medical surgical RLE

CANCER q Thickening or lump in breast or elsewhere

q A disease caused when cells divide q Indigestion or difficulty swallowing
uncontrollably and spread into surrounding q Obvious change in wart or mole
tissues. q Nagging cough or hoarseness

ONCOLOGIC TERMINOLOGIES CHEMOTHERAPY

q Benign neoplasm: A harmless growth that does q an aggressive form of chemical drug therapy
not spread or invade other tissues meant to destroy rapidly growing cells in the
body.
q a systemic treatment and is often used in
combination with other therapies, such as
surgery, radiation, or hormone therapy.

GOALS OF CHEMOTHERAPY
a. CURE
q Neoplasia: Abnormal cellular changes and q chemo is used to cure cancer, meaning that the
growth of new tissues. cancer is destroyed – it goes away and doesn’t
come back.
b. CONTROL
q chemo is used to shrink tumors and/or stop the
cancer from growing and spreading
c. PALLIATION
q to reduce symptoms or improve comfort
q For example, anti-nausea treatments or pain
medicines are palliative, and can be used at all
stages of treatment

q Dysplasia: change in cell shape, size and IT IS RECOMMENDED WHEN:

organization q Disease is widespread
q Hyperplasia: increase in cell number q Tumor cannot be resected and is resistant to RT
q Hypertrophy: increase in cell size
q Metastases: spread of cancer cells to distant OBJECTIVE OF CHEMOTHERAPY
parts of the body to set up new tumors ü To destroy malignant tumor cells without
q Adenocarcinoma: cancer that arises from excessive destruction of normal cells.
grandular tissues. Examples: cancer of the
breast, thyroid, and pancreas. TYPES OF CHEMOTHERAPY TREATMENT
q Sarcoma: a cancer of supporting or connective 1. Neoadjuvant Chemotherapy
tissues such as cartilage, bones, muscles or fats. q Delivered before surgery with the goal of
q Carcinogens: factors associated with cancer shrinking a tumor or stopping the spread of
causation, eg. Radiation, chemicals, viruses, cancer to make surgery less invasive and
physical agents. more effective.
2. Adjuvant Chemotherapy
WARNING SIGNS OF CANCER q Administered after surgery to kill any
q Change in bowel/ bladder habits remaining cancer cells with the goal of
q A sore that does not heal reducing the chances of recurrence.
q Unusual bleeding or discharge

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3. Palliative Chemotherapy q Cell cycle time: the time required for one tissue
q Treatment designed for terminal cancer cell to divide and reproduce two identical
patients to prolong survival and ease daughter cells.
symptoms but not cure disease. q It has FOUR distinct phases
A. G1 PHASE- RNA and protein synthesis (8 or
USES OF CHEMOTHERAPY more hours);
1. Lower the total number of cancer cells in the B. S PHASE- DNA synthesis (6-8 hours)- genetic
body information could be duplicated and passed on to
2. Reduce the likelihood of cancer spreading succeeding generations/ DNA makes a copy of
3. Shrink tumor size itself during cell division.
4. Reduce current symptoms C. G2 PHASE- pre-mitotic phase; DNA synthesis is
5. After surgery or remission, to remove any complete; mitotic spindle forms (2-5 hours)
remaining cancer cells and delay or prevent a D. MITOSIS – cell division occurs
recurrence G 0- resting or dormant phase
6. To slow disease progression and reduce
symptoms in the later stages, even if a cure is ADDITONAL EXPLANATION
unlikely A. G1 PHASE- post mitotic phase during which RNA
and protein synthesis are increased and cell
CHARACTERISTICS OF CHEMOTHERAPY growth occurs
q It affects both normal and cancer cells. It disrupts B. S PHASE- nucleic acids are synthesized and
cell function and division by destroying rapidly chromosome replicated in preparation for cell
dividing cells like mucous membrane, blood cells, mitosis
hair follicles, skin cells. C. G2 PHASE- RNA and protein synthesis occur like
q It has FRACTION CELL-KILL. Only a certain g1 (PMAT)
number of cancer cells are killed with each course D. MITOSIS – cell division occurs
of chemotherapy. Thus, it must be given in series G 0- resting or dormant phase – dangerous cells are not
and repetitive cycles of therapy are necessary. actively dividing but have potential to replicate
q It may be: The administration of certain chemotherapeutic agents is
o CELL- CYCLE SPECIFIC (CCS): may destroy coordinated with the cell cycle
cancer cells at specific stage of cell division.
o CELL-CYCLE NON- SPECIFIC: may destroy CELL KILL AND CELL CYCLE
cancer cells at any stage of cell division q Only 20 to 99% of tumor cells are destroyed
q Most sensitive to chemotherapeutic agents:
actively proliferating cells within a tumor
q Least sensitive to chemotherapeutic agents:
non-dividing cells

