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Session 2 - Overview - Treatment of cancer patients.pptx

What is Cancer?
Definition
? Family of complex diseases
? Affect different organs and organ systems
? Normal cells mutate into abnormal cells
that take over tissue
? Eventually harm and destroy host

Risk factors for cancer
Some are controllable; some are not
? Heredity: 5-10% of cancers; documented
with some breast and colon cancers
? Age: 70% of all cancers occur in persons
>65
? Lower socio-economic status
? Stress

? Diet: certain preservatives in pickled,
salted foods; fried foods; high-fat, low fiber
foods; charred foods, high fat foods, diet
high in red meat
? Occupational risk: exposure to known
carcinogens, radiation, high stress
? Infections: especially specific organisms
and organ (e.g. papillomavirus causing
genital warts and leading to cervical cancer

? Tobacco Use: Lung, oral and laryngeal,
esophageal, gastric, pancreatic, bladder
cancers
? Alcohol Use: also tied with smoking
? Sun Exposure (radiation) e.g. skin cancer

Normal Cell vs. Cancer Cell
? Normal cells in the body follow an orderly path
of growth, division, and death. Programmed cell
death is called apoptosis, and when this
process breaks down, cancer begins to form
? Unlike regular cells, cancer cells do not
experience programmatic death and instead
continue to grow and divide.This leads to a
mass of abnormal cells that grows out of
control

Normal Cell Characteristics
? Metabolism: Strictly controlled & predictable
? Maturation & Specialization: Occurs before
dividing. Strictly controlled
? Reproduction = Cell death
? Contact Inhibition : Mechanism for switching
off division when in contact with different cells
? Recognition : Like cells stay together

Cancer Cell Characteristics
? Unchecked & Uncontrolled Growth
? Loss of contact inhibition
? Loss of capacity to differentiate
? Increased growth fraction
? Chromosomal Instability
? Capacity to metastasize
? Altered biochemical properties

Physiology of Cancer
Background
Normal cell growth includes two events
? Replication of cellular DNA
? Mitosis (cell division)

Normal Cell Cycle
? G0-------------G1 S G2 M
��
? G0- Dormant or resting
? G1- normal cell activities
? S- DNA Synthesis
? G2-premitotic, synthesis of proteins for
cellular division
? M-Mitotic phase (I-P-M-A-T

Mitosis
? Cell cycle is under control of cyclins, and
suppresor gene products which control process
by working with enzymes;
�C Cyclins promote cell division
�C Suppresor gene products limit cell division
? Forms the basis of how some chemotherapeutic
agents work against cancers

Theories of Carcinogenesis
What causes cancer to occur
? Cellular Mutation
�C Cells begin to mutate (change the DNA to
unnatural cell reproduction)
? Oncogenes/Tumor Suppressor Genes Abnormalities
�C Oncogenes are genes that promote cell
proliferation and can trigger cancer
�C Tumor suppressor genes normally suppress
oncogenes but are damaged.

Causes for Carcinogenesis
? Exposure to known carcinogens
�C Act by directly altering the cellular DNA (genotoxic)
�C Act by affecting the immune system (promotional)
? Viruses break the DNA chain and mutates the normal
cells DNA
? Epstein-Barr virus
? Human papilloma virus
? Hepatitis virus

? Drugs and Hormones
�C Sex hormones often affect cancers of the
reproductive systems (estrogen in some breast
cancers; testosterone in prostate cancer)
�C Glucocorticoids and steroids alter immune
system

? Chemical Agents
�C Industrial and chemical
�C Can initiate and promote cancer
�C Examples: hydrocarbons in soot; arsenic in
pesticides; chemicals in tobacco

? Physical Agents
�C Exposure to radiation
? Ionizing radiation found in x-rays, radium, uranium
? UV radiation from sun
? Immune function
�C Protects the body from cancerous cells
�C Increased rate of cancer in immunocompromised
pts

Neoplasms
? Mass of new tissue that grows independently of
surrounding organs
Types of neoplasms:
? Benign
�C Localized growths respond to body��s homeostatic
controls
�C Encapsulated
�C Stop growing when they meet a boundary of another
tissue
�C Can be destructive

Neoplasms
? Malignant
�C Have aggressive growth, rapid cell division
outside the normal cell cycle
�C Not under body��s homeostatic controls
�C Cut through surrounding tissues causing
bleeding, inflammation, necrosis (death) of
tissue

