cancer module

8/6/2019 Cancer Module

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CARE OF CLIENTSCARE OF CLIENTS

WITH CELLULARWITH CELLULARABERRATIONABERRATION


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Stages in CarcinogenesisStages in Carcinogenesis

InitiationInitiation exposure of normal cells toexposure of normal cells to

carcinogenscarcinogens

PromotionPromotion cigarette smoking, alcoholcigarette smoking, alcohol

abuse or dietary components that act onabuse or dietary components that act on

the transformed cellthe transformed cell

ProgressionProgression uncontrolled growth ofuncontrolled growth ofmalignant tumor capable of metastaticmalignant tumor capable of metastatic

activityactivity


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Carcinogenesis TheoriesCarcinogenesis Theories

Environment TheoryEnvironment Theory environmentalenvironmental

factors are implicated directly or indirectlyfactors are implicated directly or indirectly

in cancer developmentin cancer development PhysicalPhysical sexual development, reproductivesexual development, reproductive

patterns and sexual practicespatterns and sexual practices

ChemicalChemical tobacco, alcohol, drugs,tobacco, alcohol, drugs,radiation, occupational, pollution, dietradiation, occupational, pollution, diet


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Genetic TheoryGenetic Theory inherited disordersinherited disorders

(deranged gene, chromosomal defect) or(deranged gene, chromosomal defect) or

altered DNA may result in changes thataltered DNA may result in changes thatrender the cell vulnerable to malignantrender the cell vulnerable to malignant

transformation; cancer families tend totransformation; cancer families tend to

inherit the same type of cancer andinherit the same type of cancer anddevelop the disease at an early agedevelop the disease at an early age


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Immunological TheoryImmunological Theory failure of thefailure of the

normal immune mechanism maynormal immune mechanism may

predispose one to certain cancerspredispose one to certain cancers

e.g high incidence of tumors in earlye.g high incidence of tumors in early

childhood and old agechildhood and old age periods whenperiods when

the immune system is weakthe immune system is weak


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TerminologiesTerminologies

HyperplasiaHyperplasia increase in the size of anincrease in the size of an

organ because of an increase in cellorgan because of an increase in cell

numbernumber

HypertrophyHypertrophy increase in the size of anincrease in the size of an

organ because of an increase in cell sizeorgan because of an increase in cell size

MetaplasiaMetaplasia a reversible process ina reversible process inwhich one adult cell type in an organ iswhich one adult cell type in an organ is

replaced by another adult cell typereplaced by another adult cell type


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TerminologiesTerminologies

DysplasiaDysplasia alteration in adult cellsalteration in adult cellscharacterized by changes in their size,characterized by changes in their size,

shape, and organizationshape, and organization AtrophyAtrophy decrease in cell sizedecrease in cell size

AnaplasiaAnaplasia reversed cellularreversed cellulardevelopment to a primitive cell typedevelopment to a primitive cell type

NeoplasiaNeoplasia abnormal cellular changesabnormal cellular changesand growth of new tissuesand growth of new tissues


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Warning Signs of CancerWarning Signs of Cancer

CC hange in bowel or bladder habitshange in bowel or bladder habits

AA sore that doesnt healsore that doesnt heal

UU nusual bleeding or dischargenusual bleeding or discharge

TT hickening or lumphickening or lump

II ndigestion or dysphagiandigestion or dysphagia

OO bvious change in a wart or molebvious change in a wart or mole

NN agging cough or hoarsenessagging cough or hoarseness


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Warning Signs of CancerWarning Signs of Cancer

Unexplained weight lossUnexplained weight loss

Unexplained anemiaUnexplained anemia

Persistent headachePersistent headache


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Cancer Early DetectionCancer Early Detection

Breast SelfExamination (BSE)Breast SelfExamination (BSE)

Once a month, one week after menstruationOnce a month, one week after menstruation

starting at menarchestarting at menarche


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Steps in BSESteps in BSE

Stand or sit in front of the mirrorStand or sit in front of the mirror notenotecontour changes, asymmetry, nipplecontour changes, asymmetry, nipple

discharge, color of skin (orange peeldischarge, color of skin (orange peelskin), presence of dimpling, puckering orskin), presence of dimpling, puckering orretractionretraction

Supine position with a small pillow orSupine position with a small pillow or

folded bath towel under the shoulder offolded bath towel under the shoulder ofthe breast to be examined with the armthe breast to be examined with the armraised over the headraised over the head


