Introduction to Oncology

Nursing
 Lecture contents

 Objective
 Introduction of Cancer
 Pathophysiology of cancer
 Treatment modality of cancer
 Nursing diagnosis and nursing care
 Learning Objectives

At the end of this chapter, students should be able to:

 Define key terms.
Explain the behavior of cancer cells differs from that
of normal cells.
Discuss treatments modalites for cancer
Describe the role of the nurse in cancer detection.
 C a n c e r Te r m i n o l o g y
• Anaplasia: cells that lack normal cellular characteristics
and differ in shape and organization with respect to their
cells of origin.
• Benign tumors may grow but are unable to spread to
other areas.
• Malignant: having cells or processes that are
characteristic of cancer.
• Metastasis: spread of cancer cells from the primary
tumor to distant sites
 Continued...

• Neoplasia: uncontrolled cell growth that follows no

physiologic demand
• Palliation: relief of symptoms and promotion of
comfort and quality of life
 Cancer
• Cancer is a disease resulting from the uncontrolled
growth of abnormal cells, which causes malignant
cellular tumors.
 C -is one of the most common and severe problem of
clinical medicine.
 C- has emerged as a major public health problem in
developing countries for the first time, matching its
effect in industrialized nations. This is a global
 Continued...

 Malignant or cancerous:- tumours are defined as

“uncontrolled growth of cells” which manifest as:

• Rapid proliferation

• Decreased cellular differentiation

• Invasion of surrounding tissues

• Ability to metastasize
 Cancer Epidemiology

 One-half of all men and one-third of all women will

develop cancer at some time in their lives.

 Prostate cancer is the most common form of cancer in

males, and breast cancer is the most common form in

females,

 Lung cancer causes the highest mortality rates for

either gender (American Cancer Society, 2007).

 Continued...

• African-Americans have lower survival rates for most

cancers compared with other groups of people.
• The five-year survival rate from all cancers is currently
estimated at 58% (American Cancer Society, 2000).
• The disabilities include movement dysfunctions, limited
physical activity levels, chronic fatigue, and depression.
 Etiology

 The exact mechanism that causes cancer is

unknown, but most authorities believe that cancer
develops from a combination of factors rather than
from a single factor.
 The etiology of cancer is multifactorial with viruses
and bacteria, physical agents, chemical agents,
genetic or familial factors, dietary factors, and
hormonal agents..
 Continued...

 Chemical substances that initiate or promote the

development of cancer are known as carcinogens.
 Most cancer is caused by genetic mutations often,
by a series of mutations.
 These agents are thought to alter the DNA in the
cell nucleus.
 Continued...

• Abnormalities in the genetic material due

to:
Error in DNA replication (randomly acquired).
Effects of carcinogens, such as tobacco smoke,
radiation, chemicals, or infectious agents.

Inheritance, and thus present in all cells from birth.

 Risk Factors
A risk factor is anything that increases a person's
chance of getting a disease.
 Environmental

 lifestyle

 Genetic ,and

 viral, may increase an individual’s chances of

developing cancer.
 Different cancers have different risk factors
 Lifestyle Factors
 Lifestyle factors include the use of tobacco, sun exposure,
alcohol consumption, and diet.
 Tobacco accounts for nearly one in five deaths in the
United States (ACS, 2008).
 Tobacco use includes cigarettes, cigars, pipes, and
smokeless forms (e.g., snuff and chewing tobacco).
 The same carcinogens are found in all forms of tobacco,
causing cancer of the oral cavity, esophagus, pharynx,
larynx, lung, pancreas, uterus, cervix, kidney, and bladder.
 Continued...
 Overexposure to the sun’s ultraviolet rays over long
periods of time is the cause of many skin cancers.
 The most serious form of skin cancer is melanoma.
 Heavy alcohol consumption has also been implicated in
mouth, throat, esophageal, and liver cancers.
 Alcohol is hypothesized to cause 5% of cancer deaths.
 Alcohol and tobacco used together greatly increase the
risk of oral and esophageal cancers.
 Continued...
 The mechanisms for increased rates of breast cancer from
alcohol consumption are unclear but may be related to
 Impairments in the immune function

 The inability of the liver to clear the body of carcinogens, or

 Decreases in cell membrane permeability in the breast

 High consumption of dietary fat may increase bile acids and

cholesterol metabolites that may increase carcinogens in the
body that are associated with colorectal cancers.
 Genetic Factors

 Women whose mothers, grandmothers, or sisters

have had breast cancer have twice the risk of
developing cancer as those whose first-degree
relatives have not had the disease (ACS, 2008).
 Viral Factors
 Although viruses have been linked to several

cancers, their exact role is unclear.

