Cancer Disease

Christine Joy Bandala

Liver Cancer
Occurs majority to male
Hepatocellular carcinoma most common
cause of primary liver cancer
Other cause:
Cholangiomas and bile duct carcinomas
80% of people with primary liver cancer
has liver cirrhosis
Cirrhosis is a risk factor
50-60% is caused by hepatitis Cinfection
20% - is due to Hepatitis B

Liver Cancer
Metastatic liver carcinoma is more
common than primary carcinoma
Clinical Manifestations
Difficult to diagnose liver cancer in early stage
cause it resembles with cirrhosis
(Eg, hepatomegaly, spleenomegaly , jaundice
weight loss, peripheral edema, ascites and portal
hypertension)
Other CM: abd pain in R epigastric or right upper
quadrant anorexia, vomiting and inc. abd girth,
pulmonary embolism

Liver Cancer
Diagnostic Studies

Liver scan. MRI, hepatic angiography,

endoscopic retrograde
cholangiopancreatography elevated AFP
Nursing and Collaborative Management
1. Prevention, Identification and treatment of
Hep B and C virus, and chronic alcohol
ingestion
2. Treatment is dependent with liver cancer
size and number of tumors present of spread
beyond the liver, age and overall patient
health

Liver Cancer
3. surgical excision, or liver transpalant of
tumor is localized to one portion of the liver
(15%)
4.Other therapies
- radiofrequency ablation, cryosurgery,
alcohol injection and chemotherapy and or
chemoembolization

Liver Cancer
Radiofrequency ablation

A thin needle is inserted in the core of tumor,

then electrical energy is used to create heat in
a specific location for a limited time
Done with tumor less than 5 cm and
considered resectable and palliative
purpose

Cyroablation

Used when tumor is unresectable but has no

signs of metastasis
Open surgical approach where cryoprobes are
placed. Liquid nitrogen /argon gas is introduced
to the liver and freezes the tissue

Liver Cancer
Percutaneous Ethanol Injection (PEI)/
Percutaneous acetic Injection (PAI)

Used for unresectable liver that has not metastasized

outside the liver
A catheter is inserted into the liver guided via
ultrasound, then ethanol or acetic acid is injected for
6-8 treatments over a 3-4 hour period with 2 -3
injections per week
SE. transient pain, intraperitoneal hemorrhage bile duct
necrosis, hepatic infarction, transient hypotension
Chemotherapy
5 flourouracil and leucovorin can be administered
systemically or regionally,
Sorafinib (Nexavar) : TI

Liver Cancer
Chemoembolization

Minimally invasive,
a catheter is placed into the arteries to the tumor

Nursing Management of all procedures

1.making the patient comfortable
2. Address the signs and symptoms
manifested
3. Most interventions are the same to clients
with liver cirrhosis

Liver Transplant
Practical option for clients with end stage liver
cancer
Not recommended to patients with wide spread
liver disease
Candidates must go through rigorous physical
exam
CI: for pts with sever pulmonary hypertension,
morbid obesity, obstructed splanchnic blood
flow
Donors can be live or cadaver

Liver Transplant
Comp for donor: billiary problems, hepatic
artery thrombosis, wound infection,
postoperative ileus and pneumothorax
Split organ transplant
Comp: rejection:
Hyperacute rejection
Acute rejection
Chronic rejection

Ist 2 months after surgery is the most

critical for monitoring

Pancreatic cancer
Adenocarcinomas originating from the
epithelium of the ductal system
More than half of the tumor originates in
the head of pancreas

Poor prognosis patient dies within 3-12

mos of initial diagnosis and 5 year survival
rate is less than 5 %

Pancreatic Cancer
Etiology
Unknown cause but high risk with DM and
with chronic pancreatitis
Risk factors: cigarette smoking family
history of pancreatic cancer, high fat diet,
and exposure to benzidine and coke
Smokers and alcohol drinkers are twice
likely to develop pancreatic cancer

Pancreatic Cancer
CM

Left hypochondriac pain that radiates at the back,

obstructive jaundice, anorexia rapid and progesive
weight loss

Diagnostic Staging
transabdominal ultrasound and CT scan- initial
study and provides information on metastasis
involvement.
ERCP(endoscopic retrograde
cholangiopancreatography) allows visualization
of pancreatic duct and biliary study, pancreatic
secretions and tissues can be collected for tumor
markers (CA 19-9)

