8 - Cancer - Management

8/13/2019 8 - Cancer - Management

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are oflients with

ancerJessie T. Orao, RN, RMMN Student - SPC

O ncology

ursin

CANCER TREATMENTMODALITIES


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OBJECTIVES

After 1.5 hours of lecture, the learnersare expected to:

1. enumerate the treatment modalities for cancer;2. discuss surgical interventions for cancer;3. identify the importance of radiation therapy, its

principles and sources;4. describe chemotherapy mechanism of action,

side-effects and nursing care; and5. determine the indications of immunotherapy and

bone marrow transplant in relation to cancermanagement.


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WORDS TO PONDER

Trust in the LORD with all yourheart and do not lean upon yourown understanding. In all your

ways take notice of HIM, and HEHIMSELF will make your paths

straight. Proverbs 3:5-6


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NURSING WORDS

Options are thousands but choice for action

limits us to few, even only to one and series ofit among emerging choices.

This one act can make the whole difference. Ac

as if it is your last, so you give it all. Act as ifyou have it all, so you can reap it. Act as if you

are sure, so you can hit it all. Action defines your results. It comes from a

choice you make among many options. CARL E BALITA


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MANAGEMENT

http://www.cancer.org


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MANAGEMENT

Goals

Cure complete eradication of malignantdiseaseControl prolonged survival andcontainment of cancer cell growth

Palliation relief of symptoms associatedwith the disease


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Surgical

Interventions RadiationTherapy

Chemotherapy

Immunotherapy

Bone MarrowTransplantation

TREATMENT MODALITIESMANAGEMENT


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MANAGEMENTSurgery

A. Diagnostic Surgerybiopsy

B. Primary Method of TreatmentprophylacticPalliativereconstructive


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MANAGEMENTSurgery

Diagnostic Surgery

Diagnostic surgery is the definitive method ofidentifying the cellular characteristics thatinfluence all treatment decisions.


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MANAGEMENTSurgery

Needle biopsies

Fine needlebreast biopsy


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MANAGEMENTSurgery

Stereotactic biopsy of a brainlesion


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MANAGEMENTSurgery

Diagnostic Surgery

Exfoliative cytology used to study cells that the bodyhas shed during the normal sequence of body tissue

growth and development


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MANAGEMENTSurgery

Surgery as Primary Treatment

GOAL

remove the entire tumor or as much as isfeasible (a procedure sometimes called

debulking) and any involved surrounding

tissue, including regional lymph nodes.


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MANAGEMENTSurgery


A. Prophylactic Surgery

Prophylactic surgery involves removing nonvital tissuesor organs that are likely to develop cancer. Thefollowing factors are considered when electingprophylactic surgery:

Family history and genetic predisposition Presence or absence of symptoms Potential risks and benefits Ability to detect cancer at an early stage

Patients acceptance of the postoperative outcome


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MANAGEMENTSurgery


A. Prophylactic SurgeryColectomy, mastectomy , and oophorectomy

Example: a strong family history of breast cancer, positiveBRCA-1 or BRCA-2 findings, an abnormal physical finding onbreast examination such as progressive nodularity and cysticdisease, a proven history of breast cancer in the opposite

breast, abnormal mammography findings, and abnormalbiopsy results may be factors considered in making thedecision to proceed with a prophylactic mastectomy(Houshmand, Campbell, Briggs, McFadden & Al-Tweigeri,

2000; Zimmerman, 2002).


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MANAGEMENTSurgery


B. Palliative Surgery

GOAL

to make the patient as comfortable as possible and topromote a satisfying and productive life for as long as

possible.


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MANAGEMENTSurgery


B. Palliative Surgery

Palliative surgery is performed in an attempt torelieve complications of cancer, such as ulcerations,obstructions, hemorrhage, pain, and malignant

effusions.

Communicatio n: Honest and informative


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MANAGEMENT


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MANAGEMENTSurgery


C. Reconstructive Surgery

GOAL

improve function or obtain a more desirable

cosmetic effect


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MANAGEMENTSurgery


C. Reconstructive Surgery

GOAL

improve function or obtain a more desirable

cosmetic effect

Reconstructive surgery may be indicated for breast,head and neck, and skin cancers


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MANAGEMENTSurgery


Video-assisted endoscopic surgery is replacingsurgeries associated with long incisions and extended

recovery periods.Salvage surgery is an additional treatment option thatuses an extensive surgical approach to treat the localrecurrence of the cancer after a less extensive

primary approach is used.Example: A mastectomy to treat recurrent breast

cancer after primary lumpectomy and radiation is anexample of salvage surgery.


