AHII Cancer Flashcards
a tumor that arises from glandular epithelial tissue
adenocarcinoma
usually refers to growths that are encapsulated, remain localized, and are slow growing
Benign
a neoplastic disorder that can involve all body organs. cells lose their normal growth-controlling mechanism, and the growth of cells is uncontrolled
cancer
a physical, chemical, or biological stressor that causes neoplastic changes in normal cells
carcinogen
a premalignant tumor that originates from epithelial cells, the skin, gastrointestinal tract, lungs, uterus, breast, or other organ
carcinoma in situ
neoplasm involving abnormal overproduction of leukocytes, usually at an immature stage, in the bone marrow (WBCs)
leukemia
neoplasm that originates from the lymphoid tissue
lymphoma
term for growths that are not encapsulated but grow and metastasize. These growths are cancerous lesions having the characteristics of disorderly, uncontrolled, and chaotically proliferating cells.
malignant
the transfer of disease from one organ or part to another not directly connected with it. Secondary malignant lesions, originating from the primary tumor, are located in anatomically distant places
metastasis
a malignant proliferation of plasma cells within the bone.
myeloma
the period of time during which an antineoplastic medication has its most profound effects on the bone marrow (greatest bone marrow suppression and platelet count is prob extremely low too); avoid anticoags and ASA during this time!
nadir
an abnormal growth, which may be benign or malignant
neoplasm
neoplasm that originates from muscle, bone, fat, the lymph system, or connective tissue
sarcoma
a method of classifying malignancies on the basis of the presence and extent of the tumor within the body
staging
specific bodily substances that seem to indicate tumor progression or regression
tumor marker
cells that have lost the capacity for specialized functions
undifferentiated cells
TNM Staging
T=size and # of tumors
N=extent of spread to lymph nodes
M=metastasis
cancer grading
GX: grade cannot be assessed
G1: well-differentiated (resembles tissue of origin) mild dysplasia
G2: Moderately differentiated moderate dysplasia
G3: poorly differentiated (little resemblance to tissue of origin) severe dysplasia
G4: undifferentiated (unable to tell tissue of origin) anaplasia
any sore that does not heal change in bowel or bladder habits indigestion nagging cough or hoarseness obvious change in wort or mole thickening or lump in breast or elsewhere unusual bleeding or discharge
warning signs of cancer
What is the definative means of diagnosing cancer and provides histological proof of malignancy
Biopsy (needle, incisional, excisional, stage=multiple needle or incisional biopsies in tissues where metastasis is suspected or likely)
What are the pros and cons of frozen vs parrafin tissue examination following a biospy?
frozen is faster (within minutes) but parrafin is clearer although it takes 24 hours
brachytherapy
the radiation source is within the client; for a period of time, the client emits radiation and can pose a hazard to others
external beam radiation (teletherapy)
radiation source is outside the client, and thus the client does not pose a risk to anyone else
Brachytherapy: unsealed radiation source
patient and excreta are radioactive for about 48 hours
Brachytherapy: sealed radiation source
the client emits radiation while the implant is in place, but the excreta are not radioactive
special instructions to females who had a sealed radiation source
resume sex 7-10 days
douche if implant was in cervix
saline enema if prescribed
notify HCP: n/v/d, frequent urination, vaginal or rectal bleeding, hematuria, foul-smelling vaginal discharge, abdominal pain/distension, or fever
BMT and PBSCT
Bone Marrow Transplant and Peripheral Blood Stem Cell Transplantation are procedures that replace stem cells that have been destroyed by high doses of chemo/radiation; most commonly treats leukemia and lymphoma, but may treat neurblastoma and multiple myeloma; client would die of hemorrhage or infection without BMT and PBSCT
refers to an immunosuppression therapy regimen used to eradicate all malignant cells, provide a state of immunosuppression, and create space in the bone marrow for the engraftment of the new marrow
conditioning
Where do you administer or IVP stem cells?
central line
the transfused stem cells move to the marrow-forming sites of the recipient’s bones and occurs when the WBC, erythrocyte, and platelet counts begin to rise (typically takes 2-5 weeks)
engraftment: client will die if cells fail to engraft
this disease involves occlusion of the hepatic venules by thrombosis or phlebitis: RUQ pain, jaundice, ascites, weight gain, and hepatomegaly: early detection is critical as there is no way to open the hepatic vessels; client will be treated with fluids and supportive therapy
veno-occlusive disease
mostly lymphoblasts present in bone marrow and onset is younger than 15 years
Acute Lymphocytic Leukemia
mostly myeloblasts present in bone marrow and onset is 15-39 years
Acute Myelogenous Leukemia
mostly granulocytes present in bone marrow onset is in the fourth decade
Chronic myelogenous leukemia
mostly lymphocytes present in the bone marrow and onset is after age 50
Chronic lymphocytic leukemia
What platelet count indicates a risk for bleeding and spontaneous bleeding?
