11. CANCER
• abnormal cell is transformed by the
genetic mutation of the cellular DNA
• can involve all body organs
• Manifestations are r/t the system
affected & degree of disruption
23/09/12 cancer 11
13. benign malignant
Differentiation Well Lack of
differentiated differentiation
with anaplasia
Rate of growth Progressive and Erratic and slow
slow to rapid
Local invasion Cohesive and well Locally invasive,
demarcated infiltrating
Metastasis None Frequently
present
23/09/12 cancer 13
15. The characteristics
of normal cells
• Reproduce themselves exactly
• Stop reproducing at the right time
• Stick together in the right place
• Self destruct if they are damaged
• Become specialised
23/09/12 cancer 15
16. How cancer cells are
different
• don't die if they move to another part of
the body
• don't stop reproducing
• don't obey signals from other cells
• don't stick together
• don't specialise
23/09/12 cancer 16
18. iNCIDENCE
• Ranks 2nd to CVD as the leading
cause of death
• 1:4 deaths is due to cancer
• Ranks third in leading cause of
morbidity & mortality in the
Philippines
• Occurs at any age but with 75% of
cancers occuring after 50
23/09/12 cancer 18
19. Cells lose their Normal growth-controlling
mechanisms & the growth of cell is uncontrolled
Develops from a mutation in a single cell
Grows w/o the control that char. Normal cell
growth
CA cells fail to mature into the type of Normal cell
from w/c it originates
metastasis
23/09/12 cancer 19
25. • Cancer grow & metastisize thru:
– Directly extending into adjacent tissues
– Invading nearby body cavity
– Invading along lymphatic vessels
– Traveling via lymphatic vessels to lymph
nodes
– Traveling via blood vessels to any part of the
body but usually to the lungs, liver & bones
23/09/12 cancer 25
27. Malignant tumours are
made up of cancer cells
• Usually grow faster than benign
tumors
• Spread into and destroy surrounding
tissues
• Spread to other parts of the body
23/09/12 cancer 27
33. LATE WARNING SIGNS
of CANCER
Change in bowel/bladder habits (alternating diarrhea &
constipation, early morning)
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 wart or mole
Nagging cough or hoarseness of voice
Unexplained anemia
Sudden unexplained weight loss
23/09/12 cancer 33
34. BEST DEFENSE?
IMMUNOSURVEILLANCE
- Promotes antibody
production, cellular immunity
& immunologic memory
23/09/12 cancer 34
35. PREVENTION
• Avoidance of
known or potential
carcinogens
• Avoidance or
modification of the
factors associated
with development
of CA cells
23/09/12 cancer 35
37. PRIMARY
• Education
–Avoid known carcinogens
–Adopting healthy lifestyle
23/09/12 cancer 37
38. SECONDARY
• individualized education and
recommendations for continued
surveillance and care in high-risk
populations
• Public awareness
23/09/12 cancer 38
39. GENERAL PREVENTION
• Increase consumption of fresh
vegetables
• Increase fiber intake
• Increase intake of vitamin A
• Increase intake of foods rich in
vitamin C
• Practice weight control
23/09/12 cancer 39
40. GENERAL PREVENTION
• Reduce intake of dietary fat
• Practice moderation in consumption of salt-
cured, smoked, and nitrate-cured foods
• Stop smoking cigarettes and cigars
• Reduce alcohol intake
• Avoid overexposure to the sun, wear protective
clothing, and use a sunscreen to prevent skin
damage from ultraviolet rays
23/09/12 cancer 40
41. EARLY CANCER
DETECTION
• Breast CA
• Colon and rectal CA
• Uterine CA
• Prostate CA
23/09/12 cancer 41
42. EARLY DETECTION
Enables more effective
treatment and better
prognosis for the patient
23/09/12 cancer 42
45. BREAST
• Age 20, routine BSE
• 20-39, BE by health
care provider every 3
years
• 40 and older, yearly
mammogram & BE
by health provider
23/09/12 cancer 45
51. TMN Classification
System
• Tumors are staged depending on size,
lymph node involvement &
metastasis
T – primary tumor
N – lymph node involvement
M – metastasis
23/09/12 cancer 51
52. T-extent of tumor
• TX –cannot be assesses
• T0 – no evidence
