Treatment Mod Ali Ties

8/3/2019 Treatment Mod Ali Ties

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Treatment modalities

1. Surgery/operation oldest form of effective ca therapy GOALS:a. Ca prevention

E.g. polyposis partial gastrectomy if there is family hx

b. Diagnostic surgery/toolE.g. biopsy (excision or needle aspiration)

c. Primary tx for cad. Debulking cytoreduction, surgical resection to reduce tumore. Palliative goal to relieve the sxf. Reconstructive goal

E.g. breast augmentation

SURGICAL INTERVENTIONS:a. Breast ca

MRM breast tissues, lymph nodes underneath the arm

Radical Mastectomy - breast tissues, lymph nodes underneath the arm + tail of Spence

Lympectomy remove benign/ malignant tumor

b. Lung caPneumonectomy affected lung

Lobectomy affected lobe of affected lung

c. Uterine caTotal hysterectomy complete removal of uterus and cervix

Subtotal hysterectomy uterus leaving cervix in place

Radical hysterectomy TAH-BSO (Total abdominal hysterectomy-bilateral salpingo-oophorectomy)

2. Radiation therapy/ radiotherapy energy released in forms of waves or particles GOALS:a. Preventive goalb. Curative goal to destroy/ eliminate ca cellsc. Palliative to relieve sxd. Adjuvant goal after therapy; to destroy all microscopic ca cellse. Neoadjuvant goal before surgery; to shrink the tumor; to decrease the size TYPES:a. External radiation therapy/ teletherapy

Cobalt gamma x-ray

Linear electricity to produce x-ray

*DONT REMOVE MARK!!

DOSE: 3-5/ week x 5-7 weeks


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S/E: easy fatigability

Alopecia only at area of target

Redness or erytheme

Mucositis inflammation of mucosal lining of mouth or G.I.T.

Radiation pneumonia

Immunosuppression (WBC and platelets )

Gastro-intestinal effect ( N & V, diarrhea)

b. Internal Radiotherapy/ brachytherapy head, neck, breast, thyroid, uterus, prostate, cervixTYPES:

Seeds sealed R.T.

Intracavitary interstitial

Unsealed directly to tumor; orally/ IV

Nsg. Care: safe handling of excretions or body fluids

S/E: fatigue

Anorexia

Immunosuppression

PneumonitisPruritus

Edema

ADVERSE EFFECT:

xerostomia dry mouth

Retinal damage

Sterility

SAFETY STANDARDS

y Time amount of radiation exposure*limit contact for 30 min in 8 hr. shift

y Shielding use of protective gadgets------lead apron, dosimeter badge, long-handled forcep, PIG (lead container)

y Distance 6 ft.Children 16 y/o and pregnant = OFF LIMITS

NURSING CARE:

y place pt. in a private roomy provide reassurance that when implants are removed, pt. is not radioactivey wear protective gloves and disposable aprony Implant is dislodged call radiation dept.

3. Chemotherapy antineoplastic drugs; use of drugs to treat ca GOALS:

a. To cure specific cab. To control tumor growthc. Palliative goald. Neoadjuvant & adjuvant


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*remission disappearance of s/sx

*relapse backsliding/ recurrence/ worsening

ROUTE OF ADMINISTRATION:a. Oralb. Topicalc. SQd. IM not indicated in leukemiae. IV most common method

y Angiocatheter most common venous access device; RADIAL VEIN; remove afterchemo is given

y PICC (peripherally inserted central catheter) LARGER VEIN; brachial, cepahalic,basilic; 6 weeks

y Tunnelled catheter - @ jugular vein; SUPERIOR VENA CAVA; HICKMANNSGROSHONG, BRAVIAC

NURSING CARE: dressing changesy port-a-cath- permanent; chest wall; w/ reservoir; inserted @ superior vena cava

to the r. atriumy no dressing changes

f. intrathecal/ intraventricular drug needs to reach the CSF; @ lumbar area, similar toepidural anesthesia

*intraventricular ommaya reservoir; SQ of scalp; inserted into ventricle of brain

g. intraperitoneal directly @ peritoneal cavity; TENCKOFF CATHETER (peritoneal dialysish. intravesicular urinary bladderi. intrapleura lung spaces; chest tube

PRE-MEDS BEFORE CHEMOOncology nurse prone to ca prolonged exposure to drugs

a. Ondansetron (Zofran) anti-emetic; pt. experiences anticipatory nauseab. Ranitidine (Zantac) anti-ulcer; coats gastric mucosa

CLASS OF CHEMO Cell-cycle specific kill ca cells when they are dividing; G1, G2, S and M phases Cell-cycle non-specific kills ca cells when they are @ rest; G0

TYPES OF CHEMO ALKYLATING AGENTS cell-cycle non-specific

a. Mustard gas derivatives chlorambucil, cyclophosphamide, melphalanInd: leukemia, testicular, breastS/E: sterility

b. Ethylenimines thiolepac. Alkylsufonates busulfand. Nitrosureas carmustine, lomustine

Ind: brain ca

e. Mental salts carboplatin, cisplatinInd: ovarian ca, testicular ca, bladder ca and lung ca

S/E: ototoxicity, nephrotoxicity


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PLANT ALKALOIDSa. Vinca alkaloids vincristine, vinblastine (periwinkle)

Ind: leukemia

S/E: peripheral neuropathy (numbness and tingling of lower extremities)

b. Taxanes paclitaxel (pacific yellow tree)Ind: breast ca, ovarian ca, and lung ca

S/E: brittle hair, joint pain

c. Podophyllotoxins etoposideInd: lung ca, testicular ca, lymphoma, leukemia

S/E: flu-like sx

d. Camptothecanalogs topotecanInd: colon & rectal ca

S/E: diarrhea

ANTITUMOR ANTIBIOTICSa. Anthracyclines doxorubian, epirubicin

Ind: breast ca, lymphoma, multiple myeloma

S/E: cardiac damageb. Chromomycin dactinomycin, bleomycin

Ind: colorectal ca

S/E: gynecomastia, libido

ANTIMETABOLITESa. Folic-acid antagonist methotrexate

Ind: leukemia, breast ca, lung ca, lymphoma

S/E: nephrotoxicity and hepatotoxicity

Antidote: leucoverin

b.

Pyrimidine 5 FU (fluoracil), cytarabineInd: pyramidine antagonist, leukemia and breast ca

S/E: photosensitivity

c. Purine 6-mercaptopurineInd: leukemia

S/E: immunosuppression

HORMONESa. Tamoxifen breast cab. Flutamide prostate ca

*all chemo drugs = ALOPECIA*6-8 wks. after completion of the treatment = HAIRREGROWTH

4. IMMUNOTHERAPY / BIOTHERAPY TYPES:

Immunostimulantsy Interleukin acts primarily @ leukocytes/ WBC; most expensive immunotherapyy Interferon-alpha IV


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Treatment Mod Ali Ties

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