Cancer Flashcards
Type of cell growth for malignant cells vs benign cells
Benign = non neoplastic growth:
- hypertrophy
- hyperplasia
- dysplasia
Malignant = neoplasia (new growth)
- anaplasia
Mutations in cellular differentiation that occur with cancer
Proto-oncogenenes (regulate normal cell growth) get turned to oncogenes
Tumor suppressor genes (suppress growth) are mutated to become inactive
3 stage theory of mutation and what happens in each stage
Stage 1: initiation (changes in cell DNA from carcinogens)
Stage 2: promotion (reversible changes from promoters - unhealthy lifestyle)
Latent period: 1-40 yrs
Stage 3: progression (malignancy occurs, angiogenesis, tumor cells can metastasize)
Known risk factors that increase cancer risk
Cigarette smoke and smoking tobacco
Infections
Radiation (UV rays)
Immunosuppressive medicines after organ transplant
7 warning signs of cancer
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast, testicle, or elsewhere
Indigestion or difficulty swallowing
Obvious change in size, color, shape, or thickness of
wart, mole, or mouth sore
Nagging cough or hoarseness
Classification of cancer using Grading and what each grade means
Grade 1: cells differ slightly from normal cells and are well differentiated
Grade 2: cells are more abnormal and moderately differentiated
Grade 3: cells are very abnormal and poorly differentiated
Grade 4: cells are immature and primitive and undifferentiated. Cell of origin difficult to determine
Classification of clinical staging and what each stage means
0: cancer in situ
1: tumor limited to tissue of origin, localized tumor growth
2: limited local spread
3: extensive local and regional spread
4: metastasis
What does TNM stand for?
Tumor size
Lymph node status
Metastasis
List the two classes of cancer drugs we need to know for class
Platinum drug
Anti tumor antibiotic
Prototype platinum drug
Cisplatin (Platinol)
Side effects of Cisplatin (Platinol)
Nephrotoxic
Ototoxic
Peripheral neuropathy
N/V
Nursing management for pts taking Cisplatin (Platinol)
Hydration and diuretics (for neurotoxicity)
Monitor I&O, renal labs (for neurotoxicity)
Antiemetics (for N/V)
Monitor hearing (for Ototoxicity)
Prototype anti tumor antibiotic
Doxorubicin (Adriamycin)
Side effects of Doxorubicin (Adriamycin)
Cardiotoxic
Myelosuppression
Vesicant
Alopecia
(Life time max cumulative dose)
Nursing management for pts taking doxorubicin (Adriamycin)
Monitor cardiac function
Monitor for signs of CHF
Teach pt urine and sweat may be discolored red
What is nadir?
Point at which blood cell counts are at their lowest
(7-10 days after chemo admin)
*Time pts are most likely to get an infection
Preferred rout for chemo administration
Intravenous (*CVAD)
Potential complications of chemotherapy administration
Infection
Extravasation
What is radiation used for?
Primary tumors
Metastatic lesions
Palliation
Most common type of radiation
External radiation (Teletherapy)
What should nurses teach pts when they’re receiving external radiation?
1 = skin reactions/ dermatitis
(Monitor and wash with plain water)
#2 = fatigue (Cumulative)
(Monitor hemoglobin level, tell to moderate exercise)
What is internal radiation called?
Brachytherapy
WBC count indicating neutropenia
<4,000
Usual sites of infection when a pt has neutropenia
Lungs (pneumonia)
Genitourinary system (UTI)
Mouth, rectum
Peritoneal cavity
Blood (sepsis)
If pt has myelosuppression, how can you figure out if they can have chemo?
By calculating their ANC (absolute neutrophil count)
WBC x [% of bands + % of segs] / 100
Normal ANC range that indicates a pt can be given chemo
1,500 - 8,000 / mm3
When should neutropenia precautions be used for a pt?
When their ANC is <1000
And if it’s <500, they’re severely neutropenic
When should the provider be notified immediately when a pt is on neutropenic precautions?
