ONCOLOGY: SHORT NOTE FOR NURSES( PART 1)

ONCOLOGY

CANCER

It is a neoplastic disorder that can involve or affect any part of the body. it is a condition characterized by abnormal multiplication of cell.

It means study of cancer

  • Rout of metastasis
    • Local ceding
    • Blood born
    • Lymphatic system

Metastasis is spreading cancer to one site to another site.






COMMON SITE OF METASTASIS

  • Breast cancer,- bone, lung and brain
  • Lung cancer:- brain
  • Colorectal cancer :- liver
  • Prostate cancer: – bone, spine and legs.
  • Brain cancer:- with in CNS

GRADING ANT STAGING

GRADING

  • Grade 1:- mild dysplasia (abnormal development of tissue),  slight abnormal and well differentiated cell
  • Grade 2:- moderate dysplasia, cells are more abnormal, and are moderately differentiated
  • Grade 3 :- severe dysplasia, cells are very abnormal and undifferentiated , cells of organ are difficult to determine

STAGING

  • Stage 0 :- carcinoma in sit
  • Stage 1 :- tumor limited to the tissue of organ (grade 3 )
  • Stage 2 :- limited local spreading
  • Stage 3 :- extensive local and regional spreading
  • Stage 4 :- metastasis to other region

 

 

FACTOR INFLUVENCE CANCER DEVELOPMENT

  • Environmental factor
    • Chemical carcinogen ex drug, tobacco, acid and alkali
    • Physical carcinogen ex tissue damage, radiation, chronic irritation.
    • Viral carcinogen ex hepatitis B, human papilloma virus, ebstern bar virus
  • Dietary factor
    • High fat and low fiber diet
    • Increase animal fat intake
    • Use of preservative, additives and color
  • Genetic predisposing factor. ex breast cancer
  • ex prostate cancer
  • Immune suppressant. ex Kaposi sarcoma

WARNING SIGN’S OF CARCINOMA

  • C- change in bowel and bladder function
  • A- any sore that does not heal
  • U- unusual bleeding or discharge
  • T- thickening or lump anywhere in the body
  • I-  indigestion
  • O- obvious change in war or mole
  • N- nagging cough or hoarseness

PREVENTION OF CANCER

  • Avoid pre disposing factor
  • Mammography – above 35yrs at least one , above 40yrs every yearly
  • Self-breast and testicular examination
  • Stool for occult blood
  • PAP smear
  • Sigmoidoscopy and colonoscopy
  • Skin examination

BREAST SELF EXAMINATION

  • It should be performed 7 to 8 day after menstruation, for pre-menopausal lady, and for post-menopausal lady select a specific day on every month

Procedure

Step 1 during bath

  • It can be performed while shower or during bath
  • Use second, third, and forth finger to press firmly on every part of the breast
  • Use right hand to palpate left breast and left to palpate right breast
  • Examine entire breast using small circular motion in a spiral or up and down motion
  • Repeat pattern of palpitation under the arm
  • Check for any lump or thickness of the tissue

Step 2 in front of mirror

  • Stand with arm at the side
  • Look for any asymmetry
  • Raise arm overhead and check for any changes in the shape of breast
  • Monitor for any dimple on the skin or changes in the nipple
  • Place your arm on the hips and press down firmly to tighten pectoral muscle and observe any asymmetry

Step 3 while lying on bed

  • When you examine right breast place a folded towel or a small pillow under the right shoulder
  • And put your right hand behind your head. then do step one

TESTICULAR SELF EXAMINATION

  • It should be performed every month. select a day and perform examination on the same day each month

Procedure

  • It should be performed after shower when scrotal skin is moist and relax
  • Gently lift each testis, each should feel like an egg firm but not hard. Smooth with no lump
  • Using both hand placing middle finger on the underside of the each testis and thump on the top. Gently roll testis between thump and finger to feel for any lump, swelling or mass

VARIOUS DIAGNOSTIC PROCEDURE




  • FNAC (fine needle aspiration cytology)
  • Incision biopsy
  • Excisional biopsy
  • Staging and grading
  • Bone marrow examination
  • X-ray, CT scan, and MRI
  • PAP smear (papanicolau’s smear)
  • Mammogram
  • Liver function test
  • Radio isotope scan

