onco rns can u help me :)

  1. hello all,

    pretty much new here, everyone on this bb seems really intelligent so i was wondering if anyone can help me figure out this oncology section of nursing. well i am a student and our instructors have "thrown" us into onco with no foundation to build on. I am soo confused about the drugs and classifications of tumors, nursing intervention ect.

    I am probably being vague, but can sombody please help me with a "crash course". I have no experiance in onc and i dont plan on specializing in that area, so because of that it is hard for me to "make it understandable" (lack of vocab to express myself:imbar extremely tired and stressed)

    I m not looking for a "short-cut" to learning just a foundation to build on... can anyone help ?
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  2. 13 Comments

  3. by   renerian
    You cannot crash course hem/onc. I worked on a bmt/hem/onc unit for over six years what type of questions do you have. Way to much information.......

    renerian
  4. by   caroladybelle
    Agree with above.

    Oncology requires a lot of indepth information. I wouldn't even know a reference to direct you to for quick information.

    "Core Curriculum For Oncology Nursing" put out by ONS for OCN certification is about the only reference that comes to mind. The other books that I use were given to me by a Hematologist from Johns Hopkins and not readily available to Nurses. It is very difficult to find a good affordable Hematology book for Nurses, specifically (I've been looking for 5 years - thus I settled for the Johns Hopkins one from my MD friend)

    Nursing Schools (in my experience) generally do not cover Onco very thoroughly. My school spent all of two weeks on it. We were told that it was a "specialty" that would taught later indepth if needed (tell that to all those people that list onco nurses as Med-surg).
  5. by   jule
    agree with the above., but maybe a little help. ilive in germany, so i cant recommend you any book. but if youre really unexpierienced in hem/onc, try to get a book for "amateurs",e.g. for patients or for their relatives. in some of these books there are short, but exact and comprehensible descriptions of the diffenrent tumors, therapies etc.
    my school didnt cover very much of oncology, never worked on onc. as a student.so when i started my new job on onc. someone gave me a book called " krebs, mein kind?" which means "cancer, my child?". it heped me to get a short summary about the most important subjects. after reading this working a while, i was ready to read the "pro`s" books with lot more information.
    good luck!
  6. by   happystudent
    thanks for responding!

    you are right,school does not focus too much on oncology.....sigh
    my main issues are understanding how the tumor grading system works. for example : the T subclasses, N subclasses and Msubclasses. I dont understand how its used to determine a tumors growth. Ive been reading and reading in my medsurg book, checking out some websites but its not clicking...

    any suggestion would help out greatly
    thanking in advance
    me
  7. by   caroladybelle
    I generally do not think in grades, the grading frequently varies from type of cancers.

    If the Ca is well-differentiated (closest appearance/histiology to tissue of origin), encapsulated, with no node involvement and no mets - prognosis is best.

    If it has lymph node involvement /wo extension - a little worse.

    Extension into other tissues, worse still.

    Anything with any distal mets has poor prognosis. The more distant, the poorer the outcome, regardless of local extension.

    Of course, massive local extension in and of itself can be a problem.

    Also tissue with really poor differentiation (looking less like the normal origin tissue) are usually in for poor prognosis. Upon ocasion, I have seen tumors of unknown origin, where the tumor cells look so bizarre that the tissue of origin cannot be determined (No, it is not merely where the tumor located). Ocasionally, distal mets or node involvement occurs when the original tumor cells have died/disappeared. As a general rule the stranger (from normal) that it looks and the farther it is from where it is supposed to be - the worse the cure rate.

    A tumor of unknown origin generally has the poorest prognosis for cure, along with tumors with distal mets, or widely desiminated mets.

    A primary tumor is the one at the origin (if existing), mets are what you find when cells of that tumor get relocated to another site. Thus, you generally do not have lung cancer with brain cancer and spine cancer - It usually is Lung cancer (primary) with mets to brain and spine. (It is possible to have more than one primary but not that common. ) And you would treat the mets sometimes with some of the treatments used for lung ca - as the cells are lung ca (not spine/brain) even though treatment varies some with the different location.

    As a working Onco nurse, I focus on the location of the tumor, the tissue of origin(not always the same), extension, mets and treatments undergone. Numbers and grades don't really come into regular use.

