Alfredo Olaez Bautista Jr

8/9/2019 Alfredo Olaez Bautista Jr

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Alfredo Olaez Bautista Jr. August 7 at 11:58amBAUTISTA JR. ALFREDO OLAEZ

4B GROUP-A

ASSIGNMENT 1 ON CANCER (INDIVIDUAL ASSIGNMENT)

1. Discuss the theories of cancer development and provide an example of each. What is theimplication for the prevention of cancer based on these theories? (10%)

a. Cellular Transformation & Derangement Theory

-Conceptualizes that normal cells may be transformed into cancer cells due to exposure to someetiologic agents.

Example:

-an example is a person who is fund of tinapa or tocino wich is an example of carcinogens richfood that may trigger oncogenes that causes development of cancer to the patient.

Prevention:

-we must have balance diet to have a healthy body like eating green leafy vegetables andlycopene rich food like tomatoes. And we must avoid exposure to carcinogens to prevent

formation of cancer cells.

b. Failure of the Immune Response Theory-Advocates that all individuals possess cancer cells. However, the cancer cells are recognized by

the immune response system. So, the cancer cell undergoes destruction. Failure of the immuneresponse system leads to inability to destroy the cancer cells.

Example:

-an example is a person who has AIDS; this person has already failure of their immunity becauseof his present illness. They can easily acquired cancer because of their failed immune response.

Prevention:

-for the person who already has failure of their immune response, they can prevent acquiringcancer through reverse isolation because their body can no longer defends any attack from any

virus. For those who will handle this kind of patient. Reverse isolation is the best way to preventsharing of virus to the person who has failed immune response.

2. Explain how a person with Acquired Immune Deficiency Syndrome (AIDS) can develop

cancer. Relate this to the concept of immunosurveillance. (10%)-immunosurveillance acts as a detector for arising abnormal cell in the body of a human. A

person with AIDS has already corrupted our immunity because of its virus. The body of a personwith AIDS can easily develop cancer because their immune response is already affected and can

no longer fight abnormal growth of cells in the body.

3. Chemotherapy for cancer treatment is always administered in several doses or cycles. What isthe rationale for this? Relate it to the cell cycle and reproduction of cancer cells. (10%)


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-in the process of cell growth, billions of cell into our body has an initiative of telling every cellwhen to reproduce mitotic reproduction occurs in sequence called the cell cycle. When cancer

cells enter the cell cycle, they reproduce at an uncontrolled rate through the acitivity of specificcontrol regulator genes called proto oncogenes. These genes produce problems that act as on and

off switches in chemotherapy. It inhibits the spread of cancer cells and stops it from entering

mitosis.4. Describe pathophysiologic mechanisms by which a person with cancer could developoxygenation problems. Provide as many possible scenarios. This question tests your ability to

integrate learning regarding alterations in oxygenation as it relates to cancer. (15%)-when the patient is under chemotherapy, the patient will suffer from body weakness that can

result to respiratory depression that causes oxygenation problems, if the patient has a lungcancer. The lungs will shrink and unable to expand anymore because of the growth of tumor in

the lungs that will result to oxygenation problems too. Other case is a brain cancer. If there willbe a presence of tumor in the brain. There will be a destruction of the brain because of the tumor

that may cause compression or damage of the brainstem that will alter the respiration of theperson who has brain cancer.

II. COGNITIVE ANALYSIS:

1. Discuss the cancer causation factors using the table below:

CANCER CAUSATION

FACTORS DESCRIPTION INTERRELATIONSHIP

OF THE FACTORS

Environmental Factors

associated with cancer

causation: This are factors that are being acquired within the environment when the host has a low

immune resistance like exposure to some carcinogens-nitrites, nitrates, asbestos, etc. The environment

is the main source of antigens or carcinogens that may infect people with low immune resistance like

those who are AIDS patients.

Host Characteristics

influencing cancer

susceptibility: If the host has a very immune response he could not able to detect antigens that may

cause alteration in cellular division that result in the development of cancer. Sometimes the host is the

carrier of the virus that may cause development of cancer especially those who have

immunosuppression like AIDS,

2. Differentiate normal cells from cancer cells based on the fallowing

factors:

FACTORS NORMAL CELLS CANCER CELLS

1. Difference in

growth Reproduce at controlled rate; genetic control over growth is exerted through DNA, and the


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daughters are identical to the parent cell; subjected to stimuli such as hormones or inhibition by contact

with nearby cells. Variable and depends on level of differentiation; the more anaplastic the tumor, the

faster its growth

Fail to recognize signals emitted by nearby cells regarding available tissue space; loss of control over

normal growth

2. Difference in

appearance Divided in standard rate and pace.

Organized in an orderly arrangement in a tissue Immature and undifferentiated

Mitotic cell

-appears atypical and bizarre; breaks, deletions, translocations, and abnormal karyotypes are common

>nucleus

- pleomorphic, highly pigmented, larger than normal nucleol; >Chromatin

-may clump along the outer areas

>arent encapsulated >vary in size and shape

3. Difference in

differentiation Well differentiated cell that resembles normal cells of the tissues.

Cells are organized in an orderly arrangement in tissue. Undifferentiated and often bear little

resemblance to the normal cells of the tissue from which they arose.

Lose ability to differentiate; they enter a sate called anaplasia, in which they no longer appear or

function like the original cell; absent

4. Difference in cell

structure

5.Biochemical

difference

6. Genetic

Difference

3. Discuss the multistage phase of the process of carcinogenesis.

PHASES

Initiation Carcinogens escape normal enzymatic mechanism and alters genetic structure of the cellular

DNA

It refers to the damage to or mutation of DNA that occurs when the cell is exposed to an initiating

substance or event (such as virus, chemical or radiation) during DNA replication (transcription). Usually

enzymes detect errors in transcription and remove or repair them. Sometimes, however, an error is

missed. If regulatory proteins recognize the error and block further division, then the error may be

repaired or the cell may self-destruct. If these proteins miss the error, it becomes a permanent mutation

thats passed on to future generations of cells.

Promotion Repeated exposure to co-carcinogens causes the expression of abnormal or mutant genetic

information even after long latency periods.

