Oncology PDF

MEDICAL SURGICAL: Sir Vince ONCOLOGY muffin | BSN 2A | CEBU NORMAL UNIVERSITY Oncology f. Anaplasia...

MEDICAL SURGICAL: Sir Vince ONCOLOGY muffin | BSN 2A | CEBU NORMAL UNIVERSITY Oncology f. Anaplasia - refers to disorganized, irregular cells that have nor structure and have loss of differentiation; the Onkos- meaning bulk, mass, tumor, result is always malignant (undifferentiated cell) suffix - logy - meaning “study of” Branch of medicine that deals with tumors(cancer) The diagnosis of any cancer in a person Epidemiology of Cancer Therapy (e.g. surgery, chemotherapy, radiotherapy, and Cancer affects every age group though most cancer and other modalities) cancer deaths occur in people older than 65 years of age Follow-up of cancer patients after successful treatment Age of 60 - as verbalized Palliative care of patients with terminal malignancies Cancer ranks 3rd as the cause of morbidity in the Ethical questions surrounding cancer care Philippines Screening efforts of populations, or of the relatives of Highest incidence of all cancer is prostate cancer patients (in types of cancer that are thought to have a Highest cancer incidence in males in order of frequency: hereditary basis, such as breast cancer) prostate cancer, lung cancer and colorectal cancer Highest cancer incidence in females in order of Normal Cell frequency: breast cancer, lung cancer and colorectal cancer Characteristics of Normal Cells - The Biology of Normal Cells Have limited cell division Malignant Cell Undergo Apoptosis Show specific morphology Characteristics of Malignant Cell Perform specific differentiated functions Rapid cell division and growth: Adhere tightly together regulation of the rate of mitosis is lost Non migratory No contact inhibition: Grow in orderly and well regulated manner cells do not respect boundaries of other cells and invade Are euploid their tissue areas Loss of differentiation: Normal cell growth (cell cycle) consists of 5 intervals or cells lose specialized characteristics of function for that cell phases type and revert back to an earlier, more primitive cell type Differentiation - refers to the process whereby cells Ability to migrate (metastasize); develop specific structures and functions in order to cells move to distant areas of the body and establish new specialize in certain tasks site malignant lesions (tumors) Apoptosis - cell suicide, normal event. Alteration in cell structure: differences are evident between normal and malignant cells with respect to cell membrane, cytoplasm and overall cell shape Self-survival: a. may develop ectopic sites to produce hormones needed for own growth b. can develop a connective tissue stroma to support growth c. May develop own blood supply by secreting angiotensin growth factor to stimulate local blood vessels to grow into tumor Cellular Adaptation a. Hypertrophy - increase in size of normal cells b. Atrophy - shrinkage of cell size c. Hyperplasia - increase in the number of normal cells d. Metaplasia - conversion from the normal pattern of differentiation of one type of cell into another type of cell not normal for that tissue. Replacement of other mature cell. e. Dysplasia - refers to an alteration in the shape, size, appearance and distribution of cells (reversible) 1 ㅤㅤㅤㅤ - Chapter Title ㅤㅤㅤㅤ - Main Lesson/Topic ㅤㅤㅤㅤ - Sub Lesson/Topic ㅤㅤㅤㅤ - Keywords ㅤㅤㅤㅤ - Functions ㅤㅤㅤㅤ - Synonyms  Initiation Normal Malignant occurs when carcinogen damages DNA Speed of growth slow growing fast growing carcinogenesis cause changes in the structure and function of the cell at the genetic or molecular level. Spread with contact inhibition no contact inhibition Shape uniform irregular, altered This damage may be reversible or may lead to genetic mutations if not repaired; however the mutations may lead able to perform immediately to cancer Function specific differentiated altered function functions Promotion Apoptosis Yes No occurs with additional assaults to the cell, resulting in Nucleus single multiple nuclei further genetic damage DNA and RNA normal mutated These genetic events result in a malignant conversion Progression Hallmarks of cancer cells - Based on video (5) Need little or no growth factors the cells are increasingly malignant in appearance and Can evade growth suppressors behavior and develop info an invasive cancer with Can divide indefinitely metastases to distant body parts Show genetic instability Can resist cell