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NURS 232 > Cancer > Flashcards

Cancer Flashcards

1
Q

If 20 > age > 60, who is more likely to get cancer?

A

Men

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2
Q

If 20 < age < 60, who is more likely to get cancer?

A

Women

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3
Q

What kind of cancers account for half of all cancers diagnosed in Canada

A

Lung, colorectal, breast, and prostate cancers

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4
Q

Most common cancer in males

A

prostate

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5
Q

most common cancer in females

A

breast

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6
Q

What percentage of cancer is developed in ages < 50?

A

10%

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7
Q

Defects in cellular proliferation:

A
  • Normal cellular function vs. cancer cell
  • Stem cell theory (loss of intracellular control from mutation of stem cells, DNA substituted/rearranged permanently)
  • Loss of contact inhibition (grow on top of and between one another)
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8
Q

Defects in cellular differentiation: (2 types of genes affected by mutation)

A

Proto-oncogenes (regulate normal cellular processes such as promoting growth, they can be activated by mutations to function as oncogenes which are tumour inducing genes)

Tumour suppressor genes (suppress growth of tumours, inactivated by mutations

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9
Q

Options of a cell when mutated

A

Apoptosis - cellular suicide
Repair itself
Survive and pass on damage to 2 or more daughter cells (have potential to become malignant)

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10
Q

3 developmental stages of cancer

A
  1. Initiation - resulting from inherited mutation (genetic) or carcinogen - including chemical, radiation, bacterial/viral
  2. Promotion - latency period
  3. Progression - invasive growth and metastasis, tumour angiogenesis, evidence of clinical disease
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11
Q

Origin of cancer may be: (6)

A
  1. genetic
    carcinogens:
  2. tobacco
  3. radiation
  4. viral
  5. bacterial
  6. chemical
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12
Q

Do all mutated cells become tumours?

A

No. Only when they establish the ability to self-replicate and grow.

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13
Q

UV radiation is associated with

A

Melanoma, squamous, and basal cell carcinoma

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14
Q

In the promotion stage, what can reduce the risk of cancer development?

A

Reducing obesity, smoking, alcohol, and dietary fat

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15
Q

How long is the latent period in cancer?

A

1-40 years, associated with mitotic rate of tissue of origin and environmental factors

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16
Q

What’s the smallest size of a tumour that can be detected?

A

0.5 cm

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17
Q

5 most frequent sites of metastasis

A
  1. Bone
  2. Brain
  3. Lungs
  4. Liver
  5. Adrenal glands
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18
Q

Tumour angiogenesis

A

formation of blood vessels within a tumour, develops its own blood supply

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19
Q

Metastasis

A

begins with rapid growth of primary tumour, segments then detach and invade surrounding tissues, lymph nodes, and travel through BVs

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20
Q

Role of the Immune System in Cancer

A
  • Respond to tumour-associated antigens
  • Lymphocytes destroy abnormal cells
  • Produce cytokines
  • Natural killer cells, Cytotoxic T Cells, and activated macrophages can lyse tumour cells
  • B cells produce antibodies directed to tumour surface antigens
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21
Q

Changes in immune system d/t cancer

A
  • Suppression of T cell stimulation
  • Weak surface antigens (cancer cells sneak through)
  • Tolerance to some tumour antigens
  • Blocking antibodies that bind tumour associated antigens, prevent recognition
  • shield produced around cancer cells to decrease recognition
  • Bone cancer can decrease lymphocytes
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22
Q

Most common clinical manifestation of cancer

A

Cachexia (weight loss)

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23
Q

Early detection and screening of cancer

A

CAUTION
C- change in bowel or bladder habits
A - a sore that does not heal
U - unusual bleeding or discharge
T - thickening or lump
I - indigestion or difficulty in swallowing
O - obvious change in wart or mole
N - nagging cough or hoarseness

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24
Q

Cancer Screening Recommendations

A

Fecal tests done Q2years (50+). If test is positive or pt is at risk of colorectal cancer, colonoscopies Q5years (50-75)

Digital Rectal Exam Q1Year (40+)

PAP Smear and Pelvic Exam Q1year (21) until 3 consecutive -ves, then Q3years until 69

Mammogram Q2-3yeras (50-74)

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25
Q

How is cancer diagnosed?