 Herpes simplex II virus and some of the human
papillomaviruses that are transmitted sexually are
known to predispose women to cervical cancer.
 Reducing the number of sexual partners can reduce
the risk of contracting these viruses.
PATHOPHYSIOLOGY OF CANCER
Normal Cellular Differentiation
 Cell Cycle in Cancer
 In normal cells, the cell cycle is controlled by a

complex series of signaling pathways by which a

cell grows, replicates its DNA and divides.
 Continued...

 This process also includes mechanisms to ensure

errors are corrected, and if not, the cells commit
suicide (apoptosis).
 In cancer, as a result of genetic mutations, this
regulatory process malfunctions, resulting in
uncontrolled cell proliferation.
 The Cell Cycle Biology
 The process of cell division, also called mitosis, is
accomplished through four phases:
1. The G1/gap phase:- the cell grows and prepares to
synthesize DNA
2. The S/synthesis phase:- in whichthe cell synthesizes DNA
3. The G2/second gap phase:- the cell prepares to divide
3. The M/mitosis phase:- in which cell division occurs.
 checkpoint G1/S
 As a cell approaches the end of the G1 phase it is
controlled at a vital checkpoint, called G1/S, where
the cell determines whether or not to replicate its
DNA.
 The cell is checked for DNA damage to ensure that it
has all the necessary cellular machinery to allow for
successful cell division.
 Continued...
 a result of this check, which involves the interactions of
various proteins, a "molecular switch" is toggled on or
off.
 Cells with intact DNA continue to S phase
 cells with damaged DNA that cannot be repaired are
arrested and "commit suicide" through apoptosis, or
programmed cell death.
 Continued…
 A second such checkpoint occurs at the G2 phase.
 Cells use a complex set of enzymes called kinases to
control various steps in the cell cycle.
 CDKs, are a specific enzyme family that use signals to
switch on cell cycle mechanisms.
 CDKs themselves are activated by forming complexes
with cyclins, another group of regulatory proteins only
present for short periods in the cell cycle.
 Continued…
 When functioning properly, cell cycle regulatory proteins
act as the body's own tumor suppressors by controlling
cell growth and inducing the death of damaged cells.
 Genetic mutations causing the malfunction or absence
of one or more of the regulatory proteins at cell cycle
checkpoints can result in the "molecular switch" being
turned permanently on, permitting uncontrolled
multiplication of the cell, leading to carcinogenesis, or
tumor development.
 Patho
 Cancer results from a series of molecular events that

fundamentally alter the normal properties of cells.

 In cancer cells the normal control systems that prevent
cell overgrowth and the invasion of other tissues are
disabled.
 These altered cells divide and grow in the presence of
signals that normally inhibit cell growth.
 Continued...
 As these cells grow, they develop new
characteristics, including
- changes in cell structure,
- decreased cell adhesion,
- production of new enzymes.
 These heritable changes allow the cells divide and
grow and also the cancer cell to spread and invade other
tissues.
 Continued...
 The abnormalities in cancer cells usually result from

mutations in protein-encoding genes that regulate cell

division.

 Over time more genes become mutated.

 This is often because the genes that make the proteins

that normally repair DNA damage are not functioning

normally because they are also mutated.

 Defect in Cellular Differentiation
 Proto-oncogenes:- produces protein(p53) products that
normally enhance cell division /inhibit normal cell death.
– Normal cellular genes that are important regulators
on normal cellular processes
– Mutations that alter their expression can activate
them to act as oncogenes (tumor-inducing)
– Mutations is a change happens in the genes when a
cell divides. That is a gene has been damaged, lost or
copied twice.
 Proto-oncogene
 Regulates normal cell growth/division
 Oncogene
 It Cells divide uncontrollably
 Continued...
These malfunctioning genes can be broadly classified into
three groups.
o Proto-oncogenes, produces protein products that
normally enhance cell division or inhibit normal cell
death.
o The mutated forms of these genes are called oncogenes.
o Tumor suppressors, makes proteins that normally
prevent cell division or cause cell death.
o DNA repair genes, which help prevent mutations that
 Continued...
 Controlled cell growth is maintained by regulation of
proto-oncogenes
 which accelerate growth, and tumor suppressor genes,
which slow cell growth.
 Mutations produce oncogenes that accelerate growth
while those affect tumor suppressors. In either case,
uncontrolled cell growth occurs.
 Cancer is a disease characterized by neoplasia, an
uncontrolled Growth of abnormal cells.
 Continued...

