University of duhok College of nursing

Prepared By students:
1.Raveen Ismail 2.Kajeen Salih 3.Rojan Abdullah
3/4/2011

My Objectives
Giving Simple introduction about skeletal system Definition of bone tumor Bone tumor Classification The staging of bone tumors Clinical features ,causes ,complications ,risk factors of bone tumor Diagnostic tests , treatment , epidemiology for bone tumor Applying nursing process for patient with bone tumor ,home care

Introduction
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 have C. 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

 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.

Head (epiphysis)

shaft (diaphysis ) neck

Bone tumor
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).

Staging of bone tumor

In 1980 Enneking described a system (bone tumors ) Based on three criteria: 1. Extent of the tumor(tumor size) 2. Metastasis of the tumor 3. The grade of the tumor
for staging

Staging of bone tumor

stages Stage IA Stage IB Stage IIA Stage IIB Stage III G1 G1 G2 G2 G1 or G2 grade Size of tumor T1 T2 T1 T2 T1 or T2 M0 M0 M0 M0 M1 metastasis

G1=low grade (tumor grade is less than25%) G2=high grade(tumor grade is more than 25%) T1=size of tumor is 8cm or less than 8 cm T2=size of tumor is greater than 8cm M0=no regional or distant metastasis M1=regional or distant metastasis

Classification
Benign tumors: for ex. osteochondroma
primary

Bone tumor
secondary

malignant tumors: for ex Ewing's sarcoma

Metastatic tumors

Primary bone tumors

Originate in the bone and may be noncancerous or cancerous.

The difference between benign and malignant tumors

Benign
Rarely life-threatening Easier to remove and does not recur after excision. Slow growth Cells multiply slowly. Never spread to other sites (metastasize). Mobile mass.

Malignant
life-threatening Difficult to remove and recurs after excision. Rapid growth Cells multiply rapidly spreads to other sites if not removed or destroyed Fixed or ulcerating mass.

metastatic tumors
 Are cancerous tumors that originate elsewhere in the body for eg.prostate and then spread to bone ,The most common cancers that spread to the bone are cancer of the: 1. Breast 2. Kidney 3. Lung 4. Prostate 5. Thyroid These forms of cancer usually affect older people

The Most Common Area For Effecting Bone Tumor

toes

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

Risk factors
1. Age 2. Combinations of radiation and chemotherapy for treating prior cancer Family history of bone cancer An overactive parathyroid gland

3. Certain kinds of anticancer drugs (alkylating agents) 4. 5.

6. Multiple benign tumors 7. Paget's disease 8. osteomyelitis 9. Radiation

Clinical features
1. 2. 3. 4. 5. 6. 7. 8. 9. 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) 10. Note ! Some benign tumors have no symptoms

Complications
1. 2. 3. 4. 5. 6. 7. Delayed wound healing Nutritional deficiency Infection Hypercalcaemia muscle wasting, bone weakening pathological fracture 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. Pain 11. Spread of the cancer to other nearby tissues (metastasis)

Diagnosis & Tests

Blood test Bone biopsy Bone scan computed tomography (CT). MRI ( magnetic resonance imaging ) X-ray of bone CT scan Bone densitometry for determining bone minerals density

Bone biopsy:

removal of a sample of bone tissue to test for cancer cells.

Open Biopsy Needle Biopsy insert a needle into the tumor to remove some tissue small incision is made and the tissue is removed

Treatment
Systemic therapy  Local therapy
1.Chemotherapy 2. hormone therapy 3. Immunotherapy ex. Interferon 1.Radiation therapy 2. surgery

Systemic therapy
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

Local therapy
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
Surgical Treatment Amputation Rotationplasty
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.

Bone graft

Artificial bone

affected bone is removed, putting an artificial bone in.

Pain medications
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

Epidemiology
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

Nursing process
Nursing assessment Nursing diagnosis Nursing planning Nursing Implementation Nursing evaluation

Nursing assessment
 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 achy 2. pain may or may not get worse with activity 3. Fatigue, anxiety

 Collection Of Objective Data:

1. 2. 3. 4. 5. 6. 7. 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

1 Nursing Diagnosis Acute or chronic pain related to the pathologic process and surgery

Nursing Planning Control of pain

Nursing Implementation 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 patients degree of pain and the effectiveness of analgesics and other pain relief measures, such as positioning.

Nursing evaluation Experiences no pain or decreased pain

2 Nursing Diagnosis Deficient knowledge related to the disease process and therapeutic regimen

Nursing Planning Giving knowledge about the disease process and treatment regimen

Nursing Implementation Nursing evaluation Promoting understanding of the disease process and treatment regimen(Provide foods high in protein, vitamins and folic acid) Dont 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

3 Nursing Diagnosis Risk for injury: pathologic fracture related to tumor and metastasis Nursing Planning Absence of complication Absence of pathologic fracture Nursing Implementation Nursing evaluation Exhibits absence of complication

The effective extremities must be supported and handled gently

4 Nursing Diagnosis Risk for situational low selfesteem related to loss of body part

Nursing Nursing Planning Implementation Improved selfesteem (Promoting self Esteem)Try to help the patient develop a positive attitude toward recovery and urge him to resume an independent lifestyle

Nursing evaluation Demonstrate positive self concept

5 Nursing Diagnosis Ineffective coping related to fear of the unknown ,perception of disease process

Nursing Planning Effective pattern of coping

Nursing Implementation (Promoting coping skills)Encourages the patient and family to verbalize their fears ,concerns, and feelings

Nursing evaluation Demonstrates effective coping pattern

Home care
teach the patient addresses medication dressing treatment regimen and the importance of physical and occupational therapy program the nurse teach weight Bearing limitation and special handling to prevent pathologic fractures it is important that the patient and family know sign a symptoms of possible complication for continuing care and report it to the doctor

Home care
Consume diet to promote healing and health Use of effective coping strategies. Maintain role performance. Nutrition and diet
Provide foods high in protein, vitamins and folic acid and decrease diet contain high amount of calcium .

References
 http://en.wikipedia.org/wiki/Bone_tumor  http://www.medicinenet.com/bone_cancer /article.htm  http://www.nlm.nih.gov/medlineplus/enc y/article/001230.htm  http://www.differencebetween.net/science /health/difference-between-benign-andmalignant/

References

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

References

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