Cancer Treatments
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Transcript of Cancer Treatments
Goals of TherapyGoals of Therapy
CureCure• refers to prolonged absence of refers to prolonged absence of
detectable diseasedetectable disease
ControlControl• when cure is unrealisticwhen cure is unrealistic• prevent new cancer growthprevent new cancer growth
Goals of Therapy Goals of Therapy (cont.)(cont.)
PalliationPalliation• when cure or control is impossiblewhen cure or control is impossible• reduce side effects/symptoms of reduce side effects/symptoms of
diseasedisease
Types of TreatmentTypes of Treatment
SurgerySurgery Radiation TherapyRadiation Therapy ChemotherapyChemotherapy Hormone TherapyHormone Therapy
Therapies can be used alone or in Therapies can be used alone or in combinationcombination
SurgerySurgery
Removal of cancerous tissue from Removal of cancerous tissue from the bodythe body
Local treatmentLocal treatment Can also be used for: diagnosis, Can also be used for: diagnosis,
staging, relief of side effects, or to staging, relief of side effects, or to ease painease pain
Side Effects of SurgerySide Effects of Surgery
Depends on type of surgery & Depends on type of surgery & overall health of personoverall health of person
Most common side effect is PainMost common side effect is Pain Other side effects include: Other side effects include:
bleeding, constipation, fatigue, bleeding, constipation, fatigue, wound care, and management of wound care, and management of drainsdrains
Surgical TreatmentsSurgical Treatments
CervicalCervical Cryosurgery, laser surgery, conization, Cryosurgery, laser surgery, conization,
hysterectomyhysterectomy Feel less womanly, incision, bleedingFeel less womanly, incision, bleeding
BreastBreast Lumpectomy, mastectomyLumpectomy, mastectomy Feel less womanly, balance, Feel less womanly, balance,
numbness/tingling, drains, numbness/tingling, drains, lymphademalymphadema
Surgical Treatments Surgical Treatments
ColonColon Colectomy, resectionColectomy, resection Altered bowel function, colostomyAltered bowel function, colostomy
LungLung Resection, lobectomy, Resection, lobectomy,
pneumonectomypneumonectomy Chest tube, respirator, short of Chest tube, respirator, short of
breathbreath
Surgical TreatmentsSurgical Treatments
ProstateProstate Prostatectomy, orchiectomyProstatectomy, orchiectomy Impotence, incontinence, libidoImpotence, incontinence, libido
Radiation TherapyRadiation Therapy
High energy x-rays High energy x-rays to kill cancer cellsto kill cancer cells
Local treatmentLocal treatment Given externally Given externally
or internallyor internally Skin may be Skin may be
marked by tattoos marked by tattoos to direct beamsto direct beams
Daily treatments Daily treatments
Side Effects of Side Effects of RadiationRadiationSide effects depend on targeted areaSide effects depend on targeted area Skin irritation Skin irritation Hair lossHair loss Digestive problemsDigestive problems FatigueFatigue Urinary & Bladder problemsUrinary & Bladder problems Sexual/Fertility problemsSexual/Fertility problems Bleeding/Infection*Bleeding/Infection*
*Risks associated with implanted radiation source*Risks associated with implanted radiation source
Skin ChangesSkin Changes
May start a few weeks after May start a few weeks after radiation begins & last a few radiation begins & last a few weeks after radiation endsweeks after radiation ends
Redness Redness ItchingItching Dry, PeelingDry, Peeling Sores, ulcersSores, ulcers SwollenSwollen
Management of Skin Management of Skin ChangesChanges
ClinicalClinical May hold treatmentMay hold treatment Prescribe special Prescribe special
creamscreams May prescribe May prescribe
medications for pain, medications for pain, itching, or infectionitching, or infection
At HomeAt Home Use mild soap with Use mild soap with
lukewarm waterlukewarm water Do not rub or scratch areaDo not rub or scratch area Loose clothing, soft fabricsLoose clothing, soft fabrics Sun protectionSun protection Sitz bathsSitz baths Check with Provider Check with Provider
before using any skin before using any skin productsproducts
Hair LossHair Loss
Also called alopeciaAlso called alopecia Only happens on the part of body Only happens on the part of body
being treated being treated Hair loss starts 2 to 3 weeks after first Hair loss starts 2 to 3 weeks after first
treatment treatment Hair may grow back 3 to 6 months Hair may grow back 3 to 6 months
after treatment is over after treatment is over New hair may not look or feel the way New hair may not look or feel the way
it did before it did before
Management of Hair Management of Hair LossLoss
