bone tumor 2011nursing students

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1. Prepared By students: Bone tumor 3/4/2011 1.Raveen Ismail 2.Kajeen Salih 3.Rojan Abdullah University of duhok/ Kurdistan College of nursing

2. My Objectives Simple introduction about skeletal system Definition of bone tumor Bone tumor Classification Deference between malignant and benign bone tumor The staging of bone tumor Clinical features ,causes ,complications ,risk factors of bone tumor Diagnostic tests for bone tumor, treatment , epidemiology for bone tumor in united state Applying nursing process for patient with bone tumor ,home care

3. The Skeletal System The skeleton is the name given to the collection of bones that holds our body up. It does three major jobs. It protects our vital organs such as the brain, the heart, and the lungs. It gives us the shape that we have It allows us to move..  .  When we were born our skeleton had around 350 bones. By the time we become an adult, we will only have around 206 bones Introduction

4. Bone comes in several shapes and sizes the structure and composition of bone is the same in all. Bone is composed of protein , minerals and cells. The main part are: shaft neck head

5. A tumor is a lump or mass of tissue that forms when cells divide uncontrollably. A growing tumor may replace healthy tissue with abnormal tissue. It may weaken the bone, causing it to break (fracture). Bone tumor

6. A bone tumor is an abnormal growth of cells within the bone that may be noncancerous (benign) or cancerous (malignant ). Definition

7. Malignant Benign Fatal without treatment May recur after removal Rarely fatal Rarely recur after removal Rapid growth Slow growth Distant metastases , not localized No metastases , localized The difference between benign and malignant tumors

8. Enneking described the most widely used staging system for ( benign bone tumors ) The stages are denoted by the Arabic numerals 1, 2, and 3, whereas malignant bone tumors are classified by Roman numerals (I, II, III). Many benign bone tumors have the potential to present at, and progress through, various stages during their disease course. Stage of benign tumors

9. . Stage 1-LATENT, it do not have any characteristics of growth or progressive change, may resolve spontaneously. Stage 2-ACTIVE , lesion deform the host bone but remain contained in bone, require intralesional curettage. Stage 3-AGGRESSIVE , tumor extend beyond the bone, require complete work-up and a removal with wide margins to avoid possible local recurrence. Stage of benign bone tumors

10. The staging system for malignant tumor adopted by the Musculoskeletal Tumor Society, and originally developed by ( Enneking ) is based on the histological grade, the local extent(Tumors whether they are intra-compartmental or extra-compartmental) and the presence or absence of metastasis Stage of malignant bone tumors

11. Stage IA is defined as G1 and Intra-compartmental Stage IB is G1 and extra-compartmental Stage IIA is G2 and Intra-compartmental Stage IIB is G2 and extra-compartmental Stage III is G1 or G2, intra- or extra-compartmental, and has evidence of metastasis Stage of malignant bone tumors

12. Classification

13. Is a tumor which have spread from other organs ,The most common cancers that spread to the bone are cancer of the: Breast Kidney Lung Prostate Thyroid These forms of cancer usually affect older people metastatic tumors

14. Any Question?

15. Age Combinations of radiation and chemotherapy for treating prior cancer Certain kinds of anticancer drugs (alkylating agents) Family history of bone cancer An overactive parathyroid gland Multiple benign tumors Paget's disease osteomyelitis Radiation Risk factors

16. Movement problems Stiff bones Bone lumps and masses Bone tenderness Anemia Weight loss, Fatigue Bone pain, may be worse at night fevers and night sweats Bone fracture, especially fracture from slight injury (trauma) Note ! Some benign tumors have no symptoms Clinical features

17. The cause of bone tumors is unknown. They often arise in areas of rapid growth Inherited genetic mutations Radiation Trauma Causes

18. Delayed wound healing Nutritional deficiency Infection Hypercalcaemia muscle wasting, bone weakening pathological fracture temporary burn to the skin and fatigue from radiation therapy Complications

19. 8. nausea, vomiting, mouth sores, hair loss, and lowered resistance to infection from chemotherapy. 9. infection of the surgical site and possible blood clotting disturbances from surgery. 10. Pain 11. Spread of the cancer to other nearby tissues (metastasis) Complications

20. Blood test Bone biopsy Bone scan computed tomography (CT). MRI ( magnetic resonance imaging ) X-ray of bone CT scan Diagnosis & Tests

21. Open Biopsy Needle Biopsy insert a needle into the tumor to remove some tissue small incision is made and the tissue is removed removal of a sample of bone tissue to test for cancer cells. Bone biopsy :

