oncologic nursing part 2

8/14/2019 Oncologic Nursing Part 2

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Cancer Detection

and Testing Detecting cancers early is an importantstep in preventing significant health

problems. Give the accurate manage for the present

illness(stage) of patient

To prevent further complication


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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 adisease when she does not


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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 whenin fact the patient has the disease


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Specificity of

Medical Tests Sensitivity refers to how accurately a testidentifies people who have the disease.

Specificity refers to how accurately a testidentifies people who do not have the disease

The best medical tests have high sensitivity

and high specificity.


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SENSITIVITY It refers to the proportion of the times that

a test yields true positives.

The closer the sensitivity is to 100%, themore likely a positive result actually meansthat the patient has a disease.

The sensitivity of a medical test is a measureof how well the test identifies people whohave a particular disease.


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SPECIFICITY It refers to the proportion of the time

that a test yields true negatives.

The closer the specificity is to 100%, themore likely a negative result means thatthe patient is truly disease-free.

The specificity of a medical test is ameasure of how well the test identifiespeople who do not have a particular disease


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Importance: samples may show cancer cells,

proteins or other substances made bythe cancer

idea of how well your organs arefunctioning and if they've beenaffected by cancer

enera

Detection


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Non - Invasive InvasiveTechniques

Analysis of Biopsy

Complete Blood

Count (CBC)UltrasoundMRIPET ScanCT Scan

Fine Needle

Aspiration

Core Needle Biopsy

Immunohistochemistry

(IHC)

Fluorescent In SituHybridization (FISH)

enera

Detection


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A. Complete blood count (CBC) 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 cancers may be detected using this test iftoo many or too few of a type of blood cell or

abnormal cells are found. eg., Leukemias

and Diagnostic

Techniques


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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

NON-INVASIVEA. Complete blood count (CBC)


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Leukocyte ( WBC) Phagocytes-

Are cells that are able to consume and breakdown foreign material, invading microbes andbroken down cells/cell parts.

They get their name from the Greek'phagein', to eat.



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Leukocyte ( WBC) Lymphocytes- These are recognition cells responsible for

initiating the specific immune response of theimmune system.

Three Major Types of Lymphocytes

B cells T cells natural killer cells (NK cells)



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T- Cells Formed by the pluripotent stem cells in

the bone marrow, T-cells mature in thethymus (a small organ located in the upperportion of the chest).

Two Subtypes of T cells; cytotoxic T cells (CD8 cells) helper T cells (CD4 cells).



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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.

Helper T cells (CD4 cells)release special chemicals that help activate other cells

of the immune response, including; B cells, cytotoxic Tcells, other helper T cells, NK cells, and macrophages.



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B- Cells These cells are produced from

the pluripotent stem cells in

the bone marrow and stay inthe marrow to mature. B cells bind to their specific

antigens, become activated

'plasma' cells and secretelarge amounts antibodies.

Natural killercells (NK cells)

It bind to virallyinfected cells andcancer cells anddirectly kill them.



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Granulocytes granules contain

chemicals and proteins

(from cells)

controlinflammatory andimmune functions.

Granulocytes are alsocapable of engulfingand destroying foreignmatter

NeutrophilsAre usually the first

cells to arrive at the

scene of infection orinflammation

They engulf anddestroy foreignmatter and then die,forming pus



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Eosinophils

known to play a

role in parasiticinfections andallergic reactions

Basophils

These cells are

stimulated byother immune cellsand play a role in

systemic allergicreactions.



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Granulocytes lack the granules

of granulocytes

capable ofengulfing and

destroying foreignmatter.

Monocytes/Macrophages

These cells are the largesttype of white blood cell.

The second cells on thescene of a problem.

They engulf and processforeign matter so thatlymphocytes can recognize itand mount a specificdefense.



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CBC: Red Blood Cells (RBC)

Red blood cells (also called erythrocytes)

pick up oxygen in the lungs and deliver itto the rest of the cells in the body.

2 Subtypes of RBC

HemoglobinHematocrit



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Hemoglobin

Each red blood cell carries around 300

million molecules of a protein calledhemoglobin. Hemoglobin is what actually grabs and

carries oxygen. Each molecule of hemoglobin can carry 4molecules of oxygen


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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 are30 milliliters of red blood cells in 100 milliliters ofblood.



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Reticulocyte Count

Is the percentage of immature red blood

cells (reticulocytes) in the total red bloodcell count (reticulocytes / red blood cells).

