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95 Cards in this Set
- Front
- Back
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How is cancer treatment planned?
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1. Assess symptoms
2. Assess history, physical exam, lab data 3. Perform biopsy 4. Determine if benign or malignant |
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What is the plan for benign cancer?
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Monitor
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What is the plan for malignant cancer?
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1. Classification & grading (pathologic), Staging (clinical)
2. Tumor board or multidisciplinary treatment planning 3. Treatment 4. Restaging 5. "Cure" treatment or Palliation/Control treatment |
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What is the "cure" treatment?
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1. If the cancer is removed and no longer malignant, then treatment is completed
2. However, if there is a relapse, need further treatment and restaging |
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What is the palliation or control treatment?
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Continue further treatment and restaging of the tumor
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What factors are considered in determining how radical a treatment should be for cancer patients?
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1. Aggressiveness of the cancer
2. Predictability of its spread 3. Morbidity and mortality that can be expected in the individual from the therapeutic procedure being considered 4. Cure rate 5. Patient’s desires |
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What are the goals of cancer therapy?
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1. Cure
2. Control 3. Palliation |
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What is "cure"?
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1. Refers to prolonged absence of detectable disease
2. Desired outcome but not always achievable |
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What is control?
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1. Preventing growth of cancer cells without complete elimination of the disease
2. Provides extension of life when cure is unrealistic |
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What is palliation?
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1. Cure or control is impossible
2. Provides comfort, reduction of side effects and symptoms |
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What factors affect the response to cancer treatment?
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1. Tumor burden
2. Rate of tumor growth 3. Combination vs. single agent therapy 4. Dose or dose intensity 5. Hormone receptor status 6. Drug resistance |
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What is tumor burden?
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The smaller the tumor, the higher the rate of response
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What is the rate of tumor growth?
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The tumor doubling time and its growth fraction
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What is the doubling time?
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Time for tumor to double in size
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What is the tumor growth fraction?
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Proportion of proliferating cells in relation to the total # of tumor cells
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What is the difference between combination vs. single agent therapy?
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Combination treatments with different mechanism of action increases the proportion of cells killed at one time
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How does dose or dose intensity affect the response to cancer treatment?
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1. Studies have shown that higher than standard doses of chemotherapy provide significant survival benefit
2. Decreasing the time between chemotherapy cycles may reduce the tumor regrowth |
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How does hormone receptor status affect the response to cancer treatment?
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Tumors that grow more rapidly in the presence of hormones may be suppressed with antihormonal agents
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What healthcare realities present potential ethical issues related to cancer therapy?
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1. Technologic advances
2. Changing healthcare environment 3. Increasing number of uninsured and insufficiently insured individuals 4. Increases in culturally diverse populace that present cultural and communication challenges 5. Use of unproven cancer treatments |
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What are the ethical issues regarding technological advances?
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1. Can sustain life longer but this ability may not always be employed for the “right” reason
2. Important to discuss pt’s wishes and treatment options with the family |
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What are the ethical issues regarding the changing healthcare environment?
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Cutbacks in nursing staff, reallocation of resources, consolidation and corporatization have resulted in growing administrative dominance over clinical practice
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What ethical issues do oncology nurses face daily?
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1. End-of-life decisions
2. Informed consent 3. Patient autonomy 4. The right to refuse treatment 5. Undertreatment of pain 6. Healthcare environment and reform 7. Access to care 8. Confidentiality 9. Scientific integrity 10. Nurse-physician conflicts 11. Physician-family conflicts 12. Participation in clinical research |
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What does JACHO mandate regarding cancer patients?
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JACHO requires that a nurse be able to request an ethical consultation to assist in evaluating the decision-making of an individual as well as to assist with problem resolution
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What are the types of treatment plan for cancer patients?
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May involve a single modality or multiple modalities:
1. Primary therapy 2. Adjuvant therapy 3. Neoadjuvant therapy |
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What is primary therapy?
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Indicates the best, most definitive treatment aimed at a cure for a given cancer
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What is an example of primary therapy?
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Surgery
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What is adjuvant therapy?
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“Assisting or aiding” treatments – other modalities are used after the primary treatment
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What is an example of adjuvant therapy?
