intro to oncology

1. CELL ABBERATION
Maria Hazel Torres Organo-Rosario, RN,MAN
Clinical Instructor
College of Nursing
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2. GRADING SYSTEM
ATTENDANCE
10%
QUIZZES 40%
MIDTERM/FINAL EXAM
50%
100%
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3. CELL CYCLE
• G0
• Interphase
–G1
–S
–G2
• Mitosis
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4. 23/09/12 cancer 4

5. 23/09/12 cancer 5

6. DIFFERENTIATION
• Cells develop specific structures and
functions in order to specialize in
certain tasks
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7. How the
cancer cells
grow?
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8. A normal cell divides only
approximately 60 times but a
single CANCER cell can divide
indefinitely.
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9. 23/09/12 cancer 9

10. CELLULAR ADAPATION
• Hypertrophy
• Atrophy
• Hyperplasia
• Metaplasia
• Dysplasia
• Anaplasia
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11. CANCER
• abnormal cell is transformed by the
genetic mutation of the cellular DNA
• can involve all body organs
• Manifestations are r/t the system
affected & degree of disruption
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12. NEOPLASIA
• Abnormal cell growth or
tumor
–Benign
–Malignant
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13. benign malignant
Differentiation Well Lack of
differentiated differentiation
with anaplasia
Rate of growth Progressive and Erratic and slow
slow to rapid
Local invasion Cohesive and well Locally invasive,
demarcated infiltrating
Metastasis None Frequently
present
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14. Benign means not
cancer
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15. The characteristics
of normal cells
• Reproduce themselves exactly
• Stop reproducing at the right time
• Stick together in the right place
• Self destruct if they are damaged
• Become specialised
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16. How cancer cells are
different
• don't die if they move to another part of
the body
• don't stop reproducing
• don't obey signals from other cells
• don't stick together
• don't specialise
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17. Cancer cells don't
stick together
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18. iNCIDENCE
• Ranks 2nd to CVD as the leading
cause of death
• 1:4 deaths is due to cancer
• Ranks third in leading cause of
morbidity & mortality in the
Philippines
• Occurs at any age but with 75% of
cancers occuring after 50
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19. Cells lose their Normal growth-controlling
mechanisms & the growth of cell is uncontrolled
Develops from a mutation in a single cell
Grows w/o the control that char. Normal cell
growth
CA cells fail to mature into the type of Normal cell
from w/c it originates
metastasis
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20. RISK FACTORS
• Environmental
– Chemical
– Physical
– Viral -oncovirus
• Immunologic
• Dietary
• Genetic
• Hormonal
• Socioeconomic
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21. RISK FACTORS
• Age
• Gender
• location
• Race
• Occupation
• Obesity
• stress
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22. CARCINOGENESIS
Cells transformation from normal
to cancerous
- No SINGLE CAUSE
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23. CARCINOGENESIS
• Initiation
• Promotion
• progression
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24. metastasis
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25. • Cancer grow & metastisize thru:
– Directly extending into adjacent tissues
– Invading nearby body cavity
– Invading along lymphatic vessels
– Traveling via lymphatic vessels to lymph
nodes
– Traveling via blood vessels to any part of the
body but usually to the lungs, liver & bones
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26. 23/09/12 cancer 26

27. Malignant tumours are
made up of cancer cells
• Usually grow faster than benign
tumors
• Spread into and destroy surrounding
tissues
• Spread to other parts of the body
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28. Primary vs
Secondary
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29. 23/09/12 cancer 29

30. Cancers According to
Tissue Type
• Lymphoma – infection-fighting organs
• Leukemia –blood-forming organs
• Sarcoma –bones, muscle, or connective
tissue
• Carcinoma –epithelial cells
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31. Benign
• Adenoma – glandular tissue
• Leiomyoma – smooth muscle
• Chondroma – cartilaginous tissue
• Hemangioma – blood vessels
• Lymphagioma – lymphatics
• Neurofibroma – nerve sheath
• Lipoma – adipose tissue
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32. Malignant
• Adenocarcinoma – epithelial cells
• Carcinoma – epithelial surface
• Sarcoma – connective tissue
• Osteosarcoma – bone osteoblasts
• Angiosarcoma – blood vessels
• Lymphagiosarcoma – lymphatics
• Neurofibrosarcoma – nerve sheath
• Liposarcoma – adipose tissue
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33. LATE WARNING SIGNS
of CANCER
Change in bowel/bladder habits (alternating diarrhea &
constipation, early morning)
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty in swallowing
Obvious change in wart or mole
Nagging cough or hoarseness of voice
Unexplained anemia
Sudden unexplained weight loss
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34. BEST DEFENSE?
IMMUNOSURVEILLANCE
- Promotes antibody
production, cellular immunity
& immunologic memory
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35. PREVENTION
• Avoidance of
known or potential
carcinogens
• Avoidance or
modification of the
factors associated
with development
of CA cells
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36. DETECTION and
PREVENTION
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37. PRIMARY
• Education
–Avoid known carcinogens
–Adopting healthy lifestyle
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38. SECONDARY
• individualized education and
recommendations for continued
surveillance and care in high-risk
populations
• Public awareness
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39. GENERAL PREVENTION
• Increase consumption of fresh
vegetables
• Increase fiber intake
• Increase intake of vitamin A
• Increase intake of foods rich in
vitamin C
• Practice weight control
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40. GENERAL PREVENTION
• Reduce intake of dietary fat
• Practice moderation in consumption of salt-
cured, smoked, and nitrate-cured foods
• Stop smoking cigarettes and cigars
• Reduce alcohol intake
• Avoid overexposure to the sun, wear protective
clothing, and use a sunscreen to prevent skin
damage from ultraviolet rays
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41. EARLY CANCER
DETECTION
• Breast CA
• Colon and rectal CA
• Uterine CA
• Prostate CA
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42. EARLY DETECTION
Enables more effective
treatment and better
prognosis for the patient
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43. 23/09/12 cancer 43

