Particular Cancers

Leukemia
Group of hematological malignancies
Overproduction of leukocytes, usually at early
stages
Classifications:
Acute and Chronic Lymphocytic Leukemia
Acute and Chronic Myelogenous Leukemia
Assessment
Anemia
Bleeding
Elevated temperature
Enlarged lymph nodes, spleen and liver
Pallor
Palpitations
Bone pain and joint swelling
Normal, elevated to reduced WBC count
Positive bone marrow biopsy identifying
leukemic blast phase cells
Acute Myelogenous Leukemia (AML)
Defect in the Myeloid cells
Affects all age groups
Fever, Infection, Weakness, Fatigue, and Bleeding
Diagnosis: CBC and Bone marrow analysis
Management
Induction Therapy
Cytarabine and Daunorubicin or
Mitoxantrone or Idarubicin, sometimes
Etoposide
Consolidation Therapy
Blood products
GCSF or GMCSF
BMT or PBSCT
Chronic Myelogenous Leukemia (CML)
Pathologic increase in the production of forms of
blasts cells
BCR-ABL gene
Uncommon in people younger than 20 years
3 stages: Chronic, Transformation and Accelerated
Management
Tyrosine kinase inhibitor
Imatinib mesylate (Gleevec)
Interferon alfa (Roferon A) and Cytosine
Oral Chemo
Hydroxyurea or Busulfan
Leukapheresis
Anthracycline chemo
Daunomycin
Acute Lymphocytic Leukemia (ALL)
Uncontrolled proliferation of lymphoblasts
B Lymphocytes 75%, T Lymphocytes 25%.
Most common in young children
BCR ABL gene in 20% of cases
CNS involvement
Management
Induction Therapy
Corticosteroids and Vinca Alkaloids
Intrathecal Methotrexate
Imatinib
Alemtuzumab (Campath)
Chronic Lymphocytic Leukemia (CLL)
Common malignancy of older adults
Malignant clone of B Lymphocyte
Prevalent antigen CD52
B symptoms
Management
Chemo with Fludarabine or Corticosteroids and
Chlorambucil
Rituximab and Alemtuzumab
Leukemia Management
Infection
Bleeding
Fatigue and Nutrition
Chemotherapy
Induction
Consolidation
Maintenance

Management of Infection
1. Protective/Reverse isolation precaution.
2. Hand hygiene.
3. Limit visitors/ Staff entering the room.
4. Strict aseptic technique for all procedures.
5. Give private room with door closed.
6. Avoid fresh fruits, flowers and standing water in
room.
7. Avoid receiving immunization with live virus.
Management for Bleeding
1. < 50,000/mm3 increase risk for bleed <
20,000/mm3 spontaneous bleed occurs.
2. Platelet transfusions.
3. Avoid injections.
4. Pad side rails.
5. Avoid rectal temp and exams.
6. Use soft bristled toothbrush and avoid flossing.
7. Use electric razor.
8. Avoid NSAIDS.
9. Avoid blowing nose.
Hodgkins Disease
Abnormal proliferation of lymphocytes
Characterized by presence of Reed Sternberg cells
in the nodes
Associated with viral infections
Assessment
B Symptoms
Malaise, fatigue and weakness
Anemia and thrombocytopenia
Enlarged lymph nodes, spleen and liver
Staging
Stage 1 Involvement of a single LN
region/extralymphatic organ or site.
Stage 2 Involvement of 2 or more LN regions
on same side of the diaphragm or localized
extralymphatic organ or site.
Stage 3 Involvement of LN regions on both
sides of the diaphragm.
Stage 4 Disseminated involvement of 1 or
more extralymphatic organs with or w/o
associated LN involvement.

Management
External radiation stage 1 and 2
Monitor for signs of infection and bleeding
Multiple Myeloma
Abnormal proliferation of plasma cells with the
bone.
Unknown cause.
The abnormal plasma cells produce abnormal
antibody.
Assessment
Bone pain in the ribs, spine and pelvis
Osteoporosis
Anemia, thrombocytopenia and leukopenia
Elevated calcium and uric acid levels
Spinal cord compression
Renal failure
Diagnostic Exams
Bence Jones Urine Test detects abnormal
globulin in the urine.
Xray or Bone scan establishes the degree of
bone involvement.
Bone Marrow Aspiration detects number of
plasma cell in the bone marrow.
Management
Chemotherapy
Infection and bleeding precautions
2 3 L fluids per day
Encourage ambulation
Skeletal support
Analgesics
IV fluids and diuretics
Administer Pamidronate disodium(aredia) and
Zoledronic acid(Zometa)

