Wk 2: Oncology Nursing #2

Question 1

Define chemotherapy

Answer 1

= a group of drugs that destroy cancer cells.
- can use one or multiple

Action:
- shrink tumor
- destroy cells after surgical removal
- improve symptoms
prolong life where possible

Question 2

What is the typical chemo routine and why?

Answer 2

• it is usually given in cycles to with multiples treatments making up a cycle then repeating cycles for as long as it takes to reach desired outcome.

Cycles allow for bodily cells to recover inbetween nect administration.

Question 3

What are some types of chemo?

Answer 3

• oral : tablet or liquid
• IV
• Centeral line
• IM injection
• IA intra arterial
• Intraperotineal
• intrathecal
• subcut

Question 4

Explain the action of chemotherapy

Answer 4

Kills any rapidly dividing cells of the body.
- normal bodily cells can repair from the trauma where as cancer cells can not.

Question 5

Side effects of chemo

Answer 5

• fatigue
• nausea
• hair loss
• low libido
• sore throat and mouth
• loss of apetite

Question 6

What are some long term effects of chemo?

Answer 6

• organ damage such as heart, liver, kidneys, lung or brain.
• infertility
• increased risk of other cancers

Question 7

Explain radiation

Answer 7

= destroy and deactivate cancer cells.

A parallel goal is to preserve the integrity of normal tissues with the treatment field.

• damaging the nuclease of cells which in turn damages DNA synthesis which causes their ability to reproduce.

Question 8

What are some of the key uses of radiation?

Answer 8

• shrink a tumor before removal to make removal easier
• after surgery to destroy any remaining cancer cells
• as a main treatment if surgery
• in a combo with surgery, chemo or stem cell transplant

Question 9

What is the strategy of radiation administration?

Answer 9

The total dose is divided into smaller doses or fractions and given daily until that total is reached.

Usually given 5x per week with 2 day rest and continues for several weeks. Each exposure if only a few minutes.

High dose can be directly aimed at the tumor depending on the location and shape.
- however this does limit the amount of radiation that reaches healthy areas of the body.

Question 10

What are the two types of radiation?

Answer 10

• external
• internal

Question 11

What is involved in external radiation

Answer 11

= Beams radiation onto the tumour
- The area receiving radiation is very precise
- Minimises the radiation to surrounding healthy tissue.

• Treatment is painless however you must sit very still during the procedure which can be very uncomfortable.

Question 12

What is another term for internal radiation?

Answer 12

brachytherapy

Question 13

What in involved in brachytherapy?

Answer 13

= giving radiation through a needle, catheter or another specialised device. The device stays in place for a few minutes to a few days.

Question 14

Top 5 cancers in Aus?

Answer 14

1. prostate
2. breast
3. melanoma
4. colorectal
5. Lung

Question 15

What is a key practice pain of radiation?

Answer 15

• you may give off small amounts of radiation for a short time after internal radiation therapy.
• May need to stay in seperate room to prevents others from being exposed.
• Certain people (e.g. pregnant women, children, adolescents) should not get too close to you until the radiation weakens.

Question 16

What are some side effects of radiation therapy?

Answer 16

• for some it causes few to none
• skin issues at the site of radiation: dryness, itchiness, peeling and blistering
• fatigue
• head and neck: dry mouth, jaw stiffness, mouth problems like swallowing and dental problems
• chest: stiffness and some lung inflammation
• Stomach: N+V and diarrhoea
• Pelvis: urination problems, reproductive problems, fertility

Question 17

What are some examples of complementary therapies to couple with cancer therapy?

Answer 17

• mind and body e.g. counselling, yoga, art therapy, music therapy
• Body based: accupunture, massage
• Energy therapies: healing touch
• Therapies using hers or plants: bush remidies, chinese herbal medicines, medicinal cannabis

Question 18

Why may someone utilise a complementary therapy?

Answer 18

• symptoms management of primary treatment
• mental/emotional support
• less side effects
• more options
• cultural/spiritual influences

Question 19

What are some factors that should be taken into account when working with hazardous medicines such as cytotoxics?

