Prepared By students:
3/4/2011
1.Raveen Ismail2.Kajeen Salih3.Rojan Abdullah
University of duhok/ Kurdistan College of nursing
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
• The Skeletal System • The skeleton is the name given to the collection
of bones that holds our body up. It does three major jobs.
A. It protects our vital organs such as the brain, the heart, and the lungs.
B. It gives us the shape that we haveC. 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
• 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
neckhead
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
A bone tumor is an abnormal growth of cells within the bone that may be noncancerous (benign) or cancerous (malignant).
Definition
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
• 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
. 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
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
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
Bone tumorprimary
Benign tumors: for ex. osteochondroma
malignant tumors: for ex Ewing's sarcoma
secondary
Metastatic tumors
Classification
Is a tumor which have spread from other organs ,The most common cancers that spread to the bone are cancer of the:
1. Breast 2. Kidney 3. Lung 4. Prostate 5. ThyroidThese forms of cancer usually affect older people
metastatic tumors
•Any Question?
1. Age
2. Combinations of radiation and chemotherapy for treating prior cancer
3. Certain kinds of anticancer drugs (alkylating agents)
4. Family history of bone cancer
5. An overactive parathyroid gland
6. Multiple benign tumors
7. Paget's disease
8. osteomyelitis
9. Radiation
Risk factors
1. Movement problems2. Stiff bones3. Bone lumps and masses4. Bone tenderness5. Anemia 6. Weight loss, Fatigue7. Bone pain, may be worse at night8. fevers and night sweats9. Bone fracture, especially fracture from slight injury
(trauma) 10.Note ! Some benign tumors have no symptoms
Clinical features
The cause of bone tumors is unknown. They often arise in areas of rapid growth
Inherited genetic mutations Radiation Trauma
Causes
1. Delayed wound healing2. Nutritional deficiency 3. Infection4. Hypercalcaemia5. muscle wasting, bone weakening 6. pathological fracture7. temporary burn to the skin and
fatigue from radiation therapy
Complications
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. Pain11. Spread of the cancer to other
nearby tissues (metastasis)
Complications
Blood testBone biopsyBone scan computed tomography
(CT).MRI ( magnetic resonance imaging )X-ray of boneCT scan
Diagnosis & Tests
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:
Systemic therapy Local therapy
1.Chemotherapy2. hormone therapy3. Immunotherapy ex. Interferon α
1.Radiation therapy2. surgery
Nutritional therapy
• Provide foods high in protein, vitamins and folic acid.
Treatment
• 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
• Radiation TherapyRadiation therapy uses high-dose x-
rays to kill cancer cells and shrink tumors. may be given either before or after surgery
Local therapy
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
Narcoticsanalgesics
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
• 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
Nursing assessment Nursing diagnosisNursing planningNursing ImplementationNursing evaluation
Nursing process
Collection Of Subjective Data:1. Bone pain in the area of the tumor , may be worse at
night, pain is generally described as dull and achy2. pain may or may not get worse with activity3. Fatigue, anxiety
Collection Of Objective Data:1. Bone lumps and masses determining the location and size of
tumor ,soft tissue swelling2. Stiff bones3. Weight loss4. Bone fracture, especially fracture from slight injury (trauma) 5. fevers and night sweats6. Movement problems7. Anemia
Nursing assessment
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 painRegularly 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
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 temperatureDuring 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
Nursing evaluation
Nursing Implementation
Nursing Planning
Nursing Diagnosis
Risk for injury: pathologic fracture related to tumor and metastasis
Absence of complicationAbsence of pathologic fracture
The effective extremities must be supported and handled gently
Exhibits absence of complication
3
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
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
Home care
http:// www.google.com http:// www.wekipedia.org http://www.bonetumor.org help.com/Bonetumors.htm
References
Books1. Writer :Patricia M , Dillon Book :nursing health assessment Edition :second edition Pages :467_470 Year :2003
References
Books2.Writer :Suzanne C .smltzor Book :medical and surgical nursing Edition :eleventh edition pages:2419_2413 year :2008
References
Thanks for all