44. 23/09/12 cancer 44

45. BREAST
• Age 20, routine BSE
• 20-39, BE by health
care provider every 3
years
• 40 and older, yearly
mammogram & BE
by health provider
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46. 23/09/12 cancer 46

47. COLON & RECTAL
• 50 & older, yearly
FOBT
• DRE & sigmoidoscopy,
every 5 years
• Colonoscopy w/
barium, every 10 yrs
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48. UTERINE
• Sexually active
females & any female
over 18 yrs, PAPSmear
• Endometrial tissue
sample-menopause
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49. PROSTATE
Age 50, yearly DRE
Age 50, yearly PSA test
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50. NURSING INTERVENTIONS
• Relieve fear and anxiety
–Explain
–Reinforce
–Clarify
–Encourage communication
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51. TMN Classification
System
• Tumors are staged depending on size,
lymph node involvement &
metastasis
T – primary tumor
N – lymph node involvement
M – metastasis
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52. T-extent of tumor
• TX –cannot be assesses
• T0 – no evidence
• Tis – carcinoma in situ
• T1, T2, T3, T4 –
increasing size and/or
local extent of primary
tumor
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53. N- lymph node
• NX – cannot be
assessed
• N0 – no
metastasis
• N1, N2, N3 –
increasing
involvement
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54. M-Metastasis
• GX-cannot be
assessed
• G1-well
differentiated
• G2-moderately
• G3-poorly
• G4-undifferentiated
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55. STAGES OF TUMORS
• I: tumor <2cm, (-) lymph node
involvement, no detectable metastases
• II: tumor >2cm but <5cm, (-) or (+) unfixed
lymph node involvement, no detectable
metastases
• III: large tumor >5cm, tumor of any size
with invasion of skin or chest wall or (+)
fixed lymph node involvement without
evidence of metastases
• IV: tumor of any size, (+)/(-) lymph node
involvement, distant metastases
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56. Grading & Staging
• A method used to describe the tumor
• Grading – CELLULAR aspect of CA
• Staging – CLINICAL aspect of CA
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57. 23/09/12 cancer 57

58. 23/09/12 cancer 58

59. TUMOR MARKER
• Protein substances
• Oncofetal antigens
• Hormones
• Isoenzymes
• Tissue specific proteins
• Host response tumor markers
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60. 23/09/12 cancer 60

61. 23/09/12 cancer 61

62. TUMOR MARKER ID
• Analysis of substances found in blood
or other body fluids that are made by
the tumor or by the body in response
to the tumor
• Breast, colon, lung, ovarian,
testicular, prostate cancer
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63. MAMMOGRAPHY
• low-dose amplitude-X-rays
• NO: Deodorant, talcum powder or
lotion
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64. mammography

65. SIGMOIDOSCOPY
• Large
intestines
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66. COLONOSCOPY
• Colon and
distal part of
the small
bowel
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67. Digital Rectal Exam
• simple test to
check the
prostate
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68. Barium enema
• radiological examination of the
rectum and the entire colon
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69. 23/09/12 cancer 69

