cancer nursing2

8/14/2019 Cancer Nursing2

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CANCER NURSING

by:

Mrs. Theresa MargaritaMarivee L. Saldevar


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DI AG NOST IC EX AMS History and Physical Assessment

Radiographic Procedures

Basic X-ray studies - use

of electromagnetic

radiation of wavelengths

to produce radiographicimages


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Radioisotope Studies

- involve theintroduction of a

radioactivesubstance into thebody to detectcancer

CT Scan - is used to generate athree-dimensional image of the inside

of an object from a large series of

two-dimensional X-ray images taken

around a single axis of rotation
http://en.wikipedia.org/wiki/Stereoscopyhttp://en.wikipedia.org/wiki/X-rayhttp://en.wikipedia.org/wiki/Axis_of_rotationhttp://en.wikipedia.org/wiki/Axis_of_rotationhttp://en.wikipedia.org/wiki/X-rayhttp://en.wikipedia.org/wiki/Stereoscopy


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Angiogram - is a medical imaging

technique in which an X-ray

image is taken to visualize

the inside, orlumen, of bloodvessels and organs of the

body, with particular interest

in the arteries, veins and the

heart chambers

Mammogram - is the process

of using low-dose X-rays(usually around 0.7 mSv)

to examine the humanbreast
http://en.wikipedia.org/wiki/Medical_imaginghttp://en.wikipedia.org/wiki/X-rayhttp://en.wikipedia.org/wiki/Lumen_%28anatomy%29http://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Heart_chamberhttp://en.wikipedia.org/wiki/X-rayhttp://en.wikipedia.org/wiki/Sieverthttp://en.wikipedia.org/wiki/Breasthttp://en.wikipedia.org/wiki/Breasthttp://en.wikipedia.org/wiki/Sieverthttp://en.wikipedia.org/wiki/X-rayhttp://en.wikipedia.org/wiki/Heart_chamberhttp://en.wikipedia.org/wiki/Veinhttp://en.wikipedia.org/wiki/Arteryhttp://en.wikipedia.org/wiki/Lumen_%28anatomy%29http://en.wikipedia.org/wiki/X-rayhttp://en.wikipedia.org/wiki/Medical_imaging


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Lymphangiogram - is a medicaltest, whereby pictures ofthe lymphatic systemtaken with X-rays after a

special dye is injected tooutline the lymph nodesand blood vessels

Blood Studies

Cytologic Examination

*Papanicolaou Test*

Materials that can be examnined: cervical

scrapings, bronchial secretions and

washings obtained by bronchoscopy,

urine sediment, coughed-up sputum,

aspirated gastric secretions and

mammary gland discharge fluid
http://en.wikipedia.org/wiki/Lymphatic_systemhttp://en.wikipedia.org/wiki/X-rayshttp://en.wikipedia.org/wiki/Lymph_nodeshttp://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Lymph_nodeshttp://en.wikipedia.org/wiki/X-rayshttp://en.wikipedia.org/wiki/Lymphatic_system


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Bi opsy surgical excision ofa small piece of tissue for

microscopic examination

Excision Biopsy surgical

removal of the entire abnormal

growth

Incision Biopsy surgical

removal of a section of the

neoplasm

Needle or Aspiration Biopsy

removing of a small plug of

tumor by use of a needle or

syringe


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Ultrasound Procedures uses high-frequency sound

waves to visualize the interfaces around the

organs and within pathologic masses

Used to detect lesions in the female pelvis,

abdominal lymph nodes, prostate


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Direct Visualization/Endoscopy- is a minimally invasive

diagnostic

medical procedure that isused to assess the interiorsurfaces of an organ byinserting a tube into the

body Bronchoscopy

Laryngoscopy

Colposcopy

Cystoscopy Laparoscopy
http://en.wikipedia.org/wiki/Minimally_invasivehttp://en.wikipedia.org/wiki/Diagnostichttp://en.wikipedia.org/wiki/Medical_procedurehttp://en.wikipedia.org/wiki/Medical_procedurehttp://en.wikipedia.org/wiki/Diagnostichttp://en.wikipedia.org/wiki/Minimally_invasive


