Cancer Flashcards by Brina Quintanilla Reyes

The following flashcards are going to be based on the cancer recording from in class lecture

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something to keep in mind is that every part in our body can develop what?

cancer

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as a new grad, can you hang chemo ? why or why not

no we can’t, because of the fact that is so intense and we need additional training

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what does cancer mean ?

group of diseases characterized by uncontrolled and unregulated growth of cells

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your body has these cells named ____that functions as a protector against cells in your body that are trying to become cancerous

turmor necrosis factors

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we understand that chemotherapy is a poison, and we have to use special precautions and be certified to hang chemo up. Its been very effective in treating patients who have been diagnosed with cancer. However, what is the sad part of patients who end up being cured from cancer?

they are more likely to develop it again

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what are the 2 major dysfunctions in the the process of cancer development?
in other words, what are the 2 ways normals cells turn into cancer cells?

defective cell proliferation ( growth )
defective cell differentiation

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what is defective cell proliferation ( growth ) mean?

what is defective cell differentiation ?

healthy cells are controlled by an intracellular mechanism that determines proliferation
- cancer cells do not regulate their growth normally, meaning they end up growing on top of one another

a defect in cellular differentiation is that when the cells are starting to mature and develop, they dont ever mature fully/divide fully and so they stay the same
( this can only be diagnosed as genetics )

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what are the 4 stages a cancer cell develops?

initiation
promotion
latent period
progression

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describe to me what happens in each phase

initiation
promotion
latent period
progression

genetic mutation of a cell
( start of the changes )

reversible proliferation of altered cells
( can reversible !!! )

period of time that can elapse between initiation and/or proliferation and progression to the point where there is clinically evident disease

increased growth rate of altered cells, cells become invasive and eventually metastasize

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what’s the big thing around the promotion phase of the development of cancer?

its reversible
- meaning your body can either fight off the cancer cell or simply the cancer cell mutates even more and heads into the latent period

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what does carcinogens mean ?

notes
- many are detoxified by protective enzymes and are harmlessly excreted

failure of protective mechanisms allow them to enter cells nucleus and alter DNA

cancer causing agents capable of producing cell alterations

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what are some examples of carcinogens?

smoking
asbestos
radiation

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the more you are exposed to a carcinogen or practice that carcinogen ( such as smoking ) the greater the what?

risk of developing cancer

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what does metastasis mean and how is it applied to cancer?

metastasis means the ability of a cancer location to spread to another site

so meaning if you have lung cancer, you have a greater chance of developing brain cancer cause of its ability to spread

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possible test question
if you have breast cancer, where is it more likely to spread to?

your bones = bone cancer

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one of the things that we do as nurses is that we collect data on ______ in order to evaluate how far the cancer has spread

sentinel lymph node

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additional information to understand what im going to ask you.

we understand that lymph nodes are all lined together in like a chain, so no matter where in the body when there is an infection or possible injury, all those lymph nodes will swell up together.

however in cancer, its the same thing, but instead of looking at all the lymph nodes. we end up just looking at the sentinel lymph node as its known to be what?

the indictor of being positive or negative of cancer.

meaning if the sentinel lymph node is not effected , then the chances of it being cancerous is very unlikely

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however something important to remember about the sentinel lymph node detection or prognosis is that its not 100% accurate to depend on.

for the reason of ?

skip metastasis
- meaning the tumor cells skip regional nodes and travel to distant nodes
- in smaller terms, the cancer ignore the sentinel lymph node

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what is the role of the immune system?

to be able to fight off infection by using lymphocytes and other white blood cells

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its very sad to say but cancer cells can create _______ to digsuise themselves from the lymphocytes

TAA
- tumor associated antigens

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we have specialized cells in our body for certain jobs, tell me what each of these 3 do

cytotoxic T cells and natural killer cells?

tumor necrosis factor ?

colony stimulating factors?

search out and destroy cancer cells

causes hemorrhagic necrosis of tumor cells

encourage growth of white blood cells

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tumors can be both benign and malignant.

what does benign mean?

what does malignant mean?

what makes them different?

non-cancerous

cancerous

malignant tumor cells can invade and metastasize

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what is the appearance or feeling of a benign tumor vs a malignant tumor?

benign
- mobile, usually non tender, smooth

malignant tumor
- fixed, rough, tender

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what are the 2 classification of cancer that we typically perform on a patient?

anatomic histologic

what does anatomic mean ? what does histologic classification mean?

where the cancer oriented by what we call it, for example, lymphomas/ leukemias = it orientated in the hematopoietic system vs with histologic how the cancer resembles the tissue of origin ( how it started off as )

what is something important to understand about histologic and identifying the cancer cells origin?

we all start off with the same cells to work on a certain system however with cancer, the cell when it slowly starts to change is what we are tying to identify in histologic before it changes in a cell that is too difficult to even understand what It was suppose to be in the first place.

what are the 5 clinical staging classifications for cancer?

