ONCOLOGY NURSING Cancer is a NEOPLASTIC, MALIGNANT, CURABLE, and an IDIOPATHIC Disease.

NEOPLASMS HAVE TWO DIFFERENT TYPES: IT IS EITHER BENIGN OR MALIGNANT. TWO TYPES OF METASTASIS: TUMOR (New Growth) OR HEMATOGENOUS (e.g. Leukemia) CARCINOGENESIS IS THE DEVELOPMENT OF A CANCER. *note: CA means Cellular Aberration Factors in the Development of cancer; Decreased apoptosis Increased proliferation Abnormal proliferation Phases: Initiation: includes external factors such as carcinogens Promotion: includes internal factors such as oncogene associated with genetics Progression: cells complete transformation which leads to invasion and metastasis *Endometriosis is a the only benign tumor that is metastasizing Risk factors: Bacteria and viruses: H. Pylori Gastric CA Epstein Barr virus Nasopharyngeal CA HPV - Cervical CA Chemicals Alcohols Liver Cancer Smoking All CA * Alcohol + Smoking = 2x Effect Nitrosamines Found in Cosmetics, Latex, Pesticides, Rubber Products Benzopyrenes Grilled Foods Hydrocarbons smoke belched Aflatoxin Amag Nuts and rice Talc Ovarian CA Chronic Irritation Multiple Sexual Partners Toxic Diet hi fat, low fiber> Colon CA *Cruciferous foods (cauliflower, broccoli, cabbage) can prevent prostate CA *Carotenoids (carrots and tomatoes- which is high in lycopene) are anti CA agents

Early Detection and Prompt Treatment: Breast CA: BSE, Mammography Cervical CA: Pap Smear over age 18 in between menses annually Colorectal CA: DRE,Guiac Test, Colonoscopy Prostate CA: DRE, PSA (Prostate Specific Antigen) DIAGNOSTIC TESTS: 1. Biopsy most definitive test for cancer Aspirational Biosy with use of fine needle Excisional Biopsy Removal of the Entire tumor- for small sized tumor only Incisional Biopsy - only a portion of tumor is being removed for big sized tumors.

2. Cancer Markers Chemical Being produced by cancer Breast CA CA-153/ BRCA 1&2 Colon CA CEA Carcinoembryonic Antigen Prostate CA - Increased PSA Liver CA Increased AFP 3. Host Response Marker tNF (Tumor Necrotic Factor) Suppresses Satiety Center of the Brain Appetite Center (Hypothalamus) Sever Anorexia Muscle wasting / Muscle weight loss CACHEXIA Weight Loss CHEMOTHERAPY : kills rapid dividing cells* *Hair cells- alopecia Lasts for 2-3 weeks (Cut hair before chemo) Child/boy/man use cap Prevention ice helmet intermittent application of 30 minutes. *Mucus membrane stomatitis/mucositis Use of soft toothbrush, bland soft diet DANGEROUS CHARACTERISTICS: Viscous lidocaine TERATOGENIC *Gonads- Infertility CARCINOGENIC *Bone marrow depression VESICANT Anemia PHOTOSENSITIVE- USE ALLUMINUM FOIL Neutropenia PANCYTOPENIA Thrombocytopenia

ROUTES OF CHEMOTHERAPY: ORAL- MOST CONVENIENT IV MOST DANGEROUS AND DEADLIEST INTRAMUSCULAR RARELY GIVEN INTRATHECAL OMMAYA RESERVOIR INTRAPERITONEAL- COLON CANCER INTRAVESICAL THRU FOLEY CATHETER

HAZARDS: INHALATION SKIN ABSORPTION/TOPICAL INGESTION MOST COMMON

TYPES OF CHEMOTHERAPEUTIC DRUGS: Cell Cycle Specific: Antimetabolites S phase inhibitor: does not allow duplication of chromosomes. UREA, -METR, -ABINE,-GUANINE Methotrexate decreases folic acid, FOLIC ACID ANALOG ALSO TREATS R.ARTHRITIS, contraindicated with B9 (Folic Acid) Leucovorine/folinic acid Fluorouracil inhibits DNA synthesis COUMADIN ANTAGONIST Mecaptopurine Used To Treat Paratuberculosis Capecitabine COUMADIN INTERACTION PENTOSTATIN PURINE ANALOG, TREATS LEUKEMIA

