2015 STUD_Intro 2 CR N236-1.pdf - Cancer Diagnos-cs...

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Unformatted text preview: Cancer Diagnos-cs Laboratory tests, Radiographic tests, Biopsy, Bone Marrow Aspira8on Laboratory Tests Lab Tests affected by CA: •  Platelets: •  Normal range •  Thrombocytopenia (low) • Below •  Mild • Moderate • Severe Laboratory Tests Lab Tests affected by CA: •  WBC: normal /mm3 – Leukopenia (low) – below Neutrophils: normal /mm3 – Neutropenia (low) less than /mm3 Laboratory Tests •  Tumor markers – PSA – prostate-­‐specific an-gen – CEA – carcinoembryonic an-gen – CA-­‐125 an-gen Laboratory Tests •  Genomics •  Proteomics Biopsy Purpose: The removal of a sample -ssue to iden-fy a suspicious mass through histologic or cytologic analysis. Techniques: •  Needle biopsy •  Surgical biopsy Excisional Incisional Endoscopic •  Bone marrow aspira-on Radiographic Tests •  •  •  •  •  •  •  CT Scans – computed tomography MRI – magne-c resonance imaging X-­‐ray Bone scans PET scans – positron emission tomography Mammography Fluoroscopy Other Diagnos-c Tests •  Bronchoscopy •  Colonoscopy •  Endoscopy •  Electroencephalogram (EEG) Cancer Treatment Goals of Cancer Treatment •  Cure the cancer •  Control its spread •  Manage as a chronic illness •  Pallia-on – reduce symptoms •  Maximize quality of life Cancer Treatments Most common treatment methods for Cancer: 1.  Surgery 2.  Pharmacotherapy – including Chemotherapy 3.  Radia-on 4.  Hormonal Therapy 5.  Biotherapy 1.  Surgical Treatment Goals of CA Surgery: •  Prophylaxis •  Diagnosis – biopsy & stage tumors •  Cure – remove cancer •  Control -­‐ decrease tumor size •  Pallia-on -­‐ relieve discomfort & symptoms •  Reconstruc-on Collabora-ve Management: Surgical Treatment Nursing Management during Surgical Treatment of the Cancer Pa-ent •  Pre opera8ve •  Post opera8ve •  Complica8ons 2. Radia-on Therapy Radia-on therapy is the use of high energy rays to damage or kill cancer cells by preven-ng growth and division. •  Principles of Treatment •  External Radia-on •  Internal Radia-on -­‐ Brachytherapy Radia-on Therapy: External External Radia8on: Delivers high energy ray directly to tumor site from outside the body Radia-on Therapy: Internal Internal Radia8on: Brachytherapy Delivers high dose radia-on to localized area internally Radia-on Therapy Side Effects: •  Neuro: neuropathy, fa-gue •  CV: pericardi-s, myocardi-s •  GI: Radia-on enteri-s-­‐ N/V, diarrhea, anorexia, dry mouth, stoma--s, esophagi-s, hepatotoxicity, dysphagia Radia-on Therapy Side Effects: •  GU: cys--s, urethri-s, nephrotoxicity •  Skin: alopecia, redness, dryness, itching, thinning, pain, desquama-on •  Reproduc8ve: infer-lity •  Hematologic: anemia, leukopenia, thrombocytopenia, bone marrow suppression •  Secondary Cancers Safety for Radia-on Therapy Key principles: •  Distance •  Time •  Shielding •  Badges Safety for Radia-on Therapy Distance: •  The > greater the distance from the source the less < the exposure to ionizing rays. Safety for Radia-on Therapy Time: •  Minimize the amount of -me exposed to the radia-on source. •  Exposure is generally limited to 30 minutes of direct care per 8 hour shic. •  Staff members should be rotated. Safety for Radia-on Therapy Shielding: Badges: Radia-on Therapy: Nursing Interven-ons Nursing Care: Radia8on Therapy pa8ent •  Assess: CV, GI, I&O, inspect mouth & skin •  Monitor labs: CBC, LFT, platelets •  Mouth care & skin care •  Markings: Do NOT wash off •  Diet: as