NCM112OFI o Rough Endoplasmic Reticulum is lined with

CELLULAR ABBERATION ribosomes and is rough in appearance and smooth

CANCER endoplasmic reticulum contains no ribosomes and
→ it is a group of complex diseases with various is smooth in appearance.
manifestations depending on which body system is
affected and the type of tumor cells involved. RIBOSOMES
o Ribosomes are small particles which are found
CELL individually in the cytoplasm and also line the
→ from Latin cella, meaning "small room” membranes of the rough endoplasmic reticulum.
→ is the basic structural, functional, and biological unit Ribosomes produce protein. They could be thought
of all known living organisms. A cell is the smallest of as "factories" in the cell.
unit of life. Cells are often called the "building blocks
of life". The study of cells is called cell biology or GOLGI BODY / APPARATUS
cellular biology. o Golgi bodies are stacks of flattened membranous
stacks (they look like pancakes). The Golgi Body
THE CELL THEORY STATES THAT: temporarily stores protein which can then leave the
1) All organisms are made up of one or more cells cell via vesicles pinching off from the Golgi.
and the products of those cells.
2) All cells carry out life activities (require energy, LYSOSOMES
grow, have a limited size). o Lysosomes are small sac-like structures
3) New cells arise only from other living cells by the surrounded by a single membrane and containing
process of cell division. strong digestive enzymes which when released can
break down worn out organelles or food. The
Parts of the Cell lysosome is also known as a suicide sac.
PLASMA MEMBRANE/ CELL MEMBRANE
o Structure - a bilipid membraneous layer composed MITOCHONDRIA
of proteins and carbohydrates. It is fluid like. o The mitochondria are round "tube-like" organelles
o Function - the cell membrane separates the cell that are surrounded by a double membrane, with
from its external environment and is selectively the inner membrane being highly folded. the
permeable (controls what gets in and out). It mitochondria are often referred to as the
protects the cell and provides stability. "powerhouse" of the cell.
o Proteins are found embedded within the plasma o The mitochondria releases food energy from food
membrane, with some extending all the way molecules to be used by the cell. This process is
through in order to transport materials. called respiration. Some cells (muscle cells) require
o Carbohydrates are attached to proteins and lipids more energy than other cells and so would have
on the outer lipid layer. many more mitochondria.

CYTOPLASM VACUOLES
o Structure - The jelly-like substance composed of o Vacuoles are fluid filled organelles enclosed by a
mainly water and found between the cell membrane membrane. They can store materials such as food,
and nucleus. The cytoplasm makes up most of the water, sugar, minerals and waste products.
"body" of a cell and is constantly streaming.
o Function - Organelles are found here and DIVISION
substances like salts may be dissolved in the → The division of a cell to produce two daughter cells
cytoplasm. is fundamental to most forms of life.
→ The ‘life cycle’ of a dividing eukaryotic non-
NUCLEUS embryonic cell starts with the cell triggered to enter
o Structure - The largest organelle in the cell. It is the cell cycle and ends with the equal partitioning of
dark and round, and is surrounded by a double the genetic material and cleavage of the cell during
membrane called the nuclear envelope/membrane. cytokinesis (the physical process of cell division,
In spots the nuclear envelope fuses to form pores which divides the cytoplasm of a parental cell into
which are selectively permeable. The nucleus two daughter cells).
contains genetic information (DNA) on special → The whole process is called the cell cycle and
strands called chromosomes. consists of four main phases.
o Function - The nucleus is the "control center" of the
cell, for cell metabolism and reproduction. (G1) First Growth Phase
- Growth and normal metabolic roles
The following organelles are found (2) Synthesis Phase
in both plant and animal cells: - DNA Replication
"ER" OR ENDOPLASMIC RETICULUM (G2) Second Growth Phase
o The Endoplasmic Reticulum is a network of - Growth and preparation for mitosis
membranous canals filled with fluid. They carry (M) Mitotic Phase
materials throughout the cell. The ER is the - Prophase, Metaphase, Anaphase, Telophase
"transport system" of the cell.
o There are two types of ER: rough ER and smooth G1, S, G2 = Interphase
ER.
 MITOTIC CELL DIVISION APOPTOSIS
PROPHASE → ancient Greek = “falling off”
→ cell prepares itself for the division → programmed cell death
→ average adult loses = 50-70 billion cells/day
→ average child (8-14y/o) loses = 20-30 billion
cells/day

METAPHASE
→ The disappearance of nuclear membrane and
nucleolus marks the beginning of metaphase. The
chromosomes become shorter by further coiling.

