CELLULAR ABERRATIONS

Rhealeen Viray Vicedo, MAN, RN

 TOPIC OUTLINE
I. Cellular Aberration IX. Neoplasms of the Brain
II. Definition of Terms X. Bone Tumors
III. Neoplasia XI. Nephroblastoma
IV. The Cell Cycle XII. Skin Cancer
V. Pathogenesis of Cancer XIII.Treatment Modalities for
VI. Etiologic Factors for Cancer Cancer
VII. Leukemias
VIII.Lymphoma
 CELLULAR ABERRATION
• Aberration
– Deviation
– distortion
– “aberrātiō” : “diversion”
– “aberrāre” : “to wander away”
– + “-tiō” : action

• Cellular aberration
– Cells that deviate from normal
DEFINITION OF TERMS:
• Cancer – a disease process that begins when a cell is
transformed by the genetic mutations of the cellular DNA
• Oncology – Field of study of cancer
• Invasion –growth of the primary tumor into the surrounding
host tissues
• Metastasis – spread of cancer cells from the primary tumor to
distant sites
 NEOPLASIA
• “new growth”
• typically used to refer to a new abnormal
growth that does not respond to normal
growth-control mechanisms.
• Neoplasms are either:
– benign (growth is limited)
– malignant (cancerous or with unlimited growth)
 COMPARISON OF THE CHARACTERISTICS OF
BENIGN AND MALIGNANT
CHARACTERISTICS BENIGN MALIGNANT
(Tumor) (Ca)
Speed of Growth Slowly Rapidly
Mode of Growth Remains localized Infiltrates surrounding
tissues
Capsule Encapsulated Not encapsulated
Cell Characteristics Well differentiated mature Poorly differentiated
cells; functions poorly
Recurrence Extremely unusual when Common following surgery
surgically removed
Metastasis Never occur Very common
Effect of neoplasm Not harmful to host Always harmful
Prognosis Very good Poor
THE CELL CYCLE
THE CELL CYCLE
 THE CELL CYCLE
• Any malfunction can result in the rapid proliferation
of immature cells
• In some cases, proliferating immature cells are
considered cancerous (malignant)

• Importance in Cellular Aberration:

– development of chemotherapeutic drugs
 PATHOGENESIS OF CANCER
• CELLULAR TRANSFORMATION & DERANGEMENT
THEORY

– Normal cells are transformed into cancer cells due to exposure

to etiologic agents
 PATHOGENESIS OF CANCER
• FAILURE OF THE IMMUNE RESPONSE THEORY

– All individuals has cancer cells and failure of the immune

system to recognize the cells leads to cancer development
 ETIOLOGIC FACTORS FOR CANCER
• CHEMICAL CARCINOGENS
– Act by causing cell mutations

1. INDUSTRIAL COMPOUNDS
a. Vinyl chloride – plastic manufacture, asbestos
factories, construction works
b. Polycyclic Aromatic Hydrocarbons – refuse
burning, auto and truck emissions, oil
refineries (air pollution)
ETIOLOGIC FACTORS FOR
CANCER
1. INDUSTRIAL COMPOUNDS
c. Fertilizers, weed killers
d. Dyes – aniline dyes (beauty shops:
hair bleach, wood working, textile
industries)

2. TOBACCO – tar nicotine

3. ALCOHOL
4. CYTOTOXIC DRUGS
ETIOLOGIC FACTORS FOR CANCER
5. HORMONES

a. Estrogen – amphiregulin gene

b. Diethylstilbestrol (DES) - synthetic

form of the female hormone estrogen
ETIOLOGIC FACTORS FOR CANCER
• FOOD & PRESERVATIVES
a. Nitrites - Processed meats through
smoking, curing, salting or adding
preservatives
e.g. Ham
Bacon
Salami
Hot dogs
Sausages
 ETIOLOGIC FACTORS FOR CANCER
6. FOOD AND PRESERVATIVES
b. Talc
c. Food Sweeteners – e.g. Saccharine
aspartame
d. Nitrosomines – rubber baby nipples and pacifiers
(1980)
 ETIOLOGIC FACTORS FOR CANCER
6. FOOD AND PRESERVATIVES
e. Aflatoxins - mold in nuts, grains, milk, cheese,
peanut butter
f. Polycyclic aromatic hydrocarbons
e.g. Charred flesh foods (meat, poultry, fish)
ETIOLOGIC FACTORS FOR CANCER

