Oncologic Nursing Part 2
Content
Detecting cancers early is an important step in preventing significant health problems. Give the accurate manage for the present illness(stage) of patient To prevent further complication
Importance of Cancer Detection and Testing
Four Possible Outcomes in Detecting Cancer True positive
- test indicates that a patient has a disease
that the patient does indeed have
False positive
- if the test indicates that a patient has a disease when she does not
Four Possible Outcomes in Detecting Cancer True negative
- test indicates the patient is disease-
free, and this is indeed the case
False negative
- test indicates the patient is healthy when
in fact the patient has the disease
Sensitivity refers to how accurately a test identifies people who have the disease. Specificity refers to how accurately a test identifies people who do not have the disease The best medical tests have high sensitivity and high specificity.
Sensitivity and Specificity of Medical Tests
SENSITIVITY
It refers to the proportion of the times that a test yields true positives. The closer the sensitivity is to 100%, the more likely a positive result actually means that the patient has a disease. The sensitivity of a medical test is a measure of how well the test identifies people who have a particular disease.
SPECIFICITY
.
It refers to the proportion of the time that a test yields true negatives The closer the specificity is to 100%, the more likely a negative result means that the patient is truly disease-free. The specificity of a medical test is a measure of how well the test identifies people who do not have a particular disease
General Detection
Importance: samples
may show cancer cells, proteins or other substances made by the cancer of how well your organs are functioning and if they've been affected by cancer
idea
General Detection Non - Invasive
Invasive Techniques
Complete Blood Count (CBC) Ultrasound MRI PET Scan CT Scan Fine Needle Aspiration
Analysis of Biopsy
Immunohistochemistry (IHC)
Core Needle Biopsy Fluorescent In Situ Hybridization (FISH)
It
provides information about the number, parts, shape, and structure of the different cell types found in blood. 3 Main Types of Blood cells: WBC RBC Platelets
Blood
General Detection and Diagnostic Techniques A. Complete blood count (CBC)
cancers may be detected using this test if too many or too few of a type of blood cell or abnormal cells are found. eg., Leukemias
A. Complete blood count (CBC)
NON-INVASIVE
Leukocyte ( WBC)
Are major players in the immune system and help defend against infection and disease. WBC can be divided into two main groups:
Phagocytes Lymphocytes
A. Complete blood count (CBC)
Leukocyte ( WBC) Phagocytes
NON-INVASIVE
Are cells that are able to consume and break down foreign material, invading microbes and broken down cells/cell parts. They get their name from the Greek 'phagein', to eat.
A. Complete blood count (CBC)
NON-INVASIVE
Leukocyte ( WBC)
Lymphocytes These are recognition cells responsible for initiating the specific immune response of the immune system. Three Major Types of Lymphocytes B cells T cells natural killer cells (NK cells)
A. Complete blood count (CBC) T- Cells
NON-INVASIVE
Formed by the pluripotent stem cells in the bone marrow, T-cells mature in the thymus (a small organ located in the upper portion of the chest). Two Subtypes of T cells;
cytotoxic T cells (CD8 cells) helper T cells (CD4 cells).
A. Complete blood count (CBC)
NON-INVASIVE
T- Cells
Cytotoxic T cells (CD8 cells)
bind specifically to targetcells; virally infected cells, cancer cells, or any foreign cells. After binding, cytotoxic T cells directly destroy the target cell. special chemicals that help activate other cells of the immune response, including; B cells, cytotoxic T cells, other helper T cells, NK cells, and macrophages.
Helper T cells (CD4 cells)
release
A. Complete blood count (CBC)
NON-INVASIVE
B- Cells
These cells are produced from the pluripotent stem cells in the bone marrow and stay in the marrow to mature. B cells bind to their specific antigens, become activated 'plasma' cells and secrete large amounts antibodies.
Natural killer cells (NK cells)
It bind to virally infected cells and cancer cells and directly kill them.
Granulocytes
A. Complete blood count (CBC)
NON-INVASIVE
Neutrophils
Are
granules
contain chemicals and proteins (from cells) control inflammatory and immune functions. are also capable of engulfing and destroying foreign matter
usually the first cells to arrive at the scene of infection or inflammation engulf and destroy foreign matter and then die, forming pus
Granulocytes
They
A. Complete blood count (CBC)
NON-INVASIVE
Eosinophils
Basophils
known
to play a role in parasitic infections and allergic reactions
These
cells are stimulated by other immune cells and play a role in systemic allergic reactions.
A. Complete blood count (CBC)
Granulocytes lack the granules of granulocytes
NON-INVASIVE
Monocytes/Macrophages
capable of engulfing and destroying foreign matter.
These cells are the largest type of white blood cell. The second cells on the scene of a problem. They engulf and process foreign matter so that lymphocytes can recognize it and mount a specific defense.
A. Complete blood count (CBC)
NON-INVASIVE
CBC: Red Blood Cells (RBC)
Red blood cells (also called erythrocytes) pick up oxygen in the lungs and deliver it to the rest of the cells in the body. 2 Subtypes of RBC
Hemoglobin Hematocrit
A. Complete blood count (CBC)
NON-INVASIVE
Hemoglobin
Each red blood cell carries around 300 million molecules of a protein called hemoglobin. Hemoglobin is what actually grabs and carries oxygen. Each molecule of hemoglobin can carry 4 molecules of oxygen
A. Complete blood count (CBC)
NON-INVASIVE
Hematocrit
The hematocrit is the proportion of red blood cells to an entire sample of blood (red blood cells / blood). It may also be called packed cell volume (PCV) and it is normally represented as a percentage. For example: a hematocrit of 30% means there are 30 milliliters of red blood cells in 100 milliliters of blood.
A. Complete blood count (CBC)
NON-INVASIVE
Reticulocyte Count
Is the percentage of immature red blood cells (reticulocytes) in the total red blood cell count (reticulocytes / red blood cells). 1-2% of the total RBC count
A. Complete blood count (CBC)
Red Blood Cell Indices The RBC indices evaluate the structure of red blood cells and hemoglobin. They include:
NON-INVASIVE
mean corpuscular volume (MCV) mean corpuscular hemoglobin (MCH) mean corpuscle hemoglobin concentration (MCHC).
NON-INVASIVE
Red Blood Cell Indices
MCV describes the size MCHC describes the average concentration of or volume of RBC's hemoglobin in the RBC's Classificatioon; Classification: microcytic (small),
normocytic (normal) macrocytic (large)
MCH describes the average weight of the hemoglobin in the RBC's. A small RBC will have a smaller MCH.
hypochromic (low concentration, pale color), normochromic (normal concentration, normal color) hyperchromic (increased concentration, bright red color).
