7.1 Cancer and HIV

Question 1

Cancer

Answer 1

• Begins when a cell is transformed by genetic mutation of the cellular DNA
  Metastasis - These cells travel to surrounding tissue via lymph system or blood vessels
• Benign tumors do not travel through metastasis, they grow slowly and are usually encapsulated cells that are not cancerous

Question 2

Malignant

Answer 2

• Tumors that invade surrounding tissue via lymph nodes and blood vessels.
• Mutation is the problem
• Mutated cells proliferate abnormally
• Contain tumor associated antigens
• General effects such as anemia, inflammation, weight loss, tissue destruction.

Question 3

Benign

Answer 3

• Resembles normal tissue of cells
• Encapsulated tumor that expands but does not infiltrate surrounding tissue
• Slow growth and no metastasis
• Localized effects, no systemic
• ## Does not cause tissue destruction

Question 4

Neoplasm

Answer 4

• New and abnormal growth of body

- Characteristic of cancer

Question 5

Carcinogenesis

Answer 5

• Malignant transformation
• 3 Steps
  Initiation
  Promotion
  Progression

Question 6

Step 1 - Initiation

Answer 6

• Cancer causing substances mutate cellular DNA. These can include chemical, physical, or biological agents.
• Mutated cells do not have apoptosis (program to die)

Question 7

Step 2 - Promotion

Answer 7

• Proliferation and expansion of initiated cells

- Formation of preneoplastic (benign lesions)

Question 8

Stem 3 - Progression

Answer 8

• Altered cells increase in malignancy
• Grows into blood vessels and adjacent tissue
• Metastasize

Question 9

Carcinogenic Agents

Answer 9

• Carcinogens promote malignant transformation
• Viruses make up 11% of these carcinogenic factors
• Physical agents such as sunlight, UV light, radiation
• Chemical agents such as tobacco (most lethal)
  (Accounts for 1/3 of cancer deaths)

Question 10

Other Risk Factors of Cancer

Answer 10

• Genetic such as leukemia and breast cancer
• Lifestyle such as diet, obesity, alcohol, physical activity
• Processed foods
• Taking hormonal agents such as estrogen

Question 11

Prevention of Cancer

Answer 11

Primary - Reducing risk of disease such as smoking cessations and sunscreen
Secondary - Screening early detection such as mammogram
Tertiary - Prevention of re-occurrence in cancer survivors

Question 12

Diagnoses of Cancer

Answer 12

• Based on assessment of physiological and functional changes
• Result of diagnostic evaluation
• Purpose is to identify presence and extent of cancer
• Evaluate function of uninvolved systems
• Obtain tissue cells for analysis

Question 13

Staging of Cancer (TNM Classification)

Answer 13

• Involves size, local invasion, lymph node involvement, and metastasis

Question 14

Grading of Cancer

Answer 14

• Defines the type of tissue where the tumor originated and the differentiation of tissue from origin
• Graded 1 - 4
  1 = Tissue closely resembles tissue of origin
  4 = More aggressive and less responsive to treatment

Question 15

Cancer Surgeries

Answer 15

• Diagnostic (Biopsy) - Obtain tissue at tumor site or local lymph node to check for spread.
• Tumor Removal - Ideal and most frequent treatment
• Prophylactic Surgery - Such as mastectomy (removal of breasts) for a patient who is predisposed for breast cancer
• Curative surgery - Breast implants after mastectomy

Question 16

Radiation Treatment

Answer 16

• 60% of patients receive radiation therapy at some point
  External radiation - Directed at tumor from outside body
  Internal radiation - Implant is placed inside body
  Systemic radiation - Taken by mouth or infused via vein

Question 17

Brachytherapy

Answer 17

Internal Radiation

• Radioactive source is placed next to cancer site
• High targeted intense dose of radiation
• Patients must be in private room, pregnant women must avoid the room, staff needs to wear badges that show exposure to radiation.
• Maximum amount of time spent in room is 30 minutes
• No children in room but if they are must be 6 feet away
• Shielding equipment needed

Question 18

Brachytherapy

Answer 18

• If implant falls out, you must use tongs to pick it up
• Place the implant in a lead container
• Can be used as curative or to control the spread
• Can also be used palliatively to relieve symptoms

Question 19

Nursing Assessment

Answer 19

• Assess skin frequently
  (Toxicities with radiation therapy are usually localized in the area being eradicated)
• Monitor nutritional status
• Explain symptoms such as weight loss, skin reactions, GI Tract reactions, Explain that this is treatment and does not represent progression of disease

Question 20

Chemotherapy

Answer 20

• Antineoplastic drugs to destroy cancer cells by interfering with cell function or replication
• Can be curative, control, or palliative
• 20-99% cancer destroyed when exposed to chemo. Repeated doses may be needed.
• Dosage based on weight, previous exposure, organ function.
• Can be administered via PICC line, surgically placed port
• IV can be dangerous due to extravasation

Question 21

Vesicant (drugs)

Answer 21

• SubQ or IV or Surrounding Tissue

- Cause inflammation, tissue damage, and necrosis to tendons, muscle, nerves and blood vessels.

Question 22

Administering Chemotherapy Drugs

Answer 22

• Wear 2 pairs of specialized gloves
• Eye and face protection
• Chemo drugs pose high threat to hypersensitivity
• Repeated doses heighten risk of hypersensitivity

Question 23

Chemotherapy Drug Side Effects

Answer 23

• Decreased platelet count (risk of bleeding)
• Nausea/Vomiting
• Decreased bone marrow function
• Renal/Liver/Kidney Damage
• Heart Failure
• Sterility
• Neurotoxicity
• Sensory Alterations
• Chemobrain (Cognitive impairment)

Question 24

Chemotherapy Drug Side Effects

Answer 24

• Fatigue

- Destroys normal and malignant cells

Question 25

Nursing Role of Drug Therapy

Answer 25

• Modify risks we are aware of
• Preventing side effects
• Managing N/V and fatigue

Question 26

Biological Response Modifiers

Answer 26

• Modifies bodies immune system to fight cancer

Question 27

Types of Stem Cell Transplant

Answer 27

Used to treat mostly bloodborne cancers
Allogenic - Person other than patient is the donor
(Risk includes Graft vs Host. Patients must take immunosuppressants like cyclosporin for life)
Autologous - Patient themself is donor
(Apheresis - Blood passes through apparatus separating blood cells and plasma. Cells are then processed and infused into patient)
Synergistic - Identical twin is the donor
(Prevents need for immunosuppressants for life)

Question 28

Nursing for Cancer Patients

Answer 28

• Take care of side effects such as N/V
• Tissue integrity
• Surgical site/fusion site care
• Prevention of infection
• Nutrition (anorexia or malabsorption)
• Relieving pain

Question 29

Pain control

Answer 29

• Start with opioids
• Monitor for infection
• S/S of sepsis shock
  (Drop in BP, urine output, increased HR)
• Monitor bleeding

Question 30

Untreatable Cancer

Answer 30

• Option of hospice
• Needs are best met with interdisciplinary programs
• Focuses on quality of life, physical, psycho-social, spiritual support for patients and families.