OUR LADY OF FATIMA UNIVERSITY

QUEZON CITY

NCMB 312 LECTURE

Medical Surgical
Nursing

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 FINALS
Week 15

CANCER OVERVIEW
Week 13

DISEASES CAUSED BY
BACTERIA AND PARASITES
with VECTOR BORNE
DISEASES
Week 16

CANCER OF THE AND GUT,

BREAST, GYNECOLOGIC,
LUNGS AND CNS
Week 14

VECTOR BORNE DISEASES

AND SEXUALLY
TRANSMITTED DISEASES

Week 17

BLOOD CANCERS

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Week 13:
Diseases caused by bacteria and parasites
CHOLERA
Cholera is an acute, diarrheal illness
caused by infection of the intestine
with the toxigenic bacterium and
etiologic agent Vibri coma or Vibrio
cholerae serogroup
Major contribution to fighting cholera
when he was able to demonstrate a
link between cholera and the
contaminated drinking water
through his pioneering studies
SYMPTOMS
Profuse watery diarrhea
Vomiting
Leg cramps
7 F's
1. Fluid/Water
By drinking water that has been
contaminated by feces and has not been
treated (disinfected).
Step Four
2. Fingers
By getting hands in one’s mouth, when
hands are not washed after
using the toilet or after contact with feces on
the ground (which is especially common for
young
children who are crawling).
3. Flies
Because flies sit on feces and then land
on food.
4. Food:
By eating food that has been
contaminated (made dirty) by fingers,
flies, or water that have come in contact
with feces.
5. Fields/Floors
The soil where food is grown can contain
feces when
cholera-infected people or animals feces on
the ground or near water sources instead of
using latrines or burying the feces
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
6. Fomites:
Inanimate objects that can become
contaminated with infectious agents
and serve as a mechanism for
transfer between hosts.
7. Feces
The cholera bacterium is usually
found in water or food sources that
have been contaminated by feces
(poop) from a person infected with
cholera.
" Cholera is also known as El Tor and
Violent Dysentery. "
INCUBATION PERIOD
From a few hours
to 5 days (average of 3 days). It can
take anywhere from a few hours to 5
days for symptoms to
appear after infection. Symptoms
typically appear in 2-3 days.
PERIOD OF COMMUNICABILITY
As long as microorganisms are
present in the bowel excreta.
CLINICAL MANIFESTATIONS
milddiarrhea that becomes
voluminous; rice-watery stool
PATHOGNOMONIC SIGN
Washer woman’s hands;
effortless vomiting; cramping of the
extremities (hypokalemia) and signs
of severe dehydration.
DIAGNOSTIC TESTS
1. Stool or vomitus culture
2. Serum electrolytes
3. Dark field or phase microscopy
 Diseases caused by bacteria and parasites
TREATMENT MEDICAL MANAGEMENT

Oral rehydration solution (ORS) Antibiotics of metronidazole

Severe cases also require intravenous
fluid replacement
BACILLARY DYSENTERY
MEDICAL MANAGEMENT
Also known as Shigella infection
Dehydration and fluid imbalance and (shigellosis) or Bloody Flux is an
antibiotics of tetracycline as drug of
choice intestinal disease caused by a family
of bacteria known as shigella.
NURSING MANAGEMENT Shigella can be passed through direct
contact with the bacteria in the stool.
1. Assess patient for signs of
The incubation period is 1 to 4 days.
dehydration and The mode of transmission is same as
2. complications cholera with 7 Fs.
3. Observe enteric precautions (feces)
Increase oral fluid intake. SIGNS AND SYMPTOMS

Usually begin a day or two after contact

AMOEBIC DYSENTERY with shigella, but may take up to a
week to develop
Amoebic dysentery, also known
Diarrhea (often containing blood or
as Amoebiais is caused by the
mucus)
protozoan parasite Entamoeba Abdominal pain or cramps, with or
histolytica. without fever, with or without
Transmitted in areas where poor vomiting
sanitation allows contamination
Step (Shigella dysenteriae) that comes in
of drinking water and food withFour three (3) strains
feces Shigella flexneri,
Shigella boydii,
SYMPTOMS Shigella sonnei.

Quite mild fever

TREATMENT
Vomiting
Abdominal pain
Diarrhea with tenesmus and Oral rehydration solution (ORS)
Severe cases also require intravenous
muco-purulent blood streaked fluid replacement
loose stool (poop) Pedialyte (for children)
Stomach
cramping TYPHOID FEVER
"Rarely, E. histolytica invades the liver and
forms an abscess (a collection of pus)." Typhoid fever, also known as enteric
fever, is a potentially fatal
DIAGNOSIS
multisystemic illness caused primarily
by Salmonella enterica serotype typhi
1. Fecalysis
and, to a lesser extent, S enterica
2. Blood Test
serotypes paratyphi A, B, and C.
The simple etiologic agent is
Salmonella typhi.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Diseases caused by bacteria and parasites
INCUBATION PERIOD
varies, usually 1 – 3 weeks,
average of 2weeks.
PERIOD OF COMMUNICABILITY
as long as the bacilli appears
in the excreta
MODE OF TRANSMISSION
Fecal – oral route with
iIngestion of contaminated
food and water through
7 F’s – fingers, feces, flies,
food, fomites, fluids and fields.
CLINICAL MANIFESTATIONS
Gradual onset of
A-norexia and abdominal pain
B-radycardia
C-onstipation
D-iarrhea
E-nlarged spleen
F-ever and chills
G-eneralized body weakness
H-eadache.
The three (3) cardinal signs of
Step
Pyrexial stage of Typhoid
Fever
are: Rose Spots,
Enlargement of the Spleen
(Splemomegaly and Fever (REF).
PATHOGNOMONIC SIGN
D-evelop skin eruptions on the
abdomen, back and chest
(ROSE SPOTS)
DIAGNOSIS
1. Analyzing samples of
blood, stools or
2. Urine for culture
3. Complete blood count
(CBC)
4. Fluorescent antibody
5. Widal blood test
Rose Ann C. Lacuarin
MEDICAL MANAGEMENT
1. Antibiotics: chloramphenicol – drug
of choice.
2. IVF to correct dehydration or fluid
imbalance.
3. Paracetamol for the fever
4. Oral therapy rehydration (oresol,
hydrites).
Antibiotic therapy is the only effective
treatment for typhoid fever. Commonly
prescribed antibiotics includes
Ciprofloxacin (Cipro). In the United
States, doctors often prescribe this
for non-pregnant adults. Another
similar drug called ofloxacin also may
be used.
Unfortunately, many Salmonella typhi
bacteria are no longer susceptible to
antibiotics of this type, particularly
strains acquired in Southeast Asia.
Azithromycin (Zithromax).
NURSING MANAGEMENT
1. Enteric isolation
Four
2. Vital signs must be recorded
accurately.
3. Intake and output must be accurately
measured.
4. Concurrent disinfection.
5. Increase oral fluid intake
HEPATITIS
Hepatitis refers to an inflammatory
condition of the liver. It’s commonly
caused by a viral infection, but
there are other possible causes
of hepatitis.
Other name for Hepatitis A are
Infectious hepatitis and Catarrhal-
jaundice hepatitis, Hepatitis B is
Serum Hepatitis and Hepatitis C is
Post-transfusion hepatitis.
ACADEMICIAN HEAD
 Diseases caused by bacteria and parasites
MODE OF TRANSMISSION
Consuming food or water contaminated by
feces from a person infected with hepatitis.
Close contact with a person or object that's
infected.
Fecal-oral or oral-anal route of
transmission
Injection drug use, having sex with an
infected partner, or sharing razors with an
infected person
Ingesting fecal matter that contaminates
the water supply
Hepatitis A
is always acute, short-term disease
caused by an infection with the
hepatitis A virus (HAV).
The virus is one of several types of
hepatitis viruses that cause
inflammation and affect the liver's
ability to function.
Hepatitis B
is most likely to become ongoing and
chronic and transmitted through
contact with infectious body fluids,
such as blood, vaginal secretions,
Step Four or
semen, containing the hepatitis B virus
(HBV).
Hepatitis C
comes from the hepatitis C virus (HCV).
Hepatitis C is transmitted through
direct contact with infected body
fluids, typically through injection drug
use and sexual contact".
Hepatitis D
is also called delta hepatitis, hepatitis D
is a serious liver disease caused by the
hepatitis D virus (HDV).
can’t multiply without the presence of
hepatitis B
Hepatitis E
is a waterborne disease caused by
the hepatitis E virus (HEV). Hepatitis
E is mainly found in areas with poor
sanitation
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
SIGNS AND SYMPTOMS
Fatigue (up 2-4 months)
Sudden nausea and vomiting
Abdominal pain or discomfort,
especially on the upper right side
beneath the lower ribs
(hepatomegaly)
Clay-colored bowel movements
(excretion of conjugated bilirubin
into the intestines is decreased)
Loss of appetite (encourage high
calorie and low fat diet)
Lowgrade fever
Dark urine (increase bilirubin)
Joint pain
Yellowing of the skin (jaundice)
Whites of the eyes (icteric sclera)
Intense itching (Pruritus)
Symptoms may not occur until the
damage affects liver function.
Chronic hepatitis develops slowly,
so these signs and symptoms may
be too subtle to notice.
DIAGNOSIS
Liver function tests (SGOT/SGPT
– serum transaminase)
Liver biopsy
NURSING INTERVENTION
1. Practicing good hygiene including
washing hands is one of the best way to
protect against hepatitis A
2. Bed rest
3. Small frequent feeding, high in
carbohydrates, in severe cases spare
protein
4. Avoid alcohol and OTC drugs
5. Implement Standard precaution
6. Prevention is vaccination
 Diseases caused by bacteria and parasites
MEDICAL MANAGEMENT
Hepatitis A
Usually doesn’t require treatment
because it’s a short-term illness.
Bed rest may be recommended if
symptoms cause a great deal of
discomfort.
If the patient experience vomiting
or diarrhea, the nurse may
encourage the patient to follow
the doctor’s orders for hydration
and nutrition.
Acute hepatitis B
Doesn’t require specific treatment.
Chronic hepatitis B
is treated with antiviral
medications. This form of
treatment can be costly because it
must be continued for several
months or years.
Treatment for chronic hepatitis
B also requires regular medical
evaluations and monitoringStep
to Four
determine if the virus is
responding to treatment.
Hepatitis B can be prevented with
vaccination.
Hepatitis C
Antiviral medications are used to treat
both acute and chronic forms of
hepatitis C.
People who develop chronic hepatitis
C are typically treated with a
combination of antiviral drug
therapies.
They may also need further testing to
determine the best form of treatment.
People who develop cirrhosis (scarring
of the liver) or liver disease as a result
of chronic hepatitis C may be
candidates for a liver transplant.
Currently, there is no vaccination for
hepatitis C.
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Hepatitis D
No antiviral medications exist for the
treatment of hepatitis D at this time
Hepatitis D can be prevented by
getting the vaccination for hepatitis
B, as infection with hepatitis B is
necessary for hepatitis D to develop
Hepatitis E
Currently, no specific medical
therapies are available to treat
hepatitis E.
Because the infection is often
acute, it typically resolves on its own.
People with this type of infection are
often advised to get adequate rest,
drink plenty of fluids, get enough
nutrients, and avoid alcohol.
However, pregnant women who
develop this infection require close
monitoring and care.
MENINGITIS
Inflammation of the meninges
(covering of the brain and spinal
cord)
CAUSATIVE AGENT
Neisseria meningitides
Cytomegalovirus
Cryptococcal meningitis
Staphylococcal meningitis - H.
influenzae
MODE OF TRANSMISSION
Droplet infection (Direct)
INCUBATION PERIOD
• 2-10 days
SIGNS AND SYMPTOMS
1. Fever
2. Sore throat 3. headache
3. cough and colds
4. Body malaise
5.(+) kernig sign
6. (+) Brudzinski sign
 Diseases caused by bacteria and parasites
DIAGNOSTIC EXAMINATION DIAGNOSTIC EXAMINATION

1.Lumbar Puncture 1.Lumbar Puncture – (+) Pandy Test

2. Blood Culture 2. EMG

DRUGS
TETANUS
A.Corticosteroid – Dexamethasone
or Solu-cortef Does not spread from person to
B. Mannitol person. The bacteria are usually found
C. Phenytoin (Dilantin) in soil, dust, and manure and enter the
body through breaks in the skin —
POLIOMYELITIS usually cuts or puncture wounds
caused by contaminated objects.
is an infectious disease caused by C. tetani secretes the toxins,
the poliovirus
tetanospasmin, and tetanolysin,
CAUSATIVE AGENT causing the characteristic “tetanic
spasm,”
Legio debilitans
Synonym: Lockjaw
MODE OF TRANSMISSION CAUSATIVE AGENT

Droplet infection Clostridium tetani

Portal of entry: Respiratory System by the MODE OF TRANSMISSION
nasopharynx
Fecal-Oral route Acquired thru wound (any kind of
wound)
laceration, burn, bite, umbilical
INCUBATION PERIOD Step Four stump
Most poliovirus infections cause INCUBATION PERIOD
asymptomatic viral replication that is
limited to the 3 and 21 days (average 10 days) may
Alimentary tract. However, following an range from one day to several
months, depending on the kind of
incubation period of approximately 7–10 wound.
days Most case within 14 days
(range, 4–35 days), about 24% of those
infected develop clinical signs such as
Muscles Affected and Manifestations
fever, headache and sore throat
(considered a minor illness)
Muscles Affected and Manifestations
SIGNS AND SYMPTOMS Masseter muscle – trismus or lockjaw
Facial muscle- risus sardonicus or
1. Severe muscle pain sardonic grin
2. Stiffness of Hamstring Muscle of spine- opisthotonus or arching
3. Presence of Hoyre’s sign of the back
4. Opisthotonus Respiratory muscle- dyspnea and chest
5. Paralysis heaviness
Abdominal muscle- abdominal
rigidity(1st)
Extremity muscles- stiffness of
extremities

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Diseases caused by bacteria and parasites
4. Neonatal tetanus
Clinical forms of tetanus
1. Generalized
The most common form- 80%
Most common initial sign is spasm of
the muscles of the jaw or “lockjaw”.
Painful spasms in other muscle groups
in the neck, trunk, and extremities and
generalized, seizure-like activity or
convulsions in severe cases.
Even with modern intensive care,
death rates of 10% to 20%.
2. Localized tetanus
Is an unusual form of the disease
consisting of muscle spasms in a
confined area close to the site of the
injury.
Occurs in people with partial immunity
and is usually mild, progression to
generalized tetanus can occur.
3. Cephalic Tetanus
Rarest form and is associated with
lesions of the head or face and may
also be associated with otitis media.
The incubation period is short, usually
1 to 2 days. Unlike generalized and
localized tetanus, cephalic tetanus
results in flaccid cranial nerve palsies
rather than spasm.
Spasm of the jaw muscles may also be
present. Like localized tetanus, cephalic
tetanus can progress to the generalized
form.
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Occurs in newborns of unimmunized
mothers or from infection through a
contaminated instrument when cutting
the umbilical cord.
Infants of immunized mothers generally
do not get tetanus due to passive
immunity from the mother.
S/SX exhibit irritability, poor feeding,
facial grimacing, rigidity, and severe
spastic contractions triggered by touch.
DIAGNOSTIC EXAM
1. History of wound
2. Wound culture
3 Objectives of Medical Management
1. To neutralize the toxin with ATS-
antibodies to prevent/treat
tetanus --> prepare epinephrine
and corticosteroid in cases of
delayed hypersensitivity reaction
2. To kill the microorganism with
Penicillin, Metronidazole,
Cephalosporin
3. To prevent and control spasms
with muscle relaxant (Diazepam-
Valium)
3 Stimuli that may predispose patient
to spasm
Exteroceptive - bright lights and
noise
Interoceptive - stress,pain
Proprioceptive - Turning, touching,
jarring of bed
INTERVENTIONS
Dim light, quiet environment
Minimal and gentle handling of patient
Protect patient from injury
Provide px comfort
Always have padded tongue depressor
Watch for urinary retention
 Diseases caused by bacteria and parasites
LEPROSY EARLY MANIFESTATION

Chronic disease of the skin, Change in skin patch

peripheral nerves and nasal Pain and redness of the eyes
mucosa Loss of sensation, hair growth and
anhydrosis
Synonym: Hansen’s disease
LATE MANIFESTATION

CAUSATIVE AGENT Lagophthalmos – inability to close

eyelids
Mycobacterium leprae
Madarosis – falling of eyebrows
MODE OF TRANSMISSION Sinking of the bridge of the nose due
to absorption of the small bones (
Prolonged intimate skin to skin nose, fingers, ears)
contact
Leonine face
Droplet Infection
Contractures ( clawing of fingers and
TYPES: toes)
Gynecomastia – for males
1.Indeterminate
hypopigmented macule, minimal DIAGNOSIS
local sensory loss. 1. Skin smear test
2. Skin lesion biopsy
3. Lepromin skin test
TREATMENT
Monotherapy: Dapsone
Step Four Multi drug therapy (MDT)
- prevent drug resistance
- to hasten recovery
- to lessen the period of communicability
2. Borderline
In between Treatment approach: depends on
microorganisms in skin lesions
tuberculoid
and lepromatous 1. Paucibacillary:Rifampicin once a month
Dapsone OD (6-9 mos)
2. Multibacillary: Rifampicin once a month
3. Tuberculoid Dapsone OD (24-30 mos)
Localized macule, Lamprene OD (24-30 mos) (clofazimine)
enlarged peripheral
nerve RED TIDE

4. Lepromatous Term which means harmful algal

Infectious, malignant bloom (HAB)
Numerous macules, papules
and nodules

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Diseases caused by bacteria and parasites
Occur when colonies of algae—simple Respirator use
plants that live in the sea and NO VACCINE
freshwater—grow out of control while NO ANTIDOTE
producing toxic or harmful effects on THE TOXIN CANNOT BE KILLED BY
fish, shellfish, marine mammals, and COOKING.
birds
Coastal phenomenon in which water is
colored due to high algal biomass

ETIOLOGIC AGENTS

Dinoflagellate Gonyaulax- produces

saxitoxin and gonyautoxins which
accumulate in shellfish and if ingested
may lead to paralytic shellfish
poisoning (PSP) and can lead to death.
Saxitoxin blocks sodium channels
movement in tissues affecting neurons
and muscles
Ingestion can cause paralysis within 30
minutes.

SIGNS AND SYMPTOMS

Initial signs
Tingling of the lips and tongue
Steptime
Symptoms start quickly, median Four
between ingestion and onset is 1 hour
(between 30 minutes to 3 hours).
H/A , N/V, dizziness – can be mistaken
as the patient is drunk
Severe cases
Muscular paralysis
Diaphragm paralysis -DOB may occur 5-
12 hours

DIAGNOSTIC

Saxitoxin in urine/ feces within 24

hours
Detection of saxitoxin in shellfish

TREATMENT

Induce vomiting
Charcoal lavage
Alkaline fluids- sodium
bicarbonate

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Week 14:
Vector borne diseases and STD

GONORRHEA

Most common venereal disease, an

infection of the GUT. It may also affect
the rectum, pharynx and eyes
Synonyms: Gonococcus (GC),
Gonoclap, Jack, Gleet, Morning Drop

CAUSATIVE AGENT

Neisseria gonorrhea
Ophthalmia neonatorum
MODE OF TRANSMISSION
Develops 2-5 days after birth
Direct contact with exudate via
sexual contact or transmission to the (+)Profuse purulent
neonate during the passage through Conjunctival exudate
the birth canal Erythromycin opthalmic ointment –
INCUBATION PERIOD drug of choice, applied from inner
to outer cantus
2-7 days
DIAGNOSTIC
PERIOD OF COMMUNICABILITY
Step Four 1. Positive gram stain smear of
Contagious as long as gonococci discharge or secretion
are present in the patient 2. Positive culture
Male
TREATMENT
- purulent discharge (inc. in am)
- burning sensation upon urination Tetracycline 500mg QID for 7 day s
- redness and edema of urinary meatus Ceftriaxone is the drug of choice for
- abscess formation in the prostate gland pregnant women
(protatitis) Ceftriaxone IM and oral azithromycin
- chronic-scar in epididymis Penicillin
-obstruct flow of sperms- sterility
NURSING CARE
Female
- burning sensation upon urination if Prophylactic antibiotic treatment for
urinary meatus is involved gonorrhea eye infection in the
- (+/-) of purulent discharge neonate (ophthalmia neonatorum)
Encourage follow up cultures in 4 to
abscess formation in Bartholins/Skene’s
7 days after treatment and again at 6
glands months
If untreated, may result to PID- when the Teach importance of abstinence from
gonococcus spread through uterine and sexual intercourse until cultures are
fallopian tubes negative
– sterility/ectopic pregnancy

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Vector borne diseases and STD
MANAGEMENT

Urge the client to inform sexual partner

so that he/she may be treated for
infection
Importance to take full course of antibiotics
Preventive:
No artificial or acquired immunity for
gonorrhea and syphilis. A person can
get gonorrhea and syphilis again and
again
Safe sex, Monogamous relationship
SYPHILIS
Synonyms: Pox, Lues, Bad Blood Disease
3. Latent stage
1-2 yrs.- not infectious except to the
fetus of the pregnant
4. Tertiary syphilis
Gummas – Lesion that are found in the
deeper tissue and body organ.
- Lesions in the skin, liver, bones,
cardiovascular and CNS.

