med surge

• new growth of abnormal tissue called neoplasms or tumors
• carcimonas- cancer from epithelial cells
• lyphoma- cancer from organs that fight infection
• leukemias-cancer from organs that form blood
• sacomas- cancer from connective tissue (like bone & muscle)

• benign tumors- dont spread, grow large, but slower than malignat, usually dont cause death unless it impairs function of vital organs
• malignant- undergo metastasis (spread), uncontrolled growth unless completly removed

• carcinogenesis- process of melignant transformation
• initiation- involves carcinogens, alters gentetic factors of DNA w/i cells
• promotion- transforms genetic info so that cell starts to produce mutant cells
• progression- malignant cells could invade adjacent tissue & metstasize

carcinogenics- chemical, enviromental, dietary, viruses, defective genes, medically RX interventions

• decrease red meats, processed meats that have nitrates & nitrates preservatives
• increase servings of cruciferous vegetables ike broccoli, cabbage, caulliflower
• increase fiber
• decrease ft to 20-30% of total daily calories
• increase foods w/ vit. A & C, like fruits & yellow & leafy green vegetables
• reduce alcohol 2 more more than 2 drink daily 4 men, & 1 for women

• recognizes tumor-associated antigens
• poduces macrophages & T lymphocytes that eliminates malignant cells
• generating interferons
• making antibodies
• producing natural killers

• change in bowel habits or bladder infection
• sores that dont heal
• unusual bleeding or discharge
• lumps on breast or other part of body
• indigestion or difficulty swallowing
• change of wart or mole
• persistant cough or hoarsness

SEE pg 215 box 18-2

• tumor marker- checks for specific protiens, antigen, hormones, genes, & enzymes that cancer cells release
• CBC (EX. could show anemia that caoulf come from colon cancer or occult blood in stool)
• x-ray- uses contrast to see tumor in organs
• CT- 3D- to see tumor density, location, shape, size, value
• MRI- to differentiate diseases tissue from healthy & to study blood flow, help when tumor hidden by other structures
• Nuclear scans- tracer injected, checking 4 hot spots/cold spots
• ****PET- used in brain, ling, colon, liver, & pancrease
• ****radioimmunocojugates- used in colorectal, breast, ovarian, head & neck, also 4 lymphomas, & melanomas
• ultrasound- differentiate solid & cystic tumors of abd, breast pelvis, & heart
• fluoroscopy- for moving body structures w/ continuous x-ray (ex. barium study)
• biopsy- excise tissue, best method
• frozen section- when tumor remove itz froze & cut, the DRthen decides what surgy needed
• endoscopy- shines light thru specific body structure
• cytology- microscopic exam, cells obtained by needle aspiration, scaping, brushing, sputum (ex. pap)

• staging system referred as TNM
• t- size, N-involement of lymph node, M- presence of metastasis
• then simplified to
• stage 0- in situ, no metastasis
• stage 1,2,3- higher # means tumor is of greater size or spread to nearby lymph nodes/organs
• stage 4- cancer invaded other organs

• Well-differentiated- resemble more the tissue or origin
• undifferentated- no resemblance
• cell differentation graded from 1-4, higher the # less differentated, when poorly diffentiation graded @ 4- tumors aggressive & unpredicatable, dont respond to tx

• surgery
• radiation
• chemotherapy
• bone marrow transplant
• stem cell transplant
• immunotherapy
• gene therapy

• depends on extent of disease, pathology, pt age, physical condition, anticipated result
• when tumor confined & hasnt invaded other organs surgery is curative or called primary tx
• when tumor cant b removed they remove as much as possibile itz called debulking or cytoreduction surgery
• 2 types of excisions
• local- tumor & healthy tissue removed
• wide/radical- removes primary tumor, lymphnodes, & involved adjacent structures or surrounding tissue @ risk 4 metastasis

• salvage surgery- when reoccurance of cancer, more extensive (lumpectomy-mastectomy)
• prophylactic surgery- when hx of cancer
• palliative surgery- ex. paracentisis, thoracentisis

• surgical interventions-
• cryosurgery-liquid nitrate to freeze tissue & desroys cells
• electrosurgery- uses electric current to destroy cell
• laser-vaporizes cells, destroying & sealing tissue
• Mohs surgery(chemosurgery)- shaving off thin layer of skin, layer by layer until normal cells seen under micrscope
• stereotatic surgery- single high dose of radiation, used 4 brain, head, & neck tumors

kills both abnormal & normal cell, but kills abnormal faster

• external radiation
• kilovoltage therapy- superficial lesion
• linear accelerators & betatron machines- high enegy x-ray, deeper tumors & spare damage to skin
• gamma rays- high energy, 4 deeper structures
• introoperative radiation therapy(IORT)- high-fraction single dose to exposed tumor, avoids radiation to skin & other tissue