ANTINEOPLASTIC AGENTS
I. CELL-CYCLE NON-SPECIFIC
A. Alkylating agents
Mechanism of Action: It damages the DNA of cancer
cells and prevent them from dividing.
Uses: Multiple Myeloma, Sarcoma, Hodgkin’s Disease,
CELL CYCLE Lung Cancer, Breast Cancer, Ovarian Cancer

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EXAMPLES: NORMAL Ca, normal P?

Chlorambucil, Cyclophosphamide(Cytoxan), Cisplatin,
Musulfan,Ifosfamide, Thiotepa, mechlorethamine HCL
(Mustargen), Carboplatin, Dicarbazine, Melphalan II. CELL CYCLE- SPECIFIC

COMMON SIDE EFFECTS: Bone marrow suppression, A. Anti-metabolites

n/v, alopecia, cystitis, stomatitis Mechanism of Action: Replaces structures in the DNA of
cancer cells and alter the function of enzymes within the
cell.
USES: Breast Cancer, Leukemia, Ovarian Cancer,
Gastrointestinal Cancer
EXAMPLES: Azacitidine, Cytarabine, Gemcitabine,
Clofarabine, Floxuridine, Edatrexate Fludarabine, 5-
Fluorouracil (5-FU), FUDR, Hydroxyurea, Leustatin, 6-
Mercaptopurine, Methotrexate, Pentostatin,
6-Thioguanine.
SIDE EFFECTS
q n/v, diarrhea, bone marrow suppression,
stomatitis, renal toxicity, hepatoxicity,
q Ulcers, Loss of appetite, Hair loss, Fatigue,
Fever, Low white blood cell count, Pancreatitis

B. Topoisomerase inhibitors- -
B. Anti- tumor Antibiotics Mechanism of Action: blocks cancer cells from dividing
Mechanism of Action: interferes with DNA and RNA and spreading by interfering with enzymes called
synthesis; Works by uncoiling strands of DNA inside topoisomerases.
cancer cells and preventing them from replicating. Uses: Leukemia, Pancreatic Cancer, Ovarian Cancer,
Uses: Lung Cancer, Colorectal Cancer, Ovarian Cancer, Gastrointestinal Cancer, Lung Cancer
Prostate Cancer Examples: Irinotecan, Topotecan, Teniposide
EXAMPLES: Doxorubicin(Adriamycin), Dactinomycin, SIDE EFFECTS: bone marrow depression, Anemia
Bleomycin, Mitoxantrone, Daunorubicin, Idarubicin, Neutropenia, Thrombocytopenia
Mitomycin, Plicamycin diarrhea, n/v, hepatoxicity
SIDE EFFECTS: Mouth sores, Fatigue, Less appetite,
N/V, bone marrow suppression, alopecia, cardiac toxicity

C. HORMONAL AGENTS
Mechanism of Action: Inhibits RNA synthesis
USES: breast, endometrial or prostate cancer,
Examples:
1. Glucocorticoids: Prednisone, Methylprednisone
(Solu-Medrol, Medrol)
2. Anti-estogens: Tamoxifen (Nolvadex)
3. Nitrosoureas: Carmustine (BCNU), Lomustine (CCNU),
Streptozocin (zanosar)
SIDE EFFECTS: Hypercalcemia, sodium and fluid
retention, n/v hot flashes, jaundice

