MS Oncology Midterms PDF

I. ONCOLOGY cancer deaths; 283,721 were among females ONCOLOGY and 315,553 among males. Lung cancer is the leading...

I. ONCOLOGY cancer deaths; 283,721 were among females ONCOLOGY and 315,553 among males. Lung cancer is the leading cause of cancer death, accounting for - Branch of medicine that deals with the study, 24% of all cancer deaths. detection, treatment and management of Mortality rates in the poorest counties were cancer. 2-fold higher for cervical cancer and 40% higher - Refers to the many aspects of administering for male lung and liver cancers during care to a cancer patient. The responsibilities of 2012-2016. such professionals include helping patients with Cancer death rates decreased every year during chemotherapy procedures, educating them the past 20-year data period (1999 to 2018). about their treatment options and managing Cancer death rates are higher among males the pain associated with cancer. These specialty than females, although this gap has narrowed nurses can be found in hospitals, health care over time clinics, and home health care agencies.’’ CANCER PHILIPPINE STATISTICS: - Cancer is the uncontrolled growth of abnormal According to PSA’s latest data, more Filipino cells in the body. Cancer develops when the women die from cancer compared to men, with body’s normal control mechanism stops 30,954 annual cases logged. working. Old cells do not die and instead grow The Philippine Cancer Registry shows that out of control, forming new, abnormal cells. breast cancer is the leading kind of cancer that These extra cells may form a mass of tissue, affects both sexes in the country at 24.9 called a tumor. percent. - Cancer may occur anywhere in the body. In Breast cancer is the leading cancer type but it is women, breast cancer is one of the most not the leading cause of cancer death in the common. In men, it’s prostate cancer. Lung country. cancer and colorectal cancer affect both men Lung cancer is the leading cause of cancer and women in high numbers. mortality in the Philippines Cancer Statistics in US: EPIDEMIOLOGY In 2019, 1,762,450 new cancer cases and Older than 65 years old 606,880 cancer deaths are projected to occur in Higher in men than in women the United States. Cancer ranks 3rd following heart disease and Over the past decade of data, the cancer stroke as a leading cause of death in the incidence rate (2006-2015) was stable in women Philippines ( 2011 ) and declined by approximately 2% per year in More than 1.3 millions of Americans diagnosed men, whereas the cancer death rate with cancer each year (2007-2016) declined annually by 1.4% and 1.8%, respectively. Leading cause of cancer death (prostate, breast, lung, Cancer is the second leading cause of death in colon) 2011 the United States. In 2018, there were 599,274 men: prostate, lung and colorectal 1|7  women: breast, lung and colorectal STEM CELL THEORY Children: Leukemia, brain tumors, and Loss of intracellular control of proliferation results from lymphoma mutation of stem cells NOTE DNA is substituted or permanently rearranged 5-year survival rate is now 66.7% for those who are A normal cellular hierarchy comprising stem cells at the disease free, in remission, or under treatment Cases of apex, which generate common and more restricted Skin, kidney, thyroid and liver cancer are rising progenitor cells and ultimately the mature cell types (lymphomas) that constitute particular tissues. II. CHARACTERISTICS OF CANCER CELLS Once mutated Cell can die from damage or by initiating programmed Appearance changes. cellular Altered metabolism. suicide (apoptosis) Tumor- specific antigens. Can recognize damage and repair itself Altered cellular function. Survive and pass on damage Surviving mutated cells have potential to become MALIGNANT PROCESS malignant PYRAMID EFFECT Each cell division creates two or more offspring cells Continuous tumor growth PROLIFERATIVE PATTERNS Hyperplasia - an increase in the no. of cells of a tissue, most often associated with a period of rapid body growth Metaplasia - abnormal replacement of cells of one type of cells of another - refers to the transition of a particular type of tissue into another type of tissue. It can be normal, as for example when cartilage hardens into bone, or abnormal, as in the case of Barrett’s esophagus, a condition in which the lining of the esophagus is changed by prolonged exposure to stomach acid. Dysplasia - -Bizarre cell growth resulting in cells that differ in size, shape or arrangement from other cells of the same type of tissue Defect in Cellular Proliferation - - It can lead to a wide range of conditions that involve enlarged tissue or pre-cancerous cells. 