70. 23/09/12 cancer 70

71. PapSmear
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72. PSA
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73. IMAGING TESTS
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74. Magnetic Resonance
Imaging
• Use of magnetic fields and
radiofrequency signals to create
sectioned images of various body
structures
• Neurologic, pelvic, abdominal,
thoracic cancers
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75. CT Scan
• Use of narrow beam x-ray to scan
successive layers of tissue for a cross-
sectional view
• Neurologic, pelvic, skeletal,
abdominal, thoracic cancers
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76. Fluoroscopy
• Use of x-rays that identify contrasts
in body tissue densities; may involve
the use of contrast agents
• Skeletal, lung, gastrointestinal
cancers
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77. Ultrasonography
• High-frequency sound waves echoing
off body tissues are converted
electronically into images
• to assess tissues deep within the body
• Abdominal and pelvic cancers
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78. Endoscopy
• Direct visualization of a body cavity
or passageway by insertion of an
endoscope into a body cavity or
opening
• allows tissue biopsy, fluid aspiration
and excision of small tumors
• Bronchial, gastrointestinal cancers
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79. Nuclear Medicine
Imaging
• Uses intravenous injection or
ingestion of radioisotope substances
followed by imaging of tissues that
have concentrated the radioisotopes
• Bone, liver, kidney, spleen, brain,
thyroid cancers
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80. Positron Emission
Tomography
• Computed cross-sectional images of
increased concentration of
radioisotopes in malignant cells
• Provide information about biologic
activity of malignant cells
• help distinguish between benign and
malignant processes and responses to
treatment
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81. PETScan
• Lung, colon, liver, pancreatic, breast,
esophagus cancers; Hodgkin’s and
non-Hodgkin’s
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82. Radioimmunoconjugate
• Monoclonal antibodies are labeled
with a radioisotope and injected
intravenously into the patient
• the antibodies that aggregate at the
tumor site are visualized with
scanners
• Colorectal, breast, ovarian, head and
neck cancers; lymphoma
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83. MANAGEMENT
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84. GOALS
•cure
•control
•palliation
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85. TREATMENT
• Surgery
• Chemotherapy
• Radiation Therapy
• Biologic Response Modifier
• Bone Marrow Transplantation
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86. SURGERY
• Diagnose, stage & treat
–Prophylactic Sx
–Curative Sx
–Control (cytoreductive) Sx
–Palliative Sx
–Reconstructive Sx
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87. DIAGNOSTIC SURGERY
• BIOPSY
– Excisional
• Remove the entire tumor and surrounding
marginal tissues
– Incisional
• wedge of tissue from the tumor is removed
– Needle Method
• sample suspicious masses that are easily
accessible
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88. Excisional biopsy
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89. Incisional biopsy
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90. Needle biopsy
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91. Primary Treatment
• Local and wide excisions
• Salvage surgery
• Electrosurgery
• Cryosurgery
• Chemosurgery
• Laser surgery –light amplification
• Stereotactic radiosurgery
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92. PROPHYLACTIC SURGERY
• removing nonvital tissues or organs
that are likely to develop cancer
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93. Factors to consider:
• Family history and genetic
predisposition
• Presence or absence of symptoms
• Potential risks and benefits
• Ability to detect cancer at an early
stage
• Patient’s acceptance of the
postoperative outcome
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94. PALLIATIVE SURGERY
• make the patient as comfortable as
possible and to promote a satisfying and
productive life for as long as possible
• attempt to relieve complications of cancer,
such as ulcerations, obstructions,
hemorrhage, pain, and malignant
effusions
• GOAL: HIGH QUALITY OF LIFE
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95. Reconstructive Sx
• may follow curative or radical
surgery and
• is carried out in an attempt to
improve function or obtain a
morecdesirable cosmetic effec
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96. NURSING INTERVENTIONS
• Perioperative NI
• assesses the patient’s responses to the
surgery
• monitor for possible complications
• Provision of comfort
• Postoperative teaching addresses wound
care, activity, nutrition, and medication
information
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97. S/E of Surgery
• Loss of function of a body part
• Reduced function
• Scarring
• grieving
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98. CHEMOTHERAPY
• Kills or inhibits reproduction of
neoplastic cells
• Systemic effect: Normal & CA cells
• Combination chemotherapy – avoid
meds during nadirs
• NADIRS – time during w/c bone
marrow activiy & WBC are low)
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99. Chemotherapy
• GOALS: cure, control, palliation
• Coordinated with the cell cycle
• For each tx: 20-99% are destroyed
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100. Growth Fractions
• Actively proliferating cells within a
tumor
• Most sensitive
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101. Non dividing cells
• Least sensitive
• Must be destroyed to eradicate cancer
completely
• Repeated doses @ active cell division
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102. Cell cycle time
• time required for one tissue cell to
divide and reproduce two identical
daughter cells
–G1 phase
–S phase
–G2 phase
–Mitosis
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103. Classifications
