Oncology_Spring_2025_Stephens-2

Page 1: Introduction to Oncology

• Presenters: Sarah Stephens, MSN, RN, Spring 2025

• Textbook References:

  • Hinkle Chapter 12 pp. 301-366

  • Ricci Chapter 46 pp. 1683-1739

• Key Visuals:

  • Diagram depicting normal cells vs cells forming a tumor.

Page 2: Patient Safety and Professional Standards

• Patient Safety Advocate:

  • Implement measures to promote a safe environment for patients and self.

  • Formulate goals and outcomes to reduce risk using evidence-based guidelines.

• Member of the Profession:

  • Demonstrate professional attitudes and behaviors; personal accountability and growth; advocacy.

• Provider of Patient-Centered Care:

  • Use clinical decision-making skills, develop teaching plans, integrate caring approaches, manage resources.

• Member of the Healthcare Team:

  • Facilitate communication, collaborate effectively, function as part of an interdisciplinary team.

Page 3: End of Course Student Learning Outcomes

• Identify and apply clinical judgment stages in patient care.

• Demonstrate knowledge of disease processes across the lifespan.

• Recognize appropriate treatments and nursing interventions for health conditions.

• Utilize clinical assessment techniques effectively.

• Communicate and collaborate efficiently with healthcare teams.

• Integrate legal and ethical guidelines in care.

• Outline nursing care during operative procedures.

• Appropriate care for pregnant patients through pregnancy and postpartum.

Page 4: Objectives for Cancer Care

• Define cancer and related terminology.

• Identify the seven warning signs of cancer (American Cancer Society).

• Discuss roles of surgery, chemotherapy, radiation, and other modalities in treatment.

• Recognize actions and side effects of chemotherapeutic drugs.

• Understand dietary modifications related to cancer care.

• Differentiate between types of radiation therapy and their side effects.

• Safety precautions when caring for clients receiving radiation or chemotherapy.

Page 5: Supplemental Assignments in Course

• Assignments:

  • Pre-Lecture Quiz

  • Concepts in Action: Cell Cycle

  • Interactive Tutorial: Cancer

  • Watch and Learn: Complications from Chemotherapy

  • Journal Article: Evaluating Fatigue in Prostate Cancer Patients

Page 6: Overview of Cancer Treatments

• Common Treatments Include:

  • Surgery

  • Radiation Therapy

  • Chemotherapy

  • Hematopoietic Stem Cell Transplantation

  • Immunotherapy

  • Targeted Therapy

• Hormone therapy: specific to hormone-dependent cancers (not discussed).

Page 7: Cancer Prefixes

• Prefix Meanings:

  • adeno-: gland

  • chondro-: cartilage

  • erythro-: red blood cell

  • hemangio-: blood vessels

  • hepato-: liver

  • lipo-: fat

  • lympho-: lymphocyte

  • melano-: pigment cell

  • myelo-: bone marrow

  • myo-: muscle

  • osteo-: bone

Page 8: Anatomic Classifications of Cancer

• Carcinoma: skin, glands, mucous membranes

• Sarcoma: connective tissue, muscle, bone, fat

• Leukemia: blood cells

• Lymphoma: lymphatic tissue

• Myeloma: bone marrow

• Melanoma: skin

• Germ Cell: cells with 23 chromosomes

• Carcinoid: hormone-producing cells

Page 9: Understanding Cancer

• Definition: A group of disorders involving uncontrolled abnormal cell growth.

• Key Dysfunctions:

  • Defective cell proliferation

  • Defective cell differentiation

• Notable Terms:

  • Carcinogenesis: process of cancer formation.

  • Carcinogens: substances that promote cancer development.

  • Metastasis: spread of cancer cells to distant parts of the body.

Page 10: Major Dysfunctions in Cancer Cells

• Cellular Proliferation: Unregulated division of cancer cells; variations in size and structure.

• Loss of Contact Inhibition: Cancer cells invade adjacent tissues without respect for boundaries.

• Origin of Cancer: Can arise from any type of cell capable of evading normal growth controls.

Page 11: Neoplasms

• Benign Characteristics:

  • Grow slowly, localized, well-defined borders, frequently encapsulated.

  • Do not endanger life or health.

• Malignant Characteristics:

  1. Aggressive growth and spreading

  2. Do not respond to homeostatic controls

  3. Irregular borders, invasive behavior, leading to severe complications.

Page 12: Common Metastatic Sites

• Brain and cerebrospinal fluid

• Lung

• Liver

• Adrenals

• Bone

Page 13: Etiology of Cancer

• Potential Causes:

  • Viruses: HPV, Hepatitis B, Epstein-Barr linked to 10-12% of cancers.