General Detection and Laboratory Techniques that Urine cytology- reveal cancer cells
could come from the bladder, ureters or kidneys Blood protein testing- examine various proteins in your blood (electrophoresis) can aid in detecting certain abnormal immune system proteins
General Detection and Laboratory Techniques Tumor marker tests- chemicals made
by tumor cells that can be detected in your blood
prostate-specific antigen (PSA)- for prostate cancer cancer antigen 125 (CA 125)- for ovarian cancer Calcitonin- for medullary thyroid cancer alpha-fetoprotein (AFP)- for liver cancer human chorionic gonadotropin (HCG)- for germ cell tumors, such as testicular cancer and ovarian cancer
General Detection (DIAGNOSTIC TECHNIQUES)
is an ultrasound-based diagnostic imaging technique used to visualize subcutaneous body structures A computer program is used to analyze the echoes of sound waves sent into the body and generates an image on screen.
ULTRASOUND (UTZ)
ULTRASOUND (UTZ)
Purpose of UTZ
Are good exams to gain important information about a suspicious mass It can be used to help guide a needle during a biopsy.
ULTRASOUND (UTZ)
ADVANTAGES breasts Can detect lesions in women with dense
when mammograms cannot. Less expensive than a mammogram. Present the difference between a cyst and a solid mass without using a needle to draw out fluid (noninvasive). Never exposed to radiation detect blood flow through vessels no known harmful effects to humans.
ULTRASOUND (UTZ)
Sometimes it is unable to determine whether or not a mass is malignant, and a biopsy will be recommended. Many cancers cannot be detected via an ultrasound. Calcifications that are visible on mammograms are not visible on ultrasound scans
DISADVANTAGES
Also
called as nuclear magnetic resonance imaging (NMRI)
MAGNETIC RESONANCE IMAGING(MRI)
Can
locate and describe the gross extent of a mass or tumor but cannot differentiate between benign and malignant
When contrast agent is not used an MRI When contrast agent is used MRI can can show: show:
MAGNETIC RESONANCE IMAGING(MRI)
• contrast agent is not used an MRI can show: •The shape, size, appearance, and location of organs, bones, and joints •The presence of abnormal growths •Signs of inflammation or infection
•size and location of benign or malignant growths •enlarged lymph nodes •changes in blood flow extracellular volume
Positron Emission Tomography (PET) Is an imaging technique that uses
radioactive molecules to create a dynamic image of internal tissues and organs.
It produce images that reveal the activity of living tissue. PET scans use radioactively labeled tracers (radiotracers) that are injected into the bloodstream
PET SCAN
Drink plenty of water, but do not eat or drink anything (except water) for 6 hours before your exam Take your medications normally and drink them with ample water Make sure you arrive at the imaging center on time, the compound used for the scan breaks down rapidly and if you are late, the images may not be as good Wear loose fitting clothing Do not wear any jewelry; watches, chains, rings, piercings, etc
Preparation:
Computed Tomography CT’s Scan
uses
special x-ray equipment to obtain crosssectional pictures of the body
Computed Tomography Use In CancerCT’s Scan to:
To
detect or confirm the presence of a tumor; To provide information about the size and location of the tumor and whether it has spread; To guide a biopsy (the removal of cells or tissues for examination under a microscope); To help plan radiation therapy or surgery; and
To
determine whether the cancer is responding to treatment.
Biopsy
-
-
is the removal of tissue from a living subject to determine the presence or extent of a disease CYTOLOGY SPECIMEN Visualization of Specimen can be obtain change cell from tumors that tend to microscopically shed cells from their
BIOPSY
NEEDLE BIOPSY
Incision Biopsy
Only
NEEDLE BIOPSY
Excision Biopsy
Entire
part of tumor is removed Cell tissue only
tumor is surgically removed for examination Used for small tumors (2-3cm) Serve as treatment if tissue margin contain no tumor cells
Biopsy
Invasive Techniques
Fine needle aspiration (FNA)
uses
Core needle biopsy (CNAB)
uses
a small needle to collect small samples of a lesion.
a larger needle to collect samples of a lesion
Biopsy
Invasive Techniques
Fine needle aspiration (FNA)
ADVANTAGES: diagnose benign lesions Inexpensive, quick, readily available, and very safe
Core needle biopsy (CNAB)
ADVANTAGES: Strong ability to specifically diagnose benign lesions. Some ability to differentiate between in situ and invasive breast cancer. DISADVANTAGES: More invasive, time consuming, expensive
DISADVANTAGES: No ability to differentiate between in situ and invasive breast cance
Immunohistochemistry (IHC)
Fluorescence in Situ Hybridization (FISH) measures protein expression measures genetic changes (i.e. using specially labeled amplification) using antibodies. fluorescently labeled DNA example: Three proteins of probes. particular interest in breast Is a technique that measures cancer are HER2, the gene amplification and estrogen receptor (ER) and chromosomal abnormalities using fluorescently labeled DNA the progesterone receptor probes. (PR).
Analysis of Biopsy Samples
Cancer Specific Techniques
Mammography
uses
low dose xray to create an image of a breast.
Cancer Specific Techniques Direct Visualization Direct Visualization
Sigmoidoscopy
uses a small tube containing viewing equipment to view the colon. Virtual Colonoscopy uses an MRI or CT scan to create an image of the inside of the colon.
Bronchoscopy
Endoscopy Cystoscopy Exploratory Surgery
Cancer Specific Techniques
Pap smears use a sample of cells from the cervix to detect cervical cancer. Pap smears may also detect ovarian and uterine cancers that have migrated to the cervix. Prostate specific antigen (PSA) test measures levels of a glycoprotein in the blood. Elevated levels of PSA are associated with prostate cancer
Sentinel Lymph Node Biopsy (SLN)
Use to detect metastasis the hypothetical first lymph node or group of nodes reached by metastasizing cancer cells from a tumor used in the staging of certain types of cancer to see if they have spread to any lymph node
Grading and Staging GRADING STAGING
Evaluation of degree of differentiation of cancer cells Grade 1- the least malignant To Grade 4- the most malignant Grade 1- the most differentiated Grade 4- the least differentiated
To
The process of describing the local extent of the disease or the spread of cancer from the original site Essential in determining the choice of therapy and assessing prognosis Based on information about the tumor size and location in the body, and whether or not it has spread to other areas of the body
Measure
“TNM” Staging System
tumors in three
Tumor (T)
ways:
Primary Node
(N) (M)
Metastasize
“TNM” Staging System
Tumor • • •
T0- no evidence of primary tumor TIS- carcinoma in situ T1-T4- ascending degrees of tumor size and involvement
“TNM” Staging System
Nodes
• • •
N0- no evidence of disease in lymph nodes N1a, N2b- disease found in regional lymph nodes, metastasis not suspected N1a, N2b, N3 - disease found in regional lymph nodes, metastasis suspected
“TNM” Staging System
Metastasis
• •
M0- no evidence of distant metastasis M1, M2, M3- Ascending degrees of metastasis involvement, including distant nodes
Once
the T, N, and M are determined, a “Stage” of I, II, III, or IV is assigned Stage I - (T1,N0,M0) - Early Stage Stage II - (T2,N1,M0) - Local Spread Stage III - ( T3,N2,M0) – Extensive spread but no metastasis Stage IV (T4,N3,M+) – Advanced stage, with distant metastasis
“TNM” Staging System
1.
