Oncology

Care of the Patient with Cancer

Objectives

• Differentiate between benign and malignant tumors

• Screening procedures for cancer

• General signs and symptoms of cancer

• Discuss the prevalence of cancer

• Identify risk factors for cancer

• Treatment and nursing care of patients with cancer with cancer

What Is Cancer?

• Cancer = abnormal, uncontrolled cellular growth

• Benign versus malignant tumors

– Malignant tumor = cancerous and capable of spreading; neoplasm

– Benign tumor = noncancerous and nonspreading

• 1.3 million cases of cancer per year; 550,000 deaths

• Oncology

• branch of medicine that deals with the study of tumors

• Pathophysiology of Cancer

• Defect in cellular proliferation

• No contact inhibition

• Proliferate indiscriminately

How Cancer Spreads: Metastasis

• Metastasis = spread of cancer cells from one part of the body to another

– Blood vessels

– Lymphatic system

• Secondary tumors or metastases

• Carcinogen = any substance that causes cancer

Statistics

• Cancer is the second leading cause death in the United States

• Men have a 1 in 2 lifetime risk of developing cancer

• Women have a 1 in 3 lifetime risk developing cancer

• Lung cancer is the leading cause of death in both men and women death in both men and women

Tumor Development

Normal Body Cells

• Look like other cells from the tissue of origin

• When mature serve a specific purpose

• Reproduce in a controlled predictable manner

• Stop dividing when nutrients are insufficient or space is inadequate

• Remain in tissue of origin, except blood cells

Benign Tumors Malignant Tumors• Slow steady growth

• Enlarges and expands but remains localized but remains localized

• Resembles parent tissue

• Rarely recurs

• Usually does not cause tissue destruction in compression or obstruction

• Smooth, well defined edges, may be movable edges, when palpated

• Varied rate of growth, often rapid metastasizes

• Little or no resemblance to parent tissue to parent tissue

• Commonly recurs after removal

• Can cause tissue necrosis, ulceration, perforation, tissue sloughing, and can be fatal

• Irregular edges, more immobile when palpated

Malignant & Benign Characteristic Malignant Benign

Encapsulated Rarely Usually

Differentiated Poorly Partially

Metastasis Frequently present Absent

Recurrence Frequent Rare

Vascularity Moderate to marked Slight

Mode of growth Infiltrative & Expansive

Expansive

Cell Characteristics Cells not similar to parent cells

Fairly normal similar to parent cells

Metastasis

• Process by which tumor cells are spread to distant parts of body to distant parts of body

• Occurs several different ways:

– Direst spread of cells by diffusion

– Circulation by way of blood and lymph

– Accidental transplant during procedures

Staging

• Staging is a way of describing a cancer, such as the size of the tumor and where it has spread

• Staging is the most important tool doctors have to determine a patient’s prognosis

• The type of treatment a

person receives depends on the stage of the cancer

• Clinical diagnostic staging

• Bone and liver scan

• Ultrasonography

• Computed tomography

• MRI

• Surgical Staging-

• Describe extent of the disease after biopsy or surgical exploration

Grading and Staging of Tumors

• Grading: based on the degree of malignancy, how alike the cells are to the parent tissue or “differentiated”

• Grade 1 – most differentiated

• Grade 4 least differentiated, most malignant

• Staging: general extent of cancer and spread of disease rather than cell appearance

• Stage 1 – No invasion of other tissues, localized

• Stage IV – Metastasized to distant parts

Grading and Staging of TumorsT=Primary Tumor Size N=lymph node

involvementM = distant metastases

T0- no evidence of metastasis

Tis – tumor is in epithelial tumor is in epithelial

T1 T1 –minimal size and extension

T2, T3, T4– progressively larger and extensive larger and extensive

N0- indicates no abnormal lymph nodes detected

N1– minimal involvement

N2,N3,N4 progressively more involvement more involvement

M0 = no evidence metastasis

M1 – distant metastasis present (specify site/s)

Risk Factors

• The following promotes additional damage to cells causing further genetic alteration– Dietary fats– Cigarette smoking– Alcohol consumption– Prolonged severe stress