If pt has any slight symptoms of infection
(Fever >100.4, chills, any hot, redness, swelling)
Should anticipate diagnostic testing and antibiotics
Category of meds given to treat myelosuppression
Colony stimulating growth factors
(Stimulates bone marrow to produce blood components)
Med to stimulate growth of neutrophils
Filgrastin (Neupogen)
Meds to stimulate growth of erythrocytes
Epoetin (Procrit)
darbepoetin (Aranesp)
Med to stimulate growth of platelets
Oprelvekin (Neumega)
Symptoms of thrombocytopenia
Bruising
Petechia
Prolonged bleeding if cut
Blood in urine, stool
Spontaneous bleeding nose, gums
Platelet count indicating thrombocytopenia
<50,000
What platelet count would a pt likely need a platelet transfusion?
<20,000
Nursing considerations for pts with GI symptoms from cancer/chemo
Monitor for alkalosis, dehydration
Monitor I&O, weight at least 2x/week
Small, frequent, nonirritating meals
Low-fiber, high-calorie, high-protein diet
Nutritional supplements (ensure)
Assess for taste loss and dysphagia
Monitor albumin and prealbumin levels
Chemo drug used to stimulate appetite
Megace (synthetic progesterone)
List the oncologic emergencies
Hypercalcemia
Superior vena cava syndrome
Tumor lysis syndrome
Syndrome of inappropriate antidiuretic hormone (SIADH)
Spinal cord compression
Sepsis
Calcium level indicating Hypercalcemia
> 12 mg/dl
Causes of Hypercalcemia
Bone metastasis (cancer in bone)
Increase in parathyroid hormone/tumor
Immobility
Signs and symptoms of Hypercalcemia
Fatigue
Loss of appetite
N/V
Constipation
Polyuria
Serious S/S:
Severe muscle weakness
Loss of DTRs
Paralytic ileus
Dehydration
ECG changes
Treatment for Hypercalcemia
Hydration (3L/day)
Loop diuretics (NOT thiazide)
Cause of SVC syndrome
SVC compressed by growing tumor
S/S of SVC syndrome
Early:
- Facial edema then distended neck, chest veins
- Mediastinal mass seen on CXR
Later:
- Edema in arms, hands
- Dyspnea
- Erythema of upper body
- Epistaxis
Late:
- Hemorrhage
- Cyanosis
- Lack of perfusion to brain (decreased LOC)
Treatment of SVC syndrome
Radiation, chemo, or surgery to reduce tumor size
Cause of tumor lysis syndrome
Release of:
- uric acid
- potassium
- phosphorous
Into blood stream when excessive cancer cells destroyed by chemo
S/S of tumor lysis syndrome
Weakness
N/V
Can lead to AKI (acute kidney injury)
Treatment for tumor lysis syndrome
Hydration (to protect kidneys)
Allopurinol (for elevated uric acid)
What causes SIADH?
Elevated ADH level - from tumor or chemotherapy
(Pt retaining too much water = low sodium)
S/S of SIADH
Hyponatremia:
- weakness
- weight gain (from too much H2O absorption)
- muscle cramps
- fatigue
- decreased appetite
- *Altered mental status, headache, confusion
- extreme muscle weakness
- seizures, coma, death
Treatment for SAIDH
Fluid restriction
Oral salt tablets
Lasix
IV NS
Causes of spinal cord compression
Lung, breast, prostate, GI, renal, lymphomas, melanoma metastasis to spinal cord
S/S of spinal cord compression
Persistent back pain*
Weakness - decreased motor neuron function
Decreased sensory neuron function
- change in bowel or bladder function
Treatment of spinal cord compression
Steroids (to decrease inflammation in area)
Surgery
Cause of sepsis (in cancer pts)
Infection in blood stream due to tumor or myelosuppression
Most at risk during nadir
S/S of sepsis
Fever
Elevated HR
Decreased BP
Would need to do lab work and blood cultures to see what pathogen is causing infection
Skin cancer in order of least to most lethal
Basal cell
Squamous cell
Melanoma
Precancerous form of squamous cell carcinoma
Actinic keratosis
Most common skin cancer
Basal cell
Skin cancer with slow growth and rarely metastasizes
Basal cell
What does basal cell cancer look like and where is it typically found
Flat, firm, pale
Sun-exposed areas
Skin cancer that can spread to blood or lymph but isn’t super aggressive
Squamous cell
What does squamous cell carcinoma look like?
Red, scaly, rough patch
Can scab or bleed
Risk factors for melanoma
20-45 years
Fair complexion
Freckles
Red hair, blue eyes
ABCDE’s of mole or skin lesion assessment
Asymmetry
Border irregular?