Primary Prevention Focuses on eliminating the conditions that cause cancer to develop Pre-cancerous stage
Levels of Cancer Prevention and Control
2. Secondary Prevention
Levels of Cancer Prevention and Control
Refers to early detection coupled with effective therapy Cancer maybe curable in early stage.
3.
Tertiary Prevention Refers to the prevention of cancer recurrence, symptoms and complication Involves Supportive Care, Rehabilitation and pain relief
Levels of Cancer Prevention and Control
Principles of Cancer Treatment Objectives:
Aims
to prevent cancer from spreading locally or recurring/ relapsing at sites distant from the original location.
Treatments
Surgery Radiation Therapy Hormonal Therapy Targeted Therapy Antibodies Cancer Vaccines Complimentary and Alternative Medicines Chemotherapy
TREATMENT MODALITIES
A. Loco-Regional Treatment 1. Surgery 2. Radiation Therapy 3. Transplant B. Systemic Treatment 1. Cytotoxic Chemotherapy 2. Hormonal Therapy
SURGERY
The first line of treatment for many solid tumors. M single cancer cell is invisible to the naked eye but can regrow into a new tumor, a process called recurrence A local treatment used to remove visible tumors or the entire organ Purposes:
Diagnose Cure Control Pallative
SURGERY
Local Excision- simple surgery with small margin of normal tissue surrounding tumor. En bloc Dissection- removal of tumor, tissues, and any contiguous structures.
Electrosurgery- application of electrical current to cancerous cells Cryosurgery- deep freezing with liquid nitrogen
Surgery on Cancer in Situ
Chemosurgery- applied chemotherapeutic agents layer by layer with surgical incision. Co2 laser- use of laser for laser excision.
RADIATION THERAPY
The use of high-energy ionizing rays to treat a variety of cancers Destroys the cell’s ability to reproduce by damaging the cell’s DNA Rapidly dividing cells are more vulnerable to radiation than slower dividing cells It can be used alone or in conjunction with other treatments (e.g. chemotherapy and surgery) to cure or stabilize cancer.
RADIATION THERAPY
Objectives:
This treatment seeks to relieve symptoms of the cancer and to prolong survival, making life more comfortable.
Types of Radiation Therapy
External Radiation Therapy Internal Radiation Therapy Photon Radiation
Types of Radiation Therapy
1.
External Radiation Therapy Administered by high energy Xray machines (e.g. Betatron and Linear Accelerator) or machines containing radiosotope
External Radiation: Nursing Care Marks must not remove
Keep the skin dry Talcum and Lotions are contraindicated Avoid strong sunlight, extremes temperature, constricting clothes. No Eating (NPO) Patient is not the SOURCE of Radiation after the procedure.
Types of Radiation Therapy
Internal Radiation Therapy Involves the placement of specially prepared radioisotopes directly into near the tumor itself or into the systemic circulation Also called “brachytherapy”
Types of Internal Radiation Therapy
Sealed Un
(Brachytherapy)
Source RT
Sealed- Source RT
Sealed- Source RT
Sealed
radiation source is placed in a cavity or adjacent to cancer. Radium, Iridium, Cesium
Ex:
Sealed- Source RT
INTRACAVITARY Therapy
Radioisotope
is placed into an applicator, then placed into the body cavity for a carefully calculated time (usually 24 – 72 H)
Ex: Radioisotopes: Celsium 137 Radium 226
INTERSTITIAL THERAPY Radioisotope of choice is placed into needles, beads, seeds, ribbons or catheters and then implanted directly into the tumor. Implants may be left in the tumor temporarily or permanently. Ex: Iridium 192, Iodine 125, Celsium 137, Gold 198, Radon 222
Sealed- Source RT
UNSEALED –SOURCE RT
Used in Systemic therapy. Source of Radiation is given orally, intravenously. PO Administration: Low dose: Graves Disease 131I High Dose: Thyroid Ca IV Administration: 32p Treats Polycythemia Vera
It uses high energy rays composed of particles of energy called photons. Gamma rays: are produced by the breakdown of radioactive isotopes of elements such as Cobalt-60 and radium X-rays: originate from machines that excite electrons using cathode ray tubes or linear accelerators.
Other Types of Radiation Therapy
Nursing Care Highlight Care of the Client with Sealed Implants of Radioactive Sources
Assign the client to a private room, with private bath. Place “Caution: Radioactive Material” sign on the door of the clients room. Pregnant nurses should not care for these clients; do not allow children younger than 16 and pregnant women to visit.
Limit each visitor to ½ hour per day Never touch the radioactive material with bare hands Save all dressings and bed linens until after the radioactive source is removed.
Three
factors which determine the total exposure one receives in a given radiation field are: 1. Time of exposure. 2. Distance from Source. 3. Amount of shielding present.
RADIATION SAFETY
TIME
The Shortest Possible Time
The
less time you spend near a source, the less radiation you will receive
DISTANCE
As far as possible ( can spend more time at a distance of 20 feet) The farther you get from a source, the less radiation you will receive.
SHIELDS
Protective Lead Apron
more shielding you have, the less radiation you will receive.
The
Advantages of Radiotherapy
Destroys quickly dividing cells at the margins of tumors. Surgery may miss these cells leading to recurrence of disease. Can successfully eradicate growth without permanently damaging the adjacent normal In conjunction with other treatments, may cure tumors that are not responsive to any single agent.
II. SYSTEMIC TREATMENT
HORMONAL THERAPY
BIOLOGIC TREATMENTS
Fights cancer by altering the amounts of hormones in the body.
Referred to by many terms including: Immunologic therapy, Immunotherapy, biotherapy. (Interferon, Interleukin) Often used to help restore the functioning of the immune system. Stimulates the diseasefighting ability of the body.
CHEMOTHERAPY
“Chemo”, refers to a wide range of drugs used to treat cancer work by damaging the dividing cancer cells and preventing their further reproduction Death of the normal cells produces some of the common side-effects of chemotherapy.
PRINCIPLE OF CHEMOTHERAPY
Timing of dose around the cell cycle and in relation to other drugs is critical Combination therapy is more effective Effectiveness of the drug relies on the number of cells in division
CHEMOTHERAPY
The
use of powerful drugs to:
Kill
Cancer Cells Control their Growth Relieve Pain Symptoms
Types of Chemotherapy
1.
2.
Primary Chemotherapy The use chemotherapy alone for the cure of a specific tumor. Adjuvant Chemotherapy The use of chemotherapy after primary, loco –regional treatment, with the intent of decreasing the relapse rate and improving survival.
