MANAGEMENT FOR PATIENT WITH CANCER 9

1. Surgery 2. Radiation

3. Chemotherapy

SURGERY
- Removal of the entire cancer - It is indicated to diagnose, stage and treat cancer - Types: 1. Diagnostic Surgery 2. Prophylactic Surgery 3. Palliative Surgery 4. Reconstructive Surgery

SURGERY
Side Effects: 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 altered body image and or Imposed change of lifestyle

RADIATION THERAPY
Used to kill a tumor Reduce the tumor size Relieve obstruction Decrease pain

RADIATION THERAPY
INTERNAL
Brachytherapy

EXTERNAL
Teletherapy

INTERNAL RADIATION
- Sources: 1. Implanted into affected tissue or body cavity 2. Ingested as a solution 3. Injected as a solution into the bloodstream or body cavity 4. Introduced through a catheter into the tumor

INTERNAL RADIATION
Side Effects: 1. Fatigue 2. Anorexia 3. Immunosuppression Nursing Dx: 1. Impaired tissue integrity 2. Fatigue

INTERNAL RADIATION
3. Anxiety 4. Risk for infection 5. Social Isolation 6. Imbalanced nutrition less than body requirements

INTERNAL RADIATION
Nursing Management: 1. Protection from radiation a. Time b. Distance c. Shield 2. Place the client in private room 3. Ensure proper disposal of body fluids

INTERNAL RADIATION
4. Ensure proper handling of bed linens and clothing 5. In the event of a dislodged implant: Use a long handled forceps and place the implant in a lead container 6. Do not allow pregnant women to come in contact with radiation sources 7. If working routinely near radiation sources, wear a monitoring device to measure exposure

INTERNAL RADIATION
Health Teachings: 1. Maintained balanced diet 2. If the implant is temporary advised the client to maintain bed rest 3. Excreted body fluids may be radioactive, double-flush toilets after use

EXTERNAL RADIATION
- The radiation oncologist marks specific locations for radiation treatment using a semi-permanent type of ink - Side effects: 1. Tissue damage to target area 2. Ulcerations of oral mucosa 3. GI effects 4. Radiation pneumonia 5. Fatigue 6. Alopecia 7. Immunosuppression

EXTERNAL RADIATION
Nursing Dx: 1. Risk for Infection 2. Impaired skin integrity 3. Social Isolation 4. Disturbed body Image 5. Anxiety 6. Fatigue

EXTERNAL RADIATION
Nursing Management: 1. Monitor for side effects 2. Monitor for significant decrease in WBC and platelet 3. Health Teachings: a. Washed the marked area with plain water only and pat skin dry b. Avoid rubbing, scratching, or scrubbing the treatment site; do not apply extreme temperature

EXTERNAL RADIATION
c. Wear soft, loose-fitting clothing over the treatment area d. Protect skin from sun exposure during the treatment and for at least 1 year after the treatment is completed e. Maintain proper rest, diet and fluid intake as essential to promoting health and repair of normal tissues f. If hair loss occurs: choose a wig, hat or scarf to cover and protect head

CHEMOTHERAPY
- Involves the administration of cytotoxic medications and chemicals to promote tumor cell death - The most preferable route is intravenous - Indications: 1. Cure 2. Increase Survival Time 3. Decrease life-threatening complications

Antineoplastic Medications
1. Alkylating Agents 2. Antimetabolites 3. Cytotoxic antibiotics 4. Hormone and hormones antagonist 5. Plant alkaloids 6. Miscellaneous agents 7. Topoisomerase inhibitors 8. Immunomodulator agents: Biological response modifiers

SIDE EFFECTS
1. Immunosuppression - Risk for infection - Avoid crowds, people with infection, and small children - Use meticulous personal hygiene - Wash hands before and after eating, after toileting and after contact with other people and pets