NORMAL CELL GROWTH

→ Mature normal cells are uniform in size and have
nuclei that are characteristics of the tissue to which
the cells belong.
→ Within the nucleus of normal cells, chromosomes
containing deoxyribonucleic acid (DNA) molecules
ANAPHASE carry the genetic information that controls the
→ Division of centromere marks the beginning of synthesis of polypeptides (proteins).
anaphase. → Genes are subunits of chromosomes and consist of
portions of DNA that specify the production of
particular sets of proteins.
→ Thus, genes control the development of specific
traits.
→ The genetic code in the DNA of every gene is
translated into protein structures that determine the
type, maturity and function of a cell.
→ Any change or disruption in a gene can result in an
inaccurate “blueprint” that can produce an aberrant
cell, which then become cancerous.
TELOPHASE
→ Chromosome is a long deoxyribonucleic acid (DNA)
→ The events in the telophase are the reverse of the molecule with part or all the genetic material
events in the prophase (genome) of an organism.
→ Chromosomes are structures found in the center
(nucleus) of cells that carry long pieces of DNA.
DNA is the material that holds genes. It is the
building block of the human body. Chromosomes
also contain proteins that help DNA exist in the
proper form.

CELLULAR ABERRATIONS
→ a large group of diseases that are characterized by
uncontrolled growth and spread of an abnormal cell
→ a malignant tumor of any type
CYTOKINESIS
→ After karyokinesis NORMAL CELL CANCER CELL
(nuclear division), the have limited cell division cell division is rapid
cytoplasm is divided by undergo apoptosis; show partial or complete
the formation of the cell specific morphology differentiated function of
wall between the two parent cell is lost
daughter nuclei. This have a small nuclear- there is a large nucleus-
division of the cytoplasm cytoplasmic ratio cytoplasm ratio
is called as the
are no migratory/ cells can migrate
cytokinesis.
non-migratory
 NORMAL CELL CANCER CELL 5) The Tissue Organization Field Theory (TOFT)
adhere tightly together loosely adherent - carcinogenesis is a problem of tissue
organization, comparable to organogenesis
grow in an orderly and growth rate is not during early development, and proliferation is the
well-regulated manner well-regulated default state of all cells.
cells recognize or respect do not recognize or
tissue barrier respect tissue barrier GENETICS AND CANCER
cells are contact inhibited are not contact inhibited • CARCINOGEN – any substance, situation or
exposure that can damage genetic material (DNA)
• ONCOGENE – genetic material that carries the
ability to induce cancer
• PROTO-ONCOGENE – normal gene that has the
potential to transform itself into an oncogene
• TUMOR SUPRESSOR GENE – are a family of
normal genes that instruct cells to produce proteins
that restrain cell growth and division
• P53 GENE – family of suppressor gene that triggers
apoptosis
• DNA REPAIR GENE – a code for proteins whose
normal function is to correct errors that arise when
cells duplicate their DNA prior to cell division

DIFFERENTIATION - is the process where a cell

changes from one cell type to another. Usually, the cell
changes to a more specialized type. Differentiation
occurs numerous times during the development of a
multicellular organism as it changes from a simple
zygote to a complex system of tissues and cell types.

