Cancer: Neoplasia
Cancer
 Abnormal, uncontrolled
cell division
 Damage to genes
controlling cell growth
 Cancer cells lose normal
functions
 Divide rapidly
 Invade surrounding cells
Definitions
 Metastasis: abnormal
cells traveling to
different sites and
starting new tumors
 Tumor: abnormal
enlargement
 Neoplasm: same as tumor
Tumors
 Benign – slow growing,
do not mets
 Adenoma
 Malignant – fast
growing, usually mets,
can result in death
 Sarcoma – connective
tissue
 Carcinoma – epithelial
tissue (more common)
Tumors
 Leukemia – cancer in
blood-forming cells in bone
marrow
 Lymphoma – cancer of
lymph tissue
 Glioma – cancer in glial
cells
Causes of Cancer
 Carcinogens
 Exposure to large amounts
of radiation or sun
 Viruses
 Genetic components
Genetic cancers
 Oncogenes: mutated
genes that contribute to
cancer development by
disrupting a cell’s ability
to control its own growth
and DNA repair
mechanisms
 Ties with environmental
component
Minimizing Chance of Cancer
 Healthy lifestyle with
check-ups
 No smoking, drinking
 Low fat, increase fiber
 Exercise
 Self-exams
Minimizing chances of Cancer
 Periodic testing if
genetic ties with cancer
 Cancer curable if caught
early
 Protect from direct sun
if sensitive or fair skin
 Watch moles and
freckles
Testicular Ca
Treatment
Goal: Removal of ALL
cancer cells
Surgery
Radiation therapy
Drug therapy
Surgery
 Large tumors reduced by
radiation or removed by
surgery
 Check “borders” for cells
 Then chemo to eradicate
micro metastasis
 Combination chemotherapy
has a higher cancer cellkill than single drug
Radiation
 Effective non-surgical
treatment
 High doses of radiation
directed at tumor
 Confined to area of
tumor
 Palliation: shrinking of
inoperable tumors for
comfort
Radiation - Proton
 Effective non-surgical
treatment
 Proton beam aimed
directly at tumor
 Radiate tumor only
 Changes ionization
 Change atoms of
diseased cells
Chemotherapy
 Drugs transported via
blood
 Reduce size of tumor for
surgical removal or for
palliation
 Prophylaxis to prevent
recurrence of cancer
 Growth fraction: # tumor
cells undergoing mitosis
Chemotherapy administration
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Intravascular – peripheral
versus central lines
Oral
Topical
Intra cavity
Principles of Chemotherapy
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Most effective against
small tumors – good blood
supply
Small tumors have higher
percent of dividing cells
Nadir: lowest point
neutrophil count has been
depressed – increase
chance for infection
Cell cycle
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Tumor cells similar to non-cancerous cells
Neoplastic and normal cell differ in the
number of cells undergoing cell division
Cancer cells lack normal mechanism of
suppressing cell growth
Anti-cancer drugs target cells that are
dividing
Cell cycle
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Interfere with DNA,
RNA, or protein
synthesis – S-phase
specific
Inhibit microtubule
formation during
mitosis – M-phase
Cell cycle
 Damage DNA
 Cell-cycle nonspecific
 DNA alkylating
agents damage
tumor cells
whether dividing or
not
Combination Chemotherapy
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Each drug active against
the cancer
Different site of action
Different toxicity levels
If similar, toxic levels
occur at different times
Nadirs different times
Total Cure
 Destroy all cancer cells
 One cancer cell can be enough to re-start
proliferation of cells
 Not really total cure, “remission” where cancer
cells not active
Anti-cancer drugs
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“Kills” cells
Interfere with cell
proliferation
Damage cell DNA
Prevent DNA repair
in cell
Protection of Health care
workers
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Prevent
Prevent
through
Prevent
inhalation
absorption
skin
ingestion
Protection of Health care
workers
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Careful disposal of
contaminated materials
Careful handling and/
or disposal of body
fluids contaminated by
chemotherapy within 48
hours
Protection of Family

