1. Cancer 101 Monica Schlatter, RN, ND, AOCNP

2. Types of Cancer AIDS- related malignancies AIDS- related malignancies Bone and soft tissue sarcoma Bone and soft tissue sarcoma Bladder and kidney cancer Bladder and kidney cancer Breast cancer Breast cancer Central nervous system cancers Central nervous system cancers Colon and rectal cancer Colon and rectal cancer Endocrine malignancies Endocrine malignancies Esophageal, stomach, liver, gallbladder, and pancreatic cancers Esophageal, stomach, liver, gallbladder, and pancreatic cancers Gynecologic cancer Head and neck malignancies Leukemia Lung cancer Malignant lymphomas Multiple myeloma Prostate cancer Skin cancer Testicular germ cell cancer

3. Types of Treatment Chemotherapy Chemotherapy Radiotherapy Radiotherapy Surgery Surgery Biotherapy Biotherapy Transplantation Transplantation

4. Side Effects of Chemotherapy Bone Marrow Suppression Bone Marrow Suppression Infection, bleeding, fatigue related to anemia Infection, bleeding, fatigue related to anemia Fatigue Fatigue Gastrointestinal Tract Gastrointestinal Tract Nausea/vomiting Nausea/vomiting Diarrhea/constipation Diarrhea/constipation Loss of appetite Loss of appetite

5. Side Effects (cont’d) Heart Heart Congestive heart failure (low blood pressure, changes in heart rate) Congestive heart failure (low blood pressure, changes in heart rate) Brain/nerves Brain/nerves Short term memory loss Short term memory loss Cognitive Dysfunction Cognitive Dysfunction Peripheral Neuropathy Peripheral Neuropathy Vision/Hearing effects Vision/Hearing effects Dizziness Dizziness Lungs Lungs Shortness of breath Shortness of breath Cough Cough Pain with breathing Pain with breathing

6. Side Effects (cont’d) Liver Liver Jaundice Jaundice Unclear thinking Unclear thinking Pain/Increased abdominal girth Pain/Increased abdominal girth Musculoskeletal Musculoskeletal Sore muscles and joints Sore muscles and joints Fragile bones Fragile bones

7. Side Effects (cont’d) Bladder Bladder Bloody urine Bloody urine Painful urination Painful urination Kidneys Kidneys Decreased urination Decreased urination Changes in electrolytes that could affect muscle function Changes in electrolytes that could affect muscle function Hormones Hormones Infertility Infertility Symptoms of menopause Symptoms of menopause Decreased muscle mass Decreased muscle mass Difficulty in thermoregulation Difficulty in thermoregulation Decreased libido Decreased libido Secondary Cancers Secondary Cancers

8. Side Effects (cont’d) Skin Skin Rash Rash Increased sensitivity Increased sensitivity Dry Dry Alopecia Alopecia Mouth Mouth Ulcers Ulcers Dry Dry Poor dentition Poor dentition

9. Side Effects of Radiation Skin Skin Redness, dryness, desquamation Redness, dryness, desquamation Alopecia Alopecia Bone Marrow Bone Marrow Possible decrease in white blood cells and platelets Possible decrease in white blood cells and platelets Gastrointestinal Gastrointestinal Mucositis Mucositis Dry mouth Dry mouth Nausea/vomiting, gastritis, diarrhea Nausea/vomiting, gastritis, diarrhea

10. Side Effects of Radiation Reproductive Reproductive Infertility Infertility Early menopause Early menopause Urinary Urinary Cystitis, urethritis Cystitis, urethritis Cardiovascular Cardiovascular Clot formation Clot formation Pericarditis Pericarditis Fatigue Fatigue

11. Side Effects of Radiation Skeletal Skeletal Pain Pain Pathological fracture Pathological fracture Respiratory Respiratory Hoarseness Hoarseness Pneumonitis Pneumonitis Nervous Nervous Lhermitte’s Syndrome Lhermitte’s Syndrome

12. Side Effects of Biotherapy Short term or Infusion- related Short term or Infusion- related Commonly low blood pressure, rash, fever/chills, headache, malaise, and sore joints Commonly low blood pressure, rash, fever/chills, headache, malaise, and sore joints Long term Long term Increased risk of viral infections Increased risk of viral infections

14. Transplantation Autologous Hematopoetic Stem Cell Autologous Hematopoetic Stem Cell The use of the patient’s own cells to “rescue” them following high dose chemotherapy The use of the patient’s own cells to “rescue” them following high dose chemotherapy Used mostly in Multiple myeloma and Lymphomas. Use occasionally in Acute Myelogenous Leukemia Used mostly in Multiple myeloma and Lymphomas. Use occasionally in Acute Myelogenous Leukemia All patients require a central line All patients require a central line Can be done as an outpatient but many are admitted Can be done as an outpatient but many are admitted

15. Transplantation Autologous: Autologous: The patient’s cells are collected then frozen The patient’s cells are collected then frozen The patient is then given high dose chemotherapy The patient is then given high dose chemotherapy The cells are given about 48 hrs following the chemo The cells are given about 48 hrs following the chemo The cells grow and “engraft” in about 2 weeks The cells grow and “engraft” in about 2 weeks Most patients are discharged back to their oncologists after about a month Most patients are discharged back to their oncologists after about a month

17. Side Effects of an Auto Transplantation The same as those listed for chemotherapy The same as those listed for chemotherapy

18. Bone Marrow Harvest

20. Transplantation Allogeneic Hematopoetic Stem Cell Allogeneic Hematopoetic Stem Cell The use of someone else’s cells to replace the patient’s immune system to generate a “graft versus leukemia/lymphoma” effect The use of someone else’s cells to replace the patient’s immune system to generate a “graft versus leukemia/lymphoma” effect Used mostly in Leukemias and Lymphomas. Used occasionally in Multiple myeloma Used mostly in Leukemias and Lymphomas. Used occasionally in Multiple myeloma All patients have a central line All patients have a central line Most patients are inpatient for up to a month with no complications Most patients are inpatient for up to a month with no complications

21. Transplantation Allogeneic: Allogeneic: The patient is given their “conditioning” regimen (chemotherapy or chemo with total body irradiation) The patient is given their “conditioning” regimen (chemotherapy or chemo with total body irradiation) The patient’s donor is then collected a day or two before the cells are to be given The patient’s donor is then collected a day or two before the cells are to be given Donor can be the patient’s sibling, or on occasion, parent, an unknown donor from the NMDP (National Marrow Donor Program), or a cord blood Donor can be the patient’s sibling, or on occasion, parent, an unknown donor from the NMDP (National Marrow Donor Program), or a cord blood

22. Cord Blood Stem Cells

24. Side Effects of an Allo Transplantation The same as those listed for chemotherapy. The same as those listed for chemotherapy. TBI (total body irradiation) usually causes nausea/vomiting, mouth sores, diarrhea, fatigue, and alopecia TBI (total body irradiation) usually causes nausea/vomiting, mouth sores, diarrhea, fatigue, and alopecia Graft vs. Host Disease Graft vs. Host Disease Syndrome where the donor cells “attack” the host. Syndrome where the donor cells “attack” the host. Manifested as a rash, nausea, vomiting, diarrhea, abdominal cramps, and/or loss of appetite Manifested as a rash, nausea, vomiting, diarrhea, abdominal cramps, and/or loss of appetite Can affect the eyes, mouth, lungs, liver, kidneys, and muscles Can affect the eyes, mouth, lungs, liver, kidneys, and muscles