Overview about tumor Therapeutic modalities of cancer and Nursing Care

Cancer Definition

– Cancer is a disease process that begins when an abnormal cell is transformed by the genetic alteration of the cellular DNA.

Pathophysiology of Cancer

– The abnormal cell forms a copy and begins to multiply abnormally. The cells acquire invasive characteristics, and changes occur in surrounding tissues.

– The cells infiltrate these tissues and gain access to lymph and blood vessels, which carry the cells to other areas of the body.

– This phenomenon is called metastasis (cancer spread to other parts of the body)

Benign and Malignant Tumors

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Invasion and Metastasis

Invasion

– Growth of the primary tumor into the surrounding host tissues, occurs in several ways.

Metastasis

– Direct spread of tumour cells to body cavities or through lymphatic and blood circulation.

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Etiology Of cancer

Viruses and Bacteria

– Epstein-Barr virus (EBV), Chronic hepatitis B, bacterium Helicobacter.

– Viruses are integrated themselves in the genetic structure of cells and altering future generation of the cell.

Physical Agent

– As exposure to sunlight or radiation, chronic irritation or inflammation, and tobacco use.

Chemical Agent

– Chemicals are present in air, water, soil, food,

drugs, and tobacco smoke. Alcohol and tobacco are the most frequent causes of cancers of the mouth and throat.

– It altering DNA structure in body sites distant from chemical exposure.

Genetic and familiar factors

– It is result from abnormal chromosomal pattern.

Dietary Factors

– People who eat high-fat, low-fiber, high caloric diet is more prone to develop colon cancers. Diets high in fiber reduce the risk of colon cancer.

Hormonal Agent

– Hormonal agents that disturb the balance of

the body may also promote cancer. Long-term use of the female hormone estrogens is associated with cancer of the breast, uterus, ovaries, cervix, and vagina.

Detection and Prevention of cancer

Primary prevention

– Is concerned with reducing the risk of cancer in healthy people.

Secondary prevention

– Involves detection and screening to achieve early diagnosis and rapid intervention.

Tertiary prevention

– The care and rehabilitation of patient after cancer diagnosis and treatment.

Primary prevention

– Dietary and various lifestyle changes.

– Encourage patient to Participate in cancer prevention programs.

– Identify medications that may help reduce the incidence of certain types of cancer.

Secondary prevention

The warning signals can be remembered with the following CAUTION:

– Change in bowel or bladder habits.

–  A sore that fails to heal.

– Unusual bleeding or discharge.

– Thickening or lump in breast or other tissue.

— Dyspepsia or swallowing difficulties.

– Obvious change in growth of mole.

– Irritating cough or hoarseness.

– Nurses must aware of factors such as race, cultural influences, access to care, physician patient- relationship, level of education, income and age.

– Health education and health maintenance program.

– Breast and testicular self- examination and papanicolaou (pap) test.

– Cancer screening events.

( Mammograms, rectal examination, blood test ) .

Diagnosis of Cancer

– Tumor marker identification.

–  Magnetic resonance imaging.

– Computed tomography.

– Fluoroscopy…….. X ray with contrast.

– Endoscopy.

– Nuclear medicine imaging.

– Radio-immuno-conjugates

Monoclonal antibodies are labeled with a radioisotope and injected intravenously into the patient; the antibodies that aggregate at the tumour site are visualized with scanners.

Therapeutic modalities of cancer

I. Surgery

A. Diagnostic Surgery

– Such as biopsy, is usually performed to obtain a tissue sample for analysis of cells suspected to be malignant.

– There are three common biopsy methods , excisional, incisional, and needle methods.

1. Excisional biopsy

– The surgeon can remove the complete tumor and surrounding marginal tissues as well.

– This removal of normal tissue beyond the tumor area decreases the possibility that residual disease cell may lead to a recurrence of the tumor.

2. Incisional biopsy

– Is performed if the tumor mass is too large to be removed.

– A wedge of tissue from the tumor is removed for analysis.

3. Needle biopsy

– Performed to sample mistrustful masses that are easily accessible ( breast, thyroid, lung, liver, kidney).

– It involves aspirating tissue fragments through a needle guided into an area suspected of bearing disease.

B. Surgery as Primary Treatment

The surgical approaches used are :

1. Local excision.

Salvage surgery : That uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach ( mastectomy after primary lumpectomy and radiation )

– Electro surgery: Use of electrical current to destroy the tumor cells.

– Cryosurgery : Uses liquid nitrogen or a very cold probe to freeze tissue to cause cell destruction.

– Chemosurgery : Uses chemicals applied to tissues to facilitate their removal.

– Laser surgery : Use light and energy aimed at an exact tissue location and depth to vaporise cancer cells.

Prophylactic Surgery

– Involves removing nonvital tissues or organs that are likely to develop cancer.

– It is offered selectively to patients.

Factors to be considered in prophylactic sur.

– Family history and genetic predisposition.

– Presence or absence of symptoms.

– Potential risks and benefits.

– Ability to detect cancer at an early stage.

