Cellular Aberrations

CANCER, MALIGNANT NEOPLASM, ONCOLOGIC DISORDER

 family members with more than 1 type
of cancer
DEFINITION OF TERMS
 a rare cancer in one or more family
members (retinoblastoma,
ONCOLOGY- field of study of Cancer
pheochromocytoma)
CANCER-a disease process whereby cells
5. Dietary factors
proliferate abnormally, ignoring growth-
regulating signals in the environment
surrounding the cells  fats, alcohol, salt-cured or
smoked meats
CARCINOGENESIS-the process of transforming  nitrate & nitrite containing
normal cells into malignant cells foods
 high caloric dietary intake
DYSPLASIA- bizarre cell growth resulting in cells
that differ in size, shape or arrangement from 6. Hormonal Agents
other cells of the same type tissue
 oral contraceptive
MALIGNANT- having cells or processes that are  prolonged estrogen
characteristic of cancer replacement therapy (ERT)
 Diethylstilbestrol (DES)-non-
METASTASIS- spread of cancer cells from the steroidal estrogen medication
primary tumor to distant sites
ASSESSMENT
NEOPLASIA- uncontrolled cell growth that
follows no physiologic demand WARNING SIGNAL SIGNS OF CANCER

(2nd leading cause of death that is only second C- hange in bowel or bladder habits
on CVD) A- sore that does not heal
U- nusual bleeding or discharge
RISK FACTORS OF CARCINOGENEIS U- nexplained sudden weight loss
1. Viruses and Bacteria U- nexplained anemia
T- hickening or lump in the breast or elsewhere
 prolonged or frequent viral
infections I- ndigestion or difficulty in swallowing
 Epstein-Barr virus highly suspect O- bvious change in wart or mole
cause of Burkitt lymphoma,
nasopharyngeal cancer, some non-
N- agging cough or hoarseness of voice
Hodgkins and Hodgkins disease
 Helicobacter pylori bacteria-Gastric
malignancy CLASSIFICATION OF A TUMOR= refers to the
site where malignancy originates
2. Physical agents
1. Carcinomas (skin, mucous membranes,
 excessive sunlight
glands)
 to ionizing radiation
2. Sarcomas (bone, blood, lymphatics,
3. Chemical agents
connective tissues)
 tobacco smoke
 industrial compounds 3. Gliomas (brain and spinal cord tissues)

4. Genetic and Familial factors (Accounts 4. Melanomas (pigmented cells)

for 5%)
5. Myelomas (plasma cells)
 cancer in 2 or more relatives
 cancer in family members younger than 6. Lymphoma (lymphatic tissue)
50 years old
 the same type of cancer in several 7. Leukemia (leukocytes)
family members
8. Erythroleukemia (erythrocytes)
 Cellular Aberrations
CANCER, MALIGNANT NEOPLASM, ONCOLOGIC DISORDER
3. Prostatic Acid Phosphatase
DIAGNOSTICS/LABORATORY EXMINATIONS It may be found in increased amounts
in men who have prostate cancer or
A. Screening tests – BSE, Pap smear, other diseases. The highest levels
digital rectal examination, TSE of acid phosphatase are found in
*Papanicolau Test (Pap smear – test for metastasized prostate cancer.
cervical cancer)
4. Prostate Specific antigen-
RESULTS NV=0.2-4.0 ng/mL (nanogram/mL)
 Class I=Normal =increased in prostate cancer, BPH-
 Class II=Inflammation benign prostatic hyperthrophy, TUR-P
 Class III=Mild to moderate
dysplasia – bizzare cell growth 5. Carcinoembryonic Antigen (CEA)-
 Class IV=Probably malignant increased in colon, rectum, pancreas and
 Class V=Malignant stomach cancers
NV= 0-2.5 ug/L non-smoker
Staging (T,N,M) 0-5 ug/L smokers