• Reversible proliferation of altered cells is a key concept in cancer prevention

Risk Factors of Cancer

• Heredity

• Age - Inactivity and obesity

• Chemical Agents

• Tobacco

• Alcohol

• Diet – Dietary fat and meat– Fruits and vegetables

• Carotenoids• Antioxidants• Phytochemicals

• Environmental – Carcinogens in the

environment– Ingested chemicals– Environmental and industrial

pollution– Radiation– Microorganisms

Percentage of All Cancer Deaths Linked to Risk Factors

Seven Major Warning Signs of Cancer

The Causes of Cancer: Role of DNA

• DNA basics

– DNA = deoxyribonucleic acid, a chemical substance that carries genetic information

– Chromosome = threadlike body in a cell nucleus that contains molecules of DNA

– Gene = section of chromosome that contains the instructions for making a particular protein

The Causes of Cancer: Role of DNA

• DNA mutations and cancer

– A mutated gene no longer contains the proper code for producing its protein

– Oncogene = gene involved in the transformation of a normal cell into a cancer cell

• Cancer promoters = compounds that accelerate cell growth

Dietary Guidelines for Cancer Prevention

• Eat a varied plant-based diet

• Eat 5–9 servings of fruits and vegetables each day– Cruciferous vegetables– Citrus fruits and berries– Dark-green leafy vegetables– Dark-yellow, orange, or red fruits or vegetables

• Eat high-fiber foods

• Limit consumption of meat and total fat; favor monounsaturated and omega-3 polyunsaturated fats

• Limit consumption of charred, blackened, cured, and smoked meat and fish

• Be moderate in consumption of alcohol

SOURCE: National CancerInstitute

Levels of Disease Prevention

• Primary Prevention

– Avoidance of causative agent

• Secondary Prevention

– Early detection, screening

• Tertiary Prevention

– Treatment, symptom control, rehabilitation

Primary Prevention Avoidance of causative agent

• Alteration in lifestyle behaviors to eliminate or reduce exposure to carcinogens

• Avoid smoking. Tobacco is linked with lung, oropharyngeal, bladder, pancreatic, cervical, kidney cancer

• Risk is related to:“Pack Years” – number of packs of cigarettes smoked per day multiplied by the number of years a person has smoked

• Example – Patient smoked 1 pack per day for 30 years• 1x 30 = 30 pack years

Primary Prevention – continued Avoidance of causative agent

• (1) Abstain from smoking

• Major single cause of cancer death in US

• Most preventable cause of premature death

• (2) Dietary

• Eat variety of foods, with emphasis on plant sources

• Limit consumption of red meat, especially high in fat and processed

Primary Prevention – continued Avoidance of causative agent

• (3) Adopt a physically active lifestyle

• Moderate activity – 30 minutes or more 5x or more days of the week

• Vigorous activity – 45 minutes or more further decrease risk of breast and colon cancer

• (4) Maintain a healthy weight throughout lifetime

• Overweight increase risk of cancer – breast, colon, endometrium, kidney, etc.

Primary Prevention – continued

Avoidance of causative agent• (5)Alcoholic beverage – limit consumption

• Alcohol increases risk of cancers of mouth, pharynx, larynx, esophagus, liver, breast, colon

• (6) Sunlight & Ultraviolet Exposure

• UV exposure can increase skin cancer risk

• Actinic keratosis – small (<1/4 inch) rough or scaly spots. Found on face, ears, back of hands, arms.

