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oncology phase II

Alopecia Loss of hair due to the destruction of hair follicles.
Anaplasia means “without form” and is an irreversible change where the structures of adult cells regress to more primitive levels.
Autologous Something having its origin within an individual, especially a factor present in tissues or fluids.
Allogenic Bone marrow came from another person
Syngenio Donation came from the pt’s identical twin
Related Donation came from a relative, usually a sibling.
Unrelated Donation came from a nonrelative.
Benign Not malignant, not recurrent, not spreading, and favorable for recovery.
Biopsy Removal of a small piece of tissue from and organ or other part of the body for microscopic examination, used to confirm or establish a diagnosis, establish a prognosis, or follow the course of a disease.
Cancer A group of diseases characterized by the uncontrolled growth and spread of abnormal cells that can result in death if not detected and controlled. The exact cause of most human cancers is still unknown. It is not known how many tumors have a chemical, env
About 90% of cancers not inherited.
Hereditary cancers are diagnosed at an earlier stage usually 15 to 20 years earlier than cancers that are not inherited.
Hereditary cancers are characterized by the presence of precursor lesions, such as polyps in colorectal cancer, and dysplastic nevi in melanoma.
Carcinoma A malignant growth or tumors composed of (epithelial cells and glands) that tend to spread to other areas of the body.
Carcinogenesis The process by which normal cells are transformed into cancer cells. Carcinogen
Differentiated Most like the parent tissue.
Hypotrichosis Absence of hair or decease in hair growth.
Hypertrichosis/Hirsutism Excessive growth of hair.
Leukopenia Reduction in the number of circulating white blood cells due to depression of the bone marrow.
Immunosurveillance The immune system’s recognition and destruction of newly developed abnormal cells.
Malignant Tending to become progressively worse, resistant to treatment, tending to spread and result in death.
Metastasis The process by which tumor cells are spread to distant parts of the body, from a primary site to a secondary site (usually through Blood and Lymphatic systems). Neoplasm
Benign (not recurrent or progressive; nonmalignant)
malignant (growing worse and resisting treatment, as in cancerous growths).
benign or malignant growths are also called tumors, which mean swelling or enlargement
tumors swelling or enlargement They may be localized or invasive.
Abnormal cellular growth is classified non-neoplastic growth and neoplastic growth.
The four common non-neoplastic growth patterns are hypertrophy, hyperplasia, metaplasia, and dysplasia. Though not neoplastic conditions, these may precede the development of cancer. ONCOLOGY
Palliation or Palliative care Therapy designed to relieve pain and distress and to control the signs and symptoms of disease; not designed to produce a cure.
Curative Care is the arresting of the growth, or shrinking, or removal of the cancer to cure the disease (e.g., surgery, chemotherapy, radiation therapy), and ease the pain.
Hospice Care is the care for the dying patient. It is a palliative care. Hospice treats the whole pt. It treats the pt and their family/friends.
Primary focus of hospice care enhance the quality of life for the individual, does not strive to prolong pt’s life.
Papanicolaou (“Pap”) smear A means of studying cells that the body has shed during the normal sequence of growth and replacement of body tissue, if cancer is present cancer cells also shed; commonly used in pelvic examinations to detect cancer in women.
Sarcoma Malignant tumors of connective tissues, such as muscle/bone, present as painless swelling. Sarcoma may affect the bones, bladder, kidneys, lever, lungs, parotids, and spleen.
Thrombocytopenia Reduction in the number of circulating platelets due to the suppression of the bone marrow.
Tumor lysis syndrome An oncologic emergency that occurs with rapid lysis of malignant cells; May occur by chemotherapy.
As malignant cells are lysed intracellular contents are rapidly released into blood stream (hyperkalemia, hyperphosphatemia, hyperuricemia (high in uric acid)).
All these lead to renal failure hyperkalemia, hyperphosphatemia, hyperuricemia (high in uric acid)
S/S of TLS: N/V, diarrhea, anorexia, cramping, tetany, seizure, anuria, cardiac arrest.
Urticaria presence of wheals or hives in an allergic reaction commonly caused by drugs, food, insect bites, inhalants, emotional stress, or exposure to heat or cold.
Urticaria or hives caused by the release of histamine in an antigen-antibody reaction.
Chemotherapy drugs are used to reduce or slow the growth of metastatic cancer. Drugs that interfere with a cell’s replication process damage the cell and cause cellular death.
Both malignant and normal cells are affected chemotherapy.
Cells that multiply rapidly are affected the most by chemotherapy, hematopoietic system, reproductive system (sperm cells, ovarian cells), the hair follicles, and the GI system.
Most of the side effects from chemotherapeutic agents results destruction of normal cells.
Radiation therapy use reduce the size of a tumor; or postoperatively to destroy malignant cells not removed by surgery;
Radiation therapy is not recommended when when cancers are radiation resistant.
For external radiation specific area the body is marked to indicate port; Don’t wash these marks.
Lung cancer the leading cause of cancer-related death in both men and women.
86 percent die within 5 years of diagnosis.
Incidence peaks between 55 and 65 years of age.
Smoking the primary cause of lung cancer.
Breast cancer the most common cancer in women (excluding skin cancer). It can rarely occur in men also.