It involves the mutated cells exposure to promoters (factors) that enhance its growth. This exposure

may occur shortly after initiation or years later. Promoters may be hormones such as estrogen, food


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additives such as nitrates, or drugs such as nicotine. Promoters can affect the mutated cell by altering

the function of genes that control cell growth and duplication, the cellular response to growth

stimulators or inhibitors, and intercellular communication.

Progression Cellular changes exhibits increase malignant behavior. Cell shows propensity to invade

adjacent tissues and metastasize.

It is a late promotion phase in which the tumor invades, metastasizes, and becomes resistant to drugs.

4. Specify the risk factors associated with the following types /site of cancer

SITE OF CANCER RISK FACTORS

1. LUNG Tobacco use, including cigarettes, cigar, chewing tobacco and snuff

>Air pollution

-outdoor air pollutants: arsenic, benzene hydrocarbons, and polyvinyl chlorides

-indoor air pollutants: cigarette smoke and radon; more carcinogenic than outdoor air

2. BREAST Early menarche and late menopause

High fat diet

Obesity

Physical inactivity

Excessive alcohol consumption

Women or mother who have had breast cancer are more likely to develop the disease

3. CERVICAL Tobacco use

Human papillomavirus infection

Chlamydia infection

Diet low in fruits and vegetables

Family history of cervical cancer

4. COLORECTAL Personal/family history of polyps

High fiber diet or low fiber diet

History of ulcerative colitis

Age: > 50 years

5.NASOPHARYNGEAL Tobacco use

Poor nutrition

Alcohol

Weakened immune system

Occupational exposure to wood dust, paint fumes.

Gender: 4-5 times more common in men

Age: more than 60yrs

6. PROSTATE Advancing age race and diet

Race: more common in Africa and American men than among white men

High fat diet

Men with a father or brother who has prostate cancer are more likely to get prostate cancer them selves


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5. Describe your role in the screening and prevention of cancer.

>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. Evaluate 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.

III. APPLICATION: You are a nurse assigned to care for DC. Using the

situation and the questions below, describe your roles and responsibilities

as an Oncology Nurse

SITUATION A.

Situation :

JA, a 50 y.o. teacher, was diagnosed with infiltrating ductal breast cancer after a biopsy was done. The

pathology revealed 3 out of 14 lymph nodes were positive and HER 2 was also positive. Her CT & bone

scans results were negative. Her admitting diagnosis is infiltrating ductal carcinoma, T2, N1, M0,

premenopausal. She was ordered to undergo chemotherapy.

Questions:

1. Knowing the risk factors, how will you teach a group of women with fear of having breast cancer

about early detection of this type of Cancer?

-a group of woman must be aware about any irregularities of their menstrual cycle, and other risk factor

like early menarche and late menopausal. Early detection will determine if there will be a development

of cancer in our body. Self breast examination is a method to know if there is a presence of mass or

lump on their breast that will serve as early sign for development of tumor.

2. What is Sentinel lymph node biopsy?

- When breast cancer is diagnosed, women (and men) must often undergo auxiliary lymph node

dissection (i.e., removal of underarm nodes) to check for the spread of cancer. This process is part of

staging the cancer. Unfortunately, the removal of these lymph nodes can lead to lymph edema

(chronic swelling) of the arm in a certain percentage-- about 10-20%--of cases.


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Sentinel lymph node biopsy is a new diagnostic procedure used to determine whether breast cancer has

spread (metastasized) to auxiliary lymph nodes (i.e., lymph glands under the arm). A sentinel lymph

node biopsy requires the removal of only one to three lymph nodes for close review by a pathologist. If

the sentinel nodes do not contain tumor (cancer) cells, this may eliminate the need to remove additional

lymph nodes in the auxiliary area.

Early research on this technique indicates that sentinel lymph node biopsy may be associated with less

pain and fewer complications than standard auxiliary dissection. However, because the procedure is so

new, long term data are not yet available.

3. How will you explain to JA her diagnosis of infiltrating ductal carcinoma, T2, N1,M0, premenopausal?

- Infiltrating ductal carcinoma is the most common invasive breast cancer, accounting for 70 percent of

all cases. A very hard lump that has irregular borders and seems anchored in surrounding tissues is

characteristic of infiltrating ductal carcinoma. The skin over the area or the nipple may retract (pull in).

T2 are increasing size or local extent of the primary tumor and N1 means increasing involvement of

regional lymph nodes but there is no distant metastasis in M0.

4. What is the implication of her having HER2 +?

- HER2-positive breast cancer is a breast cancer that tests positive for a protein called human epidermal

growth factor receptor 2 (HER2), which promotes the growth of cancer cells. In about 1 of every 5 breast

cancers, the cancer cells make an excess of HER2 due to a gene mutation. This gene mutation and the

elevated levels of HER2 that it causes can occur in many types of cancer not only breast cancer.

-the effect to the patient of having HER2+ are patient might experience body weakness and weight loss,

because the proteins that the body needed are being use by the cancer cells for its growth.

5. If she will ask you of her chances of survival, how will you explain this to her?

-if we will make an action. Theres a chance for surviving breast cancer. Depends on the prognosis of the

breast cancer. The 5-year survival rate for women diagnosed with cancer is 80%. About 88% of women

diagnosed with breast cancer will survive at least 10 years.

6. What is Tamoxifen? Why are women placed on long term Tamoxifen therapy as a treatment for

breast cancer?

-Tamoxifen (Nolvadex) is a medication in pill form that has been used for 25 years to treat breast

cancer in women and men. Tamoxifen is one of the most common hormonal therapy drugs. It has been

shown to decrease the chance of recurrence in some early-stage breast cancers and to prevent the

development of cancer in the opposite breast. Tamoxifen also slows or stops the growth of cancer cells

present in the body.

-The length of time a woman with advanced breast cancer can take tamoxifen depends on their

response to the treatment as well as other factors. For reducing the risk of developing breast cancer in

high-risk women and in women with DCIS, tamoxifen is generally prescribed for 5 years. Studies have

confirmed that taking adjuvant tamoxifen for 5 years reduces the risk of recurrence of the original

breast cancer as well as the risk of developing a second primary cancer in the other breast. (Adjuvant


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treatment is a secondary treatment used to increase the chances of a cure.) The studies also showed

that taking tamoxifen for more than 5 years was not any more effective than the 5-year treatment.