Clinical Clinical Prescription for Prescription for
wigwig ““Look Good, Feel Look Good, Feel
Better”Better”
At HomeAt Home Cut hair short or Cut hair short or
shave head shave head Buy a wig (before Buy a wig (before
loss)loss) Wash hair gently Wash hair gently Avoid harsh productsAvoid harsh products Protect scalp Protect scalp Stay warm Stay warm
Digestive ChangesDigestive Changes
Changes depend on amount of Changes depend on amount of radiation and concurrent radiation and concurrent chemotherapychemotherapy
DiarrheaDiarrhea Mouth/Throat changes Mouth/Throat changes Nausea & Vomiting Nausea & Vomiting
DiarrheaDiarrhea
Frequent bowel Frequent bowel movements which movements which may be soft, formed, may be soft, formed, loose, or wateryloose, or watery
Can occur at any Can occur at any time time
Radiation to the Radiation to the abdomen or pelvis abdomen or pelvis may cause diarrheamay cause diarrhea
Management of Management of DiarrheaDiarrhea
ClinicalClinical I.V. FluidsI.V. Fluids Electrolyte Electrolyte
replacementreplacement Imodium or other Imodium or other
anti-diarrheal anti-diarrheal medicationsmedications
At HomeAt Home Drink 8 to 12 cups Drink 8 to 12 cups
of clear liquids per of clear liquids per day day
Eat 5 or 6 small Eat 5 or 6 small meals and snacks meals and snacks
Eat foods that are Eat foods that are low in fiber, fat, and low in fiber, fat, and lactose lactose
Avoid spicy foodsAvoid spicy foods
Mouth & Throat Mouth & Throat ChangesChangesRadiation to head or neck can cause: Radiation to head or neck can cause: Dry mouth and throatDry mouth and throat Difficulty swallowingDifficulty swallowing Mouth sores Mouth sores Loss or changes in taste Loss or changes in taste Tooth decay Tooth decay InfectionsInfections
Some side effects my last for months or Some side effects my last for months or years after treatment endsyears after treatment ends
Management of Management of Changes to Changes to Mouth/ThroatMouth/ThroatClinicalClinical Dental examDental exam Prescribe special Prescribe special
mouthwash for mouthwash for pain or infectionpain or infection
At HomeAt Home Avoid tobacco, Avoid tobacco,
alcoholalcohol Eat moist, soft foods Eat moist, soft foods
that are cool or that are cool or room temperatureroom temperature
Eat 5-6 small meals Eat 5-6 small meals high in calories & high in calories & proteinprotein
Drink 6-8 cups of Drink 6-8 cups of fluid each dayfluid each day
Nausea & VomitingNausea & Vomiting
Nausea and vomiting may occur 30 Nausea and vomiting may occur 30 minutes to many hours after radiation minutes to many hours after radiation therapy session ends therapy session ends
Patients are likely to feel better on Patients are likely to feel better on days off from radiationdays off from radiation
Those receiving radiation to the Those receiving radiation to the abdomen & certain parts of the brain abdomen & certain parts of the brain are at riskare at risk
Management of Management of Nausea & VomitingNausea & VomitingClinicalClinical I.V. fluidsI.V. fluids Electrolyte Electrolyte
replacementreplacement Prescribe anti-Prescribe anti-
nausea medsnausea meds
At HomeAt Home Eat bland, easy-to-Eat bland, easy-to-
digest foods and digest foods and drinksdrinks
Eat small meals Eat small meals and snacks (5-6 and snacks (5-6 meals a day)meals a day)
Have foods and Have foods and drinks that are drinks that are warm or cool warm or cool
FatigueFatigue
Feeling weak, weary, worn out, heavy, or Feeling weak, weary, worn out, heavy, or slowslow
Possible Causes:Possible Causes: Anemia Anemia Anxiety Anxiety Depression Depression Infection Infection Lack of activity Lack of activity Medicines Medicines
Fatigue may last even after therapy is over Fatigue may last even after therapy is over
Management of Management of FatigueFatigue
ClinicalClinical Assess for Assess for
underlying causeunderlying cause Treat patient for Treat patient for
anemia, anxiety, anemia, anxiety, depression or depression or infection as infection as indicated indicated
At HomeAt Home Try to sleep at Try to sleep at
least 8 hours each least 8 hours each night night
Plan time to rest Plan time to rest Exercise Exercise Adjust work Adjust work
schedule schedule Let others help at Let others help at
home home
Urinary & Bladder Urinary & Bladder ChangesChanges Frequency, burning or Frequency, burning or
painpain Trouble starting or Trouble starting or
emptying bladderemptying bladder IncontinenceIncontinence Blood in urineBlood in urine SpasmsSpasms Starts 3-5 weeks after Starts 3-5 weeks after
therapy begins therapy begins Most problems go away Most problems go away
2-8 weeks after therapy 2-8 weeks after therapy is over. is over.