CAUSATIVE AGENT

Treponema pallidum

INCUBATION PERIOD

10-90 days, average of 21 days

MODE OF TRANSMISSION
Step Four
Sexual contact, blood transfusion,
placental transmission(5th mo of
gestation)
3 Stages
1. Primary
chancre first sign of syphilis– painless,
papular lesions that heal spontaneously
w/ or w/o tx (4-6 weeks)
2. Secondary
6-8weeks- systemic disease
a. Dermatitis – condyloma lata dry hard
wart-like lesions fused together found under
breasts or on the genitalia
b. Mucous patches – mouth, throat, cervix
c. Changes in hair growth – patchy alopecia
moth eaten appearance
d. Iritis
e. Arthritic and bone pain
DIAGNOSIS
VDRL- venereal disease research lab,
RPR- rapid plasma reagin test-
screening test for syphilis
Fluorescent Treponemal Antibody
Absorption Test (FTA-ABS)
TREATMENT
Penicillin G
Newborn = 100,000 units/kg single IM
dose
Adult = 2.4 million units IM single dose
Doxycycline and tetracycline
Jarish Herxheimer Reaction
May occur in patient given large doses
of penicillin
Flu-like symptoms subsiding within 24
hours

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Vector borne diseases and STD
MANAGEMENT CHLAMIDIAL INFECTION

Bed rest and aspirin Non-gonococcal urethritis

Warn the patient that this reaction may
be expected CAUSATIVE AGENT

CANDIDIASIS Chlamydia trachomatis bacteria

Synonym: Moniliasis MODE OF TRANSMISSION

Itching, beefy red irritation, inflammation of Sexual contact (vaginal or rectal)
the vaginal epithelium Oral-gentital
White, cheese-like, odorless discharge Primary reservoir: male – urethra;
Patches of curdlike, cheesy material that female - cervix
adhere to the vaginal mucosa
Increased risk in women with diabetes and INCUBATION
women taking birth control pills, during
2-35 days
pregnancy and after treatment with
Males and females are usually
antibiotics
asymptomatic
CAUSATIVE AGENT 1 in 4 men have no symptoms
Symptoms similar with gonorrhea
Candida albicans
CLINICAL MANIFESTATION

1. Pruritus in vagina
2. Burning sensation in vagina
3. Painful intercourse
4. Pruritus of urethral infection in men
5. Burning sensation during urination
6. Abdominal or low back pain
7. Fever
MEDICAL MANAGEMENT
DIAGNOSTIC
Antibiotics
Isolation of the organism in a tissue
TREATMENT culture or serological complement
fixation
Nystatin vaginal suppository twice a day
for 7-14 days
Vaginal douche of 2 tsp ordinary baking
powder dissolved in 1 quart of warm
water
Application of gentian violet to the
vagina and perineum to prevent
staining of undergarments

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Vector borne diseases and STD
MANAGEMENT HSV-2
Urge client to have sexual partner HSV-2 infection is widespread
treated throughout the world and is almost
Emphasize the importance of long term exclusively sexually transmitted,
drug therapy because of the pathogens causing genital herpes.
unique life cycle, which make it difficult HSV-2 is the main cause of genital
to eliminate herpes, which can also be caused by
a. Antibiotics: herpes simplex virus type 1 (HSV-1).
Doxycycline and azithromycin are the Infection with HSV-2 is lifelong and
primary antibiotic for treatment incurable
b. erythromycin
Ofloxacin
c. Penicillin
its derivatives are not effective against
these organisms. This explains the
persistence of infection in clients who are
treated for gonorrhea and do not respond.

HERPES SIMPLEX VIRUS SIGNS AND SYMPTOMS

2 types: herpes simplex virus type 1 Tingling, itching or burning sensation

(HSV-1) and herpes simplex virus type 2
(HSV-2).
HSV-1 is mainly transmitted by oral-to-
oral contact to cause oral herpes (which
can include symptoms known as “cold
Step
sores”) but can also cause Four
genital herpes.
HSV-2 is a sexually transmitted infection
that causes genital herpes.
Both HSV-1 and HSV-2 infections are
lifelong.
HSV-1
HSV-1 is a highly contagious infection,
that is common and endemic throughout
the world. Most HSV-1 infections are
acquired during childhood, and infection
is lifelong.
majority of HSV-1 infections are oral
herpes (infections in or around the
mouth, sometimes called orolabial, oral-
labial or oral-facial herpes), but a
proportion of HSV-1 infections are
genital herpes (infections in the genital or
anal area).
around their mouth, before the
appearance of sores. After initial
infection, the blisters or ulcers can
periodically recur.
Painful blisters or open sores called
ulcers in or around the mouth (cold
sores)
MODE OF TRANSMISSION
oral to oral
rare circumstances, transmitted from a
mother with genital HSV-1 infection to
her infant during delivery to cause
neonatal herpes
Transmitted during sex,
Through contact with genital surfaces,
skin, sores or fluids of someone
infected with the virus
SIGNS AND SYMPTOMS
genital or anal blisters or open sores
fever, body aches, and swollen lymph
nodes.
Complications- neonatal herpes

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Vector borne diseases and STD
TREATMENT General discomfort or ill feeling
Drowsiness and fatigue
Antiviral medications, such as
Loss of appetite
acyclovir, famciclovir, and valacyclovir,
Muscle aches or neck stiffness, chest pain
These can help to reduce the severity
and frequency of symptoms,but Enlarged spleen
cannot cure the infection. Jaundice (yellow cast to skin) or a red
measles like rash
PREVENTION

Avoid oral contact with others and

sharing objects that have contact with
saliva.
Abstain from oral sex, to avoid
transmitting herpes to the genitals of
a sexual partner. Individuals with
symptoms of genital herpes should
abstain from sexual activity while DIAGNOSTIC
experiencing any of the symptoms.
Personal hygiene Elevated WBC with the characteristic
finding of atypical lymphocytes —
INFECTIOUS MONONUCLEOSIS unusual-appearing white blood cells
(IM, MONO, GLANDULAR FEVER)
under a microscope.
“Kissing disease” is a viral infection causing Abnormal liver function tests
fevers, sore throat, and swollen lymph
Common tests for EBV include:
glands.
A Monospot (positive for infectious
It is typically caused by the Epstein-Barr
virus (EBV) mononucleosis).
Epstein-Barr Virus Antigen (for EBV)
INCUBATION PERIOD
Epstein-Barr Virus Antibody Titers can
30-50 days help distinguish acute infection from past
infection with EBV
MODE OF TRANSMISSION
MANAGEMENT
Often transmitted by saliva. While it is
known as “the kissing disease,” occurring Purely symptomatic and supportive
often in 15- to 17-year-olds, the Steroids for airway obstructions and
infection may occur at any age. CNS involvement
Blood and genital secretions Bed rest
Contagiousness is low and will have a adequate fluid
lasting immunity
Soft diet
SIGNS AND SYMPTOMS Proper disposal of oral secretions

Fever, H/A, photophobia

Sore throat, swollen tonsils with the whitish
covering.
Enlarged lymph nodes, especially in the neck
and armpit

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 Vector borne diseases and STD
ACQUIRED IMMUNODEFICIENCY
SYNDROME (AIDS)

End stage of HIV infection

CAUSATIVE AGENT

HIV, a retrovirus which causes

progressive destruction of the immune
system, targeting the T-cells

MODE OF TRANSMISSION

Blood 90%
Sexual contact 0.1 to .5 %
Sharps or needle – 0.1 % to .5%

INCUBATION PERIOD

6 wks to 6 months

PATHOPHYSIO

HIV is in the circulation, it invades

lymphocytes, macrophages, the
Langerhans cells and neurons.
HIV attacks body’s immune system and
attaches to CD4 found in the surface of T4
Step
and inserts genetic materials Four
into T4 cell
nucleus and replicate itself and eventually
dies after being used to replicate HIV.
Rapid virus mutation making the body’s
immune system to recognize the invaders

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 Vector borne diseases and STD
DIAGNOSTIC VECTORS
1. ELISA – screening test 1. Aedes aegypti
2. Western blot – confirmatory test 2. Aedes albopictus- tiger mosquito
3. CD4 – T cell count (1000) 3. Culex fatigans

TREATMENT (DRUG COCKTAIL) Characteristics of Aedes aegypti:

1. Mononucleoside Reverse
Low-flying
Transcriptase Inhibitors Day-biting
Azidothymidine Breeds on stagnant water
Zidovudine Urban areas
Has white stripes on the legs
Lamivudine
Retrovir PATHOGENESIS
2. Non- MNRTI
Dideoxyinosine (Didanosine) Infectious virus is deposited in the skin
Dideixycytidine ( Zalcitabine) via vector
There is marked increase in vascular
3. Protease inhibitors permeability, hemoconcentration,
Saquinavir thrombocytopenia with increased
Indanavir agglutinability
Ritonavir Hypovolemic shock that resulted from
increased permeability of the vascular
Nelfinavir endothelium and loss of plasma from
the intravascular space
NURSING CARE
Manifestations of patients with DHF
1. Symptomatic and supportive
depends on its grade:
2. Counseling
Grade I
3. Prevention Step Four - High grade fever (3-5 days)
A abstinence - Headache, peri-orbital pain
B be faithful - Joint & bone pain
C condom - Abdominal pain
- Nausea & vomiting
D don’t use drug
- Petechial formation
DENGUE FEVER Herman’s sign – generalized flushing of
the skin
Tropical disease caused by different Grade II
strains of dengue virus which are - signs & symptoms of grade I + bleeding
transmitted by mosquitoes - Epistaxis
Synonyms: Dandy Fever, Break bone - GI bleeding
fever - Gum bleeding
ETIOLOGY Grade III
- grade II + circulatory failure
Arthropod-Borne virus - Cold, clammy skin
(arbovirus)belonging to the family - Altered VS – decreased BP, rapid, weak
Flaviviridae 4 serotypes (DENV1, 2, pulse, increased RR
3, 4)
Grade IV
INCUBATION PERIOD - grade III + hypovolemic shock
4-6 days

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 Vector borne diseases and STD
DIAGNOSTIC TESTS
Tourniquet test (Rumpel-Leede test)
- presumptive test that checks for
capillary fragility
- pedia: 3-5 mins; adults: 5-10 mins
+ if > 20 petechiae formation in 1 square
inch
NS1 antigen, DENGUE DUO
Platelet count (decreased)
Hematocrit
TREATMENT
Symtomatic and supportive
1. Oral fluids and electrolyte
2. Antipyretics (don’t use aspirin)
3. Platelet transfusion
4. Convulsions – Dilantin
5. bleeding- FFP, Platelet conc
NURSING CARE
Watch for bleeding:
Nosebleed – cold compress over
forehead
Melena – cold compress over
stomach area, avoid eating dark
colored foods
Gingival bleeding – offer ice chips,
use soft bristle toothbrush
Step Four
Hematemesis - NPO
Observe for signs of shock
Prevention: DOH CLEAN Program
C – hemically treated mosquito nets
L – arvae eating fish
E – nvironmental sanitation (4pm habit)
A – ntimosquito soaps (basil, citronel)
N – atural mosquito repellants (neem
tree, eucalyptus, oregano)
MALARIA
Synonyms: Ague, “King of Tropical
Diseases”
Infectious disease that is arthropod-
borne, characterized by chills followed
by fever occurring regular intervals
Caused by the protozoan Plasmodium
Vector: Female anopheles mosquito
Night biting
Breeds in clear, slow-moving water
(rural areas)
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ACADEMICIAN HEAD
ANOPHELES MOSQUITO
1. Brown in color and bigger than
othert mosquito
2. Night biting mosquito
3. Usually does not bite a person in
motion
4. Assumes 36 degrees when alights a
wall, curtain, trees
5. Breeds in clear ,flowing, shaded
streams, usually in the mountains
Species of plasmodium
1. P. vivax - causes benign tertian
malaria
2. P. falciparum – malignant tertian
malaria
- Most frequently encountered here ff
by vivax; most fatal; multiplies rapidly
3. P. malariae – less frequent; causes
quartan malaria
4. P. ovale – rarely seen
INCUBATION PERIOD
P. falciparum: 12-14 days
P. vivax/ovale: 13-17 days
P. malariae: 28-30 days
PERIOD OF COMMUNICABILITY
Infective as long as gametocytes &
asexual forms remain in blood
STAGES OF MALARIA
Cold stage
- Chilling manifestations (10-15 mins)nursing
responsibility: provide warmth to patient
> Add clothing
> Warm drinks
> Hot water bags
> Socks
 Vector borne diseases and STD
2. Hot stage
– Characterized by fever, headache,
abdominal pain & vomiting
- Lasts for 4-6 hours
Nursing responsibility:
> lower body temperature
> TSB
> Light, loose clothing
> Antipyretics
3. Diaphoretic stage
– Excessive sweating/ feeling of weakness
due to the past stages px underwent
Nursing Responsibility:
-Keep patient comfortable with dry, warm
clothes, replace fluid loss.
-Monitor V/S
-Diet high calories, vitamins and minerals
-Fluid and electrolytes balance
Complications of P. falciparum
Cerebral malaria – delirium, coma, death
- Severe hemolytic anemia
- Pulmonary edema
- Shock
DIAGNOSTIC EXAMINATION
Step Four
Malarial Smear- collect at the peak of
fever-The classic and most used
diagnostic test for malaria is the blood
smear on a microscope slide that is
stained (Giemsa stain) to show the
parasites inside red blood cells
Quantitative Buffy Coat (QBC)- rapid test
for malaria
TREATMENT
Anti-malarial agents
-Chloroquine (drug of Choice)
-Quinine- neurologic toxicity, muscular
twitching, delirium, convulsion
-Primaquine
-Fansidar
PREVENTIVE
1. Advise malaria chemopropylaxis when
travelling to malaria endemic areas
2. Limit dusk to dawn exposure, wear
protective clothing, sleep under mosquito
nets and use topical repellents
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ACADEMICIAN HEAD
LEPTOSPIROSIS
orange eye
Synonyms:Mud fever, Swamp fever,
Canicola fever, Weil’s Disease, Swine
herd’s Disease, Ictero-Hemorrhagia
Caused by Leptospira interrogans
spirochetes
Affects farm animals- cattle, pig,
horses, rats
Source of infection: urine of rats
MODE OF TRANSMISSION
Skin penetration,
through direct contact with urine,
blood or tissue from an infected
animal.
Can enter through broken skin or
through the soft tissues on the inside
of the mouth, nose or eyes.
Can be transmitted by the semen of
infected animal
Human to human transmission is
very rare
Population at risk:
1. Farmers
2. Sewage workers
3. Miners
4. Slaughterhouse workers
5. People living in manila (due to
floods)
AFFECTED ORGANS
Multiplies in the bloodstream and
invade liver resulting in jaundice
Kidneys- inflammation of the
nephrons and tubular necrosis
resulting in renal failure
Muscles- pain
Eyes- iritis, due to liver involvement,
giving an orange colored sclera
CLINICAL MANIFESTATION
Septicemic/ septic stage – high fever
4-7 days, headache, N/V, abdominal
pain, joint pain, respiratory distress
 Vector borne diseases and STD
Immune or toxic stage- with or without
jaundice- 4-30 days
Anicteric – low grade fever, meningeal
manifestation (convulsion, disorientation)
Icteric (Weil’s syndrome) – jaundice,
hemorrhages, hepatomegaly, renal
involvement (RF)
Convalescence stage-
Relapse may occur during 4th to 5th weeks
DIAGNOSTIC TESTS
BLOOD EXAMINATION
LAT- Leptospira Agglutination Test
LAAT- Leptospira Antigen-Antibody Test
Liver function test. BUN CREATINE
TREATMENT
Antibiotics: penicillin,
doxycycline,Tetracycline (not given to <
8 yrs old and pregnant women)
***Do not give calcium- rich foods
(tetracycline binds with calcium)
Prophylaxis- doxy 100 mg p.o q12 x 7
days
NURSING CARE
Symptomatic and supportive
Monitor urine output Step Four
PREVENTIVE
1. Eradicate rats – environmental
sanitation, rat poisons
2. Avoid wading in contaminated pool
of water/ swamps
JAPANESE ENCEPHALITIS
Synonym:
Brain fever one of a group of
mosquito-borne virus diseases that
can affect the central nervous system
Arbovirus is short for arthropod-
borne virus. --group of viruses that
are spread by certain invertebrate
animals (arthropods), most commonly
blood-sucking insects
Causes inflammation of the brain
MODE OF TRANSMISSION
Mosquito bite (Culex)
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ACADEMICIAN HEAD
CAUSATIVE AGENT
Culex trieantorhynchus
The incubation period is 4 to 21
days.
Uncommon but serious condition in
which the brain becomes inflamed
resulting from either a viral infection
or due to the body’s own immune
system mistakenly attacking brain
tissue.
It can be life threatening and
requires urgent treatment in hospital.
Very young and very old are most at
risk.
sometimes starts off with flu-like
symptoms, such as a high
temperature and headache.
TYPES
Primary encephalitis occurs when a
virus directly infects the brain and
spinal cord.
Three main categories of viruses:
Common viruses, including HSV
(herpes simplex virus) and EBV
(Epstein-Barr virus)
Childhood viruses, including measles
and mumps
Arboviruses (spread by mosquitoes,
ticks, and other insects), including
Japanese encephalitis, West Nile
encephalitis, and tick-borne
encephalitis.
CLINICAL MANIFESTATIONS
s/s appears after 6-8 days after bite
Altered Level of consciousness
Lethargic
Fever, chills and vomiting
Convulsion
Signs of neurologic damage
DIAGNOSIS
Lumbar puncture
EEG
 Vector borne diseases and STD
MEDICAL MANAGEMENT PATHOGENESIS

Patient is treated symptomatically Transferred person to person with

NURSING CARE
Same as meningitis
PREVENTIVE MEASURE
Eradicate mosquito thru DOH program
Vaccination of equine or swine
MANAGEMENT
Symptomatic and supportive management
Provide comfort – keep patient in a quiet,
well ventilated room; encourage oral
hygiene and bed bath.
Prevent from complications – turn the
patient at least every 2 hoursincrease oral
fluid intake, encourage high caloric diet,
moisten lips with mineral oil.
Monitor intake and output. The
prevention are identification of vectors
and eliminating breeding grounds,
destruction of larvae, screening homes,
and use of
MEDICAL MANAGEMENT
Step Four
Anticonvulsant for seizure
Mannitol to decrease ICP
Corticosteroids
Paracetamol
Mechanical ventilation
circulating microfilariae by mosquito
bites
Adult worm lives for 7 years in the
lymph vessels, mate and releases
microfilaria in the blood stream
Damages the kidneys, collects fluid in
arms, breast leg and genital area
Bacterial infection and skin hardens
and thickens- elephantiasis
Elephantiasis occurs in the chronic
stage of lymphatic filariasis due to the
obstruction of lymphatic vessels by
filariae.
After invasion into lymph vessels, third
stage larvae grow to maturity in the
lymphatic system, mainly in and around
the genitourinary system.
DIAGNOSTIC
Circulating filarial antigen (CFA)
MANAGEMENT
Health education- control mosquito
TREATMENT
Ivermectin, albendazole or
diethylcarbamazine (DEC)to
eliminate larvae and its reproduction

FILARIASIS

Elephantiasis
Parasitic disease caused by
microscopic, threadlike african eye
worm
Adult worm can live in human lymphatic
system and would cause disfigurement,
disability
Causative organism-
wuchereriabancrofti- thread worm 4-
5cms long and affects lymph nodes and
lymph vessels of the legs, arms vulva
and breast
MODE OF TRANSMISSION
transferred person to person with
circulating microfilariae by mosquito bites

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 Vector borne diseases and STD
SCHISTOSOMIASIS
Acute and chronic disease caused by
parasitic worms.
Caused by blood flukes (trematode
worms) of the genus Schistosoma.
People are infected during routine
agricultural, domestic, occupational,
and recreational activities, which
expose them to infested water.
Lack of hygiene and certain play habits
of school-aged children such as
swimming or fishing in infested water
make them especially vulnerable to
infection.
Synonyms: Snail fever, Bilharzia, Blood
fluke
ETIOLOGY
S. Japonicum-infects the intestinal
tract, also known as oriental
schistosomiasis
S. mansoni- affects intestinal tract and
common is Africa
S. Haematobium – affects urinary tract
and common in Middle east like Iraq
and Iran
INCUBATION PERIOD
Step Four
2-6 weeks to 2 months
MODE OF TRANSMISSION
Skin penetration of free swimming
fork-tailed cercariae, ingestion of
contaminated water
SOURCES OF INFECTION
1. Feces of infected person
2. Dogs, pigs, carabaos, monkeys and
wild rats have been found to be
infected and can serve as a host
3. Transmitted through intermediary host
a tiny snail called Oncomelania
quadrasi-
4. Thrives in riverbaks, creeks, swamps,
clings to grasses, hyacinths, bamboo
and loves sandy loamy soil
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INFECTION & TRANSMISSION
People become infected when larval
forms of the parasite – released by
freshwater snails – penetrate the
skin during contact with infested
water.
Transmission occurs when people
suffering from schistosomiasis
contaminate freshwater sources with
their excreta containing parasite
eggs, which hatch in water.
In the body, the larvae develop into
adult schistosomes. Adult worms live
in the blood vessels where the
females release eggs. Some of the
eggs are passed out of the body in
the feces or urine to continue the
parasite’s lifecycle.
Others become trapped in body
tissues, causing immune reactions
and progressive damage to organs.
MANIFESTATIONS
Itchiness at the site of penetration
“swimmer’s itch”
Low grade Fever, myalgia and
cough
Dysentery –like symptoms
Emaciations from chronic disease
Hepatomegaly, splenomegaly,
lymphadenopathy
Enlarged abdomen because of
inflamed liver, resulting from the
accumulation of eggs in the organ
 Vector borne diseases and STD
COMPLICATIONS 6. Lung fluke disease – Paragonimiasis
raw mountain crab
Liver cirrhosis/portal hypertension s/sx: productive cough
Ascites hemoptysis
Heart failure
Fibrosis of the bladder and ureter
Renal failure
Genital lesions, vaginal bleeding, pain
during sexual intercourse, and nodules in
the vulva.
Pathology of the seminal vesicles,
prostate
Cerebral schistosomiasis

DIAGNOSIS

Stool exam – look for egg of parasite,

kato katz technique Skin of the feet
Blood exam – COPT (circumoval precipitin 1. Hookworm (Ancyclostomiasis)
test) 2. Threadworm (Strongyloidiasis)
ELISA
TREATMENT MANIFESTATIONS
Weakness
1. effective only when given early at the Anemia
course of disease Stunted growth
2. Praziquantel (Biltricide) = 30 mg/kg BID
3. Fuadin IM OR IV DIAGNOSTIC
Stool examination
PREVENTIVE MEASURES
TREATMENT
Snail Control (Oncomelania quadrasi) –
use of molluscides Step Four
ALBENDAZOLE 400 MG
Environmental Sanitation – proper MEBENDAZOLE 500 MG
disposal of excretion IVERMECTIN- ADULT AND
MIGRATING LARVAL STAGE OF
HELMINTHS NEMATODES
Two ways of acquiring parasitism: PREVENTION
INGESTION
1. Pinworm- Enterobiasis, Seatworm, A. Personal hygiene
Oxyuriasis B. Proper preparation of foods
SIGNS AND SYMPTOMS
1. Nocturnal itchiness of anus (female
pinworm lays eggs at night on the anal
sphincter)
2. Giant Roundworm (Ascariasis)
3. Whipworm (Trichuriasis)
4. Trichinosis
Ingestion of insufficiently cooked meat
5. Tapeworm
Taenia saginata- raw beef
Taenia solium- raw pork
Diphyllobotrium latum – raw fish

