Cancer Treatment Modalities and Nursing Care - Cheat Sheet
Your last-minute revision companion for NLE-style oncology nursing questions. This sheet covers chemotherapy toxicities, radiation safety, surgery, newer agents, and life-threatening emergencies you MUST recognize instantly.
CHEMOTHERAPY: CELL-CYCLE ACTIVITY & CLASSIFICATION
Important facts
- Chemotherapy is SYSTEMIC — reaches cancer throughout the body but damages all fast-dividing cells.
- Three normal tissues hit hardest: bone marrow (myelosuppression), GI mucosa (mucositis/diarrhea), hair follicles (alopecia).
- Cell-cycle-specific = more effective against actively dividing cells; cell-cycle-nonspecific = effective against resting cells too.
- Alkylating agents (cyclophosphamide) and antitumor antibiotics (doxorubicin) are cell-cycle-nonspecific.
- Antimetabolites (methotrexate, 5-FU) and plant alkaloids (vincristine, vinblastine) are cell-cycle-specific.
Key definitions
Cell-Cycle-Specific Agents
Example
Methotrexate, fluorouracil (S phase); vincristine (M phase)
Drugs that kill cancer cells only during specific phases of mitosis (e.g., antimetabolites in S phase, vinca alkaloids in M phase); most effective against rapidly dividing cells; given as divided or continuous doses.
Cell-Cycle-Nonspecific Agents
Example
Cyclophosphamide, doxorubicin
Drugs that kill cancer cells in any phase, including resting cells; given as single bolus doses.
Nadir
Example
Monitor CBC closely at day 7–14; may delay next dose if recovery incomplete
The point of lowest blood counts after chemotherapy, typically occurring 7–14 days post-infusion; patient is most vulnerable to infection and bleeding.
Diagrams to know
- Cell cycle phases (G1, S, G2, M) and which drugs target each phase
- Nadir timeline: administration → nadir window (day 7–14) → recovery
MYELOSUPPRESSION: NEUTROPENIA & INFECTION RISK
Formulas
ANC = (WBC count × % neutrophils) ÷ 100
Meaning
ANC = absolute neutrophil count; WBC = white blood cell count; % neutrophils from differential
Watch out
Do NOT confuse ANC with total WBC; a patient can have normal WBC but low ANC if neutrophils are a small percentage
When to use
Calculate infection risk; interpret lab results for chemotherapy patients
Common values
Value
ANC < 1,000/mm³
Symbol
Mild neutropenia
Quantity
Neutropenia threshold
Value
ANC < 500/mm³
Symbol
High infection risk
Quantity
Severe neutropenia threshold
Value
Day 7–14 post-chemotherapy
Symbol
Peak vulnerability
Quantity
Nadir timing
Value
≥38.3°C once OR ≥38.0°C for ≥1 hour
Symbol
Emergency threshold
Quantity
Febrile neutropenia: fever threshold
Important facts
- Myelosuppression is the DOSE-LIMITING toxicity — determines maximum chemotherapy dose.
- Neutropenia = greatest danger; can cause overwhelming sepsis with minimal signs (no pus, no obvious inflammation).
- Nadir occurs day 7–14 post-chemotherapy; patient is most vulnerable then.
- Thrombocytopenia (low platelets) causes bleeding; anemia causes fatigue and dyspnea.
- Neutropenic precautions: private room, meticulous hand hygiene, no sick visitors, low-bacteria diet (no raw fruits/vegetables, undercooked foods), avoid invasive procedures, monitor temperature.
- Granulocyte colony-stimulating factors (G-CSF, e.g., filgrastim) given to speed neutrophil recovery.
Key definitions
Neutropenia
Example
Patient with ANC 800 → monitor temperature, educate on hand hygiene and food safety
ANC below 1,000/mm³; increased risk of infection; requires monitoring and precautions.
Severe Neutropenia
Example
ANC 300 → private room, low-bacteria diet, no fresh flowers, monitor temperature Q4H
ANC below 500/mm³; HIGH RISK of life-threatening infection; STRICT precautions mandatory.