2|7 Anaplasia II. TUMORS - a condition of cells with poor cellular TUMORS differentiation, losing the morphological a swelling of a part of the body, generally without characteristics of mature cells and their inflammation, caused by an abnormal growth of tissue, orientation with respect to each other and to whether benign or malignant. endothelial cells. Neoplasia an abnormal benign or malignant new growth of tissue - occurs when there is an atypical proliferation of that possesses no physiological function and arises cell growth. This results in an abnormal tissue from uncontrolled usually rapid cellular proliferation mass known as a neoplasm. —called also neoplasm. TUMORS ARE CLASSIFIED AS: 1. BENIGN NEOPLASM - well-differentiated - encapsulated - slow rate growth - Localized - does not cause tissue damage - does not usually cause death 2. MALIGNANT NEOPLASM - undifferentiated - Infiltrative and expansive - growth rate is variable - Able to metastasize (the growth can spread to other site of the body) - have generalized effect - extensive tissue damage - causes death unless growth can be controlled INVASION AND METASTASIS Metastasis – dissemination or spread of malignant cells from the primary tumor to distant sites by direct spread of tumor cells MECHANISM OF METASTASIS Visit this website: Open Youtube link and watch: On How Cancer Spreads https://www.youtube.com/watch?v=fQwar_-QdiQ 3|7  - mutant genetics promote its own reproduction Lymphatic Spread -the transport of tumor cells and survival through the lymphatic circulation - activities in promotion: growth-promoting hormones, viral infection, chronic cell damage Hematogenous Spread -dissemination of malignant and regeneration cells via the bloodstream 3. LATENCY PERIOD Angiogenesis -the growth of new capillaries from the vary with the type of agent and the dosage of the host tissue by the release of growth factors (vascular promoter as well as the innate characteristics of the endothelial growth factor VEGF) which the tumor cells target cell are ensured with blood supply 4. PROGRESSION CANCER DEVELOPMENT Characterized by increased growth rate of tumor as -Etiology: well as its invasiveness and metastasis - viruses and bacteria - physical agents - Ionizing I. CLASSIFICATION OF - radiations CANCER IS MADE -chemical agents ACCORDING TO THE FF: -hormonal agents - genetics and familial factors -dietary factors Site of origin of the malignant cells Oncogenesis Cancer grading (histology or cell analysis) -the production or causation of tumors Cancer staging (extent of the disease) TWO TYPES OF ONCOGENESIS SITE OF CANCER ORIGIN 1. Multistep Oncogenesis – involves several sequential stages including: ➔ Carcinomas - a cancerous tumor (originates in - Initiation epithelial tissue) - Promotion ➔ Adenocarcinoma -Epithelial cells of glandular - Mutation / Progression tissue 2. Viral Oncogenesis - retroviruses, papovaviruses, ➔ Sarcomas - connective tissue, bone, cartilage adenoviruses, hepadnaviruses, herpes viruses and or striated muscle poxviruses ➔ Lymphomas - lymphoid tissues ➔ Myeloma - bone marrow, spleen & lymph nodes 1. INITIATION ➔ Blastoma – originates in embryonic tissue of cells are exposed to initiators (carcinogens) and alter organs the genetic structure of cellular deoxyribonucleic acid (DNA) CANCER GRADING - initiate apoptosis- or programmed cell death - if cells escape this protective mechanism, - Refers to the classification of tumor cells permanent cellular mutation occur - Appearance of cells and degree of differentiation are evaluated 2. PROMOTION - clonal expansion - continuous cellular proliferation 4|7  GRADING CHARACTERISTICS Grade 1 -Cells differ slightly from normal cells and are well differentiated Grade 2- Cells more abnormal and moderately differentiated Grade 3 -Cells very abnormal and poorly differentiated Grade 4 - Cells immature and primitive and undifferentiated; cell of origin difficult to determine KEY POINTS MECHANISM OF METASTASIS 1. Lymphatic Spread - the transport of Tumor cells through the lymphatic circulation 2. Hematogenous Spread Cancer Staging - dissemination of malignant cells via the - Determines the size of the tumor bloodstream/circulation 3. Angiogenesis - the growth of new capillaries from the host tissue by the release of growth factors (vascular endothelial growth factor VEGF) which the tumors cells are ensured with blood supply SITES 0F CANCER ORIGIN 1. Carcinomas - A Cancerous Tumor; originates in the epithelial Tissue) 2. Adenocarcinoma - -Epithelial cells are affected TNM CLASSIFICATION 3. Sarcomas - Connective tissue, bone, cartilage or striated - Tumor size muscle - Spread to lymph Nodes 4. Lymphomas - Metastasis - Lymphoid tissues (CNS cancers, hematologic cancers, malignant 5. Myeloma melanoma) - bone marrow, spleen and lymph nodes 5|7 6. Blastoma 7 WARNING SIGNS OF CANCER (ACS) - originates in the embryonic tissue of organs C - change in bowel or bladder habits 7. Leukemia - originates in tissue that form blood cells A - –a sore that does not heal U - –unusual bleeding or discharge T - thickening or lump in the breast, testicles or elsewhere I - –indigestion or difficulty swallowing O - obvious change in size, color, shape, or thickness of a wart, mole or mouth sore N - nagging cough or hoarseness III. ROLE OF THE IMMUNE SYSTEM WATCH OUT FOR OTHER SIGNS Persistent headaches Unexplained loss of weight or loss of appetite IMMUNE SYSTEM Chronic pain in bones or any areas of the body - Immune response is to reject or destroy cancer Persistent fatigue, nausea or vomiting cells if perceived as non-self Persistent low-grade fever, either constant or - May be inadequate as cancer cells arise from intermittent normal human cells Repeated infection - Some cancer cells have changes on their surface antigens DIAGNOSIS OF CANCER Patient may experience fear and anxiety The Immune System’s Response to Cancer: Clear and repeated explanations may be Visit this site and learn more about it: necessary https://www.youtube.com/watch?v=KnsohmSsV1k Diagnostic plan includes Health history (emphasis on risk factors) Physical exam Prevention and Detection of Cancer Reduce or avoid Specific studies exposure to known or suspected carcinogens Biopsy involves histologic examination by a Eat balanced diet