• GENOTOXIC - directly alter DNA and cause

mutation
• PROMOTER - cause adverse biologic effects, e.g
cytotoxicity (ability to kill cells)
• CARCINOGENESIS - a process by which normal
cells are transformed into cancer cells
• TUMOR - an abnormal lump or mass of tissue.
• SECONDARY TUMOR - a tumor that forms as a
result of spread (metastasis) of cancer from the
place where it started.
• NEOPLASIA - the uncontrolled, abnormal growth of
cells or tissues in the body, and the abnormal
growth itself is called a neoplasm
5 THEORIES OF CARCINOGENESIS • NEOPLASM/TUMOR – the abnormal growth itself
1) Cellular Transformation & Derangement Theory • MUTATION - a change in a gene.
- exposure of normal cells to some etiologic agent • BENIGN - a term used to describe non-cancerous
may transform normal cells into cancer cells. tumors which tend to grow slowly and do not
spread.
2) Failure of the Immune Response Theory • MALIGNANT - a term used to describe cancerous
- conceptualizes that all individuals possess tumors which tend to grow rapidly, can invade and
cancer cells but these cancer cells are NOT destroy nearby normal tissues, and can spread.
recognized by the immune system. Thus, cancer • METASTASIS - the spread of tumor cells to other
cells undergo destruction. Failure of the immune areas of the body.
response system to kill or destroy the cancer • REMISSION - complete or partial disappearance of
cells leads to cancer. the signs and symptoms of cancer in response to
treatment; the period during which a disease is
3) Genetic Code under control. A remission may not be a cure.
- the idea that genes are the basic units in which • GENETIC TESTING - tests performed to determine
characteristics are passed from one generation
if a person has certain gene changes (mutations) or
to the next. The gene theory provides the basis chromosome changes which are either known to
for understanding how genes enable parents to increase cancer risk or which may be present in
transmit traits to their offspring. cells from a tumor.
4) The Somatic Mutation Theory (SMT)
- cancer is derived from a single somatic cell that
successively has accumulated multiple DNA
mutations
 DYSPLASIA 5. HIV - human immunodeficiency virus. It weakens a
→ the presence of cells of an abnormal type within a person's immune system by destroying important
tissue, which may slightly signify a stage preceding cells that fight disease and infection.
the development of cancer 6. Helicobacter Pylori - is a type of bacteria. These
→ Ex: Cervical Dysplasia: growth of abnormal cells on germs can enter your body and live in your digestive
the surface of the cervix leading to cervical cancer tract; can cause ulcers in the lining of your stomach
or the upper part of your small intestine.
HYPERPLASIA 7. Human T-cell Lymphotropic Virus - are known to
→ he enlargement of an organ or tissue caused by an cause a type of cancer called adult T-cell
increase in the reproduction rate of its cells, often leukemia/lymphoma
as an initial stage in the development of cancer
→ occurs in response to stress, increased metabolic B. Chemical Carcinogens
demands, or elevated levels of hormones. These chemicals cause cell mutation or alter the cell
enzymes and proteins.
METAPLASIA
→ abnormal change in the nature of a tissue 1. Industrial Compounds
• Vinyl chloride - plastic manufacture, asbestos
ANAPLASIA factories, construction works
→ a condition of cells with poor cellular differentiation, • Polycyclic aromatic hydrocarbons
losing the morphological characteristics of mature • Fertilizers; Weed killers
cells and their orientation with respect to each • Dyes - analine dyes (most commonly found in
other and to endothelial cells. beauty shops and used at homes), hair bleach
• Drugs - cytotoxic drugs, tar nicotine in tobacco,
THE CARCINOGENESIS PROCESS alcohol
1) INITIATION - irreversible mutation of a gene, that
leads to a malignant transformation 2. Hormones
2) PROMOTION - cell becomes malignant; the • Estrogen
promoting agent stimulates the growth and division • Diethystilbesterol (DES) – synthetic estrogen
of cell • Foods, preservatives
3) PROGRESSION - refers to a series of changes that • Nitrites in bacon or smoked meat
lead to the characteristics of an undifferentiated cell • Talc (polished rice, salami and chewing gum)
• Food sweeteners
TYPES OF METASTASIS • Nitrosomines (rubber baby nipples)
1) TRANSCOLEMIC - peritoneal, pleural, pericardial, • Aflatoxins (mold in nuts, grains, milk, cheese
or subarachnoid spaces and peanut butter)
2) LYMPHATIC SPREAD – most common route for
• Polycyclic hydrocarbons
initial metastasis; lymph nodes; also called nodal
involvement, positive nodes, or regional disease
C. Physical Agent
3) HEMATOGENOUS SPREAD - venous flow
1. Radiation
4) CANALICULAR SPREAD – canalicular spaces
• From x-rays or radioactive isotopes
(CBD, urinary system, airways, subarachnoid
spaces) • From sunlight or UV rays

