Ch. 16 Cancer

August 25, 2010

Objectives

1. Explain the use of OR, chemo, radiation, and biologic & targeted therapy in the treating cancer

2. Discuss the appropriate nsg mgmt of patients receiving the above interventions

Terminology Review

• Benign VS Malignant• Carcinogens• Carcinomas VS Sarcomas• Protooncogenes VS Oncogenes• Hyperplasia VS Hypertrophy

Classification of Cancer

Tumors can be classified by–Anatomic site–Histology

• Grading severity–Extent of disease

• Staging

Grades of Abnormal Cells

–Grade 1• slightly different but well differentiated

–Grade 2–Grade 3–Grade 4

• Cells immature, primitive and undifferentiated

• Cell of origin is difficult to determine

Clinical Staging

–0: Cancer in situ–1: Tumor limited to tissue of origin; localized

tumor growth–2: Limited local spread–3: Extensive local and regional spread–4: Metastasis

Interpreting TNM

Breast cancer T2 N2 M0

Prostate cancer T3 N2 M0

Prevention

• C- change in bowel or bladder habit (colon cancer)

• A- a sore that doesn't heal on skin or on mouth

• U- unusual bleeding or discharge from rectum, bladder, or vagina

• T- thickening or lump in the breast tissue

• I- indigestion or difficulty swallowing

• O- obvious changes in a wart or mole (skin cancer)

• N- nagging cough or hoarseness (lung or throat cancer)

Detection

• Lifestyle habits to reduce risks• Avoid or reduce exposure to

known or suspected carcinogens

• Cigarette smoke, excessive sun exposure

• Eat a balanced diet • Exercise regularly• Obtain adequate rest• Regular health examination • Change perceptions of stressors • Learn to cope with stress• Enjoy consistent periods of

relaxation and leisure

• Surgery• Chemotherapy• Radiation• Biologic & Targeted Therapy

Medical Interventions

Goals–Cure–Control–Palliation

Collaborative Care of Cancer

Surgical therapy is used• Prophylaxis – removal of at risk tissue• Dx – Biopsy• Cure – attempts to remover all CA tissue• Control – debulks the tumor, does not cure• Determine efficacy of Tx – “second look”• Palliation – does not extend life, ↑ quality of life• Reconstruction - ↑ function/appearance

Surgery

• Purpose: To destroy CA cells with minimal exposure of the normal cells to the damaging actions of radiation

Radiation

• Mechanism of Action• Delivery methods

–Teletherapy (Externally)–Brachytherapy (Internally)

• Brachytherapy safety principles: ALARA, time, distance, and shielding

Radiation Tx for CA - cont

• Vary acc. to the side• Local skin ∆• ∆ taste sensations• Fatigue r/t ↑ energy demands• Inflammatory response r/t radiation

S/E of Radiation Therapy

• Teach accurate objective facts to help the clt to cope

• Do not remove markings• Administer skin care• Do not use lotions or ointments• Avoid direct sun exposure• Care for xerostomia• R/O bone fracture

Nsg Care/Mgmt: Radiation Tx

Chemotherapy

• Used to cure and/or add survival time• Some selectivity for killing cancer

cells over normal cells

S/E of Chemo

• Skin Δ• Hair• Intestinal tissues• Spermatocytes• Hematopoietic Sx Δ • Anxiety & sleep disturbances

Chemotherapy Administration

• Given by Oncology nurse• Checked by 2 nurses

• Cancer cycle: course of tx subj.to Nadir• Nadir: the time when bone marrow activity +

WBC are @ their lowest

Nsg Care/Mgmt: Chemotherapy

Major role of the oncology - Chemo• Drug therapy• Protection from infection• CAM

Tx issues with Chemo• Drug dosage• Drug schedule• Drug administration:

– Oral– IV: Central line– Spine– Interthecal

• Extravasation• Vesicants

Biologic & Targeted Therapy

• Biological response modifier: modify the clt biologic responses to tumor cells – 3 ways

• Targeted therapy: targeting specific cellular pathways that are important in tumor growth

Stem Cell Transplantation

• Source Hematopoietic SCT: BMT, PSCT, umbilical cord blood

• Types of HSCT: allogeneic (HLA), syngeneic, autologous

• Allows very high dose of chemo & radiation• Goal: eradicate tumor cell and/or clear the

marrow for engraftment of SCT• BMT VS PSCT

Main Oncology Nursing Outcome

• Management of fatigue, nausea and vomiting, prevention of infection, and return to usual function

Oncology Nursing Approach/Intervention/Measure

• symptom experience (dyspnea, fatigue, mucositis, nausea and vomiting, pain, peripheral neuropathy, and sleep-wake disturbances),

• functional status (nutritional status and return to usual functioning),

• safety prevention of adverse events (prevention of infection), and

• psychological distress (depression)

Oncology Emergencies

• IV access issues• Adverse response to chemo drugs• Sepsis• DIC

Collaborative Tx in Oncology Emergencies

• Prevention• Intravenous IV abx tx• Anticoagulants• Cyroprecipitated clotting factors

Questions & Answers

Resources

• Article: Put Evidence in Practice Nursing-Sensitive Patient Outcomes: The

Development of the Putting Evidence Into Practice Resources for Nursing Practice

• PodCast on Blackboard/Media Library– Managing stress – Advocating cancer clients and caregivers