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c. Mitotic inhibitors/ Anti- microtubule agents/Mitotic 2. TOPICAL

Spindle Poisons- q ex. Fluorouracil cream (treats actinic keratosis)
Mechanism of Action: Prevents cancer cells from q Commonly prepared as ointments, and usually
replicating by inhibiting enzymes the cells need to make used to treat sun cancers.
certain proteins.
Uses: Breast Cancer, Lung Cancer, Myeloma, Lymphoma,
Leukemia
Examples: Cabazitaxel, Docetaxel, Vinorelbine,
Vinblastine, Vincristine, vindesine, etoposide, teniposide,
paclitaxel, docetaxel
Side Effects: Bone marrow suppression, neuropathies,
stomatitis, bradycardia, alopecia

NEUROPATHY, a result of damage to the nerves outside

of the brain and spinal cord (peripheral nerves), often
causes weakness, numbness and pain, usually in your
hands and feet. 4. INTRA-ARTERIAL
q done for cancer in the intraabdominal area eg.
Routes of Administration Ovarian cancer
q Direct administration of agents into the peritoneal
1. INTRAVENOUS CHEMOTHERAPY cavity.
q Venous Access Device (VAD): is a surgically q It allows ovarian or colorectal cancers to be
implanted device that provides continuous 'bathed' in high concentrations of antineoplastic
chemotherapy, for administration of parenteral agents.
fluids, antibiotics
q Ex. Subcutaneous implanted ports (port-a-cath).
q Complications; infection and obstruction

5. INTRATHECAL
q Agents are administered directly into the
cerebrospinal fluid, via lumbar puncture
usually as prophylaxis in leukemia or lymphoma.

5. INTRAPLEURAL

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q Direct administration of agents into the pleural q Clearly label the hanging IV bottle with
cavity. “ANTINEOPLASTIC CHEMOTHERAPY”
q It allows treatment of malignant effusions, which q Contaminated needles and syringes must be
may be associated with lung, breast, prostate, disposed in a clearly marked special container
gastrointestinal and ovarian cancers. q Dispose half- empty ampules, vials, IV bottles by
putting into plastic bag, seal and then into another
plastic bag or box, clearly marked before placing
for removal. Label as “Hazardous waste”
q Items soiled with body fluids should be kept in
plastic bags until washed.
q Temperature of water when washing: HOT!
q Pregnant women should not come in contact with
medications or body fluids.
6. INTRAVESICAL q Use wet cotton pledgets, wrap around ampules or
q Administration of agents directly into the bladder vials when breaking or withdrawing the drug
to treat superficial cancer of the bladder. q Wipe external surfaces of syringes and IV bottles.

7. ORAL
q Disadvantages: not monitored as intensively,
noncompliance, possibility of under- or
over-dosing,
NURSING INTERVENTIONS FOR SIDE EFFECTS
Generalized 1. Encourage several rest
Fatigue, lack of periods
energy 2. Increase night time sleep-
3. Cluster, rearrange and
organize daily activities.
4. Consume a well-balanced
SAFE HANDLING OF CHEMOTHERAPEUTIC diet with adequate calorie,
AGENTS protein, iron, and vitamins
q Perform hand hygiene before and after handling and stay adequately
all medications. hydrated at all times.
q Wear mask, eye shield, gloves and back- closing 5. Engage in light exercise as
gown. tolerated throughout the
q Skin contact with drug must be washed week
immediately with soap and water. Eyes must be
flushed immediately with copious amount of H2O.