Management of Management of Urinary ChangesUrinary ChangesClinicalClinical Urine sample to Urine sample to
rule out infectionrule out infection Prescribe meds to Prescribe meds to
help with spasms, help with spasms, burning or painburning or pain
Refer to a Refer to a therapist for therapist for exercises to exercises to improve bladder improve bladder controlcontrol
At HomeAt Home Drink 6-8 cups of Drink 6-8 cups of
fluid each dayfluid each day Avoid coffee, Avoid coffee,
black tea, black tea, alcohol, spices, alcohol, spices, and all tobacco and all tobacco productsproducts
Continence pads Continence pads
Sexual & Fertility Sexual & Fertility ChangesChanges Radiation to Radiation to
pelvic areapelvic area Can cause sexual Can cause sexual
changes: loss of changes: loss of interest in or interest in or ability to have ability to have sex sex
It can also affect It can also affect fertilityfertility
ManagementManagement
Patients should talk to their Provider:Patients should talk to their Provider:
FertilityFertility: Before starting radiation, let your doctor : Before starting radiation, let your doctor know if you think you might want to father children know if you think you might want to father children in the future. in the future.
ImpotenceImpotence: The doctor can let you know whether : The doctor can let you know whether you are likely to become impotent and how long it you are likely to become impotent and how long it might last. Your doctor can prescribe medicine or might last. Your doctor can prescribe medicine or other treatments that may help.other treatments that may help.
SexSex: Ask if it is okay for you to have sex during : Ask if it is okay for you to have sex during radiation therapy. Most men can have sex, but it is radiation therapy. Most men can have sex, but it is a good idea to ask and be sure.a good idea to ask and be sure.
Long-term Side EffectsLong-term Side Effects
Radiation can sometimes have long Radiation can sometimes have long lasting effects:lasting effects:
Second cancerSecond cancer FatigueFatigue InfertilityInfertility Heart problemsHeart problems Gastrointestinal problemsGastrointestinal problems Lung fibrosisLung fibrosis Neurologic problemsNeurologic problems
ChemotherapyChemotherapy
Variety of drugs used Variety of drugs used to kill cancer cellsto kill cancer cells
Systemic treatment: Systemic treatment: damages healthy damages healthy cells along with cells along with cancer cellscancer cells
Given orally, IV, or Given orally, IV, or by injection into by injection into various sitesvarious sites
Side Effects of Side Effects of ChemotherapyChemotherapy Bone MarrowBone Marrow
CardiacCardiac
PulmonaryPulmonary
Nerves Nerves
GastrointestinalGastrointestinal
Mouth & ThroatMouth & Throat
Kidney & BladderKidney & Bladder
Hair, Skin & NailsHair, Skin & Nails
MyelosuppressionMyelosuppression
Refers to the suppression of the bone Refers to the suppression of the bone marrowmarrow
Bone marrow produces:Bone marrow produces: White blood cellsWhite blood cells Red blood cellsRed blood cells PlateletsPlatelets
Nadir Nadir Point at which the lowest blood cell Point at which the lowest blood cell
count is reached after chemotherapycount is reached after chemotherapy
NeutropeniaNeutropenia
• A low number of white blood cells A low number of white blood cells (neutrophils)(neutrophils)
• White blood cells help fight infectionsWhite blood cells help fight infections
• The most common dose-limiting side effect The most common dose-limiting side effect of chemotherapyof chemotherapy
• A fever of 100.4 F or higher may be the only A fever of 100.4 F or higher may be the only sign of infection for neutropenic patientssign of infection for neutropenic patients
ManagementManagement
ClinicalClinical Treatment with Treatment with
colony colony stimulating stimulating factorsfactors
Avoid invasive Avoid invasive proceduresprocedures
No live No live vaccinationsvaccinations
At HomeAt Home Frequent hand Frequent hand
washingwashing Wash fresh fruits & Wash fresh fruits &
vegetablesvegetables Avoid raw meats/fishAvoid raw meats/fish Avoid crowds, sick Avoid crowds, sick
peoplepeople Avoid animal excretaAvoid animal excreta