• cell cycle–specific drugs
• cell cycle–nonspecific agents
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104. Chemotherapeutic Agents
• Topical
• Oral
• Intravenous
• intramuscular
• Subcutaneous
• Arterial
• intracavitary
• intrathecal routes
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105. DOSAGE
• patient’s total body surface area
• previous response to chemotherapy or
radiation therapy
• major organ function
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106. ALKYLATING AGENTS
• busulfan, carboplatin, chlorambucil,
• cisplatin, cyclophosphamide,
• dacarbazine,
• hexamethyl melamine, ifosfamide,
• melphalan, nitrogen mustard,
thiotepa
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107. Alkylating Agents
• Alter DNA structure by misreading
DNA code, initiating breaks in the
DNA molecule, cross-linking DNA
strands
• Cell cycle non-specific
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108. Alkylating Agents
• Bone marrow suppression
• nausea, vomiting, cystitis
(cyclophosphamide, ifosfamide)
• Stomatitis
• alopecia
• gonadal suppression
• Renal toxicity (cisplatin)
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109. Nitrosureas
• carmustine (BCNU)
• Lomustine (CCNU)
• semustine (methyl CCNU)
• streptozocin
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110. Nitrosureas
• Similar to the alkylating agents
• cross the blood–brain barrier
• Cell cycle non-specific
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111. Nitrosureas
• Delayed and cumulative
myelosuppression
• thrombocytopenia
• Nausea
• vomiting
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112. Topoisomerase I
Inhibitors
• Irinotecan
• topotecan
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113. Topoisomerase I
Inhibitors
• Induce breaks in the DNA strand by
binding to enzyme topoisomerase I
• Preventing cells from dividing
• Cell cycle specific
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114. Topoisomerase I
Inhibitors
• Bone marrow suppression
• Diarrhea
• Nausea
• vomiting
• hepatotoxicity
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115. Antimetabolites
• 5-azacytadine
• cytarabine
• edatrexate fludarabine
• 5-fluorouracil (5-FU)
• FUDR
• Gemcitabine
• hydroxyurea
• Leustatin
• 6-mercaptopurine,
• methotrexate, pentostatin,
• 6-thioguanine
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116. Antimetabolites
• Interfere with the biosynthesis of
metabolites or nucleic acids necessary
for RNA and DNA synthesis
• Cell specific – S phase
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117. antimetabolites
• Nausea
• Vomiting
• diarrhea
• bone marrow suppression
• Proctitis
• Stomatitis
• renal toxicity (methotrexate)
• hepatotoxicity
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118. Antitumor antibiotics
• Bleomycin
• dactinomycin
• Daunorubicin
• Doxorubicin (Adriamycin)
• idarubicin
• Mitomycin
• mitoxantrone
• plicamycin
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119. Antitumor antibiotics
• Interfere with DNA synthesis by
binding DNA; prevent RNA synthesis
• Cell cycle non specific
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120. Antitumor
antibiotics
• Bone marrow suppression
• nausea, vomiting
• alopecia
• Anorexia
• cardiac toxicity (daunorubicin,
doxorubicin)
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121. Mitotic Spindle Poisons
• Plant alkaloids: etoposide,
teniposide, vinblastine, vincristine
(VCR), vindesine, vinorelbine
• Taxanes: paclitaxel, docetaxel
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122. Mitotic Spindle
Poisons
• Arrest metaphase by inhibiting
mitotic tubular formation (spindle)
• inhibit DNA and protein synthesis
• TAXATENES
–Arrest metaphase by inhibiting
tubulin depolymerization
• Cell specific –M phase
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123. Mitotic Spindle
Poisons
• Bone marrow suppression (mild with
VCR)
• Neuropathies (VCR)
• stomatitis
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124. Mitotic Spindle
Poisons
• Bradycardia
• hypersensitivity reactions
• bone marrow suppression
• Alopecia
• neuropathies
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125. Hormonal Agents
• androgens and antiandrogens
• estrogens and antiestrogens
• progestins and antiprogestins
• aromatase inhibitors
• Luteinizing hormone–releasing
hormone analogs
• steroids
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126. Hormonal Agents
• Bind to hormone receptor sites that
alter cellular growth
• block binding of estrogens to receptor
sites (antiestrogens)
• inhibit RNA synthesis
• Suppress aromatase of P450 system,
which decreases estrogen level
• Cell cycle non-specific
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127. Hormonal Agents
• Hypercalcemia
• jaundice, increased appetite
• masculinization, feminization
• Sodium and fluid retention
• nausea, vomiting
• hot flashes
• Vaginal dryness
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128. Chemo: Problems
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129. EXTRAVASATION
• Vesicants - those agents that, if
deposited into the subcutaneous
tissue (extravasation), cause tissue
necrosis and damage to underlying
tendons, nerves, and blood vessels
• dactrinomycin., daunorubicin, doxorubicin
(Adriamycin), nitrogen mustard,
mitomycin, vinblastine, vincristine, and
vindesine
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130. extravasation
• Absence of blood return from the
intravenous catheter
• Resistance to flow of intravenous fluid
• Swelling, pain, or redness at the site
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131. Nursing Interventions
• STOP immediately!
• Ice packs on the site (except for vinca
alkaloids)
• Aspirate any infiltrated medication
from the tissues and inject
neutralizing solution into the area
– sodium thiosulfate, hyaluronidase, and
sodium bicarbonate
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132. Nursing
Interventions
• right atrial Silastic catheters or
venous access devices
–Possible complications: infection
and thrombosis
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133. 23/09/12 cancer 133