 normal cells, which reproduce in an orderly manner and

grow for a purpose, while cancer cells develop rapidly and
indiscriminatingly.
 Neoplasms is any abnormal growth of new tissue that can
be found in any body tissue.
 Neoplasms may be benign (not progressive and, thus,
favorable for recovery) or malignant (becoming
progressively worse and often resulting in death).
 Factors affect tumor growth and
development
 The status of an individual's immune system
 The rate the tumor cells are growing,
 The number of tumor cells actively spreading, and
 The rate that the normal tissues are being destroyed by
the tumor.
Several factors affect normal immune function, including
stress, malnutrition, advancing age, and chronic
diseases.
 Cancer itself appears to suppress the immune system
Development of Cancer
 How cancer spreads into
surrounding tissues?
 As a tumour gets bigger, it takes up more space in the body.
 The cancer can then cause pressure on surrounding
structures.
 It can also grow into body structures nearby. This is called
local invasion.
 How a cancer actually grows into the surrounding tissues is
not fully understood.
 A cancer may grow out in a random direction from the place
where it started. However, researchers know that tumours
 Continued...
 Research reveled 3 different ways that tumours
may grow into surrounding tissues.
 Which way is used most depends on the type of
tumour, and where in the body it is growing. These
are:-
• 1. Pressure from the growing tumour
• 2. Using enzymes
• 3.Cancer cells moving through the tissue
 Classification of Cancer

Anatomic Site Classification

Histologic Analysis Classification
Clinical Staging
TNM Classification
 Anatomic Site Classification

This classification is identified by:-

 Tissue origin
 Anatomic site
 Behavior of the tumor (benign vs. malignant)
 Classifications of Cancer According
to Tissue Type
 Cancers are usually named according to the site of the primary

tumor or to the type of tissue involved.

 There are different classifications of cancer according to tissue type:

 Lymphomas:- cancers occurring in infection-fighting organs, such

as lymphatic tissue

 Leukemia:- cancers occurring in blood-forming organs, such as the

spleen, and in bone marrow

 Sarcomas :- cancers occurring in connective tissue, such as bone

 Carcinomas:- cancers occurring in epithelial tissue, such as the skin

 Histologic Analysis Classification
Based on cellular appearance and differentiation
Grade 1: Differ slightly from normal; well
differentiated
 Grade 2: More abnormal; moderately differentiated
 Grade 3: Very abnormal; poorly differentiated
 Grade 4: Immature, primitive and undifferentiated
cells; difficult to determine cell of origin
 Types of Staging Systems
 There are 2 main types of staging systems for cancer.
 These are the TNM system and the number system.
 The systems mean that:
 To describe the size and spread of cancers
 Treatment results can be accurately compared
between research studies
 blood cancers or lymph system cancers have own
staging system
 1. TNM staging of tumors

 Staging determines the extent of the spread of

cancer.

 The TNM ( Tumour, Node, Metastasis) classification

proposed by the American Joint Commission on

Cancer is one of the most frequently used systems.

 Staging of cancer is determined and noted as Stages

0 to IV.
 Continued…

• This system is used to describe the extent of the

disease for example, 0 indicates undetectable, and
I, II, III, and IV indicate a progressive increase in the
size or the extent of the disease.
 Continued...

 T, the anatomical size of the tumor /cancer and how far

it has spread into nearby tissue – it can be 1, 2, 3 or 4,
with 1 being small and 4 large ( tumor size)
 N, whether the cancer has spread to the lymph nodes
– it can be between 0 -no lymph nodes containing
cancer cells and 3- alots of lymph nodes containing
cancer cells (Spread to lymph nodes
 Continued...

 M, whether the cancer has spread to another part

of the body – it can either be 0, the cancer hasn't
spread, or 1, the cancer has spread. the presence or
absence of metastasis
 Staging is important because it influences
decisions about treatment modalities and helps
predict overall prognosis.
 The TNM Clinical Classification
System is represented as follows:
 Tumor (T) codes:
 TX: Cannot be assessed
 T0: No evidence of a primary tumor
 Tis: Carcinoma in situ
 T1, T2, T3, and T4: Increasing size, local extent, or
both, of primary tumor
 Continued...

 Regional lymph node (N) codes:

 NX: Cannot be assessed
 N0: No metastasis
 N1, N2, and N3: Increasing involvement of regional
lymph nodes
 The spread of cancer cells from the primary site, or
site of origin, is called metastasis.
 Continued...

 Metastasis (M) codes:

 MX: Cannot be assessed

 M0: No distant metastasis

 M1: Distant metastasis

 Combining the TNM Clinical Classification codes

leads to the actual tissue staging.

 Grading of Tumors
• Normal body cells have individual characteristics that allow
them to perform different body functions. This process is
called differentiation
 Tumor cells that presented with identifiable tissue
characteristics of the original cell are termed well
differentiated.
 Tumor cells having little similarity to the tissue of origin are
termed undifferentiated.
 Tumor grading is based on the degree of differentiation of
malignant cells.
 Continued…

 The higher the grade, the higher the number and the

worse for prognosis.

