cancer cancer is in chapter 45 page 695. some terminology so some terminology you see listed here is tumor or neoplasm this would be a new and abnormal growth that is uncontrolled very progressive so we have new tissue mass of new cells angiogenesis this would be new blood vessels that actually form from existing vessels so what we have is the resulting new vessels actually feed these growing tumors with oxygen and nutrients so that's what allows a tumor to enlarge and those cancer cells to invade nearby tissue to move throughout the body okay so a you see listed here um as a prototype that you need to remember that is bev zumab i know interesting name right that is an angiogenesis inhibitor so what it does it's going to slow tumor growth and i know you saw that before in unit 9 i believe um but um as we're moving along you're going to have to remember some of those prototypes that you didn't have to remember for that particular unit okay benign the terminology for benign so that's a neoplasm that is non-cancerous it is very uniform in shape in size there's no invasiveness so it's much easier to remove than something that is actually malignant so malignant is an actual cancer cells that invade surrounding tissues and they're more invasive so much harder to remove when they are malignant and then metastasis that is actually the spread of cancer from its original site um antenioplastic agents or chemotherapy these are drugs used to treat cancer and then we have a couple of different types here so we have cell cycle specific otherwise known as ccs these are antinoplastic drugs that are cytotoxic during a specific phase of the cellular growth cycle okay cytotoxic during a specific phase of the cellular growth cycle unlike cell cycle non-specific ccns these are anteneoplastic drugs that are cytotoxic in any phase of cellular growth okay non-specific to phase of that cell cycle so um seven and eight are important to remember and then we also have what's called the nadir then in deer is also important to remember that is the lowest point in any fluctuating value and when we're talking about chemotherapy or cancer patient sorry were mainly in reference to blood counts after chemotherapy so what we're looking at is the lowest wbc and platelet count after chemo okay so in a nutshell that's what the nedir is so the lowest level of neutrophils reach during therapy right those are wbcs types of wbcs right so lowest levels of neutrophils or platelets reached after or reached during therapy sorry classes um anti-metabolites these are ccs's so these are cell cycle specific they're on page 702 their role in cancer what they do is they basically act as a false substitute for folic acid so we need folic acid and what's needed for synthesis of dna uh purine or pyrimidine these are compounds that are all very critical for cell reproduction so it acts as a false substitute for folic acid it inhibits enzymes that are critical in synthesis so in and what it's essentially doing then is because it's acting acting as a false substitute it's inhibiting that cellular growth of those cancer cells so the result is decreased synthesis of dna rna and proteins which equal cell death okay methotrexate methotrexate is a folate antagonist we administer that concurrently with leucovorin likovoran actually helps decrease the toxic effects of methotrexate so we have healthy cells that die um basically due to lack of folic acid and what leucovore does is it rapidly converts to the active form of folic acid which prevents the death of normal cells uses we can use them on solid tumors such as those in the breast head neck and liver hematologic hematologic cancers um like acute lymphocytic leukemia um non-hodgkin's lymphoma reed sternberg cell presence is actually what's happening this is for patients who are positive for hodgkin's lymphoma and then autoimmune processes such as rheumatoid arthritis example of drugs um your prototypes listed here is the only one you need to know for that is methotrexate so with methotrexate this has immunosuppressive activity and you want to remember that it's very useful for treatment of rheumatoid arthritis and psoriasis mitotic inhibitors so roland cancer treatment this is also cell cycle specific ccs this starts on page 705 the role in cancer treatment so all exert activity before or during mitosis so we'll have decreased cell division produces non-functional parts of the cells which equates to cell death so uses we can use these for solid tumors or hematologic cancers and then paclitaxel is the prototype you'll need to remember so you want to remember paclitaxel as your prototype for meiotic inhibitors which are cell cycle specific all right so um topoisomerase so that's topoisomerase roland cancer treatment it binds to dna so we have topoisomerase one complex so it's going to impair relegation of dna strand relegation is basically when that dna strand splits or it suffers temporarily and then it reattaches so since it impairs relegation what happens is that dna strand breaks so we'll typically use this for ovarian or colorectal cancers example um the prototype there is topotecan i know these are also very interesting names and enunciations all right so number four is alkylating agents which is ccns this is a cell cycle non-specific type of drug this starts in chapter 46 on page 721 um the first alkylating drugs were actually developed from mustard gas agents that were used for chemical wear warfare before and during world war one interestingly enough that's just a fun fact to remember um so roland cancer treatment important to remember for these alkylating agents it alters the cell's dna so we have alkyl group attaches to the dna molecule and it prevents a correct bond so what happens cell death so it's going to alter the