1. oncology treatment
1) surgery
- Surgery is indicated to diagnose, stage, and treat cancer.
- types of surgery
| ① prophylactic surgery | • Prophylactic surgery is performed in clients with an existing premalignant condition or a known family history that strongly predisposes the person to the development of cancer.
• An attempt is made to remove the tissue or organ at risk and thus prevent the development of cancer. |
| ② curative surgery | • All gross and microscopic tumor is removed or destroyed. |
| ③ control surgery (cytoreductive surgery, debulking surgery) |
• Control surgery is a debulking procedure that consists of removing a large portion of a locally invasive tumor, such as advanced ovarian cancer. Surgery decreases the number of cancer cells. Therefore, it may increase the chance that other therapies will be successful. |
| ④ palliative surgery | • Palliative surgery is performed to improve the quality of life during the survival time. Palliative surgery is performed to reduce pain, relieve airway obstruction, relieve obstructions in the gastrointestinal or urinary tract, relieve pressure on the brain or spinal cord, prevent hemorrhage, remove infected or ulcerated tumors, or drain abscesses. |
| ⑤ reconstructive surgery (rehabilitative surgery) |
• Reconstructive surgery is performed to improve quality of life by restoring maximal function and appearance, such as breast reconstruction after mastectomy. |
2) chemotherapy
- ex) Cytotoxin
- Chemotherapy kills or inhibits the reproduction of neoplastic cells and kills normal cells. Normal cells most profoundly affected include those of the skin, hair, and lining of the gastrointestinal tract, spermatocytes, and hematopoietic cells.
- Usually, several chemotherapies and biotherapy agents are used in combination to increase the therapeutic response (combination therapy). Combination chemotherapy is planned by the HCP so that medications with overlapping toxicities and nadirs (the time during which bone marrow activity and white blood cell counts are at their lowest) are not administered at or near the same time. This will minimize immunosuppression.
- Chemotherapy may be combined with other treatments, such as surgery and radiation.
- common side effects: fatigue, alopecia, nausea and vomiting, mucositis, skin changes, and myelosuppression (neutropenia, anemia, and thrombocytopenia), Cr elevation (after chemotherapy, most concerned)
- personal protective equipment를 착용하고 항암제를 다뤄야 한다.
- 피부에 묻었으면, 즉시 물로 씻는다. 바닥에 쏟았을 경우 spill kit 이용하고 청소부가 아니라 전문가 필요하다.
3) radiation therapy
- Radiation therapy destroys cancer cells, with minimal exposure of normal cells to the damaging effects of radiation. The damaged cells die or become unable to divide.
| external beam radiation (teletherapy) |
• The actual radiation source is external to the client. The client does not emit radiation and does not pose a hazard to anyone else.
• client education regarding self-care of the skin site of radiation therapy: Wash the irradiated area gently each day with warm water alone or with mild soap and water. Take shower, not a bath. Use the hand rather than a washcloth to wash the area. Rinse soap thoroughly from the skin. Dry the irradiated area with patting motions rather than rubbing motions. Use a clean, soft towel or cloth. Take care not to remove the markings that indicate exactly where the beam of radiation is to be focused. Use no powders, ointments, lotions, or creams on the skin at the radiation site unless they are prescribed by the radiologist. Wear soft clothing over the skin at the radiation site. Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site. Avoid exposure to the irradiated area to the sun. No sunscreens. Avoid heat exposure. |
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| internal beam radiation
(brachytherapy) |
• The radiation source is within the client. For a period of time, the client emits radiation and can pose a hazard to others. The radiation source comes into direct, continuous contact with tumor tissues for a specific time.
• unsealed radiation source / sealed radiation source
|
- sides effects: fatigue (most common), vary according to the site of treatment
| anorexia, an altered taste sensation, nausea, vomiting, mucosal ulceration, diarrhea |
• Monitor for weight loss. Monitor for dehydration.
• Encourage fluids and foods as best tolerated. Provide small, frequent meals. • Provide soothing oral hygiene and prescribed mouth rinses. • Administer antiemetics around the clock. A topical anesthetic may be prescribed. • Administer antispasmodics and antidiarrheal preparations as prescribed. |
| bone marrow depression | • precaution and care for the infection
• Monitor for fever. Administer antibiotics as prescribed. • precaution and care for bleeding • Monitor for signs of anemia. |
| cystitis | • Encourage fluid intake and frequent voiding.
