oncology

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ONCOLOGY
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BASIC CONCEPTS

• Cancer is the second leading cause of death in
  the United States (heart disease is the first).
• One in three Americans will develop some kind of
  cancer, with lung cancer having the highest
  mortality rate.
• The two most common cancers in men are cancer of
  the lung and the prostate in women they are the
  breast and the colon.

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Cancer Cells

• Normal cells are governed by regulatory
  mechanisms that control their growth and
  reproduction.
• Cancer cells have lost these control mechanisms
  and grow uncontrollably.
• Cancer cells are also not differentiated as well
  as normal tissue and thus cannot perform the same
  functions.
• These cells are not as easily attached or
  encapsulated as normal cell groups and can
  metastasize to distant areas of the body

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Cancer Risk Factors

• Risk factors for developing cancer are multiple,
  although environmental factors are thought to be
  responsible for 6090 percent of cancers.
• Known carcinogens include radiation chemicals,
  such as nitrites, asbestos, vinyl chloride, and
  DES cigarette smoke and hormones.
• Certain viruses have been linked to some types of
  cancer.
• Individuals who are immunosuppressed are more
  likely to develop cancer.
• However, none of these completely rule out
  genetic links as well as dietary and
  psychological factors

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Preventive Measures

• A. Dietaryavoid obesity, decrease fat intake,
  increase fiber, increase consumption of vitamins
  A, C, and E, preferably from natural sources,
  such as fruits and vegetables.
• B. Carcinogen Exposureavoid smoking and exposure
  to asbestos, chemicals, and radiation. Obtain
  adequate rest and exercise to decrease stress.

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CANCER DIAGNOSIS

• A. Early Detection
• 1. Screening/Self-Monitoring
• a. Pap smearcervical cancer
• b. Breast self-exam, mammogrambreast cancer
• c. Colonoscopycolon cancer
• d. PSA levelprostate cancer
• e. Skin inspectionskin cancer

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CANCER DIAGNOSIS

• 2. Seven Warning Signs of Cancer (CAUTION)
• CChange in bowel or bladder habits
• AAny sore that does not heal
• UUnusual discharge or bleeding
• TThickening or lump in breast or elsewhere
• IIndigestion or difficulty swallowing
• OObvious change in wart or mole
• NNagging cough or hoarseness

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B. Identification, Diagnosis, and Staging

• Characteristics of Types of Neoplasms
• Benignusually encapsulated, localized, and grow
  slowly
• b. Malignantundifferentiated margins, will grow
  and metastasize
• 2. Types of Malignant Neoplasms

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2.Types of Malignant Neoplasms

• a. Carcinomaarise from epithelial cells (those
  covering the internal and external surfaces of
  the body) and are usually solid tumors. Examples
  skin, stomach, colon, breast, rectal
• Squamous cell carcinomasurface epithelium
• (2) Adenocarcinomaglandular or parenchymal
  tissue
• b. Sarcomaarise from connective tissue such as
  bone or muscle
• c. Lymphomaarise from lymphoid tissue
  (infection-fighting cells)
• d. Leukemias and myelomasarise from
  blood-forming organs

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3. Diagnosis

• a. Laboratory and imaging tests usually first
  identification of a problem
• b. Tissue biopsy is the definitive means of
  diagnosis

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4. Cancer Staging

• Identifies the severity of the disease by
  describing the extent of metastasis.
• TNM system
• (1) T primary growth
• (2) N lymph node involvement
• (3) M metastasis
• T1 to T4. T1 is the smallest tumor T4 is the
  largest
• N0 to N. N0 is no node involvement N4 is
  increasing number of nodes involved
• M0 or M1. M0 is no metastasis M13
  indicates increasing degrees of metastasis
• Stages 0IVseverity of cancer increasing
  numbers indicate increased size, nodal
  involvement, metastases

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CANCER TREATMENT

• A. Typesdepend on protocols for different types
  and stages of cancer, as well as the goals of
  treatment.

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1. Surgery

• used either to reduce the size of a tumor
  (palliative surgery), or to completely remove a
  primary localized tumor.
• For localized disease, it has the highest
  probability of cure. However, the surgery may
  cause functional or cosmetic problems.
• a. Preoperative care
• (1) Help the patient attain optimum health status
  prior to the surgery
• (2) Provide emotional support to patient and
  family
• b. Postoperative care
• Traditional care for postoperative patient
• Provide emotional support and accurate
  information
• c. Help patient recover and continue with
  follow-up treatment if needed
• Make appropriate referrals for post-discharge
  follow-up
• Encourage family involvement

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2. Radiation

• May be internal or external, uses ionizing
  radiation to destroy cancer cells. Effects are
  not limited to cancer cells all exposed cells
  are affected, and rapidly dividing cells are most
  susceptible. Systemic effects are related to
  cellular breakdown products.
• a. External radiationhigh-energy beams directed
  to the affected area. Irradiated cells lose the
  ability to reproduce. Side effects include
  fatigue, nausea and vomiting, skin irritation,
  scaling, erythema, and dryness

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b. Nursing Interventions

• Explain procedure and expected side effects
• Promote high protein, carbohydrate, and fat-free,
  low-residue diet increase fluids
• (3) Administer medications Compazine
  (anti-emetic), and Lomitil (for diarrhea)
• (4) Provide skin care, avoiding lotions and soap.
  Do not expose skin to sunlight.