134. TOXICITY
• At risk: Cells with rapid growth rates
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135. GIT
• n/v – most common, 24 hrs post
• Serotonin blockers - ondansetron, granisetron,
and dolasetron
• dopaminergic blockers - metoclopramide
(Reglan)
• Sedatives
• Corticosteroids
• histamines
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136. GIT
• Delayed n/v -48 to 72 hrs
–Antiemetics
–SFF
–Bland foods
–Comfort foods
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137. GIT
• Stomatitis and anorexia
• Mucositis –antimetabolies, antitumor
antibiotics
• Diarrhea- Irinotecan
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138. Hematopoietic System
• myelosuppression (depression of bone
marrow function)
–Leukopenia
–Anemia
–thrombocytopenia
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139. Hematopoietic System
• colony-stimulating factors
(granulocyte colony-stimulating
factor [G-CSF]
• granulocyte-macrophage
• colony-stimulating factor [GM-CSF]
• erythropoietin [EPO])
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140. Renal System
• Cisplatin, methotrexate, mitomycin
• Tumor lysis syndrome –
hyperkalemia, hyperphosphatemia,
hypocalcemia
• Hydration, monitoring, alluporinol
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141. Cardiopulmonary
• Antitumor antibiotics (daunorubicin
and doxorubicin)-CARDIAC
–total dosage reaches 550 mg/m2
• Bleomycin, carmustine (BCNU), and
busulfan –PULMO
–Bleomycin -not to exceed 400 units
• PULMONARY FIBROSIS
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142. Reproductive System
• Normal ovulation, early menopause,
or permanent sterility
• temporary or permanent
azoospermia (absence of
spermatozoa)
• Banking of sperm before tx
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143. Neurologic System
• taxanes and plant alkaloids,
vincristine
• Peripheral neuropathies, loss of deep
tendon reflexes, and paralytic ileus
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144. General Nursing Care
• Assess F&E status
• Modify risk for infection & bleeding
– Avoiding contact with people who have
known or recent infection or recent
vaccination
– Private room
– Aseptic technique
– Stool softeners
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145. • Use of electric razor
• Personal hygiene
• Ambulation –skin breakdown
• Avoid fresh fruits, raw meat, fish, and
vegetables
• remove fresh flowers and potted
plants
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146. • Each day: change drinking water,
denture cleaning fluids, and
respiratory equipment containing
water
• Assess intravenous sites every day for
evidence of infection
• NO IM injections, IFC
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147. Erythematous areas
• Avoid the use of soaps, cosmetics,
perfumes, powders, lotions and ointments,
deodorants
• Use only lukewarm water to bathe the
area
• Avoid rubbing or scratching the area.
• Avoid shaving the area with a straight
edged razor
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148. Erythematous areas
• Avoid applying hot-water bottles, heating pads,
ice, and adhesive tape to the area
• Avoid exposing the area to sunlight or cold
weather
• Avoid tight clothing in the area
• Use cotton clothing
• Apply vitamin A&D ointment to the area
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149. stomatitis
• Avoid commercial mouthwashes
• Brush with soft toothbrush; use nonabrasive toothpaste
after meals and bedtime
• Use normal saline mouth rinses every 2 h while awake;
every 6 h at night.
• Use soft toothbrush
• Remove dentures except for meals; be certain dentures
fit well
• Apply lip lubricant
• Avoid foods that are spicy or hard to chew and those
with extremes of temperature
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150. alopecia
• Prevent or minimize hair loss through the following:
• Use scalp hypothermia and scalp tourniquets
• Cut long hair before treatment
• Use mild shampoo and conditioner, gently pat dry,
and avoid excessive shampooing
• Avoid electric curlers, curling irons, ryers, clips,
barrettes, hair sprays, hair dyes, and permanent
waves
• Avoid excessive combing or brushing; use wide-
toothed comb.
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151. alopecia
• Prevent trauma to scalp.
–Lubricate scalp with vitamin A&D
ointment to decrease itching.
–Have patient use sunscreen or wear
hat when in the sun
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152. alopecia
• Purchase wig or hairpiece before hair
loss
• Begin to wear wig before hair loss
• Wear hat, scarf, or turban
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153. nutrition
• Adequate fluid intake
• SFF
• High calorie, high CHON diet
• Relaxed, quiet env’t during mealtime
• Cold foods if desired
• Wine if possible
• Frequent oral hygiene
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154. fatigue
• Rest periods
• Inc night time sleep hrs
• Reduce job workload
• Relaxation technique
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155. RADIATION
THERAPY
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156. RADIATION
• Destroys CA cells w/ minimal
exposure of Normal cells to the
damaging effects
• Teletherapy & brachytherapy
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157. Teletherapy
• Beam radiation
• Actual radiation source is external
• Does not emit radiation & does not
pose hazad to anyone else
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158. Brachytherapy
• Direct, continuous contact with tumor
• Radiation source is w/in the client
• Client emits radiation and poses
hazard to others
• Sealed or unsealed
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159. S/E of Radiation
• Skin changes and irritation, alopecia,
fatigue, altered taste sensation
• Vary according to the site of tx
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160. BONE MARROW
TRANSPLANTATION
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161. • For treatment of leukemia for clients
who have closely matched donors and
who are experiencing temporary
remission with chemotherapy
• GOAL: rid the client of all leukemic or
other malignant cells through
treatment with high doses of
chemotherapy & whole-body
irradiation