7. JA will be receiving 6 cycles of combination chemotherapy consisting of Doxirubicin(Adriamycin) and

Cyclophosphamide (Cytoxan)?

-

8. How will you teach JA about immunosuppression?

-the patient must avoid crowded places because shes immune system is already low and because of

that she can easily acquired illness because of immuosuppression.

9. Discuss the nursing care of clients undergoing chemotherapy.

-if client is undergoing chemotherapy we must conserve the clients energy because chemotherapy can

cause fatigue because of that the clients body may be traumatize because of that procedure and we can

also provide safety of the client because the patient is risk for fall because of body weakness. And we

must monitor V/S and lab values to monitor alteration in lab results and can cause for bleeding. Proper

nutrition and hydration must be given to the patient because chemotherapy alters the nutrition of the

body. We can also provide the patient a wig. Because the patient has disturb body image due to hairloss.

10. Should the patient undergo surgery, what are the things nurses need to do to prepare JA for

surgery?

- The client must undergo for a surgery because the cancer cell can metastasize to other parts of the

body when it is neglected, the client must be aware that her breast will be removed and the patient

must be ready for disturbance of her body image.

11. What are the health education topics that you will educate JA post mastectomy?

- During the rehabilitation process, the woman must receive information on the care after the surgery,

orientation and information about the different stages of the recovering process, care with the upperlimb on the side of the surgery, exercises to recover the functional capacity of the arm and the shoulder,

as well as on other treatments such as radiotherapy, chemotherapy and hormonal therapy, we discuss

some important aspects of the care, such as orientation on self-care; the performance of daily activities,

physical exercises and specific care with the upper limb in the operated side, preventing lymphedema.

The client must be aware of his alteration of her body image because of removal oh her one breast. We

must encourage him by giving him an advice like good news that there are new surgery now that can

restructure their breast if they undergone mastectomy. That will relieve their anxiety and hopelessness.

12. Discuss altered self concept in relation to breast cancer.

-because of the present condition that the client is experiencing. The client may be decrease her self

steam because all she knows is he will be not be in normal again because of his present condition. Even

thou he already undergone mastectomy. After she recovers from that surgery. Her self steam is still low

because of incompleteness.

IV. CARING FOR PATIENTS WITH THE BIG C


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Here are three case situations. These case situations utilizes the modalities

commonly done to clients with cancer.

Case study #1

Situation :

PB, a 48 y.o woman was diagnosed adenocarcinoma of the lung with metastases to the brain and liver.

She is a single parent, has a 16 year old son, and is currently unemployed because of poor health. She

claimed to have smoking for the past 20 years consuming one to two packs per day. A year ago she

developed scapular and arm pain in her right side, was diagnosed as having adenocarcinoma of the lung

and underwent resection of the urpper right lobe of the lung. Because of limited financial capability she

did not receive any follow up care.

PB experienced pain in her right temporal areal 48 hours ago and was brought to the emergency room

after she had tonic-clonic convulsions at home. IV Dexamethasone was given after CT scan revealed a

large mass in the right frontal area. She was admitted to the oncology ward with slightly slurred speech

and intermittent bone pain.

Questions:

13. Identify the risk factors for Lung CANCER?

- Tobacco use, including cigarettes, cigar, chewing tobacco and snuff, exposure to environmental

pollutants and exposure to occupational pollutants.

14. Identify the usual location, growth rate, and likelihood of metastasis of

adenocarcinoma of the lungs.

-

15. What is the significance of the presence of bone pain and weight loss?

-the significance of bone pain and weight loss in a cancer patient is, there is a bone pain because of the

over production of RBC by bone marrow to produce haemoglobin to deliver oxygen. But because the

tumour absorbs all the oxygen in the body the bone marrow compensate to the oxygen demand of the

body that causes bone pain. There is a weight loss because of the presence of tumour in the body. The

tumour gets all the nutrition and oxygen in the body that causes growth for the tumour and leads to

malnutrition in the body of the client that causes weight loss.

16. What are the possible tests done to determine whether metastasis has occurred?

-The diagnosis of metastasis begins with a medical history and physical exam. The healthcare provider

may order various blood tests, including those for tumor markers. X-rays and other imaging studies are

often used to diagnose a metastasis. Special X-rays, such as MRIs and CT scans, may be used. These can

sometimes find tumors smaller than 1/2 centimeter. Finding even smaller, microscopic metastases

would be useful. Future tests may check for cancer genes in parts of the body where tiny metastases are

suspected.

Some people are assumed to have microscopic metastasis because of the nature of the primary tumors.

They are treated to try to overcome this problem. Sometimes the situation is unclear, and a biopsy may


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be needed. Testing can involve removal of a lymph node, needle puncture of a tumor, or examination of

a bone marrow sample.

It was found out that there were metastases to lymph nodes, liver, and brain. PB is scheduled for

radiation.

17. What are the goals of radiotherapy as cancer modality?

- To definitively sterilize the cancer cells within the irradiated volume in order to obtain total cure of the

cancer.

Goals of radiotherapy are curative and palliative. In curative radiotherapy. Some degree of risk is

accepted for a reasonable probability of permanent eradication of the malignancy. In medulloblastoma,

risks of radiation injury to cognition, a diminution of bone growth, or other toxicities may be acceptable

for a 60%-80% probability of cure. In palliative radiotherapy, the intent is to ameliorate the symptoms

and it would be a short course avoiding radiation induced CNS toxicity. Currently, the whole brain

radiotherapy for the treatment of GBM is no longer practiced. Localized field covering 2 - 3cm area

around the peritumoral edema is the standard portal up to 45Gy. This is followed by the booster dose to

the reduced field with 1.5-2.0cm around the tumor.