chemical structure of that dna to prevent replication so for uses we can use for combination chemotherapy treatment and then examples of drugs okay the prototype listed here is cisplatin cisplatin is the prototype you want to remember that is an alkalining agent which is a ccns remember what the rolling cancer treatment is for these and then important to remember for cisplatin okay cisplatin is very nephrotoxic very hard on those kidneys so it's very very very important that we're following renal function very closely and then dosing adjustments are probably going to be made based upon the kidney function so it's very possible the provider may have to limit dosing based upon kidney damage or function so those are some very important facts to remember about that particular drug cytotoxic antibiotics or ccns's roland cancer treatment so drug molecule is basically inserted between two dna strands so you have a dna helix that's two chains made of nucleotides that basically basically coil around each other so um you have drug molecules inserted between the two dna strands that dna helix becomes unstable and so it blocks synthesis and we can use this for solid tumors and hematologic cancers so examples and prototypes you're going to need to remember doxorubicin is the prototype you'll need to remember really important about this particular medication is looking at the patient's ejection fraction so this particular drug can cause left ventricular failure so we want to look at the ejection fraction and we how do we look at that we look at it through a an echocardiogram so it's going to affect cardiac output it's very cardiotoxic so we would have decreased cardiac output so remember the ejection fraction that is the volume of blood that left ventricle pumps out with each contraction so um for an example if we're saying a patient's ejection fraction is equal to sixty percent what that is saying is that sixty percent of total volume of blood is actually being ejected with each contraction okay normal is fifty to seventy percent so sixty percent is a great ejection fraction but with this doxorubicin we really want to pay attention to that ejection fraction because it can cause left ventricular failure again very very cardiotoxic so cardiac output will decrease so general side effects general side effects side effects listed here so typically for a lot of these drugs the patient is going to have nausea vomiting there's going to be some hair loss fever malaise fatigue renal damage is a big one we really want to pay attention that kidney function bone marrow suppression so how do we manage them what do we do for our patients so management of side effects what we can do for the allergic response that can occur is we can administer diphenhydramine so remember diphenhydramine you want to remember that's your prototype for and your generic for benadryl the trade is the trade name is benadryl okay that is an antihistamine right that's your h1 antagonist so we've talked about that before so hopefully this is looking real familiar um inflammatory response for inflammatory response we can administer dexamethasone that's a very potent anti-inflammatory it's a steroidal anti-inflammatory right and then for nausea and vomiting because that's typical for these types of patients we can give them hondincetron remember is your generic name for zofran zofran is the trade on incetron is the generic and that is one of your prototypes you've already had to remember in the past renal damage so again we're going to follow those labs um hydration is really important drug dosaging is going to happen based upon renal function maintain the patient's blood pressure per their baseline and then we want to make sure that we are educating them on and we as nurses are making sure as much as possible that we're minimizing those nephrotoxic agents in their life right so those things like antibiotics they don't need nsaids the use of contrast dyes for imaging right if it's not dire they don't need it or we can't give a reversal agent for it they shouldn't have it okay so it's really important that we are trying to minimize nephrotoxic agents bone marrow suppression bone marrow suppression so we want to limit exposure to infectious sources so again large crowds limit that diet we're talking about avoiding fresh fruits and vegetables why is that so important the patient is at increased risk for being tainted with bacteria especially with those leafy veggies because they hide dirt right and then also rest is very important so all of those things large crowds avoiding fresh fruits and vegetables all those are very important to remember another one that's not listed here that i'm going to give you is that chemo causes toxicity and affects rapidly growing normal cells as well so bone marrow cells hair follicle cells and gi mucus membrane cells all of those are affected so it's really important um that we're aware of how chemo can actually cause those types of toxic side effects okay lab diagnostic studies so diagnosis how do we diagnose cancer right or how do we diagnose a problem well typically we're going to do blood work maybe we will do a biopsy if we actually know where the mass is or where the problem area is and then we're also looking at clinical manifestations meaning what is the patient presenting with staging for staging we have what's called tnm staging that's based on the extent of the tumor okay so based on the extent of the tumor is um the t portion of the tnm staging the extent of spread to the lymph nodes is the in portion of the tnm's staging and then the presence of metastasis is the m component of that mnemonic for tnm staging okay complete blood count or cbc so we're going to look at their wbcs we're going to look at their platelets we want to look