MalignantTumors
Malignant tumors can metastasize
? Tumor cells travel through blood or lymph circulation
to other body areas and invade tissues and organs
�C Primary tumor: the original site of the malignancy
�C Secondary tumor (sites): areas where
malignancy has spread i.e. metastasis (metastatic
tumor)
�C Common sites of metastasis are lymph nodes,
liver, lungs, bones, brain
�C 50-60% of tumors have metastasized by time
primary tumor identified

MalignantTumors
? Cancerous cells must avoid detection by immune
system
? Malignant neoplasms can recur after surgical
removal of primary and secondary tumors and
other treatments
? Malignant neoplasms vary in differentiation
�C Highly differentiated are more like the
originating tissue
? Undifferentiated neoplasms consist of immature
cells with no resemblance to parent tissue and
have no useful function.

MalignantTumors
? Malignant cells progress in deviation with each
generation and do no stop growing and die, as
do normal cells
? Malignant cells are irreversible, i.e. do not revert
to normal
? Malignant cells promote their own survival by
hormone production, cause vascular
permeability; angiogenesis; divert nutrition from
host cells

How is cancer classified?
? There are five broad groups that are used to
classify cancer.
? Carcinomas are characterized by cells that
cover internal and external parts of the body
such as lung, breast, and colon cancer.
? Sarcomas are characterized by cells that are
located in bone, cartilage, fat, connective
tissue, muscle, and other supportive tissues

? Lymphomas are cancers that begin in the
lymph nodes and immune system tissues.
? Leukemias are cancers that begin in the
bone marrow and often accumulate in the
bloodstream.
? Adenomas are cancers that arise in the
thyroid, the pituitary gland, the adrenal gland,
and other glandular tissues.

Cancer Classification
? Cancers are often referred to by terms that
contain a prefix related to the cell type in which
the cancer originated and a suffix such as -sarcoma,
-carcinoma, or just -oma. Common prefixes include:
? Adeno-gland
? Chondro-cartilage
? Erythro-red blood cell
? Hemangio-blood vessels
? Hepato-liver
? Lipo-fat

Spread of Cancer
? Lymphatic
? Most common
? Hematogenous
? Blood-borne, commonly to Liver and Lungs
? Direct Spread
? Seeding of tumors

Spread of Cancer
? Lympho-white blood cell
? Melano-pigment cell
? Myelo-bone marrow
? Myo-muscle
? Osteo-bone
? Uro-bladder
? Retino-eye
? Neuro-brain

Body Defenses AgainstTumor
? T cell System/Cellular Immunity
? Cytotoxic T cells kill tumor cells
? B cell System/ Humoral immunity
? B cells can produce antibody
? Phagocytic cells
? Macrophages can engulf cancer cell debris

Effects of Cancer
? Disturbed or loss of physiologic functioning, from
pressure or obstruction
? Anoxia and necrosis of organs
? Loss of function: bowel or bladder obstruction
? Increased intracranial pressure
? Interrupted vascular/venous blockage
? Ascites
? Disturbed liver functioning

Effects of Cancer
? Motor and sensory deficits
? Cancer invades bone, brain or compresses
nerves
? Respiratory difficulties
? Airway obstruction
? Decreased lung capacity

Effects of Cancer
? Hematologic Alterations: Impaired function of blood
Cells
? Secondary to any cancer that invades the bone
marrow (leukemia)
? May also be caused by the treatment
? Abnormal WBC��s: impaired immunity
? Diminished RBC��s and platelets: anemia and
clotting
disorders
? Infections: fistula development and tumors may
become necrotic; erode skin surface

Effects of Cancer
? Hemorrhage: tumor erosion, bleeding, severe
anemia
? Anorexia-Cachexia Syndrome: wasting away of
client
? Unexplained rapid weight loss, anorexia with
altered smell and taste
? Catabolic state: use of body��s tissues and
muscle proteins to support cancer cell growth

Effects of Cancer
? Paraneoplastic Syndromes: ectopic sites with
excess hormone production
? Parathyroid hormone (hypercalcemia)
? Ectopic secretion of insulin (hypoglycemia)
? Antidiuretic hormone (ADH: fluid
retention)
? Adrenocorticotropic hormone (ACTH)

