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Assessment and Management

The document summarizes signs and symptoms of cancer in children, methods of assessing and staging cancer like grading, TNM staging, diagnostic exams, and management approaches including surgery, chemotherapy, radiation therapy, and hormone therapy. It describes common chemotherapy drug classes, side effects, and nursing considerations like careful handling, extravasation prevention, antiemetics, and monitoring of blood counts, organ function, and symptoms.

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Jmarie Brillantes Popioco
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135 views23 pages

Assessment and Management

The document summarizes signs and symptoms of cancer in children, methods of assessing and staging cancer like grading, TNM staging, diagnostic exams, and management approaches including surgery, chemotherapy, radiation therapy, and hormone therapy. It describes common chemotherapy drug classes, side effects, and nursing considerations like careful handling, extravasation prevention, antiemetics, and monitoring of blood counts, organ function, and symptoms.

Uploaded by

Jmarie Brillantes Popioco
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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ASSESSMENT AND

MANAGEMENT
• Unexplained fever/ weight loss
• Bleeding/bruising
SIGNS AND • Morning headaches and
SYMPTOMS neurologic changes
OF CANCER • Palpable abdominal mass
• Swollen lymph nodes
IN • Bone and joint pain
CHILDREN • Fatigue
• Eye deviations/changes
• Grading – refers to the classification
of tumor cells
• seeks to define the type of tissue from
which the tumor originated & the
degree to which the tumor cells retain
the functional & histologic
characteristic of tissue of origin.
• Staging – determines the size of
tumor & existence of metastasis
TNM Staging System
• Primary Tumor (T)
TX> no primary tumor can be assessed
T0> no evidence of primary tumor
TIS> carcinoma in situ
T1, T2, T3, T4> increasing in size and extent of the primary
tumor
• Regional Lymph Nodes (N)
NX> cannot be assessed
N0> no regional lymph node involvement
N1, N2, N3> increasing involvement of regional lymph nodes
• Distant Metastasis (M)
MX> presence of metastasis cannot be assessed
M0> no distant metastasis
M1> distant metastasis
CANCER DETECTION EXAMINATIONS
• Biopsy – is the surgical
excision of small piece
of tissue for
microscopic
examination
• Endoscopic
Examinations
Magnetic Resonance Imaging – identifies abnormalities by creating sectional
(tomographic images of the body without the use of ionizing radiation.
MANAGEMENT
A. Surgery
• Curative Surgery – the most widely employed method of cancer
therapy the goal is to remove all of the tumor
• Palliative Surgery – attempts to relieve the complications of cancer.
It has three fundamental objectives:
• To reduce pain.
• To retard the growth of the tumor.
-- To decrease the size existing tumor
• Diagnostic Surgery – the purpose of which is to
either confirm or rule out a possible diagnosis of
malignancy. It establishes the type, extent and
classification of tumor. Tissue samples may be
obtained for diagnosis by incisional, excisional or
needle biopsies.
• Preventive/Prophylactic Surgery – an attempt is
made to remove the tissue or organ at risk, thus
prevent development of CA.
• Reconstructive Surgery – to improve the person’s
quality of life by restoring maximal function and
appearance.
B. Chemotherapy
• Treatment with antineoplastic drugs may induce
tumor or regression and prevent or delay metastasis.
• Useful for controlling residual disease or as an
adjunct to surgery or radiation therapy.
• As palliative treatment, it aims to improve the
patient’s quality of life by relieving pain and other
symptoms.
• Different drugs act on tumor cells in different stages
of the cell growth cycle.
Classification of Chemotherapy
• Cell cycle specific – medications are effectively by dividing cells
only during certain phases of the cell cycle
• Cell cycle non-specific – medications act during all phases of the
cell cycle.
Types of Chemotherapeutic Drugs
• Antimetabolites (ccs): foster cancer cell death by interfering with
cellular metabolic process.
• Alkylating agents (ccns): act with DNA to hinder cell growth and
division.
• Plant alkaloids (ccs): obtained from the periwinkle plant; makes the
host’s body a less favorable environment for growth of cancer cells.
• Antitumor antibiotics (ccns): affect RNA to make the environment less
favorable for cancer growth.
• Steroids and sex hormones (ccns): after the endocrine environment to
make it less conducive to growth of cancer cells.
• Antimetabolites
Antimetabolites are types of chemotherapy treatments
that are very similar to normal substances within the
cell. When the cells incorporate these substances into
the cellular metabolism, they are unable to divide.
• Folic acid antagonist: Methotrexate.
• Pyrimidine antagonist: 5-Fluorouracil, Foxuridine,
Cytarabine, Capecitabine, and Gemcitabine.
• Purine antagonist: 6-Mercaptopurine and 6-
Thioguanine.
• Adenosine deaminase inhibitor: Cladribine, Fludarabine,
Nelarabine and Pentostatin.
• Alkylating agents
Mustard gas derivatives: Mechlorethamine,
Cyclophosphamide, Chlorambucil, Melphalan, and
Ifosfamide.
• Ethylenimines: Thiotepa and Hexamethylmelamine.
• Alkylsulfonates: Busulfan
• Nitrosureas: Carmustine, Lomustine and
Streptozocin. Nitrosureas are unique because, unlike
most types of chemo treatments, it can cross the
blood-brain barrier. It can be useful in treating brain
tumors.
• Metal salts: Carboplatin, Cisplatin, and Oxaliplatin.
• Plant Alkaloids
Plant alkaloids are chemotherapy treatments
derived made from certain types of plants. The vinca
alkaloids are made from the periwinkle plant
(catharanthus rosea). The taxanes are made from the
bark of the Pacific Yew tree (taxus).
• Vinca alkaloids: Vincristine, Vinblastine and
Vinorelbine.
• Taxanes: Paclitaxel and Docetaxel.
• Antitumor Antibiotics
Antitumor antibiotics are chemo treatments made from natural
products produced by species of the soil fungus Streptomyces.
• Anthracyclines: Doxorubicin, Daunorubicin, Epirubicin,
Mitoxantrone, and Idarubicin.
• Chromomycins: Dactinomycin and Plicamycin.
• Miscellaneous: Mitomycin and Bleomycin.
• Hormone Therapy: Antiestrogens
Antiestrogens bind to estrogen receptor site on cancer cells thus
blocking estrogen from going into the cancer cell. This interferes with
cell growth and eventually leads to cell death.
• tamoxifen, toremifene
• Nursing Implications
• Handle antineoplastic agents carefully – mutagenic and carcinogenic.
• Nurses should wear gloves, long-sleeved cover gown, protective goggles, and
mask as appropriate.
• Monitor IV site closely to assess for extravasation and stop IV if it occurs.
• Treat used equipment as hazardous waste.
• Administer antiemetic if ordered prior to chemotherapy and up to 48 hours
afterwards.
• Monitor CBC.
• Monitor I&O.
• Monitor liver and renal function studies.
• Inspect oral cavity daily.
Extravasation
Major Side Effects and Nursing Interventions
GI system
• Nausea and vomiting
- Administer antiemetics routinely every 4-6
hours as well as prophylactically before
chemotherapy is initiated.
- Withhold foods/fluids 4-6 hours before
chemotherapy.
- Provide bland foods in small amounts
after treatments.
Diarrhea
• Administer antidiarrheals.
• Maintain good perineal care.
• Give clear liquids as tolerated.
• Monitor potassium, sodium, and chloride levels.

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