NCM 112: Oncology Nursing PDF

NCM 112: Oncology Nursing Joem o. Gregorio, RN, MN Basic 01 Concepts CANCER Is a large group of disorders with different causes, manifestations, treatments, and prognoses. Oncology Nursing- known as scope, responsibilities, and goals of cancer nursing  Epidemiology 2019- 1,700,000...

NCM 112: Oncology Nursing Joem o. Gregorio, RN, MN Basic 01 Concepts CANCER Is a large group of disorders with different causes, manifestations, treatments, and prognoses. Oncology Nursing- known as scope, responsibilities, and goals of cancer nursing  Epidemiology 2019- 1,700,000 new cancer cases would be diagnosed in United States of America 600,000 Americans die as a result of cancer Cancer is 2nd leading cause of death in America Men: lung, prostate and colorectal cancer Women: lung, breast and colorectal cancer 80% of all cases are diagnosed in people 55 years old and above.  Epidemiology According to the Philippine Statistics Authority (PSA) report, cancer ranked as the second leading cause of mortality in 2022, with lung, breast, and liver cancers topping the mortality list, as reported by the WHO International Agency for Research on Cancer - Global Cancer Observatory (IARC - GCO). The enactment of the NICCA in 2019 marked a significant milestone, improving access to cancer centers, providing financial support, and establishing a multi-sectoral council for policy-making, planning, and coordination in cancer prevention and control. https://www.who.int/philippines/news/detail/14-02-2024-doh- NICCA - National Integrated Cancer Control Act (RA 11215)  CHARACTERISTICS OF BENIGN AND MALIGNANT CELLS CHARACTERISTICS BENIGN MALIGNANT CELLS Well differentiated cells resemble normal cells of Cells are undifferentiated and may bear little the tissue from which the tumor originated resemblance to the normal cells of the tissue from which they arose MODE OF GROWTH Tumor grows by expansion and does not infiltrate Grows at the periphery and overcomes contact the surrounding tissues; usually encapsulated inhibition to invade and infiltrate surrounding tissues RATE OF GROWTH Rate of growth is usually slow Rate of growth is variable and depends on level of differentiation: the more anaplastic the tumor, the faster its growth anaplastic - cancer cells that divide rapidly  CHARACTERISTICS OF BENIGN AND MALIGNANT CELLS CHARACTERISTICS BENIGN MALIGNANT METASTASIS Does not spread by metastasis Gains access to the blood and lymphatic channels and metastasizes to other areas of the body or grows across body cavities such as the peritoneum GENERAL EFFECT Usually a localized phenomenon Often causes generalized effects, such as that does not cause generalized anemia, weakness systemic inflammation, effects unless its location interferes weight loss, and CACS. CACS - cancer anorexia- with vital functions cachexia syndrome TISSUE Does not usually cause tissue Often causes extensive tissue damage as DESTRUCTION damage unless its location the tumor outgrows its blood supply or interferes with blood flow encroaches on blood flow to the area; may also produces substances that cause cell damage ABILITY TO CAUSE Does not usually cause death Eventually causes death unless growth can DEATH unless its location interferes with be controlled vital functions  120 days - lifespan of RBC Carcinogenesis MOLECULAR PROCESS INITIATION Carcinogens( substance that can cause cancer) such as chemicals, physical factors, or biologic agent, cause mutations in cellular DNA. Apoptosis (programmed cellular death) PROMOTIOM Repeated exposure to promoting agents (co-carcinogens) causes proliferation and expansion of initiated cells with increased expression or manifestations of abnormal genetic information, even after long latency period. Carcinogenesis MOLECULAR PROCESS PROGRESSION The altered cells exhibit increasingly malignant behavior. These cells acquire the ability to stimulate angiogenesis (growth of new blood vessels that allow cancer cells to grow) to invade adjacent tissues and to metastasize. spread or travel to other parts  Terminologies CANCER a disease of the cell in which the normal mechanisms of the control of growth and proliferation have been altered MALIGNANT NEOPLASM it is invasive, spreading directly to surrounding tissues as well as to new sites in the body BENIGN NEOPLASM a harmless growth that does not spread or invade other tissues NEOPLASIA abnormal cellular changes and growth of new tissues HYPERPLASIA increase in cell number dumadami HYPERTROPHY increase in cell size lumalaki  Terminologies METAPLASIA replacement of one adult cell type by a different adult cell type DYSPLASIA changes in cell size, shape, organization ANAPLASIA reverse