Cancer Flashcards
General overview of cancer
Genes inside each cell tell it when to grow, work, divide and die. Normally, our cells follow these instructions and we stay healthy. But sometimes the instructions get mixed up, causing our cells to grow and divide out of control or not die when they should.
As more and more of these abnormal cells grow and divide, they can form a lump in the body called a tumor
Hyperplasia
means that abnormal cells are dividing and increasing in number faster than normal. The cells look normal under the microscope but there are more cells than normal. Some types of hyperplasia are precancerous but most aren’t
i.e. BPH
Atypia
means that cells are slightly abnormal (atypical).
Sometimes atypia may be caused by healing and inflammation but some types of atypia are precancerous.
Metaplasia
means that there has been a change to the types of cells that are normally found in this area of the body. The cells look normal but they aren’t the type of cells that are normally found in that tissue or area. Most types of metaplasia aren’t precancerous but some are.
Dysplasia
means that cells are abnormal, there are more cells than normal, the cells are growing faster than normal and they aren’t arranged like normal cells. Dysplasia is a precancerous condition.
Carcinoma in situ
is the most severe type of precancerous change. The cells are very abnormal but have not grown into nearby tissue. Carcinoma in situ is usually treated because it has a high risk of developing into cancer.
Precancerous changes can be mild to severe. There are different ways of describing precancerous changes based on how mild or severe the changes are.
Hyperplasia
Atypia
Metaplasia
Dysplasia
Carcinoma in situ
People with precancerous conditions are usually checked regularly, so they can be treated quickly if cell changes become more severe or turn into cancer.
Describe normal cellular differetiation
Orderly process progressing from a state of immaturity to a state of maturity
Stable and will not change
Exact mechanism of normal cellular differentiation not completely understood
Most human tissues contain _____-stem cells.
predetermined, undifferentiated
All cells are controlled by a_______________ that determines proliferation.
intracellular mechanism
Cancer cells grown in culture are characterized by loss of
contact inhibition.
Stem cell theory of defect in cellular proliferation
Loss of intracellular control of proliferation results from mutation of stem cells.
DNA is substituted or permanently rearranged.
Two types of genes that can be affected by mutation are
Proto-oncogenes
Regulate normal cellular processes such as promoting growth
Tumour suppressor genes
Suppress growth
Proto-oncogenes
Genetic locks that keep cells functioning normally
Mutations that alter their expression can activate them to function as oncogenes (tumour inducing genes).
Which can interfere with normal cell growth causing the cell to become malignant.
Like a gas pedal, helping cell grow and dvide
oncogenes are like gas pedals that are stuck down - out of control
Tumour suppressor genes
Function to regulate cell growth
Suppress growth of tumours
Are rendered inactive by mutations
Result in loss of suppression of tumour growth
BRCA1 and BRCA2 genes
if mutated, increase risk of ovarian cancer and breast cancer
What happens to cells once they mutate
Cells can die from damage or by initiating programmed cellular suicide (apoptosis).
Can recognize damage and repair itself
Can survive and pass on damage to two or more daughter cells
Surviving mutated cells have potential to become malignant.
When do normal cells divide
When new cells are required
Malignant or cancer cells and adhereance
Less adherant and more mobile than normal cells
Normal cells adhere to
Other normal cells
Angiogenesis
Cancer cells have the ability to secrete a substance that stimulates blood vessel growth to support the rapidly growing mass. This is called angiogenisis
Do normal cells or cancer cells die more easily
Cancer cells do not die as easy
Development of cancer, origin of cancer may be
Radiation
Viral/bacterial
lifestyle
environemnt
How do cells go from normal to neoplastic
Mutation of cell’s genetic structure
From inherited mutation
From exposure to a chemical, radiation, or viral agent
Many carcinogens are detoxified and harmlessly excreted. If not they enter the cells nucleus and alter its DNA.
Mutated cell has the potential to develop into neoplastic cells.
Carcinogens
Radiation
Chemical
Viral
Cells damaged by carcinogens may
Self repair
Die
Replicate into daughter cells with same genetic alteration
Chemical carcinogens
Chemolytics
Radiation
Ionizing radiation can cause cancer in almost any human tissue.
Dose of radiation needed to cause cancer is unknown.
Ultraviolet radiation is associated with melanoma and squamous and basal cell carcinoma.
Hepatitis B and C viruses, associated with
hepatocellular carcinoma
Human papillomavirus, associated with which cancers
squamous cell carcinomas such as cervical, anal, and head and neck cancers
The withdrawal or reduction of promoting factors like ________,_______,_________, &_________ _______ can reduce the risk of cancer development
obesity, smoking, drinking, dietary fat, colon cancer,
Latent period for cancer cells
1-40 years
Critical mass
0.5 cm
1 cm cancer cell has how many cells in it
1 billion
what is a criticao mass
For disease to be clinically evident, tumour must reach a critical mass that can be detected.