Skin cancer the most common cancer in both men and women:
Melanoma the most serious type, killing over 7,300 people in the US yearly.
Non-melanoma skin cancer most common and much less dangerous.
Sunlight exposure the primary cause of skin cancer.
People of fair complexion are at higher risk.
Prostate cancer the most common cancer in men (excluding skin cancer):
Over 317,000 cases diagnosed annually in the US.
Gastrointestinal cancer the third most common cancer affecting both men and women:
Ovarian and testicular cancers are common malignancies.
The American Cancer Society recommends that all men and women get a cancer-related checkup every three years from age 20 to 40 and then yearly thereafter.
Cancer checkup may include examinations for cancer of the skin, thyroid, mouth, lymph nodes, prostate, testes, breast, cervix and ovaries.
Preventive behaviors and screening tests as recommended by the American Cancer Society: Beginning at age 50, Yearly fecal occult (hidden) blood test (FOBT) combined with flexible sigmoidoscopy every 5 years. .
Preventive behaviors and screening tests as recommended by the American Cancer Society: Beginning at age 50, Double contrast barium enema every 5 years.
Preventive behaviors and screening tests as recommended by the American Cancer Society: Beginning at age 50, Colonoscopy every 10 years.
Preventive behaviors and screening tests as recommended by the American Cancer Society: Beginning at age 50, Skin examination yearly over age 40.
Preventive behaviors and screening tests as recommended by the American Cancer Society: Beginning at age 50, Colorectal Cancer (may be prevented by following screening guidelines to remove adenomatous polyps before they become cancer) Colorectal Cancer may be prevented by following screening guidelines to remove adenomatous polyps before they become cancer a
Preventive behaviors and screening tests as recommended by the American Cancer Society: Beginning at age 50, Skin Cancer may be prevented by staying out of the sun, especially between 10:00 AM and 4:00 PM; wearing protective clothes and other gears, such as, sunglasses; using sunscreen; checking your skin regularly for abnormal or changing areas, especially
Preventive behaviors and screening tests as recommended by the American Cancer Society: Beginning at age 50, Lung cancer (may be avoided by quitting smoking.)
If you smoke, let your physician know if you develop a cough that does not go away,
If you smoke, let your physician know if you develop chest pain often aggravated by deep breathing, hoarseness,
If you smoke, let your physician know if you develop weight loss and loss of appetite, bloody or rust color sputum, shortness of breath,
If you smoke, let your physician know if you develop fever without a known reason, recurring infection such as, bronchitis, and pneumonia, and new onset of wheezing.
Females should undergo the following screening exams: (1) Yearly pelvic examination with Pap smear beginning at age 18.
Females should undergo the following screening exams: (2) Monthly breast self-examinations.
Females should undergo the following screening exams: (3) Clinical breast examination by health care professional every 3 year.
Females should undergo the following screening exams: (4) A yearly mammogram by physician to screen for breast cancer after the age of 40.
Females should undergo the following screening exams: (5) Watching for and reporting any abnormal uterine spotting or bleeding (may be the signs and symptoms of Endometrial Cancer).
Females should undergo the following screening exams: (6) If taking hormone replacement therapy with your uterus still intact, take estrogen with progesterone.
Females should undergo the following screening exams: (7) Ovarian Cancer for those who use oral contraceptives for several years
CA 125 (blood study) used to diagnose ovarian cancer.
Males should undergo the following screening exams: Prostate specific antigen (PSA) blood test and digital rectal exam starting at age 50, or at age 45 if at high risk (family history).
People with higher risk, such as a family history of cancer, should undergo earlier and more frequent screening tests.
Exposure to carcinogens in the workplace, home or recreation may indicate early or specialized cancer screening.
The Risk Factors for Cancer: Smoking, Dietary habits, Exposure to radiation, Exposure to environmental and chemical carcinogens,Smokeless tobacco,Frequent heavy consumption of alcohol.
Tumors are named for the parent tissue, location of the growth, its cellular makeup, or the person by whom it was identified.
sarcoma refers to malignant tumors of connective tissues such as muscle and bone.
Tumors are classified grade 1 to 4 by the degree of malignancy with 4 being a neoplasm most unlike the parent tissue and therefore most malignant.
Tumor, Nodes, Metastasis system (TNM), tumors staged by size, extent of spread to lymph nodes and extent of metastasis to other organs.
Medical management of tumors depends on level of invasion and thickness of the lesion.
Persons who show signs and symptoms of cancer should undergo diagnostic tests to confirm or rule out that they have cancer.
The only sure way to know if one has a malignancy with a tissue biopsy, a sample of tissue for pathological examination:
Incisional biopsy the removal of a portion of tissue for examination, such as when a polyp is removed during endoscopy.
Excisional biopsy the removal of a complete lesion, such as a suspicious mole.
Needle aspiration biopsy the process of aspirating fluid or cells from suspicious tissue by use of a needle.
An endoscope used to directly visualize an internal structure through a body cavity, orifice or through a small incision. Examples are upper gastrointestinal (UGI) endoscopy and colonoscopy to look for suspicious polyps and growths in the GI tract.
Bone Scans involve radioactive material injected into a vein in the arm that is absorbed by malignant cells in the bone. These "hot" malignant cells then "light up" on imaging.
