CANCER MANAGEMENT

TREATMENT GOALS

CURE

CONTROL

PALLIATION

CANCER TREATMENT

SURGERY

RADIATION THERAPY (RT)

CHEMOTHERAPY

TARGETED THERAPIES

CANCER TREATMENT BIOPSY

NEEDLE METHODS

EXCISIONAL

INCISIONAL

FINE

CORE

USED FOR ACCESSIBLE TUMORS SKIN BREAST UPPER & LOWER GI URT

REMOVE ENTIRE TUMOR AS WELL AS THE SURROUNDING MARGINAL TISSUE

WEDGE TISSUE

STAGING

RECURRENCE OF THE TUMOR

CHANCE OF SEEDING OF THE TUMOR

ELECTROSURGERY

CRYOSURGERY

CHEMOSURGERY

SURGICAL TECHNIQUES
LASER SURGERY

PHOTODYNAMIC THERAPY
RADIOFREQUENCY ABLATION (RFA)

OTHER PURPOSES

PROPHYLACTIC
REMOVAL OF NON-VITAL TISSUES OR ORGANS THAT ARE RISK TO DEVELOP CANCER

PALLIATIVE
RELIEVE COMPLICATION OF CANCER PAIN OBSTRUCTION ULCERATION MALIGNANT EFFUSION HEMORRHAGE

RECONSTRUCTIVE
TO IMPROVE FUNCTION OR TO OBTAIN a MORE DESIRABLE COSMETIC EFFECT BREAST HEAD NECK SKIN

RADIATION

CURE

CONTROL

PROPHYLAXIS

NEOADJUVANT PALLIATIVE

TYPES OF IONIZING RADIATION

ELECTROMAGNETIC (X-RAY & GAMMA RAYS)

PARTICULATE

TISSUE DISRUPTION

BETA PARTICLES ELECTRONS PROTONS ALPHA NEUTRONS

ALTERATION OF THE DNA MOLECULE (BREAKS THE STRANDS OF THE DNA HELIX)

ADMINISTRATION OF RT

EBRT (TELETHERAPY)

INTERNAL RADIATION (BRACHYTHERAPY)

EBRT
IMRT (Intensity)
ENHANCEMENT

IGRT (Image Guided)

RESPIRATORY GATING

COBALT 60
(OLDEST FORM)

SBRT
HIGHER TREATMENT FRACTION DOSES, 1-5 DAYS

PROTON
UTILIZES HIGH-LINEAR ENERGY TRANSFER (LET)

Gamma Knife

Cyber Knife Trilogy

Tomotherapy

Penetrate very deeply into the body to control deepseated tumors (that cannot be treated by other approaches such as surgery)

CYCLOTRON

Capable of delivering its high energy dose to a deep-seated tumor, with no energy exiting through the pts healthy tissue behind the tumor

BRACHYTHERAPY

TEMPORARY

PERMANENT

INTRALUMINAL

CONTACT OR SURFACE APPLICATIONS

INTRACAVITARY

INTERSTITIAL IMPLANT

SYSTEMIC

HDR

LDR

Temporary

HDR

LDR
HOSPITALIZATION

SHORTER

EXPOSURE TO PERSONNEL

OPD

MORE EXTENDED TIME

 Insertion of catheters, hollow tubes into lumens of organs. Obstructive lesions in the bronchus, esophagus bile duct HDR

 Retinoblastoma Ocular Malanoma HDR

LDR

BED REST

SEVERAL DAYS

LOG-ROLLED

 Indwelling catheter inserted Low-residue diet Anti-diarrheals Limit time & proximity

Interstitial Implants
Permanent
- Prostate Cancer

Temporary

- Pancreatic Cancer
- Breast Cancer - Implants Seeds Wires Small Catheter

Systemic
Radioactive Iodine Thyroid Cancer Strontium 89 Bone Metastases Samarium 153 Metastatic Bone Lesion Phosphorus 32 Malignant Ascites Radioisotopes

Radio Immunotherapy

Treatment for Refractory Non- Hodgkin Lymphoma (NHL)

Next
Click me

Administrative of Radionuclide chemically conjugated to a monoclonal antibody

Zevalin (Ibritumomab Tiuxetan)

Iodine 131

NHL
TOSITUMOMAB (BEXXAR) Ytrium 90

Tumors of the Eye

Retinoblastoma

Prostate Cancer

Pancreatic Cancer

Breast Cancer

Non- Hodgkin Lymphoma

RADIATION

A. Localized skin irritation; erythema to moist desquamation B. Vary based on site and size of treatment field 1. Gastrointestinal tract: nausea, vomiting, diarrhea, xerostomia, mucositis, dysphagia 2. Gonads: temporary or permanent sterility 3. Bone marrow: leukopenia, thrombocytopenia, anemia 4. Respiration tract: pneumonitis, cough, dyspnea 5. Genitourinary tract: cystitis, urethritis 6. Internal radiotherapy: excessive tissue sloughing 31 can cause hemorrhage, pain and/or infection