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Steps in BSESteps in BSE

The other hand palpates or kneadsThe other hand palpates or kneads

breast in a circular motion starting frombreast in a circular motion starting from

the outside inwardsthe outside inwards

Press the nipple to check for anyPress the nipple to check for any

dischargedischarge

Repeat palpation while in the showerRepeat palpation while in the shower


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Testicular selfTesticular self--examination (TSE)examination (TSE) donedone

by males 15by males 15--35 years old35 years old


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Steps in TSESteps in TSE

Examine for testicular tumor periodicallyExamine for testicular tumor periodicallypreferably done during a shower or bath.preferably done during a shower or bath.

Use both hands to palpate. CarefullyUse both hands to palpate. Carefullyexamine all scrotal contents.examine all scrotal contents.

Locate the epididymis; this is the cordLocate the epididymis; this is the cordlike structure at the back of the testis.like structure at the back of the testis.

The spermatic cord and vas extendsThe spermatic cord and vas extendsupward from the epididymis.upward from the epididymis.


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Steps in TSESteps in TSE

Feel each testis between the thumb andFeel each testis between the thumb and

the first two fingers of each hand.the first two fingers of each hand.

Note size, shape, abnormal tenderness.Note size, shape, abnormal tenderness.

Stand infront of the mirror and look forStand infront of the mirror and look for

changes in size and shape of thechanges in size and shape of the

scrotum.scrotum.


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MammographyMammography radiologic study of theradiologic study of thesoft tissue of the breast used to evaluatesoft tissue of the breast used to evaluate

differences in the density of tissuedifferences in the density of tissueespecially small or poorly definedespecially small or poorly definedmasses or nodules; capable of detectingmasses or nodules; capable of detectingbreast cancers that are too small to bebreast cancers that are too small to be

palpated on physical examination.palpated on physical examination. XeromammographyXeromammography xx--ray image of theray image of the

breast recorded on paper rather than filmbreast recorded on paper rather than film


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Papanicolau SmearPapanicolau Smear microscopicmicroscopic

examination of the cells collected fromexamination of the cells collected from

the vaginal pool, exocervix andthe vaginal pool, exocervix andendocervixendocervix

Rectal Digital ExaminationRectal Digital Examination donedone

annually on clients over forty years old.annually on clients over forty years old.


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BiopsyBiopsy surgical excision of small piecesurgical excision of small piece

of tissue for microscopic examinationof tissue for microscopic examination

Incisional or Partial BiopsyIncisional or Partial Biopsy only part ofonly part ofneoplasm is removed and examined underneoplasm is removed and examined under

microscopemicroscope

Excisional or Total BiopsyExcisional or Total Biopsy entire tumor isentire tumor is

removed and examined under microscoperemoved and examined under microscope


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Fine Needle Aspiration BiopsyFine Needle Aspiration Biopsy aspirationaspiration

of secretions from suspicious nodule andof secretions from suspicious nodule and

examination under microscopeexamination under microscope Rush Frozen SectionRush Frozen Section incisional biopsyincisional biopsy

done in the operating room while the patientdone in the operating room while the patient

and the surgical staff awaits for the resultand the surgical staff awaits for the result

that comes back after a few minutes;that comes back after a few minutes;determines the type of surgery to be done.determines the type of surgery to be done.


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Bone orBone Marrow BiopsyBone orBone Marrow Biopsy done bydone by

means of bone marrow aspiration; usesmeans of bone marrow aspiration; uses

trocar or bone marrow needletrocar or bone marrow needle Sites of Aspiration:Sites of Aspiration:

SternumSternum

Iliac CrestIliac Crest most commonmost common

TibiaTibia


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Cancer ClassificationCancer Classification

GradingGrading

defines the origin of the tumor and degreedefines the origin of the tumor and degree

to which tumor cells retain the functional andto which tumor cells retain the functional andhistologic characteristics of tissue origin;histologic characteristics of tissue origin;

usually done by pathologist (histologicusually done by pathologist (histologic

classification)classification)


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GradingGrading

G1G1 well differentiatedwell differentiated

G2G2 moderately well differentiatedmoderately well differentiated

G3G3 poorly differentiatedpoorly differentiated

G4G4 very poorly differentiated with highvery poorly differentiated with high

degree of malignancydegree of malignancy


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Cancer ClassificationCancer Classification