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Progression of cancer characterized by
increased growth rate
invasivness
Metastasis
Most frequent site of meastasis
Brain
Lung
Liver
Bone
Adrenal
Tumor angiogenisis
_________ is formation of blood vessels within tumour.
Certain segments of a primary tumour can detach and invade surrounding tissues.
Immunological surveillance
Response to tumour-associated antigens
Lymphocytes continually check cell surface antigens and detect and destroy abnormal cells.
Involves cytotoxic T cells, natural killer cells, macrophages, and B lymphocytes
Cytotoxic T cells
Kill tumour cells directly
Produce cytokines
- Natural killer cells and activated macrophages can lyse tumour cells.
- B cells produce antibodies directed to tumour surface antigens.
Other ways that cancer cells avoid immune response
Tumor burden too small to trigger a response or too great and overwhelms the immune response.
Cancer cells produce shields around cells that decrease recognition by the immune system.
Tumor invasion in bone cancer can decrease lymphocytes. Why is that concern?
Immunological escape-Mechanism by which cancer cells evade immune system
Suppression of factors that stimulate T cells
Weak surface antigens allow cancer cells to “sneak through” surveillance.
The development of tolerance of the immune system to some tumour antigens
Blocking antibodies that bind tumour associated antigens, preventing recognition
Benign
Have cells that stay in one place
Tend to have a regular and smooth shpae and have a covering called capsule
Don’t usually come bac kafter they are removed
Malignant tumors
Can grow into nearby tissue and spread to other parts of the body
Can stil come back after removal bc cancer cells might have alread yspread
Early detection is improtant becauce
Cancer is usually smaller and easier rto treat
Less chance cancer has spread
Primary cancer prevention
Drink in moderation
smoking cessation
Exercise and diet
CAUTION
Change in bowel or bladder habits
A sore that doesn’t heal
Unusual bleeding and discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty in swallowing (Thyroid)
Obvious change in wart or mole
Nagging cough or hoarseness
Also cancer cachexia
- most cancer pts die from malnutrition
FOBT or FIT test
For those whoodn’t have increased risk of colorectal cancer Q2 years after 50 years
Digital rectal exam
Exam for prostate cancer in men
Women screening
PAP smear and pelvic examinations: Q1 year until three consecutive negative exams then Q3 years until 69 years
Mammogram: Q2-3 years from 50-74 years of age;
Cancer is nrearly always diagnosed by
Expert pathologist
Prognostic factors
Favorable prognostic factors can have a positive effect on the outcome. Unfavorable prognostic factors can have a negative effect on the outcome.
Type of cancer
Subtype of cancer based on the type of cells or tissue (histology)
Size of the tumor
Stage: how far and where the cancer has spread
Grade: how fast the cancer cells are growing
More prognostic factors
Age (younger)
Comorbidities
Functional status
Wt loss
Coping ability
Stage of cancer includes
the size of the tumor,
which parts of the organ have cancer,
whether the cancer has spread (metastasized)
0: Cancer in situ
I: Tumour limited to tissue of origin; localized tumour growth
II: Limited local spread
III: Extensive local and regional spread
IV: Metastasis
Grading used for
Describes how the cancer cells look compared to normal, healthy cells
Used to help predict how the cancer will grow and to plan treatment
Grading depends on
how different the cancer cells look from normal cells (differentiation) and other features of the tumor such as the size and shape of the cells and how the cells are arranged
how fast the cells are growing and dividing
whether there are areas of cell death in the tumor (called necrosis)
High grade vs low grade cancer
Some cancers have their own grading systems, but most solid tumor cancers are given a grade between 1, 2, 3 or 4. (Solid tumor cancers, like breast or prostate cancer, form lumps.) A lower number means the cancer is a lower grade. Different parts of a tumor can have cancer cells with different grades. But the tumor is usually graded as the highest grade seen anywhere within the tumor.
Know the TNM table
Tumor
Nodes
Metastasis
Tumor classicivation TNM
T0 – no evidence of primary tumor
Tis – evidence of carcinoma in situ
T1, T2, T3, etc. Progressive increase in tumor size and involvement.
Tx – unable to assess tumor
Node classication TNM
N0 – No regional lymph node metastasis
N1, N2, N3 – Increasing involvement of regional nodes.
Nx –Regional lymph nodes cannot be assessed clinicall
Metasistis CLassification
M0 – no evidence of distant metastasis
M1, M2, M3 – Metastatic involvement
Mx- Presence of metastasis cannot be assessed.
