Cancer

Treatments
Welcome to class!
TODAY'S AGENDA

Modalities commonly
used in Cancer
treatment:
• Surgery
• Radiation Therapy
• Chemotherapy
• Biotherapies
(HSCT,Hyperthermia, Targeted
Therapy, Hormonal Therapy)
Learning Objectives
• At the end of this section, the
students will be able to :
Outcomes: • List the most common types of
EXPECTATIONS AND OUTCOMES Cancer treatment
• Explain what is chemotherapy
• Differentiate the types of radiation
therapy
• Identify and differentiate the types
of HSCT
• Familiarize the S/E of Cancer
Treatments and nursing mgmt
Cancer
Treatment
BRIEF INTRODUCTION

What is the importance of

knowing these?
CA Treatments

Chemotherapy “Upera”/Surgery Radiation Therapy

Chemotherapy
involves the use Surgical removal Radiation kills
of antineoplastic of the entire rapidly dividing
drugs in an cancer remains cells thru DNA
attempt to destroy the ideal and most
frequently used damage which
cancer cells by leads to cell
interfering with treatment method.
cellular functions. death.
 CA Treatments
Hyperthermia Targeted Therapy

❑ Also “thermal Therapy” ❑ specifically target (like a

lock and key
❑ The generation of
temperatures greater mechanism) receptors,
than physiologic fever proteins, signal
range (greater than transduction pathways,
41.5 °C or 106.7 °F)
and other processes to
prevent the continued
growth of cancer cells
CA Treatments
HSCT(Hematopoietic Stem
Cell Transplantation) Hormonal Therapy
❑ The process of obtaining stem
cells and processed and The use of hormones in the
ultimately reinfused into the treatment of cancer.
patient as to treat
hematologic malignancies and
solid tumors.
 Understanding CANCER Treatment Deeper
Chemotherapeutic Agents
BROAD CLASSIFICATION:
• A. AGENTS THAT
INTERFERES WITH DNA
REPLICATIONS

• B. AGENTS THAT
INTERFERE WITH CELL
DIVISION BY BLOCKING
MITOSIS
 Understanding CA Treatment Deeper
AGENTS THAT INTERFERES WITH DNA
REPLICATIONS

Metals (Platinum Alkylating Agents

agents) • C – cyclophosphamide
• C - cisplatin (Cytoxan)
• O - oxaliplatin • A- alkeran
• C - carboplatin • L - leukeran
Chemotherapeutic • M - Myteran
Agents Anti-metabolites
• 5-Fluorouracil (5FU)
• 6MP
Antibiotics
• Methotreaxate
• Trimetreaxate • Doxorubicin(Doxil)
• Xeloda, Gemzar, Alimta

Topoisomerase Inhibitors

❑ Etoposide(VP-16)
❑ Irinotecan (Camptosar)
 Understanding CA Treatment Deeper
• B. AGENTS THAT
INTERFERE WITH CELL
DIVISION BY BLOCKING
MITOSIS

Chemotherapeutic
Agents

Mitotic Inhibitors

❑ Vincristine
❑ Vinblastine
❑ Taxol
❑ Onconin
❑ Velban
Understanding Chemotherapeutic Agents Deeper

SIDE EFFECTS NURSING INTERVENTIONS

•NAUSEA AND VOMITING Provide bland diet

Administer antiemetics (plasil, Reglan)
Withhold food/Fluid
Non-irritating /Non-
Spicy Foods
• 3A’s Health Teachings : Self-image, Banking
ALOPECIA, AMENNORHEA/AZOOSPERMIA, eggs/sperms, Dietary Modifications
ANOREXIA
• HEMORRHAGIC CYSTITIS
Fluid intake, Administer diuretics as ordered

• Bone Marrow Depression Reverse-isolation

(infection, bleeding, fatigue) Oxygen Therapy
Monitor for signs of Bleeding
Enforce CBR
 Administering Chemotherapy

