CARE OF PATIENTS WITH CANCER

What is CANCER? other tissue and organs to form a

secondary tumor.
- Cancer is a disease process that begins
when an abnormal cell is transformed by
the genetic mutation of the cellular DNA.
This abnormal cell forms a clone and TUMOR GRADING
begins to proliferate abnormally, ignoring
- we examine the tumor through biopsy
growth-regulating signals in the
under a microscope.
environment surrounding the cell. The cells
- abnormality of the cells determines the
acquire invasive characteristics, and
grade of the cancer.
changes occur in surrounding tissues. The
- increasing abnormality increases the grade,
cells infiltrate these tissues and gain access
from 1–4.
to lymph and blood vessels, which carry
the cells to other areas of the body.
- GRADE 1 Cells slightly abnormal and well
differentiated
REMEMBER THAT CANCER CELLS:
- GRADE 2 Cells more abnormal and
- Have uncontrollable growth moderately differentiated
- when we mention carcinoma, the tumor - GRADE 3 Cells very abnormal and poorly
usually arises from surface or glandular differentiated
epithelium - GRADE 4 Cells immature and
- sarcoma: arises from the connective undifferentiated
tissues.
- lymphoma and myeloma start in the cells
of the immune system.

CELLULAR ORIGIN
- CARCINOMA: originates in epithelial tissue
- ADENOCARCINOMA: originates in the
glandular tissue (breast, prostate)
- SARCOMA: originates in fat, muscle blood
vessels, nerves, bones

WARNING SIGNS OF CANCER

Change in bowel or bladder habits
 A sore that does not heal
 Unusual bleeding or discharge
 Thickening or lump in the breast or elsewhere CANCER STAGING
 Indigestion or difficulty in swallowing -Staging is the classification of the extent of the
 Obvious change in a wart or mole disease. There are several types of staging
 Nagging cough or hoarseness methods. The tumor, node, metastases
 Unexplained Anemia (TNM) system classifies cancer by tumor size
(T), the degree of regional spread or node
 Sudden Unexplained weight loss
involvement (N), and distat metastasis (M).
-
OTHER DEFINITIONS AND STAGE LEVEL OF INVOLVEMENT
CHARACTERISTICS OF CANCER ARE: TUMOR
- BENIGN NEOPLASM – Slow-growing, T1 Limited to mucosa and
localized, and encapsulated with well- submucosa
defined borders. Not cancerous.
T2 Extension into but not
- MALIGNANT NEOPLASM – Aggressive form
through mascularis propria
that invades and destroys tissues. having
cells or processes that are characteristic of T3 Invasion of perirectal fat
cancer
- METASTASIS – Cells travel through the
blood or lymphatic system and invade

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 T4 Invasion of adjacent mutation. In both cases these genes lead to
structures cancerous changes in the tissues.
- TUMOR SUPPRESSOR GENES – these genes
NODES normally inhibit cell division and prevent
N0 No involved lymph nodes survival of cells that have damaged DNA. In
N1 Fewer than four regional patients with cancer these tumor
nodes involved suppressor genes are often disabled. This is
caused by cancer-promoting genetic
N2 More than four regional changes. Typically, changes in many genes
nodes involved are required to transform a normal cell into
a cancer cell.
N3 Distant nodes involved
METASTASIS
M0 No metastasis
M1 Distant metastasis

A NUMERICAL SYSTEM ALSO IS USED

TO CLASSIFY THE EXTENT OF ASSESSMENT (GENERAL)
DISEASE.
SUBJECTIVE CUES OBJECTIVE CUES
Stage 0 Cancer in situ (limited to surface cells)
 Fatigue  Lump or area of
Stage 1 Cancer limited to the tissue of origin,
 Changes in bowel or thickening that can
evidence of tumor growth
bladder habits be felt under the
Stage 2 Limited local spread of cancerous
 Difficulty swallowing skin
cells
 Persistent  Weight changes,
Stage 3 Extensive local and regional spread
indigestion or including
Stage 4 Distant metastasis
discomfort after unintended loss or
eating gain
PATHOPHYSIOLOGY  Skin changes, such
 Persistent,
- Cancer cells differ from normal cells in size, unexplained muscle as yellowing,
structure, function, and growth rate. These or joint pain darkening or
malignant cells lack the normal controls of redness of
growth seen in healthy cells, and grow the skin, sores that
uncontrollably. This uncontrolled growth won't heal, or
allows the cancer cells to invade adjacent changes to existing
structures and then destroy surrounding moles
tissues and organs. Malignant cells may  Persistent cough or
also metastasize to other areas of the body trouble breathing
through the cardiovascular or lymphatic  Hoarseness
systems. This uncontrolled growth and  Persistent,
spread of cancer cells can eventually unexplained fevers
interfere with one or more of a person's or night sweats
vital organs or functions and possibly lead  Unexplained
to death. The primary sites of cancer bleeding or bruising
metastasis are the bone, the lymph nodes,
the liver, the lungs, and the brain

THERE ARE TWO BROAD CATEGORIES OF

GENES THAT
ARE AFFECTED:
- ONCOGENES – these are cancer causing
genes. They may be normal genes which
are expressed at inappropriately high levels
in patients with cancers or they may be
altered or changed normal genes due to

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 MEDICAL MANAGEMENT- PHYSICIAN’S ORDER

SPECIAL NOTATION LABORATORY /DIAGNOSTIC MEDICATION IV FLUID

EXAMINATION

Treatment may be - Computed tomography CHEMOTHERAPEUTIC IV as ordered

primary (to kill (CT) scans, DRUGS
cancer cells), adjuvant (to - Magnetic resonance - Alkylating agents
kill remaining imaging (MRI) - Topoisomerase
cancer cells), or palliative - Positron emission inhibitors
(to treat signs tomography (pet) - Mitotic inhibitors
and symptoms) - Ultrasound scans. - Antimetabolites
- External-beam
- SURGERY radiation therapy Antibiotics
- STEM CELL Enzymes
TRANSPLANTS  Tomotherapy
- RADIATION THERAPY  Proton therapy PROTEASOME
- SMOKING CESSATION INHIBITORS
- BALANCED
- Internal radiation
NUTRITION
therapy Tyrosine kinase inhibitors
 Brachy therapy

- X ray examination
- Mammography
- Cytology studies
- Biopsy
 Needle
 Incisional
 o Excisional

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  LARGE CELL—fast-growing, early
metastasis

ASSESSMENT

SUBJECTIVE OBJECTIVE CUES

CUES

CARE OF PATIENTS WITH CANCER

FATIGUEOF THE LUNGS
• Coughing due to irritation
from mass. Presence of
mucous or exudate may not
What is LUNG CANCER? be until later in disease.
• Coughing up blood
- Lung cancer is the abnormal, uncontrolled (hemoptysis).
cell growth in lung tissues, resulting in a • Weight loss due to the caloric
tumor. A tumor in the lung may be primary needs of the tumor, taking
when it develops in lung tissue. It may be away from the needs of the
secondary when it spreads (metastasizes) body.
from cancer in other areas of the body, • Anorexia.
such as the liver, brain, or kidneys. There • Difficulty breathing (dyspnea)
are two major categories of lung cancer— caused by damaged lung
small cell and non-small cell. tissue. The patient begins to
- Repetitive exposure to inhaled irritants have respiratory problems
increases a person’s risk for lung cancer. later in the disease.
Cigarette smoke, occupational exposures, • Chest pains as mass presses
air pollution containing benzopyrenes, and on surrounding tissue; may
hydrocarbons have all been shown to not be until late in disease.
increase risk. • Sputum production.
• Pleural effusion.
SMALL CELL-OAT CELL CARCINOMA – • Hoarseness
FAST-GROWING, EARLY METASTASIS
MEDICAL MANAGEMENT-PHYSICIAN’S
ORDER

SPECIAL NOTATION

• Surgical removal of affected area of the lung

(Wedge resection, segmental resection,
NON-SMALL CELL: lobectomy) or total lung (pneumonectomy).
• Radiation therapy to decrease tumor size.
 ADENOCARCINOMA—moderate growth • Oxygen therapy to supplement the needs of the
rate, early metastasis body.
 SQUAMOUS CELL—slow-growing, late • High-protein, high-calorie diet to meet the
metastasis needs of the body.

