Page 20 Complete Your CE Test Online - Click Here birth control to avoid pregnancy during treatment with tamoxifen if sexually active. Women who want to have children sometimes postpone this treatment until after pregnancy or suspend it for a time and then resume it after delivery. Women who are postmenopausal and have hormone-receptor-positive breast cancer can use aromatase inhibitors, which are specifically to be avoided before menopause and during pregnancy. Gynecologic cancers can mean surgical removal of part of the reproductive tract. Sometimes it is possible to preserve fertility, but this depends on a number of factors, including the type and stage of cancer. Women who want more children should involve a fertility specialist in the early stages of cancer treatment planning, well before treatment begins, as it can take a few weeks to harvest ova. Men It is always best talk about future plans for children before cancer treatment starts. Some chemotherapy drugs are more likely than others to cause infertility, and men older than 40 may be less likely to recover fertility. Sperm production usually recovers, if at all, within four years. As in women, bone marrow or stem cell transplants often cause permanent infertility. Radiation to the testicles or lower abdomen can harm sperm production. It is important for men to know that they should avoid impregnating anyone during radiation or chemotherapy and for some time afterward because of possible damage to the sperm. Surgery that removes the prostate or urinary bladder causes men to be unable to conceive during sex, although a fertility specialist might be able to extract sperm from the testes or epididymis. Men who have not yet started cancer treatment can bank sperm at any time. This does involve some costs, including annual fees to maintain the frozen sperm, but it allows great flexibility with future parenthood for up to 20 years out. Insurance plans rarely cover sperm freezing and storage. Nursing consideration: Men and women who want to have biological children after cancer treatment should consider banking sperm, embryos, or eggs before starting cancer treatment. Cancer surgery Surgery for cancer, especially early stage tumors, is sometimes the mainstay of treatment. With solid tumors, surgery is almost always a part of the treatment plan. Cancer surgery can have different goals, just like all cancer treatment. Depending on the type of cancer and how advanced it is, surgery can be used for the following: ● ● Remove the entire tumor: Surgery removes localized cancer and may check nearby organs and nodes for metastases for staging purposes. ● ● Debulk a tumor (cytoreduction): Surgery removes as much cancer as possible. Debulking is used when removing all of the cancer might cause organ damage. Removing part of it may be done before other types of treatment as neoadjuvant therapy. ● ● Palliate cancer symptoms: Surgery is used to remove tumors that are causing pain or pressure. Two other kinds of surgery and surgical procedures are often performed in people with cancer to manage cancer treatments and its effects: 1. Procedures to facilitate treatment: Vascular access devices, local drug delivery devices, peritoneal ports, and other devices can be surgically placed to make treatments easier. 2. Reconstructive surgery: Surgery is used to help restore the patient’s appearance or function after cancer surgery. It is important that the patient understands the goal of surgery beforehand and has an idea of postoperative expectations and management. People who still smoke should be offered ways to quit before surgery. Even though many people want to believe that there is no need to quit smoking after they receive a diagnosis cancer, it is well documented that wound healing after surgery is slowed in smokers. Studies have shown that continued smokers also have a higher risk of cancer recurrence. Surgical techniques to manage solid tumors are continuously evolving as new procedures are added. Robotic or robot-assisted surgery is common now, in which laparoscopic surgery is performed using robotic arms to control the instruments. Some cancer surgeries have become less invasive as surgeons use laparoscopic surgery and endoscopy to remove cancerous lesions; some are even conducted on an outpatient basis. However, it is important to know that studies have not validated the equivalence of laparoscopic surgery in every instance, and that the surgeon’s experience with that particular type of surgery will affect outcomes. Initial cancer surgery for cancer in which multiple organs can be affected, such as ovarian cancer, often has two goals: to debulk the cancer and to stage it. This calls for a surgeon with experience in oncologic debulking, who has expertise in finding and delicately removing abnormal tissue from multiple organs. Open surgeries are typically required for debulking situations. There are also laser surgeries; cryosurgeries; electrosurgeries, such as radiofrequency ablation; and other techniques. These procedures do not use a scalpel, but they use other types of energy (lasers, cold, or electricity) to cut or destroy tumor tissue. Nursing management After cancer surgery, as with other types of surgery, pain management, safety, and infection control are the first priorities. There is also the need to teach the patient about wound care, activities of daily living during recovery, and any specific procedures that will be needed after discharge (e.g., drain maintenance). There may also be body image issues, especially concerning for head and neck cancer, breast cancer, and any cancer surgery in which the results are publicly visible. Patients with mastectomy often need special instruction and exercise for range of motion in the affected upper extremity. Lymphedema is a possibility, especially if a full lymph node dissection was done. For many types of cancer surgery, the patient will want to know if the procedure “got it all,” and this may require a discussion between the patient and the surgeon. Sometimes the patient will need support and educational reinforcement in coping with the operative findings. Often, the outcome of the surgery will include more complete information on the stage of the cancer, although there may still be some delay for the biopsy (pathology) report, which is needed for the final stage grouping (see also “Cancer Staging”). The final staging information often shapes the plan for further treatment as well as prognosis. Depending on the outcome, this can be overwhelming to the patient, as he may be looking forward to an uneventful recovery or preparing for a long chemotherapy or radiation treatment or starting hospice care. Radiation therapy Radiation, in high doses, kills or slows the growth of cancer cells, but it also causes damage to normal cells. Radiation therapy is used with the following goals: ● ● Curative intent. ● ● To slow or stop the growth of cancer cells to shrink a tumor before or during other types of cancer treatment. ● ● To kill remaining cancer cells after surgery or other treatment to prevent recurrence. ● ● Palliative care (shrink tumors to treat pain, pressure, gut blockage, or other symptoms). Radiation therapy does not kill cancer cells right away. It takes days or weeks of treatment before cancer cells begin dying, and cancer cells keep dying for weeks or months after radiation therapy ends. Nursing consideration: Helping patients understand the intent and goals of their radiation, chemotherapy, or surgical treatments can help them make better decisions about their preferences. This becomes critically important in advanced or refractory cancer and near the end of life. External beam radiation therapy External beam radiation therapy typically comes from a linear accelerator machine (also called a LINAC) that aims beams of ionizing radiation toward the cancer from different angles and locations on the body. Radiation is a local treatment, but it affects skin and other organs and tissues in its path and can cause some systemic side effects. Intraoperative radiation is an option for some; it is one large dose given during surgery so that radiation does not have to pass through skin. External beam radiation therapy begins by the patient meeting with the radiation oncologist for the treatment planning process. Planning begins