Bone scans used to determine if cancer has spread to the bone.
Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) use sophisticated imaging to examine suspicious tissues, especially very small, deep lesions.
Radioisotope or nuclear medicine studies (similar to bone scans) use radioactive materials that are known to be absorbed by certain growths such as thyroid and brain tumors which "light up" on imaging.
Ultrasound uses painless high-frequency sound waves to visualize internal organs to look for tumors.
Laboratory tests are used to find "markers" in blood and body fluids that may indicate the presence of cancer:
Elevated prostate-specific antigen (PSA) blood levels may indicate the presence of prostate cancer, but not always. Further tests are ordered by the evaluating doctor if the PSA is suspiciously high.
Elevated levels of alkaline phosphatase, serum calcitonin and Carcinoembryonic Antigen (CEA) indicate cancer is present.
Stool examination for blood (guaiac testing) commonly used to detect occult (hidden) blood in the stool that may be the result of bleeding from pre-cancerous polyps or cancerous tissue.
Nursing interventions for patients undergoing diagnostic testing center on proper patient education and pretest preparation: (1) Consider that any patient undergoing tests to rule out cancer is anxious and may need reassurance.
Nursing interventions for patients undergoing diagnostic testing center on proper patient education and pretest preparation: (2) Nurses should reinforce education about preparation for the procedure such as careful hydration prior to radioisotope and dye studies to assure these substances are optimally cleared by the kidneys.
Nursing interventions for patients undergoing diagnostic testing center on proper patient education and pretest preparation: (3) Patients must be informed about how tests are conducted to minimize anxiety. This is especially true of MRI and CT tests where the patient is immobilized in a small space.
Nursing interventions for patients undergoing diagnostic testing center on proper patient education and pretest preparation: (4) MRI tests use a huge magnet. Patients must not have any ferrous metal on or in their body as a safety measure.
Bone Marrow Transplant: the process of replacing diseased or damaged bone marrow with normally functioning bone marrow to treat variety of diseases and offer a chance for long term survival.
Survival after BMT depends on the pt’s age, remission, and physical status.
BMT (bone marrow transplant) is a painful procedure, a pain med is necessary for the pt.
A Cancer pt may show anger, but it is not directed toward the stuff.
Cancers seven warning signs: (CAUTION): Changes in bowel or bladder habits, A sore that does not heal, Unusual bleeding or discharge, Thickening or lump in breast or elsewhere, Indigestion or difficulty in swallowing, Obvious change in warts or moles, Nagging cough or hoarseness.
What kind of diet is optimal for cancer pt? Diet high in fiber and low in fat.
Leading cause of cancer related death Lung cancer (smoking).
Most common cancer found in men Prostate cancer,
Most common cancer in women Breast cancer.
When should females take pelvic exams? When they become 18 year old, or if they become sexually active before 18. (Whichever is earlier).
Used to stage cancer by indicating tumor size, spread of lymph nodes, and extent of metastasis TNM (tumor, nodes, and metastasis).
Primary prevention of cancer quit smoking, dietary modification, exposure to radiation, exposure to chemicals, and limiting alcohol.
Method to detect metastatic tumors Bone Scan.
Noninvasive procedure using high frequency sound waves Ultrasound.
Painless diagnostic procedure that doesn’t involve any exposure to radiation MRI.
Reduction in the number of circulating platelets Thrombocytopenia;
Pt teaching for the client with thrombocytopenia includes using a soft toothbrush, and electric shaver.
Bone marrow may be removed from an individual for personal use autologous.
Common side effects of chemotherapy leucopenia, neutropenia, stomatitis.
Drugs that reduce or slow growth of metastatic cancer Chemotherapy drugs.
Three IV meds given to prevent nausea, and vomiting in chemo patients Zofran, Kytril, Compazine.
Primary medical intervention for skin tumors Surgical Removal.
Most serious type of skin cancer melanoma.
Pain a late symptom of cancer.
Higher the grade or stage, worse the cancer.
4 reasons/types of surgery used in dealing with cancer Preventative, Diagnostic, Curative, Palliative.
Therapy designed to relive pain and discomfort, not to cure it Palliative Surgery; removal of tumor or growth
Care given to dying patients to increase quality of life, not to prolong life Hospice. Program that provides continued bereavement support for the family for up to a year
Narcotic opioids are the class of drugs most often used to control advanced cancer pain Morphine, Hydromorphone, fentanyl and methadone Opioids may be given IV, SQ, intrathecally and transdermally
Cancer Pain Management Nursing considerations Constipation Adverse reactions Nausea/vomiting Respiratory and CNS depression
Non-narcotic methods of pain control Use pain relief measures BEFORE the patient’s pain becomes severe Include pain relief measures the patient is willing and able to use Consider non-verbal behavioral clues such as grimacing in assessing pain relief Distraction, biofeedback, massage,
Non-narcotic medications such as Aspirin Ibuprofen Acetaminophen
can worsen pain. Anxiety
Name three routes for administering narcotic pain medications Oral, IV, transdermal, SQ, intrathecal
Antineoplastics Uses Used in the treatment of various solid tumors, lymphomas, and leukemias
Antineoplastics Uses Used in some autoimmune disorders such as rheumatoid arthritis (cyclophosphamide, methotrexate).
