Cancer Neoplasia Cancer Abnormal uncontrolled cell division Damage

Cancer: Neoplasia

Cancer ü ü ü Abnormal, uncontrolled cell division Damage to genes controlling cell growth Cancer cells lose normal functions Divide rapidly Invade surrounding cells

Definitions ü ü ü Metastasis: abnormal cells traveling to different sites and starting new tumors Tumor: abnormal enlargement Neoplasm: same as tumor

Tumors ü Benign – slow growing, do not mets ü ü Adenoma Malignant – fast growing, usually mets, can result in death ü ü Sarcoma – connective tissue Carcinoma – epithelial tissue (more common)

Tumors ü ü ü Leukemia – cancer in blood -forming cells in bone marrow Lymphoma – cancer of lymph tissue Glioma – cancer in glial cells

Causes of Cancer ü ü Carcinogens Exposure to large amounts of radiation or sun Viruses Genetic components

Genetic cancers ü ü Oncogenes: mutated genes that contribute to cancer development by disrupting a cell’s ability to control its own growth and DNA repair mechanisms Ties with environmental component

Minimizing Chance of Cancer ü ü ü Healthy lifestyle with check -ups No smoking, drinking Low fat, increase fiber Exercise Self-exams

Minimizing chances of Cancer ü ü Periodic testing if genetic ties with cancer Cancer curable if caught early Protect from direct sun if sensitive or fair skin Watch moles and freckles Testicular Ca

Treatment Goal: Removal of ALL cancer cells ü Surgery ü Radiation therapy ü Drug therapy ü

Surgery ü ü Large tumors reduced by radiation or removed by surgery Check “borders” for cells Then chemo to eradicate micro metastasis Combination chemotherapy has a higher cancer cellkill than single drug

Radiation ü ü Effective non-surgical treatment High doses of radiation directed at tumor Confined to area of tumor Palliation: shrinking of inoperable tumors for comfort

Radiation - Proton ü ü ü Effective non-surgical treatment Proton beam aimed directly at tumor Radiate tumor only Changes ionization Change atoms of diseased cells

Chemotherapy ü ü Drugs transported via blood Reduce size of tumor for surgical removal or for palliation Prophylaxis to prevent recurrence of cancer Growth fraction: # tumor cells undergoing mitosis

Chemotherapy administration ü ü Intravascular – peripheral versus central lines Oral Topical Intra cavity

Principles of Chemotherapy ü ü ü Most effective against small tumors – good blood supply Small tumors have higher percent of dividing cells Nadir: lowest point neutrophil count has been depressed – increase chance for infection

Cell cycle ü ü Tumor cells similar to non-cancerous cells Neoplastic and normal cell differ in the number of cells undergoing cell division Cancer cells lack normal mechanism of suppressing cell growth Anti-cancer drugs target cells that are dividing

Cell cycle ü ü Interfere with DNA, RNA, or protein synthesis – S-phase specific Inhibit microtubule formation during mitosis – M-phase

Cell cycle ü ü ü Damage DNA Cell-cycle nonspecific DNA alkylating agents damage tumor cells whether dividing or not

Combination Chemotherapy ü ü ü Each drug active against the cancer Different site of action Different toxicity levels If similar, toxic levels occur at different times Nadirs different times

Total Cure ü ü ü Destroy all cancer cells One cancer cell can be enough to re-start proliferation of cells Not really total cure, “remission” where cancer cells not active

Anti-cancer drugs “Kills” cells ü Interfere with cell proliferation ü Damage cell DNA ü Prevent DNA repair in cell ü

Protection of Health care workers Prevent ü Prevent through ü Prevent ü inhalation absorption skin ingestion

Protection of Health care workers ü ü Careful disposal of contaminated materials Careful handling and/ or disposal of body fluids contaminated by chemotherapy within 48 hours

Protection of Family ü ü ü Safe handling of body waste Double bag items Wash linens separately for 48 hours post chemo

Side Effects - General ü ü B A R F – bone marrow suppression – alopecia – retching - fatigue

Hematological ü ü ü ü Neutropenia Leukopenia Thrombocytopenia Anemia Fatigue Risk for infection Risk for bleeding

Skin ü ü ü Alopecia From thin wispy pattern to total loss of hair Hair regrows: ü ü ü Thicker Wavier Darker color

Body systems – GI ü ü ü Emetic center triggered Nausea/ Vomiting Anorexia Diarrhea Constipation

Mucosal tissue ü ü ü Stomatitis Ulcerating lesions on mucosa Burning sensation with fluids Pain to oral or esophageal mucosa Nutrition poor – no appetite

Neurological ü ü ü Parasthesia Motor weakness fatigue Paralytic ileus

Urinary ü ü ü Hemorrhagic cystitis Renal toxicity Purines released during cell destruction converted to uric acid crystals

Cardiopulmonary ü ü Rare occurrence Cardiac- toxicity Pulmonary toxicity EKG changes

Hepatic ü Hepatic toxicity

Reproductive ü ü ü Infertility Cause birth defects Cause sterility or decrease sperm

Emotional ü ü ü Anticipatory grief Anger Anxiety Depression Guilt

Sociocultural ü ü ü Isolation Withdrawal May feel others are uncomfortable around them

Developmental ü Varying responses: ü ü Loss of control Role change

Spiritual ü ü ü Varying responses Hope Dependence on God Anger at God Guilt for not being better Christian/ worshipper

Body image disturbance ü ü Alopecia Weight loss/ gain Muscle wasting from steroid therapy Loss of previous functions

Pain ü ü Chronic pain from cancer Will depend on type and extent of cancer

Goals of Nursing ü ü ü Understand what type of chemo used Watch for s/s side effects Pre-med with antiemetics – ATC medications x 24 hours Supportive care Usually given at night

