Radiation Therapy PDF

RADIATION THERAPY - Radiation therapy may be It is painless used as a PRIMARY, ADJUVANT No residual radioactivity after after OR PALLIATIVE TREATMENT MODALITY. radiation therapy. 1. P...

RADIATION THERAPY - Radiation therapy may be It is painless used as a PRIMARY, ADJUVANT No residual radioactivity after after OR PALLIATIVE TREATMENT MODALITY. radiation therapy. 1. Primary modality - it is the only treatment Skincare in External RT used and aim to achieve local cure of the 1. Keep skin dry cancer. ( ex. Early stage of SKIN 2. DO NOT wash the tx area until permitted. CANCER, HODGKIN'S DISSEASE , When permitted wash gently with water or CARCINOMA OF THE CERVIX] MILD soap, rinse well and pat dry. 2. Adjuvant therapy - RT can be done 3. DO NOT RUB. Use warm or cool water preoperatively or postoperatively to aid in NOT HOT water. destruction of cancer cells. 4. DO NOT remove the line or ink marks - In addition, it can be used in conjunction placed on the skin. avoid using powders or with chemotherapy to enhance destruction creams, lotion, deodorants and alcohol on of cancer cells. the treated skin. 3. Palliative therapy - RT can be used to 5. Wear loose fitting clothing to avoid friction relieve pain caused by obstruction, over the treatment area. pathologic fractures, spinal cord 6. DO NOT apply tape to the treatment area compression and metastases. if dressings are applied. 7. Shave with a electric razor BUT NO use of Radiosensitivity - the relative sensitivity of pre and after shave lotion tissues to radiation, depends on the 8. Protect skin from exposure to direct individual cell and the characteristics of sunlight, chlorinated pools and extremes the tissue itself. temperature like hot water bottles and RT is the use of high energy ionizing heating pads. radiation - that destroys a cell's ability to reproduce by damaging its DNA. CHEMOTHERAPY - The goals MAY BE cure, control or palliation of manifestation. It is a Types of Radiation Therapy systemic intervention. 1. External radiation (teletherapy) recommended when: administration of high energy or gamma The disease is widespread xray machine. No need for isolation. the risk of undetectable disease is high 2. Internal Radiation therapy- administering The tumor cannot be resected and i near the tumor or into the systemic resistant to RT circulation. The objective is to destroy all malignant 3. Sealed source (brachytherapy)- the tumor cells with radioisotope is placed within or near the excessive destruction to normal cells tumor, clients urine and other out are not contaminated with isotopes. Ex. Iodine CCS - Destroy cancer cells at Specific stage of cell 125 division. 4. Unsealed - the radioisotopes may be anti metabolites administered orally. intravenously or by 5 Fluorouracil (5-FU) instilling directly into the body cavity. Methotrexate - therefore the clients urine, vomitous, Vinca Alkaloids like: Vincristine (Oncovin) blood contains radioactive isotopes. Ex. Taxanes like Paclitaxel (Taxol) Iodine 131 for thyroid cancer others: Hydroxyurea (Hydrea) Principles for Radiation Protection *DIS* CCNS - Destroy cancer cells at any stage of cell 1. DISTANCE - the greater the distance from division alkylating agent the ionizing source the less the exposure Carboplatin dose. Maintain a distance of 3 feet when Cisplatin not performing a nursing procedure. Cytoxan 2. TIME limit contact with client to 5 minutes Antitumor Antibiotic each time to a total of 30 minutes per 8 ○ Bleomycin, Doxorubicin, hour shift. Mitoxantrone, Plicamycin 3. SHIELDING - use lead shield during Hormonal Therapy contact with the patient ○ Glucocorticoids, Estrogen pregnant are not allowed Antiestrogen (Tamoxifen). clients with unsealed should be in private Pregesties (Depe Provera Nitrosoureas) room and bath ○ Streptozocin External RT Routes of Chemotherapy ICE, SN.  1. Intravenous Chemotherapy - These drugs are nephrotoxic and Administration of Parenteral Extravasation hepatotoxic. (escape from the fluids, antibiotics and Recent Radiation Therapy - both are frequent vein) of some chemotherapeutic immunosuppressive. agent can cause tissues necrosis in the Pregnancy - can cause congenital defects area. Bone marrow depression - the drugs may ○ Use of VAD (Vascular Access aggravate the condition. The wbc must be Devices) are now preferred as within normal limits. Vellious access. This provides continuous chemotherapy SAFE HANDLING OF CHEMOTHERAPEUTIC multiple access, route for blood AGENTS testing. 