Febrile Neutropenia
Example
Patient on chemo with ANC 200 and temp 38.5°C → blood cultures STAT, broad-spectrum antibiotics within 1 hour, do NOT wait for culture results
A fever (≥38.3°C once or ≥38.0°C sustained ≥1 hour) in a neutropenic patient (ANC <500); a medical EMERGENCY.
Diagrams to know
- Timeline of myelosuppression: chemo administration → day 7–14 nadir → recovery
- ANC interpretation scale: >1,000 (safe) vs. 500–1,000 (at-risk) vs. <500 (severe, strict precautions)
MAJOR CHEMOTHERAPY SIDE EFFECTS & NURSING CARE
Important facts
- Nausea & vomiting: Give ANTIEMETICS PROPHYLACTICALLY before chemotherapy (ondansetron, aprepitant, dexamethasone); continue around treatment; offer small, bland meals; monitor hydration.
- Alopecia: Temporary; reassure and prepare patient; offer wig/scarf/cap options — body image concern, not safety.
- Mucositis: Soft toothbrush; saline or bland rinses; topical anesthetics; AVOID alcohol-based mouthwash, hot/spicy/acidic foods.
- Fatigue: Most commonly reported symptom; teach energy conservation and rest.
- Diarrhea & constipation: Manage diet, fluids, medications. NOTE: vinca alkaloids (vincristine) cause constipation AND peripheral neuropathy.
- Vesicants (doxorubicin, vincristine) can cause extravasation; use central line when possible.
- Extravasation = EMERGENCY: STOP infusion immediately but DO NOT remove needle; leave in place to aspirate residual drug; apply cold or warm compress per protocol; elevate extremity; document.
Key definitions
Alopecia
Example
Prepare patient BEFORE treatment; suggest wigs, scarves, caps; reassure regrowth will occur
Hair loss from chemotherapy; temporary; hair regrows post-treatment (sometimes with different texture/color).
Stomatitis/Mucositis
Example
Soft toothbrush, saline rinses, topical anesthetics; avoid alcohol-based mouthwash, hot/spicy/acidic foods
Painful inflammation of the oral mucosa; ranges from mild erythema to severe ulceration.
Extravasation
Example
Doxorubicin or vincristine leaks into arm tissue → STOP infusion, leave needle in place, aspirate residual drug, apply protocol-specific compress, elevate limb, notify provider
Leakage of a vesicant chemotherapy drug out of the vein into surrounding tissue; causes severe tissue damage, blistering, necrosis; a NURSING EMERGENCY.
Diagrams to know
- Extravasation response flowchart: recognition → stop infusion → aspirate → apply compress → elevate → notify
- Mucositis management pathway: assessment → oral hygiene protocol → nutritional modification → pain management
SAFE HANDLING OF CHEMOTHERAPY DRUGS
Common values
Value
~48 hours post-chemotherapy
Symbol
Precaution window
Quantity
Duration of body-fluid hazard
Important facts
- Always wear chemotherapy-rated gloves (double-glove often recommended), gown, and eye protection.
- Prepare chemotherapy in a BIOLOGICAL SAFETY CABINET.
- Dispose of all drugs, tubing, and contaminated materials in designated CYTOTOXIC (HAZARDOUS) WASTE containers — NOT regular trash.
- Treat patient's body fluids (urine, stool, vomit, blood) as HAZARDOUS for approximately 48 hours after chemotherapy administration; use precautions when handling.
- Follow spill-kit procedures for any spill of chemotherapy.
- PREGNANT NURSES: Avoid handling chemotherapeutic agents and should not care for patients with internal radioactive sources.
- This aligns with RA 9173 (Philippine Nursing Practice Act) regarding safe practice and occupational health protection.
Key definitions
Chemotherapy Hazards
Example
Pregnant nurses should NOT handle chemotherapy agents or care for internal-radiation patients; all staff must wear PPE
Chemotherapy drugs are mutagenic, teratogenic, and carcinogenic; hazardous to healthcare workers who handle them.
