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Med- Surg 2012 sprin

Oncology

QuestionAnswer
cell consist of cell membrane, cytosol (cytoplasm,) cell organelles, nucleus
what is the genetic code sequence of amino acids needed for protein synthesis
How are mutations caused a structural change in the DNA code of a cell
Mitosis - how does it work> process of cell reproduction - 1 cell divides into 2
do all cells undergo mitosis? some cells undergo mitosis and some do not
3 functions of the cell cycle 1- cells are always actively dividing 2- cells leave the cycle after a certain point and die 3- cells temporarily leave the cycle and remain inactive until reentry into the cycle
tissue group of cells with similar structure and function
4 types of human tissue epithelial, connective, muscle , nerve
how is a particular cancer named? depends o the cell from which they are primary
oncology the branch of medicine that deals with tumors including study, development, diagnosis, treatment, and prevention
neoplasm -cells that produce abnormal -they may not contain cancerous cells -they are usually not detected until approx 1 cm and contains 500 cells
benign - noncancerous cell - not normal to the body - slower growth of tumors - cells closely resemble original tissue - do not generally result in death unless pressure is exerted on a vital organ
malignant -growth with cancerous cells - infiltrates surrounding tissue and spreads - tumor grows -quickly -primary site -secondary or metastatic site -
what is a primary site? where the cancer cell originates
what is a secondary or metastatic site? area to which the cancer travels (spreads) to
where does cancer begin? all cancers begin in cells (caused by mutations in DNA code of a cell)
How do mutations disrupt the cell? mutations disrupt cell division leading to the growth of abnormal malignant cells
characteristics of cancerous cells - poorly constructed - can form anywhere in the body, at any time , from any cell - multiplies quickly
what is cancer -group of related diseases with varying causes, manifestations, treatments and prognosis - caused by mutations of cellular genes
what is the characteristic of cancer cells - cancerous cells adopt characteristics of the cell it changes - they have no limits to cell divisions
what are the 2 steps of growth and reproduction of cancer cells 1- initiation 2 promotion
what is initiation (in relation to cancer) initiation - causes an alteration in the genetic structure of the cell - results in the cell becoming more susceptible to carcinogens and causing the cell to become cancerous
what is promotion ( in relation to cancer) promotion - results after repeated exposure to carcinogens causing the initated cells to mutate (even after long latency periods) - formation of a tumor due to cell mutation
what can increase a persons risk for cell mutation? any substance that weakens or alters the immune system
can a healthy immune system kill cancer cells? Yes, a healthy immune system can kill cancer cells, however cancer cells duplicate faster than those of the immune system - initial attacks may be fended off- repeated attacks will wear they healthy system down
Common risk factor of cancer - oncoviruses -radiation -chemical / irritants - heredity - diet - hormones - poor immune function
cancer classification 4 types (found Where) carcinoma ( epithelial) sarcoma - ( bone / muscle) leukemia ( bone marrow/ blood) lymphoma ( immune system)
Where does Carcinoma originate: Epithelial
where does sarcoma originate bone and or muscle
where does leukemia originate bone Marrow or blood
where does lymphoma originate immune system
in situ used to describe cancerous cells that remain in one area (localized) - usually detected microscopically and once removed surgically , requires no further tx
what is encapsulated? why is it beneficial? encapsulated - with in a membrane the abnormal cells are generally in one area
metastasis spread of the tumor from the primary site to another area in the body (secondary)
metastasis involves 3 steps: 1- cells invade blood or lymph vessels 2- cells move by mechanical means cells lodge and grow in a new location
What does metastatic tumors carry with them? metastatic tumors carry with them the characteristics of the primary tumor site
what are 4 of the most common metastatic sites liver lungs bones brain
what is the most common type of cancer in adults skin
what is the most preventable type of cancer - Skin
what increases the risk of skin cancer Exposure to UV rays increases risk
what can be done to reduce the risk of skin cancer protective clothing and sunscreen reduce risk
what sex has the highest occurrence of cancer Men
what are the 3 leading cancer causes of death in men? 1- lung cancer 2 prostate cancer 3 colon cancer
what are the 3 leading cancer causes of death in women? 1- Lung cancer 2- Breast cancer 3- colon / rectum
what is crucial for prevention and treatment early detection
what 3 main things would you educate your client on regarding cancer? 1 risk factors 2 self examination 3 cancer screening programs
Early Detection and prevention CAUTION what does this letter stand for? C Change in bowel or bladder habits
Early Detection and prevention CAUTION what does this letter stand for? A a sore that does not heal
Early Detection and prevention CAUTION what does this letter stand for? U unusual bleeding or discharge
Early Detection and prevention CAUTION what does this letter stand for? T thickening or lump in breast or other tissue
Early Detection and prevention CAUTION what does this letter stand for? I indigestion or swallowing difficulties
Early Detection and prevention CAUTION what does this letter stand for? O obvious change in wart or mole
Early Detection and prevention CAUTION what does this letter stand for? N Nagging cough or hoarseness
American Cancer Society recommends: Baseline Mammogram beginning at age 35-39 then >40 annually (asymptomatic women - w/o 1st degree relatives affected)
American Cancer Society recommends: initial pap smear and pelvic exam By age 21 (or when the female becomes sexually active)
American Cancer Society recommends: Pap smear / Pelvic exam (If Normal) normal X 3 consecutively, q2-3years unless risk factors are present