AnemiaAnemia
• A low number of red blood cellsA low number of red blood cells
• Red blood cells help transport Red blood cells help transport oxygen from the lungs to body oxygen from the lungs to body tissuestissues
• Symptoms can include fatigue, Symptoms can include fatigue, shortness of breath, chest pain, shortness of breath, chest pain, dizziness/lightheadeddizziness/lightheaded
ManagementManagement
ClinicalClinical Blood transfusionBlood transfusion EPO EPO
administrationadministration Iron supplementsIron supplements Oxygen therapyOxygen therapy
At HomeAt Home Plan activities to Plan activities to
conserve energyconserve energy Sleep at least 8 Sleep at least 8
hours each nighthours each night Maintain optimal Maintain optimal
level of physical level of physical activityactivity
Well balanced Well balanced diet (iron & diet (iron & protein rich)protein rich)
ThrombocytopeniaThrombocytopenia
A low number of platelets A low number of platelets (thrombocytes)(thrombocytes)
Platelets stick together to form a Platelets stick together to form a clot in order to stop bleedingclot in order to stop bleeding
Overt bleeding or petechiae (a Overt bleeding or petechiae (a purplish red rash) could signify a purplish red rash) could signify a low platelet countlow platelet count
ManagementManagement
ClinicalClinical Platelet Platelet
transfusiontransfusion IL 11 injectionsIL 11 injections Avoid invasive Avoid invasive
proceduresprocedures Prescribe stool Prescribe stool
softenerssofteners
At HomeAt Home Avoid injuriesAvoid injuries Electric razor, soft Electric razor, soft
toothbrushtoothbrush High protein diet, High protein diet,
non-irritating foodsnon-irritating foods Avoid aspirin, Avoid aspirin,
NSAIDSNSAIDS
HeartHeart
Cardiac toxicityCardiac toxicity Usually dose relatedUsually dose related May be irreversibleMay be irreversible Symptoms: fast heartbeat, Symptoms: fast heartbeat,
shortness of breath, cough, ankle shortness of breath, cough, ankle swelling swelling
Cardiac ManagementCardiac Management
ClinicalClinical Discontinue or Discontinue or
reduce reduce medicationmedication
Order tests: Order tests: EKG, MUGA, EKG, MUGA, Holter monitorHolter monitor
At HomeAt Home Avoid alcohol and Avoid alcohol and
tobaccotobacco Modify diet as Modify diet as
indicatedindicated Report symptomsReport symptoms
PulmonaryPulmonary
Risk increases with chest radiation, Risk increases with chest radiation, underlying lung disease, patient is a underlying lung disease, patient is a smokersmoker
Hypersensitivity, inflammatory, fluid Hypersensitivity, inflammatory, fluid retentionretention
Symptoms: cough, shortness of Symptoms: cough, shortness of breath, fatigue, restlessness, rapid breath, fatigue, restlessness, rapid respirationsrespirations
Pulmonary Pulmonary ManagementManagement
ClinicalClinical May discontinue May discontinue
medicationmedication Prescribe home Prescribe home
oxygenoxygen Further testsFurther tests
At HomeAt Home Refrain from Refrain from
smokingsmoking Use a fanUse a fan Elevate head of Elevate head of
bedbed Conserve energyConserve energy Restrict fluids as Restrict fluids as
indicatedindicated Report symptomsReport symptoms
NervesNerves
Central, Peripheral, Central, Peripheral, and Cranial and Cranial NervesNerves
Symptoms depend Symptoms depend on which nerves on which nerves are damagedare damaged
Symptoms Include:Symptoms Include: HearingHearing VisionVision Touch, SensoryTouch, Sensory PainPain BalanceBalance StrengthStrength
ManagementManagement
ClinicalClinical May discontinue May discontinue
drugdrug Treat vitamin Treat vitamin
deficiencydeficiency Prescribe pain Prescribe pain
medicationmedication Consult Consult
neurologistneurologist
At HomeAt Home Ensure safe Ensure safe
environmentenvironment Report symptomsReport symptoms
Gastrointestinal Gastrointestinal
Nausea, Vomiting, DiarrheaNausea, Vomiting, Diarrhea Acute or DelayedAcute or Delayed
ConstipationConstipation Decreased intakeDecreased intake MedicationsMedications DepressionDepression Advanced cancer stageAdvanced cancer stage
Management of Management of ConstipationConstipation
ClinicalClinical May suggest a May suggest a