death Stages of Metastasis 1. Detachment Mutation Consequence Example 2. Migration 3. Dissemination Proto-oncog 4. Angiogenesis Activating Promote cell division HER2/neu enes 5. Subsequent metastasis Tumor Loss of control suppressor Deactivating p53 mechanism genes Cancer cell development - Based on video (5) 1. Damage to the DNA 2. Error is passed on 3. Latency 4. Progression Cancer cell development - causes the following Uncontrolled proliferation Escape from apoptosis Immune System and Cancer - 2 Critical Component Genetic alterations 1. Ability to recognize a pathogen as foreign Increased mitosis and abnormal mitosis 2. Ability to mount a response to eliminate the pathogen Telomerase expression Neoangiogenesis Immune Surveillance Theory Nuclear atypia Immune responses, particularly cell- mediated, provide a Vessel infiltration defense against cancer cells by recognizing the antigens Infiltrative growth on the surface of some neoplastic cell as foreign. Metastasis and/or dissemination Cancer cells are killed by cytotoxic T cells that have receptors for specific tumor antigens and by interferon External Factors of Cancer activated natural killer (NK) lymphocytes and Lifestyle macrophages Exposure to carcinogens Macrophages phagocytize the pathogen and present it Virus as antigen to T and B lymphocytes Internal Factors of Cancer Failure of immune defenses Genetic the immune system may be unable to recognize cancer Race cells as foreign or to mount an immune response due to Age the following: a. it's immature, old or weak b. malnutrition or chronic ailment Carcinogenesis (IPP) c. cancer cells escape detection because they resemble normal cells. Others produce substances that shield 2 ㅤㅤㅤㅤ - Chapter Title ㅤㅤㅤㅤ - Main Lesson/Topic ㅤㅤㅤㅤ - Sub Lesson/Topic ㅤㅤㅤㅤ - Keywords ㅤㅤㅤㅤ - Functions ㅤㅤㅤㅤ - Synonyms  them from recognition or they may be coated with Screening - helps to identify high-risk populations and fibrin individuals d. use of immunosuppressive drugs which can suppress Early Detection - involves finding a precancerous lesion immune system or a cancer at its earliest, most treatable stage a. inspection Classification of Neoplasm b. palpation c. use of tests or procedures 1. Benign - from latin word "benignus"- kind 2. Malignant Approach to Cancer Prevention Characteristics (Benign vs Malignant) Education Regulation - prohibit the sale of tobacco and alcohol to minors, limiting smoking in public places, imposing Benign Malignant excise taxes, regulating the use of manufactured Speed of growth slow Fast carcinogens such as asbestos, and prohibiting Mode of Growth expansive invasive carcinogens in foods Host modification - aims to alter the body's internal Capsule capsulated not capsulated environment to decrease the risk of or to reverse a Cell carcinogenic process well differentiated poorly differentiated Characteristics Recurrence rare frequent Diagnostic Tests of Cancer Metastasis localized metastasize Biopsy/cytology Effect of slight pressure effect remarkable pressure Histologic and cytologic examination of specimens are Neoplasm on neighboring organ effect on other organs performed by the pathologist on tissues collected by Prognosis good, favorable poor needle aspiration of solid tumors, exfoliation from epithelial surface, and aspiration of fluid from blood or body cavities Cancers By Cell/Tissue Type Tissues may be obtained by excisional biopsy, incisional Carcinomas: Epithelial cells (skin, body cavities, biopsy, and needle biopsy organs) By examination of these tissues, the name, grade, and Sarcomas: Bones and soft tissues stage of the tumor can be identified Myelomas: Plasma cells (manufacture antibodies) Leukemias: Blood cells (originates in bone marrow) Papanicolaou Test (Pap Smear) Lymphomas: Immune system (lymph nodes, spleen, stomach, testicles) Class 1: Normal Mixed types: Derive from multiple cell/tissue types Class II: Inflammation Adenomas: benign tumor of epithelial tissue with Class III: Mild to moderate dysplasia glandular origin, glandular characteristics, or both. Class IV: Probably malignant Class V: Malignant Warning Signs of Cancer (CAUTION US) X-Ray X-rays are quick, painless tests that produce images of Change in blood bowel or bladder habits the structures inside the body A sore that does not heal Imaging Method: ionizing radiation Unusual bleeding or discharges Used to diagnose: bone fractures; arthritis; osteoporosis; Thickening or lump in