cellular development to a more primitive or embryonic cell type METASTASES spread of cancer cells to distant parts of the body to set up new tumors ONCOLOGY the medical specialty that deals with diagnosis, treatment, and study of cancer CARCINOGENS factors associated with cancer causation  Types of Cancer 01 03 Adenocarcinoma Sarcoma cancer that arises from glandular tissues (breast, lung, thyroid, colon 02 cancer of supporting or connecting tissues such as cartilage, bones, and pancreas CA) muscles or fats Carcinoma cancer that is composed of epithelial cells; develops in tissues covering or lining organs of the body such as skin, uterus or breast  Types of Cancer CLASSIFICATION TISSUE OF ORIGIN TERM EXAMPLE SARCOMA BONE Osteosarcoma Femur, humerus CARTILAGE Chondrosarcoma Femur, pelvis ADIPOSE Liposarcoma Retroperitoneum, thigh SMOOTH MUSCLE Leimyosarcoma Uterus, intestines, stomach SKELETAL MUSCLE Rhabdosarcoma Head, neck, limbs MEMBRANE LINING Mesothelial sarcoma Pleura, peritoneum BODY CAVITIES or mesothelioma BLOOD VESSELS Angiosarcoma Liver, heart  Types of Cancer CLASSIFICATION TISSUE OF ORIGIN TERM EXAMPLE CARCINOMA GLANDULAR Adenocarcinoma Breast, lung, prostate EPITHELIUM SQUAMOUS Squamous Cell Skin, lung, esophagus EPITHELIUM Carcinoma  Pathogenesis of Cancer 01 02 Cellular Transformation Failure of the Immune and Derangement Response Theory Theory normal cells may be transformed all individuals possess cancer cells, into cancer cells due to exposure to however, recognized by the immune some etiologic agents response system  Etiologic Factors Viruses Hormones Chemical carcinogens Genetics Physical agents VIRUSES and BACTERIA - oncogenic viruses may be one of the multiple agents acting to initiate carcinogenesis - prolonged or frequent viral infections may cause breakdown of the immune system or overwhelm the immune system - infections that increase risk of certain forms of cancer are as follows: > Human Papilloma Virus (HPV) – cervical cancer > Epstein-Barr Virus – lymphoma > Hepatitis B and C – hepatocellular cancer > Helicobacter Pylori – gastric cancer CHEMICAL CARCINOGENS - causing cell mutation or alteration in cell enzymes and proteins causing altered cell replication 1. INDUSTRIAL COMPOUNDS vinyl chloride (used for plastic manufacture, asbestos factories, construction works) polycyclic aromatic hydrocarbons (such as from refuse burning, auto and truck emissions, oil refineries, air pollution) fertilizers, weed killers dyes (aniline dyes used in beauty shops, hair bleach) CHEMICAL CARCINOGENS 2. DRUGS tobacco (tar nicotine), 90% of all cases of lung CA are due to smoking alcohol cytotoxic drugs 3. HORMONES diethylstilbestrol (DES) – non-steroidal estrogen medication used for pregnancy support, hormone therapy for menopausal symptoms and estrogen deficiency 4. FOODS, PRESERVATIVES nitrates (bacon, smoked meat) talc (polished rice, salami, chewing gum) food sweeteners CHEMICAL CARCINOGENS 4. FOODS, PRESERVATIVES nitrates (bacon, smoked meat) talc (polished rice, salami, chewing gum) food sweeteners nitrosamines (rubber baby nipples) aflatoxins (mold in nuts and grains, milk, cheese, peanut butter) 5. POLYCYCLIC HYDROCARBON charcoal broiling  PHYSICAL AGENTS 1. RADIATION - from X-rays or radioactive isotopes - from sunlight/UV rays 2. PHYSICAL IRRITATION/TRAUMA - from pipe smoking - multiple deliveries - jagged tooth - irritation of the tongue - overuse of any organ/body part  HORMONES - estrogen as replacement therapy has been found to increase incidence of vaginal, cervical and uterine CAs  GENETICS - when oncogene (hidden or repressed genetic code for cancer that exists in all individuals) is exposed to carcinogens, changes in cell structure occurs, malignant tumor develops - regardless of the cause, several cancers are associated with familial patterns  Predisposing Factors AGE - older individuals are more prone to cancer because they have been exposed to carcinogens longer - they have developed alterations in the immune system SEX - the most common type of cancer in females is breast cancer, and prostate cancer in males URBAN vs RURAL - cancer is more common among urban dwellers RESIDENCE than among rural residents, probably due to greater exposure to carcinogens, more stressful lifestyle and greater consumption of preservatives  Predisposing Factors GEOGRAPHIC - most common type of cancer in Japan is gastric DISTRIBUTION cancer, in USA is breast cancer - may be due to influence of environmental factors such diet (raw foods greatly consist Japanese diet), ethnic customs, types of pollution OCCUPATION - there is greater risk of exposure to carcinogens among chemical factory workers, farmers, radiology