Cancer Flashcards
top new cases of cancer in US
female breast cancer
top cancer deaths in the US
lung and bronchus
what prevents cancer in normal cells
tumor suppressor genes
cells have abnormal regulation of growth
cells continue to grow, even at the expense of their host
malignant (cancerous) cells
process in which healthy cells become malignant, is a multi-step process involving both environmental exposure to cancer-causing agents and random errors in replication of DNA that result in genetic mutations over time
carcinogenesis
The following cellular changes are essential to carcino-genesis:
loss of sensitivity to growth inhibitory signals
evasion of apoptosis (programmed cell death)
limitless replicative potential
angiogenesis (growth of new blood vessels)
potential for metastatic/tissue invasion
Tumors also have the capacity to invade and spread from their original site to other organs in the body
metastasis
possible etiologies for cancer
-viruses and bacteria
-physical agents
-chemical agents
-genetics or familial factors
-dietary and lifestyle factors
-hormonal agents
immune systems job with cancer
-An intact immune system has the ability to combat cancer cells in several ways
-Usually, the immune system recognizes as foreign certain antigens on the cell membranes of many cancer cells.
cell mutation begins in a solid organ, cells grow into a tumor and invade, destroy and overtake surrounding tissues
solid tumors
cell mutation begins in the bone marrow, lymph tissue or spleen. Can impact any one (or all) of the blood forming components
hematological malignancies
examples of solid tumors
lung
breast
bone
prostate
liver
examples of hematological malignancies
leukemia
lymphoma
multiple myeloma
prevention strategies are aimed at preventing or delaying the development of cancer
primary prevention
examples of primary prevention strategies
-cancer prevention programs
-minimize exposure to known carcinogens
-adopt healthy lifestyles (tobacco)
-maintaining a healthy weight
-performing regular exercise (150 min/wk)
-eating a diet rich in fruits and vegetables (at least five servings per day) -limiting red meat, high fat, and processed foods
-limiting alcohol
-using sun protection
-getting regular checkups
-being familiar with their own family history and personal cancer risks
-immunizations (hep and HPV)
examples of secondary prevention
-early detection
-cancer-screening events that focus on cancers with the highest incidence rates or those that have improved survival rates if diagnosed early, such as breast cancer
management of progression of a disease to later stages
tertiary prevention
CAUTION UP acronym for diagnosing cancer
Changes in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty swallowing
Obvious changes in warts or moles
Nagging cough or persistent hoarseness
Unexplained weight loss
Pernicious anemia
Patients with suspected cancer undergo extensive testing to:
(1) determine the presence of a tumor and its extent
(2) identify possible spread (metastasis) of disease or invasion of other body tissues
(3) evaluate the function of involved and uninvolved body systems and organs
(4) obtain tissue and cells for analysis to assist in the evaluation of tumor type, stage, grade, and molecular and genetic changes.
lab tests for diagnosing cancer
Complete blood count (CBC).
Tumor markers.
Blood protein testing.
Circulating tumor cell tests.
imaging for diagnosing cancer
X-ray
ultrasound
CT scan
MRI
PET scan
what should the nurse do to prepare the pt for diagnostic cancer testing
nurse can help relieve the patient’s fear and anxiety by explaining the tests to be performed, the sensations likely to be experienced, and the patient’s role in the test procedures
encourages the patient and family to voice their fears about the test results, supports the patient and family throughout the test period, and reinforces and clarifies information conveyed by the primary care provider.