the breast or elsewhere infections; breast cancer; swallowed items; digestive tract Indigestion or difficulty in swallowing problems Obvious change in wart or mole Nagging cough or hoarseness CT Scan Unexplained anemia CT scans use a series of x-rays to create cross- sections Sudden unexplained weight loss of the inside of the body, including bones, blood vessels, and soft tissues Management of Cancer Imaging Method: ionizing radiation Used to diagnose: injuries from trauma; bone fractures; tumors and cancers; vascular disease; heart disease; Prevention and Control infections; used to guide biopsies. Prevention - involves measures to avoid or reduce exposure to Ultrasound carcinogens Ultrasound uses high-frequency sound waves to produce - activities are aimed at interventions before pathologic images of organs and structures within the body change has begun Imaging Method: sound waves 3 ㅤㅤㅤㅤ - Chapter Title ㅤㅤㅤㅤ - Main Lesson/Topic ㅤㅤㅤㅤ - Sub Lesson/Topic ㅤㅤㅤㅤ - Keywords ㅤㅤㅤㅤ - Functions ㅤㅤㅤㅤ - Synonyms  Used to diagnose: gallbladder disease; breast lumps; Enzymes genital/prostate issues; joint inflammation; blood flow Lactate dehydrogenase - elevated in lymphoma, problems; monitoring pregnancy; used to guide biopsies leukemia, and germ cell tumors Alkaline phosphatase - elevated in liver cancer and MRI bone metastasis MRIs use magnetic fields and radio waves to create detailed images of organs and tissues in the body. Imaging Method: magnetic waves Used to diagnose: aneurysms; Multiple Sclerosis (MS); stoke; spinal cord disorders; tumors; blood vessel issues; joint or tendon injuries PET Scan PET scans use radioactive drugs (called tracers) and a scanning machine to show how the tissues and organs are functioning Imaging Method: sound waves Used to diagnose: gallbladder disease; breast lumps: genital/prostate issues; joint inflammation; blood flow problems; monitoring pregnancy; used to guide biopsies TNM Staging Tumor Markers - HOLD ME Tumor markers are protein substances found in the blood or body fluids. released either by the tumor itself, or by the body as a defense in response to the tumor (called host response). Hormones Human chorionic gonadotrophins (elevated in trophoblastic tumors), Calcitonin (elevated in medullary carcinoma of the thyroid), and Catecholamines (elevated in pheochromocytoma). Oncofetal antigens Alpha-fetoprotein (elevated in liver cell cancers) and Carcinoembryonic antigen (CEA, elevated in colon and other cancers). Lineage specific antigens Prostate-specific antigen (PSA, elevated in prostate cancer) and monoclonal immunoglobulins M protein (elevated in multiple myeloma and other plasma cell disorders). DNA markers Epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer and K-RAS mutations in colorectal and pancreatic cancers. BRAF V600E mutation in Melanoma and papillary thyroid Different Modalities for Cancer cancer Surgical interventions Chemotherapy Mucin and other glycoproteins Radiation therapy CA125 - elevated in ovarian cancer Immunotherapy CA19-9 - elevated in colorectal and pancreatic cancers Bone Marrow transplantation CA15-3 - Breast cancer 4 ㅤㅤㅤㅤ - Chapter Title ㅤㅤㅤㅤ - Main Lesson/Topic ㅤㅤㅤㅤ - Sub Lesson/Topic ㅤㅤㅤㅤ - Keywords ㅤㅤㅤㅤ - Functions ㅤㅤㅤㅤ - Synonyms  Principles of Cancer Treatment Place client in private room Instruct visitors to maintain at least a distance of 6 feet from the client and limit visitors to 10-30 minutes Surgical Intervention Ensure proper handling and disposal of body fluids, Preventive surgery - removal of precancerous lesions or assuring the containers are marked appropriately benign tumors Ensure proper handling of bed linens and clothing Diagnostic surgery - biopsy In the event of a dislodged implant, use long-handled Curative surgery - removal of an entire tumor forceps and place the implant into a lead container. Reconstructive surgery – improvement of structures Do not allow pregnant woman to come into any contact and function of an organ with radiation Palliative surgery – relief of distress in signs and Educate client in all safety measures symptoms; retardations of metastasis Radiation Therapy: Teletherapy Radiation Therapy Client Education Used to kill a tumor, reduce the tumor size, relieve Wash the marked area of the skin with plain water only obstruction, or decrease pain and pat skin dry; do not use soaps, deodorants, lotions, Causes lethal injury to DNA, so it can destroy rapidly perfumes, powders