department personnel HEREDITY - positive family history of cancer increases risk to develop the disease in adults, approximately (34% of cancers have a familial basis)  Predisposing Factors STRESS - depression, grief, anger, aggression, despair, or life stresses decrease immunocompetence because of affectation of hypothalamus and pituitary gland - immunodeficiency may spur the growth and proliferation of cancer cells PRECANCEROUS LESIONS - pigmented moles, burn scars, senile keratosis, leukopenia, benign polyps or adenoma of the colon or stomach, fibrocystic dse. of the breast, may undergo transformation into cancerous lesions and tumors OBESITY - studies have linked obesity to breast and colorectal cancer  Characteristics of Benign and Malignant Neoplasm BENIGN MALIGNANT Speed of growth grows slowly grows rapidly remains localized infiltrates surrounding Mode of growth tissues Capsule encapsulated not encapsulated well-differentiated mature poorly-differentiated; Cell characteristics cells, but cells poorly anaplastic/embryonic type function of cells  Characteristics of Benign and Malignant Neoplasm BENIGN MALIGNANT extremely unusual when commonly following surgery Recurrence surgically removed because of spread to other tissues Metastasis never occur very common not harmful to host, unless it always harmful to host, may compresses tissues or result in necrosis, Effects of neoplasm obstruct vital organ ulcerations, hemorrhage, infection  Characteristics of Benign and Malignant Neoplasm BENIGN MALIGNANT very good poor prognosis if cells are Prognosis poorly differentiated and evidence of metastasis THANK YOU NCM 112: Oncology Nursing Prevention, 02 Screening and Early Detection  Prevention PRIMARY PREVENTION - activities are aimed at prevention before pathologic change has begun - can help reduce cancer risk through alteration of lifestyle behaviors to eliminate or reduce exposure to carcinogens > adapting more healthy diet > limiting exposure to sun and other sources of UV radiation > modifying sexual practices > avoiding cigarettes smoking and alcohol drinking > decreasing exposure to environmental and occupational carcinogens SECONARY PREVENTION - early detection, provides the opportunity to detect precancerous lesions or early-stage cancers, to treat them promptly  Early Detection American Cancer Society (ACS) Recommendations for the Early Detection of Cancer in Asymptomatic People - cancer-related check-up: 01 AGE FREQUENCY 20 to 40 years every 3 years 40 years and annual older  AGE BREAST EXAMINATIONS and FREQUENCY 02 20 to 39 years - have clinical breast exam (CBE) every 3 years - perform breast self-exam (BSE) monthly 40 years and - annual mammogram older - annual CBE - perform breast self-exam (BSE) monthly AGE COLON AND RECTUM EXAMINATIONS and 03 FREQUENCY 50 years and - annual fecal occult blood tests older - flexible sigmoidoscopy every 5 years (men/women) - colonoscopy every 10 years - double-contrast barium enema every 5 -10 years - digital rectal exam (DRE) done at the same time as sigmoidoscopy, colonoscopy or double- contrast barium enema  AGE PROSTATE EXAMINATIONS and FREQUENCY 04 50 years and - annual prostate-specific antigen (PSA) blood older test - annual DRE PROFILE UTERINE EXAMINATIONS and FREQUENCY 05 women who are CERVIX or have been - annual Pap smear test and pelvic exam sexually active (after 3 or more consecutive satisfactory exams with normal findings, may be performed less or 40 years and frequently) older - HPV test is recommended started ENDOMETRIUM menopause - endometrial biopsy  Dietary Recommendations American Cancer Society (ACS) Recommendations Against Cancer 1. Avoid obesity 2. Cut down on total fat intake 3. Eat more high fiber foods, like raw fruits and vegetables, whole grain cereals 4. Include foods rich in vit A and C in daily diet 5. Include cruciferous vegetables in the diet like broccoli, cabbage, cauliflower, Brussel sprouts 6. Be moderate in the consumption of alcoholic beverages 7. Be moderate in the consumption of salt-cured, smoked-cured and nitrate-cured foods  Common Causes of Cancer BREAST CANCER - early menarche - late menopause - nulliparous or older than 30 years at the birth of a first child LUNG CANCER - tobacco abuse - asbestos - radiation exposure - air pollution COLORECTAL CANCER - greater incidence in men - familial polyposis - ulcerative colitis - high-fat, low-fiber diet  Common Causes of Cancer PROSTATE CANCER - common among males who are 50 years and older - African-American have the highest incidence in the world - (+) family history - exposure to cadmium CERVICAL CANCER - sexual behavior: > first intercourse at an early age > multiple sexual partners > sexual partner who has had multiple sexual partners - (+) HPV and AIDS - low socioeconomic status - cigarette smoking  Common Causes of Cancer HEAD AND NECK CANCER - more common among males - alcohol and tobacco use - poor oral hygiene - long term sun exposure - occupational SKIN CANCER - individuals with fair complexion - (+) family history - moles (nevi) - exposure to coal tar, creosote, arsenic, radium - sun exposure between 11am to 3pm Warning Signals of Cancer C change in bowel or bladder habits A a sore that does not heal U unusual bleeding or discharge U unexplained anemia U unexplained sudden weight loss T thickening or lump in the breast or elsewhere I Indigestion or difficulty swallowing O obvious change in wart or mole N nagging cough or hoarseness of voice Staging and Grading of Neoplasia STAGING - determining the size of the tumor and existence of metastases - necessary at the time of diagnosis to determine: > extent of disease (local vs metastatic); > prognosis > proper management GRADING - classification of tumor cells  Staging and Grading of Neoplasia Stage What it means Stage 0 Abnormal cells are present but have not spread to nearby tissue. Also called carcinoma in situ, or CIS. CIS is not cancer, but it may become cancer. Stage I, Stage II, and Stage III Cancer is present. The higher the number, the larger the (may also be written as cancer tumor and the more it has spread into nearby Stage 1, Stage 2, and Stage 3) tissues. Stage IV (may also be written The cancer has spread to distant parts of the body. as Stage 4) Staging and Grading of Neoplasia NOMENCLATURE OF NEOPLASIA - tumor is named according to: 1. PARENCHYMA 3. EMBRYONIC ORIGIN Hepatoma- liver Ectoderm- usually gives Osteoma-bone rise to epithelium Myoma-muscle Endoderm- glands Mesoderm- connective 2. PATTERN AND STRUCTURE, either tissues gross or microscopic Fluid-filled- Cyst Glandular- Adeno Finger-like- Papillo Stalk- Polyp Staging and Grading of Neoplasia BENIGN TUMOR MALIGNANT TUMOR - suffix used, -”OMA” 1. Ectodermal, endodermal, glandular, epithelial adipose tissue- LipOMA - suffix used, -”CARCINOMA” bone- osteOMA muscle- myOMA Pancreatic AdenoCARCINOMA blood vessels- angiOMA Squamous Cell CARCINOMA fibrous tissue- fibrOMA 2. Mesodermal, connective tissue origin - suffix used, -”SARCOMA” FibroSARCOMA MyoSARCOMA AngioSARCOMA Staging and Grading of Neoplasia 1. -”OMA” but Malignant HepatOMA, LymphOMA, GliOMA, MelanOMA 2. THREE-germ layers, -”TERATOMA” 3. Non-neoplastic but -”OMA” HematOMA  TNM Classification - a system developed by American Joint Committee of Cancer (AJCC) that can be applied to all tumor types T- primary/main tumor size TX – primary tumor is unable to be assessed TO – no evidence of primary tumor TIS – carcinoma in situ (abnormal cells are present but have not spread to nearby tissue) T1, T2, T3, T4 – increasing size and/or local extent of primary tumor N- presence or absence of regional nearby lymph node involvement NX – regional lymph nodes are unable to be assessed NO – no regional lymph nodes involvement N1, N2, N3 – increasing involvement of regional lymph nodes M- presence or absence of distant metastases MX – unable to be assessed MO – absence of distant metastases M1 – presence of distant metastases Cancer Detection Examinations CYTOLOGIC EXAMINATION OR PAPANICOLAOU TEST (PAP’S EXAM, PAP SMEAR) - cytologic specimen can be obtained from tumors that tend to shed cells from their surface > GI tract through endoscopy > GU tract through colposcopy of the cervix and vagina > cystoscopy of the bladder > laparoscopy of the pelvic and abdominal cavity Cancer Detection Examinations CYTOLOGIC EXAMINATION OR PAPANICOLAOU TEST (PAP’S EXAM, PAP SMEAR) - interpretation of Papanicolaou Test results are as follows: Class I Normal follow-up examination every 1-3 yrs as recommended by physician Class II Inflammation may require Pap exam in 3-6 mos as prescribed Class III Mild to moderate dysplasia Class IV Probably malignant Require biopsy as prescribed Class V Possibly malignant Cancer Detection Examinations BIOPSY - involves obtaining tissue samples by needle aspiration, or incision of tumor 1. NEEDLE BIOPSY - done by aspiration of tumor cells with needle and syringe 2. EXCISION BIOPSY - done by removing the entire tumor (small) 3. INCISION OR SUBTOTAL BIOPSY - done by taking only a part of the tumor (large) Cancer Detection Examinations RADIOLOGIC EXAMINATIONS - ultrasound (UTZ) - magnetic resonance imaging (MRI) - radiodiagnostic tests - computerized axial tomography (CT scan) - endoscopic examinations Cancer Detection Examinations LABORATORY BLOOD TESTS 1. HEMATOLOGIC (CBC) - hemoglobin (hgb) and hematocrit (hct) low in