American Cancer Society recommends: Pap smear / Pelvic exam (After age 70) normal x 3 consecutively , paps no longer required
American Cancer Society recommends: colorectal screening options 1- annual stool test for occult 2 flexible sigmoidoscopy q5 years 3- annual stool test for occult and flexible sigmoidoscopy q5 years 5- double contrast barium enema 6- colonoscopy q 10 years
What is the preferred method for a colorectal screening? annual stool test for occult and flexible sigmoidoscopy q5 years
At what age should (normal) screening for prostate begin? At age 50 screening for prostate should begin ** earlier if risk factors are present
What is a PSA level indicative of? Prostate cancer
What is generally included in a prostate exam? Digital rectal exam and PSA (Prostate Specific Antigen) blood testing
Genetic Testing (related to Cancer) - cancer is a genetic disease - Genetic factors play an important role in cancer cell development - - associated genetic mutation is found in all cells and represents an inherited susceptibility to cancer for all family members who carry the mutation
examples of cancers influenced by genetics: * Cowden syndrome * familial adenomatous polyposis * familial melanoma syndrome * Hereditary breast / ovarian cancer * hereditary nonpolyposis colon cancer * neurofibromatosis type 1 * retinoblastoma
Family history assessment- the nurse should... * info about maternal/paternal family * obtain cancer hx >3< generations * clustering of cancers occuring younger ages, multiple primary cancers in 1 individual, paired organs, 2+ close relatives w/same cancer (hereditary cancer syndrome)
Dietary factors (related to cancer) * are linked to environmental cancers ** the risk of cancer increase w/ long-term ingestion of carcinogen or co-carcinogens or chronic absence of protective substances in the diet
dietary substances can be proactive (protective) carcinogenic co-carcinogenic
dietary substances that appear to increase the risk of cancer includes: fats, alcohol, salt-cured or smoked meats, nitrite/nitrate - containing foods; red and processed meats
Alcohol increase the risk of which cancers? mouth , pharynx, larynx, esophagus, liver, colorectum, and breast
greater consumption of vegetables and fruits is associated with ... decreased risk of lung, esophageal, stomach and colorectal cancers
high caloric intake is associated with increased cancer risk
Obesity is clearly associated with what types of cancer? endometrial, post menopausal breast cancers, colon, esophagus, and kidney cancers *** Evidence for increased risk of cancer in pancreas; gallbladder; thyroid; ovary; cervix; prostate; and for multiple myeloma and Hodgkin lymphoma ***
Vaccines- (in relation to cancer) What protects against the HPV virus Guardasil
Biopsy
laboratory tests
cytological study
radiological studies
nuclear imaging procedures
Ultrasound
MRI
Endoscopy
What is Staging (TNM), what is it used for. International staging system used to classify solid tumors by - size and tissue involvement, - extent of lymph node involvement - and Metastasis
TNM - Classification system T- T- Primary tumor the extent of the primary tumor ( size of tumor and tissue involvement)
TNM - Classification system N N - the absence or presence and extent of regional lymph node metastasis
TNM - Classification system M M- the absence of presence of distant metastasis
What are the numerical subsets of the TNM components indicate the progressive extent of the malignant disease
TNM - Classification system Tx Primary tumor can not be assessed
TNM - Classification system T0 no evidence of primary tumor
TNM - Classification system Tis carcinoma in situ (localized)
TNM - Classification system T1, T2, T3, T4 increasing size of local extent of the primary tumor
TNM - Classification system Nx regional lymph nodes can not be assessed
TNM - Classification system N0 no regional lymph node metastasis
TNM - Classification system N1, N2, N3 increasing involvement of regional lymph nodes
TNM - Classification system Mx distant metastasis can not be assessed
TNM - Classification system M0 no distant metastasis
TNM - Classification system M1 distant metastasis
Grading refers to the classification of the tumor cells - to measure how aggressive the tumor is
Grading aids in ... * predicts long term results * response to treatment * chance of survival
How are cancer cells graded? Based on how much they resemble normal mature cells
GRADING Well differentiated cells of tumor greatly resembles cells of normal tissue
GRADING Moderately differentiated some of the tumor cells resemble normal tissue and some do not
GRADING poorly differentiated majority of cells are differentiated
GRADING undifferentiated all cells are abnormal
surgery excision of a tumor and surrounding tissue
prophylactic surgical removal of anything that poses a risk
Palliative care and comfort for Symptom control
Reconstructive cosmetic purposes or for return of function of a body part
Why is Radiation therapy used? * used to destroy the rapid dividing cancerous cells * may involve the use of radioisotopes
side effects of radiation fatigue; nausea & vomiting; anorexia (lack of appetite); mucositis; Xerostomia; skin reactions; bone marrow depression
* What is palliative for for Sx control
* what is curative for? for localized tumors
what is numerical staging in cancer?
Numerical Staging what does this number stand for? 0 cancer in situ ( limited to surface cells)
Numerical Staging what does this number stand for? 1 cancer limited to the tissue of origin, evidence of tumor growth
Numerical Staging what does this number stand for? 2 limited local spread of cancer cells
Numerical Staging what does this number stand for? 3 extensive local and regional spread
Numerical Staging what does this number stand for? 4 distant metastasis
How is radiation administered? Externally and Internally
what is meant by Externally?
What is meant by Internally?
what three factors are important in protection from Radiation Exposure? time; distance; shielding
what is the desired action of chemotherapy - Cytotxic cells destroy cancer cells **more effective with multiple drugs ** may be used pre-op or post-op
what routes can be used for Chemo administration? Oral; IM; IV
What are vesicant drugs?
