MAYA FE NG-DARJUAN, MD-RNMAYA FE NG-DARJUAN, MD-RN

◦Neoplastic disorder that can involve all body organs

◦Cells lose their normal growth-controlling mechanism

◦Growth of cells uncontrolled

MAYA FE NG-DARJUAN MD-RN

via Contact inhibition Contact inhibition and Suppresor gene Suppresor gene

MAYA FE NG-DARJUAN MD-RN

Source: Core Curriculum for Oncology Nursing (Itano and Taoka)

CELL CYCLECELL CYCLE

Go – Resting phaseRestriction checkpoint

8hrs or more

6-8 hrs

2-5 hrs

PARTS OF A CELL

MAYA FE NG-DARJUAN MD-RN

Source: Core Curriculum for Oncology Nursing (Itano and Taoka)

Normal Cell

DNA Damage

Mutations in the genome of somatic cells

Alteration of genes that regulates apoptosis

Expression of altered gene products

Loss of regulatory gene product

MALIGNANT NEOPLASM

Activation of growth promoting oncogene

Inactivation of cancer suppresssor genes

Acquired (environmental DNA damaging agents)

ChemicalsRadiationviruses

Successful DNA repair

Failure of DNA repair

•Clonal expansion•Additional mutations•Heterogeneity

CARCINOGENESIS

Clinical Staging◦0: cancer in situ◦1: tumor limited to tissue of origin◦2: limited local spread◦3: extensive local and regional spread◦4: metastasis

TNM Classification◦Tumor size◦Spread to lymph nodes◦Metastasis

Reduce or avoid exposure to known or suspected carcinogens

Eat balanced dietExercise regularlyAdequate restHealth examination on a regular basis

Eliminate, reduce, or change perceptions of stressors and enhance ability to cope

Enjoy consistent periods of relaxation and leisure

Know 7 warning signs of cancerSelf-examinationSeek medical care if cancer is suspected

Patient may experience fear and anxiety

Clear and repeated explanations may be necessary

Diagnostic plan includes◦Health history (emphasis on risk factors)◦Physical exam◦Specific studies

Biopsy - involves histologic examination by a pathologist of a piece of tissue

Imaging techniques – CT scan, MRI, UTZ

Laboratory test and tumor markers.

SURGERYCHEMOTHERAPYRADIOTHERAPYIMMUNOMODULATIONBONE MARROW TRANSPLANT

Goal is to reduce number of cancer cells in the tumor site(s)◦Directed to cells with high mitotic index

Main problem:Main problem:◦Cancer cells can escape death by Cancer cells can escape death by staying in the Gstaying in the G00 phase phase

◦drug- resistantdrug- resistant

Cell-cycle Nonspecific (CCNS)◦Alkylating agents - CYCLOPHOSPHAMIDE◦Antitumor antibiotics - DOXORUBICIN◦Hormones - CORTICOSTEROIDS

Cell specific (CCS)◦Antimetabolites – FLOUROURACIL◦Mitotic inhibitors – VINCA ALKALOIDS

OralIMIVIntracavitaryIntrathecalIntraarterial

Continuous infusion

SubcutaneousTopical

• causing cross- linking of DNA strands•Cell cycle-nonspecific Cell cycle-nonspecific (CCNS)(CCNS)

ALKYLATING AGENTS1. Busulfan (myleran)2. Carboplatin (Paraplatin)3. Carnustine ( BCNU)4. Chlorambucil ( Leukeran)5. Cisplatin ( Platinol AQ)6. Cyclophosphamide ( Cytoxan)7. Ifosfamide ( (Ifex)8. Lomustine ( CCNU)9. Melphalan ( Alkeran)10. Streptozocin ( Zanosar)11. Temozolamide ( Temodar)

• acts like a natural metabolite thus disrupting cancer metabolic processes

• CCS – S phase

ANTIMETABOLITES1. Capecitabine ( Xeloda)2. Cladribine ( Leustatin)3. Clofarabine ( Clolar)4. Cytarabine Hcl ( Cytosar)5. Fludarabine ( Fludara)6. Fluorouracil ( 5-FU)7. Gemcitabine ( gemzar)8. Mercaptopurine ( 6-MP, Purinethol)9. Methotrexate ( MTX)10. Thiohuanine ( TG, Tabloid)

• SIDE EFFECTS • same as alkylating agents

• Bone marrow depression• Infection• Bleeding• anemia

• GI disturbance• hemorrhagic cystitis• Skin – stomatitis, alopecia

MOA: •Block the formation of the mitotic spindle during mitosis, thus inhibiting cell division

