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Importance of

Cancer Detection
and Testing
 Detecting cancers early is an important
step in preventing significant health
problems.
 Give the accurate manage for the present
illness(stage) of patient

 To prevent further complication


Four Possible
Outcomes in
Detecting
 True positive
Cancer
- test indicates that a patient has a disease
that the patient does indeed have

 False positive
- if the test indicates that a patient has a
disease when she does not
Four Possible
Outcomes in
Detecting
 True negative
Cancer
 - test indicates the patient is disease-
free, and this is indeed the case

 False negative
- test indicates the patient is healthy when
in fact the patient has the disease
Sensitivity and
Specificity of
Medical Tests
 Sensitivity refers to how accurately a test
identifies people who have the disease.
 Specificity refers to how accurately a test
identifies people who do not have the disease
 The best medical tests have high sensitivity
and high specificity.
SENSITIVITY
 It refers to the proportion of the times that
a test yields true positives.
 The closer the sensitivity is to 100%, the
more likely a positive result actually means
that the patient has a disease.
 The sensitivity of a medical test is a measure
of how well the test identifies people who
have a particular disease.
SPECIFICITY
 It refers to the proportion of the time
that a test yields true negatives
.

 The closer the specificity is to 100%, the


more likely a negative result means that
the patient is truly disease-free.
 The specificity of a medical test is a
measure of how well the test identifies
people who do not have a particular disease
General
Detection
 Importance:
 samplesmay show cancer cells,
proteins or other substances made by
the cancer
 idea
of how well your organs are
functioning and if they've been
affected by cancer
General
Detection
Non - Invasive Invasive Analysis of Biopsy
Techniques
Complete Blood Fine Needle Immunohistochemistry
Count (CBC) Aspiration (IHC)
Ultrasound
MRI Core Needle Biopsy Fluorescent In Situ
PET Scan Hybridization (FISH)
CT Scan
General Detection
and Diagnostic
Techniques
 A. Complete blood count (CBC)
 It provides information about the number, parts,
shape, and structure of the different cell types
found in blood.
 3 Main Types of Blood cells:
 WBC
 RBC
 Platelets

 Blood
cancers may be detected using this test if
too many or too few of a type of blood cell or
abnormal cells are found. eg., Leukemias
NON-INVASIVE
A. Complete blood count (CBC)
 Leukocyte ( WBC)
 Are major players in the immune system and
help defend against infection and disease.
 WBC can be divided into two main groups:
 Phagocytes
 Lymphocytes
NON-INVASIVE
A. Complete blood count (CBC)
Leukocyte ( WBC)

 Phagocytes-
 Are cells that are able to consume and break
down foreign material, invading microbes and
broken down cells/cell parts.
 They get their name from the Greek
'phagein', to eat.
NON-INVASIVE
A. Complete blood count (CBC)
 Leukocyte ( WBC)
 Lymphocytes-
 These are recognition cells responsible for
initiating the specific immune response of the
immune system.
 Three Major Types of Lymphocytes
 B cells
 T cells
 natural killer cells (NK cells)
NON-INVASIVE
A. Complete blood count (CBC)
 T- Cells
 Formed by the pluripotent stem cells in
the bone marrow, T-cells mature in the
thymus (a small organ located in the upper
portion of the chest).
 Two Subtypes of T cells;
 cytotoxic T cells (CD8 cells)
 helper T cells (CD4 cells).
NON-INVASIVE
A. Complete blood count (CBC)
 T- Cells
 Cytotoxic T cells (CD8 cells)
 bind specifically to targetcells; virally infected cells,
cancer cells, or any foreign cells. After binding,
cytotoxic T cells directly destroy the target cell.
 Helper T cells (CD4 cells)
 release special chemicals that help activate other cells
of the immune response, including; B cells, cytotoxic T
cells, other helper T cells, NK cells, and macrophages.
NON-INVASIVE
A. Complete blood count (CBC)
 B- Cells  Natural killer
 These cells are produced from cells (NK cells)
the pluripotent stem cells in
the bone marrow and stay in  It bind to virally
the marrow to mature.
infected cells and
 B cells bind to their specific cancer cells and
antigens, become activated
'plasma' cells and secrete
directly kill them.
large amounts antibodies.
NON-INVASIVE
A. Complete blood count (CBC)
 Granulocytes  Neutrophils
 granulescontain  Are usually the first
chemicals and proteins cells to arrive at the
(from cells)  control scene of infection or
inflammatory and inflammation
immune functions.
 Theyengulf and
 Granulocytesare also destroy foreign
capable of engulfing matter and then die,
and destroying foreign forming pus
matter
NON-INVASIVE
A. Complete blood count (CBC)
 Eosinophils  Basophils