• PHYSICAL AGENTS
a. Radiation
- X-rays or radioactive isotopes
- Sunlight / UV rays
b. Physical irritation/ trauma
- e.g. multiple deliveries
Breast Ca and trauma history
 ETIOLOGIC FACTORS FOR CANCER
• GENETICS

a. Oncogenes
- hidden / repressed genetic code existing in all
individuals

b. Familial pattern/ History

LEUKEMIAS
 LEUKEMIA

• distorted and uncontrolled proliferation of WBCs

(leukocytes)
• the most frequently occurring type of cancer in children.
 LEUKEMIA
ACUTE LYMPHOCYTIC (LYMPHOBLASTIC) ACUTE MYELOID LEUKEMIA
LEUKEMIA (ALL) (AML)
Description Rapid proliferation of so many immature lymphocytes, Over proliferation of granulocytes
the production of red blood cells (RBCs) and platelets (neutrophils, basophils, and
declines. The abnormally proliferating cells are so eosinophils).
immature that they may be identifiable as an immature
“blast cell.”
Assessment decreased RBC production (anemia) such as pallor, low- Children with AML have the same
grade fever, and lethargy. A low thrombocyte (platelet) symptoms as those with ALL.
count will lead to petechiae and bleeding from oral Comprehensive history and physical
mucous membranes and cause easy bruising on arms examination focused on local or
and legs. systemic infections is warranted.

Therapeutic A chemotherapy program is aimed at, first, achieving a chemotherapy to effect remission
Management complete remission or absence of leukemia cells begins.
(induction phase); second, preventing leukemia cells
from invading or growing in the CNS (sanctuary or Bone marrow transplantation may be
consolidation phase); third, administering delayed attempted after the initial remission to
intensive therapy; and fourth, maintaining the original ensure a sustained remission
remission (maintenance phase).
LYMPHOMAS
 LYMPHOMA

• malignancies of the lymph or reticuloendothelial system

• they account for about 11% of all malignancies
• Categorized as:
– Hodgkin
– Non-Hodgkin lymphomas.
 LYMPHOMA
HODGKIN DISEASE NON-HODGKIN LYMPHOMA
Description lymphocytes proliferate in the lymph glands, and special malignant disorders of the lymphocytes (either B or T cells)
Reed-Sternberg cells (large, multinucleated cells that are and occur in a number of forms. Unlike Hodgkin disease,
probably nonfunctioning monocytemacrophage cells) spread from the original site is through the bloodstream
develop. rather than directly by lymph flow, making the course of the
disease unpredictable. Metastatic spread to CNS may
occur early in the disease, with the common age of
occurrence at 5 to 15 years.
Assessment enlargement of only one painless, enlarged, rubbery involve the lymph glands of the neck and chest most
lymph node. Other nodes then become involved and commonly, although axillary, abdominal, or inguinal nodes
potentially spread to the liver, spleen, and bone marrow. may be the first involved. If mediastinal lymph glands are
The child may report accompanying symptoms of swollen, the child may notice a cough or chest “tightness.”
anorexia, malaise, night sweats, and loss of weight.
Fever may be present.
Therapeutic Hodgkin disease once was treated mainly with radiation Non-Hodgkin lymphomas are treated with systemic
Managemen therapy, today the standard of care is combination chemotherapy, similar to that used acute lymphocytic
t chemotherapy using the agents cyclophosphamide, (lymphoblastic) leukemia
vincristine, procarbazine, and prednisone; with radiation
reserved for those who have a limited response to
chemotherapy or those with recurrent/progressive
disease.
NEOPLASMS OF
THE BRAIN
 NEOPLASMS OF THE BRAIN

• Brain tumors are the second

most common form of cancer
and the most common solid
tumor in children.
• Tumors tend to occur
between 1 and 10 years of
age, with 5 years being the
peak age of incidence.
 NEOPLASMS OF THE BRAIN
ASSESSMENT increased intracranial
pressure: headache, vision changes, vomiting, an
enlarging head circumference, or
papilledema. Lethargy, projectile vomiting, and
coma are late signs.
MANAGEMENT combination of surgery, radiation, and
chemotherapy, depending on the location and
extent of the tumor
BONE TUMORS
 BONE TUMORS

• Tumors derived from connective tissue, such as bone and

cartilage, muscle, blood vessels, or lymphoid tissue, are
termed sarcomas.
– They are the second most frequently occurring neoplasms in
adolescents
 BONE TUMORS
OSTEOGENIC SARCOMA EWING SARCOMA

Description malignant tumor of long bone malignant bone tumor; it occurs

involving rapidly growing bone most frequently in the bone
tissue (mesenchymal-matrix marrow of the diaphyseal area
forming cells). (midshaft) of long bones and
spreads longitudinally through the
bone
Assessment area may be painful and swollen; the pain becomes constant and so
it may be inflamed and feel warm severe the child cannot sleep at
because tumors are highly night.
vascular and therefore call
increased blood into the area.
Therapeutic Chemotherapy is prescribed to therapy consists of a combination
Management shrink the tumor before surgery. of surgery to remove the primary
tumor, radiation, and
chemotherapy.
NEPHROBLASTOMA
NEPHROBLASTOMA (WILMS TUMOR)