• Monitor for hematuria. |
| alopecia (hair loss), irritation, dry or moist desquamation |
• Provide scalp hygiene. Keep skin clean. Wash skin daily, using a mild soap sparingly.
• Do not remove skin markings for radiation. • Avoid exposure to the sun and other extreme temperature changes. Stress the need for head covering in cold weather. • For dryness, apply lubricant as prescribed. • Introduce the idea of a wig. |
4) bone marrow transplantation
- Bone marrow transplantation and peripheral blood stem cell transplantation are procedures that replace stem cells that have been destroyed by high doses of chemotherapy and/or radiation therapy. The goal of treatment is to rid the client of all leukemic or other malignant cells through treatment with a high dose of chemotherapy and whole-body irradiation. Because these treatments are damaging to bone marrow cells, without the replacement of blood-forming stem cell function through transplantation, the client would die of infection or hemorrhage.
- Bone marrow transplantation and peripheral blood stem cell transplantation are most commonly used in the treatment of leukemia and lymphoma but are also used to treat other cancers, such as neuroblastoma and multiple myeloma.
2. oncology
1) laryngeal cancer
| • risk factor: cigarette smoking, heavy alcohol use, the combined use of tobacco and alcohol, exposure to environmental pollutants, exposure to radiation, voice strain | • persistent hoarseness, change in voice quality, sore throat, burning sensation in the throat, painless neck mass
• dyspnea, foul breath odor, hemoptysis • dysphagia • weakness and weight loss |
• Monitor respiratory status.
• Monitor for signs of aspiration. • Place in Fowler’s position to promote optimal air exchange. • Administer oxygen as prescribed. • Provide activity as tolerated. • Provide a high-calorie and high-protein diet. Provide nutritional support via parenteral nutrition, nasogastric tube feedings, or gastrostomy or jejunostomy tube, as prescribed. • radiation therapy • chemotherapy • surgical intervention: Types of resection include cordal stripping, cordectomy, partial laryngectomy, and total laryngectomy. A tracheostomy is performed with a total laryngectomy. (The airway opening is permanent and is referred to as a laryngectomy stoma.) |
2) lung cancer
| • Classified according to histological cell type; small cell lung cancer, non-small cell lung cancer (including squamous cell, adenocarcinoma, large cell anaplastic carcinoma)
• risk factor: cigarette smoking, also exposure to passive tobacco smoke, exposure to environmental pollutants |
• hoarseness
• dyspnea, chronically cough, hemoptysis, purulent sputum • diminished or absent breath sounds, respiratory changes, wheezing • chest pain • weakness, weight loss, anorexia • tactile fremitus ↑, dullness • AP diameter ↑ • diaphoresis (×) |
• Monitor respiratory status. Monitor breathing patterns and breathing sounds and for signs of respiratory impairment. Assess for tracheal deviation.
• Place in Fowler’s position to help ease breathing. • Administer oxygen as prescribed and humidification to moisten and loosen secretions. • Administer bronchodilators and corticosteroids as prescribed to decrease bronchospasm, inflammation, and edema. • Provide activity as tolerated. • Provide a high-calorie, high-protein, and high-vitamin diet. • radiation therapy • chemotherapy • surgical intervention: Types of resection include thoracotomy with pneumonectomy (opening into the thoracic cavity with surgical removal of one entire lung), thoracotomy with lobectomy (surgical removal of a single lobe of the lung), thoracotomy with segmental resection (surgical removal of a lobe segment), laser therapy to relieve endobronchial obstruction, thoracentesis and pleurodesis to remove pleural fluid and relieve hypoxia |
3) kidney cancer
| • chemotherapy
• radiation therapy • radical nephrectomy: surgical removal of the entire kidney, adjacent adrenal gland, and renal artery and vein |
4) [Pediatric] neuroblastoma
| • Neuroblastoma is a tumor that originates from the embryonic neural crest cells that normally give rise to the adrenal medulla and the sympathetic ganglia. Most tumors develop in the adrenal gland or the retroperitoneal sympathetic chain. | • firm and non-tender mass in the abdomen that crosses the midline
• urinary retention or frequency |
• radiation therapy
• chemotherapy • surgical intervention |
5) [Pediatric] nephroblastoma (Wilms’s tumor)
| • Wilms’s tumor is the most common intraabdominal and kidney tumor of childhood. | • swelling or mass within the abdomen Mass is characteristically firm, non-tender, confined to one side, and deep within the flank.• urinary retention or hematuria or both • hypertension caused by secretion of excessive amounts of renin by the tumor |
• Avoid palpitation of the abdomen. Place a sign at the bedside that reads. Do not Palpate Abdomen. Avoid palpation of the abdomen in a child with Wilms’s tumor and be cautious when bathing, moving, or handling the child. It is important to keep the encapsulated tumor intact. Rupture of the tumor can cause the cancer cells to spread throughout the abdomen, lymph system, and bloodstream.