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Bone marrow Neutropenia: blood cells in your body. Because of this, it will be
suppression q Protect from infection extra hard for your body to fight off germs during this
q Report s/s of infection: time.
q Avoid people with infection § This period of time is sometimes referred to as nadir,
q Place in private room if WBC which means “lowest point.”
count is <1,000/cu.mm § For example, if you have chemotherapy on August 7,
q Report changes in urinary you are at highest risk of picking up an infection
frequency, burning, diarrhea, between August 14 and August 19. This period varies
q Check VS every 4 hours slightly depending upon the chemotherapy drug, or
q Monitor WBC count each day combination of drugs, used.
q Inspect all sites as entry
ports for pathogens (IV sites, THROMBOCYTOPENIA
wounds, skin folds, bony 1. No contact sports or activities
prominences, perineum and 2. Blow nose gently.
oral cavity 3. Any falls with head trauma must be evaluated by
q Change IV sites , all clinician due to risk for hemorrhage in the brain.
solutions every other day or 4. Avoid blood thinners:
every 48 hours 5. Do not use any rectal suppositories
q Obtain C and S 6. avoid dental work.
q Avoid rectal or vaginal 7. Use emery board for nail care
procedures (rectal temp, 8. Avoid IM , use smallest needle
suppositories, vaginal 9. Apply direct pressure to injection and
tampons) venipuncture sites for at least 5 mins
q Use stool softeners 10. Maintain fluid intake at least 3L/24 hours unless
q Instruct to use electric razor contraindicated.
q Avoid fresh fruits, raw meat, NORMAL PLATELET COUNT: 150,000 to
fish and vegetables 450,000 platelets per microliter of blood.
q Avoid IM injections
Thrombocytopenia WHEN PLATELET IS LESS THAN 20,000/mm3
q Assess for bleeding q Bed rest with padded side rails
q Protect from trauma q Avoidance of strenuous activity
q NADIR. q Platelet transfusions as prescribed
q May require platelet q Administer diphenhydramine hydrochloride
transfusion when count is < (Benadryl) or hydrocortisone sodium succinate
20,000mm/m3 (solu-cortef):
q monitor for signs of bleeding
or easy bruising.
q Use a soft toothbrush and
avoid flossing
NADIR
§ Chemotherapy treatment will usually involve a
number of chemotherapy doses (sometimes called
cycles).
§ The period of time beginning 7–12 days after you
finish each chemotherapy dose—and possibly lasting
up to one week—is when you have the fewest white

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Integumentary 1. Provide good skin care 7. Lubricate scalp with vitamin A and D ointment
dermatitis/skin rash, 2. Avoid cosmetics, 8. Instruct to use hat when in the sun.
folliculitis, urticaria, perfumes, lotions,
pruritis, nail changes, ointments, deodorants STOMATITIS
hyperpigmentation, 3. Use lukewarm water to 1. assess oral cavity daily
bathe the area 2. instruct to report oral burning, pain, areas of
4. Avoid scratching or redness, open lesions of lips associated with
rubbing the area swallowing or decreased tolerance to
5. Avoid exposing the area temperature extremes of food
to sunlight or cold 3. Brush with soft-bristled toothbrush; use
weather non-abrasive toothpaste after meals and bedtime
6. Avoid tight clothing 4. Floss every 24h unless painful or platelet count
7. Apply vitamin D and A falls below 40,000 cu/mm
ointment to area : a 5. prepare homemade mouth rinse by mixing 1 cup
moisturizer to treat or of warm water with 1⁄2 teaspoon of salt or baking
prevent dry, rough, soda.
scaly, itchy skin and 6. Avoid commercial mouthwashes: Rinse mouth
minor skin irritations with half strength peroxide and NSS
8. Use mild, moisturizing
soap MILD STOMATITIS: generalized erythema, limited
ulcerations, small white patches
Folliculitis q Use NS mouth rinses every 2h while awake; every 6h
q a common skin condition in which hair follicles at night
become inflamed. q Remove dentures except for meals
Dermatitis q Apply lip lubricant
q a general term for skin inflammation. q Avoid foods that are spicy or hard to chew and those
With dermatitis, your skin will typically look dry, with extremes of temperature
swollen, and red.
Hives SEVERE STOMATITS: ulcerations with bleeding and
q also known as urticaria, are itchy, raised welts white patches covering more than 25% of oral mucosa
that are found on the skin. q obtain tissue samples for C/S
q They are usually red, pink, or flesh-colored, and q assess ability to chew and swallow
sometimes they sting or hurt. q Use oral rinses as prescribed or place patient on
q In most cases, hives are caused by an allergic side and irrigate mouth
reaction to a medication or food or a reaction to q Remove dentures
an irritant in the environment. q Use lip lubricant
q provide liquid or pureed diet
ALOPECIA q to minimize discomfort, diphenhydramine and
1. Hair loss usually begins about 7-15 days after the dyclonine as ordered
first dose.
2. avoid harsh shampoos or soaps on bare scalp Gastrointestinal 1. Administer anti-emetics 30-60
3. Reassure it is temporary Nausea, vomiting, min before chemotherapy as
4. Encourage to wear wigs, hats or head scarf anorexia, diarrhea, prescribed.
5. Use mild shampoo and conditioner constipation 2. small, frequent high-calorie
6. Avoid excessive combing; use wide-toothed and high-protein
comb meals/shakes and