18. What are the effects of radiation at the cellular level?

-In external or brachytherapy radiation therapy the tumor is attacked by either a beam or a small

constant dose of ionizing radiation. The radiation used consists of highly energized x-rays and gamma

waves that have the ability to detach or ionize an electron from an atom or molecule. At low levels of

radiation there is no detectable ionization effect, unlike at the higher doses that are used for radiation

therapy, there are a variety of outcomes. The radiation ionizes the bonds in the cell's water molecules

releasing hydroxyl free radicals. The hydroxyl free radicals attack the DNA molecules causing damage,

mutations, and sometimes even break the DNA strands. The DNA is the basis of the genetic materials;the command center in the cells, without functioning DNA the cancer cells can no longer function

properly or repair themselves leading it to apoptosis. Apoptosis or "cell suicide" is the cells innate ability

to destroy itself when it is irreparably damaged. Since cancer cells have lost the ability to detect that

they are damaged and to destroy themselves; radiation restores the ability. The amount and length of

the radiation treatment depends on the radio sensitivity of the cancer and also on the sensitivity of

target zone. If damage to the local tissues is detrimental, then the amount of radiation may be limited.

19. Discuss the major side effects of radiation and its management.

-Side effects of radiation therapy are related to the area treated; with most common effects being skin

reactions, loss of appetite and fatigue. In rare occasions your white blood cell counts will be lowered

making you more susceptible to infection. These effects may increase with the treatments but will

subside as the treatments end.

-Your doctor and nurse are the best people to talk to about your treatment, side effects, things you

need to do to take care of yourself, and any other medical concerns you may have. Tell them about any

changes in the way you feel and about any side effects you are having, including skin changes, tiredness

(fatigue), diarrhea, or trouble eating. Be sure that you understand any home care instructions and know


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whom to call if you have more questions.

Side effects vary from person to person and depend on the radiation dose and the part of the body

being treated. Some patients have no side effects at all, while others have quite a few. There is no way

to know who might -- or might not -- have side effects. Your overall health can sometimes affect how

your body reacts to radiation treatment and whether you have side effects.

We need to take special care of yourself to protect your health during radiation treatment. Your doctor

or nurse will give you advice based on your treatment and the side effects you might have. Here are

some other tips:

Be sure to get plenty of rest. You may feel more tired than normal. Try to get good, restful sleep at

night. Severe tiredness, often called fatigue, may last for several weeks after your treatment ends. See

the fatigue" section for more information.

Eat a balanced, nutritious diet. Depending on the area of your body getting radiation (for example, the

belly or pelvic area), your doctor or nurse may suggest changes in your diet. You can get more

information in our booklet called

Take care of the skin in the treatment area. If you get external radiation therapy, the skin in the

treatment area may become more sensitive or look and feel sunburned. Ask your doctor or nurse before

using any soap, lotions, deodorants, medicines, perfumes, cosmetics, talcum powder, or anything else

on the treated area. Some of these products may irritate sensitive skin. See the skin problems" section

for more information.

Do not wear tight clothes over the treatment area. This includes girdles, pantyhose, or close-fitting

collars. Instead, wear loose, soft cotton clothing. Do not starch your clothes.

Do not rub, scrub, or use adhesive tape on treated skin. If your skin must be covered or bandaged, use

paper tape or other tape for sensitive skin. Try to put the tape outside the treatment area, and do not

put the tape in the same place each time.

Do not put heat or cold (such as a heating pad, heat lamp, or ice pack) on the treatment area. Talk

with your doctor first. Even hot water may hurt your skin, so use only lukewarm water for washing the

treated area.

Protect the treated area from the sun. Your skin may be extra sensitive to sunlight. If possible, cover

the treated skin with dark-colored clothing before going outside. Ask your doctor if you should use a

lotion that contains a sunscreen. If so, use a sunscreen product with a sun protection factor (SPF) of at

least 15. Reapply the sunscreen often, even after your skin has healed. Continue to give your skin extra

protection from sunlight for at least 1 year after radiation therapy.

Tell your doctor about all medicines you are taking before treatment. Give your doctor a full list of

everything you take and how often you take it, even things like aspirin, vitamins, or herbs. Don't forget

to list those you take only when you need them, such as sleep aids, antacids, headache remedies, and

antihistamines. It's a good idea to keep a list like this with you at all times, in case of emergency, even

when you aren't getting cancer treatment.

20. What are the factors that affect contribute to cell radiosensitivity?

- ATR Affecting Cell Radiosensitivity Is Dependent on Homologous Recombination Repair but

Independent of Nonhomologous End Joining

ATR is one of the most important checkpoint proteins in mammalian cells responding to DNA damage.


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Cells defective in normal ATR activity are sensitive to ionizing radiation (IR). The mechanism by which

ATR protects the cells from IR-induced killing remains unclear. DNA double-strand breaks (DSBs) induced

by IR are critical lesions for cell survival. Two major DNA DSB repair pathways exist in mammalian cells:

homologous recombination repair (HRR) and nonhomologous end joining (NHEJ). We show that the

doxycycline (dox)-induced ATR kinase dead (ATRkd) cells have the similar inductions and rejoining rates

of DNA DSBs compared with cells without dox induction, although the dox-induced ATRkd cells are more

sensitive to IR and have the deficient S and G2 checkpoints. We also show that the dox-induced ATRkd

cells have a lower HRR efficiency compared with the cells without dox induction. These results indicate

that the effects of ATR on cell radiosensitivity are independent of NHEJ but are linked to HRR that may

be affected by the deficient S and G2 checkpoints.

21. What are the factors that influence the success of external radiotherapy?

- Radiation Therapy can, to some extent, be regarded as a drug like any other. It is therefore useful to

distinguish the total dose from the fractionation schedule. Radiation therapy is usually given daily, the

dose depends primarily on tumor type, but many other factors such as whether radiation is given alone

or with chemotherapy, before or after surgery, the success of surgery and its findings and many other

reasons that are considered by the treating doctor (known as a radiation oncologist). These small

frequent doses allow healthy cells time to grow back, repairing damage inflicted by the radiation. In

short, total dose can be given in daily fractions using external beam radiation or the total dose can be

given via other methods such as implants that deliver radiation continuously over a given timeframe.

Depending on the implant type, it may be given as a fraction (e.g. High Dose Rate HDR) over minutes or

hours or as another example permanent seeds may be implanted (such as in the prostate) which slowly

deliver radiation until the seeds become inactive.

22. If you will be the one to explain to this patient, what instructions will you give regarding the process

the client has to undergo when undergoing radiotherapy?

-The process of undergoing to radiotherapy depends on the situation of the client. Breast cancer will be

given many therapies like radiotherapy before her procedure and after her procedure. the client must

understand the importance of continues therapy for her body and must be closely monitored because to

give chance for the normal cell to grow and develop.