Goals of Nursing ü ü Prevent infection Maintain fluid/ elyte balance Promote adequate nutrition Maintain skin integrity

Goals of Nursing ü ü Monitor bowel/ elimination patterns Patient safety (falls) Maintain emotional health Positive body image

Misc. education ü ü ü No over the counter medications No live virus immunizations Watch herbal supplements – can increase effect of chemo drug

Chemotherapy Treatment ü ü Prehydration Solution 150 -200 ml/hr usually Pre-med with antiemetics prn or around the clock (ATC) Careful I&O

Extravasations ü ü Vesicants – use central lines Different antidotes for different vesicants Follow hospital protocol Ulcerations develop – 48 -96 hours

Extravasations Ø Ø Ø Pain – severe that lasts Redness – blotchiness around site Swelling – occurs immediately

Extravasations Ø Ø Ø Blood return – stop if none Ulceration – usually occurs later Necrosis – if untreated

Ankylating agents – Mechanism of action

Ankylating agents – Mechanism of action ü ü Cell-cycle non-specific Works on: Already formed DNA Cross-linked strands Prevents replication

Alkylating Agents ü ü Nitrogen mustard Cyclophosphamide (Cytoxan) Chlorambucil (Leukeran) Cis-platin (platinol)

Alkylating agents - Nursing ü ü Blood dyscrasias Intake and output Report any buzzing, ringing in ears (loss of high-freq hearing) s/s allergic reaction

Alkylating agents - Nursing ü ü ü Blood counts GI mucosa – nutrition important Skin blistering Renal/ liver function tests Can cause sterility – use contraception

Alkylating agents – Interactions ü ü Immunosuppressants – increase infection Anticoagulants – bleeding Digoxin – decrease dig effect Thiazides - leukopenia

Antimetabolites – Mechanism of action

Antimetabolites ü ü ü Methotrexate 5 -fluorouracil Cytosine arabinoside Cytarabine (Ara-C) Thioguanine

Antimetabolites ü ü ü Cell-cycle specific (S-phase) Inhibit protein synthesis Interferes with DNA synthesis

Antimetabolites - Nursing ü ü ü Most toxicity in hematopoietic and GI systems – bone marrow stem cells and GI epithelium Renal/ Liver function tests s/s respiratory infection

Antimetabolites Interactions ü ü Decreases Digoxin Affects protein bound drugs (ASA, dilantin) NSAIDs, ASA – increase toxicity Other chemo agents/ radiation – increase effect

Anti-Metabolite: Methotrexate ü ü Leucovorin rescue Form of folic acid Treats systemic toxic effects Administer within the first 36 -42 hours

Cytotoxic antibiotics

Cytotoxic antibiotics Doxorubicin (adriamycin) ü Bleomycin ü Danorubicin ü Idarubicin ü

Cytotoxic antibiotics ü ü ü Cell-cycle non-specific Interfere with nucleic acid synthesis Inhibit DNA & RNA synthesis

Cytotoxic antibiotics Nursing ü Most toxicities occur: Hematopoietic GI Reproductive Cardiac

Cytotoxic antibiotics Nursing ü ü Vesicant drugs Assess: Pain Redness Swelling Ulceration

Cytotoxic antibiotics – Interactions ü ü ü Digoxin – decrease dig level Phenobarbital – decreased chemo effectiveness Dilantin – decrease dilantin level

Plant alkaloids

Plant Derivations Periwinkle ü Pacific yew ü Mandrake ü Campthecus acuminata ü Pacific Yew Periwinkle Mandrake

Plant alkaloids Ø Ø Ø Etopside (VP-16) Paclitaxel (Taxol) Vincristine (Oncovin) Vinblastine Vinorebline

Plant alkaloids Ø Ø Cell-cycle specific (Mphase) Arrest metaphase by binding to cell proteins Inhibit protein Inhibit RNA synthesis

Plant alkaloids - Nursing ü ü ü Check of allergies to plants prior to administration Assess for bronchospasms Can lower seizure threshold Nutritional plan to combat constipation Assess mental status – depression

Plant alkaloids – Interactions ü ü Dependent on drug Calcium channel blockers – increase vincristine effect Digoxin – decrease dig effect Dilantin – decrease dilantin effect

Hormones/ Hormone antagonists ü Glucocorticoids Act indirectly on malignant cells ü Estrogens Suppress testosterone production in males Alter response of breast cancers

Hormones/ Hormone antagonists ü Anti-estrogens Compete with estrogens for binding ü Progestins Promote palliation/ tumor cell regression

Hormones/ Hormone antagonists ü Androgens Inhibit binding of androgens Advanced prostate cancer ü Anti-androgens Palliative for advanced breast carcinomas Surgery/ radiation not appropriate

Hormones - Nursing ü ü Side effects specific to the drug given Most include fluid retention Steroids – increase infection, edema Masculinizing or feminizing effects

Hormones - Nursing ü ü ü Blood clots Blood glucose monitoring Nutrition Fertility counseling Blood, liver counts

Hormones – Interactions ü ü Will depend on the drug being used Some treatments used for other disease processes

Biologic Response Modifiers ü ü ü Do not kill tumor cells Stimulate body’s immune response Limits severe immunosuppressive effects

Biologic Response Modifiers ü ü Drugs work by depriving cancer cells of needed ingredients OR inhibiting enzymes necessary to complete proliferation

Integrative Cancer Therapy ü ü Wholistic approach Herbal therapies Colonics Vitamins/ supplements ü ü ü Vitamin C Ave – Fermented wheat germ Involve family

Low Dose Chemotherapy ü ü ü IPT – Insulin potentiation therapy 10% dose Integrative care Results just as effective as traditional chemo Less side effects, i. e. , alopecia, N/V