Oncology Nursing: Radiation, Chemotherapy & Emergencies

Radiation

High-energy radiation to kill cancer cells with curative or palliative intent - destroys cancer cells while minimizing damage to surrounding normal tissue.

Local Treatment

Considered 'local treatment' - effects are seen only in tissues within the radiation field or path.

Mechanism of Action (MOA) of Radiation

When cancer cells are exposed to radiation, their DNA is damaged directly, resulting in changes in cellular regulation; these damages mean they can no longer reproduce or function, leading to cell death.

External Beam Radiation

Radiation delivered from outside the patient; patient is not radioactive after treatment and is not a hazard to others.

Side Effects of External Beam Radiation

Radiation dermatitis (redness, rash), fatigue, altered taste, bone marrow suppression, hair loss, tissue fibrosis and scarring, increased risk of malignancies.

Internal Beam Radiation

Radiation delivered directly inside or immediately next to a tumor via a radioactive source (pellets, seeds, wires, etc); patient is recommended to avoid direct/close contact with others while receiving therapy.

Side Effects of Internal Beam Radiation

Localized swelling, tenderness, fatigue, minor irritation in the treated area.

Chemotherapy

Systemic treatment that exerts effects on all cells within the body - drugs target rapidly diving cancer cells but also affect normal fast-growing cells.

Side Effects of Chemotherapy

Bone marrow suppression (Neutropenia, thrombocytopenia, anemia, pancytopenia, nadir), alopecia (hair loss), mucositis (mouth sores), chemotherapy-induced peripheral neuropathy, changes in cognitive function ('chemo brain'), chemo-induced nausea/vomiting.

Nadir

Time when bone marrow activity and blood cell counts are at their lowest levels after chemo administration, typically 7-10 days after treatment.

Effects of Nadir

Affects all blood cells: RBCs, WBCs, and platelets; neutropenia, anemia, thrombocytopenia; reduced immunity can lead to sepsis/death if not managed appropriately.

Safety Considerations for Chemotherapy

Chemotherapy agents are hazardous drugs; watch for extravasation (as these meds are vesicants); monitor for severe adverse effects; patients are at high risk for infection, immunosuppression, and treatment complications.

Sepsis

Organisms enter the bloodstream, causing severe infection; symptoms include fever, tachycardia, confusion, disorientation, fatigue, shortness of breath, feeling of impending doom.

Superior Vena Cava (SVC) Syndrome

Compression or obstruction by tumor growth or clots leads to blood congestion; symptoms include facial edema, feelings of 'head fullness,' engorged blood vessels/hyperpigmentation of the upper body, edema in arms and hands, dyspnea, stridor, hemorrhage, cyanosis, LOC changes, decreased cardiac output, hypotension.

Tumor Lysis Syndrome (TLS)

Rapid tumor cell destruction that releases cellular contents faster than the body can eliminate them; symptoms include lethargy, nausea/vomiting, muscle weakness, cramps, seizures, altered mental status, hyperkalemia, uric acid crystal precipitation.

Disseminated Intravascular Coagulation (DIC)

Extensive, abnormal clotting throughout blood vessels, depleting circulating clotting factors and platelets; symptoms include bleeding (from oozing to hemorrhage), pain, ischemia, stroke-like symptoms, dyspnea, tachycardia, reduced kidney function, bowel necrosis.