StagingStaging determines the size of thedetermines the size of thetumor and extent metastasis; determinestumor and extent metastasis; determines

extent of the diseaseextent of the disease Stage 0Stage 0 in situin situ

Stage IStage I limited to tissue of origin; localizedlimited to tissue of origin; localized

Stage IIStage II limited local spreadlimited local spread

Stage IIIStage III extensive local and regionalextensive local and regionalspreadspread

Stage IVStage IV metastasismetastasis


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StagingStaging

TNM StagingTNM Staging provides categorization ofprovides categorization of

primary lesion and extent of involvementprimary lesion and extent of involvement

in the clinical assessment of cancerin the clinical assessment of cancer TT primary tumor extentprimary tumor extent

NN lymph node involvementlymph node involvement

MM metastasismetastasis


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TT

TTXX tumor cannot be adequatelytumor cannot be adequately

assessedassessed

TT00 no incidence of primary tumorno incidence of primary tumor

TTISIS tumor in situtumor in situ

TT11, T, T22, T, T33,, TT44 progressive increase inprogressive increase in

tumor size and involvementtumor size and involvement


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NN

NNXX regional lymph node cannot beregional lymph node cannot be

assessed clinicallyassessed clinically

NN00 regional lymph node demonstrableregional lymph node demonstrableabnormalabnormal


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MM

MMXX not assessednot assessed

MM00 no known distant metastasisno known distant metastasis

MM11 distant metastasis present in sitedistant metastasis present in site


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Treatment GoalsTreatment Goals

Complete irradication of malignancyComplete irradication of malignancy

Prolong survival in the presence ofProlong survival in the presence of

malignancymalignancy

Relief of associated symptoms withRelief of associated symptoms with

cancer disease processcancer disease process


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CancerManagementCancerManagement

SurgerySurgery

DiagnosticDiagnostic biopsybiopsy

Radical surgery (wide resection)Radical surgery (wide resection) removeremoveall tumors without disturbing the structure orall tumors without disturbing the structure or

function of host extensively, useful in earlyfunction of host extensively, useful in early

stages; if invasivestages; if invasive not curativenot curative

Enbloc resectionEnbloc resection excision of original growthexcision of original growth

and lymph channel around areand lymph channel around are


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ProphylacticProphylactic remove preremove pre--cancerous lesioncancerous lesion

while it is still harmless and nonwhile it is still harmless and non--malignantmalignant

PalliativePalliative retard growth of tumor; relieveretard growth of tumor; relievesigns and symptoms of tumor; preventsigns and symptoms of tumor; prevent

complicationcomplication


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RadiotherapyRadiotherapy to destroy the malignantto destroy the malignant

tumors without unduly harmingtumors without unduly harming

surrounding tissuessurrounding tissues Tumor must e radiosensitive and rapidlyTumor must e radiosensitive and rapidly

dividing, poorly differentiated, embryonic anddividing, poorly differentiated, embryonic and

immature, characterized by increasedimmature, characterized by increased

metabolic activitymetabolic activity


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Tumor must be located in areas where theyTumor must be located in areas where they

can be treated with large doses of radiationcan be treated with large doses of radiation

without causing serious injury to neighboringwithout causing serious injury to neighboringtissues; tumors located deep within the bodytissues; tumors located deep within the body

cant be safely irradiatedcant be safely irradiated


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Means of AdministrationMeans of Administration

External RadiotherapyExternal Radiotherapy skin mark, tatoo,skin mark, tatoo,

ports (X marks) to localize the are to beports (X marks) to localize the are to be

exposed to external radiationexposed to external radiation


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External RadiotherapyExternal Radiotherapy

XX--ray machineray machine

Low voltage roentgen therapyLow voltage roentgen therapy skinskin

cancercancer

High voltage roentgen therapyHigh voltage roentgen therapy deepdeep

seated cancerseated cancer


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External RadiotherapyExternal Radiotherapy

RadioisotopesRadioisotopes

TeletherapyTeletherapy cobalt 60 or cesium 137;cobalt 60 or cesium 137;

enclosed and shielded in protectiveenclosed and shielded in protectivecasing cobalt bomb; sealed radiationcasing cobalt bomb; sealed radiation


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Advantages ofAdvantages of

TeletherapyTeletherapy Eradicates and destroys deep internalEradicates and destroys deep internal

cancer without seriously damaging skincancer without seriously damaging skin

Fewer cases of radiation sicknessFewer cases of radiation sickness

May be incorporated into external moldsMay be incorporated into external molds

Can be applied topically to eyes and skin,Can be applied topically to eyes and skin,

ears, lips, mouth, scalp, larynx and penisears, lips, mouth, scalp, larynx and penis


