NEOPLASMS DISORDERS OF THE APPENDAGES

Identify non-malignant and malignant neoplasms Identify surgical options for treatment of

neoplasms Explain nursing considerations Describe pharmacological treatment options Discuss the nursing management of the client

undergoing chemotherapy Identify the components of a therapeutic diet for

clients undergoing chemotherapy Identify abnormal assessment characteristics of

hair, nails and mucous membranes. Describe alopecia

Remains a mystery› Could be:

Environment Lifestyle Occupation Genetic and ethnic factors

› Age- and sex-related differences

Benign tumors -usually require no treatment Lipomas -fatty tumors -surgical removal is recommended Keloids -abnormal growth of scar tissue Angiomas -birthmarks Verruca -warts Nevi -moles

Three most common skin cancers- -Basal cell carcinoma -Squamous cell carcinoma -Malignant melanoma

Exposure to sun leading cause Skin damage from the sun is cumulative Most long-term skin damage occurs

during childhood. It takes 10-20 years before unprotected

sunbathing results in skin cancer

-Most frequent type of skin cancer. -Prolonged sun exposure -Metastasis is rare. - Extends into the dermis and may form

an ulcer -Face and upper torso -Surgical removal cures this type of

cancer 40% - 50%

Characteristics› -waxy border› -papule, with a red central crater› -rarely metastasizes

-Curettage and desiccation -Surgical excision -Radiation therapy -Cryosurgery -Mohs micrographic surgery

-nodular lesion in the epidermis. -sun, gamma rays, and x-rays -second most common cancer in caucasians -head, neck, lower lip and areas of chronic irritation or injury -extends into the dermis and lymph nodes - metastasizes and can cause death -treatment -removal of the lesion or chemosurgery

-firm, red nodule -flat lesion with a scaly crust -new ulceration or raised area on a pre- existing scar or ulcer -face, lower lip, neck, hands or arms -ulcer/flat, white patch inside the mouth -red, raised patch/ulcerated sore in anus/genitals

(Courtesy of the Department of Dermatology, School of Medicine, University of Utah.)

FIGURE 43-17 Squamous cell carcinoma.

Freezing Simple excision Laser therapy Mohs surgery Radiation therapy Chemotherapy

-Most serious skin cancer.--Begins in a mole. -irregular shape -larger than 6mm -inconsistent color -metastasizes to every organ in the body -blood and lymphatic system-Treatment—no cure-Prevention -limiting sun-exposure - use of sunscreen

(From Habif, T.P. [2004]. Clinical dermatology: a color guide to diagnosis and therapy. [4th ed.]. St. Louis: Mosby.)

FIGURE 43-18 The ABCDs of melanoma. A, Asymmetry (one half unlike the other).

Asymetrical-one half is not like the other

(From Habif, T.P. [2004]. Clinical dermatology: a color guide to diagnosis and therapy. [4th ed.]. St. Louis: Mosby.)

FIGURE 43-18 The ABCDs of melanoma. B, Border (irregularly scalloped or poorly circumscribed border).

(From Habif, T.P. [2004]. Clinical dermatology: a color guide to diagnosis and therapy. [4th ed.]. St. Louis: Mosby.)

FIGURE 43-18 The ABCDs of melanoma. C, Color varied from one area to another; shades of tan and brown, black, and sometimes white, red, or blue; change in shape, size, or color of mole.

(From Habif, T.P. [2004]. Clinical dermatology: a color guide to diagnosis and therapy. [4th ed.]. St. Louis: Mosby.)

FIGURE 43-18 The ABCDs of melanoma. D, Diameter larger than 6 mm as a rule (diameter of a pencil eraser).

Surgical removal Chemotherapy Radiation therapy immunotherapy

-Mycosis Fungoides -involving both skin and multiple organs. -early stages - resembles psoriasis/seborrheic dermatitis -fatal

Mycosis Fungoides

SUBJECTIVE: -health history related to skin cancer. -population at greatest risk -fair complexions -blue eyes -red or blond hair -freckles.OBJECTIVE DATA: -inspect lesions -location, color, and appearance

-Biopsy of suspicious lesions -Inspection for any other lesions -Monitor any suspicious lesions for changes

-depends on the level of invasion. -wide, surgical excision of the primary lesion with a margin of normal skin. -Skin grafts

-Follow-up treatments (depends on the stage of the disease) -chemo-immunotherapy -radiation -immunotherapy -chemotherapy -gene therap.

