Oncology Nursing - CA1 - PDF

Oncology Nursing Michael Norbert L. De Guzman, RN, MAN  Oncology defined Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia  “Root words” Neo- new Plasia- growth Plasm- substance Trophy- size +Oma- tumor...

Oncology Nursing Michael Norbert L. De Guzman, RN, MAN  Oncology defined Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia  “Root words” Neo- new Plasia- growth Plasm- substance Trophy- size +Oma- tumor Statis- location  “Root words” A- none Ana- lack Hyper- excessive Meta- change Dys- bad, deranged  Characteristics of Neoplasia Uncontrolled growth of Abnormal cells 1. Benign 2. Malignant 3. Borderline  Characteristics of Neoplasia BENIGN Well-differentiated Slow growth Encapsulated Non-invasive Does NOT metastasize  Characteristics of Neoplasia MALIGNANT Undifferentiated Erratic and Uncontrolled Growth Expansive and Invasive Secretes abnormal proteins METASTASIZES  PROLIFERATIVE PATTERNS Anaplasia: cells that lack normal cellular characteristics and differ in shape and organization Dysplasia: bizarre cell growth, differ in size, shape, or arrangement from other cells of the same type of tissue  PROLIFERATIVE PATTERNS Metaplasia: conversion of one type of mature cell into another type of cell  Nomenclature of Neoplasia Tumor is named according to: 1. Parenchyma, Organ or Cell Hepatoma- liver Osteoma- bone Myoma- muscle  Nomenclature of Neoplasia Tumor is named according to: 2. Pattern and Structure, either GROSS or MICROSCOPIC Fluid-filled🡪 CYST Glandular🡪 ADENO Finger-like🡪 PAPILLO Stalk🡪 POLYP  Nomenclature of Neoplasia Tumor is named according to: 3. Embryonic origin Ectoderm ( usually gives rise to epithelium) Endoderm (usually gives rise to glands) Mesoderm (usually gives rise to Connective tissues)  BENIGN TUMORS Suffix- “OMA” is used Adipose tissue- LipOMA Bone- osteOMA Muscle- myOMA Blood vessels- angiOMA Fibrous tissue- fibrOMA  MALIGNANT TUMOR Named according to embryonic cell origin 1. Ectodermal, Endodermal, Glandular, Epithelial Use the suffix- “CARCINOMA” Pancreatic AdenoCarcinoma Squamos cell Carcinoma  MALIGNANT TUMOR Named according to embryonic cell origin 2. Mesodermal, connective tissue origin Use the suffix “SARCOMA FibroSarcoma Myosarcoma AngioSarcoma  “PASAWAY” 1. “OMA” but Malignant HepatOMA, lymphOMA, gliOMA, melanOMA 2. THREE germ layers “TERATOMA” 3. Non-neoplastic but “OMA” Choristoma Hamatoma  CANCER NURSING Review of Normal Cell Cycle 3 types of cells 1. PERMANENT cells- out of the cell cycle Neurons, cardiac muscle cell 2. STABLE cells- Dormant/Resting (G0) Liver, kidney 3. LABILE cells- continuously dividing GIT cells, Skin, endometrium , Blood cells  CANCER NURSING Cell Cycle G0------------------G1🡪 S🡪 G2🡪 M G0- Dormant or resting G1- normal cell activities S- DNA Synthesis G2- pre-mitotic, synthesis of proteins for cellular division M- Mitotic phase (I-P-M-A-T)  CANCER NURSING Proposed Molecular cause of CANCER: Change in the DNA structure🡪 altered DNA function🡪 Cellular aberration 🡪 cellular death 🡪 neoplastic change Genes in the DNA- “proto-oncogene” And “anti-oncogene”  CANCER NURSING Etiology of cancer 1. PHYSICAL AGENTS Radiation Exposure to irritants Exposure to sunlight Altitude, humidity  CANCER NURSING Etiology of cancer 2. CHEMICAL AGENTS Smoking Dietary ingredients Drugs  CANCER NURSING Etiology of cancer 3. Genetics and Family History Colon Cancer Premenopausal breast cancer  CANCER NURSING Etiology of cancer 4. Dietary Habits ❑ Low-Fiber ❑ High-fat ❑ Processed foods ❑ alcohol  CANCER NURSING Etiology of cancer 5. Viruses and Bacteria DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus RNA Viruses- HIV, HTCLV Bacterium- H. pylori  CANCER NURSING Etiology of cancer 6. Hormonal agents DES OCP especially estrogen  CANCER NURSING Etiology of cancer 7. Immune Disease AIDS  CANCER NURSING CARCINOGENSIS Malignant transformation I🡪 P🡪 P Initiation Promotion Progression  CANCER NURSING CARCINOGENSIS INITIATION Carcinogens alter the DNA of the cell Cell will either die or repair Apoptosis  CANCER NURSING