23. Discuss grieving among relatives of patients with cancer?

-The patient will be suffering for taking care of their client because of presence of any complication that

may lead to severity of the case of the client. The relatives will also suffer from financial problems

because a person who will going to undergone to many therapy causes a lot and its too much expensive.

.

Case Study #2

Situation :

BK, a 25 y.o. has been a gasoline station attendant for the past ten years. He also smokes during his

break time and occasionally drinks alcohol during socialization. He sought medical attention due to


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complaints of fatigue, easy bruising, epistaxis and gingival bleeding. Owing to financial difficulty, the

client did not seek medical attention early despite the signs and symptoms. He only sought medical

attention because of inability to report to work for a week. BK was admitted, underwent several

diagnostic procedures and was diagnosed to have acute myeloid leukemia.

Questions:

24. Compare and contrast lymphoblastic and myeloid leukemia?

-lymphoblastic is characterized by proliferation and accumulation of small, abnormal, mature

lymphocyte that is common in adult ages 55 and above. It is usually common in men and it is incurable

but can involve supportive treatment like blood transfusion, prevention of infection and chemotherapy

not like myeloid leukaemia it is proliferation of all bone marrow elements and common in children. It is

usually common in women and can be treated with chemotherapy.

25. What are the other manifestations BK are likely to manifest?

-General signs and symptoms of the early stages of acute myelogenous leukemia may mimic those of

the flu or other common diseases. Signs and symptoms may vary based on the type of blood cell

affected. Signs and symptoms of acute myelogenous leukemia include:

>Fever

>Bone pain

>Lethargy and fatigue

>Shortness of breath

>Pale skin

>Frequent infections

>Easy bruising

>Unusual bleeding, such as frequent nosebleeds and bleeding from the gums

26. How will you respond to the question of the mother of the patient when she asked, how come we

did not know he has leukemia? How could he have prevented from having it?

-because when the client is manifesting some signs and symptoms like fatigue, easy bruising, epistaxis

and gingival bleeding he does not seek for any medical attention because of financial difficulties. The

client did not diagnose early because of neglecting what the client is experiencing. We can prevent him

to have this disease when he changes his lifestyle and proper diet and exercise. A healthy body will give

us protection from any degenerative diseases.

27. Chemotherapy is the management of choice for Leukemia. Discuss induction,consolidation, and

maintenance therapy in relation to management of Leukemia.

-Consolidation therapy: Cancer treatment given after induction therapy to consolidate the gains

obtained, further reduce the number of cancer cells and achieve a complete remission. Often just called

consolidation.

The overall sequence of therapy may be induction, consolidation, and maintenance therapy. Induction

therapy is the initial step toward reducing the number of cancer cells. Consolidation is designed to

further diminish the number of cancer cells and achieve a complete remission. Maintenance is given to


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maintain the remission and prevent a relapse.

28. What are the disease related complications of leukemia and treatment for each?

-Raynaud's Phenomenon - Treatment

The following lifestyle changes may help people with Raynaud's phenomenon:

Stop smoking

Avoid caffeine

Stop and avoid medications that cause tightening or spasms of the blood vessels

Avoid exposure to cold in any form. Wear mittens or gloves outdoors and when handling ice or frozen

food. Avoid getting chilled, which may happen after any active recreational sport.

Wear comfortable, roomy shoes and wool socks. When outside, always wear shoes.

Your health care provider may prescribe medications to relax the walls of the blood vessels. These

include topical nitroglycerin, calcium channel blockers, sildenafil (Viagra), and ace inhibitors.

Roth spots -

Pyoderma Gangrenosum - If you have an underlying disease associated with pyoderma gangrenosum,

treating that condition may help control the ulcers. However, other treatments may be necessary to

heal the wounds.

Drugs

Your doctor may prescribe the following:

Corticosteroids. Corticosteroids help relieve inflammation. Usually

pyoderma gangrenosum is treated with oral corticosteroids, such as prednisone. Side effects of

corticosteroids may include increased blood pressure, weight gain with fat deposits in your abdomen,

face and back of your neck, and increased risk of infection. In some milder cases, a topical steroid a

medication you apply to your skin may be used. Side effects may include skin thinning and acne.

Immunosuppressant drugs. These drugs help calm the autoimmune response in your skin, which

reduces inflammation. Because these drugs suppress your immune system, they can place you at higher

risk of infections.

Nonsteroidal anti-inflammatory medications. Medications in the sulfone family, such as dapsone, are

often used. Milder cases might involve using minocycline, an anti-inflammatory and antibiotic

medication.

Tumor necrosis factor inhibitors. Drugs such as infliximab (Remicade), etanercept (Enbrel) and

adalimumab (Humira) have shown some success in treating pyoderma gangrenosum, especially in

people who have associated inflammatory bowel disease. Remicade is given by infusion, and Enbrel and

Humira are given as injections. These drugs also can make you more vulnerable to infection and to

certain cancers.

High-dose intravenous immunoglobulin. When corticosteroids aren't enough to control pyoderma

gangrenosum, intravenous immunoglubulin has shown promise as a treatment.

As your skin heals, you'll likely taper off the corticosteroids or immunosuppressants. You can expect

your skin to recover several months after beginning therapy. Without treatment, the ulcers may widen,

remain the same or slowly heal.

Surgery

Doctors don't commonly use surgery as a treatment option because trauma to the skin may worsen

existing ulcers or stimulate new ones to develop. This tendency to worsen after surgery is called


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pathergy. Doctors may perform surgery to carefully remove dead or necrotic tissue, and once the

inflammation has improved consideration could be given to skin grafting if the ulcers on your skin are

large and need help with healing, your doctor may surgically attach a piece of real or artificial skin over

the open sores but most often the wounds heal without grafting.