162. TYPES OF DONOR
MARROW
• ALLOGENIC
• SYNGENEIC
• AUTOLOGOUS

163. ALLOGENIC
• from a donor other than the patient):
–either a related donor (ie, family
member)
– a matched unrelated donor
(national bone marrow registry,
cord blood registry)
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164. • Autologous (from patient)
• Syngeneic (from an identical twin)
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165. PROCEDURE
• HARVEST
• CONDITIONING
• TRANSPLANTATION
• ENGRAFTMENT

166. HARVESTING
• Large amts under GA
• Peripheral Blood Stem Transplant
–uses apheresis of the donor to
collect stem cells for reinfusion
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167. HARVESTING
• ALLOGENIC
–Human leukocyte antigen matched
donor
• ADV: transplanted cells should not be
immunologically tolerant of the
patient’s malignancy and should
cause a lethal graft-versus-disease
effect to the malignant cells
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168. HARVESTING
• AUTOLOGOUS
–Frozen (cryopreserved)
–80-190 oC
• ALLOGENIC
–treated to remove "T-cells" (T cell
depletion)
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169. ENGRAFTMENT
• establishment of the new bone
marrow
• harvested donor marrow is infused
intravenously into the recipient and
travels to sites in the body where it
produces bone marrow
• COMPLETE: 2-4 wks/longer
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170. COMPLICATIONS
• Failure to engraft
• Graft-versus-host disease (GVHD)
• Veno-occlusive disease