or medications on the site during the multiplying cancer cells, as well as normal cells duration of the treatment; do not wash off the treatment Can be classified as internal radiation therapy site marks (brachytherapy) or external radiation therapy Avoid rubbing, scratching, or scrubbing the treatment site; (teletherapy) do not apply extreme temperatures (Heat or Cold) to the treatment site; if shaving, use only an electric razor Radiation Therapy: Brachytherapy Wear soft, loose-fitting over the treatment area Sources of internal radiation Protect skin from sun exposure during the treatment and Implanted into affected tissue or body cavity for at least 1 year after the treatment is completed; when Ingested as a solution going outdoors, use sun-blocking agents with sun Injected as a solution into the bloodstream or body cavity protector factor (SPF) of at least 15. Introduced through a catheter into the tumor Maintain proper rest, diet, and fluid intake as essential to promoting health and repair of normal tissues Side effects Hair loss may occur; choose a wig, hat, or scarf to cover Fatigue and protect head Anorexia Immunosuppression Nursing management Other side effects similar to external radiation Monitor for adverse side effects of radiation. Monitor for significant decreases in white blood cell Client education counts and platelet counts. Avoid close contact with others until treatment is Client teaching (refer to later sections for management of completed. immunosuppression, thrombocytopenia. Maintain daily activities unless contraindicated, allowing for extra rest periods as needed. Bone Marrow Transplant Maintain a balanced diet; may tolerate food better if Used in the treatment of leukemias, usually in conjunction consumes small, frequent meals. with radiation or chemotherapy Maintain fluid intake ensure adequate hydration (2-3 a. Autologous BMT – the client is infused with own liters/day) bone marrow harvested during remission of disease If the implant is temporary, maintain bedrest to avoid b. Allogenic BMT – the client is infused with donor dislodging the implant. bone marrow harvested from a healthy individual Excreted body fluids may be radioactive; double-flush toilets after use. The bone marrow is usually harvested from the iliac crest, Radiation therapy may lead to bone marrow suppression. then frozen and stored until transfusion. Before receiving the BMT, the client must first undergo a Nursing management phase of immunosuppressive therapy to destroy the Exposure to small amounts of radiation is possible during immune system, infection, bleeding, and death are major close contact with persons receiving internal radiation: complications that can occur during this conditioning 1. Time: minimize time spent in close proximity to the phase. radiation source; a common standard is to limit After immunosuppression, the bone marrow is transfused contact time to 30 minutes total per 8-hour shift; intravenously through a central line. possible 2. Distance: maintain the maximum distance possible Side Effects from the radiation source; minimum distance of 6 feet malnutrition used when infection related to immunosuppression 3. Shielding: use lead shields and other precautions to bleeding related to thrombocytopenia reduce exposure to radiation 5 ㅤㅤㅤㅤ - Chapter Title ㅤㅤㅤㅤ - Main Lesson/Topic ㅤㅤㅤㅤ - Sub Lesson/Topic ㅤㅤㅤㅤ - Keywords ㅤㅤㅤㅤ - Functions ㅤㅤㅤㅤ - Synonyms Nursing Management Usually associated with cancer of the lungs and Monitor for graft-versus-host disease lymphomas (enlargement of lymph nodes) Provide private room for the hospitalized client; client will signs and symptoms are the result of blockage of venous be hospitalized for 6-8 weeks circulations of head, neck, and upper trunk Encourage contact with significant others by using Early signs and symptoms are periorbital edema and telephone, computer, and other means of communication facial edema due to blockage if venous drainage to reduce feelings of isolation Symptoms progress to edema of neck, arms, and hands, Refer to management for imbalanced nutrition, difficulty swallowing, shortness of breath immunosuppression and thrombocytopenia Late signs and symptoms are cyanosis, altered mental status, headache, and hypotension Immunotherapy/Biologic Response Therapy Death may occur if compression is not relieved Enhances the person’s own immune responses in order to modify the biologic processes resulting in