Prepared byMs. Asmaa Farouk

Head Nurse of Prince Faisal Oncology Center

Abnormal growth of cells which tend to proliferate in an uncontrolled way.

An oncology nurse is a specialized nurse who cares for cancer patients.

Asses the nursing care needs of cancer patient

Asses the learning needs, desires, emotional support and capabilities of cancer patient

All information required for informed consent which will include randomization registration process explanation of the treatment its mode of action treatment goals how frequent hospital clinic visits occur, potential side effects and complications

Help patient and family to receive a comprehensive & holistic approach

Support with diagnosis and prognosis

Collecting blood and urine samples.

Safe handling, storage and transport of cytotoxic agent.

Insertion of portacatheter needle (venous access device).

Chemotherapy administration following the safety precaution.

Managing Extravasations of vesicant chemotherapy agent.

Spillage management of cytotoxic/hazardous agents

complete documented records

Rehabilitation support and care once treatment is over

Evaluate the goals and resultant outcomes of care with the patient and the family.

Although cancer affects every age group, most cancers occur in people old than 65 years of age. Overall, the incidence of cancer is higher in men than in women and higher in industrialized sectors due to exposure to chemical agents.

The overall rate of mortality from all cancer has fallen by 11% in the last 10 years, though there are large variations in this trend between different cancers. The main reasons for the decrease in mortality are: Primary prevention of cancer for example a reduction in

smoking.

Earlier detection due to screening programmes.

e.g Mammogram

Better treatment, for example new drugs and new protocols.

Certain categories of agents or factors implicated in carcinogenesis.

Carcinogen

Is any substance or agent that promotes cancer development. Generally cause genetic mutation, i.ethey damage DNA in cells, therefore interfering with normal biological processes

INFECTION

Chemical Agents

Genetic and familial factors

Dietary factors

Hormonal agents

PHYSICAL AGENTS

Virus and bacteria are though to incorporate themselves in the genetic structure of cells, thus altering future generations of cells. For example

The Epstein-barr virus

Hepatitis B virus

Human immunodeficiency virus (HIV)

Bacterium helicoactor pylori which is important factor in Ca. stomach

Most hazardous chemicals produce their toxic effects by altering DNA structure in body sites distant from chemical exposure

The liver , lungs and kidneys are the organ systems most often affected, presumably because of their roles in detoxifying chemicals

Tobacco

Alcohol

Uranium

Benzene

Almost every type has been shown to run in families. Genetic factors play a role in cancer cell development. Abnormal chromosomal patterns and cancer have been associated with extra chromosomes

The risk for cancer increases with long-term ingestion of carcinogens or co-carcinogen or chronic absence of proactive substances in diet. Dietary substance associated with an increased cancer risk include

Fats

Alcohol

Smoked meat

Foods containing nitrates and nitrites

High caloric dietary intake

In some Tumors, i.e (Breast and prostate) cancer growth may be promoted by disturbances in hormonal balance either by the body's own (endogenous) hormone production or by administration of exogenous hormones.

Sun exposure

There is a fair evidence that reducing exposure to ultra-violet radiation reduces the incidence of non-melanoma skin cancer. Increasing exposures of ultra-violet over a lifetime increase the risk of basal cell squamous cell carcinoma.

Exposure to ionizing radiation can occur with repeated diagnostic x-ray procedures or with radiation therapy

Knowing cancer biology has opened up the opportunity for targeted treatment and method of screening.

Cancer is not one disease but many; although there are some striking similarities in how all cancers develop. Cancer is a monoclonal disease, formation of a normal cell into its malignant counterpart is an accumulative, multistage process of gene mutation. As each mutation occurs, the cell's DNA becomes less stable. The genes involved control the process of cell division (cell cycle).

It may take many years for multiple mutations of a single cell to occur. This explains the increasing risk of cancer as we get older.

CANCER CELLNORMAL CELL

Uncontrolled and don't obey the

rules of their own tissue

Controlled and will only divide

when instructed

CONTROL

Can grow when there is not

room or when there are low

levels of nurients

Cannot divide if there is not

enough space or when nutrients

are inadequate

GROWTH

Not fully differentiate and

therefore maintain the ability to

divide

Fully differentiate and reach their

mature

DIFFERENTIATION

Can develop the ability to invade

other tissues space and grow at

other sites

Cannot invade other tissuesMETASTATIC

Once tumor reaches a size of

around 1-2cm³ its oxygen and

nutrients supply are insufficient

for further growth, cancer cells

sending out angiogenic factor,

which stimulate new capillaries

toward the tumor

No new angiogenesisANGIOGENESIS

Numerous changes take place

lead to changed in bshaviour

Identical cell daughtersCELL CHANGES

There are hundreds of different cancers, due to the many tissue types and point of origin for cancer within the human body. They can be loosely classified into main types;

CARCINOMAS

SARCOMAS

MYELOMA

LEUKAEMIAS

LYMPHOMAS

CARCINOMAS:

Are cancers of epithelial tissue. Divided into two subtypes:

- ADENOCARCINOMA:

which develops in an organ or gland

- SQUAMOUS CELL CARCINOMA

which develops in the squamous.

- SARCOMAS:

Originate in supportive and connective tissues such as bones, tendons, cartilage, muscles and fat.