 This, a grade I tumor is the most differentiated, and a

grade IV tumor is the most undifferentiated (or least

differentiated).
 Tumors containing poorly differentiated cells are more

aggressive in growth and may display uncharacteristic

behaviors, leading to a poorer prognosis.
 Continued…

 0: cancer in situ
 1: tumor limited to tissue of origin
 2: limited local spread
 3: extensive local and regional spread
 4: metastasis
 2. Number staging systems
 Number staging systems usually use the TNM system to
divide cancers into stages.
 Most types of cancer have 4 stages, numbered from 1 to 4
 Stage I usually means that a cancer is relatively small and
contained within the organ it started in
 Stage II usually means that the tumour is larger than in
stage 1, but the cancer has not started to spread into the
surrounding tissues. Sometimes stage 2 means that cancer
cells have spread into lymph nodes close to the tumour.
 Ccontinued…
 Stage III means the cancer is larger.
 It may have started to spread into surrounding tissues
and there are cancer cells in the lymph nodes in the area
 Stage IV means the cancer has spread from where it
started to another body organ.
 This is also called secondary or metastatic cancer
 The stages and Grade of cancer are:
Stage Code Description

Stage 0 Tis Cancer in situ (encapsulated)

Stage I T2, N0, M0 Cancer is limited to original site or organ

Cancer has spread to surrounding tissue in same anatomic

Stage II T2, N1, M0
region

Stage III T3, N2, M0 High probability of metastatic disease

Stage IV T4, N3, M1 Metastatic spread to other anatomic regions

 Benign and its Character
 Benign neoplasms are not cancerous and are usually
harmless.
 They grow slowly
 They are encapsulated and well defined
 They do not spread to neighboring tissues. Unless their
location interferes with vital functions
 Benign neoplasms are associated with a favorable
prognosis.
 Hyperplasia refers to an increase in the number of cells in a tissue or in a
part of a tissue.
 Malignant and its Character
 Malignant neoplasms form irregularly shaped masses with fingerlike
projections.
 They usually multiply quickly and spread to distant body parts through
the bloodstream or the lymph system. This process is called metastasis.
 Patterns of metastasis will differ depending on the type of cancer.
 Dysplasia is a general category that indicates a disorganization of cells. I.e. a cell varies
from its normal parent cell in size, shape, or organization.
 Benign versus Malignant Tumors
Characteristic Benign Malignant

Differentiation Well differentiated Anaplastic

Growth Rate Slow Rapid

Mode of growth Expansive Infiltrative and expansive

Metastases None Can spread to distant

sites

Prognosis Usually harmless Can be fatal if not treated

 Characterstics of Cancer
 Unregulated cell cycle progression,
 abnormal secretion of growth factors/Insensitivity to anti-
growth signals
 evasion of apoptosis
 unlimited cell division
 Self-sufficiency in growth signaling
 Induction and sustainment of angiogenesis
 Activation of metastasis and invasion of tissue.
 Sign and symptoms of cancer

Some of the early symptoms of cancer are

• Fatigue • Headache
• Weakness • Pain
• Depression • Change bowel habitis
• Weight loss • Persistence cough/
hoarseness sound
 Seven Warning Signs of Cancer

 Change in bowel or bladder habits

 A sore throat that does not heal
 Unusual bleeding or discharge from body orifice
 Thickening or lump in breast or elsewhere
 Indigestion of difficulty in swallowing
 Obvious change in wart or mole
 Nagging cough or hoarseness
 Screening
Timely screenings have markedly improved early detection
and survival rates from cancer
 X-rays,
 Breast self-examinations,
 CT scans,
 Mammography,
 ultrasound examinations,
 Prostate screenings,
 bone scans, liver and
 Chest X-rays, and
spleen scans, and
Colonoscopy,
 biopsy analysis to confirm
 Physicians may also use
a diagnosis of cancer.
evidence from laboratory
tests
 Complications
 Common cancer related complications could
include:
– Hypercalcemia
– Spinal cord compression
– Superior vena cava syndrome
– Cardiac tamponade and
– Psychosocial alterations
TREATMENT MODALITIES
 Factors that determine treatment modality
– Cell Type
– Location and size of tumor
– Extent of disease
 Physiologic and psychologic status and expressed
needs also determine treatment
 TREATMENT MODALITIES

• Surgery • Hormone therapy

• Radiation therapy • Targeted therapy
• Chemotherapy (use of • Photodynamic therapy
drugs to treat illness) • Bone marrow
• Biotherapy/ transplantation
immunotherapy

These methods may be used alone or in

combination
 Surgery

 Surgery is the oldest form of cancer treatment and remains

the most common method of treatment today.
 Surgery is classified as curative, palliative, or reconstructive.