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MANAGEMENTSurgery


Electrosurgery makes use of electrical current todestroy the tumor cells.

Cryosurgery uses liquid nitrogen to freeze tissue tocause cell destruction.Chemosurgery uses combined topicalchemotherapy and layer-by-layer surgical removalof abnormal tissue.


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MANAGEMENTSurgery


Laser surgery (light a mplification by s timulatede mission of r adiation) makes use of light and

energy aimed at an exact tissue location and depthto vaporize cancer cells.Stereotactic radiosurgery SRS) is a single andhighly precise administration of high-dose radiationtherapy used in some types of brain and head andneck cancers.


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MANAGEMENTSurgery

Post-operative Considerations

1. body image2. self-esteem

3. functional abilities4. rehabilitation


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MANAGEMENTSurgery

Nursing Management

complete a thorough preoperative assessment for allfactors that may affect patients undergoing surgical

procedures.provide education and emotional support by assessingpatient and family needs and exploring with the patientand family their fears and coping mechanisms,

encouraging them to take an active role in decisionmaking when possible.communicate frequently with the physician and otherhealth care team members to be certain that the

information provided is consistent.


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MANAGEMENTSurgery

Nursing Management

assess the patients responses to the surgery andmonitors for possible complications, such as infection,

bleeding, thrombophlebitis, wound dehiscence, fluidand electrolyte imbalance, and organ dysfunctionaddress wound care, activity, nutrition, and medicationinformation.

plan for discharge, follow-up and home care, andtreatment are initiated as early as possible to ensurecontinuity of care from hospital to home or from acancer referral center to the patients local hospital andhealth care provider.


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MANAGEMENT


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MANAGEMENT


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MANAGEMENTRadiation Therapy

Two types of ionizing radiation (can lead to tissuedisruption)1. electromagnetic rays (x-rays and gamma rays)2. particles (electrons [beta particles], protons,

neutrons, and alpha particles

Sources:

1. External2. Internal

a. sealedb. Unsealed

TYPES


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2. Internal Radiation Therapy . This is administered

within or near the tumor or in the systematiccirculation.delivers a high dose of radiation to a localizedarea. The specific radioisotope for implantation isselected on the basis of its half-life.

A. Sealed source (brachytherapy) . Theradioisotope is placed within or near the tumor. Theradioactive material is enclosed in a sealed container.

Sealed source is used for both intracavityand interstitial therapy.Intracavity RT is used to treat cancers of theuterus and cervix.

Jessie T. Orano, RN, RM - St. Alexius College

TYPES


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TYPES


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TYPES

TYPES


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The radioisotope is placed in the bodycavity, generally for 24 to 72 hours (cesium137 or radium 226).Interstitial therapy radioisotope is placedin needles, beads, seeds, ribbons, orcatheters, implanted directly into the

tumor ( iridium 192, iodine 125 cesium 137,gold 198, and radium 222).In SSIR, radioisotope cannot circulatethrough clients body nor contaminate the

clients urine, sweat, blood or vomitus.Direct contact with sealed sourcecontainer results to radiation exposure.


TYPES

EXAMPLE


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Radioactive Seed


EXAMPLE

EXAMPLE


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Radioactive Beads


EXAMPLE

TYPES


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B. Unsealed source . The radioisotope may beadministered intravenously, orally or by instillation directlyinto the body cavity.

Radioisotopes circulates in the body.Urine, sweat, blood or vomitus contain theradioactive isotope.

Examples:

Iodine 131 for Graves disease and thyroidcancerAlrontium chloride for relief of painful bonymetastasis

ALERT: Iodine is eliminated within 48 hours.


TYPES

MANAGEMENT


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Radiation Dosage

The radiation dosage is dependent on thesensitivity of the target tissues to radiation and on

the tumor size.

The lethal tumor dose is defined as that dose thatwill eradicate 95% of the tumor yet preservenormal tissue.

MANAGEMENT


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Radiation Dosage

Radiation destroys cancer cells byaffecting cell structure and the cellenvironment. It is used in fractionated divided)doses to prevent destructive side effects;however, side effects can occur in the area

being treated because of damage to normalcells.


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MANAGEMENT


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Radioactive Seed


MANAGEMENT


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Radioactive Beads


MANAGEMENT


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DDistance

TTime

SShielding

Radiation TherapyMANAGEMENT


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MANAGEMENT


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Limit contact with the client or 5 minuteseach time a total of 30 minutes per 8-hourshift.