Diagrams to know
- Chemotherapy safety protocol: PPE → biological safety cabinet → administration → hazardous waste disposal
- Body-fluid hazard timeline: 0 hours (highest hazard) → 48 hours (hazard ceases)
RADIATION THERAPY: EXTERNAL vs. INTERNAL
Important facts
- Radiation is a LOCAL treatment — side effects confined to area being irradiated.
- External-beam patients are NOT radioactive and pose NO risk to others.
- Internal-radiation (brachytherapy) patients emit radiation while source is in place; are a source of exposure.
- With unsealed sources (radioactive iodine), body fluids are radioactive.
- Skin markings for external radiation are CRITICAL for targeting — NEVER wash them off.
- Radiation skin care: wash gently with lukewarm water and mild soap only; NO lotions, powders, creams, perfumes, or deodorants (can alter dose or worsen reaction); avoid sunlight, extreme heat/cold, tight/abrasive clothing; do not scratch or rub.
Key definitions
External Beam Radiation (Teletherapy)
Example
Patient with lung cancer receives daily external-beam radiation; markings drawn on chest to guide treatment area
Radiation delivered from a machine outside the body; patient is NOT radioactive; poses NO risk to others; skin markings used to target beam.
Internal Radiation (Brachytherapy)
Example
Sealed implant for cervical cancer; unsealed source (radioactive iodine) makes body fluids radioactive
Radioactive source placed inside or next to tumor; WHILE SOURCE IS IN PLACE, patient EMITS RADIATION and is a source of exposure to others.
Radiodermatitis
Example
Patient undergoing chest radiation develops erythema and dryness in treatment field by week 2–3
Radiation-induced skin reaction in treatment field: redness, dryness, irritation; local effect of external radiation.
Diagrams to know
- External vs. internal radiation comparison: external = patient not radioactive, internal = patient emits radiation
- Skin-care do's and don'ts pathway
RADIATION SAFETY: TIME, DISTANCE, SHIELDING
Important facts
- THREE PRINCIPLES OF RADIATION PROTECTION: TIME (less) + DISTANCE (more) + SHIELDING (lead).
- Internal-radiation patient requires PRIVATE ROOM.
- All staff caring for internal-radiation patient must wear a RADIATION DOSIMETER (film badge).
- PREGNANT NURSES and CHILDREN must NOT enter the room and must NOT be caregivers to internal-radiation patients.
- Keep a LEAD-LINED CONTAINER and LONG FORCEPS in the room in case the implant becomes dislodged.
- If implant dislodges: NEVER touch it with bare hands; pick it up with forceps and place in lead container.
- Rotate staff assignments to limit any one nurse's radiation exposure.
- This aligns with Philippine Department of Health occupational safety standards and RA 9173 nurse safety requirements.
Key definitions
Time Principle
Example
Cluster all assessments and care into one brief visit rather than multiple short visits
Minimize time spent near the radioactive source; organize care to be efficient and swift.
Distance Principle
Example
Stand at the far side of the room when not directly caring for the patient; use long forceps to manipulate items
Maximize distance from the radioactive source; radiation intensity falls sharply with distance (inverse-square law principle).
Shielding Principle
Example
Lead aprons, lead-lined containers for dislodged sources
Use lead shielding as appropriate to block or reduce radiation exposure.
Radiation Dosimeter (Film Badge)
Example
RN wears film badge on chest during all shifts with internal-radiation patients
Personal device worn to measure cumulative radiation exposure; required when caring for internal-radiation patients.
Diagrams to know
- Radiation safety setup: private room → film badge → lead container at bedside → long forceps accessible → staff rotation protocol
- Time-Distance-Shielding triangle with inverse-square law illustration
SURGERY IN CANCER TREATMENT
Important facts
- Surgery is used for diagnosis (biopsy), cure, debulking, palliation, prevention/prophylaxis, and reconstruction.
- Nursing care follows general perioperative principles PLUS attention to patient's overall condition (may be compromised by cancer and prior treatments).
