Week 15 - Treatment Modalities PDF

# Week 15 - Treatment Modalities ## Chemotherapy * **Use of antineoplastic drugs** * Destroys normal and abnormal cells * Abnormal cells are the target, but normal cells are affected, too, like hair and sperm * **3 Categories** * **Neoadjuvant:** Used to reduce tumor size before surg...

# Week 15 - Treatment Modalities ## Chemotherapy * **Use of antineoplastic drugs** * Destroys normal and abnormal cells * Abnormal cells are the target, but normal cells are affected, too, like hair and sperm * **3 Categories** * **Neoadjuvant:** Used to reduce tumor size before surgery. * **Adjuvant:** Destroys any remaining tumor cells post-operatively. Done after surgery. * **Primary:** Used to treat some forms of leukemia or lymphoma. * **20-99% of tumor cells are destroyed** * **TAKE NOTE:** 100% eradication of tumor cells is impossible. The goal is to destroy enough tumor cells so that the remaining malignancy cells can be destroyed by the body's immune system. * **Active proliferating cells (most sensitive):** Cells that are actively multiplying and dividing are most sensitive * **Non-dividing cells (least sensitive):** Cells that are not actively dividing. * **Meaning of Active and Non-dividing cells:** The active cell is more likely to die than cancer cells not ready for cell division, but the non-dividing cells must be destroyed to prevent future cell proliferation. * **Route:** Oral and IV (common) * **Remember:** Chemotherapy is highly vesicant or cytotoxic. If you are to use IV chemotherapy, the largest blood vessel must be used. If it spills, it will burn your peripheral cells. This is called **extravasation**. ## Side Effects of Chemotherapy ### Hair - **Temporary Alopecia** - 14 days after chemo - Hair grows 3-6 months - **Mngt:** - Mild Shampoo - Wide-toothed comb - Wigs, hats, turbans, scarfs **Question:** Is hair loss a sign of cancer? The answer is no. Hair loss is a side effect of chemotherapy. Hair is rapidly growing and is affected by chemo. ### Mucus Membrane - **Stomatitus:** - Tagalog: *Singaw* - **Dysgeusia:** Bad taste in the mouth - **Loss of appetite or change in appetite** - **Xerostomia (Dry Mouth):** - **Mngt:** - Avoid hot, spicy, citrus, alcoholic mouthwash - Increase fluids - Non-sugar candies to prevent xerostomia ### Stomach Lining - **N&V:** - **Mngt:** - Anti-emetics 30 minutes before chemo * **Remember:** Your chemo drug affects the chemoreceptor trigger zone in the brain, making you vomit. Anti-emetics help prevent vomiting. ## Extravasation - IV chemo drugs are highly vesicant and if they infiltrate the surrounding tissues, it can lead to extravasation. - **Mngt:** Stop, leave the catheter in place, aspirate remaining drug, and notify the physician. ## Sperm - **(Aspermia/Sterility:** - **Mngt:** Cryopreservation. - Sperm is rapidly growing and can be killed off by chemo, leading to aspermia and sterility. ## Bone Marrow Depression - **Pancytopenia:** Low WBC, RBC, and platelets, leading to infection, anemia, and bleeding - **Mngt:** - Infection control - Bleeding precautions ## Chemotherapy Drugs ### Mechanism of action is classified in relation to the cell cycle * **Cell-cycle specific agents:** These drugs act during specific phases of the cell cycle. * They destroy cells specifically in the S-phase by interfering with DNA replication. * **Vinca Alkaloids** * The drugs act specifically in the M-Phase by inhibiting mitosis. They specifically inhibit the mitotic spindle formation. * **Example:** Vincristine and Vinblastine. * **Anti-metabolites** * They act in the S-phase. - **Example:** Fluorouracil and Methotrexate. * **Cell-cycle nonspecific agents:** They act independently of the cell-cycle phases. * These drugs can act anywhere in the cell cycle and have a prolonged affect on the cells, leading to cell damage or death. * **Alkylating Agents** - **Example:** Cyclophosphamide and Busulfan. * **Antitumor-antibiotics** - **Example:** Bleomycin, Daunorubicin, Doxorubicin. ## CI: - Renal failure because of its slow renal excretion. ## SE: * **Neurologic** * Tingling * Numbness * Constipation * Paralytic ileus * **GIT** * **Alkylating Agents** * **Nitrogen Mustard:** SE = bone marrow suppression, N&V, alopecia, gonadal suppression, renal toxicity, and hemorrhagic cystitis. * **Cyclophosphamide:** WOF = hemorrhagic cystitis. Mngt = increase oral fluids to help prevent bladder complication. * **Nitrosureas (Example: Carmustine, Lomustine, Streptozocin):** SE = suppresses the immune system, especially thrombocytopenia, N&V, pulmonary, hepatic, and renal damage. * **Alkylating-like (Example: Busulfan):** WOF = increased uric acid. * **Carboplatin and cisplatin:** WOF = ototoxic (hearing impairment) and nephrotoxic (kidney impairment) * **Anti-metabolites (Example: Hydroxyurea):** They act in the S-phase. * **Hormonal Drugs (Example: Finasteride and Saw Palmetto):** * W.O.F = Gynecomastia (enlarged breast in males) and viriltization (development of male traits in females) * **Antitumor-antibiotics (Example: Bleomycin, Daunorubicin, Doxorubicin):** * WOF = Decreased immune response, N&V, alopecia. **Doxorubicin:** *Cardiotoxicity (heart failure), dysrhythmias, and cardiomyopathy.