Central Lines External
Central lines Internal
Side effects of Chemo? Bone marrow depression; Stomatis; alopecia (temp); reproductive alterations; neurotoxicity
Side effects of Chemo? Bone Marrow Depression Leukemia (decreased WBCs; Thrombocytopenia (Decreased Platelets); Anemia (decreased RBCs)
Side effects of Chemo? Stomatis
Side effects of Chemo? Alopecia Hair loss (usually temporary)
Side effects of Chemo? reproductive alterations Clients may choose to store eggs or sperm for later use
Side effects of Chemo? neurotoxicity
Nursing Dx For Chemo pts. Chronic pain; risk for infection; risk for injury; imbalanced nutrition; self care deficit; anticipatory grieving ; care giver role strain; social isolation; ineffective sexuality pattern; disturbed body image
Nursing Dx For Chemo pts. (Interventions) Chronic pain
Nursing Dx For Chemo pts. (Interventions) risk for infection
Nursing Dx For Chemo pts. (Interventions) risk for injury
Nursing Dx For Chemo pts. (Interventions) imbalanced nutrition
Nursing Dx For Chemo pts. (Interventions) self care deficit
Nursing Dx For Chemo pts. (Interventions) anticipatory grieving
Nursing Dx For Chemo pts. (Interventions) care giver role strain
Nursing Dx For Chemo pts. (Interventions) social isolation
Nursing Dx For Chemo pts. (Interventions) ineffective sexual pattern
Nursing Dx For Chemo pts. (Interventions) disturbed body image
What are oncology emergencies
Oncology emergency Superior Vena Cava Syndrome * may occur with lung cancer * tumor blocks circulation resulting in edema of the head and neck (cranial pressure) * radiation may be used to shrink the tumor
Oncology emergency Spinal Cord Compression * cancer may metastasize to the spine resulting in spinal cord compression * very painful- results in motor function loss
Oncology emergency Hypercalcemia * elevated calcium serum levels > 11mg/dl * calcium is released into the blood * IV meds used to decrease Ca levels
Oncology emergency Pericardial Effusion (Cardiac Tamponade) *tumor invades pericardial sac, fluid builds up in the sac, the heart is compressed * result- decreased C/O (may lead to death) *
What are some treatment options for Cardiac Tamponade (pericardial Effusion) * Drain Fluid * Sclerosing Agents
What is DIC? What Happens with DIC *Disseminated Intravascular Coagulation ** fibrin and platelets activated abnormally causing all of the blood clotting proteins to be "Used Up" or destroyed resulting in abnormal fusion
How is DIC treated?
What are 2 primary determining factors in Cancer Tx? * The type of cancer * The stage of the cancer
Briefly Describe the following Cancer Tx goal. Elimination (cure) * recover from specific cancer w/ Tx * Alert for recurrence * May involve rehab w/ physical/occupation therapy
What are the three seasons of survival? 1- diagnosis/ treatment 2- extended survival; ( treatment completed and watchful waiting) 3- permanent survival- risk of recurrence is small
Briefly Describe the following Cancer Tx goal. Prevent Metastasis
Briefly Describe the following Cancer Tx goal. Decrease/reduce cellular growth
Briefly Describe the following Cancer Tx goal. Palliation
Briefly Describe the following Cancer Tx goal. Control control of sx and progression of cancer * continued surveillance * tx when indicated (e.g. some bladder cancer; prostate cancer)
Surgery can be used for what? * Dx * prophylaxis * tx * reconstruction * palliation
What types of surgery can be performed fine needle aspiration ; core biopsy; incisional biopsy; excisional biopsy ; endoscopy; laproscopy; reconstructive ; and surgery in conjunction w/other tx (may be shrunk by radio/chem then surgically removed)
treatment (tx) options Chemotherapy
Chemotherapy - Principles * based on ability of drug to kill cancer cells * normal cells also damaged which produces side effects * Effect is greates with rapidly dividing cells * different drugs act on tumor cells in different phases of the growth cycle
Effect of chemo is greatest with rapidly dividing cells. Give 2 prime examples and describe why they are affected *GI Tract- plenty of nutrients and blood * Hair - grows extremely fast
4 phases of the cell cycle * G1 * S * G2 (* Mitosis M Phase ) * G0
G1 cell cycle phase - gap 1 phase; cell enlarges, synthesizes proteins to prepare for DNA replication
S Cell cycle Phase Synthesis (S) phase - _ DNA replicates and Chromosomes Duplicate
G2 cell cycle phase Gap 2 phase: cell prepares for mitosis ** Mitosis M Phase** Mitosis occurs w/ 2 copies of cell (daughter cells)
G0 cell cycle Phase Resting Phase
Chemotherapy (in relation to Cell Phases) - Chemo includes phase-specific and non-phase specific drugs for specific type cancers - often combinations of drugs in specific protocols over varying time periods
Chemo Kill-Cell hypothesis with each cell a percentage of cancerous cells are killed but some remain; repeating chemo kills more cells until those left can be handled by the body's immune system
Classes of Chemo Drugs Alkylating agents action = create deficits in tumor DNA = these deficits hinder cell growth and division = MOST ACTIVE in G1 (G 0 phase)
Classes of Chemo Drugs Alkylating agents Examples Nitrogen Mustard; Cisplatin; Cytoxan; Myleran
Classes of Chemo Drugs Common cancers treated w/ Alkylating agents * Hodgkins, lymphocarcinoma, lung cancer, * chronic leukemia, chronic myelogenous leukemia * multiple myeloma, adenocarcinoma of lung/breast
Classes of Chemo Drugs Alkylating agents adverse side effects * permanent sterility * Permanent bone marrow failure * Hair Loss (alopecia) * Hemorrhagic Cystitis (inflammation of bladder) * renal tubular necrosis * pulmonary fibrosis
Classes of Chemo Drugs Anti-metabolites Action: specific for S phase * interfere with nucleic acid synthesis
Classes of Chemo Drugs Anti-metabolites Examples: * Methotrexate * 5 fluorouracil
