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NURSING 3 > CANCER > Flashcards

CANCER Flashcards

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1
Q

Benign cells

A 
Grow by expansion
Specific mophology
Smaller nuclear by cytoplastic ratio 
Tight adherence/do not migrate
Orderly, well organized 
Normal chromosomes
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2
Q

What are examples of benign cells

A

moles, skin tags, and require no intervention

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3
Q

Malignant cell description

A 
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
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4
Q

Table on benign vs malignant on slide 6

A

go

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5
Q

Carconeogensis: what are the phases?

A

Initiation
Promotion
Progressoin

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6
Q

Carcineogenesis: initiation

A

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

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7
Q

Carcinogenesis: promotion

A

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

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8
Q

Carcinogenesis: progression

A

Ability to proliferation and spread

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9
Q

Carinogenesis - mutation – germ line

A

DNA of sperm or egg cells

Significant if impede ability to make essential proteins needed for cell growth

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10
Q

Carinogenesis - mutation – somatic

A

acquired

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11
Q

Carcinogenesis: Proto-oncogenes

A

promote cell proliferation

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12
Q

Carcinogenesis - tumor suppressor genes

A

inhibit cell proliferation

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13
Q

Carcinogenesis - apoptosis

A

the death of cells which occurs as a normal and controlled part of an organism’s growth or development.

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14
Q

Carcinogenesis: mitosis

A

occurs more frequently in malignant cells than normal cells

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15
Q

Carcinogenesis: glucose and o2 need

A

if no glucose and o2 available – anaerobic metabolism

— cells are then less dependent on the availability of a constant o2 supply

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16
Q

Describe metastatic or secondary tumors

A

Invasion/Spreading from original site

Must develop own blood supply, Angiogenesis

Lymphatic Spread

Hematogenous Spread

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17
Q

Cancer etiology

A 
virus/bacterial 
physical agents
chemical agents
genetics
diet and lifestyle 
hormones
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18
Q

3 stages of tumor progression:

A

elimination
equilibrium
escape

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19
Q

stage of tumor progression: elimination

A

recognized tumor

starts response

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20
Q

stages of tumor progression: equillibrium

A

tumor and immune system are equal

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21
Q

stages of tumor progression: escape

A

too many tumor cells - overwhelm immune system

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22
Q

What are the 7 warning signs of cancer?

A 
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
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23
Q

Diagnosis of cancer:

A

Complete H&P

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24
Q

Cancer diagnostic tools (CT, MRI, PET) - what is the purpose?

A

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

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25
Q

tumor staging - we will not be tested on them

A

slide 16

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26
Q

Tumor grading

A

Defining the type of tissue from origin

Samples through cytology, biopsy, or surgical excision

Graded from I to IV

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27
Q

Surgical management of cancer: diagnostic surgery

A 
Primary Treatment
Debulking 
Local excision 
Wide or radical excision
Prophylactic surgery
Palliative
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28
Q

What are surgical considerations with cancer?

A 
stroke 
HF
angina or MI
pneumonia 
pleural effeusoins 
renal insuffiecy 
DM
bleeding 
appropriate neutrophil count
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29
Q

Surgical complications

A

infection, bleeding, thrombophlebitis, would dehiscence, fluids and electrolyte imbalance, organ dysfunction, DTV, pneumonia, nutrition and medication education

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30
Q

Gerontological considerations

A

skin, skeletal fx, immune response, metabolism, elimination

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31
Q

gerontological impairments r/t chemo

A

renal impairment

declining organ fct. - pulmonary/cv

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32
Q

Gerontological and end of life considerations

A 
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
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33
Q

Cancer - end of life care options

A

hospice

palliative care

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34
Q

Radiation

A

Used to cure, control or prophylactically

35
Q

internal radiation

A

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

36
Q

External radiation

A

Source external, patient does not emit radiation & is not hazardous to others

37
Q

What type of radiation is used for gynecological cancers?

A

intracavity

38
Q

How do HCP know where to apply the radiation?

A

tattoo a few tiny dots on you in your affected area so they can line up the machine correctly with your tumor.