 The goal of curative surgery is to heal or restore to health.

 This involves excising all of the tumor, the involved

surrounding tissue, and the regional lymph nodes.
 Surgery most often has curative results when performed in
the early stages of cervical, breast, or skin cancer.
 Contineud….
 palliative surgery Because 70% of clients show evidence
of metastasis at diagnosis. It indicates cure is not always
possible, so palliative surgery may be necessary.
 This surgery is effective in relieving symptoms in more
advanced stages of cancer, although it does not alter the
course of the disease.
 It is usually performed in an attempt to relieve
complications such as obstructions or to surgically interrupt
nerve pathways for intractable pain.

 Continued…
 It may also be used to insert special access devices or
to place tubes for enteral nutrition.
 Reconstructive surgery is performed to reestablish
function or rebuild for a better cosmetic effect.
 Reconstructive surgery to areas such as the head,
neck, breast, and extremities minimizes deformity.
 The surgery is completed all at once or done in stages.
 2. Radiation Therapy

 Radiation therapy is the second most common method

of treating cancer.
 Radiation therapy, or radiotherapy uses high-energy
ionizing radiation to kill cancer.
 Ionizing radiation penetrates tissue cells and deposits
energy within them.
 This intense energy causes breakage in chromosomes
within the cell, thus preventing the ability of the cell to
replicate.
 Continued...
 Cell death occurs hours, days, or even years after
treatment, depending on the rate of mitosis.
 The goal of radiation therapy is to eradicate malignant
cells without causing harm to healthy tissues.
 As a single treatment modality is most often used
when the disease is localized.
 Preoperative radiation is frequently used to reduce the
tumor mass before surgery.
 Continued…
 Postoperative radiation therapy is frequently used to
decrease the risk of local recurrence after surgery.
 Radiation therapy is classified as curative or palliative.
 It is frequently used to alleviate symptoms of
metastasis, such as pain.
 There are two types of radiation therapy:
 external radiation and
internal radiation.
 External Radiation

 External radiation, or teletherapy, is performed with

special equipment that can deliver high-energy
radiation.
 Customized shielding blocks are created to protect
healthy tissues, and immobilization devices are used
to maintain the exact position for each treatment.
 Dyes or tattoos may be used to designate reference
points on the skin.
 Continued…