Effects of Cancer
? Pain: major concern of clients and families
? Types of cancer pain
Acute: symptom that led to diagnosis
Chronic: may be related to treatment or to progression of disease
? Causes of pain
Direct tumor involvement including metastatic pain
Nerve compression
Involvement of visceral organs
? Physical Stress: body tries to respond and destroy
neoplasm
Fatigue,Weight loss,Anemia, Dehydration, Electrolyte imbalances

Effects of Cancer
? Psychological Stress
? Cancer equals death sentence
? Guilt from poor health habits
? Fear of pain, suffering, death
? Stigmatized

Collaborative Care
DiagnosticTests: used to diagnose cancer
? Determine location of cancer
? X rays
? Computed tomography
? Ultrasounds
? Magnetic resonance imaging
? Nuclear imaging

Collaborative Care
? Diagnosis of cellular type of can be done through
tissue samples from biopsies, shredded cells (e.g.
Papanicolaou smear) washings
? Cytologic Examination: tissue examined under
microscope
? Identification System ofTumors: Classification-
Grading-- Staging

Diagnostic Tests
? DirectVisualization
? Sigmoidoscopy
? Cystoscopy
? Endoscopy
? Bronchoscopy
? Exploratory surgery; lymph node biopsies
to determine metastases

Diagnostic Tests
? Other non-specific tests
? CBC, Differential
? Electrolytes
? Blood Chemistries: (Liver enzymes) Alanine
Aminotranferase (ALT);Aspartate Aminotransferase
(AST) Lactic Dehydrogenase (LDH)
? NGS ( Next Generation Sequencing is often used to
identify genetic variations and mutations. NGS assay
has important applications in hereditary cancer
diagnosis or risk population assessment.)

Cancer grading and staging
? Grading: Cancer is graded upon the
resemblance to normal cells; denoted by ��G�� i.e.
G1, G2, G3, G4
? The higher the number, the worse the grade of
cancer
? Grade 1- Low grade
? Grade 4- high grade

Tumor Markers
? Chemical substances that can be found in
abnormal amounts in the blood, urine, or tissues
of some patients with cancer
? Different tumor markers are found in different
types of cancer
? Used to help diagnose cancer, predict a patient��s
response to particular therapies, check a
patient��s response to treatment, or determine if
cancer has returned

Tumor Markers
? Examples of tumor markers
? CA 125 : ovarian cancer
? CA 15-3 : breast cancer
? CEA : ovarian, lung, breast, pancreas, and
gastrointestinal tract cancers
? PSA : prostate cancer

Nursing Assessment
Utilize the ACS 7 Warning Signals
? CAUTION
? C- Change in bowel/bladder habits
? A- A sore that does not heal
? U- Unusual bleeding
? T- Thickening or lump in the breast
? I- Indigestion
? O- Obvious change in warts
? N- Nagging cough and hoarseness

CancerTreatment Goals
Depending on type and stage of cancer
? Cure
? Recover from specific cancer with treatment
? Alert for reoccurrence
? May involve rehabilitation with physical and
occupational therapy.

CancerTreatment Goals
? Control: of symptoms and progression of cancer
? Continued surveillance
? Treatment when indicated (e.g. some bladder
cancer, prostate cancer)
? Palliation of symptoms: may involve terminal
care if client��s cancer is not responding to
treatment

? Factors that determine treatment plan and modality
? Cell type
? Location and size of tumor
? Extent of disease
? Physiologic and psychologic status
? Expressed needs and desires
CancerTreatment

? Treatment Options alone or with combination are:
? Chemotherapy
? Surgery
? Radiation Therapy
? HormonalTherapy
? Biologic therapy
? Bone MarrowTransplant
Treatment Options

CHEMOTHERAPY
? Chemotherapy is a chemical combination of
drugs used in treatment of cancer.
? Chemotherapy is cytotoxic in nature.
( Harmful for Cells)
? CHEMOTHERAPY affects cancerous cell as
well as normal cells.