  • Radiation Exposure: Carcinogenic effects.

  • Chemical Agents: Tobacco, dyes, and other harmful chemicals.

  • Genetic Factors: Chromosomal abnormalities.

  • Hormonal factors: Disruptions leading to increased risk.

  • Idiopathic: Unknown causes.

Page 14: Steps in Carcinogenesis

• Stages of Carcinogenesis:

  1. Initiation

  2. Promotion

  3. Progression

  4. Angiogenesis (blood supply to tumors).

• Mitigation of Risk: Manage lifestyle factors such as diet, obesity, inactivity, and substance use.

Page 15: Examples of Carcinogenic Agents

• Chemical Agents:

  • Tobacco, fuel, pesticides.

  • Varied risks including asbestos, benzene, etc.

• Genetic Risks:

  • BRCA1, BRCA2 for breast and ovarian cancer.

  • MEN1, MEN2 for multiple endocrine neoplasia.

  • Specific cancers: nephroblastoma, lung, prostate, colorectal, etc.

Page 16: Lifestyle and Hormonal Factors

• Lifestyle Risks:

  • Obesity, alcohol consumption, poor diet, inactivity.

• Hormonal Risks:

  • Endogenous (natural) and exogenous (external) hormones linked to specific cancers (e.g., estrogen and breast cancer).

Page 17: Primary Cancer Prevention Strategies

• Recommended Actions:

  • Eat balanced diets, avoid carcinogens, maintain healthy weight, ensure adequate sleep, reduce stress.

  • Engage in regular physical activity; limit alcohol use and implement sunscreen practices.

  • Ensure vaccinations against HPV and HBV.

Page 18: Nine Ways to Reduce Cancer Risk

• Recommendations:

  • Exercise regularly, avoid tobacco, eat a healthy diet, protect skin, obtain vaccinations, limit alcohol, undergo regular screenings, maintain a healthy weight, and understand family history.

Page 19: Screening Guidelines for Common Cancers

• Oral Cancer: Annual screenings and risk factors.

• Breast Cancer: Annual mammograms start at ages 45-54; self-exams monthly.

• Cervical Cancer: Pap tests every 3 years (ages 21-29); co-test every 5 years (ages 30-65).

• Colon Cancer: Start screening at age 45, every 10 years until age 75.

• Lung Cancer: Low-dose CT scan for ages 55-77 with relevant smoking history.

Page 20: Cancer Diagnosis and Treatment Framework

• Tertiary Goals:

  • Address patterns and quality of care, economic impact, including hospice care and comprehensive support for patients and families.

Page 21: TNM Staging System

• Stages and Definitions:

  • T0 – No primary tumor, Tis – In situ.

  • T1, T2, T3, T4 – Increasing size and local extent.

  • N and M staging indicate regional involvement and distant spread, respectively.

Page 22: Seven Warning Signs of Cancer

• Signs to Recognize:

  • Change in bowel or bladder habits

  • A sore that does not heal

  • Unusual bleeding or discharge

  • Thickening or lump in breast or elsewhere

  • Indigestion or dysphagia

  • Change in wart or mole

  • Persistent nagging cough or hoarseness

Page 23: Diagnostic Tools for Cancer

• Tests Include:

  • X-ray, tissue biopsy, radiographic studies, cytology studies, PET scans, tumor markers, endoscopic exams, CBC, bone marrow evaluations, and molecular receptor status assessments.

Page 24: Biopsy Types

• Biopsy Methods:

  • Incisional, excisional, endoscopic, and needle biopsies.

• Purpose: To obtain tissue samples for definitive cancer diagnosis.

Page 25: Cancer Diagnostic Procedures

• Common Techniques: Upper GI, colonoscopy, genetic markers, staging methods, imaging tests including CT/MRI, and mammography.

Page 26: Overview of Cancer Treatment Modalities

• Types of Cancer Treatment:

  • Surgery, chemotherapy, stem cell transplants, hematopoietic stem cell transplantation, immunotherapies - all may require combination therapies.

Page 27: Surgical Types in Cancer Treatment

• Types of Surgeries:

  • Diagnostic, staging, curative, palliative, supportive, reconstructive, preventive surgeries utilized based on clinical needs.

Page 28: Chemotherapy Overview

• Combination Therapy: More effective than single agents; aim for optimal therapeutic ratio balancing effectiveness and adverse effects.