TYPES OF CARCINOGENS 2. Physical Irritation or Trauma

A. Viruses or Oncogenic • Pipe smoking
Prolonged and recurrent viral infections may lead to the • Multiple deliveries
breakdown of the immune system. The overwhelmed
immune system may fail to destroy the cancer cells D. Genetics
present in the body. Risk Factors:
• Older individuals
1. Human Papilloma Virus (HPV) - are particularly • Women are more prone to breast, uterine
common cancer-causing virus which is well-known cervical cancer
for causing genital warts and all cases of cervical • Men are more prone prostate and lung
cancer. • Urban dwellers
2. Epstein-Barr Virus - formally called Human gamma • Chemical factory workers, Farmers
herpes virus 4, it is best known as the cause of • Personnel of radiology department
infectious mononucleosis • Obesity, Stress
3. Cytomegalovirus - is a genus of viruses in the order
Herpesvirales, humans and monkeys serve as FAMILY HISTORY
natural hosts Hallmark of families with hereditary cancer syndrome:
4. Hepatitis Virus – (A) cause of infectious or epidemic a) cancer in two or more relatives.
hepatitis transmitted by the fecal-oral route, (B) b) cancer in family members > 50 years old.
causes hepatitis B, (C) is a blood-borne virus. c) same type of cancer in several family
Today, most people become infected with the members/family member with more than one type
Hepatitis C virus by sharing needles or other of cancer.
equipment to inject drugs. d) a rare cancer in one or more family members.
E. Immunologic CATEGORIES OF NEOPLASM
T-Lymphocytes or T-Cells 1. CARCINOMA – skin or the tissue lining organs
is a type of lymphocyte which develops in the thymus 2. SARCOMA – bones and in soft tissues
gland and plays a central role in the immune response. 3. LYMPHOMA – lymphatic system
4. LEUKEMIA – blood, including bone marrow
1) KILLER T-CELLS - scan the surface of cells 5. MYELOMA – blood (plasma cells in bone marrow)
2) HELPER T-CELLS - to start and control the
immune response against foreign substances CANCER PREFIXES AND LOCATION
3) REGULATORY T-CELLS OR TREGS - control or adeno- gland
suppress other cells chondro- cartilage
4) MEMORY T-CELLS - protect the body against erythro- red blood cell
previously found antigens hemanglo- blood vessel
5) NATURAL KILLER T-CELLS - influence other hepato- liver
immune cells and control immune responses lipo- fat
lympho- lymphocyte
GENE MUTATIONS melano- pigment cell
→ is a permanent alteration in the DNA sequence that myelo- bone marrow
makes up a gene, such that the sequence differs myo- muscle
from what is found in most people. Mutations range osteo- bone
in size.
SYSTEMIC EFFECTS OF CANCER
TUMOR SUPPRESSOR GENE
PAIN
or antioncogene; gene that protects a cell from one step
a) Pressure on the nerve endings
on the path to cancer. When this gene mutates to cause
b) Distention of organ & blood vessels
a loss or reduction in its function, the cell can progress
c) Lack of O2 to tissues and organs
to cancer, usually in combination with other genetic
d) Release of pain mediators
changes
RAT = can be used to manage pain
HEREDITARY MUTATIONS
R – recognize
are inherited from a parent and are present throughout
A – assess
a person’s life in virtually every cell in the body. These
T – treat
mutations are also called germline mutations because
they are present in the parent’s egg or sperm cells.
CLASSIFICATION OF PAIN
1) Acute vs. Chronic
SOMATIC MUTATIONS
2) Cancer vs. Non-cancer Pain
or acquired mutations; occur at some time during a
3) Nociceptive vs. Neuropathic Pain
person’s life and are present only in certain cells, can
be caused by environmental factors or can occur if an
TYPES OF CANCER PAIN
error is made as DNA copies itself during cell division;
• Nerve pain – neuropathic
and cannot be passed to the next generation.
• Bone pain – somatic pain
Predisposing Factors • Soft tissue pain – visceral
1. Age 2. Gender • Phantom pain
3. Geographic Locations 4. Occupation • Referred pain
5. Heredity 6. Stress
7. Precancerous Lesions 8. Health Practices ASSESS PAIN CHARACTERISTICS:
▪ Quality (e.g., burning, sharp, shooting)
TYPES OF NEOPLASM ▪ Severity (scale of 0 to 10 or most severe pain)
• Benign Tumor ▪ Location (anatomical description)
• Potentially-Malignant Neoplasms ▪ Onset (gradual or sudden)
▪ Duration (how long; intermittent or continuous)
• Malignant Neoplasms
▪ Precipitating or relieving factors
• Secondary Neoplasm - malignant tumor whose
cause is the treatment
NURSING DIAGNOSIS:
• Cancer of Unknown Primary Origin
Acute pain, Chronic pain, Constipation, Fatigue, Sleep
pattern disturbance
BENIGN MALIGNANT
Differentiation well differentiated undifferentiated PAIN MANAGEMENT
Encapsulation capsulated un-capsulated Opioids: moderate to severe
