Cancer Nursing Care

7/29/2019 Cancer Nursing Care

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Nursing Management in Cancer

Care

Larry Santiago, MSN, RN


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7 Warning Signs of Cancer

Change in bowel or bladder habits

A sore that does not heal

Unusual bleeding or discharge

Thickening or lump in breast or elsewhere

Indigestion or difficulty in swallowing

Obvious change in a mole or wart

Nagging cough or hoarseness


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Benign Tumors

Benign Not recurrent or progressive.

Opposite of malignant


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Pathophysiology of the Malignant

Process

Characteristics of Malignant Cells

- All cancer cells share some common cellular

characteristics- Cell membrane of malignant cells contain

proteins called tumor-specific antigens, such

as carcinoembryonic antigen and PSA


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Pathophysiology 2

Invasion growth of the primary tumor into

the surrounding host tissues

Metastasis dissemination or spread of

malignant cells from the primary tumor to

distant sites


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Detection and Prevention of

Cancer

Primary Prevention

- Use teaching and counseling skills to

encourage patients to partipate incancer prevention and promote a

healthy lifestyle


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Detection and Prevention of

Cancer 2

Secondary Prevention

Examples breast and testicular self-

examination, Pap smear


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Detection and Prevention of Cancer 3

Tumor Staging and Grading

Staging determines size of tumor and

existence of metastasisGrading classifies tumor cells by type

of tissue


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Cancer Management-

Cure, Control, or Palliation

Surgery

Radiation

Chemotherapy
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Chemotherapy problems

Myelosuppression

Pulmonary or cardiac toxicity

Nausea and vomiting

Extravasation Hypersensitivity reactions

Neuropathy

Pain at the injection site

Flulike syndrome

Hyperglycemia


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Cancer Management-

Cure, Control, or Palliation

Bone marrow transplantation


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Nursing Process: The Patient with

Cancer

Risk for Infection

Impaired Skin Integrity

Impaired Oral Mucous Membrane: Stomatitis Imbalanced Nutrition: Less Than Body

Requirements

Fatigue Chronic Pain


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Leukemia

A neoplastic proliferation of one particular cell

type (granulocytes, monocytes, lymphocytes,

or megakaryocytes)

Common feature is an unregulated

proliferation of WBCs in the bone marrow


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Acute leukemia

Progresses rapidly; characterized by ineffective,immature cells in the bone marrow pushing out thenormal cells.

Acute myeloid leukemia (AML)--adults

Acute lymphocytic leukemia (ALL)--children

Signs and symptoms: Pallor, headache, fatigue,malaise, loss of appetite, weight loss, tachycardia,

shortness of breath, petechiae, ecchymosis,splenomegaly, and bone tenderness.


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Acute myelogenous leukemia (AML)

Normally, myelogenous line of cells mature into

neutro-phils, monocytes, eosinophils, RBCs, and

platelets. AML develops when cells commit to one

type, typically neutrophils. Diagnosis: Bone marrow biopsy

Prognosis: Favorably affected by age under 60 years,

spontaneous rather than secondary leukemia, WBC

less than 10,000/mm3 and remission after one round

of chemotherapy.


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AML treatment options

Induction chemotherapy

Goal is remission

Cytosine arabinoside and an anthracycle

Postinduction therapy (consolidation)

Goal is to prevent relapse after remission, buteffective in only 25% to 35% of patients.

High-dose cytarabine has improved duration of firstremission in young patients with AML.

Options: Standard chemotherapy, autologous stemcells, or human-leukocyte-antigen (HLA) matchedsibling or donor (allogenic).


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Acute lymphocytic leukemia (ALL)

Rapidly developing immature lymphocytes crowd our

normal cells

Poor prognostic factors:High WBCs (> 25,000/mm3

at presentation), age over 50 years, and slow firstremission (longer than 4 weeks).

Treatment - Induction chemotherapy, administered in

two phases, followed by maintenance therapy for up

to 36 months.

Goal is complete remission.


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Chronic leukemia

Progresses slowly and rarely affects people

under age 20.

Chronic myeloid leukemia (CML) strikes ages

40 to 50, more in males.

Chronic lymphocytic leukemia (CLL) strikes

after age 40 and is most common in older

men.


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Chronic myeloid leukemia (CML)

Too many neutrophils and the presence of the

Philadelphia chromosome.

Chronicphase follows an indolent course, mild symptoms,


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CML treatment options

Kinase inhibitor imatinib (Gleevec) is treatment of

choice

Interferon alpha reduces growth and division 55%

to 60%. Hydroxyurea may prolong the chronic phase.

Stem cell transplant--greatest risk of dying in the

first 100 days.


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Chronic lymphocytic leukemia (CLL)

Average survival is 2.5 years for advanced

disease and 14 years for those with early-

stage disease.

Indolent disease characterized by

lymphocytosis, lymphadenopathy and

hepatosplenomegaly. Risk of death from

infection as the disease advances.


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CLL treatment options

Standard chemotherapy, which can produce a

remission not a cure and has harsh adverse

reactions. Usually delayed till signs and

symptoms appear. Chemotherapy, radiation,and Rituximab to enhance the response.


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Lymphoma

Neoplastic disease in which lymphocytes

undergo malignant changes and produce

tumors

Classified as Hodgkins disease (accounts for

12% of lymphomas) and non-Hodgkins

lymphoma (NHL)

Hodgkins disease accounted for 5 % of all

cancer diagnoses in 2005; 3% NHL


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Stages of lymphoma

Stage I involves a single lymph node orlocalized involvement

Stage II involves two or more lymph node

regions on the same side of the diaphragm Stage III involves several lymph node regions

on both sides of the diaphragm

Stage IV involves extralymphatic tissue, suchas the bone marrow


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Hodgkins treatment options

Radiation is treatment of choice for stage IA or

IIA nonbulky (


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Non-Hodgkins lymphoma (NHL)

Incidence has increased about 7% annually

over 20 years, primarily older adults. Cause is

unknown but increased risk: long-term

immunosuppressant therapy, bone marrowtransplant, inherited immune defects,

rheumatoid arthritis, and prior Hodg-kins

disease and treatment. Spread through thebloodstream.


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NHL Treatment Options

Radiation, chemotherapy, or both

Stem cell transplant for recurrent disease


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Multiple Myeloma

A malignant disease of the most mature form

of B lymphocyte


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Multiple Myeloma 2

Clinical Manifestations

- Bone pain

- Hypercalcemia

- Renal failure

- Anemia

- Oral hemorrhage- Fatigue, weakness


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Assessment and Diagnostic Findings


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Medical/Nursing Management


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Cancer Nursing Care