• Tis – carcinoma in situ
• T1, T2, T3, T4 –
increasing size and/or
local extent of primary
tumor
23/09/12 cancer 52
53. N- lymph node
• NX – cannot be
assessed
• N0 – no
metastasis
• N1, N2, N3 –
increasing
involvement
23/09/12 cancer 53
54. M-Metastasis
• GX-cannot be
assessed
• G1-well
differentiated
• G2-moderately
• G3-poorly
• G4-undifferentiated
23/09/12 cancer 54
55. STAGES OF TUMORS
• I: tumor <2cm, (-) lymph node
involvement, no detectable metastases
• II: tumor >2cm but <5cm, (-) or (+) unfixed
lymph node involvement, no detectable
metastases
• III: large tumor >5cm, tumor of any size
with invasion of skin or chest wall or (+)
fixed lymph node involvement without
evidence of metastases
• IV: tumor of any size, (+)/(-) lymph node
involvement, distant metastases
23/09/12 cancer 55
56. Grading & Staging
• A method used to describe the tumor
• Grading – CELLULAR aspect of CA
• Staging – CLINICAL aspect of CA
23/09/12 cancer 56
62. TUMOR MARKER ID
• Analysis of substances found in blood
or other body fluids that are made by
the tumor or by the body in response
to the tumor
• Breast, colon, lung, ovarian,
testicular, prostate cancer
23/09/12 cancer 62
74. Magnetic Resonance
Imaging
• Use of magnetic fields and
radiofrequency signals to create
sectioned images of various body
structures
• Neurologic, pelvic, abdominal,
thoracic cancers
23/09/12 cancer 74
75. CT Scan
• Use of narrow beam x-ray to scan
successive layers of tissue for a cross-
sectional view
• Neurologic, pelvic, skeletal,
abdominal, thoracic cancers
23/09/12 cancer 75
76. Fluoroscopy
• Use of x-rays that identify contrasts
in body tissue densities; may involve
the use of contrast agents
• Skeletal, lung, gastrointestinal
cancers
23/09/12 cancer 76
77. Ultrasonography
• High-frequency sound waves echoing
off body tissues are converted
electronically into images
• to assess tissues deep within the body
• Abdominal and pelvic cancers
23/09/12 cancer 77
78. Endoscopy
• Direct visualization of a body cavity
or passageway by insertion of an
endoscope into a body cavity or
opening
• allows tissue biopsy, fluid aspiration
and excision of small tumors
• Bronchial, gastrointestinal cancers
23/09/12 cancer 78
79. Nuclear Medicine
Imaging
• Uses intravenous injection or
ingestion of radioisotope substances
followed by imaging of tissues that
have concentrated the radioisotopes
• Bone, liver, kidney, spleen, brain,
thyroid cancers
23/09/12 cancer 79
80. Positron Emission
Tomography
• Computed cross-sectional images of
increased concentration of
radioisotopes in malignant cells
• Provide information about biologic
activity of malignant cells
• help distinguish between benign and
malignant processes and responses to
treatment
23/09/12 cancer 80
81. PETScan
• Lung, colon, liver, pancreatic, breast,
esophagus cancers; Hodgkin’s and
non-Hodgkin’s
23/09/12 cancer 81
82. Radioimmunoconjugate
• Monoclonal antibodies are labeled
with a radioisotope and injected
intravenously into the patient
• the antibodies that aggregate at the
tumor site are visualized with
scanners
• Colorectal, breast, ovarian, head and
neck cancers; lymphoma
23/09/12 cancer 82
87. DIAGNOSTIC SURGERY
• BIOPSY
– Excisional
• Remove the entire tumor and surrounding
marginal tissues
– Incisional
• wedge of tissue from the tumor is removed
– Needle Method
• sample suspicious masses that are easily
accessible
23/09/12 cancer 87
93. Factors to consider:
• Family history and genetic
predisposition
• Presence or absence of symptoms
• Potential risks and benefits
• Ability to detect cancer at an early
stage
• Patient’s acceptance of the
postoperative outcome
23/09/12 cancer 93
94. PALLIATIVE SURGERY
• make the patient as comfortable as
possible and to promote a satisfying and
productive life for as long as possible
• attempt to relieve complications of cancer,
such as ulcerations, obstructions,
hemorrhage, pain, and malignant
effusions
• GOAL: HIGH QUALITY OF LIFE
23/09/12 cancer 94
95. Reconstructive Sx