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Means of AdministrationMeans of Administration

Internal RadiotherapyInternal Radiotherapy placement ofplacement of

especially separated isotopes into theespecially separated isotopes into the

tumor or systematic circulationtumor or systematic circulation


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Internal RadiotherapyInternal Radiotherapy

Interstitial TherapyInterstitial Therapy

placed in beads, seeds, needles, catheterplaced in beads, seeds, needles, catheter

and ribbons implanted in tumorand ribbons implanted in tumor Eg. Cobalt 60, Iodine 125, Tantalium 182Eg. Cobalt 60, Iodine 125, Tantalium 182

Intracavity Isotope TherapyIntracavity Isotope Therapy(brachytherapy)(brachytherapy)

placed inside a body cavity; cancer ofplaced inside a body cavity; cancer ofuterus; bladderuterus; bladder Radium, Cobalt 60, IridiumRadium, Cobalt 60, Iridium192192


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Systematic TherapySystematic Therapy

IntravenousIntravenous

Eg. Na phosphate (32 P)Eg. Na phosphate (32 P) polycythemiapolycythemiavera, myelogenous leukemiavera, myelogenous leukemia


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Modes of AdministrationModes of Administration

SealedSealed completely enclosed by noncompletely enclosed by non--

radioactive materialradioactive material therefore cannottherefore cannotcirculate through patients bodycirculate through patients body

UnsealedUnsealed given by IV, mouth or instillationgiven by IV, mouth or instillation

directly into body cavity, not enclosed indirectly into body cavity, not enclosed in

radioactive containersradioactive containers

External hazardExternal hazard due to emission of gamma ordue to emission of gamma or

beta rays from the patients bodybeta rays from the patients body

Internal hazardInternal hazard due to radio active contaminationdue to radio active contamination

of one or all or patients body fluidof one or all or patients body fluid


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Toxic Effects of RadiationToxic Effects of Radiation

Radiation SicknessRadiation Sickness

Early: nausea or vomitingEarly: nausea or vomiting

Late: purpura, bleeding, petechiae, diarrhea,Late: purpura, bleeding, petechiae, diarrhea,stomatitisstomatitis


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Radiation SicknessRadiation Sickness

Nursing Interventions:Nursing Interventions:

BedrestBedrest

Small frequent feedingsSmall frequent feedings Increased calories, increased protein dietIncreased calories, increased protein diet

Adequate fluid intakeAdequate fluid intake

Administer vitamins, sedatives,Administer vitamins, sedatives,antihistamine, antiemeticsantihistamine, antiemetics

Monitor intake and outputMonitor intake and output


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Skin ReactionSkin Reaction

Over damaged; heals slowly; pigmentation;Over damaged; heals slowly; pigmentation;

desquamation; erythema; subcutaneousdesquamation; erythema; subcutaneousfibrosisfibrosis


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Skin ReactionSkin Reaction


Inspect skin integrityInspect skin integrity

Apply lanolin, petroleum jelly or cod liver oil toApply lanolin, petroleum jelly or cod liver oil toaffected areaaffected area

Avoid ointments, powder, lotion or any irritantAvoid ointments, powder, lotion or any irritant

Wash with water only, no soapsWash with water only, no soaps

Avoid constricting clothesAvoid constricting clothes loose for adequateloose for adequateair circulationair circulation

Avoid extremes of temperaturesAvoid extremes of temperatures


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Bone marrow depressionBone marrow depression

Deficiency of essential blood componentDeficiency of essential blood component

leading to anemia, leukopenia,leading to anemia, leukopenia,thrombocytopeniathrombocytopenia


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Bone Marrow DepressionBone Marrow Depression

Nursing Assessment:Nursing Assessment:

Weakness, pallor, easy fatigabilityWeakness, pallor, easy fatigability

Susceptibility to infectionSusceptibility to infection

BleedingBleeding


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Bone Marrow DepressionBone Marrow Depression