– The patient’s acceptance of the postoperative outcome.

Palliative Surgery

– Is performed in an attempt to relieve complications of cancer, such as ulceration, obstructions, hemorrhage, pain, and malignant effusions.

– Honest and informative communication with the patient and family to avoid false hope and dissatisfaction.

Reconstructive Surgery

– May follow curative or radical surgery and is carried out in an attempt to improve function or obtain a more desirable cosmetic effect.

– It may be indicated for breast, head, neck, and skin cancers.

– The individual needs of the patient undergoing reconstructive surgery must be accurately assessed and addressed.

II. Radiation Therapy

– In radiation therapy, ionizing radiation is used to interrupt cellular growth.

– Two types of ionizing radiation – electromagnetic rays (x- rays and gamma rays) and particles (electrons).

– Ionizing radiation breaks the strands of the DNA spiral, leading to cell death.

External Radiation

– Kilovoltage therapy devices deliver the maximal radiation dose to superficial lesions, such as skin and breast.

– Linear accelerators machines produce higher- energy x- rays to deeper structures with less harm to the skin and less spreading of radiation within the body tissues.

– Gamma rays. It deliver radiation dose lower than the skin surface , careful skin tissue from unfavorable effects.

Radiation Therapy

Radiation therapy of the pelvis. Lasers and a shape under the legs are used to determine exact position.

Internal Radiation

 

– Internal radiation implantation, delivers a high dose of radiation to a localized area.
– It can be implanted by means of needles, seeds, beads, or catheters into body cavities (vagina, abdomen, pleura) or breast.
– The radioisotopes remain in place for a prescribed period and then are removed.

Radiation Dosage

– Is dependent on the sensitivity of the target tissues to radiation and on the tumor size.
– The fatal tumor dose is defined as that will eliminate 95% of the tumor yet protect normal tissue.
– The total radiation dose is delivered over several weeks to allow healthy tissue to repair and to achieve greater cell kill.

Toxicity

– Altered skin integrity as  Alopecia (hair loss), erythema, and shedding of skin.
– Dryness of the mouth,  entire GIT mucosa.
– Esophageal irritation with chest pain and dysphagia .
– Nausea, vomiting, and diarrhea.

Chemotherapy

– It is antineoplastic agents used in an attempt to destroy tumor cells by interfering with cellular function, including replication.
– It may be combined with surgery, radiation.
– Repeated doses are necessary over  a prolonged period to achieve deterioration of the tumor.

Administration of chemotherapeutic agents.

– It may be administering oral, IV., IM., SC., arterial, intracavity.
– It depends on the type of agent; the required dose; and the type, location, and extent of tumor being treated.

Dosage

– Is based on the patient’s total body surface area, previous response to chemo. Or radiation therapy, and function of major organ system.

Special problems: Extravasations

– Vesicants are those agents that, if deposited into the SC. Tissue(extravasations), cause tissue necrosis and damage to underlying tendons, nerve, and blood vessels.

Indication of extravasations during administration

– Absence of blood return from the IV catheter
– Resistance to flow of intravenous fluid.
– Swelling, pain, or redness at the site.

If extravasations is suspected:

– The medication administration is stopped.
– Ice is applied to the site.
– The physician may aspirate any infiltrated medication from the tissues.
– Inject a neutralizing solution into the area to reduce tissue damage ( Sodium bicarb.)

Toxicity

Gastrointestinal System

– Nausea and vomiting, it may persist for as long as 24- 48 hours after its administration.
– Mucositis ( inflammation of the mucosa lining) and diarrhea is a common result.

Hematopoietic System

– Myelosuppression (depression of bone marrow function) resulting in decreased production of blood cells. Includes
– Decrease the number of WBCs (Leukopenia),
– Decreased red blood cells (anaemia)
– Decreased platelets (thrombocytopenia)
– Increases the risk of infection and bleeding

Renal System

– Damage the kidneys because of their direct effects during excretion and the accumulation of end products after cell lysis.    Uric acid.

Cardiopulmonary System

– Permanent cumulative cardiac toxicities signs of heart failure must be monitored.
– Pulmonary fibrosis.

Reproductive System

– Sterility, early menopause

Neurologic System

– Peripheral neuropathies.
– Loss of deep tendon reflexes.
– Paralytic ileus may occur.

Miscellaneous

– Fatigue can be weakening and can last for months after treatment.

Nursing Care of the Client with Cancer

–  Nursing role includes health promotion to lower the controllable risks

1.  Routine medical check up and screenings.

2.  Client awareness to act if symptoms of cancer occur.

3.  Screening examination recommendations by American Cancer Society; specifics are made according to age and frequencies.

a. Breast Cancer: self-breast exam, breast examination by health care professionals, screening mammogram.

b. Colon and Rectal Cancer: fecal occult blood, colonoscopy.

c. Cervical, Uterine Cancer: Papanicolaou (Pap) test.

d. Prostate Cancer: digital rectal exam, Prostate-specific antigen (PSA) test.

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