oncologic nursing cells and principles of treatment

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Surgery on ancer in Si tu

y Electrosurgery- application of electrical current tocancerous cells

y Cryosurgery- deep freezing with liquid nitrogeny Chemosurgery- applied chemotherapeutic agents layer

by layer with surgical incision.y Co2 laser- use of laser for laser excision.



II. Radiat ion The rapyy The use of high- energy ionizing rays to treat a variety

of cancers.y Destroys the cell s ability to reproduce by damaging

the cell s DN A .y Rapidly dividing cells are more vulnerable to radiation

than are slower dividing cells.



Bio log ica l Eff e cts of Radiat ion on living cells

y Cells experience DN A damage and are able to detect andrepair the damage.

y Cells experience DN A damage and are unable to repair thedamage. These cells may go through the process of programmed cell death, thus eliminating the potentialgenetic damage from the larger tissue.

y Cells experience a nonlethal DN A mutation that is passed

on to subsequent cell divisions. This mutation may contribute to the formation of a cancer.



Pre- op e rat ive Radiat ion The rapyy It can kill tumor cells at margins of the tumor site.y It can keep the cancer under control and prevent

metastases, and also convert technically inoperabletumors into operable ones.



Postop e rat ive Radiat iony It can destroy cancer cells still present around the

margins after a tumor has been surgically removed.



1. External Radiation Therapy 2. Internal Radiation Therapy



Exte rna l Radiat iony It utilizes a machine to deliver

radiation to the tumor.y This therapy is primarily an

outpatient treatment.y Series of daily radiation exposure

as patient is left alone in a room.y A lso called as Teletherapy-

external source of radiation. (machine is a distance from client)



Exte rna l Radiat ion : Nur sing Car ey M arks must not removey Keep the skin dry y

Talcum and Lotions are contraindicatedy A void strong sunlight, extremes temperature,

constricting clothes.y No Eating (NPO)y Patient is not the SOURCE of Radiation after the

procedure.



Int e rna l Radiat ionIs the process of implantingradioactive material onto ornear the tumor or placingradioactive sources into thebody.Implantation of radioactivesubstance within a client.

It can be temporary orpermanent.A lso called Brachytherapy



Sealed Source RT ( Brachytherapy)

Un Sealed- Source RT



Sea led- S our ce RTy Sealed radiation source is placed in a cavity or

adjacent to cancer.

y Ex: Radium, Iridium, Cesium



Sea led- S our ce RTy INTR A C A VIT A RY Therapy

y Radioisotope is placed into an applicator, then placed into thebody cavity for a carefully calculated time (usually 24 72 H)

Ex: Radioisotopes : Celsium 137Radium 226



Sea led S our ce of RTINTERSTITI A L THER A PY y Radioisotope of choice is placed into needles, beads,

seeds, ribbons or catheters and then implanteddirectly into the tumor.

y Implants may be left in the tumor temporarily orpermanently.

y Ex: Iridium 192, Iodine 125, Celsium 137, Gold 198,Radon 222



UNSEALED SOURCE RTy Used in Systemic therapy.y Source of Radiation is given orally, intravenously.y

PO A

dministration:

Low dose:Graves Disease131I High Dose : Thyroid Ca

y IV A dministration : 32p Treats Polycythemia Vera

N i C Hi hli ht



Nursing Care HighlightCare of the Client with Sealed Implants of

Radioactive Sourcesy A ssign the client to a private room, with private bath.y Place Caution : Radioactive M aterial sign on the door

of the clients room.y Pregnant nurses should not care for these clients; donot allow children younger than 16 and pregnant women to visit.



y Limit each visitor to ½ hour per day y Never touch the radioactive material with bare handsy

Save all dressings and bed linens until after theradioactive source is removed.



Th f hi h d i h l



Three factor s which de te rm ine the tota l expo sur e on ere ceives i n a give n ra diat ion f ield ar e:

1. Time of exposure.

2. Distance from Source.

3. A mount of shielding present.



TIMEThe Shortest PossibleTime

y The less time you spend neara source, the less radiation you will receive



DISTANCEy A s far as possible ( can

spend more time at adistance of 20 feet)

y The farther you get froma source, the lessradiation you willreceive.



SHIELDSProtective Lead Apron

y The more shielding you have,

the less radiation you willreceive.