•Cell cycle specific agentsCell cycle specific agents

PERIWINKLE PLANT

PERIWINKLE PLANT

NATURAL PRODUCTS 1. Etoposide ( Ve Pesid) 2. Docetaxel ( Taxoterel) 3. Paclitaxel ( Taxol) 4. Vinblastine sulfate ( Velban)

5. Vincristine sulfate ( Oncovir) 6. Vinorelbine ( Navelbine)

MOA:•Bind to DNA, inhibiting DNA or RNA synthesis, eventually inhibits protein synthesis, preventing cell replication

• CCNS CCNS

ANTIBIOTICS1. Daunorubicin ( Cerubidine)2. Doxorubicin ( Adriamycin)3. Epirubicin ( Ellence)4. Idarubicin ( Idamycin)5. Mitomycin C ( Mutamycin)6. Mitoxantrone ( Novantrone)7. Valrubin ( valstar)

Note: DoxurubicinDoxurubicin is cardiotoxic

1. CORTICOSTEROIDS – anti-inflammatory

2. HORMONEa. ESTROGEN – retards prostate cancerb. PROGESTINS – retards breast and

uterine cancerc. TAMOXIFEN – synthetic anti-

estrogen,

DRUG INDICATIONS1. AMIFOSTINE( Ethyol)

Reduce cumulative toxicity associated with repeated administration of CISPLATIN in patients with advanced ovarian cancer

2. DEXRAZOXANE ( Zinecard)

Reduce the incidence and severity of cardiomyopathy associated with DOXORUBICIN in women with metastatic breast cancer.

3. MESNA( Mesnex)

Reduce the incidence of IFOSFAMIDE and CYCLOPHOSPHAMIDE induced hemorrhagic cystitis

Chemotherapeutic agents cannot distinguish between normal and cancer cells

Body’s response to products of cellular destruction in circulation may cause fatigue, anorexia, and taste alterations

Acute toxicity ◦Vomiting◦Allergic reactions◦Arrhythmias

Delayed effects◦Mucositis◦Alopecia◦Bone marrow suppression

Chronic toxicities◦Damage to HeartKidneyLiverLungs

• SIDE EFFECTS:• Bone marrow depression

• Infection• Bleeding• anemia

• GI disturbance• hemorrhagic cystitis• Skin – stomatitis, alopecia

• CLIENT TEACHINGS• Take drug in the day – prevent drug accumulation at night

• Excreted in breast milk• Reversible oligospermia – sperm bank

• CLIENT TEACHINGS• Avoid pregnancy for 3-4 mos• Protective isolation• Good oral hygiene – soft bristled toothbrush

• Recommend wig, head scarf• Low purine diet – organ meats, beans and peas

- alkalinize the urine

• SmalSmall frequent meals

Drugs usually given in combination◦ synergistic efffects◦ CCNS and CCS combination◦ note: combined side effects also

Carefully calculated according to body weight or body surface area

Must differentiate between tolerable side effects and toxic side effects

Serious reactions must be reported◦Some toxicities are not reversible

Administration of antiemetic drugs

Monitor lab results, particularly WBCs, platelet, and RBCs◦Assess for signs of bleeding if platelet count falls below 50,000/μl

Patient must be told what to expect to decrease anxiety

Encourage discussion of fearsReassure patient that situation is only temporary

Inform patient of supportive care that will be provided

Risk for leukemias and other secondary malignancies resulting

from therapy

Secondary malignancies have been reported◦Includes breast, ovarian, uterine, thyroid, and lung cancers, fibrosarcomasfibrosarcomas

1. A client is scheduled to receive doxorubicin (Adriamycin) as part of his treatment for cancer. You note in his medical record that he is taking a calcium channel blocker (e.g., verapamil). As the nurse you will monitor closely the client because:

A. doxorubicin decreases the effectiveness of verapamil.B. doxorubicin increases the toxicity of verapamil.C. calcium channel blockers increase the risk

of cardiac toxicity.D. calcium channel blockers decrease the risk

of cardiac toxicity.

Answer: C

Your client is scheduled to receive fluorouracil (5-FU) to treat colon cancer. Which of the following statements made by your client indicates a need for additional teaching about 5-FU?

A. “I should call the physician if I develop signs of infection.”

B. “I should examine my mouth occasionally for soreness or ulceration.”

C. “I should not visit anyone who has the flu or a cold.”

D. “I should use sunscreen when I go outsidoutside during the daylight.”

Answer: B