Oncologic Nursing/Surgery Flashcards
Describe the normal cell life cycle.
Interphase
Mitosis - prophase, metaphase, anaphase, telophase
Cytokinesis
Define cancer.
Phenotypic end result of a whole series of changes that may have taken a long time to develop
How does cancer arise?
Accumulation of genetic mutations - eliminates normal cell constraints
Increased longevity of life allows more of these mutations to accumulate
What are some environmental causes of cancer?
Chemical carcinogens e.g. smoke, pesticides
Physical agents e.g. sunlight, radiation
Hormones e.g. neutering
Cancer-causing viruses e.g. papilloma virus, retroviruses (FeLV)
How can mutations in DNA cause deviation in normal cell cycle?
Sustained proliferative signalling
Evade growth suppressors
Resist cell death
Enable replicative immortality
Induce angiogenesis
Activate invasion and metastasis
Define neoplasia.
Formation of new abnormal growth that is not responsive to normal physiologic control mechanisms
May be benign or malignant
What are the 7 main goal types of chemotherapy?
Primary induction
Primary neoadjuvant
Adjuvant
Consolidation
Maintenance
Rescue or salvage
Palliative
Describe multimodal chemotherapy plans.
Maximal cell kill within range of tolerable host toxicity
Broader range of interaction between drugs and tumour cells
Slows development of tumour drug resistance
Preferably drugs with non-overlapping toxicities
Use drugs at optimal doses and schedules, at consistent intervals
Name some specific chemotherapy agents.
Alkylating agents
Antitumour antibiotics
Antimetabolites
Antimicrotubule agents
Corticosteroids
Platinum
L-Asparginase
Targeted agents
What is the CHOP protocol?
Cyclophosphamide
Hydroxydaunorubicin (Doxorubicin)
Oncovin (Vincristine)
Prednisolone
Discontinuous protocol
What are some possible side effects of the CHOP protocol?
All dividing cells affected by cytotoxic drugs
Bone marrow toxicity
GI toxicity
How do we administer chemotherapy?
Quiet area, IV catheter placement ‘clean stick’, double check dose and draw up drug
Bolus injection/infusion - check IV placement, connect syringe, administer
Describe haemopoietic tumours.
Leukaemia - in blood-forming tissues, acute and chronic
Lymphoma - in cells that make up part of immune system, B-cell and T-cell
Treated with chemotherapy
Describe osteosarcomas.
Typically distal radius/top of femur
Metastatic - usually has occurred by time of presentation
Surgery to remove affected limb
Chemotherapy, bisphosphonates, radiation therapy useful
Describe haemangiosarcomas.
Spleen, heart (blood vessels)
Treated with combination of surgery and chemotherapy
Describe soft tissue sarcomas.
Tumour of connective tissue
Describe carcinomas.
Tissue that covers any body surface, line a body cavity or makes up an organ
‘Adeno’ = arises from a gland
Describe squamous cell carcinomas.
Common in cats - mouth, nose, ears
Surgery to remove
Locally invasive
Radiation therapy/chemotherapy useful
Describe mast cell tumours.
Most common malignant skin tumour in dogs
Manifests in many ways anywhere on the body
Range from almost benign to highly malignant with high rate of spread
In skin layers = hard and firm, under skin layers = mobile and soft
Cats can have splenic/GI presentation
Often need surgical removal - appropriate margins can be curative
Radiation therapy/chemotherapy useful
Describe melanomas.
Sometimes pigmented black
Mouth, toes, skin
Surgery to improve quality of life - mass painful and can bleed
Immunotherapy to slow spread - melanoma vaccine
Describe benign tumours.
Slow-growing, tend not to metastasise
Lipoma, haemangioma, adenoma
Describe paraneoplastic syndrome and lymphoma.
Cancer-associated alterations not directly related to tumour or metastases
Lymphoma - e.g. hypercalcaemia, anaemia, neutrophilic leucocytosis, thrombocytopaenia
What can PNS signify?
Occurrence may signify malignancy - can result in greater morbidity than tumour itself causes
Successful treatment of tumour leads to disappearance of many PNSs
Recurrence of PNS may signify return of tumour
Describe tumour sensitivity to chemotherapy.
High sensitivity e.g. lymphoma, some leukaemias
Moderate sensitivity e.g. high grade sarcomas, mast cell tumours
Low sensitivity e.g. slow growing sarcomas, carcinomas, melanomas
What factors can affect treatment of a tumour?
Benign/malignant
Staging and grading
Chemotherapy/surgery best option
Resectable/non-resectable
Owner expectation e.g. disfiguring surgery, cost
Patient temperament
What treatments can be used for cancers?
Chemotherapy
Radiation therapy
Cryotherapy
Hyperthermic therapy
Photodynamic therapy
Immunotherapy
Surgery
What surgical treatment options are available for tumours?
Complete excision, wide, radical
Excisional biopsy
Incisional biopsy
Trucut biopsy
FNA
What are the principles of staging a tumour?
TNM system
T - primary tumour size
N - level of lymph node involvement
M - presence of metastasis
How can we stage a tumour?
Physical exam and history-taking
Urinalysis
Bloods - haem/biochem
Thoracic radiographs
Abdo u/s - aspirate liver, spleen, lymph nodes
Imaging - echocardiogram, CT, MRI
How are tumours graded?
Histologic findings
Appearance under microscope
Mitotic index
How well organised the cells are
Evidence of cancer cells invading blood vessels
Low, intermediate, high - important prognostic indicator
What specific nursing considerations should we have for oncologic patients?
May be hospitalised for long periods of time
Can be anorexic
May have impaired immune function
Chemotherapy drugs - barrier nursing, excreted in urine/bodily fluids for 3-5 days
Chemotherapy should be given with care using specific equipment
