oncologic management: chapter 12

Nonmyeloablative

-Also called mini-transplants; does not completely destroy bone marrow cells

Myeloablative

-Consists of giving patients high-dose chemotherapy and, occasionally, total-body irradiation

Allopurinol

-It lowers serum and uric acid levels -lessens N/V in chemo pts

hair loss (alopecia)

-cut hair before treatment -avoid hot hair tools -obtain wig BEFORE treatment starts -once no hair-protect scalp

Prophylactic surgery

-removes "at risk" tissue to prevent cancer development -family history can be an inquiry for this -breast cancer

assessments during BMT

-Nursing management during stem cell infusion consists of monitoring the patient's vital signs and blood oxygen saturation; assessing for adverse effects, such as fever, chills, shortness of breath, chest pain, cutaneous reactions, nausea, vomiting, hypotension or hypertension, tachycardia, anxiety, and taste changes; and providing strategies for symptom control, ongoing support, and patient education. -prepU says: Psychological status

palliative surgery

-To relieve or reduce intensity of illness; is not curative -only reason for surgery is to promote comfort

Superior vena cava syndrome

-Tumor can compress SVC -s/s:progressive dyspnea (shortness of breath), cough, hoarseness, chest pain, and facial swelling, JVD, edema above waist (bad), visible chest veins, ICP - obstructs venous circulation; or drainage of the head, neck, arms, and thorax. -Most often associated with lung cancer, SVCS is also associated with lymphoma, thymoma, and testicular, & breast cancer. -If untreated, SVCS may lead to cerebral anoxia, laryngeal edema, bronchial obstruction, and death. -tx: radiation, chemotherapy, Anticoagulant or thrombolytic therapy, stents

plant alkaloids/ taxanes (vincristine) -(idk if important)

-With repeated doses can cause cumulative peripheral nervous system damage with sensory alterations in the feet and hands. -described as tingling, pricking, or numbness of the extremities; burning or freezing pain; sharp, stabbing, or electric shock-like pain; -If unreported by patients or undetected, progressive motor axon damage can lead to loss of deep tendon reflexes, with muscle weakness, loss of balance and coordination, and paralytic ileus.

assessment finding indicates a chemotherapy-induced complication

-low serum potassium levels

Primary prevention

-reducing the risks of disease through health promotion and risk reduction strategies -examples: dietary= no read meat, lifestyle changes, avoid known carcinogens, where sunscreen, vaccinations

Extravasation r/t chemotherapy pts

-site looks red and swollen -The consequences of extravasation range from mild discomfort to severe tissue destruction -Unlike irritants, vesicants are agents that cause inflammation, tissue damage, and possibly necrosis of tendons, muscles, nerves, and blood vessels if extravasation occurs -Examples of commonly used agents classified as vesicants include dactinomycin, daunorubicin, doxorubicin, nitrogen mustard, mitomycin, vinblastine, and vincristine- ANTIDOTE MUST BE AVALIBLE WHEN GIVING CHEMO TREATMENT!!! -Vesicant chemotherapy should never be given in peripheral veins involving the hand or wrist-venipuncture site should be on the forearm area using a soft, plastic catheter- most chemo pt have ports- NEED TO WATCH FOR INFECTION -NEED TO DISCONTINUE THE IV IMMEDIATELY

Protecting Caregivers r/t pts with radioactive implants

-contact with the healthcare team is guided by principles of time, distance, and shielding to minimize exposure of personnel -assign client to appropriate room -post appropriate notices about radiation -staff members wearing dosimeter badges -make sure that NO pregnant staff members are assigned to patients care -PROHIBIT VISITS from children, pregnant women -visits only for 30 minutes a day -6-foot distance from radioactive sources -Patients with seed implants typically are able to return home because exposure is minimal

syngeneic

-donor and recipient are identical twins -Syngeneic transplants result in less incidence of GVHD and graft rejection; however, there is also less graft-versus-tumor effect to fight the malignancy.