• may follow curative or radical
surgery and
• is carried out in an attempt to
improve function or obtain a
morecdesirable cosmetic effec
23/09/12 cancer 95
96. NURSING INTERVENTIONS
• Perioperative NI
• assesses the patient’s responses to the
surgery
• monitor for possible complications
• Provision of comfort
• Postoperative teaching addresses wound
care, activity, nutrition, and medication
information
23/09/12 cancer 96
97. S/E of Surgery
• Loss of function of a body part
• Reduced function
• Scarring
• grieving
23/09/12 cancer 97
98. CHEMOTHERAPY
• Kills or inhibits reproduction of
neoplastic cells
• Systemic effect: Normal & CA cells
• Combination chemotherapy – avoid
meds during nadirs
• NADIRS – time during w/c bone
marrow activiy & WBC are low)
23/09/12 cancer 98
99. Chemotherapy
• GOALS: cure, control, palliation
• Coordinated with the cell cycle
• For each tx: 20-99% are destroyed
23/09/12 cancer 99
101. Non dividing cells
• Least sensitive
• Must be destroyed to eradicate cancer
completely
• Repeated doses @ active cell division
23/09/12 cancer 101
102. Cell cycle time
• time required for one tissue cell to
divide and reproduce two identical
daughter cells
–G1 phase
–S phase
–G2 phase
–Mitosis
23/09/12 cancer 102
107. Alkylating Agents
• Alter DNA structure by misreading
DNA code, initiating breaks in the
DNA molecule, cross-linking DNA
strands
• Cell cycle non-specific
23/09/12 cancer 107
110. Nitrosureas
• Similar to the alkylating agents
• cross the blood–brain barrier
• Cell cycle non-specific
23/09/12 cancer 110
111. Nitrosureas
• Delayed and cumulative
myelosuppression
• thrombocytopenia
• Nausea
• vomiting
23/09/12 cancer 111
112. Topoisomerase I
Inhibitors
• Irinotecan
• topotecan
23/09/12 cancer 112
113. Topoisomerase I
Inhibitors
• Induce breaks in the DNA strand by
binding to enzyme topoisomerase I
• Preventing cells from dividing
• Cell cycle specific
23/09/12 cancer 113
114. Topoisomerase I
Inhibitors
• Bone marrow suppression
• Diarrhea
• Nausea
• vomiting
• hepatotoxicity
23/09/12 cancer 114
116. Antimetabolites
• Interfere with the biosynthesis of
metabolites or nucleic acids necessary
for RNA and DNA synthesis
• Cell specific – S phase
23/09/12 cancer 116
122. Mitotic Spindle
Poisons
• Arrest metaphase by inhibiting
mitotic tubular formation (spindle)
• inhibit DNA and protein synthesis
• TAXATENES
–Arrest metaphase by inhibiting
tubulin depolymerization
• Cell specific –M phase
23/09/12 cancer 122
123. Mitotic Spindle
Poisons
• Bone marrow suppression (mild with
VCR)
• Neuropathies (VCR)
• stomatitis
23/09/12 cancer 123
124. Mitotic Spindle
Poisons
• Bradycardia
• hypersensitivity reactions
• bone marrow suppression
• Alopecia
• neuropathies
23/09/12 cancer 124
125. Hormonal Agents
• androgens and antiandrogens
• estrogens and antiestrogens
• progestins and antiprogestins
• aromatase inhibitors
• Luteinizing hormone–releasing
hormone analogs
• steroids
23/09/12 cancer 125
126. Hormonal Agents
• Bind to hormone receptor sites that
alter cellular growth
• block binding of estrogens to receptor
sites (antiestrogens)
• inhibit RNA synthesis
• Suppress aromatase of P450 system,
which decreases estrogen level
• Cell cycle non-specific
23/09/12 cancer 126
127. Hormonal Agents
• Hypercalcemia
• jaundice, increased appetite
• masculinization, feminization
• Sodium and fluid retention
• nausea, vomiting
• hot flashes
• Vaginal dryness
23/09/12 cancer 127
129. EXTRAVASATION
• Vesicants - those agents that, if
deposited into the subcutaneous
tissue (extravasation), cause tissue
necrosis and damage to underlying
tendons, nerves, and blood vessels
• dactrinomycin., daunorubicin, doxorubicin
(Adriamycin), nitrogen mustard,
mitomycin, vinblastine, vincristine, and
vindesine
23/09/12 cancer 129
130. extravasation
• Absence of blood return from the
intravenous catheter
• Resistance to flow of intravenous fluid
• Swelling, pain, or redness at the site
23/09/12 cancer 130
131. Nursing Interventions
• STOP immediately!
