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Oncology

Oncology. Janna Wickham RN MSN LSSC Spring 2014. Statistics & Definition . Cancer 1500 people die every day from cancer 1 out of 4 deaths is caused by cancer Lung cancer 28% of all deaths Cancer Any age, gender, ethnicity, or geographic region

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Oncology

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  1. Oncology Janna Wickham RN MSN LSSC Spring 2014

  2. Statistics & Definition • Cancer • 1500 people die every day from cancer • 1 out of 4 deaths is caused by cancer • Lung cancer 28% of all deaths • Cancer • Any age, gender, ethnicity, or geographic region • Normal cells change and acquire malignant properties

  3. Risk Factors • Heredity • Age • Gender • Poverty

  4. Risk Factors • Stress • Diet • High fat • Low fiber • Occupation • Infection • Virus (Epstein –Barr for example) • Tobacco Use

  5. Risk Factors • Alcohol Use • Recreational Drug Use • Obesity • Sun Exposure

  6. Figure 14–1 Interaction of factors that promote cancer.

  7. Cell Cycle • G0 • Gap 1 (G1) • Synthesis (S) • Gap 2 (G2) • Mitosis (M)

  8. Differentiation • Hyperplasia • Under normal DNA control • Metaplasia • Dysplasia • Abnormal variation in size, shape, and appearance • HPV causes dysplasia of the cervix • Anaplasia

  9. Theories of Carcinogenesis • Cellular Mutation • Carcinogens cause mutations in cellular DNA • Oncogene • BRCA1 BRCA2 • Tumor Suppression Genes • Suppress oncogene • p53

  10. Carcinogens • Genotoxic • Directly alter DNA • Promotor Substances • Adverse biologic effects • Cytotoxicity • Hormonal imbalances • Altered immunity • Chronic tissue damage

  11. Carcinogens • Viruses • Drugs and Hormones • Chemical agents • Physical Agents

  12. Metastasis • Blood or lymph • Target organs • Cell morphology • Immune response

  13. Types of Neoplasms

  14. Physiologic Effects of Cancer • Disruption of Function • Hematologic • Anemia • Neutropenia • Thrombocytopenia • Infection • Tumor necrosis

  15. Physiologic Effects of Cancer • Hemorrhage • Anorexia-Cachexia Syndrome • Unexplained rapid weight loss • Emaciation • Malnutrition • Loss of energy • Paraneoplastic Syndrome • Endocrine related

  16. Physiologic Effects of Cancer • Pain • Acute • Chronic • Physical Stress

  17. Psychological Effects of Cancer • Stress

  18. Diagnosis • Assess • Lab • Diagnostic workup • Biopsy

  19. Classification

  20. Cytologic Examination • Exfoliation from an epitheleal base • Aspiration of fluid from • Body cavity • Blood • Needle aspiration of solid tumors

  21. Grading/Staging • Differentiation – level of functional maturity • Grade 1 – Grade 4 • Grade 1 most like parent cell • Grade 4 least differentiated • TNM –used to stage solid tumors

  22. Example • 45 year female with lobular breast cancer • Tumor 0.8cm • 1 positive axillary lymph node • No evidence of metastasis

  23. Laboratory Tests • Table 14-8 • CBC • Normal • Abnormal • Critical

  24. Nadir • The nadir is the time point after cancer treatment when your blood counts (white blood cell, hemoglobin and platelets) are at their lowest • complications of low counts; including infection risk (due to low white blood cell count), bleeding risk (due to low platelet count), poor oxygen delivery to tissues which can cause fatigue, chest pain, shortness of breath, dizziness (due to low hemoglobin, also called anemia) • The nadir most commonly occurs 10-14 days after chemotherapy treatment, but this time can vary depending on the chemotherapy

  25. Neutropenic Precautions • https://www2.ons.org/ClinicalResources/media/ons/docs/research/outcomes/infection/quickview.pdf

  26. Thrombocytopenia <100,000 • How to take care of yourself if your platelets are low: • Watch for unexplained bruises • Try not to bump or cut yourself. • Be careful with knives and other sharp instruments. • If you develop bleeding, place pressure over the area for 5–10 minutes with ice. • Use a soft tooth brush for mouth care. • Do not use aspirin or products • Take any steroid medications such as prednisone or decadron with milk, food, or an antacid • A platelet transfusion may be necessary if platelet count is below 20,000 or bleeding • Use an electric shaver rather than blades to shave with. • Avoid constipation—when straining to have a bowel movement. • Do not use suppositories, enemas, or a rectal thermometer. • Avoid intra-muscular (IM) injections if possible. • Monitor for bleeding with intercourse. • Try to avoid blowing your nose too hard or coughing too hard.

  27. Tumor Markers • Antigens • Hormones • Proteins • Enzymes

  28. Imaging • Scans • Computerized tomography • Has the tumor metastasized • MRI • Nuclear Imaging • Bone metastasis • Thyroid cancer • PET • Metastasis

  29. End of Day One

  30. Pharmacologic Management

  31. Chemotherapy • Alkylating Agents • Antimetabolites • Antitumor Antibiotics • Mitotic Inhibitors • Hormones and Hormone Antagonists

  32. Cell Cycle Specific Table 14-10

  33. Toxic Reaction Miotic Inhibitor Alkylating Agent busulfan- Myleran Bone Marrow Failure Assess for infection • Vincristine • Depression of deep tendon reflexes (motor weakness) • Paresthesias(pain and altered sensations)

  34. Venous Access Devices • PICC • Port • Tunneled Catheter

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