 Tumor involvement – T0 – T4 Characteristics Benign Malignant

 Nodes involvement – N0 – N4 Speed of Grows slowly Grows
 Metastasis involvement growth rapidly
M0 – No metastasis Mode of Remains Infiltrates
M1 – There is metastasis growth localized surrounding
tissues
B. NON-INVASIVE Capsule Encapsulated Not capsule
Cell Well Poorly
 MRI Characteristic differentiated differentiate
 CT scans mature cells; (Anaplastic
 Fluoroscopy cells function type)
 Ultrasonography poorly
 Endoscopy Recurrence Never recur Very
 Nuclear Imaging common
 PET scan Metastasis Extremely Common
 PET fusion unusual following
 Radioimmuno conjugates when surgery
surgically
C. INVASIVE removed
Effect of Not harmful Always
 Biopsy neoplasm to host harmful
 DRE Prognosis Very good Poor
 Cyst Aspiration prognosis prognosis
 Lymph angiography
 Cerebral arteriography DEFINITIVE MANAGEMENT
=a treatment plan for a disease or disorder
chosen as the best one for a patient
LABORATORY EXAMINATIONS
Surgery= removal of the entire cancer tumor
1. Alpha-feto protein- NV: 15mg/dL or
<15mg/dL – Increased in 2 common approaches:
hepatocarcinoma metastatic cancer of
the liver 1. local excisions (en bloc resection)
involves removal of the mass & the
2. Human Chorionic Gonadotropin (hCG) small margin of normal tissue that is
-Very low HCG levels may point to a easily accessible
problem with the pregnancy, an ectopic
pregnancy, or warn that a miscarriage 2. wide or radical excision (en bloc
could happen. Rapidly rising HCG levels dissection) includes removal of the
can signal a molar pregnancy when a primary tumor, lymph nodes, adjacent
uterine tumor grows. involved structures & surrounding
tissues that may be @risk for tumor
spread
 Cellular Aberrations
CANCER, MALIGNANT NEOPLASM, ONCOLOGIC DISORDER
SURGERY =INTERNAL RADIATION- implantation or
Brachytherapy delivers a high dose of radiation
Diagnostic surgery using biopsy to determine to a localized area.
whether the tumor is benign or malignant and
the presence of cancer >It can be implanted by means of needles,
seeds, beads or catheters into the body cavity
 BIOPSY- obtaining a tissue sample for as vagina, abdomen, pleura or interstitial
analysis of cells suspected to be compartment (breast).
malignant
 Video-assisted laparoscopic surgery >It can be administered orally= RAI Iodine-
 Salvage surgery – To treat the local 131(Radioactive Iodine) for thyroid cancer
recurrence of a cancer after the use of
the less extensive primary approach NURSING MANAGEMENT IN BRACHYTHERAPY
EX: Mastectomy – Removal of the (intracavitary radioisotopes)
affected breast
 Electrosurgery – Make use of electric A. Maintain on complete bed rest without
current bathroom priveleges: when the patient
 Cryosurgery –  is a type of surgery that needs to move you need to logroll the
involves the use of extreme cold to patient to prevent displacement of the
destroy abnormal tissues, such as IC delivery device
tumors. B. IFC is inserted to empty the bladder
 Chemosurgery - a method of treating using foley catheter
cancer involving the use of chemicals to C. Low residue diet and anti-diarrheal
destroy malignant tissue  agents as Diphenoxylate to prevent
 Laser surgery - is a type of surgery that bowel movement during therapy
uses special light beams instead of D. While the implant is in place, contacts
instruments for surgical procedures. with health care team are guided by the
 Stereotactic radiosurgery - single and principles of time, distance, and
higher precise use in cancers of the shielding to minimize exposure to
brain, head and neck radiation
 Prophylactic surgery – The removal of
benign tumor, preventive surgery *patient is in a private room
 Palliative surgery - use when cure is *posting appropriate radiation notices
not possible, Relief on any destressing of safety precautions
s/sx and metastasis (UNDER BRACHYTHERAPY)
 Reconstructive surgery – attempt to *staff members should wear
improve function. EX: Breast prosthesis DOSIMETER badges (used for
measuring cumulative radiation dose)
*be sure pregnant staff were not
RADIATION THERAPY assigned
*prohibit visits by children or pregnant
=an ionizing radiation to interrupt cellular visitors
growth as a cure for: *limit visits to 30 minutes/day,
maintaining 6-foot distance from the
a. Hodgkin’s disease – radiation source
b. Testicular seminomas
c. Thyroid cancer
d. Localized cancer of the head & neck RADIATION THERAPY
e. Cancer of the uterine cervix
=Radiation dosage: lethal tumor dose-the dose
=it breaks the strands of the DNA helix leading that will eradicate 95% of the tumor yet
to cell death preserve normal tissue.