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Magnetic Resonance Imaging identifiesabnormalities by creating sectionalimages of the body without the use ofcontrast dyes/radiation

- provides clear images of internalstructures in response to the magneticfield created by harmless, low-energyradio waves


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Antigen Skin Testing

use of dinitochlorobenzene

skin test


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STA GI NG AN DGRA DI NG

No evidence of distant metastasis

Ascending degrees of distant metastasis

METASTASIS

M0

M1, M2, M3

Regional lymph nodes not demonstrably abnormal

Increasing degrees of demonstrable abnormality of regional lymph nodes

Regional lymph nodes cannot be assessed clinically

NODES

N0

N1, N2, N3

NX

No evidence of primary tumor

Carcinoma in situ

Progressive increase in tumor size and involvementTumor cannot be assessed

TUMOR

T0

TiS

T1, T2, T3, T4TX

DescriptionStage

TNM Staging System


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Gradi ng - evaluation of theextent to which tumor cellsdiffer from their precursors

Grade I or II cells are well differentiated

and deviate minimally from the normal cells

Grade III or IV cells are poorly

differentiated and most aberrant compared

with the normal cells


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CLINICAL MANIFE STATI ONSOF CA NCER*Wa rn ing Sig ns of Cancer* Change in bowel/bladder habits A sore that does not heal Unusual bleeding/discharge Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing Obvious change in wart/mole Nagging cough or hoarseness


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*Local E ffe cts*Benign

Symptoms of obstruction of thelumen of tubular structures

Atrophy

Ulceration

Malignant

Symptoms of obstruction

Hemorrhage

Ulceration

Secondary infection


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*Sys temi cEffects*

Ascites, pleural effusionGeneral disorders

Weakness, fatigue, weight lossGIT

DermatomyositisSkin and connective

tissue

Weakness, cerebellar disease, peripheral neuritis

Poor pulmonary respiration, stasis of secretion and pneumonia

UTI and constipation

Neuromuscular

Syndromes such as Cushings hyperthyroidism, cachexiaHormonal andendocrinologic

HemorrhageVascular

InfectionImmunologic

Anemia, leucopenia, thrombocytopeniaHematologic


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MEDI CAL- SURGIC ALMANAGEM ENT Diagnostic Surgery

Cytology Specimens

Needle Biopsy

Incisional Biopsy

Excisional Biopsy

Curative Surgery

Primary Lesions

Recurrent Lesions

Metastatic Lesions

Palliative Surgery

Reconstructive Surgery

Preventive Surgery


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Chemotherapy is the treatment of cancer withdrugs ("anticancer drugs") that

can destroy cancer cells

usually refers to cytotoxicdrugs

interfere with cell division in

various possible ways
http://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Medication


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Neurotoxicity, constipation,

peripheral neuropathies,

abdominal pain, mild bone

marrow depression,

alopecia, tissue necrosis

Arrest mitosis in

metaphase,

blocking cell

division

Testicular,

neuroblastoma,le

ukemia,

lymphoma,

breast, lung,

multiple

myeloma

Vincristine (Oncovin)

Vinblastine (Velban)

Vindesine (Eldisine)

Vinca (Plant)

Alkaloids

Bone marrow depression, tissue

necrosis, N/V, anorexia,

cardiotoxicity, alopecia,

stomatitis, diarrhea, red

discoloration of urine

Interfere with DNA-

dependent RNA

synthesis by

intercalation

Breast, lung, head and

neck, pancreas,

soft-tissue

sarcoma, ovarian

Doxorubicin

(Adriamycin)

Bleomycin

(Blenoxane)

Mitomycin C(Mutamycin)

Antitumor

Antibiotics

GIT ulceration, stomatitis, bone

marrow depression,

nephrotoxicitydiarrhea,

hepatotoxicity, pulmonary

toxicity, neuro symptoms,photosensitivity

Interrupt cell

reproduction by

incorporating into

DNA and RNA,

interfering nucleicacid synthesis (by

miscoding)

Leukemia, lymphoma,

ovarian, breast

Methotrexate

(Mexate)

Cytarabine (Cytosar)

5-Fluorouracil (5-FU)

Antimetabolites

Bone marrow depression, N/V,

anorexia, alopecia,

hemorrhagic cyctitis,

amenorrhea, sterility

Act to destroy rapidly

dividing cells by

targeting nucleic

acids ti preventstrands from

separating for

replication.