II. SYSTEMIC TREATMENTH ORMO N AL THE RAPY

BIOLOGIC TR E ATME N TSy Fights cancer by

altering theamounts of hormones in thebody.

y Referred to by many terms including : Immunologic therapy,Immunotherapy, biotherapy.(Interferon, Interleukin)

y Often used to help restore thefunctioning of the immune system.

y Stimulates the disease- fighting

ability of the body.



CHEMOTHERAPYy The use of powerful drugs to :

y Kill Cancer Cellsy Control their Growthy Relieve Pain Symptoms



CHEMOTHERAPYy A systemic treatment.y Directly or indirectly disrupts reproduction of cells by

altering essential biochemical processes.y The desired outcome is control or eradication of all

malignant cells.



Typ es of Che mot he rapy

Primary

N eo-adjuvant

Palliativ eConcurrent

Adjuvant



1 . Primary Chemotherapy The use chemotherapy alone for the cure of a specifictumor.

2 . Adjuvant Chemotherapy The use of chemotherapy after primary, loco regional treatment, with the intent of decreasing therelapse rate and improving survival.



3. N eo- adjuvant Chemotherapy The use of chemotherapy before loco- regionaltreatment with the intent of decreasing tumor sizeenhancing chances for resectability and preservationof normal structures.

4. Concurrent Chemotherapy The use of chemotherapy combined with radiotherapy in order to increase local response and controlsystemic spread.



5. Palliative Chemotherapy The use of chemotherapy in advanced malignancies,the intent of which is not cure but control of thedisease and tumor related symptoms.



Types of Che mot he rapy Drug sy A ntimetabolitesy Genotoxic Drugsy Spindle Inhibitorsy Other Chemotherapy A gents



Ant i- Me tabo litesy Drugs that interfere with the formation of key bio-

molecules within the cell including nucleotides, thebuilding blocks of DN A .

y These drugs ultimately interfere with DN A replicationand therefore cell division.



Types of Ant i- m e tabo litesy Folate A ntagonists

y

Purine A

ntagonistsy Pyrimidine A ntagonists



Ge noto xic Drug s

y Drugs that damage DN A . By causing DN A damage,these agents interfere with DN A replication, and celldivision

y 3 Treatments :

y A lkylating A gentsy Intercalating A gentsy Enzyme Inhibitors

e ge no o x c c e mo e rapy t t t i l d



tr e atm e nt s include:

Alkylating agents :

y The first class of chemotherapy agents used. Thesedrugs modify the bases of DN A , interfering with DN A replication and transcription and leading to mutations



Intercalating agentsy These drugs wedge themselves into the spaces between

the nucleotides in the DN A double helix. They interfere with transcription, replication and inducemutations.

E nzyme inhibitorsy These drugs inhibit key enzymes, such as

topoisomerases, involved in DN A replication inducingDN A damage.



Sp indle I nhib itor sy These agents prevent proper cell division by

interfering with the cytoskeletal components thatenable one cell to divide into two.

y Vinca A lkaloidsPaclitaxel (Taxol®)Docetaxel (Taxotere®)Ixabepilone (Ixempra®)

Add it i l th Ag t



Add it ion a l e o thera y Age n tsy

Drugs that work through mechanisms that do notneatly fit into one of the categories.

y A rsenic trioxide (Trisenox®)

BleomycinHydroxyureaStreptozocin



Che mot he rap e ut ic Adm in istrat iony Oraly IM / SQy IV y Central Venous Cathetery Venous A ccess Devices (V A D)y Intraarterial Routey Intraperitoneal Route



Chemo Drugs Major Side E ffects N ursing Interventions

Doxurubicin Cardiotoxicity M onitor VS & HR

Cyclophosphamide

Vincristine

Hemorrhagic Cystitis

Peripheral Neuropathy

Encourage OFI,unexpected bleeding,hematuria or dysuria.

Tell the client to reportnumbness or tingling infinger and toes.

F- A sparaginase A llergic Reactions Skin test to assess allergic

reaction before first use. W atch for signs of anaphylactic shock.



Anti- Cancer Drugs

Nausea, Vomiting, Hair lossand Bone M arrowSuppression

H IGH RISK F OR INF E CTIO N



Te rm s rel at ed to Che mot he rapy Drug sIRRIT A NTS

Drugs that are capable of producing pain at the IV siteor along the vein, with or without inflammatory reaction.