• malignant tumor that rises

from the metanephric
mesoderm cells of the upper
pole of the kidney
NEPHROBLASTOMA (WILMS TUMOR)
ASSESSMENT:
• firm, nontender abdominal mass
• hematuria
• low-grade fever
• anemia
NEPHROBLASTOMA (WILMS TUMOR)
MANAGEMENT:
• “No Abdominal Palpation” sign over the child’s crib
• Nephrectomy (excision of the affected kidney)
• Radiation Therapy
• Chemotherapy
SKIN CANCER
 SKIN CANCER (MALIGNANT MELANOMA)
• Melanomas can be differentiated from
benign moles by an a-b-c-d
assessment:
– Asymmetry,
– border irregularity,
– color (variable or dark pigmentation),
– diameter (over 6 mm).

• Melanomas are treated with surgery,

radiation, and immunotherapy to
improve overall survival.
TREATMENT MODALITIES
FOR CANCER
TREATMENT MODALITIES FOR CANCER

• Surgical Treatment
• Chemotherapy
• Radiation Therapy
• Immunotherapy
• Bone Marrow Transplant
TREATMENT MODALITIES FOR CANCER
• CHEMOTHERAPY
• Objectives
-To destroy all malignant cells w/o
destruction of normal cells
-To control tumor growth
-Adjuvant therapy
 TREATMENT MODALITIES FOR CANCER
• CHEMOTHERAPY
• Contraindications
-Infection
-Recent surgery
-Impaired Renal or Hepatic function
-Recent radiation therapy
-Pregnancy
-Bone Marrow Depression
NURSING INTERVENTIONS FOR CHEMO SIDE
EFFECTS
• GI SYSTEM
•Nausea and vomiting
-Antiemetics 4-6 hrs and prophylactically
(Metocholopramide, Plasil or Tigan)
-NPO 4-6 hrs before chemotherapy
-Bland foods in small amounts after treatment
NURSING INTERVENTIONS FOR CHEMO SIDE
EFFECTS
• GI SYSTEM
•Diarrhea
Antidiarrheal drugs
Clear liquid if tolerated
Good perineal care
Monitor K, Na and Cl levels
NURSING INTERVENTIONS FOR CHEMO SIDE
EFFECTS
• GI SYSTEM
• Stomatitis
• Good oral hygiene
• Viscous lidocaine before meals
• Gargle & rinse with water and diluted
hydrogen peroxide after meals
• KY jelly to cracked lips
• Suck popsicles
NURSING INTERVENTIONS FOR CHEMO SIDE
EFFECTS
• INTEGUMENTARY SYSTEM
•Alopecia- temporary
Scalp hypothermia – ice pack
Wig during treatment
Hair grows back 6 mos after chemotherapy
•Pruritus, Urticaria
Provide good skin care
•Skin pigmentation- temporary
•Nail changes - temporary
NURSING INTERVENTIONS FOR CHEMO SIDE
EFFECTS
• HEMATOLOGIC SYSTEM
• Thrombocytopenia
• Epistaxis, petechiae, ecchymosis
• Avoid bumps or bruise of skin
• Protect from physical injury/ trauma
• Avoid aspirin and aspirin products
• Avoid IM injection
• Monitor blood count
NURSING INTERVENTIONS FOR CHEMO SIDE
EFFECTS
• HEMATOLOGIC SYSTEM
• Leukopenia
• Hand washing, reverse isolation
• Note signs and symptoms of respiratory infection
• Avoid crowd or persons with infection
• Anemia
• Adequate rest period
• H & H monitoring
• O2 PRN
• Hemorrhagic cystitis
• ↑ fluid intake to 3L/day
NURSING INTERVENTIONS FOR CHEMO SIDE
EFFECTS

• GENITO-URINARY SYSTEM
• Urine Color changes
• Reassure that it is harmless
NURSING INTERVENTIONS FOR CHEMO SIDE
EFFECTS

• REPRODUCTIVE SYSTEM
• Premature menopause or
amenorrhea
•Reassure that menstruation resumes
after chemo
RADIATION THERAPY