171. GENE THERAPY
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172. •insertion, alteration, or
removal of genes
•first conducted on
September 14, 1990
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173. • mainly involves the
modification of genetic
material (DNA and genes)
• plays a key role in
determining the traits and
characteristics of individuals
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174. GOALS
• destroying or preventing the growth
of cancerous cells
• improving the ability of the normal
cells to fight against the cancerous
cells
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175. GERM LINE GT
• involves insertion of functional genes
into the germ or reproductive cells
(sperm and egg) of the body
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176. SOMATIC GT
• therapeutic genes are introduced into
the somatic cells
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177. INSERTION
• Thru liposome
• Thru viruses:
–Retroviruses
–Adenoviruses
–herpes viruses
–Lentiviruses
–poxviruses
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178. INSERTION
• EX vivo
–collection of some blood or bone
marrow cells from the patient
–viruses with the necessary genes are
introduced into the cells in a
laboratory, which are then injected
into the patient's body
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179. COMPLICATION
• Infection
• Cancer
• Gene mutation
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180. INSERTION
• IN vivo
–direct insertion of viruses or
liposomes that contain the desired
gene into the patient's body
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181. IMMUNOTHERAPY
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182. NURSING DIAGNOSIS
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183. Nursing Diagnoses
• Impaired tissue integrity r/t effects of tx & dse
• Imbalanced Nutrition: LBR r/t anorexia,
malabsorption, cachexia
• Pain, chronic r/t disease & tx effects
• Fatigue r/t physical & psychological stressors
• Anticipatory grieving r/t expected loss & altered
role function
• Disturbed body image r/t changes in appearance &
role functions
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184. •Hopelessness – terminally ill
•Powerlessness – unable to do
things
•Knowledge Deficit – upon
admission
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185. NURSING
INTERVENTIONS
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186. Nursing Interventions
• Maintaining tissue integrity
• Managing stomatitis
• Managing malignant skin lesions
• Promoting nutrition
• Relieving pain
• Decreasing fatigue
• Improving body image & self-esteem
• Assisting in grieving
• Monitoring & managing potential complications
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187. GAS EXCHANGE
AND
RESPIRATORY
SYSTEM
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188. LARYNGEAL CANCER
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189. Larynx
• an organ at the front of your neck. It
is also called the voice box.
• It is about 2 inches long and 2 inches
wide
• The larynx plays a role in breathing,
swallowing, and talking
• acts like a valve over the windpipe
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190. RISK FACTORS
• CAUSE: UK
• Age - over the age of 55
• Gender – 4x greater in male
• Race – African Americans than whites
• Smoking
• Alcohol
• Personal Hx of neck and head CA
• Occupation - sulfuric acid mist or nickel, asbestos
• Virus and low in Vit A
• GERD
• Familial tendency
• Straining of voice
• Weakened immune system
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191. RISK FACTORS
A. CARCINOGENS
Tobacco Combined effects of
alcohol and tobacco
abuse
Asbestos Second-hand smoke
Paint fumes Wood dust
Cement dust Chemicals
Tar products Mustard gas
Leather and metals
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192. Clinical
Manifestations
• Hoarseness or other voice changes
• A lump in the neck
• A sore throat or feeling that something is
stuck in your throat
• A cough that does not go away
• Problems breathing
• Bad breath
• An earache
• Weight loss
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193. CLINICAL MANIFESTATIONS
SUBJECTIVE
a. Sore throat / cough
b. Dyspnea
c. Dysphagia
d. Weakness
e. Unilateral nasal obstruction or discharge
f. Pain
g. Hoarseness of voice
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194. CLINICAL MANIFESTATIONS
OBJECTIVE
a. Persistent hoarseness
b. Foul breath
c. Persistent ulceration
d. Cervical lymph adenopathy
e. Unexplained weight loss
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195. Diagnosis
• Physical exam
• Indirect laryngoscopy -small, long-
handled mirror to check for abnormal
areas and to see if your vocal cords move
as they should
• Direct laryngoscopy - thin, lighted tube
called a laryngoscope through your nose
or mouth
• CT scan
• Biopsy
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196. Treatment
• The choice of treatment depends on a
number of factors
–general health
–where in the larynx the cancer
began
–the size of the tumor
–whether the cancer has spread.
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197. • Radiation therapy (also called
radiotherapy) uses high-energy x-
rays to kill cancer cells.
–Radiation therapy is local therapy.
–It affects cells only in the treated
area.
–Treatments are usually given 5 days
a week for 5 to 8 weeks.
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198. Combination of
treatment
• Radiation therapy alone
• Radiation therapy combined with
surgery –before or after surgery
• Radiation therapy combined with
chemotherapy - may be used before,
during, or after chemotherapy.
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199. SURGERY
• When patients need surgery, the type
of operation depends mainly on the
size and exact location of the tumor
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200. • Total laryngectomy: The surgeon removes
the entire larynx.
• Partial laryngectomy
(hemilaryngectomy): The surgeon removes
part of the larynx.
– Supraglottic laryngectomy: The surgeon
takes out the supraglottis, the top part
of the larynx.
– Cordectomy: The surgeon removes one
or both vocal cords.
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201. • Lymph node dissection
• Thyroidectomy or thyrotomy
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202. 23/09/12 cancer 202

203. Chemotherapy
• Before surgery or radiation therapy
• After surgery or radiation therapy
• Instead of surgery
23/09/12 cancer 203

204. Implementation
• Radiation therapy
• Dry mouth
– Drinking lots of fluids can help.
– Some patients find artificial saliva helpful.
– It comes in a spray or squeeze bottle.
• Sore throat or mouth
– special rinses to numb your throat and mouth
and help relieve the soreness.
• Delayed healing after dental care.
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205. • Tooth decay
– Good mouth care
– a soft toothbrush, or a toothbrush that has a spongy
tip instead of bristles.
– A mouthwash made with diluted peroxide, salt
water, baking soda, or a combination can keep your
mouth fresh and help protect your teeth from decay.
– It may also be helpful to use fluoride toothpaste or
rinse.
• Changes in sense of taste and smell
– During radiation therapy, food may taste or smell
different.
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206. • Fatigue.
– During radiation therapy, you may become very
tired, especially in the later weeks of treatment.
– Resting is important, but doctors usually advise their
patients to stay as active as they can.
• Changes in voice quality
– Your voice may be weak at the end of the day.
– Voice changes and the feeling of a lump in your
throat may come from swelling in the larynx caused
by the radiation.
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207. • Skin changes in treated area
– Good skin care is important at this time.
– Try to expose this area to the air but
protect it from the sun.
– Avoid wearing clothes that rub, and do
not shave the treated area.
– You should not put anything on skin
before radiation treatments.
– never use lotion or cream without
doctor's advice.
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208. Implementation
• Surgery
• Pain
• Low energy
• Swelling in the throat
– won't be able to eat, drink, or swallow.
– IV
– Feeding tube
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209. • Increased mucus production
–the lungs and windpipe produce a
lot of mucus, also called sputum
–Suction PRN
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210. Implementation
• High CHON and Calorie diet
• soft, bland foods
• Thick soups, puddings, and
milkshakes often are easier to
swallow
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211. Rehabilitation
• Stoma Care
• Communication
–partial laryngectomy, you will be
able to talk in the usual way
–total laryngectomy, pt. must learn
to speak in a new way
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212. 23/09/12 cancer 212