Testicular Cancer
Often occurs between 15 40 yrs
Unknown cause; associated with history of
undescended testicle and thru genetics
Types:
Germinal tumors
Nongerminal tumors
Assessment
Painless testicular swelling
Dragging or pulling sensation
Palpable lymphadenopathy
Late: Back or bone pain
Management
Chemo and radiation
Reproductive options
Surgery:
Unilateral of radical Ochiectomy
Cervical Cancer
Preinvasive Cancers
Stage 1 Mild dysplasia
Stage 2 Moderate dysplasia
Stage 3 Severe dysplasia to carcinoma in situ
Risk factors
HPV infection
Smoking
Early first intercourse, multiple sex partners or
male partners with multiple sex partners
Assessment
Painless vaginal postmenstrual and postcoital
bleeding
Foul smelling or serosanguinous vaginal
discharge
Pelvic, lower back, leg or groin pain
Anorexia and weight loss
Dysuria and hematuria
Management
Nonsurgical
Chemotherapy
Cryosurgery
External radiation
Internal radiation implants (intracavitary)
Laser therapy

Surgical
Conization
Hysterectomy
Pelvic exenteration
Ovarian Cancer
Diagnostic exams
Pelvic Exam
Ultrasound
CA-125 assay
Lower GI series or Barium enema
CT Scan
Biopsy
Assessment
GI disturbances
Pelvic pressure
Leg pain and pelvic pain
Slight anorexia
Dysfunctional vaginal bleeding
Management
Total hysterectomy
Bilateral salpingo-oophorectomy
Radiation therapy
Chemotherapy
Cyclophosphamide
Doxurubicin
Cisplastin
Carboplastin
Nursing Intervention
Administer intravenous therapy to alleviate
fluid and electrolyte imbalances
Provide adequate nutrition
Provide pain relief and managing drainage
tubes
Provide small frequent meals
Provide quite environment

Uterine Cancer
Risk factors
Family history of uterine or colon CA
Age : at least 55 years; median age 65 years
Postmenopausal bleeding/Late menopause
Obesity
Unopposed estrogen therapy(ERT)
Polycystic ovary disease
Nulliparity
Assessment
Abnormal uterine/vaginal bleeding or discharge
Low back or abdominal pain
Enlarged uterus
Management
Total hysterectomy
Bilateral salpingo-oophorectomy
Radiation therapy
Chemotherapy
Progestational therapy
Tamoxifen
Bilateral Salpingo-Oophorectomy
Nursing Interventions
Institute routine pre and post-op care
Assess for hemorrhage, infection or other post
surgical complications
Support woman and family through procedure
encourage expression of feelings and reactions
to procedure
Allow woman to verbalize concerns about
sexuality post surgery
Maintain the patient on low residue diet to
prevent bowel movements which might
dislodge apparatus





Breast Cancer
Types:
Ductal Carcinoma In Situ
Invasive
Infiltrating Ductal
Infiltrating Lobular
Medullary
Mucinous
Tubular ductal
Inflammatory
Pagets disease
Etiology
Unknown, but areas under investigation
includes:
Smoking
Age
Family history
Early menarche
Late menopause
Nulliparous or first child after age 34
High fat
Use of oral contraceptive
Assessment
Mass the most common location is the upper
outer quadrant (UOQ)
Mass is NON-tender. Fixed, hard with irregular
borders
Skin dimpling
Nipple retraction
Peau d orange
Lymphedema
Asymmetry
Nipple discharges
Diagnostic exam
Biopsy procedure
Mammography
Management
Tamoxifen Therapy blocks estrogen receptor
sites
Radiation therapy
Surgical Management
Radical Mastectomy removal of tumor, pect.
Major, pect. Minor + LN
Modified Radical Mastectomy pect. Minor
remains, removal of tumor, pect. major + LN
(most commonly done)
Lumpectomy
Quadrantectomy
Nursing Intervention
Post-op
Position patient
Supine
Affected extremity elevated to reduce
edema
Relieve pain and discomfort
Moderate elevation of extremity
IM/IV injection meds
Warm shower on 2nd post-op
Maintain skin integrity
Immediate post-op, snug dressing with
drainage
Maintain patency of drain
Monitor for hematoma with in 12 hour and
apply bandage and ice refer to surgeon
Drainage is removed when the discharge is
less than 30 ml in 24 hour, inform the
doctor to remove JP
Lotions, creams are applied only when the
incision is healed in 4-6 weeks
Promote activity
Support operative site when moving
Hand, shoulder exercise done on 2nd day
Post-op mastectomy exercise 20 minutes
TID
No BP or Iv procedure on the operative side
Heavy lifting is avoided
Elevate the arm at the level of the heart
On a pillow for 45 minutes TID to relieve
transient edema
Gardening is prohibited
Arm > elbow
Elbow > shoulder