Types of Chemotherapy
3. Neo- adjuvant Chemotherapy The use of chemotherapy before loco- regional treatment with the intent of decreasing tumor size enhancing chances for resectability and preservation of normal structures. 4. Concurrent Chemotherapy The use of chemotherapy combined with radiotherapy in order to increase local response and control systemic spread.
Types of Chemotherapy
Types of Chemotherapy
5. Palliative Chemotherapy The use of chemotherapy in advanced malignancies, the intent of which is not cure but control of the disease and tumor related symptoms.
CHEMOTHERAPY DRUGS Types
Antineoplastic Agents- drugs that inhibit and combat the development of neoplasms Classes: Antimetabolites Genotoxic Drugs Alkylating agents: Intercalating agents Enzyme inhibitors
CHEMOTHERAPY
Types
Spindle Inhibitors Additional Chemotherapy Agents
Drugs that interfere with the formation of key biomolecules within the cell. work by blocking the activity of enzymes These drugs often prevent the normal replication of DNA , nucleic acids and therefore cell division. Other antimetabolites may interfere with the creation of RNA or other cellular processes
ANTIMETABOLITE S
Classes:
ANTIMETABOLITE S
Folate Antagonists- known as antifolates inhibit dihydrofolate reductase (DHFR), an enzyme involved in the formation of nucleotides. When this enzyme is blocked, nucleotides are not formed, disrupting DNA replication and cell division Ex. Methotrexate (Wellcovorin): ADVERSE EFFECT
Bone
marrow depression stomatitis
Purine Antagonists
ANTIMETABOLITE S
purines (adenine and guanine) are chemicals used to build the nucleotides of DNA and RNA inhibiting DNA synthesis in two different ways They can inhibit the production of the purine containing nucleotides, adenine and guanine They may be incorporated into the DNA molecule during DNA synthesis
Ex. 6-Mercaptopurine, Dacarbazine, Fludarabine
Pyrimidine Antagonists
ANTIMETABOLITE S
act to block the synthesis of pyrimidine containing nucleotides (C and T in DNA; C and U in RNA). The drugs used to block the construction of these nucleotide have structures that are similar to the natural compound. By acting as 'decoys', these drugs can prevent the production of the finished nucleotides. They may exert their effects at different steps in that pathway and may directly inhibit crucial enzymes.
Ex. 5-fluorouracil; Arabinosylcytosine
damage, these agents interfere with DNA replication, and cell division 3 Treatments:
Alkylating Agents Intercalating Agents Enzyme Inhibitors
Genotoxic Drugs DNA Drugs that damage DNA. By causing
Alkylating agents:
Genotoxic Drugs
The first class of chemotherapy agents used. These drugs modify the bases of DNA, interfering with DNA replication and transcription and leading to mutations
Intercalating agents These drugs wedge themselves into the spaces between the nucleotides in the DNA double helix. They interfere with transcription, replication and induce mutations. Enzyme inhibitors These drugs inhibit key enzymes, such as topoisomerases, involved in DNA replication inducing DNA damage.
Genotoxic Drugs
These agents prevent proper cell division by interfering with the cytoskeletal components that enable one cell to divide into two. Vinca Alkaloids Paclitaxel (Taxol®) Docetaxel (Taxotere®) Ixabepilone (Ixempra®)
Spindle Inhibitors
agents fit into one of the three previously described groupings (Genotoxic, Cytoskeletal, and Antimetabolite), some of them work through mechanisms that do not neatly fit into one of these categories. Arsenic trioxide (Trisenox®) Bleomycin Hydroxyurea Streptozocin
Additional Chemotherapy Agents While many of the commonly used chemotherapy
Chemotherapeutic Administration
Oral IM/ SQ IV Central Venous Catheter Venous Access Devices (VAD) Intraarterial Route Intraperitoneal Route
STEM CELLS
• •
Stem cells are able to grow into other blood cells that mature and function as needed in the body. Stem cells create the three main types of blood cells:
– – –
red blood cells white blood cells platelets
Bone marrow (the spongy center of the bone where blood cells are made) Peripheral blood (found in blood vessels throughout the body) Cord blood (found in the umbilical cord and collected after a baby’s birth)
Stem cells for transplantation are obtained from any of these three places.
Stem cells Location
Transplant in Cancer A. Stem Cell Transplant
a
procedure that is used in conjunction with highdose chemotherapy more effective than conventional chemotherapy in destroying myeloma cells restore blood cell production
Bone
stem
marrow transplant
Types of Stem Cell Transplants
cell-containing bone marrow is collected, stored, and infused following high-dose chemotherapy and/or radiation therapy. Peripheral blood stem cell (PBSC) transplant Procedure in which blood containing mobilized stem cells is collected by apheresis, stored, and infused following high-dose chemotherapy and/or radiation therapy. Cord blood transplants refer to transplants where the stem cells are obtained from umbilical cord bld
their own stem cells. Syngeneic transplants, patients receive stem cells from their identical twin. Allogeneic transplants, patients receive stem cells from their brother, sister, or parent. A person who is not related to the patient (an unrelated donor) also may be used.
Types of Transplants according to Donor Autologous transplants, patients receive
THE CANCER PAIN PROBLEM
PAIN
In cancer is the most feared and distressing symptom of the disease.
THE CANCER PAIN PROBLEM
WHO reveals that everyday at least 4 million people suffer from cancer pain. 30 – 50% of cancer patients undergoing treatment, and up to 95% of patients with advanced disease, suffer from pain. More than 50% of patients still suffered from unrelieved cancer pain.
WHO: 3 Step Analgesic Ladder For Cancer Pain Management Basic Principles:
BY THE MOUTH If the patient can swallow, oral administration is the route of choice.
WHO: 3 Step Analgesic Ladder For Cancer Pain Management BY THE CLOCK Analgesics should be given regularly and prophylactically. BY THE LADDER Use a few drugs well than many badly.
WHO Three-Step Analgesic Ladder
•
•
•
Step I For mild to moderate pain non-opioids (treatment of choice). may or may not be combined with adjuvant drugs (drugs that are used to hasten or add to the primary mode of treatment). Step II For moderate pain, who did not feel relief after using only non-opioids, a combination of opioids and non-opioids should be tried. Again, adjuvants may or may not be used. Step III For moderate to severe pain, opioids should be used, with or without non-opioids, and with or without adjuvants.
WHO Three-Step Analgesic Ladder
C
– Comfort A- Altered Body Image N – Nutrition C – Chemotherapy E- Evaluate the Response in Treatment R - Rest
Cancer : Management
SUMMARY
Early detection and screening of high risk individuals play significant roles in treating cancer. Patient and family caregivers should be involved in all aspects of nursing care. Various treatment modalities are available to cure, control and palliate cancer.
SUMMARY
Safety Standards of treatment must always implemented. Life long surveillance for recurrence after treatment.
