NOVEMBER 2023 NLE: ONCOLOGY 101. Don Kim Tan Escato RN. HAAD RN. MAN NATIONAL BOARD REVIEWER/ INTERNATIONAL LECTURER NORMAL CELL CYCLE PHASE GO Phase- Resting Phase G1 Phase- RNA /Minor Protein Synthesis/ Growth S Phase/ Synthesis Phase- DNA synthesis G2 Phase- Major Protein synthesis/growth and PREP M Phase- Mitosis Phase: Cell Division (Cytokinesis) prophase Metaphase anaphase telophase- actual cell division BENIGN VS. MALIGNANT NEOPLASM aire In MU eC Bury Gisavetaeniuase BLOOD AND LYMPHATIC arco eee pail Ura) LITTLE RESEMBLANCE eam Nese MODE OF GROWTH Brees Nae Oo Pinson sees) Roseanne sd GENERALIZED EFFECT: CO uals WEIGHT LOSS Relea am inte es ed A Da aac td Saree) Prorat rad Pee eiaae) NO (EXCEPT IF IT IS ON THE Bao all Reiner Drs esas VITAL ORGANS) Pore Neomeiatty COT ake)WARNING SIGN OF CANCER -CAUTION US- * Change in Bowel and Bladder Habbits * Asore does not heal SORE-SQUAMOS CELL MOLE-MELANOMA WARTS- BASAL CELL C. + Unusual bleeding or discharge * Thickenning of lump in the breast + Indigestion and difficulty in swallowing * O bviuos change in warts + Nagging cough and hoarseness. * Unexplained Anemia COLON CANCER BLADDER CANCER: BOWEL:CHANGES PAINLESS HEMATURIA BLOOD IN THE STOOL RECTAL BLEEDING CERVICALCA FOUL SMELLING VAGINAL DISCAHRGE PAINLESS VAGINAL BLEEDING BREAST CA: LUMP IS: Painless -hard have irregular edges {bean like shape) -immovable * Sudden weight loss Metastasis; SPREAD -Cancer cells move from their original location to other sites. *ROUTES *GRADING *TNM STAGING * STAGING + Routes of metastasis *1. Local seeding: occurs in the local area of the primary tumor. * 2. Bloodborne metastasis: Tumor cells enter the blood. -which is the most common cause of cancer spread. * 3. Lymphatic spread: lymphatics-earliest metastatic spreadGRADING * classify the cellular aspect of the ide I: - cell -Cells are very abnormal and * To describe the tumor -are poorly differentiated * Grade I: -mild dysplasia (growth) Grade IV: -anaplasia -Cells differ slightly from normal cells -well differentiated -(losing the morphological characteristics) -Cells are immature and --- undifferentiated; * Grade II: -moderate dysplasia -cell of origin is difficult to -Cells are more abnormal and are determine -moderately differentiated STAGING Degree of metastasis Stage 0: ' Carcinoma in situ :earliest stage. 4 -{stayedin the place where it began and has not spread j | Ae neighboring tissues) Y Stage |: =. ete ‘Tumor limited to the tissue of origin; Stage Il: Stages of Breast Cancer Stage III: = Extensive local and regional spread stage i ie Distant metastasis TNM STAGING TUMOR (erimary rumor) NODES (wmeuaric invowementr) METASTASIS TK CANNOT BE ASSESSED. NOINFoRMaTION. NX CANNOT BE ASSESSED MX | CANNOT BE ASSESSED CANNOT BE MEASURED E : TO | NO EVIDENCE. CANNOT BE FOUND | NO NO REGIONAL LYMPHNODES MO __NO DISTANT METASTASIS INVOLVEMENT TE TIS CARCINOMAIN SITU (PRE CANCER) N41 to 3 regionallymph nodes MI___ DISTANT METASTASIS T1 [2 emoR LESS N2 | 4ormoreregionallymph | nodes T2 | 3 to Sem 'N3 Distant regional involvement 73 (>6emUP 4 | Direct extension to chest wall and/or skin (BREAST CA)RESIDUAL TUMOR * The tumor status following treatment is described by the residual tumor RX CANNOT BE ASSESSED corresponds to resection for cure or complete remission. RO _NoRresibuaLTUMOR R1 [microscopic