• Ice packs on the site (except for vinca
alkaloids)
• Aspirate any infiltrated medication
from the tissues and inject
neutralizing solution into the area
– sodium thiosulfate, hyaluronidase, and
sodium bicarbonate
23/09/12 cancer 131
132. Nursing
Interventions
• right atrial Silastic catheters or
venous access devices
–Possible complications: infection
and thrombosis
23/09/12 cancer 132
141. Cardiopulmonary
• Antitumor antibiotics (daunorubicin
and doxorubicin)-CARDIAC
–total dosage reaches 550 mg/m2
• Bleomycin, carmustine (BCNU), and
busulfan –PULMO
–Bleomycin -not to exceed 400 units
• PULMONARY FIBROSIS
23/09/12 cancer 141
142. Reproductive System
• Normal ovulation, early menopause,
or permanent sterility
• temporary or permanent
azoospermia (absence of
spermatozoa)
• Banking of sperm before tx
23/09/12 cancer 142
143. Neurologic System
• taxanes and plant alkaloids,
vincristine
• Peripheral neuropathies, loss of deep
tendon reflexes, and paralytic ileus
23/09/12 cancer 143
144. General Nursing Care
• Assess F&E status
• Modify risk for infection & bleeding
– Avoiding contact with people who have
known or recent infection or recent
vaccination
– Private room
– Aseptic technique
– Stool softeners
23/09/12 cancer 144
145. • Use of electric razor
• Personal hygiene
• Ambulation –skin breakdown
• Avoid fresh fruits, raw meat, fish, and
vegetables
• remove fresh flowers and potted
plants
23/09/12 cancer 145
146. • Each day: change drinking water,
denture cleaning fluids, and
respiratory equipment containing
water
• Assess intravenous sites every day for
evidence of infection
• NO IM injections, IFC
23/09/12 cancer 146
147. Erythematous areas
• Avoid the use of soaps, cosmetics,
perfumes, powders, lotions and ointments,
deodorants
• Use only lukewarm water to bathe the
area
• Avoid rubbing or scratching the area.
• Avoid shaving the area with a straight
edged razor
23/09/12 cancer 147
148. Erythematous areas
• Avoid applying hot-water bottles, heating pads,
ice, and adhesive tape to the area
• Avoid exposing the area to sunlight or cold
weather
• Avoid tight clothing in the area
• Use cotton clothing
• Apply vitamin A&D ointment to the area
23/09/12 cancer 148
149. stomatitis
• Avoid commercial mouthwashes
• Brush with soft toothbrush; use nonabrasive toothpaste
after meals and bedtime
• Use normal saline mouth rinses every 2 h while awake;
every 6 h at night.
• Use soft toothbrush
• Remove dentures except for meals; be certain dentures
fit well
• Apply lip lubricant
• Avoid foods that are spicy or hard to chew and those
with extremes of temperature
23/09/12 cancer 149
150. alopecia
• Prevent or minimize hair loss through the following:
• Use scalp hypothermia and scalp tourniquets
• Cut long hair before treatment
• Use mild shampoo and conditioner, gently pat dry,
and avoid excessive shampooing
• Avoid electric curlers, curling irons, ryers, clips,
barrettes, hair sprays, hair dyes, and permanent
waves
• Avoid excessive combing or brushing; use wide-
toothed comb.
23/09/12 cancer 150
151. alopecia
• Prevent trauma to scalp.
–Lubricate scalp with vitamin A&D
ointment to decrease itching.
–Have patient use sunscreen or wear
hat when in the sun
23/09/12 cancer 151
152. alopecia
• Purchase wig or hairpiece before hair
loss
• Begin to wear wig before hair loss
• Wear hat, scarf, or turban
23/09/12 cancer 152
153. nutrition
• Adequate fluid intake
• SFF
• High calorie, high CHON diet
• Relaxed, quiet env’t during mealtime
• Cold foods if desired
• Wine if possible
• Frequent oral hygiene
23/09/12 cancer 153
154. fatigue
• Rest periods
• Inc night time sleep hrs
• Reduce job workload
• Relaxation technique
23/09/12 cancer 154
156. RADIATION
• Destroys CA cells w/ minimal
exposure of Normal cells to the
damaging effects
• Teletherapy & brachytherapy
23/09/12 cancer 156
157. Teletherapy
• Beam radiation
• Actual radiation source is external
• Does not emit radiation & does not
pose hazad to anyone else
23/09/12 cancer 157
158. Brachytherapy
• Direct, continuous contact with tumor
• Radiation source is w/in the client
• Client emits radiation and poses
hazard to others
• Sealed or unsealed
23/09/12 cancer 158
159. S/E of Radiation
• Skin changes and irritation, alopecia,
fatigue, altered taste sensation
• Vary according to the site of tx
23/09/12 cancer 159
160. BONE MARROW
TRANSPLANTATION
23/09/12 cancer 160
161. • For treatment of leukemia for clients
who have closely matched donors and
who are experiencing temporary
remission with chemotherapy
• GOAL: rid the client of all leukemic or
