CANCER

- is a disease process that begins when an abnormal cell is transformed by the genetic
mutation of the cellular DNA.

Neoplasia
- process of tumor formation
Neoplasm: Other term for tumor

Cancer according to target organ

Carcinoma - epithelial tissues ( eg. skin, breast, lungs and colon)

Sarcoma- connective tissues ( Muscle and Bones)

Lymphoma- Lymph nodes (hodgkin's disease)

Multiple Myeloma- (blood related) abnormal Plasma

Luekemia - (blood related) immature WBC

Cancer Staging

Stage 0: Cancer in Situ (Origin)

Stage I: tumor less than 2 cm, negative lymph node involvement, no detectable
metastases

Stage II: tumor greater than 2 cm but less than 5 cm, negative or positive unfixed
lymph node involvement, no detectable metastases

Stage III: large tumor greater than 5 cm, or a tumor of any size with invasion of the
skin or chest wall or positive fixed lymph node involvement in the clavicular area
without evidence of metastases

Stage IV: tumor of any size, positive or negative lymph node involvement, and
distant metastases

Priority: Pain management

DOC: Narcotic Analgesics (opiods) Morphine SO4
Warning signs of CANCER

 C- Change in bowel movements (diarrhea/ Constipation)

 A sore that does not heal
 U- Unusual Bleeding
 T- Thickening of the Lump
 Indigestion ( Dyspepsia)
 O- Obvious Change in warts or mole
 N- Nagging Cough or Hoarseness of voice
 U- Unexplained Anemia
 S- Sudden weight Loss

Note: Having 3 or more, At risk to developed Cancer

 Risk Factors For Cancer Formation:

 Age 40 yrs old and above (Post menopausal)

 Gender - Male -prostate Cancer (Lifestyle)

o Female - Breast Cancer (Hormonal Changes)

 Smoking, Alcohol and Exposure to Asbestos

 Benzene: chemical that can be found in gasoline and Paints
 Polyvinyl: Plastic and PVC pipes
 Chlorofluorocarbon (CFC): Aircon and refrigerator
 Hair dye
 Aplatoxins Gas Forming foods
 Benzopyrine; Charcoaled foods
 Low Fiber and High Fat Diet

Treatment for Cancer

O-ral therapy
R-adiation therapy
CHE-motheraphy
D-(the) bone marrow aspiration
S-urgery

Chemotherapy- normally last for 6 to 12 months

RADIATION CHEMOTHERAPY
 Reduce the size of tumor  Interrupts the cell cycle
 Relieves obstructions  Affects all fast growing cells
 Only affects the cancer cell ( Normal and Cancer cell

ALOPECIA- Common side effect

Two types of Radiation Therapy

INTERNAL ( BrachyTherapy ) EXTERNAL ( Teletherapy)

(+) Residual Radiation (-) residual Radiation
SEALED Exposure to Beam of light or Ultra violet
(+) Container implant beads Rays
UNSEALED
(-) Container, it can be oral or IV
(eg, Phosphorous 32)

Type of Radiation Rays

 Alpha Rays- Does Not penetrate in the skins ( therapeutic). Does not need
Protection.

 Beta Rays- Penetrates into the skin ( internal radiation. Need for rubber
gloves.

 Gamma Rays- Penetrates to into the bones (External Radiation)

Factors Affecting Exposure to Radiation

 Shielding
 Time
 Distance
 Half Life

Shielding
1. Patient should be in a private room
2. Farthest room as possible
3. Avoid Pregnant and children below 17 years old
4. Led Apron should be wear all through out the procedure
5. Implants
a. Bedrest
b. POC; Flat (supine)
c. Bedpan / catheterization
d. Patient should be facing opposite the door
e. patient should stand opposite the implant
f. Log rolling (turning)
g. Picked-up by long forceps and put to the led container
h. if not found close and leave the room. Call the radiology department.
Geiger Machine/ Counter - Use to locates dislodge radiation implant
i. Sex is resumed 3 weeks after the removal of implant
6. secretions and discharges
Rubber gloves should be wear when dealing with Patients secretions.
Always flush at least 3 times due to residual radiation
Time
 30 minutes per shift with interval of 1-2 hours
 5 mins for exposure
 enter the room 5 times only
 organized task
 1 patient and 1 nurse at a time
Dosimeter (badge, bandage or patch) It measures the amount of
radiation exposure.