The lesser the time spent close to the radiation source, the lesser the amount of

radiation exposure

TTime

Radiation TherapyMANAGEMENT

MANAGEMENT


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Wear a dosimeter film badge at all times while caringfor clients

Shielding is the physical barrier between a

person and a radiation source.Use lead shield/lead apron during contact

with client

The more tightly packed particles and atomsliterally absorb more radiation

SShielding

MANAGEMENT


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Private roomPrivate bathRadioactive Material sign on the door

MANAGEMENT


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Nursing responsibilities include

knowledge about the following:

1 Radiation source being used

2 Method of administration

3 Start of treatment

4 Length of treatment

5 Prescribed nursing precautions

Radiation Therapy

MANAGEMENT


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1. To avoid exposure to radiation while the patient isreceiving therapy, consider the following: DTS

2. If exposed to penetrating radiation, wear filmbadges on the front of the body.

3. Take appropriate measures associated with sealedsources of radiation implanted within a patient.

4. Know that all casing material absorbs radiation.

5. Do not linger longer than necessary in givingpatient care, even though all precautions arefollowed.

Radiation Therapy

MANAGEMENT


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6. Be alert of implants that may have become loosened(those inserted in cavities that have access to the exterior).

Example: check the emesis basin following mouthcare for patient with an oral implant.

7. Notify the radiation therapist of any implant that hasmoved out of position.

8. Use long-handled forceps or tongs and hold at arms length when picking up any dislodged radium, needle,

seeds, or tubes.9. Do not discard any dressing or linens unless you are surethat no radioactive source is present.

Radiation Therapy

CLIENT EDUCATION


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CLIENT EDUCATION

Field markings are

made with what arecalled felt-tippedpens, or Eddingmarker pens, onto thepatients skin. These ofcourse, fade offbecause of sweating,washing ormoisturizing cream

applications.

MANAGEMENT


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ALERT:

Never pick-up radioactive source with yourhands.

Deposit the radioactive source in the lead

container kept in the clients room.

Radiation Therapy


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MANAGEMENT


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Chemotherapy

MANAGEMENT


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CHEMOTHERAPY

- an approach that uses chemicals todestroy cancer cells on selective basis.

The cytotoxic agents used in cancertreatments generally do not kill thecancer cells directly but instead impairtheir ability to replicate by interfering withDNA and RNA activities.


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Chemotherapy may be used as

1.) Adjuvant therapy

2.) Neoadjuvant therapy3.) Chemoprevention4.) Myeloablation


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ADJUVANT THERAPY a course ofchemotherapy used in conjunction withanother treatment modality ( surgery,radiation, biotherapy ) and aimed attreating micro-metastasis

NEO-ADJUVANT CHEMOTHERAPY administration of chemotherapy to shrink

the tumor prior to surgical removal of thetumor


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PRIMARY THERAPY the treatment of clients withlocalized cancer for which there is an alternativebut less than completely effective treatment.

INDUCTION CHEMOTHERAPY the drug therapygiven as the primary therapy for clients withcancer for which no alternative treatment exists.

COMBINATION CHEMOTHERAPY administration

of two or more chemotherapeutic agents in thetreatment of cancer, allowing each medicationto enhance the action of the other or to actsynergistically.


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CYTOPROTECTIVE AGENTS

Protect normal tissue by binding withmetabolites of other cytotoxic drugs

DexrazoxaneMesna

FOLIC ACID ANALOGS

Antidote for methotrexate toxicityLeucovorin

Classification of Chemotherapy Drugs


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HORMONE AND HORMONE INHIBITORSInterfere with binding of normal hormonesto receptor proteinsManipulate hormone levels

After hormone environmentUsually palliative,not curative

Androgens, Antiandrogens,Antiestrogens, Estrogens, Gonadotropin,Progestins

Ch thMANAGEMENT


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Chemotherapy

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Chemotherapy

ChemotherapyMANAGEMENT


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Chemotherapy

MANAGEMENT


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Classification of Chemotherapy

Drugs


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CYCLE SPECIFIC



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Common Side Effects

Nausea and vomitingDiarrhea

Bone Marrow suppressionStomatitisRenal ToxicityHepatoxicity

CHEMOTHERAPY

MANAGEMENT


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CHEMOTHERAPYMethotrexate

C antineoplasticE evaluate tumor sizeA no specificS avoid alcoholReport black tarry stool and sore throatE keep the antidote leucovorine at the bedside. May causebirth detects.Administer antiemetic to counteract nausea and vomitingThe drug depresses the bone marrow and damage the liver

Sample question: which blood profile is monitored if a patientwill receive methotrexate?

a. uric acid c. creatinineb. S. G. O. T. d. W.B.C.