anemia, may indicate malignancy - leukocytes (wbc) immature WBCs high in leukemia, lymphomas mature WBCs low in leukemia and metastatic dse in bone marrow - platelets high in chronic myelocytic leukemia (CML), Hodgkin’s dse low in acute lymphocytic leukemia (ALL), acute myelocytic leukemia (AML), multiple myeloma, bone marrow depression Cancer Detection Examinations LABORATORY BLOOD TESTS 2. TUMOR MARKERS - alpha-feto-protein (AFP) elevated in lung, testicular, pancreatic, colon, gastric CAs and choriocarcinoma - carcinoembryonic antigen (CEA) elevated in colorectal, breast lung, stomach, pancreatic and prostate CAs - human chorionic gonadotropin (HCG) elevated in choriocarcinoma, germ cell, testicular CA - prostatic acid phosphatase elevated in metastatic prostate CA - prostatic-specific antigen (PSA) elevated in prostate CA THANK YOU NCM 112: Oncology Nursing Pathophysiologic Basis of 03 Malignant Neoplasia  PREDISPOSING FACTORS/ETIOLOGIC FACTORS CELLULAR ABBERATIONS CANCER CELL PROLIFERATION - disrupt normal cell growth and interfere with tissue function Pressure Obstruction Pain Effusion Ulceration Vascular thrombosis, thrombophlebitis  Cancer Cell Proliferation PRESSURE - due to increase in size of neoplastic growth OBSTRUCTION - as tumor continues to grow, hollow organs and vessels become compressed and obstructed esophagus, bronchi, ureters, bowel, blood vessels, lymphatic system PAIN - due to: 1. pressure on the nerve endings 2. distention of organs/vessels 3. lack of oxygen to tissues and organs 4. release of pain mediators by the tumor - a late sign of cancer  Cancer Cell Proliferation EFFUSION - when lymphatic flow is obstructed, there may be effusion in serous cavities pleural cavity, pleural effusion abdominal cavity, ascites ULCERATION AND NECROSIS - result as the tumor erodes blood vessels and pressure on tissue causes ischemia ➜ tissue damage and bleeding ➜ infection VASCULAR THROMBOSIS, EMBOLISM, THROMBOPHLEBITIS - tumors tend to produce abnormal coagulation factors that cause increased clotting pulmonary embolism  PREDISPOSING FACTORS/ETIOLOGIC FACTORS CELLULAR ABBERATIONS CANCER CELL PARANEOPLASTIC PROLIFERATION SYNDROME - disrupt normal cell growth - malignant cells produce and interfere with tissue enzymes, hormones, and function other substances Pressure Anemia Obstruction Hypercalcemia Pain Edema Effusion Disseminated Ulceration Intravascular Coagulation Vascular thrombosis, (DIC) thrombophlebitis  Paraneoplastic Syndrome ANEMIA - CA cells produce chemicals that interfere with RBC production - iron uptake is greater in the tumor than that deposited in the liver - blood loss that results from bleeding leads to anemia HYPERCALCEMIA - tumors of the bone, squamous cell lung CA, breast CA, produce a parathyroid-like hormone that increases or accelerates bone breakdown and release of calcium - also results from metastasis to the bones - enhanced by immobilization and dehydration DESSIMINATED INTRAVASCULAR COAGUALTION (DIC) - more likely to occur in lungs, pancreas, stomach, prostate Cas - precipitated by the release of tissue thromboplastin or endothelial injury  PREDISPOSING FACTORS/ETIOLOGIC FACTORS CELLULAR ABBERATIONS CANCER CELL PARANEOPLASTIC Anorexia and Cachexia PROLIFERATION SYNDROME Syndrome - disrupt normal cell growth - malignant cells produce - final outcome of and interfere with tissue enzymes, hormones, and unrestrained cancer cell function other substances growth Pressure Anemia Tissue wasting Obstruction Hypercalcemia Severe weight loss Pain Edema Severe debilitation Effusion Disseminated Ulceration Intravascular Coagulation Vascular thrombosis, (DIC) thrombophlebitis Anorexia-Cachexia Syndrome - malignant neoplasms deprive normal cells of nutrition - tumors produce alteration in enzyme system necessary for normal metabolism ➜ stored fat is lost, tissues lost nitrogen (negative nitrogen balance) - tumors revert to anaerobic metabolism ➜ consume glucose; deplete glycogen stores in the liver and convert glucose to lactate - protein depletion, serum albumin levels decrease - tumors take up sodium; water retention marks malnutrition and is not immediately reflected as weight loss - CA cells produce anorexigenic substances that act in the satiety center of the hypothalamus, causing anorexia - taste sensation diminishes or becomes altered, and individual may have aversion to eating particularly meat (tastes bitter) Treatment 04 Modalities  Surgical Interventions DIAGNOSTIC SURGERY - done by cytologic specimen collection and biopsy PREVENTIVE SURGERY - involves removal of precancerous lesions or benign tumors patients with familial polyposis and ulcerative colitis undergo subtotal colectomies to