Oncology Dead Man’s party

1. Oncology Dead Man’s party Biology of abnormal cells Cancer grading and stages Cancer statistics Chemotherapeutic agents Radiation treatments Bone Marrow and Stem Cell transplants Onco-gene therapy

2. Oncology Objectives • 1. Identify the different phases of cancer cell replication. • 2. Compare the features of a benign versus malignant tumor • 3. Recognize the TNM stage and grading system of cancer tumors. • 4. Discuss the role of oncogenes and suppressor genes in cancer development. • 5. Identify behaviors with corresponding primary and secondary nursing prevention for risks of cancer development • 6. Recognize the different classes of chemotherapies. • 7. Create appropriate nursing interventions for a case study of a patient with cancer.

3. Oncology Objectives • 8. Identify appropriate testing for cancer patients. • 9. Recognize signs and symptoms of chemotherapy side effects. • 10. Recognize signs and symptoms of radiation therapy. • 11. Prioritize nursing interventions for a patient with neutropenia. • 12. Prioritize nursing interventions for a patient with thrombocytopenia. • 13. Prioritize nursing interventions for a patient receiving bone marrow or stem cell transplant.

4. Oncology Objectives • 14. List 4 risk factors for the development of leukemia. • 15.Compare Leukemia and Lymphoma pathophysiology, etiology and clinical manifestations.

5. Cellular Review • Evolve 3D Cellular Differentiation on web site

6. Oncology • Biology of abnormal cancer cells • They have continuous or inappropriate, usually faster growth or larger growth patterns • They have no specific morphology and often do not resemble their parent cells = anaplastic • They do not respond to signals for apoptosis = programmed cell death

7. Oncology • Biology of abnormal cancer cells • Have a large nuclear – cytoplasmic ratio; the nucleus may occupy most of the cell area • They lose some or all of their normal cell functions • They do not make fibronectin, and thus cannot connect easily and break off easily

8. Oncology • Biology of abnormal cancer cells • They are able to migrate throughout the body = metastasis • They invade other tissues and types of cells. • They are not controlled by contact • They have more or less chromosomes than the parent cells = aneuploid or a mutation of the genes

9. Oncology • Cancer development • Initiation – there are many theories as to when the genes in the cells are damaged, maybe in utero, from physical or chemical exposure, latent oncogenes, viruses, or a lack of suppressor genes from our parents, and at this point the cell is not dividing.

10. Oncology • Skin cells

11. Oncology • Cancer development • Promotion - the stage when the abnormal cell starts to divide, may be stimulated by environmental changes, hormones, drugs, or irritants

12. Oncology • Cancer development • Progression – the phase when the abnormal cells have continued to grow into a Primary tumor, may produce angiogenesis factors which supply blood and vascular nourishment to the tumor. The tumor may have subcolonies of cells with different genes and features

13. Oncology • Cancer development • Metastasis the movement of cancer cells into other organs of the body, thus creating new tumor sites.

14. Oncology • Cancer grading and staging • Cancer is graded upon the resemblance to normal cells = G (The higher the number, the worse the grade of cancer) i.e. G1, G2, G3, G4 • Staging is based upon • the presence of a primary tumor = T • involvement in lymph nodes = N • and appearance of metastasis = M • Numbers of the stage range from x = none to 3 or 4 for each letter

15. Oncology • Is this a high grade or low grade cancer? • Case study Julie has a breast lump in her right breast, and has also found one in her right armpit. Biopsy and lumpectomy were performed. The tumor was graded G3, T2, N2, M1.

16. Is this a high grade or low grade cancer? • High • Low

17. Oncology • Julie opted to have a lymphectomy of her right arm lymph nodes, and started radiation treatment right away. Her doctor also suggested that she start Adriamycin IV chemotherapy to get any cells that the radiation might miss.