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Safe handling of
body waste
Double bag items
Wash linens
separately for 48
hours post chemo
Side Effects - General
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B
A
R
F
– bone marrow suppression
– alopecia
– retching
- fatigue
Hematological
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Neutropenia
Leukopenia
Thrombocytopenia
Anemia
Fatigue
Risk for infection
Risk for bleeding
Skin
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Alopecia
From thin wispy
pattern to total loss
of hair
Hair regrows:
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Thicker
Wavier
Darker color
Body systems – GI
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Emetic center triggered
Nausea/ Vomiting
Anorexia
Diarrhea
Constipation
Mucosal tissue
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Stomatitis
Ulcerating lesions on
mucosa
Burning sensation
with fluids
Pain to oral or
esophageal mucosa
Nutrition poor – no
appetite
Neurological
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Parasthesia
Motor weakness fatigue
Paralytic ileus
Urinary
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Hemorrhagic cystitis
Renal toxicity
Purines released during
cell destruction
converted to uric acid
crystals
Cardiopulmonary
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Rare occurrence
Cardiac- toxicity
Pulmonary toxicity
EKG changes
Hepatic

Hepatic toxicity
Reproductive
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Infertility
Cause birth defects
Cause sterility or
decrease sperm
Emotional
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Anticipatory grief
Anger
Anxiety
Depression
Guilt
Sociocultural
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Isolation
Withdrawal
May feel others are
uncomfortable
around them
Developmental
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Varying responses:
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Loss of control
Role change
Spiritual
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Varying responses
Hope
Dependence on God
Anger at God
Guilt for not being
better Christian/
worshipper
Body image disturbance
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Alopecia
Weight loss/ gain
Muscle wasting from
steroid therapy
Loss of previous
functions
Pain
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Chronic pain from
cancer
Will depend on type
and extent of cancer
Goals of Nursing
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Understand what type of
chemo used
Watch for s/s side effects
Pre-med with antiemetics –
ATC medications x 24 hours
Supportive care
Usually given at night
Goals of Nursing
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Prevent infection
Maintain fluid/ elyte balance
Promote adequate
nutrition
Maintain skin
integrity
Goals of Nursing
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Monitor bowel/
elimination patterns
Patient safety (falls)
Maintain emotional
health
Positive body image
Misc. education
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No over the counter
medications
No live virus
immunizations
Watch herbal
supplements – can
increase effect of
chemo drug
Chemotherapy Treatment
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Prehydration
Solution 150-200
ml/hr usually
Pre-med with antiemetics prn or around
the clock (ATC)
Careful I&O
Extravasations
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Vesicants – use
central lines
Different antidotes
for different
vesicants
Follow hospital
protocol
Ulcerations develop –
48-96 hours
Extravasations
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Pain – severe that lasts
Redness – blotchiness
around site
Swelling – occurs
immediately
Extravasations
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Blood return – stop if
none
Ulceration – usually
occurs later
Necrosis – if untreated
Ankylating agents –
Mechanism of action
Ankylating agents –
Mechanism of action
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Cell-cycle non-specific
Works on:

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Already formed DNA
Cross-linked strands
Prevents replication
Alkylating Agents
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Nitrogen mustard
Cyclophosphamide
(Cytoxan)
Chlorambucil
(Leukeran)
Cis-platin
(platinol)
Alkylating agents - Nursing
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Blood dyscrasias
Intake and output
Report any buzzing,
ringing in ears (loss of
high-freq hearing)
s/s allergic reaction
Alkylating agents - Nursing
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Blood counts
GI mucosa – nutrition
important
Skin blistering
Renal/ liver function
tests
Can cause sterility –
use contraception
Alkylating agents –
Interactions
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Immunosuppressants –
increase infection
Anticoagulants – bleeding
Digoxin – decrease dig
effect
Thiazides - leukopenia
Antimetabolites –
Mechanism of action
Antimetabolites
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Methotrexate
5-fluorouracil
Cytosine arabinoside
Cytarabine (Ara-C)
Thioguanine
Antimetabolites
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Cell-cycle specific (S-phase)
Inhibit protein synthesis
Interferes with DNA
synthesis
Antimetabolites - Nursing
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Most toxicity in
hematopoietic and GI
systems – bone marrow
stem cells and GI
epithelium
Renal/ Liver function
tests
s/s respiratory infection
Antimetabolites Interactions
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Decreases Digoxin
Affects protein bound
drugs (ASA, dilantin)
NSAIDs, ASA –
increase toxicity
Other chemo agents/
radiation – increase
effect
Anti-Metabolite:
Methotrexate
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Leucovorin rescue
Form of folic acid
Treats systemic toxic
effects
Administer within the
first 36-42 hours
Cytotoxic antibiotics
Cytotoxic antibiotics
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Doxorubicin
(adriamycin)
Bleomycin
Danorubicin
Idarubicin
Cytotoxic antibiotics
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Cell-cycle non-specific
Interfere with nucleic
acid synthesis
Inhibit DNA & RNA
synthesis
Cytotoxic antibiotics Nursing
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Most toxicities occur:
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Hematopoietic
GI
Reproductive
Cardiac
Cytotoxic antibiotics Nursing
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Vesicant drugs
Assess:
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Pain
Redness
Swelling
Ulceration
Cytotoxic antibiotics –
Interactions
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Digoxin – decrease dig level
Phenobarbital – decreased
chemo effectiveness
Dilantin – decrease dilantin
level
Plant alkaloids
Plant Derivations
Periwinkle
 Pacific yew
 Mandrake
 Campthecus acuminata

Pacific Yew
Periwinkle
Mandrake
Plant alkaloids
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Etopside (VP-16)
Paclitaxel (Taxol)
Vincristine (Oncovin)
Vinblastine
Vinorebline
Plant alkaloids
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Cell-cycle specific (Mphase)
Arrest metaphase by
binding to cell proteins
Inhibit protein
Inhibit RNA synthesis
Plant alkaloids - Nursing
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Check of allergies to plants prior
to administration
Assess for bronchospasms
Can lower seizure threshold
Nutritional plan to combat
constipation
Assess mental status –
depression
Plant alkaloids – Interactions
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Dependent on drug
Calcium channel blockers –
increase vincristine effect
Digoxin – decrease dig
effect
Dilantin – decrease dilantin
effect
Hormones/
Hormone antagonists
 Glucocorticoids
 Act indirectly on
malignant cells
 Estrogens
 Suppress testosterone
production in males
 Alter response of breast
cancers
Hormones/
Hormone antagonists
 Anti-estrogens
 Compete with
estrogens for binding
 Progestins
 Promote palliation/
tumor cell regression
Hormones/ Hormone
antagonists
 Androgens
 Inhibit binding of androgens
 Advanced prostate cancer
 Anti-androgens
 Palliative for advanced
breast carcinomas
 Surgery/ radiation not
appropriate
Hormones - Nursing
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Side effects specific to
the drug given
Most include fluid
retention
Steroids – increase
infection, edema
Masculinizing or feminizing
effects
Hormones - Nursing
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Blood clots
Blood glucose monitoring
Nutrition
Fertility counseling
Blood, liver counts
Hormones – Interactions
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Will depend on the drug
being used
Some treatments used for
other disease processes
Biologic Response Modifiers
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Do not kill tumor cells
Stimulate body’s
immune response
Limits severe
immunosuppressive
effects
Biologic Response Modifiers

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Drugs work by depriving
cancer cells of needed
ingredients
OR inhibiting enzymes
necessary to complete
proliferation
Integrative Cancer Therapy
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Wholistic approach
Herbal therapies
Colonics
Vitamins/ supplements
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Vitamin C
Ave – Fermented wheat germ
Involve family
Low Dose Chemotherapy
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IPT – Insulin
potentiation therapy
10% dose
Integrative care
Results just as
effective as traditional
chemo
Less side effects, i.e.,
alopecia, N/V