patient, such as a combination of radiation therapy and chemotherapy. Adjuvant therapy a term used to describe when physicians choose more than one therapy in treating a patient. However, the term adjuvant therapy is more specifically used to describe treatment given after the primary cancer treatment is completed to improve the chance of a cure. For example, if the physician wants to treat cancer cells that may be present, he or she may prescribe one or more additional treatments.
Neoadjuvant therapy a term used to describe when physicians choose to use more than one therapy in treating a patient. However, the term neoadjuvant therapy is more specifically used to describe cancer treatment given before the primary therapy both to kill any cancer cells and contribute to the effectiveness of the primary therapy. Cryotherapy- treatment by the application of extreme cold as in cryosurgery (Use of extreme cold to destroy tissue) SPECIFIC MANAGEMENT FOR SOME COMMON CANCER Hodzkin Lymphoma Chemo , radiotherapy Leukemia Chemo Non Hodzkin chemo, radio KCs local Cryotherapy, radio KCssystemic Chemo Bladder Cystectomy Bone Limb sparing surgery, amputation Brain Chemo..,radio..,Surgery Breast chemo.., radio.., hormonal, Surgery(mastectomy and lumpectomy) Modified Radical Mastectomy(whole Breast) Breast sparing procedure(wedge resection, partial mastectomy, and lumpectectomy) Colorectal chemo.., surgery Endocrine chemo.., surgery Gastric surgery Gallbladder chemo Pancreas whipples procedure Prostrate prostatectomy Lung chemo..,radio.. Testes Radical inguinal orchiectomy
ELEMENTS OF PALLIATIVE CARE Distress from Physical Symptoms assess the patients understanding on Cause of the symptoms Goal for relief Current side effect Consider patient goal What is important for the patient How can we help the patient live well Psychological and Spiritual Assessment How the patient cope with the stressful situation Who does the patient turn for support? Discuss the Prognosis Support System