for any type of hematologic cancers or determine also how a patient is handling cancer treatment so remember we've talked about certain types of medications before so if our patient had decreased rbcs we could give them epolene alpha remember that e point alpha helps stimulate rbc production failure stem was something that we could get for patients with low wbcs and the no problem can is something we could give a patient who has low platelets so those are all drugs we've already talked about before chemistry we're going to look at that renal function for sure and then we have something called a carcinombrionic antigen or cea that is a protein that's normally found in tissue of a developing fetus however in adults it drops low to a very low level in the blood however can be elevated and if it if they're a sign of cancer okay so elevation you might see if which could be a sign of cancer is what i'm trying to say so tumor markers or biomarkers is what we also call those um those are produced as well by healthy cells but the substances are found actually higher than normal levels in the blood urine or body tissue of some people with cancer as well so blood urine or body tissues of some people with cancer lymph node biopsy we can also do a biopsy of the lymph nodes computerized axotomography ct scan so we can do a ct scan of the patient and visualize any type of masses or again problem areas and then the positron emission at tomography this is a pet scan pet scans use radioactive tracers so the patient can swallow them inhale or they can even be injected and they can reveal the size shape position and function of the organs and then cancer show cancer cells will actually show up as white spots um when they are exposed to these radioactive tracers so they scan the patient and then these white spots will show up and let us know that those are actually cancer cells and then number 10 we have cardio echo sorry we have cardiac echocardiography and so that is how we can actually and i actually mentioned that before we can look at the patient's ejection fraction and how treatment is actually affecting them cardiac speaking all right patient education so this is a big in here so disease process we're going to talk about the diagnosis and treatment plan hope um you know hope is a big one what you're wanting to be careful is that we're not instilling false hope right we want to be positive for our patients but we also want to be very realistic um you know so saying things like everything's going to be okay or it's going to work out fine are probably not the greatest choices of words so you really want to think about what will come out of your mouth when you're talking to patients like this and not instilling false hope but also you know feeding their spirit right and being for them in a positive manner action of drugs um we want to talk to them about how their medications work and then especially with number three the side effects and management of those drugs so for side effect and management um some of the big ones are nausea and vomiting a lot of these different types of medications are just going to make your patient feel horrible right so nausea and vomiting is a very big one so we can pre-medicate the patient though right we can give them something to help get rid of or lessen the blow of that nausea and vomiting and then prn medication so we might have medication for either pain or nausea and vomiting that we can give them as they need it skin and mucous membranes so especially with chemo the skin will become dry it could be an itchy red it may even peel they may develop a rash and they may even have very much so sun sensitivity so all of these things are really important to educate the patient about weight loss and hair loss are actually really typical as well fatigue and risk for infection we've talked about this already a few times so we wouldn't pay attention to the nadir remember the nadir is the lowest levels of neutrophils reached during therapy okay that's why i want you to remember that so what's happening because we have myosuppression so that's bone marrow suppression it's going to decrease wbcs decrease rbc so if we don't have you know a lot of circulating rbcs the patient can become hypoxic and fatigued we have decrease in platelets so if we have decrease in platelets what's going to happen our patient is susceptible to bleeding so we might even administer antibiotics to help prevent and treat the patient as well um just some a couple interesting things uh about radioactive implants when you're thinking about patient contact because i have i've had even as a charge nurse when i've had patients that have had chemotherapy pregnant mommies who are worried about taking care of these types of patients which is you should right that's that's a valid concern so with patients who have had radioactive implants it's important that there's no close contact for two months with patients who are pregnant and with kids okay no close contact for two months with patients who are pregnant and with kids with chemo or radiation it's okay the chemo meds are most often they're excreted from the body via the urine stool or vomit for about 48 to 72 hours after each treatment so contact with the patient is okay for pregnant people and kids what you don't want to come in contact with for at least the next 48 to 72 hours after chemo radiation is any of their bodily fluids so you want to be really careful of how you're handling that right so not handling the urine stool or vomit okay those are just some interesting patient contact information i wanted to give you nothing you need to memorize for exam purposes but you know important info to know as you're caring for these patients any questions please make sure you reach out for clarification