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 LABORATORY /DIAGNOSTIC EXAMINATION

• Mass in lung shown on chest x-ray.

• CT scan shows mass, lymph node involvement.
• Bronchoscopy may show cancer cells on bronchoscopic washings;
may reveal tumor site.
• Cancer cells seen in sputum.
• Biopsy will show cell type:
• Needle biopsy through chest wall for peripheral tumors.
• Tissue biopsy from lung for deeper tumors.
• Bone scan or CT scans shows metastasis of the disease.

MEDICATIONS

• Chemotherapy often with a combination of drugs: (Cyclophosphamide, Doxorubicin, Vincristine,

Etoposide, Cisplatin)
• may see relapse after treatment
• Administer antiemetics to combat side effects of chemotherapy: (Ondansetron, Prochlorperazine)
• Administer analgesics for pain control: (Morphine, Fentanyl)
• IV as ordered

CARE OF PATIENTS WITH CANCER OF THE LIVER

LIVER CANCER exposure to aflatoxins; and excessive
alcohol consumption.
 Liver cancer is cancer that begins in the PATHOPHYSIOLOGY
cells of your liver. Your liver is a football-
sized organ that sits in the upper right • Liver cancer happens when liver cells
portion of your abdomen, beneath your develop changes (mutations) in their DNA.
diaphragm and above your stomach. A cell's DNA is the material that provides
 Several types of cancer can form in the instructions for every chemical process in
liver. The most common type of liver your body. DNA mutations cause changes
cancer is hepatocellular carcinoma, which in these instructions. One result is that cells
begins in the main type of liver cell may begin to grow out of control and
(hepatocyte). Other types of liver cancer, eventually form a tumor — a mass of
such as intrahepatic cholangiocarcinoma cancerous cells.
and hepatoblastoma, are much less • Sometimes the cause of liver cancer is
common. known, such as with chronic hepatitis
 Risk factors include: chronic infection of infections. But sometimes liver cancer
hepatitis B or C virus; liver cirrhosis; happens in people with no underlying
inherited liver diseases such as diseases and it's not clear what causes it.
hemochromatosis and Wilson’s disease;
diabetes; nonalcoholic fatty liver disease;

ASSESSMENT

SUBJECTIVE CUES OBJECTIVE CUES

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 • Fatigue • Weight loss due to the caloric needs of the tumor, taking away from the
• Loss of appetite needs of the body.
• Generalized weakness • Abdominal swelling
• Anorexia. • Jaundice
• Upper abdominal pain • White chalky stool

MEDICAL MANAGEMENT- PHYSICIAN’S ORDER

SPECIAL NOTATION LABORATORY MEDICATION IV FLUID

/DIAGNOSTIC
EXAMINATION

• Surgical removal of • CT scan shows mass • Chemotherapy often IV as ordered

affected area of the • Biopsy will show cell with A combination of
liver or liver transplant type: drugs:
• Radiation therapy to • Needle biopsy (cyclophosphamide
decrease tumor size. through liver Doxorubicin,
• Oxygen therapy to • tissue for peripheral vincristine, etoposide,
supplement the needs tumors. cisplatin) may see
of the body. • Tissue biopsy from relapse after
• High-protein, high- liver for treatment
calorie diet to meet • deeper tumors. • Administer
the needs of the body. • Bone scan or CT scans antiemetics to
shows Combat side effects of
• metastasis of the chemotherapy:
disease. (Ondansetron,
• Ultrasound of the liver Prochlorperazine).
• Serum AFP, amylase, • Administer analgesics
lipase for pain control:
(Morphine, fentanyl)
• Administer Diuretics
as needed to
combat fluid
retention: (Aldactone
or Lasix)

CARE OF PATIENTS WITH CANCER OF THE THYROID

Thyroid cancer can be very aggressive. Most cases of thyroid

• Thyroid cancer occurs in the cells of the cancer can be cured with treatment.
thyroid — a butterfly-shaped gland located at
the base of your neck, just below your Adam's • Thyroid cancer rates seem to be increasing.
apple. Your thyroid produces hormones that Some doctors think this is because new
regulate your heart rate, blood pressure, body technology is allowing them to find small
temperature and weight. thyroid cancers that may not have been found
in the past. Risk factors include: of the female
• Thyroid cancer might not cause any symptoms gender, exposure to high levels of radiation and
at first. But as it grows, it can cause pain and certain inherited genetic syndromes.
swelling in your neck. Several types of thyroid
cancer exist. Some grow very slowly and others
Types of Thyroid Cancer

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 • Thyroid cancer is classified into types Follicular Thyroid Cancer.
based on the kinds of cells found in the tumor. • Follicular thyroid cancer also arises from the
Your type is determined when a sample of follicular cells of the thyroid. It usually affects
tissue from your cancer is examined under a
microscope. The type of thyroid cancer is
considered in determining your treatment and
prognosis.

people older than age 50. Hurthle cell cancer is

a rare and potentially more aggressive type of
follicular thyroid cancer.

Papillary Thyroid Cancer Anaplastic Thyroid Cancer

• The most common form of thyroid cancer, •Anaplastic thyroid cancer is a rare type of
papillary thyroid cancer arises from follicular thyroid
cells, which produce and store thyroid cancer that begins in the follicular cells. It
hormones. Papillary thyroid cancer can occur at grows
any age, but most often it affects people ages rapidly and is very difficult to treat.
30 to 50. Doctors sometimes refer to papillary Anaplastic
thyroid cancer and follicular thyroid cancer thyroid cancer typically occurs in adults age
together as differentiated thyroid cancer. 60 and
older.

normal
cells
would.
The

Medullary Thyroid Cancer

•Medullary thyroid cancer begins in
thyroid cells called C cells, which produce the accumulating abnormal thyroid cells form a
hormone calcitonin. Elevated levels of calcitonin tumor. The abnormal cells can invade nearby
in the blood can indicate medullary thyroid tissue and can spread (metastasize) to other
cancer at a very early stage. Certain genetic parts of the body.
syndromes
ASSESSMENT
Other Rare Types Subjective Cues Objective cues
•Other very rare types of cancer that start in  Fatigue  Weight loss due
the  Loss of appetite to the caloric
thyroid include thyroid lymphoma, which  Generalized needs of the
begins in weakness tumor, taking
the immune system cells of the thyroid, and  Pain in your neck away
thyroid and throat  from the needs
sarcoma, which begins in the connective  Difficulty of the body.
tissue cells swallowing  Anorexia.
of the thyroid.  A lump (nodule)
that can be felt
PATHOPHYSIOLOGY through the skin
on your neck
 Changes to your
• It's not clear what causes thyroid cancer.
voice, including
Thyroid canceroccurs when cells in your thyroid
increasing
undergo genetic changes (mutations). The
hoarseness
mutations allow the cells to grow and multiply
rapidly. The cells also lose the ability to die, as  Swollen lymph