MANAGEMENT


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2. Mitotic Spindle Poisons- It arrests metaphase by inhibiting mitotictubular formation; inhibits DNA and proteinsynthesis

ExamplesEtoposide, Vinblastine, Vincristine, Docetaxel,Paclitaxel, Etoposide, Teniposide

Common Side EffectsBone Marrow suppression, Neuropathies,Stomatitis

CHEMOTHERAPY


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A. EnzymesUseful only for leukemias

Example: Asparaginase

B. Plant Alkaloids Cycle-specific to M Phase Prevent mitotic spindle formation

Example: Vinblastine, vincristine


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CYCLE-NONSPECIFIC


MANAGEMENT


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1. Alkylating Agents- It alters DNA structure by misreading

DNA code, initiating breaks in the DNAmolecule and cross-link DNA strands

Examples:Busulfan, Carboplatin, Chlorambucil,Cisplatin, Cyclophosphamide, Melphalan,Thiotepa

MANAGEMENT


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Common Side Effects:

Bone marrow suppressionNausea

VomitingCystitisStomatitisAlopecia

Gonadal SuppressionRenal Toxicity

CHEMOTHERAPY

MANAGEMENT


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CHEMOTHERAPYCytoxan (Cyclophosphamide)

C AntineoplasticE Decreased tumor sizeA Best given in the morning to preventhemorrhagic cystitis S Alopecia is temporary; report sore throat ; reporthematuria dysuria immediatelyE Monitor CBC

Increase fluid intake and outputAssess for signs and symptoms of

nephrotoxicity. Monitor CBC.

MANAGEMENT


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CHEMOTHERAPYCytoxan (Cyclophosphamide)

Sample Questions : a nurse should include which ofthe following strategies in the care plan of a childwho is receiving cyclophosphamide (Cytoxan) for

treatment of Hodgkins disease?

a. monitor the childs intake and output b. assess the childs apical heart rate c. place a footboard at the end of the childs bed d. evaluate the childs hemoglobin level

MANAGEMENT


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2. Antitumor Antibiotic- It interferes with DNA synthesis bybinding DNA; prevents RNA synthesis

ExamplesBleomycin, Dactinomycin, Doxorubicin,Idarubicin, Mitomycin, Mitoxantrone,Plicamycin

CHEMOTHERAPY

MANAGEMENT


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Common Side Effects

Bone Marrow suppressionNausea and vomitingAlopeciaAnorexiaCardiac Toxicity

CHEMOTHERAPY

MANAGEMENT


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Adriamycin (Doxorubcin)

C Antineoplastic AntibioticE (-) infection CBC changesA Best taken in the morningS May turn the urine red, can cause diarrhea and alopeciaE Increase fluid intake the drug can cause hyperuricemia

Asses for Allergy

Sample question: which of the following statements if made bya patient who is administered doxocrubicin hydrochloride(adriamycin) would indicate to nurse that the patient needsfurther instruction about the adverse effects of the drugs?

a. my hair is going to fall outb. my urine will turn redc. I can expect to become constipatedd. I may develop an irregular heartbeat

CHEMOTHERAPY

MANAGEMENT


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CHEMOTHERAPYOncovin (Vincristine)

C antineoplasticE evaluate tumor sizeA no specificS may cause alopecia nausea vomiting and constipation

Use birth control it is teratogenic

E instruct the patient that the drug is not taken during pregnancy

Sample question: To which of the following nursing measuresshould a nurse give priority in the care of a patient who is receivingvincrestine sulfate (oncovin)?

a. limiting environment stimulib. observing for gum hyplasiac. monitoring for cardiac dysrhythmiasd. increasing dietary fiber content


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MANAGEMENT


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3. Nitrosureas- Similar to the alkylating agents; it cancross the Blood-Brain Barrier

ExamplesCarmustine, Lomustine, Semustine, Streptozocin

Common Side Effects:Delayed and cumulative myelosuppresion,nausea and vomiting

CHEMOTHERAPY


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MANAGEMENT


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NUTRITION NOTES

Reducing Cancer Risk

Encourage patient to consume these foods: Fruits and vegetables, especially those rich in vitamin C or

carotene Cruciferous vegetables (cabbage, broccoli, brussels sprouts) Whole grainsEncourage patient to limit these foods: Excessive meat, especially when smoked, salted, charbroiled, or

cooked at high temperature Excessive fat (more than 30% of daily calories) Excessive calories Alcohol

PARTING WORDS

Th l


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Theres only one

corner of the universeyou can be certain ofimproving, and thats

your own self.Commit to your self

and struggle to becomea better player of yourlif

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8 - Cancer - Management