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 Vector borne diseases and STD
RABIES
Synonyms: Hydrophobia, Lyssa, La Rage
CAUSATIVE AGENT
Rhabdovirus (has a special affinity to the
CNS) causing encephalitis
Primarily a disease of animals (dogs, cats
and other mammals)
MODE OF TRANSMISSION
Bite, abrasion or lick on
A damaged skin or mucous membrane
is a vaccine-preventable viral disease that
transmits from mammals to humans that
causes acute encephalitis
Once clinical symptoms appear, rabies is
virtually 100% fatal.
- can affect both domestic and wild
animals.
99% of cases, domestic dogs are
responsible for rabies virus transmission
to humans
spreads to people and animals through
bites or scratches, usually via saliva.
2 Stages of Manifestations
(animal)
Dumb stage
complete change in disposition
(withdrawn, stays in one corner, quite-
depressive behavior, hyperactive, walks to
and fro- manic behavior)
Furious stage
easily agitated; bites, fearful look, drooling
of saliva, animal expected to die.
INCUBATION PERIOD
is 10 days up to 15 years (longest record
is 21 years)
3 STAGES OF MANIFESTATIONS
Prodromal/Invasive stage
numbness on site, sore throat, flu – like
symptoms, marked insomnia, restless, copious
salivation,irritable, apprehensive, with slight
photosensitivity, sensitive to sound and temp.
Pain in the site bite. Aches and body pain
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ACADEMICIAN HEAD
Excitement stage
aerophobia, hydrophobia, px fears
water due to laryngospasm, difficulty
in swallowing, profuse drooling
Marked excitation and apprehension
Nuchal rigidity, convulsions, delirium
If the patient survives this phase,
patient deteriorates rapidly and
enters to terminal phase
Paralytic stage
spasms stops but paralysis will set in
starting from toes up, done in a matter
of minutes.
patient becomes quiet and
unconscious
Death occurs due to respiratory
paralysis and cardiac failure
Death expected in 24 hours from
invasive to paralytic stage
*Rabies is preventable but not
curable.
DIAGNOSIS
established largely from history of
animal bite
Observation of dog for 10 days –
dead or w/ behavior changes w/in 10
days (rabid)
Virus culture and isolation of saliva
and throat
Flourescent rabies antibody (FRA)-
MOST DEFINITIVE DIAGNOSIS
diagnostic tools are not suitable for
detecting rabies infection before the
onset of clinical disease, and unless
the rabies-specific signs of
hydrophobia or aerophobia are
present
Brain Biopsy – negri bodies
MANAGEMENT
Wash the wound immediately with
soap and water, povidone iodine for
15 minutes.
Do not cover or suture the wound. If
suturing is necessary, ensure that
RIG has been applied locally
 Vector borne diseases and STD
MANAGEMENT OF BITING ANIMAL NURSING CARE

Capture the animal and keep under
veterinary surveillance
a. If animal remains healthy in 10 days
b. If animal dies
POSTEXPOSURE PROPHYLAXIS (PEP)
Consists of a dose of human rabies
immune globulin (HRIG) and rabies vaccine
given on the day of the rabies exposure,
and then a dose of vaccine given again on
days 3, 7, and 14.
For people who have never been
vaccinated against rabies, postexposure
prophylaxis (PEP) should always include
administration of both HRIG and rabies
vaccine.
Combination of HRIG and vaccine is
recommended for both bite and non-bite
exposures, regardless of the interval
between exposure and initiation of
treatment.
2 types of vaccines administered
A. Active
PVCV: purified vero cell vaccine (verorab)
: 0.50 cc/vial (IM) .1cc (ID)
Site: Deltoid or Vastus lateralis
Schedule: Verorab:
Day 0: 2 vials-1 vial for each site
Day 7: 1 vial Step Four
Day 21: 1 vial
Day 90: booster dose of 1 vial in case dog
dies in 10 days
Purified duck embryo
IM deltoid or SubQ OD for 14 days
1. Lyssavac N – no skin test, cloudy solution
2. Lyssavac plain – with skin test, pink in color
B. Passive immunization:
For immediate effect
Given up to 7 days after being bitten,
Deep IM at buttocks area
Single dose
Animal Serum (ERIG) equine rabies
immunoglobulin
Eg. ARS (antirabies serum); HyperRAB
Skin testing done 40 IU/kg body weight
qHuman serum (HRIG) human rabies
immunoglobulin (administered only once
at the start of anti rabies prophylaxis)
E.g. Rabuman; Imogam
Skin testing not necessary; 20 IU/kg body
weight.
Provide a dim & quiet environment
Room should be away from sub-
utility rooms (area for washing: avoid
sound of water)
Restrain patient even before
aggressive behavior sets in
Wear protective barriers
PREVENTION
Immunization of animals
All animals should be caged or
chained
Stay away from stray animals
PEDICULOSIS
Condition characterized by
infestation of the hairy areas of the
body with lice
Causative organism- Pediculus
Humanus
Head lice or pediculosis capitis-
pediculus humanus capitis
Body lice or Pediculosis corporis
caused by pediculus humanus
humanus or pediculus corporis
Pubic lice n or Pediculosis pubis –
crab louse or pthirus pubis
SIGNS & SYMPTOMS
Itching tends to be more intense at
night
Excoriation are produced from
scratching
Erythematous macules, wheals that
may result in secondary infection
Itchy scalp- allergic reaction to the
bug’s saliva
The presence of nits (lice eggs) on
shafts of hair.

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 Vector borne diseases and STD
Use of shampoo with LINDANE, If pneumonic plague patients are not
PERMETHRIN, PYRETHRIN given specific antibiotic therapy, it can
PYRETHRIN LOTION progress rapidly to death.
Crotamiton lotion
Malathion 1% powder??? DIAGNOSIS
Removal of nits by combing the hair
with fine tooth comb Recent history of travel to the western
Disinfect or boil the clothing, bedding United States or any other plague
and endemic area like China
pillows
Lymph node aspirate
PLAGUE (BLACK DEATH) Blood cultures
BUBONIC AND PNEUMONIC
Gram staining- “safety pin” appearance
Infectious disease found in some small Sputum culture , bronchial/tracheal
mammals and their fleas. washings for very ill pneumonic
CAUSATIVE AGENT patients

Yersinia Pestis bacteria

Sometimes bubonic plague progresses
to pneumonic plague, when the bacteria
reaches the lungs.
INCUBATION PERIOD

for bubonic plague is usually 2 to 6

days.
MODE OF TRANSMISSION TREATMENT

If person is bitten by infected rodent fleas IV ANTIBIOTIC THERAPY

Contact with contaminated fluid or tissue. STREPTO- 1GM INTRAMUSCULAR
Step Four
Humans can become infected when BID
handling tissue or body fluids of a plague- GENTAMYCIN- 5MG/KG OD- IM
infected animal. OR IV
Infectious droplets. When a person has FLUOROQUINOLONES-
pneumonic plague coughs, droplets LEVOFLOXACIN, CIPROFLOXACIN
containing the plague bacteria into air that DOXYCYCLINE
can be inhaled by another person and
ISOLATE THE PATIENT
direct and close contact with the person
with pneumonic plague. USE MASK AND GLOVES WHEN IN
CONTACT WITH PNEUMONIC
Transmission of droplets is the only way
that plague can spread between people PLAGUE PATIENT

SIGNS & SYMPTOMS PREVENTION

The most common primary manifestation
are painful bubo usually occurring in the
groin, axilla or cervical nodes. H/A, chills
and fever
If untreated, bacteria invades the
bloodstream and spread rapidly, causing
septicemic plague, and if the lungs are
seeded, secondary pneumonic plague.
A person with pneumonic plague may
experience high fever, chills, cough, DOB
and may have hemoptysis.
Reduce rodent habitat around your
home, workplace, and recreational
areas. Remove brush, rock piles,
junk, cluttered firewood
Wear gloves if you are handling or
skinning potentially infected animals
to prevent contact between your skin
and the plague bacteria.

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ACADEMICIAN HEAD
 Vector borne diseases and STD
Use flea repellant
Keep fleas off of your pets by applying
flea control products.. If your pet
becomes sick, seek care from a
veterinarian ASAP. Do not allow dogs or
cats that roam free in endemic areas to
sleep on your bed.
ANTHRAX
Anthrax is a serious infectious disease
caused by gram-positive, rod-shaped
bacteria known as Bacillus anthracis.
Rare, people can get sick if they come in
contact with infected animals or
contaminated animal products.
Can be found naturally in soil and
commonly affects domestic and wild
animals around the world.
Although it is rare, people can get sick
with anthrax if they come in contact with
infected animals or contaminated animal
products.
Anthrax is most common in agricultural
regions of Central and South America,
sub-Saharan Africa, central and
southwestern Asia, southern and eastern
Europe, and the Caribbean.
Types of Anthrax
1. Cutaneous
through a cut or scrape. most common
form of anthrax infection, and it is also
considered to be the least dangerous.
Infection usually develops from 1 to 7
days after exposure. Without
treatment, up to 20% of people with
cutaneous anthrax may die.
*rash of anthrax looks like pink, itchy
bumps that occur at the site where B.
anthracis comes into contact with
scratched or otherwise open skin. The
pink bumps progress to blisters, which
further progress to open sores with a
black base (called an eschar).
Necrotic scar and edema
in cutaneous anthrax
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
2. Gastrointestinal or ingestion anthrax
When a person eats contaminated
raw or undercooked meat from an
animal infected with anthrax.
Intestinal lesions are formed with
hemorrhagic lumphadenitis
Infection usually develops from 1 to 7
days after exposure. Without
treatment, more than half of patients
with gastrointestinal anthrax die.
However, with proper treatment, 60%
of patients survive.
LOWER GI- ILEUM , CECUM-
Ulcerative lesions, edema, N/V,
bloody diarrhea
3. Inhalation
considered to be the most fatal form
Infection usually develops within a
week after exposure, but it can take
week up to 2 months. Without
treatment, inhalation anthrax is
almost always fatal. However, with
aggressive treatment, about 55% of
patients survive.
People who work in places such as
wool mills, slaughterhouses, and
tanneries may breathe in the spores
when working with infected animals
or contaminated animal products
from infected animals
SIGNS & SYMPTOMS
Early- fever, cough, myalgias
Late- mediastinal lymph node
enlargement, respiratory failure
Possible meningeal symptoms
4. Injection Anthrax
Symptoms may be similar to those of
cutaneous anthrax, but there may be
infection deep under the skin or in
the muscle where the drug was
injected. It can spread throughout the
body faster and be harder to
recognize and treat.
COMPLICATIONS
Anthrax Meningitis- intense
inflammation of meninges and spinal
cord- 100% fatality rate
 Vector borne diseases and STD
Anthrax sepsis- lymphohematogenous
spread from the primary lesion
manifested by high fever , toxemia and
shock with death following in short time

DIAGNOSTIC

Blood culture
Skin lesion exudates
Tissue biopsy or autopsy
Rectal swab
Pleural fluid
CSF
Ascitic fluid

MANAGEMENT

Supportive measures
Anti toxin
Antibiotics- CIPROFLOXACIN,
DOXYCYCLINE
Vaccination of animals with endemic

Step Four

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Week 15:
Cancer Overview
Tumor
An abnormal mass of tissue that forms
when cells grow and divide more than
they should or do not die when they
should
Neoplasm neo means new plasm means
growth, may be benign or malignant
Benign
is a growth that does not have cellular
features of cancer or pre-cancer and is,
thus, highly unlikely to become
dangerous
Malignant
means that a tumor is cancerous
–Suffix : -OMA
THEORIES
1.Cellular differentiation theory
is the process in which a cell changes
from one cell type to another.
Step Four
2.Failure of the immune response theory
adequately generated or by the induction
of immune tolerance or other inhibitory
mechanisms that allows tumour to
escape immune detection and elimination
Benign Growth Patterns
Hypertrophy
Increase in the size of the cell.
Hyperplasia
Increase in the number of cells
Metaplasia
is defined as the conversion of one cell
type to another and can include
conversions between tissue-specific stem
cells
Dysplasia
describe the presence of abnormal cells
within a tissue or organ
-Precursor of cancer
Anaplasia
are typically poorly differentiated or
undifferentiated, and exhibit advanced
cellular pleomorphism
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Carcinogenesis
Initiation – exposure to initiating agents
(carcinogens)
Promotion – carcinogens cause unregulated
accelerated growth in previously initiated
cells: reversible
Progression – tumor cells acquire malignant
characteristics
Characteristic of cancer cells
–Altered cell differentiation
–Appearance changes
Cancer cells vary in size and shape
(Pleomorphism)
Abnormal nuclei or multiple nuclei
Abnormal number of chromosomes
(Aneuploidy))
Abnormal chromosome arrangement
The more undifferentiated, the more
aggressive a malignant cells
–Altered metabolism
Production of surface enzymes that aid in
invasion and metastasis
Higher rate of anaerobic glycolysis
Production of abnormal growth factor
Inappropriately secrete hormone or
hormone like substance resulting in
paraneoplastic syndrome
–Tumor specific antigens
Proteins marking the cancer cells as “non
– self ”
–Altered Cellular function
Normal control mechanisms fail to stop
proliferation of cancer cells
Loss of contact inhibition
Cancer cells are less genetically stable ->
increasing malignant mutations
METASTASIS – hallmark of cancer
 Cancer Overview

Tumor Growth

–Cell cycle

G0 or Resting phase – cells perform all

functions other than proliferation, non
dividing cells are not considered to be
in the cell cycle

–Cell – cycle time : the amount of time

required for a cell to move from one
mitosis to another. The sum of M,G1, S
and G2. Carcinogenic Factors
–The length of Go phase is the major –Heredity
factor in determining the cell cycle time –Obesity
–Hormonal factors
–Age
–Bacteria and parasites
–Doubling time: the length of time it –Smoking
–Oncogenic viruses
takes for a tumor to double its volume. -Alcohol
–Immune system deficiency
–HPV, HBV, HCV, H.
–Environmental factors
–Average doubling time for solid tumor pylori
–Chemicals
is 2 months. Vary in different types of –Food Preservatives
–Radiation
tumor

–A tumor is clinically undetectable until Route of spread

it has doubled 30 times and contained
1 billion cells, at this point is –Lymphatics
approximately 1 cm in size and equals –Blood vessels
1 gram in weight –Direct seeding
–Growth fraction: the ratio of the total
number of cells to the number of
dividing cells. Tumor with large growth
factors increase their tumor volume
more quickly. As tumor volume Most common cancer in the Philippines
increases, growth factor decreases as a
result of hypoxia, decreased nutrient 1. Breast
availability and toxins 5. Prostate
2. Lung
6. Adult leukemia
3. Cervical
7. Head and Neck
4. Colorectal
8. Thyroid

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Cancer Overview

Levels of Care
Cervical - Papsmear
–Primary level of care -> Prevention
–Secondary level of care -> Screening, Class 1 - Normal
Detection, Diagnosis and Treatment Class 2 - Inflmmation
–Tertiary level of care -> Palliative treatment Class 3 - Dysplasia
Class 4 - Probably Malignant
WARNING SIGNS OF CANCER Class 5 - Malignant
C - Changes in bowel or bladder habit
Diagnostic tests
A - A sore that does not heal
U - Unusual bleeding or discharge Tumor Markers
T - Thickening or lump in the breast or
elsewhere A. Prostate specific antigen
I - Indigestion or difficulty of swallowing B. S – 100 – melanoma cells
O - obvious changes of warts and moles C. Thyroglobulin
N - Nagging cough or hoarseness
D. CA 15 – 3 / CA 27 – 29 – breast cancer
U - Unexplained Anemia
S - Severe weight loss E. Carcinoembronic antigen(CEA)/CA 19 -9 –
colorectal cancer
F. CA 125 – ovarian cancer
FOR SECONDARY LEVEL OF CARE
G.HCG – germ cell tumors
Lungs - CXR 40 years old and above annually H. AFP (Alpha fetoprotein) – liver cancer
Breast - Breast self examintion (BSE) monthly I. Beta 2 macroglobulin (B2M) - multiple
after menses myeloma, lymphocytic leukemia an some
Clinical breast exam
< 40 years old every 3 years lymphomas
> 40 years old yearly J. Chromogranin A (CgA) – neuroendocrine
Mammography and Breast Ultrasound tumors, most sensitive for carcinoid tumors
Prostate - (DRE) Digital Rectal Examination
Men 40 years old annually
Prostate Specific Antigen (PSA) = 0-4
ng/ml

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Cancer Overview
Diagnostic Imaging TNM staging system
X ray The TNM system uses letters and numbers to
Mammography describe the cancer. This system is used in
different ways depending on the kind of cancer
CT scan
you have.
Ultrasound
Nuclear medicine For the TNM system:
Positron Emission Tomography T describes the size of the tumour, with
Lymphoscintigraphy numbers 1 to 4 (1 for small, 4 for large)
MRI
N stands for lymph nodes, with numbers 0
BIOPSY to 3 (0 means no lymph nodes have cancer,
- the most definitive diagnostic test for cancer 3 means many do)

Histopathology M stands for metastases or whether the

Staging of cancer
- Process of describing the extent or spread
of a disease from its origin.
Surgical staging
> utilizes invasive surgical techniques to
actually visualize structures and assess the
extent of the disease
Clinical staging
> based on professional judgment and
measurement of primary tumor’s size,
location in the body and evidence of the
disease through physical examination
Pathologic staging
> the practice of examination of the tissue of
interest both grossly and microscopically to
evaluate its characteristics and make an
assessment a to the aggressiveness of the
malignant tumor.
cancer has spread to another part of the
body, with numbers 0 or 1 (0 means it has
not spread, 1 means it has)
Staging
Stage 0 – the cancer is where it started (in-
situ) , it has not spread
Stage 1 – confined to the tissue and small, it
has not spread
Stage 2 – with increase growth of cancer,
has not spread
Stage 3 – larger and has spread to
surrounding tissues and LN
Stage 4 – with distant metastasis
Cancer grades
The grade of a cancer depends on what the
cells look like under a microscope.

In general, a lower grade indicates a slower-

growing cancer and a higher grade indicates a
faster-growing one. The grading system that's
usually used is as follows:

grade 1 – cancer cells that resemble normal

cells and aren't growing rapidly
grade 2 – cancer cells that don't look like
normal cells and are growing faster than
normal cells
grade 3 – cancer cells that look abnormal and
may grow or spread more aggressively

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Cancer Overview
Modalities of treatment Prevention and identification of risk factors:
The age and specific risk related to age
1. Surgery must be considered.
2. Chemotherapy Survival and quality adjusted survival
3. Radiation therapy curves for the preventive measures should
4. Biotherapy be discussed.
5. Stem cell therapy Routine screening with increased
Surgery frequency of clinical examination should
> is the branch of medicine that uses be established
manual and instrumental to deal with Hereditary- the family may alert and
the diagnosis and treatment of educate the potential of certain cancer
injury, deformity, and disease and possible occurrence in other family
members.
Comorbid conditions.
Debilitation due to cancer.
Surgical oncology Paraneoplastic syndrome
> defined as the branch of surgery focusing
on the surgical management of malignant, Types
neoplasm including biopsy, staging and 1. Diagnostic Surgery
surgical resection. 2. Prophylactic surgery
3. Curative surgery
•Surgical oncology procedures used to:
4. Palliative surgery
a.prevent a cancer occurrence in the high-
5. Reconstructive surgery
risk patient.
b. diagnose a primary or metastatic site of Biopsy
malignancy 1. Fine needle aspiration biopsy
c.Provide a primary or secondary treatment 2. Core needle biopsy
3. Incision biopsy
of an identified malignancy 4. Excision biopsy
d. Provide a route of administration of 5. “Frozen section” biopsy -For rapid
therapy. microscopic analysis and diagnosis of
e. To rehabilitate by means of specimen
reconstruction intervention.
f. To offer palliative care through symptom
management in advance cancer.

Nursing roles in the care of surgical

oncology :

1. To identify risk factors or behaviors that

prompt a preventive surgical procedure.
2. Nurses must understand the
fundamentals of surgical oncology.
3. Play a role during the initial assessment
and evaluation of symptoms, testing, and
diagnosis throughout the preoperative,
intraoperative and post-operative care of
primary or secondary surgical procedure
4. Nurses must be instrumental in the
Identification, planning, implementation
and evaluation phases of surgical
treatment.
5. To provide a comprehensive plan of care
and enhance patient outcomes.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Cancer Overview
Curative surgery Minimally invasive procedures
1. Ductal lavage and fine needle aspiration
Definitive surgery for primary cancer,
local therapy, integration with other > identify cytologic and molecular changes
adjuvant modalities. overtime that correlate with breast cancer
Surgery for residual disease. development for early diagnosis
Surgery for metastatic disease.
Surgery for oncologic emergency 2. Sentinel LN biopsy

Definitive surgery for primary cancer
> aims to remove the cancer with margin
of clear tissue around the cancer itself.
An assessment and removal of adjacent
or regional structure to verify the stage
of disease.
Surgery for residual disease
> Or cytoreductive surgery, may
enhance the ability of other interventions
to improve the outcome for specific
cancer. Ex Burkitt’s lymphoma and
ovarian cancer.
Surgery for metastatic disease
> intraoperative mapping of lymph node with
dye or radioactive tracer, the sentinel LN is
dissected, the first draining LN of the tumor, if
negative for tumor, no LN dissection is
necessary.
3.Radio-guided surgery
ex. Radioguided parathyroidectomy neoprobe is
used to localize parathyroid tissues that may
otherwise be difficult to identify thus reducing
operative tissue time and frozen sections
4. Video-assisted thoracosurgery (VATS)
5.Light amplification by stimulated (LASER)
> light is an intense, narrow beam that enables
the performance of precise surgery to remove
precancerous or cancerous tissues, or to relieve
symptoms of cancer

> maybe curative in nature, based on the 6.Cryosurgery – or cryotherapy

type of cancer, location and number of
metastatic deposits.
Surgery for oncologic emergencies
> utilizes cold effect of liquid nitrogen to destroy
precancerous or cancerous tissues, it is applied
externaly to a skin or through a cryoprobe
instrument.

> surgery related to impending 7.Radiofrequency ablation (RFA)

destruction of vital organs, hemorrhage. > to eradicating cancerous tissueby thermal
It promote comport and ease of pain, coagulation and protein denaturation
even death is imminent
8.Laparoscopy

> to diagnose intraperitoneal and retroperitoneal

masses, lymph nodes and visceral lesions.

Surgery in older adults is often modified due

to overall life expectancy is too short.
Functional recovery variables:
Age
comorbidities
Site of cancer
Symptom severity.