Detecting cancers early is an important step in preventing significant health problems. Give the accurate manage for the present illness(stage) of patient To prevent further complication
Importance of Cancer Detection and Testing
Four Possible Outcomes in Detecting Cancer True positive
- test indicates that a patient has a disease
that the patient does indeed have
False positive
- if the test indicates that a patient has a disease when she does not
Four Possible Outcomes in Detecting Cancer True negative
- test indicates the patient is disease-
free, and this is indeed the case
False negative
- test indicates the patient is healthy when
in fact the patient has the disease
Sensitivity refers to how accurately a test identifies people who have the disease. Specificity refers to how accurately a test identifies people who do not have the disease The best medical tests have high sensitivity and high specificity.
Sensitivity and Specificity of Medical Tests
SENSITIVITY
It refers to the proportion of the times that a test yields true positives. The closer the sensitivity is to 100%, the more likely a positive result actually means that the patient has a disease. The sensitivity of a medical test is a measure of how well the test identifies people who have a particular disease.
SPECIFICITY
.
It refers to the proportion of the time that a test yields true negatives The closer the specificity is to 100%, the more likely a negative result means that the patient is truly disease-free. The specificity of a medical test is a measure of how well the test identifies people who do not have a particular disease
General Detection
Importance: samples
may show cancer cells, proteins or other substances made by the cancer of how well your organs are functioning and if they've been affected by cancer
idea
General Detection Non - Invasive
Invasive Techniques
Complete Blood Count (CBC) Ultrasound MRI PET Scan CT Scan Fine Needle Aspiration
Analysis of Biopsy
Immunohistochemistry (IHC)
Core Needle Biopsy Fluorescent In Situ Hybridization (FISH)
It
provides information about the number, parts, shape, and structure of the different cell types found in blood. 3 Main Types of Blood cells: WBC RBC Platelets
Blood
General Detection and Diagnostic Techniques A. Complete blood count (CBC)
cancers may be detected using this test if too many or too few of a type of blood cell or abnormal cells are found. eg., Leukemias
A. Complete blood count (CBC)
NON-INVASIVE
Leukocyte ( WBC)
Are major players in the immune system and help defend against infection and disease. WBC can be divided into two main groups:
Phagocytes Lymphocytes
A. Complete blood count (CBC)
Leukocyte ( WBC) Phagocytes
NON-INVASIVE
Are cells that are able to consume and break down foreign material, invading microbes and broken down cells/cell parts. They get their name from the Greek 'phagein', to eat.
A. Complete blood count (CBC)
NON-INVASIVE
Leukocyte ( WBC)
Lymphocytes These are recognition cells responsible for initiating the specific immune response of the immune system. Three Major Types of Lymphocytes B cells T cells natural killer cells (NK cells)
A. Complete blood count (CBC) T- Cells
NON-INVASIVE
Formed by the pluripotent stem cells in the bone marrow, T-cells mature in the thymus (a small organ located in the upper portion of the chest). Two Subtypes of T cells;
cytotoxic T cells (CD8 cells) helper T cells (CD4 cells).
A. Complete blood count (CBC)
NON-INVASIVE
T- Cells
Cytotoxic T cells (CD8 cells)
bind specifically to targetcells; virally infected cells, cancer cells, or any foreign cells. After binding, cytotoxic T cells directly destroy the target cell. special chemicals that help activate other cells of the immune response, including; B cells, cytotoxic T cells, other helper T cells, NK cells, and macrophages.
Helper T cells (CD4 cells)
release
A. Complete blood count (CBC)
NON-INVASIVE
B- Cells
These cells are produced from the pluripotent stem cells in the bone marrow and stay in the marrow to mature. B cells bind to their specific antigens, become activated 'plasma' cells and secrete large amounts antibodies.
Natural killer cells (NK cells)
It bind to virally infected cells and cancer cells and directly kill them.
Granulocytes
A. Complete blood count (CBC)
NON-INVASIVE
Neutrophils
Are
granules
contain chemicals and proteins (from cells) control inflammatory and immune functions. are also capable of engulfing and destroying foreign matter
usually the first cells to arrive at the scene of infection or inflammation engulf and destroy foreign matter and then die, forming pus
Granulocytes
They
A. Complete blood count (CBC)
NON-INVASIVE
Eosinophils
Basophils
known
to play a role in parasitic infections and allergic reactions
These
cells are stimulated by other immune cells and play a role in systemic allergic reactions.
A. Complete blood count (CBC)
Granulocytes lack the granules of granulocytes
NON-INVASIVE
Monocytes/Macrophages
capable of engulfing and destroying foreign matter.
These cells are the largest type of white blood cell. The second cells on the scene of a problem. They engulf and process foreign matter so that lymphocytes can recognize it and mount a specific defense.
A. Complete blood count (CBC)
NON-INVASIVE
CBC: Red Blood Cells (RBC)
Red blood cells (also called erythrocytes) pick up oxygen in the lungs and deliver it to the rest of the cells in the body. 2 Subtypes of RBC
Hemoglobin Hematocrit
A. Complete blood count (CBC)
NON-INVASIVE
Hemoglobin
Each red blood cell carries around 300 million molecules of a protein called hemoglobin. Hemoglobin is what actually grabs and carries oxygen. Each molecule of hemoglobin can carry 4 molecules of oxygen
A. Complete blood count (CBC)
NON-INVASIVE
Hematocrit
The hematocrit is the proportion of red blood cells to an entire sample of blood (red blood cells / blood). It may also be called packed cell volume (PCV) and it is normally represented as a percentage. For example: a hematocrit of 30% means there are 30 milliliters of red blood cells in 100 milliliters of blood.
A. Complete blood count (CBC)
NON-INVASIVE
Reticulocyte Count
Is the percentage of immature red blood cells (reticulocytes) in the total red blood cell count (reticulocytes / red blood cells). 1-2% of the total RBC count
A. Complete blood count (CBC)
Red Blood Cell Indices The RBC indices evaluate the structure of red blood cells and hemoglobin. They include:
NON-INVASIVE
mean corpuscular volume (MCV) mean corpuscular hemoglobin (MCH) mean corpuscle hemoglobin concentration (MCHC).
NON-INVASIVE
Red Blood Cell Indices
MCV describes the size MCHC describes the average concentration of or volume of RBC's hemoglobin in the RBC's Classificatioon; Classification: microcytic (small),
normocytic (normal) macrocytic (large)
MCH describes the average weight of the hemoglobin in the RBC's. A small RBC will have a smaller MCH.
hypochromic (low concentration, pale color), normochromic (normal concentration, normal color) hyperchromic (increased concentration, bright red color).