22. Systemic therapy Local therapy 1.Chemotherapy 2. hormone therapy 3. Immunotherapy ex. Interferon α 1.Radiation therapy 2. surgery Nutritional therapy Provide foods high in protein, vitamins and folic acid. Treatment

23. Hormone therapy removal of the organs which produce hormones which can promote the growth of certain types of cancer (such as testosterone in males and estrogen in females), or drug therapy to keep the hormones from promoting cancer growth. Chemotherapy used to kill tumor cells when they have spread into the blood stream Systemic therapy

24. Radiation Therapy Radiation therapy uses high-dose x-rays to kill cancer cells and shrink tumors. may be given either before or after surgery Local therapy

25. Surgical Treatment Amputation Rotationplasty Bone graft Artificial bone removes all or part of an arm or leg when the tumor is large and/or nerves and blood vessels are involved. is a form of amputation, in which the patient's foot is turned upwards in a 180 degree turn and the upturned foot is used as a knee . affected bone is removed, bone from elsewhere from the body is taken. affected bone is removed, putting an artificial bone in. Local therapy

26. Narcotics analgesics Ex. Biphosphonates are drugs that can be used to reduce bone pain and slow down bone damage in people who have cancer that has spread to their bones,increase bone strength Ex. Metastron also known as strontium-89 chloride is an intravenous medication given to help with the pain and can be given in three month intervals Pain medications

27. Age: Bone tumor are more common in children and young adults when bones grow rapidly The incidence of bone cancer is higher in families with familial cancer syndromes. The incidence of bone cancer in children is approximately 5 cases per million children each year , in united states Epidemiology

28. Nursing assessment Nursing diagnosis Nursing planning Nursing Implementation Nursing evaluation Nursing process

29. Collection Of Subjective Data : Bone pain in the area of the tumor , may be worse at night, pain is generally described as dull and achy pain may or may not get worse with activity Fatigue, anxiety Collection Of Objective Data: Bone lumps and masses determining the location and size of tumor ,soft tissue swelling Stiff bones Weight loss Bone fracture, especially fracture from slight injury (trauma) fevers and night sweats Movement problems Anemia Nursing assessment

30. Acute or chronic pain related to the pathologic process and surgery Control of pain Administer analgesics as necessary. Make sure the patient has received his analgesic before morning care or any activity that may increase pain Regularly monitor the patient’s degree of pain and the effectiveness of analgesics and other pain relief measures, such as positioning or guided imagery Experiences no pain or decreased pain Nursing evaluation Nursing Implementation Nursing Planning Nursing Diagnosis 1

31. Nursing evaluation Nursing Implementation Nursing Planning Nursing Diagnosis Deficient knowledge related to the disease process and therapeutic regimen Giving knowledge about the disease process and treatment regimen Promoting understanding of the disease process and treatment regimen(Provide foods high in protein, vitamins and folic acid) Don’t give I.M. injections or take rectal temperature During radiation therapy or chemotherapy, take measures to reduce adverse reactions, such as providing the patient with plenty of fluids to drink and saline mouthwash for gargling Described disease process and treatment regimen 2

32. Nursing evaluation Nursing Implementation Nursing Planning Nursing Diagnosis Risk for injury: pathologic fracture related to tumor and metastasis Absence of complication Absence of pathologic fracture The effective extremities must be supported and handled gently Exhibits absence of complication 3

33. Nursing evaluation Nursing Implementation Nursing Planning Nursing Diagnosis Risk for situational low self-esteem related to loss of body part Improved self-esteem ( Promoting self –Esteem)Try to help the patient develop a positive attitude toward recovery and urge him to resume an independent lifestyle Demonstrate positive self –concept 4

34. Nursing evaluation Nursing Implementation Nursing Planning Nursing Diagnosis Ineffective coping related to fear of the unknown ,perception of disease process Effective pattern of coping (Promoting coping skills)Encourages the patient and family to verbalize their fears ,concerns, and feelings Demonstrates effective coping pattern 5

35. Home care

36. http:// www.google.com http:// www.wekipedia.org http://www.bonetumor.org help.com/Bonetumors.htm References

37. Books Writer :Patricia M , Dillon Book :nursing health assessment Edition :second edition Pages :467_470 Year :2003 References

38. Books 2. Writer :Suzanne C .smltzor Book :medical and surgical nursing Edition :eleventh edition pages:2419_2413 year :2008 References

39. Any Question?

40. Thanks for all