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Chemotherapy
Chemotherapy is the use of cytotoxic 4. Induction chemotherapy
drugs in the treatment of cancer. > primary treatment for patients who have
Its function is to kill tumor by interfering
cancer for which no alternative treatment
with cellular functions and reproduction
Systemic Treatment rather than localized exist.
treatment 5. Combination therapy
GOAL > combination of 2 or more agents / drugs to
treat cancer.
CURE 6. Myeloablative therapy
> To cure tumor and cancer, to disappear > dose intensive therapy used in preparation
and do not re-occur for peripheral blood stem cell transplantation.
CONTROL Factors influencing chemotherapy
> To control or to stop the cancer from selection and administration
growing and spreading.
PALLIATION Blood-Brain Barrier
> inhibit certain substances from entering the
>If / when cure and control is no longer
brain or CNS.
possible, its goal is to relieve symptoms
caused by cancer. - Intrathecal route (Omaya reservoir / lumbar
puncture)
Cell cycle generation
G1 Phase- the phase where RNA and
protein synthesis occur.
S Phase- the phase where DNA synthesis
occur.
G2 Phase- pre-mitotic phase. For further
protein synthesis in preparation for mitosis
M Phase- Mitosis and cell division.
G0 Phase- resting phase

Tumor growth
Doubling time – time required to reach
certain size.
Micrometastasis- the possibility for the
tumor to shed cells (7th-10th )
Gompertzian function- a pattern where
doubling time is more rapid during the early
stages.
Chemotherapeutic agent
1. Adjuvant therapy
> chemotherapy used in conjunction with
another treatment modality and aimed to treat
micrometastases.
2. Neoadjuvant chemotherapy
> done to shrink a tumor before it is removed
surgically.
3. Primary therapy
treatment for patient who have localize cancer,
alternative way but less than completely
effective treatment.
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Chronotherapy / Circadian Rhythm
-regular repeated fluctuation in biologic
functions during 24 hour period
“diurnal” means events happening in the
daytime
Circadian Variables
Influence drug absorption, metabolism,
distribution and elimination.
Cytoprotectants
> is used to prevent or decrease specific
system effects related to drug therapies.
(cardiotoxicity,nephrotoxicity)
- It protects normal tissues from cytotoxic
effects of drugs or irritation while
preserving their anti-tumor effects
 Chemotherapy
Liposomes
> use to enhance drug delivery to
specifically target tissue
Chemotherapy drug classification
Cell Cycle Phase- specific
Most effective against actively growing
tumors that have greater proportion of cell
cycling. (the drugs attack the cell).
Mostly affect the cell in S phase by
interfering DNA & RNA.
anti-metabolites= interfere or block essential
enzymes necessary for DNA and RNA synthesis
(cyclophosphamide)
Cell Cycle Phase- Non specific
Active in all phases of the cycle and maybe
effective in large tumors that have few
active cells dividing at the time of
administration.
It has long acting effect on the cells.
Resulting damage or death to the T- cells.
1. Alkylating agents – preventing mitosis.
Bond to nucleic acid that interfere its
duplication. (Carboplatin)
2. Antibiotic (anti-tumor agents) – disrupt
DNA transcription and inhibit DNA and
RNA synthesis. (Dactinomycin)
Hormonal Agents
> secreted by the endocrine glands
Affecting the cell membrane permeability,
manipulating hormone levels, tumor growth
can be suppressed.
> not cytotoxic and not curative and its
purpose is to prevent cell division and prevent
further growth of hormone-dependent
tumors.
> anti-androgen, antii-estrogen
Nitrousoureas
Action is similar to alkylating agents,
inhibits synthesis of DNA & RNA
Carmustine
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Monoclonal antibodies
> Destroys cancer cells and spare normal cells.
Rituximab, Gentuzumab
Routes of administration
ORAL
> most convenient
> Needs patients compliance with the
prescribed schedule.
> Plan for drugs with emetic potential to be
taken with meals.
Subcutaneous and Intramuscular
> Drugs is injected into the muscle
> Injection site should be rotated for each
dose and log kept on the dose schedule.
Intravenous (IV)
> most common
> Medication is given directly to the vein
> In some drug it is the most feasible
according to their chemical structure
> It has the faster effect
> Can be perform “Bolus” or “Short or Long
term infusion”
> Peripheral venous access
> Central venous access
> Percutaneous line
> Peripherally inserted central catheters
(PICC)
> Implantable devices (port-a- caths)
> Tunneled venous access devices (Hickman
catheter)
Intrathecal / Intraventricular
> Ommaya reservoir or implantable pump
> Agents are administered directly into the
cerebrospinal fluid. Usually as prophylaxis in
leukemia or lymphoma.
Intra arterial
> Catheter placement in artery near the
tumor
 Chemotherapy
Intracavitary
> Instill the drug into the bladder through
the catheter or into pleural cavity via
chest tube.
Intravesical
> Therapy for bladder cancer, drugs are
puut directly into the bladder through a
catheter.
Topical
> Cover surface area w/ a thin film of
medication, instruct the patient to wear
loose fitting cotton clothing, wear gloves
and wash hands thoroughly after the
procedure.
> Commonly prepared as ointments and
usually used to treat sun cancers.
Safe administration of
chemo drugs
1. Chemo drugs are dangerous
2. There should be NO CONTACT with it
3. Pregnant should not undergo
Chemotherapy
Preparing chemotherapy drugs
1. Prepare in well-ventilated area
2. Wash hands before and after procedure
3. Wear gloves at all times
4. Wear gown
5. Wear face shields
6. Wrap gauze or alcohol pad around ampules
neck
7. Label prepared medication
8. Wrap gauze around injection site when
withdrawing syringe
9. Dispose in a leak and puncture proof
container
10. Do not eat, chew and smoke when preparing
medications
Management of chemotherapy
spills
Should be clean up immediately by properly
protected personnel and must be trained.
A spill should be identified w/ warning sign
so that other people will not be
contaminated.
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Spill on linen
remove soiled, contaminated linen from the
patient.
Place the linen in an appropriate, approved,
especially marked, impervious laundry bag.
should be washed twice and laundry personnel
must wear latex gloves and gown when
handling this material
clean contaminated area with absorbent and
detergent solution.
Spill in Personnnel or Patient
immediately remove any contaminated
protective garments or linen.
wash the affected area of skin with soap and
water.
follow proocedure for contaminated linen.
notify the physician if there is a drug spill oon
the patient.
place all contaminated materials in doubled-
bag waste disposal bag.
discard the waste bags and contents in
approved container.
then wash your hands thoroughly with soap and
water.
Eyes Exposure
Immediately flood the affected eyes with water
for at least 5 minutes.
Follow agency guidelines regarding follow up
carewith a clinical eye exam
Common side effects of
chemotherapy
Nausea and Vomiting
> Most common for the first 24-48 hours
> Delayed N&V ! Week after chemotherapy
> Cause unknown
> Activation receptor
> Stimulation of the peripheral autonomic
and vestibular pathways
> Serotonin
Management
Oral hygiene
Assess for dehydration ( anti emetic)
Ice chips
Round the clock medication
 Chemotherapy
Common side effects of chemotherapy Watch out for:
Vesicant Etravasation
> Leak of chemo drugs to subcutaneous
Alopecia tissue that causes pain, necrosis and
sloughing of tissues
> Begins 2-3 weeks Flare
> Ends after 3 months / regrowth of the hair > Localized allergic reaction, without pain
may begin in 8 weeks. and marked with red blotches along the vein
line.
Management Phlebitis (venipuncture) (48 hours)
> Wigs for female, cap for male
> Pre - emptive hair cut Anaphylaxis
•Aminophyline, Dipenhydramine
Stomatitis hydrochloride, Dopamine, Epinephrine,
Heparin, Hydrocortisone
Management •O2 set-up, tubing cannula or mask and
> Inspect mouth routinely airway devices
> Oral care (saline)/ soft bristle toothbrush/ do •Suction equipment
not use listerine •IV fluids – isotonic solutions
> Avoid spicy and citrus foods •IV tubings and supplies for venous access
> Provide ice chips and popsicles •- anxiety, hypotension, urticaria, cyanosis,
> Soft bland diet respiratory distress, abdominal cramping,
> Viscous lidocaine (adult) flushed appearance and chills.
contraindicated to child, it reduces gag reflex
= stop the drug infusion
Anorexia = maintain IV line, isotonic saline
> Makes the food taste metallic (meat) = Position comfortably to promote perfusion
Management of the vital organs
> Place patient in comfortable position = notify the physician
> Maintain good hygiene = maintain airway and anticipate the need
> Serve food atractively for cardiopulmonary resuscitation
> Provide general comfort = monitor vs
= administer medication as prescribed
Anemia = follow the institution protocol for follow up
Management care
> Assess skin for pallor = document the incident in patients medical
> Schedule activities w/ rest periods record.
> Administer erythropoietin as ordered
Neutropenia MEDICAL MANAGEMENT:
Management Check for Phlebitis and Vesicant
> Assess sign of infection - Fever extravasation (leak of drug into
subcutaneous tissue) (pain, necrosis,
> Abnormal lung sound - Cough sloughing of tissues)
> Practice cleanliness - Handwashing before High calorie and hiigh protein diet
and after procedures Encourage hydration
> No flowers, fish, fruits, vegetables and raw Monitor cbc
fruits Oral examination for stomatitis
SIDE EFFECTS:
Thrombocytopenia
Management Teratogenic
> Assess skin and mouth for sign of bleeding Hair loss concerns
> Check stool and urine for blood Encourage counseling
Report complications
> No shaving Administer anti emetic drugs
> No suppositories and enema Practice aseptic techniques at all time
> Gentle oral care
> AVOID SEX

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Chemotherapy
Flouroscopy
DIAGNOSTIC TEST
- Used of x-ray that identify contrast in body tissue
> Skeletal Cancer
Tumor marker identification
> Lung Cancer
- Analysis of substances found in the
body tissues, blood and other body > Gastrointestinal Cancer
fluids that are made by tumor.
Breast cancer Position Emission Tomography
Colon cancer > Lung
Lung cancer > Colon
Ovarian cancer
> Liver
Prostate cancer
Testicular cancer > Pancreatic
> Hodgkin and Non Hoodgkin
Mammography > Lymphoma
> for breast cancer
Magnetic Resonance Imaging (MRI) Endoscopy
> Neurologic Cancer - for diagnostic and therapeutic purpose
> Pelvic Cancer > Bronchial
> G.I Cancer
> Abdominal Cancer
> Thoracic Cancer
> Breast Cancer

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Chemotherapy

Anticancer Drugs CYCLOSPHOSPHAMIDE

Uses
Cell Cycle specific drugs > Non Hodgkin's Lymphoma, breast &
> act mainly on dividing cells ovarian cancers
ANTIMETABOLITES : Methotrexate, 5 > As immunosuppressant - Rheumatoid
Fluorouracil arthritis, nephrotic syndrome & organ
ANTIBIOTIC: Bleomycin transplantation
VINCA ALKALOIDS: Vinblastine, Vincristine
Adverse effects
Cell Cycle non specific drugs > Hemorrhagic cystitis - prevented by
vigorous hydration & MESNA - Sodium
> act on dividing as well as resting cells mercaptoethane sulfonate
ALKYLATING AGENTS: Cyclophosphamide, > Myelosuppression
Busulphan
ANTIBIOTICS: Doxorubicin, Daunorubicin
METAL COMPLEXES: Cisplatin CISPLATIN
Hormonal Agents Uses
Glucocorticoids - Prednisone > Testicular CA & cancers of bladder,
Gonadal Hormone Antagonists - Tamoxifen, lung and ovary
Flutamide
Adverse effects
METHOTREXATE > Nephrotoxicity
> Vomiting (prevented by Ondansetron)
Mechanism of Action > Myelotoxicity
> Inhibits dihydrofolate reductase and decrease
nucleic acid synthesis. CARBOPLATIN is less nephrotoxic, has
greater myelotoxicity
Uses
> Acute leukemias, Non Hodgkin's lymphoma, VINCA ALKALOIDS
Breast cancer, As immunosuppresant - Mechanism of Action
Rheumatoid arthritis, Inflammatory bowel disease. > Bind to tubulin & prevent its
polymerization into microtubules thereby
Adverse Effects block the formation of mitotic spindles
> Mucositis, Myelotoxicity, Hepatotoxicity &
Pulmonary fibrosis --- prevented by LEUCOVORIN Uses
(folinic acid) > Vincristine : Acute leukemias,
lymphomas, Wilms tumour
FLUOROURACIL (5-FU) > Vinblastine : Testicular CA, Lymphomas,
neuroblastoma
Mechanism of Action
> Converted in cells to 5 fluoro-2-deoxyuridine-5'- Adverse Effects
monophosphate (5-dUMP) which inhibits > Myelotoxicity (Vinblastine)
thymidylate synthase and leads to "thymineless" > Neurotoxicity (Vincristine)
death of cells.
ANTIBIOTICS
Uses
> Bladder, breast , colon cancers Doxorubicin & Daunorubicin - Inhibit
topoisomerase II & generate free radicals
Adverse Effects causing DNA damage.
> GI distress, myelotoxicity, Alopecia
Uses
> Doxorubicin - Hodgkin's lymphoma,
breast, endometrial, lung, ovarian,
&thyroid cancers.
> Daunorubicin - Acute leukemias

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Chemotherapy

Toxicity TAMOXIFEN
> Cardiotoxicity (prevented by dexrazoxane)
> Myelotoxicity Antiestrogenic action
SPECIFIC TOXICITIES
Uses
Haemorrhagic cystitis - Cyclophosphamide > Breast Carcinoma
Megaloblastic anaemia - Methotraxate
Nephrotoxicity - Cisplatin Adverse effects
Neuropathy - Vincristine > Endometrial hyperplasia
> Thromboembolism
Pulmonary fibrosis & pigmentation of skin
- Busulphan & Bleomycin FLUTAMIDE
Cardiotoxicity - Doxorubicin & Daunorubicin
Severe vomiting - Cisplatin, Doxorubicin Androgen receptor antagonist
Extravasation - Vesicant drugs like
Uses
doxorubicin, Vinblastine > Prostatic cancer
> gynecomastia, hot flushes
Management of cancer chemotherapy induced
adverse drug reactions

Nausea & Vomiting - Ondansetron

Bone marrow suppression - Filgrastim (CSF)
Methotraxate toxicity - Leucovorin
Cyclophosphamide toxicity - MESNa
Cisplatin toxicity - Amifostine
Doxorubicin toxicity - Dexrazoxane
Hyperuricemia ( rapid tumor cell lysis)
ALLOPURINOL

HORMONAL AGENTS
•GLUCOCORTICOIDS, ESTROGEN,
PROGESTINS
• SERM (Selective Estrogen Receptor
Modulators ) – TAMOXIFEN. TOREMIFENE
•SERD ( Selective Estrogen Down Regulators ) –
FULVESTRANT
•AROMATASE INHIBITORS – LETROZOLE,
ANASTROZOLE
•ANTIANDROGENS – FLUTAMIDE
•GnRH ANALOGUE – NAFARELIN
•5 ALPHA REDUCTASE INHIBITORS -
FINASTERIDE

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Biotherapy
What is Biotherapy?
A treatment with agents derived from
biological responses and sources.
A treatment of disease using
substances obtained or derived from
living organisms.
Approaches of Biotherapy
Active Immunotherapy
- giving tumor-bearing host agent that are
designed to elicit an immune response to
retard or eliminate tumor growth.
Specific
- immunization with tumor cell or tumor cell
extracts as antigens or vaccines.
Non-specific
- to boost overall immunity through
adjuvants.
Passive Immunotherapy
- administration or transfer of previously
sensitized immunologic reagents or immune
reactive cell to a tumor-bearing host.
Adoptive Immunotherapy
- transfer of sensitized cells.
Major agents used in
Biotherapy
Interferons (IFN)
Lymphokines-Interleukins (LI-2)
Hematopoeitic Growth Factor (HGF)
Monoclonal Antibodies (MoAb)
Radioimmunotherapy
Epidermal Growth Factor Receptor
- Tyrosine Kinase Inhibitor (EGFR-
TKI)
Angiogenesis Factor
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Interferons ( IFN )
> Is a family of glycoproteins hormones
possessing pleiotrophic biologic effects.
> 3 major classes
Alpha (IFN-α)
Beta (IFN-β)
Gamma (IFN-γ)
> IFN-α and IFN-β are produced by
leukocytes and fibroblast meanwhile IFN-γ
Is produced by T-Lymphocytes.
> IFN-γ is more potent in activating
macrophages.
> IFN have a wide range of biologic effects
including
•Antiviral
•Antiproliferative
•Immunomodulatory
> Antiviral: Renders uninfected cells
resistance to attack by the virus.
> Antiproliferative: Extends all phases of
the cell cycle and lengthens overall cell
generation time.
> Immunomodulatory: Increases the
potential of NK cells
> Low doses of IFN stimulate antibody
production and high doses have
suppressive effects.
> IFN has shown efficacy in tumors such
as melanoma, renal cancer cells, ovarian
carcinoma and superficial bladder
cancers.
> Route of Administration: IM, SubQ and
IV but also given intralesion,
intraperitoneal, intravesical, intraarterial
and intrathecal.
Side effects
> Flu-like symptoms, Fever (40°c),
Headaches, Myalgias, Arthralgias, Malaise,
Fatigue, Anorexia with weight loss
> IFN therapy have to be held or dose
reduced if the side effects became too
severe or chronic.
> Administered before bedtime
Patients with strong history
of CVD !!!
 Biotherapy
Interleukins (IL-2)
> Activates T-cells
> Supports the growth and maturation of
subpopulations of T-cells
> Stimulates cytotoxic T-cells and proliferation
and activity of NK cells
> LAK (Lymphosine Activated Killer) cells is the
basis for adoptive immunotherapy.
> IL-2 can reverse immunodeficiency
> Approved treatment of both renal cell cancer
and melanoma
> High doses by IV bolus every 8 hours for up
to 14 doses
Side effects
•chills, fevers, headaches, myalgias, arthralgias
and general malaise are given pretreatment
with acetaminophen and NSAIDs.
•major cardiovascular and pulmonary toxicity
have treatments of low-dose vasopressors
(dopamine or neosynepherine)
•nausea, vomiting, diarrhea and anorexia is
treated with multiple anti-emetics and
antidiarrheal agents.
•CNS toxicity may lead to coma and death if
therapy is discontinued.
Hematopoietic Growth Factor (HGF)
> a family of glycoproteins responsible for
proliferation, differentiation and maturation of
hematopoietic cells in vitro.
stimulates functions of certain mature leukocytes. cellular cytotoxicity
> Sargramostim (Leukine; GM-CSF) shortens time
to neutrophil recovery following chemotherapy
administration.
㎡
> 250 mcg/ /day
Side effects
bone pain, mild rash, transient-low grade fevers
and injection site reactions.
> Filgrastim (Neupogen; G-CSF) is focused on
after chemotherapy use as patients
demontrated a shorter duration of neutropenia,
fewer days of antibiotic therapy and a reduce
incidence and severity of mucositis.
5 mcg/kg until absolute neutrophil count
(ANC) recovery to normal or near normal
levels.
given 1-3 days after completion of
chemotherapy
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
> It's only drawback is the need of daily
dosing because of the kidney's rapid
clearance.
> Pegfilgrastim (Neulasta) increases
Filgrastim's molecular size which impairs
renal clearance and prolongs circulation
time and duration of action.
6 mg per chemotherapy cycle SubQ 1
to 3 days after chemotherapy.
Side effects: bone aches and pains
> Epoetin Alfa (Epogen, Procrit) is for
treatment of anemia in cancer patients.
> Darbepoetin Alfa (Aranesp) has a
longer half-life which allow for less
frequent dosing.
150 to 200 mcg subQ every 2 weeks
Side effects
fatigue, edema, nausea, vomiting
diarrhea, fever and dyspnea
> Oprelvekin or IL-11 (Neumega)
stimulates the growth and development
of megakaryocytes and platelets. It is
used to prevent severe chemotherapy
induced thrombocytopenia and to reduce
the need for platelet transfusions.
> are produced when an antigen invades
the body
> mediate an anti-tumor cytotoxic effect
through complement-dependent
cytotoxicity or antibody-dependent
> used to directly against cell surface
receptors involved in proliferation to
block or downgrade the number of
available receptors.
Monoclonal Antibodies (MoAb)
Rituxan (chimeric anti-CD20 MoAb
rituximab)
1. targets the CD20+ antigen found on the
surface of normal pre-B and B cells
including the malignant B cells of over
95% of non-Hodgkin's lytmphomas.
2. mediate antibody-dependent
cytotoxicity by human NK cells and
activate complement-dependent
cytolysis.
3. used as a frontline therapy for newly
diagnosed NHLs in combination with
CHOP chemotherapy. Response rate
increased to 95% to 100%
 Biotherapy
Trastuzumab (Herceptin)
1. the first for use in solid tumors
2. a recombinant DNA MoAb that
selectively binds to the HER2 protein
3. shifted trastuzumab-chemotherapy
combinations are first line treatment of
patients with HER2/neu-positive MBC
Gemtuzumab Ozogamicin (Mylotarg)
1. a MoAb targeted chemotherapy that
binds specifically to the CD33+ antigen
found on the surface myeloid leukemia
cells in more than 30% of patients with
AML.
㎡
2. treatment dose is 9 mg/ IV infusion
run over 2 hours, every 14 days, for 2
cycles.
Denileukin Difitox (Ontak)
1. a fusion protein; the receptor-binding
domain of IL-2 is fused to the diptheria
toxin to make a combination
MoAb/vaccine
2. targets activated T cells expressing
CD25 and releases a toxin that inhibits
protein synthesis and cell death
3. maximize tumor targeting while
minimizing potential side effect to
normal cells
4. used in the treatment of persistent or
recurrent cutaneous T-cell lymphoma
and other NHLs whose malignant cells
express the CD25 component.
5. Dosages of 9 to18 mcg/kg/day IV for 5
days every 21 days is prescribed
Alemtuzumab (Campath)
1. directed against CD52 cell surface
antigen
2. indicated for treatment of B-cell chronic
lymphocytic leukemia in patients who
have been treated with alkalyting
agents and have failed fludarabine
therapy.
3. 3 mg initial IV dose infused over 2 hours
daily until tolerated without reactions.
Doses are escalated to 30mg IV 3
times/week for 12 weeks.
4. antiinfection prophylaxis are given to
patients because the therapy may leave
patients at risk for infection.
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Bevacizumab (Avastin)
1. directly target vascular endothelial growth
factor (VEGF) and a ligand that attaches to
VEGF receptor, stimulating angiogenesis.
2. attaches to VEGF so that the receptors on
endothelial cells are unable to attach to
VEGF thus cannot stimulate growth and
survival and inhibits angiogenesis-
signaling cascade.
3. used a first line therapy for patients with
Metastatic Colorectal Cancer (MCRC) with
5-FU-based chemotherapy
4. 5 mg/kg IV every 2 weeks
Toxicities
bleeding, thrombosis, hypertension, diarrhea
and proteinuria.
Cetuximab (Erbitux)
1. chimeric immunoglobulin GI MoAb that
targets the extracellular domain of EGFR
with high specifity and affinity.
2. it inhibits ligand binding and thereby
inhibiting subsequent EGFR activation
㎡
3. doses of 400 mg/ IV over 2 hours as an
㎡
initial dose, followed by 250 mg/ IV over
1 hour weekly
4. Side effect: Acneiform Rash
5. patients are advised to limit sun exposure
and practice good skin hygiene
Radioimmunotherapy
combines radioactive isotopes such as
Iodine-131 (I-131) and Yttrium-90 (Y-90)
with a MoAb. Radioisotopes is carried to
the tumor by the MoAb that attaches to a
specific antigen present on the tumor cell
surface.
radiation is targeted to tumor with the
surrounding normal cells receiving less
radiation than if they were exposed to
external beam radiation therapy.
cancer cells are destroyed by the
combination of targeted radiation therapy,
biologic effects of MoAb and the crossfire
effect of the radiation.
 Radiation Therapy
Y-90 Ibritumomab Tiuxetan (Zevalin)
1. treatment for patients with relapsed or
refractory low-grade follicular or
transformed B-cell NHL
2. single treatment course on 2 days, 1
week apart, dosage is based upon the
patient's platelet count.
3. Y-90 only emits beta radiation and
doesn't penetrate outside the patients
body
4. patients are taught to wash hands
throughly and dispose any material
contaminated with body fluids for the
first 3 days. use condoms for a week
after treatment and avoid pregnancy
for 1 year after treatment.
Tositumomab I-131 (Bexxar)
1. emits beta and gamma rays
2. treatment for B-cell lymphoma in
combination with radiation therapy.
Side effects
hematologic toxicity, fatigue, fever,
nausea, vomiting, rash, pruritis and
infection.
Epidermal Growth Factor Receptor -
Tyrosine Kinase Inhibitor (EGFR-TKI)
EGFR is a growth promoting protein
found on the surface of many different
types of tumor cells including lung, breast,
and colon cancers.
EGFR-TKI is responsible for multiple
downstream signaling pathways
governing tumor growth.
Important treatment for patients whose
disease has progressed while receiving
chemotherapy and for who cannot
tolerate the toxicities
Getfinib (Iressa) and Erlotinib (Tarceva)
treatments of patients with advanced
Non-Small Cell Lung Cancer (NSCLC)
selectively inhibits the EGFR-TK activity
oral and taken once daily
non-smokers and women are more likely
to respond to this treatment
Side effects: skin toxicities, diarrhea,
opthalmologic toxicity
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Angiogenesis Inhibitors
Angiogenesis is the process of blood
vessel formation. Uncontrolled
angiogenesis is pathologic and may lead
to the development and progression of
malignant tumor.
Aclass of drugs that inhibits fromation of
blood vessels, thus cutting off the supply
of nutrients and oxygen to malignant
tumors, resulting to their death.
Thalidomide (Thalomid)
Inhibits basic fibroblast growth factor
(bFGF) and VEGF production
reversing the angiogenic switch.
A cytotoxic agent that inhibits
processing of mRNA that encodes
peptide molecules, TNF-α and
angiogenic VEGF
Steps for Thalidomide Education and
Precaution Safety (STEPS) was
developed to control and monitor
access to the drug due to it's
teratogenicity.
Taken orally at doses of 200mg/day
and escalated if tolerable.
Side effects: sedation,
lightheadedness, peripheral
neuropathy, constipation and skin
rash. Deep Venous Thrombosis (DVT)
is a serious complication so patients
are placed prophylactically on
anticoagulation either with warfarin
or low-molecular-weight heparin
Taken at bedtime and a good bowel
regimen
Considerations
Biotherapeutic agents are well tolerated
by geriatric patients
Many of the newest targeted therapies
are oral and have a very few side effects
For elderly patient receiving IFN or self-
injection biotherapy, assess their
willingness to learn as well physical
capabilities that may inhibit their ability
to learn
Hepatic and renal functions should be
assessed before and during the
treatment
Elderly patients are more at risk for
cardiac complications
Evaluate patient's medication profile to
detect drugs that maybe contraindicated
and may cause additional toxicity
 Radiation Therapy

