CANCER Flashcards
Benign cells
Grow by expansion Specific mophology Smaller nuclear by cytoplastic ratio Tight adherence/do not migrate Orderly, well organized Normal chromosomes
What are examples of benign cells
moles, skin tags, and require no intervention
Malignant cell description
Grow by invasion Anaplasia Larger nuclear to cytoplasmic ratio Specific fx of cells are lost Migration contact inhibition does not occur Rapid/continuous cell division Abnormal chromosomes
Table on benign vs malignant on slide 6
go
Carconeogensis: what are the phases?
Initiation
Promotion
Progressoin
Carcineogenesis: initiation
Damage that will lead to abnormal cell replication
Initiation is irreversible, not all initiated call will go on to become a tumor as many of these cells may die by apoptosis
Carcinogenesis: promotion
Cell has damaged DNA that is replicated
Initiated cells can have selective growth – allowing cells to divide and evade death
This is survival of premalignant cells and formation of benign lesions – polps
Carcinogenesis: progression
Ability to proliferation and spread
Carinogenesis - mutation – germ line
DNA of sperm or egg cells
Significant if impede ability to make essential proteins needed for cell growth
Carinogenesis - mutation – somatic
acquired
Carcinogenesis: Proto-oncogenes
promote cell proliferation
Carcinogenesis - tumor suppressor genes
inhibit cell proliferation
Carcinogenesis - apoptosis
the death of cells which occurs as a normal and controlled part of an organism’s growth or development.
Carcinogenesis: mitosis
occurs more frequently in malignant cells than normal cells
Carcinogenesis: glucose and o2 need
if no glucose and o2 available – anaerobic metabolism
— cells are then less dependent on the availability of a constant o2 supply
Describe metastatic or secondary tumors
Invasion/Spreading from original site
Must develop own blood supply, Angiogenesis
Lymphatic Spread
Hematogenous Spread
Cancer etiology
virus/bacterial physical agents chemical agents genetics diet and lifestyle hormones
3 stages of tumor progression:
elimination
equilibrium
escape
stage of tumor progression: elimination
recognized tumor
starts response
stages of tumor progression: equillibrium
tumor and immune system are equal
stages of tumor progression: escape
too many tumor cells - overwhelm immune system
What are the 7 warning signs of cancer?
Changes in b/b habits Sore throat that does not heal Unusual bleeding or discharge Thickening or lump Indigestion or dysphagia Obvious change in wart or mole Magging cough or hoarseness
Diagnosis of cancer:
Complete H&P
Cancer diagnostic tools (CT, MRI, PET) - what is the purpose?
Presence of a tumor and its extent
ID possible spread
Evaluate the fx of involved/uninvolved body systems
Obtain tissue - type, tage, graed, and molecular & genetic changes
tumor staging - we will not be tested on them
slide 16
Tumor grading
Defining the type of tissue from origin
Samples through cytology, biopsy, or surgical excision
Graded from I to IV
Surgical management of cancer: diagnostic surgery
Primary Treatment Debulking Local excision Wide or radical excision Prophylactic surgery Palliative
What are surgical considerations with cancer?
stroke HF angina or MI pneumonia pleural effeusoins renal insuffiecy DM bleeding appropriate neutrophil count
Surgical complications
infection, bleeding, thrombophlebitis, would dehiscence, fluids and electrolyte imbalance, organ dysfunction, DTV, pneumonia, nutrition and medication education
Gerontological considerations
skin, skeletal fx, immune response, metabolism, elimination
gerontological impairments r/t chemo
renal impairment
declining organ fct. - pulmonary/cv
Gerontological and end of life considerations
Half of all cancers are in patients > 65 Polypharmacy – financial concerns Sensory loss – hearing, visual May experience more severe side effects Increased risk of complications
Cancer - end of life care options
hospice
palliative care
Radiation
Used to cure, control or prophylactically
internal radiation
Brachytherapy delivers high dose radiation to a localized area. Patient emits radiation for a short period of time & potential hazard to others
Seeds, beds, catheters, oral
External radiation
Source external, patient does not emit radiation & is not hazardous to others
What type of radiation is used for gynecological cancers?
intracavity
How do HCP know where to apply the radiation?
tattoo a few tiny dots on you in your affected area so they can line up the machine correctly with your tumor.
External Beam Radiation Therapy (EBRT):
): an invisible beam of highly charged photons or gamma rays to penetrate the body and target the tumor with pinpoint accuracy
internal radiation - brachytherapy
placement of radioactive sources within or immediately next to the cancer site in order to provide a highly targeted, intense dose of radiation beyond a dose that is usually provided by EBRT
Internal radiation: systemic radiotherapy
involves the IV administration of a therapeutic radioactive isotope targeted to a specific tumor
Radiation safety: Brachytherapy - time
no more then 30 mintes exposure in 8 hours shift
Radiation safety: Brachytherapy - distance
closer you rae to patient, greater the exposure
Radiation safety: Brachytherapy shielding
lead aprons, rooms may be lead lines
Radiation safety: Brachytherapy - dosimeter
does not provide protection, measures wearers exposure to radiation
DO NOT SHARE
Radiation safety: Brachytherapy - visitors
maintain 6 foot distance from patient
Radiation safety: Brachytherapy - why might metal forcepts and lead-lined container be available
in case radiation source is dislodged
Radiation complications
Alopecia Desquamination Stomatitis Xerostomia Thrombocytopenia / leukopenia Nausea
Radiation: nursing implications – sfx from toxicity
Altered skin integrity, alopecia
Stomatitis, breakdown of oral mucosa of lining of GI tract, can lead to decreased nutrition, anorexia, N/V, diarrhea
Bone marrow suppression: anemia fatigue, weakness; leukopenia high risk for infection
Radiation: protecting caregivers
Patients receiving internal radiation emit radiation while the implant is in place
Assigning the patient to a private room, radiation safety precautions signage on door
Dosimeter badges
No pregnant staff members assigned to the patient
Chemo
Use of antineoplastic drugs in an attempt to destroy cancer cells by interfering with cellular functions
When is chemo primarily used?