1-2% of the total RBC count



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Red Blood Cell Indices The RBC indices evaluate the structure of

red blood cells and hemoglobin. They include:

mean corpuscular volume (MCV)

mean corpuscular hemoglobin (MCH) mean corpuscle hemoglobin concentration

(MCHC).



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MCV describes the sizeor volume of RBC's

Classificatioon;

microcytic (small), normocytic (normal) macrocytic (large)

MCH describes theaverage weight of thehemoglobin in the RBC's.A small RBC will have asmaller MCH.

MCHC describes theaverage concentration ofhemoglobin in the RBC's

Classification: hypochromic (lowconcentration, pale color),

normochromic (normalconcentration, normal color)

hyperchromic (increasedconcentration, bright redcolor).

NON-INVASIVERed Blood Cell Indices


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Urine cytology- reveal cancer cells thatcould come from the bladder, ureters orkidneys

Blood protein testing- examine variousproteins in your blood (electrophoresis)can aid in detecting certain abnormalimmune system proteins

and Laboratory

Techniques


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Tumor marker tests- chemicals madeby tumor cells that can be detected in yourblood

prostate-specific antigen (PSA)- for prostatecancer 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

and Laboratory

Techniques


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General Detection (DIAGNOSTIC TECHNIQUES)

ULTRASOUND


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ULTRASOUND(UTZ)

is an ultrasound-baseddiagnostic imagingtechnique used to

visualize subcutaneousbody structures

A computer program is

used to analyze theechoes of sound wavessent into the bodyand generates anima e on screen.

ULTRASOUND
http://en.wikipedia.org/wiki/Ultrasoundhttp://en.wikipedia.org/wiki/Medical_imaginghttp://en.wikipedia.org/wiki/Medical_imaginghttp://en.wikipedia.org/wiki/Ultrasound


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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)


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Can detect lesions in women with dense breasts

when mammograms cannot.

Less expensive than a mammogram.

Present the difference between a cyst and a solidmass without using a needle to draw out fluid (non-

invasive).

Never exposed to radiation detect blood flow through vessels

no known harmful effects to humans.

(UTZ)

ADVANTAGES


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(UTZ)

DISADVANTAGES Sometimes it is unable to determinewhether or not a mass is malignant, and abiopsy will be recommended.

Many cancers cannot be detected via anultrasound.

Calcifications that are visible onmammograms are not visible on ultrasoundscans


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RESONANCE

IMAGING(MRI)Also called as nuclearmagnetic resonanceimaging (NMRI)

Can locate and describethe gross extent of amass or tumor but cannotdifferentiate betweenbenign and malignant
http://en.wikipedia.org/wiki/2D-FT_NMRI_and_Spectroscopyhttp://en.wikipedia.org/wiki/2D-FT_NMRI_and_Spectroscopy


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When contrast agent is not used an MRIcan show: When contrast agent is used MRI canshow:

contrast agent is not used an MRI can

show:The shape, size, appearance, and locationof organs, bones, and jointsThe presence of abnormal growthsSigns of inflammation or infection

size and location of benign or malignant

growthsenlarged lymph nodeschanges in blood flowextracellular volume

RESONANCE

IMAGING(MRI)


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Tomography

(PET) Is an imaging technique that usesradioactive molecules to create a dynamicimage of internal tissues and organs.

It produce images that reveal the activityof living tissue.

PET scans use radioactively labeled tracers(radiotracers) that are injected into thebloodstream

PET SCAN


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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 ifyou are late, the images may not be as good

Wear loose fitting clothing

Do not wear any jewelry; watches, chains, rings,piercings, etc

PET SCANPreparation:


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Tomography

CTs Scan uses special

x-rayequipment toobtain cross-

sectionalpictures of thebody
http://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=x-ray&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=x-ray&version=Patient&language=English


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Use In Cancer 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; andTo determine whether the cancer is responding

to treatment.

Tomography

CTs Scan

i
http://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=biopsy&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=cell&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=radiation%20therapy&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=surgery&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=surgery&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=radiation%20therapy&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=cell&version=Patient&language=Englishhttp://www.cancer.gov/Common/PopUps/popDefinition.aspx?term=biopsy&version=Patient&language=English


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Biopsy

- is the removal oftissue from a

living subject todetermine thepresence orextent of a

disease- Visualization of

change cell

microscopically

CYTOLOGY SPECIMENSpecimen can be obtain

from tumors that tend to

shed cells from their

BIOPSY


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BIOPSY

NEEDLE BIOPSY Incision Biopsy

Only part of tumoris removed

Cell tissue only

NEEDLE BIOPSY Excision Biopsy

Entire tumor issurgically removed forexamination

Used for small tumors(2-3cm)

Serve as treatment iftissue margin containno tumor cells

Biopsy


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BiopsyInvasive Techniques

Fine needleaspiration (FNA) uses a small needle

to collect smallsamples of a lesion.

