2. WHAT IS CANCER? Abnormal growth of cells which tend to proliferate in an uncontrolled way.
3. Who is oncology nurse? An oncology nurse is a specialized nurse who cares for cancer patients.
4. Responsibility of nurses caring for cancer patients Asses the nursing care needs of cancer patient Asses the learning needs, desires,emotional support and capabilities of cancer patient All information required for informed consent which will include randomization registration process explanation of the treatment its mode of action treatment goals how frequent hospital clinic visits occur, potential side effects and complications Help patient and family to receive a comprehensive & holistic approach Support with diagnosis and prognosis
5. Collecting blood and urine samples. Safe handling, storage and transport of cytotoxic agent. Insertion of portacatheter needle (venous access device). Chemotherapy administration following the safety precaution. Managing Extravasations of vesicant chemotherapy agent. Spillage management of cytotoxic/hazardous agents complete documented records Rehabilitation support and care once treatment is over Evaluate the goals and resultant outcomes of care with the patient and the family.
6. CANCER EPIDEMIOLOGY Although cancer affects every age group, most cancers occur in people old than 65 years of age. Overall, the incidence of cancer is higher in men than in women and higher in industrialized sectors due to exposure to chemical agents.
7. MORTALITY The overall rate of mortality from all cancer has fallen by 11% in the last 10 years, though there are large variations in this trend between different cancers. The main reasons for the decrease in mortality are: Primary prevention of cancer for example a reduction in smoking. Earlier detection due to screening programmes. e.g Mammogram Better treatment, for example new drugs and new protocols.
8. CANCER Etiology Certain categories of agents or factors implicated in carcinogenesis. Carcinogen Is any substance or agent that promotes cancer development. Generally cause genetic mutation, i.e they damage DNA in cells, therefore interfering with normal biological processes
9. INFECTION Chemical Agents Genetic and familial factors Dietary factors Hormonal agents PHYSICAL AGENTS
10. INFECTION Virus and bacteria are though to incorporate themselves in the genetic structure of cells, thus altering future generations of cells. For example The Epstein-barr virus Hepatitis B virus Human immunodeficiency virus (HIV) Bacterium helicoactor pylori which is important factor in Ca. stomach
11. Chemical Agents Most hazardous chemicals produce their toxic effects by altering DNA structure in body sites distant from chemical exposure The liver , lungs and kidneys are the organ systems most often affected, presumably because of their roles in detoxifying chemicals Tobacco Alcohol Uranium Benzene
12. Genetic and familial factors Almost every type has been shown to run in families. Genetic factors play a role in cancer cell development. Abnormal chromosomal patterns and cancer have been associated with extra chromosomes
13. Dietary factors The risk for cancer increases with long-term ingestion of carcinogens or co-carcinogen or chronic absence of proactive substances in diet. Dietary substance associated with an increased cancer risk include Fats Alcohol Smoked meat Foods containing nitrates and nitrites High caloric dietary intake
14. Hormonal agents In some Tumors, i.e (Breast and prostate) cancer growth may be promoted by disturbances in hormonal balance either by the body's own (endogenous) hormone production or by administration of exogenous hormones.
15. PHYSICAL AGENTS Sun exposure There is a fair evidence that reducing exposure to ultra-violet radiation reduces the incidence of non-melanoma skin cancer. Increasing exposures of ultra-violet over a lifetime increase the risk of basal cell squamous cell carcinoma. Exposure to ionizing radiation can occur with repeated diagnostic x-ray procedures or with radiation therapy
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17. CANCER BIOLOGY Knowing cancer biology has opened up the opportunity for targeted treatment and method of screening. Cancer is not one disease but many; although there are some striking similarities in how all cancers develop. Cancer is a monoclonal disease, formation of a normal cell into its malignant counterpart is an accumulative, multistage process of gene mutation. As each mutation occurs, the cell's DNA becomes less stable. The genes involved control the process of cell division (cell cycle). It may take many years for multiple mutations of a single cell to occur. This explains the increasing risk of cancer as we get older.