MANAGEMENT OF CANCER

  • Radiation
  • Chemotherapy
  • Surgical management
  • Bone marrow transplantation

SURGICAL MANAGEMENT

  • Prophetic surgery
    • It should perform in the client exist pre malignant condition or known family history that strongly predisposes the person to the development of cancer
  • Curative surgery
    • Tumor is removed for the complete cure from the diseases
  • Control surgery, debunking or reduction
    • It is a debunking procedure that consist of removing part of the tumor. Surgery decreases the number of cancer cell and increase the chance of effectiveness of other therapy
  • Palliative surgery
    • To improve the quality of life during survival time it can be done to reduce pain or bad effect of diseases
  • Reconstructive surgery
    • Help the patient to become normal same like before by constructing the organ

RADIATION THERAPHY

SIDE EFFECT

  • Skin changes
  • Irritation
  • Alopecia
  • Fatigue
  • Dehydration
  • Altered taste sensation
  • Vary according to site affected

TYPE

  • Tele therapy
  • Braque therapy

TELE THERAPY (beam radio therapy)

  • Source is external to client
  • Beam is 80 to 100 cm or 31 to 39inch or one meter away from the patient

Instruction to the patient

  • Wash the area with water and mild soap
  • Use the hand rather than washed cloth
  • Rinse the soap well and patch dry with soft towel
  • Do not remove radiation marking from skin
  • Avoid powder , ointment, lotion, or creams on the area
  • Wear soft cloth over the area
  • Avoid belt, buckles, straps or any cloth that rub the skin
  • Avoid sun or heat exposure
  • Observe the skin for weeping , if it occur clean the area with warm water and patch dry
  • Apply antibiotic cream or steroid cream
  • Exposure the site to air

BRAQUE THERAPY

  • Radiation source come in to direct and continuous contact with tumor tissue for a specific time, patient emits radiation and pose hazard to other

Type – unsealed and sealed source

UNSEALED

  • By IV or oral or by instillation in to body cavity
  • It is not confined in to one body area
  • It enter body fluid and eventually eliminated via and various excreta which are radioactive and harmful to other
  • Within 48hr radiation will excrete

SEALED SOURCE

  • It is temporary or permanent solid implant with in the tumor targeted tissue
  • Excreta are not radioactive but client emits radiation

Instruction to the patient

  • Place the patient in a private room with private toilet
  • Place a CAUTION sign on the client room
  • Organize nursing task, to minimize exposure. Limit time to 30mint /care provider/ shift
  • Nursing assignment should be rotated
  • Wear dosimeter badge to measure radiation exposure
  • Should have lead apron to reduce transmission of radiation
  • A nurse should never care for more than one client with a radiation implant at one time
  • Do not allow a pregnant nurse to give care
  • Do not allow children under 16yrs
  • Limit visitor 30 minute / day, distance between patient and visitor should be 6 feet
  • Save bed linen and other linen which used by the patient until the source is removed

Care of a dislodged radiation source

  • Should not take with bear hand
  • If the source dislodge use long handle forceps to take the source and place the source in led container, which kept in the client room and call physician
  • If unable to locate the source ban visitor and notify the physician

Removal of sealed radiation source

  • Client is no longer radioactive
  • Inform the client that sexual partner does not catch cancer
  • Patient can resume sexual intercourse after 7 to 10 days
  • If the implants was cervical or vaginal, betadine doish can given
  • If vaginal or rectal bleeding, foul smelling vaginal discharge, abdominal distension should inform doctor

BONE MARROW TRANSPLANTATION

Type

  • allogeneic (usually sibling or parents)
  • syngenic (identical twins)
  • Autologous (marrow donor is also the receiver, marrow is harvested during diseases remission and is stored frozen for later use)

PROCEDURE

HARVEST (step 1)

  • Marrow is collected through multiple aspiration from the iliac crest to get sufficient bone marrow to transplant
  • 500 -1000ml of marrow is aspirated
  • Marrow is filtered for any residual cancerous cell that may cause graft VS host diseases
  • Harvest is obtain before the initiations of conditioning

CONDITIONING (step 2)

  • It is immunosuppressant therapy regimen use to irradiate all malignant cell provide a state of immune suppression and create a space in the bone marrow for the engraftment of new marrow

TRANSPLANTATION (step 3)

