Discuss:  Primary & Secondary Preventions fro Cancer

Primary-  identify & Eliminate Risks

• quit smoking, use sunscreen

Secondary- Early Detection and Treatment   

• Screenings, Exams-prostate, mamograms etc 

Define:  CACHEXIA

ematiated appearence

weight loss, anorexia, early satiety, anemia

 Define:

Situ Cancer and

Invasive Cancer

Situ Cancer-  cells abd. in growth and appearance.  No tissue boundaries broken

Invasive Cancer-  Cells invade underlying tissue

Angiogenesis

Create New Blood Supply

Palliation

Deal with symptons

(example removing an invasive tumor that is causing pain in a patient with stage 4 cancer to reduce pain)

What is the only definitive testto diagnois Cancer?

BIOPSY-removal and study of cells

Other methods such as tumor cell markers, cytology and radiology are good indicators, but only biopsy is a definitive test. 

Chemotheropy

disrupts cell cycle.  It affects cell that are most rapidly dividing the most.  Such cell include CA, GI, oral mucous membrames, hari and bone marrow. 

Chemotherapy

Goal?

Most Effective when?

Goal:  Large enogh to b lethal to CA cells , but reduce other cell damage

 

Most Effective when tumor is small and growth is fast 

Why is there an increases risk of side effects in elderly?

1. Caridac- due to previous heart disease, and decr. circulation
2. Constipation due to decr. bowel motility
3. Bone Marrow Depression due to effects of aging, bone marrow has decreased activity

5 Classifications of chemo agents

1. Alkylating agents- exp.  cytoxan
2. Antimetabolites- exp. Methotrexate
3. Vinca alkaloids- exp. Vincristine
4. Antitumor antibiotics-  exp. adriamycin
5. Hormones- estrogen and progesterone

Cytoxan(cyclophosphamide)

• chemo agent classified as a Alkylating agent
• SE:  NVD, Bone marrow depression, alopecia, hemorrhagic cystitis(bladder infection), renal toxiciyt, infertility
  • Use Mesnex(mesna) as cytoprotectant drug to treat side effects

Methotrexate

• Antimetabolities chem. medication
• SE:  NVD, stomatitis, BMD, cirrhosis
• Cytoprotectant drug- Leucovorin (wellcovorin)

Vincristine

• Vinca Alkaloids class of chemo
• SE:  mild BMD, paralytic ileus, peripheral neuritis, alopecia
• Neuothrophy- is primary side effect

Adriamycin

• color is red clear
• Antitumor antibiotics
• SE:  nausea, red urine, BMD, cariotoxicity (CHF, irreg heart rhythm) alopecia, stomatitis, pulmonary toxicity

Nursing Intervention for:

Extravasation

• define:  chemo infiltrates under skin causing necrosis
• Drugs that cause extravasation are called Vesicants
• Assess for - Blood return, watch for infiltration
• PREVENT-  Minimize damage, maintain patent line.

Nursing Intervention to treat Side Effect:

Nausea/vomiting

• assess- watch input/output, check weight weekly, s/s of dehydration
• comfort measures- rest, saft bland fod, room temp foods, small portions
• Medications:  Anti-emitics before meals, mouth analgesic
• Zofran-anti-emitic

Nursing Interventions for

ALOPECIA

• Hair falls out 2-3 weeks after treatment and regrows 1-2 mos. after chemo stopped
• Patient wear wigs, scarfs, hats, talk to people
• special shampoo

Nursing intervention for:

Stomatitis-

• defined as;  sores in the mouth and on lips
• provide mouth care, use soft tooth brush, cold ffods, prescription mouthwash, no smoking/alcohol
• Medications:  Hard Candy, Artifical saliva, anti-fungal for thrush

Nursing intervention for: 

Hemorrhagic cystitis, renal toxicity,

• Teach patient to have high fluid intake- 3000 cc a day
• Meds;  Methotrexate

Define:

Biological Response Modifiers

• Manipulation of immune system through the use of naturally occuring biological substance or geneticallly engineered agents
• ACTION:  body's response to cancer or cancer therapy is modified

5 Classes of Biological Response Modifiers

1. Hematopoitic agent- used to prevent or treat anemia.  Stimulates Bone Marrow production of Epoetin alfa (exp.  Epogen, Procrit)
2. Colongy Stimulating factor- rpoduced by recombinant DNA .  prevents/treat decr. WBC by stimulating WBC production-  Filgrasitm(neupogen)
3. Interferons: alter cell metabolism, Immune response is modified.  activate NK cells. 
4. Interluekins- activate killer cells, help lymphocytes grow
5. monoclonal Antibdoes (mab)-  combine w/ growth factor receptors on maliganant cell surfaces to inhibit tumor growth( exp. Trastuzumab(Herceptin)

Another name for:

MYELOSUPPRESSION

BONE MARROW DEPRESSION

NUETROPENIA

Decrease in WBC

Assess-  CBC, check for breaks,

Medications- antibiotics, vaccisination prior to chemo, antifungal nuepigen

anemia

decrese in RBC

S/S:  fatigue, SOB, dizzy pale,

Medications:  Iron, Epigen/Procrit

Thrombocytopenia

decreased platelets

Assess;  50,000 High Risk (150,000-300,00 normal)

< 20,000 bleed from anticoragulation

Pt. needs platlet Transfussions:  after 1st 15min. give fast

NADIR

lOW POINT OF BLOOD CELLS

occurs at 7-14 days after chemo, recover at 21-28 days after chemo

Bone Marrow Transplant

(procedure, post transplant care, complications)

Procedure:  chemo and radiation1-10 before BMT

infuse new BM cells or stem cells-takes 2hrs, hyrdrate

Post care;  TPN, nausea & pain management, fluid and electrolyte mang, Graft vs. host (GVHD)prevention

Engraftent- on day 14-  new bone marrow kicks in.

Complications:  Anorexia, NVD  Somatitis, BMD, GVHD