Oncologic Disorder

What is cancer?

• A group of disorders characterized by abnormal cell proliferation, in which cells ignore growth-regulating signals in the surrounding environment

• Disease process that begins when a cell is transformed by genetic mutation of cellular DNA

• Metastasis: Abnormal cells invade from original site to surrounding tissue and gain access to lymph and blood vessels carrying them to other areas of the body

• Malignant cancer cells: cells or processes that are characteristic of cancer

• Benign cancer cells: cells that are not cancerous

What is the malignant process?

• Cell proliferation:

  • Genetically altered cells clone and proliferate abnormally

  • Evading normal intra/extracellular processes such as growth regulating and immune system defenses

  • Abnormalities in cell signaling processes lead to cancer development

  • Ultimately metastasis occurs

What are the carcinogensis and what is the process of malignant transformation?

• Malignant transformation

• Three-step process

  • Initiation: apoptosis → malignent cells evade cell death and continue to multipy

  • Promotion: preneoplastic/benign lesions

  • Progression: angiogenesis → tumor proliferates and becomes maignant and metastasis

What are the carcinogenic agents and factors?

• Viruses, bacteria

• Physical agents: sunlight, radiation, chronic irritation

• Chemical agents: tobacco, asbestos

• Genetic, familial factors

• Lifestyle factors

• Hormonal agents

What is the staging and grading of tumors?

• Staging: determines the size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis

• Tumor, nodes, metastasis (TNM)

• Grading: pathologic classification of tumor cells: I–IV

What are some general types of ways cancer can be managed?

• Specific to type, stage, grade of cancer

• Cure

• Control

• Palliation

Lung Cancer (Bronchogenic Carcinoma); Causes, S&S, Diagnostic

• Causes: inhaled carcinogens, most often cigarette smoke (>85%); other carcinogens include radon gas and occupational and environmental agents

• S&S: cough or changes to chronic cough; dyspnea, chest/shoulder pain

• Diagnostic: fiberoptic bronchoscopy; transthoracic fine-need aspiration under CT; PET scan, MRI

What is the sugical treatment for cancer?

Diagnostic surgery

Biopsy: excisional, needle, incisional

Tumor removal: wide excision, local excision

Prophylactic surgery

Palliative surgery (Table 12-6)

Reconstructive surgery

Select surgical techniques (Table 12-5)

List some types of radiation therapy and nursing care for patient undergoing radiation therapy?

• Curative, control, or palliative

• External radiation

• Internal radiation

• Radiation reactions

• Brachytherapy

• Toxicity

• Nursing Care of the Patient Undergoing Radiation Therapy

  • Promote healing, patient comfort, quality of life

  • Assessment

    • Skin; radiation lotion to help with burning, manage radiation dermatitis by reducing dryness, itchiness, and burns

    • Nutritional status

    • Well-being

  • Protecting caregivers

What is chemotherepy (Goals, dosage, extravasation, hypersensitivity reactions)

• Agents used in attempt to destroy cancer cells by interfering with cellular function and replication

• May be combined with surgery, radiation therapy, or both

• Goals: curative, control, or palliative

• Dosage: based primarily on the patients total body surface area, weight, previous exposure and response to chemotherepy, and function of major organ systems

• Extravasation: the leakage of chemo agents administered intervenously damaging tissue

• Hypersensitivity reactions: mild or progressively worsening S&S, such as rash, uticaria, fever, hypotension, cardiac instability, dyspnea, wheezing, throat tightness, and syncope

What does chemotherapy toxity look like in each system?

• Gastrointestinal: most common N/V

• Hematopoietic: myelosuppression ( decreased WBSs, RBCs, & PLTs; pancytopenia decrese in all three blood cells)

• Renal: AKI, SIADH

• Cardiopulmonary

• Reproductive: infertility

• Neurologic: severe peripheral neuropathies

• Cognitive: trouble remembering dates, managing numbers and finances, face recognition

• Fatigue

What is the nursing management in chemotherapy?

• Assessing fluid, electrolyte status

• Assessing cognitive status

• Modifying risks for infection, bleeding

• Administering chemotherapy

• Preventing nausea and vomiting

• Managing fatigue

• Protecting caregivers

Hematopoietic Stem Cell Transplantation (HSCT); Types & Nursing management

• Used to treat several malignant and nonmalignant diseases

• Types: Allogeneic, Autologous, Syngeneic, Myeloablative, Nonmyeloablative

• Nursing Management

  • Implementing pretransplantation care

  • Providing care during treatment

  • Providing posttransplantation care

    • Caring for recipients

    • Caring for donors

Graft v. Host disease

• Major cause of morbidity and mortality in the allogeneic transplant population

• Occurs when the donor lymphocytes initiate an immune response against the recipient's tissues (skin, gastrointestinal tract, liver) during the beginning of engraftment

• To prevent GVHD, patients receive immunosuppressant drugs, such as cyclosporine

• May be acute (within first 100 days) or chronic (occurring after 100 days)

What are some immunotherapies that can be given and what is thier purpose?

