NCM112OFI o Rough Endoplasmic Reticulum is lined with
CELLULAR ABBERATION ribosomes and is rough in appearance and smooth
CANCER
→ it is a group of complex diseases with various
manifestations depending on which body system is
affected and the type of tumor cells involved.
CELL
→ from Latin cella, meaning "small room”
→ is the basic structural, functional, and biological unit
of all known living organisms. A cell is the smallest
unit of life. Cells are often called the "building blocks
of life". The study of cells is called cell biology or
cellular biology.
THE CELL THEORY STATES THAT:
1) All organisms are made up of one or more cells
and the products of those cells.
2) All cells carry out life activities (require energy,
grow, have a limited size).
3) New cells arise only from other living cells by the
process of cell division.
Parts of the Cell
PLASMA MEMBRANE/ CELL MEMBRANE
o Structure - a bilipid membraneous layer composed
of proteins and carbohydrates. It is fluid like.
o Function - the cell membrane separates the cell
from its external environment and is selectively
permeable (controls what gets in and out). It
protects the cell and provides stability.
o Proteins are found embedded within the plasma
membrane, with some extending all the way
through in order to transport materials.
o Carbohydrates are attached to proteins and lipids
on the outer lipid layer.
CYTOPLASM
o Structure - The jelly-like substance composed of
mainly water and found between the cell membrane
and nucleus. The cytoplasm makes up most of the
"body" of a cell and is constantly streaming.
o Function - Organelles are found here and
substances like salts may be dissolved in the
cytoplasm.
NUCLEUS
o Structure - The largest organelle in the cell. It is
dark and round, and is surrounded by a double
membrane called the nuclear envelope/membrane.
In spots the nuclear envelope fuses to form pores
which are selectively permeable. The nucleus
contains genetic information (DNA) on special
strands called chromosomes.
o Function - The nucleus is the "control center" of the
cell, for cell metabolism and reproduction.
The following organelles are found
in both plant and animal cells:
"ER" OR ENDOPLASMIC RETICULUM
o The Endoplasmic Reticulum is a network of
membranous canals filled with fluid. They carry
materials throughout the cell. The ER is the
"transport system" of the cell.
o There are two types of ER: rough ER and smooth
ER.
endoplasmic reticulum contains no ribosomes and
is smooth in appearance.
RIBOSOMES
o Ribosomes are small particles which are found
individually in the cytoplasm and also line the
membranes of the rough endoplasmic reticulum.
Ribosomes produce protein. They could be thought
of as "factories" in the cell.
GOLGI BODY / APPARATUS
o Golgi bodies are stacks of flattened membranous
stacks (they look like pancakes). The Golgi Body
temporarily stores protein which can then leave the
cell via vesicles pinching off from the Golgi.
LYSOSOMES
o Lysosomes are small sac-like structures
surrounded by a single membrane and containing
strong digestive enzymes which when released can
break down worn out organelles or food. The
lysosome is also known as a suicide sac.
MITOCHONDRIA
o The mitochondria are round "tube-like" organelles
that are surrounded by a double membrane, with
the inner membrane being highly folded. the
mitochondria are often referred to as the
"powerhouse" of the cell.
o The mitochondria releases food energy from food
molecules to be used by the cell. This process is
called respiration. Some cells (muscle cells) require
more energy than other cells and so would have
many more mitochondria.
VACUOLES
o Vacuoles are fluid filled organelles enclosed by a
membrane. They can store materials such as food,
water, sugar, minerals and waste products.
DIVISION
→ The division of a cell to produce two daughter cells
is fundamental to most forms of life.
→ The ‘life cycle’ of a dividing eukaryotic non-
embryonic cell starts with the cell triggered to enter
the cell cycle and ends with the equal partitioning of
the genetic material and cleavage of the cell during
cytokinesis (the physical process of cell division,
which divides the cytoplasm of a parental cell into
two daughter cells).
→ The whole process is called the cell cycle and
consists of four main phases.
(G1) First Growth Phase
- Growth and normal metabolic roles
(2) Synthesis Phase
- DNA Replication
(G2) Second Growth Phase
- Growth and preparation for mitosis
(M) Mitotic Phase
- Prophase, Metaphase, Anaphase, Telophase
G1, S, G2 = Interphase
 MITOTIC CELL DIVISION APOPTOSIS
PROPHASE → ancient Greek = “falling off”
→ cell prepares itself for the division → programmed cell death
→ average adult loses = 50-70 billion cells/day
→ average child (8-14y/o) loses = 20-30 billion
cells/day

METAPHASE
→ The disappearance of nuclear membrane and
nucleolus marks the beginning of metaphase. The
chromosomes become shorter by further coiling.