- Assess nutritional status, functional ability, and tolerance for extended anesthesia time in cancer patients.
- Post-op pain management may be complex; use multimodal analgesia.
- Monitor for complications (infection, bleeding, fluid/electrolyte imbalance, DVT/PE) more vigilantly in compromised patients.
Key definitions
Diagnostic Surgery (Biopsy)
Example
Excisional biopsy of breast mass to diagnose ductal carcinoma
Surgical removal of tissue to confirm cancer diagnosis and determine type/grade.
Curative Surgery
Example
Total mastectomy with axillary lymph node dissection for breast cancer
Complete removal of localized cancer with the intent to cure.
Debulking (Cytoreductive) Surgery
Example
Removing bulk of ovarian cancer before chemotherapy
Reduction of tumor size (not complete removal) to help other therapies work better.
Palliative Surgery
Example
Bowel resection to relieve colorectal obstruction
Surgical relief of symptoms such as obstruction or pain when cure is not possible.
Diagrams to know
- Types of cancer surgery: diagnostic → curative → debulking → palliative → prophylactic → reconstruction
IMMUNOTHERAPY & TARGETED THERAPY
Important facts
- Monoclonal antibodies (trastuzumab, rituximab) require monitoring for infusion reactions; give first doses slowly with emergency equipment ready.
- Trastuzumab: monitor for cardiac dysfunction (ejection fraction) because HER2 is also on cardiac cells.
- Rituximab: watch for infusion reactions, especially with first dose.
- Tyrosine kinase inhibitors (imatinib): monitor for GI upset, fluid retention, muscle cramps.
- Interferons & interleukins: cause flu-like symptoms (fever, fatigue, myalgia); pre-treat with acetaminophen.
- Immune checkpoint inhibitors: can cause autoimmune, inflammatory side effects in ANY organ system (dermatitis, colitis, hepatitis, pneumonitis, endocrinopathy); teach patient to report ANY new symptoms.
- Nursing focus: monitor for infusion/hypersensitivity reactions and recognize agent-specific toxicities.
Key definitions
Targeted Therapy
Example
Trastuzumab (targets HER2-positive breast cancer); rituximab (targets B-cell lymphomas); imatinib (tyrosine kinase inhibitor)
Drugs that attack specific molecules on cancer cells; more selective than chemotherapy; may include monoclonal antibodies or tyrosine kinase inhibitors.
Immunotherapy
Example
Interferon-alpha (causes flu-like symptoms); checkpoint inhibitors (can cause autoimmune, inflammatory side effects in any organ system)
Drugs that stimulate the patient's own immune system to fight cancer; includes interferons, interleukins, and immune checkpoint inhibitors.
Infusion Reaction
Example
Patient receiving rituximab develops fever, chills, and dyspnea during first infusion; slow infusion, give antihistamines and steroids
Hypersensitivity or adverse reaction during or shortly after monoclonal antibody or immunotherapy infusion; ranges from mild (fever, chills) to severe (anaphylaxis).
Diagrams to know
- Mechanism comparison: targeted therapy (blocks specific molecule) vs. immunotherapy (activates immune response)
- Monoclonal antibody infusion reaction timeline and management
ONCOLOGIC EMERGENCIES
Common values
Value
≥38.3°C once OR ≥38.0°C sustained ≥1 hour with ANC <500
Symbol
EMERGENCY
Quantity
Febrile neutropenia: fever threshold
Value
Within 1 hour of fever recognition
Symbol
Non-negotiable
Quantity
Antibiotic timing
Value
Leukemia and lymphoma (bulky, treatment-sensitive)
Symbol
High surveillance
Quantity
TLS risk: highest in
Important facts
- Febrile neutropenia: Temperature of ≥38.3°C once or ≥38.0°C sustained ≥1 hour in ANC <500 patient = EMERGENCY. Blood cultures and broad-spectrum antibiotics WITHIN 1 HOUR. Do NOT wait for results. Do NOT give antipyretics before cultures unless ordered. NEVER give aspirin.