Pancreatic Cancer
Collaborative Care
Surgery: most effective care

Classical surgery : radical

pancreaticoduodenectomy or whipple
procedure

Cholecystojejunostomy
Total pancreaticoduodonectomy with
spleenecotmy
Biliary Stents (Cotton Leung Stents)

Pancreatic Cancer
Chemotherapy
Gencitabine in combinatio with
capecitabine or erlotinib
Nursing Management
1. Provide symptomatic and supportive
nursing care
2. Pain relief
3. adequate nutrition
4. Help patient and family members in
the grieving process

Bladder Cancer
The most frequent type of cancer in the
urinary tract is transitional cell carcinoma
Common between 60-70 yrs. Old
PF: cigarette smoking, exposure to dyes
used to rubber and cable industries and
chronic abuse of phenacetin-containing
analgesics.
Women who is treated with cervical
cancer and patients receiving
cyclophosphomide also have increased
risk with unknown cause

Bladder Cancer
CM: painless hematuria, bladder irritability
with dysuria, frequancy and urgency
Dx. Urine specimen specimen for cytology can
be obtained to determine presence of
neoplastic or atypical cells.
Cystoscopy- the most reliable test for detecting
bladder tumor.
Clinical Staging is determined by depth of
invasion of the bladder and surrounding tissue

Bladder Cancer

Jewett Strong Marshall Classification

Superficial (CIS- carcinoma in situ, O, A)
Invasiveness (B1, B2, C)
Metastasis (D1 to D4)

Low grade tumors (Superficial) are more

responsive to transvesical chemotherapy and
transurethral resection of bladder tumor (TURBT)

Bladder Cancer
Collaborative Care
1. Surgical Treatment
transurethral resection with fulguration,
laser photocoagulation, open loop resection with
fulguration, cystectomy (segmental, partial, radical)

2. Radiation therapy
3. Intravesical immunotherapy

Bacille Calmette Guerin (BCG)

A interferon

4. Intravesical Chemotherapy
Thiotepa, valrubin

5. Systemic Chemotherapy

Bladder Cancer
Transurethral resection with fulguration
(electrocautery)

Treatment of superficial lesions with low recurrence rate

To control bleeding in patients with poor operative risk
or who has advance tumor

Laser photocoagulation

Treat of superficial bladder cancer

Adv. Bloodless destruction of lesions, minimal risk for
perforation, lack of need for urinary catheter

Open loop resection

Snaring of polyp type of lesion

Used to control bleeding for large superficial tumors and
multiple lesions
used together with segmental resection

Bladder Cancer
Postoperative Management:
1. Instruct patient to drink large volume of fluid
each day for the ist week following the procedure
2. taught patient self monitor the urine
3. instruct patient that pinkish urine is normal
within the the ist several days but should not be
bright red or with clots
4. 7-10 days following the procedure, patient
may observe urine, dark red or rust colorred
flecks in the urine
5. 15-20 min sitz bath, 2-3 times a day
6. folloe cystoscopy schedule whch is every 3-6
months for 3years and yearly thereafter

Bladder Cancer
Radiation therapy when cancer is inoperable or
when surgery is refused
Combined with systemic chemotherapy
(cisplatin, vinblastin, doxorubucin, and
methotrexate)
Intravesical Therapy
Protocol varies but cycle is for 6-12 weeks
Patient position maybe changed every 15 min
BCG
Thiotepa (alkylating agent) reduce WBC and
platelets within the bladder

Breast cancer
Common malignancy to women, 2nd cause of
death
Etiology and risk factors
Heredity, hormonal regulation, dietary fat intake,
weight gain in adolescence, obesity and alcohol
intake
Combined hormone therapy (estrogen and
progesterone)
Pathophysiology

May arise from epithelial lining of the ducts (ductal

carcinoma) or epithelium lobules (lobular carcinoma)

Breast Cancer Types

Types of Breast Cancer
1. Non invasive Breast Cancer

Ductal carcinoma in Situ (infiltrating ductal cell

carcinoma) tamoxifen, lumpectomy and radiation
therapy
Lobular carcinoma in Situ

2. Pagets disease

Persistent nipple and areola lesions with or without

palpable mass, nipple changes are diagnosed as
infection or dermatitis w/ch cause delays of
treatment