prevent colon cancer CURATIVE SURGERY - involves removal of an entire tumor and surrounding lymph nodes - cancers are localized to the organ of origin and the regional lymph nodes are potentially curable by surgery RECONSTRUCTIVE SURGERY - done for improvement of the appearance and function of the organ affected  Surgical Interventions PALLIATIVE SURGERY - done for relief of distressing signs and symptoms or for retardation of metastasis - attempt to improve client’s quality of life a. Reduce pain by interrupting nerve pathways or implanting pain control pumps b. Relieve airway obstruction c. Relieve obstruction in the GI and GU tracts d. Relieve pressure in the brain and spinal cord e. Prevent hemorrhage f. Remove infected and ulcerating tumors g. Drain abscesses  Radiation Therapy - use of high-energy ionizing radiation that destroys a cell’s ability to reproduce by damaging its DNA - may be used as a primary, adjuvant, or a palliative treatment modality: PRIMARY THERAPY - the only treatment used and aims to achieve local cure of the cancer early stage of skin cancer, Hodgkin’s dse., cervical carcinoma ADJUVANT THERAPY - can be done preoperatively or postoperatively to aid in destruction of cancer cells - also used in conjunction with chemotherapy to enhance destruction of cancer cells PALLIATIVE THERAPY - can be used to relieve pain cause by obstruction, pathologic fractures, spinal cord compression and metastases  Radiation Therapy - rapidly diving cells like cancer cells are more vulnerable to radiation; therefore, radiation kills cancer cells while sparing normal cells from excessive cell death -TYPES OF RT: EXTERNAL RADIATION THERAPY (TELETHERAPY, DXT(Deep X-ray Therapy) - administered through high-energy X-ray machine e.g. linear accelerator, cobalt, betatron, or a machine containing radioisotope - major advantage is its skin-sparing effect; the maximum effect of radiation occurs at tumor deep in the body, not on the skin surface - no need for isolation  Radiation Therapy INTERNAL RADIATION THERAPY - administered within or near the tumor or into the systemic circulation Sealed-source (brachytherapy) - the radioisotope is placed within or near the tumor - radioactive material is enclosed in a sealed container - used for both intracavity and interstitial therapy - intracavity RT is used to uterine and cervical CAs; the radioisotope is placed in the body cavity, generally for 24-72 hrs (cesium 137 or radium 226) - on interstitial therapy, the radioisotope is placed in needles, beads, seeds, ribbons, or catheters, which are then implanted directly into the tumor (iridium 192, iodine 125, cesium 137, gold 198, radium 222) - the radioisotope cannot circulate through the client’s body nor can contaminate the client’s urine, sweat, blood or vomitus (secretions are not radioactive)  Radiation Therapy Unsealed-source - the radioisotope may be administered intravenously, orally, or by instillation directly into the body cavity - the radioisotope circulates through the client’s body; therefore, client’s urine, sweat, blood or vomitus are radioactive - e.g. iodine 131, PO for Grave’s dse. and thyroid CA, strontium chloride 89, TIV for relief of painful bony metastases  PRINCIPLES OF RADIATION PROTECTION – “DTS” 1. DISTANCE - the greater the distance from radiation source, the less the exposure dose of ionizing rays - maintain distance of at least 3 feet when not performing nursing procedure 2. TIME - limit contact with the client for 5 minutes each time, a total of 30 mins per 8-hr shift 3. SHIELDING - use lead shield during contact with client  PRINCIPLES OF RADIATION PROTECTION - pregnant staff should not be assigned to clients receiving internal RT - staff members caring for the client with internal RT should wear dosimeter badge when in the client’s room - to prevent feelings of isolation, maintain contact with the client while keeping distance from radiation exposure; talk with the client from the doorway of the room - the client receiving an unsealed source of RT should have a private room and bath - foods are served on disposable plates and utensils. - trash and linens are kept in the client's room and are not removed until the client is ready for discharge. - the client is also instructed to rinse the sink with copious amount of water after tooth brushing and to flush the toilet several times after each use  PRINCIPLES OF RADIATION PROTECTION - anyone entering the room wears a new pair of booties each time to prevent tracking the radioisotope out into the hallway - caregivers should wear gloves when handling body fluids - any emesis (vomiting), especially that occurs shortly after ingestion of oral radioisotope, should