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 nodes  Surgical removal of affected area of the
thyroid, (thyroid lobectomy)
MEDICAL MANAGEMENT- PHYSICIAN’S  Thyroidectomy
ORDER  Lymph node dissection

SPECIAL NOTATION

 Radiation therapy to decrease tumor

size. Medication
 Oxygen therapy to supplement the • • Chemotherapy often with a combination of
needs of the body. drugs:
 High-protein, high-calorie diet to meet • • cyclophosphamide, doxorubicin, vincristine,
the needs of the body. etoposide, cisplatin
• • may see relapse after treatment
Laboratory /diagnostic examination
 CT scan or MRI shows mass • • Administer antiemetics to combat side
 Biopsy will show cell type: effects of chemotherapy:
 Needle biopsy through thyroid tissue • • ondansetron, prochlorperazine
for peripheral tumors.
 Ultrasound of the the thyroid • • Administer analgesics for pain control:
 Thyroid panel T3,T4 and calcitonin • • morphine, fentanyl
 TSH • •thyroid hormone replacement therapy:
 Radioiodine scan levothyroxine
 Positron emission tomography (PET) • • radioactive iodine
scan • IV Fluid – as ordered

STOMACH CANCER

STOMACH CANCER become much more common. This area of

Stomach cancer usually begins in the the stomach is called the
mucus-producing cells that line the gastroesophageal junction.
stomach. This type of cancer is called
adenocarcinoma.

For the past several decades, rates of

cancer in the main part of the stomach
(stomach body) have been falling
worldwide. During the same period, cancer
in the area where the top part of the
stomach (cardia) meets the lower end of
the swallowing tube (esophagus) has

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 Risk Factors
Factors that increase your risk of stomach
cancer located in the stomach body include:
• A diet high in salty and smoked foods
• A diet low in fruits and vegetables
• Family history of stomach cancer
• Infection with Helicobacter pylori
• Long-term stomach inflammation
• Pernicious anemia
• Smoking
• Stomach polyps

PATHOPHYSIOLOGY
In general, cancer begins when an error
Stages of Stomach Cancer (mutation) occurs in a cell's DNA. The mutation
The stages of adenocarcinoma of the causes the cell to grow and divide at a rapid
stomach or esophagus include: rate and to continue living when a normal cell
• Stage I. At this stage, the tumor is limited would die. The accumulating cancerous cells
to the top layer of tissue that lines the inside of form a tumor that can invade nearby
the esophagus or stomach. Cancer cells also structures. And cancer cells can break off from
may have spread to a limited number of nearby the tumor to spread throughout the body.
lymph nodes. Gastroesophageal junction cancer is associated
with having gastrointestinal reflux disease
• Stage II. The cancer at this stage has
(GERD) and, less strongly, with obesity and
spread deeper, growing into a deeper muscle
smoking. GERD is a condition
layer of the esophagus or stomach wall. Cancer
caused by frequent backflow of stomach acid
may also have spread to more of the lymph
into the esophagus.
nodes.
• Stage III. At this stage, the cancer may
There is a strong correlation between a diet
have grown through all the layers of the
high in smoked and salted foods and stomach
esophagus or stomach and spread to nearby
cancer located in the main part of the stomach.
structures. Or it may be a smaller cancer that
As the use of refrigeration for preserving foods
has spread more extensively to the lymph
has increased around the world, the rates of
nodes.
stomach cancer have
• Stage IV. This stage indicates that the declined.
cancer has spread to distant areas of the body.

Assessment
Subjective Cues Objective cues
 Fatigue  Weight loss due to the caloric needs of the
 Loss of appetite tumor, taking away from the needs of the body.
 Generalized weakness  Anorexia.
 Feeling bloated after eating  Vomiting
 Feeling full after eating small amounts of food
 Severe, persistent heartburn
 Severe indigestion that is always present
 Unexplained, persistent nausea
 Stomach pain

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 MEDICAL/SURGICAL
MANAGEMENT

Special Notation Laboratory /diagnostic Medication IV fluid

examination
• Surgical removal of • CT scan or MRI Targeted therapy uses drugs that IV as ordered
affected area of shows mass attack specific abnormalities within
the stomach • Biopsy will show cancer cells or that direct your
(subtotal cell type: immune system to kill cancer cells
gastrectomy) • Needle biopsy (immunotherapy). Targeted drugs
• Total gastrectomy through the used to treat stomach cancer include:
• Lymph node stomach tissue for - ∙ Trastuzumab (Herceptin) for
dissection peripheral tumors. stomach cancer cells that
• Radiation therapy • Ultrasound of the produce too much HER2
to decrease tumor stomach - ∙ Ramucirumab (Cyramza) for
size. • Endoscopy of the advanced stomach cancer
• Oxygen therapy to stomach that hasn't responded to
supplement the • Positron emission other treatments
needs of the body. tomography - ∙ Imatinib (Gleevec) for a rare
• High-protein, high- • (PET) form of stomach cancer called
calorie diet to meet gastrointestinal stromal
the needs of the tumor
body. - ∙ Sunitinib (Sutent) for
gastrointestinal stromal
tumors
- ∙ Regorafenib (Stivarga) for
gastrointestinal stromal
tumors

Administer antiemetics to combat

side effects of chemotherapy:
• ondansetron,
prochlorperazine

Administer analgesics for pain control:

• morphine, fentanyl

CARE OF PATIENTS WITH COLORECTAL CANCER

WHAT IS COLON CANCER? of the colon. Over time some of these
 Colon cancer is a type of cancer that polyps can become colon cancers.
begins in the large intestine (colon).  Polyps may be small and produce few,
The colon is the final part of the if any, symptoms. For this reason,
digestive tract doctors recommend regular screening
 Colon cancer typically affects older tests to help prevent colon cancer by
adults, though it can happen at any identifying and removing polyps
age. It usually begins as small, before they turn into cancer.
noncancerous (benign) clumps of cells  If colon cancer develops, many
called polyps that form on the inside treatments are available to help

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 control it, including surgery, radiation • Exercise most days of the week. Try to get
therapy and drug treatments, such as at least 30 minutes of exercise on most days. If
chemotherapy, targeted therapy and you've been inactive, start slowly and build up
immunotherapy. gradually to 30 minutes. Also, talk to your
 Colon cancer is sometimes called doctor before starting any exercise program.
colorectal cancer, which is a term that • Maintain a healthy weight. If you are at a
combines colon cancer and rectal healthy weight, work to maintain your weight
cancer, which begins in the rectum. by combining a healthy diet with daily exercise.
 Adenocarcinoma is the most common If you need to lose weight, ask your doctor
type of colon cancer and may spread about healthy ways to achieve your goal. Aim to
by direct extension through the walls lose weight slowly by increasing the amount of
of the intestine exercise you get and reducing the number of
calories you eat.