tertiary prevention

-efforts focus on monitoring for and preventing recurrence of the primary cancer as well as screening for development of secondary malignancies in cancer survivors- efforts to monitor recurrence of cancer after diagnosis -Survivors are assessed for the development of second malignancies such as lymphoma and leukemi

malignant

-having cells or processes that are characteristic of cancer characteristics: infiltrate surrounding tissues, growth rate depends, Gains access to the blood and lymphatic channels and metastasizes to other areas of the body, tissue damage, eventually causes death unless can be controlled generalized effects: anemia, weakness, systemic inflammation, weight loss, and CACS

Tumor Lysis Syndrome (TLS)

-oncologic emergency with rapid lysis (rupture) of malignant cells (usually the result of chemotherapy or sometimes radiation ) -may occur 24 hours-7 days after antineoplastic therapy is initiated -develops when chemotherapy or irradiations causes the destruction of a large number of rapidly dividing malignant cells. intracellular contents are rapidly released into the bloodstream -s/s: non specific (a lot) -tx: use of allopurinol, urate oxidase, and/or alkalinization of the urine. -TLS is associated potential cause of acute renal failure

secondary prevention

-screening and early detection activities that seek to identify precancerous lesions and early stage cancer in individuals who lack signs and symptoms of cancer -examples: go get testicles/ breasts checked, pap smears, digital rectal exam (prostate exam), mammogram, PAP smear, colonoscopy, identify pt who might be at higher risk (smokers)

reconstructive surgery

-surgery performed to return function and appearance to a specific area of the body after removal of a tumor -example: breasts, skin cancer

autologous

-vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client -considered for patients with disease of the bone marrow who do not have a suitable donor or for patients who have healthy bone marrow but require bone marrow (pt with lymphoma and multiple myeloma) -A disadvantage of autologous is the risk that tumor cells may remain in the bone marrow despite high-dose chemotherapy (conditioning regimens).

blood transfusion (Angus made seem important in clinical)

1. confirm order 2.Check that patient's blood has been typed and cross-matched. 3.verify written consent 4.explain procedure and educate pt 5. preform pt assessment and obtain vitals 6. hand hygiene 8.Use appropriately sized intravenous cannula for insertion in a peripheral vein. A Use special tubing that contains a blood filter to screen out fibrin clots and other particulate matter. Do not vent blood container.

benign

- not cancerous; benign tumors may grow but are unable to spread to other organs or body parts, slow growth rate, does not spread by metastasize,

M in TNM

Mx -Distant metastasis cannot be assessed M0- No distant metastasis M1 -Distant metastasis

TNM

tumor-node-metastasis

leading causes of cancer death in men vs. women

men- prostate, lung, colorectal women- breast, lung, colorectal

biopsy (3 different types)

-3 types: excisional, incisional, and needle biopsy -Excisional biopsy: used for small, easily accessible tumors-many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues -Incisional biopsy: performed if the tumor mass is too large to be removed. In this case, a wedge of tissue from the tumor is removed for analysis. (**If the specimen does not contain representative tissue and cells, negative biopsy results do not guarantee the absence of cancer**) -Needle biopsy -performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney- usually done in outpatient facilities

Carcinogen

-A cancer-causing substance -10% to 12% of all cancers worldwide are linked to viral infections (HPV, HBV, EBV) -other cancer causing substances: bacteria, exposure to sunlight, radiation, chronic irritation or inflammation, tobacco carcinogens, industrial chemicals, and asbestos -Lifestyle factors (e.g., obesity, alcohol intake, poor diet, physical inactivity) were estimated to account for 16% of all cancer cases -Dietary substances that appear to increase the risk of cancer include fats, alcohol, salt-cured or smoked meats, nitrate- and nitrite-containing foods (leafy greens), and red and processed meats -AGE, GENDER, AND PARASITES ARE NOT CARCINOGENS!!