tol., soc, bland, more protein & calories, supplements recommended •  Medica-ons – treat GI symptoms, MD prescribed creams for skin 3. Chemotherapy •  Principles of Treatment •  Administra-on •  Side effects •  Goals •  Medica-ons: an-neoplas-c agents Chemotherapy Routes •  Intravenous – Vascular access devices – implanted, external venous access, PICC •  Regional – Topical – Intra cavitary – Intra peritoneal – Intrathecal •  Oral Goals of Chemotherapy •  Permanent destruc-on of cancer cells •  Remission of disease •  Reduc-on of symptoms •  Improved quality of life Across the lifespan •  Children: •  Adults •  Older adults: Karch p.201 Chemotherapy: An-neoplas-c Medica-ons •  Cell cycle cell cycle specific cell cycle non specific •  Chemical group An-neoplas-c Medica-ons Classifica8ons: •  Alkyla-ng Agents – Alkylator-­‐like drugs •  •  •  •  •  •  Nitrosureas Topoisomerase Inhibitors An- metabolites An- tumor An-bio-cs Mito-c Spindle Inhibitors (Plant Alkaloids) Hormonal agents An-neoplas-c Medica-ons Alkyla8ng Agents: Txs: Breast, ovarian, lung, mult myeloma, lymphoma, leukemia Ac8on: Stops cell DNA replica-on; Cell cycle non specific Side effects: hemorrhagic cys--s, infer-lity, bone marrow failure, N/V, alopecia, nephro/hepato-­‐ tox., derma--s Med ex: Cyclophosphamide(Cytoxan) Cytoxan: Cyclophosphamide •  •    •  •  Alkyla-ng Agent Nephro / hepato toxic Metabolites in urine Bone marrow suppression Nsg: An-neoplas-c Medica-ons Alkylator -­‐ like drugs: Tx: Bladder, tes-cular & ovarian Ac8on: Stops cell replica-on Side effects: Nephrotoxic Med ex: Cisplan-n (Pla-nol) Cisplan-n •  Given IV •  Metabolites in urine •  Nephrotoxic; Allergic Rxn •  Nsg: An-neoplas-c Medica-ons Nitrosureas: Sub class alkyla-ng agents Txs: Brain tumors Ac8on: Crosses B/B barrier; cell cycle -­‐ nonspecific Side effects: Thrombocytopenia, stoma--s, N/ V Med ex: Lomus-ne (po), carmus-ne (IV) Nitrosureas: Carmus8ne/Lomus8ne Alkyla-ng –like agent Drug toxicity complica-ons are cumula-ve Drug is dose adjusted regularly May be given: –  po (lomus-ne) or –  IV (carmus-ne) •  Nsg: •  •  •  •  Given w/ Alkyla-ng chemo Cyto protec-ve drugs •  Amifos-ne (Ethyol) •  Mesna •  Dexrazoxane An-neoplas-c Medica-ons Topoisomerase Inhibitors Txs: lung, tes-culuar, leukemias, colon Ac8on: impairs DNA func-on resul-ng in cell death; cell cycle-­‐specific Side effects: N/V/diarrhea, Flu-­‐like Sx; Med ex: I: camphotothecin (colon) II: etoposide (lung) An-neoplas-c Medica-ons An8 tumor An8bio8cs: Txs: Breast, ovaries, lung, bladder, leukemia, lymphoma Ac8on: Cytotoxic; cell cycle specific Side effects: Cardio tox, N/V, alopecia, bone marrow supp, stoma-s Med ex: doxorubicin (Adriamycin), Daunorubicin Doxorubicin (Adriamycin) / Daunorubicin •  Side effects: darkening of the soles, palms, and nails, red urine (1-­‐2 days acer administra-on which clears). •  IV •  Unchanged in bile and urine •  Teratogenic •  Cardio Toxic •  Nsg: An-neoplas-c Medica-ons An8 metabolites: Txs: Leukemia, breast, lung, lymphoma, osteosarcoma Ac8on: Stop RNA & DNA synthesis Side effects: bone marrow supp, N/V, diarrhea, proc--s, folic acid, stoma--s, renal tox. Med ex: methotrexate (Folex), fluorouracil (5-­‐ FU, Adrucil) Methotrexate IV, IM, intrathecal Must rehydrate Liver toxic Folate antagonist Folic acid deple-on: Leucovorin Rasburicase Nsg: •  •  •  •  An-neoplas-c Medica-ons Mito8c Inhibitors / Plant Alkaloids: Txs: Tes-cular, breast, kidney lymphoma, cervix, neuroblastoma Ac8ons: Block cell division Side effects: N/V, alopecia, neuro