PATHOPHYSIOLOGY
 Doctors aren't certain what causes most
colon cancers.
 In general, colon cancer begins when
healthy cells in the colon develop changes
(mutations) in their DNA. A cell's DNA
contains a set of instructions that tell a cell
RISK FACTORS what to do.
Factors that may increase your risk of colon  Healthy cells grow and divide in an orderly
cancer include: way to keep your body functioning
 Older age. Colon cancer can be diagnosed normally. But when a cell's DNA is
at any age, but a majority of people with damaged and becomes cancerous, cells
colon cancer are older than 50. continue to divide — even when new cells
 African-American race. aren't needed. As the cells accumulate,
 Inflammatory intestinal conditions. they form a tumor.
 Inherited syndromes that increase colon  With time, the cancer cells can grow to
cancer risk. invade and destroy normal tissue nearby.
 Family history of colon cancer. And cancerous cells can travel to other
 Low-fiber, high-fat diet, diet high in red parts of the body to form deposits there
meat and processed meat.  (metastasis).
 Sedentary lifestyle
 Diabetes. ASSESSMENT FINDINGS
 Obesity.
 Smoking. Subjective Cues Objective cues
 Alcohol.  ∙ Fatigue  Unexplained weight
 Radiation therapy for cancer.  ∙ Loss of appetite loss due to the
 ∙ Generalized caloric needs of the
LIFESTYLE CHANGES TOREDUCE THE weakness tumor, taking away
RISK OF COLORECTAL CANCER:  ∙ Persistent from the needs of
• Eat a variety of fruits, vegetables and abdominal the body.
whole grains. Fruits, vegetables and whole discomfort, such as  Anorexia.
grains contain vitamins, minerals, fiber and cramps, gas or pain  A persistent change
antioxidants, which may play a role in cancer  ∙ A feeling that your in your bowel
prevention. Choose a variety of fruits and bowel doesn't habits,including
vegetables so that you get an array of vitamins empty completely diarrhea or
and nutrients. constipation or a
change in the
• Drink alcohol in moderation, if at all. If you
consistency of your
choose to drink alcohol, limit the amount of
stool
alcohol you drink to no more than one drink a
 Rectal bleeding or
day for women and two for men.
blood in your stool
• Stop smoking. Talk to your doctor about
ways to quit that may work for you.

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 SPECIAL NOTATION  ▪ Biopsy is confirmative for cancer.
 ▪ Ultrasonography to further delineate the
 ▪ Surgical removal of the polyp mass.
(polypectomy) or laparoscopic route  ▪ CT scan to check for metastasis
endoscopic mucosal resection partial  ▪ MRI and Positive emission tomography
colectomy with ostomy creation scan
 Lymph node dissection
 Radiation therapy.
 Radiation therapy to decrease tumor size. MEDICATIONS
 Oxygen therapy to supplement the needs
of the body. Chemotherapy before surgery to shrink some
 High-protein, high-calorie diet to meet the tumors, or after surgery:
needs of the body.  cyclophosphamide
 methotrexate
LABORATORY/DIAGNOSTIC  fluorouracil
EXAMINATION  doxorubicin
 ▪ Colonoscopy or sigmoidoscopy  epirubincin
 ▪ Fecal occult blood test  vincristine
 ▪ Double contrast barium enema  paclitaxel
 ▪ Digital rectal exam  docetaxel
 ▪ carcinoembryonic antigen, or CEA blood Administer analgesics for pain control:
level  morphine, fentanyl

BREAST CANCER

BREAST CANCER

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 Studies show that by age 80, about 1 in 8 ▪ IDC is the most common type of breast
women will have breast cancer. Ten percent of cancer, making up nearly 70- 80% of all breast
all breast cancers are inherited. Two major cancer diagnoses.
genes have been identified— BRCA1 and
▪ IDC is also the type of breast cancer that can
BRCA2. Despite the research and advances in
most commonly affects men.
medicine, the cause of breast cancer is
unknown. Some studies have implicated a
higher-fat diet. Some medications, like
estrogen, seem to increase the risk of breast
cancer. Exposure to radiation also increases the
risk. Childlessness and delayed childbirth also
may be factors.

Lobar Carcinoma in Situ

TYPES OF MALIGNANT BREAST
CANCER Lobular Carcinoma In Situ (LCIS) is a
condition where abnormal cells are found in the
lobules of the
Ductal Carcinoma in Situ breast. The atypical cells have not spread
outside of the lobules into the surrounding
What Is Ductal Carcinoma In Situ? breast tissue.
▪ Ductal carcinoma in situ (DCIS) is a
non-invasive cancer where abnormal cells have ▪ LCIS is highly treatable and seldom becomes
been found in the lining of the breast milk duct. invasive cancer. However, having LCIS in one
The atypical cells have not spread outside of the breast increases the risk of developing breast
ducts into the surrounding breast tissue. Ductal cancer in either breast.
carcinoma in situ is very early cancer that is
highly treatable, but if it’s left untreated or Invasive Lobular Breast Cancer
undetected, it may spread into the surrounding
breast tissue.
What Is Invasive Lobular Breast
Cancer?
 ▪ Invasive breast cancer that begins in the
lobules (milk glands) of the breast and
spreads to surrounding normal tissue. It
can also spread through the blood and
lymph systems to other parts of the body.
 ▪ Invasive lobular breast cancer is
the second most common type of breast
cancer. Over 10% of invasive breast
cancers are invasive lobular carcinomas.
Invasive Ductal Carcinoma  ▪ Though mammograms are helpful and
important, they are less likely to detect
What Is Invasive Ductal Carcinoma? invasive lobular breast cancer than other
▪ The abnormal cancer cells that began forming types of breast cancers. Invasive lobular
cancer doesn’t always appear clearly on a
in the milk ducts have spread beyond the ducts
into other parts of the breast tissue. Invasive mammogram, instead an MRI might be
needed.
cancer cells can
also spread to other parts of the body. It is also
sometimes called infiltrative ductal carcinoma.
riple Negative Breast Cancer

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What Is Triple Negative Breast which cancer cells infiltrate the skin and lymph
vessels of the breast. It often produces no
Cancer? distinct tumor or lump that can be felt and
A diagnosis of triple negative breast isolated within the breast. But when the lymph
cancer means that the three most common vessels become blocked by the breast cancer
types of receptors known to fuel most breast cells, symptoms begin to appear.
cancer growth–estrogen, progesterone, and the
HER-2/neu gene– are not present in the cancer
tumor. This means that the breast cancer cells Metastatic Breast Cancer
have tested negative for hormone epidermal
growth factor receptor 2 (HER-2), estrogen What Is Metastatic Breast Cancer?
receptors (ER), and progesterone receptors
(PR). ▪ Metastatic breast cancer is also
classified as Stage 4 breast cancer. The cancer
▪ Since the tumor cells lack the necessary has spread to other parts of the body. This
receptors, common treatments like hormone usually includes the lungs, liver, bones or brain.
therapy and drugs that target estrogen,
progesterone, and HER-2 are
ineffective. Using chemotherapy to treat triple
negative breast cancer is still an effective
option. In fact, triple negative breast cancer
may respond even better to chemotherapy in
the earlier stages than many other forms of
cancer.