Core needle biopsy(CNAB) uses a larger

needle to collectsamples of a lesion

Biopsy


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Fine needle aspiration(FNA)

ADVANTAGES: diagnose benign lesions Inexpensive, quick, readily

available, and very safe

DISADVANTAGES: No ability to differentiate

between in situ andinvasive breast cance

Core needle biopsy (CNAB) ADVANTAGES:

Strong ability to specificallydiagnose benign lesions.

Some ability to differentiatebetween in situand invasivebreast cancer.

DISADVANTAGES:

More invasive, timeconsuming, expensive

BiopsyInvasive Techniques

Analysis of Biopsy


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Analysis of BiopsySamples

mmunohistochemistry (IHC) measures protein expression

using specially labeled

antibodies. example: Three proteins ofparticular interest in breastcancer are HER2, the

estrogen receptor (ER) andthe progesterone receptor(PR).

Fluorescence in SituHybridization (FISH)

measures genetic changes (i.e.amplification) using

fluorescently labeled DNAprobes.

Is a technique that measuresgene amplification andchromosomal abnormalities usingfluorescently labeled DNAprobes.

Cancer Specific


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Cancer SpecificTechniques

Mammography

uses low dose x-

ray to create animage of abreast.


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Techniques

Direct Visualization Direct VisualizationSigmoidoscopy 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


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Cancer SpecificTechniques

Pap smears use a sample of cells from thecervix to detect cervical cancer. Papsmears may also detect ovarian anduterine cancers that have migrated to thecervix.

Prostate specific antigen (PSA) testmeasures levels of a glycoprotein in theblood. Elevated levels of PSA areassociated with prostate cancer

Sentinel Lymph


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Sentinel LymphNode Biopsy (SLN)

Use to detect metastasis

the hypothetical first lymph node or

group of nodes reached by metastasizingcancer cells from a tumor

used in the staging of certain types of

cancer to see if they have spread to anylymph node
http://en.wikipedia.org/wiki/Lymph_nodehttp://en.wikipedia.org/wiki/Lymph_node


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Staging

GRADING

Evaluation of degree ofdifferentiation of cancercells

Grade 1- the least

malignantTo Grade 4- the most

malignant Grade 1- the most

differentiatedTo

Grade 4- the leastdifferentiated

STAGING

The process of describing thelocal extent of the disease orthe spread of cancer fromthe original site

Essential in determining thechoice of therapy andassessing prognosis

Based on information aboutthe tumor size and location inthe body, and whether or notit has spread to other areasof the body

TNM Staging


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TNM StagingSystem

Measure tumors in threeways:

Primary Tumor (T)

Node (N)

Metastasize (M)

TNM Stag ng


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TNM Stag ngSystem

Tumor

T0- no evidence of primary tumor TIS- carcinoma in situ T1-T4- ascending degrees of tumor size and

involvement

ag ng


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Nodes

N0- no evidence of disease in lymph nodes

N1a, N2b- disease found in regional lymphnodes, metastasis not suspected N1a, N2b, N3 - disease found in regional

lymph nodes, metastasis suspected

ag ngSystem

TNM Staging


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Metastasis

M0- no evidence of distant metastasis M1, M2, M3- Ascending degrees of

metastasis involvement, including

distant nodes

TNM StagingSystem

ag ng


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Once the T, N, and M are determined, a Stageof I, II, III, or IV is assigned

Stage I - (T1,N0,M0) - Early StageStage II - (T2,N1,M0) - Local SpreadStage III - ( T3,N2,M0) Extensive

spread but no metastasis

Stage IV (T4,N3,M+) Advancedstage, with distantmetastasis

ag ngSystem


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Prevention and

Control1. Primary Prevention Focuses on eliminating the

conditions that cause cancer todevelop Pre-cancerous stage


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2. Secondary Prevention Refers to early detection coupled

with effective therapy Cancer maybe curable in early

stage.