  • Marrow is administered through client central line in a manner similar to the blood transfusion
  • Marrow is infused over 30min period or may be administer by IV push in to the central line

ENGRAFTMENT (step 4)

  • Transfused cell moved to the marrow foaming site of the recipient bone
  • Engraftment occur, when the RBC, WBC and platelet count begin to raise. successful engraftment occur within 2 to3 weeks
  • Client remain without any natural immunity until the donor marrow begin to proliferate RBC,WBC, and platelet after engraftment occur
  • Thrombocytopenia, infection, and anemia, are major concern until engraftment occur

COMPLICATION

  • Failure to engraft
  • Graft VS host diseases(immune component cell of the transplant marrow recognize the client cell as the foreign body and trigger an immune offence against them)

Management: – administration of immunosuppressant medication

  • Veno-occlusive diseases (diseases involve occlusion of the hepatic vein by thrombosis or debris

S/S

  • Pain in right upper quadrant abdomen
  • Jaundice
  • Ascites
  • Weight gain
  • Hepatomegaly

MANAGEMENT

  • Supportive treatment with increased IV fluids
  • Early detection is very important because it is a life threaten condition

CHEMOTHERAPHY

Kills or inhibit reproduction of neoplastic cell and also attacks and kills normal cells which affected are hair, lining of GI track, nails, sperm, and stem cell

SIDE EFFECT

  • alopecia
  • mucocitis
  • stomatitis
  • anorexia
  • nausea
  • vomiting
  • diarrhea
  • neutropenia
  • thrombocytopenia
  • infertility
  • hyperuricemia

NURSING RESPONSIBILITY

  • Monitor CBC
  • Take bleeding precaution, if platelet <50thousant, can lead to episode of bleeding, if platelet count < 20thousant can lead spontaneous uncontrolled bleeding
  • Avoid IM injection, vein puncture and any other invasive procedure as much as possible
  • Initiate neutropenia precaution when WBC count increases
  • Avoid row vegetable, uncooked food, and fresh flower in the room
  • Inform any sore throat, fever, or any unusual bleeding
  • Inform loss of appetites
  • Mouth care is important
  • Use saline or soda bi carbonate for mouth wash
  • Administer anti emetics before ½ an hour of the food, and it should administer 12 to 48 hour after the chemotherapy
  • Provide high calorie diet
  • Avoid hot food and high fiber diet
  • Encourage hydration (IV fluid) before and during therapy. Give at least 2 liter of fluid / day to maintain renal function
  • Give allopurinol to lower the uric acid level, that occur from rapid destruction of cell by antineoplastic medicine
  • Prepare chemotherapy in air vented space with biohazard cabinet. wear gloves, mask, gown, and eye protection
  • Nurse who are pregnant should not prepare or administer medication
  • Needle and IV tubs should be discard in biohazard container after use

ANTINEOPLASTIC MEDICATION

TYPES

  • Specific medication(this will affect cells only during a certain phase of reproduction cycle)
  • Nonspecific medication(this medication affect cell in any phase of reproduction cycle)

Group of medication

1 alkylating medication

Action; – affect the synthesis of DNA by causing cross linking of DNA to inhibit cell reproduction

Cell cycle phase:- nonspecific medication

Example of medicine

  • Nitrogen mustard
    • Chlorambucil (leukeran)
    • Cyclophosphamine (cytoxan)
    • Ifosfamide (ifex)
    • Extramustine phosphate sodium (emcyt)
    • Mechlorethamine HCL (mustargen)
    • Melphalan (alkeran)
  • Nitrosoureas
    • Busulfan (myleran)
    • Carmustine (BCNU)
    • Lomustine (CCNU)
    • Chlorozotozin (DCNU)
    • Semustine (Methile CCNU)
    • Streptozocin (zanosar)

 

  • Alkylating like medication
    • Thiotepa
    • Cisplatin (platinol)
    • Carboplatin (paraplatin)
    • Dacarbzine (DTIC)

Nursing responsibility

  • When prescribe cyclophomic, administer in empty stomach
  • Avoid intake of purine rich diet
  • Avoid infection
  • Instruct the client to report signs of infection and bleeding
  • Maintain good oral hygiene
  • Increase intake of fluid
  • Administer antiemetics 30 minutes before administration
  • Assess vital signs specially temperature
  • Monitor CBC, WBC, uric acid, and electrolyte
  • Withhold medicine if platelet count is less than 50thousand cell or WBC count less than 4000 cell/unit liter