Antineoplastics Uses Used in combinations to minimize individual toxicities and increase response.
Antineoplastic Uses Chemotherapy may be combined with other treatment modalities such as surgery and radiation therapy
Antineoplastic Uses Dosages vary greatly, depending on extent of disease, other agents used, and patient's condition
Antineoplastic Uses New formulations (daunorubicin, doxorubicin) encapsulated in a lipid membrane have less toxicity with greater efficacy
Antineoplastic Drugs Actions Antineoplastic drugs affect cells that rapidly proliferate by interfering with the cycle of cell reproduction or by destroying the cell
Antineoplastic Drugs Actions The problem is that there are normal cells in the GI tract, oral cavity, bone marrow, hair follicles, gonads and lymph tissue that proliferate rapidly, thus, antineoplastic drugs can affect normal as well as cancerous cells
Many affect DNA synthesis or function alter immune function or affect hormonal status of sensitive tumors
Antineoplastics Actions not be limited to neoplastic cells
Antineoplastic Categories Alkylating Agents busulfan (Busulfex, Myleran). carboplatin (Paraplatin). carmustine (BCNU, BiCNU, Gliadel). chlorambucil (Leukeran). cisplatin (Platinol). cyclophosphamide (Cytoxan, Neosar
Antineoplastic Categories Alkylating Agents ifosfamide (Ifex). mechlorethamine (Mustargen, nitrogen mustard). melphalan (Alkeran, L-Pam, phenylalanine mustard). procarbazine (Matulane). temozolamide (Temodar
Antineoplastic Categories Con’t (Anthracyclines) daunorubicin citrate liposome (DaunoXome) daunorubicin hydrochloride (Cerubidine) doxorubicin hydrochloride (Adriamycin PFS, Adriamucin RDF, Rubex) doxorubicin hydrochloride liposome (Doxil). epirubicin (Ellence) idarubicin (Idamycin)
Antineoplastic Categories Con’t (Anthracyclines) cytarabine (Ara-C, cytosine arabinoside, Cytosar-U, DepoCyt) fluorouracil (Adrucil, Efudex, Fluoroplex, 5-FU) gemcitabine (Gemzar) hydroxyurea (Droxia, Hydrea) methotrexate (amethopterin, Folex, Folex PFS, Rheumatrex, Trexall)
Antineoplastic Categories Con’t (Antitumor Antibiotics) bleomycin (Blenoxame) mitomycin (Mutamycin) mitoxantrone (Novantrone) plicamycin (Mithramycin, MIthracin)
Antineoplastic Categories Enzyme: asparaginase (Elspar) imatinib (Gleevac) pegaspargaseOncaspar, PEG-L-asparaginase)
Antineoplastic Categories Enzyme Inhibitors: irinotecan (Camptosar) topotecan (Hycamtin)
Antineoplastic Categories Antiestrogens: tamoxifen (Nolvadex, Tamofen) toremifene (Fareston)
Antineoplastic Categories Hormones: bicalutamide (Casodex) flutamide (Eulexin) goserelin (Zoladex) leuprolide (Lupron, VIadur) medroxyprogesterone (Depo-Provera) megestrol (Megace) nilutaminde (Nilandron) triptorelin (Trelstar Depot)
Antineoplastic Categories Aromatase Inhibitors: anastrazole (Arimidex) letrozole (Femara)
Antineoplastic Categories Kinase Inhibitor: imatinib (Gleevac)
Antineoplastic Categories Monoclonal Antibodies: aldesleukin (Proleukin, IL-2, interleukin-2) alemtuzumab (Campath) gemtuzumab ozogamicin (Mylotarg) trastuzumab (Herceptin)
Antineoplastic Categories Podophyllotoxin Derivatives: etoposides (Vepeside, VP-16)
Antineoplastic Categories Taxoids: docetaxel (Taxotere) paclitaxel (Onxol, Taxol)
Antineoplastic Categories Vinca Alkaloids: vinblastine (Velban) vincristine (Oncovin, Vincasar PFS) vinorelbine (Navelbine)
Antineoplastic Categories Miscellaneous: aldesleukin (Proleukin, IL-2, interleukin-2) altretamine (Hexalen, hexamehtylmelamine)
Antineoplastic Categories Contraindications: Previous bone marrow depression or hypersensitivity. Contraindicated in pregnancy and lactation
Antineoplastic Categories Precautions (use cautiously in patients with): Active infections Decreased bone marrow reserve Radiation therapy Other debilitating illnesses Childbearing potential
Antineoplastic Categories Side Effects/Adverse Reactions Chemotherapeutic techniques have a range of side effects mainly affecting the fast-dividing cells of the body
Antineoplastic Categories Side Effects/Adverse Reactions CNS: memory loss EENT: tinnituys, ototoxicity CV: cardiotoxicity GI: nausea, vomiting, diarrhea or constipation, malnutrition, weight loss or gain
Antineoplastic Categories Side Effects/Adverse Reactions GU: nephrotoxicity. Local: pain. Hemat: anemia, hepatotoxicity, depression of the immune system, hence (potentially lethal) infections and sepsis, hemorrhage, secondary neoplasms. Derm: hair loss.