TYPES OF RADIATION THERAPY & ADMINISTRATION

Potential sensitizer External Beam Radiation Therapy

Level (target)
or protector (Teletherapy)
Reactive oxygen
species UROD RNAi, amifostine, External beam radiation therapy is
Radicals pyridoxamine radiation delivered from a distant source,
from outside the body and directed at the
DNA damage patient's cancer site.
response Mirin, ATM/ATR inhibitors (e.g., KU-
double-stranded 55933), DT01
break recognition RS-1, R1, modulators of RAD51 Internal Radiation Therapy
homologous expression (Brachytherapy)
recombination DNA-PK inhibitors (e.g., NU7441,
repair salvicine) Brachytherapy involves placing radiation
NHEJ repair veliparib, olaparib sources as close as possible to the tumor
PARP site. Sometimes, they may be inserted
directly into the tumor.
Chromatin The radioactive sources or isotopes are in
organization Vorinostat, belinostat, panobinostat the form of wires, seeds (or molds), or
HDAC rods.
This technique is particularly effective in
treating cancers of the cervix, uterus,
Cellular response Chk1/Chk2 inhibitors, CDK4/6 vagina, rectum, eye, and certain head
Cell cycle arrest inhibitors and neck cancers. It is also occasionally
Mitogen signaling Cetuximab used to treat cancers of the breast, brain,
Pro-death signaling Pifithrin, GSK-3B inhibitors, anti- skin, anus, esophagus, lung, bladder, and
ceramide, prostate.
cytochrome c/cardiolipin complex
inhibitors

Tumor
microenvironment Statins
Inflammatory Salinomycin, thioridazine,
products homologous recombination
Tumor stem cells inhibitors
Hypoxia Carbogen, efeproxiral, tirapazamine
motexafin gadolinium, EZN-2968

Effects at tissue level

Angiogenesis Bevacizumab
Immune effects Anti-CTLA-4, anti-PD-1,IL-2 + SBRT
Gene therapy TNFerade,HSV-tk,G207
Cell repopulation Palifermin

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Radiation Therapy
GENERAL SIDE EFFECT

Skin
Wet desquamation from Radiation
Therapy
Dry desquamation from Radiation
Therapy
Abdomen
RINV: Radiation Induced Nausea and
Vomiting

INTERVENTIONS BY CANCER TYPE OR

RADIATION SITE

BREAST RADIATION
> Advise the patient to avoid bras with
underwires, nylon, or lace. Instead,
recommend a breathable cotton bra or
camisole. Tell patients they may use
deodorant but should avoid shaving the
armpits to avoid skin irritation.
HEAD AND NECK
> If the patient complains of dry mouth,
suggest an oral mouthwash, such as a
solution of 1 qt of water, 1 tsp of salt, and 1
tsp of baking soda. Instruct the patient to
swish it in the mouth and spit it out,
repeating several times a day. Some
patients may need a prescription
mouthwash. If appropriate, advise patients
to see a dentist before radiation treatment
starts to check for severely decayed teeth
or an oral infection, as these could be a
source of infection during treatment.
BRAIN TUMOR
> Assess the patient for neurologic
impairment, such as a change in level of
consciousness, speech, vision, balance, or
strength. Check for numbness, tingling, and
seizures. Recognize that any change from
baseline assessment findings requires
intervention.
BONE INVOLVEMENT
> Assess the patient’s pain level;
effectiveness of pain management
interventions; and extremity strength,
numbness, tingling, and range of motion.
Caution patients that a bone tumor impairs
bone integrity, setting the stage for
fractures.
PELVIC CANCER
> For younger patients with pelvic cancers
(both male and female), provide information
about sexuality and possible infertility before
radiation treatment begins. As appropriate,
teach them about banking sperm or egg-
harvesting options
NURSING MANAGEMENT
Patient & family education
Assessment & management of symptoms
Coordination of care
Providing emotional support
Allow patients to verbalize fears
EXTERNAL RADIATION THERAPY
What to expect during tx planning,
treatment & ff-up
Address patient & family’s questions
Inform patient about the use of oral/IV
contrast, tubes or catheters,
immobilization devices (if any)
Simple information, written copy
Provide emotional support
Patient safety & comfort
Tour in the treatment room
Atleast once a week meeting &
evaluation, esp. pt w/ special issues
BRACHYTHERAPY – Gynecological Cancers
Pt w/ LDR placed on low-fiber diets
Diphenoxylate atropine – to prevent a
bowel movement
Post-op pain – oral/IV medications

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Radiation Therapy
HDR
Provide instructions on possible side
effects, when to contact Dr, self-care
measures
Use of water-based lubricant
Routine vaginal dilatation – 1 year (if
not sexually active)
BRACHYTHERAPY – Breast Cancers
Educate about possible side
effects, S/Sx of Infx, when to call
Dr, Self-care including dressing
change
BRACHYTHERAPY – Head &
Neck Cancers
Minimize airway obstruction
Pain management
Oral care
Facilitate communication
Multidisciplinary care: dietary &
occupational consults
BRACHYTHERAPY – Prostate Cancers
Filter urine for dislodged
radioactive seeds
Condom use
Avoid close contact with
pregnant women & children for
designated period
Patient and family Instructions after
Samarium Injection
•The nurse informs them of what to expect
during treatment, planning, and follow-up.
•Some basic questions that should be
addressed.
•Let the patient know if oral or IV contrast
will be used, or if any tubes or catheters
will be necessary for planning .
•Inform them of any markings or tattoos
that they may expect.
•Patients may choose to have family
members or significant others present at
the time of consultation.
•If the patient is not capable of making
informed decisions a person who
isauthorized to do must be available.
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Weigh patients weekly on the same scale. If
appropriate, refer them to a dietitian. Be
aware that patients who have difficulty
swallowing and maintaining adequate
nutrition and hydration may need a
percutaneous endoscopic gastrostomy tube.
A dehydrated patient may require I.V. fluids.
Teach the patient to report dehydration signs
and symptoms, such as weakness, dizziness,
and decreased urine output. If the patient
reports diarrhea or vomiting, assess for
volume depletion and check orthostatic vital
signs and weight. Document the color of the
patient’s urine. Be aware that patients who
complain of dysuria may require a urinalysis
to rule out infection.
If your patient has prolonged watery diarrhea,
consult the primary healthcare provider about
ordering antidiarrheal drugs and perhaps a
low-residue diet.
Patients with prolonged nausea and vomiting
need anti nausea medication to prevent
dehydration.
BONE MARROW AND STEM
CELL TRANSPLANT
Bone marrow or Hematopoietic
Stem Cell
The soft spongy tissue found in the inner
cavities of the bone and peripheral blood.
Stem cell proliferate into mature
erythrocytes , leucocytes and platelets
Is a process of replacing diseased or
damage bone marrow with normally
functioning bone marrow
Used in the treatment of a wide variety of
malignant and nonmalignant diseases.
The 2 Main Types of Transplant
Autologous
Is a transplant in which the patient’s own
bone marrow or stem cells are collected
(harvested), placed in frozen storage
(cryopreserved) and reinfused into the
patient after the conditioning regimen.
The Patient is his own donor.
 Bone Marrow and Stem Cell
Allogenic
a transplant in which the patient’s
receives someone else’s bone
marrow or stem cells.

Types of Allogenic Transplant

Syngeneic
A patient is given stem cells from
their twin or triplet
Related
The donor related to the recipient’s,
usually a sibling
Unrelated
The donor is no relation to the Umbilical Cord Blood Stem Cells
recipient
Removed from the umbilical cord and
Sources of Stem Cells placenta after the baby no longer needs
them
Peripheral Blood ( PBSC) Birth, collected, tissue-typed,
Bone Marrow Processed and stored frozen
Umbilical Cord No access to donor
Unknown genetic disease
Bone Marrow Harvest Expensive!
Aspirated from the donor's pelvis.
This procedure occurs in the operating
room under patients general anesthesia.
Bone marrow is obtained by performing
multiple puntures with a large-bore
needle into the patient’s posterior and
occasionally the anterior iliac crests.
Less common

Diseases Treated with Hematopoietic

Stem Cell
Malignant:
1. Acute / Chronic Myelogenous
Leukemia(AML)(CML)
Peripheral Blood Stem Cells 2. Acute Lymphocytic Leukemia(ALL)
3. Juvenile Myelomonocytic Leukemia(JMML)
More Common
4. Myelodysplastic syndrome(MDS)
Requires growth factors (G-CSF)
5. Hodgkin’s disease
Apheresis procedure 6. Non-Hodgkin’s Lymphoma(NHL)
No anesthesia 7. Multiple Myeloma
Stem cells engraft faster 8. Renal Cell Carcinoma
Higher chance of GVHD 9. Neuroblasto ma
10. Testicular Cancer
11. Ewing’s Sarcoma

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Bone Marrow and Stem Cell
Diseases Treated with Hematopoietec AUTOLOGOUS TRANSPLANTATION
Stem Cell
First collect stem cells from donor
Malignant:
1. Conditioning Regimens: chemo +/-
Rhabdomyosarcoma
radiation
Wilm’s Tumor 2.stem cell infusion
Malignant Melanoma 3. Engraftment period
Lung Cancer
Brain Tumor ENGRAFTMENT PERIOD
Ovarian Cancer Bone Marrow ( 2-3 weeks )
PBSC may engraft as early as 5 days
Non malignant:
however, the average is 11-16 days
Aplastic Anemia
after stem cell reinfusion.
Myelofibrosis
Cord Blood takes 26 days but may
Wiskott-Aldrich Syndrome
take as long as 42 days to engraft
Severe Combined Immunodeficiency
During engraftment, patient
Syndrome(SCIDS)
experiences severe pancytopenia and
Munopolysacharoidosis
immunosuppression.
Osteopetrosis
Immediate complications include
Lipid Storage Diseases
infection and bleeding, and patient
Thalassemia
care focuses on prevention and early
Paroxysmal Nocturnal
treatment.
Hemoglobinuria
Patients typically receive antibiotics
and blood components during this
time.
GOAL: To shorten the length of the
pancytopenic period and curtail these
complications.

EARLY COMPLICATIONS

Acute GVHD
Bacterial & Viral Infection
Nausea & Vomiting
VENO-OCCLUSIVE DISEASE(VOD)
Pulmonary Complications
HLA TYPING Recurrence of disease

Donor and Recipient (Patient) Has LATE COMPLICATIONS

to Match Each Other
HLA-Matching. Gonodal dysfunction
We Have 6 numbers (3 from Father Growth Failure
+3 from Mother) Hypothyrodism
Brothers/Sisters Have the Highest Cataract
Chance to Match Secondary Malignancy
More Siblings You Have More Quality of life and Survivorship
Chance You Have to Match
If no matched sibling, Unrelated
matched person can be a donor

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Week 16:
CANCER OF THE AND GUT, BREAST, GYNECOLOGIC, LUNGS AND CNS

BRAIN TUMORS 4. MENINGIOMA

No definite prevention or screening - 30% of primary tumors

programs. - Originates from the arachnoid covering of
Early detection is a positive prognostic the brain
factor - 90% are benign & 10% are aggressive
EARLY AWARENESS OF SIGNS AND
SYMPTOMS LEAD TO... 5. SCHWANNOMAS

Early diagnosis - 8% of primary tumors

Fewer neurologic symptoms - Most common site of origin is the 8th nerve
Better outcomes (Acoustic neuroma)
- Develop from cranial nerve sheath
4 Most Common and Primary Brain
Tumors - Slow Growing
- Curable with surgery
Glioma
- Astrocytoma 6. PITUITARY TUMORS
- Oligodendroglioma
- Mixed Glioma - 7% of primary tumors
- Ependymoma - ADENOMA is the most common type
Meningioma
of pituitary tumor
Nerve Sheath Tumors
Pituitary - Slow growing
- Respond well with surgery, medical or
MOST COMMON SITES OF ORIGIN-GLIOMA radiotherapeutic
1.Cerebral hemispheres- 65%
frontal, parietal, temporal & occipital lobes GENERAL SYMPTOMS
2. Brain stem- 4%
3. Cerebellar - 3%
Increased ICP
4. Ventricular – 2%
Headache "+" in 50% of PTS
1. ASTROCYTOMAS Nausea and Vomiting
DIVISIONS ACCORDING TO WHO Papilledema
Changes in mental status
GRADE 1 – Pilocytic Astrocytoma Mental Slowness
GRADE 11 – Astrocytoma Inability to concentrate
GRADE 111 – Anaplastic Astrocytoma Seizures
GRADE IV – Glioblastoma Multiforme (GBM)
DIAGNOSIS OF BRAIN TUMORS
2. OLIGODENDROGLIOMA

- 10% of gliomas Physical Examination

- Most often low grade wth some malignant Blood Tests
features. Computed Tomography - CT Scan
MRI with contrast
3. EPENDYMOMA Magnetic Resonance Angiography
Spectoscopy
- 6% of gliomas Position Emission Tomography
- Develop in the walls of ventricles, slow growing (PET Scan )
and outcome improves with aggressive surgical
resection Functional MRI (fMRI)

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Neoplasms of the Brain
MOST COMMON COMPLICATIONS
MEDICAL TREATMENT MODALITIES
OF BRAIN TUMORS

1. SURGERY Increases ICP

Seizures
NURSING CONSIDERATIONS Mental Status Changes
1. Obtain client history Focal Neurologic signs
2. Perform physical examination DVT- deep vein thrombosis
3. Review and obtain consent form with PE- pulmonary embolism
the client
4. Discuss pre-operative routines MOST COMMON COMPLICATIONS
5. Discuss intraoperative therapies i.e. OF BRAIN TUMOR TREATMENTS
chemotherapy, local radiation therapy,
etc
6. Provide postoperative and discharge Intracranial Hemorrhage
plans Infection
7. Discuss rehabilitation needs, home Necrosis
care and scheduling follow ups Steroid Myopathy
8. It is pertinent that family members are
included during client information and Immunosuppression
management of disease. Cognitive Sequale

2. RADIATION THERAPY
SPINAL CORD TUMORS
NURSING CONSIDERATIONS
1. Use of RT must be explained before ABOUT FACTS…..
surgery
2. Risks and benefits are discussed 4% of central nervous system tumors
3. Client is informed about possible Benign or malignant
complications and what symptoms No known risk factors
should be reported immediately
4. Additional side effects of therapy
must be provided such as alopecia, PHYSIOLOGY
changes in saliva an taste alterations

3. CHEMOTHERAPY 1.EXTRAMEDULLARY
a. extradural-most common spinal
NURSING CONSIDERATIONS cord tumors
b. intradural – generally benign
1. Inform client that nausea and
vomiting are common side effects 2.INTRAMEDULLARY
in the beginning of therapy. - glial
2. Have emergency numbers ready for
office hours and after hours if
needed DETECTION

4. GENE THERAPY
EARLY DETECTION BEFORE
NURSING CONSIDERATIONS NEUROLOGIC DECLINE TAKES
PLACE
1. Obtain consent from the client EARLY DETECTION IS KEY TO
2. Withdrawal from the therapy will not INCREASED SURVIVAL AND
carry any consequences on the client if QUALITY OF LIFE
he experiences side effects

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Neoplasms of the Brain
RISK FACTORS
PATHOPHYSIOLOGY
Hereditary
Exposure to electromagnetic radiation Inhaled Carcinogens

TYPES
DNA is damaged
Extramedullary
Outside the cord and outside the dura
(extradural) Single Transformed Epithelial Cell
Outside the cord and inside the dura
(intradural)
Cellular Changes
Intramedullary
Inside the cord
Abnormal Cell Growth
SIGNS & SYMPTOMS

Pain Mutation
Weakness
Numbness
Bowel and bladder dysfunction
Developmental of Malignant Cell

DIAGNOSTIC TESTS
RISK FACTORS:
Cigarette Smoke (85%)
1. MRI Others (Radon Gas)
Occupational Agents
Environmental Agents
MEDICAL TREATMENT MODALITIES

1. SURGERY

NURSING CONSIDERATIONS

GOAL OF SURGERY IS
PRESERVATION OF NEUROLOGIC
FUNCTION

2. RADIATION THERAPY CLASSIFICATION & STAGING

SMALL CELL LUNG CANCER (SCLC)

LUNG CANCER
15% of tumors
"Bronchogenic Carcinoma" 2 Gen. Cell Types:
May be benign or malignant Small Cell
Primary within the lung, chest wall, Combined Small Cell
mediastinum NON-SMALL CELL LUNG CANCER (NSCLC)
Metastasis
Leading cancer killer among men and women 85% of tumors
1 out of 4 cancer deaths Squamous Cell (20%)
Each year more people die More centrally located
57% of patients with the diseases has spread Arise in segmental & subsegmental
to regional lymphatics and other sites by the bronchi
time of diagnosis
Long term survival rate is decrease (5 year
survival rate 17%)
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
 Lung Cancer
Large Cell (5%-Undifferentiated)
Fast growing
Arise peripherally
Adenocarcinoma (38%)
Most prevalent carcinoma in men
and women
Occurs peripheral masses or
nodules
Often metastasize
Others (cannot be classified -18%)
Bronchoalveolar
Found in terminal bronchi and
alveoli
Slow growing

NON-SMALL CELL LUNG CANCER (NSCLC)

Stage I
Earliest & has highest cure rate
Found in the lung , no spread RISK FACTORS
Stage II
Lung and nearby LN CIGARETTE SMOKING
Stage IIIA
Second-hand smoke (Passive
Lung + LN + middle of the chest smoking) -75%
1 side is affected Radon Gas
Stage IIIB Occupational and environmental
Tumor spread to the LN of other agents
side or LN above collar bone Respiratory illness (TB, COPD)
Stage IV Genetic predisposition
Cancer has spread to both lungs, Dietary deficits (high-dose retinoid
areas around lungs or distant b-carotene supplement
organs Asbestos exposure

Tobacco Smoke

23X higher in & 13X higher in

determined by pack-year history, age of
initiation of smoking, depth of -
inhalation, ta & nicotine levels
Younger age (higher risk)
smokers of smokeless products increase
their risk
Almost all of SCLC (most aggressive form
Grows quickly
Starts in airways (center)

Electronic cigarettes
SMALL CELL LUNG CANCER (SCLC)
> From electronic nicotine delivery system
Limited Stage Amount of nicotine & other substances a
Cancer is limited to one side person gets from each cartridge is
Treated with single radiation field questionable and vary
Extensive Stage
Cancers that has spread widely
throughout the lung, LN & other side
of chest or other parts of the body