NORMAL CELL GROWTH

→ Mature normal cells are uniform in size and have
nuclei that are characteristics of the tissue to which
the cells belong.
→ Within the nucleus of normal cells, chromosomes
containing deoxyribonucleic acid (DNA) molecules
ANAPHASE carry the genetic information that controls the
→ Division of centromere marks the beginning of synthesis of polypeptides (proteins).
anaphase. → Genes are subunits of chromosomes and consist of
portions of DNA that specify the production of
particular sets of proteins.
→ Thus, genes control the development of specific
traits.
→ The genetic code in the DNA of every gene is
translated into protein structures that determine the
type, maturity and function of a cell.
→ Any change or disruption in a gene can result in an
inaccurate “blueprint” that can produce an aberrant
cell, which then become cancerous.
TELOPHASE
→ Chromosome is a long deoxyribonucleic acid (DNA)
→ The events in the telophase are the reverse of the molecule with part or all the genetic material
events in the prophase (genome) of an organism.
→ Chromosomes are structures found in the center
(nucleus) of cells that carry long pieces of DNA.
DNA is the material that holds genes. It is the
building block of the human body. Chromosomes
also contain proteins that help DNA exist in the
proper form.

CELLULAR ABERRATIONS
→ a large group of diseases that are characterized by
uncontrolled growth and spread of an abnormal cell
→ a malignant tumor of any type
CYTOKINESIS
→ After karyokinesis NORMAL CELL CANCER CELL
(nuclear division), the have limited cell division cell division is rapid
cytoplasm is divided by undergo apoptosis; show partial or complete
the formation of the cell specific morphology differentiated function of
wall between the two parent cell is lost
daughter nuclei. This have a small nuclear- there is a large nucleus-
division of the cytoplasm cytoplasmic ratio cytoplasm ratio
is called as the
are no migratory/ cells can migrate
cytokinesis.
non-migratory
 NORMAL CELL
adhere tightly together
grow in an orderly and
well-regulated manner
cells recognize or respect
tissue barrier
cells are contact inhibited are not contact inhibited
CANCER CELL 5) The Tissue Organization Field Theory (TOFT)
loosely adherent - carcinogenesis is a problem of tissue
organization, comparable to organogenesis
growth rate is not during early development, and proliferation is the
well-regulated default state of all cells.
do not recognize or
respect tissue barrier GENETICS AND CANCER
• CARCINOGEN – any substance, situation or
exposure that can damage genetic material (DNA)
• ONCOGENE – genetic material that carries the
ability to induce cancer
• PROTO-ONCOGENE – normal gene that has the
potential to transform itself into an oncogene
• TUMOR SUPRESSOR GENE – are a family of
normal genes that instruct cells to produce proteins
that restrain cell growth and division
• P53 GENE – family of suppressor gene that triggers
apoptosis
• DNA REPAIR GENE – a code for proteins whose
normal function is to correct errors that arise when
cells duplicate their DNA prior to cell division

DIFFERENTIATION - is the process where a cell

changes from one cell type to another. Usually, the cell
changes to a more specialized type. Differentiation
occurs numerous times during the development of a
multicellular organism as it changes from a simple
zygote to a complex system of tissues and cell types.

• GENOTOXIC - directly alter DNA and cause

5 THEORIES OF CARCINOGENESIS
1) Cellular Transformation & Derangement Theory
- exposure of normal cells to some etiologic agent
may transform normal cells into cancer cells.
2) Failure of the Immune Response Theory
- conceptualizes that all individuals possess
cancer cells but these cancer cells are NOT
recognized by the immune system. Thus, cancer
cells undergo destruction. Failure of the immune
response system to kill or destroy the cancer
cells leads to cancer.
3) Genetic Code
- the idea that genes are the basic units in which
characteristics are passed from one generation
to the next. The gene theory provides the basis
for understanding how genes enable parents to
transmit traits to their offspring.
4) The Somatic Mutation Theory (SMT)
- cancer is derived from a single somatic cell that
successively has accumulated multiple DNA
mutations
mutation
• PROMOTER - cause adverse biologic effects, e.g
cytotoxicity (ability to kill cells)
• CARCINOGENESIS - a process by which normal
cells are transformed into cancer cells
• TUMOR - an abnormal lump or mass of tissue.
• SECONDARY TUMOR - a tumor that forms as a
result of spread (metastasis) of cancer from the
place where it started.
• NEOPLASIA - the uncontrolled, abnormal growth of
cells or tissues in the body, and the abnormal
growth itself is called a neoplasm
• NEOPLASM/TUMOR – the abnormal growth itself
• MUTATION - a change in a gene.