 Three essential elements in protection from hazardous radiation exposure

Time Distance Shielding

Lead shield is not adequate protection against gamma rays Follow guidelines from radiation safety officer carefully Always wear dosimetry badge to measure radiation exposure
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 Rotate care of brachytherapy clients among the team of nurses Never assign a pregnant nurse to care for a brachytherapy client Trace doses of radiation used for diagnosis do not require special precautions

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Prevent irritation of skin over treated area: Cleanse area daily with mild soap and water (do not erase markings and take care to dry skin folds carefully) Avoid irritating rubbing clothes (cotton against skin is least irritating) use of perfumed soap, ointments, powders, lotions, deodorants, heating pads, and hot or cold packs; use only an electric shaver; avoid scratching, vigorous rubbing or massage; also to avoid sun exposure when possible otherwise use sunscreen 34

Plan rest periods during the day and adequate sleep at night to combat fatigue Eat a high-protein, high-CHO, and high-calorie diet and check weight weekly for loss Take antiemetic and antidiarrheals as prescribed and eat a low-residue diet, for nausea and diarrhea associated with an abdominal port
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CHEMOTHERAPY

ANTINEOPLASTIC AGENTS

INTERFERES WITH CELLULAR REPLICATION

DESTRUCTION TUMOR CELLS

CHEMOTHERAPY

TREAT SYSTEMIC DISEASE

NEOADJUVANT
- COMBINE WITH SURGERY AND OR RT TO REDUCE SIZE PREOPERATIVELY

ADJUVANT
- DESTROY ANY REMAINING CELLS

PRIMARY TREATMENT

LEUKEMIA

LYMPHOMA

TOPICAL ORAL IV

Route of Administration

IM

SQ
ARTERIAL INTRACAVITY INTRATHECAL

TOPOISOMERASE Inhibitors

Nitrosureas

Antimetabolites

Anti tumor Antibiotics

CHEMOTHERAPEUTIC AGENTS
Mitotic Spindle Poison

Hormonal Agents

Ankylating Agents

Miscellaneous Agents

INDICATIONS OF EXTRAVASATION

Absence of Blood Return

Resistance to flow of IV fluid

Burning / Pain
Swelling / Redness

 Agents Vesicants
Cisplatin (Platinol-AQ), Dactinomycin (Cosmegen), Daunorubicin (DaunoXome), Doxorubicin, Nitrogen mustard (Mustargen), Mitomycin (Mutamycin), Paclitaxel (Taxol), Vinblastine (Velban), Vincristine (Oncovin), Vindesine (Eldisine), and Vinorelbine (Navelbine)

Ability to leak from a vein Causes tissue necrosis Damage to underlying tendons nerves and blood vessels

Side Effects of Chemotherapy

Side Effects
GI Epithelium BM Hair Follicles Reproductive Organ Toxicities

Blood Dyscracias

Alopecia

Infertility

Nadir 7 14 days After chemotherapy

GI Epithelium

Anorexia

N/V

Stomatitis

Diarrhea

24 - 48

Antiemetics

Organ Toxicities

Neuro toxity

Hepato toxicity

Nephro toxicity

Cardiac toxicity

Lungs

Allergy

Antimetobolites

Anaphylaxis

Neurotoxity
Metabolic encephalopathy Peripheral Neurologic damage

Ifosfamine

High-dose Methotrexate

Ifosfamine Cytarabine

Oxaliplatin

Cisplatin

Nephrotoxicity

Cisplatin

Methotrexate

Mitomycin

Cardiactoxicity

Anthracyclines

Daunorubicin
D E X R A Z O X A N E

Doxorubicin

Lungs

Bleomycin (Blenoxane)

Carmustine (BCNU)

Busulfan (Myleron, Rosulfex)

7400u

1400mg

Targeted Therapies

Biologic Response Modifier

Non-Biologic Response Modifier

Gene Therapy

Tumor directed

Active

Adoptive

Biologic Response Modifier

Monoclonal Antibodies (Chimeric MoAbs) (Humanized MoAbs)

Cytokines

Monoclonal Antibodies

Gemtuzumab Ibritumomab- Tositumomab Imatinib Tyrosine Bevacizumab (Avastin) Mesylate Kinase Tiuxetan (Bexxar) Ozogamicin Scrafenib (Gleevec) Inhibitors (Zevalin) (Mylotarg) (Nexavar) Sunitinib (Sutent)