- Morphine SO4, Fentanyl, Oxycodone
Metastasis (-) (+) NSAIDS
Prognosis good -
HYPERCALCEMIA
Therapeutic surgery - is a condition in which the calcium level in your blood is
above normal. Too much calcium in your blood can
weaken your bones, create kidney stones, and interfere
with how your heart and brain work. Hypercalcemia is OBSTRUCTION & PRESSURE
usually a result of overactive parathyroid glands. Psychological Stress - Stress is a feeling of emotional
or physical tension. It can come from any event or
NORMAL LEVEL: 9-11mg/dL, 1.16-1.32mmol/L thought that makes you feel frustrated, angry, or
Stored (Bones) nervous. Stress is your body's reaction to a challenge
Ionized (Nerve) or demand.
Albumin Bound (serum)
DIAGNOSTIC TESTS
Osteoclastic – bone resorption/destruction 1. TUMOR MARKERS
Osteoblast – bone formation o AFP (alpha feto protein)
Osteolytic – damaged bone o CEA (carcinoembryonic antigen)
o PAP (prostatic acid phosphatase)
NURSING DIAGNOSIS: o PSA (prostate specific antigen)
Potential for injury, Fluid volume deficit, Pain Altered o CA 125
urinary elimination, Constipation, Ineffective individual o CA 15-3
and family coping. o HCG
o S100
NURSING INTERVENTIONS: o Thyroglobulin
o Maintain adequate hydration.
o Mobilize when possible. 2. RADIOLOGIC TESTS
o Report changes in the sensory status. o Ultrasound CT Scan
o Report changes in heart rate. o MRI with or without contrast X-ray
o Continue usual diet. o Bone scans
o Nuclear medicine imaging PET Scan
MANAGEMENT: o Mammograms
Hypocalcemic Agents:
- Calcitonin, Plicamycin IV (mithramycin), Gallium PET SCAN (POSITRON EMISSION TOMOGRAPHY)
Nitrate, Bisphosphonates → an imaging test that helps reveal how your tissues
1st Generation: etidronate (Didronel) and organs are functioning
2nd Generation: zoledronic acid (Zometa), pamidronate → uses a radioactive drug (tracer) to show this activity.
(Aredia), clodronate (Bonefos) → effective way to examine the chemical activity in
3rd Generation: alendronate parts of your body
→ help identify a variety of conditions, including many
DISSEMINATED INTRAVASCULAR COAGULATION cancers
a hypercoagulable state in which inappropriate over → cancer cells show up as bright spots on PET scans
stimulation of normal coagulation causes a because they have a higher metabolic rate than do
simultaneous thrombosis and hemorrhage. normal cells.
NURSING DIAGNOSIS: PET Scans may be useful in:
Risk for trauma related to widespread thrombosis. • Detecting cancer
Altered tissue perfusion related to organ hypoxia. • Revealing whether your cancer has spread
Risk for infection related to necrosis of tissue.
• Checking whether a cancer treatment is working
• Finding a cancer recurrence
NURSING INTERVENTIONS:
Maintain circulation and oxygenation.
3. BIOPSY
Initiate recommended treatment for underlying
Needle Biopsy
malignancy.
a) Needle aspiration
Provide educational and emotional support to client &
b) Stereotactic needle aspiration
significant others.
c) Core needle Procedure
d) Sentinel node biopsy
MANAGEMENT:
Surgical Biopsy
Heparin, aminocaproic acid (Amicar)
a) Excisional
Blood Transfusion
b) Incisional
c) Endoscopic
MALNUTRITION & CACHEXIA
d) Punch
Causes:
metabolic effect of tumor, mechanical effect of tumor,
4. BONE MARROW ASPIRATION
effect of cancer treatment
Nursing Considerations
NURSING DIAGNOSIS: • Don't leave the patient unattended during the
Altered nutrition, less than body requirements. procedure.
Social Isolation, Knowledge deficit • Don't let him move during the procedure.
• Don't administer analgesics containing aspirin;
HEMATOLOGIC ALTERATIONS they may potentiate bleeding.
Anemia, Leukopenia, Thrombocytopenia
5. OTHER PROCEDURES into surrounding
Endoscopy tissues and first
Bronchoscopy, Gastroscopy, Colposcopy, station lymph
Colonoscopy nodes. The
lesion is operable
and resectable,
Nursing considerations for Colonoscopy there is
• Ensure that the patient has complied with the bowel uncertainty as to
preparation immediately. completeness of
• Instruct patient to resume a normal diet, fluids, and removal
activity as advised by the health care provider. Stage III T3, N2, M0 Clinical
• Monitor for any rectal bleeding. examination
shows evidence
• Encourage increased fluid intake.
of local spread
into surrounding
STAGING & GRADING tissues and first
STAGING – determines the size of the tumor and the station lymph
existence of metastasis. nodes. The
lesion is operable
TNM STAGING SYSTEM and resectable,
T – TUMOR N- NODE M- METASTASIS there is
TUMOR uncertainty as to
completeness of
Tx Primary tumor cannot be assessed
removal
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1, T2, T3, T4 Increasing size & local extent of primary
tumor