? Effects are systemic and kills the metastatic cells
? Often combinations of drugs in specific protocols
over varying time periods
? Much more effective then a single agent
? Cell-kill hypothesis: with each cell cycle a
percentage of cancerous cells are killed but some
remain; repeating chemo kills more cells until those
left can be handled by body��s immune system
Chemotherapy

History of Chemotherapy
? On December 2, 1943 Bari��s harbour was bombed by a
flight of 105 German bombers. Among the 24 ships of
the alliance, one ship named SS John Harvey was
carrying a secret cargo of 100 tons of liquid mustard gas.
? Many seamen on surrounding ships who survived
developed blistering of epithelial surfaces, reduced white
blood cells and profound lymphoid and myeloid
suppression on autopsies.
? Using this information Goodman and Gilman �C two
pharmacologists from the Yale School of Medicine -
reasoned that this agent could be used to treat lymphoma

Effects of Chemotherapy
? Tissues (fast growing) frequently affected
? Examples: mucous membranes, hair cells, bone
marrow, specific organs with specific agents,
reproductive organs (all fetal toxic, impair ability to
reproduce)
Chemotherapy

Basic concepts of chemotherapy
1. Neoadjuvant Chemotherapy
2.Adjuvant Chemotherapy.
3. Single Agent Chemotherapy.
6. Combination Chemotherapy.
5. High Dose Chemotherapy.
6. Salvage Chemotherapy.
7. Primary Chemotherapy.
8. Induction Chemotherapy
9. Maintenance
10.Consolidation

Administration of chemotherapeutic agents
? Trained and certified personnel, according to
established guidelines
? Preparation
? Protect personnel from toxic effects
Drugs absorbed through skin and mucous membranes Protective
clothing and extreme care
? Extreme care for correct dosage; double
check with physician orders, pharmacist��s
preparation
? Proper management patients�� excrement
Chemotherapy

Central Preparation of
Chemotherapy
? protects personnel
? protects the environment
? ensures production of sterile ready-to-use products

? Diagnosis, staging, and treatment of cancer
? May be prophylaxis or removal of at risk tissue or
organ prior to development of cancer (breast cancer)
? Involves removal of body part, organ, sometimes with
altered functioning (e.g. colostomy)
? Debulking (decrease size of) tumors in advanced
cases
? Reconstruction and rehabilitation (e.g. breast implant
post mastectomy)
? Palliative surgery to improve the quality of life
? Removal of tumor tissue that is causing pain or
obstruction
Surgery

? Treatment of choice for some tumors to kill or
reduce tumor, relieve pain or obstruction
? Destroy cancer cells with minimal exposure to
normal cells
? Cells die or are unable to divide
? Delivery
? Teletherapy (external): radiation delivered in
uniform dose to tumor
Beam radiation
RadiationTherapy

? Brachytherapy: delivers high dose to tumor and less to
other tissues; radiation source is placed in tumor or next
to it in the form of seeds
Radiation source within the patient so patient emits
radiation for a period of time and is a hazard to others
? Combination
RadiationTherapy

Treatment Goals
? Maximum tumor control with minimal damage to
normal tissues
? Caregivers must protect themselves by using shields,
distancing and limiting time with patients, following
safety protocols
Treatment Schedules
? Planned according to radio-sensitivity of tumor,
tolerance of client
? Monitor blood cell counts
RadiationTherapy

? To slow or stop the growth of certain cancers
(such as prostate and breast cancer), synthetic
hormones or other drugs may be given to block
the body��s natural hormones.
? Hormonal therapy deprives breast cancer cells of
the hormone estrogen, which many breast tumors
need to grow.
HormonalTherapy

? Biological therapies (Monoclonal antibodies) use the
body��s immune system, either directly or indirectly,
to fight cancer or to lessen the side effects that may
be caused by some cancer treatments.
? Used in combination with other therapies
? Antibodies target specific substances needed by the
cancer cell for growth (Herceptin for breast cancer)
Biological therapy

? Gene therapy is an experimental treatment that
involves introducing genetic material into a person��s
cells to fight disease.
? Gene inserted into the tumor cells to make them
more susceptible to being killed by antiviral agents.
? Genes inserted for cytokines that increase their
effectiveness in killing cancer cells.
Gene therapy

Bone MarrowTransplantation and Peripheral
Blood
Stem CellTransplantation
? Stimulation of nonfunctioning marrow or replace
bone marrow
? Common treatment for leukemias
Bone MarrowTransplant

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Session 2 - Overview - Treatment of cancer patients.pptx

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Session 2 - Overview - Treatment of cancer patients.pptx