other malignant cells through
treatment with high doses of
chemotherapy & whole-body
irradiation
163. ALLOGENIC
• from a donor other than the patient):
–either a related donor (ie, family
member)
– a matched unrelated donor
(national bone marrow registry,
cord blood registry)
23/09/12 cancer 163
164. • Autologous (from patient)
• Syngeneic (from an identical twin)
23/09/12 cancer 164
166. HARVESTING
• Large amts under GA
• Peripheral Blood Stem Transplant
–uses apheresis of the donor to
collect stem cells for reinfusion
23/09/12 cancer 166
167. HARVESTING
• ALLOGENIC
–Human leukocyte antigen matched
donor
• ADV: transplanted cells should not be
immunologically tolerant of the
patient’s malignancy and should
cause a lethal graft-versus-disease
effect to the malignant cells
23/09/12 cancer 167
168. HARVESTING
• AUTOLOGOUS
–Frozen (cryopreserved)
–80-190 oC
• ALLOGENIC
–treated to remove "T-cells" (T cell
depletion)
23/09/12 cancer 168
169. ENGRAFTMENT
• establishment of the new bone
marrow
• harvested donor marrow is infused
intravenously into the recipient and
travels to sites in the body where it
produces bone marrow
• COMPLETE: 2-4 wks/longer
23/09/12 cancer 169
173. • mainly involves the
modification of genetic
material (DNA and genes)
• plays a key role in
determining the traits and
characteristics of individuals
23/09/12 cancer 173
174. GOALS
• destroying or preventing the growth
of cancerous cells
• improving the ability of the normal
cells to fight against the cancerous
cells
23/09/12 cancer 174
175. GERM LINE GT
• involves insertion of functional genes
into the germ or reproductive cells
(sperm and egg) of the body
23/09/12 cancer 175
178. INSERTION
• EX vivo
–collection of some blood or bone
marrow cells from the patient
–viruses with the necessary genes are
introduced into the cells in a
laboratory, which are then injected
into the patient's body
23/09/12 cancer 178
189. Larynx
• an organ at the front of your neck. It
is also called the voice box.
• It is about 2 inches long and 2 inches
wide
• The larynx plays a role in breathing,
swallowing, and talking
• acts like a valve over the windpipe
23/09/12 cancer 189
190. RISK FACTORS
• CAUSE: UK
• Age - over the age of 55
• Gender – 4x greater in male
• Race – African Americans than whites
• Smoking
• Alcohol
• Personal Hx of neck and head CA
• Occupation - sulfuric acid mist or nickel, asbestos
• Virus and low in Vit A
• GERD
• Familial tendency
• Straining of voice
• Weakened immune system
23/09/12 cancer 190
191. RISK FACTORS
A. CARCINOGENS
Tobacco Combined effects of
alcohol and tobacco
abuse
Asbestos Second-hand smoke
Paint fumes Wood dust
Cement dust Chemicals
Tar products Mustard gas
Leather and metals
23/09/12 cancer 191
192. Clinical
Manifestations
• Hoarseness or other voice changes
• A lump in the neck
• A sore throat or feeling that something is
stuck in your throat
• A cough that does not go away
• Problems breathing
• Bad breath
• An earache
• Weight loss
23/09/12 cancer 192
193. CLINICAL MANIFESTATIONS
SUBJECTIVE
a. Sore throat / cough
b. Dyspnea
c. Dysphagia
d. Weakness
e. Unilateral nasal obstruction or discharge
f. Pain
g. Hoarseness of voice
23/09/12 cancer 193
194. CLINICAL MANIFESTATIONS
OBJECTIVE
a. Persistent hoarseness
b. Foul breath
c. Persistent ulceration
d. Cervical lymph adenopathy
e. Unexplained weight loss
23/09/12 cancer 194
195. Diagnosis
• Physical exam
• Indirect laryngoscopy -small, long-
handled mirror to check for abnormal
areas and to see if your vocal cords move
as they should
• Direct laryngoscopy - thin, lighted tube
called a laryngoscope through your nose
or mouth
• CT scan
• Biopsy
23/09/12 cancer 195
196. Treatment
• The choice of treatment depends on a
number of factors
–general health
–where in the larynx the cancer
began
–the size of the tumor
–whether the cancer has spread.
23/09/12 cancer 196
197. • Radiation therapy (also called
radiotherapy) uses high-energy x-
rays to kill cancer cells.
–Radiation therapy is local therapy.
–It affects cells only in the treated
area.
–Treatments are usually given 5 days
a week for 5 to 8 weeks.
23/09/12 cancer 197
198. Combination of
treatment
• Radiation therapy alone
• Radiation therapy combined with
surgery –before or after surgery
• Radiation therapy combined with
chemotherapy - may be used before,
during, or after chemotherapy.
23/09/12 cancer 198
199. SURGERY
• When patients need surgery, the type
of operation depends mainly on the
size and exact location of the tumor
23/09/12 cancer 199
200. • Total laryngectomy: The surgeon removes
the entire larynx.