Leukemia, lymphoma,

multiple

myeloma, breast,

lung, ovarianTesticular, lung,

ovarian, head

and neck cancers

Cyclophosphamide

(Cytoxan)

Cisplatin (Platinol)

Busulfan (Myleran)Chlorambucil

(Leukeran)

Alkylating

Agents

Side EffectsMechanism of ActionIndicationDrug ExampleClassisfication


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Bone marrow depression,

hypersensitivityreactions, peripheral

neuropathy, N/V

Inhibits microtubular

function, causing celldeath

Metastatic breast and ovarian

cancer

Paclitaxel (Taxol)Miscellaneous

antineoplastic

Dizziness, headache,

decreased libido,

impotence, anorexia,

bone pain,

paresthesias

Initially stimulates but then

inhibits release of

follicle-stimulating

hormone and

luteinizing hormone

Prostate cancer, used in clients

who cannot tolerate an

orchiectomy or estrogen

therapy

Leuprolide

acetate

(Leupron)

Synthetic

lutenizing

hormone

Rare bone marrow

depression, menstrual

irregularity, hot

flashes

Act as estrogen antagonistTreat estrogen receptor positive

breast cancer

Tamoxifen citrate

(Nolvadex)

Anti-estrogens

N/V, anorexia, abdominal

distention, spotting,

menstrual changes,

fluid retention, breast

tenderness

Supplements estrogenPostmenopausal syndrome,

amenorrhea due to ovarian

failure, prostatic cancer

Diethylstilbestrol

(DES)

Estrogens

Diarrhea, nausea, vomiting,

loss of libido,

impotence,

gynecomastia, hot

flushes, edema,

hypertension

Antagonizes androgen

effects at cellular level

To treat metastatic prostate

cancer

Flutamide

(Eulexin)

Anti-androgens

Males:Impotence,

gynecomastia,

epididymitis, bladder

irritation

Females: hirsutism,

amenorrhea,masculinization

Both: N/V, fluid retention

Have some antiestrogen

properties, making it

useful to treat

estrogen-dependent

breast cancers

Replacement therapy for males,

treat dysmenorrheal and

menopause in women,

inoperable breast cancer in

women

Testosterone

propionate

Androgens

Hormones:


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Administration Routes for

Chemotherapy Oral

IV, IM, SQ

Topical

Intrathecal

Intracavitary: Intrapleural,intraperitoneal, intravesical

Intra-arterial

Intratumoral

/Intralesional


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Safe Preparation, Handling

and Disposal Prevent inhalation of aerosols Prevent from absorption

Prevent ingestion

Ensure safe disposal Prevent contamination


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Nursing Responsibilities

Teach the patient and significantothers

Prevent infection

Maintain meticulous oral hygiene Maintain optimal gastrointestinal

function

Minimize alopecia

Minimize/prevent urinary effects

Minimize effects of sterility


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Short Quiz

1. Cellular changes in cancer that involves an alterationin the size, shape and organization of differentiated

cells.

2. The screening test that involves assessing the breast

for tumors via radiation.

3. The speed of growth of benign neoplasm.

4. When is breast self-exam done?

5. When is testicular self-exam done?

6-8. Give the 3 factors that contribute to the tumorgrowth

9. The phase of cell cycle in which it involves the

synthesis of DNA and chromosomes.

10. The function of the proto-oncogene.


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Short Quiz11. The phase of carcinogenesis which involves

exposing cells to cancer-causing substances.12-13. Give 2 examples of lifestyle practices that can be

a risk factor for cancer.

14. If a client has a secondary site of cancer, at what

stage of metastatic process will the client belong?15. An increase in the number of normal cells in a

normal arrangement in a tissue/organ.

16. Sarcoma means ___________________________.

17. At what age is endometrial tissue sample performedto screen cancer?

18. The classification of cancer in which metastasis isusually present.

19-20. Give 2 host susceptibility factors that can lead to

cancer

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