    **** Please note correction in steps*******
    Last edit by caroladybelle on Apr 10, '03
  8. by   happystudent
    carol,

    thanks ..very interesting. So basically the tumor grading scale is not used to differentiate (sp?) the tumors particular stages? Its all about whether or not it has met. and the extent of tissue damage? arrrrr. still kinda foggy.

    in my med/surg book it talks about this "subclass" so are you saying that method is not being used in hospitals to classify them?
  9. by   renerian
    I let the docs do the grading and let me worry about the patient care. Good post Carol.

    renerian
  10. by   delirium
    Excellent post, Carol.

    I look forward to running to you with all my new grad onc questions. Get ready!
  11. by   caroladybelle
    Originally posted by happystudent
    carol,

    thanks ..very interesting. So basically the tumor grading scale is not used to differentiate (sp?) the tumors particular stages? Its all about whether or not it has met. and the extent of tissue damage? arrrrr. still kinda foggy.

    in my med/surg book it talks about this "subclass" so are you saying that method is not being used in hospitals to classify them?
    And this waaayyy too complicated to do online.

    Staging is done by MDs - and has limited bearing on what the oncology nurse does. As Renarian put it so well, the MD grades - we take care of the patient.. Also assigning a grade to the cancer varies with the different forms of cancer. It would impossible for us to remember them all and not all that useful to us. There are also many different classification methods for the same ca (For cervical ca - the Bethesda vs the WHO scale - for example)

    For Example - Breast Ca
    Stage 0 - Ca in situ (generally encapsulated, no extension, no
    mets, no node disease)
    Stage 1 - Tumor<1cm, no extension, no mets, no node disease)
    Stage 2 - Tumor<2cm with positive axillary nodes or
    2-5 cm with neg or pos. axillary nodes or
    >5cm. with neg axillary nodes.
    Stage 3 - Tumor>5cm with pos. axillary nodes or
    Tumor of any size with direct extension to chest wall
    or skin or
    Tumor of any size with positive internal nodes, or fixed
    axillary nodes
    Stage 4 - ANY Distal mets

    So as you can see you can have a very lg tumor - if it has not metastisized, traveled to the node or extended - the stage is low. Yet a tumor of any size with ANY distant mets has a high staging number. And the lower the staging number - the better the prognosis. Prognosis also is affected by differentiation, hormone factors (with gender specific/breast ca), and some others

    Subclasses - I really don't pay that close attention to unless it is highly unusual. A Wilm's Tumor/Sarcoma in a gland of an adult - of racial makeup such that Wilm's tumors should not occur comes to mind - mainly because when a common tumor occurs in a highly uncommon patient/organ/situation - the general prognosis is poor. I do like to know what type/class lymphoma or leukemia my patient has, because it affects outcome and daily treatment issues. And I do want to know the Primary (it annoys the daylights out of me to get in report, "Well, he has brain cancer, lung cancer, bone cancer, liver cancer and had a heart attack 'cause of heart cancer). Just a picky thing.

    While in class, you should grade them as dictated by your instructor - in life our concerns involve treatment/prognosis/QOL (quality of life) issues. MDs may put numbers to it - but my responsibility is to take care of the patient with it. As such, mets/tumor burden/treatment/extension or suspicion of extension/mets is more of a concern - not numbers.
  12. by   happystudent
    thanks so much for all the great info!! Put things in a new perspective for me. If I have any questions , carol, can I ask you?
  13. by   caroladybelle
    Always, sweethearts
  14. by   jule
    ive been told about TNM-staging in school as well- and never met it again in ped.onc. but here is what ive beeen taught:

    T means the size of the primary tumor (1small-4very large)
    T depends on the localisation of the primary tumor.
    that means E.G a small brain tumor COULD be worse than a
    bigger bone-tumor
    N means the involvement of lymh nodes
    N1:the lymph node closest to the primary tumor is involved
    N2:" " " most far away from the tumor is involved
    N3as N2, but maybe with micrometastases in the blood (Dont
    know the english word)
    M means metastases
    M0 no met
    M1 met close to the primary tumor
    M2 met. far away from " "
    Mx not known if there are met.
    I learned in school that TNM can have additional "letters",
    like Nc (c means "chirurg", that means surgeon, will say the involvement of nodes seen by the surgeon) or Np for involvement seen by the pathologist.

    but as carol posted, there are so many different ways of staging ...

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