Oncology

OncologyJanna Wickham RN MSNLSSC Spring 2014

Statistics & Definition Cancer

1500 people die every day from cancer 1 out of 4 deaths is caused by cancer Lung cancer 28% of all deaths

Cancer Any age, gender, ethnicity, or geographic region Normal cells change and acquire malignant properties

Risk Factors Heredity

Age

Gender

Poverty

Risk Factors Stress

Diet High fat Low fiber

Occupation

Infection Virus (Epstein –Barr for example)

Tobacco Use

Risk Factors Alcohol Use

Recreational Drug Use

Obesity

Sun Exposure

Figure 14–1 Interaction of factors that promote cancer.

Cell Cycle G0

Gap 1 (G1) Synthesis (S) Gap 2 (G2) Mitosis (M)

Differentiation

Hyperplasia Under normal DNA control

Metaplasia

Dysplasia Abnormal variation in size, shape, and appearance

HPV causes dysplasia of the cervix

Anaplasia

Theories of Carcinogenesis Cellular Mutation

Carcinogens cause mutations in cellular DNA Oncogene

BRCA1 BRCA2 Tumor Suppression Genes

Suppress oncogene

p53

Carcinogens Genotoxic

Directly alter DNA

Promotor Substances Adverse biologic effects

Cytotoxicity Hormonal imbalances Altered immunity Chronic tissue damage

Carcinogens Viruses

Drugs and Hormones

Chemical agents

Physical Agents

Metastasis Blood or lymph

Target organs

Cell morphology

Immune response

Types of Neoplasms

Physiologic Effects of Cancer Disruption of Function

Hematologic Anemia Neutropenia Thrombocytopenia

Infection Tumor necrosis

Physiologic Effects of Cancer Hemorrhage

Anorexia-Cachexia Syndrome Unexplained rapid weight loss Emaciation Malnutrition Loss of energy

Paraneoplastic Syndrome Endocrine related

Physiologic Effects of Cancer Pain

Acute

Chronic

Physical Stress

Psychological Effects of Cancer Stress

Diagnosis Assess

Lab Diagnostic workup Biopsy

Classification

Cytologic Examination Exfoliation from an epitheleal base

Aspiration of fluid from Body cavity Blood

Needle aspiration of solid tumors

Grading/Staging Differentiation – level of functional maturity Grade 1 – Grade 4

Grade 1 most like parent cell Grade 4 least differentiated

TNM –used to stage solid tumors

Example 45 year female with lobular breast cancer Tumor 0.8cm 1 positive axillary lymph node No evidence of metastasis

Laboratory Tests Table 14-8

CBC Normal Abnormal Critical

Nadir The nadir is the time point after cancer treatment when your

blood counts (white blood cell, hemoglobin and platelets) are at their lowest

complications of low counts; including infection risk (due to low white blood cell count), bleeding risk (due to low platelet count), poor oxygen delivery to tissues which can cause fatigue, chest pain, shortness of breath, dizziness (due to low hemoglobin, also called anemia)

The nadir most commonly occurs 10-14 days after chemotherapy treatment, but this time can vary depending on the chemotherapy

Neutropenic Precautions

https://www2.ons.org/ClinicalResources/media/ons/docs/research/outcomes/infection/quickview.pdf

Thrombocytopenia <100,000 How to take care of yourself if your platelets are low: Watch for unexplained bruises Try not to bump or cut yourself. Be careful with knives and other sharp instruments. If you develop bleeding, place pressure over the area for 5–10 minutes with ice. Use a soft tooth brush for mouth care. Do not use aspirin or products Take any steroid medications such as prednisone or decadron with milk, food, or an

antacid A platelet transfusion may be necessary if platelet count is below 20,000 or bleeding Use an electric shaver rather than blades to shave with. Avoid constipation—when straining to have a bowel movement. Do not use suppositories, enemas, or a rectal thermometer. Avoid intra-muscular (IM) injections if possible. Monitor for bleeding with intercourse. Try to avoid blowing your nose too hard or coughing too hard.

Tumor Markers Antigens

Hormones

Proteins

Enzymes

Imaging Scans

Computerized tomography Has the tumor metastasized

MRI Nuclear Imaging

Bone metastasis Thyroid cancer

PET Metastasis

End of Day One

Pharmacologic Management

Chemotherapy Alkylating Agents Antimetabolites Antitumor Antibiotics Mitotic Inhibitors Hormones and Hormone Antagonists

Cell Cycle Specific Table 14-10

Toxic Reaction

Miotic Inhibitor Vincristine Depression of deep

tendon reflexes (motor weakness)

Paresthesias (pain and altered sensations)

Alkylating Agent busulfan- Myleran Bone Marrow Failure Assess for infection

Venous Access Devices PICC

Port

Tunneled Catheter

Nursing Management of Patients Receiving Chemotherapy Bone Marrow Suppression

Gastrointestinal Effects Stomstitis Nausea & Vomiting

Alopecia

Non-pharmacologic Management Surgery

Non-pharmacologic Management Radiation External(teletherapy)

Adverse effects Nursing Care

Internal (brachytherapy) Box 14-6 Safety principles Adverse effects Nursing care

Bone Marrow

Lead shieldDosimeterLimit time

Non-pharmacologic Management Biotherapy(Immunotherapy)

Monoclomal antibodies Cytokines Natural Killer Cells

Non-pharmacologic Management Photodynamic Therapy

Adverse Effects Nursing Care

Non-pharmacologic Management Bone Marrow and Stem Cell Transplants Complementary Therapies

Oncologic Emergencies Superior Vena Cava Syndrome Sepsis & Septic Shock Tumor Lysis Syndrome Hypercalcemia

Physiologic Needs in Advanced Stages of Cancer Comfort

Round the clock and breakthrough pain management Nutrition Elimination Mobility Hygiene

Supportive Care Grieving Fear Caregiver Support

Nursing Diagnosis Anxiety

Disturbed Body Image

Anticipatory Grief

Nursing Diagnosis Risk for Infection

Intervention to avoid large crowds

Risk for Injury

Imbalanced Nutrition: Less than body requirements related to anorexia

Nursing Diagnosis Impaired Tissue Integrity

Palliative Care

Terminal Diagnosis Comfort care Family Care

Pediatric Considerations Effects the whole family Lifespan considerations