Can turn into squamous cell carcinoma

• Two types of UV (a) UVA and (B) UVB

– Both cause damage of DNA of skin

– Artificial sources of UV – sunlamps, tanning booths- may increase source of skin cancer

Preventing Cancer

• Avoid tobacco

• Control diet and weight

• Exercise regularly

• Protect skin from sun

• Avoid environmental and occupational carcinogens

• Be aware of warning signs, and get recommended screening tests

Preventing Cancer

Secondary Prevention

Early detection, screening• Secondary Prevention – early detection

• Methods• 1) Inspection

• 2) Palpation

• 3) Use of tests or procedures – screening recommendations– Women – Self breast exam monthly Over 40 – mammogram– Men – Prostate – rectal exam 40 years old yearly– Both Men & Woman – Colon & Rectum at 50 baseline colonoscopy

and follow up colonoscopy q10years

Tertiary Prevention Treatment, symptom control, rehabilitation

• Tertiary prevention – reducing morbidity by– Prompt, effective treatment

– Symptom control

– Rehabilitation

• Reconstructive surgery after breast cancer

• Surgery to reverse a temporary colostomy after colon cancer treatment

• Strategies to maintain quality of life

Diagnosis of Cancer

• Health history

• Identification of risk factors

• Physical exam

• Diagnostic procedures

Clinical Manifestations of Cancer

• Depends on size and site

• Local Effects

• Benign – obstruct lumen of tubular structure such as ureters, trachea, or intestinal tract

• Intraspinal or intracranial – pressure within the close space

• Malignant• Destroy or infiltrate surrounding tissues

– Obstruction– Hemorrhage– Ulceration– Secondary infection

Systemic Effects

Problems Cause

Vascular Hemorrhage Blood vessel erosion by tumor

Neuromuscular Cachexia, weakness, cerebellar disease, pneumonia

Degenerative changes as in central nervous system and respiratory

GI Weakness, fatigue, weight loss

Malabsorption, chronic blood loss, impaired digestion

General disorders Ascitis,

pleural effusion

Metastastic implant

in abdomen

in pleural cavity

Clinical Signs

• Cachexia – sign of advanced cancer– Anorexia– Early satiety & early filling– Weight loss– Anemia

• Pain – 75% of pt will experience pain. Incidence and severity depends on site

Diagnostic Tests

• Labs– CBC, H/H, WBC

– Blood or serum Calcium increases• Hypercalcemia is often associated with malignant disease. Causes of

elevated serum-calcium levels in the absence of bony metastases;

• (a) parathyroid-hormone production by the tumor

• (b) osteolytic factors made by the tumor (dissolution of bone, especially the loss of calcium from bone)

• © coexistent primary hyperparathyroidism

– Acid phosphatase increases• an enzyme that works under acid conditions and is made in the liver,

spleen, bone marrow and the prostate gland.

• Abnormally high serum levels of the enzyme may, for example, indicate prostate disease (infection, injury, or Cancer).

Diagnostic Tests• Tumor markers

– PSA prostate specific antigen (0.4ng/ml) increases

– CEA –carcino embryonic antigen• Most commonly ordered when a patient has a cancer of the GI system-colon,

rectum, stomach, esophagus, liver, or pancreas• Once treatment for the cancer has begun, CEA tests have a valuable role in

monitoring the patient's progress. A decreasing CEA level means therapy is effective in fighting the cancer. A stable or increasing CEA level may mean the treatment is not working, and/or that the tumor is growing.

– AFP –Alpha-fetoprotein • Used to detect tumors that mark cancers of the liver, testes, ovaries• The higher the AFP level in patients with cancer, the bigger the tumor.

AFP decreases when your body responds to anti-cancer therapy. If AFP does not return to normal within about one month after cancer therapy, some of the tumor may still be present.

Common Cancers: Lung Cancer

• Leading cause of cancer death

• Chief risk factor = smoking

• Estimated causes about 3000 lung cancer deaths per year

• Symptoms = persistent cough, chest pain

• Treatment = combination of surgery, radiation, chemotherapy

• Survival rate = 15% after five years

Common Cancers: Colon and Rectal Cancer

• Second leading cause of cancer death

• Risk factors– Age

– Preexisting polyps

– Heredity

– Inactivity and obesity

– Diets high in red meat, smoked foods, simple sugars

– Excessive alcohol consumption

– Smoking

Common Cancers: Colon and Rectal Cancer

• Symptoms– Bleeding from the rectum– Change in bowel habits

• Testing– Stool blood test– Sigmoidoscopy or colonoscopy

• Treatment– Surgery is primary method of treatment

Common Cancers: Breast Cancer

• Most common cancer in women and second to lung cancer in the number of cancer deaths among women