Antineoplastics Interactions: Allopurinol decreases metabolism of mercaptopurine
Antineoplastics Interactions: Toxicity from methotrexate may be increased by other nephrotoxic drugs or larger doses of aspirin or NSAIDs
Antineoplastics Interactions: Bone marrow depression is additive
Antineoplastics Nursing Considerations Nurses must receive specialized training prior to administering antineoplastic agents
Antineoplastics Nursing Considerations Consider the anxiety and fears that the patient may have regarding the chemotherapy treatment
Antineoplastics Nursing Considerations Dosage is often based on the patient’s weight
Antineoplastics Nursing Considerations Provide pre-treatment requirements as necessary. An example of pre-administration treatment would be to hydrate the patients with 1 to 2 liters of IV fluid prior to giving the drug
Antineoplastics Nursing Considerations Assess base line lab values prior to the administration of the drugs and follow up with lab values
Antineoplastics Nursing Implications Assessment: Monitor for bone marrow depression
Antineoplastics Nursing Implications Assessment: Assess for bleeding (bleeding gums, bruising, petechiae, guaiac stools, urine, and emesis)
Antineoplastics Nursing Implications Assessment: Avoid IM injections and rectal temperatures if platelet count is low
Antineoplastics Nursing Implications Assessment: Apply pressure to venipuncture sites for 10 min.
Antineoplastics Nursing Implications Assessment: Assess for signs of infection during neutropenia Anemia may occur
Normal value for neutrophils: 3000 - 7000/mm3 Neutropenia: < 1000/mm3
Severe Neutropenia: < 500/mm3 Contact the physician First line of defense collapes, opening way for pneumonia, septicemia and other infections
Severe Neutropenia: < 500/mm3 Protect patient against pathogens VS q 4 hours and notify physician if temperature starts to rise
Fresh flowers and live plants fresh fruits and vegetables are discouraged in the room should be avoided Hold doses of chemotherapy until neutrophil levels return to normal
Antineoplastics Nursing Implications Assessment: Monitor for increased fatigue, dyspnea, and orthostatic hypotension
Antineoplastics Nursing Implications Assessment: Monitor intake and output ratios, appetite, and nutritional intake
Monitor intake and output ratios, appetite, and nutritional intake Prophylactic antiemetics may be used. Adjusting diet as tolerated may help maintain fluid and electrolyte balance and nutritional status.
Monitor IV site carefully and ensure patency Discontinue infusion immediately if discomfort, erythema along vein, or infiltration occurs
Leave IV tubing in place and administer the appropriate antidote through the existing IV tube Tissue ulceration and necrosis may result from infiltration
Monitor for symptoms of gout (increased uric acid, joint pain, and edema) Encourage patient to drink at least 2 L of fluid each day Allopurinol may be given to decrease uric acid levels. Alkalinization of urine may be ordered to increase excretion of uric acid
Monoclonal antibodies: to minimize reactions administer methylprednisolone sodium succinate
Solutions for injection should be prepared in a biologic cabinet
Health care professional should be informed immediately if symptoms of infection occur
Patient/Family Teaching Instruct patient to report unusual bleeding Advise patient of thrombocytopenia precautions
common ordered raiographic studies chest radiograph, mammography, bone scan, GI series, barium enema, IV pyelogram.
CT scan, radioisotope studies, ultrasound, MRI, PET. diagnostic imaging studies used to determine the depth of the specific lesion & ID other structures invaded
cancer laboratory & diagnostic examinations Alkaline phosphatase,serum calcitonin,carcinoebryonic antigen serum, blood markers, guaiac
alkaline phosphatase elevated if there is metastasis to the bone and liver
serum calcitonin secreted by the thyroid due to rise in calcium, increased in the blood of people with thyroid, breast, & oat cell cancer of lungs
serum calcitonin used in addition to baseline level testing to confirm diagnosis of cancer. pt is NPO at midnight
carcinoembryonic antigen serum level increases in colorectal cancer, can be elevated in smokers, used in evaluation due to tummor recurrence or metatastic disease
blood markers PSA, CA-125, CA-19-9
prostate gland cancer, normal for man over 40 is 0 to 4ng/L PSA
ovarian cancer, detected in the blood and peritoneal ascites. normal is 35 units/mL CA-125
CA-19-9 pancreatic or hepatobiliary cancer
used to determine pt's response to therapeutic intervention and surveillance of the patient with pancreatic or hepatobiliary cancer CA-19-9
Opthalmology,gynecology,urology,neurosurgery, and otolaryngology current major uses for laser beam surgery, patient must remain still
what does hot/cold or direct sunlight do to external radiated areas of the body increase chances of erythema, drying, pruritus
what is recommended for people undergoing external radiation high protein and calories and a fluid intake of 2-3 L/day
lethargy and fatigue common during external radiation treatment
radioactive implant (brachytherapy) sealed radioactive materials temporary/permanent in hollow cavities or on body surface
brachytherapy (radioactive therapy) combined with external radiation
natural placement for brachytherapy uterus and vagina
internal radiation brachytherapy (radioactive therapy)
sites for unsealed internal radiation orally, intravenously
what precautions should be taken when giving radiation treatments (cluster care)prevent direct contact with patient, or any body tissue or fluid,limit visitors to 10min
why is chemotherapy used reduces the size and/or growth of metastatic cancer
alkylating agents tin-cil-mide (c.p.p.l)
antitumor cin-trone(b.a.n)
antimetabolites bine-cil-trexate (ara-cyto-flu-fu-gem)
hormonal agents corticosteroids, mythelPREDNISOLONE, megestrol, leuprolide(deca-solu-lupro-medrol)
where do some rapid producing cells occur hematopoietic, GI system, and hair follicles.
