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Nursing Management in Cancer
Care
Larry Santiago, MSN, RN
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7 Warning Signs of Cancer
Change in bowel or bladder habits
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 a mole or wart
Nagging cough or hoarseness
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Benign Tumors
Benign Not recurrent or progressive.
Opposite of malignant
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Pathophysiology of the Malignant
Process
Characteristics of Malignant Cells
- All cancer cells share some common cellular
characteristics- Cell membrane of malignant cells contain
proteins called tumor-specific antigens, such
as carcinoembryonic antigen and PSA
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Pathophysiology 2
Invasion growth of the primary tumor into
the surrounding host tissues
Metastasis dissemination or spread of
malignant cells from the primary tumor to
distant sites
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Detection and Prevention of
Cancer
Primary Prevention
- Use teaching and counseling skills to
encourage patients to partipate incancer prevention and promote a
healthy lifestyle
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Detection and Prevention of
Cancer 2
Secondary Prevention
Examples breast and testicular self-
examination, Pap smear
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Detection and Prevention of Cancer 3
Tumor Staging and Grading
Staging determines size of tumor and
existence of metastasisGrading classifies tumor cells by type
of tissue
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Cancer Management-
Cure, Control, or Palliation
Surgery
Radiation
Chemotherapy
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Chemotherapy problems
Myelosuppression
Pulmonary or cardiac toxicity
Nausea and vomiting
Extravasation Hypersensitivity reactions
Neuropathy
Pain at the injection site
Flulike syndrome
Hyperglycemia
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Cancer Management-
Cure, Control, or Palliation
Bone marrow transplantation
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Nursing Process: The Patient with
Cancer
Risk for Infection
Impaired Skin Integrity
Impaired Oral Mucous Membrane: Stomatitis Imbalanced Nutrition: Less Than Body
Requirements
Fatigue Chronic Pain
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Leukemia
A neoplastic proliferation of one particular cell
type (granulocytes, monocytes, lymphocytes,
or megakaryocytes)
Common feature is an unregulated
proliferation of WBCs in the bone marrow
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Acute leukemia
Progresses rapidly; characterized by ineffective,immature cells in the bone marrow pushing out thenormal cells.
Acute myeloid leukemia (AML)--adults
Acute lymphocytic leukemia (ALL)--children
Signs and symptoms: Pallor, headache, fatigue,malaise, loss of appetite, weight loss, tachycardia,
shortness of breath, petechiae, ecchymosis,splenomegaly, and bone tenderness.
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Acute myelogenous leukemia (AML)
Normally, myelogenous line of cells mature into
neutro-phils, monocytes, eosinophils, RBCs, and
platelets. AML develops when cells commit to one
type, typically neutrophils. Diagnosis: Bone marrow biopsy
Prognosis: Favorably affected by age under 60 years,
spontaneous rather than secondary leukemia, WBC
less than 10,000/mm3 and remission after one round
of chemotherapy.
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AML treatment options
Induction chemotherapy
Goal is remission
Cytosine arabinoside and an anthracycle
Postinduction therapy (consolidation)
Goal is to prevent relapse after remission, buteffective in only 25% to 35% of patients.
High-dose cytarabine has improved duration of firstremission in young patients with AML.
Options: Standard chemotherapy, autologous stemcells, or human-leukocyte-antigen (HLA) matchedsibling or donor (allogenic).
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Acute lymphocytic leukemia (ALL)
Rapidly developing immature lymphocytes crowd our
normal cells
Poor prognostic factors:High WBCs (> 25,000/mm3
at presentation), age over 50 years, and slow firstremission (longer than 4 weeks).
Treatment - Induction chemotherapy, administered in
two phases, followed by maintenance therapy for up
to 36 months.
Goal is complete remission.
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Chronic leukemia
Progresses slowly and rarely affects people
under age 20.
Chronic myeloid leukemia (CML) strikes ages
40 to 50, more in males.
Chronic lymphocytic leukemia (CLL) strikes
after age 40 and is most common in older
men.
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Chronic myeloid leukemia (CML)
Too many neutrophils and the presence of the
Philadelphia chromosome.
Chronicphase follows an indolent course, mild symptoms,
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CML treatment options
Kinase inhibitor imatinib (Gleevec) is treatment of
choice
Interferon alpha reduces growth and division 55%
to 60%. Hydroxyurea may prolong the chronic phase.
Stem cell transplant--greatest risk of dying in the
first 100 days.
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Chronic lymphocytic leukemia (CLL)
Average survival is 2.5 years for advanced
disease and 14 years for those with early-
stage disease.
Indolent disease characterized by
lymphocytosis, lymphadenopathy and
hepatosplenomegaly. Risk of death from
infection as the disease advances.
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CLL treatment options
Standard chemotherapy, which can produce a
remission not a cure and has harsh adverse
reactions. Usually delayed till signs and
symptoms appear. Chemotherapy, radiation,and Rituximab to enhance the response.
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Lymphoma
Neoplastic disease in which lymphocytes
undergo malignant changes and produce
tumors
Classified as Hodgkins disease (accounts for
12% of lymphomas) and non-Hodgkins
lymphoma (NHL)
Hodgkins disease accounted for 5 % of all
cancer diagnoses in 2005; 3% NHL
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Stages of lymphoma
Stage I involves a single lymph node orlocalized involvement
Stage II involves two or more lymph node
regions on the same side of the diaphragm Stage III involves several lymph node regions
on both sides of the diaphragm
Stage IV involves extralymphatic tissue, suchas the bone marrow
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Hodgkins treatment options
Radiation is treatment of choice for stage IA or
IIA nonbulky (
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Non-Hodgkins lymphoma (NHL)
Incidence has increased about 7% annually
over 20 years, primarily older adults. Cause is
unknown but increased risk: long-term
immunosuppressant therapy, bone marrowtransplant, inherited immune defects,
rheumatoid arthritis, and prior Hodg-kins
disease and treatment. Spread through thebloodstream.
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NHL Treatment Options
Radiation, chemotherapy, or both
Stem cell transplant for recurrent disease
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Multiple Myeloma
A malignant disease of the most mature form
of B lymphocyte
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Multiple Myeloma 2
Clinical Manifestations
- Bone pain
- Hypercalcemia
- Renal failure
- Anemia
- Oral hemorrhage- Fatigue, weakness
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Assessment and Diagnostic Findings
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Medical/Nursing Management
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