pathologist of a piece of tissue Exercise regularly - Incisional Adequate rest - Excisional Health examination on a regular basis Eliminate, reduce, or change perceptions of DIAGNOSTIC AIDS TO DETECT CANCER stressors and enhance ability to cope 1. TMI (Tumor marker identification) Enjoy consistent periods of relaxation and - is a biochemical indicator produced by leisure neoplastic tissue and released into blood and Know 7 warning signs of cancer detected in blood or in other body fluids. An Self-examination ideal tumor marker should include – high Seek medical care if cancer is suspected sensitivity, high specificity, convenience, low price and should be safe. 6|7 2. MRI This scan can sometimes detect disease before - is a medical imaging technique used in radiology it shows up on other imaging test. The tracer to form pictures of the anatomy and the may be injected, swallowed or inhaled, physiological processes of the body. MRI depending on which organ or tissue is being scanners use strong magnetic fields, magnetic studied. field gradients, and radio waves to generate images of the organs in the body. 8. Radioimmunoconjugates - A radioimmunoconjugate is made by attaching a 3. CT scan radioactive molecule to an immune substance, - A computed tomography (CT or CAT) scan allows such as a monoclonal antibody, that can bind to doctors to see inside your body. It uses a cancer cells. This may help kill cancer cells combination of X-rays and a computer to create without harming normal cells pictures of your organs, bones, and other tissues. 4 Fluoroscopy - Is a type of medical imaging that shows a continuous X-ray image on a monitor, much like an X-ray movie. During a fluoroscopy procedure, an X-ray beam is passed through the body. The image is transmitted to a monitor so the movement of a body part or of an instrument or contrast agent (“X-ray dye”) through the body can be seen in detail. 5. Ultrasonography - a diagnostic imaging technique utilizing reflected highfrequency sound waves to delineate, measure, or examine internal body structures or organs. 6. Endoscopy - The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inserted directly into the organ. 7. PET Scan - A positron emission tomography (PET) scan is an imaging test that helps reveal how your tissues and organs are functioning. A PET scan uses a radioactive drug (tracer) to show this activity. 7|7  N 1 MANAGEMENT OF PATIENTS WITH ONCOLOGIC DISORDERS C 1 Lecturer: CARMEL B. GASATAYA, RN, MAN M2 By: kinakayanalangtalaga What is chemotherapy? o lasts about 18-20 hours. S Phase The use of any drug to for cancer treatment The chromosomes containing the genetic code 2 other medical terms used to describe cancer (DNA) are copied so both of the new cells formed will Chemotherapy have matching strands of DNA. (18-20 hours) ANTINEOPLASTIC THERAPY G2 Phase The cell checks the DNA & gets ready to start anti-cancer splitting into 2 cells 2 to 10 hours CYTOTOXIC THERAPY M Phase (MITOSIS) cell killing The cell splits into 2 new cells. 30-60 minutes Chemotherapy https://www.youtube.com/watch?v=U5vAO_f2LDQ Typically started after surgical dissection of tumor, The Cell Cycle by Khan Academy Retrieved on September unless the tumor is non-operative 14, 2021 Usually given by a long term venous access device, IMPORTANCE: i.e. PICC line, implanted ports, or direct Many chemotherapy drugs work only on cells that catheterization to the tumor. are actively reproducing. Chemotherapy is usually potent and horribly Some drugs specifically attack cells in a particular scarring on normal veins phase of the cell cycle. Bio chemotherapy Understanding how drugs work helps oncologists Otherwise known as chemoimmunotherapy predict which drugs are likely to work well together. The combination of cisplatin-based chemotherapy Doctors can plan how often doses of each drug with interleukin 2 (IL-2) and Alpha Interferon IFN-α should be given based on the timing of the cell phases. used for leukemias, AIDS, Hepa-C Goals of chemotherapy Beta interferon – Beta 1b used for renal carcinoma, o melanoma, AIDS, MS, Hepatitis A, B CURE Why chemotherapy is different from other - Treatment with curative intent treatments? CONTROL LOCAL TREATMENTS - the cancer does not completely go away but is Acts only on one area of the body e.g. breast, lung, controlled and managed as a chronic disease. prostate PALLIATION Targets the cancer directly - -When the cancer is at an advanced stage, Radiation and Surgery chemotherapy drugs may be used to relieve SYSTEMIC TREATMENT symptoms caused by the cancer. Drugs travel throughout the body to reach cancer cells where - the only goal of a certain treatment is to improve the they are situated. quality of life but not treat the disease itself. Chemotherapy CHEMOTHERAPEUTIC DRUGS Cell Cycle Phases: - Used to destroy both organisms that invade the G0 Resting Phase body (bacteria, viruses, parasites, protozoa, fungi) The cell has not yet started to divide. and abnormal cells within the body (neoplasms or o Can last for a few hours or years. cancer). G1 Phase Agents that affect cells by: The cell starts making more proteins & growing - Altering cellular function or disrupting cellular larger. integrity New cells will be of normal size. - Preventing cellular BSN 3 | MEDSURG|BLOCK 1 | MIDTERMS 1|4  Route of Administration: ORAL – capsule, tablet, liquid 1935 INTRAVENOUS – push (bolus) or infusion over a specified – sulfonamides were introduced. time period. MECHANISMS OF ACTION: INTRAMUSCULAR INTRATHECAL/INTRAVENTRICULAR - given - Some anti-infectives interfere with biosynthesis of by injection via a reservoir or by lumbar puncture. the bacterial cell wall. INTRA-ARTERIAL INTRACAVITARY – peritoneal cavity S - Some anti-infective prevent the cells of the invading ↑ INTRAVESICAL – uterus or bladder organism from using substances essential to their Vaccines growth & development - HPV vaccine for cervical cancer - Many anti-infectives interfere with the steps MELANOMA VACCINE involved in protein synthesis, a necessary function to maintain the cell & allow for cell division. - for stage II only at this time, or malignant melanoma - Some anti-infectives interfere with DNA synthesis in MONOCLONAL ANTIBODIES the cell – used for treatment of cancer, rheumatoid arthritis, - Other anti-infectives alter the permeability of the transplants, and other autoimmune diseases. Can be used cell membrane to stimulate immune response or suppress it. Anti-infective activity - Made by identical immune cells which are all clones belonging to a unique parent cell. Monoclonal NARROW SPECTRUM antibodies can have same epitope. -selective in their action that they are effective against only a few microorganism. Ex: Gentuzimab- sold under the brand name Mylotarg, is an BROAD SPECTRUM antibody-drug conjugate that is used to treat acute myeloid -interfere with biochemical reactions in many different kinds leukemia of microorganisms, making them useful in the treatment of ADALIMUMAB wide variety of infections. – Humira BACTERICIDAL –new treatment for severe rheumatoid arthritis, given o s.q -active against the infective microorganisms that they every other week actually cause death of the cells they affect. ALEMTUZUMAB BACTERIOSTATIC – Campath or Mabcampath -is a medication used to treat -not as aggressive against invading organisms; they interfere chronic lymphocytic leukemia (CLL) and multiple sclerosis. In with the ability of the cells to reproduce or divide. CLL has been used as both a first line and second line treatment. HUMAN IMMUNE RESPONSE BASILIXAMAB - Anti-infective drugs can not totally eliminate the - Simulect immunosuppressive monoclonal antibody for pathogen without causing severe toxicity in the host. renal transplants - Cancer patients do not have immune response in Anti-infective agents/Anti-infective therapy place to deal with even a few invading organisms. Drugs designed to act selectively on foreign organisms that have invaded & infected the body of a human host causing NATURAL OR INTRINSIC RESISTANCE cell death. – because anti-infectives act on specific enzyme systems or 1920 biological processes, many microorganisms that do not use – first drugs used to treat systemic infections. Paul Ehrlich – that system or process are not affected by a particular first scientist to work on developing a synthetic chemical that antiinfective drug. would be effective only against infection-causing cells, not ACQUIRED RESISTANCE human cells. – microorganisms develop resistance. Late 1920s - scientists discovered penicillin in a mold sample. BSN 3 | BLOCK 1 | MIDTERMS 2|4  PREVENTING RESISTANCE - All types of cells are injured or destroyed by concentrated radiation. Rapidly dividing cells are 1. Limit the use of antimicrobial agents to the the most sensitive. treatment of specific pathogens known to be sensitive to the drug being used. Types of Radiation Therapy 2. Doses should be high enough, and the duration of 1.EXTERNAL BEAM RADIATION THERAPY drug therapy should be long enough, to eradicate (TELETHERAPY) even slightly resistant microorganisms. - is radiation delivered from a distant source, from outside 3. Duration of drug use is critical to ensure that the the body and directed at the patient's cancer site. microbes are completely, not partially, eliminated - It is used to treat many types of tumors including and are not given the chance to grow and develop cancers of the head and neck area, breast, lung, colon, resistant strains. and prostate. 4. Healthcare providers should be cautious about the GAMMA KNIFE indiscriminate use of anti-infectives. Side effects of Chemotherapy - is a highly advanced instrument used to treat arteriovenous malformations (AVM), facial pain, benign - Alopecia and malignant brain tumors, and other functional brain - Fatigue disorders. - Anemia - successfully treats these conditions with no incision. so - Leukopenia precise that it damages and destroys the unhealthy - Thrombocytopenia tissue while sparing adjacent normal, healthy tissue. - Always – Nausea, Vomiting, Diarrhea 2.INTERNAL RADIATION THERAPY (BRACHYTHERAPY) - Neurotoxicity & neuropathies - Capillary leakage - Brachytherapy involves placing radiation sources as - Headaches close as possible to the tumor site. Sometimes, they may - Fluid and electrolyte imbalances be inserted directly into the tumor. - Anorexia – change in taste buds effective in treating cancers of the cervix, uterus, - Back aches Joint aches vagina, rectum, eye, and certain head and neck - Blood clots Oral mucositis – (reduced cancers. significantly by L-glutamine amino acids orally) SYSTEMIC RADIATION THERAPY - Supra opportunistic infections - Septic DIC This radiation therapy, which may be used to treat - Tumor lysis syndrome certain cancers such as those of the thyroid, bone and - Edema or pulmonary edema prostate, is delivered via radioactive drugs, or Chemotherapy Nursing Interventions radiopharmaceuticals, orally or through an injection. Because