GROUP 2

ANTITUMOR ANTIBIOTIC MEDICATION

Interfere with DNA and RNA synthesis

Cell cycle phase: – nonspecific medication

Example

  • Bloeomycine sulphate (blemoxane)
  • Dactinomycin (actinomycin D)
  • Daunorubicin (cerubidine)
  • doxorubicin (driamicin)
  • mytomycin (mutamycin)
  • plicamycin (mitracin)

Nursing responsibility

  • all same like above
  • monitor ECG change
  • assess the lung sound of rails
  • assess for myocardial toxicity, dyspnea and dysrhythmias
  • avoid the use of aspirin, anticoagulant, and thrombolytic agent with plicamycin

ANTIMETABOLITE MEDICATION

ACTION

Halt the synthesis of cell protein

Cell cycle phase:-specific and affect “S” phase

Nursing responsibility

  • all same like above
  • when administering 5-fluorouracil, assess for signs of cerebellar dysfunction such as ataxia, weakness
  • inform the doctor which may indicate medication discontinuation
  • when administering mitotaxin in large amount, prepare folic acid (leucobonin)to prevent folic acid deficiency

Example of drug

  • folic acid antagonist example :-methotrexate
  • pyrimidine anloge ex ;- 5-fu (adrucil), cytarabine HCL, floxuridine (FUBR), procarbazine HCL
  • purin anloge ex:- 6-mercaptopurine (purinethol), thioguanine
  • miscellaneous ribonuclotioreductase inhibiter ex:- hydroyuria (hydria)
  • antimicrotubal ex pentostain (nipent)
  • other antimetabolit medication Ex :_5-azacytidine, cladribine (leustatin), fludarabine, bidarabune

BINCA ALKALOIDS

Action: – prevent mitosis cause cell death

Cell cycle phase:-specific and act on M phase

Side effect

  • luckopnea
  • neurotoxicity
  • Ptosis
  • Alopecia
  • Peripheral neuropathy
  • Anorexia, nausea and vomiting
  • Hyperuricemia
  • Phlebitis

Examples of medicine

  • Etoposdice (depeside)
  • Paclitaxcl (taxol)
  • Toxotare
  • Ieniposide (gumon)
  • Binblastine sulphate (oncovin)vindesine (eldistine )binorelbine (navelvine)

Nursing responsibility

  • Monitor vital signs, WBC, platelet, and uric acid
  • Monitor for hoarseness
  • Assess for toxicity and neurotoxicity

HORMONAL MEDICATION AND ENZYME

ACTION:-suppress immune system and block normal hormone which result abnormal balance and slow the growth of the tumor tissue

Side effect

  • Anorexia nausea, vomiting
  • Gynecomastia
  • Hot flash
  • Weight gain
  • Hemorrhage from cyst
  • Electrolyte imbalance
  • Hyper tension
  • edema
  • Sex characteristic alteration

Example: – androgens

  • Progestron (texterol 50)
  • Textolactone (teslac)
  • Fluoxymesterone (halotextin)

Hormonal antagonest and enzyme

  • Aminogalthmide (sytudrem)
  • Aspraginase (elspar)
  • Diethylstilbestrol
  • Flutamide(eulexin)
  • Mytotane (lysobren)
  • Tamoxifen ( nolbadex)

Nursing responsibility

  • Monitor vital signs
  • Assess the medication that client is currently taking
  • Monitor S calcium with androgen
  • Monitor signs of altered sexual character
  • Encourage oral intake of 2 to 3 litter /day
  • Monitor pancreatic function, uric acid, and cholesterol level and signs of hemorrhage

IMMUNOTHERAPY

TYPE

  • Interleuking :-help different immune system cell to recognize and destroy abnormal body cell
  • Interferone :- slow down tumor cell division, stimulate proliferation and activation of natural killer cell and help cancer cell to resume a more normal appearance and revert to their previous characteristic
  • Cholone stimulating factor ;- induce more rapid bone marrow recovery after suppression of chemotherapy

Ex;-erythropoietin (EPO), epoepinalfa (epogen), filgrastim(neupogen), sargramostim (leukins)

 

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