A

Biopsy exam, blood tests, imaging tests

26
Q

4 classifications of cancer

A

Carcinomas: form in epithelial tissues or those lining the body’s internal organs
Sarcomas: grow in the body’s connective tissue cells (bone, cartilage, and muscle)
Leukemia: effects blood and bone marrow
Lymphomas: effects lympnodes

27
Q

Staging Cancer

A

0 - Cancer in situ
I - tumour limited to tissue of origin, localized tumour growth
II - limited local spread
III - extensive local and regional spread (surrounding tissues or the lymph nodes)
IV - metastasis

28
Q

Grading Cancer

A

depends on how different the cells looks from normal cells, size of tumour, shape of cells, arrangement of cells, how fast cell growth is, and whether there are areas of cell death in the tumour

Graded 1-4

Different parts of a tumour can have cancer cells with different grades.

29
Q

TNM table

A

3 parameters to determine the extent of disease
TUMOR
- T0 no evidence
- Tis carcinoma in situ
- T1, T2, T3 label an increase in tumor size
- Tx unable to assess

NODES
- N0 no evidence of regional lymph node metastasis
- N1, N2, N3 label an increase in involvement of regional nodes
- Nx unable to assess

METASTASIS
- M0 no evidence of distant metastasis
- M1, M2, M3 label an increase in involvement
- Mx unable to assess

30
Q

Goal of Cancer therapy

A

Cure vs Control vs Palliative

31
Q

Goal of cancer: Cure

A

Initial Tx phase leads to cure where there is a follow-up phase, no return, and a usual life-span

32
Q

Goal of cancer: Control

A

Initial Tx phase leads to control where there is a follow-up phase, re-tx phase, supportive phase, and usual or reduced lifespan

33
Q

Goal of cancer: Palliation or no response to initial tx

A

Initial Tx phase leads to palliation where there is a re-treatment phase, advanced disease phase, supportive phase, reduced lifespan, and hospice care

34
Q

Example of supportive care

A

insertion of therapeutic devices (ex. feeding tubes, suprapubic catheter)

35
Q

Chemotherapy

A

Medication Tx for cancer. Goal is to stop or slow the growth of cancer cells. Chemo medications also affect healthy cells, especially those proliferating rapidly.

Can be IV, PO, IM, SC, Intracavitary (peritoneal), Intrathecal (sub-arachnoid space), Intra-arterial (into what is supplying the tumour)

36
Q

Port-a-cath

A

A central IV line threaded into a large central vein in the chest emptying into the heart (often superior vena cava). Used for taking blood, IV hydration, chemotherapy. Prevents chemotherapy going into SC tissue and reduces needle pokes. However, there is a risk of infection that could lead to sepsis or cardiac damage due to location of the port.

37
Q

What healthy cells proliferate rapidly and therefore, can be destroyed by chemo?

A

Bone marrow, GI lining, integumentary system, and when pregnant

38
Q

Radiation

A

Making small breaks in the DNA, most normal cells around it that get affected can recover
Side effects: skin problems, fatigue

39
Q

Biological therapy/immunotherapy

A

Uses the body’s immune system to kill cancer cells

Agents used to modify relationship b/w tumour and host (interleukins, interferons, monoclonal antibodies, growth factors, and cancer vaccines)

40
Q

Bone Marrow Transplant

A
  • harvesting stem cells from the bone marrow
  • donor is put under and cells are collected by inserting a large needle into the hip bone or aspiration from the iliac crest to the sternum
  • stem cell sample is frozen, stored, then infused into recipient through a central venous catheter or port
  • takes 2-4 weeks when the pt is “pancytopenic” before production of blood cells begins
41
Q

Autologous vs Allogenic Bone Marrow Transplant

A

Autologous: Auto means self. The stem cells in autologous transplants come from the same person who will get the transplant, so the patient is their own donor.

