Cancer Complications

Question 1

What do we need to know about the cancer to provide proper care?

Answer 1

• what kind of cancer they have and where it is?
• where has it metastasized?
• what type of treatment are they receiving?
• What type of chemotherapy, when was your last treatment?

Question 2

Cachexia

Answer 2

• most common clinical manifestation of cancer.
• dramatically higher risk of mortality associated with cancer if present at diagnosis
• loss of weight, muscle atrophy, fatigue, weakness, and a significant loss of appetite in someone who is not trying to lose weight
• positive risk factor for death
• assess patient for weight loss

Question 3

Control of cancer

1. surgery
2. chemotherapy
3. radiation
4. biotherapy

Answer 3

1. diagnostic, preventative, eliminative, reconstructive, or palliative
2. exerts chemical influence on cellular division
3. local destruction of cancer cells ; adjuvant (supplements surgery) and palliative

Question 4

Surgery

Answer 4

• cure, control (to control the spread of the cancer) palliation (for comfort, cannot reverse underlying condition)
• mastectomy
• colectomy
• thyroidectomy
• the removal of a primary cancerous tumor is the most common operation to try and cure or control cancer. (almost always disrupts the structural integrity of the cancer or BV feeding cancer which can disperse the cancer throughout the body or seed in chest or abdomen. - aim to shrink tumour before removal

Question 5

Chemotherapy

Answer 5

• directly and indirectly by interrupting the cell cycle and disrupting the reproduction of cells. Different cycles of chemo are used because cells are at different points of reproduction.
• systemic. prescribed to shrink cancer, prevent cancer from returning, as a therapy on its own, or to kill cancer that has spread to other areas - travels in blood.
• combination used because it disrupts the cell cycle at different points.

Question 6

Radiation and why its used.

Answer 6

• local treatment. makes breaks in DNA inside cell. keep cancer from frowning and dividing.
• used to kill or shrink small localized cancers
• to stop cancer from coming back (after surgery)
• to treat symptoms caused by advanced cancer - lesions on the spinal cord or large vessels.
• external beam radiation, internal radiation (radioactive seeds), )systemic (PO meds)

Question 7

Biotherapy: targeted therapy

Answer 7

• restores or boosts the body’s own immune system to stop or slow the growth of cancerous cells
• monoclonal antibodies (target only cancer cells)
• cancer vaccines
• growth factors
• given PO, IV, or injection
  Side effects: skin rashes, Flu-y

Question 8

most important responsibilities of the nurse

Answer 8

• differentiating between toxic effects of treatment and progression of the malignant process. the nurse must also distinguish tolerable adverse effects from acute toxic side effects of chemotherapeutic agents. - request most recent consultation report from the cancer society.

Question 9

Common GI side effects of Chemo

Answer 9

• stomatitis, mucositis, esophagitis (inflammation of mouth, throat and esophagus), major sores. patient cant take anything in their mouth. ulceration everywhere. requires careful mouth care because the mouth can have lots of germs.
• N&V, often on meds prior to treatment to fix this.
• Anorexia or loss of taste - TNF, or interleukin 1 from macrophages being destroyed
• Diarrhea - sloughing off of cells in the colon. (risk for electrolyte fluid imbalance from ulceration, inflammation, and diarrhea.
• constipation
• hepatoxicity

Question 10

Bone marrow side effects of Chemo

Answer 10

• anemia: drop in red blood cells
• leukopenia: drop in white blood cells
• thrombocytopenia - a drop in platelets.
  All of these are related to bone marrow suppression due to chemo

Question 11

Integumentary System: side effects of chemo

Answer 11

• alopecia: hair loss (causes body image disturbances)
• skin reactions: hives, extravasation (leaking into the tissue outside the vein - this is why ports are usually put in), hyperpigmentation or radiation burns, wet-down into the dermis, area needs to be covered.

Question 12

Common complications: Infection

Answer 12

• GU system, mouth, rectum (inflammation of GI tract), peritoneal cavity, blood (sepsis)
• ulceration/necrosis caused by tumour
• compression of vital organ by tumour
• neutropenia due to disease process OR treatment

Question 13

Febrile Neutropenia

Answer 13

• infection can be rapidly fatal to cancer patients so it must be treated ASAP
• SIRS criteria
• start IV immediately (going to need antibiotic immediately) - and fluid.
• Caused by suppression the bone marrow which is related to the life cycle of the blood cells

Question 14

Life cycle of the blood cells

Answer 14

• WBC - affected within 1 week because of high turn over.
• platelets - affected within 2-3 weeks.
• RBC - affected in 2-3 months (anemia)

Question 15

neutrophils:

Answer 15

WBC that are the first line of defence in the body- arrive at a site of inflammation in 2-6 hr. engulf foreign bacterial or material. Short lifespan.

Question 16

best nursing measure

Answer 16

• preventing infection. good mouth care. asking questions immediately when it comes to signs of possible infection.

Question 17

Normal Values

Answer 17

WBC: 4.0-10.0
Neutrophils: 2.0-7.5
Neutropenia: < 0.1

Question 18

Pharmacologic Treatment: neutropenia

Answer 18

• granulocytes colony-stimulating factors
• antibiotics
• G-CSF is given as injection under the skin given daily during treatment. Trend the white cell count up. Can cause bone pain, itchy skin, or fever
• Hold chemotherapy until WBC count has increased to normal amounts

Question 19

Malnutrition

Answer 19

• protein and calorie malnutrition common
• clinical manifestations: depletion of fat and muscle
• early on in cancer treatments malnutrition is most commonly associated with the treatment
• wasting of muscle and weight loss

Question 20

Superior Vena Cava Syndrome (Oncologic Emergencies: obstructive)