• Causes/risk factors– Heredity– Long-term exposure to high blood levels of estrogen

• Early onset of menstruation• Late onset of menopause• No children or first child after age 30• Obesity• Current use of Hormone Replacement Therapy HRT• Alcohol use

– Inactivity– Diet low in vegetables and fiber

Common Cancers: Breast Cancer

• Early detection– Mammography (low-dose X ray) after age 40– Clinical breast exams– Breast awareness and self-examinations

• Diagnosis– Ultrasonography = imaging method using high-pitched

sound– Biopsy = removal and examination of a small piece of

body tissue

• Treatment– Surgery (lumpectomy, mastectomy)– Chemotherapy or radiation, social support

Common Cancers: Prostate Cancer

• Most common cancer in men and second to lung cancer in the number of cancer deaths among men

• Risk factors– Age– African American ethnicity– Heredity– Lifestyle factors

• Diets high in calories, dairy products, and animal fat and low in plant foods

• Obesity and inactivity• History of STDs

Common Cancers: Prostate Cancer

• Detection and diagnosis

– Rectal exam

– PSA (prostate-specific antigen) blood test

– Ultrasound

– Biopsy

• Treatment

– Surgery

– Radioactive seeds

• Survival rate = 98% at 5 years

Cancers of the Female Reproductive Tract

• Cervical cancer

– Linked to infection with HPV (genital warts)

– Detected with the Pap test = scraping of cells from the cervix for examination

– Abnormal cells are monitored over time; if they progress toward malignancy, they are removed

Cancers of the Female Reproductive Tract

• Uterine or endometrial Cancer

– Risk factors similar to those for breast cancer

– Usually detected by pelvic examination

– Treatment = surgery, possibly combined with radiation and chemotherapy

– Survival rate = 96% at 5 years

Cancers of the Female Reproductive Tract

• Ovarian cancer– Risk factors similar to breast and endometrial cancer

• Anything that lowers the lifetime number of ovulation cycles reduces risk

– Usually has no symptoms and is difficult to detect– Treatment = surgery– Survival rate is low due to late detection

• Other female reproductive tract cancers– Clear cell cancer of vagina or cervix is more common

among daughters of women who took DES during pregnancy

Skin Cancers

• Most common type of cancer when cases of the highly curable forms are included

• Primary risk factor is exposure to ultraviolet (UV) radiation

– UVA = longer wavelength; damages connective tissue, leads to premature aging of the skin, causes skin cancer

– UVB = shorter wavelength; causes sunburn, damages eyes and immune system, causes skin cancer

Skin Cancers

• Basal cell carcinoma = cancer of the deepest layers of the skin

• Squamous cell carcinoma = cancer of the surface layers of the skin

• Melanoma = a malignant tumor of the skin that arises from pigmented cells, usually a mole; the most dangerous form of skin cancer

ABCD Test for Melanoma

Preventing Skin Cancer

• Cover to protect skin -Wear long-sleeved shirts, long pants, hats

• Use sunscreen - a broad-spectrum sunscreen with a high SPF (30+)

• Apply sunscreen 30 minutes before sun exposure, 15–30 minutes after exposure begins, and frequently after that; apply extra if you are using DEET

• Avoid sun exposure between 10 AM and 4 PM

• Wear sunglasses that block UV

• Check UV index

• Avoid tanning salons

UV Index

Common Cancers

• Oral cancer

– Key risk factors are tobacco use (including spit tobacco) and consumption of alcohol

– Easy to detect but difficult to treat

• Testicular cancer

– Rare overall, but most common cancer in men age 20–35 years

– Can be detected with self-examination

Other Cancers

• Pancreatic cancer = very deadly form of cancer

• Bladder cancer

• Kidney cancer

• Brain cancer

• Leukemia = cancer of white blood cells

• Lymphoma = cancer that begins in the lymph nodes

Diagnosis of Cancer

• Clinical History and Presentation

• Biopsy’s (1) Incisional BiopsyThis refers to the removal of part of the

tumor from the larger tumor mass. An incisional biopsy is employed for tumors located deep within the body and after an initial needle biopsy has failed to supply enough tissue for diagnosis.