the radioactive materials leave the body - Evaluate and assess sites of chronic through urine, saliva and other fluids, special chemotherapy, ports, veins, skin area precautions are taken in the days immediately following - Accurate I & O’s treatment so the radiation does not affect the people - Monitor for fluid overload or dehydration around the patient. These precautions may include a - Monitor lab electrolytes before and after hospital stay, avoiding sharing utensils or other personal infusion Monitor BUN and Creatinine items, sleeping alone and limited contact with children - Monitor CBC with differential and pregnant women. - Monitor PT, PTT Radiation therapy side effects RADIATION THERAPY Side effects depend on the amount and area being irradiated - Is a type of cancer treatment that uses beams of Fatigue intense energy to kill cancer cells. Nausea and vomiting - Most often uses x-rays, but protons of other types of Mild anemia energy also can be used. Leukopenia - Beam from a machine outside of the body is aimed Diarrhea at a precise point on the body. Pain BSN 3 | BLOCK 1 | MIDTERMS 3|4  Erythema/burns Fatigue Pneumonitis Esophagitis Dysphasia Nursing interventions for radiation Therapy Assess incidence and severity of side effects Maximize radiation protection, all wastes will be radioactive if isotopes are injected Shielding for staff A radiation dosimeter is a device that measures dose uptake of external ionizing radiation. Cancer Nursing Interventions Nutritional assessment and weights Dentition – oral checks Monitor for signs of suprainfection, low grade temperatures, rash, etc… Vital signs before, during, and after treatments Assess bowel status Assess pain level Educate patients and family members: side effects of treatments, meds care of port and IV sites oral hygiene symptoms to report, i.e. shortness of breath or signs of infection Increase fluid intake, suck on hard candies to reduce chemotherapy metallic tastes KEY POINTS: Cell Cycle Chemotherapy Radiation Therapy Nursing Care and Nursing education After review of this session/material, go online visit Schoology/Google Classroom and answer Quiz 1 Online Test on October 5, 2022 starting at (7:30-11:30am, 10:30- 2:30pm, 2:30-5:30pm)(Philippine Time). Test expires in 1hour. This means you have to be on time for you to able to finish the test. BSN 3 | BLOCK 1 | MIDTERMS 4|4  N 1 MANAGEMENT OF PATIENTS WITH ONCOLOGIC DISORDERS PART 2 C 1 Lecturer: CARMEL B. GASATAYA, RN, MAN M2 By: kinakayanalangtalaga TREATMENT TECHNOLOGIES F. COMBINATION OF TCM & WESTERN MEDICINE TRADITIONAL CHINESE MEDICINE (TCM) FOR CANCER is a system of medical care that was developed in China A. INTERVENTIONAL THERAPY over thousands of years. It looks at the interaction Intrathecal therapy (IT) to administer analgesic between mind, body and environment, and aims to agents can be most effective in patients with prevent and cure illness and disease. Modern Cancer chronic pain, particularly those whose pain cannot Hospital Guangzhou applies combined treatment of be adequately treated using conventional medical TCM & minimally invasive targeted therapy, which management. features combined strength of two medicines and Administration for drugs via an injection into the advantages of employing brand-new therapeutic system spinal canal, or into the subarachnoid space so that to achieve better effect and lessen side effect. it reaches the cerebrospinal fluid (CSF) and is useful in spinal anesthesia, chemotherapy, or pain G. STEM CELL TECHNOLOGY management applications. This route is also used to is a field of medical research studying human and introduce drugs that fight certain infections, animal stem cells. Stem cells are naturally occurring particularly post-neurosurgical. cells essential to the growth and regeneration of organisms. Stem cells are already used for therapeutic B. CRYOSURGERY THERAPY, purposes, and research suggests potential future also named cryotherapy or cryoablation benefits of stem cells in many fields of medicine. It’s when doctors use freezing cold temperatures to kill abnormal cells or small tumors. The cold comes H. NANO SCALE TECHNOLOGY from liquid nitrogen or argon gas. Nanotechnology cancer treatments would use gold particles to carry anticancer drugs straight to the cancer. C. BIOLOGICAL IMMUNOTHERAPY This precise technology also goes one step further, not is a kind of tumor biotherapies. It kills and wounds only could it allow for less invasive cancer screening and tumors directly or induces the anti-tumor higher resolution images of tumours, it could drive more immunoreaction of the body via transfusing targeted treatments. immunocyte with antitumor activity into patients. I. PHOTODYNAMIC THERAPY (PDT) D. CAR-T THERAPY (CHIMERIN ANTIGEN RECEPTOR) is a treatment that uses a drug, called a photosensitizer has been restricted to small clinical trials, largely in or photosensitizing agent, and a particular type of light. patients with advanced blood cancers. When photosensitizers are exposed to a specific is a type of immunotherapy which involves collecting wavelength of light, they produce a form of oxygen that and using the patients’ own immune kills nearby cells.PDT was approved by the U.S. FDA for clinical application in 1996 and approved for clinical E. MICROWAVE ABLATION (MVA) application by Chinese SFDA in 2003 J. Nuclear Weapon, Particle knife (also called 125I Seed use image guidance to place a needle through the Implantation) skin into a liver tumor. is applied to a variety of primary and metastatic tumors to destroy the cancer cells, the electrical currents or nowadays. 