General Detection and Laboratory Techniques that Urine cytology- reveal cancer cells
could come from the bladder, ureters or kidneys Blood protein testing- examine various proteins in your blood (electrophoresis) can aid in detecting certain abnormal immune system proteins
General Detection and Laboratory Techniques Tumor marker tests- chemicals made
by tumor cells that can be detected in your blood
prostate-specific antigen (PSA)- for prostate cancer cancer antigen 125 (CA 125)- for ovarian cancer Calcitonin- for medullary thyroid cancer alpha-fetoprotein (AFP)- for liver cancer human chorionic gonadotropin (HCG)- for germ cell tumors, such as testicular cancer and ovarian cancer
General Detection (DIAGNOSTIC TECHNIQUES)
is an ultrasound-based diagnostic imaging technique used to visualize subcutaneous body structures A computer program is used to analyze the echoes of sound waves sent into the body and generates an image on screen.
ULTRASOUND (UTZ)
ULTRASOUND (UTZ)
Purpose of UTZ
Are good exams to gain important information about a suspicious mass It can be used to help guide a needle during a biopsy.
ULTRASOUND (UTZ)
ADVANTAGES breasts Can detect lesions in women with dense
when mammograms cannot. Less expensive than a mammogram. Present the difference between a cyst and a solid mass without using a needle to draw out fluid (noninvasive). Never exposed to radiation detect blood flow through vessels no known harmful effects to humans.
ULTRASOUND (UTZ)
Sometimes it is unable to determine whether or not a mass is malignant, and a biopsy will be recommended. Many cancers cannot be detected via an ultrasound. Calcifications that are visible on mammograms are not visible on ultrasound scans
DISADVANTAGES
Also
called as nuclear magnetic resonance imaging (NMRI)
MAGNETIC RESONANCE IMAGING(MRI)
Can
locate and describe the gross extent of a mass or tumor but cannot differentiate between benign and malignant
When contrast agent is not used an MRI When contrast agent is used MRI can can show: show:
MAGNETIC RESONANCE IMAGING(MRI)
• contrast agent is not used an MRI can show: •The shape, size, appearance, and location of organs, bones, and joints •The presence of abnormal growths •Signs of inflammation or infection
•size and location of benign or malignant growths •enlarged lymph nodes •changes in blood flow extracellular volume
Positron Emission Tomography (PET) Is an imaging technique that uses
radioactive molecules to create a dynamic image of internal tissues and organs.
It produce images that reveal the activity of living tissue. PET scans use radioactively labeled tracers (radiotracers) that are injected into the bloodstream
PET SCAN
Drink plenty of water, but do not eat or drink anything (except water) for 6 hours before your exam Take your medications normally and drink them with ample water Make sure you arrive at the imaging center on time, the compound used for the scan breaks down rapidly and if you are late, the images may not be as good Wear loose fitting clothing Do not wear any jewelry; watches, chains, rings, piercings, etc
Preparation:
Computed Tomography CT’s Scan
uses
special x-ray equipment to obtain crosssectional pictures of the body
Computed Tomography Use In CancerCT’s Scan to:
To
detect or confirm the presence of a tumor; To provide information about the size and location of the tumor and whether it has spread; To guide a biopsy (the removal of cells or tissues for examination under a microscope); To help plan radiation therapy or surgery; and
To
determine whether the cancer is responding to treatment.
Biopsy
-
-
is the removal of tissue from a living subject to determine the presence or extent of a disease CYTOLOGY SPECIMEN Visualization of Specimen can be obtain change cell from tumors that tend to microscopically shed cells from their
BIOPSY
NEEDLE BIOPSY
Incision Biopsy
Only
NEEDLE BIOPSY
Excision Biopsy
Entire
part of tumor is removed Cell tissue only
tumor is surgically removed for examination Used for small tumors (2-3cm) Serve as treatment if tissue margin contain no tumor cells
Biopsy
Invasive Techniques
Fine needle aspiration (FNA)
uses
Core needle biopsy (CNAB)
uses
a small needle to collect small samples of a lesion.
a larger needle to collect samples of a lesion
Biopsy
Invasive Techniques
Fine needle aspiration (FNA)
ADVANTAGES: diagnose benign lesions Inexpensive, quick, readily available, and very safe
Core needle biopsy (CNAB)
ADVANTAGES: Strong ability to specifically diagnose benign lesions. Some ability to differentiate between in situ and invasive breast cancer. DISADVANTAGES: More invasive, time consuming, expensive
DISADVANTAGES: No ability to differentiate between in situ and invasive breast cance
Immunohistochemistry (IHC)
Fluorescence in Situ Hybridization (FISH) measures protein expression measures genetic changes (i.e. using specially labeled amplification) using antibodies. fluorescently labeled DNA example: Three proteins of probes. particular interest in breast Is a technique that measures cancer are HER2, the gene amplification and estrogen receptor (ER) and chromosomal abnormalities using fluorescently labeled DNA the progesterone receptor probes. (PR).
Analysis of Biopsy Samples
Cancer Specific Techniques
Mammography
uses
low dose xray to create an image of a breast.
Cancer Specific Techniques Direct Visualization Direct Visualization
Sigmoidoscopy
uses a small tube containing viewing equipment to view the colon. Virtual Colonoscopy uses an MRI or CT scan to create an image of the inside of the colon.
Bronchoscopy
Endoscopy Cystoscopy Exploratory Surgery
Cancer Specific Techniques
Pap smears use a sample of cells from the cervix to detect cervical cancer. Pap smears may also detect ovarian and uterine cancers that have migrated to the cervix. Prostate specific antigen (PSA) test measures levels of a glycoprotein in the blood. Elevated levels of PSA are associated with prostate cancer
Sentinel Lymph Node Biopsy (SLN)
Use to detect metastasis the hypothetical first lymph node or group of nodes reached by metastasizing cancer cells from a tumor used in the staging of certain types of cancer to see if they have spread to any lymph node
Grading and Staging GRADING STAGING
Evaluation of degree of differentiation of cancer cells Grade 1- the least malignant To Grade 4- the most malignant Grade 1- the most differentiated Grade 4- the least differentiated
To
The process of describing the local extent of the disease or the spread of cancer from the original site Essential in determining the choice of therapy and assessing prognosis Based on information about the tumor size and location in the body, and whether or not it has spread to other areas of the body
Measure
“TNM” Staging System
tumors in three
Tumor (T)
ways:
Primary Node
(N) (M)
Metastasize
“TNM” Staging System
Tumor • • •
T0- no evidence of primary tumor TIS- carcinoma in situ T1-T4- ascending degrees of tumor size and involvement
“TNM” Staging System
Nodes
• • •
N0- no evidence of disease in lymph nodes N1a, N2b- disease found in regional lymph nodes, metastasis not suspected N1a, N2b, N3 - disease found in regional lymph nodes, metastasis suspected
“TNM” Staging System
Metastasis
• •
M0- no evidence of distant metastasis M1, M2, M3- Ascending degrees of metastasis involvement, including distant nodes
Once
the T, N, and M are determined, a “Stage” of I, II, III, or IV is assigned Stage I - (T1,N0,M0) - Early Stage Stage II - (T2,N1,M0) - Local Spread Stage III - ( T3,N2,M0) – Extensive spread but no metastasis Stage IV (T4,N3,M+) – Advanced stage, with distant metastasis
“TNM” Staging System
1.