malignant cells Treatment included high-dose radiation to shrink tumor and Currently considered experimental in use relieve symptoms Cytokines: normal growth-regulating molecules possessing antitumor abilities Nursing interventions: 1. Interleukin-2(IL-2) increases immune response a. Monitoring vital signs effective and destroys abnormal cells b. providing oxygen support 2. Interferons are substances produced by cells to c. preparing tracheostomy for artificial airway if protect them from viral infection and replication; necessary (as neck swells, it impedes airway) interferon-alpha 2b is most commonly used d. initiating seizure precautions 3. Hematopoietic growth factors such as granulocyte e. administering corticosteroids to reduce edema colony-stimulating factor (G-CSF) and erythropoietin, balance the suppression of granulocytes and ICP - increased intracranial pressure erythrocytes resulting from chemotherapy (sign of increase = seizure) - blood Monoclonal antibodies: antibodies are recovered from - CSF an inoculated animal with a specific tumor antigen, then given to the person with that particular cancer type; the Disseminated intravascular coagulopathy goal is: destruction of the tumor Severe disorder of coagulation, often triggered by sepsis, Natural killer cells (NK cells): exert a spontaneous whereby abnormal clot formation occurs in the cytotoxic effect on specific cancer cells; they also secrete microvasculature cytokines and provide a resistance to metastasis This process depletes the clotting factors and platelets, allowing extensive bleeding to occur tissue hypoxia Oncologic Emergencies occurs as a result of the blockage of blood vessels from the clots. Signs and symptoms are related to decreased blood flow Spinal Cord Compression to major organs (tachycardia, oliguria, dyspnea) and Occurs secondary to pressure from expanding tumors depleted clotting factors (abnormal bleeding and hemorrhage) Early symptoms include back and leg pain, coldness, numbness, tingling, paresthesia's, progression leads to BLEEDING due to loss of clotting factors bowel and bladder dysfunction, weakness, and paralysis - cases are clotting before bleeding for DIC Early detection is essential: investigate all complaints of back pain or neurological changes heparin - give to prevent initial signs of DIC to prevent clotting Treatment is aimed at reducing tumor size by radiation and/or surgery to relieve compression and prevent Coagulation Factors Mnemonics Irreversible paraplegia; may receive corticosteroids to 4 Fibrinogen reduce cord edema Peso Prothrombin higher level of compression, higher symptoms (T3?) = Ticket Thromboplastin respiratory distress Can Calcium full compression = paralysis in lower extremities Lead Labile Factor U Unstable/Unknown Manifestation: leg pain, paresthesia Several Stable factor Amazing Antihemophilic Factor Nursing interventions Countries Christmas Factor early recognition of symptoms So Stuart factor neurological checks Pay Plasma Thromboplastin Antecedent (PTA) medication administration Her Hageman Factor Fare Fibrin Stabilizing Factor (PSF) Superior vena cava syndrome Compression or obstruction of the superior vena cava (SVC) 6 ㅤㅤㅤㅤ - Chapter Title ㅤㅤㅤㅤ - Main Lesson/Topic ㅤㅤㅤㅤ - Sub Lesson/Topic ㅤㅤㅤㅤ - Keywords ㅤㅤㅤㅤ - Functions ㅤㅤㅤㅤ - Synonyms Treatment anticoagulants to decrease stimulations of coagulation transfusion of one or more of the following: 1. fresh frozen plasma (FFP) 2. cryoprecipitate 3. platelets 4. packed RBC Management (assess what causes DIC) control clotting control infection Risk Factors Genetics - BRCA-1 gene, BRCA-2 gene Hormones - estrogen (high in post menopausal) Nursing interventions: Age assessing client Personal & Family History monitoring for bleeding Early menarche applying pressure dressings to venipuncture sites Late menopause preventing risk of sepsis. Obesity Hormone replacement therapy Cardiac tamponade Alcohol intake Pericardial effusion secondary to metastases or esophageal History of breast disorder cancer can lead to compression of heart, restricting heart Exposure to ionizing radiation movement and resulting in cardiac tamponade Clinical Change in breast size or shape Signs and symptoms are related to cardiogenic shock or Manifestations Skin dimpling or skin changes circulatory collapse: Recent nipple Inversion or skin change or other anxiety nipple abnormalities cyanosis Nipple discharge dyspnea Axillary lump hypotension