• BENIGN - a term used to describe non-cancerous
tumors which tend to grow slowly and do not
spread.
• MALIGNANT - a term used to describe cancerous
tumors which tend to grow rapidly, can invade and
destroy nearby normal tissues, and can spread.
• METASTASIS - the spread of tumor cells to other
areas of the body.
• REMISSION - complete or partial disappearance of
the signs and symptoms of cancer in response to
treatment; the period during which a disease is
under control. A remission may not be a cure.
• GENETIC TESTING - tests performed to determine
if a person has certain gene changes (mutations) or
chromosome changes which are either known to
increase cancer risk or which may be present in
cells from a tumor.
 DYSPLASIA
→ the presence of cells of an abnormal type within a
tissue, which may slightly signify a stage preceding
the development of cancer
→ Ex: Cervical Dysplasia: growth of abnormal cells on
the surface of the cervix leading to cervical cancer
HYPERPLASIA
→ he enlargement of an organ or tissue caused by an
increase in the reproduction rate of its cells, often
as an initial stage in the development of cancer
→ occurs in response to stress, increased metabolic
demands, or elevated levels of hormones.
METAPLASIA
→ abnormal change in the nature of a tissue
ANAPLASIA
→ a condition of cells with poor cellular differentiation,
losing the morphological characteristics of mature
cells and their orientation with respect to each
other and to endothelial cells.
THE CARCINOGENESIS PROCESS
1) INITIATION - irreversible mutation of a gene, that
leads to a malignant transformation
2) PROMOTION - cell becomes malignant; the
promoting agent stimulates the growth and division
of cell
3) PROGRESSION - refers to a series of changes that
lead to the characteristics of an undifferentiated cell
TYPES OF METASTASIS
1) TRANSCOLEMIC - peritoneal, pleural, pericardial,
or subarachnoid spaces
2) LYMPHATIC SPREAD – most common route for
initial metastasis; lymph nodes; also called nodal
involvement, positive nodes, or regional disease
3) HEMATOGENOUS SPREAD - venous flow
4) CANALICULAR SPREAD – canalicular spaces
(CBD, urinary system, airways, subarachnoid
spaces)
TYPES OF CARCINOGENS
A. Viruses or Oncogenic
Prolonged and recurrent viral infections may lead to the
breakdown of the immune system. The overwhelmed
immune system may fail to destroy the cancer cells
present in the body.
1. Human Papilloma Virus (HPV) - are particularly
common cancer-causing virus which is well-known
for causing genital warts and all cases of cervical
cancer.
2. Epstein-Barr Virus - formally called Human gamma
herpes virus 4, it is best known as the cause of
infectious mononucleosis
3. Cytomegalovirus - is a genus of viruses in the order
Herpesvirales, humans and monkeys serve as
natural hosts
4. Hepatitis Virus – (A) cause of infectious or epidemic
hepatitis transmitted by the fecal-oral route, (B)
causes hepatitis B, (C) is a blood-borne virus.
Today, most people become infected with the
Hepatitis C virus by sharing needles or other
equipment to inject drugs.
5. HIV - human immunodeficiency virus. It weakens a
person's immune system by destroying important
cells that fight disease and infection.
6. Helicobacter Pylori - is a type of bacteria. These
germs can enter your body and live in your digestive
tract; can cause ulcers in the lining of your stomach
or the upper part of your small intestine.
7. Human T-cell Lymphotropic Virus - are known to
cause a type of cancer called adult T-cell
leukemia/lymphoma
B. Chemical Carcinogens
These chemicals cause cell mutation or alter the cell
enzymes and proteins.
1. Industrial Compounds
• Vinyl chloride - plastic manufacture, asbestos
factories, construction works
• Polycyclic aromatic hydrocarbons
• Fertilizers; Weed killers
• Dyes - analine dyes (most commonly found in
beauty shops and used at homes), hair bleach
• Drugs - cytotoxic drugs, tar nicotine in tobacco,
alcohol
2. Hormones
• Estrogen
• Diethystilbesterol (DES) – synthetic estrogen
• Foods, preservatives
• Nitrites in bacon or smoked meat
• Talc (polished rice, salami and chewing gum)
• Food sweeteners
• Nitrosomines (rubber baby nipples)
• Aflatoxins (mold in nuts, grains, milk, cheese
and peanut butter)
• Polycyclic hydrocarbons
C. Physical Agent
1. Radiation
• From x-rays or radioactive isotopes
• From sunlight or UV rays
2. Physical Irritation or Trauma
• Pipe smoking
• Multiple deliveries
D. Genetics
Risk Factors:
• Older individuals
• Women are more prone to breast, uterine
cervical cancer
• Men are more prone prostate and lung
• Urban dwellers
• Chemical factory workers, Farmers
• Personnel of radiology department
• Obesity, Stress
FAMILY HISTORY
Hallmark of families with hereditary cancer syndrome:
a) cancer in two or more relatives.
b) cancer in family members > 50 years old.
c) same type of cancer in several family
members/family member with more than one type
of cancer.
d) a rare cancer in one or more family members.