- TLS: Risk highest in bulky, treatment-sensitive cancers (leukemia, lymphoma). Occurs shortly after starting chemo. Management: aggressive IV hydration, allopurinol (xanthine oxidase inhibitor) or rasburicase (uricase), electrolyte correction (especially potassium), monitor renal function and cardiac rhythm.
- SVC syndrome: Signs include facial/neck swelling, arm edema, distended neck and chest veins, dyspnea, feeling of fullness in head. Management: elevate head of bed, oxygen, urgent radiation or chemotherapy to shrink tumor.
- Spinal cord compression: BACK PAIN is EARLIEST and MOST COMMON symptom. Followed by motor weakness, sensory loss, bowel/bladder dysfunction. REPORT NEW OR WORSENING BACK PAIN IN CANCER PATIENT IMMEDIATELY. Treatment: high-dose dexamethasone to reduce swelling, PLUS radiation or surgery.
- Hypercalcemia: Signs reflect slowed metabolism and neuromuscular irritability. Severe: arrhythmias and coma. Management: aggressive IV saline hydration (most important), bisphosphonates (zoledronic acid, pamidronate), may use loop diuretics AFTER rehydration, treat underlying cancer.
Key definitions
Febrile Neutropenia
Example
Chemo patient, ANC 200, temp 38.5°C → blood cultures STAT, broad-spectrum antibiotics within 1 hour, do NOT wait for culture results
Fever (≥38.3°C once or ≥38.0°C sustained ≥1 hour) in a patient with ANC <500; a MEDICAL EMERGENCY; can progress to septic shock rapidly.
Tumor Lysis Syndrome (TLS)
Example
Patient with acute leukemia after initial chemo: hyperkalemia → cardiac dysrhythmia; manage with aggressive IV hydration, allopurinol/rasburicase, electrolyte correction, renal/cardiac monitoring
Rapid release of tumor cell contents (K+, phosphate, uric acid) after chemotherapy, causing HYPERKALEMIA, HYPERPHOSPHATEMIA, HYPERURICEMIA, HYPOCALCEMIA; can cause acute kidney injury and fatal arrhythmias.
Superior Vena Cava (SVC) Syndrome
Example
Facial and neck swelling, arm edema, distended neck/chest veins, dyspnea, head fullness → elevate head, O₂, urgent radiation/chemotherapy
Compression/obstruction of the superior vena cava by tumor (often lung cancer or lymphoma); blocks venous return from head and upper body.
Spinal Cord Compression
Example
Back pain (earliest/most common symptom) → motor weakness, sensory loss, bowel/bladder changes → dexamethasone + radiation/surgery STAT
Tumor pressing on spinal cord (vertebral metastasis); a NEUROSURGICAL EMERGENCY because delay = PERMANENT PARALYSIS.
Hypercalcemia
Example
Fatigue, muscle weakness, confusion, lethargy, nausea, constipation, polyuria → severe: arrhythmias, coma → IV saline hydration + bisphosphonates (zoledronic acid, pamidronate)
Elevated serum calcium from bone metastasis or tumor-secreted substances; causes slowed neuromuscular and GI function.
Diagrams to know
- Oncologic emergency decision tree: recognition → action (cultures, fluids, medications) → monitoring
- Hypercalcemia cascade: bone metastasis/tumor secretion → elevated Ca²⁺ → slowed neuromuscular function → arrhythmias/coma
Must remember
- CHEMOTHERAPY IS SYSTEMIC: hits fast-dividing normal cells (bone marrow, GI mucosa, hair follicles). Myelosuppression is the dose-limiting toxicity.
- NADIR = lowest blood counts, day 7–14 post-chemo. Patient most vulnerable to infection and bleeding then; monitor CBC, may delay next dose.
- NEUTROPENIA: ANC <1,000 = neutropenia; ANC <500 = SEVERE, strict precautions. FEVER in ANC <500 patient = EMERGENCY: cultures and broad-spectrum antibiotics WITHIN 1 HOUR.
