• Reduced immunity and blood producing functions - esp with leukemia & lymphoma
• Altered GI structure and fxn -
• Obstruction and decompression fm tumors
• Cachexia - extreme body wasting
• Increased protein and carbs for healing and energy
• Motor and sensory deficits
• Bone - motility, pain, fxn, spinal cord compression, hypercalcemia
• Brain - Benign or malignant; sensory, motor, cognitive fxn
• Nerve compression - sensory damage
• Reduced oxygenation
• Often results in death
• A/W obstruction fm tumors
• Decreased lung capacity with lung involvement
• Compression of blood and lymph vessels - tumors pressing on arteries
• Thickening of alveolar membrane - exchange can't take place
• Primary OR metastatic lung tumor -- hypoxia.

Cancer Mgmt

Surgery

Removal of diseased tissue

Used for:

• Prophylaxis
• Diagnosis- biopsy
• Cure - tumor removal
• Control - reduce spreading
• Palliation
• Assessing therapy effectiveness
• Reconstruction - breast, oral (jaw)

Cancer Mgmt

Radiation

• Minimal damage to surrounding normal cells
• Damage greater to dividing that non-dividing cells
• Ionizing= most common

Exposure vs. Dose:

• Exposure - amt of radiation delivered
• Dose- amt absorbed

Pt should be in exact same pos for all treatments

Make sure the markings stay

Cancer Mgmt

Radiation Delivery Methods

• Teletherapy - from a source outside pt
• Stereotactic body radiotherapy - 3d tumor imaging, more accurate delivery
• Exact tumor location imperative for therapy
• Brachytherapy - from within
• Pt is radioactive and hazardous to others until isotope clears the body
• Waste included

Cancer Mgmt

Radiation Therapy SE:

Mostly limited to tissues exposed:

• Most sensitive tissues - bone marrow cells, skin, mucous membranes, hair follicles, ova and sperm
• Bone may lose density
• Increased risk of dental decay
• Skin very dry and may break down
• More sensitive to the sun

Systemic effects:

• Altered taste sensations
• Aversion to taste of red meat
• Fatigue

Cancer Mgmt

Chemotherapy

Some selectivity for cancer cells - rapid growth most sensitive to chemo

Cytotoxic against healthy cells - rapidly dividing cells most affected

Cancer Mgmt

Hormonal Manipulation

• Can control CA for many years, but does NOT cure
• Action = interference with hormonal uptake or inhibition of hormone production
• Masculinizing effects in women/ feminine effects in men

Increased risk for all pt of:

• DVT
• Hypercalcemia
• Liver dysfunction
• Acne
• Fluid retention

Cancer Mgmt

Photodynamic Therapy

• Selective destruction thru chemical reaction to laser light
• Can reduce tumor size for removal or to relieve obstruction
• Used most often with non-melanoma skin CA, ocular tumors, GI tumors, and lung CA in a/w

Cancer Mgmt

Photodynamic Therapy: Pt Education

• Sensitivity to light up to 12 weeks
• TEACH PRIOR TO INJECTION
• Bring protective clothing/gear
• Protect from direct and indirect sunlight
• Homebound 1-3 mo
• If inpatient, all source of light eliminated or reduced
• NO drugs with photosensitizing properties - some abx and anti-hypertensives

Cancer Mgmt

Immunotherapy

BRMs - cytokines

Enhance immune fxn or stimulate faster bone marrow fxn recovery after tx-induced therapy

• Interleukins (ILs)
• Regulate inflammation and immune protection
• Help immune sys recognize and destroy abnormal cells
• Interferons (INFs)
• Slow tumor cell division, stimulate NK, inhibit oncogene expression, induce CA cells to more norm appearance/fxn
• Thalidomide (Thalomid)
• Reduces tumor angiogenesis factor (TAF)
• TAF = req'd for CA cell blood supple
• Tx of multiple myeloma

Cancer Mgmt

Immunotherapy SE

General:

• Skin dryness, itching, peeling
• No swimming, no sun exposure
• No topical steroid creams on affected areas

Interferons - Peripheral neuropathy

Interleukins - generalized and severe inflammatory reactions

• Fluid shifts and capillary leak = edema in most tissues

Growth Factors - mild inflammation during and immediately after dose

• May have fever (Tylenol), chills, rigors (Demerol), and flu-like malaise

• May have adverse effects on nephrotic sys
• Nursing:
• Hydration
• Push fluids to decrease toxic effects on kidney and bladder lining

May cause GI, GU, CV toxicity

Nursing:

• Cardiac monitoring
• Mon. bleeding times
• Mon. for discolored urine (pink or red)
• Mon. bowel and bladder elimination

SE of corticos - impaired immune sys, HTN, hirustism, moon face, buffalo hump, wt gain, increased BG

Nursing:

Monitor WBC, VS, BG, antacids for GI upset, diuretics for fluid retention, monitor I&O

May cause renal or hepatic toxicity

Common for leukemia

Hydration, push fluids

May cause neurotoxicity - peripheral neuropathy, muscle weakness, constipation and paralytic illeus

Nursing: assess neuromuscular fxn, GI fxn