Oncology/Palliative Care Flashcards
What is carcinogenesis
3 step process of malignant transformation
1. Initiation: carcinogens cause mutation in cellular DNA and escape protective mechanisms resulting in permanent cellular mutations
2. Promotion: altered cells have repeated exposure to promoting agents (co-carcinogens) which cause proliferation and expansion of cells
3. Progression: altered cells exhibit malignant beh
Causes of carcinogenesis
Viruses and bacteria
Physical agents
Chemicals
Genetics
Lifestyle
Hormones
Primary prevention of cancer
Reduces risks of dz through health promotion and risk reduction
Ex. immunizations for HPV and HBV vaccines
Secondary prevention of cancer
Screening and early detection to identify pre-cancerous lesions and early-stage cancer in asymptomatic pt
Ex. colonoscopy, pap smears
Tertiary detection and prevention
Monitoring and prevention of recurrence of primary cancer
Ex. cancer pt are assessed for secondary malignancies such as lymphoma and leukemia
Diagnosis of cancer
Physical assessment
Imaging studies (CT, mammogram, MRI, PET)
Lab tests (PSA, FOBT, Tumor marker)
Procedures (pap smear, colonoscopy, bronchoscopy)
Pathologic analysis (biopsy)
Staging of cancer
Includes tumor size, local invasion, lymph node involvement, distant metastasis
Grading of cancer
The pathologic classification of tumor cells, describes the level of differentiation from the original tissue the cells originated from
Goals of treatment of cancer
Cure
Eradication of malignant dz
Control of growth
Palliation (alleviating symptoms)
External beam radiation therapy (ERBT)
Most common form of radiation
Rays penetrate the body and target tumor with pinpoint accuracy based on mapping from imaging
Proton therapy-newer target ERBT approach
Internal radiation
Localized implantation (brachytherapy)
Systemic radionuclide administration
Caring for pt with radioactive implant
Follow specific instructions from radiology department regarding: maximum time to be spent with patient, shielding equipment, special precautions
Pt in private room
Posting signage regarding radiation precautions
Pregnant women are not assigned to care for pt
Prohibiting children
Limiting visitors to 30 minute daily visits
Maintaining 6-feet distance
Radiation toxicity
Altered skin integrity: alopecia, radiomastititis
Altered oral mucosa: stomatitis, decreased salivation and xerostomia, change in taste, mucositis
Alteration in bone marrow: anemia, leukopenia, thrombocytopenia
Systemic effects: fatigue, malaise, anorexia
Late effects: occur 6 months to years after treatment
-fibrosis, atrophy, ulceration, necrosis
Chemotherapy
Antineoplastic drugs to kill cancer cells- non specific
Treatment of systemic dz rather than localized tumor
Often combined with other types of treatment
Goals: cure, control, or palliative
Chemotherapy drugs are classified based on their MOA and how they affect cell cycle
May be given with chemo protectant medications
Can be given in a variety of settings with various routes of administration
Accurate dosing is a major safety concern
Complications of chemotherapy administration
Extravasation: irritant vs vesicant
Hypersensitivity rxn
Chemo toxicities
Chemo toxicity
GI tract: nausea and vomiting, stomatitis
Hematopoietic: myelosuppression (depression of bone marrow fxn)
Renal system: many chemo drugs can cause nephrotoxicity, SIADH, renal damage from tumor lysis, hemorrhagic cystititis
Cardiopulmonary: cardiac toxicity, pneumonitis, pulmonary fibrosis
Reproductive: infertility problems, early menopause
Neurologic: encephalopathy, peripheral neuropathy, muscle weakness, loss of balance/coordination, “chemo brain”
Fatigue
Safely administering chemotherapy
Nurses are at risk when administering chemotherapy and safety is a top priority
Follow policy and procedures regarding PPE, handling, disposal, and management of spills/exposures
Emergency spill kit should be readily available where chemotherapy is administered
Hematopoietic stem cell transplant
Most commonly treats hematologic malignancies (myeloma, leukemia, lymphoma)
Stem cells are collected from pt or donor, the cells are processed and re-infused into the pt
Different types of stem cell transplants
Post stem cell transplant complications vary based on type
Immunotherapy
Mediations or biochemical mediators that stimulate or suppress components of the immune system to kill cancer
Significant advances in treatment options which have increased survival for pts
Monitor for immune mediated complications/side effects
Targeted therapies
Use agents to kill or prevent the spread of cancer cells by targeting a specific part of the cell
Have less side effects on healthy cells than chemotherapy
A “personalized” approach to treatment of pt’s cancer
Nursing management: stomatitis
Most common in pts receiving combination therapy and head and neck cancer diagnosis
Leads to dysphagia, decreased PO intake, infection
Assessment: oral cavity, dehydration, malnutrition
Treatment: oral hygiene, mouth rinses (biotin, salt/baking soda rinse), magic mouth wash, cryotherapy during infusions
Cancer treatments may be put on hold to allow for healing
Nursing management: skin integrity
Assess for skin and educate pt to notify provider of any new rashes, pruritis, lesions
Radiation dermatitis: keep skin clean, alleviate pain, prevent infection and promote a moist wound healing environment
Educate to avoid sun exposure and use of wearing sunscreen
Avoidance of long hot showers/baths
Nursing management: alopecia
Education: timeline of hair loss, type of hair loss (thinning/total/permanent), hair regrowth
Psychosocial: body image, self esteem, loss of control, depression
Cold cap therapy
Community resources/financial assistance
Nursing management: nutrition
Treat underlying cause (ex. nausea/vomiting/diarrhea)
Speech therapy/nutritional consult
Appetite stimulants: megestral acetate or corticosteroids
Enteral & parenteral nutrition
Encourage small, high calories/high protein snacks/meals
