1/2 the answer for Question #2

I tried to do all of it but it's getting late and I have to get ready for tomorrow. So I did half of the question I covered Surgery and Radiation if someone else can do Chemo and Biological that would be great. Please feel free to put any input if something else can be added or you find an error. Good night ladies!

Treatment Modalities of CA: (Chemo, Radiation, Surgery, and Biologic Therapy) May be used alone or in combination in the initial treatment phase or retreatment phasesà two or more treatment modalities are used to cure or control the CA for a long period of time.
SURGICAL THERAPY: In order for surgical therapy to be applied the following priciples are applicable: **Cure, control and palliation **
i. Cancer that arises from a tissue c slow rate of cellular proliferation or replication is most amenable to surgical treatment
ii. A margin of normal tissue must surroung the tumeor at the time or resection
iii. Only as much tissue as necessary is removed, and adjuvant therapy is used
iv. Preventive measures are used to reduce the surgical seeding of cancer cells
v. The usual sites of regional spread may be surgically removed à a debulking procedure may be used if the tumor cannot be completely removed (i.e attched to a vital organ)
TYPES OF SURGICAL THERAPY
i. Diagnostic surgeries confirms or rules out malignancy. It establishes type, extent, and classification to tumor.Examples: needle biopsies, incisional or excisional biopsies. Samples of the tumor are taken if complete removal of a lesion or tumor is not possible or undesirable (location, etc) Removable tumors with excisional surgery are usually less than 3 cm in size. Size and location determine the best procedure to perform.
ii. Curative surgery is used to remove all of the tumor with minimal damage to structures surrounding the tumor and minimal functional impairment. Removal often means loss of an organ, resulting in an alteration in body image.The process of rehabilitation continues long after discharge, utilizing outpatient services. Groups of people who have experienced similar cancers often have formed support groups.
iii. Reconstructive Surgery helps restore form and function of whatever was removed (i.e breast reconstruction). It is possible for the reconstruction to occur at the same time as the curative surgery. The goal of reconstruction is to improve the person’s quality of life by restoring maximal funciton and appearance.**helps increase the quality of life**
iv. Palliative Surgery is used to retard the growth of the tumor. Removal of secreting glands to take away hormone source—Decrease the size of an existing tumor. Removal of all of the tumor may not be possible, so debulking the tumor reduces the “tumor burden” on the person, making it possible for other therapies, such as chemotherapy or radiation. Cryrosurgery or laser surgery may be used to remove obstructions, or ulcerations when a cure is no longer possible. This reduces pain. (Examples: colostomy for relief of a bowel obstruction, laminectomy for relief of a spinal cord compression.
v. Supportive Care are surgical procedures used throughout the DZ process of CA to provide support. They include insertion of feeding tubes, creation of a colostomy to allow healing of rectal abscess, suprapubic cysttostomy for the patient c advanced prostatic CA


RADIATION THERAPY: **Cure when therapy is used alone; control: palliation most often goalàcan be used to reduce tumor size to relieve symptoms such as pain and obstruction** local treatment modality for CA . Works by producing high energy ionization, taking a way the cells ability to reproduce. Works best on rapidly dividing cells thus cells in the GI tract, o;ral mucosa and bone marrow will die fast and exhibit early acute responses to radiation. The larger the treatment area, the greater the amount of side effects. Hair over treated area will likely fall out, and probably not grow back. The higher the number of rads the higher chance that they will have a reaction. Factors most commonly used to reduce side effects or radiation Fractionation give healthy cells time to repair themselves between doses and increases the chance that the tumor cells will be hit during a growth phase. Alternate sites allow for hitting the tumor from the front, back, and either side of the tumor. The area that all angles have in common is the tumor, but by alternating the directions normal cells contact with the radiation is minimized, thus normal cells will not be harmed as badly.
i. External Radiation (external beam radiation therapy): is the most common form of treatment delivery. Adm. By high radiation machines
ii. Internal Radiation (brachytherapy): is administered by an implantation or insertion fo radioactive material directly into the tumor or in close proximity. It may be temp or permanent. ** Nurses must be aware that the patient is radioactive. Nursing care should be organized so that limited time is spent with the patient. Sheilding if available should be used usually with a film badge.

iii. Side Effects: Nurse has an important role in helping patient deal with side effects.
1. Fatigue: Patient must be aware that fatigue is an expected side effect, and not a sign that treatment is not working. Encourage patient to rest when fatigued, to maintain usual lifestyle patterns a s closely as possible and to pace activities in accordance with energy level.
2. Anorexia: May develop as a general reaction to treatment. Monitor weight to make sure weigth loss is not excessive. Provide small frequent meals of high protein, gently encourage patient to eat but avoid nagging, serve food in a pleasant environment.
3. Bone Marrow Suppression: Monitor CBC (WBC are usually more affected). If anemia occurs and Hgb drops below 10g/dl the patient may require blood transfusion.
4. Skin Reactions: Protect skin from trauma, lubricate dry skin with nonirritating creams, avoid the use of harsh soaps.
5. Oral, Oropharynx, and esophageal reactions: Be aware that eating,swallowing, and talking ae difficult. Encourage patient to use artificial saliva, assess oral mucosa daily and teach patient to do this. Discourage use of irritatnts such as tobacco and ETOH.
6. Pulmonary Effects: effects may be include both acute and late reactions. For pneumonitis monitor for dry, hacking cough, fecre and exertional dyspnea.
7. GI effects: Monitor manifestataions such as urgency, frequency,a nd hematuria. For Nausea and vomiting: administer antiemetics, use diversional activities, teach to eat and drink when not nauseated, assess for s/sx of dehydration and alkolosis. For Diarhhea: Give anitdiarrheal agents as needed, assess volume, consistency and number of stools produced a day and encourage fluid intake.
8.Reproductive effects: Be sure to discuss these changes with patients àaspermia in males and potential infertility. Inform of the possibility of harvesting sperm