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ONCOLOGY 3

L - light
A - accumulating
S - stimulating
E - emission
R – radiation
Café- au-lait – called giraffe spots or "coast of Maine spots

CANCER SCREENING GUIDELINES FOR ASYMPTOMATIC CLIENTS

 COLORECTAL CANCER (MALE AND FEMALE)


o Digital rectal examination ANNUALLY beginning at the AGE 50. (Men: yearly)
o Fecal occult blood test ANNUALLY begging at the AGE 50.
o Sigmoidoscopy EVERY 5 YEARS AT THE AGE 50.
o Colonoscopy EVERY 10 YEARS or double contrast barium enema EVERY 5 – 10 YRS.
*AS THE AGE INCREASE IMMUNE SYSTEM DECREASES THUS HIGH RISK OF CANCER.

 BREAST CANCER ( FEMALES)


o MONTHLY breast self examination beginning AT THE AGE 20.
o Clinical breast examination EVERY 3 YRS from age 20s to 30s, and then ANNUALLY
beginning at AGE 40.
o Mammogram ANNUALLY at AGE 40 AND OVER.

 CERVICAL AND UTERINE CANCER


o Papanicolaou/ pap smear test ANNUALLY for all women who are or who have been sexually
active or have reached AGE 18 ( after a woman has had three(3) or more consecutive
satisfactory normal annual examination.
o Pelvic examination EVERY 1 – 3 YEARS w/ pap test BEGINNING AT AGE 18-40.
o Endometrial tissue sample at menopause and if high risk and thereafter at the discretion of the
physician.

Prostate cancer
--

PROSTATECTOMY – solution for enlarged prostate, removal of prostate


- Dili na makapaburos
*PROSTATE – donut shape urinary bladder to urethra
*INCREASED PSA – this supports prostate cancer but not confrimative test
*BIOPSY – confirms prostate cancer
NOTE: PSA and DIGITAL RECTAL EXAMINATION ANNUALLY BEGINNING AT THE AGE 50 FOR MEN
who have at least 10 YEARS like expectancy and for younger men who are at high risk.

*BPH – who does not often masturbate.


- dribbling due to contracted prostate (2 minutes ihi)
ONCOLOGY 3

COMMON CANCER DIAGNOSIS STUDIES:


o Mammography
o Lymphangiography
o Tumor Marker
o Colposcopic examination of cervix
o Sputum – pus yellow containing substasnce
o Stool Analysis – FOBT
o X-ray
o Computerized Axial Tomography
o Cytology Study
o Radionuclide Scan/Imaging

TYPES OF HEMATOPOIETIC STEM CELL TRANSPLANTATION:


1. Allogenic – fraternal, family, friends, and other people (dili identical) donor is not self
2. Autologous – your own bone marrow/ own parts.
no/ Avoid organ rejection.
Donor from self
3. Syngenic – coming from identical twin; no chance of organ rejection
4. Myeloablative – give increased dose of chemotherapy; total body irradiation; PROCEDURE
5. Nonmyeloablative – mini transplantation doesn’t completely destroy bone marrow.

*bone marrow compatibility test is used


*differentiate – means destination to a specific something
*stem cell – capable of differentiating

BONE MARROW TRANSPLANT PROCEDURE/ PERIPHERAL BLOOD STEM CELL TRANSPLANTATION


- People with leukemia
- Leukemia is due to long effect of chemo and radiation

1. HARVEST – kuhaon ang stem cell


- APHERESIS MACHINE/ LEUKAPHERESIS
- 4-6 hrs procedure
- From iliac crest( daghan bone marrow)

2. CONDITIONING – pt. should be immunosuppressed (to prevent donor rejaction)


If not, may cause septicemia

3. TRANSPLANTATION –after transfusion

4. ENGRAFTMENT – period where transfused stem cells are working , good compltibility

- 2-5 wks for engraftment waiting


- Increase of all blood forming elements after enfraftment
ONCOLOGY 3

ENGRAFTMENT SYNDROME – incompatibilities; allogenic

Treatment: - Cortecosteroids

MANIFESTATIONS:
1. Non-infectious fever
2. Skin rashes
3. Wt. gain
4. Diarrhea
5. Pulmonary infiltrates

COMPLICATIONS:
1. Failure to engraft
2. Graft versus host dse. in allogenic transplants
3. Veno- occlusive Disease/ Hepatic Sinusoidal Obstructive Syndrome

NOTE: solution sa GVHD are syngenic and autologous.


*CYCLOSPORINE - Preventing the rejection of organ transplants

STEPS IN PREPARING CLIENTS FOR THE BONE MARROW BIOPSY:

 Verify that the physician has explained the procedure.