213. Communication
• Keep pads of paper and pens or
pencils
• Use a typewriter, computer, or other
electronic device
• Instruct the pt to carry a small
dictionary or a picture book and
point to the words you need
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214. • Do
–Give the person plenty of time to
speak
–Ask them to repeat if you don’t
understand
–Watch a person’s lips if you are
finding it hard to understand
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215. • Don’t
–Hurry them; pressure affects ability
to communicate
–Pretend you understand if you
don’t—it will be obvious
–Avoid eye contact during the
conversation
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216. TECHNIQUES OF
ALARYNGEAL
COMMUNICATION
1. ESOPHAGEAL SPEECH
2. ELECTRIC LARYNX
3. TRACHEOESOPHAGEAL
PUNCTURE
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217. Esophageal speech
• teach how to force air into the top of your
esophagus and then push it out again
• The puff of air is like a burp
• It vibrates the walls of the throat, making
sound for the new voice
• The tongue, lips, and teeth form words as
the sound passes through the mouth
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218. Esophageal speech
• speech sounds low pitched and gruff,
but it usually sounds more like a
natural voice than speech made by a
mechanical larynx
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219. Tracheoesophageal
puncture
• surgeon makes an opening between
the trachea and the esophagus
• opening is made at the time of initial
surgery or later
• small plastic or silicone valve fits into
this opening
• valve keeps food out of the trachea
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220. 23/09/12 cancer 220

221. • After TEP, patients can cover their
stoma with a finger and force air into
the esophagus through the valve.
• The air produces sound by making
the walls of the throat vibrate.
• The sound is a lot like natural speech
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222. Mechanical speech
• powered by batteries (electrolarynx) or by
air (pneumatic larynx)
• small flashlight
• It makes a humming sound. hold the
device against the neck, and the sound
travels through your neck to the mouth
• a flexible plastic tube that carries sound
into your mouth from a hand-held device
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223. 23/09/12 cancer 223

224. • pneumatic larynx
–held over the stoma and uses air
from the lungs instead of batteries
to make it vibrate
–The sound it makes travels to the
mouth through a plastic tube.
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225. 23/09/12 cancer 225

226. NURSING
1. DIAGNOSES
DEFICIENT KNOWLEDGE
2. ANXIETY AND DEPRESSION
3. INEFFECTIVE AIRWAY CLEARANCE
4. IMPAIRED VERBAL
COMMUNICATION
5. IMBALANCED NUTRITION
6. DISTURBED BODY IMAGE AND LOW
SELF-ESTEEM
7. SELF-CARE DEFICIT
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227. NURSING CARE
1. PROVIDE TIME TO DISCUSS THE DIAGNOSIS
AND THE RAMIFICATION OF SURGERY
2. ASSIST AND ENCOURAGE EXPRESSION OF
FEELINGS
3. ANSWER AS THOROUGHLY AND HONESTLY
TO QUESTIONS
4. VISIT AND DISCUSS REHABILITATION
PROCESS
5. INSTRUCT AS TO THE METHOD OF
COMMUNICATION THAT WILL BE USED
AFTER SURGERY
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228. 6. OBSERVE FOR OBSTRUCTION OF AIRWAY
7. OBSERVE FOR SIGNS OF HEMORRHAGE
8. PROVIDE SUCTION APPARATUS AND
CATHETERS
9. PROVIDE HUMIDITY
10. EXPECT AND ACCEPT A PERIOD OF
MOURNING
11. ENCOURAGE INVOLVEMENT IN SPEECH
THERAPY
12. TEACH NECESSARY TO HANDLE BODY
FUNCTIONING ALTERATION
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229. 13. TEACH CLIENT TO AVOID ACTIVITIES
THAT PERMIT WATER OR IRRITATING
SUBSTANCES TO ENTER THE TRACHEA
14. SUCTION LARYNGECTOMY TUBE PRN
15. AVOID WEARING CLOTHES WITH
CONSTRICTIVE COLLARS OR NECKLINE
16. MAKE CLIENT UNDERSTAND THAT
CERTAIN ACTIVITIES ARE IMPOSSIBLE
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230. have a nice day…
23/09/12 cancer 230

231. Assignment
• LUNG CANCER
• TUMORS OF THE MEDIATINUM
• CARDIAC TUMORS
• LEOCOCYTOSIS
LEUKEMIA
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232. Bring out ¼ sheet
of paper…
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