what are a majority of side effects from chemotherapy the destruction of normal cells
common problem for people receiving chemotherapy leukopenia (reduced WBC) <4000
normal WBC 5000-10,000/mm3
normal RBC male 4.7-6.1 female 4.2-5.4 million/mm3
hemoglobin male 14-18 g/dl female 12-16g/dl
hematocrit male 42%-52% female 37%-47%
mild anemia hemo 10-14g/dl
moderated anemia hemo 6-10g/dl
severe anemia hemo <6 g/dl
indication on blood transfusion cardiac decompensation, low hemoglobin w/ low platelet counts
tumor lysis syndrome oncologic emergency with rapid lysis (death) of a large number of proliferated malignant cells
may occur spontaneoulsy in patients with inordidately high tumor burdens tumor lysis syndrome (TLS)
TLS anywhere from 24hrs to 7days after neoplatic therapy is started.
seen in chronic lymphocytic and metastatic breast cancer TLS
late signs of TLS tetany, paresthesias, seizures, anuria, and cardiac arrest (c/a.t.p.a.s)
diagnostic test for TLS potassium, phosphate, calcium, uric acid, creatinine, B.U.N, urine pH
medications for TLS diuretics, allopurinol, sodium bicarbonate, calcium gluconate
Oral Cavity Carcinoma:The tumors are usually squamous cell epitheliomas that grow rapidly and metastasize to adjacent structures.
The lips, the oral cavity, the tongue, and the pharynx prone to develop malignant lesions.
Tumors of the salivary glands primarily in the parotid gland and are usually benign.
Tumors of the submaxillary gland a high incidence of malignancy.
Cancer or neoplasm uncontrolled growth of anaplastic cells that form a colony of abnormal and dysfunctional cells,
Cancer or neoplasm tend to invade surrounding tissue and to metastasize to distant body sites.
The tumors seen with cancer of the lip epithelioma.
epithelioma. occurs most frequently as a chronic ulcer of the lower lip in men
Due to the tongue’s abundant vascular and lymphatic drainage, patients diagnosed with this disorder Carcinoma spreads to the neck.
Recent investigation has revealed a higher incidence of cancers of the mouth and throat among persons who are heavy drinkers and smokers.
Predisposing carcinoma factors exposure to the sun, and wind, but more important is the progression of Leukoplakia to an epidermoid lip cancer.
How does one’s tongue and lymphatic drainage help spread cancer cells? The tongue is highly vascular and has extensive lymphatic drainage, which allows the cancer cells to move to other parts of the body readily and metastasize quickly.
Kaposi’s sarcoma malignant skin tumor that occurs primarily on the legs of men between 50 and 70 years of age.
Recently Kaposi’s sarcoma has been seen with increased frequency as a non-squamous tumor of the oral cavity in Pt with AIDS.
Kaposi’s sarcoma lesions purple and nonulcerated.
Kaposi’s sarcoma Irradiation is the treatment of choice.
Leukoplakia A condition characterized by white spots or patches on mucous membranes, especially of the mouth, tongue and vulva.
Leukoplakia may appear on the lips and buccal mucosa.
Leukoplakia nonsloughing lesions cannot be rubbed off by simple mechanical force. They can be benign or malignant.
Signs and Symptoms of Oral Carcinoma are Lesion, lump, Leukoplakia in mouth or on tongue longer than 2 weeks; Pain, soreness, and bleeding from lesion; Numbness, dysphagia and loss of feeling; and multiple ulcers of the tongue.
Early symptoms of Leukoplakia asymptomatic; As disease progresses: Pain, Soreness, and Bleeding; Patient may experience difficult with eating, or speaking; Earache, face ache and toothache are constant.
What are the diagnostic procedures used to detect Leukoplakia/Oral Carcinoma? Indirect laryngoscopy is recommended for men over 40 years of age with dysphagia and for those with a history of smoking and alcohol consumption.
To Rule Out presence of cancer of the mandibular structure, radiographic evaluation is performed of the head and neck.
Most accurate method for Leukoplakia/Oral Carcinoma? a definitive diagnosis is an excisional biopsy. Cytological examination (i.e. Oral exfoliative cytology) included the scraping of the lesion as a means of screening intraoral lesions.
Medical/Surgical management for Leukoplakia/Oral Carcinoma? Depends: Location, Type of tumor, Staging of tumor, Early detection of carcinomas of the oral cavity results in good prognosis.
Small tumors Medical/Surgical management for Leukoplakia/Oral Carcinoma? surgical removal of the tongue to removal of the entire larynx or portion above the true vocal cords.