CARCINOGENSIS PROMOTION Repeated exposure to carcinogens Abnormal gene will express Latent period  CANCER NURSING CARCINOGENSIS PROGRESSION Irreversible period Cells undergo NEOPLASTIC transformation then malignancy  CANCER NURSING Spread of Cancer 1. LYMPHATIC Most common 2. HEMATOGENOUS Blood-borne, commonly to Liver and Lungs 3. DIRECT SPREAD Seeding of tumors  LYMPHATIC SPREAD Tumor emboli Interstitial fluid Lymph Lymph node  NORMAL IMMUNE RESPONSE Tumor cell Ag Cellular & Humoral T lymphocytes Antibodies Lymphokines/NK cells Macrophages  CANCER NURSING Body Defenses Against TUMOR 1. T cell System/ Cellular Immunity Cytotoxic T cells kill tumor cells 2. B cell System/ Humoral immunity B cells can produce antibody 3. Phagocytic cells Macrophages can engulf cancer cell debris  CANCER NURSING Cancer Diagnosis 1. BIOPSY The most definitive 2. CT, MRI 3. Tumor Markers  CANCER NURSING Tumor Markers by Body System General Tumor Markers CEA (Carcinoembryonic Antigen): Gastrointestinal cancers (colon, pancreas), lung, and breast cancer. LDH (Lactate Dehydrogenase): General marker for tissue damage, lymphoma, and metastatic cancer.  CANCER NURSING Tumor Markers by Body System Breast Cancer CA 15-3 / CA 27.29: Breast cancer. HER2(human epidermal growth factor receptor 2)/neu: Aggressive breast cancer. Estrogen/Progesterone Receptors: Hormone-sensitive breast cancers.  CANCER NURSING Tumor Markers by Body System Liver and Germ Cell Tumors AFP (Alpha-fetoprotein): Hepatocellular carcinoma, yolk sac tumors, testicular and ovarian cancers  CANCER NURSING Tumor Markers by Body System GI System CA 19-9: Pancreatic cancer, biliary tract cancers. CEA (Carcinoembryonic Antigen): Colorectal and other GI cancers.  CANCER NURSING Tumor Markers by Body System Prostate PSA (Prostate-Specific Antigen): Prostate cancer, benign prostatic hyperplasia (BPH). Ovarian Cancer CA 125: Ovarian cancer.  CANCER NURSING Tumor Markers by Body System Testicular Cancer AFP (Alpha-fetoprotein): Non-seminomatous germ cell tumors. hCG (Human Chorionic Gonadotropin): Testicular cancer, especially choriocarcinoma.  CANCER NURSING Tumor Markers by Body System Thyroid Calcitonin: Medullary thyroid carcinoma. Thyroglobulin: Differentiated thyroid cancers (papillary and follicular).  CANCER NURSING Tumor Markers by Body System Lung Cancer CYFRA 21-1: Non-small cell lung cancer. NSE (Neuron-Specific Enolase): Small cell lung cancer. Pro-GRP (Pro-gastrin-releasing Peptide): Small cell lung cancer.  CANCER NURSING Tumor Markers by Body System Bone ALP (Alkaline Phosphatase): Bone metastases and primary bone tumors. Bladder NMP22 (Nuclear Matrix Protein 22): Bladder cancer. BTA (Bladder Tumor Antigen): Bladder cancer.  CANCER NURSING Tumor Markers by Body System Pancreas CA 19-9: Pancreatic adenocarcinoma Brain S100 Protein: Melanoma and certain brain tumors. GFAP (Glial Fibrillary Acidic Protein): Glial cell-derived tumors.  CANCER NURSING Tumor Markers by Body System Skin (melanoma) S100 Protein: Melanoma. LDH (Lactate Dehydrogenase): Advanced melanoma.  CANCER NURSING Cancer Grading The degree of DIFFERENTIATION Grade 1- Low grade Grade 4- high grade  CANCER NURSING Cancer Staging 1. Uses the T-N-M staging system T- tumor N- Node M- Metastasis 2. Stage 1 to Stage 4  CANCER NURSING GENERAL MEDICAL MANAGEMENT 1. Surgery- cure, control, palliate 2. Chemotherapy 3. Radiation therapy 4. Immunotherapy 5. Bone Marrow Transplant  SURGERY AS PRIMARY TREATMENT 1. Local excision - Removal of a tumor and a small margin of surrounding healthy tissue. 2. Wide or radical excision - Removal of the tumor along with extensive surrounding tissue, including nearby lymph nodes if necessary. 3. Salvage surgery - A follow-up procedure aimed at removing remaining or recurrent cancer after initial treatment.  SURGERY AS PRIMARY TREATMENT 1. Electrosurgery - Use of electric currents to destroy cancerous tissue or control bleeding. 2. Cryosurgery - Destruction of abnormal tissue through extreme cold, typically using liquid nitrogen. 