NODES
Nx Regional lymph nodes cannot be
assessed
N0 No regional lymph node metastasis
N1, N2, N3, N4 Increasing involvement of regional
lymph nodes

METASTASIS
Mx Distant metastasis cannot be assessed
M0 No distant metastasis
M1, M2, M3, Ascending degree of distant
metastasis, including metastasis to
distant lymph nodes

GRADING – classification of tissue from which the PRIMARY PREVENTION

tumor originated and the degree of which the tumor cells TWO main strategies:
retain the functional and histologic characteristics of the 1. Vaccine
tissue of origin. 2. Health counseling
▪ stop smoking and avoid secondhand smoke
Grade 1- well differentiated ▪ protect themselves from sunlight
Grade 2 - abnormal cells & moderately differentiated ▪ limit the drinking of alcohol
Grade 3 - very abnormal cells & poorly differentiated
Grade 4- do not resemble the tissue of origin. SECONDARY PREVENTION
Warning signs of cancer:
COMPARISON OF STAGING AND THE TNM SYSTEM ▪ Change in bladder and bowel movement
STAGE TNM CLASS CRITERIA ▪ A sore that does not heal
STAGE I T1, N0, M0 Clinical ▪ Unusual bleeding or discharge from any body
examination orifice
(70-90% reveals a mass ▪ Thickening or lump of the breast, testicle, or any
Survival) limited to the
part of the body
organ of origin.
The organ is ▪ Indigestion or dysphagia
operable and ▪ Obvious change in wart or mole
resectable with ▪ Nagging cough or hoarseness that is prolonged
only local ▪ Anorexia/appetite loss
involvement and ▪ Loss of weight/sudden weight loss
there is no nodal
and vascular EARLY DETECTION
spread BREAST
STAGE II T2, N1, M0 Clinical
• BSE >20 y/o
examination
(50+/-% Survival) shows evidence • CBE - q3 years; annually >40 y/o
of local spread • Mammography - annually >45-54 y/o
CERVIX RADIATION THERAPY
Papanicolau Smear (Pap Test) Types of Radiation Therapy
• approx. 3 years after a woman begins having • Electromagnetic Rays (X-rays, Gamma Rays)
sexual intercourse, but no later age 21, then • Cobalt 60
annually • Particles (electrons, protons, neutrons, alpha
• q 2-3 yrs at 30 y/o w/ normal test in a row particle)

Testicular Self- Examination Steps EFFECTS OF RADIATION

1. The most harmful tissue disruption is the alteration
of the DNA molecules within the cells of the tissue.
2. It breaks the strands of the DNA helix, leading to
cell death
3. Ionized constituents of body fluids leading to the
formation of free radicals and irreversibly damaging
DNA.

TYPES OF RADIATION
External Radiation
Teletherapy - the use of radioactive material for
production of an external beam of gamma rays for
COLORECTAL treatment at a distance from the radioactive source
• FOBT (Fecal Occult Blood Test) >50 yo (tele, meaning “at a distance”).
• Sigmoidoscopy - q5 years before age 50
• Contrast Barium Enema - q5 years after age 50 Internal Radiation
• Colonoscopy - q10 yrs after age 50 Brachytherapy - a type of internal radiation therapy in
which seeds, ribbons, or capsules that contain a
PROSTATE radiation source are placed in your body, in or near the
• DRE (Digital Rectal Exam) and PSA (Prostate tumor; treats only a specific part of your body.
Specific Antigen test) -starting age 50
Types of Internal Radiation
TERTIARY PREVENTION Unsealed (Oral, IV), Sealed
Primary Strategies, Health Counselling ,
Chemoprevention Safety Precautions For Brachytherapy
Private room, Radiation Safety Notice, Dosimeter
TREATMENT GOAL Badge, No children/pregnant visitors, No pregnant
CURE staff, STD
Complete eradication of malignant disease
CONTROL Preparations For Intracavitary Brachytherapy
Prolong survival and containment of cancer cell growth Bed rest and log roll, Indwelling urinary catheter, Low
PALLIATION residue diet, Antidiarrheal
Relief of symptoms association with the disease
IMPLANTS
FACTORS AFFECTING TREATMENT DECISIONS 1. Permanent 2. Temporary Implants (1-3 days)
Tumor cell kinetics, Tumor locations, Physical status of
the patient, Quality of life. KEY COMPONENTS OF RADIATION SAFETY
SHIELD, TIME, DISTANCE
TYPES OF SURGERY
Diagnostic, Primary Treatment, Prophylactic, Palliative,
Reconstructive

