11. Cancer & End of Life Care Flashcards
2 types of tumors
- Benign
- cells don’t spread and don’t come back after removal - Malignant
- cells grow into surrounding tissue
Precancerous Conditions
- precancerous cells are abnormal cells that MAY develop into cancer if not treated
- one of the first signs of cancer spread is swelling in lymph nodes
different ways to describe precancerous changes:
Hyperplasia: abnormal cells are dividing and increasing in number faster than normal
Atypia: cells are slightly abnormal/atypical (bigger in size)
Metaplasia: a change to the type of cells that are normally found in that area. The cells are normal, just wrong type
Dysplasia: cells are abnormal, increased numbers, but not arranged like normal cells - think displaced
Carcinoma in situ: most severe type of precancerous change. Cells are abnormal but have not grown into nearby tissue yet but it is very invasive. Usually treated because high risk of becoming cancer
Cancer staging
- based on where it is diagnosed and how much there is
- stage includes tumor size, which part of the organ, whether is has spread (metastisized), and where it has spread to
Cancer staging
- based on where it is diagnosed and how much there is
- stage includes tumor size, which part of the organ, whether it has spread (metastasized), and where it has spread to
- helps plan treatment and how well it will work
- helps predict pt’s outlook
Stage 0:
-cancer is where it started and hasn’t spread (in situ)
Stage 1:
-cancer is small and hasn’t spread
Stage 2:
-cancer has grown and hasn’t spread
Stage 3:
-cancer is larger and may have spread to nearby tissues and/or the lymph nodes
Stage 4:
- cancer has spread to at least one other organ
- aka metastatic or secondary cancer
Cancer grading
- based on what the cells look like under microscope
- depends on:
- size, shape, arrangement
- differentiation from normal cells
- how fast they are dividing and growing
- whether there are areas of cell death in the tumor
- low grade= slow growth, less likely to spread
- high grade= grow quickly and likely to spread
Grade I:
-cancer cells resemble normal cells and grow slowly
Grade II:
-cancer cells don’t look like normal cells and are going faster than normal cells
Grade III:
-cancer cells look abnormal and grow rapidly, spreading
therefore stage 4 and grade III have poor prognosis and are hard to treat
Prognostic Factors
- type of cancer
- subtype of cancer
- tumor size
- stage (how far and where it spread)
- grade (how fast cells are growing)
- age, gender
- presence of other health problems
- functional status
- weight loss
- ability to cope with treatment side effects
- response to treatment
how is cancer diagnosed?
- biopsy (tissue sample) done by a pathologist
- blood tests
- imaging tests (ex CT scan, ultrasound, xray)
Cancer Screening
- Fecal occut blood test (FOBT) for those who doon;t have increased risk of colorectal cancer q2y after 50
- colonoscopy after positive FOBT or if family hx of colorectal cancer q5y from 50-75
- men: digital rectal exam q1y
- women:
- PAP smear and pelvic exam q1y until 3 consecutive neg exams, then q3y until 69
- mammogram q2-3y from 50-74
Prevention
- smoking cessation
- maintain normal weight
- diet
- limit fats, processed and red meat
- avoid excessive UV light
- avoid excessive alcohol
Treatment
-consider: are goals of therapy curative or palliative?
Surgery
Chemo: -use of drugs to destroy cancer cells -they affect normal cells -months-years -systemic Side effects: -easy bruising, bleeding -infection -anemia -appetite change -constipation -nausea/vomiting -hair loss (alopecia) -fatigue
Radiation: -making small breaks in DNA -nearby normal cells affected but can recover -local Side effects: -skin problems -fatigue
Immunotherapy
Targeted drug therapy
End of Life Care
- is supportive and compassionate care that focuses on:
- comfort
- QOL
- respect for pt’s treatment decisions
- support to family (good communication, be available, suggest resources, make referrals, provide information)
- psychological, cultural, spiritual concerns for the pt and family
- palliative care: specialized care for serious illness that moves away from treatment towards support and comfort
- any diagnosis, not just close to death
- end of life is more close to death
- palliative care is more broad, at any time
Nurse’s role for palliative care
Chronic disease management (arthritis, heart failure, COPD, diabetes)
Pain management
Understand the underlying pathology
Understand how quickly the condition is progressing
Manage physical symptoms: fatigue: -assess and treat cause -energy conservation -corticosteroids (used for fatigue)
constipation:
- assess and treat cause
- bowel protocol if on narcotics and no risk of mechanical bowel obstruction
dyspnea:
- assess and treat cause
- comfort measures ex O@, position upright, fan…
- morphine to reduce breathlessness
nausea and vomiting:
- assess and treat cause
- gravol
dehydration:
- assess and treat cause
- if rt poor intake and increasing PO not possible, discuss risks and benefits of IV/SC fluids
- if not rehydrating allowing terminal process, ensure good oral hygiene
anorexia/cachexia:
-comfort measures ex reduce odors, treat pain, small meals, assist to feed prn
Signs and Symptoms at the end of life
Altered breathing patterns:
- shallow
- Cheyne-Stokes
- noisy “death rattle” treated with Atropine or Scopolamine to dry up secretions
Changing circulation:
- limbs/ears/nose become cold or mottled
- decreased BP
- weak pulse
- diaphoresis
- edema
- no urine output
Decreased muscle tone:
- relaxed facial muscles
- no gag reflex
- difficulty swallowing
- abd distention
- decreased GI activity
- incontinence
Decreased senses:
- reduced LOC
- hearing continues
Supportive Interventions
for relationship building
- presence
- compassion
- touch
- recognition of autonomy
- honesty
- expert communication
- assisting in transcendence
5 types of death trajectories
- Sudden death
- no need for hospice or palliative care
- encourage pts to think about advance care planning - Terminal Disease
- at some point, the disease overcomes the treatment
- palliative care should begin at diagnosis
- hospice care to maintain comfort and QOL throughout illness progression, esp at final stages
- challenge is reluctance of pt to transition from curative treatment to palliative - Major Organ Failure
- onset and progression is gradual, slowly decreasing function
- often worsens by flu
- require acute care ex ER, hospitalization, and rehab
- can recover but never 100%
- palliative care is best choice throughout progress - Frailty
- seen in Alzheimer’s and dementia, Parkinson’s
- constant decline 1yr+
- caregivers have emotional, physical, financial burden
- hard to determine effectiveness of treatment
- death occurs when caregiver decides to end life-prolonging intervention
- palliative care best choice throughout progress - Catastrophic Event
- both sudden and frailty
- sudden health event occurs ex brain injury, hip fracture, heart attack, aneurysm, car crash
- survives but is impaired, sometimes unconscious and dependent on long-term ventilator or. tube feeding for years
- gaol is comfort and QOL, maximizing cognitive and physical function, supporting caregivers
- palliative care best choice