3. Laser surgery - Use of focused light beams to cut or destroy cancerous tissue with precision.  PROPHYLACTIC SURGERY Family hx & genetic predisposition (+)/ (-) sx Potential risks & benefits Ability to detect cancer at an early stage  PALLIATIVE SURGERY RECONSTRUCTIVE SURGERY  CANCER NURSING GENERAL Promotive and Preventive Nursing Management 1. Lifestyle Modification 2. Nutritional management 3. Screening 4. Early detection BREAST 20- CBE q 3yrs 39 BSE q month >40 CBE q year BSE q month Mammogram q year COLON >/50 Fecal Occult bld q year Flexible Sig. q 5 years Coloniscopy q 10 years Double contrast q 5 years Barium enema PROST >50 PSA/DRE q year ATE OR /18 PAPs smear q year Pelvis exam q year  SCREENING 1. Male and female- Occult Blood, CXR, and DRE 2. Female- SBE, CBE, Mammography and Pap’s Smear 3. Male- DRE for prostate, Testicular self- exam  Nursing Assessment Utilize the ACS Warning Signals CAUTION US C- Change in bowel/bladder habits A- A sore that does not heal U- Unusual bleeding T- Thickening or lump in the breast I- Indigestion O- Obvious change in warts N- Nagging cough and hoarseness U- Unexplained anemia S - Sudden weight loss  Nursing Assessment Weight loss Frequent infection Skin problems Pain Hair Loss Fatigue Disturbance in body image/ depression  Nursing Intervention MAINTAIN TISSUE INTEGRITY Handle skin gently Do NOT rub affected area Lotion may be applied Wash skin only with SOAP and Water  Nursing Intervention MANAGEMENT OF STOMATITIS Use soft-bristled toothbrush Oral rinses with saline gargles/ tap water Avoid ALCOHOL-based rinses  Nursing Intervention ⮚ MANAGEMENT OF ALOPECIA Alopecia begins within 2 weeks of therapy ⮚ Regrowth within 8 weeks of termination ⮚ Encourage to acquire wig before hair loss occurs ⮚ Encourage use of attractive scarves and hats ⮚ Provide information that hair loss is temporary BUT anticipate change in texture and color  Nursing Intervention ⮚ PROMOTE NUTRITION ⮚ Serve food in ways to make it appealing ⮚ Consider px’s preferences ⮚ Provide small frequent meals ⮚ Avoids giving fluids while eating ⮚ Oral hygiene PRIOR to mealtime ⮚ Vitamin supplements  Nursing Intervention ⮚ RELIEVE PAIN ⮚ Mild pain- NSAIDS Mod. pain- Weak opiods ⮚ Severe pain- Morphine ⮚ Administer analgesics RTC  Nursing Intervention ⮚ DECREASE FATIGUE ⮚ Plan daily activities to allow alternating rest periods ⮚ Light exercise is encouraged ⮚ Small frequent meals  Nursing Intervention ⮚ IMPROVE BODY IMAGE ⮚ Therapeutic communication is essential ⮚ Encourage independence in self-care and decision making ⮚ Offer cosmetic material like make-up and wigs  Nursing Intervention ⮚ ASSIST IN THE GRIEVING PROCESS ⮚ Some cancers are curable ⮚ Grieving can be due to loss of health, income, sexuality, and body image ⮚ Answer and clarify information about cancer and treatment options ⮚ Identify resource people ⮚ Refer to support groups  Nursing Intervention ⮚ MANAGE COMPLICATION: INFECTION ⮚ Fever is the most important sign (38.3) ⮚ Administer prescribed antibiotics X 2weeks ⮚ Maintain aseptic technique ⮚ Avoid exposure to crowds ⮚ Avoid giving fresh fruits and veggie ⮚ Handwashing ⮚ Avoid frequent invasive procedures  FACTORS PREDISPOSING CANCER PX TO INFECTION 1. Impaired skin & mucus membrane 2. Malnutrition 3. Medications 4. Urinary catheters 5. IV catheter 6. Invasive surgery 7. Contaminated equipment 8. Age 9. Chronic illness 10. Prolonged hospitalization  Nursing Intervention ⮚ MANAGE COMPLICATION: Septic shock ⮚ Monitor VS, BP, temp ⮚ Administer IV antibiotics ⮚ Administer supplemental O2  Nursing Intervention ⮚ MANAGE COMPLICATION: Bleeding ⮚ Thrombocytopenia ( 5 cm, (+) LN IV- metastasis  Breast Cancer MEDICAL MANAGEMENT 1. Chemotherapy 2. Tamoxifen therapy 3. Radiation therapy  Breast Cancer SURGICAL MANAGEMENT 1. Radical mastectomy - Complete removal of the breast, chest muscles, and axillary lymph nodes. 2. Modified radical mastectomy - Removal of the entire breast and axillary lymph nodes, sparing the chest muscles.  Breast Cancer SURGICAL MANAGEMENT 3. Lumpectomy - Removal of the tumor and a small margin of surrounding healthy tissue. 