• radiation therapy • chemotherapy • surgical intervention: nephrectomy |
6) esophageal cancer
| • risk factors: cigarette smoking, alcohol consumption, chronic reflex | • painful swallowing (odynophagia), dysphagia
• epigastric pain • loss of appetite, weight loss |
• Monitor nutritional status, including daily weight, intake and output, and calories consumed.
• instruct the client about diet changes that make eating easier. • surgical intervention |
7) gastric cancer
| • risk factor: helicobacter pylori infection, a diet of smoked, highly salted, processed, or spiced foods, nitrate ingestion, smoking, alcohol, a history of gastric ulcer | • abdominal discomfort, full feeling, abdominal pain• indigestion, anorexia, weakness • nausea, vomiting • iron-deficiency anemia |
• Monitor nutritional status, including daily weight.
• Encourage small, bland, easily digestible meals with vitamin and mineral supplements. • Monitor hemoglobin and hematocrit. • radiation therapy • chemotherapy • surgical intervention : subtotal gastrectomy total gastrectomy (esophagojejunostomy) |
8) intestinal tumor
| • risk factors: age older than 50 years, familial polyposis, family history of colorectal cancer, previous colorectal polyps, history of colorectal cancer, history of chronic inflammatory bowel disease, history of ovarian or breast cancer | • blood in stool: most common, anemia
• abnormal stool • abdominal distention, abdominal mass • anorexia, weight loss, cachexia |
• Monitor for signs of intestinal obstruction, which include vomiting, abdominal distention, abdominal pain, constipation.
• Monitor for signs of bowel perforation, which include elevated temperature, rapid and weak pulse, low BP, distended abdomen. • radiation therapy • chemotherapy • surgical intervention: bowel and local lymph node resection, creation of a colostomy or ileostomy |
9) pancreatic cancer
| • associated with increased age, alcohol use, smoking, a history of DM, history of previous pancreatitis, ingestion of a high-fat diet. | • Symptoms usually do not occur until the tumor is large.
• abdominal pain • nausea, vomiting, clay-colored stools • unexplained weight loss • glucose intolerance • ERCP for visualization of the pancreatic duct and biliary system and collection of tissue and secretions may be done. |
• radiation therapy
• chemotherapy • surgical intervention: Whipple procedures ( involving a pancreaticoduodenectomy with the removal of the distal third of the stomach), pancreatojejunostomy, gastrojejunostomy, and choledochojejunostomy |
10) brain cancer
| • The signs and symptoms of a brain tumor depend on its anatomical location and size and, to some extent, the age of the child.