18. Oncology • Cancer Risks • #1 = advancing age • #2 = smoking tobacco • Hormones – Prempro caused a substantial increase in breast cancer on the HERS trial • Genetic inheritance of oncogenes and autoimmune diseases • Environmental exposure • Excessive intake of dietary fats

19. Oncology • Cancer risks • High alcohol consumption • Low dietary vegetables and fiber (sources of antioxidants) • Previous Viral infections: Hepatitis B or C Herpes viruses Papilloma viruses (HPV) Retrovirus HTLV –I

20. Oncology • Types of cancer cells are named for their site of origin: • Adenocarcinoma • Carcinoma in situ (CIS) • Squamous • Basal cell • Astrocytomas • Melanomas • Sarcomas • Lymphomas

21. Oncology • Symptoms of Cancer • Cachexia – weight loss,unexplained • Anorexia • Anemia • Impaired immune response • Pain – when the cancer is large enough to compress nerves or organs • Lymphadema – when the tumor blocks lymph or circulatory flow • Motor or sensory deficits

22. Oncology • The 60 year old client with small cell lung cancer is concerned that his grown children also might develop the disease. What is the nurses best response? • A. “This disease is a random event and there is no way to prevent it.” • B. “Because this disease is inherited as a dominant trait, your children have a 50% risk for developing it.” • C. “Cigarette smoking is the main cause of this disease, and helping your children not to smoke will decrease their risk.” • D. “ Lung cancer can be avoided by decreasing dietary intake of fats and increasing the amount of regular aerobic exercise.”

23. Oncology • Cancer statistics • The top four cancers found in the United States are: • Lung • Breast • Prostate • Colorectal C

24. Oncology • Cancer statistics • Prostate cancer is the most common site of cancer and the 2nd most common cause of cancer death in the United States • The first cause of death in males is Lung Cancer

25. Oncology

26. Oncology • Cancer statistics • Lung cancer has annual new cases (incidence) of 173,770 people per year: 93,110 males and 80,660 females • Annual mortality: 160,440 per year consisting of 92,000 malesand 68,510 females

27. Oncology • Cancer statistics • 28% of all cancer deaths are due to lung cancer • This is the leading cause of cancer death in both men and women • There are more deaths from lung cancer than prostate, breast, and colorectal cancers combined

28. Oncology • Cancer statistics • Risks for lung cancer: • Smoking (75-80% of cases) • Occupational exposure • Nutrition/Diet • Genetic factors

29. Oncology • Cancer statistics • Prostate cancer is number two cause of cancer in men • Breast Cancer is number two cause of cancer in women • Most common non-malignant or non-fatal cancer is non-melanoma type skin cancers

30. Oncology • The client says that she has heard that the origin of most cancers is “genetic”. What is the nurse’s best response? • A. “The development of most cancers is predetermined and not affected by environmental factors.” • B. “Cancers arise in cells that have been damaged,which may be in the genes”. • C. “ The majority of cancers are inherited” • D. “Cancer is more common among males than females.”

31. Oncology • Lab tests for cancer • Ultrasounds to determine size • CT scan with contrast– the golden standard • Genetic markers – BRCA 1 and BRCA 2 • Tumor markers: CEA – general carcinogenic antigen PSA – prostate antigen CA-125 – ovarian CA-25,27 – breast HER 2 NEU – breast tissue needed

32. Oncology • Lab tests for cancer • Liver function tests • CBC with diff • Renal function tests • PET scan – looks for metastasis using a radioactive glucose solution • PT, PTT, Fibrinogen, Fibrin levels

33. Oncology • Lab tests for cancer • Pathology slide of tumor: (Should be kept for a period of years) • Determines type of tumor • Source of tumor • Aggression of tumor – whether fast growing, differentiated, or non-differentiated • Used to determine tumor growth factors and susceptibility to certain chemotherapies

34. Oncology • Chemotherapy • Prevention chemotherapy – for high risk patients, precancerous lesions, or history of cancer • Antioxidants, vitamins • Aldara cream 3x weekly for precancerous skin lesions • Aspirin • Protease inhibitors

35. Oncology • Chemotherapy- typically started after surgical dissection of tumor, unless the tumor is non-operative • Usually given by a long term venous access device, i.e. PICC line, implanted ports, or direct catheratization to the tumor. • Chemotherapy is usually potent and horribly scarring on normal veins

