Cancer

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Description -a malignant neoplastic disorder that involves all body organs with manifestations that vary according to the body system affected and the type of tumour cells	Cancer -Cells lose their normal growth-controlling mechanism and the growth of cells is uncontrolled -produces serious health problems such as impaired immune and hematopoietic (blood producing) function, altered GI tract stracture and function, motor and sensory deficits and decreased resp function
Cancer Classification -originate from blood and cell-forming tissues, such as leukemias, lymphomas, and multiple myeloma	Hematological cancer
Cancer classification -Associated with the organs from which they develop, such as breast cancer or lung cancer	Solid tumors
Causes of pain	-bone destruction -obstruction of an organ -compression of peripheral nerves -infiltration, distention of tissue -inflammation, necrosis -psychological factors, such as fear or anxiety; a distress screening tool may be used to assess emotional health
Common sites of metastasis -Bladder Cancer -Brain Tumors -Breast Cancer -Colorectal Cancer -Lung Cancer -Prostate Cancer -Testicular Cancer	-Bladder Cancer +Lung, bone, liver, pelvic and retroperitoneal structures -Brain Tumors +CNS -Breast Cancer +Bone, lung, brain, liver -Colorectal Cancer +Liver -Lung Cancer +Brain, Liver -Prostate Cancer +Bone, spine, lung, liver, kidneys -Testicular Cancer +lung, bone, liver, adrenal glands, retroperitoneal lymph nodes
Warning signs of cancer CAUTION	-Change in bowel or bladder habits -Any sore that does not heal -Unusual bleeding or discharge -Thickening or lump in breast or elsewhere -Indigestion -Obvious change in wart or mole -Nagging cough or hoarseness
Diagnostic Tests	-Biopsy -Bone Marrow examination chest radiograph CBC CT Cytological studies TUmor markers -add more later
Pain Control Interventions	-have a health care team to develop a pain management program -give oral preparations if possible and if they provide adequate relief of pain, the transdermal route may also be prescribed -mild - moderate pain may be treated with salicylates, Tylenol and MSAIDs -severe pain is terated with opioids, such as codeine sufate, morphine sulfate, methadone, and hydromorphone hydrochloride, neuropathic pain may be treated with a variety of anticonfulsants and antidepressants as well as opiods -SUBCUT and cont IV of opioids provide rapid pain control -mon VS and for side effects of medications -monitor for effectiveness of medications and collaborate with the health care provider (HCP) if mediation is ineffective -give nonmed techniques of pain control, such as relaxation, guided imagery, bio-feedback, massage and heat-cold application
Description This is indicated to diagnose, stage and treat certain types of cancer	Surgery
Types of surgery for cancer -This is performed in clients with an existing premalignant condition or a known family history or genetic mutation that strongly predisposes the person to the development of cancer -an attempt is made to remove the tissue or organ at risk and thus prevent the development of cancer	Prophylactic surgery
Types of surgery for cancer -all gross and microscopic tumor is removed or destroyed	Curative surgery
Types of surgery for cancer -this is a debulking procedure that consists of removing a large portion of a locally invasive tumor, such as advanced ovarian cancer -surgery decreases the number of cancer cells,therefore it may increase the chance that other therapies will be successful	Control (cytoreductive or "debulking") surgery
Types of surgery for cancer -This is performed to improve quality of life during the survival time -this is performed to reduce pain, relieve airway obstruction, relieve obstructions in the gastrointestinal or urinary tract, relieve pressure on the brain or spinal cord, prevent hemorrhage, remove infected or ulcerated tumors, or drain abscesses	Palliative surgery
Types of surgery for cancer -this type of surgery is performed to improve quality of life by restoring maximal function and appearance, such as breast reconstruction after mastectomy	Reconstructive or rehabilitative surgery
Adverse effects of surgery	1. Loss or loss of function of a specific body part 2. Reduced function as a result of organ loss 3. Scarring or disfigurement 4. Grieving about altereed body image or imposed change in lifestyle 5. Pain, infection, bleeding, thromboembolism
Description -This kills or inhibits the reproduction of neoplastic cells and kills normal cells -the effects are systemic since this is administered systemically -normal cells most profoundly affected include those of the skin, hai, and lining of the GI tract, spermatocytes and hematopoietic cells -This may be used in combination with other treatments like surgery and radiation	Chemotherapy -usually, severe chemotherapy and biotherapy agents are used in combination (combination therapy) to increase the therapeutic response -combination chemotherapy is planned by the HCP so that medications with overlapping toxicities and nadirs (the time during which bone marrow activity and white blood cell counts are at their lowest) are not given at or near the same time will minimize immunosuppression
Common side effects of Chemotherapy	-fatigue, Alopecia, nausea and vomiting, mucositis, skin changes, and myelosuppression (neutropenia, anemia and thrombocytopenia)
Description -This destroys cancer cells, with inimal exposure of normal cells to the damaging effects of radiation; the damaged cells die or become unable to divide -this is effective on tissues directly within the path of the radiation beam	Radiation Therapy
Types of Radiation Therapy -the actual radiation source is external to the client -instruct the client regarding self care of the skin -client does not emit radiation and does not pose a hazard to anyone else	External beam therapy (teletherapy)