• Causes lethal injury to DNA, so it can

destroy rapidly multiplying cancer
cells
• Used to
–Kill a tumor
–Reduce the tumor size
–Relieve obstruction
–Decrease pain
 RADIATION THERAPY
• External Radiation therapy (Teletherapy)

penetrating beams of high-energy waves or

streams
(Cesium,Iridium,Iodine,Phosphorus,Palladium)
↓
interact with water present in the nucleus
↓
formation hydroxyl radical.
↓
damage to the cell's DNA.
 RADIATION THERAPY
• Internal Radiation therapy (Brachytherapy)
• Delivers a high dose of radiation to a localized area
• Implanted into tissue (interstitial implants) or cavity
(intracavitary) by used of
• Needle
• Seed
• catheter
• Administered orally
 RADIATION THERAPY
INTERNAL RADIATION THERAPY (BRACHYTHERAPY)
Nursing Management:
• Exposure to small amounts of radiation is possible during close
contact with the patient receiving internal radiation.
• Principles of protection from exposure
✓ TIME
✓ DISTANCE
✓ SHIELDING
 RADIATION THERAPY
INTERNAL RADIATION THERAPY (BRACHYTHERAPY)
Nursing Management:
• Principles of protection from exposure
– Time
o minimize time spent in close proximity to the radiation source;
o to limit contact time to 30 minutes total per 8-hour shift
 RADIATION THERAPY
INTERNAL RADIATION THERAPY
(BRACHYTHERAPY)
Nursing Management:
• Principles of protection from exposure
– Distance: maintain the maximum distance
possible from the radiation source
• minimum distance of 6 feet used when possible

– Shielding: use lead shields and other

precautions to reduce exposure to radiation
 RADIATION THERAPY
INTERNAL RADIATION THERAPY (BRACHYTHERAPY)
Nursing Management:
• Place client in a private room
• Post appropriate notices about radiation safety precaution
• Instruct visitors to maintain at least 6 feet from the patient
and limit visits to 10 – 30 minutes
• Ensure proper handling and disposal of body fluids,
assuring the containers are marked appropriately
• Ensure proper handling of linens and clothing
 RADIATION THERAPY
INTERNAL RADIATION THERAPY (BRACHYTHERAPY)
Nursing Management:
• In the event of dislodged implant, use long-handed forceps
and place the implant into a lead container.
• Do not allow pregnant women to come into contact with
radiation sources; screen visitors and staff for pregnancy
• If working routinely near radiation sources, wear a
monitoring device to measure exposure
 RADIATION THERAPY
INTERNAL RADIATION THERAPY
(BRACHYTHERAPY)
Nursing Management:
• Avoid close contact with others until treatment is
completed
• Maintain daily activities unless C/I, allowing for extra rest
periods as needed
• Maintain balance diet, small frequent meals
• Maintain adequate fluid intake
• Excreted body fluids may be radioactive; double flush
toilet after use.
 RADIATION THERAPY
EXTERNAL RADIATION THERAPY (TELETHERAPY)
Nursing Management:
• Wash the marked area with plain water and pat skin dry
• Do not wash off the treatment site marks
• Avoid rubbing, scratching, and scrubbing the treatment site
• Avoid using lotion, ointments, lotion or powders on the area
• Do not apply extreme temp to the treatment site
• If shaving, use electric razor only
• Wear soft, loose fitting clothing over the treatment area
 RADIATION THERAPY
EXTERNAL RADIATION THERAPY (TELETHERAPY)
Nursing Management:
• Protect skin from sun exposure during the treatment and for at
least a year after the treatment is completed
• Use sunblock (at least SPF 15) when going outdoors
• Maintain proper rest, diet, fluid intake as essential to promoting
health and repair of normal tissue
• Hair loss may occur, choose a wig, hat or scarf to cover and protect
head
 RADIATION THERAPY
• SIDE EFFECTS:
–Fatigue
–Malaise
–anorexia
 IMMUNOTHERAPY/ BIOLOGIC
RESPONSE MODIFIERS
• Mobilizes the immune system to fight off cancer
• Goal: destroy or stop malignant growth
• Basis: the restoration, modification, stimulation or
augmentation of body’s natural immune defenses against
cancer
IMMUNOTHERAPY/ BIOLOGIC
RESPONSE MODIFIERS

SIDE EFFECTS:
• FLU -like symptoms such chills, fever, muscle
aches, weakness, loss of appetite,
• nausea, vomiting, and diarrhea.
• Rash, bleeding or bruise
• Interleukin therapy - swelling.
 BONE MARROW TRANSPLANT
• is a procedure to replace damaged or destroyed bone
marrow with healthy bone marrow stem cells.
 BONE MARROW TRANSPLANT
• A stem cell transplant is done after
chemotherapy and radiation is complete.
• The stem cells are delivered into your
bloodstream through a tube called a central
venous catheter.
• The process is similar to getting a blood
transfusion.
• The stem cells travel through the blood into
the bone marrow.
• Usually, no surgery is needed.
 BONE MARROW TRANSPLANT
SIDE EFFECTS:
• PAIN: chest pain, headache
• ALTERED BODY TEMPERATURE: fever, chills
• SKIN: hives, flushing
• CARDIO/RESPI: drop in blood pressure, SOB
• ALTERED TASTE: Dysgeusia
• GASTRO: nausea and vomiting, mouth sores