Cancer Treatment & Side Effects PDF

Treatment overview: Chemo, Radiation Side effects (1) Book: Goal: cure the disease and maintain disease-free survival. Treatment varies according to ○ Cell type ○ Stage of disease ○ Markers The treatment also varies with the goal of care ○ Cure ○ Remission- not curable, reduce tumor burden or preven...

Treatment overview: Chemo, Radiation Side effects (1) Book: Goal: cure the disease and maintain disease-free survival. Treatment varies according to ○ Cell type ○ Stage of disease ○ Markers The treatment also varies with the goal of care ○ Cure ○ Remission- not curable, reduce tumor burden or prevent progression ○ maintenance/ prevention of progression to extend life Chemotherapy- is a medical therapy ○ Reduces the size of the tumor prior to surgery and adjuvant radiation therapy after surgery to decrease the risk of disease recurrence. Radiation Side effects ○ Erythema of the skin ○ Fibrosis- the cumulative effect of cell damage ○ Myelosuppression- decrease in bone marrow activity that results in reduced production of blood cells ○ Bleeding Thrombocytopenia- platelet in blood is too low ○ Adverse effects are usually direct reflection of the body area that is being treated Signs of local injury peak in the second to third week of treatment ATI Book: Chemo- involve administration of systemic or local cytotoxic medications that damage cell’s DNA or destroy rapidly dividing cells Radiation therapy- involves use of ionizing radiation to target tissues and destoy cells ○ Side effects Skin changes Hair loss Debilitating fatigue ○ NSG Pt in private room Limit visitor to 30 mins visits and have visitors maintain distance of 6 ft from the pt Pregnant people or under age of 16 shouldn’t come contact with the patient Keep lead container in pt’s room Monitor for radiation injury to skin and mucous membranes and implement skin regimen Skin- blanching, erythema, sloughing, hemorrhage Mouth- mucositis (stomatitis), xerostomia (dry mouth) Neck- difficulty swallowing Abdomen- gastroenteritis Monitor cbc- plt and wbc Study guide #1: ○ Brachytherapy/ internal radiation- inserted into body cavity Radiation can burn / dry out skin (educate pt to pat dry skin) ○ fatigue Scereening recommendations (1) Book: This is for early detection and management of the disease Includes non- invasive tests that identifies cancer it its earliest stage Should be highly sensitive (low risk with few false negatives) and specific (accurately detect with few false positives). General Cancer check up ○ Men and women aged 20 and older ○ Discuss individual cancer risk factors and screening needs to PCP and physical check ups ○ Share family hx of cancer esp. First degree relatives Breast cancer: Women aged 40 and older ○ Annual mammogram until age 55 y/o and then can switch to every 2 years ○ Annual clinical breast exam ○ Women aged 20-39: clinical breast exam every 3 years Lung cancer ○ CT screening for high risk patients Smokers or those having quit within the past 15 years and have 30 pack year smoking history ATI Book: Biopsy- definitive diagnosis indicating site of origin (specific cell type) and cell characteristics. ○ NSG actions: Obtain signed informed consent Prevent bleeding (hold anticoags meds) Monitor bleeding Lung cancer ○ Elevated liver function tests (LFTs)- indicate primary liver cancer or metastasis of another cancer (colorectal cancer) Genetic testing- presence of certain genes in a blood or saliva sample ○ Genetic mutations can be inherited + results indicate pt is at high risk for development certain types of cancer (BRCA 1 & 2 for breast cancer) Study guide #1: Breast cancer ○ Women aged 40 and older ○ Annual mammo until age 55 y/o then switch to every 2 years ○ Annual breast exam women 20-39 ○ Clinical breast exam every 3 years Lung cancer ○ American cancer society and national comprehensive cancer network recommends yearly helical low- dose CT screenings for high risk pt Risks (2) Book: Carcinogen- common risk factor ○ They are internal or external exposures that predispose individuals to DNA destruction → resulting in cellular mutation → leading to malignant transformation of cells ○ Examples of carcinogens include: Ionizing radiation Benzen HPV Sun exposure Tobacco Environmental factors Hormonal factors Lifestyle factors Infectious disease Medications Immune status Nutritional factors Non- modifiables ○ Age ○ genetic - genetic counseling Modifiables ○ sedentary lifestyle ○ Poor diet ○ Smoking Cancer associations with specific diseases ○ Colon cancer and inflammatory bowel disease ○ Hepatic cancer from hepatitis C infection ATI Book: Age- highest incidence of cancer occur in older adults Race ○ Caucasia over age 40 more likely to develop breast cancer than AA, american indian and hispanic women Exposure to chemicals, tobacco, and alcohol Exposure to certain virus and bacteria ○ Liver cancer- develop after many years of infection with hep b or c Disease Manifestations of cancer (4) Book: CAUTION symptoms- common “warning signs” ○ Often patients experience CAUTION symptom as driving force to go to the doctor ○ Part of the initial clinical presentation ○ C- change in bowel or bladder habits ○ A- a sore that doesn’t heal ○ U- unusual bleeding or discharge ○ T- thickening or lump in breast or any other part of the body ○ I- Indigestion or difficulty swallowing ○ O- Obvious change in wart or mole ○ N- nagging cough or hoarseness Constitutional symptoms- vague symptoms including fever, significant unexplained weight loss, fever of unknown etiology, and night sweats Malignancy- specific signs and symptoms- related to location of the primary cancer and location of metastatic disease ○ Breast cancer Breast mass Axillary node enlargement Asychrony of breasts Nipple discharge ○ Colon cancer Altered bowel habit- constipation or diarrhea or think rubbon- like stools Blood in stool- overt or occult Abdominal fullness or distention Anorexia Weight loss Unexplained anemia ○ Leukemia Fatigue Anemia Chronic infection Bruising, petechiae, gum bleeding ○ Lung cancer Chronic cough Hemoptysis Dyspnea Chest discomfort Weight loss Paraneoplastic syndromes Management of Breast cancer (2) BOOK - Diagnostic test - Mammography, ultrasonography, magnetic resonance imaging (MRI) - Treatment - Breast conservation therapy - Modified radical mastectomy - Axillary lymph node staging - Chemotherapy - Radiation therapy - Action - Chemotherapeutic drugs as ordered - Give pain medications as ordered - Give anitemetics as ordered - Have the patient cough and deep breathe postoperatively - Keep wound clean and dry - Encourage verbalization - Teaching - Explain the treatment course - Medication and treatment side effects - Wound care - Nutritional counseling - Support group - Breast cancer screening with mammography - Clinical breast examination is not recommended Lung cancer (1) Book: Interventions ○ Provide oxygen- increase to 90% Decreased SpO2 because of poor gas exchange Indicates significant oxygenation problems ○ Administer meds as ordered Pain increases RR and anxiety decrease quality of life pain/ anti- anxiety provide relief from pain and anxiety Allowing better relaxation, increased expansion of the lungs → improve oxygenation Bronchodilators- smooth mm relaxant Opens the airway and decrease work of breathing ○ Provide small, frequent meals with dietary supplements Appetite may be decreased bc of side effects of chemotherapy or loss of energy due to increased work in breathing Avoid excessive pressure on diaphragm (associated with large meal) ○ Position- Semi- Fowler’s Increase oxygenation by allowing full lung expansion ○ Breathing techniques Increase clearance of sputum and reduce sense of breathlessness Pursed lip breathing- encourage exchange of oxygen and CO2 ○ Pacing activities Conserve energy and decrease work of breathing ○ Monitor weight Identify nutritional deficiencies ATI Book Interventions: ○ Monitor for cough changing pattern ○ Monitor nutritional status, weight loss and anorexia Adequate nutrition = provide needed calories → increased work of breathing and prevention of infection ○ Maintain patent airway and suction as needed ○ Position pt in Fowler’s position to maximize ventilation ○ Bronchodilators and corticosteroids Help decrease inflammation and to dry secretions ○ Respiratory consult For inhalers, breathing treatments and suctioning for airway management ○ Monitor Vital signs Oxygenation (SaO2, ABGs) ○ Administer o2 and manage ventilator if appropriate Study guide #1: Educate pre-op teaching that is necessary to help them understand what is to expect Listen to brass sound, suction pt if necessary Administer morphine ○ Helps with dyspnea Leukemia (1) Book: How to diagnose ○ Routine CBC Reveals leukocytosis Increased WBC Anemia Thrombocytopenia- result of congested bone marrow ○ History and physical examination ○ Bone marrow biopsy After confirmation of diagnosis of leukemia follows bone marrow biopsy ○ Genetic testing- determines chromosomal abnormalities ATI Book CBC ○ WBC Decreased- Hgb, hct, and plt Biopsy of bone marrow ○ Large quantities of immature leukemic blast cells ○ Typing of protein markers Differentiate myeloid or lymphoid leukemia SG #1: CBC ○ WBC- high or low ○ RBC- going to be abnormal ○ HGB, HCT, PLT- gonna be low Coagulation time ○ Used for acute leukemia since it’s increased ○ Monitor for bleeding Complications ○ Pancytopenia- decrease in WBC, RBC, PLT Absolute neutrophil count (ANC) less than 2,000/mm3 suggest increase risk of infection NSG Maintain hygienic environment Monitor for infection (cough, alteration in breath sounds, urine or feces) Report temp greater than 100F ○ Thrombocytopenia- increase risk of bleeding Platelet counts less than 50,000/mm3 Spontaneous bleeding can occur at less than 20,000/mm3 NSG Minimize risk of trauma (make environment safe) ○ Phlebitis Monitor jaundice, ABD pain and liver enlargement Monitor daily weights and ABD girths to assess fluid retention Book: ○ Usually result from treatment and myelosuppression occuring after chemo or radiation ○ Death ○ Infection ○ Hemorrhage ○ Myelosuppression- result of chemo or radiation, bone marrow activity decreased. So blood products are low (WBC, RBC, PLT) ○ Neutropenia- pt at high risk of developing infection Neutropenic fever- ANC is less than 1,000 Monitor temp greater than 100.4F Neutropenic precautions ○ Anemia- post treatment to myelosuppression ○ Thrombocytopenia- platelet counts are low in blood ○ Put patients in bleeding precautions ○ Excessive bruising ○ Petechiae ○ Nosebleeds ○ Conjunctival hemorrhaging ○ Bleeding gums ○ Hemoptysis ○ Hematuria ○ GI bleeding