Adult Health 2 - Cancer Week 11

Cancer definition

Group of diseases characterized by uncontrolled and unregulated growth of cells

Benign growth

cells are growing, but still look like normal cells

Malignant tumor

don't look like normal cells, and no longer functioning like a normal cell

Tumor Grading

Gx

G1

G2

G3

G4

Tumors are classified as low grade or high grade tumors

Gx

Grade cannot be assessed

G1

Well differentiated

Looks normal

G2

Moderately differentiated

G3

Poorly differentiated

G4

Undifferentiated

Tumor Staging

Stage 1 - 4

Stage 1

Confined to the organ of origin

In situ (in origin)

Stage 2

Locally invasive but has not metastasized

Stage 3

Spread to regional lymph nodes

Stage 4

Metastasized to distant organs

TNM Classification System

T = tumor size

N = node involvement

M = distant metastasis

Tumor Size (T)

T0

Tis

T1-4

Tx

T0

No evidence of primary tumor

Tis

In situ - contained, no metastasis

T1-4

T1 < 2cm

T3 > 5cm

Tx

Tumor cannot be measured

Node Involvement (N)

N0

N1-4

Nx

N0

No evidence of disease in lymph nodes

N1-4

Ascending degree of nodal involvement

Nx

Regional lymph nodes unable to be assessed clinically

Distant Metastasis (M)

M0

M1-4

Mx

M0

No evidence of distant metastasis

M1-4

Ascending degrees of distant metastasis

Mx

Cannot be determined

Cancer Symptom Onset

Symptom onset occurs once cancer has become invasive, therefore it's important to ID early

Important to do screening which is the best way to catch it

People at risk need to get screening done

Cancer Dx

Tissue Biopsy

Bone marrow biopsy

Cytology studies

Chest x-rays

Tumor markers

Genetic markers

Blood tests

Pet scans

Radiographic studies

Radioisotope scans

Molecular receptors

Endoscopy exam

Tumor markers

If the patient's tumor markers are rising, treatment is not working

Increasing Tumor Markers Priority NI

Notify HCP

Genetic markers

BRCA 1

BRCA 2

Goals of Treatment

Cure

Control

Palliation

Adjuvant Therapy

Neoadjuvant therapy

Cure

Complete response that lasts for 5 years for adults

Control

Extend the length of life when a cure is not realistic

Palliation

Provision of comfort when cure or control is not possible

Adjuvant Therapy

Surgery and then chemo/biotherapy

Neoadjuvant therapy

Chemo then surgery

Cancer surgeries

Prevention

Diagnostic

Cure/control

Supportive

Rehabilitation

Palliative

Prevention tx

If at risk, patient's may choose to do this

Ex: Mastectomy for BRCA

Diagnostic Tx

Tumor biopsy

Cure/control Tx

Remove tumor

Supportive tx

Other procedures to support patient while receiving other tx for cancer

ex: feeding tube, suprapubic foley

Rehabilitation tx

Ex: Breast reconstruction after mastectomy

Palliative Tx

Remove large tumor to remove stress though it won't cure it

Safe handling of cytotoxic meds

cover if light sensitive

Use specific chemo tubing

Prep meds under hood (provides ventilation)

Chemo PPE

2 sets of chemo gloves

Special bags for hamper and trash

Clothing and linens go through isolation period

Exposure s/s

N/V

Skin rashes

Hair loss

Resp issue

Infertility & repro issues (2x risk)

Secondary cancers (ex: leukemia)

Chemo spill kit

used is urine, med, or blood is spilled on floor

3 Types of Radiation Tx

External Beam

Internal Radiation (brachytherapy)

IV Radiation

Radiation NC

Cluster cares because px is radioactive

Chemotherapy Types

Cell cycle specific

Cell cycle nonspecific

Most chemo targets what:

Proliferative phase

Hence why chemo px's loose their hair

Immunotherapy advantages

Low toxic SE

Improved outcomes

Low doses effective

Decreased development of resistance

Immunotherapy

Cytokines

Vaccines

Monoclonal antibodies

Monoclonal antibodies

"-mab"

Monoclonal antibodies "-mab" NC

Think anaphylaxis and shock

Airway = priority

Assess: airway, breathing, BP/MAP

Anaphylaxis Priority NI

O2

Nadir

the lowest point of anything

Nadir in relation to chemo

1. Chemo day

2. WBC decrease 7-12 days after chemo

3. Nadir for WBC, High infection risk (lasts 5-7 days)

4. Recovery period

Neutropenia for cancer patients

Nadir period

ANC 1500 = when chemo can be received again

Neutropenic Fever

100.4 = critical

Neutropenic Fever NI

cultures and abx w/in 1 hr

Leukocytosis

immune system dysfunction & leukemia - complication of cancer tx

Abnormal WBCs that don't function properly, provide no protection against infection

Leukocytosis s/s

WBC count is super high

100,000 - 400,000

Pancytopenia

Low RBCs, WBCs, and Plts

Complication of chemo

Pancytopenia s/s

Fatigue

Lymphedema

Complication of chemo

Don't use limb for blood draws or BP

Apply compressions

"Chemo Brain"

Need to have organizer for meds

Keep notebook/planner

Mucositis

Complication of chemo

Mouth sores

Radiation Burns

Side effect of cancer tx

Chemo Admin NC

Never give through peripheral line

Extravasation

leakage of IV meds into surrounding tissue

Especially bad with vesicants

Vesicants

Any agent that can cause blistering or tissue necrosis

Irritant

agent that causes local inflammation but not tissue necrosis

Oncologic emergencies causes

Life threatening medical emergencies caused by cancer or the cancer tx

Oncologic emergencies timing

Onset may occur with early signs of cancer or late in disease process.

TIming varies

Oncologic Emergencies

Anaphylaxis

Superior Vena Cava syndrome

Spinal cord compression

Hypercalcemia

Sepsis/Septic Shock

DIC

Cardiac Tamponade

SIADH

DI

Tumor Lysis Syndrome

Prophylactic Tx for Anaphylaxis

Antihistamines

Causes of Superior Vena Cava syndrome

Tumor causes congestion of superior vena cava

Overgrowth of lymph node

Clot (often caused by central line)

Most common cause of Spinal cord compression

Metastasized Prostate cancer

Hypercalcemia

Results from increased bone resorption (bone releasing calcium)

Hypercalcemia s/s

Coma

Dysrhythmias

Renal calculi

Hypocalcemia s/s

numbness/tingling

Muscle cramping

Dysrythmias

Hypercalcemia tx

Phosphate

calcitonin

furosemide

Cause Sepsis/Sepctic Shock

Neutropenia

Sepsis tx

Culture

abx

fluids

DIC

Damage to blood from chemo or radiation

SIADH

Cancer cells release ADH

Tumor lysis syndrome

Tumor lysis too quickly releasing all the toxins and cancerous material into the blood

Tumor lysis syndrome complication

AKI

Spinal Cord Compression Assessments

Assess how patient walks and their gait