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supplements Neurologic: 1. encourage all patients to

3. Avoid foods that are spicy, Peripheral report any symptoms to
greasy or have strong odors. neuropathy,, ensure proper assessment
4. Stay adequately hydrated at ototoxicity and management.
all times. 2. Wear closed toe footwear with
5. Add electrolyte sport drinks for rubber soles,
oral rehydration 3. Place non-slip mats in
6. Report foul-smelling, bathroom,
continuous, liquid stools 4. consider use of cane or other
7. Avoid unpleasant sights, mobility devices to steady
odors during mealtime oneself when walking.
8. Take loperamide (Imodium) 5. Take caution not to cut or burn
for diarrhea (if approved by oneself when preparing and
provider). cooking food, or when
9. For constipation, increase handling hot water/coffee.
dietary fiber and add stool 6. Make sure the water
softener, such as Docusate temperature is not too hot
Sodium (Colace) or laxative, while washing dishes or
such as Senna (Senokot) as bathing.
needed. Cardiovascular: 1. report any symptoms of
10. Eat with plastic utensils to help Weakening of heart shortness of breath, leg
reduce any metallic taste in muscle, heart swelling, chest pain, chest
the mouth. failure, peripheral tightness, or finger swelling.
11. To preserve the integrity of edema 2. Mild leg swelling induced by
oral mucosa, patients should chemotherapy can be
rinse mouth with salt water managed with elevating legs
(normal saline solution) often, above heart level and
especially before and after reducing dietary sodium/salt
meals to keep mouth clean. intake
12. Consider cold foods if desired.

DIGITALIS IS SAFE WITH:

q Adriamycin (chemical name: doxorubicin)
q carboplatin (brand name: Paraplatin)
q Cytoxan (chemical name: cyclophosphamide)
q daunorubicin (brand
names: Cerubidine, DaunoXome)

Vascular: Phlebitis, 1. discoloration and erythema at

Infiltration, the intravenous site is
Extravasation common.
2. Mild discomfort can be
managed by applying warm
packs to the affected site for
15 minutes, 4 times daily.
3. Veins may at times become

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permanently damaged and 2. Water-based moisturizers may

scarred due to chemotherapy. be used for vaginal dryness.
4. Immediately report pain, 3. Wear cotton underwear,
burning, swelling, or other
abnormal sensation at the IV
site.