• Adjuvant Therapy: Post-surgery or radiation treatment

• Immunotherapy: Employs the immune system to combat cancer.

Page 29: Mechanism and Administration of Chemotherapy

• Action: Destroys cancer cells by affecting replication and DNA repair processes.

• Administration Types: Varied routes based on agent type and treatment protocol including IV and regional delivery methods.

Page 30: Chemotherapy Administration Techniques

• Types of Administration:

  • Intravenous (IV), oral, intrathecal, intraperitoneal, and intra-arterial methods utilized based on the patient's specific needs and chemotherapy protocols.

Page 31: Catheter and Dialysis Management

• Central Line/Port: Managing and utilizing for medications while maintaining sterility and safety.

Page 32: Ommaya Reservoir in Treatment

• Purpose: Utilized to deliver chemotherapy directly into cerebrospinal fluid for targeted effect.

Page 33: Chemotherapy Patient Education

• Key Points:

  • Monitor for extravasation, select appropriate veins, manage intravenous administration effectively.

• Emphasize awareness of side effects and infections.

Page 34: Extravasation and Infiltration Management

• Symptoms to Monitor: Pain, swelling, resistance to flow; variances depend on medication type (irritants vs. vesicants).

• Interventions: Stop infusion, manage symptoms, refer to physician for severe cases.

Page 35: Side Effects of Chemotherapy

• Common Effects:

  • Fatigue, GI issues, alopecia, stomatitis, reproductive effects, anemia, myelosuppression, and risk of infections especially during nadir.

Page 36: Chemotherapy Toxicity Overview

• Risks Include:

  • Myelosuppression, nausea, peripheral neuropathy, organ dysfunction, and various hematological concerns.

  • Specific drugs may lead to unique adverse effects requiring monitoring.

Page 37: Pain Management in Cancer Patients

• Importance of Pain Control:

  • Affects patients' quality of life significantly; both pharmacologic and non-pharmacologic approaches are necessary.

Page 38: Managing Chemotherapy Induced Nausea and Vomiting

• Strategies Include:

  • Dietary modifications, pre-treatment antiemetic administration, hydration, small frequent meals.

Page 39: Nutritional Management in Cancer Care

• Key Areas of Focus:

  • Monitor for malnutrition, provide nutritional supplements; assess dietary preferences and engage in protein supplementation.

Page 40: Targeted Therapy Overview

• Mechanism: Targets specific pathways and molecules in cancer cells; including monoclonal therapies and small molecule drugs.

• Common Toxicities: May lead to mucositis, GI disturbances, and notable changes in blood counts.

Page 41: Immunotherapy Mechanisms

• Strategies in Immunotherapy:

  • Stimulating or suppressing the immune response to enhance the killing of cancer cells; diverse types including monoclonal antibodies and CAR T-cell therapy.

Page 42: Additional Immunotherapies and Their Effects

• Key Concerns:

  • Monitor for cytokine storms and neurologic toxicities; manage complications judiciously.

Page 43: Nursing Management in Immune and Target Therapies

• Educational Points:

  • Importance of reporting new symptoms, self-care education, and familiarity with the treatment process and potential side effects.

Page 44: Monoclonal Antibodies in Cancer Treatment

• Mechanism of Action:

  • Target specific antigens on tumor cells; block pathways leading to tumor growth.

• Potential Toxicities: Flulike symptoms, gastrointestinal issues, and prospects of hypertension and hepatotoxicity.

Page 45: Managing Hypersensitivity and Anaphylactic Reactions

• Response Actions:

  • Stop medications, monitor vitals, provide emergency treatment as necessary, and maintain clear documentation of events and interventions.

Page 46: Hematopoietic Stem Cell Transplant (HSCT) Overview

• Purpose and Types:

  • Utilized in acute leukemia, with various sources for stem cells including autologous and allogeneic types.

• Goals: Restore blood cell production, managing risks associated with transplant procedures.

Page 47: Risks and Management in HSCT

• Potential Complications:

  • Monitor for HSOS, graft-versus-host disease, and common post-surgical complications.

• Nursing Focus: Ongoing assessments, patient support, and infection prevention strategies.

Page 48: Side Effects of Myeloablative Treatments

• Acute and Chronic Effects:

  • Headache, alopecia, nausea/vomiting, potential for infertility, organ dysfunction, secondary malignancies.

Page 49: Nursing Management Pre and Post Transplant

• Focus Areas:

  • Comprehensive pre-transplant evaluations, careful monitoring during treatment protocols, and follow-up care for long-term effects.