(2) Excisional BiopsyAlso known as surgical biopsy, the

excisional biopsy entails the surgical removal of the entire tumor mass and is a diagnostic technique that simultaneously serves as a treatment

(3)Needle Aspiration Biopsy

Removal of a sample of fluid and cells through a needle.

• Tissue Sampling• (4)Cytology Biopsy- deals

with the formation, structure, and function of cells The removal and examination of a sample of tissue for diagnostic purposes

Diagnostic Tests

• Bone scanningA technique to create images of bones on a computer screen or on film. A

small amount of radioactive material is injected and travels through the bloodstream. It collects in the bones, especially in abnormal areas of the bones, and is detected by special instrument called a scanner. The image of the bones is recorded on a special film for permanent viewing.

• Direct Imaging Tests• Fiberoptic endoscopy - use of a very flexible tube with a lens or

camera (and a light on the end), which is connected to a computer screen, allowing the physician to see inside the body cavities, such as the uterus or upper GI, to examine the area in question for any abnormality Biopsy samples can be taken through the tube.

Diagnostic Testing

• Indirect Imaging tests, such as:

– x-ray – non-invasive

– Computed tomography (CT or CAT scan) - a non-invasive procedure that takes cross-sectional images of the brain or other internal organs; to detect any abnormalities that may not show up on an ordinary x-ray. The CT scan may indicate enlarged lymph nodes - a possible sign of a spreading cancer or of an infection.

– Radionuclide scan - an imaging scan in which a small amount of radioactive substance is injected into the vein. A machine measures levels of radioactivity in certain organs, thereby detecting any abnormal areas or tumors.

Diagnostic TestingIndirect Imaging Tests

– Ultrasound – non-invasive -an imaging technique that uses sound waves to produce an image on a monitor of the abdominal organs, such as the uterus, liver, and kidneys. A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echo patterns are shown on the screen of an ultrasound machine, forming a picture of body tissues called a sonogram or

ultrasonogram

– Magnetic resonance imaging (MRI) - a non-invasive procedure that produces a two-dimensional view of an internal organ or structure, especially the brain and spinal cord. The MRI may show abnormal nodules in bones or lymph nodes - a sign that cancer may be spreading.

– Mammogram –non invasive -A low voltage X-ray photograph of the breast. It allows early detection of malignant or benign tumors and other

microcalcification-containing lesions

Diagnostic Testing

• Indirect Imaging Tests

• GI Series

• (a) Upper GI -X-rays of the esophagus, stomach, and duodenum (the first section of the small intestine). The patient swallows barium first. Barium makes the organs show up on x-rays. The upper GI series can show a blockage, abnormal growth, ulcer, or a problem with the way an organ is working.

• (b) Lower GI -X-rays of the rectum, colon, and lower part of the small intestine. A barium enema is given first. Barium coats the organs so they will show up on the x-ray.

• Barium enema is used to check for tumors of the colon and rectum. It also can check for polyps (abnormal growths attached to the intestinal lining by a stalk), diverticulosis or other problems.

Lab Studies• Tumor markers are measurable biochemicals that are associated with a

malignancy. They are either produced by tumor cells (tumor-derived) or by the body in response to tumor cells (tumor-associated). They are typically substances that are released into the circulation and thus measured in the blood

• CEA (carcinoembryonic antigen) is a protein found in many types of cells but associated with tumors

• PSA - Prostate-specific antigen. A substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate

• Acid Phosphatase - an enzyme found throughout the body, but primarily in the prostate gland. Acid phosphatase testing is done to diagnose whether prostate cancer has metastasized and to check the effectiveness of treatment.

Lab Studies

• CBC A complete blood count (CBC) provides important information about the RBC red blood cells , WBC white blood cells , and platelets. – A CBC evaluate symptoms (such as weakness, fatigue, or bruising)

and diagnose conditions (such as anemia, infection, and many other disorders) and diagnose diseases of the blood, such as leukemia.