=it also ionize constituents of body fluids =Toxicity-localized to the region being irradiated
especially water leading to the formation of free
radicals and irreversibly damaging DNA *altered skin integrity is the common effect
(erythema, dry/moist desquamation,
EXTERNAL & INTERNAL RADIATION depigmentation, telangiectasia, ulcerative
lesions)
EXTERNAL RADIATION- aka high linear energy
transfer radiation damages target cells as well
as other cells in its path. X-rays can be used.
 Cellular Aberrations
CANCER, MALIGNANT NEOPLASM, ONCOLOGIC DISORDER

1. SKIN REACTION CHEMOTHERAPY (anti-neoplastic agents are

used to destroy tumor cells by interfering
Nursing responsibility: cellular functions including replication

 Observe for the early signs of ulceration Classification of chemotherapeutic agents:

 Keep the area dry always
 Wash only the area with water only (No 1. By relationship to the cell cycle
soap)
 Pat it dry  cell-cycle specific
 Don’t apply lotion agents=destroy cells that are
 Don’t apply heat or cold actively reproducing by means
 Avoid direct sunshine of the cell cycle. (the S phase
 Use light and cotton frabric clothes interfering with DNA & RNA
 >Do not erase the markings of the skin synthesis)

2. INFECTION  cell-cycle non-specific

agents=that act independently
NR: Inform the pt the site of infections on the cell cycle phases where
they halt mitotic spindle
3. HEMORRHAGE formation

Platelets are vulnerable to radiation 2. By chemical group

Nursing responsibility:  alkylating agent

 plant alkaloids
 Platelet count will be monitored weekly  anti-metabolites
 Avoid physical trauma  hormonal agents
 Aspirin should be discontinued  anti-tumor antibiotics
 Inform the pt the signs of hemorrhage  miscellaneous agents
 Inform the pt the risk factors of  nitrosoureas
hemorrhage
 To determine the hemorrhage, get a Objectives of chemotherapy
stool exam
 Use direct pressure so that the bleeding  to destroy malignant tumor cells
will stop without excessive destruction of normal
cells
4. FATIGUE  to control tumor growth if cure is no
 Plenty of rest longer possible
 used as adjuvant therapy (given in
5. WEIGHT LOSS addition to the primary or initial
therapy)
6. STOMATITIS
 Administer analgesic CONTRAINDICATIONS:
 No smoking
 No drinking  Infection- anti-tumor drugs are
 Give blant diet
immunosuppressives
*alopecia/ hair loss  Recent surgery-the drug may retard

*alteration in oral mucosa (stomatitis, healing process

xerostomia, change & loss of taste, decreased  Impaired renal or hepatic function-
salivation)
drugs are nephrotoxic and hepatotoxic
*altered GIT (if stomach or colon is irradiated)-  Recent radiation therapy- also
anorexia, nausea & vomiting
immunosuppressive
=SYMPTOMS SUBSIDE AND RE-  Pregnancy- may cause congenital
EPITHELIALIZATION OCCURS AFTER
TREATMENTS HAVE BEEN COMPLETED defects
 Bone marrow depression-may be
aggravated
 Cellular Aberrations
CANCER, MALIGNANT NEOPLASM, ONCOLOGIC DISORDER

NURSING RESPONSIBILITY WHEN HANDLING Chemotherapeutic Agents side effects

CHEMOTHERAPEUTIC AGENTS
1. GI symptoms (nausea, vomiting,
 Wear mask, gloves, back-closing gown diarrhea, constipation)
 Skin contact with the drug must be
2. Integumentary system (pruritus,
washed immediately with soap & water. urticaria, systemic signs)
Eyes must be flushed with copious
3. Hematopoietic system (anemia,
amount of water. neutropenia, thrombocytopenia)
 Sterile alcohol-wet cotton pledget
4. Genito-urinary system (hemorrhagic
should be used. cystitis)
 Expel air bubbles on wet cotton 5. Reproductive system (premature
 Vent vials to reduce internal pressure menopause, amenorrhea)

after mixing
 Wipe external surface of syringes and IV
bottles
 Avoid self-inoculation by needle stab
 Clearly label the hanging IV bottle with
ANTI-NEOPLASTIC CHEMOTHERAPY
 Contaminated needles & syringes must
be disposed in a clearly marked special
container “leak-proof”, puncture-proof
 Dispose half-empty ampules, vials, IV
bottles by putting into plastic bag &
then into another plastic bag or box;
clearly marked before placing for
removal. Label as hazardous waste.
 Hand washing should be done before &
after removal of gloves
 Trained personnel only should be
involved in the use of drugs.
 ideally, preparation of drugs should be
in a laminar flow condition with filtered
air. (filtered air moving along separate
parallel flow planes)