Primary Prevention Focuses on eliminating the conditions that cause cancer to develop Pre-cancerous stage
Levels of Cancer Prevention and Control
2. Secondary Prevention
Levels of Cancer Prevention and Control
Refers to early detection coupled with effective therapy Cancer maybe curable in early stage.
3.
Tertiary Prevention Refers to the prevention of cancer recurrence, symptoms and complication Involves Supportive Care, Rehabilitation and pain relief
Levels of Cancer Prevention and Control
Principles of Cancer Treatment Objectives:
Aims
to prevent cancer from spreading locally or recurring/ relapsing at sites distant from the original location.
Treatments
Surgery Radiation Therapy Hormonal Therapy Targeted Therapy Antibodies Cancer Vaccines Complimentary and Alternative Medicines Chemotherapy
TREATMENT MODALITIES
A. Loco-Regional Treatment 1. Surgery 2. Radiation Therapy 3. Transplant B. Systemic Treatment 1. Cytotoxic Chemotherapy 2. Hormonal Therapy
SURGERY
The first line of treatment for many solid tumors. M single cancer cell is invisible to the naked eye but can regrow into a new tumor, a process called recurrence A local treatment used to remove visible tumors or the entire organ Purposes:
Diagnose Cure Control Pallative
SURGERY
Local Excision- simple surgery with small margin of normal tissue surrounding tumor. En bloc Dissection- removal of tumor, tissues, and any contiguous structures.
Electrosurgery- application of electrical current to cancerous cells Cryosurgery- deep freezing with liquid nitrogen
Surgery on Cancer in Situ
Chemosurgery- applied chemotherapeutic agents layer by layer with surgical incision. Co2 laser- use of laser for laser excision.
RADIATION THERAPY
The use of high-energy ionizing rays to treat a variety of cancers Destroys the cell’s ability to reproduce by damaging the cell’s DNA Rapidly dividing cells are more vulnerable to radiation than slower dividing cells It can be used alone or in conjunction with other treatments (e.g. chemotherapy and surgery) to cure or stabilize cancer.
RADIATION THERAPY
Objectives:
This treatment seeks to relieve symptoms of the cancer and to prolong survival, making life more comfortable.
Types of Radiation Therapy
External Radiation Therapy Internal Radiation Therapy Photon Radiation
Types of Radiation Therapy
1.
External Radiation Therapy Administered by high energy Xray machines (e.g. Betatron and Linear Accelerator) or machines containing radiosotope
External Radiation: Nursing Care Marks must not remove
Keep the skin dry Talcum and Lotions are contraindicated Avoid strong sunlight, extremes temperature, constricting clothes. No Eating (NPO) Patient is not the SOURCE of Radiation after the procedure.
Types of Radiation Therapy
Internal Radiation Therapy Involves the placement of specially prepared radioisotopes directly into near the tumor itself or into the systemic circulation Also called “brachytherapy”
Types of Internal Radiation Therapy
Sealed Un
(Brachytherapy)
Source RT
Sealed- Source RT
Sealed- Source RT
Sealed
radiation source is placed in a cavity or adjacent to cancer. Radium, Iridium, Cesium
Ex:
Sealed- Source RT
INTRACAVITARY Therapy
Radioisotope
is placed into an applicator, then placed into the body cavity for a carefully calculated time (usually 24 – 72 H)
Ex: Radioisotopes: Celsium 137 Radium 226
INTERSTITIAL THERAPY Radioisotope of choice is placed into needles, beads, seeds, ribbons or catheters and then implanted directly into the tumor. Implants may be left in the tumor temporarily or permanently. Ex: Iridium 192, Iodine 125, Celsium 137, Gold 198, Radon 222
Sealed- Source RT
UNSEALED –SOURCE RT
Used in Systemic therapy. Source of Radiation is given orally, intravenously. PO Administration: Low dose: Graves Disease 131I High Dose: Thyroid Ca IV Administration: 32p Treats Polycythemia Vera
It uses high energy rays composed of particles of energy called photons. Gamma rays: are produced by the breakdown of radioactive isotopes of elements such as Cobalt-60 and radium X-rays: originate from machines that excite electrons using cathode ray tubes or linear accelerators.
Other Types of Radiation Therapy
Nursing Care Highlight Care of the Client with Sealed Implants of Radioactive Sources
Assign the client to a private room, with private bath. Place “Caution: Radioactive Material” sign on the door of the clients room. Pregnant nurses should not care for these clients; do not allow children younger than 16 and pregnant women to visit.
Limit each visitor to ½ hour per day Never touch the radioactive material with bare hands Save all dressings and bed linens until after the radioactive source is removed.
Three
factors which determine the total exposure one receives in a given radiation field are: 1. Time of exposure. 2. Distance from Source. 3. Amount of shielding present.
RADIATION SAFETY
TIME
The Shortest Possible Time
The
less time you spend near a source, the less radiation you will receive
DISTANCE
As far as possible ( can spend more time at a distance of 20 feet) The farther you get from a source, the less radiation you will receive.
SHIELDS
Protective Lead Apron
more shielding you have, the less radiation you will receive.
The
Advantages of Radiotherapy
Destroys quickly dividing cells at the margins of tumors. Surgery may miss these cells leading to recurrence of disease. Can successfully eradicate growth without permanently damaging the adjacent normal In conjunction with other treatments, may cure tumors that are not responsive to any single agent.
II. SYSTEMIC TREATMENT
HORMONAL THERAPY
BIOLOGIC TREATMENTS
Fights cancer by altering the amounts of hormones in the body.
Referred to by many terms including: Immunologic therapy, Immunotherapy, biotherapy. (Interferon, Interleukin) Often used to help restore the functioning of the immune system. Stimulates the diseasefighting ability of the body.
CHEMOTHERAPY
“Chemo”, refers to a wide range of drugs used to treat cancer work by damaging the dividing cancer cells and preventing their further reproduction Death of the normal cells produces some of the common side-effects of chemotherapy.
PRINCIPLE OF CHEMOTHERAPY
Timing of dose around the cell cycle and in relation to other drugs is critical Combination therapy is more effective Effectiveness of the drug relies on the number of cells in division
CHEMOTHERAPY
The
use of powerful drugs to:
Kill
Cancer Cells Control their Growth Relieve Pain Symptoms
Types of Chemotherapy
1.
2.
Primary Chemotherapy The use chemotherapy alone for the cure of a specific tumor. Adjuvant Chemotherapy The use of chemotherapy after primary, loco –regional treatment, with the intent of decreasing the relapse rate and improving survival.
