ONCOLOGY NOTES

Oncology: Study of diagnosis and cancer treatment

 Decrease Immune System
o Bacteria/Virus (Initiate Tumor Growth) – Carcinogens (Responsible for Mutation) – Tumor –
Benign or Malignant
o ASA (Asbestos, Smoking, and Alcohol) – Killer Triad
 Benign:
o Non-Cancerous
 Well Differentiated “Expansion” Encapsulated
 Low Growth Rate
 Low Recurrence
 Less Harmful
 Malignant:
o Cancerous
 Undifferentiated – Capsulated “Spread and Metastasize” – Angiogenesis
 Increase Growth, Increase Recurrence, and Very Harmful
 Cachexia – Severe Muscle Wasting
 Ulceration
 Bleed
 Infection
 Necrosis
 Lymph Nodes – Most common way to spread
 Circulation – The fastest way to spread
 Types of Cancer
o Carcinoma
 Usually affects epithelial tissues
 Skin and Organs
o Breast
o Lungs
o Colon
o Liver
o Sarcoma
 Connective Tissue
 Tendons and Ligaments
o Multiple Myeloma
 The Plasma of the Bone Marrow
 Bone Marrow
 Spinal Cord
o Lymphoma
 Lymph nodes
 Hodgkin’s
 Non – Hodgkin’s
o Leukemia – Cancer of the Blood
o Mixed
 Warning Signs: Caution Us (3 or More Warning Signs indicates High Risk of Cancer)
o Change in Bowel and Bladder Habits
 Colorectal Cancer, Bladder Cancer, and Kidney Cancer
 o A Sore that doesn’t heal
 Skin Cancer or Oral Cancer
o Unusual Bleeding or Discharges
 Breast Cancer, Colon Cancer, and Cervical Cancer
o Thickening of the Lump
 Breast Cancer and Testicular Cancer
o Indigestion or Difficulty with Swallowing
 Gastric or Pancreatic Cancer
 Esophageal Cancer
o Obvious change in warts and moles
o Nagging Cough
 Laryngeal Cancer and Lung Cancer
o Unexplained Anemia
o Sudden weight loss
 Cachexia
 Staging: Biopsy
o Carcinoma in Situ – Origin of Tumor
o Local Growth – Same Place Multiplication
o Local Spread – Lymph Nodes
o Extensive/Regional Spread – Goes over other Organs
o Metastasis – Creation of blood vessels to live and multiplies
 Treatment Modalities
o Cure (Complete Eradication) , Control (Containment of Growth), Prophylactic (High Risk – To
Prevent), and Palliative (Treatment for comfortable death)
 Surgery – Frequently or Primary Used
 Diagnostic Biopsy
o Needle Method – To aspirate the surrounding tissues (If Tumor is Highly
Suspicious)
o Incisional – A portion of tumor is removed
o Excisional – To remove the entire tumor and the surrounding tissues
 Treatment “Excisional”
o Local – To remove the small mass and surrounding tissues
o Wide/Debulking – To remove the entire tumor, the surrounding tissues,
and the lymph nodes.
o Salvage – From a simple approach to extensive approach (Removal of
entire organ)
 Lumpectomy with Radiation – Mastectomy
 Reconstructive – Cosmetic
 Radiation – Local Treatment (Decrease Size)
 Brachytherapy – Alpha and Beta Particles – Ionizing Agents (Patient is
Radioactive)
o Internal Radiation Therapy
 Sealed Isotope “ Cesium or Radium” – Excreta is not Radioactive
 Containers: Seeds, Beads, Needles, Catheter
o Intraluminal – Close to Tumor
o Interstitial – Directly to Tumor
o Intracavity – Implanted on the Cavity
 Enema (To prevent displacement) 2 – 3 days “Half Life”
  Sex 7 – 10 days after
 Unsealed – Excreta is Radioactive
 Oral, IV Instillation to a body cavity
o Radioactive Iodine (Iodine 131) – Thyroid Cancer
o Phosphorus 32 – Ovarian with malignant ascites
o Strontium – Bone metastasize
o 48 Hour Effectivity
 Separate their utensils
 Radiation Management: Radioactive Safety Officer (They will give the guidelines)
o Private room with bath – 2 – 3 Days (But without bathroom privilege)
o Caution Sign
