N240, Oncology Nursing
Biopsy - Answer-Percutaneous Needle Aspiration
- Fine needle
- Large core
Endoscopic
Surgical
- Incisional
-
... [Show More] Excisional
Cancer board - Answer-to assess a case, present with all infos so to determine to best
tx. Hormones in breast, prostate cancer? Is the cause is hormonal, need to fix this issue
too >>> hormone deprivation therapy
Goal of Cancer - Answer-Cure, Control & Palliation
Factors that determine treatment (tumor board) - Answer-Comorbidities
Age: slow growing prostate cancer in old men
Cell type: aggressive tumor has a faster growing rate, older and larger tumor is harder
to tx.
Location and size of tumor: METS: spread? Degree of a tumor is important for chemo
therapy
Extent of disease (metastasis) (staging) 0, I, II, III, IV (mets)
Grading: I-IV, well differentiated (I: similar to the parent cells) v. Poorly differentiated (IV:
much different from its parents) & (X) unable to be assessed
TNM
Tumor Grading: I-IV - Answer-well differentiated (I: similar to the parent cells) v. Poorly
differentiated (IV: much different from its parents)
(X) unable to be assessed
TNM - Answer-T (x,0,IS,1,2,3,4): T2 (a tumor of size of 2); IS (in suito, encapsulated,
not grown its cells yet)
N (x,0,1,2,3): nodes (how many nodes are affected, not specific but rather like there is a
lot/not a lot)
M (x,0,1): metasis, x (not yet assessed)
T: radiation and surgical
N and M: tx is chemotherapy (few cases may affect T as well, but mostly just N and M)
Surgical therapy - Answer-Cure (Complete removal or Debulk)
- Remove what is required with a margin
- Preventative measures used to reduce surgical seeding of cancer cells
- Usual sites of regional spread may be removed
Control: curing or slowing down
Palliative: improving the quality of life
Reconstructive: mammoplasty
Prophylactic: no cancer in the body, but client is at high risk
Radiation therapy - Answer-Emission and distribution of energy which results in
ionization and excitation which breaks DNA bonds in causing loss of proliferation
ALARA: Lethal tumor dose (LTD) & maximal tolerated tissue dose
- Give enough radiation to kill cancer but low enough dose to not cause any extra side
effects
Normal tissue can recover, but CA cells unable to recover
Germ cells has faster metabolic rate, can regenerate faster: skin, hair, bone marrow, GI,
taste (can replace itself later on) or ovary (once they are damaged, they are damaged)
Goal: Cure, Control, Palliation
Radiation: Internal (brachytherapy) - Answer-Can be done intraoperatively or without
surgery
Temporary sealed devices: much more significant radiation to other >>> does not stay
long, usually 2-3 days, or could be minutes.
Ex: monocytes (5-10 minutes, precaution is only during this 5 minutes, catheter usually
stays in for whatever cessions they have, usually not seen unless working in a radiology
dept)
Usually afterloaded: the central line catheter will be placed in surgery or in radiation,
after the placement of catheter, the client will then go to the a specialized room for
radiation. Radiologist with protection will then place radiation therapy into the catheter.
ALARA
Time:
- only 30 minutes in the room for a whole shift. Not 30 minutes in one time. Very limited
personal visits (nurse, doctor, nurse maybe).
- Times you can get close: head to toe, checking for the placement of the device once a
shift (marker present and how much is external)
Distant
Shielding: wear a special apron
Dosimeter: monitored by radiology department, every nurse has her own.
- Once I hit the target, I cant no longer take care of that client. If full --- no longer can
take care of this type of client ever.
- Goes to job to job.
Other safety precaution: bodily fluids. Wear 3 sets of gloves when risk for touching any
fluids. Wash hands with gloves on until all sets washed until bare hands. Flushing 3
times. Anything in the room will be incarnated. Others cant be burned will be specially
cleaned.
How can the device be dislodged? Pt movement (bedrest), discourage coughing, BW
(will have a BM cleansing such as a enemar, on clear liquids afterward, do not want BM;
so after discharge may need teaching on having a BW)
Systemic (I131)
Radiation precaution for about 7 days after (review in endocrine notes)
Radiationg: Permanent sealed implants - Answer-Small, usually used in prostate
Can be in places right in or around the tumor, will emit radiation, then it is done after half
life
Leaves in for life, not removed
Does not affect MRI, does no harm
Very little exposure to others.
Only concern: women can be pregnant, pregnant or little kids (affects the cells still
actively growing) >>> tell kids to get not too close to the patient
- Pregnant: sleep with pillow in between
- Kids: not sit on lap with grandpa
Radiation: External (teletherapy) - Answer-Many subtypes (Gamma Knife)
Most common form of radiotherapy (radiation therapy). The patient sits or lies on a
couch and an external source of ionizing radiation is pointed at a particular part of the
body.
Simulation: It is essential that exacts location and size is determine and marked. It is
done before the first time or when there is a problem (radiation sx should only occur at
the site that is affected). Have an MRI to determine where the radiation is aimed at. It
will be marked on the skin. Standard of care for safety.
Determines external radiation treatment plan to maximize dose to CA cells & minimize
cytotoxic activity of normal cells
Films, verification, marks / ports applied
Fractionated doses to achieve LTD: radiologist determined, or they give a client a
choice (gives clients some control)
Chemotherapy-Multimodality - Answer-Factors affecting response
Categories: multiple chemo drugs are used to promote a better response, more cells
are getting killed in different stages
- Cell cycle nonspecific
- Cell cycle phase specific... [Show Less]