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c. Minimizing risk to health-care workers

1. Internal radiation is more dangerous than
   external.
2. The more time spent exposed to the radiation
   source and the closer to the source, the greater
   the exposure.
3. Pregnant women and persons under 18 should not
   visit or care for a patient with a radioactive
   implant.
4. Mark the patients room with radiation safety
   precautions.

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d. Internal

• Radioactive material is injected or implanted
  into the patients body for a period of time
• (1) Sealedradioisotope is enclosed in a
  container body fluids should not become
  contaminated
• (a) Precautions still needed, even though implant
  is sealed
• (2) Unsealedradioisotope is not enclosed. It
  circulates in the body and contaminates body
  fluids.
• (a) Administered orally (liquid). High-risk
  period is during first four days

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• (3) Side effectsacute are right after chronic
  are months or years after treatment
• Alopecia (hair loss), mouth dryness, mucositis,
  esophagitis (mouth and throat inflammation),
  nausea and vomiting, erythema, dry and wet
  desquamation
• Extent of side effects are influenced by the body
  site irradiated, the radiation dose, the size of
  the site irradiated, and the method of radiation
  therapy

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3. Chemotherapy

• Drugs can kill the cancer cells, but also harm
  rapidly dividing cells.
• Different drugs attack cancer cells at different
  stages of their life cycle, thus combinations may
  be more effective than one type alone.
• It is usually used when cancer cells have
  metastasized, when the risk of recurrence is
  high, or as a palliative measure to slow the
  growth of a tumor.

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a. Types of chemotherapy

• Cell cycle specific (act on a specific stage of
  the cell reproductive cycle)
• Antimetabolitesmethotrexate, 5-fluorouracil
• Plant alkaloids - vincristine, vinblastine
• (2) Cell cycle nonspecific (act during any
  phase of reproductive cycle, some will work in
  the resting phase). These agents are dose
  dependent and are more toxic to normal tissue
  than others.
• Alkylating agentscytoxan, cisplatin
• Antitumor antibioticsadriamycin, bleomycin
• Nitrosoureasstreptozocin, methyl CCNU, BCNU

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• (3) Hormonesaffect the growth hormonal
  environment
• (a) Alter the growth of hormone-dependent tumors
  (b) Antihormones(Tamoxifen) block tumor growth
  by depriving the tumor of hormones it needs to
  grow

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Side Effects of Chemotherapy

1. Alopecianursing interventions include applying
   an ice cap and scalp tourniquet to reduce the
   amount delivered to hair follicles.
2. Nausea, vomiting, and anorexiathe nurse can
   adjust to altered food preferences, administer
   antiemetic drugs (Reglan), offer high-calorie and
   protein supplements.

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• c. Leukopeniadecreased white blood cells,
  suppresses the patients immune function
• d. Platelet suppressionif below 50,000, the
  patient is prone to bleeding gums, nose, and easy
  bruising. The nurse should suggest the patient
  use a soft toothbrush and take care with trimming
  nails and any other activity that might lead to
  abrading the skin.

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Safe Administration of Chemotherapy

1. Special training is necessary before
   administering chemotherapy.
2. Surgical latex gloves and a long-sleeved gown
   should be worn.
3. Label all prepared drugs, and double bag them
   before transport.
4. Dispose of all materials in hazardous waste
   containers.
5. Have materials ready to clean up an accidental
   spill.

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NURSING CARE

• A. Patient comfort
• Nausea
• Progressive relaxation, imagery, and antiemetic
  medications are helpful.
• Antiemetics should be administered before
  administration of chemotherapy.
• Patients who are on chemotherapy drugs that
  cause nausea and have a long half-life should be
  given around-the-clock medications for up to four
  days after treatment has ended

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2. Pain

1. Pain medications are best given around the clock.
   Waiting until a patient requests it is too late
   for continuing effectiveness.
2. Pain medications should be given before invasive
   procedures.
3. Patients on high doses of narcotics for extended
   periods of time may develop tolerance and need
   higher doses than patients who are receiving
   periodic therapy.

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B. Patient support

1. Provide emotional support by talking with the
   patient about their fears or questions.
2. Always be honest with the patient so they may
   discuss things openly.
3. Support the patients family as they go through
   the grieving process.
4. Times of increased patient stress are when they
   are diagnosed, when they enter the hospital, and
   when they are released from the hospital.
5. Denial is a common initial reaction to the
   diagnosis. It is a defense mechanism needed to
   give the patient time to get ready to confront
   the implications