• Partial laryngectomy
(hemilaryngectomy): The surgeon removes
part of the larynx.
– Supraglottic laryngectomy: The surgeon
takes out the supraglottis, the top part
of the larynx.
– Cordectomy: The surgeon removes one
or both vocal cords.
23/09/12 cancer 200
201. • Lymph node dissection
• Thyroidectomy or thyrotomy
23/09/12 cancer 201
203. Chemotherapy
• Before surgery or radiation therapy
• After surgery or radiation therapy
• Instead of surgery
23/09/12 cancer 203
204. Implementation
• Radiation therapy
• Dry mouth
– Drinking lots of fluids can help.
– Some patients find artificial saliva helpful.
– It comes in a spray or squeeze bottle.
• Sore throat or mouth
– special rinses to numb your throat and mouth
and help relieve the soreness.
• Delayed healing after dental care.
23/09/12 cancer 204
205. • Tooth decay
– Good mouth care
– a soft toothbrush, or a toothbrush that has a spongy
tip instead of bristles.
– A mouthwash made with diluted peroxide, salt
water, baking soda, or a combination can keep your
mouth fresh and help protect your teeth from decay.
– It may also be helpful to use fluoride toothpaste or
rinse.
• Changes in sense of taste and smell
– During radiation therapy, food may taste or smell
different.
23/09/12 cancer 205
206. • Fatigue.
– During radiation therapy, you may become very
tired, especially in the later weeks of treatment.
– Resting is important, but doctors usually advise their
patients to stay as active as they can.
• Changes in voice quality
– Your voice may be weak at the end of the day.
– Voice changes and the feeling of a lump in your
throat may come from swelling in the larynx caused
by the radiation.
23/09/12 cancer 206
207. • Skin changes in treated area
– Good skin care is important at this time.
– Try to expose this area to the air but
protect it from the sun.
– Avoid wearing clothes that rub, and do
not shave the treated area.
– You should not put anything on skin
before radiation treatments.
– never use lotion or cream without
doctor's advice.
23/09/12 cancer 207
208. Implementation
• Surgery
• Pain
• Low energy
• Swelling in the throat
– won't be able to eat, drink, or swallow.
– IV
– Feeding tube
23/09/12 cancer 208
209. • Increased mucus production
–the lungs and windpipe produce a
lot of mucus, also called sputum
–Suction PRN
23/09/12 cancer 209
210. Implementation
• High CHON and Calorie diet
• soft, bland foods
• Thick soups, puddings, and
milkshakes often are easier to
swallow
23/09/12 cancer 210
211. Rehabilitation
• Stoma Care
• Communication
–partial laryngectomy, you will be
able to talk in the usual way
–total laryngectomy, pt. must learn
to speak in a new way
23/09/12 cancer 211
213. Communication
• Keep pads of paper and pens or
pencils
• Use a typewriter, computer, or other
electronic device
• Instruct the pt to carry a small
dictionary or a picture book and
point to the words you need
23/09/12 cancer 213
214. • Do
–Give the person plenty of time to
speak
–Ask them to repeat if you don’t
understand
–Watch a person’s lips if you are
finding it hard to understand
23/09/12 cancer 214
215. • Don’t
–Hurry them; pressure affects ability
to communicate
–Pretend you understand if you
don’t—it will be obvious
–Avoid eye contact during the
conversation
23/09/12 cancer 215
216. TECHNIQUES OF
ALARYNGEAL
COMMUNICATION
1. ESOPHAGEAL SPEECH
2. ELECTRIC LARYNX
3. TRACHEOESOPHAGEAL
PUNCTURE
23/09/12 cancer 216
217. Esophageal speech
• teach how to force air into the top of your
esophagus and then push it out again
• The puff of air is like a burp
• It vibrates the walls of the throat, making
sound for the new voice
• The tongue, lips, and teeth form words as
the sound passes through the mouth
23/09/12 cancer 217
218. Esophageal speech
• speech sounds low pitched and gruff,
but it usually sounds more like a
natural voice than speech made by a
mechanical larynx
23/09/12 cancer 218
219. Tracheoesophageal
puncture
• surgeon makes an opening between
the trachea and the esophagus
• opening is made at the time of initial
surgery or later
• small plastic or silicone valve fits into
this opening
• valve keeps food out of the trachea
23/09/12 cancer 219
221. • After TEP, patients can cover their
stoma with a finger and force air into
the esophagus through the valve.
• The air produces sound by making
the walls of the throat vibrate.