E. Immunologic CATEGORIES OF NEOPLASM
T-Lymphocytes or T-Cells 1. CARCINOMA – skin or the tissue lining organs
is a type of lymphocyte which develops in the thymus 2. SARCOMA – bones and in soft tissues
gland and plays a central role in the immune response. 3. LYMPHOMA – lymphatic system
4. LEUKEMIA – blood, including bone marrow
1) KILLER T-CELLS - scan the surface of cells 5. MYELOMA – blood (plasma cells in bone marrow)
2) HELPER T-CELLS - to start and control the
immune response against foreign substances CANCER PREFIXES AND LOCATION
3) REGULATORY T-CELLS OR TREGS - control or adeno- gland
suppress other cells chondro- cartilage
4) MEMORY T-CELLS - protect the body against erythro- red blood cell
previously found antigens hemanglo- blood vessel
5) NATURAL KILLER T-CELLS - influence other hepato- liver
immune cells and control immune responses lipo- fat
lympho- lymphocyte
GENE MUTATIONS melano- pigment cell
→ is a permanent alteration in the DNA sequence that myelo- bone marrow
makes up a gene, such that the sequence differs myo- muscle
from what is found in most people. Mutations range osteo- bone
in size.
SYSTEMIC EFFECTS OF CANCER
TUMOR SUPPRESSOR GENE
PAIN
or antioncogene; gene that protects a cell from one step
a) Pressure on the nerve endings
on the path to cancer. When this gene mutates to cause
b) Distention of organ & blood vessels
a loss or reduction in its function, the cell can progress
c) Lack of O2 to tissues and organs
to cancer, usually in combination with other genetic
d) Release of pain mediators
changes
RAT = can be used to manage pain
HEREDITARY MUTATIONS
R – recognize
are inherited from a parent and are present throughout
A – assess
a person’s life in virtually every cell in the body. These
T – treat
mutations are also called germline mutations because
they are present in the parent’s egg or sperm cells.
CLASSIFICATION OF PAIN
1) Acute vs. Chronic
SOMATIC MUTATIONS
2) Cancer vs. Non-cancer Pain
or acquired mutations; occur at some time during a
3) Nociceptive vs. Neuropathic Pain
person’s life and are present only in certain cells, can
be caused by environmental factors or can occur if an
TYPES OF CANCER PAIN
error is made as DNA copies itself during cell division;
• Nerve pain – neuropathic
and cannot be passed to the next generation.
• Bone pain – somatic pain
Predisposing Factors • Soft tissue pain – visceral
1. Age 2. Gender • Phantom pain
3. Geographic Locations 4. Occupation • Referred pain
5. Heredity 6. Stress
7. Precancerous Lesions 8. Health Practices ASSESS PAIN CHARACTERISTICS:
▪ Quality (e.g., burning, sharp, shooting)
TYPES OF NEOPLASM ▪ Severity (scale of 0 to 10 or most severe pain)
• Benign Tumor ▪ Location (anatomical description)
• Potentially-Malignant Neoplasms ▪ Onset (gradual or sudden)
▪ Duration (how long; intermittent or continuous)
• Malignant Neoplasms
▪ Precipitating or relieving factors
• Secondary Neoplasm - malignant tumor whose
cause is the treatment
NURSING DIAGNOSIS:
• Cancer of Unknown Primary Origin
Acute pain, Chronic pain, Constipation, Fatigue, Sleep
pattern disturbance
BENIGN MALIGNANT
Differentiation well differentiated undifferentiated PAIN MANAGEMENT
Encapsulation capsulated un-capsulated Opioids: moderate to severe
- Morphine SO4, Fentanyl, Oxycodone
Metastasis (-) (+) NSAIDS
Prognosis good -
HYPERCALCEMIA
Therapeutic surgery - is a condition in which the calcium level in your blood is
above normal. Too much calcium in your blood can
weaken your bones, create kidney stones, and interfere
with how your heart and brain work. Hypercalcemia is OBSTRUCTION & PRESSURE
usually a result of overactive parathyroid glands. Psychological Stress - Stress is a feeling of emotional
or physical tension. It can come from any event or
NORMAL LEVEL: 9-11mg/dL, 1.16-1.32mmol/L thought that makes you feel frustrated, angry, or
Stored (Bones) nervous. Stress is your body's reaction to a challenge
Ionized (Nerve) or demand.