37. Oncology • Chemotherapy • Biochemotherapy – used as in-patient or outpatient settings for cancer, MS, and viral treatments: Alpha interferon – (IFN)- Alpha 2a, Roferon, Intron-A- used for leukemias, AIDS, Hep-C Beta interferon – Beta 1b – used for renal carcinoma, melanoma, AIDS, MS, Hepatitis A, B

38. Oncology • Chemotherapy/Biochemotherapy • Interleukin I (IL-1) • Interleukin 2 (IL-2), Proleukin– stimulates growth of T-cells and NK cytotoxic cells • – used investigationally for melanoma in Stage II to Stage IV cases on a monthly basis with a 80% non-recurrence rate

39. Oncology • Chemotherapy/Biochemotherapy • Tumor necrosis factor (TNF) – selectively targets abnormal cells, in nature is produced by NK cells

40. Oncology • Chemotherapy/Biochemotherapy • Vaccines HPV vaccine for cervical cancer Melanoma vaccine - for stage II only at this time, or malignant melanoma

41. Oncology • Chemotherapy/Biochemotherapy Monoclonal antibodies – used for treatment of cancer, rheumatoid arthritis, transplants, and other autoimmune diseases. Can be used to stimulate immune response or suppress it. Rituximab – Treatment of CD20 –positive non-Hodgkins B-cell lymphoma Gentuzumab – treatment of CD33 positive AML in first relapse in patients who are not candidates for reg. chemo.

42. Oncology • Chemotherapy/Biochemotherapy Monoclonal antibodies • Adalimumab – Humira –new treatment for severe rheumatoid arthritis, given s.q every other week • Alemtuzumab – Campath - treatment of B-cell lymphoma who have failed traditional chemotherapy with fludarabine • Basilixamab – Simulect - immunosuppressive monoclonal antibody for renal transplants

43. Oncology • Chemotherapy – Alkylating agents • Bisulfan oral • Carboplatin (CBDCA) IV • Chlorambucil (leukeran) oral • Cisplatin IV • Cyclophosphamide(Cytoxan) IV or PO • Melphalan (Alkeran) oral • Ifosfamide IV • Thiotepa IV or PO

44. Oncology • Chemotherapy/ Antibiotics given IV as chemotherapy • Adriamycin (Doxirubicin) • Bleomycin • Dactinomycin • Daunorubicin (actinomycin D) • Idarubicin (idomycin) • Mitomycin C • Mithramycin

45. Oncology • Chemotherapy – anti-metabolites • Cytorubine (Cytosar) IV • Floxuridine (FUDR) IA or SQ • Flourourcil (5FU) IV • Fludara IV • Hydroxyurea PO or IV • Methotrexate IV or IM • 6MP PO • IRESSA PO • Xeloda PO

46. Oncology • Chemotherapy- Hormones • Progestins – uterine cancer • Estrogens • Testosterone - myelodysplasias • Anti-hormones – block hormonal activity in hormone sensitive cancers: • Leupron • Eulexin • Tamoxifen/Nolvadex • Arimedex/Arista

47. Oncology • Chemotherapy – Plant alkaloids • Vinblastine (Velban) IV • Vincristine (Oncovin) IV • Vindesine IV • Eldisine IV • The first doses of this are usually given in a hospital setting, are vesicants, and neurotoxic. Nurses must wear protective gear!

48. Which of the following are appropriate protective gear for the nurse when hanging chemotherapy? • Splash goggles • Latex gloves • Rubber gloves • Paper gown • Special biohazard bags for disposal • Lead apron

49. Oncology • Chemotherapy –Antimitotics • Dacarbazine (DTIC – Dome) IV • Leukovorin PO or IV • Paclitaxol (Taxol) IV • Topotecan IV • Gemzar IV • Docetaxol IV • Camptothecan (CPT-11) IV • Taxotere (Ormaplatin) IV

50. Oncology • Side effects of Chemotherapy • Alopecia • Fatigue • Anemia • Leukopenia • Thrombocytopenia • Always – Nausea,Vomiting, Diarrhea • Neurotoxicity & neuropathies • Capillary leakage • Headaches • Fluid and electrolyte imbalances