Cancer Bring up T15-7 & 15-19 in book Biology ● Protooncogenes ○ >Oncogenes ● Tumor suppressor genes ● Oncofetal antigens ○ ○ Carcinoma embryonic antigens (CEA) Alpha-fetoprotein (AFP) ● Acquired mutation v genetic Stages ● Initiation ○ ○ Mutation carcinogens ● Promotion ○ ○ Reversible Lifestyle changes ● Progression ○ ○ ○ Growth and spread Tumor angiogensis Blood or lymph spread Immune response to CA Classification ● Benign v malignant ● Anatomic site/tissue of origin ● Histologic appearance (differentiation) ○ ○ Well differentiated = looks like tissue of origin Undifferentiated = more like stem cells (bad) ● ● ● ● ● Stage 0: cancer in situ Stage I: tumor limited to the tissue of origin; localized tumor growth Stage II: limited local spread Stage III: extensive local and regional spread Stage IV: metastasis Diagnosis ● ● ● ● Emotional time Cytology and biopsy Blood work and tumor markers imaging Chemo ● Good for actively replicating cells ○ Does not work in resting phase ● Staffing considerations for pregnant nurses ○ ○ Pass in report if patient is 2 weeks or less out from chemo cycle Care with body fluids ● Chemo certification ○ ○ ○ ○ May need premeds ■ Tylenol ■ Ca+ gluconate Antidotes if infiltrates Policy if infiltrates Double checked like blood ● Regional chemos Radiation Brachytherapy ● See policy for nursing and family/patient indications and precautions ● Some are removed and some radioactivity wears off Chemo and Radiation Side Effects and Nursing implications ● Skin and hair ○ ○ ● Bone marrow suppression ○ ○ ○ ● Anemia Bleeding Immunocompromised ■ Nadir timing after chemo, neurtropenic fever , ANC <1000 ● Neupogen or neulasta ● Neutropenic precautions GI upset and dec. appetite ○ ○ ● ● Erythrodyethesia syndrome (some chemos) ■ Numbness & tingling and ulcers palms of hands and feet Desquamation (radiation only) ■ Wet - wound care ■ dry - unscented lotions ■ Mucus membranes - bland, warm drinks and soft foods Premedicate with antiemetic, BDR gel seabands, Dexamethasone snacks, high cal foods, ensure, marinol Fatigue and depression and chemo fog (brain) Hear and lungs ○ ○ Inflammation from chemos or radiation ■ Sob & pulmonary effusion, pericarditis & dysrythmias ■ Penumonitis can occur 1-3 months after Anthracyclines - QTC prolongation Treat with topical pain relievers and lidocaine, protect with emollient creams Immunotherapy ● Boosts own immune system or blunts tumor ability to evade ● Less side effects…more flu like ○ Can depress bone marrow but transient and less severe ● Protein kinase (domino chain creates end result) inhibitors & cytokine modifiers (messaging system) ● See notes for specific side effects of classes Hormone Therapy ● Estrogen/testosterone blockers and modulators ● Steroids for inflammation ● Growth factors ○ ○ Neupogen Erythropoeitin Stem Cell Transplant ● Bone marrow and peripheral blood ● Self or donor ● Donor ○ ○ ○ ○ May get colony stimulating factors Take sample in OR for bone marrow Multiple blood sample collections if peripheral Irradiate sample to clear ● Recipient ○ ○ ○ ○ Myeloablate Infuse donor cells Stem cells migrate to bone marrow and proliferate Super immunocopromised in interim ● Graft v host reaction Complications of CA itself ● TLS ○ ○ ○ ○ K+ Uric acid Phosphorus AKI ● Paraneoplastic syndromes ○ ● ● ● ● Blood clots and SIADH Obstructions and obstructive shock Cachexia from TNF release Pain Depression and coping Nursing Interventions to help patient cope • Assist the patient in maintaining usual lifestyle patterns. • Maintain hope, which is the key to effective cancer care. Hope varies, depending on the patient's status—hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, hope to achieve meaningful goals, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer and cancer care. • Be available and continue to be available, especially during difficult times. • Exhibit a caring attitude. • Listen actively to fears and concerns. • Help provide relief from distressing symptoms. • Provide essential information regarding cancer and cancer care that is accurate and establishes realistic expectations about what the patient will experience. • Maintain a relationship based on trust and confidence. Be open, honest, and caring in the approach. • Use touch to exhibit caring. A squeeze of the hand or a hug may at times be more effective than words. Survivorship and Long Term Comps of Chemo ● ● ● ● Emotional, role strain, finances Brush with death Treatment can increase chances of other cancers later Later or lasting effects of chemo ○ ○ Heart, lung, liver, kidney Osteoporosis, cardiac toxicities, cataracts, endocrine dysfunctions, hepatitis, joint pains, strictures and fistulas….
