Cancer Flashcards
If 20 > age > 60, who is more likely to get cancer?
Men
If 20 < age < 60, who is more likely to get cancer?
Women
What kind of cancers account for half of all cancers diagnosed in Canada
Lung, colorectal, breast, and prostate cancers
Most common cancer in males
prostate
most common cancer in females
breast
What percentage of cancer is developed in ages < 50?
10%
Defects in cellular proliferation:
- 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)
Defects in cellular differentiation: (2 types of genes affected by mutation)
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
Options of a cell when mutated
Apoptosis - cellular suicide
Repair itself
Survive and pass on damage to 2 or more daughter cells (have potential to become malignant)
3 developmental stages of cancer
- Initiation - resulting from inherited mutation (genetic) or carcinogen - including chemical, radiation, bacterial/viral
- Promotion - latency period
- Progression - invasive growth and metastasis, tumour angiogenesis, evidence of clinical disease
Origin of cancer may be: (6)
- genetic
carcinogens: - tobacco
- radiation
- viral
- bacterial
- chemical
Do all mutated cells become tumours?
No. Only when they establish the ability to self-replicate and grow.
UV radiation is associated with
Melanoma, squamous, and basal cell carcinoma
In the promotion stage, what can reduce the risk of cancer development?
Reducing obesity, smoking, alcohol, and dietary fat
How long is the latent period in cancer?
1-40 years, associated with mitotic rate of tissue of origin and environmental factors
What’s the smallest size of a tumour that can be detected?
0.5 cm
5 most frequent sites of metastasis
- Bone
- Brain
- Lungs
- Liver
- Adrenal glands
Tumour angiogenesis
formation of blood vessels within a tumour, develops its own blood supply
Metastasis
begins with rapid growth of primary tumour, segments then detach and invade surrounding tissues, lymph nodes, and travel through BVs
Role of the Immune System in Cancer
- 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
Changes in immune system d/t cancer
- 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
Most common clinical manifestation of cancer
Cachexia (weight loss)
Early detection and screening of cancer
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
Cancer Screening Recommendations
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)
How is cancer diagnosed?
Biopsy exam, blood tests, imaging tests
4 classifications of cancer
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
Staging Cancer
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
Grading Cancer
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.
TNM table
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
Goal of Cancer therapy
Cure vs Control vs Palliative
Goal of cancer: Cure
Initial Tx phase leads to cure where there is a follow-up phase, no return, and a usual life-span
Goal of cancer: Control
Initial Tx phase leads to control where there is a follow-up phase, re-tx phase, supportive phase, and usual or reduced lifespan
Goal of cancer: Palliation or no response to initial tx
Initial Tx phase leads to palliation where there is a re-treatment phase, advanced disease phase, supportive phase, reduced lifespan, and hospice care
Example of supportive care
insertion of therapeutic devices (ex. feeding tubes, suprapubic catheter)
Chemotherapy
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)
Port-a-cath
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.
What healthy cells proliferate rapidly and therefore, can be destroyed by chemo?
Bone marrow, GI lining, integumentary system, and when pregnant
Radiation
Making small breaks in the DNA, most normal cells around it that get affected can recover
Side effects: skin problems, fatigue
Biological therapy/immunotherapy
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)
Bone Marrow Transplant
- 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
Autologous vs Allogenic Bone Marrow Transplant
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
Pancytopenia
Reduction in number of RBC, WBC, platelets
Complications: infection, bleeding, anemia
Treatment: transfusion with RBC, isolate pts with lowered WBCs
Risks of having a surgery procedure for cancer Tx?
Can cause the cancer cells to spread by disrupting the integrity of the tumor
GI effects of chemo
- NVD
- Stomatitis (inflammation in the mouth), Esophagitis
- Anorexia
- Many are hepatotoxic
Bone Marrow effects of chemo
- Anemia
- Leukopenia
- Thrombocytopenia (at risk for bleeding)
Therefore, check blood labs
Integumentary effects of chemo
- Loss of hair follicles
- Skin rashes and hives
- Photosensitivity
- Hyper pigmentation
- Can cause nerve damage
Common Oncologic complications
- Infection/febrile neutropenia from Tx or diasease, ulceration/necrosis from tumour, compression of vital organ from tumour
- Malnutrition/Cachexia
(Tumour) Obstructive emergency oncologic complications
- 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
Metabolic Emergency Oncologic complications
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.
Pharmacological Tx for neutropenia
Granulocyte Colony-Stimulating Factors (G-CSF) injected under skin, promotes WBC production
Antibiotics immediately
Malnutrition of what is common in cancer pts?
Calerie and protein
Nursing intervention for malnutrition
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
Malnutrition of what is common in cancer pts?
Calorie and protein
Antiemetics
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
Pharmacological interventions for anorexia/cachexia
Megestrol, Corticosteroids, Mirtazipine
5 Steps to Effective PRN use
- Regular assessment/documentation
- PRN use/documentation
- Re-evaluation of PRN use/documentation
- Advocacy for around the clock (ATC) managment if PRN use becomes frequent (this is preferable for chronic pain)
- Advocacy for different PRNs if initial ones are ineffective
PRNs for bone pain
tylenol, NSAIDS
PRNs for inflammatory pain
NSAIDS, steroids
PRNs for nerve pain
tricyclic antidepressants, CNS agents
PRNs for cardiac pain
O2 and nitroglycerin, morphine