✔ Check for HSRs : if it occurs D/C immediately

✔ Protecting Caregivers: Precautions and PPEs for HCP by the NIOSH
✔ Risk for EXTRAVASATION: preventive measures( skilled venipuncture,
careful admin., peripheral line use limited for less than 1 hour, use of
central lines or implanted catheters for frequent use)
• Extravasation Signs (absence of blood return
from IV cath, resistance to flow of IV fluid,
burning, pain , swelling, redness at site): STOP
LINE IMMEDIATELY
Understanding CA Treatment Deeper

Surgery

Palliative or
Diagnostic Primary Method –goal
reconstructive
Surgery or Biopsy is to remove as much as
feasible
• Excisional – small easily
accessible tumor
• Incisional – if tumor mass is Prophylactic
too large to be removed –involves removing
• Needle – to sample non vital tissues or
organs
suspicious masses
Understanding Surgery Deeper

COMPLICATIONS NURSING INTERVENTIONS

•Bleeding Shock Assessing the patient (airway, RR, CV

function, temp., skin color, LOC, ability to
• Infection respond to commands)

• Impaired wound Healing

• Altered Pulmonary or Renal Functions Maintaining patent airway

(Atelectasis)
Therapies in combination —
—
with Surgery or Radiation
Neoadjuvant therapy – A therapy (usually
chemo) given before surgery or radiation to
the primary cancer
Adjuvant therapy – A therapy (usually
chemo) given after surgery or radiation to
the primary cancer

Neoadjuvant therapy Surgery Adjuvant therapy

 Radiation Therapy

• Two Types of Ionizing radiation:

1. electromagnetic radiation ( x rays and

gamma rays)
2. particulate radiation (electrons, beta
particles, protons, neutrons, and alpha particles)

gray (Gy) - the unit of measure for

radiation doses ( 1 Gy = 100 rad)
 Radiation Therapy

• has immediate and delayed effects:

1. immediate - cell death

2. delayed - alteration of DNA, which

impairs the cells ability to reproduce

gray (Gy) - the unit of measure for

radiation doses ( 1 Gy = 100 rad)
Radiation Therapy: Caregiver Safety
 Radiation Therapy
• Two Types of Administering radiation:
1. TELETHERAPY (external beam radiation)
PATIENT PREPARATION:
● before the 1st radiation treatment, the patient goes through
a treatment simulation to determine the exact location to be
treated, various radiographs are taken then the radiation
therapist marks the skin over the area to be treated Photo source: National Cancer Institute

(radiation field)
● It is important to instruct the patient not to remove the
markings until given permission to do so by the
physician.
 Radiation Therapy
• Two Types of Administering radiation:
2. BRACHYTHERAPY (internal radiation), systemic(radioisotopes), and
contact or surface molds Photo source: National Cancer Institute

- sources may be either sealed ( e.i. cesium) the patient’s body fluids ,
as well as the objects patient touches, are not radioactive because the
radiation source is closed, however radiation is emitted from the
source while it is in the patient, safety measures must be in place

- or unsealed (additional considerations exists) wear gloves, use

disposable utensils, check equipment used for radioactivity before
removing from the room
Toxicity
Localized Radiation
Most often begins within
2 weeks up to 6 months
Therapy
Most affected: skin, Principles (brachytherapy)
epithelial linings of GI Time – 30 min per shift, 5 min per
procedure ( 6 visits/8 hr. shift)
tract, bone marrow
Distance – 3- 6 ft.
Shield – 3L’s (lead shield, lead container,
long forceps)
Position - CBR
Nursing Management
Radiation
Private room : 72 hrs. Therapy
Log-rolled
indwelling urinary
catheter
Low residue diets,
antidiarrheal agents
Limit visitors 6 ft.
Radiation Therapy
SIDE EFFECTS: NURSING IMPLICATIONS
Bone Marrow suppression schedule activities to prevent overtired, protect from
infection and injury. Watch for excessive bruising or bleeding.
Check results of blood tests. Report fever. Encourage use of
soft toothbrush and electric razor.