Albumin Bound (serum)
DIAGNOSTIC TESTS
Osteoclastic – bone resorption/destruction 1. TUMOR MARKERS
Osteoblast – bone formation o AFP (alpha feto protein)
Osteolytic – damaged bone o CEA (carcinoembryonic antigen)
o PAP (prostatic acid phosphatase)
NURSING DIAGNOSIS: o PSA (prostate specific antigen)
Potential for injury, Fluid volume deficit, Pain Altered o CA 125
urinary elimination, Constipation, Ineffective individual o CA 15-3
and family coping. o HCG
o S100
NURSING INTERVENTIONS: o Thyroglobulin
o Maintain adequate hydration.
o Mobilize when possible. 2. RADIOLOGIC TESTS
o Report changes in the sensory status. o Ultrasound CT Scan
o Report changes in heart rate. o MRI with or without contrast X-ray
o Continue usual diet. o Bone scans
o Nuclear medicine imaging PET Scan
MANAGEMENT: o Mammograms
Hypocalcemic Agents:
- Calcitonin, Plicamycin IV (mithramycin), Gallium PET SCAN (POSITRON EMISSION TOMOGRAPHY)
Nitrate, Bisphosphonates → an imaging test that helps reveal how your tissues
1st Generation: etidronate (Didronel) and organs are functioning
2nd Generation: zoledronic acid (Zometa), pamidronate → uses a radioactive drug (tracer) to show this activity.
(Aredia), clodronate (Bonefos) → effective way to examine the chemical activity in
3rd Generation: alendronate parts of your body
→ help identify a variety of conditions, including many
DISSEMINATED INTRAVASCULAR COAGULATION cancers
a hypercoagulable state in which inappropriate over → cancer cells show up as bright spots on PET scans
stimulation of normal coagulation causes a because they have a higher metabolic rate than do
simultaneous thrombosis and hemorrhage. normal cells.
NURSING DIAGNOSIS: PET Scans may be useful in:
Risk for trauma related to widespread thrombosis. • Detecting cancer
Altered tissue perfusion related to organ hypoxia. • Revealing whether your cancer has spread
Risk for infection related to necrosis of tissue.
• Checking whether a cancer treatment is working
• Finding a cancer recurrence
NURSING INTERVENTIONS:
Maintain circulation and oxygenation.
3. BIOPSY
Initiate recommended treatment for underlying
Needle Biopsy
malignancy.
a) Needle aspiration
Provide educational and emotional support to client &
b) Stereotactic needle aspiration
significant others.
c) Core needle Procedure
d) Sentinel node biopsy
MANAGEMENT:
Surgical Biopsy
Heparin, aminocaproic acid (Amicar)
a) Excisional
Blood Transfusion
b) Incisional
c) Endoscopic
MALNUTRITION & CACHEXIA
d) Punch
Causes:
metabolic effect of tumor, mechanical effect of tumor,
4. BONE MARROW ASPIRATION
effect of cancer treatment
Nursing Considerations
NURSING DIAGNOSIS: • Don't leave the patient unattended during the
Altered nutrition, less than body requirements. procedure.
Social Isolation, Knowledge deficit • Don't let him move during the procedure.
• Don't administer analgesics containing aspirin;
HEMATOLOGIC ALTERATIONS they may potentiate bleeding.
Anemia, Leukopenia, Thrombocytopenia
5. OTHER PROCEDURES into surrounding
Endoscopy tissues and first
Bronchoscopy, Gastroscopy, Colposcopy, station lymph
Colonoscopy nodes. The
lesion is operable
and resectable,
Nursing considerations for Colonoscopy there is
• Ensure that the patient has complied with the bowel uncertainty as to
preparation immediately. completeness of
• Instruct patient to resume a normal diet, fluids, and removal
activity as advised by the health care provider. Stage III T3, N2, M0 Clinical
• Monitor for any rectal bleeding. examination
shows evidence
• Encourage increased fluid intake.
