Cancer
A. Manifestations Suggesting Malignant Disease (ACS 7 Warning Signs) - Client-Teaching
mnemonic: "CAUTION"
1. Change in bowel or bladder habits
2. A sore that does not heal
3. Unusual bleeding or discharge
4. Thickening or lumps in breast or elsewhere
5. Indigestion or difficulty swallowing
6. Obvious change in wart or mole
7. Nagging cough or hoarseness
B. Cancer Therapy
1. Objective: to cure the client and to ensure that minimal functional and
structural impairment results from the disease; if cure is not possible:
a. Prevent further metastasis
b. Relieve manifestations
c. Maintain high quality of life as long as possible
2. Surgery
a. Radical
b. Prophylactic
c. Palliative
3. Chemotherapy
a. Drugs interfere with cell division; combination of drugs usually given
b. Common side effects and interventions to counteract and cope with
them
1. Bone marrow depression: some is expected or drug is not
working
a. Leukopenia (decreased WBCs): measures to prevent
infection; may need protective isolation; nadir: lowest
WBC count; monitor WBC routinely; administer
filgrastim (granulocyte colony-stimulating factor;
GCSF) (Neupogen) to stimulate proliferation of white
blood cells
b. Anemia (decreased RBCs): care with activities;
oxygen as needed; iron-rich foods; transfuse as
needed; administer epoetin alfa, erythropoietin
(Epogen) to enhance the rate of RBC production
c. Thrombocytopenia (decreased platelets): prevent
injury; watch for covert bleeding, transfuse as needed
2. Alopecia: prevent if possible; help with body image changes;
hair will return after therapy but may be a different color or
texture
3. GI tract problems: antiemetic medication prior to treatment;
diet as tolerated; high-calorie supplements; small, frequent
feedings; causes stomatitis so mouth washes are important
as well as nonirritating foods and dental care; antidiarrheal
medication or stool softeners may also be needed
4. Elevated uric acid, crystal and urate stone formation:
allopurinol (Zyloprim) therapy; increase fluid intake
5. Emotional concerns: support client and family; support
groups; help to live with this chronic disease
Drugs
A. Specific drugs have specific toxic effects; most important are:
1. Doxorubicin hydrochloride (Adriamycin): irreversible cardiomyopathy
2. Cisplatin, cisplatinum (Platinol): renal toxicity
3. Vincristine sulfate (Oncovin): peripheral neuropathy
B. Classification of drugs
1. Alkylating agents: uracil mustard (Nitro-gen mustard),
cyclophosphamide (Cytoxan)
2. Antimetabolite: fluorouracil (5-FU), methotrexate (MTX) (Folex)
3. Antibiotics: doxorubicin hydrochloride (Adriamycin), bleomycin
(Blenoxane), dactinomycin (Actinomycin D)
4. Plant alkaloids: vincristine (Oncovin), vinblastine (Velban)
5. Hormones: estrogen, progesterone, tamoxifen citrate (Tamofen)
6. Miscellaneous: procarbazine (Matulane)
4. Radiation
a. Purposes
1. Curative (Hodgkin's disease)
2. Palliative
b. Types
1. External: gamma rays
a. Nursing Interventions
1. Teach client about the procedure
2. Give antiemetic before treatment if nausea a
problem; prochlorperazine edisylate
(Compazine)] ondansetron (Zofran)
3. Give pain medication before treatment if needed
4. Provide psychological support
5. Provide skin care: dermatitis 3-6 weeks after
start of treatment; teach client to wash with
water; avoid lotions, powders, sunlight
6. Treat "wet" reaction: cleanse with warm water;
keep open; may use antibiotic cream