• The use of medications or biochemical mediators to stimulate or suppress components of the immune system to kill cancer cells

• Nonspecific immunotherapy boosts the immune system to enhance cancer cell destruction (bacilli Calmette-Guérin, cytokines)

• Monoclonal antibodies

• Checkpoint inhibitors

• Cancer vaccines

• CAR T-cell immunotherapy

Waht is target therepy + nursing management?

• The use of agents to kill or prevent the spread of cancer cells by targeting a specific part of the cell, with less negative effects on healthy cells than conventional chemotherapy

• Allows for personalization of cancer therapy

• Nursing management

  • Patient education

  • Standards of care for anticancer treatment patients

  • Promote self-care

  • Table 12-8

What is the nursing care of patients with cancer?

• Maintaining tissue integrity

  • Stomatitis

  • Radiation-associated impairment of skin integrity

  • Alopecia

  • Malignant skin lesions (see Chart 12-6)

• Promoting nutrition

  • Nutritional impairment

  • Anorexia

  • Malabsorption

  • Cancer-related anorexia–cachexia syndrome

• Relieving pain (Table 12-9, Figure 12-7)

• Decreasing fatigue (Chart 12-8)

• Improving body self-image

• Sex

What is the nursing management for continuing and transitional care?

• Nurse must assess the home environment and suggest modification for patient and caregivers

• Arrange for ongoing nursing visits

• Education

• Coordination of care

• Community resources

• Cancer survivorship (Table 12-12)

What is the care done for the advanced cancer patient?

• Care during oncologic emergencies (Table 12-13)

  • Superior Vena Cava Syndrome: A life-threatening condition caused by compression or obstruction of the superior vena cava, usually from a tumor (commonly lung cancer), leading to impaired venous return from the upper body. This results in facial/upper body swelling, increased intracranial pressure, and potential airway compromise, which can lead to cerebral anoxia and death.

    Need to Monitor: airway, breathing, neuro status, swelling of face/neck/arms

    The medical management is relieve the obstruction + support breathing:

    • High Fowler’s position ↑ (MOST IMPORTANT for symptoms)

    • Radiation / chemo → shrink tumor

    • Stent → open SVC

    • Oxygen, steroids, diuretics

    • Anticoagulants if clot-related

  • Spinal cord compression: A life-threatening condition where a tumor compresses the spinal cord, usually from metastasis to the spine, leading to decreased blood flow and nerve damage. This results in pain, neurologic deficits, and possible permanent paralysis if not treated quickly.

    Need to Monitor: neuro status (motor + sensory), pain, bowel/bladder function

    The medical management is relieve pressure + prevent damage:

    • Corticosteroids (MOST IMPORTANT early) → ↓ swelling

    • Radiation → shrink tumor

    • Surgery → decompress spine if severe

    • Pain control + supportive care

  • Hypercalcemia: A life-threatening metabolic condition where too much calcium is released from bones into the blood, often due to cancer, leading to decreased neuromuscular activity and organ dysfunction.

    Think: “everything slows down”

    This results in confusion, weakness, constipation, dehydration, and cardiac arrhythmias.

    Need to Monitor: calcium levels, mental status, heart, hydration status

    The medical management is flush it out + lower calcium:

    • LOTS of fluids 💧 (MOST IMPORTANT)

    • Loop diuretics → excrete calcium

    • Bisphosphonates → stop bone breakdown

    • Treat underlying cancer

  • Tumor Lysis Syndrome: A life-threatening condition that occurs when large numbers of cancer cells rapidly break down (usually after chemotherapy), releasing intracellular contents into the bloodstream. This leads to hyperkalemia, hyperphosphatemia (causing hypocalcemia), and hyperuricemia, resulting in potential cardiac arrhythmias, kidney failure, and neurologic complications (e.g., seizures).

  • Need to Monitor: electrolytes + heart + urine output closely.

  • The medical management is flush it out + fix electrolytes:

    • LOTS of fluids 💧 (MOST IMPORTANT)

    • Allopurinol / Rasburicase → ↓ uric acid.

    • Treat high potassium → insulin, meds.

    • Dialysis if severe

• Pain management

• Promote independence

What does hospice focus on?

• Should be referred in a timely fashion

• Comprehensive, multidisciplinary approach to care of patients with terminal illness, their families

• Focuses on

  • Quality of life

  • Palliation of symptoms

  • Psychosocial, spiritual care

  • Grief