1. Wear mask, eye shield, gloves and ○ VAD's can be implanted (Ex. back-closing gowns. skin contact with drug Port-A-Cath), central lines must be washed immediately with soap Tunneled and non Tunnelled and and water. peripherally inserted central 2. EYES must be flushed immediately wit catheters (PICC) most common copious amount of water complication of VADs are infection 3. Sterile/alcohol wet cotton pledget should and obstruction. be used. wrapped around the neck of the ampule or vial when breaking and 2. Regional Chemotherapy - Allows high withdrawing the drug. concentrations drugs to be directed to 4. Expel air bubbles on wet cotton. localized tumors. 5. Vent vials to reduce internal pressure when mixing. Types: 6. Wipe external surface of syringes and IV a. Topical - Fluorouracil cream may bottles be applied to the skin to treat 7. Avoid self inoculation by needle stab. actric keratoses 8. CLEARLY LABEL the hanging IV bottle b. Intra Arterial - Enable major with ANTINEOPLASTIC organs or tumor sites to receive CHEMOTHERAPY maximal exроsure with Limited 9. Contaminated needles and syringes-must cerum levels of medications be disposed in a dearly marked special c. Intracavity Therapy - Instilling the container" LEAK PROOF", "PUNCTURE medication directly into an area PROOF such as the abdomen; bladder: or 10. Dispose half empty ampules, vials, IV pleural space bottles by putting into a plastic bag, seal d. Intraperitoneal - done for cancer and then into another plastic bag or box, in the intra abdominal area, ex clearly marked before placing for removal. ovarian cancer. This allows high Label as " HAZARDOUS WASTE" concentration of a 11. Handwashing should be done before and Chemotherapeutic agent to be after the removal of gloves. - Delivered to the actual tumor 12. ONLY trained personnel should be site with minimal exposure of involved in used of drugs. (preferably healthy tissues. chemotherapy certified nurse) e. Intrathecal Chemotherapy - instilling the agent into the CNS CHEMOTHERAPY - SIDE EFFECTS - NURSING through a reservoir placed in the INTERVENTION ventricle via an Ommaya GI System - nausea and vomiting, reservoir or via a lumbar diarrhea and constipation. puncture. This is done because ○ Administer antiemetic to relieve most medication given nausea and vomiting systemically are not effective ○ Replace fluid and electrolyte against CNS tumors because losses, low- fiber diet to relieve they cannot cross the blood brain diarrhea. barrier. ○ increase fluid intake in fiber diet for constipation Contraindications to Chemotherapy Genito-Urinary System INFECTION ○ Hemorrhagic cystitis - provide 2-3 the drugs are immunosuppressive recent L of fluids per day surgery - the drugs may retard the healing ○ Urine color changes - reassure process. that it is harmless Impaired Renal and Hepatic function - Integumentary System ICE, SN.  ○ Pruritus; urticaria and systemic tumor or tumor cells signs - provide good skin care ○ Stomatitis (Oral Mucositis) = Fluorescence-labeled antibodies to identify provide good oral hygiene. Avoid a tumor, antibodies can be produced in a hot and spicy foods Alopecia culture against tumor-specific antigen reassure that it is temporary: taken from a patient encourage to wear wigs Immune stimulant - Boosting the host ○ Skin-pigmentation = This natural immune response to tumor cells temporary nail changes. Involves activating B and T cells to notice Reassure that nails may grow the presence normall after chemotherapy Hematopoietic System LUNG CARCINOMA ○ Anemia - provide frequent rest Currently the most frequently diagnosed period