0 : cancer in situ ( it hasn't gone anywhere) 1 : tumor limited to issue of origin, localized tumor growth ( it hasn't spread out from the body it started in ) 2 : limited local spread 3 : extensive local and regional spread 4 : metastasis ( spread far beyond from where it started )

test question we need to understand another classification system that we use for cancer called TNM what does TNM stand for?

t - tumor size/invasive n - spread to lymph nodes m - metastasis

what are the t - tumor size/invasive n - spread to lymph nodes m - metastasis numbers associated with it? THE LOWER THE NUMBER THE BETTER. THE HIGHER THE NUMBER THE WORSE.

T (1-4) N (0-4) M (0-4)

additional we can do clinical staging and surgical staging, which are? dont over think it

basic diagnostic studies surgical excision and lymph node sampling

NOTES Diagnoses of cancer Patient may experience fear and anxiety - Actively listen to patient’s concerns - Manage your own discomfort - Give clear explanations; repeat if necessary - Give written information for reinforcement - Refer to oncology team when possible

Notes Diagnoses of cancer Diagnostic plan includes Health history, risks, physical exam and diagnostic studies Indicated diagnostic studies depend on site of cancer - X-rays and other radiographic studies - Blood work - Cytology studies - Endoscopic exams - PET scan - Tumor markers - Genetic markers

why do we as nurses perform a pet scan more than often than other diagnostic studies ? think of the patho for this one

because of we inject a patient with this glucose solution in order to capture image on the scan, however we know that glucose feeds the cells in our body so the cancer cells are pretty much getting feed and we can visibly see it more often than not comapared to other tools

how do we definitive diagnose cancer? like 100%?

biopsy

what are some ways we do biopsy ?

needle or aspiration incisional procedure excisional procedure

notes prevention is key - the war on cancer will not be won with drugs or radiation therapy - a stronger emphasis on prevention is needed - nurses have an essential role education is essential goals of public education - motivate people to recognize and modify behaviors that may negatively affect health - encourage awareness of and participation in health-promoting behaviors life styles habits to reduce risks - practice recommend cancer screenings - practice self-examination - seek medical care if cancer is suspected

what are the 8 warning signs of cancer !!?? TEST QUESTION

1. change in bowel/bladder 2. a sore that does not heal 3. unusual bleeding/dischage from any body orfice 4. thickening or a lump in the breast or else where 5. indigestion or difficulty in swallowing 6. obvious change in a wart or mole 7. nagging cough or hoarseness 8. unattended weight loss

reducing the risk of cancer notes Avoid or reduce exposure to known or suspected carcinogens Cigarette smoke, excessive sun exposure Eat a balanced diet Limit alcohol use Exercise regularly Maintain a healthy weight Get adequate rest Eliminate, reduce, or cope with stress Have a regular health examination Be familiar with your family history Know your risk factors

A nurse plans a community education program related to prevention of the cancer with the highest death rates in both women and men. What should the nurse include in the teaching plan? A. Smoking cessation B. Screening with colonoscopy C. Regular examination of reproductive organs D. Use of sunscreen as protection from ultraviolet light

A. Smoking cessation

The following flashcards are still going to be about cancer but its going to be on the inter professional care and complications

what are the 3 main goals for cancer treatment?

cure control palliation

how can we "cure" cancer ?

surgery medication

how can we control cancer ?

provide anti-cancer therapies that can help prevent the growth of cancer production

how can we provide palliation for cancer patients?

relief or control of symptoms to maintain quality of life

most of the time if a patient has a strand of cancer, meaning a gene, we can do something called target therapy, which helps us how ?

aims at a cancer specific gene or protein that contribute to cancer growth and survival by attacking it

most of the time now, we like to do chemotherapy first before we do surgery/removal of the cancer why ?

because cancer tumors have a large vascular supply, so the risk of bleeding is increased 10 fold, however when we use chemotherapy first, we hope that it can shrink that tumor as small as it can be and then do surgery to reduce the risk and complications of hemorrhaging

how does chemotherapy work ? patho wise

its effective against diving cells

we understand that not all cancer cells end up being killed with chemo therapy, and why do you think they do?

because cancer cells can escape their death by staying in G0 phase ( resting phase ) in which they are not diving, cause remember chemo works on dividing cells.