Inflammatory Breast Cancer

▪ Inflammatory breast cancer is an

aggressive and fast-growing breast cancer in
 Researchers have identified hormonal,
lifestyle and environmental factors that may
increase your risk of breast cancer. But it's
not clear why some people who have no risk
factors develop cancer, yet other people
with risk factors never do. It's likely that
breast cancer is caused by a complex
interaction of your genetic makeup and your
environment.
PATHOPHYSIOLOGY
RISK FACTORS
 Doctors know that breast cancer occurs
when some breast cells begin to grow  Being female. Women are much more likely
abnormally. These cells divide more rapidly than men are to develop breast cancer.
than healthy cells do and continue to  Increasing age. Your risk of breast cancer
accumulate, forming a lump or mass. Cells increases as you age.
may spread (metastasize) through your  A personal history of breast conditions. If
breast to your lymph nodes or to other parts you've had a breast biopsy that found
of your body. lobular carcinoma in situ (LCIS) or atypical
hyperplasia of the breast, you have an
 Breast cancer most often begins with cells increased risk of breast cancer.
in the milk-producing ducts (invasive ductal  A personal history of breast cancer. If you've
carcinoma). Breast cancer may also begin in had breast cancer in one breast, you have an
the glandular tissue called lobules (invasive increased risk of developing cancer in the
lobular carcinoma) or in other cells or tissue other breast.
within the breast.  A family history of breast cancer. If your
mother, sister or daughter was diagnosed
with breast cancer, particularly at a young

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 age, your risk of breast cancer is increased.  Redness or pitting of the skin over your
Still, the majority of people diagnosed with breast, like the skin of an orange
breast cancer have no family history of the
disease.
Breast Dimpling
 Inherited genes that increase cancer risk.
Certain gene mutations that increase the risk
of breast cancer can be passed from parents
to children. The most well-known gene
mutations are referred to as BRCA1 and
BRCA2. These genes can greatly increase
your risk of breast cancer and other cancers,
but they don't make cancer inevitable.
 Radiation exposure. If you received radiation
treatments to your chest as a child or young
adult, your risk of breast cancer is increased.
 Obesity. Being obese increases your risk of
breast cancer.
Inverted Nipple
 Beginning your period at a younger age.
Beginning your period before age 12
increases your risk of breast cancer.
 Beginning menopause at an older age. If you
began menopause at an older age, you're
more likely to develop breast cancer.
 Having your first child at an older age.
Women who give birth to their first child
after age 30 may have an increased risk of
breast cancer.
 Having never been pregnant. Women who
Orange peel like skin on the breast
have never been pregnant have a greater
risk of breast cancer than do women who
have had one or more pregnancies.
 Postmenopausal hormone therapy. Women
who take hormone therapy medications that
combine estrogen and progesterone to treat
the signs and symptoms of menopause have
an increased risk of breast cancer. The risk of
breast cancer decreases when women stop
taking these medications.
 Drinking alcohol. Drinking alcohol increases
MEDICAL/SURGICAL
the risk of breast cancer. MANAGEMENT

SPECIAL NOTATION
Signs and Symptoms
 Surgical removal of affected area of
Signs and symptoms of breast cancer may
the lymph nodes lumpectomy for
include:
small tumors mastectomy
 A breast lump or thickening that feels  Lymph node dissection
different from the surrounding tissue  Radiation therapy.
 Change in the size, shape or appearance of a  Prophylactic bilateral mastectomy for
women with BRCA1 or BRCA2 genes.
breast
 Radiation therapy to decrease tumor
 Changes to the skin over the breast, such as
size.
dimpling  Oxygen therapy to supplement the
 A newly inverted nipple needs of the body.
 Peeling, scaling, crusting or flaking of the  High-protein, high-calorie diet to meet
pigmented area of skin surrounding the the needs of the body.
nipple (areola) or breast skin

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 feeling left in the nipple. If a woman has
Types of Mastectomies larger breasts, the nipple may look out of
place after the breast is reconstructed. As a
Simple or Total Mastectomy result, many doctors feel that this surgery
 In this procedure, the surgeon removes is best done in women with small to
the entire breast, including the nipple, medium sized breasts. This procedure
areola, and skin. Some underarm lymph leaves fewer visible scars, but it also has a
nodes may be removed depending on risk of leaving behind more breast tissue
the situation. Most women, if they are than other forms of mastectomy. This
hospitalized, can go home the next day. could result in a higher risk of cancer
developing than for a skin-sparing or
simple mastectomy. Improvements in
Skin Sparing Mastectomy
technique have helped lower this risk and
experts consider nipple-sparing
 In this procedure, most of the skin over
mastectomy to be an acceptable treatment
the breast is left intact. Only the breast
for breast cancer in properly selected
tissue, nipple and areola are removed.
women.
The amount of breast tissue removed is
the same as with a simple mastectomy
and implants or tissue from other parts
of the body can be used during the Modified Radical Mastectomy
surgery to reconstruct the breast.
 A modified radical mastectomy
 Many women prefer skin-sparing combines a simple mastectomy with the
mastectomy because it offers the removal of the lymph nodes under the arm
advantage of less scar tissue and a (called an axillary lymph node dissection).
reconstructed breast that seems more
natural. But it may not be suitable for
larger tumors or those that are close to
the surface of the skin.

 The risk of local cancer recurrence with

this type of mastectomy is the same as
with other types of mastectomies.
Radical Mastectomy
Nipple-Sparing Mastectomy
 This extensive surgery is rarely done now.
 Nipple-sparing mastectomy is a The surgeon removes the entire breast,
variation of the skin-sparing mastectomy. axillary (underarm) lymph nodes, and the
The breast tissue is removed, but the pectoral (chest wall) muscles under the
breast skin and nipple are left in place. This breast. This surgery was once very
can be followed by breast reconstruction. common, but less extensive surgery (such
The surgeon often removes the breast as the modified radical mastectomy) has
tissue beneath the nipple (and areola) been found to be just as effective and with
during the procedure to check for cancer fewer side effects. This operation may still
cells. If cancer is found in this tissue, the be done for large tumors that are growing
nipple must be removed. into the pectoral muscles.

 It is more often an option for women who Double Mastectomy

have a small, early-stage cancer near the
outer part of the breast, with no signs of  When both breasts are removed, it is called
cancer in the skin or near the nipple. a double (or bilateral) mastectomy.
Double mastectomy is done as a risk-
 As with any surgery, there are risks. reducing surgery for women at very high
Afterward, the nipple may not have a good risk for getting breast cancer, such as those
blood supply, causing the tissue to shrink with a BRCA gene mutation. Most of these
or become deformed. Because the nerves mastectomies are simple mastectomies,
are also cut, there often may be little or no but some may be nipple-sparing. There are

MS LEC ONCOLOGY, LANDINGINHANNAH

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 other circumstances where a double
mastectomy might be done as part of a
women's breast cancer treatment plan.
This is done after careful consideration and
discussion between the patient and their
cancer care team.