major cancer in the world and the most ○ Neutropenia - common cause of cancer mortality a. protect from infection. worldwide b. Avoid people with Largely due to carcinogenic effects of infection cigarette smoke c. Report fever and chills, Adenocarcinoma (males 37%, females diaphoresis, heat pain, 47%), Squamous Cell Carcinoma (males erythema, or exudates on 32%, females 25%) Small Cell Carcinoma any body surface (males 14%, females 18%) d. avoid rectal or vaginal Large Cell Carcinoma (males 18%, procedures females 10%) e. Avoid fresh fruits, raw meats, fish, veges, fresh Lung cancer usually develops within the wall or flowers, potted plants epithelium of the bronchial tree. f. Change IV site every other day. It is the most common cause of cancer responsible g. CHANGE all solutions for causing death in men and women. Prognosis is and IV infusion sets generally poor, but varies with cell type and extent every 48 hours of spread at the time of diagnosis ○ Thrombocytopenia a. Protect from trauma Incidence: avoid ASA NADIR is the 1. Mean age-60 years old, unusual under time after chemotherapy age of 40 administration when 2. Approximately 40% of patient survive 1 WBC or PLATELET year after diagnosis of lung cancer is count is at the lowest. It made occurs within 7 to 14 3. 5-year survival rate for all stages of lung days after drug cancer 15%-16% administration. Reproductive System Pathophysiology ○ PREMATURE menopause or Exposure to particular carcinoges amenorrhea reassure that (tobacco, ionizing radiation, viral infection) menstruation resumes after Mutation of K-ras proto-oncogens chemotherapy Chromosomal damage (3p, 5q, 13q and ○ adverse reaction of chemotherapy 17p) include hypersensitivity reaction Loss of heterozygosity and extravasation Activation of oncogenes Inactivation of tumor suppressor genes IMMUNOTHERAPY - A form of cancer treatment (TP53) that takes advantage advantage of the two cardinal Proliferation of cancer cells (lungs) features of the immune system. Effect of Lung Cancer on Lung Function specificity and memory Small peripheral tumors may not impair ○ Immunotherapy may be used to lung function in a noticeable way because identify a tumor and any sites of of their small size. Eventually, as the tumor hidden metastasis grows, the tumors may invade the lung ○ Immunotherapy may stimulate the parenchyma and reduce lung volume in hosts own immune system to proportion to tumor size. Tumors causing respond more aggressively to a airflow limitation will result in atelectasis ICE, SN.  and subsequent pneumonia. Etiology 1. Cigarette/Tobacco smoking: accounts for Classification majority of lung cancers and is closely I. Small Cell Lung Cancer (SCLC) or Oat cell associated with all histologic types; causes carcinoma (15-20% of cases) more than 80% of cases. Tumor of bronchial origin that Risk is determined by packs each typically begins centrally, year (pack each day x no. of yrs.) infiltrating submucosally to cause 2. Second hand smoke-with increased risk narrowing or obstruction of the than with unexposed non-smokers bronchus without a discrete 3. Genetic/ familial predisposition- risk luminal mass. increased 2-3 times to those who have Cancer of the wall of the major close relatives with lung cancer: Genetic bronchus, round or elongated cell. Polymorphisms. These include polymorphisms in genes coding for II. Non-small Cell Lung Cancer (NSCLC) interleukin-1, cytochrome P450, apoptosis 1. Squamous cell (epidermoid) promoters such as caspase-8, and DNA carcinoma (25-35% of cases) repair molecules such as XRCCI. People Arses from the bronchial with these polymorphisms are more likely epithelium, typically as a to develop lung cancer after exposure to centrally located, carcinogens interluminal sessile or 4. Gender polypoid mass. 5. Exposure to industrial (occupational) More likely to present carcinogens such as bis-chloromethyl with hemoptysis and are ether or air pollutions (environmental) such frequently diagnosed by as asbestos, uranium/radon (odorless gas sputum cytology. found