Prevention and

Control


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3. Tertiary Prevention Refers to the prevention of cancer

recurrence, symptoms andcomplication Involves Supportive Care,

Rehabilitation and pain relief

Prevention and

Control

C


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Cancer

TreatmentObjectives:

Aims to prevent cancer fromspreading locally or recurring/

relapsing at sites distant fromthe original location.

T


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Treatments Surgery Radiation Therapy Hormonal Therapy Targeted Therapy Antibodies Cancer Vaccines Complimentary and Alternative Medicines Chemotherapy

TREATMENT


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TREATMENTMODALITIES

A. Loco-Regional Treatment

1. Surgery

2.

Radiation Therapy3. Transplant

B. Systemic Treatment

1. Cytotoxic Chemotherapy2. Hormonal Therapy

SURGERY


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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 processcalled recurrence

A local treatment used to remove visible tumorsor the entire organ

Purposes: Diagnose Cure Control Pallative

SURGERY


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SURGERY Local Excision- simple surgery with small

margin of normal tissue surroundingtumor.

En bloc Dissection- removal of tumor,tissues, and any contiguous structures.

Surgery on Cancer


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Surgery on Cancerin Situ

Electrosurgery- application of electricalcurrent to cancerous cells

Cryosurgery- deep freezing with liquidnitrogen

Chemosurgery- applied chemotherapeutic

agents layer by layer with surgicalincision.

Co2 laser- use of laser for laser excision.

RADIATION


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RADIATIONTHERAPY

The use of high-energy ionizing rays totreat a variety of cancers

Destroys the cells ability to reproduce by

damaging the cells DNA Rapidly dividing cells are more vulnerable

to radiation than slower dividing cells

It can be used alone or in conjunction withother treatments (e.g. chemotherapy andsurgery) to cure or stabilize cancer.

RADIATION


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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

RADIATIONTHERAPY

Types of Radiation


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Types of RadiationTherapy

1. External RadiationTherapy Administered by

high energy X-ray machines(e.g. Betatronand Linear

Accelerator) ormachinescontainingradiosotope


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Nursing Care Marks must not remove Keep the skin dry

Talcum and Lotions are contraindicated Avoid strong sunlight, extremestemperature, constricting clothes.

No Eating (NPO) Patient is not the SOURCE of Radiation

after the procedure.

Types of Radiation


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Internal Radiation Therapy Involves the placement of specially

prepared radioisotopes directlyinto near the tumor itself or intothe systemic circulation

Also called brachytherapy

Types of RadiationTherapy

Types of Internal


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Types of InternalRadiation Therapy

Sealed Source RT(Brachytherapy)Un Sealed- Source RT

S l d S RT


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Sealed- Source RT

Sealed radiation source isplaced in a cavity or adjacent

to cancer.

Ex: Radium, Iridium, Cesium

S l d S RT


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INTRACAVITARY TherapyRadioisotope 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

Sealed- Source RT

Sealed- Source


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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, Gold198, Radon 222

Sealed SourceRT

UNSEALED SOURCE


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UNSEALED SOURCERT

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 TreatsPolycythemia Vera

Other Types of


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It uses high energy rayscomposed 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 machinesthat excite electrons using

cathode ray tubes or linear

accelerators.

Other Types ofRadiation Therapy

Nursing Care Highlight


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Care of the Client with Sealed Implants of

Radioactive Sources

Assign the client to a privateroom, with private bath.

Place Caution: RadioactiveMaterial sign on the door of

the clients room. Pregnant nurses should not

care for these clients; do notallow children younger than 16

and pregnant women to visit.

Limit each visitor to hour per day

Never touch the

radioactive materialwith bare hands Save all dressings

and bed linens until

after theradioactive sourceis removed.

RADIATION


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RADIATIONSAFETY

Three factors which determine thetotal exposure one receives in a givenradiation field are:

1. Time of exposure.

2. Distance from Source.

3. Amount of shielding present.

TIME


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TIME

The less time

you spend near asource, the lessradiation you will

receive

The Shortest Possible Time

DISTANCE


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DISTANCE As far as possible

( can spend moretime at a distanceof 20 feet)

The farther you get

from a source, theless radiation youwill receive.

SHIELDS


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SHIELDS

The more

shielding youhave, the lessradiation you will

receive.

Protective Lead Apron

Advantages of


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Advantages ofRadiotherapy

Destroys quickly dividing cells at the marginsof tumors. Surgery may miss these cellsleading to recurrence of disease.

Can successfully eradicate growth withoutpermanently damaging the adjacent normal

In conjunction with other treatments, maycure tumors that are not responsive to anysingle agent.