Lung Cancer
Rapid growth of abnormal cells in the lungs
Caused by smoking, second smoke, exposure to
harmful substance such as arsenic, asbestos,
radioactive dust, or radon
Types:
Small cell lung cancer
Less common but they grow more quickly
and are more likely to metastasize
Non-small cell lung cancer
Adenocarcinoma
most common type of lung cancer
Squamous cell carcinoma
second most common type of lung
cancer
Large cell anaplastic
Assessment Findings
Persistent cough (productive) with hemoptysis
Chest pain
Dyspnea
Unilateral wheezing
Friction rub
Possible paralysis of the diaphragm
Fatigue
Anorexia
Nausea and vomiting
Pallor
Diagnostic Exam
Chest X-ray may show presence of tumor or
evidence of metastasis to surrounding
structures
Sputum or cytology reveals malignant cell
Bronchoscopy: biopsy reveals malignancy
Thoracentesis: pleural fluid contains malignant
cells
Medical Management
Radiation therapy
Chemotherapy
Laser therapy
Surgery
Thoracotomy with
Pneumonectomy
Lobectomy
Segmental resection
Nursing Interventions
Provide support and guidance to the client as
needed
Provide relief/control pain
Administer medications as ordered and monitor
effects/side effects
Control nausea: administer medications as
ordered, provide oral hygiene, provide small
and more frequent feedings
Provide nursing care for a client with
thoracotomy
Provide client teaching and discharge planning
concerning
Disease process, diagnostic and therapeutic
interventions
Side effects of radiation and chemotherapy
Realistic information about prognosis
Laryngeal Cancer
Is a malignant tumor in the larynx (voice box ),
potentially curable if detected early
Less than 1% of all cancers, common in men than in
women ages 50-70 years of age.
Occurs in : glottic area, supraglottic area, subglottic
area
Risk factors
Carcinogens
tobacco together with alcohol
asbestos
paint fumes
wood dust
chemicals
Exposure to radiation
Straining the voice
Chronic laryngitis
Management:
Surgery
Cordal Stripping
Cordectomy
Partial Laryngectomy
Total Laryngectomy
Radiation therapy
Chemotherapy
Speech therapy
Esophageal speech
Mechanical devices
Tracheoesophageal fistula
Surgical Management
Laryngectomy- surgical removal of part of all of
the larynx and surrounding structures
Partial laryngectomy
Total laryngectomy
Nursing Interventions
Reducing anxiety and depression
Maintaining a patent airway
Promoting alternative communication methods
Adequate nutrition
Promoting positive body image and self-esteem
High fowlers position
Perform tracheostomy care
Monitor signs of aspiration
Assess gag reflex
Assess for hemorrhage and edema in neck
Colorectal Cancer
Etiology
Family history of polyposis and Ovarian and
Breast CA
Age above 50 years
Chronic inflammatory bowel disease
Polyps
Low fiber diet
Clinical Manifestation
Change in bowel habits
Passage of blood in stools
Unexplained anemia
Anorexia,
Weight loss
Fatigue
Diarrhea or Constipation
Diagnosis
Fecal occult blood test
Fiber optic sigmoidoscopy
Biopsy
Colonoscopy
Barium enema
Staging: Dukes Classification Modified
Class A: limited to muscular mucosa and
submucosa
Class B1: extends into mucosa
Class B2: extends through entire bowel wall
into serosa or pericolic fat, no nodal
involvement
Class C1: (+)nodes, limited to bowel wall
Class C2: (+)nodes, extends through entire
bowel wall
Class D: Advanced and with metastasis
Management
Chemotherapy
Adjuvant Therapy
Radiation therapy
Segmental resection with anastomosis
Abdomino perineal traction with sigmoid
colostomy
Ileostomy
Surgical Management
Surgery is the primary treatment
Based on location and tumor size
Resection, anastomosis, and colostomy
(temporary or permanent)
Nursing Intevention: Colostomy
Colostomy begins to function 3-6 days after
surgery
The drainage maybe soft/mushy or semi-solid
depending on the site
Gastric Cancer
Most often develops the distal third and may
spread thru the walls of the stomach into adjacent
tissues, lymphatics and abdominal organs
Men have higher incidence of gastric cancer than
women
Clinical Manifestations
Early
Indigestion or burning sensation
Epigastric, back or retrosternal pain
Full feeling
Late
Nausea and vomiting
Weight loss and Anorexia
Weakness and fatigue
Dysphagia
Iron deficiency anemia
Palpable epigastric mass