 known to play a  These cells are


role in parasitic stimulated by
infections and other immune cells
allergic reactions and play a role in
systemic allergic
reactions.
NON-INVASIVE
A. Complete blood count (CBC)
Granulocytes  Monocytes/Macrophages
 lack the granules  These cells are the largest
of granulocytes type of white blood cell.
 The second cells on the
 capable of scene of a problem.
engulfing and  They engulf and process
destroying foreign foreign matter so that
matter. lymphocytes can recognize it
and mount a specific
defense.
NON-INVASIVE
A. Complete blood count (CBC)
 CBC: Red Blood Cells (RBC)
 Red blood cells (also called erythrocytes)
pick up oxygen in the lungs and deliver it
to the rest of the cells in the body.
 2 Subtypes of RBC
 Hemoglobin
 Hematocrit
NON-INVASIVE
A. Complete blood count (CBC)
 Hemoglobin
 Each red blood cell carries around 300
million molecules of a protein called
hemoglobin.
 Hemoglobin is what actually grabs and
carries oxygen.
 Each molecule of hemoglobin can carry 4
molecules of oxygen
NON-INVASIVE
A. Complete blood count (CBC)
 Hematocrit
 The hematocrit is the proportion of red blood cells
to an entire sample of blood (red blood cells /
blood).
 It may also be called packed cell volume (PCV) and it
is normally represented as a percentage.
 For example: a hematocrit of 30% means there are
30 milliliters of red blood cells in 100 milliliters of
blood.
NON-INVASIVE
A. Complete blood count (CBC)
 Reticulocyte Count
 Is the percentage of immature red blood
cells (reticulocytes) in the total red blood
cell count (reticulocytes / red blood cells).

 1-2% of the total RBC count


NON-INVASIVE
A. Complete blood count (CBC)
 Red Blood Cell Indices
 The RBC indices evaluate the structure of
red blood cells and hemoglobin.
 They include:
 mean corpuscular volume (MCV)
 mean corpuscular hemoglobin (MCH)
 mean corpuscle hemoglobin concentration
(MCHC).
NON-INVASIVE
Red Blood Cell Indices
 MCV describes the size  MCHC describes the
or volume of RBC's average concentration of
 Classificatioon; hemoglobin in the RBC's
 microcytic (small),  Classification:

 normocytic (normal)
 hypochromic (low
concentration, pale color),
 macrocytic (large)
 normochromic (normal
 MCH describes the concentration, normal color)
average weight of the  hyperchromic (increased
hemoglobin in the RBC's. concentration, bright red
A small RBC will have a color).
smaller MCH.
General Detection
and Laboratory
Techniques
 Urine cytology- reveal cancer cells that
could come from the bladder, ureters or
kidneys
 Blood protein testing- examine various
proteins in your blood (electrophoresis)
can aid in detecting certain abnormal
immune system proteins
General Detection
and Laboratory
Techniques
 Tumor marker tests- chemicals made
by tumor cells that can be detected in your
blood
 prostate-specific antigen (PSA)- for prostate
cancer
 cancer antigen 125 (CA 125)- for ovarian
cancer
 Calcitonin- for medullary thyroid cancer
 alpha-fetoprotein (AFP)- for liver cancer
 human chorionic gonadotropin (HCG)- for germ
cell tumors, such as testicular cancer and
ovarian cancer
General Detection (DIAGNOSTIC TECHNIQUES)
ULTRASOUND
(UTZ)
 is an ultrasound-based
diagnostic imaging
technique used to
visualize subcutaneous
body structures
 A computer program is
used to analyze the
echoes of sound waves
sent into the body
and generates an
image on screen.
ULTRASOUND
(UTZ)
 Purpose of UTZ
 Are good exams to gain important
information about a suspicious mass

 It can be used to help guide a needle


during a biopsy.
ULTRASOUND
(UTZ)