Lump or contour change tachycardia Dilated veins tachypnea Ulceration impaired levels of consciousness, Redness or eczema like rash Involving nipple or increased central venous pressure surrounding area Edema or peau d'orange Pericardiocentesis is performed to remove fluid from pericardial sac Diagnostics Clinical examination Nursing interventions: Imaging tests - UTZ, Mammogram, MRI 1. administering oxygen Biopsy 2. maintaining intravenous line TNM Staging 3. Monitoring vital signs 4. hemodynamic monitoring Management 5. administration of vasopressor agents Surgery Common Cancer Conditions Mastectomy is removal of the entire breast and includes the following types: Breast Cancer Types Skin sparing Spares the pectoral muscles and enough mastectomy skin to cover the wound making breast reconstruction much easier and spares axillary lymph nodes Nipple sparing Same as skin sparing mastectomy plus mastectomy spares the nipple and areola Simple mastectomy Spares the pectoral muscles and removes axillary lymph nodes Modified radical Spares the pectoral muscles and removes mastectomy some axillary lymph nodes Radical mastectomy Removes axillary lymph nodes and the pectoral muscle 7 ㅤㅤㅤㅤ - Chapter Title ㅤㅤㅤㅤ - Main Lesson/Topic ㅤㅤㅤㅤ - Sub Lesson/Topic ㅤㅤㅤㅤ - Keywords ㅤㅤㅤㅤ - Functions ㅤㅤㅤㅤ - Synonyms  Intracranial Tumors may involve the brain or other structures (cranial nerves, meninges) 2 types of brain tumors: Primary brain tumors: Originate in the brain parenchyma (gliomas, which include astrocytoma, oligodendrogliomas and ependymomas, medulloblastomas, primary central nervous system lymphomas) or in extraneural structures (meningiomas, vestibular schwannomas) Secondary brain tumors (brain metastases): Originate Radiation therapy in tissues outside the brain and spread to the brain - Indicated after mastectomy if any of the following is present: primary lung cancer The primary tumor is 2-5 cm. Axillary nodes are Involved Risk Factors Radiation exposure Margins are positive for cancer in resected tissue. Age Chemical exposure Mild adverse effects Weakened immune system fatigue, skin changes Presence of other primary tumor Late adverse effects lymphedema, brachial plexopathy, radiation pneumonitis, Clinical Frequent headache Manifestations nausea, vomiting rib damage, secondary cancers, cardiac toxicity difficulty speaking trouble hearing Chemotherapy blurred/double visions Indications for chemotherapy are one or more of the following: memory loss, confusion Estrogen receptor (ER) and progesterone receptor (PR) - changes in mental, behavior, personality negative loss of balance Human epidermal growth factor 2 (HER2) oncogene - weakness in arms and legs positive (chemotherapy and HER2-directed therapy is seizures given) ER/PR+ and positive lymph nodes in a premenopausal patient Diagnostics Clinical examination ER/PR+ and HER2- with high Oncotype Dx score Imaging tests: T1 - weighted MRI, T2 - weighted MRI and CT scan Biopsy Doxorubicin Antitumor antibiotic (anthracycline) (Adnomycin) Causes red discoloration of secretions, cardiac toxicity causes dilated cardiomyopathy. most toxic to heart Cyclophosphamide Alkylating agent (Cytoxan) GI upset, alopecia hemorrhagic cystitis Paclitaxel (Taxol) Taxanes (antimictorubules) Unusual bleeding, neutropenia Adjuvant endocrine therapy ER+ tumors, particularly low-risk tumors Tamoxifen selective estrogen receptor modulator (Nolvadex) can induce or exacerbate menopausal symptoms increases risk of developing endometrial cancer causes hot flushing, bone pain, thromboembolism Aromatase inhibitor Management (ex Letrozole) block peripheral production of estrogen Airway protection Endotracheal intubation MESNA to reduce incidence of hemorrhagic resistance DEXRAZOXANE rescue therapy, reduce cardiac toxicity, red in color Reduction of ICP Dexamethasone, Mannitol (Osmitrol), Antiseizure medications 8 ㅤㅤㅤㅤ - Chapter Title ㅤㅤㅤㅤ - Main Lesson/Topic ㅤㅤㅤㅤ - Sub Lesson/Topic ㅤㅤㅤㅤ - Keywords ㅤㅤㅤㅤ - Functions ㅤㅤㅤㅤ - Synonyms Cranial Radiation Management Conformal: Using CT to create a 3-dimensional map of the Surgery (depending on cell type and stage) tumor facilitates precise targeting of the tumor Surgery generally plays no role in treatment of SCLC, although it may be curative in the rare patient who has a small Stereotactic: Using gamma knife or proton beam therapy to focal tumor without spread deliver multiple focused beams of high energy to the tumor Chemotherapy