– The number of white blood cells is sometimes used to identify an infection or monitor the body's response to cancer treatment.

– Monitor the response to some types of drug or radiation treatment.

• Hemetest- detects blood in stool

• CA-125 -A protein that can be made by abnormal ovary cells. It can be a tumor marker. If it is present in high levels in the blood or in other body fluids or tissues, it may be a sign of ovarian cancer

Diagnostic Testing

• laboratory tests to examine any/all of the following:– blood – urine – other fluids – tumor tissue

• biopsy to remove a sample of the suspicious tissue for examination in a laboratory by a pathologist

• Thinprep - A Pap Test AlternativeApproved by the US Food and Drug Administration (FDA), Thinprep is a liquid-based procedure in which cells from the cervix are put into a vial of liquid instead of being "smeared" onto a slide. The liquid is then filtered and only the cervical cells are placed onto a slide for examination.

Medical Treatment of Cancer

• Surgery

• Radiation Therapy

• Chemotherapy

• Biotherapy

• Bone Marrow Transplant

Radiation Therapy

• Ionizing radiation destroys cells ability to produce by damaging its DNA

• Cellular sensitivity – varies throughout cell cycles

• Safety – time of exposure, distance from time of exposure, distance from source, amount of shielding source

• Stay at least 6 feet away when not giving direct

• External – Source is outside body– Beam aimed at specific spot – Marked with marker– Protect area from heat or cold– High protein, high calorie, high fluid intake

(2-3 quarts)

Radiation Therapy

Internal Radiation Therapy

• Internal Radiation Therapy

• Source is placed inside the body

• Sealed or unsealed

• Radiation is emitted

Radiation Therapy

Internal Radiation Therapy • Sealed radiation • Sealed source of radiation – intracavity, interstitial

• Radioisotope cannot circulate thru clients body nor contaminate urine, blood or vomit. Body fluids NOT contaminated

• Clients excretion- not radioactive

• Private room properly labeled Private room properly labeled• No children under 18 or anyone pregnant • Wear film badge

• Prevent dislodgment• Monitor VS every four hours • Accurate I&O– usually have a usually have a foley • Active ROM

Radiation Therapy

Unsealed Source Radiation • Administered intravenously or orally • Used in systemic system

– Colloid suspension into body tissue– Iodine 131 – Graves disease, thyroid cancer– Strontium chloride (Metastron) for bone metastasis

• Radioisotopes do circulate through the body fluids. Sweat, blood, urine, and vomit contains radioactive isotopes

• Body fluids are contaminated– special care special care– Flush at least three times– Disposable equipment– Wear shoe covers, protective equipment– Dosimeter- device used to measure an individual's exposure to

a hazardous environment

Radiation Safety Standards

• Distance – distance & radiation

exposure is inversely related

• Time – 30 minutes per 8 hour

shift

• Shielding – lead shield

• Wear film badge or dosimeter – do not share

• Private room & bath

• Shields, lead container, & long-handled forceps in client room

• If source is dislodged – use forceps to pick

up and place in the lead container

• Notify radiation safety officer

Client with Implant• Remember Sealed radiation

– Sealed source of radiation – intracavity, interstitial

– Radioisotope cannot circulate thru clients body nor contaminate urine, blood or vomit

– Body Fluids NOT Contaminated

– Clients excretion- not radioactive

• Implant in abdominal cavity

• Confined to bed

• Indwelling catheter inserted and low fiber diet

• No bowel movement before the device is removed in 2-3 days

Internal Radiation with Unsealed Sources

• Remember that Unsealed Source Radiation is;

– Administered intravenously or orally

– Used in systemic system

– Radioisotopes do circulate through the body fluids. Sweat, blood, urine, and vomit contains radioactive isotopes

– Body fluids are contaminated– special care

Internal Radiation with Unsealed Sources

• Private room and bath

• Precautions on all secretions– Wear gloves if handling body fluids

– Emesis after ingesting oral isotope – cover with absorbent pad and notify radiation safety officer