• internal radiation (brachytherapy)
• high dose of radiation to specific tumor, not tissue around it
• intersatitial or intracavitary cavitiy- use needle, seeds, cath, ribbons, capsules radiation
• *intersatitial- inserted directly to tumor or tissue near like tumor head/neck
• *intercavitary- placed directly into body cavity & applicator hold in place, when implany removed, noradioactivity left, when seeds left (prostate/brain cancer) the radioactivity decays takin wks-mon dependin on itz half-life, pt usually go home with it, but need to stay away from peeps few day, then vistors should stay for min & 6ft away

• systemic/internal radiation- given sm. dose, orally, IV, or into bos cavity, could be excreted thru urine, feces, sweat, saliva
• To reduce exposure- wash hand reg, flush several times, use differant eating utensils, wash laundry seperate, drink alot of fluids, avoid kissing & sex

• aloplacia
• erythema(local redness & inflammation of skin)
• desquamation- shedding of epidermis
• alterations of oral mucosa- stomatitis, xerostomia, change or loss of taste, decrease salivation
• anorexia
• nausea, diarrhea, vomiting
• cystitis inflammation of bladder
• pneumonits- inflammation of lungs
• fatigue
• myeosupression- depression of bone marrow function, leading 2 anemia, leukopenia, thrombocytopenia

• give info on safety of radiation (effect on tumor & side effects
• teach pt about procedure
• explain nutritional needs
• teaching on care of mucous membrane
• protecting skin from irritation
• assess skin/mucous membrane 4 changes 2 tx areas (redness, tanning, peeling, itching, hairloss, dereased prespiratipion)
• clean the pt skin w/ mild soap & tepid water
• moisterize skin, lips
• maintain intact oral mucous membrane
• assess lesion (culture necessary)
• monitor for signs bone marrow supression
• assess 4 signs of bleeding
• assess 4 signs of irradiation(cerebral edema, malabsorption,pleural effusion, pneumonitis, esophagitis, cystitis, urethritis)
• encourage pt to talk about what emotions
• inform that fatique is likly to happen, wear loss clothes
• avoid extreme cold/heat, irritating soaps & shampoo
• report oral pain, burning, open lesions, cant swallow, use non-alcoholic mouth wash, floss gently,
• protect skin from sun exposure, chlorine, & wind
• avoid hot drink/foods, alcohol, highly seasoned foods, acidic foods, tobacco

• uses antineoplastic agents locally & systemically, prevents metastasizing, slows growth, relieves pain,
• interfers w/ cellular function & reproduction

• division of cells to daughter cells
• *G1- growth phase where RNA & protien synthesis
• *S phase- RNA synthesis complete & DNA synthesis occurs
• *G2- anothr growh phase where DNA synthesis complete & cell mitosis starts
• *M phase- mitosis/cell division takes place
• *G0- dormant or resting phase, which can occur after mitosis & during G1 phase

most chemotherapuetic agent affect S phase

cell cycle-specific drugs- used 4 fast growing tumors b/c they attack cancer cells when they enter specific phase of reproduction

Cell cycle-nonspecific drugs- effective in any phase, used 4 lrg, slow growing tumors, amount of drug more important then frequency, more prolonged effect on cells which leads to cells damages & distruction

• oral, IV, IM, intraperitoneally, intra-arterially, topically, intrathecally, directly into cavity
• dose bsed on pt total bod surface area before chemo response
• monitor 4 extravasion when given IV, inspecting 4 tenderness, pain, swelling, & induration caused by vesicants,
• PIC lines, PICC, & external cath(hickman cath, Broviac cath) & also implanted vascular acces device(IVAC) aka port

• affects fast growing cells like pithelial tissue, hair follicle & bone marrow
• nausea, vomiting duing 1st 24hrs after chemo admin. give antiemetics to reduce effect
• stomatitis & mouth soreness or ulcertion from destruction of epithelial cells
• aloplecia
• myelosupression
• fatique

• prepare in designated area
• wear gloves, gowns
• use Luer-lok fitting IV tubing used
• dispose all equipment used
• dispose all waste

• monitor symptoms of anaphylactic shock
• Assess 4 electrolyte imbalance
• prevent extravasion of vesicant drugs
• assess 4 signs bone marrow supression
• assess 4 bleeding & infection
• monitor 4 signs of renal insufficiancy
• ***elevated urine specific gravity
• ***abnormal elelctrolyte values
• ***low urine output <ml/hr
• ***elevated b/p, BUN, serum creatinine
• inform bout nasuea & vomitng
• give antimetics before & during admin
• assess oral mucosa for drying, redness, swelling, lesions, ulceration, viscous(sticky)saliva, white patches