in soil and rocks, coal dust, arsenic, 2. Adenocarcinoma (35-40% of and radioactive dust cases) 6. Nutritional deficits-Alpha-1 antitrypsin Arises from the mucus (AAT) deficiency is a condition in which the glands or the lining of the body does not make enough of a protein hing wall present as that protects the lungs and liver from peripheral nodules or damage. The earliest symptoms are: masses shortness of breath, following mild activity, Bronchoalveolar cell reduced ability to exercise, and wheezing carcinoma (2% of cases) 7. Other diseases - Pulmonary fibrosis, Arises from any epithelial COPD and sarcoidosis cell: spreads intra-alveolarly or may present as an infiltrate or as single or multiple pulmonary nodules. Arises within or distal to the terminal bronchioles 3. Large cell (anaplastic) carcinoma (5-10%) It is a heterogenous group of relatively undifferentiated tumors that share large cells. In the usual case it is discovered in This typically has rapid patients in their 50s whose symptoms are doubling tunes and has several months duration an aggressive clinical Major presenting complaints: course a. Cough (75%) Early metastasis occurs b. Weight loss (40%) to other thoracic c. Chest pain (40%) structures such as the d. Dyspnea (20%) hilar lymph nodes and mediastinum, Distant Clinical Manifestations metastasis may involve Asymptomatic until late in its course the brain, liver, bone, and Depends on the location and size of tumor, adrenal gland. degree of obstruction and the existence of metastasis ICE, SN.  Palpitations Most frequent symptoms: 1. Simple cough or chronic cough - present 3. Squamous Cell Lung Carcinoma at about 65-75% of patients with lung Hypercalcemia cancer Signs and symptoms of Cushing's ✓ People tend to ignore this as syndrome cough associated with cancer ✓ Initially, cough may start as a In general, the adenocarcinoma and squamous cell dry, persistent cough, without patterns tend to remain localized longer and have a sputum production slightly better prognosis than do the others ✓ Cough becomes productive when there is obstruction of the Paraneoplastic Syndromes – clinical airways. manifestations produced by lung tumors ✓ Cough that changes in that secrete hormones like ADH, ACTH, character should arouse PTH, calcitonin, gonadotropins, serotonin suspicion of lung cancer Lambert-Eaton Syndrome – probably due to antibodies produced by certain lung 1. Dyspnea - occurs up to 60% of patients in the carcinomas early stage of the disease Diagnosis Causes of dyspnea: 1. Chest X-ray 1. Tumor occlusion of the airway 2. CT or Combined PET-CT 2. Occlusion in lung parenchyma 3. Cytopathology Examination of pleural fluid or 3. Pleural effusion sputum 4. Pneumonia 4. Usually, Bronchoscopy-Guided Biopsy and Fine- 5. complication of treatment Needle Aspiration 5. Sometimes Open Lung Biopsy 2. Hemoptysis - expectoration of blood-tinged sputum 1. Chest X-ray 3. Chest or shoulder pain-indicates chest wall or Shows advanced lessons, pulmonary pleural involvement by a tumor density, pulmonary nodule (con lesion), 4. Pain - a late manifestation that may indicate that atelectasis, infection. bone may have been involved (metastasis) 2. Fiberoptic Bronchoscopy - more commonly used 5. Recurring fever - an early symptom related to a Provides a detailed study of the persistence of infection in an area of pneumonitis tracheobronchial tree and allows for distal to the tumor brushing, washing and biopsies suspicious 6. Unresolved infection - URTI areas Locate the tumor site and provide material Signs and Symptoms for cytologic and histologic examination according to lung cancer classification: 3. CT Scan 1. Large cell cancer and adenocarcinoma Locate small nodales not easily visualized Fever on the chest x-ray. Weakness For serial examination, of any presence of Weight loss lymphadenopathy Anorexia 4. Transthoracic fine-needle aspiration Shoulder pain Done to take samples from peripheral Bone and joint pain lessons, performed under CT scan guided Gynecomastia 5. Thoracentesis 2. Small cell (Oat