125I seeds are some small iodine microwaves emitted from the needle go through an radioactive particles that can give off short-range γ-ray electrode to ground pads on the body. to kill tumor cells continuously. K. RADIOFREQUENCY ABLATION (RFA) also called fulguration, is a medical procedure in which part of the electrical conduction system of the heart, BSN 3 | MEDSURG|BLOCK 1 | MIDTERMS 1|2  tumor or other dysfunctional tissue is ablated using the heat generated from medium frequency alternating current. KEY POINTS: Treatment technologies for cancer BSN 3 | BLOCK 1 | MIDTERMS 2|2  N 1 MANAGEMENT OF PATIENTS WITH ONCOLOGIC EMERGENCIES C 1 Lecturer: CARMEL B. GASATAYA, RN, MAN M2 By: kinakayanalangtalaga MANAGEMENT OF PATIENTS Pain often worsens when a patient lies down. Paraplegia may develop over a period of hours or WITH ONCOLOGIC days. EMERGENCIES PART 1 ONCOLOGIC EMERGENCIES: Diagnostic Procedures: A clinical condition resulting from a metabolic, MAGNETIC RESONANCE IMAGING (MRI) neurologic, cardiovascular, hematologic, and/or -diagnostic procedure of choice Myelography should be infectious change caused by cancer or its treatment that reserved for patients (such as those with cardiac requires immediate intervention to prevent loss of life or pacemakers) unable to undergo MRI. quality of life. RADIOTHERAPY ALONE An oncologic emergency may be defined as any acute potentially morbid or life-threatening event directly or is the definitive treatment for most patients Chemotherapy indirectly related to a patient's tumor or its treatment. can be used as primary therapy in o chemosensitive tumors NEUROLOGIC EMERGENCIES : INCREASED INTRACRANIAL PRESSURE Spinal Cord Compression Involvement of the brain parenchyma with mass Increased Intracranial Pressure lesions or obstruction of the flow of cerebrospinal fluid (CSF) by tumor tissue may lead to increased Seizures intracranial pressure. If the pressure increase is Altered Mental Status severe enough, herniation may result Leptomeningeal Disease Signs and Symptoms: EPIDURAL SPINAL CORD COMPRESSION headache, cranial nerve symptoms, is devastating, and it is not an uncommon complication nausea and vomiting of malignancy. Spinal cord compression occurs in the onset of seizures. approximately 5% of patients with cancer, or 20,000 patients per year in the United States. Untreated spinal Medications: cord compression will invariably progress to produce paralysis, sensory loss, or loss of anal sphincter control. DEXAMETHASONE- IV loading dose of 10 to 100 mg followed by 4 to 24 Common Causes of Spinal Cord Compression: mg four times a day metastatic breast, lung, or prostate cancer. Patients with early signs of increased intracranial In children, the tumors most commonly metastatic pressure and herniation should be given to the spine include neuroblastoma, Ewing's intravenous corticosteroids. sarcoma, osteogenic sarcoma, and INTRAVENOUS MANNITOL, rhabdomyosarcoma. 1 to 1.5 g/kg in a 20% solution. Other cancers that often cause spinal cord metastases include lymphoma, melanoma, renal Mannitol can be repeated every 4 to 6 hours cancer, sarcoma, and myeloma. Surgical intervention Surgical intervention with decompression or Signs and Symptoms: shunting should proceed as soon as possible burning or dysesthetic in nature and is exacerbated Seizures by palpation or percussion over the spine. Seizures may be the presenting symptom in 15% to 30% of Spinal cord compression pain is progressive and patients with brain metastases. unrelenting BSN 3 | MEDSURG|BLOCK 1 | MIDTERMS 1|7  Medications: Clinical Manifestations: 1.DIAZEPAM OR LORAZEPAM 5MG IV Dyspnea Cough NOTE: Patients with mass lesions should receive Chest pain dexamethasone first and then definitive therapy. Fever Peripheral edema 2. ANTICONVULSANT THERAPY Hoarseness Hiccups phenytoin at a loading dose of 15 mg/kg and a maintenance Nausea dose of 300 mg/d. Hypotension Tachycardia Altered Mental Status Narrow pulse pressure May take the form of confusion, decreased attentiveness, delirium, dementia, or coma. Diagnostic test May occur as a direct result of primary lesions of ECG- diagnostic test of choice is the the Nervous system or secondarily Paraneoplastic syndromes, organ failure or infections. echocardiogram Catheterization of the right side of the heart LEPTOMENINGEAL DISEASE Leptomeningeal carcinomatosis is seen most PERICARDIOCENTESIS -is the preferred procedure commonly in the setting of advanced for immediate relief of symptoms adenocarcinomas Clinical Manifestations: EXTERNAL BEAM RADIATION -is often effective in Headache leukemia- or lymphoma-induced effusions changes in mental status nausea or vomiting RESPIRATORY EMERGENCIES focal weakness of an extremity Airway Obstruction Seizures Massive Hemoptysis dermatomal sensory loss Toxic Lung Injury bladder and bowel dysfunction Diplopia 1. AIRWAY OBSTRUCTION hearing loss -Airway obstruction may occur as a result of endobronchial facial numbness lesions or extrinsic compression from adjacent structures. loss of visual ophthalmoplegia Signs and symptoms: cough, CARDIOVASCULAR EMERGENCIES fullness in the neck, Cardiac Tamponade hemoptysis, Superior Vena Cava Syndrome dyspnea, dysphagia, or CARDIAC TAMPONADE stridor. Malignant pericardial effusions are the most common cause of pericardial tamponade. Acute therapy for impending obstruction