Types of Chemotherapy
3. Neo- adjuvant Chemotherapy The use of chemotherapy before loco- regional treatment with the intent of decreasing tumor size enhancing chances for resectability and preservation of normal structures. 4. Concurrent Chemotherapy The use of chemotherapy combined with radiotherapy in order to increase local response and control systemic spread.
Types of Chemotherapy
Types of Chemotherapy
5. Palliative Chemotherapy The use of chemotherapy in advanced malignancies, the intent of which is not cure but control of the disease and tumor related symptoms.
CHEMOTHERAPY DRUGS Types
Antineoplastic Agents- drugs that inhibit and combat the development of neoplasms Classes: Antimetabolites Genotoxic Drugs Alkylating agents: Intercalating agents Enzyme inhibitors
CHEMOTHERAPY
Types
Spindle Inhibitors Additional Chemotherapy Agents
Drugs that interfere with the formation of key biomolecules within the cell. work by blocking the activity of enzymes These drugs often prevent the normal replication of DNA , nucleic acids and therefore cell division. Other antimetabolites may interfere with the creation of RNA or other cellular processes
ANTIMETABOLITE S
Classes:
ANTIMETABOLITE S
Folate Antagonists- known as antifolates inhibit dihydrofolate reductase (DHFR), an enzyme involved in the formation of nucleotides. When this enzyme is blocked, nucleotides are not formed, disrupting DNA replication and cell division Ex. Methotrexate (Wellcovorin): ADVERSE EFFECT
Bone
marrow depression stomatitis
Purine Antagonists
ANTIMETABOLITE S
purines (adenine and guanine) are chemicals used to build the nucleotides of DNA and RNA inhibiting DNA synthesis in two different ways They can inhibit the production of the purine containing nucleotides, adenine and guanine They may be incorporated into the DNA molecule during DNA synthesis
Ex. 6-Mercaptopurine, Dacarbazine, Fludarabine
Pyrimidine Antagonists
ANTIMETABOLITE S
act to block the synthesis of pyrimidine containing nucleotides (C and T in DNA; C and U in RNA). The drugs used to block the construction of these nucleotide have structures that are similar to the natural compound. By acting as 'decoys', these drugs can prevent the production of the finished nucleotides. They may exert their effects at different steps in that pathway and may directly inhibit crucial enzymes.
Ex. 5-fluorouracil; Arabinosylcytosine
damage, these agents interfere with DNA replication, and cell division 3 Treatments:
Alkylating Agents Intercalating Agents Enzyme Inhibitors
Genotoxic Drugs DNA Drugs that damage DNA. By causing
Alkylating agents:
Genotoxic Drugs
The first class of chemotherapy agents used. These drugs modify the bases of DNA, interfering with DNA replication and transcription and leading to mutations
Intercalating agents These drugs wedge themselves into the spaces between the nucleotides in the DNA double helix. They interfere with transcription, replication and induce mutations. Enzyme inhibitors These drugs inhibit key enzymes, such as topoisomerases, involved in DNA replication inducing DNA damage.
Genotoxic Drugs
These agents prevent proper cell division by interfering with the cytoskeletal components that enable one cell to divide into two. Vinca Alkaloids Paclitaxel (Taxol®) Docetaxel (Taxotere®) Ixabepilone (Ixempra®)
Spindle Inhibitors
agents fit into one of the three previously described groupings (Genotoxic, Cytoskeletal, and Antimetabolite), some of them work through mechanisms that do not neatly fit into one of these categories. Arsenic trioxide (Trisenox®) Bleomycin Hydroxyurea Streptozocin
Additional Chemotherapy Agents While many of the commonly used chemotherapy
Chemotherapeutic Administration
Oral IM/ SQ IV Central Venous Catheter Venous Access Devices (VAD) Intraarterial Route Intraperitoneal Route
STEM CELLS
• •
Stem cells are able to grow into other blood cells that mature and function as needed in the body. Stem cells create the three main types of blood cells:
– – –
red blood cells white blood cells platelets
Bone marrow (the spongy center of the bone where blood cells are made) Peripheral blood (found in blood vessels throughout the body) Cord blood (found in the umbilical cord and collected after a baby’s birth)
Stem cells for transplantation are obtained from any of these three places.
Stem cells Location
Transplant in Cancer A. Stem Cell Transplant
a
procedure that is used in conjunction with highdose chemotherapy more effective than conventional chemotherapy in destroying myeloma cells restore blood cell production
Bone
stem
marrow transplant
Types of Stem Cell Transplants
cell-containing bone marrow is collected, stored, and infused following high-dose chemotherapy and/or radiation therapy. Peripheral blood stem cell (PBSC) transplant Procedure in which blood containing mobilized stem cells is collected by apheresis, stored, and infused following high-dose chemotherapy and/or radiation therapy. Cord blood transplants refer to transplants where the stem cells are obtained from umbilical cord bld
their own stem cells. Syngeneic transplants, patients receive stem cells from their identical twin. Allogeneic transplants, patients receive stem cells from their brother, sister, or parent. A person who is not related to the patient (an unrelated donor) also may be used.
Types of Transplants according to Donor Autologous transplants, patients receive
THE CANCER PAIN PROBLEM
PAIN
In cancer is the most feared and distressing symptom of the disease.
THE CANCER PAIN PROBLEM
WHO reveals that everyday at least 4 million people suffer from cancer pain. 30 – 50% of cancer patients undergoing treatment, and up to 95% of patients with advanced disease, suffer from pain. More than 50% of patients still suffered from unrelieved cancer pain.
WHO: 3 Step Analgesic Ladder For Cancer Pain Management Basic Principles:
BY THE MOUTH If the patient can swallow, oral administration is the route of choice.
WHO: 3 Step Analgesic Ladder For Cancer Pain Management BY THE CLOCK Analgesics should be given regularly and prophylactically. BY THE LADDER Use a few drugs well than many badly.
WHO Three-Step Analgesic Ladder
•
•
•
Step I For mild to moderate pain non-opioids (treatment of choice). may or may not be combined with adjuvant drugs (drugs that are used to hasten or add to the primary mode of treatment). Step II For moderate pain, who did not feel relief after using only non-opioids, a combination of opioids and non-opioids should be tried. Again, adjuvants may or may not be used. Step III For moderate to severe pain, opioids should be used, with or without non-opioids, and with or without adjuvants.
WHO Three-Step Analgesic Ladder
C
– Comfort A- Altered Body Image N – Nutrition C – Chemotherapy E- Evaluate the Response in Treatment R - Rest
Cancer : Management
SUMMARY
Early detection and screening of high risk individuals play significant roles in treating cancer. Patient and family caregivers should be involved in all aspects of nursing care. Various treatment modalities are available to cure, control and palliate cancer.
SUMMARY
Safety Standards of treatment must always implemented. Life long surveillance for recurrence after treatment.