20. CLASSIFICATION OF CANCER There are hundreds of different cancers, due to the many tissue types and point of origin for cancer within the human body. They can be loosely classified into main types; CARCINOMAS SARCOMAS MYELOMA LEUKAEMIAS LYMPHOMAS
21. CARCINOMAS: Are cancers of epithelial tissue. Divided into two subtypes: - ADENOCARCINOMA: which develops in an organ or gland - SQUAMOUS CELL CARCINOMA which develops in the squamous. - SARCOMAS: Originate in supportive and connective tissues such as bones, tendons, cartilage, muscles and fat. MYELOMA: Originates in the plasma cells of bone marrow.
22. LEUKEMIAS: (blood cancers) are cancers of bone marrow. They are further divided into myeloid and lymphoid types based on the specific blood cell line from which they originate. - ACUTE LYMPHOPLASTIC LEUKEMIA (ALL). - CHRONIC LYMPHOPLASTIC LEUKEMIA (CLL). - ACUTE MYELOID LEUKEMIA (AML). - CHRONIC MYELOID LEUKEMIA (CML). LYMPHOMAS: Cancers of the glands or nodes of the lymphatic system. They may also occur in specific organs such as the stomach, breast or brain. Divided into: .Hodgkin's diease- Non-hodgkin's lymphomas.-
23. MANGEMANT OF CANCER Treatment options offered to cancer patients should be based on realistic and achievable goals for each specific type of cancer. The range of possible treatment goals may include: Cure ------ Complete eradication of malignant disease. Control ------ prolonged survival and containment of cancer cell growth. Palliative ------ relief of symptoms associated with the disease.
24. Multiple modalities are commonly used in cancer treatment. A variety of therapies, including: Surgery. Radiation therapy. Chemotherapy. And biologic response modifier (BRM) therapy.
25. CHEMOTHERAPY Antineoplastic agents are used in an attempt to destroy tumor cells by interfering with cellular functions and reproduction. Chemotherapy may combined with surgery or radiation therapy, or both to reduce tumor size preoperatively,to destroy any remaining tumor cells postoperatively, or to treat some forms of leukemia.
26. The purpose of chemotherapy Prevent cancer cells from multiplying, invading, metastasizing.
28. MECHANISM OF ACTION IN CHEMOTHERAPY Most chemotherapeutic drugs target DNA within the cell in some manner, this action may result in direct interference with DNA, inhibition of enzymes related to RNA or DNA, synthesis or both and /or destruction of the cells’ necessary proteins.
35. DOSAGE Is based primarily on the patient total body surface area
36. ADVERSE EFFECTS OF CHEMOTHERAPY ACUTE TOXICITY Vomiting, allergic reaction (anaphylactic shock), and arrythmhias. DELAYED EFFECETS Mucositis can result in mouth sores, gastritis, diarrhea, alopecia,, and bowel movement suppression. CHRONIC TOXICITY Involve damage to organs such as the heart, liver, kidney and lungs.
37. NURSING MANGEMENT IN CHEMOTHERAPY The nurse has an important role in assessing and managing many of the problems experienced by the patient undergoing chemotherapy. Because the systemic effects on normal as well as malignant cells, these problems are often widespread, affecting many body system.
38. ASSESS PATIENT FOR EVIDENCE OF INFECTION Check vital signs. Monitor WBC count and differential Inspect all site that may serve as entry ports for pathogens i.e intravenous sites, wounds, skin folds and oral cavity.
39. PREVENTION OF BLEEDING Assess potential for bleeding, monitor platelet count. Pettichae or ecchymosis. Observe decrease in Hb or HCT. Prolonged bleeding from intensive procedures, venipuctures, minor cuts or scratches. Bleeding from any body orifice. Avoid medication that will interfere with clotting e.g aspirin.
48. IMPROVE BODY IMAGE AND SELF-ESTEEM Identify potential threats to patient’s self-esteem i.e altered appearance, decreased sexual function, hair loss, decrease energy, role changes. Encourage continued participation in activities and decision-making. Assist the patient in self-care when fatigue, lethargy, nausea, vomiting and other symptoms.
49. APPROPRIATE PROGRESSION THROUGH GRIEVING PROCESS Encourage verbalization of fear, concern s and questions regarding disease, treatment and future implication. Allow for periods of crying and expression of sadness.