4. Quadrantectomy - Removal of one- quarter of the breast tissue, including the tumor and nearby tissue.  Breast Cancer NURSING INTERVENTION : PRE-OP 1. Explain breast cancer and treatment options 2. Reduce fear and anxiety and improve coping abilities 3. Promote decision making abilities 4. Provide routine pre-op care: Consent, NPO, Meds, Teaching about breathing exercise  Breast Cancer NURSING INTERVENTION : Post-OP 1. Position patient: Supine Affected extremity elevated to reduce edema  Breast Cancer NURSING INTERVENTION : Post-OP 2. Relieve pain and discomfort Moderate elevation of extremity IM/IV injection of pain meds Warm shower on 2nd day post-op  Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Immediate post-op: snug dressing with drainage Maintain patency of drain (JP) Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon  Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Drainage is removed when the discharge is less than 30 ml in 24 H Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks  Breast Cancer NURSING INTERVENTION : Post-OP Promote activity Support operative site when moving Hand, shoulder exercise done on 2ndday Post-op mastectomy exercise 20 mins TID NO BP or IV procedure on operative site  Breast Cancer NURSING INTERVENTION : Post-OP Promote activity Heavy lifting is avoided Elevate the arm at the level of the heart On a pillow for 45 minutes TID to relieve transient edema  Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Lymphedema Elevate arms, elbow above shoulder and hand above elbow Hand exercise while elevated Refer to surgeon and physical therapist  Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Hematoma Notify the surgeon Apply bandage wrap (Ace wrap) and ICE pack  Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Infection Monitor temperature, redness, swelling and foul-odor IV antibiotics No procedure on affected extremity  Breast Cancer NURSING INTERVENTION : Post-OP TEACH FOLLOW-UP care Regular check-up Monthly BSE on the other breast Annual mammography  CNS Astrocytes – maintains the BBB A type of neuroglia which supports the neurons CNS neurons – functional unit of the brain glials – supports the function of the nuerons  CNS Glials Astrocytes – maintain BBB holds the neurons in place Nutrition and digestion of dead cells Oligodendrocytes – produces myelin sheath (CNS)  CNS Ependymal – CSF production and direction of flow Surrounds the choroid plexus Schwann – myelin sheath (PNS)  CNS Meninges Dura mater Arachnoid mater Pia mater  Cancer of the Brain and CNS M > F except meningiomas Metastatic lesion to the brain Lung Breast Renal Melanoma GI  Cancer of the Brain and CNS Risk factors: Radiation Nitrosamines – (cured foods) Gene alteration  Cancer of the Brain and CNS Prevention and screening None Usually diagnosed upon the presence of the initial signs and symptoms  Cancer of the Brain and CNS Classification I-IV I – well differentiated IV – mitotically active - increase cell proliferation - + tissue necrosis  Cancer of the Brain and CNS 4 most common primary brain tumors 1. Gliomas 2. Meningiomas 3. Nerve Sheath 4. Pituitary tumors  Cancer of the Brain and CNS Gliomas Astrocytomas Oligodendrogliomas Mixed giomas Ependymomas *** most common site of gliomas cerebral hemisphere (frontal, pareital, temporal, occipital)  Cancer of the Brain and CNS Other sites are: Brain stem gliomas Cerebellar Ventricular  Cancer of the Brain and CNS Astrocytomas Grade I – pilocytic astrocytoma Grade II – astrocytoma Grade III – Anaplastic astrocytoma Grade IV – Glioblastoma multiform  Cancer of the Brain and CNS pilocytic astrocytoma Common in pediatric clients Slow growing Curable with surgery (craniotomy)  Cancer of the Brain and CNS Astrocytoma Slow growing Treated with RT after resection  Cancer of the Brain and CNS Anaplastic astrocytoma Treated with RT w/ or w/o chemo High recurrence rate  Cancer of the Brain and CNS Glioblastoma multiform Poorly differentiated Highly malignant Most common glioma