29. Discuss the types of hematopoietic stem cell transplant.-AUTOLOGOUS

Autologous HSCT requires the extraction (apheresis) of haematopoietic stem cells (HSC) from the

patient and storage of the harvested cells in a freezer. The patient is then treated with high-dose

chemotherapy with or without radiotherapy with the intention of eradicating the patient's malignant

cell population at the cost of partial or complete bone marrow ablation (destruction of patient's bone

marrow function to grow new blood cells). The patient's own stored stem cells are then returned to

his/her body, where they replace destroyed tissue and resume the patient's normal blood cell

production. Autologous transplants have the advantage of lower risk of infection during the immune-

compromised portion of the treatment since the recovery of immune function is rapid. Also, the

incidence of patients experiencing rejection (graft-versus-host disease) is very rare due to the donor andrecipient being the same individual. These advantages have established autologous HSCT as one of the

standard second-line treatments for such diseases as lymphoma. However, for others such as Acute

Myeloid Leukemia, the reduced mortality of the autogenous relative to allogeneic HSCT may be

outweighed by an increased likelihood of cancer relapse and related mortality, and therefore the

allogeneic treatment may be preferred for those conditions Researchers have conducted small studies

using non-myeloablative hematopoietic stem cell transplantation as a possible treatment for type I

(insulin dependent) diabetes in children and adults. Results have been promising; however, at the time

of this writing, it is premature to speculate as to whether these experiments will lead to effective

treatments for diabetes.

-ALLOGENICAllogeneic HSCT involves two people: the (healthy) donor and the (patient) recipient. Allogeneic HSC

donors must have a tissue (HLA) type that matches the recipient. Matching is performed on the basis of

variability at three or more loci of the (HLA) gene, and a perfect match at these loci is preferred. Even if

there is a good match at these critical alleles, the recipient will require immunosuppressive medications

to mitigate graft-versus-host disease. Allogeneic transplant donors may be related (usually a closely HLA

matched sibling), syngeneic (a monozygotic or 'identical' twin of the patient - necessarily extremely rare

since few patients have an identical twin, but offering a source of perfectly HLA matched stem cells) or

unrelated (donor who is not related and found to have very close degree of HLA matching). A "savior

sibling" may be intentionally selected by preimplantation genetic diagnosis in order to match a child

both regarding HLA type and being free of any obvious inheritable disorder. Allogeneic transplants are

also performed using umbilical cord blood as the source of stem cells. In general, by transplanting

healthy stem cells to the recipient's immune system, allogeneic HCSTs appear to improve chances for

cure or long-term remission once the immediate transplant-related complications are resolved.

A compatible donor is found by doing additional HLA-testing from the blood of potential donors. The

HLA genes fall in two categories (Type I and Type II). In general, mismatches of the Type-I genes (i.e.

HLA-A, HLA-B, or HLA-C) increase the risk of graft rejection. A mismatch of an HLA Type II gene (i.e. HLA-


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DR, or HLA-DQB1) increases the risk of graft-versus-host disease. In addition a genetic mismatch as small

as a single DNA base pair is significant so perfect matches require knowledge of the exact DNA sequence

of these genes for both donor and recipient. Leading transplant centers currently perform testing for all

five of these HLA genes before declaring that a donor and recipient are HLA-identical.

30. If your client asks you, Will I benefit from the above procedure? How will you answer?

- the benefits for this procedure is you does not require that the donor be subjected to general

anesthesia to collect the graft, results in a shorter time to engraftment, and may provide for a lower

long-term relapse rate.

-Hematopoietic stem cell transplantation remains a risky procedure with many possible complications; it

has traditionally been reserved for patients with life-threatening diseases. While occasionally used

experimentally in nonmalignant and nonhematologic indications such as severe disabling auto-immune

disease and cardiovascular disease, the risk of fatal complications appears too high to gain wider

acceptance.

31. How will you prepare the client for the stem cell transplant?

> Preparation

Youll check in to the hospital a few days before the transplant. Using a simple surgical procedure,

doctors will place a tube in a large vein in your chest. This tube is called a central venous catheter or a

central line. It allows easy access to your bloodstream.

Doctors will use the central line to give you fluids, medicines, and blood products and to collect blood

samples. The tube will stay in place for at least 6 months after your transplant.

To prepare your body for the transplant, your doctors will give you high doses of chemotherapy and

possibly radiation.

This treatment destroys the stem cells in your bone marrow that aren't working right. It also suppresses

your body's immune system so that it won't attack the new stem cells after the transplant. Some people

may get more than one cycle of chemotherapy before their transplants.

The high doses of chemotherapy and radiation can cause side effects, including nausea (feeling sick to

your stomach), vomiting, diarrhea, and tiredness. Medicines can help with these symptoms.

In older patients or those who aren't very strong, doctors may choose "reduced-intensity" treatment.

This involves lower doses of chemotherapy or radiation.

Because your immune system is very weak after this treatment, you can easily get an infection. As a

result, youll stay in a hospital room that has special features that keep the room as clean as possible.

Doctors, nurses, and visitors will have to wash their hands carefully and follow other procedures to

make sure you don't get an infection. For example, they may wear face masks while in contact with you.

Preparation before a stem cell transplant may take up to 10 days. The time depends on your medical

situation, general health, and whether you need chemotherapy or chemotherapy and radiation.


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32. Discuss the procedures in stem cell transplant.

> Transplant

A stem cell transplant is like a blood transfusion. During the procedure, you get donated stem cells

through your central line. Once the stem cells are in your body, they travel to your bone marrow and

begin making new red blood cells, white blood cells, and platelets.

You're awake during the transplant. You may get medicine to help you stay calm and relaxed. Doctors

and nurses will check your blood pressure, breathing, and pulse, and theyll watch for signs of fever or

chills. Side effects of the transplant can include headache or nausea, but you may not have side effects.

The transplant takes an hour or more. This includes the time to set up the procedure, the transplant

itself, and time to check you afterward.

33. What are the complications of having a stem cell transplant?

>Organ complications, including problems developing in the following organ systems caused by

chemotherapy, radiation, or medications:

>Liver, including veno-occlusive disease (VOD), hepatitis, and infections

>Kidneys, including kidney failure

>Lungs, including inflammation and congestion

>Heart, including reduced pumping ability

As with other complications, the staff will help you be alert for signs of these organ complications so

treatment may begin as soon as possible.

>Graft versus host disease (GVHD), is a potentially serious side effect of allogeneic transplant. In GVHD,

the donor stem cells recognize that the recipient cells (your cells) are different and attack them. GVHD

may be acute or chronic, and may affect the skin, liver, or gastrointestinal tract. Drugs are given to

reduce the likelihood of GVHD and to treat it if it does occur.