CANCER OF THE
known toOVARIES
increase the risk of ovarian
cancer.
 Family history of ovarian cancer.
OVARIAN CANCER  Estrogen hormone replacement therapy.
 Age when menstruation started and ended.
 Ovarian cancer is a type of cancer that
begins in the ovaries. The female Three Types of Ovarian Cancer
reproductive system contains two ovaries,
one on each side of the uterus. The ovaries Epithelial Ovarian Cancer
— each about the size of an almond —
produce eggs (ova) as well as the  Is a tumor starts on the outside of the
hormones estrogen and progesterone. ovary. The majority of cancer-causing
ovarian tumors are epithelial
 Ovarian cancer often goes undetected until
it has spread within the pelvis and
abdomen. At this late stage, ovarian cancer
is more difficult to treat. Early-stage
ovarian cancer, in which the disease is
confined to the ovary, is more likely to be
treated successfully.

RISK FACTORS Stromal Cancer

 Older age.  Starts from ovarian cells that make

 Inherited gene mutations. hormones. Doctors can typically diagnose
 Other gene mutations, including those these early. They make up about 1 percent
associated with Lynch syndrome, are of ovarian cancer.

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 Subjective Cues
 Fatigue  Weight loss due to
 Loss of appetite the caloric needs of
 Generalized the tumor, taking
weakness away from the needs
 Discomfort in the of the body.
pelvis area  Anorexia.
 Quickly feeling full  Vomiting
when eating  Abdominal bloating
or swelling
Germ Cell Cancer  Changes in bowel
habits, such as
 Starts in the egg cells. These tumors are constipation
very rare, making up less than 2% of  A frequent need to
ovarian cancers. They occur in younger urinate
women and girls.
LABORATORY/DIAGNOSTIC
EXAMINATIONS
 Pelvic exam
 Biopsy is confirmative for cancer.
 Ultrasonography to further delineate the
mass.
 CT scan to check for metastasis
PATHOPHYSIOLOGY
 Cancer antigen (CA) 125 test.
 It's not clear what causes ovarian cancer,
though doctors have identified factors that
can increase the risk of the disease. SPECIAL NOTATION

 In general, cancer begins when a cell  Surgical removal of affected ovary

develops errors (mutations) in its DNA. The  Lymph node dissection
mutations tell the cell to grow and multiply  Radiation therapy.
quickly, creating a mass (tumor) of  Radiation therapy to decrease tumor size.
abnormal cells. The abnormal cells  Oxygen therapy to supplement the needs of
continue living when healthy cells would the body.
die. They can invade nearby tissues and  High-protein, high-calorie diet to meet the
break off from an initial tumor to spread needs of the body.
elsewhere in the body (metastasize).
MEDICATIONS
STAGES OF OVARIAN CANCER Chemotherapy before surgery to shrink
some
tumors, or after surgery:
• cyclophosphamide • epirubincin
• methotrexate • vincristine
• fluorouracil • paclitaxel
• doxorubicin • docetaxel

Hormonal therapy:
• tamoxifen • anastrozole

Administer analgesics for pain control:

• morphine, fentanyl • Progesterone based
hormones

SIGNS AND SYMPTOMS

LIPOSOMAL THERAPY

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 Liposomal therapy, delivery of chemotherapy in
a liposome, allows the highest possible dose
of chemotherapy to the tumor target with a
reduction in adverse effects.
 This encapsulated chemotherapy allows
increased duration of action and better
targeting. The encapsulation of doxorubicin
lessens the incidence of
 nausea, vomiting, and alopecia. The patient
must be monitored for bone marrow
suppression.
 Gastrointestinal and cardiac effects may also
occur. These medications are administered by
oncology nurses as a slow intravenous
infusion over 60 to 90 minutes.

NURSING MANAGEMENT
• Nursing care may include administering
intravenous therapy to alleviate fluid and
electrolyte imbalances, initiating parenteral CARE OF PATIENTS WITH CANCER
nutrition to provide adequate nutrition,
providing postoperative care after intestinal
bypass to alleviate an obstruction, and
providing pain relief and managing drainage CERVICAL CANCER
tubes.
• Comfort measures for women with ascites What is Cervical Cancer?
• Patients with pleural effusion may • Cervical cancer is a type of cancer that
experience shortness of breath, hypoxia,
occurs in the cells of the cervix
pleuritic chest pain, and cough.
• Various strains of the human papillomavirus
(HPV), a sexually transmitted infection, play
a role in causing most cervical cancer.
• When exposed to HPV, the body's immune
system typically prevents the virus from
doing harm. In a small percentage of people,
however, the virus survives for years,
contributing to the process that causes some
cervical cells to become cancer cells.

Types of Cervical Cancer

Squamous cell carcinoma

• This type of cervical cancer begins in the
thin, flat cells (Squamous cells) lining the
outer part of the cervix, which projects into
the vagina.

Adenocarcinoma
• This type of cervical cancer begins in the
column-shaped glandular cells that line the
cervical canal.

Sometimes, both types of cells are involved in

cervical cancer. Very rarely, cancer occurs in
other cells in the cervix.

Risk Factors:

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 • Many sexual partners. Special Notation
• Early sexual activity (younger than 20).
• Other sexually transmitted infections (STIs). • Surgical removal of the cervix
• A weakened immune system. (trachelectomy)
• Smoking. • hysterectomy
• Exposure to miscarriage prevention drug. • Lymph node dissection
• Radiation therapy.
Pathophysiology • Radiation therapy to decrease tumor size.
• Oxygen therapy to supplement the needs of
• Cervical cancer begins when healthy cells in the body.
the cervix develop changes (mutations) in • High-protein, high-calorie diet to meet the
their DNA. A cell's DNA contains the needs of the body.
instructions that tell a cell what to do.
• Healthy cells grow and multiply at a set Laboratory/Diagnostic Findings:
rate, eventually dying at a set time. The
mutations tell the cells to grow and • Pelvic exam
multiply out of control, and they don't die. • Pap smear
The accumulating abnormal cells form a • HPV DNA test.
mass (tumor). Cancer cells invade nearby • Biopsy is confirmative for cancer.
tissues and can break off from a tumor to • Endo-cervical curettage
spread (metastasize) elsewhere in the • Cone biopsy
body. • Ultrasonography to further delineate the
• It isn't clear what causes cervical cancer, mass.
but it's certain that HPV plays a role. HPV is • CT scan to check for metastasis
very common, and most people with the • MRI and Positive emission tomography scan
virus never develop cancer. This means
other factors — such as your environment
or your lifestyle choices — also determine
whether you'll develop cervical cancer. Medications

Chemotherapy before surgery to shrink

some
tumors, or after surgery:
• cyclophosphamide • epirubincin
• methotrexate • vincristine
• fluorouracil • paclitaxel
• doxorubicin • docetaxel

Assessment Findings: Hormonal therapy:

• tamoxifen • anastrozole
Subjective Cues Objective cues
• ∙ Fatigue • Weight loss due to the Administer analgesics for pain control:
• ∙ Loss of appetite caloric needs of the • morphine, fentanyl • Progesterone based
• ∙ Generalize tumor, taking away from hormones
weakness the needs of the body.
• ∙ Discomfort in • Anorexia. UTERINE CANCER
the pelvis area • Vagina bleeding after • Cancer of the uterine endometrium (fundus or
intercourse, between corpus) has increased in incidence, partly
periods or after because people are living longer and
menopause because reporting is more accurate.
• Watery, bloody vaginal • Exposure to estrogen occurs with the use of
discharge that may be estrogen replacement therapy without the
heavy and have a foul use of progestin, early menarche, late
odor menopause, never having children, and
• Pelvic pain or pain anovulation. Other risk factors include
during intercourse

MS LEC ONCOLOGY, LANDINGINHANNAH

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 infertility, diabetes, hypertension,
gallbladder disease, and obesity.
• Tamoxifen may also cause proliferation of the
uterine lining, and women receiving this
medication for treatment or prevention of
breast cancer are monitored by their
oncologists.