residual tumor ‘cancer cells present microscopically at the primary Macroscopic residual tumour at primary cancer site or R2__ [macroscopic residual tumor veaonallwrghuedes American Cancer Society Guidelines for the Early Detection of Cancer CANCER SCREENING (NEW GUIDELINES) CANCER SCREENING (NEW GUIDELINES) BREAST SELF EXAMINATION Mammogram -start the age of 20 To detect small lumps -after last day of menstruationor 45-54 y.o : annually 7 TO DAYS after onset of menses 55 up: twice a year Women 55 and older should **hysterectomy/postmenopausal switch to mammograms every 2 _ age years, or can continue yearly =select specific day each month screening. Mammograms are the best way to find breast cancer earlyHPV test and the Pap test (CDC) The HPV test looks for the virus (human papillomavirus) that can cause cell changes on the cervix. The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately. PAP TEST-ask if sexually active or not if yes: and 20 pababa: within 3 years if not sexually active: start at 21: 21 y.o (initial test) Result: normal Next test: 3years after If You Are 30 to 65 Years Old HPV testing (HPV TEST ONLY’ Normal 65 YEARSOLD ANDUp: Wait 5 years until your next screening test. NO NEED IF PAST NORMAL RESULTS. An HPV test along with the Pap test. NO HISTOR OE This is called co-testing. normal HYSTERECTOMY pean wait 5 years until your next screening test. A Pap test only. normal wait three years until your next Pap test.TESTICULAR EXAMINATION * Start at 13yo ;monthly same day + -after warm bath shower * feel like an egg, firm but * not hard, and smooth with no lumps. * One testicle may be lower or slightly larger Colon cancer screening START 45 YEARS OLD Stool Test -guaiac-based fecal occult blood test (gFOBT) uses the chemical guaiac to detect blood in the stool ( once a year) -fecal immunochemical test (FIT)- uses antibodies to detect blood in the stool (once a year) - FIT-DNA test- This test checks DNA in stool cells for genetic changes that may be a sign of colorectal cancer. For this test, you collect an entire bowel movement and send it to a lab, where it is checked for altered DNA and for the presence of blood. It is done once every three years. 5 igmoidoscopy (Every 5 years ) Sigmoidoscopy is a procedure to look inside the rectum and sigmoid (lower) colon for polyps, abnormal areas, or cancer. Colonoscopy: (Every 10 years if no risk) A colonoscopy is similar to a sigmoidoscopy, but the entire colon can be viewed. If a suspected colorectal cancer is found by any screening or diagnostic test, it is biopsied during a colonoscopy.Tung Cancer CA125.CEA y Breast Cancer ‘ (CA125,CEAHER2 BIOPSY (Confirmatory Diagno is) -is the most definitive means of diagnosis. Types 1. Needle: Aspiration of cells 2. incisional: Removal of a wedge of suspected tissue from a larger mass 3. Excisional: Com plete removal of the entire lesion 4. Staging: Multiple needle or incisional biopsies ¢ CANCER HIERAPY TREATMENT IMMUNOTHERAPY OPTIONS onan ‘QOxv BONE MARROW TARGETED TRANSPLANTATION THERAPY CHEMOTHERAPYCHEMOTHERAPHY MOA: kills or inhibits the reproduction (cell division) of neoplastic cells and kills normal cells -make a tumor smaller hefore surgery or radiation therapy (called neoadjuvant chemotherapy) -destroy cancer cells that may remain after surgery or radiation therapy (called adjuvant chemotherapy) -Kill cancer cell equal to normal cell DOSAGE: BASED ON THE BODY SURFACE AREA (HEIGHT AND WEIGHT) TERATOGENIC EFFECT: CONTRACEPTION ; continue contraceptive until 6months post INFERTILITY: MAY BE IRREVERSIBLE: SPERM BANKING OR EGG PRESERVATION COMMON SIDE EFFECT: NAUSEA AND VOMITTING + FATIGUE -pre med: 30 mins to 1 hour and 12 to 48 hours after (anti emetic) -MUSIC THERAPY Preferred route: IV Vesicant: EXTRAVASATION -1. STOP/ discontinue -2. DO NOT REMOVE THE NEEDLE -3. ASPIRATE IF POSSIBLE -4, AVOID MANUAL PRESSURE ELEVATE THE AFFECTED LIMB -5. NOTIFY: : ANTIDOTE AND -These antidotes include isotonic sodium thiosulfate for mechlorethamine (and optionally for cisplatin), -DMSO (Dimethyl sulfoxide) and low dose hydrocortisone* 1. white blood cell count- STERILE TEQ. Mon for fever, sore throat or signs and symptoms of infection -MASK FOR VISITORS Neutropenia/white blood cell (WBC) count — absolute neutrophil count (ANC). NORMAL 2,500 and 6,000 cells/mcL NO FRESH FLOWER, NI FRSH FRUITS, NO TO CROWDED AREAS) + 2. platelet count — BLEEDING PREQ, AVOID VENIPUNCTURE, * MON: ECHYMOSIS, PETICHIAE lls, resulting in the release of uric acid aka, * 4. electrolytes-Promote a fluid intake of at least 2000 mL/day. 5. BITTER TASTE AND LOSS OF APPETITTE :EXPECTED 6. MOUTH CARE: SOFT TOOTHBRUSH OR RINSE AFTER MEAL: INSPECT FOR SORE; STOMATITIS PREPARATION -WEAR PPE -X PREGNANT NURSE -CENTRAL LINE IS PREFFERED -WARM THE VEIN TO DISTEND THE VEIN TO REDUCE PAIN * ALOPECIA * EXPECTED AFTER 1°° OR 2° TREATMENT * WITHIN 2 WEEKS AFTER TREATMENT. * MAY RETURN * DIFFERENT TEXTURE AND COLOR * WIG -Fluorouracil -Ciplastin -mercaptopurine -BUsUlfan -methotrexate -Cyclophospamide INHIBITORS: affect M phase -LOMUSTINE -Vinblastine -Vincristine -CARMUSTINE -BLEOMYCIN -DOXORUBUCINAcute Lymphoblastic Leukemi INDUCTION > CONSOLIDATION > MAINTENANCE > CNS PROPHYLAXIS The goal of induction therapy is to destroy as many cancer cells as possible in order to achieve (induce) a remission. -hospital stay of 4 to 6 weeks. - >Uric acid> - Minimal Residual Disease (MRD) 2. Consolidation Therapy. The goal of maintenance therapy is to -consolidation” therapy or prevent disease relapse "intensification" therapy May return to work -chemotherapy drugs are given in higher doses -duration may vary: 1 month to 9 months. A Cental Nareous System [cH] -Frequent hospitalizations are required -bec, CA cell recur in spinal fluid aah? PLATELET TRASFUSSION AS Method: intrathecal chemotherapy. -6 or more injections ( 2 to 4 months) 3. Maintenance Therapy Headaches and nausea are occasional side effects. Oral maintenance: METHOTREXATE OR MERCAPTOPURINE -low dose 18 to 24 months > out patient setting Minimal side effects : STOMATITIS ORAL CHEMO * MOA; breaks the DNA of the cancer cell with minimal exposure to normal cell 2 TYPES: ETIBEXTERNAL RADIATION IRRADIATED SKIN: SKIN MARKING: DO NOT REMOVE NSG DIAGNOSIS: RISK FOR IMPAIRED SKIN INTEGRITY METICULOUS SKIN CARE X= Direct sunlight Wash: warm water mild soap: rinse Do not rub. Use hand not washcloth: patting technique NO POWDER NO OINTMENT NO LOTION SOFT AND LOOSE CLOTHING X-RESTRICTIVE INTERNAL RADIATION SEALED AND UNSEALED SEALED VIA: VIA IMPLANT WITHIN TUMOR | PRIVATE ROOM: DOOR PRECAUTION SAVED BED LINENS INSIDE UNTIL DONE LOW RESIDUE DIET FULL BED REST