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By: Alhanouf Alkhayat Compare the structure and function of the normal cell and the cancer cell. Differentiate between benign and malignant tumors. Identify agents and factors that have been found to be carcinogenic. Describe the roles of surgery, radiation therapy, chemotherapy,bone marrow transplantation, and other therapies in treating cancer. Describe the special nursing needs of patients receivingchemotherapy. Use the nursing process as a framework for care of patients with cancer. Pathophysiology of the Malignant Process Proliferative Patterns Characteristics of Malignant Cells Management of Cancer Radiation Therapy Types of Radiation Radiation side Effects Nursing Management in Radiation Therapy Chemotherapy Administration of Chemotherapeutic Agents Special Problems: Extravasation Chemotherapy side effects Nursing Management in Chemotherapy anaplasia: cells that lack normal cellular characteristics and differ in shape and organization with respect to their cells oforigin; usually, anaplastic cells aremalignant. dysplasia: bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same type of tissue hyperplasia: increase in the number of cell of a tissue; most often associated with periodsof rapid body growth neoplasia: uncontrolled cell growth that follows no physiologic demand metaplasia: conversion of one type of mature cell into another type of cell CHARACTERISTICS BENIGN MALIGNANT Cell characteristics Well-differentiated cells. Cells are undifferentiated and often bear little resemblance to the normal cells of the tissue of origin. Mode of growth Tumor grows by expansion and does not infiltrate the surrounding tissues; usually encapsulated. Grows at the periphery and sends out processes that infiltrate and destroy the surrounding tissues. Rate of gorwth Rate of growth is usually slow. the more anaplastic the tumor, the faster its growth. Metastasis Does not spread by metastasis Metastasis to the blood and lymphatic channels and metastasizes to other areas of the body. General effects Is usually a localized phenomenon that does not cause generalized effects unless its location interferes with vital functions Often causes generalized effects, such as anemia, weakness, and weight loss Tissue destruction Does not usually cause tissue damage unless its location interferes with blood flow Often causes extensive tissue damage as the tumo outgrows its blood supply or encroaches on blood flow to the area; may also produce substances thatcause cell damage. Ability to cause Does not usually cause death Usually causes death unless growth can Cancer types can be grouped into broader categories. The main categories of cancer include: Carcinoma Sarcoma Leukemia Lymphoma and myeloma Central nervous system cancers Tumor marker identification Magnetic resonance imaging(MRI) Computed tomography(CT scan) Fluoroscopy Ultrasonography (ultrasound) Endoscopy Nuclear medicine imaging Positron emission tomography(PET scan) Radioimmunoconjugates There is 3 goals in cancer management: Cure Control Palliation Surgery Radiation Chemotherapy Bone Marrow Transplant Biology and Target therapy There is two type of radiation: External radiation Internal radiation (brachytherapy): This internal radiation can be implanted by means of needles, seeds,beads, or catheters into body cavities (vagina, abdomen, pleura)or interstitial compartments (breast). Brachytherapy may also beadministered orally as with the isotope I131, used to treat thyroidcarcinomas. The nurse assesses the patient’s skin, nutritional status, and general feeling of well-being. the patient is instructed to avoid using ointments, lotions, or powders on the area. Gentle oral hygiene is essential to remove debris, prevent irritation,and promote healing. The nurse offers reassurance by explaining that these symptoms are a result of the treatment and do not represent deterioration or progression of the disease. When a patient has a radioactive implant in place, nurses and other health care providers need to protect themselves as well as the patient from the effects of radiation. antineoplastic agents are used in an attempt to destroy tumor cells by interfering with cellular functions and reproduction. Chemotherapy is used as Adjuvant therapy or neo adjuvant therapy Each time a tumor is exposed to a chemotherapeutic agent, a percentage of tumor cells (20% to 99%, depending on