Vital signs especially temperatureVital signs especially temperature

CBC monitoringCBC monitoring

Observe signs and symptoms of infectionObserve signs and symptoms of infection

Good oral hygieneGood oral hygiene--prevent gum bleeding;prevent gum bleeding;

use softuse soft--bristle toothbrush or nonbristle toothbrush or non--stingsting

mouthwashmouthwash


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Increased susceptibility to cancer inIncreased susceptibility to cancer in

irradiated areasirradiated areas may develop skin lung,may develop skin lung,

bone cancer20 or more years afterbone cancer20 or more years aftertherapytherapy

Birth defects due to genetic mutationBirth defects due to genetic mutation ifif

gonads are exposed during 2gonads are exposed during 2ndnd

to 6to 6thth

week of gestationweek of gestation


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Basic Factors in RadiationBasic Factors in Radiation

ProtectionProtection DistanceDistance

Greater distance from source, less exposureGreater distance from source, less exposure

At least 3 feet; use of inverse square lawAt least 3 feet; use of inverse square law doubling distance reduces exposure by 1 ordoubling distance reduces exposure by 1 or

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TimeTime Less time spent close to pt, less exposureLess time spent close to pt, less exposure


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Basic Factors in RadiationBasic Factors in Radiation

ProtectionProtection ShieldingShielding

Use appropriate materials to halt and absorbUse appropriate materials to halt and absorb

rays of radiant energyrays of radiant energy Lead shieldLead shield xx--ray and gamma raysray and gamma rays

Glass, lucite and aluminumGlass, lucite and aluminum screens betascreens beta

rays, alpha particlesrays, alpha particles no shieldno shield

Rubber glovesRubber gloves stop alpha and usually betastop alpha and usually beta

raysrays


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ChemotherapyChemotherapy

Use of combination chemotherapeuticUse of combination chemotherapeutic

agents to cure or palliate cancer or as anagents to cure or palliate cancer or as anadjuvant therapyadjuvant therapy


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Factors in Effectiveness ofFactors in Effectiveness of

ChemotherapyChemotherapy Size of tumorSize of tumor

Type of cancerType of cancer

Accessibility of tumorAccessibility of tumor

General health of clientGeneral health of client


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Classification ofClassification of

Chemotherapeutic DrugsChemotherapeutic Drugs AntimetabolitesAntimetabolites foster CA cell death byfoster CA cell death by

interfering cell metabolism, interfere withinterfering cell metabolism, interfere with

the biosynthesis of nucleic acidsthe biosynthesis of nucleic acidsnecessary for RNA and DNA synthesisnecessary for RNA and DNA synthesis

Eg. Methotrexate (MTX), 5 FU Fluoracil,Eg. Methotrexate (MTX), 5 FU Fluoracil,

Thioguan, Purinethol, CytosanThioguan, Purinethol, Cytosan--U,U,

Floxuriding (FUDR)Floxuriding (FUDR)


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Chemotherapeutic DrugsChemotherapeutic Drugs Plant alkaloidsPlant alkaloids make body lessmake body less

favorable for growth of Ca cellsfavorable for growth of Ca cells

Eg. Vincristin (Oncovin), VinblastineEg. Vincristin (Oncovin), Vinblastine(Velban)(Velban)


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Chemotherapeutic DrugsChemotherapeutic Drugs Steroids and sex hormonesSteroids and sex hormones alter thealter the

endocrine environment to make it lessendocrine environment to make it less

conducive to growth of cancer cellsconducive to growth of cancer cells Eg. Diethylstilbesterol, Androgen, Estrogen,Eg. Diethylstilbesterol, Androgen, Estrogen,

Antiestrogen, Progestin, AnticorticalAntiestrogen, Progestin, Anticortical

Compounds, AntiadrenalCompounds, Antiadrenal


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Chemotherapeutic DrugsChemotherapeutic Drugs Antitumor antibioticsAntitumor antibiotics affect RNA toaffect RNA to

make environment less favorable for Camake environment less favorable for Ca

growthgrowth E. Adriamycin, Blenoxane, Cosmegen,E. Adriamycin, Blenoxane, Cosmegen,

Cerubidine, Mithramycin, Mutamycin,Cerubidine, Mithramycin, Mutamycin,

NovantroneNovantrone


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Chemotherapeutic DrugsChemotherapeutic Drugs NitrosourcesNitrosources similar to alkylatingsimilar to alkylating

agents; can cross bloodagents; can cross blood--brain barrierbrain barrier

(used in brain affectations)(used in brain affectations) Eg. Semustine, Lomustine, CarmustineEg. Semustine, Lomustine, Carmustine

