Oncology Notes

Topics: Cancer, Oncology, Chemotherapy Pages: 5 (669 words) Published: December 4, 2013
ONCOLOGIC NURSING

CANCER
A group of heterogeneous diseases that share common biologic properties. All cancers are genetic and share common molecular pathogenesis and are a result of mutations in oncogenes and tumor suppressor genes. Abnormal cell differentiation and growth results in an abnormal mass of tissue, called a neoplasm. Benign Growth Patterns

Hypertrophy – increase in cell size
Hyperplasia – increase in cell number
Metaplasia – conversion of one cell type to another
Dysplasia – abnormal changes in size, shape or organization of cells Characteristics
Altered cell differentiation
Appearance changes
Altered metabolism
Tumor-specific antigens
HCG – trophoblastic tumors
Calcitonin – thyroid carcinoma
Catecholamine and metabolites – pheochromocytoma
Alpha fetoprotein – liver cell cancer
PSA – prostate cancer
Immunoglobulins – myeloma and other gammopathies
CA-125 – ovarian cancer
CA-19-9 – Colon, Pancreatic cancer
CA15-3 – breast cancer
Altered cellular function

CELL CYCLE
G1 – hours to days; RNA and CHON synthesis
S phase – 10-20 hours; DNA replication
G2 – 2-10hours; DNA synthesis stops, RNA and CHON synthesis continue M phase (Mitosis) – 30-60 mins; Cell division occurs: Prophase, Prometaphase, Metaphase, Anaphase and Telophase G0 – resting phase

MOLECULAR PATHOGENESIS OF CANCER
Self-sufficiency in growth signals
Insensitivity to growth-inhibitory signals
Evasion of apoptosis
Defects in DNA repair
Limitless replication potential
Sustained angiogenesis
Ability to invade and metastasize

CARCINOGENIC FACTORS
Heredity
Environmental agents such as chemicals and radiation
Oncogenic viruses
Bacteria and Parasites
Immune system deficiencies

METASTASIS
Growth and progression of the primary tumor
Angiogenesis at the primary site
Local invasion
Detachment and embolization
Arrest in distant organ capillary beds
Extravasation
Proliferation

CANCER DIAGNOSIS AND STAGING
Tumor markers
Diagnostic imaging methods
X-Ray
Mammography
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Ultrasound
Nuclear Medicine
Positron Emission Tomography (PET)
Positron Emission Tomography with Computed Tomography (PET-CT) Lymphoscintigraphy
Staging
Surgical staging – utilizes invasive surgical techniques to actually visualize structures and assess the extent of disease Tissue Biopsy
Incisional/Core Biopsy
Sentinel Lymph Node Biopsy
Axillary Lymph Node Biopsy
Clinical staging – based on professional judgment and measurement of the primary tumor’s size, location in the body, and the evidence of the disease through physical examinatiom Pathologic staging – examination of tissue of interest both grossly and microscopically to evaluate its characteristics and make an assessment as to the aggressiveness of the malignant tumor Tumor-node-metastasis (TNM) system – assesses tumors based on the size/extent of primary tumor (T), absence or presenc of regional lymph node involvement (N), and absence or presence of distant metastasis (M).

CANCER TREATMENT MODALITIES
RADIATION THERAPY
Use of ionizing radiation in the treatment of patients with benign and malignant diseases. The intent is to deliver a precisely measured dose of radiation to a defined tumor volume with minimal damage to adjacent healthy tissue. Four R’s of radiation: repair, redistribute, repopulate and reoxygenate. GENERAL SIDE EFFECTS

Dry/moist desquamation
Fatigue
Bone marrow suppression
SPECIFIC SIDE EFFECTS
Oral mucositis
Xerostomia
Gustatory changes
Tooth decay and caries
Osteoradionecrosis
Hypopituitarism
Esophagitis
Non-productive cough
Radiation pneumonitis
Radiation fibrosis
N/V
Diarrhea
Cystitis
Erectile dysfunction
Vaginal stenosis
Sterility
Cerebral edema
Scalp irritation
Cognitive dysfunction

RADIATION SAFETY
Isolation precautions
Film badges
Daily care of implant patients
Minimize time spent near radioactive source
Use protective shields for radioactivity...
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