Plant Alkaloids/ Vinca Alkaloids M- phase Inhibitor: does not allow separation of chromosomes. Vincristine and Vinblastine: VESICANT IN NATURE: has the capacity to cause tissue necrosis/extravasation: USED for NON-HODGKINS LYMPHOMA ADMINISTRATION: Admix: incorporate to the IV fluid MAIN S/E : it is neurotoxic: causes CONSTIPATION Taxanes (Paclitaxel/Docetaxel) :derived from pacific yews,targets tubulin production, DEXAMETHASONE is administered prior to chemotherapy Estramustine a derivative of estrogen, USED to treat PROSTATE CANCER Epothilones inhibits microtubules critical for maintenance of cell structure Non Cell specific Alkylating Agents High doses may cause LEUKEMIA after 5-10 years. -NITRO Cyclophosphamide causes hemorrhagic cystitis: Monitor Urine Output, Treatment of LYMPHOMAS, also SLE. Cysplatin (ototoxic) and Carboplastin these are nephrotoxic agents monitor kidney functions. Used mainly on OVARIAN CA Chlorambucil/Busulfan Hyperuricemia administered with allopurinol to decrease uric acid. Used mainly on CHRONIC LYMPHOCYTIC LEUKEMIA Carmustine Causes staining of skin. mostly used for treatment of Brain Cancer Dacarbazine Highly Emetogenic Treatment of Hodgkin lymphoma CELL CYCLE: Altretamine contraindicated with Pyridoxine (B6) Treatment of Ovarian Cancer G1 PHASE DNA SYNTHESIS Anti-tumor Antibiotics irritants RUBICIN, -MYCIN S PHASE DUPLICATION OF CHROMOSOMES - ANTIMETABOLITES Anthracycline works in all cell phases can cause heart damage RUBICIN G2 PHASE PRE-MITOSIS (BEFORE SEPARATION) Doxorubicin/ Adriamycin Admix,CARDIOTOXIC, ABDV for Leukemia M PHASE MITOSIS (CELL DIVISION) PLANT ALKALOIDS Daunorubicin Admix, CARDIOTOXIC Non- Anthracycline -MYCIN BLEOMYCIN Can cause PULMONARY FIBROSIS: Pneumonectomy, ABVD for LEUKEMIA HORMONAL *MONOCLONAL ANTIBODIES TARGETS ABNORMAL CELLS The anti-estrogens: fulvestrant (Faslodex), tamoxifen, and toremifene (Fareston) CHECK FOR ALLERGY Aromatase inhibitors: anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara) SUFFIX: -MAB Progestins:megestrol acetate (Megace) Estrogens Anti-androgens: bicalutamide (Casodex), flutamide (Eulexin), and nilutamide (Nilandron) Gonadotropin-releasing hormone (GnRH), also known as luteinizing hormone-releasing hormone (LHRH) agonists or analogs: leuprolide (Lupron) and goserelin (Zoladex) CORTICOSTEROIDS SUCH AS PREDNISONE, METHYLPREDNISOLONE, DEXAMETASONE *ABVD treatment for Hodgkin lymphoma : adriamycin, bleomycin, vinblastine, dacarbazine

*Management of Extravasation Steps: 1. Stop infusion 2. Aspirate residual anti cancer meds 3. Administer antidotes: steroids 4. Remove IV line 5. Cold compress to the site 6. Elevate hand to decrease edema

FLUSHING OF INTERMITTENT IV DEVICES SALINE LOCK: SALINE FLUSH ADMINISTER DRUGSALINE FLUSH HEPARIN LOCK: SALINE FLUSH ADMINISTER DRUGSALINE FLUSHHEPARIN FLUSH TREFOIL SIGN - RADIOACTIVE RADIATION TREATMENT Damages DNA of the Cell to Decrease Replication TELETHERAPY/EXTERNAL RADIATION THERAPY painless procedure that last from 15 -30 mins NEVER LET THE PATIENT REMOVE THE SKIN MARKING Instruct the patient that the treatment is painless No residual radiation after treatment Redness, swelling , peel off Use plain water, NO soap, lotion, moisturizer TELETHERAPY DONE ON THE PELVIS DIARRHEA CYSTITIS ERECTILE DYSFUNCTION VAGINAL STENOSIS STERILITY