NOTE: preventive measure is to check DOCTORS ORDER.
 Teach that pressure or discomfort may be experienced
 Obtain a signed inform consent – thus physician ang mubuhat; witness ang nurse
NOTE: null and void if pts have signed the consent but does not understood.
 Pre-medicate w/ lorazepam (Ativan).
 Position the client in a prone positon.
 Support the client by holding the clients hand or using guided imagery (which means to
distract/diversion ex: words, phrase and visual) guided imagery skips pts. From stress.
 Check for signs of bleeding every 2 hrs for 24 hrs.
NOTE: iliac crest - site target
ANTI-NEOPLASTIC AGENT/S OR CHEMOTHERAPEUTIC AGENT/S
Chemotherapy – used of chemicals that are capable in killing microbial, virial, bacterial and etcs. Agents.
- It stopped rapidly dividing cells.
- Overall goal; to destroy the cancer cells w/out excessively damaging the normal cells
CLASSIFICATION OF CHEMOTHERAPEUTIC AGENTS

 Cell Cycle-Specific
o S- phase: anti-metabolites
o M- phase: Vinca / plant alkaloids
 Cell Cycle-Nonspecific
 Others (will vary): too complex to categorize
ONCOLOGY 3

EXAMPLES:

 Targets nucleus
o Gifitinib
o Imatinib
o Nilotinib
o Erlontinib

NOTE: alkylating agents – smooth ER

 Targets centrioles
o Docetaxel
o Paclitaxel

 Targets cell membrane


o Hormone modulators

 Targets ribosomes?
o Cladribine
o Hydroxyurea
o Dacarbazine
o Irinotecan
o Procarbazine

G1 phase - Pre synthesis


S phase- DNA synthesis
- Anti metabolites
- Anti-foliates
G2 phase -Pre- mitosis
-Antibiotics means ( bleomycin)
M phase - plant alkaloids
G0 -resting

Note: Peripheral site: in between antecubital wrist

ADMINISTRATION OF CHEMOTHERAPEUTIC AGENTS:

 SETTINGS
o Hospital
o Outpatient (enter or department)
o Clinic
o Home Care
ONCOLOGY 3

Note: Clarify information and dispel misconceptions

 ROUTE
o Topical
o Oral
o IV
o Arterial
o Muscular
o Subcutaneous
o Intracavitary
o Intrathecal- subarachnoid or subdural space, spinal cord

 DOSAGE
o Total Body Surface Area, (lawas=dosage)
o Previous responses to chemotherapy or radiation therapy
o Function of major organs

PREVENTION OF EXTRAVASATION WHEN ADMINISTERING VESICANT MEDICATIONS:


1. Administer vesicant infusions through a peripheral IV device if it is to be infused in less than 60 mins.
2. Check patency EVERY 5-20 mins.
3. Ask the client frequently about discomfort at the peripheral IV site during infusion.
4. Check for blood return in a central venous catheters w/ 5-10ml of normal saline between medications.
5. Flush the peripheral and central venous catherters with 5 to 10ml ....

Note: Vesicant first before non vesicant – grabbing opportunity

SPECIAL PROBLEMS: EXTRAVASATION

 Absence of blood return from the Iv catheter.


 Resistance to flow of IV fluid
 Swelling, Pain, or Redness at the site

(Insert druuuuuuugs, picture)

Note:
Oncology: stop the infusion but you don’t have to terminate
 Neutralizing agent: prevent tissue death
Mitotane- design for adenocarcinoma
Containdications:
 Warfarin
 Phenytoin
 Spironolactone
NEUTRALIZING SOLUTIONS EXTRAVASATED TISSUES: (to delay necrotic effect)
 Sodium thiosulfate
ONCOLOGY 3

 Hyaluronidase
 Sodium Bicarbonate
Note:
Right atrial silastic catheter/ Venous access device

- Prolonged administration of anti-neoplastic agents.

HYPERSENSITIVITY REACTIONS:

 5% overall incidence who undergo chemo


 Skin testing prior to chemo
 Type 1 hypersensitivity reaction
 Nurse should have a clear understanding of which agents have the potential for precipitating
hypersensitivity reactions.
 Provide appropriate premedication before administering the agents.
 Emphasize the importance of adherence of prescribed self administered pre-medication before
presenting to the infusion center.
 Report signs and symptoms to the nurse once the infusion has started.
 Hypersensitivity reactions can be immediate or delayed.

