Topic 6 Cancer, Hematologic Problems, Leukemia

• For patients with anemia, expect dyspnea at rest and tachycardia,
• If a patient feels cold during a blood transfusion, stop the infusion immediately.
• The priority for a patient having frequent PVCs is to check blood pressure and oxygen saturation.
• Prime the transfusion using normal saline.
• Do not run anything simultaneously with blood infusions.
• What are the two significant dysfunctions in the process of cancer development?

  Defective cell proliferation (growth) and defective cell differentiation.
• What are the three stages for the process of cancer development?

  Initiation, promotion, progression.
• What stage does cell alteration start?

  Initiation.
• When does evidence of clinical disease start?

  Progression.
• Carcinogens may be chemical, radiation, or viral.
• Tumors can be classified as benign or malignant.
• Malignant tumor cells invade and metastasize while benign tumor cells do not.
• Tumors can be classified by anatomic site, histology and extent of the disease.
• Prevention is key against the war on cancer.
• The highest number of cancer deaths by site are for cancer of the lung and bronchus which smoking is the leading cause of.
• Hodgkin's and Non Hodgkin's lymphoma are highly radiosensitive.
• Low energy beams only penetrate a short distance while high energy beams have a greater depth of penetration.
• Brachytherapy is internal radiation treatment that can be high or low dose rate.
• Palliation for cancer patients can be done at the same time as treatment.
• Surgery is the oldest form of cancer treatment and is used to eliminate or reduce risk of cancer for patients.
• Nonvital organs can be removed as prophylactic measures to prevent incidence of cancers.
• Surgical cure and control of cancer removes only as much as necessary to spare normal tissue.
• Debulking can be done if the tumor cannot be completely removed which is then followed by chemotherapy or radiation therapy.
• Neoadjuvant therapy is chemotherapy or radiation before surgery.
• Supportive care for cancer surgery patients include inserting a gastric feeding tube, placing a central venous access device and surgical fixation of bones at risk for a pathologic fracture.
• Antineoplastic therapy is mainstay for most solid tumors and hematologic cancers.
• Antineoplastic therapy can be a cure, control, or palliative care.
• Chemotherapy is effective against dividing cells so cancer can avoid it by staying in the G0 or resting phase.
• As tumors get bigger, more cells become inactive and convert to G0.
• Chemotherapy agents can be absorbed via skin, inhalation.
• Only properly trained personnel should handle cancer drugs.
• CVAD administration is done in large blood vessels, allow frequent, continuous, or intermittent administration. You can even give other fluids through CVAD.
• Low energy beams are useful for skin lesions.
• External beam radiation therapy is the most common radiation treatment.
• Limit amount of time near patients being treated with brachytherapy since patient can be radioactive.
• Time, distance and shielding help limit patient contact during radiation therapy.
• Myelosuppression is the most common side effect of chemotherapy.
• What is myelosuppression?

  Bone marrow suppression.
• Lowest blood cell counts often occur 7 - 10 days after starting therapy.
• Patients who are fatigued from cancer therapies should remain active during periods when patients feel better.