50,000 risk for bleeding
20,000 spontaneous bleeding
aimed at achieving a rapid, complete remission of all manifestations of the disease
chemo induction therapy
administered early in remission with the aim of curing
chemo consolidation therapy
may be prescribed for months or years following successful induction and consolidation therapy to maintain remission
chemo maintenance therapy
Chemo interventions
administer antibiotics, antibacterial, antiviral, antifungal, CSF, blood replacements, infection and bleeding precautions
Lymphoma: Hodgkin’s disease
Hodgkin’s disease is a malignancy of the lymph nodes that originates in a single lymph node or a chain of nodes (Reed-Sternburg cells); usually involves lymph nodes, tonsils, spleen, and bone marrow
multiple myeloma
a malignant proliferation of plasma cells within the bone and ultimately destroy the bone and invades the lymph nodes, spleen and liver. The abnormal plasma cells produce an abnormal antibody: Bence Jones protein found in blood and urine. Multiple myeloma causes decreased production of immunoglobulin and antibodies and increased levels of uric acid and calcium, which can lead to kidney failure
What is a main nursing consideration for a patient with multiple myeloma?
the client with multiple myeloma is at risk for pathological fractures. provide skeletal support during moving, turning, and ambulating and provide a hazard-free environment
What are complications of multiple myeloma?
bone fractures, hypercalcemia, kidney failure, and infections (encourage increased fluids to help kidneys)
testicular cancer
arises from germinal epithelium from the sperm-producing germ cells or from nongerminal epithelium from other structures in the testicles (onset 15-40 years)
What are know to increase risk of developing testicular cancer?
hx of undescended testicle (cryptorchidism) and genetic predisposition
TSE
testicular self exam: best after a shower monthly
painless testicular swelling
dragging or pulling sensation in scrotum
palpable lymphadenopathy, abominal masses, and gynecomastia may indicate metastasis
late signs include back or bone pain and respiratory symptoms
orchiectomy
surgical removal of affected testicle, spermatic cord, and regional lymph nodes)
What is a main nursing consideration following hysterectomy?
monitor vaginal bleeding following hysterectomy. More than one saturated pad per hour may indicate excessive bleeding
pelvic extenteration
removal of all pelvic contents (bowel, vagina, and bladder) if no lymph node involvement
When do you perform BSE (breast self exam)
perform monthly 7-10 days post menses
how do you avoid lymphedema post op for breast removal?
position client in semi-fowlers turn from back to unaffected side and raise affected arm above heart level to promote drainage and prevent lymphedema
What is the characteristic of most prostate tumors?
most prostate tumors are adenocarcinomas arising rom androgen-dependent epithelial cells. The risk increases in men after each decade over 50.
Oncological Emergency: SIADH
tumors can produce, secrete, or stimulate substances that mimic ADH. weakness, muscle cramps, loss of appetite, and fatigue (Na 115-120); more serious signs relate to water intoxication: weight gain, personality changes, confusion, and extreme muscle weakness. As serum sodium drops to 110, seizures, coma, and eventually death will occur
What do you do to treat SIADH?
fluid restrictions increase sodium intake ADH antagonist monitor serum sodium levels treat underlying cause with chemo or radiation to reduce the tumor.
Oncological Emergency: spinal cord compression
a tumor directly enters the spinal cord or when the vertebral column collapses from tumor entry, impinging the spinal cord. Can cause back pain before neurological deficits occur: numbness, tingling, loss of urethral, vaginal, and rectal sensation, and muscle weakness.
How do you treat Spinal Cord Compression?
give corticosteriods to reduce swelling; prepare client for immediate radiation to reduce the size of the tumor and relieve compression. neck/back braces if prescribed
Oncological Emergency: hypercalcemia
a late manifestation of extensive malignancy that occurs most often with bone metastasis, when the bone release calcium into the bloodstream. Decreased physical mobility contributes to or worsens hypercalcemia. early signs: fatigue, anorexia, nausea, vomiting, constipation, polyuria. Serious signs: severe muscle weakness, diminished deep tendon reflexes, paralytic ileus, dehydration, and changes on the ECG.
How do you treat hypercalcemia?
monitor serum calcium and ECG
admin oral or parenteral fluids as prescribed
admin mends that lower calcium
prepare client for dialysis if the condition becomes life-threatening or is accompanied by renal impairment
Oncological Emergency: Superior Vena Cava Syndrome
occurs when SVC is compressed or obstructed by tumor growth (lung CA and lymphoma); edema of face and tight collar (Stokes’ sign); serious signs: edema in arms and hands, dyspnea, erythema of the upper body, epistaxis then airway obstruction, hemorrhage, cyanosis, mental status changes, decreased cardiac output, and hypotension
How do we treat Superior Vena Cava Syndrome?
prepare the client for high-dose radiation therapy to the mediastinal area, and possible surgery to insert a metal stent in the vena cava
Oncological Emergency: Tumor Lysis Syndrome
occurs when large quantities of tumor cells are destroyed rapidly and intracellular components such as potassium and uric acid are released into the bloodstream faster than the body can eliminate them. This can indicate that CA Tx is destroying tumor cells, but if left untreated, can cause severe tissue damage and death.