o Linens/Trash – Only discarded when the patient is discharged
o Utensils – Disposable
o Limited Visitors – Maximum of 30 minutes per day
 No Child
 No Pregnant
 Patient:
o Flat “Logroll” SF Back Towards the Door
 Low Residue Diet
 Laxative
 Antidiarrheals
 Indwelling Catheter
 Flush 2 – 3 times
 Gloves with commode
 Vomitus
 Nurse Protection Protocol
o Shielding – Led Lined Apron
o Time – 30 minutes per 8 hours (5 mins. maximum per visit)
o Distance – 6 feet
o Dosimeter – A Badge or Ring (To measure nurse exposure)
o Geiger Muller Counter – Counts the intensity
 Dislodged Implants: Avoid Direct Skin Contact
o Long handled Forceps – Used to pick up dislodged implants
o Lead Lined Apron
o Lead Container
o Leave the room – If you can’t find the implants
 Teletherapy – X-Gamma Rays (Patient is not Radioactive) - Electromagnetic
Radiation
 External Beam Radiation Therapy
o Tumor Mapping: MRI, CT, and PET Scan
o Precision Guided: Size, Location, Shape, and Dimension
o Spare Surrounding Tissues
 Lesser Side Effects even High Dosed
 Short/Frequent Duration
 15 – 20 mins
 5 days/week
 5 – 6 weeks
  Markings Management: Beam Focused Location
o Wash (Do not attempt to remove the markings): Use Hands – Water or
with Mild Soap – Rinse – Pat Dry
 Expose to Air – Do not expose to sun
 Loose Clothing – Avoid tight fitting clothes
 Shower or Swimming – As long as water has no chemical
 Do Not Apply CLAMP:
 Cream
 Lotion
 Alcohol
 Moisturizer
 Powder
 Desquamation – Warm Water – Pat Dry
 Chemotherapy – Systemic Treatment (Disrupt Cell Cycle)
 CCNS (Cell Cycle Non-Specific): Destroys at any stage
o Alkylating, Antitumor, and Hormones
 Alkylating
 Cytoxan
o SE: Hemorrhagic Cystitis
 Hematuria (Sign)
 Increase Fluids (Management)
 Busulfan
o SE: Pulmonary Fibrosis
 Irreversible
 Monitor X-Rays
 Mustargen
o SE: Hearing Loss
 Weber’s and Rinne’s Test (Assessment)
 Cisplatin
o SE: Peripheral Neuropathy
 Avoid Hot and Cold Compress
 Antitumor
 Doxorubicin: SE: Cardiomyopathy
o Contraindicated to Patient with Heart Problem
 Bleomycin: Pulmonary Fibrosis
 Dactinomycin: Agranulocytosis (Severe Reduction of WBC)
 Hormones
 DES Diethylstilbestrol
o Estrogen for Prostate Cancer
 SE: Gynecomastia
 Tamoxifen “Nolvadex”
o Anti-Estrogen for Breast Cancer
o SE: Osteoporosis – Raloxifene (Evista)
 CCS (Cell Cycle Specific): Destroys at specific stage
o Antimetabolites: S Phase
 Mercaptopurine (Avoid Organ Meat)
 Methotrexate (Hepatotoxic)
 Nausea and Vomiting
  RUQ Pain
 Jaundice and Pruritus
o Leucovorin (Adjunct Medication)
 Cytarabine
 SE: Conjunctivitis
o Topical Steroid
 5Fu – Fluorouracil
 SE: Stomatitis
o Plant Alkaloid: M Phase
 Vincrististine: Oncovin
 SE: Peripheral Neuropathy
 Handling Chemo Agents: Avoid Direct Contact: Eyes/Skin (Water or with Mild
Soap)
o MEGG – Mask, Eye shield, Gloves, and Gown
o Label IV – Antineoplastic Therapy/Agent PUT ON THE IV BAG
 Disposal
 Plastic Bag
 Puncture and Lead Proof Container
 Chemotherapy Local Complication
o Extravasation
 STOP – Aspirate – Antidote
 Dox = Apply Cold and Vin = Warm Compress
o Vesicant (Cytotoxic – Toxic to the Tissues)
 Redness (Early Sign)
 Burning Sensation
 Necrosis “Tissue Death”
 Implanted Venous Access Device – To avoid extravasation
o Hyper Sensitivity
 Check Food Allergies
 If Patient is Allergic:
o Notify
o Premeds:
 IV Access of NSS (KVO)
o Slow Infusion – Reaction – STOP – Ready
Emergency Drugs – Position: Modified
Trendelenburg
 Epinephrine – DOC for Anaphylactic Shock
 Aminophylline
 Diphenhydramine
 Steroids
 Skin Test
 Ratio: 3:45