ADVANTAGES
Can detect lesions in women with dense breasts
when mammograms cannot.
 Less expensive than a mammogram.
 Present the difference between a cyst and a solid
mass without using a needle to draw out fluid (non-
invasive).
 Never exposed to radiation
 detect blood flow through vessels
 no known harmful effects to humans.
ULTRASOUND
(UTZ)
DISADVANTAGES
 Sometimes it is unable to determine
whether or not a mass is malignant, and a

biopsy will be recommended.
 Many cancers cannot be detected via an
ultrasound.
 Calcifications that are visible on
mammograms are not visible on ultrasound
scans
MAGNETIC
RESONANCE
 Also
IMAGING(MRI)
called as nuclear
magnetic resonance
imaging (NMRI)
 Canlocate and describe
the gross extent of a
mass or tumor but cannot
differentiate between
benign and malignant
MAGNETIC
RESONANCE
can show:
IMAGING(MRI)
When contrast agent is not used an MRI When contrast agent is used MRI can
show:

• contrast agent is not used an MRI can •size and location of benign or malignant
show: growths
•The shape, size, appearance, and location •enlarged lymph nodes
of organs, bones, and joints •changes in blood flow
•The presence of abnormal growths extracellular volume
•Signs of inflammation or infection
Positron Emission
Tomography
(PET)
 Is an imaging technique that uses
radioactive molecules to create a dynamic
image of internal tissues and organs.
 It produce images that reveal the activity
of living tissue.
 PET scans use radioactively labeled tracers
(radiotracers) that are injected into the
bloodstream
PET SCAN
Preparation:
 Drink plenty of water, but do not eat or drink anything
(except water) for 6 hours before your exam
 Take your medications normally and drink them with
ample water
 Make sure you arrive at the imaging center on time, the
compound used for the scan breaks down rapidly and if
you are late, the images may not be as good
 Wear loose fitting clothing
 Do not wear any jewelry; watches, chains, rings,
piercings, etc
Computed
Tomography
CT’s Scan
 usesspecial
x-ray
equipment to
obtain cross-
sectional
pictures of the
body
Computed
Tomography
 Use In CancerCT’s
to: Scan
 To detect or confirm the presence of a tumor;
 To provide information about the size and
location of the tumor and whether it has spread;
 To guide a biopsy (the removal of cells or tissues
for examination under a microscope);
 To help plan radiation therapy or surgery; and

 Todetermine whether the cancer is responding


to treatment.
Biopsy
- is the removal of
tissue from a
living subject to
determine the
presence or
extent of a
disease
CYTOLOGY SPECIMEN
- Visualization of  Specimen can be obtain
change cell from tumors that tend to
microscopically shed cells from their
BIOPSY
 NEEDLE BIOPSY  NEEDLE BIOPSY
 Incision Biopsy  Excision Biopsy
 Only part of tumor  Entire tumor is
is removed surgically removed for
 Cell tissue only examination
 Used for small tumors
(2-3cm)
 Serve as treatment if
tissue margin contain
no tumor cells
Biopsy
Invasive Techniques
 Fine needle  Core needle biopsy
aspiration (FNA) (CNAB)
 usesa small needle  uses
a larger
to collect small needle to collect
samples of a lesion. samples of a lesion
Biopsy
Invasive Techniques
 Fine needle aspiration  Core needle biopsy (CNAB)
(FNA)  ADVANTAGES:
 ADVANTAGES:  Strong ability to specifically
 diagnose benign lesions diagnose benign lesions.
 Inexpensive, quick, readily  Some ability to differentiate
available, and very safe between in situ and invasive
 DISADVANTAGES: breast cancer.
 No ability to differentiate  DISADVANTAGES:
between in situ and  More invasive, time
invasive breast cance consuming, expensive
Analysis of Biopsy
Samples
Immunohistochemistry (IHC)  Fluorescence in Situ
Hybridization (FISH)
 measures protein expression
 measures genetic changes (i.e.
using specially labeled
amplification) using
antibodies.
fluorescently labeled DNA
 example: Three proteins of
probes.
particular interest in breast  Is a technique that measures
cancer are HER2, the gene amplification and
estrogen receptor (ER) and chromosomal abnormalities using
the progesterone receptor fluorescently labeled DNA
probes.
(PR).
Cancer Specific
Techniques
 Mammography