tox, fever, stoma--s, cons-pa-on Med ex: Vinblas-ne, Vincris-ne (VCR) Vincris-ne/Vinblas-ne •  Mito-c Inhibitors & Plant Alkaloids •  Neuro tox. •  High risk of extravasa-on •  Given IV •  Nsg: Chemo Complica-ons: Extravasa-on •  Nsg: 4. Hormone Therapy •  Goal: Prevent hormones form s-mula-ng growth of cancer cells •  Methods: – Add, block or remove hormones to slow or stop CA cell growth •  Adjuvant therapy: shrink tumors 5. Biological Therapy Biologic chemotherapy agents: •  Biologic Response Modifiers (BMR) •  Interferon •  Cytokines -­‐ Interleukins •  Vaccines •  Monoclonal an-bodies Interferons Biologic Response Modifier •  Txs: Leukemia •  Ac8on: An-viral, an--­‐prolifera-ve, immunomodulatory, •  Side effects: Flu-­‐like syndromes-­‐fa-gue, fever, pain, chills, headache; depression •  Protocol: diphenhydramine (Benedryl) & acetaminophen (Tylenol) prior •  Med ex: Interferon alpha, beta,gamma Biological Therapy Biologic agents used for Chemo side effects: •  Erythropoie-n (RBC) •  Oprelvekin (platlets) •  Neupogen (WBC) Targeted Therapies •  Interferes with CA cell growth •  Lead to cell death – apoptosis •  Target specific enzymes or proteins •  Deliver toxic meds directly to tumors •  Block growth of blood vessels to tumors •  Fewer toxic side effects •  IV, PO admin 6. Blood & Bone Marrow Transplanta-on BMT Goals: Restore cells needed to produce blood cells •  Autologous transplant •  Allogenic transplant: Blood & Bone Marrow Transplanta-on Methods: •  Bone marrow dona8on: Harves-ng= needle aspira-on from donor bone site (usually hip) •  Bone marrow recipient: Receives marrow stem cells IV •  Apheresis: Peripheral blood stem cells are removed from whole blood 7. Complementary & Alterna-ve Medicine (CAM) •  Botanical agents •  Nutri-onal supplements •  Dietary regimens •  Mind-­‐body modali-es •  Energy healing •  Spiritual approaches •  Miscellaneous therapies Clinical Trials •  Defined: Clinical trials are research studies using human volunteers to answer specific ques-ons about cancer treatment and progression. Mul--­‐Symptom Management In pa-ents with Cancer Side Effects of Cancer Treatment •  •  •  •  •  •  •  •  •  •  Hair loss (alopecia) Dry mouth (xerostomia) Mouth sores (stoma--s) Difficulty swallowing due to esophagi-s Nausea Vomi-ng Diarrhea Fa-gue Bleeding Increased suscep-bility to infec-on Think, Pair Share: Side Effects •  Nsg Dx •  Nsg interven-ons •  Teaching GI:CINV •  Oral •  IV •  transdermal GI:CINV •  PO •  Zofran: IV •  Sancuso (Granisetron) : PO, IV, Transdermal Pain Management CA Pain Syndromes: •  Pain associated with tumor •  Pain associated with treatment •  Pain not related to CA or treatment Pain Management Cancer Pain: •  Persistent pain •  Breakthrough pain Pain Medica-on used in CA •  NSAIDS •  Narco-cs: – Codeine (Tylenol #3)-­‐ PO – Oxycodone (Percocet)– PO – Hydromorphone (Diluadid)-­‐PO, IV – Fentanyl (Duragesic)– patch Pain Medica-on used in CA •  Opiods – Morphine – IV, SQ • MS Con-n – PO • Roxanol – PO sublingual liquid Myelosuppression •  Bone marrow suppression •  Anemia •  Neutropenia •  Leukopenia •  Thrombocytopenia Nutri-on Therapy in pa-ents with Cancer Nutri-onal support for Cancer pa-ents •  Anorexia •  N / V •  Diarrhea •  Dry mouth •  Goals of Nutri-on Therapy in Ca •  Maintain weight & body mass •  Maintain adequate hydra-on •  Treat S/Sx affec-ng nutri-onal status ...
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  • Spring '14
  • Brinkley

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