WITHOUT BATH ROOM PRIVLGSAFETY MGT: DSsTANCE visitors peer ees “immnociteenon on SS DISLODGE MANAGEMENT: is LONGHANDLED FORCEP LEAD CONTAINER NomIFY VIA: BODY CAVITY ORAL IV BODY FLUIDS ARE RADIOACTIVE WITHIN 48 HOURS AFTER ADMINISTRATION FLUSH TOILET 3 TO 4 X Stem cell transplantation Bone Marrow Transplant Donor: SIBLING, PARENTS, FAMILY , NOT RELATED PERSON -TRANSFUSSED IMMEDIATELY -preferred and considered the standard therapy; SIBLING HARVESTING: -BLOOD REMOVED THROUGH CENTRAL VENOUS CATH. TO APEHRESIS MACHINE. SYNGENEIC -REMOVES STEMCELL IDENTICAL TWIN -RETURNS REMINDER BLOOD PRODUCT TO DONOR AUTOLOGOUS- MOSTCOMMON-SELF _-IS ASPIRATION: ILIAC CREASTIS. ~CRYOPRESERVATION(FROZEN) PREFERREDWhat is Aldesleukin? AKA: interleukin-2, CARDIO —-PNEUMO TOXIC MOA: scytokine signaling molecule in the immune system regulates the . . . activities of BHR EISSTeEIEl Emergency: allergic reaction: hives; (leukocytes, often lymphocytes) that difficult breathing; swelling of your are responsible for immunity and face, lips, tongue, or throat. tumor necrosis factors. Aldesleukin is approved to treat adults IV INFUSION with:SKIN (MELANOMA) KIDNEY MOST PREVALENT IN PH x sie Jes er-liee 3 Coloncancer 4 Liver cancer Peek Se a cance oasenonrony INQReport to HCP Hardened lump “mass” (painless) Dull ache Swelling & Enlarged scrotum = Hydrocele CLASSIC SIGN AND SYMPTOMS 1. Painless testicular swelling occurs. 2. “Dragging” or “pulling” sensation in the scrotum. SURGERY: ORCHIECTOMY ICE PACK WITHIN FIRST 48 HOURS TO DECREASE SWELLING * Amale patient comes to the clinic complaining of general weakness, difficulty urinating, fatigue, and pallor that began 1 week ago... laboratory results show anemia. =Which question should the nurse ask next? When as your last prostate examination * Sign and Symptoms: * 1. Asymptomatic in early stage * 2. Hard Nodule upon DRE + 3. Painless Hematuria * -Trouble urinating + -Decreased force in the stream of urine * -Blood in the sperm * -Discomfort in the pelvic area + - Increase PSA + ERECTILE DYSFUNCTION INTERVENTION: MGT -Radiation Chemo Hormone: to decrease the growth - Pain medication, radiation therapy, corticosteroids, which prostate cancer usually needs in order to continue growing. -Prostatectomy:- maintain oe “inclAKA: (bronchogenic carcinomas) PRIMARY: WITHIN THE LUNGS -tumor of the bronchi and peripheral lung tissue: * The Adenocarcinoma This is the most rom cancer elsewhere in common type. the body through venous circulation or lymphatic spread. Primary Nursing Diagnosis: Ineffective airway clearance related to obstruction caused by secretions or tumor SIGN AND SYMPTOMS* coughing which gets worse or does not go away * chest pain shortness of breath * hoarseness or wheezing © coughing out blood © chest infection * malaise * poor appetite * unexplained weight loss * exhaustion, weakness, or drowsiness Chest X. be us for mass; ‘ray may be suspicious for + clubbing of the fingers (CONSOLIDATION OF THE LUNGS CT or position emission tomography scan will be better visualize tumor. Sputum and pleural fluid + show malignant cells. ‘THE IMPACT OF LUNG CANCER Intervention: 1. Monitor VS, Respiratory Pattern 2. Monitor for hemoptysis 3. Fowlers Position 4. Administer oxygen as prescribed and humidification: to moisten and SE loosen secretions. 6. Monitor pulse oximetry. 