Alopecia Cover scalp with wig, cap, or Scarf if patient desires.

Refer to American Cancer Society for assistance with
hairpieces and help with styling and care.

Anorexia Schedule small, frequent feedings.

Respect patient preferences.

Xerostomia Promote frequent oral hygiene. Suggest artificial saliva

and ice chips. Monitor weight to assess nutritional state.
Encourage good dental care. Conduct mouth care per
protocol.

effects on reproduction Advise patient not to become pregnant during therapy or

for Specified time afterward. Physician may counsel
male patient about banking sperm.
Recap of Today's Class

CANCER COMMON TREATMENT

MODALITIES SURGERY

CHEMOTHERAPY RADIATION
 References:

Grossman, S.C. & Porth, C.M. (2014). Porth’s Pathophysiology: Concepts of

Altered Health States (9th ed.). Philadelphia: Wolters Kluwer.

Hinkle, J.L. & Cheever, K.H. (2018). Brunner & Suddarth's Textbook of
Medical-Surgical Nursing (14th ed.). Philadelphia: Wolters Kluwer.

Potter, P.A., Perry, A.G., Stockert, P.A., & Hall, A.M. (2017). Fundamentals of
Nursing (9th ed.). St. Louis: Elsevier/Mosby.

www.cancer.gov
 BIOTHERAPIES
AGENTS THAT WORK BY AFFECTING BIOLOGICAL PROCESSES
- INCLUDE IMMUNOTHERAPY, GENE THERAPY, AND SOME TARGETED
THERAPIES.
- HEMATOPOIETIC GROWTH FACTORS AND COLONY-STIMULATING FACTORS
(CSF)s
- CSFs stimulate the bone marrow to produce platelets, RBCs, WBCs in patients
receiving chemotherapy, this reduces the risk of infection by shortening the
period of neutropenia associated with chemotherapy
- Antibody therapy : monoclonal antibodies (mAbs)
- T cell therapy : CD19 chimeric antigen receptor T cells that target the tumor
cells in patients with non-Hodgkin lymphoma
 Targeted Therapy

• Examples include:
• Biological response modifiers(BRMs), monoclonal
antibodies (MAbs), several types of growth factor
and cytokines and gene therapy.(Eggert,2011)
There are different types of G-CSF, Examples of MABS that work in this way
including: include:

● lenograstim (Granocyte) ● rituximab (Mabthera) – a treatment for

● filgrastim (Neupogen, Zarzio, Nivestim, chronic lymphocytic leukaemia (CLL) and
Accofil) some types of non Hodgkin lymphoma.
● long acting (pegylated) filgrastim ● cetuximab (Erbitux) – a treatment for
(pegfilgrastim, Neulasta, Pelmeg, advanced bowel cancer and head and
Ziextenco) and lipegfilgrastim (Lonquex) neck cancer.
● trastuzumab (Herceptin) – used to treat
breast cancer and stomach cancer.
 Targeted Therapy