Classes of Chemo Drugs Anti-metabolites Cancers commonly treated: - acute lymphobalstic leukemia (ALL) - osteosarcoma - colon carcinoma - rectal carcinoma - breast carcinoma - pancreatic carcinoma
Classes of Chemo Drugs Anti-tumor Antibiotics action: non-phase specific; interfere w/ DNA
Classes of Chemo Drugs Anti-tumor Antibiotics Examples Adriamycin; bieomycin
Classes of Chemo Drugs Anti-tumor Antibiotics Toxic effect: damage to cardiac muscle
Classes of Chemo Drugs Anti-tumor Antibiotics common cancers treated: *acute lymphoblastic leukemia (ALL) * acute myeoblastic leukemia (AML) * cancer of breast, thyroid, lungs
Classes of Chemo Drugs Mitotic Inhibitors Action prevent cell division during M- Phase
Classes of Chemo Drugs Mitotic Inhibitors-Plant Alkaloids vincristine, vinblastine- derived from plant alkaloids
Classes of Chemo Drugs Mitotic Inhibitors-Plant Alkaloids Toxic effects : * affects neurotransmission * decreased DTRs (deep tendon reflexes) * paralytic ileus
Classes of Chemo Drugs Mitotic Inhibitors Taxoids: * act during G2 phase * inhibit cell division *
Classes of Chemo Drugs Mitotic Inhibitors-Tabxoids Toxic effects * alopecia * bone marrow depression
Classes of Chemo Drugs Mitotic Inhibitors cancers commonly treated : - combo txc of acute leukemia - hodgkin's and non-hodgkins - kaposi's sarcoma - testicular cancer - **BREAST CANCER UNRESPONSIVE TO OTHER TREATMENTS**** -small cell lung cancer
Classes of Chemo Drugs Hormones -Action: Stage Specific G1
Classes of Chemo Drugs Hormones -Examples: Corticosteroids
Classes of Chemo Drugs Hormones - Commonly treated Cancers - Leukemia - Lymphoma
Classes of Chemo Drugs * Hormone Antagonist -Action: block hormones on hormone binding tumors ( breast, prostate, endometrium; cause tumor regression)
Classes of Chemo Drugs * Hormone Antagonist - example -tamoxifen (breast) - flutamide (prostate)
Classes of Chemo Drugs * Hormone Antagonist - toxic effects altered secondary sex characteristics
EFFECTS OF CHEMO - tissues(fast growing) frequently affected - mucus membranes - hair cells - bone marrow - reproductive organs ( all fetal toxic, impair ability to reproduce
major side effects of chemo/ common nursing interventions - GI System (nausea/vomiting) - admin antimetics routinly q4 hrs - antimetic before chemo is started - withhold fluids/food 4-6 hours prior to chemo - bland foods in small amounts post chemo
major side effects of chemo/ common nursing interventions - GI System ( Diarrhea) - admin antidiarrheals - maintain good perineal care - clear liquids as tolerated - monitor potassium (K); Sodium (Na) Chloride (Cl) levels (electrolytes are excreted thru stool)
major side effects of chemo/ common nursing interventions - GI System (Stomatitis) - provide/teach good oral hygiene - no commercial mouth wash - rinse w/viscous lidocane pre-meal (analgesic effect) - rinse w/H20 (or water sol. lube H202)after meals - (KY Jelly) for cracked lips - suck Popsicle/moister
major side effects of chemo/ common nursing interventions - Hematologic System (thrombocytopenia) -avoid bumps/bruises / physical injury - avoid ASA products & IM Injections _ Monitor CBC Closely - Assess/teach s/s increased bleed tendencies- epistaxis, petechiae, ecchymoses
major side effects of chemo/ common nursing interventions - Hematologic System (Leukopenia) ** Decreased White Blood Cells*** - careful hand-washing techniques - reverse isolation if WBC < 1000/mm3 - assess s/s respiratory infection -avoid crowds/persons known to have infections
major side effects of chemo/ common nursing interventions - Hematologic System (Anemia) *** Low RBC*** - provide adequate rest periods - monitor hemoglobin/hematacrit - protect client from injury - admin O2 prn
major side effects of chemo/ common nursing interventions -Iintegument system- (alopecia) *** Hair Loss*** - hair loss not permanent offer support/encouragement - scalp tourniquets/scalp hypotherima ice packs (may minimize hair loss with some agents) - Buy wig before treatment)
major side effects of chemo/ common nursing interventions Renal System - may cause direct damage to kidney by excretion of metabolites - encourage fluids/frequent voiding to prevent buildup of metabolites in bladder - increased excretion of uric acid may damage kidneys
major side effects of chemo/ common nursing interventions Renal System- [ALLOPURINOL/ZYLOPRIM] _admin [ALLOPURINOL/ZYLOPRIM] as ordered to prevent uric acid formation - encourage fluids with admin allopurinol
major side effects of chemo/ common nursing interventions REPRODUCTIVE SYSTEM -damage may occur to *male/female results infertility; * chromosome mutagenic/ damage; * -
major side effects of chemo/ common nursing interventions REPRODUCTIVE SYSTEM Males are encourage to do what? * bank sperm before strarting chemo * use reliable methods of contraception during chemo ( and for a period after)
major side effects of chemo/ common nursing interventions NEUROLOGIC SYSTEM * plant alkaloids (i.e vincristine) cause neurologic damage with repeated doses * Peripheral Neuropathies, hearing loss, loss of DTRs, Parlytic ileus
Who can administer chemotherapy agents? Only trained and certified personnel, according to established guidelines
What preparations/precautions should be made when administering Chemo Agents - protect personnel from toxic effects - extreme care for proper dosage; double check w/ physician orders, and pharmacist's preparation **PROPER MANAGEMENT OF CLIENT'S EXCREMENT
WHAT WAYS CAN CHEMO AGENTS BE ADMINISTERED? - ORAL - BODY CAVITY (INTRAPERITONEAL / INTRAPLEURAL) INTRAVENOUS
WHAT ARE CHEMO AGENTS BE ADMINISTERED INTRAVENOUS
Radiation therapy Can be used to cure (i.e. thyroid carcinomas , localized cancers of head/neck; cancers x;cervix/uterine;
Radiation therapy May be used to control malignant tumor when surgery is not optional