 useslow dose x-
ray to create an
image of a
breast.
Cancer Specific
Techniques

Direct Visualization
Direct Visualization
 Sigmoidoscopy uses a small tube containing
viewing equipment to view the colon.
 Virtual Colonoscopy uses an MRI or CT scan to
create an image of the inside of the colon.
 Bronchoscopy
 Endoscopy
 Cystoscopy
 Exploratory Surgery
Cancer Specific
Techniques
 Pap smears use a sample of cells from the
cervix to detect cervical cancer. Pap
smears may also detect ovarian and
uterine cancers that have migrated to the
cervix.
 Prostate specific antigen (PSA) test
measures levels of a glycoprotein in the
blood. Elevated levels of PSA are
associated with prostate cancer
Sentinel Lymph
Node Biopsy (SLN)
 Use to detect metastasis
 the hypothetical first lymph node or
group of nodes reached by metastasizing
cancer cells from a tumor
 used in the staging of certain types of
cancer to see if they have spread to any
lymph node
Grading and
Staging
GRADING STAGING
 Evaluation of degree of  The process of describing the
differentiation of cancer local extent of the disease or
cells the spread of cancer from
 Grade 1- the least the original site
malignant
To  Essential in determining the
 Grade 4- the most choice of therapy and
malignant assessing prognosis
 Grade 1- the most
differentiated
 Based on information about
To the tumor size and location in
 Grade 4- the least the body, and whether or not
differentiated it has spread to other areas
of the body
“TNM” Staging
System
Measure tumors in three
ways:
Primary Tumor (T)
Node (N)
Metastasize (M)
“TNM” Staging
System
 Tumor

• T0- no evidence of primary tumor


• TIS- carcinoma in situ
• T1-T4- ascending degrees of tumor size and
involvement
“TNM” Staging
System
 Nodes

• N0- no evidence of disease in lymph nodes


• N1a, N2b- disease found in regional lymph
nodes, metastasis not suspected
• N1a, N2b, N3 - disease found in regional
lymph nodes, metastasis suspected
“TNM” Staging
System
 Metastasis

• M0- no evidence of distant metastasis


• M1, M2, M3- Ascending degrees of
metastasis involvement, including
distant nodes
“TNM” Staging
System
 Once the T, N, and M are determined, a “Stage”
of I, II, III, or IV is assigned
Stage I - (T1,N0,M0) - Early Stage
Stage II - (T2,N1,M0) - Local Spread
Stage III - ( T3,N2,M0) – Extensive
spread but no metastasis
Stage IV (T4,N3,M+) – Advanced
stage, with distant
metastasis
Levels of Cancer
Prevention and
Control
1. Primary Prevention
 Focuses on eliminating the
conditions that cause cancer to
develop
 Pre-cancerous stage
Levels of Cancer
Prevention and
Control
2. Secondary Prevention
 Refers to early detection coupled
with effective therapy
 Cancer maybe curable in early
stage.
Levels of Cancer
Prevention and
Control
3. Tertiary Prevention
 Refers to the prevention of cancer
recurrence, symptoms and
complication
 Involves Supportive Care,
Rehabilitation and pain relief
Principles of
Cancer
Treatment
 Objectives:

Aims to prevent cancer from


spreading locally or recurring/
relapsing at sites distant from
the original location.
Treatments
 Surgery
 Radiation Therapy
 Hormonal Therapy
 Targeted Therapy
 Antibodies
 Cancer Vaccines
 Complimentary and Alternative Medicines
 Chemotherapy
TREATMENT
MODALITIES
 A. Loco-Regional Treatment
1. Surgery
2. Radiation Therapy
3. Transplant

 B. Systemic Treatment
1. Cytotoxic Chemotherapy
2. Hormonal Therapy
SURGERY
 The first line of treatment for many solid
tumors. M
 single cancer cell is invisible to the naked eye
but can regrow into a new tumor, a process
called recurrence
 A local treatment used to remove visible tumors
or the entire organ
 Purposes:
 Diagnose
 Cure
 Control
 Pallative
SURGERY
 Local Excision- simple surgery with small
margin of normal tissue surrounding
tumor.