34. As an oncology nurse, what do you think is the future of stem cell transplant in the Philippines?

- As an oncology nurse. I think for the next generation the future stem call transplant in the Philippines

will be improve and will less the complication that the client will be going to suffer after the operation.

Case Study #3

Situation:

AK, a 40 y.o. a part time teacher by profession and conducts review classes during week ends. She does

not smoke nor drinks but had splenectomy for her easy fatigability and anemia. Prior to hospitalization,

she has been complaining of afternoon fever, night sweats, and weight loss which initially made her

think of having TB. She had her sputum cytology and chest X-ray done which all turned out to be

negative of TB. She also noted lymph node enlargement in the neck which she thought is due to recent

upper respiratory

tract infection. Bewildered by her consistent manifestations of above, she sought medical help and was

diagnosed to have Hodgkins lymphoma.


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Questions:

35. Compare Hodgkins from Non- Hodgkins lymphoma?

> Non-Hodgkin's Lymphoma vs. Hodgkin's disease

Lymphoma is divided into two general categories: Hodgkin's disease (HD; also called Hodgkin's

lymphoma) and non-Hodgkin's lymphoma (NHL). In the United States, there has been a general decline

in HD rates over the past 30 years, and this disease now accounts for only 1% of all cancers. By contrast,

rates of non-Hodgkin's lymphoma have increased by more than 70% during this same period of time.

NHL is the fifth most common type of cancer and accounts for about 4% of all cancers in the United

States. According to the National Cancer Institute (NCI), there were approximately 66,000 new cases of

NHL diagnosed in the United States in 2008 and about 19,000 people died from the disease.

The majority of NHL (95%) occurs in adults 40 to 70 years of age; however, some NHL subtypes are

among the most common cancers in children. More men than women develop NHL, and rates are

particularly high among men who live in areas with epidemic human immunodeficiency virus (HIV/AIDS)

infection, such as the San Francisco/Oakland area. Non-Hodgkin's lymphoma is more common in

Caucasians than in African Americans, Japanese Americans, or Chinese Americans.

Each year in the United States, approximately 8,000 new cases of Hodgkin's disease are diagnosed.

Among these cases, about 60% of cases involve advanced stage disease and 40% involve early stage

disease. Men typically have higher rates of Hodgkin's disease than women. This difference is particularly

noticeable in children and among people older than 35 years of age.

Hodgkin's disease is more common in Caucasians than in African Americans or Asians. The disease

affects people of all ages, although it is most common in young adults (ages 1540) and older adults

(older than 55 years of age). In women older than age 55, this age spread may be related to hormonal

factors. Only about 1015% of HD cases occur in children younger than 16 years of age. The disease is

uncommon in children age 5 and under.

36. The above patient having thoughts she had TB asked you, what are signs and symptoms of Hodgkins

lymphoma?

> The symptoms of Hodgkin lymphoma are not easily distinguished from lymphoma symptoms in

general. They include:

Painless, swollen lymph nodes in the neck, underarm, or groin

Fever

Night Sweats

Weight Loss

Fatigue

Itchy or sensitive skin

An accurate tissue diagnosis is a major determinant of treatment and is also fundamental for staging

Hodgkins lymphoma.

An accurate tissue diagnosis is a major determinant of treatment and is also fundamental for staging

Hodgkins lymphoma.

37. Discuss the role of tissue diagnosis in cancer. Include discussion of the types of tissue diagnosis, its


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indication, advantages and disadvantages.

The primary objective of the present method and apparatus is to provide a portable and new diagnosis

system for quickly and reliably examining tissue conditions. The method uses the most advance

miniaturized micro-opto-electro-mechanical systems (MOEMS) system for generating a rapid variable

optical delay line capable of generating wideband terahertz pulses. The method detects and analyzes

cancerous tissues by comparing a plurality of spectrum resolved images of suspected tissue without

applying harmful agents into the tissue to facilitate interaction with illumination sources. The method

employs non-evasive, real time terahertz imaging systems and techniques to diagnose tissue for

detecting the presence of cancer. A map showing, which tissue is healthy and which is cancerous can aid

in the accurate removal of cancerous tissue.

Your soft tissues connect, support or surround other tissues. Examples include your muscles, tendons,

fat and blood vessels. Soft tissue sarcoma is a cancer of these soft tissues. There are many kinds, based

on the type of tissue they started in. Sometimes they spread and can press on nerves and organs,

causing problems such as pain or trouble breathing. No one knows exactly what causes these cancers.

They are not common, but you have a higher risk if you have been exposed to certain chemicals, had

radiation therapy or have certain genetic diseases.To diagnose soft tissue sarcomas, doctors must

remove and look at a piece of the tumor under a microscope. Treatments include surgery to remove the

tumor, radiation therapy, chemotherapy or a combination.

-Fine needle aspiration

Inserted in the palpable mass, may remove fluid or cell sample. Simple procedure results available

quickly, relies on cytology reviews of cells obtained for diagnosis.

-Core needle biopsy

Core cutting needle inserted to the mass and core tissue remove. More tissue trauma than with fine

needles, obtains larger sample and tissue for histology.

-Incisional biopsy

Used for larger tumors usually more than 3cm piece of tumor remove from the larger mass. Risk for

bleeding. May be used when neoadjuvant therapy is expected.

-Excisional biopsy

Removal of the entire tumor plus some additional tissue, may be definitive surgery, limited use of tumor

is too large or defect would be too obvious.

-Endoscopy and Laparoscopy

Tumor visualization through lightened endoscope. Risk for perforation and bleeding.

8. What other diagnostic procedures are likely to be ordered in this type of client. State the rationale foreach diagnostic procedure.

> x-rays of the chest - a diagnostic test which uses invisible electromagnetic energy beams to produce

images of internal tissues, bones, and organs onto film.

>lymph node biopsy - a sample of tissue is removed from the lymph node and examined under a

microscope.

>computed tomography scan of the abdomen, chest, and pelvis (Also called a CT or CAT scan.) - a


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diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce

cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows

detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are

more detailed than general x-rays.

>lymph angiogram (LAG) - dye is injected into lymphatic system to determine the extent of lymphatic

involvement in areas that are otherwise difficult to visualize.