be covered with absorbent pads, and the Radiation Safety Officer should be called immediately NURSING INTERVENTIONS: cervical cancer client with isotope implant PROCEDURE RATIONALE Client’s back is turned towards To minimize exposure of the door. healthcare staff to radioisotope entering the client’s room. Encourage the client to turn to sides at regular intervals. The client should be on complete To prevent dislodgement of the bed rest. radioisotope. The client should be given Bowel movement during the enema before the procedure. procedure may cause dislodgment of the radioisotope. NURSING INTERVENTIONS: cervical cancer client with isotope implant PROCEDURE RATIONALE The client should be given low To prevent dislodgement of the fiber diet to inhibit defecation radioisotope. during the procedure until the device is removed in 2 to 3 days. The client should have a Foley To prevent bladder distention catheter in place during the and subsequently prevent procedure. irradiation of the bladder. Irradiation of the bladder may cause fistula formation between the bladder and the uterus. This causes urine to come out from the vagina NURSING INTERVENTIONS: cervical cancer client with isotope implant PROCEDURE RATIONALE Have long forceps and lead Use long forceps to pick up container readily available. dislodged radioisotope and place it in the lead container.  TEACHING GUIDELINES REGARDING EXTERNAL RT 1. It is painless. 2. Lie very still on a special table while the intervention is being given and you may be placed in a special position to maximize tumor irradiation. 3. Each treatment usually lasts for few minutes, you may hear sounds of the machine being operated, and the machine may move during the therapy. 4. As a safety precaution for the therapy personnel, you will remain alone in the treatment room while the machine is in operation. 5. The technologist will be right outside your room observing you through a window or by a closed - circuit TV. You may communicate. 6. There is no residual radioactivity after radiation therapy. Safety precautions are necessary only during the time you are actually receiving irradiation. You may resume normal activities of daily living. CLIENT EDUCATION ON SKIN CARE IN EXTERNAL RT Skin care within the treatment area includes the following: 1. Keep your skin dry. 2. Do not wash the treatment area until you are instructed to do so. When permitted, wash the treated skin gently with mild soap, rinse well, and pat dry. Use warm water or cool water, not hot water. 3. Do not remove the lines or ink marks placed on your skin. Avoid using powders, lotions, creams. alcohol and deodorants on the treated skin. 4. Wear loose - fitting clothing to avoid friction over the treatment area 5. Do not apply tape to the treatment area if dressings are applied 6. Shave with an electric razor. Do not use pre-shave or after - shave lotions. CLIENT EDUCATION ON SKIN CARE IN EXTERNAL RT 7. Protect your skin from exposure to direct sunlight, chlorinated swimming pools, and temperature extremes (e.g. hot water bottles, heating pads, lo packs). 8. Consult your radiation therapist or nurse about specific measures for individual skin reactions. NURSING INTERVENTIONS: side effects of radiation therapy SIDE EFFECT NURSING INTERVENTIONS SKIN REACTIONS - observe for early signs of skin - erythema, dry/ moist reaction and report to the physician desquamation - keep area dry - atrophy, telangiectasia, - wash area with water, no soap and depigmentation, necrotic/ pat dry (do not rub); mild soaps is ulcerative lesions permitted - don’t apply ointments, powders or lotion on the area; cornstarch may be used - don’t apply heat; avoid direct sunshine or cold on the area - use soft cotton fabrics for clothing to prevent skin irritation - don’t erase skin markings NURSING INTERVENTIONS: side effects of radiation therapy SIDE EFFECT NURSING INTERVENTIONS INFECTION - monitor blood counts weekly, - this is due to bone especially WBC marrow suppression - good personal hygiene, nutrition, adequate rest - teach the client signs of infection to report to physician HEMORRHAGE - monitor platelet count - platelets are vulnerable - avoid physical trauma or use of to radiation aspirin (ASA) - teach signs of hemorrhage to report (e.g. gum bleeding, nose bleeding, black stools) - monitor stool and skin for signs of hemorrhage. NURSING INTERVENTIONS: side effects of radiation therapy SIDE EFFECT NURSING INTERVENTIONS FATIGUE - plenty of rest and good nutrition - result of high metabolic demands for tissue repair and toxic waste removal WEIGHT LOSS - anorexia, pain and effect of cancer. STOMATITIS & - administer analgesics before meals, XEROSTOMIA (Dry