Monitoramento e avaliação dos efeitos colaterais da quimioterapia em pacientes com câncer de cólon / Monitoring and evaluation of side effects of chemotherapy in patients with colon cancer

Este estudo objetivou monitorar e avaliar a ocorrência e grau de intensidade da náusea, vômito e diarréia em pacientes com neoplasia de cólon, submetidos à quimioterapia ambulatorial, que receberam informações de enfermagem para o manejo desses sintomas. Fizeram parte do estudo 17 pacientes tratados com 5-Fluorouracil e baixas doses de ácido folínico, no Ambulatório de Quimioterapia de Adultos do Hospital São Paulo/Universidade Federal de São Paulo. Foram elaborados instrumentos para o registro da ocorrência e grau de intensidade desses sintomas e folhetos com informações sobre o seu manejo. As informações e o seguimento foram realizados pela enfermeira do setor, durante as consultas de enfermagem. Os resultados evidenciaram que a maioria dos pacientes (82,4 por cento) apresentou pelo menos um dos sinais e sintomas estudados, entre o primeiro e o 21º dias do ciclo de tratamento. A náusea foi o sintoma mais freqüente (76,5 por cento), com pico no 4º e 5º dias do ciclo, seguida da diarréia (70,5 por cento), com pico no 7º dia e, por último o vômito (53,0 por cento), com pico no 5º dia. Quanto ao grau de intensidade desses sintomas, a maioria dos pacientes situou-se no grau 1, estabelecido como aceitável para o estudo, indicando que as orientações de enfermagem e o acompanhamento contínuo contribuíram para a maior efetividade do manejo desses sintomas por parte dos pacientes

Hereditary cancers in children and ethical and psychosocial implications.

This article describes the application of genetic testing of children for hereditary cancers and the resultant ethical and psychosocial implications. Basic cancer genetics concepts are reviewed. Specific hereditary cancers that may affect children are described along with case examples and recommendations for nursing practice.

Hereditary colorectal cancer.

This article summarizes the genetics of colorectal cancer (CRC), a disease in which 15% to 20% of cases are inherited. Familial adenomatous polyposis and hereditary nonpolyposis CRC represent the two most common forms of inherited CRC. One particular mutation, APC11307K, is associated with CRC in certain Jewish populations. Inherited cancers can be prevented with careful attention to regular and frequent sigmoidoscopy or colonoscopy screening intervals and the prompt removal of premalignant polyps. The role of the nurse should include the prompt identification and referral of high-risk individuals. Ongoing patient and family counseling and education, multidisciplinary collaboration, support for primary prevention, and intensive screening are essential.

Inherited predisposition to colon cancer.

Colorectal cancer is one of the most common malignancies in the United States. Although both genetic and environmental factors play a role in colorectal tumorigenesis, recent advances in genetics have more clearly defined the impact of inheritance in the multistep process of the disease. Researchers have identified single genes that confer a susceptibility to familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer (HNPCC). Because these genes are inherited in an autosomal dominant fashion, offspring of carriers have a 50% chance of inheriting the gene mutation and its associated risk. The FAP gene, when mutated, initiates the neoplastic process. HNPCC gene mutations disrupt mismatch repair, thus inducing progression of tumor formation. Discovery of these genes has helped our understanding of sporadic colon cancer as well. Genetic testing for the FAP and HNPCC genes is now available, and results of this testing have implications for surveillance and management. In addition, testing raises complex psychosocial and ethical issues. At present, genetic testing is primarily conducted in the research setting, but it will soon be available in the clinical arena. To prepare for the challenges that these new advances will present, nurses must begin now to enhance their knowledge of genetics and its application to oncology.

Surgical treatment of familial polyposis. The ileal reservoir/anal pull-through.

The success of the procedure is evaluated by the number of bowel movements the patient has in a 24-hour period. Nine or more in 24 hours is considered poor; the average postoperative patient has five to six. As the patient's functional results improve, he is generally more at ease in social and work environments. He can govern his own routine to a great extent, rather than being tied to the bathroom. Usually, the patient can return to work in about four weeks after the ileostomy takedown. Generally, these patients seem to be satisfied with the results of their surgery. One study noted that 92% of the patients studied stated they would not hesitate to have the same operation again if faced with the same options. For the first few months postoperatively, Billy was somewhat apprehensive that he would have an "accident." He did not report any, though. He also did not leak any stools, even at night. Now, more than a year after the surgery, Billy has about four to six bowel movements a day and continues to take psyllium hydrophilic mucilloid daily. He has occasional mild irritation of the perianal skin. He has also gained 15 pounds. Billy returned to college to complete his senior year six months postoperatively. He took a full course load and planned to graduate in August 1987 with a degree in computer science. He reported that, "I'm doing very well. I just forget I had surgery."