Misc. drugsMisc. drugs

InterferonInterferon natural glucoproteinnatural glucoprotein antiviralantiviraleffecteffect


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Contraindications forContraindications for

ChemotherapyChemotherapy InfectionInfection those receiving immunosuppressivethose receiving immunosuppressive

drugsdrugs

Recent surgeryRecent surgery-- interferes with wound healinginterferes with wound healing

Impaired renal or hepatic functionImpaired renal or hepatic function metabolized in liver and excreted throughmetabolized in liver and excreted throughkidneyskidneys

Recent RadiotherapyRecent Radiotherapy suppresses bonesuppresses bone

marrow cell productionmarrow cell production PregnancyPregnancy first 3 monthsfirst 3 months

Bone marrow depressionBone marrow depression


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Methods of AdministrationMethods of Administration

OralOral pill or liquidpill or liquid

Subcutaneous injectionSubcutaneous injection

through automatic syringe or subcutaneousthrough automatic syringe or subcutaneousinjection pumpinjection pump

IntravenousIntravenous

NonNon--vesicantsvesicants do little damage to soft tissuesdo little damage to soft tissues

Eg. 5Eg. 5--FU, MethotrexateFU, Methotrexate VesicantsVesicants cause soft tissue necrosiscause soft tissue necrosis

Eg. Nitrogen mustard, Vinblastine, VincristineEg. Nitrogen mustard, Vinblastine, Vincristine


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IrritantsIrritants produces burning or minor inflammationproduces burning or minor inflammation

without necrosiswithout necrosis

IntraIntra--arterial perfusionarterial perfusion implantable orimplantable or

portable infusion pumpportable infusion pump

Intrathecal administrationIntrathecal administration

ommaya reservoirommaya reservoir mushroom shaped self sealingmushroom shaped self sealing

silicone dome with catheter attached to lateralsilicone dome with catheter attached to lateralventricles reservoirventricles reservoir--burrhole on scalp flapburrhole on scalp flap


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Vascular access graftVascular access graft

Use of dacron graft into the veinUse of dacron graft into the vein

IntraperitonealIntraperitoneal Tenchoff catherter into abdominal cavityTenchoff catherter into abdominal cavity

Eg. Cancer of liver, ovary, colon and rectumEg. Cancer of liver, ovary, colon and rectum


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Side Effects and NursingSide Effects and Nursing

InterventionsInterventions DiarrheaDiarrhea

Antidiarrheal drugsAntidiarrheal drugs

Clearliquid if toleratedClearliquid if tolerated Good perineal careGood perineal care

Monitor K, Na and Cl levelsMonitor K, Na and Cl levels


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InterventionsInterventions StomatitisStomatitis

Good oral hygieneGood oral hygiene avoid commercial mouthavoid commercial mouth

washwash

Viscous lidocaine before mealsViscous lidocaine before meals

Gargling rinse with water and diluted hydrogenGargling rinse with water and diluted hydrogen

peroxide after mealsperoxide after meals

KY jelly to cracked lipsKY jelly to cracked lips

Suck popsiclesSuck popsicles


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InterventionsInterventions Hematologic systemHematologic system

ThrombocytopeniaThrombocytopenia epistaxix, petechiae,epistaxix, petechiae,

ecchymosisecchymosisAvoid bumps or bruise of skinAvoid bumps or bruise of skin

Protect from physical injuryProtect from physical injury

Avoid aspirin and aspirin productsAvoid aspirin and aspirin products

Avoid IM injectionAvoid IM injection

Monitor blood countMonitor blood count


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InterventionsInterventions LeukopeniaLeukopenia

Hand washing, reverse isolationHand washing, reverse isolation

Note signs and symptoms of respiratory infectionNote signs and symptoms of respiratory infectionAvoid crowd or persons with infectionAvoid crowd or persons with infection

AnemiaAnemia

Adequate rest periodAdequate rest period

H and H monitoringH and H monitoring OO22 PRNPRN


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InterventionsInterventions Hemorrhagic cystitisHemorrhagic cystitis

Increase fluid to 3L per dayIncrease fluid to 3L per day


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InterventionsInterventions IntegumentaryIntegumentary

AlopeciaAlopecia temporarytemporary

Scalp tourniquetsScalp tourniquets Scalp hypothermiaScalp hypothermia ice packice pack

Wig during treatmentWig during treatment

Hair grows back 6 mos after chemotherapyHair grows back 6 mos after chemotherapy

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