What electrolytes will be out of whack with Tumor Lysis Syndrome?
hyperkalemia
hyperphosphatemia–>hypocalcemia
hyperuricemia–>AKI
How do we treat tumor lysis syndrome?
hydration and monitor kidney fxn
admin diuretics to increase urine flow through kidneys
admin meds that increase excretion of purines (allopurinol)
prepare to admin IV glucose and insulin to correct hyperkalemia
prepare the client for dialysis if hyperkalemia and hyperuricemia persist despite treatment
What are findings indicative of multiple myeloma?
increase plasma cells in bone marrow
anemia
hypercalcemia
elevated BUN
what is the primary concern for a patient with multiple myeloma?
hypercalcemia: increase fluids
What oncological emergency does a cancer patient’s immunocompromised status put them at risk of developing?
sepsis leading to DIC
How do you describe multiple myeloma?
malignant proliferation accumulation of mature plasma cells within the bone marrow
what does an ECG look like with hypercalcemia?
shortened ST segment and a widened T wave
When do you hold antineoplastic meds?
when ANC is <1800 cells/mm^3
institute neutropenia precautions!
what are some side effects of antineoplastic drugs?
mucositis alopecia anorexia n/v/d (taste changes may be due to med taste) anemia neutropenia (low WBC) thrombocytopenia infertility
Since antineoplastic drugs cause the rapid destruction of cells, what is released into the bloodstream, and what do we do to correct this?
uric acid is released, treat with allpurinol (Zyloprim) to lower the serum uric acid level
What can be done to reduce pain at the IV site of antineoplastic administration?
altering IV rates or warming the injection site to distend the vein and increase blood flow will reduce IVP pain
What do you do if extravasion occurs?
notify HCP, apply heat or cold drug depending, and an antidote may be injected into the site
What kind of fertility concerns are related to antineoplastic drugs?
councel clients about contraception; teratogenic drugs
infertility may be irreversible
Nursing Actions during a medication-induced anaphylactic rxn
assess respiratory status stop medication call HCP and rapid response team administer O2 maintain IV access w NS Raise clients feet and legs admin ER meds monitor vitals doc event, actions, and client's response
Nursing considerations for cyclophosphamide and ifosfamide
can cause hemorrhagic cystitis: increase fluids
meds break DNA helix, interfering w DNA replication
Daunorubicin (DaunoXome)
may cause heart failure and dysrhythmias
Doxorubicin (Adriamycin, Doxil) and Idarubicin (Idamycin)
cardiotoxic, cardiomyopathy, ECG changes
dexrazoxane (Zinecard) may be given with Doxorubicin to decrease cardiomyopathy
Bleomycin
pulmonary toxicity
Fluorouracil (Adrucil)
may cause alopecia, stomatitis, diarrhea, phototoxictiy and cerebellar dysfunction
Mercaptopurine (Purinethol)
may cause hyperuricemia and hepatotoxicity
Methotrexate
may cause alopecia, stomatitis, hyperuricemia, photosensitivity, hepatotoxicity, and hematological, gastro, and skin toxicity
What is leucovorin rescue?
what administering methotrexate in large doses, prepare to administer leucovorin (folinic acid or citrovorum factor) as prescribed to prevent toxicity
vincristine
neurotoxic: numbness and tingling in fingers and toes, constipation, paralytic ileus
Tamoxifen citrate
may cause edema, hypercalcemia, and elevated cholesterol and triglyceride levels
decreases effect of estrogen
What is chemo dosing based on?
total Body Surface Area: measure client’s height and weight before each medication administration
etoposide
orthstatic hypotension
asparaginase (Elspar)
contraindicated if hx of pancreatitis
megace
used with caution if thrombophlebitis
Risk factors for breast cancer
Risk factors for breast cancer include nulliparity or first child born after age 30 years; early menarche; late menopause; family history of breast cancer; high-dose radiation exposure to the chest; and previous cancer of the breast, uterus, or ovaries.
melanoma
Melanomas are pigmented malignant lesions originating in the melanin-producing cells of the epidermis. This skin cancer is highly metastatic, and the affected person’s survival depends on early diagnosis and treatment.
intravesical instillation
With intravesical instillation, normally the medication is injected into the bladder through a urethral catheter, the catheter is clamped or removed, and the client is asked to retain the fluid for 2 hours. The client changes position every 15 to 30 minutes, usually from side to side and from supine to prone. The client then voids and is instructed to drink water to flush the bladder.
CLL
CLL causes a slow increase in immature B cells. These cells infiltrate the bone marrow, lymph nodes, spleen, and liver. CLL eventually causes bone marrow failure; therefore the client will have enlarged and swollen lymph nodes.
Hairy cell leukemia
pancytopenia
oncological emergencies
Oncological emergencies include sepsis, disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, superior vena cava syndrome, and tumor lysis syndrome.