Large tumors Medical/Surgical management for Leukoplakia/Oral Carcinoma? neck dissection especially if the carcinoma has spread to the lymph nodes. Location of surgery can present complications that include:
Medical/Surgical management for Leukoplakia/Oral Carcinoma? Airway obstruction; Hemorrhage; Tracheal aspiration; Facial swelling; Fistulas; Necrosis of skin. Tracheotomy and Tube feeding may be needed.
staging of Malignant Tumors Classified? Stage I—small, accessible tumors, treated with surgery or radiation
staging of Malignant Tumors Classified? II and III—Large tumors that are less accessible, treated with Surgery and radiation.
staging of Malignant Tumors Classified? IV—Large tumors that can only be treated with palliative care.
What are the treatment options for patients with an advanced cancer prognosis? Palliative care; Survival rate < 50%.
Nursing Interventions and Patient Teachings of Oral Cancer? Focus on total patient/holistic approach
Nursing Interventions and Patient Teachings of Oral Cancer? Mental, Physical and Spiritual response; Involve family members Nutritional Management (may be challenging due to sensitive tissue of the mouth); Care of the surgery patient, explain before and after surgery.
Carcinoma of the esophagus (malignant epithelial neoplasm) a tumor with the presence of squamous cell carcinoma or adenocarcinoma that invades the esophagus.
Esophageal cancer more commonly in men than women.
90% of esophageal cancer squamous cell carcinomas which are associated with alcohol abuse and cigarette smoking.
Other noted causes of esophageal cancer chronic irritation, environmental carcinogens, mucosal damage, and nutritional deficiencies.
Esophageal cancer usually detected at a late stage due to the location.
Esophageal cancer more prevalent in ages 55 to 70 years and more common in men.
Carcinoma of the bronchus, stomach or breast metastasizes to the esophagus.
Patient's most common clinical symptom (i.e., primary symptom) of Oral Cancer? is difficulty in swallowing (dysphagia).
As the disease progresses of Oral Cancer? , patients experience the sensation of food sticking in the throat, leading to weight loss.
Assessing carcinoma of the esophagus is similar to cancer of the oral cavity.
The history of Oral Cancer? should include, symptoms and a medical, drug and allergy history, and obtain vital signs and weight.
Contributing factors of Oral Cancer may lead to weight loss may be directly related to the tumor, side effect of treatment and/or dysphagia
Postoperative nursing care for carcinoma of the esophagus should focus on (a) assessing stoma, (b) Check stoma regularly(c) Normal characteristics of a stoma(d) Anxiety may be reduced by encouraging the patient to get involved with the care of his/her stoma.(e) Monitor fluid and electrolyte balance (f) Provide meticulous skin c
Nutritional considerations: Avoid gas-forming foods such as dry beans, cabbage, uncooked onions, cheese and fish. By eating slowly and chewing food well, this will lessen the development of gas. The chlorophyll in dark green vegetables helps to deodorize the feces. Do not restrict f
carcinoma of the esophagus Pharmacological considerations: Some medications, especially vitamins, antibiotics and antituberculosis drugs cause strong odors that cling to the pouch. Patients with an ileostomy should avoid enteric-coated medications and some time-released drugs. These medications may pass through w
What types of cancer cells are usually associated with the esophagus? Squamous Cell Carcinomas.
What are the four diagnostic tests used to detect esophageal cancer? Barium swallow; Fluoroscopy; Endoscopy; Biopsy and cytological examination (performed as a final diagnosis for a high degree of accuracy)
Prior to treatment of the tumor staging and size of the tumor must be determined.
Palliative measures are offered Pt is not a surgical candidate.
Chemotherapy is considered a palliative treatment advanced cancer of esophagus.
Esophageal dilatation is performed to enlarge the area obstructed by the tumor.
Laser therapy is used to destroy some of the tumor.
Tumors on lower third of esophagus resected with the remaining two thirds reattached to the stomach.
Tumors on the upper 2/3 of the esophagus resected and the esophagus is replaced with a section of the jejunum or colon.
Explain how cancer tumors on both the lower and upper portions of the esophagus are surgically removed or reattached? Esophagogasterctomy,EsophoGastrostomy,Esophagoenterostomy,
Esophagogasterctomy Resection of a lower esophageal section with a proximal portion of the stomach, followed by Anastomosis of the remaining portions of the esophagus and stomach.
Esophagogastrostomy Resection of a portion of the esophagus with Anastomosis to the stomach.
Esophagoenterostomy Resection of the esophagus and Anastomosis to a portion of the colon.
Gastrostomy A surgical procedure in which insertion of a catheter into the stomach and suture to the abdominal wall are done (for the Pt who diagnosed with carcinoma of esophagus).
Esophageal Dilatation A condition in which the esophagus is abnormally dilated.
Name five important nursing and patient teachings for esophageal cancer: Explain treatment and care; immediately alert doctor if symptoms worsen; provide time for questions; improve nutrition preoperatively and maintain postoperatively; provide good oral hygiene.
COLON CANCER Malignant neoplasms that invade the epithelium and surrounding tissue of the colon and rectum are the third most prevalent internal cancers in the United States and the second leading cause of cancer deaths.
COLON CANCER occurs with the same frequency in men and women, with the highest incidence in persons 60 years and older.