Page 50: Post-Transplant Monitoring

• Key Considerations:

  • Longitudinal assessments of health and psychosocial factors; ensure family-centered support.

Page 51: Graft-Versus-Host Disease (GVHD)

• Causes and Types:

  • Recognition of acute and chronic GVHD; preventive strategies include administering immunosuppressive therapy.

Page 52: Neutropenic Precautions and Protocols

• Prevention Measures:

  • Ensure safety for immunocompromised patients; healthcare staff adhere to strict hygiene protocols.

Page 53: Dietary Considerations in a Neutropenic Diet

• Foods to Avoid:

  • Soft cheeses, undercooked meats, raw fruits and vegetables, and unpasteurized products.

• Goal: Minimize infection risks during treatment.

Page 54: Radiation Therapy Types

• Types:

  • Electromagnetic (x-rays, gamma rays) and particulate radiation (electrons, protons).

• Focus: Cure, control, palliation in treatment protocols.

Page 55: Radiation Therapy Administration

• Methods:

  • External Beam Radiation Therapy (EBRT), brachytherapy, and imaging-guided techniques for precise targeting.

Page 56: External Radiation Precautions and Techniques

• Procedures:

  • Precise imaging during treatment; special emphasis on skin care and dose monitoring.

Page 57: Post-External Radiation Care

• Care Recommendations:

  • Monitor skin integrity, avoid harsh treatments, protect from sun exposure, and educate on treatment effects.

Page 58: Internal Radiation Administration

• Techniques:

  • Brachytherapy methods including high and low dose modalities; patient safety remains paramount.

Page 59: Safety Precautions in Internal Radiation

• Protect Staff and Patients:

  • Private rooms, limited visit durations, and strict protocols regarding hygiene and waste disposal.

Page 60: Acute Toxicities of Radiation

• Common Effects:

  • Skin integrity changes, stomatitis, and other early physical side effects needing proactive management.

Page 61: Late Effects of Radiation Therapy

• Monitoring Required For:

  • Potential for long-term effects including cognitive changes, gastrointestinal, and hormonal dysfunction.

Page 62: Systemic Side Effects of Radiation

• Common Symptoms:

  • Fatigue, malaise, and potential alterations in bodily functions requiring attention.

Page 63: Nursing Interventions in Radiation Therapy

• Focused Care:

  • Enable patient coping, monitor for side effects, and support emotional needs during treatment.

Page 64: Pediatric Considerations in Cancer Care

• Emotional and Developmental Needs:

  • Addressing psychosocial support for both child and family; adaptation may be necessary during treatment.

Page 65: Long-term Effects of Treatment in Children

• Potential Consequences:

  • Physical and cognitive impacts including growth issues, organ dysfunction, and psychosocial adaptations.

Page 66: Cancer Treatment and Pregnancy

• Safety Considerations:

  • Discuss treatment impacts on pregnancies; very limited treatments can be safely administered.

Page 67: Nursing Responsibilities in Radiation Therapy

• Key Roles:

  • Monitor patient conditions, document treatment responses, and provide comprehensive support.

Page 68: Oncologic Emergencies

• Categories of Emergencies:

  • Obstructive, metabolic, infiltrative emergencies needing rapid recognition and intervention.

Page 69: Recognizing Oncologic Cues

• Symptoms to Note:

  • Evidence of obstructions or metabolic changes; treatments involve clinical interventions as necessary.

Page 70: Emergency Interventions in Cancer

• Focused Actions:

  • Immediate response protocols for severe symptoms including fluid management and urgent care transfers.

Page 71: Comprehensive Nursing Interventions

• Goals:

  • Maintain patient's quality of life through proactive management, education, and emotional support.

Page 72: Addressing Sexual and Reproductive Health

• Discussions Regarding Fertility:

  • Open dialogues regarding potential risks of cancer treatments on reproductive outcomes.

Page 73: Psychological Support in Cancer Care

• Key Factors:

  • Explore coping mechanisms, knowledge of support systems, and personal concerns related to illness.

Page 74: Goals of Cancer Therapy

• Therapeutic Aims:

  • Prophylaxis, cure, control, and palliation to optimize quality of life for patients.

Page 75: Hospice Care in Oncology

• Focus Areas:

  • Provide compassionate care, manage symptoms, and support families through the progression of disease.

Page 76: Resources for Patients

• Referrals Include:

  • American Cancer Society, various support groups, and community resources for patients and families.