cell) and squamous cell Samples are taken for chemical and carcinoma cytologic examination a. Respiratory symptoms Smoker's cough 1. Bone scan, PET scan, computed tomography Hoarseness scan of the brain, liver function test and UTZ, Wheezing gallium scan of the liver, spleen, and bone to locate Dyspnea distant metastasis Hemoptysis 2. Endoscopy with esophageal ultrasound b. Others: May be used to obtain a transesophageal Chest pain biopsy (lymph nodes) Flushing 3. Preoperative assessment to determine whether Diarrhea the tumor is resectable or whether the patient can Cramps tolerate the physiologic impairment resulting from Skin lesions such surgery ICE, SN.  Pulmonary Function tests surgically resected but are ABG analysis responsive to radiation V/Q scan (ventilation-perfusion scan) - a 2. Reduce the size of the tumor scintigraphic technique for demonstrating 3. Make the inoperable tumor perfusion defects in normally ventilated operable areas of the lung in the diagnosis of 4. Relieve the pressure of the tumor pulmonary embolism consisting of the by on vital structures an injected radionuclide an inhaled 5. Relieve cough, chest pain, radionuclide followed by the imaging of the dyspnea hemoptysis, bone and perfusion of the lungs by an injected liver pains radionuclide Exercise testing Complications of Radiation Therapy a. Esophagitis Management b. Pneumonitis Surgery (depending on cell type and c. Radiation lung fibrosis stage) d. lmpaired ventilatory and diffusion capacity, Chemotherapy reduced pulmonary reserve diminished CP Radiation Therapy function Nursing care - is based on supportive e. Pulmonary fibrosis treatment f. Pericarditis - inflammation of the Objective of Management: pericardial sac surrounding the heart To provide cure if possible g. Myelitis - a disease involving inflammation Treatment depends on the cell type, stage of the spinal cord which disrupts central of the disease and the patient's nervous system functions linking the brain physiologic status. and limbs h. Cor pulmonale - failure of the right side of Surgical Management: It is the main intervention the heart brought on by long-term high for squamous, adenocarcinoma, and large cell blood pressure in pulmonary arteries and carcinoma. right ventricle of the heart. 1. Surgical Resection - the most preferred method of treatment for patients with Nursing Responsibility Localized non-small cell tumors - Monitor nutritional status, psychological (SC carcinoma grows rapidly and outlook, fatigue, signs of anemia and metastasizes early and infection extensively No evidence of metastatic spread Chemotherapy With adequate cardiopulmonary 1. To alter tumor growth patterns function 2. Treat distant metastasis 3. Treat small cell cancer of the lungs CP function is assessed to 4. Done as an adjunct therapy to surgery or determine if surgery will be radiation well-tolerated 5. May provide relief of pain 6. Reduce pressure symptoms of lung Contraindications for surgery cancer 1. Coronary disease 7. Treat brain, spinal cord and pericardial 2. Pulmonary insufficiency metastasis 3. Other comorbidities 2. Lobectomy (removal of the lobe of the Complications of Chemotherapy lung) - surgery of choice for a small, Pneumonitis apparently curable tumor of the lung Pulmonary toxicity 3. Pneumonectomy - removal of the entire lung Choice of agents depends on the growth of tumor cell and the specific phase of the cell cycle that the Radiation Therapy medication affects Radiation therapy - is usually Combination of 2 or more medications recommended for early stage. may be beneficial than single-dose Preoperative radiation therapy is used to regimen re the tumor to allow surgical resertion. A combination of fluorouracil, vincristine, Prophylactic cranial irradiation may be and mitomycin induces remission of used to prevent brain metastasis. adenocarcinoma For small cell carcinoma, a combination of 1. Control neoplasms that cannot be cyclophosphamide, doxorubicin, and ICE, SN.  vincristine has proven effective. ○ Anaplastic (Undifferentiated) Carcinoma (