mouth) as prescribed - ulceration of oral mucous - bland diet, avoid smoking, alcohol membrane occurs - good oral hygiene with saline rinses every 2 hours - sugarless lemon drops or mint to increase salivation NURSING INTERVENTIONS: side effects of radiation therapy SIDE EFFECT NURSING INTERVENTIONS Diarrhea, nausea and vomiting, headache. alopecia (hair loss) and cystitis may also occur Social isolation is also experienced by the client due to fear of contaminating others with radiation CHEMOTHERAPY JOEM O. GREGORIO, RN, MN What is chemotherapy? Chemotherapy is a common cancer treatment. It uses drugs to destroy cancer cells and prevent tumor growth. It may be paired with other cancer treatments such as radiation therapy or surgery. Chemotherapy is usually given intravenously (through a vein). It’s an effective treatment but can cause side effects. How does chemotherapy work? Cancer cells grow and divide uncontrollably. Chemotherapy destroys the cancer cells and prevents them from multiplying. Chemotherapy can be use in different ways: Adjuvant therapy: Chemotherapy destroys cancer cells after surgery or radiation therapy. Curative therapy: Chemotherapy (which may also include radiation and/or surgery) eliminates the cancer, and it doesn’t return. Neoadjuvant therapy: Chemotherapy shrinks a tumor before surgery or radiation therapy. Palliative therapy: Chemotherapy shrinks tumors and lessens symptoms but doesn’t cure the cancer. Site for Chemotherapy Treatment Intravenously (IV), or through a vein as an “infusion.” Most people receive chemo through an IV. As an injection, or a shot. Orally, as a pill or liquid that you swallow. Topically, as a cream that you rub into your skin. Specific Delivery of Chemotherapy Intra-arterial chemotherapy: Goes into a single artery that supplies blood to a tumor. Intracavitary chemotherapy: Goes directly into a body cavity, such as your bladder or belly. One form is hyperthermic Intraperitoneal Chemotherapy It puts heated chemotherapy in your abdomen after surgery. Intrathecal chemotherapy: Goes into the area between your brain and spinal cord. Intravenous Chemotherapy Needle: Usually in your arm. Catheter: A thin, flexible tube attached to a vein (usually in your chest). Port: A small disc inserted under the skin. A catheter attaches to the port to deliver chemotherapy. Port placement requires minor surgery. Pump: A device that attaches to a catheter or port that controls the amount of the chemotherapy drug you receive Side effect of Chemotherapy Anemia Bleeding. Constipation Diarrhea Fatigue Hair Loss Infection. Loss of appetite. Nausea and Vomiting Late effects of chemotherapy Cognitive (memory and thinking) issues, also called “chemo brain.” Early Menopause Cardiotoxicity, or heart problems caused by cancer treatment. Neuropathy, or symptoms of nerve damage. Infertility. TYPES OF CHEMOTHERAPY Alkylating agents. These drugs damage cell DNA, which is genetic material in charge of growth and development. This prevents cancer cells from multiplying. Alkylating agents are the oldest and most common type of chemotherapy. Example Altretamine, Bendamustine, Busulfan, Carboplatin, Chlorambucil, Cisplatin, Cyclophosphamide, Dacarbazine, Ifosfamide, Mechlorethamine, Melphalan, Oxaliplatin, Procarbazine, Temozolomide, Thiotepa, Trabectedin  Nitrosoureas are a special kind of alkylating agent. They can enter your brain and attack tumors there. This makes them effective for treating some brain cancers. Examples include: Carmustine Lomustine Streptozocin Antimetabolites. These stop cells from making DNA for new cancer cells. Common antimetabolites include: Example: 5-fluorouracil, 6-mercaptopurine, Azacitidine, Capecitabine, Cladribine, Clofarabine, Cytarabine, Decitabine, Floxuridine, Fludarabine, Gemcitabine, Hydroxyurea, Methotrexate, Nelarabine, Pemetrexed, Pentostatin, Pralatrexate, Thioguanine, Trifluridine/tipiracil combination Topoisomerase inhibitors. This kind of chemotherapy drug stops a protein called topoisomerase from working. Topoisomerase helps cells copy their DNA, allowing them to multiply into new cells. If topoisomerase doesn’t work, cancer cells can’t multiply. Common ones include: Example: Etoposide Irinotecan Irinotecan liposomal Mitoxantrone Teniposide Topotecan  Antitumor antibiotics. This kind of chemotherapy drug stops cells from copying their DNA, so they can't multiply. Some drugs also damage DNA. Example: Bleomycin Dactinomycin Daunorubicin Doxorubicin Doxorubicin liposomal Epirubicin Idarubicin Mitomycin-C Mitoxantrone Valrubicin REFERENCES: https://my.clevelandclinic.org/health/treatments/16859- chemotherapy https://www.webmd.com/cancer/chemotherapy-what-to- expect