Radiation therapy May be used Where local nodal metastasis is resent
o Radiation therapy May be used Neoadjuvantly (prior to local definitive tx) w/without chemo to reduce size of tumor- enabling surgical resection
Radiation therapy May be used o Prophylactically – prevent spread of primary to secondary (i.e. irradiating brain to prevent leukemic infiltration or metastic lung cancer
o Palliative radiation Relieve sx of metastic cancer ( esp. brain, bone, soft tissue) ;Tx oncologic emergencies
oncologic emergencies Superior vena cava syndrome; Bronchial airway obstruction; Spinal cord compression
2 types ionizing radiation – both can lead to tissue disruption; Electromagnetic (x-rays/ gamma rays); Particulate ( electrons, beta &/or alpha particles, protons, neutrons
What is the MOST HARMFUL DISRUPTION of chemo Direct alteration of DNA molecule with in cells
Cells most vulnerable to radiation disruptive effects During DNA synthesis/ mitosis (early S, G1, M phases);
Body tissues w/ frequent cell division Bone marrow, lymphatic tissue, epithelium of GI tract, hair cells, gonads
Slower growing / at rest tissues are relatively radio resistant or less sensitive to the effects
Slower growing / at rest tissues Examples are: Muscle cartilage, connective tissue, cartilage
Radiation therapy –what is meant by localized tx – only tissues w/in tx field will be affected by radiation tx
What is meant by Radio sensitive tx- still allows for cell regeneration of normal tissue
Well oxygenated tumors – more sensitive to radiation
Sensitivity enhanced in what in smaller tumors w/ rapid cell division (high proliferation) and poorly differentiated (no longer resembling tissue of origin [primary]
Why would you use Combo chemo/ radiation – takes advantage of radio sensitizing effects of chemo- improved survival benefit- minimize side effects of therapy
How is Radiation dosage determined Depends on sensitivity of target tumors (tissues) ;Size of tumor ; Tolerance of surrounding tumor
What is considered a Lethal tumor dose Eradicates 95% of tumor.- preserving normal tissue
Explain External beam radiation Total radiation dose delivered over several weeks –
What are daily doses called? Fractions
What is the benefit of External beam radiation? Allow healthy tissue to repair / regenerate; Greater cell kill – rapid division cells – receive more exposure; Tumors shrink from outside in #
Radiation therapy administration Variety of ways ;Depends on radiation used; location of cancer and type of cancer targeted
Radiation primary applications Teletherapy (external beam radiation; Brachytherapy (internal radiation; System (radioisotopes; Contact or surface molds
Most commonly used form of radiation/ – External Beam Radiation Therapy [EBRT]
IMRT- intensity modulated radiation therapy Higher doses delivered to tumor (sparing important healthy structures around it
Administration of IMRT Standard daily fractions or Hyper fractions twice daily fractions (shortens duration of tx schedule
IGRT- image guided radiation therapy Continuous monitoring w/ CT /Ultrasound during tx ; Allows for auto adjustment- as tumor changes shape/position ; Spares health tissues/organs around tumor ; Reduces side effects
Gamma rays one of the oldest forms of EBRT
SBRT- stereotactic Body Radiation Therapy Another form of EBRT; High doses- deep body penetration; Control deep seated tumors that cannot be treated surgically or otherwise; 1-5 days for tx – high doses/short tx time
Proton therapy Utilizes high liner energy transfer [LET]
Advantage of Proton therapy High energy dose to a deep seated tumor with NO ENERGY exiting thru pt healthy tissue behind the tumor ; TX of deep tumors in close proximity of critical structures [i.e. heart, major blood vessels]:
Radiation therapy administration Variety of ways ;Depends on radiation used; location of cancer and type of cancer targeted
Radiation primary applications Teletherapy (external beam radiation; Brachytherapy (internal radiation; System (radioisotopes; Contact or surface molds
Most commonly used form of radiation/ – External Beam Radiation Therapy [EBRT]
IMRT- intensity modulated radiation therapy Higher doses delivered to tumor (sparing important healthy structures around it
Administration of IMRT Standard daily fractions or Hyper fractions twice daily fractions (shortens duration of tx schedule
IGRT- image guided radiation therapy Continuous monitoring w/ CT /Ultrasound during tx ; Allows for auto adjustment- as tumor changes shape/position ;Spares health tissues/organs around tumor ; Reduces side effects
Gamma rays one of the oldest forms of EBRT
SBRT- stereotactic Body Radiation Therapy Another form of EBRT; High doses- deep body penetration;Control deep seated tumors that cannot be treated surgically or otherwise; 1-5 days for tx – high doses/short tx time
Proton therapy Utilizes high liner energy transfer [LET]
Advantage of Proton therapy High energy dose to a deep seated tumor with NO ENERGY exiting thru pts healthy tissue behind the tumor; TX of deep tumors in close proximity of critical structures [i.e. heart, major blood vessels]:
Internal radiation implantation BRACHYTHERAPY High dose to localized area;
How are Specific radioisotope selected? On basis of its half-life
Can be implanted by what means? needles, seeds, beads, or catheters into body cavities/intestinal compartments
Body cavities include – vagina; abdomen; pleura
Intestinal compartments – breast; prostate
What is the time frame for treatment? Temp or perm
Temp HDR - high dose radiation – short term tx
Perm LDR – low dose radiation – long term treatment
Benefits of HDR Shorter tx time; Lower dose radiation; Reduced exposure to personnel; Typically outpatient procedure – over several days (visits) ;
How can it be used? can be used for intra-luminal, interstitial, intracavity and surface lesions