 En bloc Dissection- removal of tumor,


tissues, and any contiguous structures.
Surgery on Cancer
in Situ
 Electrosurgery- application of electrical
current to cancerous cells
 Cryosurgery- deep freezing with liquid
nitrogen
 Chemosurgery- applied chemotherapeutic
agents layer by layer with surgical
incision.
 Co2 laser- use of laser for laser excision.
RADIATION
THERAPY
 The use of high-energy ionizing rays to
treat a variety of cancers
 Destroys the cell’s ability to reproduce by
damaging the cell’s DNA
 Rapidly dividing cells are more vulnerable
to radiation than slower dividing cells
 It can be used alone or in conjunction with
other treatments (e.g. chemotherapy and
surgery) to cure or stabilize cancer.

RADIATION
THERAPY
 Objectives:
 This treatment seeks to relieve symptoms of the
cancer and to prolong survival, making life more
comfortable.
 Types of Radiation Therapy
 External Radiation Therapy
 Internal Radiation Therapy
 Photon Radiation
Types of Radiation
Therapy
1. External Radiation
Therapy
 Administered by
high energy X-
ray machines
(e.g. Betatron
and Linear
Accelerator) or
machines
containing
radiosotope
External Radiation:

Nursing
 Marks must not remove
Care
 Keep the skin dry
 Talcum and Lotions are contraindicated
 Avoid strong sunlight, extremes
temperature, constricting clothes.
 No Eating (NPO)
 Patient is not the SOURCE of Radiation
after the procedure.
Types of Radiation
Therapy
 Internal Radiation Therapy
 Involves the placement of specially
prepared radioisotopes directly
into near the tumor itself or into
the systemic circulation
 Also called “brachytherapy”
Types of Internal
Radiation Therapy

Sealed Source RT
(Brachytherapy)
Un Sealed- Source RT
Sealed- Source RT
 Sealed radiation source is
placed in a cavity or adjacent
to cancer.

 Ex: Radium, Iridium, Cesium


Sealed- Source RT
 INTRACAVITARY Therapy
 Radioisotope is placed into an applicator, then
placed into the body cavity for a carefully
calculated time (usually 24 – 72 H)

Ex: Radioisotopes: Celsium 137


Radium 226
Sealed- Source
RT
INTERSTITIAL THERAPY
 Radioisotope of choice is placed into needles,
beads, seeds, ribbons or catheters and then
implanted directly into the tumor.
 Implants may be left in the tumor temporarily
or permanently.
 Ex: Iridium 192, Iodine 125, Celsium 137, Gold
198, Radon 222
UNSEALED –SOURCE
RT
 Used in Systemic therapy.
 Source of Radiation is given orally,
intravenously.
 PO Administration: Low dose: Graves
Disease 131I High Dose: Thyroid Ca
 IV Administration: 32p Treats
Polycythemia Vera
Other Types of
Radiation Therapy
 It uses high energy rays
composed of particles of energy
called photons.
 Gamma rays: are produced by
the breakdown of radioactive
isotopes of elements such as
Cobalt-60 and radium
 X-rays: originate from machines
that excite electrons using
cathode ray tubes or linear
accelerators.
Nursing Care Highlight
Care of the Client with Sealed Implants of
Radioactive Sources
 Assign the client to a private  Limit each visitor to
room, with private bath. ½ hour per day
 Place “Caution: Radioactive  Never touch the
Material” sign on the door of
the clients room. radioactive material
with bare hands
 Pregnant nurses should not
care for these clients; do not  Save all dressings
allow children younger than 16 and bed linens until
and pregnant women to visit. after the
radioactive source
is removed.
RADIATION
SAFETY
 Three factors which determine the
total exposure one receives in a given
radiation field are:
1. Time of exposure.

2. Distance from Source.

3. Amount of shielding present.


TIME
 The Shortest Possible Time

 The less time


you spend near a
source, the less
radiation you will
receive
DISTANCE
 As far as possible
( can spend more
time at a distance
of 20 feet)
 The farther you get
from a source, the
less radiation you
will receive.
SHIELDS
 Protective Lead Apron

 The
more
shielding you
have, the less
radiation you will
receive.
Advantages of
Radiotherapy
 Destroys quickly dividing cells at the margins
of tumors. Surgery may miss these cells
leading to recurrence of disease.
 Can successfully eradicate growth without
permanently damaging the adjacent normal
 In conjunction with other treatments, may
cure tumors that are not responsive to any
single agent.
II. SYSTEMIC TREATMENT
HORMONAL THERAPY BIOLOGIC TREATMENTS