SIGNS AND SYMPTOMS OF ANAPHYLAXIS:


1. Generalized itching with localized or generalized urticarial
2. Flushing of the face, hands, or feet
3. Chest tightness ( delikado, danger marker)
4. Agitation
5. N/V
6. Dyspnea and Bronchospasm( danger marker)
7. Difficulty speaking ( feel of choking)
8. Feeling of impending doom
9. Hypotension

ANTINEOPLASTIC AGENTS: CAUSING HYPERSENSITIVITY BUT NECESSARY TO TREATMENT PLAN:

 Desensitization procedures
 Reduced dosages
 Slower infusion rates

PRE-MEDICATION REGIMENS:

 Corticosteroids (aka. Steroids)


 Histamine-1 anatgonist/blocker
 Histamine-2 anatgonist/blocker
 Antipyretics, routinely administered

TOXICITY:
ONCOLOGY 3

 GI system ( constipation, diarrhea, paralytic ileus- mawala ang paralytic fxn)


 Hematopoietic System ( lower RBC)
 Renal System
 Cardiopulmonary System
 Reproductive System (temporary or permanent sterility)
 Neurologic System( loss balance, hearing,...)
 Impairment

 COMMON SIDE EFFECT OF CHEMO and Radiation: Fatigue

CNS
Stomatitis/Mucositis
Dermatological reactions
Renal Damage
Bone Marrow Depression
Liver Damage
GI effects
Teratogenecity/infertility

NOTE: Azospermia – men; no sperm producing

GASTROINTESTINAL SYSTEM

- Nausea and vomiting ( common side effect)


- May persist for as long as 24-48 hrs after it administered
- Delayed N + V may persist one (1) week after chemotherapy
- Initiated by:
 Activation of chemoreceptor triggering zone of the medulla
 Stimulation of the peripheral autonomic and vestibular pathways
 Cognitive stimulation
 Combination of factors
G. I. MEDICATIONS: DECREASES N/V

 Serotonin Blockers
o Ondansetron (Zofran)
o Granisetron (Kytril)
o Dolasetron (Anzenet)
o Palonesetron (Aloxi)

 Anti- emetic – should be given 30 mins prior to meal


o Corticosteroids
o Phenothiazides
o Histamine either of the 4 drugs it improves emetic
Once in combination with Serotonin
o Sedatives
ONCOLOGY 3

TOXICITY:
- Gastro intestinal system
 Meds: decreases n/v
o Dopaminergic blockers
 Metoclopramide (Regun)
o Neurokinin 1 Receptor Antagonist
 Aprepitant ( Emend)
o Others:
 Corticosteroids, Phenothiazines, Histamines, Sedatives

- Non-pharmachologic approach
 Relaxation technique
 Imagery
 Acupressure

- Diet
 Small frequent meals
 Bland foods
 Comfort foods

HEMATOPOIETIC SYSTEM
- Myelosuppression (may occur 7-14 dys after admission)
 Leukopenia ( decrease WBC’s)
 Neutropenia (decrease granulocytes)
 Anemia ( decrease RBC’s)
 Thrombocytopenia (decrease platelets)
 Increase risk of infection and bleeding
- Nadir Counts
 Febrile neutropenia ( < 1,500/mm3)

- Colony Factors
 Granulocytes Colony-Stimulating Factor (G-CSF)
 Granulocytes Macrophage Colony Stimulating Factor (GM-CSF)
NOTES: G-CSF and GM-CSF stimulate RBC’s production
G-CSF and GM-CSF – slowly administer

- Erythropoietin (EPO) – Increase hormone, RBC’s production


- Interleukin 11 (11-11) – increase platelet production

RENAL SYSTEM

 Factors
o Direct affect during excretion
o Accumulation of end products after cell lysis

 Nephrotoxic Anti-neoplastic Agents


ONCOLOGY 3

o Cisplatin, Cyclophosporamide (Cystoxan)


o Methotrexate (Trexall, Rheumatrex)
o Mitomycin, Ifosfamide (Ifex)

 Rapid Tumor Lysis / Tumor Lysis Syndrome


o Hyperuricemia
o Hyperkalemia
o Hyperphosphatemia
o Hypocalcemia

 Monitor
o BUN
o Serum Creatinine
o Creatinine Clearance
o Serum Electrolyte Levels
Note: creatinine is the by-product of muscle

 Interventions:
o Adequate hydration
o Diuresis
o Alkalinization of urine
o Allopurinol – hyperurecemia
o Amifostine – minimizes renal toxicity
 Hemorrhagic cystitis
o d/t cyclophosphamide and ifosfamide therapy
o hematuria: microscopic to frank bleeding
o symptoms: ranging from transient irritative irritation dysuria, suprapubic pain , to life threatening
hemorrhage.
 Management:
 Aggressive IV hydration
 Frequent voiding
 Diuresis

 MESNA (MESNEX)
 CYTOPROTECTANT
 Prevent bleeding
ONCOLOGY 3

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