Inhibits proteins that are overexpressed and helping

the cancer to grow – this makes the therapy more
“cancer specific”
Ex. VEGF(Vascular Endothelial Growth Factor):
Bevacizumab(Avastin), Cyramza
EGFR (Epidermal growth factor receptor):Tarceva, Afatinib, Iressa,
Erbitux
HER2 :Herceptin, Perjeta, Kadcyla, Tykerb
ALK(Anaplastic lymphoma Kinase):Xalkori
mTOR(mechanistic target of rapamycin):Afinitor
CDK(cyclin dependent kinase 4 and CDK6):Ibrance
 Biotherapy and Nursing Implications
SITE SIDE EFFECTS NURSING IMPLICATIONS
GENERALIZED FLU LIKE SYMPTOMS: FEVER, CHILLS, S/E MAY MASK SIGNS AND SYMPTOMS
MUSCLE ACHES, SEVERE FATIGUE, OF INFECTION, SO ASSESS
MALAISE, HEADACHES, TACHYCARDIA CAREFULLY.
GIVE ACETAMINOPHEN AS ORDERED
FOR SEVERE CHILLS. HELP PX PLAN
FOE ADEQUATE REST.
HEART SERIOUS DYSRHYTHMIAS, MONITOR HR, AND RHYTHM,REPORT
MYOCARDIAL INFARCTION ABNORMAL FINDINGS
CAPILLARIES INCREASED PERMEABILITY, ASSESS FOR EDEMA, MONITOR BP,
PULMONARY AND DEPENDENT EDEMA, HAVE PATIENT CHANGE POSITIONS
HYPOTENSION SLOWLY; AVOID PROLONGED
STANDING, HOT BATHS AND SHOWERS.
FOR HYPOTENSION GIVE COLLOIDS OR
VASOPRESSORS AS ORDERED.
BRONCHI AND LUNGS ANAPHYLAXIS WITH BRONCHIAL NOTE SIGNS OF ALLERGY,; RASH
CONSTRICTION, PULMONARY EDEMA WHEEZING, ITCHING.
ANAPHYLAXIS: EPINEPHRINE OR
STEROIDS AS ORDERED
MAINTAIN AIRWAY, ASSESS FOR
CRACKLES. POSITION : ELEVATED HOB
Hematopoietic STEM CELL
transplantation
•Standard of care : adult hematologic
malignancies(malignant myeloma, AL, and
non-Hodgkin’s Lymphoma)
•TYPES:
•Allogeneic – from donor other than the patient
•Autologous –from the patient
•Syngeneic – from an identical twin
Hematopoietic STEM CELL
transplantation
COMPLICATIONS

•Graft-versus host Disease (GVHD)-

occurs when the donor lymphocytes
initiate an immune response against the
recipient’s tissues during the beginning
of engraftment(Harris, 2010)

•Engraftment syndrome
Hematopoietic STEM CELL
transplantation

NURSING MANAGEMENT:
• Care before Treatment :Assessment
• Care during Treatment : Monitoring and mgmt. of S/E

• Care after Treatment: nursing assessment both for

patient and donor (physical, psychosocial)
Hyperthermia(Thermal Therapy)

Most effective when combined with radiation

Thought to alter cellular membrane permeability when used

with chemotherapy

S/E: burns, fatigue, hypotension, peripheral neuropathies,

thrombophlebitis, nausea, vomiting, diarrhea, electrolyte
imbalance
Hyperthermia(Thermal Therapy)

NURSING MANAGEMENT
•The nurse assesses the patient for adverse
effects
•Health teachings for family about the
procedure, goals, and its effects
•Local skin care
Hormonal Therapy

2 types: those that block the body’s ability to produce hormones

and those that interfere with how hormones behave in the body

Indications: Breast (anti-estrogens) and

prostate (anti-testosterones) Cancers

Used with other treatments

S/E: hot flashes, diarrhea, fatigue, nausea, vomiting, mood

changes
Hormonal Therapy

NURSING MANAGEMENT

Health teachings of its effects

Management of Symptoms
Recap of Today's Class

Hematopoietic Stem Hormonal therapy

Cell transplantations

Hyperthermia Nursing management

 References:

Grossman, S.C. & Porth, C.M. (2014). Porth’s Pathophysiology: Concepts of

Altered Health States (9th ed.). Philadelphia: Wolters Kluwer.

Hinkle, J.L. & Cheever, K.H. (2020). Brunner & Suddarth's Textbook of
Medical-Surgical Nursing (15th ed.). Philadelphia: Wolters Kluwer.

Potter, P.A., Perry, A.G., Stockert, P.A., & Hall, A.M. (2017). Fundamentals of
Nursing (9th ed.). St. Louis: Elsevier/Mosby.

www.cancer.org
Thank you!