Week 12: EXPERIENCE OF CANCER Flashcards
Cancer
- Neoplastic disorder that can involve all body organs with clinical presentations that vary
according to body systems affected and type of tumour cells - Cells lose their normal growth controlling mechanism and the growth of cells is
uncontrolled
Metastasis
– cells move from original location to other sites through local, blood borne, lymphatic
Benign
grow slowly and do not spread
Malignant
grow rapidly and spread
Classification
- Solid tumours
- Hematological cancer (originate from blood cell-forming tissues)
Grading and Staging
Grading: classifies cellular aspects
- Staging: classifies clinical aspects
Factors Influencing Development
- Environmental
- Physical carcinogen
- Viral carcinogen
- Infectious carcinogen
- Genetic predisposition
- Age
- Immune function
- Lifestyle choices
Progression
- Localized – cancer cells exist in a specific region
- Regional spread – spread of cancer cells in close proximity to original tumour
- Metastasize – cancer cells metastasize to other body cells
Warning Signs
- Change in bowel/bladder pattern
- A lesion that does not heal
- Unusual bleeding or discharge
- Thickening or lump
- Indigestion or difficulty swallowing
- Obvious changes in wart or mole
- Nagging cough or persistent hoarseness
weight loss
Diagnostics
- Biopsy: definitive diagnosis by sampling of tumour tissue, can confirm malignancy
- Bone marrow examination
- X-ray, CT, MRI
- Bloodwork: CBC, serum tumour markers, system functioning (BUN, Cr, ALT/AST)
- Cellular investigations (pap smear)
Interventions: Surgery
Types:
- Prophylactic – helps to eliminate risk factors
- Control – ”debulking”, physical removal of cancerous tissue
- Palliative – QOL, symptom management remove cancerous tissue for these
reasons, no goal to cure client (eg. Spinal column cancer)
Key Considerations
- Infection prevention & control
- Physiologic reserve – immune function is impacted from radiation, chemo, etc.
Interventions: Chemotherapy
Antineoplastic Medications
- Medications that kill or inhibit the reproduction of neoplastic cells and kill normal cells
- Normal cells affected: skin, hair, lining of GI tract, spermatocytes, hematopoietic
cells - Systemic effect – impact the entire body
- Side effects:
- Fatigue, lethargy, alopecia, NVD, mucositis, immunosuppression
- Route:
o IV admin (with central line)
o Oral
o Intracavitary, isolated limb perfusion - Dosing based on body surface area and cancer diagnosis
Chemotherapy Monitoring
- Hematology: the following cells are affected:
o CBC – anemia
o WBC – leukopenia
o Platelets – thrombocytopenia - Infection
- Nutrition
- IV site – phlebitis, extravasation
Chemotherapy Administration
- Cytotoxic precautions
- PPE when handling – gloves, gown, eye protection, mask
- Not to be handled by pregnant staff
- Discard in biohazard chemo-specific containers
- Linin management
- Spill kits
Chemotherapy Toxicity
- GI system – N/V, nutrition
- Hematopoietic system – myelosuppression (decreased WBC, RBC, platelets)
- Cardiopulmonary system – cardiac/respiratory toxicity, HF, pulmonary fibrosis
- Reproductive system – possible sterility
- Neurological system – effect CNS, peripheral nerves, cranial nerves, sensory changes,
neuropathies - Cognitive impairment – decline in cognitive function
Radiation Therapy
- Destroys cancer cells with radiation beam
- Some ability to protect normal cells
- Side effects:
o Local skin changes/irritation, alopecia, fatigue, altered taste, other S&S based on site
Stem Cell Transplantation
- Donor stem cells are re-infused into patient
- Very high acquity – during immediate pre and post transplantation phase due to
significant leukopenia that is induced to prepare for transplant
Graf-vs-Host Disease:
Donor cells initiate immune response against patient’s tissues (skin, GI)
Administer immunosuppressant medications to prevent
Expect systemic response: elevated temp, elevated HR, RR, normal-low BP
Nursing Priorities : Mucositis (mouth care)
o Assess and monitor
o Oral hygiene and supplemental supports (saline rinse, saliva, lip lubricants)
o Avoid irritants, alcohol, smoking, spicy foods
o Soft toothbrush
o Dehydration, nutritional status
Nursing Priorities: Nutrition
o Nausea, vomiting, malabsorption
o Smaller, frequent meals
o Appetite stimulant medications
o Enteral or parenteral nutrition
Nursing Priorities: Bleeding precautions
o Platelet reduction = bleeding precautions
o Monitor for: GI system bleed, fiber, bowel controls