of local spread
into surrounding
STAGING & GRADING tissues and first
STAGING – determines the size of the tumor and the station lymph
existence of metastasis. nodes. The
lesion is operable
TNM STAGING SYSTEM and resectable,
T – TUMOR N- NODE M- METASTASIS there is
TUMOR uncertainty as to
completeness of
Tx Primary tumor cannot be assessed
removal
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1, T2, T3, T4 Increasing size & local extent of primary
tumor

NODES
Nx Regional lymph nodes cannot be
assessed
N0 No regional lymph node metastasis
N1, N2, N3, N4 Increasing involvement of regional
lymph nodes

METASTASIS
Mx Distant metastasis cannot be assessed
M0 No distant metastasis
M1, M2, M3, Ascending degree of distant
metastasis, including metastasis to
distant lymph nodes

GRADING – classification of tissue from which the PRIMARY PREVENTION

tumor originated and the degree of which the tumor cells TWO main strategies:
retain the functional and histologic characteristics of the 1. Vaccine
tissue of origin. 2. Health counseling
▪ stop smoking and avoid secondhand smoke
Grade 1- well differentiated ▪ protect themselves from sunlight
Grade 2 - abnormal cells & moderately differentiated ▪ limit the drinking of alcohol
Grade 3 - very abnormal cells & poorly differentiated
Grade 4- do not resemble the tissue of origin. SECONDARY PREVENTION
Warning signs of cancer:
COMPARISON OF STAGING AND THE TNM SYSTEM ▪ Change in bladder and bowel movement
STAGE TNM CLASS CRITERIA ▪ A sore that does not heal
STAGE I T1, N0, M0 Clinical ▪ Unusual bleeding or discharge from any body
examination orifice
(70-90% reveals a mass ▪ Thickening or lump of the breast, testicle, or any
Survival) limited to the
part of the body
organ of origin.
The organ is ▪ Indigestion or dysphagia
operable and ▪ Obvious change in wart or mole
resectable with ▪ Nagging cough or hoarseness that is prolonged
only local ▪ Anorexia/appetite loss
involvement and ▪ Loss of weight/sudden weight loss
there is no nodal
and vascular EARLY DETECTION
spread BREAST
STAGE II T2, N1, M0 Clinical
• BSE >20 y/o
examination
(50+/-% Survival) shows evidence • CBE - q3 years; annually >40 y/o
of local spread • Mammography - annually >45-54 y/o
CERVIX
Papanicolau Smear (Pap Test)
• approx. 3 years after a woman begins having
sexual intercourse, but no later age 21, then
annually
• q 2-3 yrs at 30 y/o w/ normal test in a row
Testicular Self- Examination Steps
COLORECTAL
• FOBT (Fecal Occult Blood Test) >50 yo
• Sigmoidoscopy - q5 years before age 50
• Contrast Barium Enema - q5 years after age 50
• Colonoscopy - q10 yrs after age 50
PROSTATE
• DRE (Digital Rectal Exam) and PSA (Prostate
Specific Antigen test) -starting age 50
TERTIARY PREVENTION
Primary Strategies, Health Counselling ,
Chemoprevention
TREATMENT GOAL
CURE
Complete eradication of malignant disease
CONTROL
Prolong survival and containment of cancer cell growth
PALLIATION
Relief of symptoms association with the disease
FACTORS AFFECTING TREATMENT DECISIONS
Tumor cell kinetics, Tumor locations, Physical status of
the patient, Quality of life.
TYPES OF SURGERY
Diagnostic, Primary Treatment, Prophylactic, Palliative,
Reconstructive
PREOPERATIVE MANAGEMENT
• Nutritional status
• Talk about concerns and ask questions
• Preoperative education: information about the
surgical procedure
POST-OPERATIVE MANAGEMENT
• Frequent pain assessment
• Monitor for possible
• Complications
• Position changes and exercise
• Institute good nutrition, Asepsis, and frequent
wound assessment
RADIATION THERAPY
Types of Radiation Therapy
• Electromagnetic Rays (X-rays, Gamma Rays)
• Cobalt 60
• Particles (electrons, protons, neutrons, alpha
particle)
EFFECTS OF RADIATION
1. The most harmful tissue disruption is the alteration
of the DNA molecules within the cells of the tissue.
2. It breaks the strands of the DNA helix, leading to
cell death
3. Ionized constituents of body fluids leading to the
formation of free radicals and irreversibly damaging
DNA.
TYPES OF RADIATION
External Radiation
Teletherapy - the use of radioactive material for
production of an external beam of gamma rays for
treatment at a distance from the radioactive source
(tele, meaning “at a distance”).
Internal Radiation
Brachytherapy - a type of internal radiation therapy in
which seeds, ribbons, or capsules that contain a
radiation source are placed in your body, in or near the
tumor; treats only a specific part of your body.