EXTR A V A S A TION

Escape of agents from a vein to a tissue



N ON V E SICA N TSDrugs that can be given by IV bolus through the sidearm of free flowing IV containing no additives.

V E SICA N TSDrugs that are capable of causing blister formationand tissue destruction.



STEM CELLSStem cells are able togrow into other bloodcells that mature and

function as needed inthe body.Stem cells create thethree main types of blood cells:

± red blood cells ± white blood cells ± platelets

Whe re re st em ce lls l c t ed?



Whe re re st em ce lls l c t ed?

y Bone marrow (the spongy center of the bone whereblood cells are made)

y Peripheral blood (found in blood vessels throughoutthe body)

y Cord blood (found in the umbilical cord and collectedafter a baby s birth)

Stem cells for transplantation are obtained from any of these three places.



STEM CELL TRANSPLANTy Is a process that takes

healthy stem cells froma donor and gives themto the patient through acentral line.



Types of Stem Cell Transplantsy Bone marrow transplants are those that are

obtained from the bone marrowy Peripheral blood stem cell (PBSC) transplants are

obtained from the peripheral blood.y Cord blood transplants refer to transplants where

the stem cells are obtained from umbilical cord blood.



Stem cell transplants are further categorized based onthe donor who provides the stem cells.

A utologous stem cell transplants (autografts)

- It refer to stem cells that are collected from anindividual and given back to that same individual.



Allog e neic ste m cell tran sp lant s(a llograft s)

y It refer to stem cells that are taken from one personand given to another.



Syng

en

eic

Ste

mCell T

ransp

lant

sy It refer to stem cells that are taken from an identical

twin of the recipient. These types of transplants arequite rare



Tran sp lant Car e



THE CA N CE R PAI N PROBL E M

PAINIn cancer is the most fearedand distressing symptom

of the disease.



THE CANCER PAIN PROBLEMy W HO reveals that everyday at least 4 million peoplesuffer from cancer pain.

y 30 50% of cancer patients undergoing treatment, andup to 95% of patients with advanced disease, sufferfrom pain.

y M ore than 50% of patients still suffered fromunrelieved cancer pain.



W HO: 3 Ste p Ana lgesi c Ladde r For Can ce r Pa in

Manag e m e ntBasic Principles :

y BY THEM OUTHIf the patient can swallow, oral administration is theroute of choice.



y BY THE CLOCK A nalgesics should be given regularly andprophylactically.

y BY THE L A DDER Use a few drugs well than many badly.



3 Medi cat ion s for Pa in Ladde ry Non- Opoid A nalgesics

y Opoid A nalgesics

y A djuvant Drugs

WHO Th ree- Step lge sic L dde r



WHO Th ree Step lge sic L dde r

Step I For patients with mild to moderate pain, the useof non-opioids is the treatment of choice. These may or may not be combined with adjuvant drugs (drugsthat are used to hasten or add to the primary mode of treatment).Step II For patients with moderate pain, who did notfeel relief after using only non-opioids, a combinationof opioids and non-opioids should be tried. A gain,adjuvants may or may not be used.

Step III For moderate to severe pain, opioids shouldbe used, with or without non-opioids, and with or without adjuvants.



Can ce r : Manag e m e nty C Comforty A - A ltered Body Imagey N Nutritiony C Chemotherapy y E- Evaluate the Response in Treatmenty R - Rest



SUMM ARYy Early detection and screening of high risk individualsplay significant roles in treating cancer.

y Patient and family caregivers should be involved in allaspects of nursing care.

y Various treatment modalities are available to cure,control and palliate cancer.



y Safety Standards of treatment must alwaysimplemented.

y Life long surveillance for recurrence after treatment.

If pain occurs, there should be prompt oral



If pain occurs, there should be prompt oraladministration of drugs in the following order :

nonopioids (aspirin and paracetamol); then, asnecessary, mild opioids (codeine); then strong opioidssuch as morphine, ntil the patient is free of pain. Tocalm fears and anxiety, additional drugs adjuvants

should be used. To maintain freedom from pain,drugs should be given by the clock , that is every 3-6hours, rather than on demand This three-stepapproach of administering the right drug in the rightdose at the right time is inexpensive and 80-90%effective. Surgical intervention on appropriate nervesmay provide further pain relief if drugs are not wholly effective.

oncologic nursing cells and principles of treatment

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