Temozolomide Alkylating agent Causes myelosuppression, GI disturbance Procarbazine Alkylating agent Causes myelosuppression, pulmonary effects, peripheral neuropathy Lomustine Alkylating agent Causes hepatotoxicity, neurotoxicity, GI upset Vincristine Vince alkaloid Causes peripheral neuropathy, intestinal bruises Lung Cancer Small cell lung cancer (SCLC) Chemotherapy Non–small cell lung cancer (NSCLC) Cisplatin / Alkylating agent Carboplatin GI toxicity, nephrotoxic, neurotoxic Risk Factors Radiation (x-ray) Docetaxel Anti-mitotic chemotherapy Aging (senescence) Gi toxicity Pollution (smog) Environment (radon gas) Etoposide (VP-16) Blood dyscrasia, GI toxicity Diseases (COPD) Radiation therapy Genetics (family history) Occupation (miners) Monitor for radiation pneumonitis Asbestos (silicates) Tobacco (smoking) Liver Cancer Smoke (second hand) Hepatocellular carcinoma most common type of primary liver cancer in Clinical Superior vena cava (SVC) syndrome adults Manifestations Pancoast syndrome Fibrolamellar carcinoma malignant hepatocytes enmeshed in lamellar Horner syndrome fibrous tissue Paraneoplastic syndromes Cholangiocarcinoma biliary epithelium Diagnostics Chest x-ray Hepatoblastoma family history of familial adenomatous polyposis CT or combined positron emission tomography Angiosarcoma industrial vinyl chloride (PET)–CT Cystadenocarcinoma malignant transformation of a cystadenoma Cytopathology examination of pleural fluid or sputum Bronchoscopy-guided or percutaneous Risk Factors Cirrhosis transthoracic biopsy Alcoholism Surgical lung biopsy Viral hepatitis TNM staging Fungal aflatoxin Obesity Clinical Pain over right upper quadrant of abdomen Manifestations tea colored urine and light gray stools appetite loss, unexplained weight loss ascites hard lump under the ribs weakness or fatigue fever, sometime accompanied by shivering yellowing of the skin or eyes 9 ㅤㅤㅤㅤ - Chapter Title ㅤㅤㅤㅤ - Main Lesson/Topic ㅤㅤㅤㅤ - Sub Lesson/Topic ㅤㅤㅤㅤ - Keywords ㅤㅤㅤㅤ - Functions ㅤㅤㅤㅤ - Synonyms Diagnostics Alpha – fetoprotein (AFP) Clinical Change in bowel habits CT scan, UTZ, MRI Manifestations Bleeding from the anus Biopsy blood in your stool Staging abdominal pain loss of appetite persistent lethargy and looking pale and jaundice Management unexplained weight loss Liver transplantation Milan criteria (one tumor < 5 cm or three tumors < 3 cm Diagnostics Colonoscopic biopsy without vascular invasion and alpha fetoprotein < 500 mcg/L) CT to evaluate extent of tumor growth and spread Genetic testing Chemotherapy CEA TNM staging Sorafenib Tyrosine Kinase inhibitor Causes thrombocytopenia, anemia, GI irritation, neuropathy Management Lenvatinib Antineoplastic Surgery GI irritation. Hypertension, fatigue, arthralgia Segmental resection with anastomosis Atezolizumab Humanized monoclonal antibody immune Abdominoperineal resection with permanent sigmoid checkpoint inhibitor colostomy Black tarry stool, edema, leg pain Temporary colostomy followed by segmental resection and anastomosis Permanent colostomy or ileostomy Surgical resection Chemotherapy 5-Fluorouracil (5-FU) pyrimidine analog Transhepatic arterial chemoembolization Capecitabine (Xeloda) nucleoside metabolic inhibitor combines the local delivery of chemotherapy to block tumor Irinotecan (Camptosar) topoisomerase inhibitor blood supply Cervical Cancer Colorectal Cancer Predominantly squamous cell cancer. Occurs most commonly Colorectal cancer is extremely common. Symptoms include in women ages 30 to 45 blood in the stool and change in bowel habits. Risk Factors Early marriage Risk Factors old age poor personal hygiene smoking nutrient deficiency processed meat low socioeconomic status alcohol weakened immune system low intake of plant-based ingredients smoking high body fat and obesity long term use of oral contraceptives genetics multiple sexual partners previous history of CRC or inflammatory bowel viral factors (HPV, HIV) disease early child birth type 2 diabetes male gender 10 ㅤㅤㅤㅤ - Chapter Title ㅤㅤㅤㅤ - Main Lesson/Topic ㅤㅤㅤㅤ - Sub Lesson/Topic ㅤㅤㅤㅤ - Keywords ㅤㅤㅤㅤ - Functions ㅤㅤㅤㅤ - Synonyms Clinical Unusual vaginal discharge Chemotherapy Manifestations bleeding after menopause Cisplatin / Alkylating agent unexplained weight loss Carboplatin GI toxicity, nephrotoxic, neurotoxic pain or bleeding after intercourse abnormal vaginal bleeding Paclitaxel (Taxol) Mitotic inhibitor pain in the legs Neutropenia, thrombocytopenia, peripheral