Types of Internal Radiation
Unsealed (Oral, IV), Sealed
Safety Precautions For Brachytherapy
Private room, Radiation Safety Notice, Dosimeter
Badge, No children/pregnant visitors, No pregnant
staff, STD
Preparations For Intracavitary Brachytherapy
Bed rest and log roll, Indwelling urinary catheter, Low
residue diet, Antidiarrheal
IMPLANTS
1. Permanent 2. Temporary Implants (1-3 days)
KEY COMPONENTS OF RADIATION SAFETY
SHIELD, TIME, DISTANCE
“Minimize the time of exposure, maximize the distance
away from the sources, and maximize the shielding
between the sources and the point of exposure”
SIDE EFFECTS OF RADIATION
Localized Effect, Skin Reaction, Alopecia,
Myelosuppression, N & V, Fatigue, Malaise
Patient Education To Minimize Skin Reactions
(External Radiation)
1) Clean skin gently w/ mild soap.
2) Avoid very hot water bath. Classifications of Chemo Therapeutic Agent
3) Avoid sun exposure and extremes hot or cold. (By Chemical Group)
4) Avoid rubbing/ friction (belts, buckles, straps) 1. Alkylating Agents
5) Moisturize prophylactically. 2. Nitrosoureas
6) Do not remove radiation markings. 3. Antimetabolites
4. Antitumor antibiotics
A DISLODGED RADIATION SOURCE 5. Mitotic Spindle Poisons
1. Do not touch a dislodged radiation source with bare 6. Hormones
hands. 7. Miscellaneous Agents
2. Use long-handled forceps to place the source in the
lead container kept in the client's room and call the ALKYLATING AGENTS
physician. Action: Alkylates DNA
3. If unable to locate radiation source, bar visitors and prevents DNA from being separated for synthesis or
notify the physician. transcription.
• Bone marrow depression with leukopenia and
REMOVAL OF SEALED RADIATION SOURCES thrombocytopenia
1. The client is no longer radioactive. • GIT disturbances
2. Resume sexual intercourse after 7-10 days (if • Depress of gametogenesis (mainly in men),
implants is cervical or vaginal) leading to sterility
3. Povidone-iodine douche (cervical) • Alopecia and cystitis
4. Fleet enema if prescribed. Note: Chloramphenicol decreases the metabolism of
Cyclophospamide
CHEMOTHERAPY
Factors Affecting Treatment Decisions: Bendamustine, Busulfan, Carmustine, Chlorambucil,
Tumor cell kinetics, Physical status of the patient, Chlormethine, Cyclophosphamide, Dacarbazine,
Tumor locations, Quality of life. Fotemustine, Ifosfamide, Lomustine, Melphalan,
Streptozotocin, Temozolomide
Role of Chemotherapy In The Treatment of Cancer
• ADJUVANT - Treatment that is given in addition to NITROSOUREAS
the primary (initial) treatment can cross the blood-brain barrier and are used to treat
• NEOADJUVANT - Treatment given as a first step brain tumors.
to shrink a tumor before the main treatment
• PALLIATION - is designed to relieve symptoms, Carmustine, Chlorozotocin, Cthylnitrosourea,
and improve your quality of life. Fotemustine, Lomustine, Nimustine, Ranimustine,
Semustine, Streptozocin
GOALS OF CHEMOTHERAPY
Cure, Control, Palliation CONTRAINDICATIONS OF CHEMOTHERAPY
1. Infection
CHEMO DRUGS CLASSIFICATION 2. Recent Surgery
1. Vesicants - result in tissue necrosis or formation of 3. Impaired Renal or Hepatic Function
blisters when accidentally infused into tissue 4. Recent Radiation Therapy
surrounding a vein. 5. Pregnancy
2. Exfoliants - can cause inflammation and shedding 6. Bone Marrow Depression
of skin without causing underlying tissue death
3. Irritants - can cause inflammation, pain or irritation VASCULAR ACCESS DEVICE
at the extravasation site, without any blister (VADs) are inserted into veins via peripheral or central
formation vessels for diagnostic or therapeutic reasons, such as
4. Inflammitants - cause mild to moderate blood sampling, central venous pressure readings,
inflammation, painless skin erythema and elevation administration of medication, fluids, total parenteral
at the extravasation site nutrition (TPN) and blood transfusions.
5. Neutrals - neither cause inflammation nor damage
upon extravasation PERIPHERALLY-INSERTED CENTRAL CATHETERS
(PICC) is a form of vascular access that is inserted at a
Routes of Cytotoxic Drug Administration peripheral site such as the veins of the arms and
Oral, Subcutaneous, Intramuscular, Intrathecal, extends in the central venous system at the superior
Intravenous vena cava.

Classifications of Chemotherapeutic Agent TUNNELED CATHETERS

(By Relationship To Cell Cycle)
• Cell Cycle Specific - effective regardless of the
cell phase
• Cell Cycle Non-Specific - effective during a
specific phase of the cell cycle
• Cytotoxic - induce cell kill
• Cytostatic- inhibit tumor cell growth for periods of
time
is a catheter (a thin tube) that is placed in a vein for
long-term use. It is most commonly placed in the neck
(internal jugular) but may also be placed in the groin
(femoral), liver (transhepatic), chest (subclavian) or
back (translumbar).