Types of Radiation Therapy -the radiation source comes into direct, continuous contact with tumor tissues for a specific time -the radiation source is within the client; for a period of time, the client emits radiation and can pose a hazard to others -this therapy includes an unsealed source or a sealed source of radiation -Unsealed radiation source: Given PO or IV or instillation into body cavities, source is not confined completed to one body area and it enters body fluids and eventually is eliminated via various excreta, which are radioactive and harmful to others, most of the source is eliminated w/in 48 hours, then neither the client nor the excrete is radioactive or harmful -sealed radiation source: temporary or permanent source is implanted w/in the tumor target tissues, the client emits radiation while the implant is in place, excreta not radioactive -removal of sealed radiation sources: client is not radioactive after, inform that cancer isnt contagious -follow the HCPs prescription regarding resumption of sex if implant was cervical or vaginal, and to notify if any occur	Internal Radiation (Brachytherapy)
Client Education about care of the skin for Radiation Therapy (Teletherapy)	-wash the irradiated area gently each day with warm water alone or with mild soap and water -Use the hand rather than a washcloth to wash the area -rinse soap thoroughly from the skin -take care not to remove the markings that indicate exactly where the beam of radiation is to be focused -dry the irradiated area with patting motions rather than rubbing motion; use a clean, soft towel or cloth -use no powders, ointments, lotions or creams on the skin at the radiation site unless they are prescribed by the radiologist -wear soft clothing over the skin at the radiation site -avoid wearing belts, buckles, straps or any type of clothing that binds or rubs the skin at the radiation site -avoid exposure of the irradiated area to the sun -avoid heat exposure
Care of the client with a Sealed Radiation Implant (Brachytherapy)	-Place the client in a private room with a private bath, radiationsign on the clients door -organize nursing tasks to minimize exposure to the radiation source -nursing assignments to a client with a radiation iplant should be rotated -limit time to 30 mins per care provider per shift -wear a dosimeter film badge to measure radiation exposure -lead shielding may be used o reduce exposure to radiation -nurse should never care than 1 client with a radiation implant a 1 time -do not allow a prefnant nurse to care the client, children younger than 16 years or a pregnant woman to visit the client -limit visitors to 30 min per day, visitors should be at least 6 feet from teh sourve -save bed linens and dressings until the source is removed, then dispose of the linens and dressings in the usual manner -other equipment can be removed from the room at any time
Description -This procedure replaces stem cells tat have been destroyed by high doses of chemotherapy and/or radiation therapy -commonly used to treat leukemia and lymphoma, but can be used to treat other kinds of cancers, such as neuroblastoma and multiple myeloma	Bone Marrow Transplantation ( but also peripheral blood stem cell transplantation for the first two points -goal of treatment is to rid the client of all leukemmic or other malignant cells through treatment with high doses of chemotherapy and whole body irradiation -because these treatments are damaging to bone marrow cells, without any replacement of blood forming stem cell function throughout transplantation, the client would die of infection or hemorrhage
Types of donor stem cells -stem cell donor is usually a sibling, a parent with similar tissue type, or a person who is not related to the client (unrelated donor)	Allogeneic
Types of stem cell donor -stem cells are from an identical twin	Syngeneic
Types of stem cell donor -most common type -client receives his or her own stem cells -stem cells harvested during disease remission and are stored frozen to be reinfused later	Autologous
Procedure f Bone Marrow Transplantation	Harvest -in PBSCT stem cells are harvsted in a 4 -6 hours process called apheresis, or leukapheris -in BMT marrow is harvested through multiple aspirations from the iliac crest to retrieve sufficient bone marrow for the transplant -marrow from the client is filtered for residual cancer cells -allogeneic marrow is transfused immediately; autologous marrow is frozen for later use (cryopreserv.) -harvesting is done before the initiation of the conditioning regimen Conditioning - im.supp therapy used to kill malignant cells, provide a state of immunosuppression and create space in the bone marrow for the engraftment of the new marrow Transplantation - stem cells are given through the clients central line similar to blood transfusions, may be given by IV or IV push to central lines Engraftment -the transfused stem cells move to the marrow-forming sites of the recipients bones, occurs when the WBC, erythrocyte and PLT counts begin to rise, when successful, the engraftment process takes 2-5 weeks Posttransplantation: until engraft, inflection, bleeding, neutro or thrombocytopenia
Complications of Bone Marrow Transplant	Failure of engraft -if it fails, the client will die unless another transplantation is attempted and is successful Graft vs host diseases in allogeneteic transplants -recipient cant recognize the donated stem cells as foreign due to imm.supp. the competent cells can and mount an immune offense -managed cautiously with immunosuppressive agents to avoid suppressing the new immune system to such an extent that the client becomes more susceptible to infection, or the transplanted cells stop engrafting Hepatic veno-occlusive disease -disease involves occlusion of the hepatic venules by thrombosis or phlebitis -signs include right upper quadrant abdominal pain, jaundice, ascites, weight gain and hepatomegaly -early detection is critical since theres no way to open the hepatic vessels -client treated with fluids and supportive therapy

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	Created by Jamie Chavez about 6 years ago