AML

Non-Hodgkin Lymphoma

CML

AML

VEGF

Cytokines
Antitumor Antiviral

IFN-a

ILs

Renal Cell Cancer

Metastatic Melanoma

IFN-a * hairy cell leukemia *CML *Kaposis sarcoma *high grade non-Hodgkin Lymphoma *Renal Cell CA Cutaneous T-cell lymphoma Melanoma

Non-Biologic Response Modifier

BCG

Corynebacterium parvum

Retinoids

Cancer Vaccine

Malinant Melanoma

Bladder Cancer

Retinoids

ATRA Tretinoin (Renova, Retin A)

4HRP (Fenretinide)

Acute Promyelocytic Leukemia

Breast Cancer

Cancer Vaccines
Autologous Allogeneric

Prophylactic e.g. Gardasil for HPV, Cervical Cancer (6, 11, 16, 18)

Therapeutic

Purpose A.Treatment of hematologic cancer B.Treatment of certain solid tumor recurrences that require ablative chemotherapy, which destroys bone marrow
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Types
A.Autologous: bone marrow is removed from the client and reinfused after high-dose chemotherapy B.Allogenic: Bone marrow from a donor with compatible human leukocyte antigen (HLA); infused after the clients own bone marrow is destroyed by chemotherapy or radiation C.Syngeneic: bone marrow is obtained from an identical twin D.Peripheral stem cell transplantation: after stem cell production is stimulated by administration of growth factor, cells are collected by apheresis and reinfused after high-dose chemotherapy
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A. Infection, fever, chill B. Cutaneous reactions C. Gastrointestinal: nausea, vomiting, diarrhea D. Cardiovascular: hypotension, hypertension, tachycardia, chest pain, bleeding E. Respiratory: shortness of breath, pneumonia

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 41.5 degree C Effective when combined with other treatments Heat produced by using:
RADIOWAVES UTZ MICROWAVE MAGNETIC WAVES HOT WATER BATH HOT WAX IMMERSION

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LOCAL

PROBES INSERTED AROUND A TUMOR AND ATTACHED TO HEAT SOURCE

REGIONAL

ISOLATED BY A TOURNIQUET AND A EXTRACORPOREA L HEATS THE BLOOD FLOWING THROUGH THE AFFECTED PART

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 Heated Melphalan (Alkeran) heated and instilled Can be local or regional

Whole body hyperthermia Immersion in heated water/paraffin Enclosure in a heated suit
63

 Mind-body and biofields

Herb and vitamin intake

Unconventional Treatment

64

 Machine and devices

Drugs and biologic agents

Metabolic and dietary regimens

65

 Spiritual Approach

66

A. Assessment 1. Obtain a description of onset and progression of signs and symptoms 2. Perform physical assessment to determine general state of health and nutrition 3. Determine clients understanding of disease and treatment plan
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B. Analysis/Nursing Diagnoses 1. Decisional conflict (choice or continuation of treatment modality) related to values and beliefs 2. Fatigue related to depletion of body reserve, therapy, and increased metabolic rate 3. Fear related to dependency, intractable pain, and death 4. Risk for infection related to altered immune response

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5. Imbalanced nutrition: less than body requirements related to disease process and therapeutic modalities 6. Impaired oral mucous membrane related to disease process and therapeutic modalities 7. Chronic pain related to disease process and therapeutic modalities 8. Powerlessness related to diagnosis and prognosis 9. Impaired tissue integrity related to treatment modalities

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TYPES of BREAST CANCER

Ductal Carcinoma in Situ

Invasive Cancer

Infiltrating Ductal Carcinoma

Infiltrating Lubular Carcinoma

Medullary Carcinoma

Mucinous Carcinoma

Tubular Carcinoma

Inflammatory Carcinoma

Pagets Disease

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Risk Factors Gender Female Familiar Tendency history of Breast CA history of Ovarian CA Race Ashkenazi Jewish Genes Mutated BRCA1, BRCA 2 ERB2 oncogene Hormonal Factors Obesity Alcoholism Exposure to Ionizing Radiation History of Proliferative Benign Breast Mass skin dimpling Nipple retraction skin ulceration
ABNORMAL CELL PROLIFERATION

Nontender fixed & hard irregular borders lesions

SURGICAL MANAGEMENT Breast Conservation Treatment Lumpectomy Wide excision PARTIAL/Segmental QUADRANTECTOMY ALND/SLND Total Mastectomy with SLND Modified Radical Mastectomy

Nursing Diagnosis Preoperative Nursing Diagnoses Postoperative Nursing Diagnoses Collaborative Problems/Potential Complications
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