PREOPERATIVE MANAGEMENT
• Nutritional status
• Talk about concerns and ask questions
• Preoperative education: information about the
surgical procedure
“Minimize the time of exposure, maximize the distance
POST-OPERATIVE MANAGEMENT away from the sources, and maximize the shielding
between the sources and the point of exposure”
• Frequent pain assessment
• Monitor for possible
SIDE EFFECTS OF RADIATION
• Complications Localized Effect, Skin Reaction, Alopecia,
• Position changes and exercise Myelosuppression, N & V, Fatigue, Malaise
• Institute good nutrition, Asepsis, and frequent
wound assessment Patient Education To Minimize Skin Reactions
(External Radiation)
1) Clean skin gently w/ mild soap.
2) Avoid very hot water bath. Classifications of Chemo Therapeutic Agent
3) Avoid sun exposure and extremes hot or cold. (By Chemical Group)
4) Avoid rubbing/ friction (belts, buckles, straps) 1. Alkylating Agents
5) Moisturize prophylactically. 2. Nitrosoureas
6) Do not remove radiation markings. 3. Antimetabolites
4. Antitumor antibiotics
A DISLODGED RADIATION SOURCE 5. Mitotic Spindle Poisons
1. Do not touch a dislodged radiation source with bare 6. Hormones
hands. 7. Miscellaneous Agents
2. Use long-handled forceps to place the source in the
lead container kept in the client's room and call the ALKYLATING AGENTS
physician. Action: Alkylates DNA
3. If unable to locate radiation source, bar visitors and prevents DNA from being separated for synthesis or
notify the physician. transcription.
• Bone marrow depression with leukopenia and
REMOVAL OF SEALED RADIATION SOURCES thrombocytopenia
1. The client is no longer radioactive. • GIT disturbances
2. Resume sexual intercourse after 7-10 days (if • Depress of gametogenesis (mainly in men),
implants is cervical or vaginal) leading to sterility
3. Povidone-iodine douche (cervical) • Alopecia and cystitis
4. Fleet enema if prescribed. Note: Chloramphenicol decreases the metabolism of
Cyclophospamide
CHEMOTHERAPY
Factors Affecting Treatment Decisions: Bendamustine, Busulfan, Carmustine, Chlorambucil,
Tumor cell kinetics, Physical status of the patient, Chlormethine, Cyclophosphamide, Dacarbazine,
Tumor locations, Quality of life. Fotemustine, Ifosfamide, Lomustine, Melphalan,
Streptozotocin, Temozolomide
Role of Chemotherapy In The Treatment of Cancer
• ADJUVANT - Treatment that is given in addition to NITROSOUREAS
the primary (initial) treatment can cross the blood-brain barrier and are used to treat
• NEOADJUVANT - Treatment given as a first step brain tumors.
to shrink a tumor before the main treatment
• PALLIATION - is designed to relieve symptoms, Carmustine, Chlorozotocin, Cthylnitrosourea,
and improve your quality of life. Fotemustine, Lomustine, Nimustine, Ranimustine,
Semustine, Streptozocin
GOALS OF CHEMOTHERAPY
Cure, Control, Palliation CONTRAINDICATIONS OF CHEMOTHERAPY
1. Infection
CHEMO DRUGS CLASSIFICATION 2. Recent Surgery
1. Vesicants - result in tissue necrosis or formation of 3. Impaired Renal or Hepatic Function
blisters when accidentally infused into tissue 4. Recent Radiation Therapy
surrounding a vein. 5. Pregnancy
2. Exfoliants - can cause inflammation and shedding 6. Bone Marrow Depression
of skin without causing underlying tissue death
3. Irritants - can cause inflammation, pain or irritation VASCULAR ACCESS DEVICE
at the extravasation site, without any blister (VADs) are inserted into veins via peripheral or central
formation vessels for diagnostic or therapeutic reasons, such as
4. Inflammitants - cause mild to moderate blood sampling, central venous pressure readings,
inflammation, painless skin erythema and elevation administration of medication, fluids, total parenteral
at the extravasation site nutrition (TPN) and blood transfusions.
5. Neutrals - neither cause inflammation nor damage
upon extravasation PERIPHERALLY-INSERTED CENTRAL CATHETERS
(PICC) is a form of vascular access that is inserted at a
Routes of Cytotoxic Drug Administration peripheral site such as the veins of the arms and
Oral, Subcutaneous, Intramuscular, Intrathecal, extends in the central venous system at the superior
Intravenous vena cava.