to treat systemic disease rather than localized lesions that are amenable to surgery or radiation
Chemo can be combined with what?
surgery, radiation therapy, or both to reduce tumor size preoperatively (neoadjuvant), to destroy any remaining tumor cells postoperatively (adjuvant)
chemo: eradication of tumor
almost impossible; goal of treatment is eradication of enough of the tumor so that the remaining malignant cells can be destroyed by the body’s immune system
Chemo: complications and sfx
fatigue, myelosuppression, infection, neutropenia, bleeding, stomatitis, n/v, skin integrity, alopecia, nutrition, pain, extravasation
What are some other therapies for cancer treatment?
immunotherapy, cytokines or melanoma, vaccines to stimulate immune system to kill cancer cells
Stem cell transplant: types
autologous (from patient)
allogenic (other than patient)
syngeneic (twin)
Stem cell transplant risk: graft vs tumor
donor cells recognize malignant cells as foreign and kill them
Stem cell transplant risk: graft vs host
donor cells recognize host cells as foreign and attack
What are complications of stem cell transplant?
acute – risk for hepatic venous occlusive disease (VOD) – lead to liver failure
Hepatic venous occlusive disease
Hematopoietic stem cell transplant (HSCT)
Standard of care treatment for certain adult hematologic cancers
Where can stem cells be collected from?
Stem cells can be collected from a bone marrow harvest (donor), apheresis (peripheral blood stem cells), or from cord blood
Types of hematopoietic stem cell transplant: allogenic
From a donor other than patient
Types of hematopoietic stem cell transplant: autologus
from patient
Types of hematopoietic stem cell transplant: syngeneic
from identical twin
hematopoietic stem cell transplant (HSCT): myeloablative
high doses of chemotherapy and possibly total-body irradiation to completely eradicate (ablate) the bone marrow and any malignant cells and help prevent rejection of the donor stem cells
hematopoietic stem cell transplant (HSCT): nonmyeloablative
“mini-transplants”, lower chemotherapy doses aimed at destroying malignant cells (without completely eradicating the bone marrow), to suppress the recipient’s immune system to allow engraftment of donor stem cells
Graft vs tumor effect
allogenic stem cells should not be tolerant of malignant cells and should act to destroy them
What is graft vs host disease?
Donor lymphocytes initiate an immune response against the recipient’s tissues (skin, gastrointestinal tract, liver) during the beginning of engraftment
acute vs chronic graft vs host disease
acute: within first 100 days
chronic: occuring after 100 days
graft vs host disease: manifestation
diffuse rash progressing to blistering and desquamation similar to second-degree burns
mucosal inflammation of the eyes and the entire gastrointestinal tract with subsequent extensive diarrhea
biliary stasis with abdominal pain, hepatomegaly, and elevated liver enzymes progressing to obstructive jaundice
chemo: extravasation treatment
ice at site 4x day for 48 hours
avoid heat, restrictive clothing and sunlight C
Cancer: targeted therapies
Target receptors, proteins, signal transduction pathways to prevent continued growth of cancer cells
Targeted therapies: biological response modifiers
the use of naturally occurring or recombinant (genetic engineered) agents or treatment methods that can alter the immunologic relationship between the tumor and the host to provide a therapeutic benefit
Targeted therapies: monoclonal antibodies (MoAb)
targeted antibodies for specific malignant cells
– destroy the cancer cells and spare normal cells
– dependent on ID key antigen proteins on the surface of tumors that are not present on normal tissues
Oncologic emergencies: superior vena cava syndrome
Restricts venous return and reduced cardiac output
superior vena cava syndrome: monitor
vital signs
cardiac status
neuro status
fluid volume statue (weight, I&O)
Superior vena cava: nursing action
Facilitate breathing by positioning the patient properly.
Assist the patient to maintain an upright position (elevated 45 degrees). This helps to promote comfort and reduce anxiety; it also reduces intracranial pressure.
Remove rings and tight clothes
Assist patient with ADLs to minimize energy expenditures.
Superior vena cava syndrome: what should patient avoid?
Valsalva maneuver, which may worsen symptoms, by providing cough suppressants and stool softeners as needed
Oncological emergencies: hypercalcemia - cause
bone destruction
Oncological emergencies: DIC
Disorder of coagulation, results in bleeding
Cancer survivorship
The period from cancer diagnosis through the remaining years of life; focuses on the health and life of a person beyond diagnostic and treatment phases.
What are the 4 components of survivorship care (IOM)?
- monitoring and treatment for late effects related to disease and prior treatments
- physical and vocational rehabilitation
- psychosocial support and counseling as necessary
- surveillance and screening for new and recurrent cancer