* **Antidote:** Leucovorin or Folinic acid. ## Radiation Therapy - **Types of radiation therapy:** * **Teletherapy (External Beam Radiation):** Most common type. It targets abnormal cells with x-ray machines. - **The radiation is administered with a Linear Accelerator Radiation Therapy (LART) machine.** - **Done in a radiation room.** - **Patients are not radioactive when they leave the room.** - **Care:** The radiation is placed in front of where the tumor is (For example, if it is in the breast, markings are placed on the breast and the radiation is aimed at those markings). **W.O.F ** = Leukopenia * **Brachytherapy:** Involves placing radiation sources inside the patient's body (usually needles or catheters) - **It is placed in body cavities where the tumor is (guided by ultrasound, CT scan, or MRI.)** - **Types:** * **Unsealed (AKA Systemic Radiotherapy/Radiopharmaceutical Therapy):** - **Examples:** Iodine 131 (treatment for thyroid cancer), Radium 223 chloride (targets prostate cancer with bone metastases) - **Route:** IV, oral or IM. - **How It Works:** The isotopes enter the body fluids and are eliminated via excreta. These are not radioactive after 48 hours. - **Source:** Usually given orally or IV and is eliminated in the body in 48 hours. * **Sealed Implants (Intracavitary Cesium):** - **Example:** Used for treatment of gynecological cancer. - **Application Time:** Patient should never receive treatment for more than one shift. - **Used to Treat:** Gynecological cancer, tumors of the cervix. ## Safety Principles * **Time:** Should be limited to one shift per day. * **Distance:** Stand at least 6ft from the bed. * **Shielding:** Lead apron is very important. ## Nursing Management: - **Room:** Private room with private bathroom. **Post radiation precautions required outside the room.** Pregnant women should not enter. - **Activity:** **Complete Bedrest (CBR) with no bathroom privileges.** - **Urine:** Insert a catheter or carefully flush the bladder 3 times. - **Diet:** Low residue, low fiber diet. - **Equipment:** Can be removed every time. Only one patient per shift. - **Bed linens:** Keep linens in place until the source is removed. The bed linens may become radioactive. - **RN:** Wear a dosimeter badge. Call the radiation oncologist if it dislodges. ## Screening Tests ### A. Breast Self Examination - **Starts at 20 years old (monthly)** - Normal breast tissue changes due to the menstrual cycle, pregnancy, onset of menopause, and hormonal therapy. - **Timing:** 5-7 days after menstruation (breast is less tender). - **Exam positions:** - Standing in front of a mirror - Lying with a pillow under the shoulder - Other positions as recommended by your physician. It's easier to find a mass when your breasts are wet. - **Palpation** - Palpate the breast using your finger pads. The right hand should be used to examine the left breast, and vice versa. - Palpate in these patterns: - Horizontal (wedge) - Vertical - Circular - Pinch the nipple (look for discharge). - Also examine the midaxillary, clavicle, and sternum. ### B. Mammography - **Starts at age 40 (and older)** - **Recommended for:** - Women between the ages of 40-44 should have the opportunity to start annual breast cancer screenings. - Healthy women should have annual mammograms starting at age 45, until age 54. - **What is used:** Two metal plates compress the breast horizontally and obliquely. - **Procedure:** The breast is mechanically compressed with metal plates from top to bottom or craniocaudal view and from side to side or mediolateral oblique view. - **Discomfort:** There may be discomfort due to maximal compression, which is needed for proper visualization. - **Uses:** To detect small abnormalities that could suggest malignancy or benign disease. - **Contraindications:** Pregnancy and breast implants. - **Mngt:** Avoid deodorant or talcum powder on the day of the exam to prevent false positive results. ### C. Pap Smear - **Starts at age 18 or when sexually active, then annually.