Answer 20

• due to: obstruction of vena cava by a tumour (common only by lung CA, Hodgkin’s and non-Hodgkin’s lymphoma)

Question 21

Clinical manifestations of superior vena cava syndrome and diagnosis and Tx

Answer 21

• facial edema
• periorbital edema
• distended neck and chest veins
• headache
• seizures
• this is due to fluid building up in the head
• diagnosis: CXR
• treatment: urgent radiation therapy
• if nothing can be done, the patient needs very comprehensive and intentional palliative care

Question 22

Malignant Spinal Cord Compression (MSCC)

Answer 22

• Due to: tumour compressing the spinal cord (primary or metastatic tumours)

Question 23

MSCC - Clinical Manifestations

Answer 23

• Back pain (localized and persistent) - ask questions about the pain, if it just onset now, and if they have not been doing anything that could have caused this back pain we need to be considering the possibility of metastasis
• vertebral tenderness
• motor weakness and dysfunction
• sensory paresthesias and loss
• changes in bowel/bladder function

Question 24

Treatment MSCC

Answer 24

• emergent glucocorticoids (dexamethasone) - IV depending on the type of cancer 4-8 mg BID or QID IV total of 16 mg a day. effective within 24 hr. reduce the swelling and inflammation
• urgent radiation therapy - slower to act. but sustains the response
• sometimes neurosurgery is indicated
• get imaging to determine the presence of a tumour.
• nerve cells do not reproduce, when the spinal cord is compressed, reduce the pressure immediately so the patient does not end up with long term damage.

Question 25

Intestinal Obstruction: Oncologic emergencies

Answer 25

• due to: complete or partial obstruction due to swelling of the intestine or solid tumour invasion

Question 26

Clinical manifestations: intestinal obstruction

Answer 26

• nausea/vomiting
• abdominal pain
• abdominal distension
• do a GI assessment

Question 27

Treatment: intestinal obstruction

Answer 27

• NG tube decompression

- Surgical removal of obstruction

Question 28

SIADH: Metabolic emergency

Answer 28

• due to: abnormal or sustained production of ADH (antidiuretic hormone) - occurs most often in small cell lung cancer
• excess of ADH increases the permeability of the distal tubule and collecting duct and reabsorption of water, body hangs onto the water which causes us to retain fluid. ECF is expanding.

Question 29

Clinical manifestations: SIADH

Answer 29

• fluid retention
• serum hypo-osmolality
• dilution hyponatremia because there’s so much water
• early: muscle cramps, weakness
• late: vomiting, abdominal cramping, seizures, come
• decreased urine output

Question 30

Treatment SIADH

Answer 30

• treat cause! the tumour. fluid restriction of 800-1000ml/day (sometimes duiretics, if it is emergent give them hypertonic solution, but not usually)

Question 31

Hypercalcemia

Answer 31

a condition in which the blood calcium level is too high

• most common oncologic metabolic emergency
• has poor prognosis, 80% of patients with hypercalcemia will die within a year.
• cancer-related hypercalcemia is the leading cause of hypercalcemia in hospitalized patients
• due to: increased breakdown of bone tissues (osteoclast activity) due to malignancy (multiple myeloma) or bony metastasis (from lung, breast cancer)
• seen in pelvis or the spine

Question 32

Clinical manifestations of hypercalcemia

Answer 32

• apathy/depression/fatigue
• muscle weakness
• ECG changes
• anorexia, nausea, vomiting
• polyuria/nocturia
  severe hypercalcemia: severe muscle weakness, decreased deep tendon reflexes, kidney stones, irregular heartbeat, even heart attach, monitor with EKG

Question 33

Normal calcium levels

Answer 33

around 2.65

- corrected calcium = measured calcium (mmol/L) + (40-albumin) x 0.02)

Question 34

Ionized calcium

Answer 34

ionized calcium is the calcium you are concerned about because it is the active form of calcium
- standard lab test will give the total calcium unless specified that the ionized calcium is the one that is wanted.

Question 35

Treatment: Hypercalcemia

Answer 35

• mobility decreases incidence in at-risk clients
• HYDRATION!!! (N/S 1-2 L IV bolus, then maintenance infusion until increased urine output is established)
• calcitonin: to inhibit bone resorption (quick-onset)
• loop diuretic (ie. lasix) ONLY in patients with fluid overload
• Biphosphates: inhibit calcium release from the bone: late onset but mainstay of treatment
• Glucocorticoids: depends on the cause

Question 36

Tumor Lysis Syndrome

Answer 36

• follows the destruction of a large number of neoplastic/cancer cells due to chemo or radiation allowing for vast number of intracellular electrolytes to enter the blood stream. often causes changes in potassium, phosphorous, and uric acid levels
• most commonly seen in patients with highly aggressive hematologic cancers because they are rapidly growing so as you target them they will also be rapidly dying.
• usually occurs when effective chemotherapy has begun.

Question 37

Hyperkalemia

Answer 37

can cause serious and occasionally fatal arrhythmia

Question 38

Hyperphosphatemia

Answer 38

can cause secondary hypocalcemia leading to neuromuscular irritability (tetany), dysrhythmias, and seizure and can also precipitate as calcium phosphate crystals in various organs

Question 39

Hyperuricemia

Answer 39

due to catabolism of nucleic acids and can induce acute kidney injury. spike in uric acid secretion.

Question 40

Clinical manifestations of TLS

Answer 40

• reduced urine output
• uremia
• fluid overload
• cardiac dysrhythmias

Question 41

Interventions TLS

Answer 41

• alopurinol prophylactically if they are at risk
• hydration, electrolyte balance
• IV hydration to flush the calcium phosphate crystals out of the kidneys

Question 42

What is allopurinol

Answer 42

• reduces production of uric acid in body

- people on moderate or high risk of TLS will be put on the medication prophylacitcally