7. Bronchodilators and corticosteroids for spasm and edema 8. high-calorie, high-protein, highvitamin diet. HEAVY BREAKFAST IS ADVISED ss 9. Activity as tolerated with a resting - period 10. Radiation and Chemo- UNCONROLLED GROWTH OF THE CELL WITHIN SKIN - BASAL CELL - WARTS - SQUAMOS CELL CA- SORE - MELANOMA- MOLE / NEVI * SIGN AND SYMPTOMS + A-ASYMMETRY — IRREGULAR (HALF RAISED, HALF FLAT GROWTH — UNEVEN EDGES RISK FACTORS EXPOSURE TO U.V LIGHTS TANNING BEDS SUN EXPOSURE- FREQUENT SUNBURN FREQUENT OUTSIDE OCCUPATION FAMILY HISTORY HIGH NUMBER OF MOLES IMMUNUSUPRESANT DRUG 7s broad sre sunscreen Reapply sunscreen + C-COLOR CHANGES: PURPLE BLACK RED = Every2 hous MIXTURE OF BROWN TAN + E-EVOLVING CHANGES IN SIZE SHAPE AND COLOR sin Leukemia there __ is that crowd out * LABS: IMMATURE WBC) * LOW H. H = RBC + LOW PLATELET an the aia of normal cells, leading HIGH WBC(_ LEUKOCYTES: © After swimming Sunburns: avoid sun 10 am - 4 p.m. AVOID tanning beds TYPES: -Acute myeloid Leukemia -Chronic Lymphocytic Leukemia DX TEST: BONE MARROW BIOPSY* Frequent infections * © Fatigue, Unsteady Gait, Pale “Pallor” . © Bruising, Petechiae, & easy Bleeding * © Weight Loss & Anorexia * ¢ Bone pain RADIATION CHEMO COLON CANCER * RISK FACTORS * ULCERATIVE COLITIS * Diet: High Fat, low residue, low fat diet * -age: 50 up + -physical inactivity + -history of ulcerative colitis- + -Fam hx * -adenomatous polyps + - diabetes * -smoking and alcohol such as cramps, gas or pain and DIAGNOSIS: diarrhea —constipation DRE AND PSA- 50 Y.O YEARLY (45 Y.O IF Abnormal stools WITH FAM HX) a. Ascending colon tumor: Diarrhea . Descending colon tumor: ome diarrhea, or flat, caused by a partial obstruction c. Rectal tumor: Alternating constipation and diarrhea 3 | SIGMOIDOSCOPY 4. Persistent abdominal discomfort,Nursing Intervention. -SIGMOID: FORMED; HARD STOOL 1. Mon for perforation: peritonitis * -empty the pouch when one third full. 2. mon for intestinal obstruction: -MASSAGE. -early sign: increase peristaltic increase bowel * -OK SWIM sound LATE: HYPOACTIVE * Colostomy Care: -ascending colon: Liquid stool - transverse colon : Loose to semiformed : MUSHY: -Fecal matter should not be allowed to remain on the skin. -descending colon colostomy: -close to normal: OVARIAN CANCER * Risk factors: 7 TRIAD signs and symptoms * Age: 50-60 -Having urinary urgency or frequency + -Fam history -Experiencing pelvic swelling or Nulliparity : Never been pregnant -abdominal swelling- INCREASING * Smoking ABDOMINAL GIRTH * -IUD * - Polycystic ovary syndrome (PCOS)- is a set of symptoms due to elevated androgens (male hormones) in women intraperitoneal chemotherapy involves the instillation of chemotherapy into the abdominal cavity. INTERVENTION CERVICAL CANCER Sign and Symptoms: 1, Painless vaginal postmenstrual and postcoital bleeding 2. Foul-smelling or serosanguineous vaginal discharge 3. Pelvic, lower back, leg, or groin pain 4. Anorexia and weight loss 5. Leakage of urine and feces from the vagina 6. Dysuria 7, Hematuria 8. Cytological changes on Pap test(OMe) Cansei UST CUA (Tabane Roe] 1 eg Re-elect mer-LaM oLM tLe N10) Sentinel lymph node biopsy during this procedure. ~metastasized from primary tumor STs are ce -radioactive substance and/or blue dye is injected near the tumor. -The first lymph node to receive the substance or dye