Intraluminal brachytherapy
Catheter/hollow tubes inserted into lumen of organs, radioisotope delivered as close as possible to tumor
Intraluminal brachytherapy Tx for – obstructive lesions on bronchus; esophagus or bile duct
Intracavity Radioisotopes – in specially positioned applications after placement verified by x-rays
Intracavity Tx for gynecologic cancers
HDR/LDR brachytherapy – depending on extent of disease
LDR
Requires hospitalization tx over several days
NURSING CARE ESSENTIAL to maximize effective and safe delivery of therapy and prevent complications
LDR Nursing Care for PT : bed rest; specially prepped private room for 72 hours; Log roll to prevent displacement of intracavity delivery device
Indwelling urinary catheter- keep bladder empty
Low residual diet / antidiarrheal meds- prevent bowel movement/ displacement during therapy
Visitors – time limits – to prevent radiation exposure
HDR
Typically outpatient procedure [delivered over several days]
Interstitial implants Provide local radiation source
Interstitial implants Treat - prostate; pancreatic; breast cancers
Implantation time can be Temp or perm
Interstitial implants consist of : seeds; needles; wires; small catheters
Interstitial implants stability INFREQUENT dislodge
Interstitial implants the further tissue is from radiation source - lower the radiation dosage is to the tissue
Most frequently used type of interstitial implants Prostate seed therapy
Prostate seed therapy Small radioactive seed placed direct into prostate gland (ultrasound guidance)
Prostate seed therapy Placement is considered Permanently placed
Prostate seed therapy Appropriate safety precautions (several days) risk of radiation exposure to others
Mammo-site-implantation breast cancer
Mammo-site-implantation Advantages Reduce tx time 5 days vs 6-8 weeks ; Less radiation exposure to healthy tissue/ adjacent organs (heart/lungs) less skin reaction, improved cosmesis of breast;
Mammo-site-implantation NURSE MANAGEMENT Instruct on rigorous catheter care and wound care management;Pt. tx as out pt. w/ double lumen catheter projecting form base
Radiation therapy administration Variety of ways; Depends on radiation used; location of cancer and type of cancer targeted
Radiation therapy administration TYPES Teletherapy (external beam radiation; Brachytherapy (internal radiation;System (radioisotopes;Contact or surface molds
Most commonly used form of radiation/ – External Beam Radiation Therapy [EBRT]
IMRT- intensity modulated radiation therapy Higher doses delivered to tumor (sparing important healthy structures around it
Administration of IMRT Standard daily fractions or Hyper fractions twice daily fractions (shortens duration of tx schedule
IGRT- image guided radiation therapy Continuous monitoring w/ CT /Ultrasound during tx;Allows for auto adjustment- as tumor changes shape/position;Spares health tissues/organs around tumor;Reduces side effects
Gamma rays one of the oldest forms of EBRT
SBRT- stereotactic Body Radiation Therapy Another form of EBRT;High doses- deep body penetration;Control deep seated tumors that cannot be treated surgically or otherwise;1-5 days for tx – high doses/short tx time
Proton therapy Utilizes high liner energy transfer [LET]
Advantage of Proton therapy High energy dose to a deep seated tumor with NO ENERGY exiting thru pts healthy tissue behind the tumor ;TX of deep tumors in close proximity of critical structures [i.e. heart, major blood vessels]:
Internal radiation implantation BRACHYTHERAPY High dose to localized area ;Specific radioisotope selected on basis of its half-life
Can be implanted by means of needles, needs, beads, or catheters into body cavities/intestinal compartments
Body cavities include – vagina; abdomen; pleura
Intestinal compartments – breast; prostate
Temp or perm Temp HDR- high dose radiation – short term tx;Perm LDR – low dose radiation – long term treatment
Benefits of HDR Shorter tx time ; Lower dose radiation; Reduced exposure to personnel; Typically outpatient procedure – over several days (visits) ;Can be used for intraluminal , interstitial, intracavity and surface lesions
Intraluminal brachytherapy Catheter/hollow tubes inserted into lumen of organs, radioisotope delivered as close as possible to tumor
Tx for – obstructive lesions on bronchus; esophagus or bile duct
Intracavity Tx gynecologic cancers
Intracavity Tx Radioisotopes – in specially positioned applications after placement verified by x-ras
HDR/LDR brachytherapy – depending on extent of disease
LDR Requires hospitalization tx over several days
NURSING CARE ESSENTIAL to maximize effective and safe delivery of therapy and prevent complications
PT: bed rest; specially prepped private room for 72 hours; Log roll to prevent displacement of intracavity delivery device
Indwelling urinary catheter- keep bladder empty
Low residual diet / antidiarrheal meds- prevent bowel movement/ displacement during therapy
Visitors – time limits – to prevent radiation exposure
HDR Typically outpatient procedure [delivered over several days]
Interstitial implants Treat- prostate; pancreatic; breast cancers
Interstitial implants Temp or perm AND INFREQUENT dislodge
Consist of : seeds ; needles; wires; small catheters
Interstitial implants Provide local radiation source
The further tissue is from radiation source - lower the radiation dosage is to the tissue
most frequently used type of interstitial implants Prostate seed therapy
Prostate seed therapy Permanently placed Small radioactive seed placed direct into prostate gland (ultrasound guidance)
Appropriate safety precautions (several days) risk of radiation exposure to others
Radioisotopes > used as radio-immunotherapy for tx of refractory non-Hodgkin’s lymphoma (NHL)