involves Cardiac tamponade is rarely caused by primary intubation or tracheostomy tumors of the pericardium Patients should receive supplemental oxygen and corticosteroids BSN 3 | BLOCK 1 | MIDTERMS 2|7  Laser therapy or endobronchial stents or Tachycardia brachytherapy. Crackles if there is fluid present 2. MASSIVE HEMOPTYSIS Diagnostic Tests: – rare condition expectoration of 400 to 600 mL of blood Arterial Blood Gas within 24 hours Blood culture Chest X-ray Causes: Bronchoscopy 1. tuberculosis, Lung biopsy for definitive diagnosis 2. aspergillosis, 3. lung abscesses, Management: 4. bronchiectasis, Corticosteroids 5. and bronchogenic carcinoma Diuretics Bleomycin therapy Diagnostic Procedures: BRONCHOSCOPY GENITOURINARY EMERGENCIES - is the diagnostic procedure of choice and allows Hemorrhagic Cystitis icedsaline lavage Urinary Tract Obstruction technique by which cells and fluid from bronchioles and lung alveoli are removed for diagnosis of 1.HEMORRHAGIC CYSTITIS disease or evaluation of treatment May be caused by certain chemotherapeutic agents (busulfan [Myleran], cyclophosphamide, ifosfamide, Medical Management thiotepa) 1. humidified oxygen Pelvic irradiation, some viruses, immune-acting 2. blood and fluid replacement agents (as in the penicillin family of antibiotics) 3. transfusion of platelets Can be caused by and invasive urothelial tumors 4. correction of abnormal clotting parameters Conservative therapies: Surgical Management clot evacuation 1. surgical resection continuous bladder irrigation with saline or 2. bronchial artery catheterization and embolization. hydrocortisone, 3. TOXIC LUNG INJURY cessation of anticoagulant therapy, toxic injuries may affect the pulmonary parenchyma, cystoscopy and fulguration vasculature, airways, or pleura The lung is uniquely susceptible to chemotherapy- Surgical Management: induced injury urinary diversion The lung also has the highest tissue oxygen content, internal iliac artery ligation or embolization which can enhance the toxicity of mitomycin cystectomy (Mutamycin), bleomycin, cyclophosphamide (Cytoxan, Neosar), and carmustine 2.URINARY TRACT OBSTRUCTION Signs and Symptoms: commonly occurs in the ureters or the bladder neck Fever can be cause by either benign or malignant Cough neoplasms Dyspnea Cyanosis Tachypnea BSN 3 | BLOCK 1 | MIDTERMS 3|7  Imaging Modalities: Causes: Intravenous urogram, hematologic malignancies, Renal ultrasound, aplastic anemia, CT of the abdomen and pelvis myelodysplastic syndromes, and rarely, solid tumors Therapies that relieve obstruction Nephrostomy tubes, Diagnostic Examination: Ureteral stents, 1.Typhlitis- is a clinical diagnosis. Typhlitis is the Suprapubic catheters, inflammation of the cecum that may be associated with Transurethral resection of the prostate infection Antibiotic Therapy 2. Laboratory and x-ray findings are nonspecific 3. Plain films of the abdomen reveal the pattern of ileus with KEY POINTS a distended cecum. Oncologic emergencies may be categorized by their system 4. CT scan is the test of choice and may reveal thickening of of origin, as metabolic, or as hematologic. The signs and the bowel wall with pneumatosis. symptoms of oncologic emergencies are often common problems experienced by individuals with cancer such as Note: Invasive studies such as endoscopy or a barium nausea, pain, headache, and fever. For prevention and early enema should be avoided as patients are at high risk for detection of oncologic emergencies, physicians must perforation. maintain a high degree of suspicion and must adequately educate patients about preventative measures and Medical management reporting of symptoms. bowel rest; nasogastric suction; MANAGEMENT OF PATIENTS broad-spectrum antibiotics WITH ONCOLOGIC use of hematopoietic growth factor support; EMERGENCIES PART 2 and total parenteral nutrition. Surgical management. GASTROINTESTINAL EMERGENCIES – indicated only for perforation, bleeding and failure medical management. Neutropenic Enterocolitis Necrotic bowel should be resected, Gastrointestinal Bleeding and Perforation Bowel diversion should be performed 1. NEUTROPENIC ENTEROCOLITIS 2. GASTROINTESTINAL BLEEDING AND PERFORATION Neutropenic enterocolitis (typhlitis) is a syndrome Causes: characterized by patchy inflammation involving the full thickness of the bowel wall. It is associated with well- hemorrhagic gastritis demarcated ulcers and necrosis with minimal inflammatory peptic ulcer disease infiltration of the ileum, cecum, or ascending colon. Malignancy –Lymphoma and tumors Signs and Symptoms: Treatment modalities abdominal distension, 1.Use of Vasopressin tenderness on the right side of the abdomen, Vasopressin is also used to treat or prevent certain watery diarrhea, and conditions of the stomach after surgery or during abdominal fever observed in the setting of chemotherapy- or x-rays. disease-induced neutropenia 2.Arterial embolization for unresectable lesions. BSN 3 | BLOCK 1 | MIDTERMS 4|7.METABOLIC EMERGENCIES headache confusion Tumor Lysis Syndrome lethargy Rapid destruction of malignant cells can result in ceizures the release of cellular breakdown products and coma intracellular ions causing potentially lethal Management: metabolic derangements. 