CELLULAR ABERATION

CANCER- disease process that begins when abnormal cells that arise from a normal body cells as a result of some poorly understood mechanism of change. DEFINITION OF TERMS: Tumor- an abnormal mass of tissue that forms when cells in a specific area reproduce at an increased rate. Neoplasm- medical term for a tumor Differentiation The process by which the cells of early embryo diversify to form the distinct tissues and organs. It also means the degree to which the microscopic appearance of cancerous tissue resembles normal tissue. Hyperplasia- tissue growth based on an excessive rate of cell division, leading to a larger than usual number of cells; the process of hyperplasia is potentially reversible; can be a normal tissue response to an irritating stimulus. An example is a callus Metaplasia- conversion of one type of cell in a tissue to another type not normal for that tissue Dysplasia- Bizarre cell growth differing in size, shape and cell arrangement Anaplasia- change in the DNA cell structure and orientation to one another, characterized by loss of differentiation and a return to a more primitive form. Neoplasia- uncontrolled cell growth, either benign or malignant PATHOPHYSIOLOGY: NEOPLASTIC PROGRESSION

Normal Cells

Exposure to carcinogens Or genetic predisposition

Hyperplasia

In situ carcinoma

Dysplasia

Metaplasia

(Reversible)

Tumor invasion and metastasis

(Irreversible) CLASSIFICATION:
Benign and Malignant Benign- resembles normal cell. Tumors that cannot spread by invasion or metastasis; hence, they only grow locally. Malignant- bears little resemblance to normal cells. Tumors that are capable of spreading by invasion and metastasis.

According to type of cell or tissue

Benign
Epithelium Gland Blood cells Blood vessels Smooth muscle
SCREENING Breast Cervix Colon and rectum Guaiac Fecal occult blood test Prostate

Malignant
Papillary Carcinoma Adrenocarcinoma Leukemia, Lyphoma

Papilloma Adrenoma

Hemangioma Rhabdomyoma

Angiosarcoma Rhabdomyosarcoma

MODALITIES OF TREATMENT I. SURGERY 1. Preventive Surgery- removing of precancerous lesions (unusual skin growth, colorectal polyps, cervical cancer in situ) 2. 3. Diagnostic Surgery - confirm or rule out malignancy from analysis of tissue sample Curative Surgery- most widely used cancer treatment, is a localized intervention aimed at removing a tumor tissue while limiting structural and functional impairment 4. Reconstructive Surgery- improve the clients quality of life by restoring maximal function and appearance, best outcome depends on the cancer site and extent of surgery. 5. Palliative Surgery- to retard tumor, decrease tumor size, relieve distressing manifestation of cancer when cure is no longer possible. II. RADIATION THERAPY

1. Curative- ionizing radiation destroys the ability of cell to multiply, thus targeting the rapidly dividing cancer cells. 2. Control- used as an adjunct to other therapy with the goal of prolonged and improved survival without disease eradication (shrink tumor- post op radiation therapy to eradicate microscopic disease in conjunction with chemotherapy) 3. Palliative- to relieve symptoms.

ADMINISTRATION: 1. 2. Teletherapy (internal)- radiation delivered in uniform dose to tumor Brachytherapy- delivers high dose to tumor and less to other tissues; radiation source is placed in tumor or next to it A) Sealed source- radioactive material is enclosed in sealed container. 1) Intracavitary therapy 2) Interstitial therapy B) Unsealed source- in which the radioactive material is administered directly, such as by injection or orally 1) Sodium Phosphate (32P) 2) 131 Iodine NURSE SAFETY PRECAUTION Distance: 4 ft (2 meters) Time: 5 min (30 min/ 8 hrs shift) Shielding: Lead Shield or apron Use of film badge: Dosimeter

SIDE EFFECTS Skin- range from erythema (similar to sunburn)

NURSING INTERVENTION: Skin care Keep area dry Wash with soap and water and dry Never apply ointment, lotion, heat, ice or other substance Avoid washing off the marks made by radiologist

III.

CHEMOTHERAPY

1) Curative- eradicate 2) Salvage- eradicate recurrent 3) Control- sustain tumor regression/ diminish symptoms 4) Palliative- relieve, diminish distressing symptoms 5) Adjuvant- after radiotherapy, meds given to avoid metastasis BASIS OF ACTION Directly or indirectly disrupts reproduction of cells by altering essential biochemical processes.

CONTRAINDICATIONS: Infection Recent surgery Impaired renal or hepatic function Recent radiation therapy Pregnancy Bone marrow depression

CLASSIFICATION/ EFFECT

ADMINISTRATION OF DRUGS A) IV infusion- most common B) Arterial infusion

Regional Perfusion- one extremity is isolated from general circulation

SIDE EFFECTS AND NURSING INTERVENTION SIDE EFFECTS Nausea and Vomiting INTERVENTION Prophylactic antiemetics- NPO 4-6 hrs before chemotherapy, then small frequent feeding after Diarrhea Stomatitis low platelets Leukopenia Anemia Alopenia Uricosuria Antimotility drugs, frequent replacement Good oral hygiene, lidocaine, mouthwash, popsicles Protect from injury (bumps, IM injection), avoid aspirin Prevent infection, asepsis, reverse isolation Adequate rest and oxygenation Temporary hair loss. Offer support, use of wigs, hats Fluids, frequent voiding, allopurinol as ordered

Infertility

Banking sperm, use of condom (chemotherapy treatment is teratogenic)

BONE MARROW PERIPHERAL STEM CELL TRANSPLANTATION aspirating bone marrow cells from compatible donor and infusing them into the recipient

IMMUNOTHERAPY u s e o f c h e m i c a l o r microbial agents to induce mobilization of Immune defenses Active Immunotherapy Active Specific Immunotherapy Active non-specific Immunotherapy

BIOLOGIC RESPONSE MODIFIERS (BRMs) use of agents that alters immunologic relationship between tumor and host in a beneficial way

GENE THERAPY - t r a n s f e r o f g e n e t i c materials into the clients DNA