Color varied?
Diameter >6mm?
Evolving?
Risk factors for Hodgkin’s Lymphoma
Age 15-35 and >55
Family history
Male
Prior Epstein Barr infection
HIV infection
Symptoms of HL
One or more painless, enlarged lymph nodes (usually starts in cervical. Or mediastinal, axillary, inguinal)
*Fever>100.4
*10% weight loss in 6 months
*Drenching night sweats
Anorexia
Fatigue
Spleen, liver enlargement
Alcohol = pain (rare)
How is a pt diagnosed with HL?
Biopsy of lymph node(s)
- presence of *Reed-Sternberg cells
CXR, CT, MRI, PET scan
CBC
ESR (erythrocyte sedimentation rate)
Most common malignant lymphocytes with NHL
B cell most common (80%)
T cell (15%)
NK cells
Diagnosis of NHL
Biopsy showing *no Reed Sternberg cells
May need more diagnostic test than HL to determine everywhere it is:
PET/CT
HIV/ Hep B & C tests to see if they instigated it
Risk factors for NHL
Age 60+, male, AA, Asian American
Immunocompromised
Viral infection (Epstein Barr)
Autoimmune disease (RA)
Chemicals (Pesticides)
Drugs (chemo therapy)
Other (radiation)
S/S of NHL
Painless, hard, enlarged lymph nodes
Fever, night sweats, weight loss
Neuro: HA, vision, sensory, or motor changes
Unpredictable spread (blood>lymph)
Other organ involvement possible
Unexplained anemia, low platelets (if in bone marrow)
Staging of HL & NHL
Stage 1: one lymph node
Stage 2: two or more lymph nodes on one side of diaphragm
Stage 3: above and below diaphragm
Stage 4: widespread disease, multiple organs
Tx for HL
Chemotherapy
Radiation
Immunotherapy
Stem cell therapy
Tx for NHL
Chemotherapy
Monoclonal antibodies (Rituximab)
Radiation
CAR-T cell therapy
Chimeric antigen receptor (CAR)
- Blood drawn, add CAR receptor to T cells, put back in to seek out cancer cells
When someone is having monoclonal antibody tx, what does the nurse need to watch for?
Flu like symptoms
Infusion reactions
Nursing considerations for HL & NHL
Resp status (large tumors on lymph nodes)
Immune: prevent infection
Pain
GI issues (nutrition/chemo)
Skin issues (radiation)
Sterility (chemo/radiation)
Secondary cancers (chemo/radiation)
What occurs with multiple myeloma?
Cancerous plasma cells (type of B cell) invade bone marrow and destroy bone
Causes immune deficiency
Risk factors for MM
Male
Over age 40
AA
What proteins are specific to MM and where are they found?
Monoclonal proteins (M proteins) found through biopsy in bone marrow
Bence-Jones proteins found in urine
M proteins also found in urine
Symptoms of MM
Bad skeletal pain (often in back/spine, hips/pelvis, skull, ribs)
Weakened bones - osteoporosis
Anemia, leukopenia, thrombocytopenia (pancytopenia)
Hypercalcemia (bone breaking down and Ca+ entering blood)
S/S of Hypercalcemia
Acts like a sedative = muscles and nerves less excitable
Lethargy, weakness, fatigue, depressed reflexes, confusion, decreased memory, constipation
Elevated BP, bone pain, fractures, renal stones, seizures, coma
Nursing actions for Hypercalcemia
Stop meds that increase calcium
Low calcium diet
Increase weight bearing activity
Ensure adequate hydration (3-4L/day)
Furosemide to promote renal excretion
Cardiac monitor (telemetry)
Examples of meds that increase calcium
IV lactated ringers
Thiazide diuretics
Antacids
Vit D
MM treatment
Chemotherapy
Corticosteriods
MM nursing considerations
Due to increased M proteins and chemo, pt is at risk for:
Renal problems (M proteins affect kidneys)
Fluid and electrolyte imbalance
Uric acid build up from cell break down (Hyperuricemia)
- Allopurinol (for elevated uric acid)
Pt at risk for pathologic fractures
(Fall precautions, but pt should still move to help with Hypercalcemia)
Pt may have peripheral neuropathy