fiber supplement, fiber supplement, laxative, stool laxative, stool softener, or softener, or enemaenema
At HomeAt Home Drink at least 8 Drink at least 8
cups of fluids each cups of fluids each dayday
Be active every day Be active every day Eat high fiber foods Eat high fiber foods Contact Provider if Contact Provider if
not had a bowel not had a bowel movement in 2 days movement in 2 days
Mouth & ThroatMouth & Throat
Dry mouth (having little or no saliva)Dry mouth (having little or no saliva) Changes in taste and smell Changes in taste and smell Infections of gums, teeth, or tongueInfections of gums, teeth, or tongue Increased sensitivity to hot or cold foodsIncreased sensitivity to hot or cold foods
MucositisMucositis Inflammation of the GI mucosa Inflammation of the GI mucosa Symptoms: pain/difficulty swallowing, Symptoms: pain/difficulty swallowing,
hoarseness, changes in color to oral hoarseness, changes in color to oral mucosa, ulcersmucosa, ulcers
Appetite ChangesAppetite Changes
Causes include:Causes include: Nausea Nausea Mouth and throat problems Mouth and throat problems Changes in tasteChanges in taste Feeling depressed or tired Feeling depressed or tired
Appetite loss may last for a day, a few Appetite loss may last for a day, a few weeks, or even months.weeks, or even months.
Management for Loss Management for Loss of Appetiteof Appetite
ClinicalClinical Prescribe vitamins Prescribe vitamins
or nutrition or nutrition supplements supplements
Prescribe Prescribe medications that medications that increase appetite increase appetite
receive nutrition receive nutrition through an IV through an IV
At HomeAt Home Eat 5 to 6 small Eat 5 to 6 small
meals each daymeals each day Drink milkshakes, Drink milkshakes,
smoothies, juice, or smoothies, juice, or soupsoup
Use plastic forks and Use plastic forks and spoonsspoons
Increase your Increase your appetite by doing appetite by doing something activesomething active
Kidneys & BladderKidneys & Bladder
BladderBladder burning, pain, bloodburning, pain, blood
KidneysKidneys Impaired water excretionImpaired water excretion ProteinuriaProteinuria Weight gainWeight gain Little urine outputLittle urine output
ManagementManagement
ClinicalClinical IV fluidsIV fluids Bladder irrigationBladder irrigation DiuresisDiuresis Monitor Monitor
electrolyteselectrolytes
At HomeAt Home Increase oral fluidsIncrease oral fluids Empty bladder Empty bladder
frequentlyfrequently Call provider: unable Call provider: unable
to urinate for more to urinate for more than 12 hours; urine than 12 hours; urine dark & concentrated; dark & concentrated; producing only small producing only small amounts of urineamounts of urine
Hair LossHair Loss
May lose some or all hair May lose some or all hair Can happen anywhere on the bodyCan happen anywhere on the body Starts 2 to 3 weeks after therapy beginsStarts 2 to 3 weeks after therapy begins Scalp may hurt at first Scalp may hurt at first It takes about 1 week for hair to fall outIt takes about 1 week for hair to fall out Almost always, hair will grow back 2 to 3 Almost always, hair will grow back 2 to 3
months after chemotherapy is over months after chemotherapy is over Hair may start growing back even while Hair may start growing back even while
on therapyon therapy
Skin & NailsSkin & Nails
Itching, dryness, redness, rashes, and Itching, dryness, redness, rashes, and peelingpeeling
Darker veinsDarker veins Sensitivity to the sun Sensitivity to the sun Nail problemsNail problems Radiation recallRadiation recall Allergic reactionsAllergic reactions Chemotherapy leaking from IVChemotherapy leaking from IV
FatigueFatigue
Most common and most Most common and most distressing symptom associated distressing symptom associated with cancer treatmentwith cancer treatment
Hormonal TherapyHormonal Therapy
May improve May improve prognosis more prognosis more than chemotherapythan chemotherapy
If taken by mouth, If taken by mouth, must be taken must be taken everydayeveryday
Usually given for 5-Usually given for 5-10 years10 years
In Stage IV disease, In Stage IV disease, can control cancer can control cancer for many yearsfor many years