- Consumed a low bacteria diet - Be aware of signs and symptoms of infection and report them immediately to primary care provider (Early Indication of Infection:) 1. Fever 2. Tachycardia 3. Tachypnea

2. Trombocytopenia - Monitor stools and urine for bleeding - For shaving use electric razor only - Avoid contact sports and other activities that may cause trauma - Avoid dental work or other invasive procedures - Avoid aspirin and aspirin containing products - Safety precautions for oral hygiene - Avoid intramuscular injections and limit venipunctures

4. Xerostomia - Apply lubricating and moisturizing agents to protect the mucous membranes from trauma and infection - May consider to use artifical saliva, and hard candy and mints to help with dryness

3. Stomatitis and mucositis - Use soft toothbrush and mouth swabs may be needed during acute episode - Avoid mouthwashes that contain alcohol - Assess daily for lesions, infection, bleeding or irritation - Avoid smoking and alcohol - Drink cool liquids and avoid hot, irritating foods

5. Inadequate nutrition and fluid and electrolyte imbalance - Small frequent feedings - Avoid spicy and fatty foods - Avoid extremely hot foods - Perform oral hygiene before and after meals - Maintain fluid intake as prescribed - Take nutritional supplements as prescribed - Maintain a daily journal of food and fluid intake

- Administer anti-emetics prior to chemotherapy - Weigh the client routinely - Monitor lab values indicative of nutritional status

6. Fatigue - Assure client that fatigue is a normal response to chemotherapy - Encourage client to continue daily activities as much as possible, allowing for rest periods in between - Assist client in self-care needs when indicated - Allow for rest periods of rest; cluster activities

7. Alopecia - Encourage client to choose a wig before hair loss occurs - Care of hair and scalps: 1. Wash hair 2-3 times a week with a mild shampoo 2. Pat hair dry 3. Do not use blow dryer - Allow client to express feelings concerning altered body image

THE CLIENT UNDERGOING OTHER THERAPEUTIC INTERVENTIONS

1. IMMUNOTHERAPY/BIOLOGIC RESPONSE MODIFIERS (BRM) - Enhances the persons immune responses in order to modify the biologic processes in malignant cells - Ex. Monoclonal antibodies Cytokines ( Interleukin-2, Interferons, Hematopoetic growth factors) Natural Killer cells (NK cells)

THE CLIENT UNDERGOING OTHER THERAPEUTIC INTERVENTIONS

2. Gene Therapy - Used to render tumor cells susceptible to damage by other treatments and make the clients immune system better and able to recognize cancer cells as non-self

THE CLIENT UNDERGOING OTHER THERAPEUTIC INTERVENTIONS

3. Photodynamic Therapy - Used to treat specific tumors such as those of the surface of bladder, bronchus, chest wall, head, neck and peritoneal cavity - Photofrin is administered IV - 3 days after, the drug is activated by a laser treatment - It produces a cytotoxic oxygen molecule

BONE MARROW TRANSPLANT and PERIPHERAL BLOOD STEM CELL - Procedures that replace stem cells that have been destroyed by high dose of chemotherapy and/or radiation therapy - Indication: 1. Leukemia 2. Lymphoma 3. Neuroblastoma 4. Multiple Myeloma

TYPES OF DONOR STEM CELLS

TYPES OF DONOR STEM CELLS

2. Syngeneic

TYPES OF DONOR STEM CELLS

TYPES OF DONOR STEM CELLS

3.

PROCEDURE
1. Harvest 2. Conditioning- refers to immunosuppression therapy regimen used to eradicate all malignant cells 3. Transplantation 4. Engraftment

POST-TRANSPLANTATION PERIOD
1. The Client remains without any natural immunity until the donor stem cells to proliferate and engraftment 2. Infection, bleeding or neutropenia and thrombocytopenia are major concerns until engraftment occurs

COMPLICATIONS
1. Failure to engraft 2. Graft-vs-host disease (allogeneic transplants) 3. Veno-occlusive disease