1. Cancer: Neoplasia

2. Cancer Abnormal, uncontrolled cell division Damage to genes controlling cell growth Cancer cells lose normal functions Divide rapidly Invade surrounding cells

3. Definitions Metastasis: abnormal cells traveling to different sites and starting new tumors Tumor: abnormal enlargement Neoplasm: same as tumor

4. Tumors Benign – slow growing, do not mets Adenoma Malignant – fast growing, usually mets, can result in death Sarcoma – connective tissue Carcinoma – epithelial tissue (more common)

5. Tumors Leukemia – cancer in blood-forming cells in bone marrow Lymphoma – cancer of lymph tissue Glioma – cancer in glial cells

6. Causes of Cancer Carcinogens Exposure to large amounts of radiation or sun Viruses Genetic components

7. Genetic cancers Oncogenes: mutated genes that contribute to cancer development by disrupting a cell’s ability to control its own growth and DNA repair mechanisms Ties with environmental component

8. Minimizing Chance of Cancer Healthy lifestyle with check-ups No smoking, drinking Low fat, increase fiber Exercise Self-exams

9. Minimizing chances of Cancer Periodic testing if genetic ties with cancer Cancer curable if caught early Protect from direct sun if sensitive or fair skin Watch moles and freckles Testicular Ca

10. Treatment Goal: Removal of ALL cancer cells Surgery Radiation therapy Drug therapy

11. Surgery Large tumors reduced by radiation or removed by surgery Check “borders” for cells Then chemo to eradicate micro metastasis Combination chemotherapy has a higher cancer cell- kill than single drug

12. Radiation Effective non-surgical treatment High doses of radiation directed at tumor Confined to area of tumor Palliation: shrinking of inoperable tumors for comfort

13. Radiation - Proton Effective non-surgical treatment Proton beam aimed directly at tumor Radiate tumor only Changes ionization Change atoms of diseased cells

14. Chemotherapy Drugs transported via blood Reduce size of tumor for surgical removal or for palliation Prophylaxis to prevent recurrence of cancer Growth fraction: # tumor cells undergoing mitosis

15. Chemotherapy administration Intravascular – peripheral versus central lines Oral Topical Intra cavity

16. Principles of Chemotherapy Most effective against small tumors – good blood supply Small tumors have higher percent of dividing cells Nadir: lowest point neutrophil count has been depressed – increase chance for infection

17. Cell cycle Tumor cells similar to non-cancerous cells Neoplastic and normal cell differ in the number of cells undergoing cell division Cancer cells lack normal mechanism of suppressing cell growth Anti-cancer drugs target cells that are dividing

18. Cell cycle Interfere with DNA, RNA, or protein synthesis – S-phase specific Inhibit microtubule formation during mitosis – M-phase

19. Cell cycle Damage DNA Cell-cycle non- specific DNA alkylating agents damage tumor cells whether dividing or not

20. Combination Chemotherapy Each drug active against the cancer Different site of action Different toxicity levels If similar, toxic levels occur at different times Nadirs different times

21. Total Cure Destroy all cancer cells One cancer cell can be enough to re-start proliferation of cells Not really total cure, “remission” where cancer cells not active

22. Anti-cancer drugs “Kills” cells Interfere with cell proliferation Damage cell DNA Prevent DNA repair in cell

23. Protection of Health care workers Prevent inhalation Prevent absorption through skin Prevent ingestion

24. Protection of Health care workers Careful disposal of contaminated materials Careful handling and/ or disposal of body fluids contaminated by chemotherapy within 48 hours

25. Protection of Family Safe handling of body waste Double bag items Wash linens separately for 48 hours post chemo

26. Side Effects - General B – bone marrow suppression A – alopecia R – retching F - fatigue

27. Hematological Neutropenia Leukopenia Thrombocytopenia Anemia Fatigue Risk for infection Risk for bleeding

28. Skin Alopecia From thin wispy pattern to total loss of hair Hair regrows: Thicker Wavier Darker color

29. Body systems – GI Emetic center triggered Nausea/ Vomiting Anorexia Diarrhea Constipation

30. Mucosal tissue Stomatitis Ulcerating lesions on mucosa Burning sensation with fluids Pain to oral or esophageal mucosa Nutrition poor – no appetite

31. Neurological Parasthesia Motor weakness - fatigue Paralytic ileus

32. Urinary Hemorrhagic cystitis Renal toxicity Purines released during cell destruction converted to uric acid crystals

33. Cardiopulmonary Rare occurrence Cardiac- toxicity Pulmonary toxicity EKG changes

34. Hepatic Hepatic toxicity

35. Reproductive Infertility Cause birth defects Cause sterility or decrease sperm

36. Emotional Anticipatory grief Anger Anxiety Depression Guilt

37. Sociocultural Isolation Withdrawal May feel others are uncomfortable around them

38. Developmental Varying responses: Loss of control Role change

39. Spiritual Varying responses Hope Dependence on God Anger at God Guilt for not being better Christian/ worshipper

40. Body image disturbance Alopecia Weight loss/ gain Muscle wasting from steroid therapy Loss of previous functions

41. Pain Chronic pain from cancer Will depend on type and extent of cancer

42. Goals of Nursing Understand what type of chemo used Watch for s/s side effects Pre-med with antiemetics – ATC medications x 24 hours Supportive care Usually given at night