3. Inflammatory breast Cancer

Most malignant form of all breast cancers, breast

looks red, feels warm and has thickened appearance
resembling an orange peel (peau de orange)

Breast Cancer

Breast Cancer

Breast cancer
Clinical Manifestations
Detected as a lump or mammographic
abnormality in the breast
Irregular shaped poorly delineated non mobile
non tender
Complication:
Recurrence either local, regional or distant,
Metastsis primarily occurs via lymphnode

Breast Cancer
Diagnostic study
Axillary lymph node involvement
Mammography, ultrasound , biopsy, MRI
Collaborative care:
1. Surgery

a. Breast conserving (lumpectomy) with

sentinel lymph node involvement

B, Biopsy/dissection and or lymph node dissection
C. Simple mastectomy
D. Modified radical mastectomy,
E. Radical mastectomy
F. Oopherectomy
G. adrenalectomy

Breast Cancer

Collaborative Therapy
2. Radiation Therapy
3. Chemotherapy
4. Hormonal therapy
5. Biologic and target therapy

Breast Cancer Estrogen and

progesterone Status
Receptor positive receptor

Receptive Negative tumor

1. commonly well
differentiated
2. diploid DNA and low
proliferative indices
3. lower chance of recurrence
4. hormone dependent and
responsive to hormonal
therapy

1. Poorly differentiated
2. Aneuploid and higher
proliferative indices,
3. Frequently reoccur
4. Unresponsive to hormonal
therapy

Breast Cancer
Post OP Care
1. Check for bleeding(hemovac or JP drain)
2. dec incisional pain (splinting area during
coughing, DBE, managed cough)
3. Prevent lymphedema
4. maintain abduction of affected arm
5. NO BP taking on affected arm
6. Post mastectomy exercises

Breast cancer

Post mastectomy exercises

1. Ball squezzing (8-10 hrs post op)
2. hand wall climbing (7-10 day post op)
3. back scratch: non operative scapula (7-10 day post op)

Follow up care
1. CBE every 6 months for 2 years then annually
2. manage postmastectomy pain syndrome
(EMLA: eutectic mixture of local anesthetics)
3. avoid gardening
4. wear gloves when performing household chores.

Breast Cancer
Radiation Therapy
Performed after locally excision of the breast
mass or surgery

High dose brachytherapy

Alternative to traditional radiation treatment
Traditional 5-6 weeks
Alternative- balloon catheter 1-5 days

Breast Cancer
Chemotherapy
1. CMF (cyclophosphamide, methotrexate, 5fluorouracil)
2. AC (adriamycin, cyclophosphamide) w/ or w/o
paclitaxel, or docetaxel
3. CEF or CAF (cyclophosphamide, epirubicin or
adriamycin, 5 FU)
4. vinorelbine new drug for metastatic cancer
Hormone Therapy
Removes or blocks source of estrogen promoting
tumor regression

Breast Cancer
Mechanism of action

Examples

Blocks estrogen receptors

Tamoxifen
Toremifine (metastatic breast
cancer in postmenopausal
women)

Destroys estrogen receptor

Fulvestrant (Faslodex), IM

Prevents production of estrogen

by inhibiting aromatase

Anastrozole
Letrozole
Exemestane
aminogluthetemide

Breast Cancer
Breast reconstructive options
1.Mammoplasty
-change of size and shape of breast

2.Breast augmentation
-procedure to enlarge the breast
Implant is placed into the pockets of the
breast and pectoralis fascia
Silicon envelopes are filled with dextran
,saline or silicone

Breast Cancer

Breast Cancer

Breast Cancer
Breast Reduction
To reduce breast size
Done through resecting
wedges of tissue from
upper
and
lower
quadrants of the breast
tissue
Excess skin is removed
and areola and nipple
is relocated

 Nursing Management Breast augmentation

and Reduction
1. Drains are placed at surgical site and removed
2-3 days post op or when drainage is lesser <
20ml
2, wear bra continuously for 2-3 days post op
3. resume normal activities 2-3 days after breast
reduction