Complete removal of all cells RT and chemo not possible Median survival (12-18 months)  Cancer of the Brain and CNS Oligodendrogliomas Most often low grade Slow growing Sensitive to tx  Cancer of the Brain and CNS Epedymomas Develop from the walls of the ventricles WOF hydrocephalus Slow growing Improves with aggresive surgical resection  Cancer of the Brain and CNS Meningiomas Originated from arachnoid covering of the brain High recurrence Grade I – benign Cured with surgery  Cancer of the Brain and CNS Schwannomas & Pituitary tumors Usually benign Responds to tx (med or surg) or RT Develop from the CN sheath Slow growing Curable with surgery Most common site CN 8 Adenomas – most common pituitary tumor Treated medically & RT for recurrence  Cancer of the Brain and CNS Clinical features Increase ICP (distruption of the BBB) Triad symptoms: Headache (different from typical headache) Nausea and/or vomiting Papilledema (swelling of the optic disk) Change in mental status (due to inc ICP or hydrocephalus) Mental slowness Inability to concentrate Seizures (presenting sign in 1/3 of pxs)  Cancer of the Brain and CNS Diagnosis CT scan MRI with contrast MRA (magnetic resonance angiography) Identify vascular anatomy particularly vessels providing blood supply to the tumor (feeding vessels) MRS (spectroscopy) Evaluates the metabolism of the tumor Distinguish high grade or low grade tumors Evaluate new area of abnormality in previously treated tumor  Cancer of the Brain and CNS Actively growing tumors tend to exhibit high levels of metabolites (choline & lactate) and low levels of N – acetylaspartate (NAA) Normal: Low choline & lactate; high NAA *** the test for this are done during MRI with no special prep needed  Cancer of the Brain and CNS Oligodendroglioma Well differentiated but some may be malignant Treated with RT w/ residual tumor RT and chemo for anaplastic oligodendroglioma  Cancer of the Brain and CNS Mixed glioma (oligoastrocytoma) Depends on location & degree of malignancy  Cancer of the Brain and CNS Ependymoma Common in pediatric clients and young adults Originate from lining of the ventricles Frequently in posterior fossa Usually benign Treated with RT for residual or recurrent disease Craniospinal RT for evidence of spinal disease Has good prognosis  Cancer of the Brain and CNS Embryonal (primitive neuroectodermal tumor) Medulloblastoma is most common Common in pediatric clients Malignant Occur in posterior fossa With CSF metastasis in 33 % of pt Treated with craniospinal RT Has poor prognosis  Cancer of the Brain and CNS Medical treatment modalities ICP – DOC is dexamethasone If patient complains of GI symptoms: Administer antacids or histamine 2 blockers Seizure – anticonvulsant  Cancer of the Brain and CNS Stereotactic biopsy For dignostic purposes Used for tumors that are deep or in areas of the brainstem where resection is not feasible  Cancer of the Brain and CNS Radiation Therapy It may be used alone or in combination with chemotherapy Focused to treat the tumor resection cavity and the surrounding brain Total dose divided into (fractions) over a 6-week period 5 days a week Accepted dose for primary brain tumor is 6000 cGy For metastatic lesions 3000 cGy  Cancer of the Brain and CNS Forms of RT 1. 3DCRT (three-dimensional conformal radiation) Beams shape to match shape of 3D projection of target from each direction Dose to target and normal tissues calculated throughout the 3D volume Indication: for multiple tumor type and grade  Cancer of the Brain and CNS 2. IMRT (intensity-modulated RT) Non-uniform beams in varying patterns and intensities (not shaped like in 3-DCRT) Intensity maybe increased or decreased to protect normal tissues Indication: better protects normal brain tissue and increase dose to tumor 3DCRT & IMRT  Cancer of the Brain and CNS Stereotactic radiosurgery (e.g. Gamma knife, linear accelerator, cyber knife, tomotherapy) Single large dose to specific, well defined area that contains minimal normal tissues Obtained under MRI Very focused beams Indication: small (