Allogeneic: Allo means other. The stem cells in allogeneic transplants are from a person other than the patient, either a matched related or unrelated donor

42
Q

Pancytopenia

A

Reduction in number of RBC, WBC, platelets
Complications: infection, bleeding, anemia
Treatment: transfusion with RBC, isolate pts with lowered WBCs

43
Q

Risks of having a surgery procedure for cancer Tx?

A

Can cause the cancer cells to spread by disrupting the integrity of the tumor

44
Q

GI effects of chemo

A
  • NVD
  • Stomatitis (inflammation in the mouth), Esophagitis
  • Anorexia
  • Many are hepatotoxic
45
Q

Bone Marrow effects of chemo

A
  • Anemia
  • Leukopenia
  • Thrombocytopenia (at risk for bleeding)

Therefore, check blood labs

46
Q

Integumentary effects of chemo

A
  • Loss of hair follicles
  • Skin rashes and hives
  • Photosensitivity
  • Hyper pigmentation
  • Can cause nerve damage
47
Q

Common Oncologic complications

A
  • Infection/febrile neutropenia from Tx or diasease, ulceration/necrosis from tumour, compression of vital organ from tumour
  • Malnutrition/Cachexia
48
Q

(Tumour) Obstructive emergency oncologic complications

A
  • Superior vena cava syndrome: facial edema, periorbital edema, distended neck/chest veins, headache, seizures. Tx is urgent radiation therapy
  • Intenstinal obstruction: common in ovarian cancer, NV, ab pain, ab distention. Tx is surgery if they are a candidate, NG tube NPO
  • Malignant Spinal Cord Compression: neuropathy, back pain, ventricular tenderness, motor weakness, loss of sensation, changes in bowel and bladder function. Tx is emergent glucocorticoids, urgent radiation therapy
49
Q

Metabolic Emergency Oncologic complications

A

SIADH - Syndrome of inappropriate antidiuretic hormone secretion occurs when excessive levels of ADH are produced - fluid retention, dilutional hyponatremia, muscle cramps and weakness (early)

Hypercalcemia - d/t increased breakdown of bone tissue, most common and poor prognosis - fatigue, muscle weakness, ECG changes, Anorexia, NV, Polyuria. Tx mobility, hydration, calcitonin to inhibit bone resorption, loop diuretic only in pts with fluid overload, bisphosphonate inhibits Ca release from the bone

Tumor Lysis Syndrome - follows large neoplastic cell destruction since lots of intracellular electrolytes could enter the BC. Often causes changes in K, P, and uric acid. - reduced output, then uremia, fluid overload, cardiac dysrhythmias. Tx IV hydration, fluid and electrolyte balances.

50
Q

Pharmacological Tx for neutropenia

A

Granulocyte Colony-Stimulating Factors (G-CSF) injected under skin, promotes WBC production

Antibiotics immediately

51
Q

Malnutrition of what is common in cancer pts?

A

Calerie and protein

52
Q

Nursing intervention for malnutrition

A

high protein diet when on chemotherapy, monitor albumin (lower in cancer, most common protein in blood to avoid third spacing, keeps blood in veins, transports vitamins

53
Q

Malnutrition of what is common in cancer pts?

A

Calorie and protein

54
Q

Antiemetics

A

For gastritis/functional bowel obstruction: Metoclopramide

For if it is a SE of drugs or hypercalcemia: Haloperidol

If motion sickness, mechanical bowel obstruction, increased ICP: Gravol or Meclizine

If general antiemetic: Ondansetron

55
Q

Pharmacological interventions for anorexia/cachexia

A

Megestrol, Corticosteroids, Mirtazipine

56
Q

5 Steps to Effective PRN use

A
  1. Regular assessment/documentation
  2. PRN use/documentation
  3. Re-evaluation of PRN use/documentation
  4. Advocacy for around the clock (ATC) managment if PRN use becomes frequent (this is preferable for chronic pain)
  5. Advocacy for different PRNs if initial ones are ineffective
57
Q

PRNs for bone pain

A

tylenol, NSAIDS

58
Q

PRNs for inflammatory pain

A

NSAIDS, steroids

59
Q

PRNs for nerve pain

A

tricyclic antidepressants, CNS agents

60
Q

PRNs for cardiac pain

A

O2 and nitroglycerin, morphine

NURS 232 (11 decks)

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