• The sound is a lot like natural speech
23/09/12 cancer 221
222. Mechanical speech
• powered by batteries (electrolarynx) or by
air (pneumatic larynx)
• small flashlight
• It makes a humming sound. hold the
device against the neck, and the sound
travels through your neck to the mouth
• a flexible plastic tube that carries sound
into your mouth from a hand-held device
23/09/12 cancer 222
224. • pneumatic larynx
–held over the stoma and uses air
from the lungs instead of batteries
to make it vibrate
–The sound it makes travels to the
mouth through a plastic tube.
23/09/12 cancer 224
226. NURSING
1. DIAGNOSES
DEFICIENT KNOWLEDGE
2. ANXIETY AND DEPRESSION
3. INEFFECTIVE AIRWAY CLEARANCE
4. IMPAIRED VERBAL
COMMUNICATION
5. IMBALANCED NUTRITION
6. DISTURBED BODY IMAGE AND LOW
SELF-ESTEEM
7. SELF-CARE DEFICIT
23/09/12 cancer 226
227. NURSING CARE
1. PROVIDE TIME TO DISCUSS THE DIAGNOSIS
AND THE RAMIFICATION OF SURGERY
2. ASSIST AND ENCOURAGE EXPRESSION OF
FEELINGS
3. ANSWER AS THOROUGHLY AND HONESTLY
TO QUESTIONS
4. VISIT AND DISCUSS REHABILITATION
PROCESS
5. INSTRUCT AS TO THE METHOD OF
COMMUNICATION THAT WILL BE USED
AFTER SURGERY
23/09/12 cancer 227
228. 6. OBSERVE FOR OBSTRUCTION OF AIRWAY
7. OBSERVE FOR SIGNS OF HEMORRHAGE
8. PROVIDE SUCTION APPARATUS AND
CATHETERS
9. PROVIDE HUMIDITY
10. EXPECT AND ACCEPT A PERIOD OF
MOURNING
11. ENCOURAGE INVOLVEMENT IN SPEECH
THERAPY
12. TEACH NECESSARY TO HANDLE BODY
FUNCTIONING ALTERATION
23/09/12 cancer 228
229. 13. TEACH CLIENT TO AVOID ACTIVITIES
THAT PERMIT WATER OR IRRITATING
SUBSTANCES TO ENTER THE TRACHEA
14. SUCTION LARYNGECTOMY TUBE PRN
15. AVOID WEARING CLOTHES WITH
CONSTRICTIVE COLLARS OR NECKLINE
16. MAKE CLIENT UNDERSTAND THAT
CERTAIN ACTIVITIES ARE IMPOSSIBLE
23/09/12 cancer 229
231. Assignment
• LUNG CANCER
• TUMORS OF THE MEDIATINUM
• CARDIAC TUMORS
• LEOCOCYTOSIS
LEUKEMIA
23/09/12 cancer 231
232. Bring out ¼ sheet
of paper…
23/09/12 cancer 232
Hinweis der Redaktion
Acte lymphocytic leukemia
The place where a cancer begins is called the 'primary cancer'. Cancers may also spread into nearby body tissues. For example, lung cancer can spread to the lining of the chest, the pleura. Ovarian cancer can spread to the lining of the abdomen (the peritoneum). This is called locally advanced cancer.
Increase consumption of fresh vegetables Increase fiber intake (breast, prostate, and colon) Increase intake of vitamin A (esophageal, laryngeal, and lung cancers) Increase intake of foods rich in vitamin C (stomach and esophageal cancers) Practice weight control (uterus, gallbladder, breast, and colon)
Reduce intake of dietary fat (breast, colon, and prostate) Practice moderation in consumption of salt-cured, smoked, and nitrate-cured foods( esophageal and gastric) Stop smoking cigarettes and cigars Reduce alcohol intake Avoid overexposure to the sun, wear protective clothing, and use a sunscreen to prevent skin damage from ultraviolet rays
CELLULAR – type of tissue CLINICAL – size of tissue
Gleason Grade 1 – Here, cancerous tissue is well differentiated and looks like normal prostate tissue. Glands are well packed and formed. Gleason Grade 2 – Here, well-formed large glands have more tissue between them. Gleason Grade 3 – Glands begin to look darker and show signs of randomness. They seem to be breaking away from monotony of their existence and invading surrounding tissue. Gleason Grade 4 – Majority of glands appear to be interspersed with surrounding tissue. A few recognizable glands are still present though. Gleason Grade 5 – There are no recognizable glands. Cells with distinct nuclei appear in sheets within surrounding tissue.