Most concerning s/s at cancer diagnosis
Cancer cacthexia
Wt loss (muscle)
Why do palliative cancer pts recieve treatment
To keep them comfortable
Surgery
diagnostic, preventative, eliminative, reconstructive, or palliative
Radiation
local destruction of cancer cells; adjuvant (supplements surgery) and palliative.
Biotherapy
Biotherapy-uses the body’s immune system to kill cancer cells.
3 reasons why surgery is used for cancer
Remove tumor (Cure)
Control spread, slow process
Paliation (Causing pain)
The removal of the primary cancerous tumor is
the most common operation to try and cure or control cancer.
Risks of primary cancerous tumor
Some tumor cells can shed off and seed for regrowth
Chemo definition
type of treatment that includes a medication or combination of medications to treat cancer. The goal ofchemois to stop or slow the growth of cancer cells. Chemo medications attack rapidly growing cancer cells, but they can also affect healthy cells that grow rapidly.
How is chemo dilivered what route
IV, PO, IM, Intracavitary (peritoneal), Intrathecal (into sub-arachnoid space), intra-arterial (into artery supplying the tumor), intravessicle (directly into the bladder) or SubQ
How long is chemo therapyu
Months to years
Big concern with chemo
Affects bone marrow
Disrupts production of blood cells
Why would someone be prescribed chemo
If cancer is in the lymph or bloodstream
If they suspect cancer has spread
Why do combo of chemo work better
Attack cnacer cells at different time in cell cycle
Focus more on THIS lecture
Chemo delivery often occurs via
porta cath
Central IV line that is threaded into one of the large central veins in the chest, which empties into the heart. The vein which is used most often is the superior vena cava. This vein is preferred because it is very close to the skin and easy to find with ultrasound
Use for porta cath
Blood draws
IV hydration
Chemotherapy
How does radiation work
Works by making small breaks in the DNA inside cells. These breaks keep cancer cells from growing and dividing and cause them to die.
More localized than chemo
Most times in early stages to shrink tumor prior to operation
General side effects of radiation
Skin problems and fatigue
Other side effects reflect the location of the XRT
3 types of radiation
External
Internal
Systemic
Internal radiation
Internal radiation is also called brachytherapy. A radioactive source is put inside the body into or near the tumor.
Less side effects
Systemic radiation
Radioactive drugs given by mouth or put into a vein are used to treat certain types of cancer. These drugs then travel throughout the body.
Biological therapy how does it work
Restore or help host immune system responses, and interfere for the cancer’s ability to metastasize or differentiate.
Growth Factors
stimulate production, maturation, and release of cells from the bone marrow, increasing functional ability of blood cells. Ex. GCSF (Neupogen and Neulasta). Bone pain is common.
If chemo causes low WBCs, this can be given to increase cell count so they can continue chemo
One of the most important responsibilities of the nurse is that of differentiating between
Is the effect from the drug or from the dx process
Chemotherapeutic agents cannot selectively distinguish between normal and cancerous cells
therefore the adverse effects of chemo are caused by the destruction of normal cells especially those that proliferate rapidly like cells from the ________ ________, _____ ______ and _____________systems.
GI Tract, skin and hair
When you think of the function of the bone marrow what should we monitor?
RBCs, Hgb, WBCs, and platlets
WBCs affected quickest and most ( a week)
Platlets 2-3 weeks
RBCs 2-3 months before affected
Interventions for low WBC count
Reverse precautions
Response to low RBC
Blood tranfusion, folic acid, iron
GI system efects
N/V
Aorexia
Diarrhea
Toxic effects on the liver
Stomatitis (sores in mouth and upper resp tract)
Cool foods are good, Antiemetic drugs
Integ effects of chemo
Alopecia
Skin rashes
Neurogenic sensations
photosensitivity
Hyperpigmentation
Extravasation
Infection related to cancer
Common Sites: Lungs, GU system, Mouth, Rectum, Peritoneal cavity, blood
Caused by ulceration, compression of vital organs
Neutropenia due to disease process or tx
Febrile Neutropenia in cancer pts
Increase temp, HR, RR
Infection can be rapidly fatal in cancer patients so it must be treated ASAP.
A patient with a temp higher than 38 C should go to emergency or the cancer clinic ASAP
Tx for neutropenia
Preventing infection is best
Reverse protection
Hold chemo, no pets, gardening, etc.
Pharm
Granulocyte Colony-Stimulating Factors (G-CSF)
Antibiotics
Malnutrition
Measure albumin, give them any food they want
Ensure, protein etc.
Oncologival emergencies
Superior Vena Cava Syndrome
Due to: Obstruction of vena cava by a tumor (commonly by Lung Ca, Hodgkins and Non-Hodgkins Lymphoma)
- Malignant Spinal Cord Compression (MSCC)
- Intestinal Obstruction:
Requires urgent radiation therapy
Superior vena cava syndrome manifestations
Facial Edema
Periorbital edema
Distended neck and chest veins
Headache
Seizures
- Malignant Spinal Cord Compression (MSCC)
Due to: Tumour compressing the spinal cord (primary or metastatic tumours)
Manifestations of Malignant Spinal Cord Compression
Tingling, loss of sensation, bowel and bladder function impaired/lost, paralysis pain etc.