- ANTIEMETICS PROPHYLACTICALLY before chemotherapy (ondansetron, aprepitant, dexamethasone); continue around treatment. Alopecia is temporary but distressing — prepare patient.
- EXTRAVASATION of vesicant (doxorubicin, vincristine) = EMERGENCY: STOP infusion, leave needle in to aspirate drug, apply protocol-specific compress, elevate, notify provider.
- SAFE HANDLING: wear PPE (double gloves, gown, eye protection), prepare in biological safety cabinet, dispose in cytotoxic bins, treat body fluids as hazardous ~48 hrs post-admin. Pregnant nurses must NOT handle chemo.
- RADIATION: External beam = patient NOT radioactive, safe to others. Internal (brachytherapy) = patient EMITS RADIATION while source in place; private room, film badge, staff rotation, pregnant staff excluded.
- RADIATION SKIN CARE: Wash gently (lukewarm water, mild soap only); NO lotions/powders/deodorant on field; NO sun exposure; DO NOT wash off skin markings.
- RADIATION SAFETY = Time (minimize) + Distance (maximize) + Shielding (lead). If implant dislodges: NEVER touch bare hands; use forceps, place in lead container.
- ONCOLOGIC EMERGENCIES: Febrile neutropenia (antibiotics within 1 hour) → TLS (hydrate + allopurinol/rasburicase) → SVC syndrome (elevate head, O₂, urgent treatment) → Spinal cord compression (report back pain immediately, dexamethasone + urgent treatment) → Hypercalcemia (aggressive IV saline + bisphosphonates).
Last minute tips
- NLE loves ANC interpretation and febrile neutropenia response: ANC <500 + fever = blood cultures and antibiotics within 1 hour. You will see this on exam. Memorize it cold.
- Extravasation is a nursing emergency AT THE BEDSIDE. Remember: STOP infusion, leave needle in place (do not pull it out immediately), aspirate, then protocol-specific compress. Doxorubicin and vincristine are your high-risk drugs.
- Radiation safety is TIME + DISTANCE + SHIELDING. If asked about internal radiation patient: private room, film badge, pregnant nurses excluded, forceps and lead container at bedside. This is testable detail.
- Spinal cord compression = back pain first. In a cancer patient with new or worsening back pain, immediately report and think dexamethasone + urgent imaging. Delay = permanent paralysis. This is a high-yield emergency.
- Chemotherapy side effects are testable, but ANTIEMETICS PROPHYLACTIC (not reactive) is key. Give before chemo starts, not after nausea. Ondansetron, aprepitant, dexamethasone are the trio.
Comparison tables
Cell-Cycle-Specific vs. Cell-Cycle-Nonspecific Chemotherapy
| Feature | Cell-Cycle-Specific | Cell-Cycle-Nonspecific |
|---|---|---|
| Target | Specific phase only (S, M, G1, G2) | Any phase, including resting cells |
| Most effective against | Rapidly dividing cells in that phase | Both rapidly dividing and resting cells |
| Dosing schedule | Divided or continuous doses | Single bolus doses |
| Examples | Methotrexate, 5-FU (S phase); vincristine, vinblastine (M phase) | Cyclophosphamide, doxorubicin, daunorubicin |
| Clinical use | Proliferative tumors (fast-growing) | Slower-growing or mixed tumors |
External Radiation (Teletherapy) vs. Internal Radiation (Brachytherapy)
| Feature | External Beam (Teletherapy) | Internal Radiation (Brachytherapy) |
|---|---|---|
| Source location | Outside the body; machine delivers beam | Inside or next to tumor (sealed implant or unsealed) |
| Patient radioactivity | NOT radioactive; poses NO risk to others | EMITS radiation while source in place; is source of exposure |
| Body fluids | Not radioactive | May be radioactive (with unsealed sources) |
| Skin marking | Critical; NEVER wash off; used to target beam | Not applicable for internal sources |
| Precautions | Skin care in field (no lotions); gentle washing; avoid sun | Private room, film badge, staff rotation, pregnant staff excluded, forceps & lead container at bedside |
