Cancer Treatment | NURS211

Clayton Chapter 43

what is cancer?

diseases characterized by uncontrolled cellular growth, tissue invasion, and distant metastases (sites beyond the original growth site)

what are the main factors that contribute to the development of cancer?

1. the environment (based on socioeconomic, environmental hazard exposure, etc)

2. genetic

true or false: for most types of cancers, Black of African American population have the highest mortality rate than all other racial and ethnic groups

true

true or false: the incidence rates of colorectal, lung, and cervical cancer are higher for those who live in rural Appalachian areas compared to those who live in more urban areas (socioeconomic status played a HUGE factor!)

true

true or false: people with more education are less likely to die before the age of 65 than those with less education, regardless of their race or ethnicity

true

true or false: the rate of smoking and alcohol use (known carcinogens) are higher among LGBTQ youth than cisgender heterosexual young adults

true

true or false: cancer care disparities are exacerbated by a lack of diversity in clinical research participation

treatment for cancer is usually multi-model which means…

there are many ways of treating cancer

what is adjuvant therapy and when in the process of cancer treatment does it usually takes place?

additional treatment given after the initial/main treatment with surgery (usually after surgery) to reduce the risk of cancer recurrence by destroying leftover cells

1. chemo

2. radiation

3. etc

what is neoadjuvant therapy and when in the process of cancer treatment does it usually takes place?

initial treatment given to shrink the cancer before surgery (given before adjuvant therapy)

1. chemo

2. radiation

3. etc

what is salvage therapy and when in the process of cancer treatment does it usually takes place?

second line therapy administered/done when first-line therapy is unsuccessful (e.g., radical prostatectomy (surgical removal of the prostate) for recurrent prostate cancer after initial radiation)

what is targeted therapy and when in the process of cancer treatment does it usually takes place?

a type of treatment “targets” cancerous cells and spares normal cells that results in fewer systemic effects than a general type of treatment would

• usually more complex and more expensive

what is biologic therapy and when in the process of cancer treatment does it usually takes place?

a type of treatment used to enable the immune system to better target and kill cancerous cells

• Examples of biologic therapies for cancer include monoclonal antibodies, which target cancer cells, and cytokines, which boost the immune system to fight cancer.

what are the three phases in which cancer treatments usually proceed along?

1. induction - induce remission - frontline (main) therapy (e.g., chemo, radiation, surgery, etc) - may be the only phase required if the cancer are not as aggressive/widespread, etc

2. consolidation (AKA intensification or post-remission therapy) - eradication of remaining cells after remission

   → usually used for hematological cancers

3. Maintenance - prevent recurrance of cancer

   → cancer occur after induction or consolidation phase and is typically the longest phase (can takes years!) and is often about making sure the cancer do not reawake

each cell goes through ____ phases of mitosis before producing daughter cell

5

chemotherapy agents that causes the cancer cell death in all phases of mitosis are called _____________

cell cycle nonspecific medications

chemotherapy agent that are effective only in one phase of mitosis are called ____________

cell cycle specific medications

for combination cancer therapy, _______ nonspecific and cell-cycle specific medications will be use to eliminate cancer cells more completely

both

what is alkylating drugs in term of cancer treatment?

what is antimetabolites in term of cancer treatment?

what is antitumor antibiotics in term of cancer treatment

what is plant alkaloids in term of cancer treatment?

what is taxanes in term of cancer treatments

what is supportive therapies in term of cancer treatments?

what are the different ways chemotherapy can be administer?

1. oral

2. subcutaneous

3. intramuscular

4. intracavitaries (inside the cavity)

5. topically

6. intrathecally (inside the of the spinal column)

7. intracranially

chemotherapeutic agents are _________! (which mean they _____ cells!!!)

cytotoxic; kill

true or false: beside from being considered as cytotoxic, chemotherapeutic agent are also considered to be vesicant

true

what is vesicant in term of cancer treatment

vesicant medications are medications taht cause severe tissue damage if they leak from the vein

what is extravasate?

[stuff] leaking from the vein

what are the symptoms that occur when vesicant extravesate?

1. kill all of the surrounding tissues and cells that are exposed to the medications (necrosis)

2. pain

3. inflammation

4. blistering

if vesicant drugs kill surrounding tissue when they leak out of a vein, why don’t they destroy the vein itself when infused?

in the bloodstream, vesicants are quickly diluted and carried away by blood flow, and the endothelium is relatively resistant - but if they extravasate into surrounding tissue, the drug stays concentrated and stagnant, causing severe local necrosis

what should the nurse do when vesicant extravasate?