complete eradication of malignant disease ( cure) prolonged survival and containment of cancer cell growth ( control) relief of symptoms associated with the disease ( palliation)
Electrosurgery makes use of electrical current to destroy the tumor cells. Cryosurgery uses liquid nitrogen to freeze tissue to cause cell destruction. Chemosurgery uses combined topical chemotherapy and layer-by-layer surgical removal of abnormal tissue. Laser surgery ( l ight amplification by stimulated emission of radiation) makes use of light and energy aimed at an exact tissue location and depth to vaporize cancer cells. Stereotactic radiosurgery (SRS) is a single and highly precise administration of high-dose radiation therapy used in some types of brain and head and neck cancers. This type of radiation has such a dramatic effect on the target area that the changes are considered to be comparable to more traditional surgical approaches
Certain chemotherapeutic agents (cell cycle–specific drugs) destroy cells actively reproducing by means of the cell cycle. Many of these agents are specific to certain phases of the cell cycle. Most affect cells in the S phase by interfering with DNA and RNA synthesis. Others, such as the vinca or plant alkaloids, are specific to the M phase, where they halt mitotic spindle formation.
new bone marrow becomes functional and begins producing red blood cells, WBCs, and platelets
If cancer is caused due to missing or altered genes, then gene therapy involves the replacement of these genes with the healthy ones. Besides, gene therapy can also be carried out to stimulate the immune system to attack the cancer cells. Through this technology, genes can be inserted into the patient's body; which, either instruct the cancer cells to produce certain proteins for inhibiting the cancer-causing oncogenes or stimulate the tumor suppressor genes. Some other studies are also ongoing to introduce genes into the cancerous cells, which can help to make the cancerous cells more responsive to various cancer treatments , including chemotherapy and radiation therapy. Besides, researches are also being carried out to reduce the side effects of various anti-cancer drugs, by increasing the resistance of the stem cells.
owever, in gene therapy, genes are not directly inserted into the patient's body, but uses viruses for that purpose. The viruses, generally used for this therapy, include retroviruses, adenoviruses, herpes viruses, lentiviruses and poxviruses. Sometimes, liposome (a tiny vesicle found in a cell that stores and transports substances within a cell) is also used as a carrier in gene therapy. The viruses can be used both for the ex vivo, as well as in vivo gene therapies. The ex vivo gene therapy involves the collection of some blood or bone marrow cells from the patient. Then, the viruses with the necessary genes are introduced into the cells in a laboratory, which are then injected into the patient's body. On the other hand, in vivo gene therapy involves the direct insertion of viruses or liposomes that contain the desired gene into the patient's body.
However, gene therapy is not free from disadvantages. One of the most potential dangers associated with gene therapy, is the possibility of infection of the healthy cells caused by the viruses used for delivering the gene. Besides, if the genetic material is accidentally introduced into the germ cells, then the changes induced by it, would pass on to the next generation. Again, it is very important to insert the desired gene at the correct location, failure of which might result in genetic mutation and even cause cancer. More scientific researches are required to remove the drawbacks of gene therapy, so it can truly revolutionize the treatment of life-threatening diseases like cancer.
Breathing: When you breathe, the vocal cords relax and open. When you hold your breath, the vocal cords shut tightly. Swallowing: The larynx protects the windpipe. When you swallow, a flap called the epiglottis covers the opening of your larynx to keep food out of your lungs. The food passes through the esophagus on its way from your mouth to your stomach. Talking: The larynx produces the sound of your voice. When you talk, your vocal cords tighten and move closer together. Air from your lungs is forced between them and makes them vibrate. This makes the sound of your voice. Your tongue, lips, and teeth form this sound into words.
Age. Cancer of the larynx occurs most often in people over the age of 55. Gender. Men are four times more likely than women to get cancer of the larynx. Race. African Americans are more likely than whites to be diagnosed with cancer of the larynx. Smoking. Smokers are far more likely than nonsmokers to get cancer of the larynx. The risk is even higher for smokers who drink alcohol heavily. People who stop smoking can greatly decrease their risk of cancer of the larynx, as well as cancer of the lung, mouth, pancreas, bladder, and esophagus. Also, quitting smoking reduces the chance that someone with cancer of the larynx will get a second cancer in the head and neck region. (Cancer of the larynx is part of a group of cancers called head and neck cancers.) Alcohol. People who drink alcohol are more likely to develop laryngeal cancer than people who don't drink. The risk increases with the amount of alcohol that is consumed. The risk also increases if the person drinks alcohol and also smokes tobacco. A personal history of head and neck cancer. Almost one in four people who have had head and neck cancer will develop a second primary head and neck cancer. Occupation. Workers exposed to sulfuric acid mist or nickel have an increased risk of laryngeal cancer. Also, working with asbestos can increase the risk of this disease. Asbestos workers should follow work and safety rules to avoid inhaling asbestos fibers.