screening tools for breast cancer
breast self-exam
clinical breast exam
mammogram
ultrasonography
MRI
screening tools for cervical cancer’
pap test
HPV test
screening tools for prostate cancer
prostate-specific antigen
digital rectal exam
lung screening tools
baseline low-dose CT scan
colorectal cancer screening tools
guaiac-based fecal occult blood test
fecal immunochemical test
stool DNA test
CT colonography
double-contrast barium enema
sigmoidoscopy
colonoscopy
TNM staging designation for solid tumors
T = the extent of primary tumor
N = The absence or presence and extent of regional lymph node metastasis
M = The absence or presence of distant metastasis
Tx meaning (primary tumor)
tumor cannot be assessed
T0 meaning (primary tumor)
no evidence of primary tumor
Tis meaning (primary tumor)
carcinoma in situ
T1-4 meaning (primary tumor)
increasing size and/or local extent of primary tumor
Nx meaning (regional lymph nodes)
regional lymph nodes cannot be assessed
N0 meaning (regional lymph nodes)
No regional lymph nodes metastasis
N1-3 meaning (regional lymph nodes)
increasing involvement of regional lymph nodes
Mx meaning (distant metastasis)
distant metastasis cannot be assessed
M0 meaning
no distant metastasis
M meaning
distant metastasis
types of surgery for cancer treatment
-diagnostic
-surgery as primary treatment
-phophylactic surgery
-palliative surgery
used to control malignant disease when a tumor cannot be removed surgically or when local nodal metastasis is present, or it can be used prophylactically to prevent leukemic infiltration to the brain
radiation therapy
palliative radiation therapy is used to relieve symptoms of:
metastatic disease, especially when the cancer has spread to brain, bone, or soft tissue, or to treat oncologic emergencies, such as superior vena cava syndrome (SVCS) or spinal cord compression.
what is the purpose of chemotherapy
primarily to treat systemic disease rather than localized lesions that are amenable to surgery or radiation
what is the goal when chemotherapy is combined with surgery and radiation
cure
control
palliation
-reduce tumor size preoperatively
-to destroy any remaining tumor cells postop
-conditioning therapy prior to stem cell transplant
-treat hematologic malignancies (lymphoma and leukemia)
most common side effects of chemotherapy
myelosuppression (decreased bone marrow activity)
alopecia
N/V
anorexia
fatigue
pt education before chemotherapy
side effects
exposure risk
toxicity
chemotherapeutic agents that are specific to certain phases of the cell cycle are termed:
cell cycle-specific agents
Chemotherapeutic agents that act independently of the cell cycle phases are termed:
cell cycle-nonspecific agents
Delivery of ionizing radiation to the cancer cells to induce death
radiation
types of electromagnetic rays (radiation therapy)
x-rays
gamma rays
types of particles (radiation therapy)
electrons
protons
neutrons
alpha particles
safety precautions for radiation therapy
TIME - with pt increases exposure rates
DISTANCE - closer you are to pt, greater the radiation
Shielding - use of lead shied to buffer exposure of radiation
side effects of radiation therapy
radiation dermatitis
bone marrow suppression
gonadal toxicity
skin changes
salivary changes
nausea
pituitary and thyroid glands
lungs
bones
breasts
cartilage
pancreas
goal of bone and stem cell transplant
allows the bone marrow to be “rescued” from the toxic effects of the chemotherapy, therefore allowing higher doses of chemotherapy to be delivered safely
side effects of transplants
rejection
graft vs host disease
immunosuppressants
normal RBC range
4.2-5.9 x 10^6
normal WBC range
4-10,000
normal platelet range
150-300,000
normal platelet range
150-300,000
nursing management of cell transplants
vital signs
assess adverse effects (fever, chills, SOB, chest pain, hives, N/V, hypotension or hypertension, tachycardia, anxiety, taste changes
neutrophil normal range
> 75%
Diagnosis for w patient cancer
Appropriate nursing diagnoses of the patient with cancer may include:
Impaired oral mucous membranes
Impaired skin integrity
Nausea
Pain, acute
Pain, chronic
Imbalanced nutrition: Less than body requirements
Fatigue
Activity intolerance
Risk for infection
Risk for bleeding
Disturbed body image
Based on the assessment data, potential complications include the following:
Infection and sepsis
Hemorrhage
SVCS
Spinal cord compression
Hypercalcemia
Pericardial effusion
Disseminated intravascular coagulation (DIC)
Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
Tumor lysis syndrome
planning for pt with cancer
major goals for the patient may include
relief of fatigue,
absence of complications,
management of stomatitis,
maintenance of nutrition,
body image, relief of pain,
effective progression through the grieving process.