what is the preparation and handling process of chemotherapy agents? remember we aren't allowed to do this as new grad nurses

entire PPE vented outside

most of the time, how are we administering chemotherapy and why do you think thats the way we do it?

we usually do central or picc lines in order to have access to a bigger viein the reason why we do it this way is because chemo is a vasacant, meaning that if it spills anywhere or pops in a small vein, it will cause severe tissue damage to the site and surrounding areas

what does extravasation mean ?

infiltration of chemotherapy into surrounding tissues

as mentioned before, chemotherapy can be irritant and vesicant. what do both of these words mean ?

irrtant - cause damage to the vein, causing phlebitis and sclerosis and limiting future peripheral venous access vesicants - if inadvertently infiltrate in toes skin, may cause severe local tissue breakdown and necrosis

most of the time we can do iv and picc lines, however we can do something called regional administration what does it mean and how is it better?

delivery of chemo drug directly into the tumor site - higher concentrations of drug can be delivered with less systemic toxicity

some basics side effects of chemotherapy what are acute things ? what are delayed things? what are chronic things?

acute effects are usually either allergic to it or nausea/vomiting delayed - vomiting, rashes, diarrhea, mucositis, alopecia chronic - damage to other organs like heart, liver, kidney, lungs

the very sad part of chemotherapy is that it can't what?

it can't distinguish between normal and cancer cells, so it'll just destroy literally everything

notes chemotherapy treatment plan drugs given in combination - dosages are calculated according to body surface area - regimens involve drugs with different mechanism of action and varying toxicity profiles - resistance is managed by giving multiple drugs that work at different places in cell cycles can more effectively kill cancer cells

cancer treatment radiation therapy notes 50% of all cancer patients will receive radiation therapy at some point in their treatment Not a treatment for systemic disease-used alone or with chemo and/or surgery. Can be part of treatment or palliation Simulation-the process of identifying exactly what areas need treatment and marking skin to outline area of treatment

notes something I just want to mention in my flashcards is that we use radiation to help shrink down the tumor as much as we can, and sometimes we can use radiation as palliative care as well.

typically we use external radiation in which we ask the patient to lay down and we place the beam at them what is low-energy beams good and used for what is high energy beams good and used for

low - penetrate a short distance - useful for skin lesions high - greater depth of penetration - suitable for optimal dosing of internal targets while sparing skin

as previous mentioned we have external radiation, but we also have something called internal radiation or brachytherapy, which helps us how ? as well how does it work?

we implant these radioactive materials like seeds into or close to the tumor and it helps us mainly by causing minimal exposure to healthy tissue and lack of side effects

what are some education on patients with brachytherapy ?

they are radioactive, so dont make food for others, different rooms, use different bathroom

notes cardiac problems - cardiotoxicity - pericarditis - myocarditis nursing intervention - continuous ekg

patients who are on chemotherapy or simply have cancer, they are going to be very fatigued, from the side effects of cancer and the treatment for cancer. what are some things you can recommend for a patient ? dont over think it

try to cluster care, meaning put everything together and then rest after, the finish up it later and then rest. try conserve as much energy as you can - rest before activity - get assistance with activity - remain active during periods of time patients feel better

most of the time patients who are receiving chemotherapy will loose their appetite and become nausea, so what do we recommend before giving them food? what are some foods we should recommend to a patient ? what are we monitoring?

administration of antiemetics low fiber, high calories, high protein diet, small, frequent meals anorexia, try to avoid weight loss and check weights twice weekly

onto of your stomach being irritated and losing your appetite, we can also see patients end up developing mucositites and esophagitis meaning what? and why is this a problem ?

development of small bumps in their throat and this becomes a problem with not wanting to eat because its so painful

what are the two major complications of nutrition when it comes to cancer patients?

malnutrition altered taste senstation ( dysgeusia )

how can we help a patient who is having dysguesia?

avoiding foods they don't like experimenting with spices and seasonings to mask alterations

what is cancer cachexia?

wasting syndrome - losing so much weight and appetite - skeletal looking person which is very sad

what are the two major gu issues patients with cancer often experience ?

hemorrhagic cystitis nephrotoxicity

what are things we need to monitor for patients with GU problem?

monitor for symptoms urine output avoid nephrotoxic drugs increase fluid intake

most of the time patients with cancer, there urine is very acidic, with already having all the uric acid build up and the drug being intense, what Is something we can do to help alkaline the urine ?

adding sodium bicarbonate to IV

what is a medication we can use to help avoid neuropathy for patients who has cancer?