1. IMMEDIATELY stop the infusion

2. take an empty syrine and take as much of the medication from the IV in the affected vein as you can

3. elevate the extremities to restore blood flow and prevent the medicationf rom spreading further

true or false: when dealing with chemotherapy, the nurse would need to perform special donning and doffing procedure with specialized PPE

true

what are alkylating agent in term of cancer treatment?

a class of chemotherapy that damages the DNA of cancer cells by substituting an alkl group for a hydrogen atom on the DNA helix which create cross-links between the two strand an make it impossible for the cells to copy their DNA and reproduce (DNA nee to be able to separate

nitrogen mustards vs mustard gas in term of cancer treatment?

1. both are alkylating agents & vesicant

2. mustard gas is a specific compoun

3. nitrogen mustard are a class of related compound

4. nitrogen mustard is the kind that is use for chemotherapy

5. nitrogen mustard is considered to be more immediately toxic

what are the three different types of alkylating agents?

1. nitrogen mustards

2. nitrosoureas

3. alkyl sulfonates

what is the method of action of cyclophospamide (Cytoxan)?

causes cross-linking of DNA during mitosis to cause nucleis acid chain breakage, resulting in cell destruction

what conditions is cyclophosphamide (Cytoxan)?

1. lymphomas

2. multiple myelomas

3. leukemia

4. ovarian an breast cancers

what are the adverse effects of cyclophosphamide (Cytoxan)?

1. myelosuppresion

2. sepsis

3. nephrotoxicity

4. pulmonary toxicity

5. cardiotoxicity

6. infertility

7. hyponatremia

8. hemorrhagic cystitis (mesna as a precaution

myelosuppresion

the bone marrow ability to produce red blood cell are reduced

hemmorhagic cystitis

the lining of the bladder starts to become inflammed and bleed → resulting in blood appearing in urine with pain and frequent urination due to irritation

what are the route of cyclophosphamide (Cytoxan)?

1. oral (tablet)

2. intravenous

3. infusion

what are antimetabolites in term of cancer treatment?

a substance that interferes with the normal metabolic processes within cells (inhibits it) by imitating metabolites but do the reversed function of metabolites

what are the three types of antimetabolites?

1. purine

2. pyrimidine

3. folic acid

what are the cancer conditions that antimetabolites can be used to treatment?

1. lymphoma

2. leukemia

3. cancer of the GI tract

4. cancer of the billiary tract

what are the common side effects of antimetabolites?

1. nausea

2. vomitting

3. diarrhea

4. anorexia

5. allopecia

6. myelosuppresion

how does the pyrimidine antimetabolites work?

designed to mimic the pyrimidine base of the DNA and RNA → enter cancer calls → interfere with DNA and RNA synthesis by being converted into faulty metabolites that either get incporporated into DNA, causing errors and halting its production or inhibit essential enzyme needed to create the thymine base for DNA

what is a common side-effects often seen with specifically pyrimidine antimetabolites?

hand-foot syndrome (palmar-plantar erythrodysthesia)

1. redness, swelling, pain, peeling, and cracking of the sole and palm

2. on a patient with lighter skin - the condition might manifest to look like a sunburn

3. on a patient with darker skin - the condition might manifest to look not abnormal but there might be swelling and warm to the touch and also pain too!

what are the methods of action, indications (conditions that it is used for), and adverse effects of carmustine?

what are the methods of action, indications (conditions that it is used for), and adverse effects of busulfan?

how does folate antimetabolites work?

how does purine antimetabolites work?

what is a common side-effects often seen with specifically folate antimetabolites?

what is a common side-effects often seen with specifically purine antimetabolites?

what is a common side-effects often seen with specifically folate antimetabolites?

what are the methods of action of methotrexate (MTX)?

they perform various function,s but the main one is that they prevent DNA synthesis by imitating folic acid - so instead of using folic acid for the cell cycles, the body instead uses methotrexate which prevents cell proliferation

what are the cancer types and conditions that methotrexate (MTX) can be used to treat?

1. breast cancer

2. ALL (acute lymphoblastic leukemia)

3. non-Hodgkin lymphoma

4. refractory psoriasis

5. rheumatoid arthritis

6. osteosarcoma

7. eczema

8. sarcoidosis

why does patient using methotrexate might have folate deficiency?

because methotexate imitating folic acid and prevent the body from using those folic acid

what are the common adverse effects of methotrexate (MTX)?

1. anorexia

2. hepatotoxicity

3. folate deficiency

4. mucosal ulceration

5. alopecia

6. fatigue

7. fever

8. increase risk of infection

9. gastrointestinal bleeding (GIB)

10. pancreatitis

11. renal failure

what does it mean that methotrexate is considered to be pregnancy category X?

1. cannot be given to pregnant individual

2. people who are not pregnant but are having sex need to use double the amount of contraception

   → using both hormonal and physical contraceptive