| Type of effect | LOCAL to treatment area | LOCAL to tumor but patient is radioactive source |
Neutropenia Risk Levels & Precautions
| ANC Level | Classification | Infection Risk | Precautions Required |
|---|---|---|---|
| >1,000/mm³ | Normal | Minimal | Standard precautions |
| 500–1,000/mm³ | Mild-moderate neutropenia | At-risk; monitor closely | Hand hygiene, avoid crowds, low-bacteria diet, monitor temperature, consider growth factors |
| <500/mm³ | SEVERE neutropenia | HIGH RISK of overwhelming infection | STRICT: private room, meticulous hygiene, low-bacteria diet, no sick visitors, no fresh flowers, monitor temp Q4H, avoid invasive procedures, growth factors, educate patient |
Oncologic Emergencies: Recognition & Immediate Action
| Emergency | Key Signs/Symptoms | Pathophysiology | Immediate Nursing Action |
|---|---|---|---|
| Febrile Neutropenia | Temp ≥38.3°C once or ≥38.0°C sustained ≥1 hr; ANC <500 | Inadequate immune response to infection; minimal signs | Blood cultures STAT, broad-spectrum antibiotics WITHIN 1 HOUR, do NOT wait for results, monitor closely |
| Tumor Lysis Syndrome | Hyperkalemia (cardiac dysrhythmia), hyperphosphatemia, hyperuricemia, hypocalcemia; occurs shortly after chemo start | Rapid tumor cell death releases intracellular contents → kidney injury, cardiac toxicity | Aggressive IV hydration, allopurinol/rasburicase, electrolyte correction, monitor renal/cardiac function, monitor urine output |
| SVC Syndrome | Facial/neck swelling, arm edema, distended neck/chest veins, dyspnea, head fullness | Tumor obstructs superior vena cava → impaired venous return from head/upper body | Elevate head of bed, oxygen, notify provider, urgent radiation/chemotherapy |
| Spinal Cord Compression | Back pain (earliest, most common), motor weakness, sensory loss, bowel/bladder dysfunction | Vertebral metastasis compresses spinal cord → tissue ischemia, permanent damage if delayed | REPORT NEW/WORSENING BACK PAIN IMMEDIATELY, stat dexamethasone, notify provider, urgent imaging and radiation/surgery |
| Hypercalcemia | Fatigue, weakness, confusion, lethargy, nausea, constipation, polyuria; severe: arrhythmias, coma | Bone metastasis or tumor-secreted PTHrP raises serum Ca²⁺ → slowed neuromuscular/GI function | Aggressive IV saline hydration (most critical), bisphosphonates, correct electrolytes, monitor cardiac rhythm, treat cancer |
Diagrams
Cancer Treatment Modalities Overview
Hierarchical mind map showing all cancer treatment modalities, major toxicities, radiation concepts, and oncologic emergencies covered in chapter.
Febrile Neutropenia: Recognition & Emergency Response
Decision tree for recognizing and managing febrile neutropenia, the most common oncologic emergency. Emphasizes the 1-hour antibiotic window and common mistakes to avoid.
Chemotherapy Extravasation: Immediate Bedside Management
Step-by-step flowchart for responding to vesicant chemotherapy extravasation. Highlights the critical 'leave needle in place' step that students often miss.
Myelosuppression & Nadir Timeline After Single Chemotherapy Dose
Timeline illustrating the typical bone marrow recovery curve after a chemotherapy dose, emphasizing the nadir window (day 7–14) when counts are lowest and patient is most vulnerable.
Spinal Cord Compression: Clinical Progression States
State diagram showing the progression of spinal cord compression symptoms and the critical decision point: early reporting/intervention (dexamethasone + urgent treatment) leads to preservation; delay leads to permanent paralysis.
Radiation Safety Precautions: Internal Source Patient
Comprehensive flowchart for setting up and maintaining safety precautions for a patient with an internal radioactive source, including the emergency protocol if implant dislodges.