• outpt
• keep all appt
• what actions to take b/c of hair loss, usually grow back in 4-6mon, but diffrant color texture
• diet- eat sm. frequent meals, slow, eat cool bland & liquids, avoid hot/very cold, foods high in fiber & fat, spicy & caffine
• increase fluid 2500-3000ml/day
• report high wt loss/gain, LOC, weakness, ataxia, parathesia, siezures, headache, muscle cramps/twitching, nausea, vomiting, diarrhea

pt could suck on hard candy during chemo to reduced bitter/metallic taste

• when cancer sensitie to high doses of chemo & radiation
• stem cells refer to young immature cells called hematopoietic(blood forming) stem cells
• used to replace bone marrow destroyed by cancer or cancer tx
• new stem cells develope into healthy blood cells settling in bone marrow and producing new cells process called engraftment
• adults stem cells obtained from bone marrow or peripheral blood
• for children stem cells obtain from umbilical cord blood

• comes from pt. either from bone marrow or blood
• stem cells removed before tx and frozen to be reinfused after cancer treatment complete
• pt. doesnt need immunosuppressant drugs
• risk that tumor cells may be present in stem cells and blood may be tx with chemo before infusion

• uses stem cells from doner whose tissue matches pt.
• doner stem cells produce immune cells that can destroy any remaining cancer cells
• engraftment may not occur
• pt. prone to infection carried by doner
• other risk is graft vs. host disease (gvhd)-doner cells make new cells that attack the pt.'s body
• used for cancer effecting blood (leukemia and other bone marrow disorders)

• reduced/intensity transplant a.k.a none- myelo avlative transplant or mini transplant
• has lower doses of chemo/radiation
• most effective in pt. whose disease is slow growning and less extensive

• rare b/c only possible if pt. has identical twin
• doesnt cause dvhd
• however all cancer cells must be destroyed before transplantation b/c doner stem cells cant destroy remaining cancer cells

• before procedure
• asses physical condition organ function nutritional status complete blood studies (hiv,hep,CMV) and cycle social status
• chemo and radiation
• b/c stem cells takes long to multiply (2-6 weeks) has no way to fight infection
• pt. @ risk for bleeding renal complications and liver damage

• after
• monitior pt. for 3 mon.
• get blood counts back to normal may take 6/12 mon
• infection DHVD possible
• asses pt.'s cyclogical status (pt. gets mood swins and needs support)

• assess nutirtional status
• monitor S/S of infection & renal insufficient, GVHD-irritability,pulmonary infiltration, hep, enlargment spleen& lymphnodes, anemia, sepsis, diarrhea, macularpaular rash, skin desquamation
• special precaution(isolation)
• assess w/ hygiene
• review info rt prevention of infection, signs of rejection, importance of follow-up appt. med. regimen, meds info, dietary needs
• encourage to discuss emotional needs
• provide info on recovery & status recuperation

• uses pt own immune system
• body's natural immunity, process of surveillance, recognition, & attack of foreign cells is a defence of cancer
• purpose is 2 manipulate natural immune response by restoring, modifying, stimulating, or augmenting natural defenses
• not used till after surgery, radiation, chemo hasnt worked

• 3 types of immunotherapy
• *non-specific- tx of local melonoma & bladder cancer, cytokines also stimulate immune sytem & inhibits growth, SIDE EFFECT- flu-like symptoms, GI disturbances, alopecia, low blood counts
• *monoclonal antibody- to purge remainig tumor cells from blood or bone marrow, used in tx of hodgkins lymphoma, breast cancer, & some leukemias

• cancer vaccines
• for HPV

• temp. greater then 106.7 to destroy tumor cells
• heat in form of radio waves, ultrasound, microwaves, magnetic wav, hot water baths, hot wax
• method for delivery is extracorporeal circulators, probes, infusion

• reason for high temps.
• *malignant cells cant repair self
• *tumor cells lack blood supply to give the increased need 4 oxygen req. during hyperthermia
• *hyperthermia stimuates immune system
• *tumor blood vessels indequate 4 dispersing heat

pt may get local burns & tissue damage, electrolyte imbalance, fatique, GI disturbance, & neuropathies

• photoactive drug via IV
• then laser light activates drug & destroy tumor cells, minimal damage to healthy tissue
• req. pt to protect eyes, & skin from sunlight & bright indoor light 4 @least 30 days after getting porfimer,
• if failure to comply pt may req. hospitalization to tx pain, dehydration, & local skin care
• used for lung cancer

• replacing altered genes w/ correct genes, inhibiting defective genes & introducing substance that destroys genes & cancer cells
• used for tx of brain tumors, melanoma, & renal, breast, ovarian, lung, & colon cancer

many types of cancer cells need a anti-cell-death molecule called (BCL-2) to survive

• phase 1- tx give to sm. group 2 determine doses, schedule, & toxicity
• phase 2- tx given to lrg group, 2 check effectiveness w/ specific cancer & to get better info about dosing, side effects,
• phase 3- if tx effective in phase 2 then larger group
• phase 4- further testing & new tx 4 other uses, dosing, & toxicity

• complimantary & alternative therapies
• imagery, meds, special diet, spiritual approaches