Classifications of Chemotherapeutic Agent TUNNELED CATHETERS

(By Relationship To Cell Cycle) is a catheter (a thin tube) that is placed in a vein for
• Cell Cycle Specific - effective regardless of the long-term use. It is most commonly placed in the neck
cell phase (internal jugular) but may also be placed in the groin
• Cell Cycle Non-Specific - effective during a (femoral), liver (transhepatic), chest (subclavian) or
specific phase of the cell cycle back (translumbar).
• Cytotoxic - induce cell kill
• Cytostatic- inhibit tumor cell growth for periods of
time
 PORT-A-CATH Anemic syndrome, Thrombocytopenic syndrome
are small devices that are surgically placed just under
the skin (usually on the front of the chest) which are HEMATOPOEISIS AND IMMUNE RESPONSE
connected to a tube which is placed into the main → Cancer therapy has a direct impact on
veins in the neck. hematopoiesis.
→ Chemotherapy and Radiation therapy kill cells that
Central Venous Catheter Complications divide rapidly.
Pneumothorax, Infection, Bleeding, Thrombosis, → When a patient receives cancer therapy, the white
Misplacement blood cells (WBC), hemoglobin and platelet count
will begin to drop approximately 7 – 10 days after
ANTITUMOR ANTIBIOTIC the first day of treatment, the counts will recover
Adriamycin - Adriamycin PFS (doxorubicin approximately 14 – 21 days later.
hydrochloride) Injection - is a cancer (antineoplastic)
medication used to treat many types of cancer. NADIR
→ Patients are at greatest risk for infectious
Mitomycin - a chemotherapy drug used to treat complication during the Nadir period.
different cancers including breast, bladder, gullet → The period in which the patient’s blood count is the
(oesophagus), stomach, pancreas, lung, anal and liver lowest.
cancers. Mitomycin is given into a vein.
BIOTHERAPY
SPECIFIC SIDE EFFECTS Types of Biotherapy:
▪ Alkylating Agents: Hemorrhagic Cystitis, 1. Immunomodulators
Hyperuricemia 2. Colony Stimulating Factors
▪ Antimetabolites: Anemia
▪ Antitumor Antibiotics: Cardiotoxicity IMMUNOMODULATORS
▪ Vinca Alkaloids: Peripheral Neuropathy Interleukin: aldesleukin, Interferons, BCG
GENERAL SIDE EFFECTS Two Categories:
Bone Marrow Depression, Alopecia, Fatigue/ Body, Immunosuppressants & Immunostimulants.
Weakness, Nausea & Vomiting, Diarrhea,
Extravasation, Dry mouth/mouth sores, Infections, Lifelong Users of Immunomodulator Therapy
Skin/Nail changes, Sexual/Fertility changes are at Particular Risk For:
Infections, Secondary malignancies, Nephrotoxicity,
Other Ways To Minimize Chemotherapy Nausea: Hepatotoxicity, Impaired glycemic control.
• If you are vomiting, stop eating.
• Avoid caffeine and smoking. COLONY STIMULATING FACTORS
• Suck on hard candy, popsicles, or ice during 2.1 Granulocyte-Macrophage: sargramostim (Prokine,
chemotherapy. Leukine)
• Take the medications for nausea and vomiting as 2.2 Granulocyte: Neupogen, GM-CSF
prescribed by your doctor. 2.3 Erythropoetin: epoeitin alfa (Epogen)
• Notify your nurse or doctor if you feel nauseated
during chemotherapy. HEMATOPOEITIC STEM CELL TRANSPLANT
1. Bone Marrow Transplant
EXTRAVASATION 1.1 Autologous - a patient's healthy stem cells are
is the leakage of a fluid out of its container. In collected from the bone marrow before treatment,
inflammation, it refers to the movement of wbc from the stored, and then given back to the patient after
capillaries to the tissues surrounding them, also known treatment.
as diapedesis. 1.2 Allogeneic – a patient receives healthy stem cells
to replace their own stem cells that have been destroyed
Management: by treatment with radiation or high doses of
Stop the administration immediately chemotherapy.
Leave the needle and aspirate any residual drug
Instill antidote UMBILICAL CORD BLOOD CELLS
Remove needle Cord blood contains blood (hematopoietic) stem cells,
Notify the attending physician which can produce all the other cells found in blood,
Apply topical ointment including cells of the immune system.
Monitor site closely
Document the event MONOCLONAL ANTIBODIES (MAB)
made in a laboratory to fight a particular infection and
RARE SIDE EFFECTS are given to you directly in an infusion
Fluid retention and swelling, Hematuria, Hearing
impairment, Blurring of visual fields Latest Breakthrough:
PHOTODYNAMIC THERAPY (PDT)
LONG TERM EFFECTS A treatment that uses a drug, called a photosensitizer
Leukopenic Syndrome - a decrease in the number of or photosensitizing agent.
leukocytes