is removed. A hysterectomy is surgery to remove the uterus. Total hysterectomy — (U.C) removes the uterus and the cervix METHOD: Total vaginal hysterectomy- no abdominal incision- removal of uterus thru vagina Total abdominal hysterectomy- large incision on the abdomen Total laparoscopic hysterectomy- small incision on the abdomen. * Radical hysterectomy : (U-CE-PA) removes the uterus, cervix, part of the vagina, The ovaries, fallopian tubes, or nearby lymph nodes may also be removed. * Modified radical hysterectomy (U-CE-UP) removes the uterus, cervix, upper part of the vagina, The ovaries, fallopian tubes, or nearby lymph nodes may also be removed6. avoid sexual intercourse for 3 to 6 weeks as prescribed 1. PAIN MEDS COMPLICATIONS: REPORT !! 2. limit stair climbing for 1 month as vaginal bleeding or discharge presenibed pain in the abdomen, back, or leg 3. avoid tub baths and sitting for long swelling in the leg en trouble urinating 4. Avoid strenuous activity or lifting more than 20 pounds. 5. consume foods that promote tissue healing. BLADDER CANCER 2 types/ GRADE: Cause: UNKNOWN Risk Factors: -cancer cells that are closer in appearance and organization to normal -drug: Cyclophospmide cells . . -(well differentiated). -chemical: Arsenic -usually grows more slowly - less likely to invade the bladder’s muscular wall -Chronic Bladder infection -cells are abnormal-looking -lack any resemblance to normal- appearing tissues -poorly differentiated -grow more aggressively than a low-grade tumor -METASTASIZED> and may be more likely to spread to the muscular wall of the bladder and other tissues and organs.* Intervention: * 1. External Radiation + Chemo (alkylating agent) + Alky-Instill into the bladder — 2. Intravesical immunotherapy -direct into the bladder -early stage Bacillus Calmette-Guerin (BCG)- bacetria/activate immune system to attack cancer cell Virus- activating interferon alpha 2b to attack cancer cell into the bladder wall 3. Transurethral resection of bladder tumor — may use to diagnose also- laser to kill cancer cell-/ can be followed by injection of chemotherapy * Cause: xxxx * Risk factors * 2. Family history of breast cancer + 4, Previous cancer of the breast, uterus, or ovaries * 5. Nulliparity, late first birth * 6. Obesity( high fat diet) * 7. High-dose radiation exposure to chest * 8. Postmenopausal hormone therapy: ESTROGEN + -Nipple retractionor elevation + -Assymetry: affected breast is HIGHER + -Skin dimpling, retraction, ulceration + -Axillary lymphadenopathy + - Lymphedema of the affected arm + -Symptoms of bone or lung metastasis in late * stageTumor is excised and removed. Breast tissue and the nipple are removed. Lymph nodes are usually left intact. Breast tissue, nipple, and lymph nodes are removed. Muscles are left intact. underlying chest muscle (including pectoralis major and pectoralis minor), and lymph nodes of the axilla are removed as a treatment for breast cancer. JACKSON PRAT BULB Over 100 M' hours “bright ré LEEDING :NOTIF' MGT: 2. pressure sleeve as prescribed and diuretics if edema severe. 3, check VS, BLEEDING, and sign of infection. 4, EXERCISE TO PREVENT MUSCLEDYSTROPHY Avoid affected ARM! NO IV & Blood Draws * NO Vaccines * NO Blood pressure * Compression sleeve * Elevate arm above the heart * Perform exercises + Lymph Node swelling