NEOPLASTIC DISORDERS

Pathogenesis of Cancer
Cellular Transformation and Derangement Theory
Failure of the Immune Response Theory
Etiologic Factors
Virus
Chemical carcinogens
Industrial Compounds
Hormones
Food, preservatives
Physical Agents
Radiation
Trauma/physical irritation
Hormones
Genetics
Predisposing Factors
Age
Sex
Urban vs rural residence
Geographic distribution
Occupation
Heredity
Stress
Precancerous lesions
Obesity
Warning Signs of Cancer
C- change in bowel or bladder habits
A- sore throat that does not heal
U- unusual bleeding or discharge
U- unexplained sudden weight loss
U- unexplained anemia
T- thickening or lump in the breast or elsewhere
I- indigestion or difficulty in swallowing
O- obvious change in warts or moles
N- nagging cough or hoarseness of voice
Comparison of Benign & Malignant Neoplasm
Characteristics
Benign
Malignant
Speed of growth

Slow

Rapid

Mode of growth

Localize

Infiltrating

Capsule

Encapsulated

No capsule

Recurrence

Unusual

Common

Metastasis

None

Common

Effect

Harmless to host

Harmful

Prognosis

Very good

Poor

Chemotherapy
1. Objectives
To destroy Ca cells w/o excessive destruction of normal cells
To control tumor growth if cure is no longer possible
Used as adjuvant therapy
2. Contraindications
Infection
Recent surgery
Impaired renal/hepatic function
Pregnancy
Bone marrow depression
Recent radiation
Safe Handling of Chemotherapeutic Agents
1. Wear mask, gloves and back-closing gown
2. Avoid skin contact
3. Sterile/alcohol-wet cotton pledgets should be used in opening vials
4. Expel air bubbles on wet cottons
5. Vent vials to reduce pressure after mixing
6. Wipe external surface of syringes and IV bottles
7. Avoid needle stab
8. Clearly label the hanging bottle with ANTINEOPLASTIC CHEMOTHERAPY
9. Contaminated needles should be disposed in a clearly marked special container
10. Dispose half-empty ampules, vials, IV bottles in a sealed plastic bag with label
11. Handwashing should be done before and after removal of gloves
12. Trained personnel only should be involved in the use of drugs
13. Ideally preparation of drugs should be in laminar flow condition with filtered air
Nursing Intervention for Chemotherapeutic Side-effects
1. GI system nausea, vomiting, diarrhea, constipation
Administer antiemetic
Replace fluid & electrolyte loss, low fiber diet to relieve diarrhea
High fiber diet to relieve constipation
2. Integumentary system
Pruritus, urticaria
Provide good skin care
Stomatitis
Provide good oral care, avoid hot & spicy food
Alopecia
Skin pigmentation
Nail changes
3. Hematopoietic system
Anemia
Provide frequent rest periods

Neutropenia
Protect from infection
Thrombocytopenia
Protect from trauma, avoid ASA
3. Genito-urinary system
Hemorrhagic cystitis
Provide 2-3 L of fluids/day
Urine color changes
Reassure client that it is harmless
3. Reproductive system
Premature menopause or amenorrhea
Reassure that menstruation will resume after chemotherapy
Summary of Effects of Chemotherapy
Antineoplastic drugs affects both normal and Ca cells by
disrupting cell function and division at various points
of cell cycle.
Most Ca drugs are most effective against cells that multipl
rapidly neoplasm, bone marrow cells, cells in the GI tract,
and cells in the skin or hair follicles. Adverse reaction to
cancer drugs tend to occur in these organs.
Chemotherapeutic agents should not be used during
pregnancy or lactation. Congenital defects may occur in the
fetus.
Antiemetics
Dronabinol (Marinol)
Odansetron (Zofran)
Granisetron (Kytril)
Alprazolam (Zanax)
Lorazepam (Ativan)
Haloperidol (Haldol)
Prochlorperazine (Compazine)
Antimetabolites
(foster cancer cell death by interfering with cellular metabolic process.)
Alkalyting agents
(produces cytoxic effects by damaging DNA and interfering with cell replication. Most effective against rapidly
dividing cells ).
Adverse effects:
gonadal suppression,
hemorrhagic and nonhemorrhagic cystitis,
N/V.(Reglan for vomiting).
Related drugs: (cytoxan, platinol, myeleran, leukeran).
Nursing implication:
force fluids
assess for signs and symptoms of unexplained bleeding.

 Assess leukocytes count frequently.

Monitor CBC,uric acid, electrolytes, thrombocytosis and hepatic/renal function at least twice a week.
Instruct client to report hematuria or dysuria immediately
Plants or vinca alkaloids
(acts on cells undergoing mitosis, thus stopping cell division).
Adverse effects:
peripheral neuropathy
Cramps
Constipation
N/V
Stomatitis
alopecia,
leukopenia,
photosensitivity.
Nursing implications:
do not give IM or SC as tissue necrosis can occur.
Monitor bowel function, frequent neuro checks,monitor CBC and platelets,advise client to avoid
overexposure to sun.
Related drugs:
vincristine(oncovin), vinblastine(velban
Antibiotic Antineoplastic agents
(attaches to DNA and prevents DNA synthesis in vulnerable cells)
Adverse effects:
N/V,stomatitis,
hyper pigmentation of skin and nails,
alopecia.
Related drugs: Mitomycin, Plicamycin Blenoxane, Dactinomycin.
Nursing implication
dont give SC or IM- local reaction and skin necrosis may occur.
Do not mix with other drugs,
monitor CBC,serum uric acid levels,
frequent mouth care,
client needs sufficient fluids to prevent hyperuricemia,
assist client with information on wigs and head coverings before hair loss starts,
wear gloves to prepare this drug,
wash skin with soap and water if powder or solution contacts skin,
urine is red colored for 1-2 days after administration, clears within 48 hours.
Antineoplastic affecting hormonal balance
(keeps cancer cells in resting phase/alter the endocrine environment to make it less conducive for growth of the
cancer cells)

 Related drugs: nolvadex, cytadren, lupron.