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Lung Cancer
Second-hand smoke Fiberoptic Bronchoscopy
Commonly used to provide detailed
Aka Passive Smoking study of tracheobronchial tree
Cause of cancer in non-smokers Allows brushings, washings and
Involuntary exposure in an enclosed biopsies
environment FNAB
Higher risk of developing lung Under CT guidance
cancer Variety of scans
Bone scans, abdominal scans, pet
Environmental & occupational exposure
scan, liver utz, ct of brain, mri,
mediastinoscopy, endobronchial utz
Motor vehicle emissions & pollutants Preoperative
from refineries & manufacturing PFT, ABG analysis, V/Q scans,
plants exercise testing
Radon
Colorless, odorless gas found in the
soil & rocks
Arsenic, Asbestos, mustard gas,
chromates, coke oven fumes, nickel,
oil & radiation

Genetic Mutations

Inherited gene changes

Acquired gene changes
Often results to factors in the clinical envi MANAGEMENT
TP53 or p16 tumor suppressor genes
K-RAS or ALKoncogenes (NSCLC) 1. Medical Management
OBJECTIVE:
CLINICAL MANIFESTATIONS provide cure if possibleCrizotinib
(Xalkori)
1. Develops insidiously Ceritinib (Zykadia)target genetic
2. Asymptomatic until late course alterations
3. S&sx depend on the location and size, 2. Surgical Management
degree of obstruction & presence of Preferred method for localizedNSCLC,
mets no evidence of mets, adequate
4. M. freq sx cardiopulmonary function
5. cough/change in chronic cough CAD, pulmo, insufficiency & other
6. Dyspnea (prominent early ) from tumor comorbidities are contraindicated
occlusion in airway, pleural effusion, Bronchogenic ca are inoperable at the
pneumonia time of diagnosis
7. Hemoptysis
8. Chest or shoulder pain (chest wall or
pleural involvement)
9. Recurring fever

ASSESSMENT & DIAGNOSTIC

FINDINGS

1. CHEST X-RAY
2. PULMONARY DENSITY, PULMO
NODULE, ATELECTASIS & INFXN
3. Ct Scan f the Chest
4. Identify small nodules not visualized on
CXR & lymphadenopathy
5. Sputum Cytology
6. Rarely used

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Lung Cancer
RADIATION THERAPY
May offer cure in small percentage
Useful in controlling neoplasm that
cannot be surgically resected
Reduce the size of a tumor to make it
operable or to relieve pressure
Reduce symptoms of SC METS & SVC
COMPRESSION
PROPHYACTIC BRAIN IRRADIATION
(FOR MICROSCOPIC METS TO THE
BRAIN)
LEAD TO COMPLICATIONS
(esophagitis, fibrosis, pneumonitis)
NURSING INTERVENTIONS
1. Monitor patient's nutritional status
2. Check patients's psychological outlook,
fatigue level.
3. Check for signs of anemia and infection.
CHEMOTHERAPY
Used to alter tumor growth patterns,
treat distant METS OR SCLC & AS
ADJUNCT TO SURGERY/ADIATION
THERAPY
May provide relief (PAIN)
Accompanied side effects choice of
agent depends on growth of tumor
and SP phase of the cell cycle
In combination with symptoms
Neoadjuvant or Adjuvant
PALLIATIVE THERAPY
Concurrent with std onco care
May include radiation therapy to
shrink tumor size for pain relief
Bronchoscopic Interventions to open
narrowed airway
Evaluation & referral for hospice
care (comfortable and dignified end-
of-life care)
TREATMENT-RELATED
complications
SURGICAL RESECTION
Respi. Failure
Prolonged mech. Vent
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
RADIATION THERAPY
Diminished CP function
Pulmo fibrosis, pericarditis, myelitis,
Cor pulmonale
CHEMOTHERAPY
Pneumonitis
Pulmo toxicity
NURSING MANAGEMENT
1. Address the physiologic and
psychological needs of the patient
2. Strategies to ensure relief of pain and
discomfort
3. Prevent complications
4. Educate the patient and family about
potential s/e of specific treatments
with strategies to manage them
5. Airway clearance techniques to
maintain airway patency
Removal of excess secretions
Deep breathing exercise
Chest physiotherapy
Directed cough
Suctioning
Broncodilator meds prescription
Supplemental oxygen ( impaired
breathing pattern and poor gas
exchange)
6. Nursing measures to decrease dyspnea
Encourage patient to assume positions
to promote lung expansion
Perform breathing exercises for lung
expansion and relaxation
Px educ ation abt energy conservation
7. Reducing fatigue
8. Providing Psychological support &
identifying potential resources
Help deal with the prognosis &
relatively rapid progression of the
dse
Informed decision making re: txt
Maintain quality of life
End-of-life txt options
 Breast Cancer
Life-threatening malignancies that No clear association
develop in one or both breast
This type of cancer can be found in 1. Personality type
both women and men. 2. Abortion
Most common in women
3. Anti-perspirant
The most leading cause of cancer
illness among women. 4. Underwire bras
5. Electromagnetic fields
ETIOLOGY 6. Silicone breast implants
7. Caffeine
Unknown
Heterogenous disease 8. Hair dyes

RISK FACTORS PREDISPOSING FACTORS

1. Gender - > women Inherited mutation

2. Age – 40 y/o and older. Majority 50 y/o Genetics
3. Personal history of cancer – history of breast Environmental factors
cancer increases the risk of developing second
breast cancer. Tumor marker
4. Family history of cancer and genetics – one
first degree (mother, sister, daughter). 2.1 – 4.0 Carcinoembryonic antigen (CEA), CA
5. Hormonal factors – early onset menarche 13-3 and CA 27-29.
(before 12), late menopause (55 above). Total CA 15-3 and CA 27-29 maybe
lifetime exposure of the breast to estrogen and elevated in benign breast conditions
progesterone. Changes in the breast tissues
or inflammatory or malignant
every ovulation cycle.
conditions of epithelial organ.
6. Nulliparity
CEA can also be elevated in
7. First full term pregnancy after the age of 30.
smokers.
8. Oral contraceptives or hormone replacement
therapy.
9. Benign breast disease – never biopsied Sign and symptoms
fibrocystic disease
10. Obesity, dietary fat – postmenopausal women A lump, swelling or thickening in
11. Radiation exposure – ionizing radiation part of the breast or underarm.
12. Alcohol consumption – increased the number Dimpling, puckering or flattening
of circulating estrogen and androgen of the breast skin or nipple.
13. Proliferative lesion with atypia / atypical Skin irritation, redness, itching or
hyperplasia – increased growth of epithelial scaling of the breast.
cells in ductal or lobular tissue of the breast Changes in size, color or contour
of the breast.
Unusual nipple discharge,
Other factors especially if clear or bloody.
Socioeconomic Pain or tenderness of the breast.
Ethnicity Nipple discharge
Smoking Persistent crusting, ulceration or
Stress eczema type symptoms on the
nipple
Changes in breast size and shape
Changes in the skin of the breast

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Breast Cancer
DIAGNOSIS

Fine needle aspiration (FNA)

biopsy - dominant masses are
palpable
Core Needle Biopsy /
Stereotactic FNA – core of
tissue from dominant mass
Incisional Biopsy
Excisional Biopsy
PREVENTION Sentinel Lymph node biopsy
(SLNB)- removal of the lymph
Keep weight in check node that is first to receive
Be physicaly active
Avoid too much alcohol drainage from the site of a
Don’t smoke breast cancer.
Breast-feed if possible
Avoid birthcontrol pills, particularly after the TREATMENT
age of 35
Find out your family history. SURGERY
If high risk, consider risk-reducing CHEMOTHERAPY
medications RADIATION THERAPY
Prevention is better tha cure!!!!! HORMONAL THERAPY

Prophylactic Mastectomy STEPS

> unilateral or bilateral removal of the Normal
Breast.
1. While sitting or standing, raise each
strong family hx of BCA
biopsy proven, or benign breast dse. arm and examine the armpits for any
Personal hx of BCA lumps, because breast tissues extend
Woman with an identified mutation in to that area.
BRCA1 and BRCA2 or other breast cancer 2. Lie down on the back and place left
susceptibility gene.
hand behind the head with the
SCREENING middle finger on the right hand
gently yet firmly press down on the
BSE monthly by all women beginning at the breast area.
age of 20.
3. Gently squeeze the nipple, checking
Examine the breast for any lumps and
squeezing the nipple and checking for for any discharge, repeat the process
the discharge. on the right breast.
CBE
> every 3 years for ages between 20 – 39,
yearly for ages 40 and above.

Mammography
> routine screening mammography, every
year at the age of 40.
MRI

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Breast Cancer
SURGICAL PROCEDURES NURSING CARE PLANS

Simple mastectomy / Total Mastectomy Post Operative Nursing Diagnoses

> breast tissue are removed Impaired physical mobility
Radical mastectomy / Quadrantectomy Deficient knowledge
> breast, lymph nodes and pectoralis Disturbed body image
muscles are removed. Anxiety
Modified Radical Mastectomy Sexual dysfunction
> breast and lymph nodes are removed. Compromised family coping
Breast conserving. (Stage 1 and 2 BCA)
Lumpectomy MANAGEMENT
> excision of the lump. Reduce fear and anxiety
Educate
CHEMOTHERAPY Reducing potential complications
(infection , seroma , lymphedema ,
CYCLOPHOSPHAMIDE
(Cytoxan) paresthesia , pain in the axilla and arm,
METHOTREXATE impaired mobility of the arm)
(Mexetate) Relieving Pain and Discomfort
DOXURUBICIN Analgesics (oxycodone ,
(Adriamycin) acetaminophen , propoxyphene)
FLUOURICIL (5FU)
PACLITAXEL (Taxol) Excruciating pain must be reported
Warm shower
HORMONAL MANAGEMENT
NURSING CONSIDERATIONS
ADJUVANT THERAPY FOR EARLY
BREAST CANCER 1. Inform patient and family about the
TAMOXIFEN FOR 5 YEARS (PRE hospital and surgical routines.
AND POST MENOPAUSAL ) 2. Describe post operative activity so the
ANASTROZOLE AND LETROZOLE ( patient will be prepared to participate
POST MENOPAUSAL ) appropriately.
ADVANCED OR METASTATIC
CANCER 3. Reinforce the importance of early
TAMOXIFEN ambulation, coughing and deep
breathing.
RECONSTRUCTION 4. All intravenous access sites must be
placed on the non-operative sides
Silicone gel-filled implants
5. Monitor wound for swelling,
Capsular contracture – hardening of the
tenderness inflammation or purulent
scar tissue resulting in the firmness of the
drainage.
breast tissue.
6. Wound care- wound dressing when
Latissimus dorsi myocutaneous flap –
ordered using aseptic technique.
transfer of fats on the surface of the
7. Monitor drains, record amount and
latissimus dorsi and overlaying skin to the
color
anterior chest wall.
8. Assess for pain and discomfort and
Transverse rectus abdominis myocutaneous
administer medications as prescribed.
(pedicled or tunneled) flap (TRAM) – rectus
9. Provide information on expected
abdominis muscle
NORMAL sensation. (paresthesias,
Augmentation, mastopexy – (lifting of the
Phantom breast)
breast) or reduction of the remaining breast
to achieve symmetry

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Gynecologic Cancer
CERVICAL CANCER
CLASSIFICATION
EPIDEMIOLOGY
SQUAMOUS CELL CA= 80- 90%
1. 2nd most common cancer in women ADENOCARCINOMA = 10- 20%
worldwide
2. One of the leading causes of
morbidity and mortality in women
3. Seen in two main age groups:
30- 39 years
60 and 69 years
ETIOLOGY AND RISK FACTORS

Sexual practices
Tobacco use
Hormonal and diet factors
Immunosuppresion
Unavailability or lack of screening
Ethnicity
Diethylstilbestrol (DES) exposure in utero
Sexually transmitted diseases
PREVENTION CLINICAL FEATURES

1. Asymptomatic
Counseling
STD screening 2. Abnormal vaginal bleeding
Use of barrier types of contraceptives 3. Postcoital , intermenstrual or
Limiting the number of sexual partners postmenopausal bleeding
Discourage tobacco use 4. Increase in length and amount of
Anti HPV vaccine menstrual flow
5. Thin watery, serosanguineous or yellow
SCREENING and sometimes malodorous vaginal
discharge
1. PAP smear
2. HPV DNA testing LATE SYMPTOMS
3. Conventional or liquid-based cytology Dysuria
Urinary retention
Urinary frequency
Hematuria
Hydronephrosis
Bowel symptoms
Edema to the lower extremities
Pelvic or sciatic pain

DIAGNOSTIC TESTS
Chest and skeletal radiographs
IV pyelography
DETECTION Barium enemas
Blood chemistry studies
History Cystoscopy
Bimanual PE Rectosigmoidoscopy
Clinical examination CT and MRI
Rectal exam PET
Colposcopic exam Biopsy

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Gynecologic Cancer
TREATMENT CLASSIFICATION

1. SURGERY ADENOCARCINOMA- >80%

Cryotherapy CLEAR CELL CA
Laser therapy PAPILLARY SEROUS
Loop electrosurgical excisional MUCINOUS
procedure (LEEP) SQUAMOUS CELL CA
Conization
Modified radical hysterectomy CLINICAL FEATURES
2. RADIATION THERAPY Abnormal vaginal bleeding
3. CHEMOTHERAPY Serosaguineous vaginal discharge
Pain
ENDOMETRIAL CANCER
DIAGNOSIS
EPIDEMIOLOGY
1. Most common gynecologic 1. PE
malignancy 2. Tissue sampling
2. 4th most common cancer in women 3. Radiography
3. Affects postmenopausal aged 55 – 4. Laboratory studies
70 years 5. CA -125 level

ETIOLOGY AND RISK FACTORS

Unknown
Hereditary
High cumulative exposure to estrogen
Estrogen replacement therapy
Obesity
Nulliparity
Late menopause
Irregular menstrual history
Failure to ovulate TREATMENT
History of infertility
History of tamoxifen use SURGERY
Hereditary nonpolyposis colon cancer TAH-BSO
(HNPCC) Pelvic and para-aortic lymphadenectomy
Omental biopsy
PREVENTION
RADIATION THERAPY
Oral contraceptive use HORMONAL THERAPY
Control obesity, DM and HPN CHEMOTHERAPY
Add progesterone to estrogen
replacement
Avoid tamoxifen use and high fat diet
SCREENING TESTS

None for asymptomatic women

Endometrial biopsy
Physical exam
Rectal exam

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Gynecologic Cancer

OVARIAN CANCER CLINICAL FEATURES

EARLY SYMPTOMS
EPIDEMIOLOGY GI distress
Dyspepsia
1. 5th most common cancer in women (U.S.)
2. 4th leading cause of death from Abdominal discomfort*
malignancy in women Back pain
3. Peak incidence: bet 60- 64 years Loss of appetite
4. Seen bet. 40 and 65 years Changes in bowel habits
Bloating*
ETIOLOGY AND RISK FACTORS Eructation
Increase in pelvic pressure
Unknown Vaginal bleeding
Low parity/ nulliparity LATE SYMPTOMS
Early menarche Palpable abdominal mass
Late menopause Ascites
Environmental factors Weight loss
Genetic factors N and V
History of PID Intestinal obstruction
Low serum gonadotropin Vaginal bleeding
Prior use of talc
Family hx of breast and ovarian cancer
Lives in industrialized countries
Jewish descent

PREVENTION

None
Prophylactic oophorectomy

SCREENING METHODS

1. Pelvic examinations DIAGNOSIS

2. Tumor markers (CA-125) 1. Exploratory laparotomy
3. Pelvic ultrasonography 2. Specimens for cytology and biopsies
4. Transvaginal ultrasound
TREATMENT
DETECTION
SURGERY
Bimanual palpation TAH-BSO
CXR CHEMOTHERAPY
CT scans RADIATION THERAPY

CLASSIFICATION

Epithelial tumors- 90%

Nonepithelial tumors- 10%

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Gynecologic Cancer
4. Cystoscopy
VULVAR CANCER 5. IVP
6. Barium enema
7. Proctosigmoidoscopy
EPIDEMIOLOGY

Uncommon disease TREATMENT

ETIOLOGY AND RISK FACTORS 1. SURGERY

Wide local excision
Unknown Skinning vulvectomy
HPN 2. RADIATION THERAPY
DM 3. CHEMOTHERAPY
Obesity
HPV type 16 VAGINAL CANCER
Venereal warts
HSV 2 EPIDEMIOLOGY
Syphilis 1. Rare
Multiple sexual partners 2. Less than 2%
Chronic vulvar disease 3. Age 50- 70 years
Hx of smoking
Hx of immunosuppression
Age > 60 years
Previous malignancy of the genital tract
PREVENTION ANG SCREENING

1. PAP smear
2. Careful examination of the female
genitalia
DETECTION ETIOLOGY AND RISK FACTORS
1. Complete hx and PE Unknown
2. Colposcopy HPV
Prior radiation therapy
CLASSIFICATION
Abdominal hysterectomy
SQUAMOUS CELL CA- 90% DES exposure in utero
Age
CLINICAL FEATURES
CLASSIFICATION
Vulvar pruritus
SQUAMOUS CELL CA- 85%
Irritation
Mass in the vulvar area CLINICAL FEATURES
Vulvar bleeding Abnormal vaginal bleeding
Discharge Vaginal discharge
Dysuria Dysuria
Palpable mass
DIAGNOSIS Pain in the perineum
Urinary retention w/ spasms
1. Wedge biopsy Hematuria
2. CXR Blood in the stool
3. CT/ MRI Constipation

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Gynecologic Cancer
DIAGNOSIS TREATMENT

1. HX AND PE SURGERY
2. Colposcopy w/ biopsy TAH-BSO
3. Cytologic evaluation Node dissection
4. Imaging studies RADIATION THERAPY
5. Blood studies CHEMOTHERAPY

TREATMENT
KIDNEY CANCER
Surgery
Radical Vaginectomy
> Also called RENAL CANCER
Radical Hysterectomy > Almost all kidney cancers first appear in the
Pelvic Lymphadenectomy lining of the tubules in the kidney.
Radiation Therapy > This type of kidney cancer is called RENAL
Chemotherapy CELL CARCINOMA.
> In adults, RENAL CELL CARCINOMA, is the
FALLOPIAN TUBE CANCER most common type of kidney cancer. However,
other less common types of kidney cancer can
EPIDEMIOLOGY occur.
> In young children, the kidney cancer more
1. 1% of all gynecologic tumors likely to develop is WILM’S TUMOR.
2. Mean age: 55
ETIOLOGY AND RISK FACTORS SYMPTOMS OF KIDNEY CANCER

Unknown Kidney cancer usually does not have signs or

Chronic tubal inflammation symptoms in its early stages.
Infertility Blood in the urine, which may appear pink,
Salpingitis red or cola colored
Tubal endometriosis A lump in the side or abdomen
Mutations in BRCA 1 or 2 gene Pain at the back or side that does not go
CLASSIFICATION away
Loss of appetite
Papillary serous adenocarcinoma- 90% Unexplained weight loss
Extreme fatigue or tiredness
CLINICAL FEATURES Fever that lasts for weeks and isn't caused
by a cold or other infection
LATZKO TRIAD OF SYMPTOMS (15%) Swelling in the ankles or legs
Pelvic pain
Pelvic mass RISK FACTORS
Intermittent, profuse serosanguineous
vaginal discharge 1. Older age
2. Being male
DIAGNOSIS 3. Smoking
4. Being obese
HX AND PE 5. Having high blood pressure
Imaging studies 6. Using certain pain medications for a long time
7. Treatment for kidney failure
CA-125 8. Having certain GENETIC CONDITIONS
9. Having a FAMILY HISTORY of kidney cancer

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Genitourinary Cancer
10. Being exposed to carcinogenic chemicals
11. Having LYMPHOMA
PREVENTING KIDNEY CANCER
1. Quit smoking
2. Avoid being exposed to HARMFUL
CHEMICALS.
3. MAINTAIN A HEALTHY BODY
WEIGHT.
◦ Proper food intake
◦ Reduce the number of calories
consume each day
◦ Be physically active most days of the
week.
◦ Seek professional help
4. CONTROL HIGH BLOOD PRESSURE
◦ Change lifestyle.
◦ Exercise
◦ Weight loss
◦ Diet change.
◦ Medication compliance
DIAGNOSING KIDNEY CANCER
URINE TESTS
Check presence of blood in the urine or other
signs of kidney problems.
BLOOD TESTS
Show how well the kidneys are working.
Ex: Albumin-creatinine ratio(ACR) or
Glomerular filtration rate (GFR)
INTRAVENOUS PYELOGRAM (IVP)
Involves x-raying the kidneys after injecting a
dye that travels to the urinary tract,
highlighting any presence of tumors in the
kidney.
ULTRASOUND
Uses sound waves to create a picture of the
kidneys. It can help tell if a tumor is solid or
fluid-filled.
CT SCAN
Uses x-rays and a computer to create a series
of detailed pictures of the kidneys. This may
also require an injection of dye.
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
MAGNETIC RESONANCE IMAGING (MRI)
Uses strong magnets and radio waves to
create detailed images of soft tissues in the
kidney. A contrast agent may be injected to
create a better pictures of the kidney
structures.
RENAL ARTERIOGRAM
Use to evaluate the blood supply to the
tumor. It is not given often, but may help in
diagnosing small tumors.
Staging cancers – tnm descriptions
T - Tumor
The letter "T" plus a number (0 to 4)
describes the size and location of the
tumor, including how much the tumor has
grown into nearby tissues.
For some types of cancer, lowercase
letters, such as “a,” “b,” or "m" (multiple),
are added to the “T” category to provide
more detailed descriptions. Ex: T1a
N – Node
The letter "N" plus a number (0 to 3)
stands for lymph nodes.
Regional lymph nodes - if near the cancer
where it started.
Distant lymph nodes – if lymph nodes is in
other parts of the body
M – Metastasis
The letter "M" indicates whether the
cancer has spread to other parts of the
body,
Cancer standard treatment
SURGERY (local)
RADIATION (local)
HORMONAL THERAPY (systemic)
CHEMOTHERAPY (systemic)
TARGET THERAPY (systemic)
 Genitourinary Cancer
TREATING KIDNEY CANCER
1. SURGERY
1.1. Radical nephrectomy
Surgical removal of the kidney, adrenal
gland, surrounding tissue and nearby
lymph nodes. It is the most common
surgery for kidney cancer and can now
be done through a small incision with a
laparoscope.
1.2. Simple nephrectomy
Surgical removal of the kidney only.
1.3. Partial nephrectomy
Surgical removal of the cancer in the
kidney along with some tissue around
it. This procedure is used for patients
with smaller tumors (less than 4 cm) or
in those patients in which a radical
nephrectomy might affect the other
kidney.
2. RADIATION THERAPY
Uses high-energy x-rays or other types of
radiation to kill cancer cells or stop their
growth.
2.1. EXTERNAL BEAM RADIATION
THERAPY
Comes from a machine that aims
radiation at the cancer.
2.2. Internal radiation therapy
Source of radiation is put inside the body
in the form of solid or liquid.
Brachytherapy – when solid source is
used
3. BIOLOGIC THERAPY
(IMMUNOTHERAPY)
Uses the immune system to fight cancer
by boosting, directing, or restoring the
body's natural defenses
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Substances for biologic therapy are made by the
body or in a laboratory.
Takes some of the patient’s own immune
cells, genetically engineers them in a
laboratory to fight prostate cancer and then
injects the cells back into the patient’s body
through the vein.
Examples of biologic therapy for metastatic
kidney cancer
Interferon alpha
Interleukin-2.
4. TARGETED THERAPY
Uses drugs or other substances to target
specific molecules involved in the growth
and spread of cancer cells.
Blocking these molecules may kill cancer
cells or may keep cancer cells from growing
or spreading.
This therapy causes less harm to normal cells
and may have fewer side effects than other
types of cancer treatment.
1. Anti-angiogenic agents.
2. Multikinase inhibitor
3. Tyrosine kinase inhibitors.
4. M-TOR inhibitors.
Other treatment options to destroy the tumor:
1. Cryotherapy
> Uses extreme cold to kill the tumor.
2. Radiofrequency ablation
> Uses high-energy radio waves to "cook" the
tumor.
3. Arterial embolization
> Uses small particles injected into an artery
or vein through a catheter that leads to the
kidney to block the blood flow to the tumor.
This may be done to shrink the tumor before
surgery.
 Genitourinary Cancer
BLADDER CANCER