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Surgery + Radiation
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What is neoadjuvant therapy?
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Uses other adjuvant modality before the primary, definitive therapy
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What is the oldest form of cancer therapy?
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Surgery
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What is the most important treatment of solid tumors?
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Surgery
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What is the significance of surgery for cancer treatment?
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1. Oldest form of cancer therapy and remains an important component for treatment of solid tumors
2. Usually necessary to combine with other treatment modalities because approx. 70% of patients have evidence of micrometastasis at time of diagnosis ( Chemotx, radiation, immunotherapy) |
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What are the principles of cancer surgery?
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1. Slow growing cancers are the most amenable to surgical treatment
2. The initial surgery for malignancy is more successful than a secondary operation for recurrence. This is the guiding principle behind many radical surgeries. 3. A margin of normal tissue must be excised to assure an adequate resection 4. Clinical staging to determine the extent of the disease should be completed before definitive surgery 5. Removal of the tumor with adjacent lymph nodes is preferable to simple tumor excision (if no serious disfigurement would occur) 6. The patient must find the potential impairment resulting from surgery acceptable 7. Reconstruction and rehabilitation are essential components of cancer surgery and post-op care |
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What is the diagnostic type of cancer surgery?
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Tissue biopsy confirms diagnosis and identifies specific type of cancer (histology)
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What are the biopsy techniques?
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1. Aspiration biopsy
2. Needle biopsy 3. Excisional biopsy 4. Staging—determines extent of disease and helps determine surgical procedure and additional therapy |
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What is sentinel node biopsy?
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The sentinel node is the first node draining a tumor and whether the node contains cancer cells predicts the status of the regional nodes
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What is the technique of sentinel node biopsy?
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Involves the use of a dye to pinpoint the lymph node closest to the cancer site
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What are the advantages of sentinel node biopsy?
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1. Allows a more accurate staging of cancer
2. Alternative to removing several lymph nodes |
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What are the uses of sentinel node biopsy?
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Used to stage lung, breast, and skin (Melanoma) cancers
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What is the definitive cancer surgery?
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1. Entire tumor, associated lymphatics, and a margin of the surrounding tissue are removed as one specimen
2. Can be curative for some early stage cancers |
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What are the types of definitive cancer surgeries?
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1. Local excision
2. Wide local excision 3. Wide excision 4. Extended radical excision |
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What is a local excision?
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Removal of entire tumor only -- small
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What is a wide local excision?
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Removal of tumor + adjacent tissue
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What is a wide excision?
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Adjacent structures and usual lymph channels draining the area (small to moderate size tumor with local invasion)
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What is an extended radical excision?
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Lymphatics, adjacent organs and all tissues (no known distant metastasis)
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What is cytoreductive cancer surgery?
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1. Debulking surgery when tumor is large or unresectable
2. Reducing the tumor mass in certain cancers can increase the effectiveness of subsequent radiation or chemotherapy |
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What is cryosurgery?
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Application of liquid nitrogen to destroy malignant cells
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What is laser surgery?
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2. Light amplification by stimulated emission of radiation, a source of intense monochromatic radiation of the visible, ultraviolet, or infrared portions of the spectrum
2. Lasers are used in surgery to divide or cause adhesions or to destroy or fix tissue in place |
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What is preventative cancer surgery?
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Plays a limited role in the prevention of malignancy for pts with strong family history, or congenital predisposition that increases the risk of developing cancer
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What are the examples of preventative surgery?
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1. Colectomy for a pt with ulcerative colitis or family history of familial polyposis
2. Subcutaneous mastectomy for women with a very strong family history of breast cancer and fibrocystic disease |
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What is reconstructive cancer surgery?
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Repairs anatomic defects, improves functions and cosmetic appearance following radical surgery
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What are the examples of reconstructive cancer surgery?
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1. Breast reconstruction
2. Use of artificial joints after surgery for sarcoma 3. Use of penile implants after urological organ surgery |
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What is palliative cancer surgery?
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1. Effective in relieving symptoms in advanced stages
2. Release of obstructions related to local expansion of the tumor (bowel in colorectal and ovarian cancers) |
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What is a "second look"?