• headache • vomiting • seizure • ataxia • behavioral changes |
• radiation therapy
• chemotherapy • surgical intervention |
11) [Pediatric] osteosarcoma (osteogenic sarcoma)
| • cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur. | • localized pain at the affected site that may be attributed to trauma or the vague complaint of ‘growing pains’
• limping if weight-bearing limb is affected • progressive limited range of motion • palpable mass • pathological fractures |
• surgical resection by limb salvage to remove affected tissue, amputation, and chemotherapy
• treatment modalities • Prepare for prosthetic fitting as necessary. • Assist the child in dealing with problems of self-image. |
12) breast cancer
| • risk factors: age, family history of breast cancer, early menarche and late menopause, previous cancer of the breast or uterus, nulliparity, late first birth, obesity, high-dose radiation exposure to chest | • mass felt during monthly BSE (usually felt in the upper outer quadrant, beneath the nipple, or in the axilla): early detection
• a fixed, irregular non-encapsulated mass • asymmetry, with the affected breast being higher • bloody or clear nipple discharge • skin dimpling, retraction, ulceration, • presence of the lesion on mammography • Diagnosis is made by breast biopsy through a needle aspiration or by surgical removal of the tumor with a microscopic examination for malignant cells. |
• hormonal manipulation via the use of medication in postmenopausal women or other medications for estrogen receptor-positive tumors
• radiation therapy • chemotherapy • surgical intervention: simple mastectomy (Breast tissue and nipple are removed), lumpectomy (Breast tissue and lymph node are removed), radical mastectomy (Breast tissue, nipple, lymph node, and muscle are removed), modified radical mastectomy (Breast tissue, nipple, and lymph node are removed), breast reconstruction |
- BSE (Breast Self Examination): Perform monthly 7 to 10 days after menses. Postmenopausal clients or clients who have had a hysterectomy should select a specific day of the month and perform BSE monthly on that day. While in the shower or bath, when the skin is slippery with soap and water, examine your breasts. Use the pads of your second, third, and fourth fingers to press every part of the breast firmly. Use your right hand to examine your left breast, and use your left hand to examine your right breast. Using the pads of the fingers on your left hand, examine the entire right breast using small circular motions in a spiral or up-and-down motion so that the entire breast area is examined. Repeat the pattern of palpation under the arm. Check for any lump, hard knot, or thickening of the tissue. Loot at your breasts in a mirror. Stand with your arms at your side. Raise your arms overhead and check for any changes in the shape of your breasts, dimpling of the skin, or any changes in the nipple. Next, place your hands on your hips and press down firmly, tightening the pectoral muscles. Observe for asymmetry or changes, keeping in mind that your breasts probably do not match exactly. While lying down, feel your breasts as described in examination while in the shower or bath. When examining your right breast, place a folded towel under your right shoulder and put your right hand behind your head. Repeat the procedure while examining your left breast. Mark your calendar that you have completed your BSE. Note any changes or unique characteristics you want to check with your HCP.
13) ovarian cancer
| • risk factor: age, family history of ovarian cancer and colorectal cancer, early menarche and late menopause, polycystic ovary disease, nulliparity, use of estrogen replacement therapy (smoking 및 alcohol과는 직접적 관련 없음.) |
• In its early stages, ovarian cancer is often asymptomatic.
• dysfunctional vaginal bleeding • elevated tumor marker (CA-125) • abdominal discomfort |
• radiation therapy: External radiation may be used if the tumor has invaded other organs. Intraperitoneal radioisotopes may be instilled for stage 1 disease.
• chemotherapy: Intraperitoneal chemotherapy involves the instillation of chemotherapy into the abdominal cavity. • surgical intervention: total abdominal hysterectomy, bilateral salpingo-oophorectomy |
14) uterine cancer (endometrial cancer)
| • risk factors: age, family history of uterine cancer, early menarche and late menopause, polycystic ovary disease, nulliparity, obesity, DM, use of estrogen replacement therapy | • abnormal bleeding, especially in postmenopausal women
• vaginal discharge • abdominal pain |
• progesterone therapy with medication
• anti-estrogen medication • radiation therapy • chemotherapy • surgical intervention: total abdominal hysterectomy, bilateral salpingo-oophorectomy |
15) cervical cancer
| • risk factors: HPV (Human Papilloma Virus) infection, reproductive behavior including early first intercourse, multiple sex partners, or male partners with multiple sex partners. | • Screening via regular gynecological examinations and Pap test (Papanicolaou smear)
• painless vaginal postmenstrual and postcoital bleeding • foul-smelling or serosanguineous vaginal discharge • pelvic pain |
• radiation therapy: external radiation, internal radiation implants (intracavity)
• chemotherapy • laser therapy: Energy from the beam is absorbed by fluid in the tissues, causing them to vaporize. • cryosurgery: Cryosurgery involves freezing to the tissues, using a probe, with subsequent necrosis and sloughing. • surgical intervention: conization (A cone-shaped area of the cervix is removed), hysterectomy, pelvic exenteration |
16) bladder cancer
| • gross or microscopic, painless hematuria
• frequency, urgency, dysuria |
• radiation therapy
• chemotherapy • surgical intervention: transurethral resection of bladder tumor (local resection and fulguration), partial cystectomy (the removal of up to half the bladder), |
17) testicular cancer
| • Testicular cancer arises from germinal epithelium from the sperm-producing germ cells or from nongerminal epithelium from other structures in the testicles.