Currently 2 radio immunotherapy tx avail for NHL Ibritumomab tiuxetan (Zevalin) ; Iodine 131 tositumomab (Bexxan)
Toxicity Localized to region being irradiated, May be increased if concomitant chemo is used
Acute local reactions Normal cells in tx area are destroyed - > cellular death exceeds cellular regeneration
Body tissue most affected That with rapid proliferation (cell regeneration) ,Skin, epithelial lining of GI tract and oral cavity ; bone marrow
common side effect can include alopecia Altered skin integrity
Skin reactions graded by severity along continuum ranging from Erythema and dry desquamation (flaking of skin >>>TO >>>Moist desquamation (dermis exposed, skin oozing serous fluid),Potentially ulceration
common side effect Re-epithelialization occurs (after cessation of tx )Alterations on oral mucosa secondary to Stomatis ( inflammation of oral tissue) ,Xerostomatis ( dryness of the mouth) ,Change or loss of taste
,Entire gastrointestinal mucosa may be involved ,Decreased salivation Esophageal irritation with chest pain and dysphagia may result
may occur if stomach or colon is in irradiated field Anorexia, nausea, vomiting , diarrhea –
Symptoms subside – gastro-epithelialization occurs after cessation of tx
Bone marrow cells proliferate rapidly (iliac crest, sternum)
PT is at risk for infection / bleeding until wbc counts return to normal Chronic anemia may occur
Systemic side effects common to radiation pts. Fatigue; malaise; anorexia may be secondary to substances released when tumor cells breakdown ,Temporary- most subside with cessation of tx
Late Effect of radiation (months- yrs. after tx ceases) Various body tissues ; usually chronic; are not reversible,May affect lungs, heart, CNS, bladder ,Toxicity may intensify when radiation combined w/other tx modalities
System symptoms Weakness fatigue - Result of tx DO NOT represent deterioration / progression of disease process
Contact with health care providers guided by Principles of time; distance; shielding ; Guides set by radiation safety officer
Pt w/ seed implants – can typically return home with proper teaching ,Radiation exposure to others is minimum
Pt may or may not require special precaution / hospitalization Dependent on dose / and energy emitted by systemic radionuclide *** Explain rational to patient for precaution to prevent undue feeling of isolation
• Admin of chemo intravenous use of vascular access device because of threat of extravasation (leakage into tissue) and long term therapy
• Types of vascular access devise PICC- (peripherally inserted tunnel catheters) ; tunneled catheters ( Hickman/ Groshong) ; surgically implanted ports (accessed with 90 degree angle needle)
• Central Venous Access
• Groshong
• Hickman
• PICC
• Surgically implanted port portacath
• Peripheral IV infusion discouraged for chemo – (central line preferable)
• Always check placement by aspirating blood sample and discarding- NEVER push blood back in
• Peripheral IV Infusion(high Risk Extravasation) most chemo drugs vesicants ; STOP INFUSION; apply cold compress; DOCUMENT time/date/site/ Size/type of IV; drug being infused; approximate amount infused
• Peripheral IV know and adhere to Hospital Policy; chemo administration; extravasation kits (antidotes to particular meds)
• Nursing Care for chemo clients assess and manage toxic effects of drugs; side effects of drugs
• Chemo side effects manage nausea and vomiting; inflammation and ulceration of mucus membranes; hair loss; anorexia; nausea and vomiting with specific nursing and medical interventions
• Monitor lab results (chemo) drugs withheld if blood counts seriously low (blood/blood product admin); dehydration; oncologic emergency.
• Teach chemo clients about : fatigue, immunosuppression cautions
• Provide chemo clients and family with emotional and spiritual support
• Why is Surgery performed diagnosis, staging and sometimes tx of cancer
• What does surgery involve? removal of body part, organ, sometimes w/altered function (e.g. colostomy )
• Why is Debulking used decrease size of tumor in advanced cases
• Example of reconstruction/ rehabilitation breast implant post mastectomy
• Why give psychological support? to help client deal w/surgery and w/ cancer dx
• Radiation therapy uses ionizing radiation to kill /limit growth of cancer cells
• How does radiation work injures cell membrane, destroys or alters DNA so cells cannot reproduce – affects both good and bed cells and therefore causes side effects
• Principles of radiation localized vs. generalized localized effects are related to body of area being treated; generalized effects may be related to cellular break down
• Why is radiation tx of choice for some tumors? it kills or reduces size of tumor, relieves pain and obstruction (those that cannot be surgically removed this is good alternative)
• Delivery of radiation therapy teletherapy (external) delivered in uniform dose to tumor ; Brachytherapy – delivers high dose to tumor less to other tissues – radiation source placed in / next to tumor
• Internal radiation therapy- sealed implants vs. unsealed implants (sealed) radioisotope enclosed container – DOES NOT circulate the body, clients body fluids should not become radiation contaminated (unsealed) radioisotope NOT encased- circulates in body- contaminates body fluids
• Types of radiation energy emitted_ GAMMA (electromagnetic or X-rays) penetrate deeper areas of body; most common form of external radiation therapy
• vesicants, which have the potential to cause severe or irreversible tissue injury and necrosis
• Complications related to extravasation are possible w/many medications, but it is a particular concern with cytotoxic/chemotherapeutic drugs used in the treatment of cancer, since these are often highly toxic medications that must be administered in controlled fashion to avoid adverse events.