 Nursing care is directed toward client teaching, safety,

and performing interventions that provide relief from
side effects.
 Undesirable side effects that are most likely to occur
include varying degrees of skin reactions and
gastrointestinal discomfort, such as abdominal
cramping, diarrhea, loss of appetite, and fatigue.
 Treatments have a cumulative effect and may thus
produce symptoms after the therapy has been
 Internal Radiation
 Internal radiation delivers radioactive isotopes directly
within the body.
 Clients treated with internal sources of radiation are a
source of radioactivity.
 Isotopes are introduced into the body by sealed or
unsealed sources.
 With sealed sources, radioactive elements are
encapsulated in special containers such as tubes,
wires, needles, seeds, or capsules.
 Continued…
 Radioactive implants are used in the treatment of
cancers of the tongue, lip, breast, vagina, cervix,
endometrium, rectum, bladder, and brain.
 The degree of exposure is dependent on three
factors:
 The distance between the individual and the
source
 The amount of time an individual is exposed
 The type of shielding provided
 Continued…
 Radioactive isotopes also are placed in suspensions or
solutions as unsealed sources of radiation.
 They are given orally or parenterally or instilled into
intrapleural or peritoneal spaces.
 Some radioactive elements used in unsealed radiation
sources are eliminated in body secretions, including
urine and stool. Unsealed sources are not usually
radioactive as long as the sealed sources.
 3. Chemotherapy
 Chemotherapy is the treatment of cancer using
specific chemical agents or drugs that are selectively
destructive to malignant cells and tissues.
 Chemotherapy is the systemic (whole body) treatment
of cancer with anticancer drugs.
 Broadly, most chemotherapeutic drugs work by
impairing mitosis (cell division), and effectively
targeting fast-dividing cell. .
 Drugs used in chemotherapy are called
antineoplastics because they inhibit the growth and
reproduction of malignant cells
 Chemotherapy is used to cure, prevent, or relieve
cancer symptoms.
 Almost all anticancer drugs kill cancer cells by affecting
DNA synthesis or function, but they vary in how they
exert their activity within the cell cycle.
 Most chemotherapeutic drugs are classified as cell-cycle
specific (CCS) or cell-cycle nonspecific (CCNS).
 CCS drugs attack cancer cells when the cells enter a
certain phase of reproduction.
 These agents are most effective against rapidly growing
tumors.
 Many of the drugs are “schedule dependent” because
they produce a greater cell kill when given in multiple,
repeated doses.
 G1 – Vinblastine
 S – Methotrexate, 6-Mercaptopurine, 5-Fluorouracil
 G2 –Bleomycin(10-20 units/m2 IV, IM, or SC ) ,
Etoposide, Topotecan, Daunorubicin
 M – Vincristine, Vinblastine, Paclitaxel,Docetaxel
 CCNS drugs can destroy cancer cells in any phase of
the cell cycle even on G0 and are used for large
tumors that have fewer actively dividing cells.
 These drugs are not schedule dependent but, rather,
dose dependent.
 This means that the number of cells destroyed is
determined by the amount of drug given.
E.G Cyclophosphamide, Chlorambucil, Cisplatin
Actinomycin-D, L-asparaginase
Cancer Chemotherapy and Cell Cycle
 Depending on mechanism at cell
level
 Anticancer agents are cytotoxic (toxic to cells) and
destroy both normal and abnormal cells.
 They are most effective against cells that reproduce
rapidly, such as those in bone marrow, gastrointestinal
lining, hair follicles, and the ova and sperm.
 Because cells multiply at their most rapid rate at the
beginning of the disease, the drugs work best against
cancer in its earliest stages.
 Directly acting cytotoxic drugs
 Many of these drugs are given in combination with or
after radiation or surgery to achieve maximum effect.
 They are usually given intermittently over an extended
period.
 The most common routes of administration are oral and
intravenous.
 Directly acting cytotoxic drugs:
 Alkylating agents,Antimetabolites
 Natural products and Miscellaneous:
 Indirectly acting- by altering the
hormonal mileau
 Corticosteroids
 Estrogens
 5 alpha reductase inhibitors
 Progestins
 Drugs Commonly Used in Chemotherapy
Antimetab Antibiotics Antihormo Alkylating Hormones Corticosteroi Nitrosureas
olites (CC5) (CCNS) nal Agents Agents (CCNS) ds (CCNS)
(CCNS) (CCNS)

cytarabine Dactinomycin flutamide busulfan diethylstilbes dexamethaso carmustine

* trol (DES) ne (BiCNU)

fluorouracil Daunorubicin goserelin chlorambuci megestrol hydrocortiso lomustine

( 5-FU) * acetate l acetate ne sodium (CeeNU)
succinate

methotrexat doxorubicin tamoxifen cisplatin medroxyprog prednisone

e hydrochloride esterone
* acetate

6- Mitomycin* cyclophosph testosterone

mercaptopu amide
rine
 Frequently Used Combinations drugs

 CAF >>>cyclophosphamide, doxorubicin, and

fluorourcil (5-FU)
 CHOP>>> cyclophosphamide, doxorubicin,
vincristine (Oncovin), and prednisolone
 C-VAMP>>> cyclophosphamide, vincristine,
doxorubicin, and methyl-prednisolone
 CVP >>>cyclophosphamide, vincristine, and
prednisone
 Continued…

 FEC >>>fluorourcil, epirubicin, and cyclophosphamide

 MMM>>>mitomycin, methotrexate, and mitoxantrone
 MOPP>>> mechlorethamine hydrochloride
(Mustargen), vincristine, procarbazine, and prednisone
 MVP>>> mitomycin, vinblastine, and cisplatin
 Drug Schedule in combination
chemotherapy
• Initiate therapy with cycle-nonspecific drugs
followed by cycle-specific drugs.
• e.g. start with alkylating agents
• to reduce tumour bulk and recruit slowly dividing
tumours into DNA synthetic phase in which
antimetabolites as Methotrexate and 5-Fluorouracil
are most active.

• regimen of breast cancer.pdf

 Continued…

 Careful attention is given to intravenous

administration.
 Leakage of fluid from the vein into the surrounding
tissues during infusion is called extravasation.
 Because most chemotherapeutic drugs are irritating
to the tissues extravasation is a potentially serious
problem, especially if the drugs administered are
vesicants. These agents are so irritating that they can
 Continued…

