Oncology LECTURE Notes PDF

Oncology Inge Luce, MSN/ED, RN-C, NRP Epidemiolo Globally gy Leading cause of death worldwide Second leading cause in US Socioeconomic indicators United States Second most common illness and cause of death Most...

Oncology Inge Luce, MSN/ED, RN-C, NRP Epidemiolo Globally gy Leading cause of death worldwide Second leading cause in US Socioeconomic indicators United States Second most common illness and cause of death Most common Men: prostate Women: breast Children: leukemia Risk Factors Exposure to carcinogen Advanced age Genetic predisposition Lifestyle Pathophysiology: Carcinogenesis Carcinogen exposure Gene mutation Immune system does not detect mutated cells Proliferation and progression to cancer Biology of Normal Cells Specific morphology Small nuclear-to- cytoplasmic ratio Differentiated function Anchorage dependence Apoptosis Biology of Cancer (Malignant) Cells Abnormal Serve no useful function Harmful to normal body tissues Mild Dysplasia Uncontrolled Cell Growth Yellow cells are abnormal cells Cancer cells grow and flourish in atypical patterns and environments Cell Growth Cancer Characteristics Uncontrolled Cell Altered Cell Growth Differentiation Healthy cells are well Cancer cells lack contact differentiated and have inhibition and anchorage specific structure and dependence. function Cancer cell no longer Cancer cells proliferate performs expected rapidly function of parent cell (Anaplasia)  Normal cells growing in the wrong place or at the wrong Benign time Result of small problem Tumor with cellular regulation Moles, uterine fibroid tumors, skin tags, endometriosis, nasal polyps Abnormal cell Maligna growth nt Can lead to death Tumor without intervention Metastasis Solid Tumor Hematological Malignancies Malignancies May arise from cells of Arise from specific body the hematopoietic cell organs line May arise from Grow into masses that secondary immune invade and erode organs (lymph node or normal body tissue spleen) Examples: -Leukemia Ex. Lung cancer -Lymphoma -Multiple myeloma  Once cancer has been Staging diagnosed, the cancer is further classified by stage. T: Tumor Size N: Number of lymph nodes involved M: Metastasis (present or absent) Stage Localized and contained One Stage Deeper tissues or local Two lymph nodes Stage Large or locally invasive Three tumors Stage Metastasized cancer Four CAUTION! C: Change in bowel/bladder A: A sore that does not heal U: Unusual bleeding T: Thickening or lump in breast or other part of body I: Indigestion or difficulty swallowing O: Obvious change in wart/mole N: Nagging cough or hoarseness Additional Symptoms Specific Symptoms Related to location of primary cancer Example: Brain tumor PAIN Vague symptoms: Fatigue Weight loss Fever Night sweats Oncological Emergencies Can be direct result of tumor growth, or secondary changes, or as a result of treatment Structural Metabolic Hematological Treatment considerations Oncologic Emergencies Bowel Obstruction Hypercalcemia Leukostasis Pericardial effusions/tamponade Pleural effusions Spinal cord compression Superior Vena Cava Syndrome SIADH Tracheobronchial obstruction Tumor lysis syndrome Cancer Prevention Primary Secondary Avoidance of known Regular Screening carcinogens Mammograms, breast Modifying risk factors exam, colonoscopy Removal of “at risk Genetic Screening tissues” Ex. BRCA gene mutation Chemoprevention Immunization Tertiary Focus on reducing morbidity and mortality once disease has been diagnosed. Treatment Management of side effects Diagnosing Cancer Biopsy: Laboratory incisional, Imaging: CT, tests: blood, excisional, fine PET, MRI tissue samples needle aspiration Endoscopic: allow visualization of. hollow structures (GI tract, airway)  Reduced immune and blood- producing function General Disease- Altered GI structure and function Related Consequen Motor and sensory deficits ces of Cancer Decreased respiratory function Cancer Therapies: Therapy used to shrink the tumor Neoadjuva prior to removal or destruction May be used with large solid tumors nt Therapy that are not resectable at diagnosis Treatment used when patient is Adjuvant disease-free or in remission but at risk for relapse Therapy Evidence for effectiveness is limited to certain cancers (breast, colon, head/neck, lung and melanoma) Cancer Treatments Modalities Radiatio Medicati Surgery n on Prophylaxi Destroy cancer cells: chemotherapy s, diagnostic Cure Biologic therapies Curativ Contro e l Targeted agents Palliative, control, Palliativ Hormonal agents reconstructi on e Cancer Treatment: Surgical Offers greatest probability of cancer free state Primary modality for solid tumor malignancies Goal: total excision of malignant tumor and local area surrounding tumor May involve redirection and reconstruction of vital functions Ostomies Breast removal or reconstruction Nursing considerations for surgical oncology patients Cancer Treatment: Radiation Therapy External Internal Systemic External Beam delivered by Brachytherapy: internal Injection of Radioactive “dose”. Dose is determined by placement of low dose or high- Substance the amount of radiation needed dose radiation. Radioactive to destroy the type and size of isotopes are placed in “seeds” tumor. via a catheter or surgical implantation. Possible Side Effects of Radiation Therapy Acute and long-term site- specific changes Vary according to site Local skin changes and hair loss Altered taste sensations Fatigue Bone marrow suppression  Provide accurate Nutritional support Patient- information to help patients cope Centered Skin care needs during Care for xerostomia Collaborat radiation therapy (dry mouth) ive Care Do not remove Teach about risk for temporary ink markings fractures (for bone exposed to radiation) Avoid skin irritation Exercise and sleep Follow radiation- interventions for oncology department’s fatigue policy for skin care product use  Treatment of cancer with chemical agents Used to cure and increase survival time Adjuvant therapy = Chemotherapy + surgery Cancer or radiation Cytotoxic effects exerted on healthy cells and Treatments: cancer cells Chemothera Alkylating agents Antimetabolites py Antimitotic agents Antitumor antibodies Topoisomerase inhibitors Miscellaneous chemotherapeutic agents Health Care Provider Safety Specific protocol for handling chemotherapy drugs, or excreta from patients receiving IV chemotherapy PPE Eye protection Masks Double gloves (or “chemo” gloves) Gown  Infection risk Some Bone marrow suppression Neutropenia Common Anemia, thrombocytopenia risk Side Bone marrow suppression Impaired clotting Effects: Chemotherapy-induced nausea and vomiting (CINV) Nursing Oral Mucositis Implication Alopecia s Cognitive changes Chemotherapy-induced peripheral neuropathy (CIPN) Stem Cell & Bone Marrow Transplant Step One: administration of high dose antineoplastic therapy Step Two: infusion of stem cells or bone marrow If stem cell is donated, donor cells may offer immunity Stem cells may be autologous Tumor Lysis Syndrome Geriatric Considerations Comorbidities Polypharmacy Organ dysfunction Risk for falls Decreased tolerance for treatment regimens Clinical presentation of infection  Provide education: SKIN PATIENT Risk Factors ABCDE TEACHING Signs and FEMALE Symptoms Cervical Prevention Uterine Screening and Ovarian Early Detection Breast promote good outcomes MALE Oral cancers Testicular Dental exams Prostate Colon cancers Endoscopy Breast