 PORT-A-CATH
are small devices that are surgically placed just under
the skin (usually on the front of the chest) which are
connected to a tube which is placed into the main
veins in the neck.
Central Venous Catheter Complications
Pneumothorax, Infection, Bleeding, Thrombosis,
Misplacement
ANTITUMOR ANTIBIOTIC
Adriamycin - Adriamycin PFS (doxorubicin
hydrochloride) Injection - is a cancer (antineoplastic)
medication used to treat many types of cancer.
Mitomycin - a chemotherapy drug used to treat
different cancers including breast, bladder, gullet
(oesophagus), stomach, pancreas, lung, anal and liver
cancers. Mitomycin is given into a vein.
SPECIFIC SIDE EFFECTS
▪ Alkylating Agents: Hemorrhagic Cystitis,
Hyperuricemia
▪ Antimetabolites: Anemia
▪ Antitumor Antibiotics: Cardiotoxicity
▪ Vinca Alkaloids: Peripheral Neuropathy
GENERAL SIDE EFFECTS
Bone Marrow Depression, Alopecia, Fatigue/ Body,
Weakness, Nausea & Vomiting, Diarrhea,
Extravasation, Dry mouth/mouth sores, Infections,
Skin/Nail changes, Sexual/Fertility changes
Other Ways To Minimize Chemotherapy Nausea:
• If you are vomiting, stop eating.
• Avoid caffeine and smoking.
• Suck on hard candy, popsicles, or ice during
chemotherapy.
• Take the medications for nausea and vomiting as
prescribed by your doctor.
• Notify your nurse or doctor if you feel nauseated
during chemotherapy.
EXTRAVASATION
is the leakage of a fluid out of its container. In
inflammation, it refers to the movement of wbc from the
capillaries to the tissues surrounding them, also known
as diapedesis.
Management:
Stop the administration immediately
Leave the needle and aspirate any residual drug
Instill antidote
Remove needle
Notify the attending physician
Apply topical ointment
Monitor site closely
Document the event
RARE SIDE EFFECTS
Fluid retention and swelling, Hematuria, Hearing
impairment, Blurring of visual fields
LONG TERM EFFECTS
Leukopenic Syndrome - a decrease in the number of
leukocytes
Anemic syndrome, Thrombocytopenic syndrome
HEMATOPOEISIS AND IMMUNE RESPONSE
→ Cancer therapy has a direct impact on
hematopoiesis.
→ Chemotherapy and Radiation therapy kill cells that
divide rapidly.
→ When a patient receives cancer therapy, the white
blood cells (WBC), hemoglobin and platelet count
will begin to drop approximately 7 – 10 days after
the first day of treatment, the counts will recover
approximately 14 – 21 days later.
NADIR
→ Patients are at greatest risk for infectious
complication during the Nadir period.
→ The period in which the patient’s blood count is the
lowest.
BIOTHERAPY
Types of Biotherapy:
1. Immunomodulators
2. Colony Stimulating Factors
IMMUNOMODULATORS
Interleukin: aldesleukin, Interferons, BCG
Two Categories:
Immunosuppressants & Immunostimulants.
Lifelong Users of Immunomodulator Therapy
are at Particular Risk For:
Infections, Secondary malignancies, Nephrotoxicity,
Hepatotoxicity, Impaired glycemic control.
COLONY STIMULATING FACTORS
2.1 Granulocyte-Macrophage: sargramostim (Prokine,
Leukine)
2.2 Granulocyte: Neupogen, GM-CSF
2.3 Erythropoetin: epoeitin alfa (Epogen)
HEMATOPOEITIC STEM CELL TRANSPLANT
1. Bone Marrow Transplant
1.1 Autologous - a patient's healthy stem cells are
collected from the bone marrow before treatment,
stored, and then given back to the patient after
treatment.
1.2 Allogeneic – a patient receives healthy stem cells
to replace their own stem cells that have been destroyed
by treatment with radiation or high doses of
chemotherapy.
UMBILICAL CORD BLOOD CELLS
Cord blood contains blood (hematopoietic) stem cells,
which can produce all the other cells found in blood,
including cells of the immune system.
MONOCLONAL ANTIBODIES (MAB)
made in a laboratory to fight a particular infection and
are given to you directly in an infusion
Latest Breakthrough:
PHOTODYNAMIC THERAPY (PDT)
A treatment that uses a drug, called a photosensitizer
or photosensitizing agent.