• Factors controlling exposure to radiation Half-life; Time; Distance; Shielding
• Half-life- time required for half of the radioactive atoms to decay ; each isotope has a different half-life ; at the end of half-life danger from exposure decreases
• Time the sorter the duration the less the exposure
• Distance - the greater the distance from the radiation source- the less the exposure
• Shielding all radiation can be blocked; rubber gloves ; thick lead or concrete stops gamma rays
• Health care workers / exposure at greater risk from internal than external sources; film badge can measure the amount of exposure received; no pregnant nurses of visitors allowed near radiation source
• Goals/ radiation therapy mas tumor control with minimal damage to normal tissues;
• Caregiver goals / radiation therapy must protect selves by using shield, distancing and limiting time with client, following safety protocols
• Treatment schedules / radiation planed according to radio sensitivity of tumor, tolerance of client; Monitor Blood Cell Count
• Radiation therapy /side effects skin (external radiation ) blanching, erythema, sloughing, oozing, burning
Radiation therapy /side effects (SKIN) AVOID foreign substances; medicated solutions(oint./pwdrs); pressure, trauma, skin infection; WASH w/ plain H20 Pat dry Avoid soap; talcum powder; constricting/irritating clothing; (exposure heat/sun/ cold) ((sterile dressing(sloughing) micro pore tape))
• Radiation therapy /side effects (ANOREXIA/ NAUSEA/ VOMITING mealtime NOT directly pre/post tx; bland foods; small attractive meals; avoid extreme temps; admin antiemetic’s as ordered pre meals
• Radiation therapy / SE (DIARRHEA) encourage low residue, bland , high protein foods; admin antidiarrheal as ordered; GOOD PERINEAL Care; Monitored electrolytes (NA< K <Chl)
• Radiation therapy / SE (ANEMIA/LEUKOPENIA/THROMBOCYTOPENIA) Isolate from known infections; frequent rest periods; high protein diet; pt. avoid injury; assess for bleeding ; Monitor CBC, leukocytes, platelets; AVOID ASA; shaving- (electric razor , soft toothbrush, no flossing
• Biotherapy modification of biologic process result in malignancies; based on immune surveillance hypothesis; used for hematological malignancies, renal and melanoma; monoclonal antibodies (inoculate animal w/tumor antigen- retrieve antibodies against tumor for human
• Photodynamic therapy client given photosensitizing compound which concentrates in malignant tissue; later given laser tx to destroy tissue
• Bone marrow transplant/ stem cell transplant stimulation of nonfunctioning marrow or replace bone marrow; common tx for leukemia; tx for solid tumors elsewhere in body (breast/brain) destroys bone marrow (BMT may be done as result- autologous if possible)
• Pain Control directly from cancer; treatment or unrelated- necessary for continuing function or comfort in terminally ill pts.
• Goal of pain control max relief w/ min side effects
• Pain Medications multiple combos of analgesics (narcotic/non-narcotic) ((adjuvants – steroids/antidepressants)) includes ATC(around the clock) schedule w/additional meds for breakthrough pain
• Pain medication routes multiple routes; may involve injections of anesthetics into nerve, surgical severing of nerves; may need to progress to stronger pain meds as pain increases and client develops tolerance to pain meds
• Nursing DX – ANXIETY therapeutic interactions w/ client /family; community resources such as ACA (American cancer society) “I Can Cope” ; availability of community resources for terminally ill (hospice care in patient; home care )
• Nursing Dx- DISTURBED BODY IMAGE loss of body parts (amputations) ; appearance changes (skin. Hair, ) altered functions ( colostomy) cachexia appearance, loss of energy , ability to be productive – fear of rejection
• Nursing DX ANTICIPATORY GRIEVING facing death and making preparations for death; offer realistic hope that cancer tx may be successful
• Nursing Dx RISK FOR INFECTION: most tx suppressed immune function increasing risk for infections
• Nursing DX RISK FOR INJURY organ obstruction; pathological fractures (bones weaken due to suppression caused by chemo/ radiation)
• Nursing DX ALTERED NUTRITION less than body requires: consultation dietician, lab evaluation of nutritional status; manage problems w/ eating, anorexia, nausea, vomiting ; may involve use of parenteral nutrition
• Nursing DX IMPAIRED TISSUE INTERGRITY; oral, pharyngeal, esophageal tissues (due to chemo, bleeding due to low platelet counts, fungal infections as in thrush) - ; tch inspection ; frequent oral hygiene, specific non-irritating products, thrush control
• Oncological emergencies pericardial effusion and neoplastic cardiac tamponade ; superior vena cava syndrome; Sepsis and septic shock ; Spinal Cord Compression; obstructive uropathy; hypercalcemia; hyperuricemia ; SIADH;
• Oncologic emergencies pericardial effusion and neoplastic cardiac tamponade compression of heart by fluid in pericardial sac, compromised cardiac output
• Oncologic emergency pericardial effusion and neoplastic cardiac tamponade tx pericardiocentesis
• Oncologic emergencies superior vena cava syndrome; obstruction of venous system w/increased venous pressure and stasis; facial and neck edema with slow progression of respiratory distress
• Oncologic Emergency superior vena cava syndrome; Treatment respiratory support; decrease tumor size with radiation therapy or chemo
• Oncologic Emergency Sepsis and septic shock concern Concern: early recognition of infection
• Oncologic Emergency Sepsis and septic shock Treatment Prompt treatment required
• Oncologic Emergency – Spinal Cord Compression - Concern pressure from expanding tumor can cause irreversible paraplegia ; back pain initial symptom with progressive paresthesias – leg pain and weakness
• Oncologic Emergency – Spinal Cord Compression Treatment early detection and radiation or surgical decompression
• Oncologic emergency – obstructive uropathy concern blockage of urine flow; undiagnosed can lead to renal failure
• Oncologic emergency – obstructive uropathy Treatment restore urine flow
• Oncologic emergency – Hypercalcemia – concern high calcium from ectopic parathyroid hormone or metastasis
• -Oncologic emergency – Hypercalcemia- behaviors fatigue , muscle weakness; polyuria; constipation; progressing to coma; seizures
• - Oncologic emergency – Hypercalcemia- Treatment restore fluids with IV saline, loop diuretics, more definitive tx
• Oncologic emergency – Hyperuricemia- concern occurs with rapid necrosis of tumor cells as with chemo; can result in renal damage and failure
• Oncologic emergency – Hyperuricemia treatment PREVENTION AND TREATMENT WITH FLUIDS AND ALLOPURINOL (Zyloprim)
• Oncologic emergency – SIADH- concern SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION) ectopic ADH production from tumor leads to excessive hyponatremia
• Oncologic emergency – SIADH- Treatment restore sodium level
Created by: Kyn269