Clinical manifestations: Signs and Symptoms of Colon Cancer vary with the location of the growth. During the early stages, most patients are asymptomatic. Most common clinical manifestations are chronic blood loss and anemia.
Predisposing factors COLON CANCER :Ulcerative colitis and diverticulosis increase the risk of colorectal cancer
COLON CANCER Polyps may undergo malignant changes and become carcinomas; Lack of bulk in diet increases transit time (normally r/t malignancy); High fat intake; Prolonged high bacterial count in colon.
What are the key diagnostic tests used to detect colon cancer? (1) Digital Examination; (2) Fecal Occult Blood (3) proctosigmoidoscopy with biopsy (inspection of the lower colon); and (4) colonoscopy (inspection of the entire colon).
Other COLON CANCER diagnostic tests may be used : Endorectal ultrasonography, CT scan of the abdomen and pelvis, Upper GI series, Radiological abdominal series, Barium enema, Blood test for hemoglobin, hematocrit, and electrolyte levels, and Carcinoembryonic antigen test (CEA).
What are the most reliable tools for screening of Colon Cancer? Fecal occult blood exam followed by a proctosigmoidoscopy.
What type of diet should a patient consume to avoid colon cancer? A lot of bulk in the diet, low fat intake, high fiber foods found in fruits, vegetables, and bran. Cruciferous vegetables such as cauliflower, broccoli, Brussels sprouts, and cabbage protect against malignancy.
How do we assess and Diagnose Colon Cancer? Complaints of a change in bowel habits, alternating between constipation and diarrhea, excessive flatus, cramps, rectal bleeding varying from dark to bright red,
COLON CANCER abdominal pain, nausea, and cachexia—late symptoms.
COLON CANCER Observe for vomiting, weight loss, chronic blood loss and anemia, abdominal distention, ascites in the abdomen, and test results that are compatible with the diagnosis.
Preoperative and Postoperative nursing teachings, and Medical Management of Colon Cancer:Preoperative Bowel preparation, usually 2-3 days of liquid diets; a combination of laxatives, GoLYTELY, or enemas; and oral antibiotics to sterilize the bowel; Instruction on turning, coughing, and deep breathing; Wound splinting and leg exercises;
Postoperative COLON CANCER Assess for stable vital signs, return of bowel sounds,Dressings checked for drainage or bleeding, Monitor NG tube and Foley catheter, turning/coughing/deep breathing, early ambulation
Medical Management of COLON CANCER radiation, chemotherapy, and surgery. Mitrolan (for diarrhea) & Metamucil (for constipation)
What medication of colon cancer is contraindicated for a complete bowel obstruction? Promotility or antidiarrheal Agents, such as Mitrolan.
Complications after Surgery/Abdominal Resection Paralytic ileus
Paralytic ileus (a common complication that produces the classic signs of increased abdominal girth, distension, nausea, and vomiting.
Interventions of COLON CANCER Surgery/Abdominal Resection include decompression of the bowel with an NG tube, NPO status, and increased Pt activity; urinary retention, or incontinence; pelvic abscess;
two common stoma complications are manifested by necrosis and abscess; failure of perineal wound healing or wound infection; and sexual dysfunction. Every effort is made to preserve the sphincter.
SURGICAL PROCEDURES FOR COLORECTAL CANCER: Anterior rectosigmoid resection, Left Hemicolectomy,
Right Hemicolectomy Resection of ascending colon and hepatic flexure; ileum anastomosed to transverse colon.
Left Hemicolectomy Resection of splenic flexure, descending colon, and sigmoid colon; transverse colon anastomosed to rectum.
Anterior rectosigmoid resection Resection of part of descending colon, the sigmoid colon, and upper rectum; descending colon anastomosed to remaining rectum.
In carcinoma of the rectum every effort is made by the surgeon to preserve the sphincter.
Stomach Cancer: Heredity and chronic inflammation of the stomach appear to be contributing factors.
Gastric cancer is more prevalent in persons between 50-70 y/o.
as cancer progresses may pt’s have feelings of fullness, anorexia, weight loss and anemia.
PAIN IS A LATE SYMPTOM. stomach cancer
What body organs do stomach cancer usually spread or metastasizes to? It spreads to the lymph nodes, and metastasizes to liver, spleen, pancreas, esophagus or colon.
How do we assess and diagnose stomach cancer? Subjectively, complaints of epigastric discomfort or indigestion and postprandial fullness, anorexia and weakness, and ulcerlike pain that do not respond to therapy.
How do we assess and diagnose stomach cancer? Objectively, look for weight loss, melena, hematemesis, anemia, and vomiting after taking any fluids or meals.
How do we assess and diagnose stomach cancer? Diagnostic tests: (a) Radiographic studies (barium swallow)/Endo/gastroscopic examination with biopsy;/Stool occult blood test and Gastric analysis;Lab studies to include (CEA) levels, CBC, and serum B12 levels.
Risk factors for stomach cancer: A diet high in Salts, Smoking and preserved food may be a risk factor for stomach cancer.
What is the only definitive medical management of stomach cancer? Complete/ Partial Surgical removal (gastric bypass) of the stomach is the only definitive management.
Other types of cancer other than lung cancer occur more frequently, but are more curable than lung cancer:
Created by: SGT.MOSS