 Referred to by many terms


 Fights cancer by including: Immunologic
altering the therapy, Immunotherapy,
amounts of biotherapy. (Interferon,
Interleukin)
hormones in the
 Often used to help restore
body. the functioning of the
immune system.
 Stimulates the disease-
fighting ability of the body.
CHEMOTHERAPY
 “Chemo”, refers to a wide  PRINCIPLE OF
range of drugs used to CHEMOTHERAPY
treat cancer  Timing of dose around the
 work by damaging the cell cycle and in relation
dividing cancer cells and to other drugs is critical
preventing their further  Combination therapy is
reproduction more effective
 Death of the normal cells  Effectiveness of the drug
produces some of the relies on the number of
common side-effects of cells in division
chemotherapy.
CHEMOTHERAPY
 The use of powerful drugs to:
KillCancer Cells
Control their Growth
Relieve Pain Symptoms
Types of
Chemotherapy
Types of
Chemotherapy
1. Primary Chemotherapy
The use chemotherapy alone for the cure of
a specific tumor.
2. Adjuvant Chemotherapy
The use of chemotherapy after primary,
loco –regional treatment, with the intent of
decreasing the relapse rate and improving
survival.
Types of
Chemotherapy
3. Neo- adjuvant Chemotherapy
The use of chemotherapy before loco- regional
treatment with the intent of decreasing tumor
size enhancing chances for resectability and
preservation of normal structures.
4. Concurrent Chemotherapy
The use of chemotherapy combined with
radiotherapy in order to increase local response
and control systemic spread.
Types of
Chemotherapy
5. Palliative Chemotherapy
The use of chemotherapy in advanced
malignancies, the intent of which is not
cure but control of the disease and tumor
related symptoms.
CHEMOTHERAPY
DRUGS
Types 
 Antineoplastic Agents- drugs that inhibit and combat the
development of neoplasms
 Classes:
 Antimetabolites
 Genotoxic Drugs
 Alkylating agents:
 Intercalating agents
 Enzyme inhibitors
CHEMOTHERAPY
 Types
 Spindle Inhibitors

 Additional Chemotherapy Agents


ANTIMETABOLITE
S
 Drugs that interfere with the formation of
key biomolecules within the cell.
 work by blocking the activity of enzymes
 These drugs often prevent the normal
replication of DNA , nucleic acids and
therefore cell division.
 Other antimetabolites may interfere with
the creation of RNA or other cellular
processes
ANTIMETABOLITE
S
 Classes:
 Folate Antagonists- known as antifolates
 inhibit dihydrofolate reductase (DHFR), an enzyme
involved in the formation of nucleotides. When this
enzyme is blocked, nucleotides are not formed,
disrupting DNA replication and cell division
 Ex. Methotrexate (Wellcovorin):
 ADVERSE EFFECT
 Bone marrow depression
 stomatitis
ANTIMETABOLITE
S
 Purine Antagonists
 purines (adenine and guanine) are chemicals used to
build the nucleotides of DNA and RNA
 inhibiting DNA synthesis in two different ways
 They can inhibit the production of the purine
containing nucleotides, adenine and guanine
 They may be incorporated into the DNA molecule
during DNA synthesis
 Ex. 6-Mercaptopurine, Dacarbazine, Fludarabine
ANTIMETABOLITE
S
 Pyrimidine Antagonists
 act to block the synthesis of pyrimidine containing
nucleotides (C and T in DNA; C and U in RNA).
 The drugs used to block the construction of these
nucleotide have structures that are similar to the
natural compound.
 By acting as 'decoys', these drugs can prevent the
production of the finished nucleotides. They may exert
their effects at different steps in that pathway and
may directly inhibit crucial enzymes.
 Ex. 5-fluorouracil; Arabinosylcytosine
Genotoxic

Drugs
Drugs that damage DNA. By causing DNA
damage, these agents interfere with DNA
replication, and cell division
 3 Treatments:
 Alkylating Agents
 Intercalating Agents
 Enzyme Inhibitors
Genotoxic
Drugs
 Alkylating agents:

 The first class of chemotherapy agents


used. These drugs modify the bases of
DNA, interfering with DNA replication
and transcription and leading to mutations
Genotoxic
Drugs
Intercalating agents
 These drugs wedge themselves into the spaces
between the nucleotides in the DNA double
helix. They interfere with transcription,
replication and induce mutations.
Enzyme inhibitors
 These drugs inhibit key enzymes, such as
topoisomerases, involved in DNA replication
inducing DNA damage.
Spindle
Inhibitors
 These agents prevent proper cell division
by interfering with the cytoskeletal
components that enable one cell to divide
into two.
 Vinca Alkaloids
Paclitaxel (Taxol®)
Docetaxel (Taxotere®)
Ixabepilone (Ixempra®)
Additional
Chemotherapy
 Agents
While many of the commonly used chemotherapy
agents fit into one of the three previously described
groupings (Genotoxic, Cytoskeletal, and Anti-
metabolite), some of them work through mechanisms
that do not neatly fit into one of these categories.
 Arsenic trioxide (Trisenox®)
 Bleomycin
 Hydroxyurea Streptozocin
Chemotherapeutic
Administration
 Oral
 IM/ SQ
 IV
 Central Venous Catheter
 Venous Access Devices (VAD)
 Intraarterial Route
 Intraperitoneal Route
STEM CELLS
• Stem cells are able to
grow into other blood cells
that mature and function
as needed in the body.
• Stem cells create the
three main types of blood
cells:
– red blood cells
– white blood cells
– platelets
Stem cells
Location
 Bone marrow (the spongy center of the
bone where blood cells are made)
 Peripheral blood (found in blood vessels
throughout the body)
 Cord blood (found in the umbilical cord
and collected after a baby’s birth)

Stem cells for transplantation are obtained from any of these three
places.
Transplant in

Cancer
A. Stem Cell Transplant
a procedure that is used
in conjunction with high-
dose chemotherapy
 more effective than
conventional
chemotherapy in
destroying myeloma cells
 restore blood cell
production
Types of Stem Cell
Transplants
 Bone marrow transplant
 stem cell-containing bone marrow is collected, stored,
and infused following high-dose chemotherapy and/or
radiation therapy.
 Peripheral blood stem cell (PBSC) transplant
 Procedure in which blood containing mobilized stem cells
is collected by apheresis, stored, and infused following
high-dose chemotherapy and/or radiation therapy.
 Cord blood transplants refer to transplants where the
stem cells are obtained from umbilical cord bld
Types of
Transplants

according to Donor
Autologous transplants, patients receive
their own stem cells.
 Syngeneic transplants, patients receive stem
cells from their identical twin.
 Allogeneic transplants, patients receive stem
cells from their brother, sister, or
parent. A person who is not related to the
patient (an unrelated donor) also may be
used.
THE CANCER PAIN
PROBLEM

PAIN
In cancer is the most feared
and distressing symptom
of the disease.
THE CANCER PAIN
PROBLEM
 WHO reveals that everyday at least 4
million people suffer from cancer pain.
 30 – 50% of cancer patients undergoing
treatment, and up to 95% of patients with
advanced disease, suffer from pain.
 More than 50% of patients still suffered
from unrelieved cancer pain.
WHO: 3 Step Analgesic Ladder
For Cancer Pain Management

Basic Principles:

 BY THE MOUTH
If the patient can swallow, oral
administration is the route of choice.
WHO: 3 Step Analgesic Ladder
For Cancer Pain Management

 BY THE CLOCK
Analgesics should be given regularly and
prophylactically.

 BY THE LADDER
Use a few drugs well than many badly.
WHO Three-Step
Analgesic Ladder
• Step I For mild to moderate pain non-opioids
(treatment of choice). may or may not be combined
with adjuvant drugs (drugs that are used to hasten
or add to the primary mode of treatment).
• Step II For moderate pain, who did not feel relief
after using only non-opioids, a combination of opioids
and non-opioids should be tried. Again, adjuvants may
or may not be used.
• Step III For moderate to severe pain, opioids should
be used, with or without non-opioids, and with or
without adjuvants.
WHO Three-Step
Analgesic Ladder
Cancer :
Management
C – Comfort
 A- Altered Body Image
 N – Nutrition
 C – Chemotherapy
 E- Evaluate the Response in
Treatment
 R - Rest
SUMMARY
 Early detection and screening of high risk
individuals play significant roles in
treating cancer.
 Patient and family caregivers should be
involved in all aspects of nursing care.
 Various treatment modalities are available
to cure, control and palliate cancer.
SUMMARY
 Safety Standards of treatment must
always implemented.

 Life long surveillance for recurrence after


treatment.