• Testicular cancer most often occurs between the ages of 15 and 40 years. |
• during monthly TSE: early detection
• painless testicular swelling • dragging or pulling sensation in the scrotum |
• radiation therapy
• chemotherapy • surgical intervention: unilateral orchiectomy, radical orchiectomy, retroperitoneal lymph node dissection |
- TSE (Testicular Self Examination): Perform monthly. A day of the month is selected, and the examination is performed on the same day each month. The best time to perform this examination is right after a shower when your scrotal skin is moist and relaxed, making the testicles easy to feel. First, gently lift each testicle. Each one should feel like an egg, firm but not hard, and smooth with no lumps. Then, using both hands, place your middle fingers on the underside of each testicle and your thumbs on top. Gently roll the testicle between the thumb and fingers to feel for any lumps, swelling, or mass. If you notice any changes from one month to the next, notify your HCP.
18) prostate cancer
| • Prostate cancer, a slow-growing malignancy of the prostate gland, is common cancer in American men. Most prostate tumors are adenocarcinomas arising from androgen-dependent epithelial cells.
• The risk increases in men with each decade after the age of 50 years. |
• asymptomatic in the early stages
• gross and painless hematuria • hard, pea-sized nodule or irregularities palpated on DRE • The prostate-specific antigen level is elevated in various noncancerous conditions. |
• Prepare the client for hormone manipulation therapy as prescribed. LH (Luteinizing hormone) may be prescribed to slow the rate of growth of the tumor.
• radiation therapy • chemotherapy • surgical intervention |
3. Hematology
1) leukemia
| • Leukemias are a group of hematological malignancies involving abnormal overproduction of leukocytes, usually at an immature stage, in the bone marrow.
• classification of leukemia ① ALL (Acute Lymphocytic): Age of onset is younger than 15 years. • risk factors: genetic factors, viral factors, immunological factors, environmental factors, exposure to radiation, exposure to chemicals, medications such as previous chemotherapy |
• In leukemia, proliferating immature WBCs depress the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production.
• fatigue, weakness, anorexia, weight loss • anemia • elevated temperature, palpitation, tachycardia, orthostatic hypotension • overt bleeding: nosebleeds, gum bleeding, rectal bleeding, hematuria, increased menstrual flow, occult bleeding, ecchymoses, petechiae, prolonged bleeding after minor abrasions or lacerations • enlarged lymph nodes, spleen, liver • bone pain, joint swelling • positive bone marrow biopsy identifying leukemic blast-phase cells |
• precaution and care for the infection
• precaution and care for bleeding • care for fatigue and malnutrition: Assist the client in self-care and mobility activities. Allow adequate rest periods during care. Do not perform nursing care activities unless they are essential. Assist the client in scheduling important or pleasurable activities during periods of highest energy. • chemotherapy • radiation therapy • Prepare the client for hematopoietic transplantation if indicated. • Instruct the client about appropriate home care measures. • Provide psychosocial support and support services for home care. |
- precaution and care for infection: Initiate protective isolation procedures. Maintain the client in a private room with the door closed. Place the client in a room with high-efficiency particulate air filtration or a laminar airflow system if possible. Staff and visitors with known infections or exposure to communicable diseases should avoid contact with the client until the risk of infectious spread has passed. Limit the number of staff entering the client’s room to reduce the risk of cross-infection and ensure that anyone entering the child’s room wears a mask. Reduce exposure to environmental organisms by eliminating fresh and raw fruits and vegetables (low-bacteria diet) from the diet. Eliminate fresh flowers and live plants from the client’s room and avoid leaving standing water in the client’s room. Keep supplies for the client separate from supplies for other clients. Ensure frequent and thorough hand washing by the client, family, and HCPs. Use strict aseptic technique for all procedures. Avoid invasive procedures such as injections, insertion of rectal thermometers, and urinary catheterization. Change wound dressings daily, and