Pulmonary: 1. Immediately report any Psychiatric: 1. Active listening and empathy

pneumonitis, shortness of breath, fever, Anxiety, 2. Encourage verbalization of
pulmonary edema productive cough with pink/red depression, anger, feelings, regarding body image
mucus, difficulty taking a deep fear, grief/loss, and self-esteem
breath, feeling easily winded, body image 3. Encourage participation of
or feeling like you are ‘under distortion family in tx
water’. 4. The nurse should assess
Management: patient needs and connect to
1. High flowlers: and coordinate referrals to
2. 02 therapy psychosocial services as
3. Aminophylline iv as ordered appropriate:
4. Diuretics as ordered (monitor psychiatrist/psychologist,
serum k) therapist, or social workers.
5. Morphine sulfate (10-15mg iv 5. Assist in self-care when
as ordered) fatigue, lethargy, n/v, and
Reproductive/Sexua 1. Discussions regarding fertility other s/s that prevent
lity preservation (egg harvesting independence
Infertility, loss of or sperm banking) occur prior 6. Assist patient in selecting
libido, impotence, to starting treatment; make scarves, hair pieces and
erectile referrals to fertility clinics and clothing to increase
dysfunction, specialists as indicated. attractiveness
amenorrhea, early 2. Patients should be told to 7. The patient should consider
menopause engage in safe sex practices, complementary and
such as use of a barrier alternative medicine
method (i.e. condom) to avoid modalities to reduce anxiety
exposure to partners during (i.e. imagery, relaxation,
intercourse and prevent 8. The patient should also
pregnancy while on consider joining a support
chemotherapy. Chemotherapy group.
can induce significant harm to 9. Antidepressants and
the fetus. anxiolytics may be offered.
3. Patients should speak openly 10. Light physical exercise can
with their partner about sexual help improve mood through
problems and fears. endorphin release.
Females: Reiki
1. avoid douching, as well as § A Japanese energy healing technique
using soaps, bubble bath and § It was developed in Japan by Mikao Usui in the
creams 1920s.

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§ In Japanese, “reiki” means universal life energy. 2. TUMOR LYSIS SYNDROME

q Destruction of large number of malignant cells
ADVERSE REACTIONS TO CHEMOTHERAPY may rapidly release intracellular K, P into
I. HYPERSENSITIVITY REACTIONS circulation
q Dyspnea, chest tightness or pain, pruritus, q True for Malignancies that are responsive to
urticarial, tachycardia, dizziness, anxiety, Treatment like lymphomas, leukemias and small
agitation, inability to speak, nausea, hypotension, cer carcinoma
cloudy mental status, flushed appearance, 3. SYNDROME OF INAPPROPRIATE ANTIDIURETIC
cyanosis HORMONE
IF ANAPHYLACTIC REACTION OCCURS q Caused by antineoplastic agents like Cytoxan
q Stop drug administration (cyclophosphamide), oncovin (vincristine),
q Maintain IV access with 0.9 % NS (NaCl) velban (Vinblastin), Cisplatin
q Keep an open airway
q Keep client in modified Trendelenburg position
(supine with legs elevated at 20 to 30 degrees
unless contraindicated: to increase venous return
to the heart, increase cardiac output and improve
organ perfusion
q Notify physician
q Monitor VS until stable
q Administer epinephrine, aminophylline,
diphenhydramine and corticosteroids as
prescribed.
q Extravasation (from vesicants): SIGNS: pain, MANIFESTATIONS
erythema, swelling and lack of blood return § Edema, weight gain
q Escape from veins § neurologic symptoms
q Cause or form blister and cause tissue necrosis § including headache, changes in mental status or
q Ex. Adriamycin (doxorubicin), oncovin personality, lethargy and irritability,
(vincristine) § Urine specific gravity: < 1.010
q Can cause venous pain at site and along vein.
MANAGEMENT
ü Interventions § Monitor I and O, weigh daily
o Administration is stopped STAT § Assess skin turgor every 8 hours
o Leave needle in place and attempt to aspirate § IV hypertonic saline (3 to 5%) to prevent
any residual drug from tubing, needle and site pulmonary edema
o Then remove the needle § Diuretics: furosemide
o Apply warm or cold compress (Ice) § Demeclocycline (Declomycin): DOC
o Document appearance of the site before and
after chemotherapy

ONCOLOGIC EMERGENCIES
1. INFECTION AND PAIN
q Infection arises from neutropenia

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