expected pt outcomes may include:
Maintains integrity of oral mucous membranes
Maintains adequate tissue integrity
Maintains adequate nutritional status
Achieves relief of pain and discomfort
Demonstrates increased activity tolerance and decreased fatigue
Exhibits improved body image and self-esteem
Progresses through the grieving process
Experiences no complications, such as infection, or sepsis, and no episodes of bleeding or hemorrhage
oncological emergencies
superior vena cava syndrome
spinal cord compression
hypercalcemia
pericardial effusion and cardiac tamponade
DIC
SIADH
tumor lysis syndrome
why does a SVCS occur in oncology:
bronchiogenic cancer
lymphoma
internal occlusion from central vein catheter occlusion
why does SCC occur in oncology:
malignant disease or a pathologically collapsed vertebrae compresses or displaces the thecal sac that contains the spinal cord, leading to neurologic impairment.
why does hypercalcemia occur in oncology:
-Bone destruction by tumor cells and subsequent release of calcium
-Production of prostaglandins and osteoclast-activating factors, which stimulate bone breakdown and calcium release
-Tumors that produce parathyroid-like substances that promote calcium release
-Overproduction of vitamin D analogues (calcitriol), seen most commonly in hematologic malignancies
-Most commonly seen in breast cancer, lung cancer, and myeloma
why does Pericardial Effusion and Cardiac Tamponade occur in oncology
late-stage disease and carries a high mortality rate
why does DIC occur in oncology:
hematologic cancers (leukemia)
cancer of prostate, GI tract, and lungs
chemotherapy (methotrexate, prednisone, L-asparaginase, vincristine, and 6-mercaptopurine)
disease processes such as sepsis, hepatic failure, and anaphylaxis
why does SIADH occur in oncology:
failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone (ADH).
Some malignancies, such as small-cell lung cancer, inappropriately release antidiuretic hormone (ADH). The excessive release of ADH produced by tumor cells or by the abnormal stimulation of the hypothalamic–pituitary network leads to uncontrolled water reabsorption.
The most common cause of SIADH is cancer, especially small cell cancer of the lung.
why does TLS occur in oncology:
rapid release of intracellular contents as a result of radiation- or chemotherapy-induced cell destruction of large or rapidly growing cancers, such as leukemia, lymphoma, and small cell lung cancer.
nursing priorities for end of life cancer care
PAIN CONTROL!!!
What are the patient/family goals? Patient/family preference. Have these discussions prior to end of life
Advanced directives
Hospice vs. palliative care
common cancer nursing diagnosis
Activity Intolerance (Risk for)
Anxiety
Disturbed body image
Impaired Comfort
Impaired skin integrity
Impaired tissue integrity
Chronic pain
Ineffective coping
Constipation (Risk for)
Fatigue
Fluid volume, deficient
Risk for infection
Nausea
Acute pain
shape of benign cancer cells
rounded edges and easier to remove
shape of malignant cancer cells
frayed edges and harder to remove
problem where the body cannot absorb vitamin B12
pernicious anemia
Lab tests for diagnosing cancer
CBC
SBC
PLT
blood protein
tumor markers
PSA (males)
urine test
fecal-occult
what to look for in endoscopy
stomach cancer
polyps and lesions
nursing role in biopsy
education, pain management, witness consent, emotional support, witness consent
hematological cancer are always considered:
stage IV
characteristics of stage I tumors
loacalized and contained
characteristics of stage II tumors
involvement of lymph nodes
invasion of deeper tissue
characteristics of stage III tumors
large, invasive
characteristics of stage IV tumors
spread to different sites
advanced
goal for curing cancer
cancer free for at least 5 years
goal of remission of cancer
disease free but cancer could return at any point
who and how are chemotherapy drugs administered
certified nurse
port-a-cath
symptoms of toxicity of chemotherapy
N/V
Myelosuppression
Thrombocytopenia
Leukemia
Neutropenia
Anemia
side effects and timing for external radiation
beam to skin – dermatitis – requires sensitive touch and handling – fatigue – 2-3 wks
side effects of internal radiation
radioactive emission – spreads – pt on bedrest so radiation does not spread through the body
side effects of systemic radiation
specific spots
sores inside the mouth
stimulate body’s own immune response - flu like side effects
immunotherapy
cannot return blood to the heart
superior vena cava syndrome
causes neurological impairment
spinal cord compression
causes bone destruction
hypercalcemia
causes electrolytes to be leaked into system
Tumor lysis syndrome