S S C


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II. SYSTEMIC TREATMENT

HORMONAL THERAPY

Fights cancer byaltering the

amounts ofhormones in thebody.

BIOLOGIC TREATMENTS

Referred to by many termsincluding: Immunologictherapy, Immunotherapy,

biotherapy. (Interferon,Interleukin)

Often used to help restorethe functioning of the

immune system. Stimulates the disease-

fighting ability of the body.

CHEMOTHERAPY


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CHEMOTHERAPY Chemo, refers to a wide

range of drugs used totreat cancer

work by damaging the

dividing cancer cells andpreventing their furtherreproduction

Death of the normal cells

produces some of thecommon side-effects ofchemotherapy.

PRINCIPLE OFCHEMOTHERAPY

Timing of dose around thecell cycle and in relation

to other drugs is critical Combination therapy is

more effective Effectiveness of the drug

relies on the number ofcells in division

CHEMOTHERAPY


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The use of powerful drugs to:

Kill Cancer CellsControl their GrowthRelieve Pain Symptoms

CHEMOTHERAPY

Types of


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ypes oChemotherapy

Types of


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Types ofChemotherapy

1. Primary ChemotherapyThe use chemotherapy alone for the cure ofa specific tumor.

2. Adjuvant ChemotherapyThe use of chemotherapy after primary,loco regional treatment, with the intent of

decreasing the relapse rate and improvingsurvival.

Types of


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Types ofChemotherapy

3. Neo- adjuvant ChemotherapyThe use of chemotherapy before loco- regionaltreatment with the intent of decreasing tumor

size enhancing chances for resectability andpreservation of normal structures.

4. Concurrent Chemotherapy

The use of chemotherapy combined withradiotherapy in order to increase local responseand control systemic spread.

ypes o


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ypes oChemotherapy

5. Palliative Chemotherapy

The use of chemotherapy in advancedmalignancies, the intent of which is notcure but control of the disease and tumorrelated symptoms.

CHEMOTHERAPY


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Types Antineoplastic Agents- drugs that inhibit and combat the

development of neoplasms Classes:

Antimetabolites Genotoxic Drugs

Alkylating agents: Intercalating agents

Enzyme inhibitors

CHEMOTHERAPYDRUGS

CHEMOTHERAPY


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Types

Spindle Inhibitors

Additional Chemotherapy Agents

CHEMOTHERAPY

ANTIMETABOLITE


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ANTIMETABOLITES

Drugs that interfere with the formation ofkey biomolecules within the cell.

work by blocking the activity of enzymes These drugs often prevent the normal

replication of DNA , nucleic acids andtherefore cell division.

Other antimetabolites may interfere withthe creation of RNA or other cellularprocesses

ANTIMETABOLITE
http://www.cancerquest.org/dictionary.cfm?lookup_id=DNA&lang=englishhttp://www.cancerquest.org/dictionary.cfm?lookup_id=RNA&lang=englishhttp://www.cancerquest.org/dictionary.cfm?lookup_id=RNA&lang=englishhttp://www.cancerquest.org/dictionary.cfm?lookup_id=DNA&lang=english


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Classes:

Folate Antagonists- known as antifolates

inhibit dihydrofolate reductase (DHFR), an enzyme

involved in the formation of nucleotides. When thisenzyme is blocked, nucleotides are not formed,disrupting DNA replication and cell division

Ex. Methotrexate (Wellcovorin):

ADVERSE EFFECTBone marrow depression stomatitis

ANTIMETABOLITES

ANTIMETABOLITE
http://www.cancerquest.org/index.cfm?page=430http://www.cancerquest.org/index.cfm?page=430


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Purine Antagonists 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 moleculeduring DNA synthesis

Ex. 6-Mercaptopurine, Dacarbazine, Fludarabine

ANTIMETABOLITES

ANTIMETABOLITE
http://www.cancerquest.org/index.cfm?page=435http://www.cancerquest.org/index.cfm?page=435


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Pyrimidine Antagonists 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 thenatural compound.

By acting as 'decoys', these drugs can prevent the

production of the finished nucleotides. They may exerttheir effects at different steps in that pathway andmay directly inhibit crucial enzymes.