Cancer found in the urinary bladder

It is more common in people older than 50-
year old, and affects men more often than
women (4:1).
According to the WHO data published in
2018 bladder cancer deaths in Philippines
reached 469 or 0.08% of total deaths.
Philippines ranks #174 in the world in the
number of bladder cancer deaths.
Bladder cancer most often begins in the
UROTHELIAL CELLS that line the inside of
the bladder. DIAGNOSING BLADDER CANCER
Urothelial cells are also found in the
kidneys and ureters 1. BIMANUAL EXAMINATION OR PELVIC
Urothelial cancer can also happen in the EXAMINATION UNDER ANESTHESIA
> Internal exam in the rectum and/or
kidneys and ureters, but it's much more vagina are perform to feel for the
common in the bladder presence of tumors in the bladder.
Cancers arising from the prostate, colon,
and rectum in MEN and from the lower
gynecologic tract in WOMEN may
metastasize to the bladder

CLINICAL MANIFESTATION

1. Bladder cancer signs and symptoms may

include:
2. Hematuria which makes urine to appear
bright red or cola colored
3. Frequent urination and urgency
4. Painful urination
5. Back pain 2. URINE ANALYSIS
3. CYSTOSCOPY
6. Any alteration in voiding or change in the
urine is indicative.
◦ Uses a cystoscope to look inside the
urethra and bladder to determine the
cause of bladder problems.
◦ Blood in the urine
◦ Painful urination
◦ Frequent urination
◦ Urinary retention
◦ Recurrent bladder infections
◦ Pelvic pain

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ACADEMICIAN HEAD
 Genitourinary Cancer
BLADDER CANCER can be described based on
4. BIOPSY how far they have spread into the wall of the
Involves taking a small sample of tissue
bladder:
from the bladder to be examined under
a microscope
Biopsy of the tumor and adjacent
mucosa are definitive diagnosis for
cancer, however, cystoscopy is the
mainstay of diagnosis

1. NON-INVASIVE CANCERS

> grow only in the inner layer of the cells

5. UROGRAPHY
> imaging of the kidneys, ureters and
bladder.
6. EXCRETORY UROGRAPHY
(INTRAVENOUS PYELOGRAM (IVP))
> Urography that uses imaging and
contrast material to evaluate or detect
blood in urine, kidney or bladder stones,
and cancer in the urinary tract.
7. CT and MR UROGRAPHY
> Proven effective in detecting urinary
tract cancer and other bladder problems.
8. ULTRASONOGRAPHY
> An ultrasound scan using high-
frequency sound waves to capture live
images from the bladder for medical
analysis.
9. URINE CYTOLOGY:
> A microscope is used to look
for cancer cells in the urine. However, it's
not reliable enough to make a good
screening test.
> A research study findings said that a
combination of cystoscopy and urine
cytology can improve bladder tumor
detection rates and lower the number of
unnecessary biopsies.
(transitional epithelium) and not into the
deeper layers.
2. INVASIVE CANCERS
> grow into deeper layers of the bladder wall
and more likely to spread thus harder to treat.
3. SUPERFICIAL OR NON-MUSCLE
INVASIVE
> include both non-invasive and invasive
cancers that have not grown into the main
muscle layer of the bladder.
4. METASTATIC CANCER
> is cancer that spreads from its site of origin
to another part of the body.
BLADDER CANCERS can be categorized
based on how they grow.
1. Papillary carcinoma
> grows in slender, finger-like projections
from the inner surface of the bladder toward
the hollow center.
> It is called non-invasive papillary cancer or
papillary urothelial neoplasm of low-malignant
potential (PUNLMP).

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ACADEMICIAN HEAD
 Genitourinary Cancer
This type of cancer is slow growing
or does not grow into the deeper
bladder layers, thus it has a very
good prognosis.
2. FLAT CARCINOMA
> It does not grow toward the hollow part
of the bladder.
2.1. Non-invasive flat carcinoma
2.2. Flat carcinoma in situ (CIS)
> Tumor is only in the inner layer of
bladder cells
2.3. Invasive papillary or flat cancer
> Tumor grows into deeper layers of the
bladder
Types of bladder cancer include:
1. Urothelial carcinoma
2. Squamous cell carcinoma
3. Adenocarcinoma
UROTHELIAL CARCINOMA,
previously called Transitional Cell
Carcinoma (TCC).
It is by far the most common type
of bladder cancer. If a bladder
cancer is diagnosed it is almost
certain to be a urothelial
carcinoma.
The urothelial cells also line the
inside of the kidney, ureters and
the urethra, so cancers can also be
formed in those areas.
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
SQUAMOUS CELL CARCINOMA
It is associated with chronic irritation of
the bladder such as infection or long-term
use of a urinary catheter.
It is rare but common in parts of the world
where a certain parasitic infection
(schistosomiasis) is a common cause of
bladder infections.
ADENOCARCINOMA
is a rare cancer that begins in cells
that make up mucus-secreting
glands in the bladder.
TREATING BLADDER CARCINOMA
Treatment of bladder cancer depends
on the following:
Grade of tumor
Stage of tumor growth
Multicentricity of the tumor.
Age and physical, mental, and emotional
status of patient
In general, the main treatment options for
bladder cancer are:
◦ Surgery
◦ Radiation therapy
◦ Immunotherapy (local and systemic)
◦ Chemotherapy
◦ Targeted therapy
STAGES AND TREATMENT
Stage 0a
> It is a noninvasive papillary carcinoma that
grow only on a small section of bladder
tissue.
1. Low grade non-invasive
This cancer may recur
2. High-grade non-invasive
This cancer is more likely to recur and grow
Treatment STAGE 0a – low
grade non-invasive
TURBT (Transurethral Resection of Bladder
Tumor).
> A surgical operation to remove early cancer
in the bladder with the use of a resestoscope.
 Genitourinary Cancer
INTRAVESICAL CHEMOTHERAPY or LOCAL
IMMUNOTHERAPY
It is often done within 24 hours after the TURBT
procedure.
The goal is to kill any cancer cells that may be
left in the bladder and reduce the risk of future
tumors in developing.
INTRAVESICAL THERAPY PROCEDURE
A liquid drug is put into the bladder through
a soft catheter via the urethra.
The drug stays in the bladder for up to 2
hours.
This way, the drug can affect the cells lining
the inside of the bladder without having
major effects on other parts of the body.
Stage 0is – CARCINOMA IN SITU
The cancer cells are only found on or near
the surface of the bladder.
It also called non-muscle-invasive bladder
cancer, superficial bladder cancer, or non-
invasive flat carcinoma.
This type of bladder cancer often comes
back after treatment, usually as another
non-invasive cancer in the bladder.
The tumor has spread to the connective tissue
(lamina propria) that separates the lining of the
bladder from the muscles.
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Treatment: STAGE 0a-high grade non-
invasive
STAGE 0is and STAGE I
1. TURBT
> Transurethral Resection of Bladder
Tumor
2. radical cystectomy
> A surgical removal of the whole
bladder to prevent the tumor to recur
In MEN, it includes removal of the
prostate and seminal vesicles.
In WOMEN, it includes removal of
the uterus, ovaries and part of the
vagina.
Procedures after cystectomy
ileal conduit
An option for urinary diversion after
cystectomy using a short segment of
the small intestine and places it at an
opening on the surface of the
abdomen to create a mouth, or
stoma.
Continent urinary diversion
An internal pouch is made to hold
the urine allowing the patient to
control (be continent)
when urine comes out.
Orthotopic neobladder
A new reservoir is constructed using
various segments of intestine, ileum
and colon to allow the patient to
urinate voluntarily and maintain
continence .
 Genitourinary Cancer
Treatment: STAGE 0a-high grade
noninvasive STAGE 0is and STAGE I

3. LOCAL INTRAVESICAL
IMMUNOTHERAPY using Bacillus
Calmette-Guerin (BCG)
To reduce the risk of recurrence and the
development of muscle-invasive
disease.
The first round of BCG treatment is
given every week for 6 weeks.
Then, cystoscopy and sometimes a
bladder biopsy is perform to see if all of
the cancer has been eliminated.
If the cancer is gone, the patient usually Stage iII – FATTY TISSUE
have maintenance therapy with BCG, INVASIVE cancer
◦ once every 3 months for the first 6
months The tumor has grown into the fatty
◦ once every 6 months tissue that surrounds the bladder).
◦ once every 1 to 3 years. T3a: the tumor has grown into the
◦ Followed with long-term surveillance. fatty tissue (perivesical tissue), as
seen through a microscope.
4. Pembrolizumab (Keytruda) T3b: the tumor has grown into the
A humanized antibody used in cancer fatty tissue macroscopically.
immunotherapy.
Used when the patient is unresponsive to
BCG treatment (“BCG-unresponsive”) or
when radical cystectomy cannot be
performed because of other medical
reasons or the patient chooses not to have
surgery.

Stage II – MUSCLE INVASIVE

cancer
The tumor has spread to the muscle of
the bladder wall.
T2a - the tumor has spread to the inner
half of the muscle of the bladder wall,
which may be called the superficial
muscle.
T2b: - the tumor has spread to the deep
muscle of the bladder (the outer half of
the muscle).
Treatments FOR STAGE II
and STAGE III
1. NEOADJUVANT CHEMOTHERAPY
A systemic chemotherapy given before
surgery to shrink the tumor in the bladder
or destroy microscopic cancer cells that
have spread beyond the bladder.
2. RADICAL CYSTECTOMY

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ACADEMICIAN HEAD
 Genitourinary Cancer
3. TRIMODAL THERAPY (TMT) (Bladder
Preservation Approach) URETERAL CANCER
An approach using chemotherapy with Cancer found in the ureters
radiation therapy using Cisplatin alone or a Begins in the cells that line the inside
combination with Mitomycin-C and Fluorouracil of the ureters
(5-FU). It affects both MEN and WOMEN but
4. TURBT it is uncommon
Used to determine the extent of the cancer, It occurs most often in older adults and
rather than as a treatment. in people who have previously been
treated for bladder cancer.
Stage IV – metastatic
bladder cancer SIGNS AND SYMPTOMS

The tumor has spread to other parts of the Blood in urine

body. Back pain
T4a: the tumor has spread to the MAN’s Pain when urinating
prostate or seminal vesicle, or the Losing weight without trying
WOMAN’s uterus or vagina Fatigue
T4b: the tumor has spread to the pelvic wall
or the abdominal wall. RISK FACTORS
Increasing age ( 70s-80s)
Smoking
Previoud bladder and kidney
cancer

DIAGNOSTIC TESTS & PROCEDURES

Imaging tests
To help assess the extent of the
ureteral cancer.
Intravenous pyelogram (IVP)
CT urography
Detect blood in urine, kidney or
Treatment for stage IV bladder stones, and cancer in the
urinary tract.
CLINICAL TRIALS Magnetic resonance urogram
> are often the best treatment option for Produce detailed pictures of the
most patients. kidneys, ureters and bladder
GOALS FOR treatment
To slow the spread of cancer.
To shrink the tumor.
To help relieve symptoms through
palliative care.
To extend life for as long as possible and
make them feel better

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ACADEMICIAN HEAD
 Genitourinary Cancer
Urine tests TREATING URETERAL CANCER
Determine abnormalities in the
urine.
1. Surgery
Urinalysis
Ureterectomy – surgical removal of a
Urine cytology
portion or all parts of ureter
Ureteroscopy
nephroureterectomy – surgical
An invasive procedure that uses
removal of ureter and/or a portion of
a URETEROSCOPE to look
inside the ureters and kidneys. the bladder.

2. Chemotherapy to kill cancer cells.

Stages of ureteral cancer Chemotherapy before surgery is to
shrink the tumor and make it easier
to remove during surgery.
Stage 0, 0a and 0is Chemotherapy after surgery is to kill
The tumor is only in the lining of the ureter. any cancer cells that remain in the
area.
Stage 1
URETHRAL CANCER
The tumor has grown through the lining into
the connective tissue layer of the ureter. 1. Cancer that occurs in the urethra.
2. urethra is a tube that connects the
Stage 2 bladder to the urinary meatus,
allowing urine to exit the body.
The tumor has grown through the
connective tissue and into the muscle layer 3. In WOMEN, the urethra is about
of the ureter. 1.5 inches long and emerges above
the vaginal opening.
Stage 3 4. In MEN, the urethra is about 8
inches long, travels through the
The tumor has grown through the muscle
layer and into the kidney or fat that penis and prostate
surrounds the ureter.
SYMPTOMS ASSOCIATED
Stage 4
Abdominal pain
The cancer cells has spread to other organs
Increased urinary or urgency
Difficulty urinating
Pain during urination
Blood in urine
Blood in semen
TYPES OF URETHRAL CANCER

1. Adenocarcinoma
occurs in the glands around the
urethra
2. Squamous cell carcinoma
In WOMEN, it develops in the urethral
cells near the bladder
In MEN, it affects the urethral lining in
the penis.

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ACADEMICIAN HEAD
 Genitourinary Cancer
3. Transitional cell carcinoma
In WOMEN, it develops in the area
near the urethral opening
In MEN, it passes through the
prostate gland
RISK FACTORS
1. Over age 60
2. Had previous bladder cancer
3. Had frequent urinary tract infections
4. Had sexually transmitted diseases
5. Had been exposed to human
papillomavirus (HPV)
HPV vaccine
Recommended for girls and boys at
ages 11 or 12. Although it can be
given as early as age 9
Gardasil 9 HPV vaccine
Recommended for males and
females ages 9 to 45.
STAGES OF URETHRAL CANCER
Stage 0a and 0is:
Abnormal cells are inside the lining of
the urethra
Stage 1:
Cancer has spread to the connective
tissues underneath the lining of the
urethra.
Stage 2:
Cancer spread in the muscle around the
urethra.
For MEN, the penile tissue that
surrounds the urethra may be involved
Stage 3:
Cancer has spread beyond the urethra.
In WOMEN, it spread in the vagina,
vaginal lips or nearby muscle
In MEN, it spread in the penis or nearby
muscle.
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Stage 4:
Cancer has spread to other organs of the
body (nearby/distant lymph nodes in the
pelvis and groin; lungs; liver; and bone.
DIAGNOSING URETHRAL CANCER
Medical Exam
Taking medical history
Physical exam
In WOMEN, a pelvic exam will be
performed to determine the size and
shape of the uterus and ovaries.
MEN and WOMEN may undergo a
digital rectal exam to test for lumps or
skin thickening that could indicate
potentially cancerous cells.
Laboratory Testing
Tissue, blood and urine tests will be
done to inspect abnormal cells that
may indicate presence of cancer.
Imaging TESTS
MRI
Intravenous urography (IVU)
Computed Tomography (CT) Scanning.
Urethrography
To determine the extent of cancer cells in
the urethra
Cystoscopy
Uses cystoscope to look inside the urethra
and the bladder
TREATING URETHRAL CANCER
1. Surgery
1.1. Electro-resection with fulguration
Uses a tool that transmits electric
current to burn away cancerous cells
without surgical incision.
Use for superficial cancers that have not
yet spread to surrounding tissues.
1.2. Laser surgery
Uses a laser beam to remove or destroy
cancerous tissue.
Most often used on superficial tumors
that have not spread significantly.
 Genitourinary Cancer
1.3. Radical penectomy
Surgical removal of the entire penis
Performed when the cancer has
spread beyond the urethra and deep
into a man's erectile tissues.
Reconstructive procedures are
possible and a new opening for the
urethra can be created to allow
proper urine flow.
1.4. Partial penectomy
Surgical removal of the head of the
penis.
Performed when the cancer affects
only a portion of the male urethra
and enough tissue can be spared so
that a man can still urinate while
standing.
1.5. Cystoprostatectomy
A combination of cystectomy and
prostatectomy to
Remove the urethral cancers that
extend to the bladder and prostate
gland.
1.6. Cystourethrectomy
A combination of cystectomy and
urethrectomy for invasive cancers
that affect the urethra and the
bladder
1.7. Anterior exenteration
A surgery that removes the organs
from the urinary and gynecologic
systems.
2. Radiation Therapy
3. Chemotherapy
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
TESTICULAR CANCER
Cancer that occur in the testicles
(testes).
Rare but is the most common cancer
in American males between the ages
of 15 and 35.
It usually affects only one testicle
It is highly treatable, even when
cancer has spread beyond the
testicle.
SIGNS AND SYMPTOMS
Lump or enlargement in either
testicle
Feeling of heaviness in the scrotum
Sudden collection of fluid in the
scrotum
Pain or discomfort in a testicle or the
scrotum
Dull ache in the abdomen or groin
Enlargement or tenderness of the
breasts
Back pain
RISK FACTORS
1. Family History
2. Age
It affects teens and younger men
between ages 15 and 35. However, it
can occur at any age.
3. Race
It is more common in white men than
in black men.
4. UNDESCENDED TESTICLE
(Cryptorchidism)
The testes is formed in the abdominal
area during fetal development and
normally descend into the scrotum
before birth.
Orchiopexy. The testicle is moved to
the scrotum through a surgery
 Genitourinary Cancer
5. Abnormal development of the
testicle (KLINEFELTER
SYNDROME)
The syndrome may adversely
affect testicular growth,
resulting in smaller than normal
testicles that lead to lower
production of testosterone or
little or no sperm production
PREVENTING TESTICULAR CANCER
There's no way to prevent testicular
cancer.
Some doctors recommend regular
testicle self-examinations to identify
testicular cancer at its earliest stage.
STAGES OF TESTITCULAR CANCER
Stage I.
Cancer is found only in the testicle.
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Stage II
Cancer has spread to nearby lymph nodes in
the abdomen or pelvis.
Stage III
Cancer has spread to other organs of the
body (nearby/distant lymph nodes, lungs,
brain, liver, or others) parts
DIAGNOSING TESTICULAR CANCER
1. Ultrasound.
Use to determine the nature of any testicular
lumps, if it is solid or fluid-filled.
2. Blood tests.
Use to determine the levels of tumor markers
in the blood.
3. Computerized tomography (CT)
scan/Magnetic resonance imaging (MRI).
Use to determine the extent metastasis.
TREATING TESTICULAR CANCER
1. Surgery
radical inguinal orchiectomy
Surgical removal of the testicle
Primary treatment for nearly all stages and
types of testicular cancers
The testicle can be replaced by a
prosthetic, saline-filled testicle
retroperitoneal lymph node dissection
Surgical removal of the nearby lymph
nodes .
 Genitourinary Cancer
3. Radiation Therapy
4. Chemotherapy
PROSTATE CANCER
1. Cancers that develop from the
prostate gland cells
2. It is the most common types of
cancer in the urinary tract among
men.
3. Almost all prostate cancers
are adenocarcinoma.
4. According to the WHO data
published in 2018 prostate cancer
deaths in Philippines reached
3,319 or 0.54% of total deaths.
Philippines ranks #104 in the
world in the total number of
deaths of prostate cancer.
Prostate cancer is often called the “SILENT
KILLER” because it doesn’t always have
symptoms.
For those with symptoms, the most
common are:
Painful or burning sensation during
urination or ejaculation.
Frequent urination, particularly at night.
Difficulty stopping or starting urination.
Sudden erectile dysfunction.
Blood in urine or semen
RISK FACTORS
1. Family History
2. Age
most common after age 50 It can be felt during DRE because of the
3. Race common in black men than in white increased in size.
men.
4. Obesity
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
PREVENTING PROSTATE CANCER
1. Maintain a healthy weight.
2. Exercise most days of the week.
3. Choose a healthy diet full of fruits and
vegetables.
4. Choose healthy foods over supplements.
5. See a doctor if risk of prostate cancer is
increased.
DIAGNOSING PROSTATE CANCER
1. Transrectal ultrasound
use to create a picture of the prostate gland
to determine abnormalities.
2. Prostate-specific antigen (PSA) test.
PSA is a substance that's naturally produced
by the prostate gland.
Small amount of PSA - normal
High than usual amount - may indicate
prostate infection, inflammation,
enlargement or CANCER.
3.Digital rectal exam (DRE)
4. Transrectal biopsy of the prostate
5. IMAGING TESTS
Use to create a more detailed picture of
the prostate gland .
Magnetic resonance imaging (MRI)
Ultrasound
Computerized tomography (CT) scan
STAGING PROSTATE CANCER
Stage I:
Cancer is usually slow growing.
Involves one-half or less of 1 side of the
prostate.
Cancer cells are well differentiated and
PSA levels are low.
The tumor cannot be felt during the DRE
or seen during imaging
Stage II:
The tumor is confined to the prostate.
 Genitourinary Cancer
STAGE 3: PENILE CANCER