 Pain, swelling, redness, and the presence of vesicles

are all signs of extravasation.
 If extravasation occurs, the drug is stopped
immediately and protocols for treatment initiated.
 Improved infusion techniques, control of symptoms
 Adjuvant chemotherapy
 Adjuvant chemotherapy (postoperative treatment)
refers to giving patients anti-cancer drugs after the
primary tumor has been removed by surgery or
Radiotherapy because there is no evidence that cancer
remains in the body.
 The intent of adjuvant chemotherapy is to attack
microscopic cancer cells that remained after tumor
removal.
Neo-adjuvant
(Primary)chemotherapy
 Neoadjuvant chemotherapy (preoperative treatment),
is the use of anticancer drugs as the main form of
treatment or as a treatment prior to Surgery or
Radiotherapy.
In some cases, the tumor may be so large that surgery to
remove it would destroy major organs or would be quite
disfiguring.
Primary neoadjuvant chemotherapy may reduce the tumor
size, making it possible for a surgeon to perform a less
 4. Biotherapy
 Biotherapy/immunotherapy is performed with biologic
response modifiers (BRMs), agents that stimulate the
body’s natural immune system to control and destroy
malignant cells.
 Biotherapy is used after surgery, radiation, &
chemotherapy have removed the bulk of the tumor.
 Some agents currently used include interferon,
monoclonal antibodies, interleukin-2, tumor necrosis
factor, bacillus CalmetteGuérin (BCG), and colony-
 Side effects of Biotherapy
 Are usually less severe than those seen in
chemotherapy and include fever, malaise, myalgia,
and headache.
 An anaphylactic reaction can occur, the client must
be closely monitored.
 5. Photodynamic Therapy

 Photodynamic therapy (PDT) has a 90% effective

rate when used for esophageal cancer and early-stage
lung cancer.
 PDT is also used as an investigation therapy for
obstructive lung cancer, Barrett’s esophagus, and
head, neck and skin cancer.
 The client is injected with a light-activated drug
(Photofrin) that targets cancerous cells.
 Continued…

 The side effects of PDT

 are discomfort from local swelling, nausea, fever, and
constipation.
 The client experiences sunburn, redness, and swelling
if the skin and eyes are exposed to a bright light or
sunlight.
 6. Hormone Therapy

 Some cancerous cells need estrogen, progesterone, or

testosterone to grow.
 The goal of hormone therapy is to deprive the cancerous
cells of these hormones.
 Clients may have the ovaries (oophorectomy) or
testicles (orchiectomy) removed. Or
 Give women with early-stage breast cancer tamoxifen
citrate (Nolvadex) and to give men luteinizing hormone-
releasing hormone (LHRH).
 Continued..

 LHRH prevents the testes from producing testosterone.

 The hormone therapy is no longer effective when this
occurs.
 7. Targeted Cancer Therapy
 The goal of targeted cancer therapy is to stop the growth
and spread of cancer cells by preventing normal cells
from changing into cancerous cells at the molecular or
cellular level.
 This therapy is more effective than present treatments
and causes less harm to healthy cells. An example of
targeted therapy is STI-571, or imatinib mesylate
(Gleevac®), which is a small-molecule drug used to treat
gastrointestinal stromal Tumor and chronic myeloid
 8. Bone Marrow Transplantation
 Bone marrow transplantation (BMT) is used for
cancers that respond to high doses of chemotherapy
or radiation therapy.
 Treatment involves aspirating and storing a fraction of
bone marrow, exposing the client to high-dose drug
therapy or total-body irradiation, and then reinfusing
the bone marrow after the treatment is complete.
 Continued…

• The bone marrow used in transplantation can be the :-

• client’s own marrow (autologous)
• marrow taken from an identical twin (syngeneic)
• marrow taken from a histocompatibly matched donor,
preferably a sibling (allogeneic).
 SYMPTOM MANAGEMENT

 Cancer clients undergoing treatment experience a

variety of secondary problems.
 One of the most important responsibilities of the
oncology nurse is to formulate nursing interventions to
manage these problems.
 1. Bone Marrow Dysfunction

 Cancer treatments kill both malignant cells and normal

cells in bone marrow.
 Blood counts are monitored carefully during and after
treatment.
 A low white-cell count increases the risk of infection. i.e

 A decreased neutrophil count (<500 mm) is an indicator

that special infection prevention measures should be
initiated.
 Clients with a platelet count of <50,000 mm are
monitored for bleeding. So follow
 Their skin is inspected daily for bruises or
petechiae.
 Shaving is undertaken with an electric razor to
minimize the chance of cutting the skin.
 Stool and urine are monitored for occult blood.
 Observe the client for bleeding from the vagina,
rectum, nose, mouth, and venipuncture sites.
 Continued…