Distance
- Nurse should maintain at least 6 feet distance to the patient when not performing
procedure.

Half life
- time required for the half of the radioisotopes to decay.

CHEMOTHERAPY
- A drug or combination of drugs to alter the cancer formation and eradicated the
cancer cell in the body.

Types of Chemotherapy Drugs:

 Alkylating Agents
 Anti-Metabolites
 Anti-Tumor
 Plant-Alkaloids
 Corticosteroids
 Hormones

Alkylating Agents:
- Prevent DNA and RNA Formation
- Non Cell Specific
Example: Cytoxan and Nitrogen Mustard (Mustargen)

Nursing Responsibilities

Cytoxan;
CARDIOTOXIC, HEPATOXIC, NEPHROTOXIC.
- Nurse should monitor for arrhythmias, Monitor Serum glutamic pyruvic
transaminase liver enzymes and Bun / Creatinine.

Nitrogen Mustard (Mustargen)

(Potent Vesicant- Acid/Alkali nature)
Complication EXTRAVASATIONS
- Nurse should be monitor for manifestations ( redness, swelling, inflammation,
burning sensation on the site)
- Nurse should monitor for complication ( risk for Renal Calculi)
- Instruct the patient to increase fluid intake
When Preparing Nurse should wear the following;

 Gaggles
 Face mask
 Gown
 Gloves

Pre and During Administration

 Ensure IV potency
 Vesicant First before non-Vesicant

During Extravasations
 Discontinue and change site
 Apply Cold Compress
 Report to physician

ANTI-METABOLITES
- Substitute erroneous DNA.
- Cell Cycle Specific ( Synthesis)

Example Medication:
Methotrexate - Hmole and ectopic Pregnancy
5FU Flurouracil - Lung and Colon Cancer

Side effect :
Decrease Folic Acid (Vit. B9) >>>> Magaloblastic anemia
Antidote; Leucovolin

ANTI-TUMOR
- prevent DNA cell replication
- non cell cycle specific

Example Medication:
Bleomycin
Nurse should monitor for prothrombin time and O2 sat (Bleeding and Pulmotoxic)

Adriamycin
Side effects: Alopecia, Diarrhea, Arrhythmia, red orange secretion

PLANT ALKALOIDS
- Plant poison on the cancer cell
- Cell cycle specific (M phase)

Example Medications
Oncovin, Vinblastin, Vinplastin, Vincrystin
Complications;
Seizure, medication should be accompanied by Benzopyramine
CORTICOSTEROID
- Anti inflammatory Drug

Prednisone
Dexamethasone
Betamethasone
Hydrocortisone

Complications :
Immunosuppressant

HORMONES
- artificial hormones to prevent metastasis

Tamoxiflen (niovaldex) - Breast Cancer

Lupron
Diethylstilbestrol - For prostate Cancer

COMPLICATIONS OF RADIATION AND CHEMOTHERAPY

1. Bone marrow depressant ( aplastic anemia)

- Anemia
- Infection
- Bleeding

2. Sterility (Radiation)
Management
-Female oophorexy Elevation of ovary
-Male Sperm banking

3. Extravasations and Dermatitis

Management
- Cold application
- wash with water and mild soap
- avoid lotion, powder and alcohol
- pat dry avoid friction
- avoid constrictive clothes
- avoid exposure to direct sunlight ( affected part)

4. Stomatitis - Lanker sore

- check for blister
- avoid alcohol based product
- gargle with warm saline solution
- avoid smoking (irritant)

5. dryness of the mouth

- offer ice cold fluids
6. Dryness of vagina
- Avoid alcohol based product
- Apply water base lubricant
- Cornstarch mix with water

7.Alopecia
- reassure the patient that hair will grow after 6 months when chemotherapy is
finished
- advice the patient to comb the not more than 3 times a day