39
Q

External Beam Radiation Therapy (EBRT):

A

): an invisible beam of highly charged photons or gamma rays to penetrate the body and target the tumor with pinpoint accuracy

40
Q

internal radiation - brachytherapy

A

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

41
Q

Internal radiation: systemic radiotherapy

A

involves the IV administration of a therapeutic radioactive isotope targeted to a specific tumor

42
Q

Radiation safety: Brachytherapy - time

A

no more then 30 mintes exposure in 8 hours shift

43
Q

Radiation safety: Brachytherapy - distance

A

closer you rae to patient, greater the exposure

44
Q

Radiation safety: Brachytherapy shielding

A

lead aprons, rooms may be lead lines

45
Q

Radiation safety: Brachytherapy - dosimeter

A

does not provide protection, measures wearers exposure to radiation
DO NOT SHARE

46
Q

Radiation safety: Brachytherapy - visitors

A

maintain 6 foot distance from patient

47
Q

Radiation safety: Brachytherapy - why might metal forcepts and lead-lined container be available

A

in case radiation source is dislodged

48
Q

Radiation complications

A 
Alopecia 
Desquamination
Stomatitis 
Xerostomia 
Thrombocytopenia / leukopenia 
Nausea
49
Q

Radiation: nursing implications – sfx from toxicity

A

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

50
Q

Radiation: protecting caregivers

A

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

51
Q

Chemo

A

Use of antineoplastic drugs in an attempt to destroy cancer cells by interfering with cellular functions

52
Q

When is chemo primarily used?

A

to treat systemic disease rather than localized lesions that are amenable to surgery or radiation

53
Q

Chemo can be combined with what?

A

surgery, radiation therapy, or both to reduce tumor size preoperatively (neoadjuvant), to destroy any remaining tumor cells postoperatively (adjuvant)

54
Q

chemo: eradication of tumor

A

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

55
Q

Chemo: complications and sfx

A

fatigue, myelosuppression, infection, neutropenia, bleeding, stomatitis, n/v, skin integrity, alopecia, nutrition, pain, extravasation

56
Q

What are some other therapies for cancer treatment?

A

immunotherapy, cytokines or melanoma, vaccines to stimulate immune system to kill cancer cells

57
Q

Stem cell transplant: types

A

autologous (from patient)
allogenic (other than patient)
syngeneic (twin)

58
Q

Stem cell transplant risk: graft vs tumor

A

donor cells recognize malignant cells as foreign and kill them

59
Q

Stem cell transplant risk: graft vs host

A

donor cells recognize host cells as foreign and attack

60
Q

What are complications of stem cell transplant?

A

acute – risk for hepatic venous occlusive disease (VOD) – lead to liver failure

Hepatic venous occlusive disease

61
Q

Hematopoietic stem cell transplant (HSCT)

A

Standard of care treatment for certain adult hematologic cancers

62
Q

Where can stem cells be collected from?

A

Stem cells can be collected from a bone marrow harvest (donor), apheresis (peripheral blood stem cells), or from cord blood

63
Q

Types of hematopoietic stem cell transplant: allogenic

A

From a donor other than patient

64
Q

Types of hematopoietic stem cell transplant: autologus

A

from patient

65
Q

Types of hematopoietic stem cell transplant: syngeneic

A

from identical twin

66
Q

hematopoietic stem cell transplant (HSCT): myeloablative

A

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

67
Q

hematopoietic stem cell transplant (HSCT): nonmyeloablative

A

“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

68
Q

Graft vs tumor effect

A

allogenic stem cells should not be tolerant of malignant cells and should act to destroy them

69
Q

What is graft vs host disease?

A

Donor lymphocytes initiate an immune response against the recipient’s tissues (skin, gastrointestinal tract, liver) during the beginning of engraftment

70
Q

acute vs chronic graft vs host disease

A

acute: within first 100 days
chronic: occuring after 100 days

71
Q

graft vs host disease: manifestation

A

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

72
Q

chemo: extravasation treatment

A

ice at site 4x day for 48 hours

avoid heat, restrictive clothing and sunlight C

73
Q

Cancer: targeted therapies

A

Target receptors, proteins, signal transduction pathways to prevent continued growth of cancer cells

74
Q

Targeted therapies: biological response modifiers

A

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

75
Q

Targeted therapies: monoclonal antibodies (MoAb)

A

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

76
Q

Oncologic emergencies: superior vena cava syndrome

A

Restricts venous return and reduced cardiac output

77
Q

superior vena cava syndrome: monitor

A

vital signs
cardiac status
neuro status
fluid volume statue (weight, I&O)

78
Q

Superior vena cava: nursing action

A

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.

79
Q

Superior vena cava syndrome: what should patient avoid?

A

Valsalva maneuver, which may worsen symptoms, by providing cough suppressants and stool softeners as needed

80
Q

Oncological emergencies: hypercalcemia - cause

A

bone destruction

81
Q

Oncological emergencies: DIC

A

Disorder of coagulation, results in bleeding

82
Q

Cancer survivorship

A

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.

83
Q

What are the 4 components of survivorship care (IOM)?

A
  1. monitoring and treatment for late effects related to disease and prior treatments
  2. physical and vocational rehabilitation
  3. psychosocial support and counseling as necessary
  4. surveillance and screening for new and recurrent cancer

NURSING 3 (16 decks)

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