If bleeding occurs, pressure is applied to the site for 5

min.
 Any bleeding that does not stop in 5 minutes is
reported.
Aspirin or any medication containing acetylsalicylic
acid is not given.
 2. Nutritional Alterations
 Cytokines are substances secreted by the tumor in an
attempt to cannibalize the body and by the immune
system to fight the tumor.
 Cytokines make the body digest muscle for energy
instead of using stored fat for this purpose.
 This state of malnutrition and protein (muscle) wasting is
called cachexia.
 It occurs in conjunction with lung, pancreatic, stomach,
bowel, and prostate cancers but rarely with breast
 3. Bowel Dysfunctions
 Cancer clients frequently exhibit changes in bowel patterns.
 Constipation, diarrhea and subsequent perineal skin breakdown,
and bowel obstructions are common elimination disorders.
 Constipation results from decreased motility of the colon.
 It is frequently caused by chemotherapy, opioid analgesic.
 Monitor and record the frequency of the client’s bowel movements.
 Constipation is an early sign of vincristine toxicity.
 Fluid consumption is encouraged and a stool softener is
given daily.
 Common causes of diarrhea include radiation therapy,
chemotherapy, antibiotics, tube feedings, hyperosmolar
dietary supplements, stress, and fecal impactions.
 If the client is receiving a chemotherapy drug known to
cause diarrhea, such as fluorouracil [Adrucil] or
doxorubicin hydrochloride [Adriamycin]), a low-residue
and lactose-free diet is encouraged.
 NURSING DIAGNOSES
 Fear related to cancer diagnosis

 Anticipatory Grieving related to potential loss of body

function
 Acute Pain related to tumor growth and tissue destruction as
evidenced by verbal report
 Risk for Impaired Skin Integrity related to chemotherapy
and radiation
 Risk for Infection related to side effects of chemotherapy

 Risk for Injury related to altered clotting factors secondary

to side effects of radiation therapy
 Responsibilities of the Nurse in Cancer Care
 Support the idea that cancer is a chronic illness that has acute exacerbations
rather than one that is synonymous with death and suffering.
 Assess own level of knowledge relative to the pathophysiology of the disease
process.
 Make use of current research findings and practices in the care of the patient with
cancer and his or her family.
 Identify patients at high risk for cancer.

 Participate in primary and secondary prevention efforts.

 Assess the nursing care needs of the patient with cancer.

 Assess the learning needs, desires, and capabilities of the patient with cancer.
 Identify nursing problems of the patient and the family.

 Assess the social support networks available to the patient.

 Plan appropriate interventions with the patient and the family.

 Assist the patient to identify strengths and limitations.

 Assist the patient to design short-term and long-term goals for care.

 Implement a nursing care plan that interfaces with the medical care regimen and
that is consistent with the established goals.
 Collaborate with members of a multidisciplinary team to foster continuity of care.

 valuate the goals and resultant outcomes of care with the patient, the family, and
members of the multidisciplinary team.
 Reassess and redesign the direction of the care as determined by the evaluation.
 Health teaching to prevent Cancer
 Increase consumption of fresh vegetables (especially those of the cabbage family)

because studies indicate that roughage and vitamin-rich foods help to prevent certain kinds
of cancer.
 Increase fiber intake because high-fiber diets may reduce the risk for certain cancers (e.g,

breast, prostate, and colon).

 Increase intake of vitamin A, which reduces the risk for esophageal, laryngeal, and lung

cancers.
 Increase intake of foods rich in vitamin C, such as citrus fruits and broccoli, which are

thought to protect against stomach and esophageal cancers.

 Practice weight control because obesity is linked to cancers of the uterus, gallbladder,

breast, and colon.

 Reduce intake of dietary fat because a high-fat diet increases the
risk for breast, colon, and prostate cancers.
 Practice moderation in consumption of salt-cured, smoked, and
nitrate-cured foods; these have been linked to esophageal and
gastric cancers.
 Stop smoking cigarettes and cigars, which are carcinogens.

 Reduce alcohol intake because drinking large amounts of alcohol

increases the risk of liver cancer. (Note: People who drink heavily and
smoke are at greater risk for cancers of the mouth, throat, larynx.)
 Avoid overexposure to the sun, wear protective clothing, and use
a sunscreen to prevent skin damage from ultraviolet rays that
increase the risk of skin cancer.
 Cancer Prevention
 Reduce or avoid exposure to known or suspected
carcinogens
 Eat balanced diet
 Exercise regularly
 Adequate rest
 Health examination on a regular basis
 Continued…

 Eliminate, reduce, or change perceptions of

stressors and enhance ability to cope
 Enjoy consistent periods of relaxation and leisure
 Know 7 warning signs of cancer
 Self-examination
 Seek medical care if cancer is suspected
 CONCLUSION:

 Cancer is an any malignant growth or tumor caused

by abnormal and uncontrolled cell division;
 it may spread to other parts of the body through the
lymphatic system or the blood stream.
 It can be cured if it is identified and treated in very
early stage.
 • THANK YOU
• ANY QUESTIONS