Management
Chemotherapy
Radiation therapy
Pharmacologic drugs
Cisplastin
Irinotecan
Doxorubicin
Xeloda
Surgery
Subtotal Gastrectomy
Billroth I
Billroth II
Total Gastrectomy
Nursing Intervention
Encourage the family to support the patient
Offer reassurance and support coping measures
NPO until peristalsis
Do not remove or irrigate NGT w/o orders
Monitor IV therapy
Record intake and output
Monitor daily weights
Assess for signs of dehydration
Liver Cancer
Hepatic tumors may be malignant or benign. Benign
liver tumors were uncommon until the wide spread
use of oral contraceptives. Primary liver tumors are
associated with chronic liver diseases Hepatitis B
and C infection and Cirrhosis.
Clinical Manifestation
Weakness
Anemia
Weight loss
Anorexia
Nausea and vomiting
Right upper quadrant discomfort
Blood tinged ascites
Friction rub over liver
Jaundice
Diagnostic Exam
Increase serum levels of bilirubin
Alkaline phosphatase
Lactic dehydrogenase
AST
GGT
AFP
CEA
Management
Chemotherapy
Percutaneous biliary drainage
Lobectomy
Radiation therapy
Wilms Tumor
Is a malignant tumor that rises from the
metanephric mesoderm cell of the upper role of the
kidney.
Also known as Nephroblastoma
Assessment
Mass is firm, non tender, confined to 1 side and
deep within the flank
Abdominal pain
Urinary retention
Anemia
Pallor
Anorexia
HPN
Management
Surgery
Total Nephrectomy
Partial Nephrectomy
Chemotherapy with or without Radiation
Staging
Stage 1 Tumor confined to the kidney and
completely removes surgically.
Stage 2 Tumor extending beyond the kidney
but completely removes surgically.
Stage 3 Regional spread of the diseases
beyond the kidney w/ residual abdominal dse.
Stage 4 Metastases to lung, liver, bone
distance lymph nodes or other distance sites.
Stage 5 Bilateral diseases.
Nursing Intervention
Monitor BP
Avoid palpation of the abdomen
Place sign at door: Do not palpate abdomen
Prostate Cancer
The most common cancer in the men other than
non melanoma skin cancer
Second most common cause of cancer death in
American men older than 55 y/o
It is estimated that 189,000 new cases of prostate
cancer and 30,200 death occurs annually
Increase risk prostate cancer only 47 % of the men
in sample who were 40 y/o or Older had prostate
cancer screening as part of annual physical
examination.
Risk Factors
Increasing age rapidly with the age of 50 years.
Familial predisposition
Diet high in red meat and fat increase
Heavy metal exposure
Smoking
History of STDs
Clinical Manifestations
Difficulty and frequency of urination
Decrease size and force of urinary stream
Painful ejaculation
Hematuria
Hard pea sized nodule
Late signs:
Weight loss, urinary obstruction, bone pain
radiating to lumbosacral area to legs.
Management
Hormone Manipulation Therapy
Luteinizing hormone
Estrogen
For advance stages:
Pain meds
Radiation therapy
Corticosteriods
Surgery
Orchiectomy(Palliative)
B. Radical Prostatectomy removal of PG
Suprapubic
Retropubic
Perineal
Nursing Intervention
Reducing anxiety
Relieving discomfort
Providing instruction
Preparing patient
Maintaining fluid balance
Relieving pain
Monitoring for hemorrhage and infection