** - **Uses:** To see abnormalities in the cervix and detect cervical cancer. Can also be used to test for HPV. - **HPV** (Human Papillomavirus) is the primary causative agent of cervical cancer. - **Recommendation:** Annual Pap smears and if three consecutive tests are negative, the exam can be done every three years. - **Mngt:** Avoid douching or sexual intercourse before the test, as this might give a false negative result. ### D. Testicular Exam - **Monthly:** The best time for self-examination is right after a warm shower, when the scrotum is moist and relaxed. - **Procedure:** - Lift each testicle and feel for any lumps. The normal testicle feels like a smooth egg, firm, but not hard. - Gently roll the testicle between your thumb and fingers to feel for any abnormalities. - If any bumps or changes are found, see your doctor. ### E. Digital Rectal Exam (DRE) - **Starts at age 40 and older.** - **Procedure:** A lubricated gloved finger is placed in the rectum to assess the size, shape, symmetry, and consistency of the prostate gland. - **Exam for males:** Bending forward, leaning over the examination table, Sims position or lithotomy. - **Exam for females:** Lithotomy - **Exam considerations:** - Also, assess for tenderness and the presence of any nodules. - **Men:** Check the prostate gland. - **Women:** Check the uterus and hemorrhoids. - **Uses:** To detect colorectal cancer. ### F. Sigmoidoscopy - **Starts at age 50 and older.** - **Recommendation:** Every 3-5 years. ### G. Tumor Markers * **PSA (Prostate Specific Antigen):** - This is a protein produced by normal and malignant cells of the prostate glands. - It measures the PSA levels in the blood. - Elevated PSA levels may indicate prostate cancer. - Note: Benign conditions (prostatitis and benign prostatic hyperplasia [BPH]) can also cause elevated PSA levels. But there is no evidence that prostatitis or BPH cause prostate cancer. However, it is possible that they might encourage the development of prostate cancer. * **PAP (Prostate Acid Phosphatase):** - An enzyme released by prostate cells. - Elevated PAP levels suggest advanced prostate cancer. - Is usually used in conjunction with PSA levels to assess the prognosis of prostate cancer. * **ALP (Alkaline Phosphatase):** - An enzyme released by the liver. - Elevated levels may indicate liver damage or increased bone cell activity. - If ALP levels are high due to liver damage or increased bone cell activity, it might indicate metastasis of prostate cancer. * **CA 125 (Cancer Antigen 125):** - A protein measured in the blood that may indicate: - Ovarian cancer - Fallopian tube cancer - Endometrial cancer - Note: CA 125 levels can also increase during menstruation or if benign conditions like uterine fibroids are present. * **CEA (Carcinoembryonic Antigen):** - A protein released by colon cancer cells. - Elevated levels may indicate: - Colorectal cancer - Cervical cancer - Note: CEA levels can be elevated in other conditions. * **AFP (Alpha Fetoprotein):** - A protein found in the blood. - Elevated levels can be a sign of: - Testicular cancer - Hepatocellular carcinoma - Cancer of the stomach, pancreas, biliary tract, and lungs. * **HCG (Human Chorionic Gonadotropin Hormone):** - A protein released by: - Cancer in the uterus - A type of gestational trophoblastic disease called choriocarcinoma. * **CA 19-9 (Cancer Antigen 19-9):** - A protein found in blood. - Elevated levels often indicate: - Pancreatic Cancer - Cancer in the bladder, lung, colon, or stomach. * **CA 15-3 (Cancer Antigen 15-3):** - A protein found in blood. - Elevated levels often indicate: - Breast Cancer - Can be produced by both normal and cancerous breast cells. * **NSE (Neurospecific Enolase):** - A substance produced by certain types of tumor cells. - Elevated levels may indicate: - Neuroblastoma (cancer of the nerve cells) * **Neuroblastoma:** - A type of cancer that usually starts in the part of the nervous system that controls involuntary actions (such as heart rate, breathing, and digestion). ### H. Biopsy - **Definitive test for cancer.** - **Histological proof of cancer.** - **Procedure:** Suspected tissue is removed from the patient's body and examined under a microscope. **Types:** - **Fine Needle Aspiration Biopsy (Aspiration):** A thin, hollow needle is attached to a syringe and used to collect a small sample tissue from the suspected area. It is then examined under a microscope. - **Incisional (Wedge Tissue):** The surgeon removes just a portion of the tissue in the affected area. - **Excisional (Entire):** The entire suspected area of neoplasm is removed. This procedure is commonly used for changes on the skin and for small, easily removable lumps under the skin.