MYELOMA:

Originates in the plasma cells of bone marrow.

LEUKEMIAS:

(blood cancers) are cancers of bone marrow. They are further divided into myeloid and lymphoid types based on the specific blood cell line from which they originate.

- ACUTE LYMPHOPLASTIC LEUKEMIA (ALL).

- CHRONIC LYMPHOPLASTIC LEUKEMIA (CLL).

- ACUTE MYELOID LEUKEMIA (AML).

- CHRONIC MYELOID LEUKEMIA (CML).

LYMPHOMAS:

Cancers of the glands or nodes of the lymphatic system. They may also occur in specific organs such as the stomach, breast or brain. Divided into:

.Hodgkin's diease-

Non-hodgkin's lymphomas.-

Treatment options offered to cancer patients should be based on realistic and achievable goals for each specific type of cancer. The range of possible treatment goals may include:

Cure ------ Complete eradication of malignant disease.

Control ------ prolonged survival and containment of cancer cell growth.

Palliative ------ relief of symptoms associated with the disease.

Multiple modalities are commonly used in cancer treatment. A variety of therapies, including:

Surgery.

Radiation therapy.

Chemotherapy.

And biologic response modifier (BRM) therapy.

Antineoplastic agents are used in an attempt to destroy tumor cells by interfering with cellular functions and reproduction.

Chemotherapy may combined with surgery or radiation therapy, or both to reduce tumor size preoperatively,to destroy any remaining tumor cells postoperatively, or to treat some forms of leukemia.

Prevent cancer cells from multiplying, invading, metastasizing.

Cytotoxic drugs are classified according to their mechanism of action.

Most chemotherapeutic drugs target DNA within the cell in some manner, this action may result in direct interference with DNA, inhibition of enzymes related to RNA or DNA, synthesis or both and /or destruction of the cells’ necessary proteins.

Chemotherapeutic agents may be administered in the hospital, clinic, or home setting.

Safety recommendation for prepartion and handling of anti-neoplastic agents are as follows:

- Proper aseptic techniques must be used in the prepation of chemotherap to protect the patient health care professioinal.

- Use a biologic safety cabinet (laminar air-flow cabinet) for the preparation of all chemotherapy agents.

- Wear surgical gloves when handling anti-neoplasticagents.

- Wear disposable, long-sleeved gowns when preparing and administering chemotherapy agents.

- Dispose of all chemotherapy wastes as hazardous materials.

TOPICAL

ORAL

INTRAVENOUS

INTRAMUSCULAR

SUBCUTANEOUS

ARTERIAL

INTRACAVITARY

AND INTRATHECAL

Is based primarily on the patient total body surface area

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ACUTE TOXICITY

Vomiting, allergic reaction (anaphylactic shock), and arrythmhias.

DELAYED EFFECETS

Mucositis can result in mouth sores, gastritis, diarrhea, alopecia,, and bowel movement suppression.

CHRONIC TOXICITY

Involve damage to organs such as the heart, liver, kidney and lungs.

The nurse has an important role in assessing and managing many of the problems experienced by the patient undergoing chemotherapy. Because the systemic effects on normal as well as malignant cells, these problems are often widespread, affecting many body system.

Check vital signs.

Monitor WBC count and differential

Inspect all site that may serve as entry ports for pathogens i.e intravenous sites, wounds, skin folds and oral cavity.

Assess potential for bleeding, monitor platelet count.

Pettichae or ecchymosis.

Observe decrease in Hb or HCT.

Prolonged bleeding from intensive procedures, venipuctures, minor cuts or scratches.

Bleeding from any body orifice.

Avoid medication that will interfere with clotting e.g aspirin.

In an eythematous area :

- Avoid the use of soap, lotion and perfumes.

- Use only lukewarm water to bathe the area.

- Avoid rubbing, scratching or exposing the area to sunlight.

If wet desquamation occurs

- don’t disrupt any blister that may have formed.

Encourage and assist in oral hygiene.

Brush with soft toothbrush.

Instruct the patient to report oral burning , pain, areas of redness, open lesion on the lips, pain associated with swallowing.

- If with mild stomatitis

Use normal saline to rinse mouth, apply lubricant and avoid spicy foods.

- If with severe stomatitis

Remove denture if patient is using one.

Use anti candida agent such as mycostatin.

Monitor for dehydration

Discuss potential hair loss and re growth with patient and family

- Use scalp hypothermia if appropriate.

- Cut long hair before treatment.

- Use wide-toothed comb.

- Explain that hair growth usually begins again once therapy is completed.

Use scale to assess pain and discomfort, location, quality, frequency, duration etc….

Assess other factors contributing to patient’s pain, fear, fatigue, anger etc….

Teach patient new strategies to relieve pain and discomfort by distraction, imagery, relaxation, cutaneous stimulation etc…

Identify potential threats to patient’s self-esteem i.e altered appearance, decreased sexual function, hair loss, decrease energy, role changes.

Encourage continued participation in activities and decision-making.

Assist the patient in self-care when fatigue, lethargy, nausea, vomiting and other symptoms.

Encourage verbalization of fear, concern s and questions regarding disease, treatment and future implication.

Allow for periods of crying and expression of sadness.

Thank you