Antitumor antibiotics

-Bleomycin, dactinomycin, daunorubicin, doxorubicin, epirubicin, idarubicin, mitomycin, mitoxantrone, plicamycin END IN "CIN" -Cell cycle—nonspecific -remember Extravasation: need antidote, only IV in forearm -alter DNA synthesis

treatment for chemotherapy pt with N/V

-Corticosteroids, phenothiazines, sedatives, and histamines are helpful, especially when used in combination with serotonin blockers to provide antiemetic protection (example: metoclopramide and dexamethasone) antiemetic!! -Nonpharmacologic approaches: relaxation techniques, imagery, acupressure, Small frequent meals, bland foods, and comfort foods may reduce the frequency or severity of symptoms. -pharmacologic approach is 1st priority

Cytokines

-Cytokines are messenger substances that may be released by a cell to create an action at that site or may be carried by the bloodstream to a distant site before being activated -they are also called biochemical or inflammatory mediators. -These substances are produced primarily by cells of the immune system to enhance or suppress the production and functioning of other components of the immune system and thus can be used to treat cancer or the adverse effects of some cancer treatments. -Cytokines are grouped into families, such as interferons (IFNs), interleukins (ILs), and colony-stimulating factors.

Allogeneic

-From a donor other than the patient (may be a related donor such as a family member or a matched unrelated donor from the National Bone Marrow Registry or Cord Blood Registry) -DISADVANTAGE: Graft-versus-host disease (GVHD)-DEADLY-occurs when the donor lymphocytes initiate an immune response against the recipient's tissues (donors cells take over recipient body), To prevent GVHD- patients receive immunosuppressant drugs, such as cyclosporine, methotrexate, tacrolimus, or mycophenolate mofetil. EARLY S/S- a diffuse rash and diarrhea -The first 100 days or so after Allogenic is crucial for patients; the immune system and blood-making capacity (hematopoiesis) must recover sufficiently to prevent infection and hemorrhage.

Thrombocytopenia

-a decrease in the circulating platelet count, is the most common cause of bleeding in patients with cancer (epistaxis) -often results from bone marrow depression after certain types of chemotherapy and radiation therapy and with tumor infiltration of the bone marrow -Bacterial and viral infections may lead to early platelet destruction or impaired bone marrow production -Some medications (e.g., heparin, vancomycin) may cause bone marrow toxicity -early S/S are petechiae (pinpoint purple or red spots from minute hemorrhages under the skin) and ecchymoses (bruising)

myelosuppression

-bone marrow depression -resulting in leukopenia (decreased WBCs), neutropenia (decreased granulocytes), anemia (decreased red blood cells [RBCs]), thrombocytopenia (decreased platelets), and increased risk of infection and bleeding=Depression of these cells is the usual reason for limiting the dose of the chemotherapy. -S/S = fever associated with neutrophil count less than 1,500 cells/mm3 (pt needs to protect themself from infection= absolute isolation, no plants/fresh fruit, use styrofoam tray)

cervical cancer

-can stop PAP smears at age 66 -after hysterectomy testing is no longer needed -Pap smear need to be done every 3 years

cachexia syndrome

-cancer related anorexia, weight loss, anemia, marked weakness, taste alterations, altered metabolism -seeing humans ribs and bone thru skin

adjuvant therapy (idk if important)

Additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back example: Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate?

N in TNM

Nx -Regional lymph nodes cannot be assessed N0 -No regional lymph node metastasis N1, N2, N3- Increasing involvement of regional lymph nodes

T in TNM

Tx -Primary tumor cannot be assessed T0 -No evidence of primary tumor Tis- Carcinoma in situ T1, T2, T3, T4 -Increasing size or local extent of the primary tumor

formula for neutrophil count (ANC)

neutrophil count (ANC) = (segmented neutrophils % + band %) xWBC count example= (25% seg + 25% band) x6000 WBC = 3000 ANC

cardiac tamponade (idk if important)

oncologic emergency involves the accumulation of fluid in the pericardial space