>bone marrow biopsy/aspiration - a procedure that involves a small amount of bone marrow fluid and

tissue to be taken, usually from part of the hip bones, to further examine the number, size, and maturity

of blood cells and/or abnormal cells.

Management of the disease includes radiation or chemotherapy or both.

Management of the disease includes radiation or chemotherapy or both.

39. When is each therapy indicated?

-The above management is targeting both the healthy and abnormal cells, however immunotherapy is

one of the promising discoveries in treatment of both Hodgkins and non Hodgkins lymphoma.

40. What is immunotherapy? Compare/ contrast it with chemotherapy and radiation.

> Cancer immunotherapy attempts to harness the exquisite power and specificity of the immune system

for the treatment of malignancy. Although cancer cells are less immunogenic than pathogens, the

immune system is clearly capable of recognizing and eliminating tumor cells. The immune system has

evolved strategies, largely in response to infections to efficiently search for and specifically destroy

diseased targets. After nearly a century of debate as to whether the immune system can actually target

tumors, compelling evidence now suggests that immune cells play an important role in the control of

malignancy. This has first been implied by both occasional, spontaneous regressions of cancers in

immunocompetent hosts and increased cancer incidence in immunocompromised individuals. Second,

tumor immunity can be demonstrated in experimental animal models, e.g. mice with defined

immunological defects exhibit greater susceptibility to spontaneous and induced tumors, with many of

these tumors rejected if transplanted into normal hosts. Third, the immune system often appears

cognizant of tumors, as reflected by an accumulation of immune cells at tumor sites, which correlates

with improved prognosis. Finally, with improved technologies, antitumor immune responses can now

be detected directly from many patients. Augmenting these responses has started to yield therapeutic

benefits not only in experimental models but also in cancer patients. Advances in cellular and molecular

immunology in the past two decades have provided enormous insights into the nature and

consequences of interaction between tumors and immune cells and continue to suggest strategies by

which the immune system might be harnessed for therapy of established malignancies.

41. Major agents use for immunotherapy includes interferon, lymphokines, hematopoietic growth

factors, and monoclonal antibodies. How does each of this function in the management of cancer?

>Interferon, lymphokines and hematopoietic.

Interferons belong to a group of proteins known as cytokines. They are produced naturally by white

blood cells in the body (or in the laboratory) in response to infection, inflammation, or stimulation. They

have been used as a treatment for certain viral diseases, including hepatitis B.Interferon-alpha was one


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of the first cytokines to show an antitumor effect, and it is able to slow tumor growth directly, as well as

help to activate the immune system. Interferon-alpha has been approved by the FDA and is now

commonly used for the treatment of a number of cancers, including multiple myeloma, chronic

myelogenous leukemia, hairy cell leukemia, and malignant melanoma. Interferon-beta and interferon-

gamma are other types of interferons that have been investigated. Other cytokines with antitumor

activity include the interleukins (e.g., IL-2) and tumor necrosis factor. IL-2 is frequently used to treat

kidney cancer and melanoma. Some of the problems with these cytokines, including many of the

interferons and interleukins, are their side effects, which include malaise and flu-like syndromes. When

given at a high dose, the side effects can be greatly magnified

>Monoclonal Antibodies

Another important biological therapy involves antibodies against cancer cells or cancer-associated

targets. Monoclonal antibodies are artificial antibodies against a particular target (the "antigen") and are

produced in the laboratory. The original method involved hybridoma cells (a fusion of two different

types of cells) that acted as factories of antibody production. A major advance in this field was the ability

to convert these antibodies, which originally were made from mouse hybridomas; to "humanized"

antibodies the more closely resemble our natural antibodies. Even newer techniques can be used to

generate human antibodies from genetically engineered mice or bacteria containing human antibody

genes. Monoclonal antibodies have been widely used in scientific studies of cancer, as well as in cancer

diagnosis.

As therapy for cancer, monoclonal antibodies can be injected into patients to seek out the cancer cells,

potentially leading to disruption of cancer cell activities or to enhancement of the immune response

against the cancer. This strategy has been of great interest since the original invention of monoclonal

antibodies in the 1970s. After many years of clinical testing, researchers have proven that improved

monoclonal antibodies can be used effectively to help treat certain cancers. An antibody called

rituximab (Rituxan) can be useful in the treatment of non-Hodgkin's lymphoma, while trastuzumab

(Herceptin) is useful against certain breast cancers. Other new monoclonal antibodies are undergoing

active testing.

Researchers also are studying ways of linking cytotoxic drugs, toxins, or radioisotopes to monoclonal

antibodies to enhance their effectiveness against cancer cells. In this case, the antibodies would function

as a targeted delivery mechanism; the result would be like a "guided missile," capable of seeking out a

specific target-a cancer cell.

42. What is your role in managing patients undergoing chemotherapy?

- Pharmacologic

The treatment of dysgeusia has vexed clinicians for decades. This is partially due to incomplete

understanding of its pathophysiology, but also because this diagnosis has been understudied. Currently,

no guidelines exist for the pharmacologic management of dysgeusia. Several studies have looked at the

use of zinc sulfate in mitigating taste alterations, but conflicting findings have resulted.

-Non-pharmacologic

Non-pharmacologic management strategies and patient education have been the mainstay of treatment

for dysgeusia. Many of the suggested recommendations deal with food preparation. Several published


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studies (Hong et al., 2009; Rehwaldt et al., 2009) along with The American Institute for Cancer Research

(2010) suggests the following for improving the flavor of foods:

- onsume foods that are cold or at room temperature.

- Avoid the use of metallic silverware.

- Add more seasonings and spices to foods, such as salt, oregano, basil, cinnamon, and ginger.

- Choose protein products with a mild flavor such as chicken, turkey, tofu, dairy products and eggs.

- Add sugar to decrease salty or bitter tastes.

- Reduce consumption of bitter or metallic tasting foods such as coffee, chocolate, and red meat.

- Marinate meats to change the taste.

- Choose frozen fruits such as melon balls, grapes, or oranges.

- Add fats and sauces to foods.

- Choose more bland foods.

- Suck on hard, sugarless candies.

- Drink more water with meals to help with swallowing or rinse away bad taste.

- Eat small meals several times a day.

43. What are your perspectives in patients using drugs under clinical trials?

-

GOD BLESS

Alfredo Olaez Bautista Jr

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