dosage) is destroyed. Repeated doses of chemotherapy are necessary over prolonged period to achieve regression of the tumor. Eradication of 100% of the tumor is nearly impossible. the remaining tumor cells can be destroyed by the body’s immune system. As a cell approaches the end of the G1 phase it is controlled at a vital checkpoint, called G1/S, where the cell determines whether or not to replicate its DNA Cells with intact DNA continue to S phase; cells with damaged DNA that cannot be repaired are arrested and ‘‘commit suicide’’ through apoptosis 2- A second such checkpoint occurs at the G2 phase following the synthesis of DNA in S phase but before cell division in M phase Cyclin Dependent Kinases, or CDKs, are specific enzymes that use signals to switch on cell cycle mechanisms. CDKs are activated by forming complexes with cyclins (another group of regulatory proteins only present for short periods in the cell cycle) Genetic mutations causing the malfunction or absence of one or more of the regulatory proteins at cell cycle checkpoints can result in the ‘‘molecular switch’’ being turned permanently on, permitting uncontrolled multiplication of the cell, leading to carcinogenesis, or tumor development. cell cycle–specific drugs cell cycle–nonspecific drugs. Oral chemotherapy. Intravenous Intramuscular subcutaneous Intrathecal intracavitary peritoneum such as GIT :nausea,vomiting,stomtitis,mucositis, anorexia,diarrohea or constipation. Hematopoietic System: myelosuppression,nutropenia, leukopenia, anemia and thrombocytopenia . Renal system: hyperkalemia ,hyperphosphatemia ,hypocalcemia and renal damage. Cardiopulmonary System:cardiactoxicities,lung Fibrosis Reprouctive System: Abnormal ovulation, early menopause, or permanent sterility may result. In men, temporary or permanent azoospermia may develop. Neurologic System:Peripheral neuropathies, loss of deep tendon reflexes, and paralytic ileus may occur. Also, ototoxcisity and hearing loss. Miscellaneous: Fatigue is a distressing side effect for most patients that greatly affects quality of life. ASSESSING FLUID AND ELECTROLYTE STATUS MODIFYING RISKS FOR INFECTION AND BLEEDING ADMINISTERING CHEMOTHERAPY IMPLEMENTING SAFEGUARDS MONITORING THERAPEUTIC AND ADVERSE EFFECTS Extravasation: defined as the accidental leakage from its intended compartment (the vein) into the surrounding tissue.Usually, this occurs when intravenous (IV) medication passes from the blood vessel into the tissue around the blood vessels and beyond. Cancer drugs can be grouped into 3 broad categories, based on their potential to cause tissue damage upon extravasation: ■ Non-vesicants ■ Irritants ■ Vesicants Step 1 Stop the infusion immediately. DO NOT remove the cannula at this point. Step 2 Disconnect the infusion (not the cannula/needle). Step 3 Leave the cannula/needle in place and try to aspirate as much of the drug as possible from the cannula with a 10 mL syringe.Avoid applying direct manual pressure tosuspected extravasation site. Step 4 Mark the affected area and take digital images of the site. Step 5 Remove the cannula/ needle. Step 6 Collect the extravasation kit (if available), notify the physician on service Step 7 Administer pain relief if required. step8 • Apply a cold pack to the affected area for 20 min 4 times daily for 1—2 days. Step9 • NEUTRALISE Neutralise the drug by using the specific antidote.for drugs without antidotes omit step 9 • Remove the cannula after confirming no more antidote will be Step 10 prescribed or given. Step 11 Step12 step13 • Elevate the limb. • Document the incident using extravasation documentation sheet • Arrange follow up for the patient as appropriate STEP 8 – DISPERSE STEP 9 – DILUTE • Apply a warm compress to the affected area for 20 minutes 4 times daily for 1—2 days • Give several subcutaneous injections of 150–1500 IU of hyaluronidase diluted in 1 m • Document the incident using extravasation documentation sheet Step 10 • Arrange follow up for the patient as appropriate. Step11 Smeltzer,c and Bare,b,2008.Medical Surgical Nursing.11ed.USA:Lippincott William and Wilkins. Gates,R and Fink,R.2008.Oncology Nursing Secrets.3rd ed. USA: Mospy elsevier. Yarbro,C.Wjcik,D and Gobel,B.2011.Cancer Nursing Principles and Practice.7th ed.UK: Jones an Bartlett publishers. Wengström,y and et al.2007,” Extravasation guidelines 2007:guideline implementation toolkit”[online] available at http://www.cancernurse.eu/