– Use of disposable utensils

– Covering floor areas with chux, papers

– Flush toilet at least 3 times after each use

• Limited visitor and staff contact

Nursing Management

• Provide Education

• Skin care within the treatment field– Keep skin dry– Wash with mild soap, rinse well, pat dry– Use cool water, not hot– Do not remove lines or ink marks– Protect skin from exposure to sunlight, chlorinated

swimming pools, extreme temp

• Minimize side effects

Chemotherapy

• Reduce or slow the growth of cancer

• Anti-neoplastic agents; anti-cancer agents

• Interfere with cells replication process therefore damaging the cell and causing cell death

• Different types of cancer respond differently to various combinations of chemotherapy

Side Effects of Chemotherapy

• Most dangerous – bone marrow suppression

• Nausea & vomiting

• Alopecia

• Stomatitis

• Heart Failure

Biotherapyboost marrow function: the hematopoietic growth factors

“Agents that affect the biological process”

• Colony stimulating factors - granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) to increase granulocyte production

• Monoclonal antibodies (mAb) are antibodies that are identical because they were produced by one type of immune cell, all clones of a single parent cell

• Erythropoietin – stimulate RBC production

• Neumega – stimulates platelet production

Medical Emergencies

• The bone marrow produces 3 main types of mature blood cells: – platelets– red blood cells – white blood cells.

• Myelosuppression– reduction of bone marrow to produce blood cells.

– any or all of the three main types of blood cells that are normally produced in the bone marrow are decreased in number and/or may take a prolonged period of time to return to "normal levels“

– Patients may be at an increased risk of infection or bleeding or may experience symptoms from anemia.

– myelosuppression is the most common side effect that causes chemotherapy treatment delays or chemotherapy treatment dose reductions

Medical Emergencies- continued

• Neutropenia – decreased WBC • Thrombocytopenia- decreased platelets

• Neutropenia =A reduced white blood cell count– lowers resistance to infection – may cause delay in patient receiving chemotherapy

• Thrombocytopenia (low platelet count) • Platelets - prevent bleeding by causing coagulation• Decreased platelets s/s

– Bruising easily– Nosebleeds– Excessive bleeding from cuts, wounds, gums (brushing

teeth), blood in urine/stool

Medical Emergencies- continued

• Thrombocytopenia

• Platelet count – normal 150,000-400,000mm

• When platelet count is less than 20,000 pt has risk of hemorrhage

• Chemo is withheld until platelets increase to >100,000

Nursing Management – Pt Teaching

• Thrombocytopenia

• Use soft toothbrush to avoid bleeding gums

• When shaving, use electric razor

• Avoid constipation, enemas, rectal temps

• Do not use products that contain aspirin, NSAID

• Avoid IM or sc injection

• Notify MD/RN if petechiae, bruising, frank or tarry stools, change in color of urine – frank blood, dark amber, bleeding from any part of body such as nosebleed

Nursing Management

• Minimize Side Effects of Nausea and Vomiting

• Serotonin receptor antagonists such as Ondasetron (Zofran)

• Granisetron (Kytril)

• Dolasetron (Anzemet)

• Avoid offensive odors

• Small frequent feedings rather than 3 big meals

• Adjust oral and fluid intake

• Relaxation exercises, hypnosis, etc.

Nursing Care of Client with Cancer

• Diagnostic Phase– Support– Denial common– Stress signs may be due

to something other than cancer

– Educate on effects of delaying treatment

• Treatment Phase– Varies on type of cancer– Side effect treatment– Neutropenia precautions– Nutrition– Activity Intolerance– Pain control– Grieving

• Terminal Phase– Hospice – Grief counseling – for

both patient and family

References• American Cancer Society www.cancer.org

• Chemo, Radiation & Cancer Therapy Center, Cancer Help Online, A division of Health Centers Online http://cancer.healthcentersonline.com/chemoradiationcancertherapy/?WT.srch=1

• Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness www.umich.edu/~exphysio/ mvs.240/Lectures/Cancer.ch12.ppt

• Health A to Z – Innovating Consumer Health http://www.healthatoz.com

• Lab Tests Online http://www.labtestonline.org

• National Cancer Institute http://www.cancer.gov