Session 6: Oncology

Oncology

 

Review:

  • uncontrolled proliferation of cells in the body
  • Grade is the size of the tumor
  • Stage is the process for no metastasis to fully metastasized
  • Treatments: chemo, Radiation, biological (targeted), and surgery
  • Late vs. long term effects

 

  • be empathetic
  • When giving chemo, watch closely for extravasation.
    • If the medications given outside of the vessel the medication can cause major damage to the tissues.
    • If the med is given through a central line make sure the catheter is advanced the correct amount and not slid out at any point.
  • Radiation can cause burns to the skin and structures inside the body nearby the cancer location
    • Maintain skin integrity
    • Radiation can be external or implanted “seeds” for prostate cancer.
  • Biological targeted therapy
    • This type of therapy is often used first due to the higher specificity to the patient’s cancer and also tends to have fewer side effect.
  • ANC absolute neutrophil count
    • Important to keep a close eye on this during chemo because the level can drop rapidly.
    • Graded 1-4. 4 being the worst.
  • Oncologic emergencies
    • Sepsis
      • Temp above 100.4 degrees F
      • WBCs above 12000 or less than 4000
    • DIC
      • Monitor platelets, a drop indicated potential for DIC
    • SIADH
      • The tumor can produce ADH which causes retention of water.
      • Tumors can produce other hormones as well, but ADH is common and causes immediate issues.
      • These patients need to be on a water restriction.
      • Demecolcine can decrease the action of the ADH to help the patient urinate, and balance out their I’s and O’s
    • Spinal cord compression
      • Monitor for back pain which could be caused by a tumor pressing on the spinal cord
      • Treat immediately and this could cause paralysis
    • Hypercalcemia
      • A hormone similar to PTH can be secreted by cancer cells causing increased CA levels
    • Superior vena cava syndrome
      • The SVC is compressed be a tumor and the tumor must be removed to restore normal flow.
    • Tumor lysis syndrome
      • HyperK Ca phos, and uricemia
      • From the breakdown of a large number of tumor cells
  • Leukemia
    • Cancer of the blood cells usually white blood cells, and blood forming structures
    • This includes bone marrow, which will proliferate immature WBC’s
  • Lymphoma
    • Cancer of lymphocytes that also originate in the bone marrow.
    • Hodgkin’s disease – Reed-Sternberg cells
      • Most curable cancer
      • Lymph Nodes most commonly inflamed first, are around the neck and clavicles.
      • B symptoms indicate the progression of the disease from local to systemic.
        • The symptoms are: Fever, night sweats and more than 10% weight loss in less than six months.
    • Non Hodgkin’s Lymphoma –
      • Classifies all other lymphoid cancers without Reed-Sternberg cells.
      • Hallmark is painless enlarged node.
      • Full remission is uncommon.
      • B symptoms indicate the progression of the disease from local to systemic.
        • The symptoms are: Fever, night sweats and more than 10% weight loss in less than six months.
  • Multiple Myeloma
    • Proliferation of Plasma cells affecting the bone marrow and destroy bone
    • Treatable but not often curable.
    • First s/s is BONE PAIN, Pathologic fractures are common
    • Diagnosis with Monoclonal antibody, X-ray, increased bone marrow plasma cells, Beta 2-microglobulin and albumin.
    • Signs and symptoms – Babs the CRAB: HyperCalcemia, Renal failure, Anemia thrombocytopenia, and Bone pain
    • Hypercalcemia is due to high bone turnover causing pathological fractures
    • Renal failure is due to Monoclonal production of Ig
    • Anemia is due to the resources going to make cancerous plasma cells instead of regular RBCs and thrombocytes.
    • Bone pain is due to increased bone turnover

 

  • HACT
    • Replacing stem cells in a patient
    • Autologous Transplant is where the patient’s own bone marrow stem cells are collected, the patient goes through chemo and/or radiation, then the stem cells are put back so that they can start making blood cells again.
    • Allogeneic transplant is where a donor provides the bone marrow Stem cells for the patient.  
    • Prepare with immune protective measures
    • Bone marrow is stripped then replaced with healthy stem cells
    • The donor cell can be auto which means the donor is the patient previously, or
  • AML
  • Case 3 multiple myeloma
    • Leaking kidneys
    • Thirst
    • Creatinine

Multiple myeloma specific findings: high calcium levels and hence-jones protein in the urine

  • high priority – maintain high fluid intake to dilute calcium of 3-4L per day
  • Limiting movement will increase risk for pathological fractures

 

GM-CSF

  • can stimulate the production and function of neutrophils and monocytes

Leukemia patients are susceptible to infection even when they have a high white count because there is a left shift in the white cells and they are immature

 

Chemo induced anemia can cause activity intolerance due to hypoxia.

 

Stomatitis should be treated with a soft non irritating toothbrush and mouthwash to prevent further breakdown of the mouth.

 

Leukemia and bone marrow stem cells are eliminated in chemo and radiation for AML then a donor replaces the bone marrow stem cells through a transfusion

 

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