CLASIFICATION Benign suffix oma after name of parent tissue (neuroma, fibroma, lipoma, leiomyoma) Malignant - -carcinoma sarcoma

coma STAGING AND GRADING Staging extent Clinical staging Surgical staging Pathologic staging (most defenitive) TNM system

Grading cellular maturity & characteristics - The higher the grade the more aggressive the CA (anaplastic)

Stage 1(T1NoMo) - Mass limited to organ of origin (operable) Stage 2 (T2N1Mo) - Evidence of local spread into sorrounding tissue and 1st station lymph node Stage 3(T3N2Mo) - Extensive primary tumor with fixation into a deeper structure, bone invasion, & lymph nodes of a similar nature (operable but not resectable)

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Stage 4 (T4N3M+) - Evidence of distant metastasis beyond site of origin

CANCER DETECTION CYTOLOGIC EXAMINATION or PAPANICOLAOU TEST (PAP SMEAR) - Originally designed to identify CA of cervix Results: o o o o o Class I NORMAL Class II INFLAMMATION Class III MILD TO MODERATE DYSPLASIA Class IV PROBABLY MALIGNANT Class V MALIGNANT

MONOCLONAL ANTIBODIES BIOPSY EXCISIONAL BIOPSY INCISIONAL BIOPSY NEEDLE OR ASPIRATION BIPOSY UTZ PROCEDURE MRI cant differentiate, for staging and high-risk screening RADIODIAGNOSTIC TEST XRAY CT SCAN- can differentiate ANTIGEN SKIN TESTING - DINITROCHLOROBENZENE skin test Nursing Assessment HISTORY HEALTH OF PATIENTS FAMILY MEMBERS WORK ENVIRONMENT OBTAINING ASSESSMENT DATA EARLY Fails to produce symptoms PROB! MANIFESTATION WITH INCREASING SIZE
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Pressure, distortion, obstruction, interference of blood supply/ organ function, metabolic disturbance, parasitic use of bodys reserve, inflammatory changes

Common Manifestation CNS ALTERATION WT. LOSS WEAKNESS OR FATIGUE PAIN HEMATOLOGIC & METABOLIC ALTERATION

PSYCHOSOCIAL ISSUES DURING DIAGNOSIS o Give information over a period of time o Give explanation to the individuals level of understanding o Individual need to hear the information several time, from several trusted people o Individual need to know what alternatives are available o Help patient explore new and perhaps more successful coping o Accurate information KEYSTONES OF COPING CANCER PREVENTION PRIMARY & SECONDARY PRIMARY - dietary and environmental precaution SECONDARY - early detection / screening & removal of precancerous lesion

COLORECTAL DIGITAL RECTAL EXAM - q year, p 40 yo STOOL BLOOD TEST - q year, p 50 yo PROCTOSIGMOIDOSCOPY - q 3 5 years, p 50 (after 2 exams, 1 year apart) COLONOSCOPY - q 10 years, p 50 yo

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DOUBLE CONTRAST BARIUM ENEMA - q 5 years, p 50 yo CERVIX PAPTEST Annually until 2 consecutive (-), then q 3 years, for sexually active or > 20 yo q year (3 consecutive year, decrease), > 18 yo or sexually active

PELVIC EXAM - q year, > 18 yo or younger if sexually active

BREAST MONTHLY BREAST SELF EXAM (BSE), 20 yo > CBE, q 3 years for 20 40 yo, then q year Mammography q year, 50 yo above Baseline mammography 35 39 yo q 1-2 years 40 - 49 yo

PROSTATE - > 5O YO (OR < 50 IF AT RISK) - PSA and DRE q year 7 WARNING SIGNS o C Change in bowel or bladder habits o A A sore that does not heal o U Unusual bleeding or discharge o T Thickening or lump in breast or elsewhere o I Indigestion or difficulty swallowing o O Obvious changes in wart or mole o N Nagging cough or hoarseness o U Unexplained anemia o S Sudden weight loss

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INTERVENTION GOALS CURE PERSON WITH MINIMAL FUNCTIONAL & STRUCTURAL DAMAGE

If not possible: Prevent further metastasis Relieve symptoms Maintain high-quality life for as long as possible EARLY AGGRESSIVE INTERVENTION MAJOR/ MAIN SURGERY CHEMOTHERAPY RADIATION THERAPY ALTERNATIVE THERAPY IMMUNOTHERAPY BM TRANSPLANTATION SURGERY PREVENTIVE DIAGNOSTIC CURATIVE o Remove all of the tumor with minimal structural and functional impairment o (-) sacrifice of an organ - permanent disfigurement RECONSTRUCTIVE Improve quality of life by restoring maximal function & appearance PALLIATIVE To retard growth of the tumor To decrease size of existing tumor To remove the distressing manifestation of CA

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CHEMOTHERAPY Systemic intervention Objective: Destroy all malignant tumor cells without excessive destruction of normal cells Control tumor growth after cure is not possible ADJUVANT THRPY or SALVAGE THRPY