Risk Factors for Uterine Cancer

• Age
• Postmenopausal bleeding
• Obesity that results in increased estrone
levels (related to excess weight) resulting
from conversion of androstenedione to
estrone in body fat, which exposes the
uterus to unopposed estrogen
• Unopposed estrogen therapy
• Other: nulliparity, truncal obesity, late
menopause and, possibly, use of tamoxifen

Assessment Findings
• Endometrial aspiration or biopsy
• Ultrasonography

Medical Management
• Treatment of endometrial cancer consists of
total hysterectomy and bilateral salpingo-
oophorectomy and node sampling.
Depending on the stage, the therapeutic
approach is individualized and is based on
stage, type, differentiation, degree of
invasion, and node involvement.
• Whole pelvis radiotherapy is used if there is
any spread beyond the uterus. Preoperative
and postoperative treatments for stage II
and beyond may include pelvic, abdominal,
and vaginal intracavitary radiation.
• Recurrent cancer usually occurs inside the
vaginal vault or in the upper vagina, and
metastasis usually occurs in lymph nodes or
the ovary. Recurrent lesions in the vagina are
treated with surgery and radiation.
Recurrent lesions beyond the vagina are
treated with hormonal therapy or
chemotherapy. Progestin therapy is used
frequently. Patients should be prepared for
such side effects as nausea, depression, rash,
or mild fluid retention with this therapy.

MS LEC ONCOLOGY, LANDINGINHANNAH

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 • Erectile dysfunction
CARE OF THE PATIENTS WITH PROSTATE CANCER
WHAT IS PROSTATE CANCER?
SPECIAL NOTATION
• Prostate cancer is cancer that occurs in
the prostate — a small walnut-shaped gland
• Surgical removal of the prostate
in men that produces the seminal fluid that
(prostatectomy)
nourishes and transports sperm.
• retropubic surgery
• Lymph node dissection
• Prostate cancer is one of the most • Radiation therapy.
common types of cancer in men. Usually, • Radiation therapy to decrease tumor size.
prostate cancer grows slowly and is initially • Oxygen therapy to supplement the needs of
confined to the prostate gland, where it may the body.
not cause serious harm. However, while • High-protein, high-calorie diet to meet the
some types of prostate cancer grow slowly needs of the body.
and may need minimal or even no • cryosurgery or cryoablation
treatment, other types are aggressive and
can spread quickly. RADICAL RETROPUBIC
PROSTATECTOMY

• A radical retropubic prostatectomy

is a surgical procedure in which the prostate
gland is removed through an incision in the
abdomen, and the blood vessels that were
connected to the prostate gland are tied off.

PATHOPHYSIOLOGY
• It's not clear what causes prostate cancer.
• Doctors know that prostate cancer begins
when some cells in your prostate become
abnormal. Mutations in the abnormal cells'
DNA cause the cells to grow and divide more
rapidly than normal cells do. The abnormal
cells continue living, when other cells would CRYOSURGERY
die. The accumulating abnormal cells form a
tumor that can grow to invade nearby tissue. • Cryotherapy (also called cryosurgery or
Some abnormal cells can also break off and cryoablation) is the use of very cold
spread (metastasize) to other parts of the temperatures to freeze and kill prostate
body. cancer cells as well as most of the prostate.
Even though it is sometimes being called
ASSESSMENT FINDINGS cryosurgery, it is not actually a type of
surgery.
Subjective Cues Objective cues
• Fatigue • Unexplained weight LABORATORY/DIAGNOSTIC EXAMS
• Loss of appetite loss due to the
• Generalized weakness caloric needs of the • Digital rectal exam
• Trouble urinating tumor, taking away • Prostate specific antigen test
• Discomfort in the from the needs of • Biopsy is confirmative for cancer.
pelvic area the body. • Ultrasonography to further delineate the
• Bone pain • Anorexia. mass.
• Decreased force in • CT scan to check for metastasis
the stream of urine • MRI and Positive emission tomography scan
• Blood in semen

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 HORMONAL THERAPY FOR PROSTATE treat advanced prostate cancer. One side
CANCER effect of this drug is that it may cause a
severe allergic reaction.
• An oral LHRH antagonist, relugolix
BILATERAL ORCHIECTOMY (Orgovyx), is also approved by the FDA for
the treatment of advanced prostate cancer.
• Even though this is a surgical procedure, it is • Relugolix is different from other LHRH
considered hormonal therapy because it antagonists in 2 ways. First, it has a lower
removes the main source of testosterone risk of causing serious heart problems in
production, the testicles. The effects of this patients with preexisting heart disease.
surgery are permanent and cannot be Second, when treatment with relugolix is
reversed. stopped, testosterone production is restored
within weeks, rather than months, which
LHRH AGONISTS may be helpful for those undergoing
intermittent hormonal therapy
• LHRH stands for luteinizing
hormone-releasing hormone. ANDROGEN RECEPTOR INHIBITORS
Medications known as LHRH agonists
prevent the testicles from receiving • While LHRH agonists and antagonists lower
messages sent by the body to make testosterone levels in the blood, androgen
testosterone. By blocking these signals, receptor (AR) inhibitors block testosterone
LHRH agonists reduce a man’s testosterone from binding to so-called “androgen
level just as well as removing his testicles. receptors,” which are chemical structures in
Unlike orchiectomy, the effects of LHRH cancer cells that allow testosterone and
agonists are often reversible, so testosterone other male hormones to enter the cells. In
production usually begins again once effect, AR inhibitors stop testosterone from
treatment stops. However, testosterone working.
recovery can take from 6 months to 24 AR INHIBITORS
months, and for a small number of patients,
testosterone production does not return. • Apalutamide. Apalutamide is approved by
the FDA for the treatment of non-metastatic
• LHRH agonists are injected or placed as castration-resistant prostate cancer and for
small implants under the skin. Depending on metastatic castration-sensitive prostate
the drug used, they may be given once a cancer in combination with hormonal
month or once a year. When LHRH agonists therapy.
are first given, testosterone levels briefly
increase before falling to very low levels. • Darolutamide. Darolutamide is approved
This effect is known as a “flare.” Flares occur for the treatment of non-metastatic
because the testicles temporarily release castration-resistant prostate cancer.
more testosterone in response to the way
LHRH agonists work in the body. This flare • Enzalutamide. Enzalutamide is a
may increase the activity of prostate cancer nonsteroidal AR inhibitor that is approved to
cells and cause symptoms and side effects, treat metastatic and non-metastatic
such as bone pain if the cancer has spread to castration-resistant prostate cancer as well
the bone. as metastatic castration-sensitive prostate
cancer.
LHRH ANTAGONISTS
ANDROGEN SYNTHESIS INHIBITORS
• This class of drugs, also called a
gonadotropin-releasing hormone (GnRH) • Although the testicles produce most of the
antagonist, stops the testicles from body's testosterone, other cells in the body
producing testosterone like LHRH agonists, can still make small amounts of the hormone
but they reduce testosterone levels more that may drive cancer growth. These include
quickly and do not cause the flare associated the adrenal glands and some prostate cancer
with LHRH agonists. cells. Androgen synthesis inhibitors target an
• The FDA has approved degarelix enzyme called CYP17 and stop cells from
(Firmagon), given by\ monthly injection, to making testosterone.