1. Treating the tumor producing the antidiuretic hormone Causes: 2. Usually fluid restriction or induced diuresis 3. Fluid intake should be limited to less than 1,000 mL/d 1. induction chemotherapy and less than 500 mL/day 2. after treatment with radiotherapy 4. Normal saline with IV furosemide may also be effective 3. corticosteroids, hormonal agents 2.HYPERCALCEMIA OF MALIGNANCY This syndrome is characterized by: Hypercalcemia is the most common metabolic hyperuricemia, emergency seen in cancer patients. hyperkalemia, Hypercalcemia confers a grave prognosis; survival rate hyperphosphatemia, at 3 months is only 44% with mean survival times of 1 and hypocalcemia to 6 months Hypercalcemia in malignancy is caused by the tumor's Management: elaboration of systemically acting humoral factors, 1.Regular monitoring of electrolytes, blood-urea-nitrogen which alter calcium metabolism in the bones, kidney, or (BUN), creatinine, uric acid, phosphorus, and calcium levels intestines and by stimulation of bone resorption at sites 2. Hydration should exceed 3,000 mL/day of tumor metastases. 3. Patients with hyperkalemia should be monitored The most common tumor types associated with continuously hypercalcemia include those of the breast, lung, kidney, 4. Antibiotic therapy for opportunistic infections. and esophagus, hematologic malignancies, cancer of 5. Hemodialysis may be required in situations wherein the head and neck. conservative management fails. Clinical Manifestations of Cancer-Related 7.SIADH – SYNDROME OF INAPPROPRIATE SECRETION Hypercalcemia OF ANTI-DIURETIC HORMONE Dehydration -Hypercalcemia of Malignancy Weight loss Anorexia 1.SIADH Pruritus Occurs when an excessive amount of antidiuretic Polydipsia hormone is released resulting in water retention Neuromuscular and a low sodium level. Fatigue is characterized by hyponatremia with Lethargy inappropriately concentrated urine Muscle weakness The differential diagnosis of SIADH includes adverse Hyporeflexia effects of cytotoxic chemotherapy agents, notably Confusion cyclophosphamide and vincristine Psychosis Signs and symptoms: Seizure Obtundation mental status and cognitive changes fatigue Coma Gastrointestinal anorexia Nausea myalgias Vomiting BSN 3 | BLOCK 1 | MIDTERMS 5|7  Constipation Disseminated Intravascular Coagulation ( DIC ) Laboratory test findings include: high serum calcium level (can be greater than 14 1.BLEEDING mg/dL The hemostatic system can be significantly altered by low serum chloride level- 96 and 106 MeQ/L malignant disease and its treatment elevated or normal serum phosphate - 2.5 to 4.5 Some Hemorrhagic Syndromes Occurring With mg/dL Metastatic Malignancy bicarbonate levels increased- Thrombocytopenia elevated alkaline phosphatase levels -20 to 140U/L Immune thrombocytopenia Bacteremia 8.HEMATOLOGIC EMERGENCIES Massive transfusions Hyperviscosity Syndrome Shock Hyperleukocytosis Syndrome Decreased clotting factors/coagulation factor 1.HYPERVISCOSITY SYNDROME 2.THROMBOSIS is characterized by sludging and decreased Solid tumors may cause tissue injury and perfusion of the microvasculature and by vascular elaboration of the tissue factor that initiates local stasis brought on by markedly increased thrombosis. paraproteins or poorly deformable cells in the blood. Life-threatening thrombotic events can be treated with surgery (embolectomy or vena cava the syndrome is characterized by three symptoms: interruption) or thrombolytic therapy with streptokinase, urokinase, or plasminogen 1. Bleeding activators. Therapy for the acute condition should 2. visual signs and symptoms and then be followed by anticoagulation with heparin 3. neurologic defects 3.DISSEMINATED INTRAVASCULAR COAGULATION ( Diagnosis is clinical and is confirmed by DIC) determination of the serum viscosity The normal range for serum viscosity (compared Is considered an “acquired bleeding disorder”. Is not a with water) is 1.4 to 1.8.millipoise units disease entity but an event that can accompany various disease processes. Is an alteration in the blood clotting 2.HYPERLEUKOCYTOSIS SYNDROME mechanism: abnormal acceleration of the coagulation Patients with leukemia who have markedly elevated cascade, resulting in thrombosis As a result of the white blood cell (WBC) counts are at risk for end- depletion of clotting factors, hemorrhage occurs organ damage simultaneously Diseases that predispose patients to leukostasis include acute myelogenous leukemia and chronic 10.CHEMOTHERAPY-INDUCED EMERGENCIES myelogenous leukemia in blast crisis with peripheral WBC counts greater than 100,000/mL Extravasation Management Chemotherapeutic agents are classified as nonvesicants, irritants, or vesicants. By definition, Supplemental oxygen, vesicants can cause necrosis if extravasation Leukapheresis occurs. Hydroxyurea If extravasation takes place, the drug should be immediately discontinued.HEMOSTATIC EMERGENCIES KEY PONTS Bleeding Oncologic emergencies may be categorized by their Thrombosis system of origin, as metabolic, or as hematologic. BSN 3 | BLOCK 1 | MIDTERMS 6|7  The signs and symptoms of oncologic emergencies are often common problems experienced by individuals with cancer such as nausea, pain, headache, and fever. For prevention and early detection of oncologic emergencies, physicians must maintain a high degree of suspicion and must adequately educate patients about preventative measures and reporting of symptoms. After review of this session/material, go online visit Schoology/ Google Classroon and answer Quiz 1 Online Test on October 5, 2022 starting at (7:30-11:30am, 10: 30- 2:30pm, 2:30-5:30pm) (Philippine Time). Test expires in 1hour. This means you have to be on time for you to able to finish the test. BSN 3 | BLOCK 1 | MIDTERMS 7|7