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Surgery performed to assess the disease status in clients who have been treated and have no symptoms of remaining or recurrent tumor
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What is radiotherapy?
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1. Uses high-energy ionizing radiation to kill cancer cells
2. Considered a local therapy because cancer cells are destroyed only in the anatomic area being treated |
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What is the action of radiotherapy?
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The radiation causes the breakage of one or both strands of the DNA molecule inside the cells, thereby preventing their ability to grow and divide
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What are the principles of radiation therapy?
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1. Radiation is administered in smaller doses or fraction because tumor-lethal dose given as a single treatment would result in unacceptable toxicity or even death
2. Fractionation also allows multiple opportunities to destroy cancer cells that survived the initial hit of radiation while minimizing damage to normal tissues |
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How is the dose of radiation administration determined?
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Determined by:
1. Radiosensitivity of the tumor 2. Normal tissue tolerance 3. Volume of tissue to be irradiated |
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How is radiation administered?
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1. External beam radiation
2. Internal radiation or brachytherapy |
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What is external beam radiation?
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Given from a longer distance
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What is internal radiation or brachytherapy?
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Radiation that is given from a short distance
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What is the principle of internal radiation/brachytherapy?
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1. Sealed radiation sources - intracavitary implant, interstitial sources (seeds or needles)
2. Unsealed radiation sources — usually administered orally, IV, or instilled into body cavities such as the peritoneal cavity and the spinal fluid space (Radioactive Iodine) |
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What are the sources of sealed radiation?
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Seeds or needles
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What are the sources of unsealed radiation?
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Radioactive iodine I-131
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How is external beam radiation delivered?
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Delivered by machines ( called linear accelerator) that deliver high energy radiation
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What is the machine that delivers the external beam radiation callled?
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Linear accelerator
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What is a simulator?
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A simulator (X-ray machine) is used to visualize and define the exact treatment area for external beam radiation
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What are the precautions of external beam radiation?
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1. Customized shielding blocks are created to protect healthy tissue from radiation beam
2. Patient is not considered radioactive while receiving external radiation treatments |
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What are the guidelines for skin care during external beam therapy?
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1. Assess skin within the treatment area for erythema, pain, and dry or moist desquamation (peeling of skin)
2. Markings on skin for treatment purposes must not be removed unless otherwise instructed 3. Wash treated area only with tepid water and a soft wash cloth 4. Within the treatment area, avoid the use of soaps, deodorants, powders, perfumes, cosmetics, lotions, and skin preparations 5. Avoid wearing tight-fitting clothing over treatment area 6. Wear cotton clothing close to the skin 7. Items that produce extreme temperatures such as hot water bottles, electric heating pads, and hot and cold packs must NOT be applied to the treatment area 8. Protect the treatment area from the sun, wind and cold. Utilize protective clothing. If sun exposure is unavoidable, use sunscreen with SPF of 15 or higher. Increased skin sensitivity within the treatment area may be a permanent outcome of irradiation. 9. If dry desquamation occurs, a moisturizing lotion may be prescribed |
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What is low dose brachytherapy?
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Radioactive isotopes are used for either temporary or permanent implants (cesium, iridium, radium, iodine, phosphorous, palladium)
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What are intracavitary implants?
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1. Applicators are placed surgically or under fluoroscopy
2. Radioactive isotope is loaded into the applicator once the patient returns to room 3. Implant removed when the prescribed dose is delivered 4. The client emits radiation while the implant is in place (Excreta are not radioactive) |
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What are the indications for low dose brachytherapy?
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Indicated for cancers of the tongue, lip, breast, vagina, cervix, endometrium, rectum, bladder and brain
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What are tandem cylinders used for?
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Treat cervical cancer
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What is the nursing care for patients with a sealed implant (low dose brachytherapy - intracavitary)?
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1. Private room with bath
2. Place sign “Caution: Radioactive Material” on the door 3. Wear a dosimeter film badge at all times while caring for clients with radioactive implants 4. No pregnant nurses to care for client 5. No pregnant visitors or children < than 16 6. Never touch the radioactive source with bare hands. In the rare instance that it is dislodged, use a long-handled forceps to retrieve it. Deposit the radioactive source in the lead container kept in client’s room. 7. Save all dressings and bed linens until after the radioactive source is removed. After the source is removed, dispose of dressings and linens in the usual manner. Other equipment can be removed from the room at any time. |
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What is the purpose of the dosimeter film badge?