Answer 19

• dose form of medication
• route of exposure
• frequency and duration of the task
• workplace practice
• presence or absence of any exposure controls such as engineering controls, administrative controls or personal protective equipment (PPE).

Question 20

What is a hazardous medicine?

Answer 20

Those that exhibit one or more of the following six characteristics in humans or animal studies:
1. Carcinogenicity
2. teratogenicity or other developmental toxicity
3. reproductive toxicity
organ toxicity at low doses
4. Genotoxicity
5. and/or structure and toxicity profiles of new medicines that mimic existing medicines determined hazardous by the above criteria

Question 21

What are the 7 types of cancer treatment?

Answer 21

• surgery
• radiation
• chemotherapy
• targeted therapy
• immunotherapy
• hormone therapy
• Transplant

Question 22

Explain targeted cancer therapy

Answer 22

any known treatment that is specific the a cancer because of its location or development.

e.g. Herceptin: reduces her2 gene over-expression that often occurs in breast cancer/

Question 23

Explain immunotherapy as a cancer treatment

Answer 23

= uses own body immune system to fight cancer
- challenge is no way to find specific cancer cells and not have an immune reaction to the rest of the body. Need a way to put markers on cancer cells.

• minimal side effects
• great effect on cancer

One side effect:
- can cause immune system to go into hyperdrive but we cant turn it off and thus wear out the bodys immune system.

Question 24

Explain hormone therapy as a cancer treatment

Answer 24

= uses synthetic hormones to block the effect of the body’s natural hormones. The aim is to lower the amount of hormones the tumour receives.
- can help reduce the size and slow down the spread of the cancer.

PO or injected

Question 25

Explain stem cell transplant therapy as a cancer treatment. And what are the different types?

Answer 25

= takes stem cells and grows them then give them back to the person on chemo whos effected cells are in theory killed by the chemo. Syngenic transplant: from an identical twin Allogenic transplant: from someone else Can be taken from the placenta.

Question 26

Define neo-adjuvant treatment

Answer 26

= all treatments that are administered before primary cancer treatment. e.g. radiation before surgery or chemo before surgery

Question 27

Define adjuvant treatment

Answer 27

= therapy that us administered after the primary treatment. e.g. chemo after radiation when radiation is parimary treatment or radiation after surgery.

Question 28

What is the cell kill theory?

Answer 28

states that a chemotherapy concentration given for a defined period of time, kills a constant fraction of the cells in the population, independent of the number of cells. - hence why repeat doses need to be administered.

Question 29

What are the two types of chemo?

Answer 29

1) cell cycle specific 2) cell cycle non-specific

Question 30

Explain cell cycle specific chemo

Answer 30

= some chemos can only work on certain points of the cell cycle. - excellent cell kill however only at certain times. - this is why we use more than on chemo/treatment strategy

Question 31

Explain cell cycle non-specific chemo

Answer 31

- can effect a cell in any stage of the cycle even resting. - effective again slow growing and rapidly dividing tumors.

Question 32

Given an example of a way to utalise cell specific and cell non specific

Answer 32

E.g. give 2 cell cycle specific and 1 cell cycle non specific. Aim: knock off as many cells at that time. - Gives maximum killing off. - This is why we combine agents - This is not an option for some cancers which don't respond to many types of cancer.

Question 33

What are some reasons why the chemo cycles are far apart?

Answer 33

- we need to split them up as giving the whole amount would kill he human. - Giving the whole amount that suppresses bone marrow function so no RBC, WBC or platelets so would come down in serious infections, inflamation, N + V. - we usually do 2 more cycles than needed.

Question 34

What is the impact of chemo on bone marrow?

Answer 34

- it can suppress it Anaemia: low red blood cells Leucopenia: low white blood cells Thrombocytopenia: low platelets

Question 35

What is the neutrophil nadir?

Answer 35

the lowest point of WBC hit at about 10 days post chemo. - this is when bacterial infections are most common.