gabapentin

notes Reproductive effects Inform patient of expected sexual side effects Use appropriate shielding Encourage discussion of issues related to reproduction and sexuality Refer to counseling if needed

for hematologic system for cancer, we understand that anemia and leukopenia and thrmobocytopenia is very common to occur, so what can we do to keep an eye on this?

monitor h&h monitor WBC monitor platelet count observe for signs of bleeding and encourage high iron foods

what are the two skin reactions that we can see for patients In cancer?

dry desquamation wet desquamation

notes skin Management: Prevent infection Facilitate wound healing Protect irritated skin temperature extremes Avoid constricting garments, harsh chemicals, and deodorants Help patients deal with hair loss (alopecia)

notes nursing managment nursing implications pulmonary May be progressive and irreversible Cough, dyspnea, pneumonitis, pulmonary edema Treatment Bronchodilators Expectorants/cough suppressants Bed rest Oxygen

complications of cancer infection notes Primary cause of death Caused by: ulceration, compression of vital organ by tumor, neutropenia Usual sites of infection Lungs Genitourinary tract system Mouth, rectum Peritoneal cavity Blood

late effects of radiation and chemotherapy Most at risk are patients treated with alkylating agents and high-dose radiation May be progressive Generally permanent Secondary cancers Leukemia, angiosarcoma, skin cancer

mentioning back about immunotherapy and target therapy what do both of these terms mean ?

immunotherapy uses the immune system to fight cancer - boost the immune system to fight cancer targeted - target specific cancer cells to help treat - less damage to normal cells

what are the side effects of immunotherapy and targeted therapy ?

flu like systmpoms anorexia weight loss fatigue nausea and vomiting

immunotherapy and targeted therapy notes Nursing Management Side effects occur more acutely and are dose limited Can influence patient decision to continue therapy May not be reported for fear treatment may be stopped

why would we do sex hormones therapy ? why would we do colony stimulating factors therapy ? why would we do corticosteroid therapy ?

can stop growth of cancer cells can help with recovery of bone marrow suppression used in combination with drug regimens to help curb side effects

why is stem cells trasnplantion the last thing we do for cancer?

we destroy their entire bone marrow and then transplant IV stem cells in hopes that these new cells can make home in the bone and create new cells that are not cancerous

what is the most common post-transplant complications from stem cells transplant?

infection graft vs host

cancer emergencies Life threatening Misc emergencies Third space emergencies Hypercalcemia SIADH Cardiac tamponade Carotid artery rupture

what is an obstructive oncology emergencies ? (2)

spinal cord compression ( neurologic emergency ) superior vena cava syndrome

why is spinal cord compression an emergency? how do we fix?

they lose function below the tumor location - lost of function - pins and needles surgery to remove the tumor

why is superior vena cava syndrome an emergency ? treatment?

tumor presses onto the superior vena cava and doesn't allow blood to flow through to the rest of the body so now your heart is smushed, hard to take a deep breath chemo and radiation to try to get rid fo the tumor blocking it

what is the metabolic oncology emergency disease?

tumor lysis syndrome

how does tumor lysis syndrome occur?

massive cell destruction relates intracellular comments, so chemo works too good in destroying the cells and the cells release so much uric acid into the body

what are the 4 electrolytes labs to tumor lysis syndrome ?

hyper ureicima hyper phosphatemia hyper kalmmia hypocalcemia

what are the signs and symptoms of tumor lysis syndomre ?

weakness muscle cramps diarrhea nausea vomitting

when does tumor lysis syndrome being and how long can it last?

1-2days after starting chemo lasts up to a week

what are the 2 medications to help treat tumor lysis syndrome ?

allopurinol sodium bicarbonate

cancer pain notes Patient report should always be believed and accepted as primary source for pain assessment data Drug therapy should be used to control pain approximately 50% of patients who are receiving active treatment for their cancer and in 80% to 90% of patients with advanced cancer. These statistics have not changed in the past 30 years. Undertreatment of pain causes Needless suffering Decreased quality of life Increased burden on family caregivers Inadequate pain assessment is single greatest barrier to effective cancer pain management

managing cancer pain notes Fear of addiction is unwarranted Numerous drug options for pain management Nonpharmacologic interventions, including relaxation therapy and imagery, can be used effectively

cancer gerontologic considerations notes Clinical manifestations may be mistaken for age-related changes More vulnerable to complications of cancer and cancer therapy Functional status should be considered when a treatment plan is selected

cancer survivorship Be aware of late and long-term effects of cancer Secondary cancer Cognitive changes Cardiovascular/sexual dysfunction Psychosocial effects culturally competent care : cancer Underserved populations are at risk for late-stage disease at time of diagnosis You need to know how to Assess for cultural differences Identify barriers to care Adapt care to meet specific cultural needs