Ex. 5-fluorouracil; Arabinosylcytosine

OS

eno ox c


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Drugs that damage DNA. By causing DNAdamage, these agents interfere with DNAreplication, and cell division

3 Treatments: Alkylating Agents Intercalating Agents Enzyme Inhibitors

eno ox c

Drugs

eno ox c


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Alkylating agents:

The first class of chemotherapy agentsused. These drugs modify the bases ofDNA, interfering with DNA replicationand transcription and leading to mutations

eno ox c

Drugs

eno ox c


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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 astopoisomerases, involved in DNA replicationinducing DNA damage.

eno ox c

Drugs

p n e


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p n eInhibitors

These agents prevent proper cell divisionby interfering with the cytoskeletalcomponents that enable one cell to divide

into two. Vinca Alkaloids

Paclitaxel (Taxol)Docetaxel (Taxotere)Ixabepilone (Ixempra)

Chemotherapy


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Chemotherapy

Agents While many of the commonly used chemotherapyagents fit into one of the three previously describedgroupings (Genotoxic, Cytoskeletal, and Anti-metabolite), some of them work through mechanisms

that do not neatly fit into one of these categories. Arsenic trioxide (Trisenox) Bleomycin

Hydroxyurea Streptozocin

Chemotherapeutic


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pAdministration

Oral

IM/ SQ

IV

Central Venous Catheter

Venous Access Devices (VAD)

Intraarterial Route Intraperitoneal Route

STEM CELLS


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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

tem ce s


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e ce sLocation

Bone marrow (the spongy center of thebone where blood cells are made)

Peripheral blood (found in blood vesselsthroughout the body)

Cord blood (found in the umbilical cordand collected after a babys birth)

Stem cells for transplantation are obtained from any of these threeplaces.

Transplant in


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pCancer

A. Stem Cell Transplant a procedure that is used

in conjunction with high-

dose chemotherapymore effective than

conventionalchemotherapy indestroying myeloma cells

restore blood cellproduction

Types of Stem Celll


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ypTransplants

Bone marrow transplant stem cell-containing bone marrow is collected, stored,

and infused following high-dose chemotherapy and/orradiation therapy.

Peripheral blood stem cell (PBSC) transplant Procedure in which blood containing mobilized stem cells

is collected by apheresis, stored, and infused followinghigh-dose chemotherapy and/or radiation therapy.

Cord blood transplantsrefer to transplants where thestem cells are obtained from umbilical cord bld

Transplants


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Autologous transplants, patients receivetheir 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 thepatient (an unrelated donor) also may beused.

Transplants

according to Donor

THE CANCER PAIN
http://www.cancer.gov/dictionary/db_alpha.aspx?expand=ahttp://www.cancer.gov/dictionary/db_alpha.aspx?expand=ahttp://www.cancer.gov/dictionary/db_alpha.aspx?expand=ahttp://www.cancer.gov/dictionary/db_alpha.aspx?expand=ahttp://www.cancer.gov/dictionary/db_alpha.aspx?expand=a


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PROBLEM

PAINIn cancer is the most fearedand distressing symptom

of the disease.

THE CANCER PAINPROBLEM


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WHO reveals that everyday at least 4million people suffer from cancer pain.

30 50% of cancer patients undergoingtreatment, and up to 95% of patients withadvanced disease, suffer from pain.

More than 50% of patients still sufferedfrom unrelieved cancer pain.

PROBLEM

WHO: 3 Step Analgesic LadderF C P i M t


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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 LadderF C P i M t


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BY THE CLOCK

Analgesics should be given regularly andprophylactically.

BY THE LADDERUse a few drugs well than many badly.

For Cancer Pain Management

WHO Three-Step


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Analgesic Ladder Step IFor mild to moderate pain non-opioids

(treatment of choice). may or may not be combinedwith adjuvant drugs (drugs that are used to hastenor add to the primary mode of treatment).

Step II For moderate pain, who did not feel reliefafter using only non-opioids, a combination of opioidsand non-opioids should be tried. Again, adjuvants mayor may not be used.

Step IIIFor moderate to severe pain, opioids shouldbe used, with or without non-opioids, and with orwithout adjuvants.

WHO Three-StepA l i L dd


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Analgesic Ladder

ancer :


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ManagementC ComfortA- Altered Body Image

N NutritionC ChemotherapyE- Evaluate the Response in

TreatmentR - Rest

SUMMARY


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SUMMARY Early detection and screening of high risk

individuals play significant roles intreating cancer.

Patient and family caregivers should beinvolved in all aspects of nursing care.

Various treatment modalities are availableto cure, control and palliate cancer.

SUMMARY


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Safety Standards of treatment mustalways implemented.

Life long surveillance for recurrence aftertreatment.

SUMMARY

oncologic nursing part 2

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