Treatment for Malignant Spinal Cord Compression
Steriods to decrease inflammation
Urgent radiation therapy
- Intestinal Obstruction:
Complete or partial obstruction d/t swelling of the intestine or solid tumour invasion.
Manifestations of Complete or partial obstruction d/t swelling of the intestine or solid tumour invasion.
Profuse, projectile vomiting with foul smelling vomit (like feces)
Ovarian cancer is a high risk
Symptoms of Complete or partial obstruction d/t swelling of the intestine or solid tumour invasion.
N/V, abdom distention and pain
Intervention for bowel blockage
Surgery removal
NG tube
- Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
abnormal or sustained production of ADH (occurs most often in Small Cell Lung Ca)
Symtoms of inapproriate ADH
Fluid retention
Serum hypo-osmolality
Dilutional hyponatremia
Early: muscle cramps, weakness
Late: vomiting/ abd cramping/ seizures/ coma
Decreased urine output
Treating SIADH
Fluid restriction
Treat the cause
Oncological Hypercalcemia
Most common condition metabolic oncolgoical emergency
-Has a poor prognosis,80% of patients with hypercalcemia will die within a year and there is a median survival of 3 to 4 months.
-Cancer-related hypercalcemia is the leading cause of hypercalcemia in hospitalized patients.
What causes hyperCa in cancer pts
Increased breakdown of bone tissue (osteoclastic activity) due to malignancy (multiple myeloma) or bony metastases (from lung, breast, etc). Or release of parathyroid like substance from certain cancers.
Clijnical manifestations of hyperCa
Confusion
Apathy/ Depression/ Fatigue
Muscle weakness
ECG changes
Anorexia/ Nausea/ vomiting
Polyuria/ nocturia
severe muscle weakness, decreased deep tendon reflexes, kidney stones, irregular heartbeat even heart attack.
Calcium measurement
It’s the ionized calcium that you are concerned about because ionized calcium is the physiologically active form of calcium; calcium bound to albumin is inactive. Standard lab tests usually measure the total calcium.
Ionized vs Total Calcium
Ionized CAN be calculated from total
HyperCa tx
Mobility
Hydration***
Calcitonin
Loop diuretic
Bisphotphonates
Glucocorticoids
. Tumor Lysis Syndrome (TLS):
Follows the destruction of a large number of neoplastic / cancer cells due to chemo or radiation allowing for vast numbers of intracellular electrolytes to enter the blood stream. Often causes changes in potassium, phosphorous and uric acid levels.
Tumor Lyusis synd most comon in which pts?
Most commonly seen in patients with highly aggressive hematologic cancers (ie high-grade lymphomas and acute leukemias
Usually occurs when effective chemotherapy has begun, but can occur after radiation and/ or spontaneously
Hyperkalemia can cause serious and occasionally fatal — ___________
Dysrrythmias
Tumor Lysis syndrom labs
HyperKalemia
Hyperphosphatemia
Hypocalcemia
Hyperuricemia
Tx for TLS
Lots of Fluids**
Alipuronal - reducing buildup of uric acid in the blood
What is allopurinol? Why do you think it would be used in Tumor Lysis syndrome?
TO preserve the kidneys
Hyper viscosity Syndrom
Hyper viscosity syndrome is a condition that occurs when your blood becomes so thick that your body’s overall blood flow decreases.
It can be caused by blood cellschanging shape or by an increase in serum proteins, red blood cells, white blood cells, or platelets.
Classic hyperviscosity
includes mucosal bleeding, visual abnormalities, and neurological abnormalities
LOOK on slides for HVS
Standard of care for managing hyperviscosity
therapeutic apheresis
Cardiac Tamponade
Fluid accumulation in the pericardial sac, constriction of the pericardium by a tumour, or percarditis secondary to radiation.
S/S of Cardiac tamponade
Heavy feeling over the chest
Tachycardia
SOB
Cough
Distant heart sounds
Dyspahgia and many more…..
Treament for cardiac tamponade
Treatment- Reduce the fluid around the heart and mange symptoms
Managing physical symptoms
Treating fatigue with steriods
Constipation - must be on bowl protocol
Dyspnea - treated with chest tube draining
- pace activites
- Narcotics reduce. experience of breathlessness
- Fans
N/V
Assessing and treating cause
Dehydration
- Oral hygeine
- Giving fluid
Anorexia/Cachexia
Meds to help make you eat
Vomiting or pain treated first
Nausea/vomiting