inspect the wounds for redness, swelling, or drainage. Initiate a bowel program to prevent constipation and prevent rectal trauma. Assist the client with daily bathing, using an antimicrobial soap. Assist the client to perform oral hygiene frequently. Be sure that the client’s room is cleaned daily. Monitor temperature, pulse, respiration, blood pressure, and pain. Monitor WBC and neutrophil counts. Assess the urine for cloudiness and other characteristics of infections. Assess skin and oral mucous membranes for signs of infection. Auscultate lung sounds, and encourage the client to cough and deep breathe. Notify the HCP if signs of infection are present, and prepare to obtain specimens for culture of the blood, open lesions, urine, and sputum. A chest radiograph must also be prescribed. Administer prescribed antibiotic, antifungal, and antiviral medications. Instruct the client to avoid crowds and those with infections. Instruct the client to avoid activities that expose the client to infection, such as changing a pet’s litter box or working with house plants or in the garden. Instruct the client that neither they nor their household contacts should receive immunization with a live virus such as measles, mumps, rubella, polio, varicella, shingles, and some influenza, including the H1N1 vaccine. Instruct the client about a low-bacteria diet.
- precaution and care for bleeding: Handle the client gently. Pad side rails and sharp corners of the bed and furniture. Avoid injections, if possible, to prevent trauma to the skin and bleeding. Apply firm and gentle pressure to a needle stick site for at least 5 minutes, or longer if needed. Avoid rectal suppositories, enemas, and thermometers. Use caution when taking blood pressures to prevent skin injury. Monitor laboratory values. Examine the client for signs and symptoms of bleeding. To check petechia in dark skin, the nurse should assess the oral mucosa. Monitor for signs of internal hemorrhage. Examine all body fluids and excrement for the presence of blood. If the female client is menstruating, count the number of pads or tampons used. Clients with platelet count lower than 20,000cells/㎣ may need a platelet transfusion. Administer blood products as prescribed. Provide soft foods that are cool to warm to avoid oral mucosa damage. Instruct the client to use a soft toothbrush and avoid dental floss. Instruct the client to avoid blowing the nose. Instruct the client to use only an electric razor for shaving. Instruct the client to avoid constrictive or tight clothing. Discourage the client from engaging in activities involving the use of sharp objects. Contact sports also need to be avoided. Instruct the client to avoid using NSAIDs and products that contain aspirin.
2) lymphoma (Hodgkin’s disease)
| • Lymphoma is characterized by the abnormal proliferation of lymphocytes. Hodgkin’s disease is a malignancy of the lymph nodes that originates in a single lymph node or a chain of nodes.
• Classified as Hodgkin’s and non-Hodgkin’s depending on the cell type |
• fatigue, weakness, weight loss
• anemia • fever • thrombocytopenia • enlarged lymph nodes, spleen, and liver • painless enlargement of lymph nodes • presence of Reed-Sternberg cells in nodes |
• precaution and care for the infection
• precaution and care for bleeding • care for fatigue and malnutrition • chemotherapy • radiation therapy |
3) MM (Multiple Myeloma)
| • A malignant proliferation of plasma cells within the bone. Excessive numbers of abnormal plasma cells invade the bone marrow and ultimately destroy the bone. MM causes decreased production of immunoglobulin and antibodies and increased levels of uric acid and calcium, which can lead to kidney failure. | • bone pain, osteoporosis
• weakness, fatigue • anemia • infection • thrombocytopenia • elevated calcium and uric acid levels • UA shows Bence Jones proteinuria and elevated total serum protein levels. • kidney failure |
• precaution and care for the infection
• precaution and care for bleeding • care for fatigue and malnutrition • Encourage the consumption of at least 2L of fluids per day to offset potential problems associated with hypercalcemia, hyperuricemia, and proteinuria. • Encourage ambulation to prevent renal problems and to slow down bone resorption. Provide skeletal support during moving, turning, and ambulating. • chemotherapy • radiation therapy |
4. complication of cancer
1) SIADH
- sodium ↓ → IICP
2) SVC syndrome
- edema of the face
- airway obstruction
- decreased cardiac output