Question 36

What is the intent of scalp cooling?

Answer 36

Causes vasoconstriction of blood vessels that supply hair and thus reduce the amount of he chemo drug that reaches the hair cells.

Question 37

Give an exaple of how a dose and fraction radiation regimine may work.

Answer 37

Dose: 60 greay of radio therapy Fractions: 30 aka 30 days

Question 38

What is hyperfraction?

Answer 38

fractions given multiples times per day.

Question 39

Explain neutropenic sepsis?

Answer 39

= Neutrophils (WBC) are vulnerable to standard cytotoxic agents and thus get depleted after chemo and thus the patients are highly susceptible to infection and severity of sepsis. If an immune compromised patient is exposed to a pathogen, the reduced ability to mount an immune response means that patients can deteriorate quickly into sepsis. - most common Treatment: - must be treated within the hour or 30 minutes if crashing. - if deteriorating must do a MET

Question 40

Explain the management of oncologic emergencies neutropenic sepsis

Answer 40

Recognise React - MET - broard spectrum antibiotics - fluid restriction - investions e.g. blood cultures, CXH Review- Frequent monitoring of patient to escalate care. - Fluid replacement and - consider HDU/ICU for septic patients. - Possible renal filtering and vasopressin support as required. - Review blood results and culture results. - Change antibiotics as required.

Question 41

Explain spinal cord compression

Answer 41

= occurs when cancer grows near to the spine resulting in swelling and reduced blood supply to the cord and nerves. - if untreated SCC will cause dysfunction and paralysis Symptoms - back pain often described as banding pain as though apressure is felt squeezing their hips, pelvis) worsens when lying down. - loss of function reduced power and strength pins and needles - changes in bowel habits Diagnosis - MRI - CT - Bone scan - Clinical exam Treatment of SCC - high dose steroids - monitor BGL - Monitor and treatment of urinary retention (such as IDC), constipation or diarrhoea - potential surgery - reduce mobilisation as falls risk *If action isnt taken with in a bout 24hrs the paralysis can be permanent.

Question 42

Explain tumor lysis (TSL)

Answer 42

= metabolic disturbance which results from sudden injury and death of cancerous cells usually within 3 days following treatment = damaged/killed cells release intracellular components/toxins causing sudden and sever electrolyte imbalance. - risk periods: 5-7 days usually within 24-48 hours. Symptoms - Hyperuricaemia - Hyperkalaemia - Hyperphosphataemia - Hypocalcaemia. = cause cardiac arythmias, acute renal failure, seziures and paralysis. - Weakness - Muscle cramps - Diarrhoea - Nausea and vomiting Investigations - clinical exam - biochemistry - ECG Management - protect renal system with agressive hydration - strict FBC - allopurinol to reduce uric acid crystilation - 6/24 blood tests monitor urine pH

Question 43

Explain hypercalcaemia

Answer 43

= metabolic function, characterised by a serum calcium above 2.6 mmol. Those at risk; - metastatic disease in bones - patients with breast, prostate and lung cancer, multiple myeloma, lymphoma and leukemia Symptoms - confusion vomiting - dehydration - sezuires - Apathy - Fatigue - Muscle weakness - ECG changes - Polyuria and noctris - calcium serum levels >3mmol/L Management Immediate: - reduce serum Ca+ level - maintain renal function with IV fluids - hydration Ongoing: bisphosphonate therapy will inhibit further bone breakdown and promote remodeling and reabsorption. When giving: sit up right for 30mins to reduce irritation to oesphagus

Question 44

Explain superior vena cava obstruction

Answer 44

= caused my mechanical obstruction from a tumor via migration or occlusion. - Cardiac output is reduced. Symptoms - swelling of face, neck, and arms, - peri orbital oedema (Looks like eyes are coming out of head) - dyspnoea - reduced perfusion - Real facial odema Distended veins in kneck Treatment - Includes reducing the size of the obstruction by radiation therapy or surgery - The aim of treatment is to restore vascular function as quickly as possible - Radiotherapy which is ironic as it can cause it!