The tumor has grown outside 1. Cancer of the penis

the prostate. It may have spread 2. Rare form of cancer, which targets the
to the seminal vesicles. skin around the penis before getting
its way further inside.
STAGE 4:
3. Affects men over the age of 60, but
The tumor has spread to other there are cases where younger adults
organ of the body (rectum, have also been diagnosed.
bladder, urethral sphincter
and/or pelvic wall).
SYMPTOMS
TREATING PROSTATE CANCER Changes in the skin of the penis are
the most common symptom of
1. Surgery penile cancer. They can show up on
radical prostatectomy the foreskin of uncircumcised men,
on the penis tip (the glans), or on the
2. Radiation therapy shaft.
External beam radiation
Brachytherapy
3. Hormone therapy
Use to stop the body from producing the
male hormone testosterone.
Prostate cancer cells rely on testosterone to
help them grow. Cutting off the supply of
testosterone may cause cancer cells to die
or to grow more slowly.
Luteinizing Hormone-Releasing Hormone Changes in skin color and thickness
Rash or small crusty bumps that
(LHRH) agonists and antagonists
looks like an unhealed scab.
Gonadotropin-Releasing Hormone (GNRH)
Growths that looks bluish-brown
agonists and antagonists
Lump on the penis or under the
ORCHIECTOMY – Removing the testicles
skin of the groin
reduces testosterone levels in the body
Bad-smelling discharge underneath
quickly and significantly. the foreskin
4. Chemotherapy Sore on the penis which may bleed
Uses drugs to kill rapidly growing cells Swelling at the end of the penis
5. Immunotherapy
Monoclonal antibodies – antibodies can be
produced that target and destroy cancer
cells
Cancer vaccines – vaccines given to
prevent cancer (HPV & HBV)
Sipuleucel-t (Provenge) – cancer vaccine
Non-specific Immunotherapies
Cytokines – stimulate the immune system
Pembrolizumab (Keytruda) -
Immunomodulators

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Genitourinary Cancer
TYPES OF PENILE CANCER PENILE CANCER PREVENTION

SQUAMOUS CELL OR There’s no one way to prevent penile

EPIDERMOID CARCINOMA.
This makes up 95% of penile cancer cases.
It usually starts on or under the foreskin
but can also appear on other parts of the
penis.
SARCOMA.
This cancers form in tissues
like blood vessels, muscle, and fat.
MELANOMA
This is cancers start in the cells that gives
color to the skin.
BASAL CELL CARCINOMA.
This cancers start deep in the skin. They
grow slowly and aren’t likely to spread to
other areas of the body.
cancer, but some things can lower the
risk:
1. Have a circumcision. When you don’t
have a foreskin, it’s easier to keep the area
clean.
2. Promote hygiene. If you have a
foreskin, make sure to carefully clean
underneath.
3. Avoid using cigarette and tobacco.
4. Use safe sex practices to avoid HPV
and HIV infections
STAGES OF PENILE CANCER
Stage 0

RISK FACTORS carcinoma in situ

cancer cells are only on the surface of
Research shows that penile cancer is the skin.
more common in men who: Stage I
Are over age 60
Smoking Cancer cells have grown into the tissue
Aren’t circumcised just below the surface of the skin but
not into blood vessels or lymph nodes.
Have HPV infections
Poor hygiene Stage II
Have a weakened immune
Cancer cells have spread to the deeper
system because of HIV/AIDS tissues of the penis, but not to lymph
Had psoriasis treatment with the drug nodes or distant organs
Psoralen and Ultraviolet (UV) light
Stage III
Have PHIMOSIS, which makes the
foreskin of the penis tight and cannot Cancer cells have grown into the
be stretched to be pulled back over the urethra and/or the deeper tissues of
the penis. It may have spread to one or
glans more lymph nodes but not to distant
organs.

Stage IV

Cancer cells have spread to nearby

structures, to the lymph nodes deep in
the groin, and to other parts of the
body

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ACADEMICIAN HEAD
 Genitourinary Cancer
DIAGNOSIS PENECTOMY
is surgical removal of some or all parts of
1. History taking the penis
2. Physical exam Mohs surgery
3. Biopsy is the surgical removal of the affected skin
4. Imaging tests one layer at a time until they reach healthy
5. Ultrasounds, tissue
6. CT scan RADIATION and/or CHEMOTHERAPY to get
7. Magnetic resonance imaging (MRI) rid of the cancer cells from the body

Standard approaches for

treating penile cancer

SURGERY, RADIATION, and

CHEMOTHERAPY are the
STANDARD APPROACHES for
treating penile cancer.
The main goal of all penile cancer
treatments is to eliminate disease
while maintaining as much as
possible the appearance and function
of the penis.
TREATMENT

Topical cream
For penile cancer at early stages
5-fluorouracil (5-FU) cream given
twice a day.
SURGERY
CIRCUMCISION
Surgical removal of the foreskin of
the penis to patient if cancer is only
found in the foreskin.
Cryotherapy
Uses an extremely cold liquid or a
device to freeze and destroy
cancerous tissue
Laser therapy
Uses to cut and destroy areas that
contain thecancer cells

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Colorectal Cancer
INCIDENCE SURGERY
Curative or palliative
The third most common malignancy and Segmental Resection
the second most deadly cancer, colorectal Abdomino Perineal Resection
cancer (CRC) induces estimated 1.9 Temporary Colostomy
million incidence cases and 0.9 million Construction of Coloanal
deaths worldwide in 2020. Reservoir of J Pouch
RISK FACTORS
Increasing age
Family history
Previous colon cancer
High alcohol consumption
Smoking
Obesity
Inflammatory bowel disease
High fat, High Protein diet
Genital cancer in women

CLINICAL MANIFESTATIONS

Changes in bowel movements

Blood in the stool
Fatigue, weight loss, anemia and
anorexia
Right sided lesions - dull abdominal
pain and melena
Left sided lesions - associated with
obstruction, bright red blood in the
stool
Rectal lesions - tenesmus, rectal pain,
feeling of incomplete evacuation of
stools, alternating diarrhea and
constipation

DIAGNOSTIC TESTS

Fecal Occult Blood Test

CEA
Barium Enema
Colonoscopy with biopsy

MANAGEMENT

Adjuvant Therapuy
5 Flurouracil (5FU) plus leucovorin
Pelvic Irradiation

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ACADEMICIAN HEAD
 Esophageal Cancer
INCIDENCE Endoscopic Ultrasonography
CT SCAN
8TH Leading cause of cancer PET
7TH Leading cause of cancer deaths in STAGING
men (2018)
More common in african americans
STAGE 0 – Tis, N0,M0
ETIOLOGY AND RISK FACTORS
STAGE 1 – T1,N0,M0
STAGE II A – T2,N0M0 OR T3N0M0
Age
Male > Female STAGE II B – T1N1M0 OR T2N1M0
GERD STAGE IIIA – T3,N1M0 OR T4, ANY N M0
Smoking STAGE IV – Any T Any N M1
Obesity STAGE IV A – ANY T, ANY N Mia
Alcohol (METASTASIS IN CELIAC LYMPH NODES)
Low Fiber Diet
Dry Cleaning agents and lye STAGE IV B – ANY T ANY N M1b
Barrett's Esophagus (OTHER DISTANT METASTASIS )
Achalasia
Esophageal Webs MANAGEMENT
Plummer Vinson Syndrome
Genetics EARLY STAGE
Esophagectomy
RADIATION THERAPY
CHEMOTHERAPY
Cisplatin, Mitomycin, 5FU, Paclitxel,
Vindesine
Cisplatin and 5FU are most common
single agents
COMPLICATIONS

PREVENTION DISEASE RELATED

Weight loss/ Anorexia
Hematemisis/Melena
Avoidance of risk factors Hemoptysis
CLASSIFICATION Dysphonia
SVC Syndrome
Adenocarcinoma Malignant pleural effusion
Squamous Cell Carcinoma Malignant Ascites
Mucoepidermoid Carcinoma Bone Pain and Laryngeal nerve palsy
Small cell carcinoma
Sarcoma TREATMENT RELATED –
Melanoma CHEMOTHERAPY
Adenoid cyctic carcinoma Nausea and Vomiting
Lymphoma Nephrotoxicity
CLINICAL MANIFESTATIONS Myelosuppresion
Mucositis/ Diarrhea
Peripheral Neuropathy and skin
Dysphagia toxicity
GERD OR Heart burn TREATMENT RELATED – RADIATION
Pain PNEUMONITIS
DIAGNOSTIC TESTS Stricture
Fistula
Endoscopy and biopsy
Barium swallow

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ACADEMICIAN HEAD
 Pancreatic Cancer
EPIDEMIOLOGY DIAGNOSTIC

Pancreatic cancer is the most common 1. Multidetector and Multiphase CT

GI cancer. -optimal study for clinical staging of
Fourth leading cause of cancer in US pancreas.
Two main categories:
1. arising in the exocrine parenchyma
2. arising in the endocrine cells of the
islets of Langerhans.
•The term pancreatic cancer usually refers
to cancer of the exocrine pancreas.
•7% of all related cancer deaths in men and
women (Medscape 202
•Pancreatic Cancer more common in men
than women, incidence increases with age
65 and 79 , rarely in those under 45. 2. Laparoscopy
detect extrapancreatic tumor not
RISK FACTORS seen on CT scans.

Cigarette smoking 3. Endoscopic ultrasound (EUS) and

Diabetes mellitus Endoscopic retrograde
Chronic Pancreatitis cholangiopancreatography(ERCP)
Dietary Factors
Obesity If a mass is not seen on contrast-
Familial genetic alterations enhanced CT
If mass is located, EUS may be used
SIGNS AND SYMPTOMS to guide a fine-needle aspiration.

Abdominal Pain TNM Clinical Classification System

dull, constant pain radiating to the
middle or upper back.
Severe pain usually indicative of
invasion of the celiac and mesentric
plexus, a sign of locally advanced or
metastatic disease.
Anorexia, Weight loss
caused by multiple factors , Tumor
Obstruction of the duodenum,
decreased gasrtic motility,and
increased metabolic activity due to
tumor-related cytokines.
Early Satiety
Sleep Problems
Jaundice- cause by lesions in the
pancreatic head.
Fatigue
Weakness, nausea,constipation
Depression
Ascites
for staging Pancreatic Cancer
PRIMARY TUMOR (T)
TX Primary tumor cannnot be
assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ*
T1 Tumor limited to the pancreas, 2 cm
or less in greatest dimension
T2 Tumor limited to the pancreas ,
more than 2cm in greatest dimension.
T3 Tumor extends beyond the
pancreas but w/o involement of the
celiac axis or the superior mesentric
artery
T4 Tumor involves the celiac axis or
the superior mesentric artery
(unresectable primary tumor)

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ACADEMICIAN HEAD
 Pancreatic Cancer
Regional Lymph Nodes (N)
NX Regional lymph nodes cannot
be assessed
N0 No regional lymph node
metastasis
N1 Regional lymph node
metastasis

Distant Metastasis (M)

MX Distant metastasis cannot be
assessed
M0 No distant metastasis
M1 Distant metastasis

TREATMENT
Surgery
Pancreaticoduodenectomy ( WHIPPLE
procedure) removal of pancreatic head ,
the gallbladder, the common bile duct,
the duodenum, the distal stomach, and
regional lymph nodes.
Series of anastomoses- performed to
reestablish gastro intestinal motility
Pylorus –preserving
pancreaticoduodenectomy – may be
used for small periampullary
lesions;however this procedure is
controversial.
Total pancreatectomy- an extension of
the pancreadenectomy, removal of the
body and tail of the pancreas, the spleen
and more extensive lymph nodes.
Chemotherapy- the hope to shrink the
tumor and eliminate micrometastases.
Radiation therapy- used in combination
with 5-FU or gemcitabine.

NURSING CARE

Surgical patient:careful post operative

monitoring for complications, pain
control, and nutritional support.
Health teaching about the side effects
of chemotherapy and radiation
therapy

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Week 17:
Blood Cancers
DIAGNOSTIC TEST

LEUKEMIA Physical exam

The common feature of the
leukemias is an unregulated
proliferation or accumulation of
white blood cells (WBCs) in the bone
marrow.
CLINICAL MANIFESTATION
Cardinal signs and symptoms
include weakness and fatigue,
bleeding tendencies, petechiae
and
ecchymoses, pain, headache,
vomiting, fever, and infection.
ASSESSMENT FINDINGS
Blood and bone marrow studies
confirm proliferation of WBCs
(leukocytes) in the bone marrow.
The doctor will look for physical signs of
leukemia, such as pale skin from anemia
and swelling of your lymph nodes, liver
and spleen.
Blood tests
By looking at a blood sample, the doctor
can determine if there are abnormal
levels of white blood cells or platelets,
which may suggest leukemia.
Bone marrow test
The doctor may recommend a procedure
to remove a sample of bone marrow from
hipbone. The sample is sent to a
laboratory to look for leukemia cells.

RISK FACTORS TYPES OF LEUKEMIA

Genetic disorders Step Four

Down syndrome Leukemia is classified according to the
Klinefelter syndrome rate of progression and the type of
Patau syndrome white blood cell involved.Leukemia,
Ataxia telangiectasia according to the rate of progression, has
Shwachman syndrome two types:
Kostman syndrome
Neurofibromatosis 1. Acute leukemia
Fanconi anemia > is a rapidly developing condition.
Li-Fraumeni syndrome The cells divide rapidly so the disease
Physical and chemical exposures escalates very
Benzene, Drugs such as pipobroman quickly. For acute leukemia, aggressive
Pesticides, Cigarette smoking treatment is
Embalming fluids required.
Herbicides
2. Chronic leukemia
Chemotherapy
Alkylating agents > is characterized by mature blood
Topoisomerase-II inhibitors cells that divide and replicate more slowly.
Anthracyclines These cells could initially function like a normal
Taxanes WBC. As a result, chronic leukemia could
Radiation exposure remain undiagnosed for years.
Nontherapeutic, therapeutic
radiation

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Blood Cancer
Leukemia, according to the type of white
blood cell involved, also has two types:
Lymphocytic leukemia
affects the lymphoid cells. The
symptoms include swollen lymph
nodes in the neck, armpits and groin.
Myelogenous leukemia
affects myeloid cells, which are
immature white blood cells.
The 4 Main Types
of Leukemia
Acute lymphocytic leukemia (ALL)
This is the most common type of
leukemia affecting young children. ALL
still does affect adults. But when this
happens, the affected adults usually
have a worse prognosis than children
suffering from the same condition.
Acute myelogenous leukemia (AML)
This is the most common type of acute
leukemia in adults. It is a rapidly-
developing condition. AML can quickly
spread to different parts of the body like
spleen, liver and brain.
Step Four
Chronic lymphocytic leukemia (CLL)
Many people with the condition will not
have any symptoms for years. This being
the
case, chronic leukemias tend to be harder to
manage than acute ones.
Chronic myelogenous leukemia (CML)
CML affects mostly adults. It is a slow-
moving subtype. But that said, CML can
alter its progression and suddenly
become an acute, rapidly-progressing
condition.
TREATMENT
Induction Therapy
Killing of leukemia cells in the blood
and bone marrow. Treatments include
chemotherapy. Induction usually lasts
for 4-6 weeks.
Rose Ann C. Lacuarin
ACADEMICIAN HEAD
Consolidation Therapy
Killing off the remaining leukemia cells /
or the aberrant cells. If these cells are not
killed, they could re-grow and could
cause a relapse. Treatment include
chemotherapy and may include stem cell
transplant (replacement of damaged bone
marrow cells with healthy ones).
Maintenance Therapy
Preventing any remaining leukemia cells
from growing or from coming back by
using low doses of chemotherapy and
intravenous treatment (the infusion of
liquid substances directly into a vein).
CHRONIC MYELOID LEUKEMIA
This type affects the lymphoid cells
created in the bone marrow. It is
classified as chronic leukemia, because
the affected cells carry out some of their
normal functions initially, making it
difficult to detect.
The progression of this disease is slow
and symptoms show up only in the later
stages.
The prognosis depends on the stage in
which the disease has advanced.
ACUTE MYELOID LEUKEMIA
The more severe form of the disease is
acute myeloid leukemia, which is
characterized by faster progression of
the disease. This is the most commonly
type among adults. If detected early,
statistics show that 20% to 40% of
patients survive for at least 60 months.
Chemotherapy is the recommended
treatment method. Older people in the
sixty plus age group, affected by it,
have a very low life expectancy.
 Blood Cancer
CHRONIC LYMPHOCYTIC LEUKEMIA HODGKIN’S LYMPHOMA

This type almost never occurs among A type of lymphoma (cancer of

children and has a very high lymph tissue found in the lymph
incidence rate among people aged nodes, spleen, liver, and bone
more than 60. marrow)
Men are more likely to be affected by Involved cells are Reed-Sternberg
it, than women. cells
Progression of this disease is slow. > Binucleated or multinucleated
If the disease has affected the B- cells
cells, then life expectancy can be > Large malformed cells with 2 nuclei
anywhere between 10 to 20 years, if > Distinguishes Hodgkins and Non
treatment begins early. However, hodgkins
those with T cell chronic lymphocytic
leukemia have a very low life RISK FACTORS
expectancy. Age : 1st peak – 20s to 30s; 2nd
peak – 50s and up
ACUTE LYMPHOCYTIC LEUKEMIA Family History
The most common form of cancer in Male
children is acute lymphocytic Epstein Barr Virus
leukemia.
One-fourth of all cancers in children CLINICAL FEATURES
belong to this type.
It has a high incidence rate among Lymphadenopathy - painless
adults, older than 45 years of age. Neck, above the clavicle, elbow,
under the arms or near the groin
Step Four
Chemotherapy is the established
treatment method for this disease. Fever
Before chemotherapy and other Persistent fatigue
cancer cure methods were invented, Night sweats
a patient with acute lymphocytic Weight loss
leukemia could survive for 4 months Pruritus
at the most. DIAGNOSIS
However, thanks to modern
treatment methods, about 80% of History and Physical exam
the affected children are completely Chest X-ray
cured. Adults have been seen to CT scan
have a 40% chance of complete Chest, abdomen, pelvis
cure. Lymphangiogram
PET scan
CHRONIC MYELOGENOUS Gallium-67 scan
LEUKEMIA Widely used in nuclear medicine as
Uncommon in people under 20 years a tumor-imaging agent by gamma-
of age; incidence rises with age emission scintigraphy
Usually associated with an abnormal
chromosome called the Philadelphia
chromosome (hallmark)

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Blood Cancer
LABORATORY TREATMENT
CBC
LDH Relapsed or Recurrent
Liver and Renal function test BEAM- the most common high dose
regimen
Bone marrow biopsy- lymphoma cells
B-Carmustine, etoposide,
Percutaneous needle biopsy
cytarabine, melphalan
STAGING LAPAROTOMY
Bone marrow or peripheral blood
Rarely done today because NHL is
stem cells are removed before
considered systemic
therapy
IMMUNOPHENOTYPING
Process used to identify cells, based
NON-HODGKINS LYMPHOMA
on the types of antigens or markers
on the surface of the cell Malignancies that arise from
proliferation of B or T Lymphocytes
METASTASIS
Morphologically and clinically
Spreads from 1 lymph node to another different from HD
Retroperitoneal node Diagnosed at more advanced stage
Liver
Lungs RISK FACTORS
Spleen Autoimmune disorders
Bone Marrow RA, SLE, Hashimoto’s disease
TREATMENT Infectious Agents
EBV, Herpes, H. Pylori, Hep C
Stage I or II Environmental factors
RT, Chemo or both Carcinogen exposures
Pt are treated according Step
to stage and
Four
prognosis CLINICAL FEATURES
Chemo regimen:
MOPP- usually for older than 75 y/o 1. Generalized lymphadenopathy
Mechlorethamine, vincristine/ Oncovin, 2. Bone marrow involvement
procarbazine. prednisone 3. Coughing or shortness of breath
ABVD- Primary choice may occur if the cancer affects the
Doxorubicin, bleomycin, vinblastine, thymus gland or lymph nodes in
dacarbazine the chest
Dose-escalated BEACOPP 4. Abdominal pain or swelling
Bleomycin, etoposide, doxorubicin/
Adriamycin, cyclophosphamide, DIAGNOSIS
vincristine, procarbazine, prednisone)
LABORATORY
Stage III or IV
CXR, CT of thorax, abdomen, pelvis
Presence of B symptoms or bulky disease
and head
ABVD
PET scan
Improved compliance due to IV
Gallium 67 scan
administration
MRI
Less cumulative myelotoxicity
Bone scans
Lower risk of secondary malignancy
Lower rate of infertility

Rose Ann C. Lacuarin

ACADEMICIAN HEAD
 Blood Cancer
TREATMENT CLINICAL FEATURES

Indolent/low grade NHL 1. Bone pain – common in humerus,

RT- field or total nodal radiation scapula, spine;
Chemo- no improved survival shown osteoporosis
CVP- cyclophosphamide, vincristine, 2. Hypercalcemia – loss of appetite,
prednisone constipation;
CHOP- cyclophosphamide, feeling sleepy or confused
doxorubicin, vincristine, prednisone 3. Kidney problems
Interferon 4. Anemia (weakness, pale skin, SOB,
Nucleosides Analogues – fludarabine dizziness)
and cladribine 5. Infections
Aggressive Lymphoma 6. Low platelet count = bleeding, bruising
Chemotherapy
CHOP DIAGNOSIS
RT
Serum and urine electrophoretic and
Highly aggressive lymphoma
immunologic studies
CNS prophylaxis (methotrexate)
Elevations in immunoglobulin = tall,
Hyper CVAD
narrow based monoclonal spike (M-
Cyclophosphamide, mesna, vincristine,
spike) – all the exact same- hallmark
doxyrubicin, decadron
24-hr urine – reveals Bence Jones
Protein
MULTIPLE MYELOMA Laboratory studies- increase creatinine,
low albumin, high calcium , anemia
Cancer that forms in a type of WBC
Bone marrow biopsy
called plasma cell which helps fight
Step Four MRI, X-rays
infection by making antibodies that
recognizes and attacks foreign TREATMENT
antigens.
Cancerous plasma cells accumulate in 1. Chemotherapy – Combination
bone marrow and crowd out normal chemotherapy
healthy cells. MP – melphalan + prednisone
No cure, but can live in 10-20 years VBCMP –vincristine + melphalan +
carmustine + cyclophosphamide +
RISK FACTORS prednisone
VBAP – vincristine + melphalan +
Chromosomal abnormalities carmustine + doxorubicin + prednisone
70 y/o and above + doxorubicin + prednisone
Male VAD - vincristine
Black-American Race
Family history 2. RADIATION – for chemo-resistant
Occupational exposure to ionizing Relieves bone pain
radiation Treat spinal cord compression
Improves quality of life but does not
Pesticides, oil-related, farming enhanced survival
chemicals, Wood, leather

Rose Ann C. Lacuarin

ACADEMICIAN HEAD