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 • Leukemia is cancer of the body's blood-
EXAMPLES OF ANDROGEN forming tissues, including the bone marrow
INHIBITORS and the lymphatic system.
• Many types of leukemia exist. Some forms of
• Abiraterone acetate (Zytiga). Abiraterone leukemia are more common in children.
acetate is taken in the form of a pill. Patients Other forms of leukemia occur mostly in
take 4 pills per day along with prednisone adults.
(multiple brand names) or prednisolone • Leukemia usually involves the white blood
(multiple brand names) twice a day. cells. Your white blood cells are potent
Prednisone or prednisolone helps prevent infection fighters — they normally grow and
some of the side effects of abiraterone. divide in an orderly way, as your body needs
Abiraterone acetate may cause serious side them. But in people with leukemia, the bone
effects, such as high blood pressure, low marrow produces abnormal white blood
blood potassium levels, fatigue, and fluid cells, which don't function properly.
retention. Common side effects include • Treatment for leukemia can be complex —
weakness, joint swelling or pain, swelling in depending on the type of leukemia and
the legs or feet, hot flushes, diarrhea, other factors. But there are strategies and
vomiting, shortness of breath, and anemia. resources that can help to make your
treatment successful.
• Ketoconazole (Nizoral). Ketoconazole is an
androgen synthesis inhibitor that is no RISK FACTORS FOR LEUKEMIA
longer widely used because of multiple drug
interactions. However, ketoconazole may be • Previous cancer treatment
an option for some patients. • Genetic disorders
• Exposure to certain chemicals
SIDE EFFECTS OF HORMONAL • Smoking
• Family history of leukemia
THERAPY
• Loss of sexual desire
PATHOPHYSIOLOGY
Scientists don't understand the exact causes of
• Hot flashes with sweating
leukemia. It seems to develop from a
• Gynecomastia, which is growth of breast
combination of genetic and environmental
tissue that sometimes can lead to
factors.
discomfort
• Depression
How leukemia forms
• Cognitive dysfunction and memory loss
• In general, leukemia is thought to occur
• Heart problems and heart disease
when some blood cells acquire mutations in
• Weight gain
their DNA — the instructions inside each cell
• Loss of muscle mass
that guide its action. There may be other
• Osteopenia or osteoporosis, which is
changes in the cells that have yet to be fully
thinning of bones
understood that could contribute to
leukemia.
CHEMOTHERAPEUTIC DRUGS • Certain abnormalities cause the cell to grow
and divide more rapidly and to continue
• cyclophosphamide • epirubincin living when normal cells would die. Over
• methotrexate • vincristine time, these abnormal cells can crowd out
• fluorouracil • paclitaxel healthy blood cells in the bone marrow,
• doxorubicin • docetaxel leading to fewer healthy white blood cells,

CARE OF THE PATIENTS WITH LEUKEMIA

LEUKEMIA

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 blood cells, white blood cells and platelet-
producing cells.

TYPES OF LEUKEMIAS
• red blood cells and platelets, causing the The major types of leukemia are:
signs and symptoms of leukemia.
Acute lymphocytic leukemia (ALL).
• This is the most common type of leukemia in
HOW IS LEUKEMIA CLASSIFIED? young children. ALL can also occur in adults.

Doctors classify leukemia based on its speed of

progression and the type of cells involved.
Acute myelogenous leukemia (AML).
The first type of classification is by how fast the • AML is a common type of leukemia. It occurs
leukemia progresses: in children and adults. AML is the most
common type of acute leukemia in adults.
• Acute leukemia. In acute leukemia, the
abnormal blood cells are immature blood Chronic lymphocytic leukemia
cells (blasts). They can't carry out their (CLL).
normal functions, and they multiply rapidly, • With CLL, the most common chronic adult
so the disease worsens quickly. Acute leukemia, you may feel well for years
leukemia requires aggressive, timely without needing treatment.
treatment.
• Chronic leukemia. There are many types of
chronic leukemias. Some produce too many Chronic myelogenous leukemia
cells and some cause too few cells to be (CML).
produced. Chronic leukemia involves more • This type of leukemia mainly affects adults. A
mature blood cells. These blood cells person with CML may have few or no
replicate or accumulate more slowly and can
symptoms for months or years before
function normally for a period of time. Some
entering a phase in which the leukemia cells
forms of chronic leukemia initially produce
grow more quickly.
no early symptoms and can go unnoticed or
undiagnosed for years.
Other types.
• Other, rarer types of leukemia exist,
including hairy cell leukemia,
myelodysplastic syndromes and
myeloproliferative disorders

ASSESSMENT FINDINGS

Subjective Cues Objective cues

• Fatigue • Unexplained weight loss
• Loss of appetite due to the caloric needs of
THE SECOND TYPE OF • Generalized the tumor, taking away
CLASSIFICATION IS BY TYPE OF WHITE weakness from the needs of the
BLOOD CELL AFFECTED: • Bone pain or body.
tenderness • Anorexia.
• Fever or chills
• Lymphocytic leukemia. This type of • Frequent or severe
leukemia affects the lymphoid cells infections
(lymphocytes), which form lymphoid or • Swollen lymph nodes,
lymphatic tissue. Lymphatic tissue makes up enlarged liver or spleen
your immune system. • Easy bleeding or bruising
• Myelogenous (my-uh-LOHJ-uh-nus) • Recurrent nosebleeds
leukemia. This type of leukemia affects the • Tiny red spots in your skin
myeloid cells. Myeloid cells give rise to red (petechiae)

MS LEC ONCOLOGY, LANDINGINHANNAH

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 • Excessive sweating, • Avoid going to public places
especially at night • Always wear a mask when going out
SPECIAL NOTATION • Avoid people with obvious infection
• Stem cell transplant
• Oxygen therapy as needed To prevent bleeding:
• High calorie, high fiber diet • Avoid contact sports
• Low fat, high protein diet • Always wear shoes or slippers at all
times
• Use an electric shaver
• Cut nails across
• Avoid handling sharp objects

LABORATORY/DIAGNOSTIC
EXAMINATIONS
• Physical exam, noting enlargement of lymph
nodes, liver and spleen, pale skin from
anemia
• Complete blood count (CBC) and WBC
differential.
• Blood smear. A blood smear, or peripheral
blood smear,
• Bone marrow biopsy is confirmative for
cancer.
• CT scan to check for metastasis
• Spinal tap (lumbar puncture) and
cerebrospinal fluid analysis.
• Immunophenotyping or phenotyping by flow
cytometry and/or immunohistochemistry
• Cytogenetic tests (FISH and karyotyping)
• Molecular testing

MEDICATIONS
Chemotherapy before surgery to shrink some
tumors, or after surgery:
• cyclophosphamide • epirubincin
• methotrexate • vincristine
• fluorouracil • paclitaxel
• doxorubicin • docetaxel

Administer analgesics for pain control:

morphine, fentanyl tyrosine kinase inhibitors
and anti-leukemia
antibodies.

PATIENT TEACHING FOR PATIENTS

WITH LEUKEMIA

To prevent infection:
• Avoid eating raw foods

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