43. Goals of Nursing Prevent infection Maintain fluid/ e- lyte balance Promote adequate nutrition Maintain skin integrity

44. Goals of Nursing Monitor bowel/ elimination patterns Patient safety (falls) Maintain emotional health Positive body image

45. Misc. education No over the counter medications No live virus immunizations Watch herbal supplements – can increase effect of chemo drug

46. Chemotherapy Treatment Prehydration Solution 150-200 ml/hr usually Pre-med with anti- emetics prn or around the clock (ATC) Careful I&O

47. Extravasations Vesicants – use central lines Different antidotes for different vesicants Follow hospital protocol Ulcerations develop – 48-96 hours

48. Extravasations  Pain – severe that lasts  Redness – blotchiness around site  Swelling – occurs immediately

49. Extravasations  Blood return – stop if none  Ulceration – usually occurs later  Necrosis – if untreated

50. Ankylating agents – Mechanism of action

51. Cell-cycle non-specific Works on: Already formed DNA Cross-linked strands Prevents replication

52. Alkylating Agents Nitrogen mustard Cyclophosphamide (Cytoxan) Chlorambucil (Leukeran) Cis-platin (platinol)

53. Alkylating agents - Nursing Blood dyscrasias Intake and output Report any buzzing, ringing in ears (loss of high-freq hearing) s/s allergic reaction

54. Alkylating agents - Nursing Blood counts GI mucosa – nutrition important Skin blistering Renal/ liver function tests Can cause sterility – use contraception

55. Alkylating agents – Interactions Immunosuppressants – increase infection Anticoagulants – bleeding Digoxin – decrease dig effect Thiazides - leukopenia

56. Antimetabolites – Mechanism of action

57. Antimetabolites Methotrexate 5-fluorouracil Cytosine arabinoside Cytarabine (Ara-C) Thioguanine

58. Antimetabolites Cell-cycle specific (S-phase) Inhibit protein synthesis Interferes with DNA synthesis

59. Antimetabolites - Nursing Most toxicity in hematopoietic and GI systems – bone marrow stem cells and GI epithelium Renal/ Liver function tests s/s respiratory infection

60. Antimetabolites - Interactions Decreases Digoxin Affects protein bound drugs (ASA, dilantin) NSAIDs, ASA – increase toxicity Other chemo agents/ radiation – increase effect

61. Anti-Metabolite: Methotrexate Leucovorin rescue Form of folic acid Treats systemic toxic effects Administer within the first 36-42 hours

62. Cytotoxic antibiotics

63. Doxorubicin (adriamycin) Bleomycin Danorubicin Idarubicin

64. Cytotoxic antibiotics Cell-cycle non-specific Interfere with nucleic acid synthesis Inhibit DNA & RNA synthesis

65. Cytotoxic antibiotics - Nursing Most toxicities occur: Hematopoietic GI Reproductive Cardiac

66. Cytotoxic antibiotics - Nursing Vesicant drugs Assess: Pain Redness Swelling Ulceration

67. Cytotoxic antibiotics – Interactions Digoxin – decrease dig level Phenobarbital – decreased chemo effectiveness Dilantin – decrease dilantin level

68. Plant alkaloids

69. Plant Derivations Periwinkle Pacific yew Mandrake Campthecus acuminata Periwinkle Pacific Yew Mandrake

70. Plant alkaloids  Etopside (VP-16)  Paclitaxel (Taxol)  Vincristine (Oncovin)  Vinblastine  Vinorebline

71. Plant alkaloids  Cell-cycle specific (M- phase)  Arrest metaphase by binding to cell proteins  Inhibit protein  Inhibit RNA synthesis

72. Plant alkaloids - Nursing Check of allergies to plants prior to administration Assess for bronchospasms Can lower seizure threshold Nutritional plan to combat constipation Assess mental status – depression

73. Plant alkaloids – Interactions Dependent on drug Calcium channel blockers – increase vincristine effect Digoxin – decrease dig effect Dilantin – decrease dilantin effect

74. Hormones/ Hormone antagonists Glucocorticoids Act indirectly on malignant cells Estrogens Suppress testosterone production in males Alter response of breast cancers

75. Hormones/ Hormone antagonists Anti-estrogens Compete with estrogens for binding Progestins Promote palliation/ tumor cell regression

76. Hormones/ Hormone antagonists Androgens Inhibit binding of androgens Advanced prostate cancer Anti-androgens Palliative for advanced breast carcinomas Surgery/ radiation not appropriate

77. Hormones - Nursing Side effects specific to the drug given Most include fluid retention Steroids – increase infection, edema Masculinizing or feminizing effects

78. Hormones - Nursing Blood clots Blood glucose monitoring Nutrition Fertility counseling Blood, liver counts

79. Hormones – Interactions Will depend on the drug being used Some treatments used for other disease processes

80. Biologic Response Modifiers Do not kill tumor cells Stimulate body’s immune response Limits severe immunosuppressive effects

81. Biologic Response Modifiers Drugs work by depriving cancer cells of needed ingredients OR inhibiting enzymes necessary to complete proliferation

82. Integrative Cancer Therapy Wholistic approach Herbal therapies Colonics Vitamins/ supplements Vitamin C Ave – Fermented wheat germ Involve family

83. Low Dose Chemotherapy IPT – Insulin potentiation therapy 10% dose Integrative care Results just as effective as traditional chemo Less side effects, i.e., alopecia, N/V