Action: Directly or indirectly disrupts reproduction of cell by altering essential biochemical process Blocks metabolic activity CLASSIFICATION OF CHEMOTHERAPY CELL CYCLE SPECIFIC (CCS) CELL CYCLE NON-SPECIFIC (CCNS) 1. Alkylating agents (CCNS) - alkyl groups, binds with DNA & prevent replication & mitosis - ex. Chlorambucil (Leukeran), Cyclophosphamide (Cytoxan) 2. Antimetabolite (CCS) - interfere with synthesis of nucleic acids and CHONs during S phase5 Fluorouracil (5Fu), Cytarabine (Ara-C) - ex. Methotrexate, 3. Antitumor Antibiotic (CCNS) - inhibits DNA synthesis, w/c prevents mitosis - ex. Doxorubicin HCl (Andriamycin), Mithramycin (Mithracin) 4. Natural products (CCS) - disrupts mitosis by binding with microtubular spindle - ex. Vincristine Sulfate (Ocovin), Vinblastine Sulfate (Velban) 5. Hormones (CCNS) - interfere with subcellular hormone receptor proteins - ex. Diethylstilbestrol (DES), Estrogen, Mege(Decadron)strol acetate (Megace), Prednisone, Dexamethasone 6. Antihormones (CCNS) - Tamoxifen citrate, Aminoglutethimide

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ADMINISTRATION OF CHEMO. SYSTEMIC ORAL, IM, SQ, IV Iv --- EXTRAVASATION REGIONAL Allows high concentrations of chemotherapy to be directed to localized tumors Ex. Topical, Intrathecal, Intracavitary, Intra-arterial, Intraperitoneal CONTRAINDICATION INFECTION RECENT SURGERY (5-7 DAYS) IMPAIRED RENAL OR LIVER FUNCTION RECENT RADIATION THERAPY (3 4 WKS.) PREGNANCY BONE MARROW SUPPRESSION reduce dose or delay til wbc is normal SIDE EFFECTS MYELOSUPPRESSION/ BM SUPPRESSION PANCYTOPENIA (NADIR) GIT EFFECTS antiemetic drug 6 12 hours prior to chemo Integumentary effects Reproductive effects FATIGUE HYPERSENSITIVITY REACTION SPECIFIC ORGAN TOXICITIES RADIATION THERAPY Use of ionizing radiation to interrupt cellular growth 3 Roles Primary Curative Role Adjunct to other therapy Palliation Add: + hyperthermia + Mesonidazole

+ Hyperbaric O2 therapy

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TYPES OF RADIATION THERAPY TELETHERAPY INTERNAL RADIATION THERAPY Sealed Unsealed EXTERNAL BEAM High energy x-ray machines or machine containing radio-isotope Advantage: SKIN SPARING effects INTERNAL BEAM (BRACHYTHERAPY) Placement of a specially prepared radio-isotope directly or near the tumor itself or in systemic circulation SEALED OR UNSEALED SOURCE A. SEALED SOURCE Enclosed n a sealed container 1) INTRACAVITARY ex. Uterus, cervix, prostate - AEG bed rest, log rolled, FBC, lomotil 2) INTERSTITIAL - radioisotope is packed into needles, beads, seeds, ribbons, or catheters, and implanted directly into the malignant tumor ex. BREAST CA - implants left temporary or permanent depending on half life B. UNSEALED SOURCE Used in systemic therapy, via, veins, or arteries Ex. Sodium Phosphate (32P) Polycythemia Vera, IV Flush the bowl many times before & after use by aeg SIDE EFFECTS Permanent damage GI tract Skin rxns esp. At the site of affected area Fatigue Nausea Anorexia Mucocytis Xerostomia
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3 KEY PRINCIPLES OF RADIATION PROTECTION TIME Less time, less radiation Plan activities well Ex. 5 mins = less than 10 mins DISTANCE Greater distance, lesser the radiation Inverse square law 0 --- SHIELDING Use lead shield device to decrease exposure & film badge RADIATION SAFETY PRECAUTION: Private room Plan care well Change linens less frequently Prepare meal tray outside the room disposable? Work as quickly as possible Use lead apron for prolonged contact Provide care for client standing at the clients shoulder Never care for more than 1 client with radiation implant more than 1 at the same time Wear appropriate monitoring device Mark the room with appropriate signs, chart, kardex, I.D. Bracelet termination of precaution is done only by RADIATION OFFICER! Keep long handled forceps with a lead line container available in the nursing unit & in the patients room. BONE MARROW TRANSPLANTATION ALLOGENEIC AUTOLOGOUS SYNGENEIC o o o o PROCESS OF BM TRANSPLANTATION ABLATIVE CHEMOTHERAPY & TOTAL BODY IRRADIATION 2- 4 WKS OF ENGRAFTMENT PERIOD FIRST 100 DAYS IS CRUCIAL

SUPPORT MEASURE INCLUDES: ANTIBIOTIC BLOOD TRANSFUSION HEMOPOIETIC GROWTH FACTOR

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BIOLOGIC RESPONSE MODIFIER THE FOCUS IS NOW ON THE IMMUNE SYSTEM NONSPECIFIC BIOLOGIC RESPONSE MODIFIER MoAbs ex. Rituximab (Rituxan) RETINOIDS - Vitamin A derivatives that play a role in growth, reproduction, epithelial cell differentiation, and immune function CYTOKINES INTERFERONS antiviral and antitumor INTERLEUKINS lymphokines and monokines Ex. IL2 stimulate lymphocyte & other cytokines COLONY-STIMULATING FACTORS (HEMATOPOIETIC GROWTH FACTOR) Ex. IL 11, GM-CSF, G-CSF, EPO (Epogen) TUMOR NECROSIS FACTORS With antitumor prop but severe toxicities

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