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The badge offers no protection but measures an individual’s exposure to radiation and should be used by only one individual
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What is the interstitial implant?
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1. Encapsulated sources are left within the patient as permanent implants
2. “Seeding” emits continuous low-energy radiation to tumor tissues 3. The patient’s body blocks or attenuates most of the radiation so radiation precautions are usually not required |
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What are the indications for interstitial implant?
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Usually indicated for localized prostate cancers, and localized but inoperable lung cancer
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What follows interstitial implant?
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External beam therapy
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What is the permanent seed implantation?
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1. Involves injecting approximately 100 radioactive seeds into the organ
2. Seeds (smaller than a grain of rice) are contained in thin needles 3. Seeds give off radiation at a low dose rate over several weeks or months 4. Seeds remain in the organ permanently 5. Radioactivity of the seeds slowly decays over time 6. Restrictions are usually placed on small children and pregnant women because of the radioactivity being released by the seeds |
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What is high dose rate?
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1. Temporary. Removed after 3 treatments (3 treatments in 24 hours; or 4-6 treatments over 1-2 weeks- fractionated)
2. Involves placing very tiny plastic catheters (18-25) into the organ 3. Computer-controlled machine pushes a single highly radioactive seed into the catheters one by one 4. Computer controls the amount of radiation given to each catheter 5. Catheters are pulled after treatment and no radioactive material is left in the organ |
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What are the side effects of radiation?
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1. Fatigue and malaise
2. Anorexia 3. Mucositis - most visible when XRT is given to the mouth and oropharynx 4. Xerostomia 5. Esophagitis and Dysphagia 6. Nausea and Vomiting 7. Diarrhea 8. Skin irritations 9. Bone marrow depression |
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What are the treatments for mucositis?
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1. NS mouth rinses
2. Benadryl elixir mixed in 1 qt of water 3. Maalox soothes oral mucosa 4. Viscous Lidocaine 5. Mouth care must be done q3-4hrs |
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What is xerostomia?
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Dry mouth resulting from radiation to the salivary glands
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What are the effects of xerostomia?
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1. Alterations in taste frequently accompany xerostomia
2. Maybe temporary or permanent depending on dose received and the total percentage of salivary tissues irradiated |
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What are the treatments for xerostomia?
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1. Frequent sips of water
2. Saliva substitute 3. Frequent mouth care provide moisture |
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What are the treatments for esophagitis and dysphagia?
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Mylanta, Viscous Lidocaine and Benadryl Elixir mixture. 1-2 tbsp. 15 mins. AC and HS
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What is the nursing care for esophagitis and dysphagia?
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1. Maintain adequate nutrition by providing high calorie, high protein, high CHO liquids
2. Soft bland diet |
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What causes nausea and vomiting during radiation therapy?
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1. Not common
2. Present when treatment is directed to the abdomen, large pelvic fields, epigastrium, wide mediastinal field, whole brain irradiation |
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What are the treatments for nausea and vomiting?
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Treated with antiemetic on a regular schedule
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What is the nursing care for nausea and vomiting?
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Delay meal until 3-4 hours after treatment
(if nausea occurs, it will usually appear from 3-4 hours after treatment) |
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What causes diarrhea during radiation therapy?
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Not an expected side effect unless treated area is in the abdomen and pelvis
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What are the treatments for diarrhea?
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1. Low residue diet
2. Anti-diarrheals (Lomotil, Imodium) |
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What types of skin irritations are side effects of radiation?
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Varies from mild erythema to moist desquamation that leaves a raw surface similar to a second degree burn
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What causes bone marrow depression during radiation?
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Occurs when large volumes of active bone marrow are irradiated esp. in the pelvis, spine, sternum, ribs, metaphysis of the long bones, and skull
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What is the nursing care for bone marrow depression?
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1. CBC weekly
2. Transfusions of PRBC and platelets PRN 3. Neutropenic and thrombocytopenic precautions 4. Anemia nursing interventions |