pain the back neuropathy discomfort while urination and loss of bladder Bevacizumab VEGF blocker control HPN, proteinuria, arterial thrombosis Diagnostics Pap smear Radiation HPV testing punch biopsy Radiation therapy and chemotherapy (chemoradiation) if endocervical curettage there is spread to parametria or beyond cone biopsy LEEP Criteria: Presence of lymphovascular space invasion Depth of invasion Management Tumor size Surgery cone biopsy Nursing Management Hysterectomy Pelvic exenteration Maintaining Tissue Integrity Radical trachelectomy Stomatitis. Assessment of the patient's subjective experiences and an objective assessment of the oropharyngeal tissues and tooth are important for the treatment of oral mucositis. Radiation-associated skin impairment. maintaining skin integrity. cleansing the skin, promoting comfort, reducing pain, preventing additional trauma, and preventing and managing infection. Alopecia. Provide information about hair loss and support the patient and family in coping with changes in body image. Malignant skin lesions. cleansing the skin, reducing superficial bacteria, controlling bleeding, and reducing odor. protecting the skin from further trauma, and relieving pain. Promoting Nutrition Anorexia. Anorexia may occur because people feel full after eating only a small amount of food Malabsorption. Surgical intervention may change peristaltic patterns, later gastrointestinal secretions, and reduce the absorptive surfaces of the gastrointestinal mucosa, all leading to malabsorption. Cachexia. Assess patients who are at risk of altered nutritional intake so that appropriate measures may be instituted prior to nutritional decline. Relieving Pain Assessment. Assess the patient for the source and site of pain as well as those factors that increase the patient's perception of pain. Cancer pain algorithm. Various opioid and nonopioid medications may be combined with other medications 1o control pain as adapted from the World Health Organization three-step ladder approach. 11 ㅤㅤㅤㅤ - Chapter Title ㅤㅤㅤㅤ - Main Lesson/Topic ㅤㅤㅤㅤ - Sub Lesson/Topic ㅤㅤㅤㅤ - Keywords ㅤㅤㅤㅤ - Functions ㅤㅤㅤㅤ - Synonyms Education. Provide education and support to correct fears and misconceptions about opioid use. Decreasing Fatigue Assessment. Assess physiological and psychological stressors that can contribute to fatigue and use several assessment tools such as a simple visual analog scale to assess levels of fatigue. Exercise Pharmacologic interventions. Occasionally pharmacologic interventions are utilized. including antidepressants for patients with depression, anxiolytics for those with anxiety, hypnotics for patients with sleep disturbances, and psychostimulants for some patients with advanced cancer or fatigue that does not respond to any medication. Improving Body Image and Self-esteem Assessment. Identify potential threats to the patient's body image experience, Assess the patient's ability to cope with the many assaults to the body image experienced throughout the course of the disease and treatment. Sexuality, Identify physiologic, psychologic or communication difficulties related to sexuality or sexual function. Assisting in the Grieving Process Assessment. The nurse assesses the patient's psychological and mental status, as well as the mood and emotional reaction to the results of diagnostic testing and prognosis. Grieving is a normal response to these fears and to actual or potential losses. Monitoring and Managing Potential Complications Infection. The nurse monitors laboratory studies to detect any early changes in WBC counts. Septic shock. Neurologic assessments are carried out, fluid and electrolyte status is monitored, arterial blood gas values and pulse oximetry are monitored, and IV fluids, blood, and vasopressors are administered by the nurse. Bleeding and hemorrhage. Promoting Home and Community-Based Care Teaching patients self-care. Follow-up visits and telephone calls from the nurse assist in identifying problems and are often reassuring, increasing the patient's and the family's comfort in dealing with complex and new aspects of care. Continuing care. The responsibilities of the home care include assessing the home environment, suggesting modifications at home or in care to help the patient and the family address the patient's physical needs 12 ㅤㅤㅤㅤ - Chapter Title ㅤㅤㅤㅤ - Main Lesson/Topic ㅤㅤㅤㅤ - Sub Lesson/Topic ㅤㅤㅤㅤ - Keywords ㅤㅤㅤㅤ - Functions ㅤㅤㅤㅤ - Synonyms