Pain, related to lesion Anxiety, related to cancer, its

treatment, and prognosis

-Explaining procedures/diagnostic tests in terms that the pt. can understand. -Listen/accept expressions of

anger, sadness, and helplessness. -Assess pain. -Provide comfort measures -back rubs, foot massages

-detailed discharge instructions -wound care -medications -cleansing of wounds, lesions -follow-up care -assess the pt.’s and family’s knowledge -seriousness/treatment of the disease -regular physical exams/skin self-exams. -asepsis -prevent a secondary infection -protecting the skin from the sun -use of sunscreen

-Depends on the thickness of the lesion. -less than 0.76 mm thick has a survival rate of almost 100%. -3 mm thick or thicker has a survival rate of less than 50%. -Spreads to regional lymph nodes -50%, 5-year survival rate. -Metastasis -treatment is pallative -condition is terminal

Anorexia Increased metabolism Negative nitrogen balance Nausea, vomiting Diarrhea Mouth problems

Calories Protein Vitamins, minerals Fluids Enteral feedings Parenteral feedings

What is the: -aggressiveness of the cancer? -potential for spreading? -potential hazards of the therapy itself? -established success rate of the therapy?

Divided into two groups1. Cell cycle nonspecific (CCNS)2. Cell cycle specific (CCS)

CCNS effective against slow-growing cancer cells

CCS effective against fast-growing cancer cells

Alkylating agents –cause abnormal chemical bonding between adjacent DNA molecules

Antimetabolites –interfere with various metabolic actions of the cell -result in the cell’s destruction

Miotic inhibitors -interferes with cell division or mitosis

Antibiotics –should not be confused with the antibiotics one takes for an infection. -interfers with one or more stages of

RNA or DNA synthesis, or both

Hormones – -selectively suppresses the growth of certain tissues of the body Corticosteroids -used to decrease inflammatory processes caused by cancer or therapies Radioactive drugs -destroys some or all of the tissue in which the drug is localized

Biological/Response Modifiers – -targets/enhances the immune system -destroys/interferes with the

cellular activity of the tumor

Miscellaneous Agents

Combination therapy -Single chemotherapeutic agent is very rare or effective in treating cancer. -different toxicities -different mechanisms of action -act on different times in the cell division cycle -individually active against the specific cancer -more pronounced beneficial effects when used in combination vs alone

Adjuvant Agents -Rescue drugs -given with chemotherapy -prevents side effects _Mesnex -prevents hemorrhaging of the bladder _Leucovorin -interferes with folic acid metabolism -causes elevated uric acid

Affect all cells, both healthy and sick Dose-limiting effects

› Hair falls out› Cells in the gastrointestinal tract

die› Nausea and vomiting occur;

emetic potential› Myleosuppression

Nadir: lowest point for the bone marrow cells

Common› Fever, chills, headache, nausea,

and vomiting Serious

› Bronchospasm, dyspnea, and hypotension

During administration of the antineoplastic:

› -provide significant hydration to› prevent nephrotoxicity› -provide periodic monitoring of

heart and lung function

True or False: Antineoplastic drugs are used to

cure, control, or provide palliative therapy for patients with cancer.

True or False: Alkylating agents interfere with the

process of cell division of malignant cells and have no effect on the normal cells

True or False: Antineoplastic drugs may be given

alone or in combination with other antineoplastic drugs.

True or False: Antineoplastic drugs can be given only

by the intravenous route

True or False: Cisplatin cannot be administered

with needles containing aluminum because the cisplatin reacts with the aluminum, causing a precipitate formation and loss of potency.

True or False: Alopecia most often occurs 30 – 45

days after the chemotherapy treatment cycle is completed.

True or False: Immediately before

administration of the first dose of antineoplastic drug, the vital signs are taken.

True or False: The patient taking oral

chemotherapy is instructed to contact the primary health care providers if any problems occur, no matter how minor.

Alopecia - loss of hair. -Causes: -aging -drugs (anti-neoplastic agents) -anxiety -disease processes -usually not permanent, unless from aging -hair grows back, but can take several months -devastating to a person’s self-esteem and self- image

-excessive growth of hair in a masculine distribution -hereditary or acquired -treatment -dermabrasion -electrolysis -chemical depilation -shaving - plucking or rubbing with pumice -If the specific cause is treated, additional hair growth will stop

Absence or decrease in hair growth Causes: -skin disease -endocrine problems -malnutrition Treatment: -identifying and removing the cause

Disorder of the nails -soft or brittle -shape can change as the soft tissue grows -ingrown toenails Infection - nails become painful, loose and separate from the tissue Treatment: -wet dressings -topical antibiotics -surgical excision of the infected area