Cancer Flashcards
Adenocarcinomas
Glandular organs
Carcinomas
Epithelial tissue
Sarcomas
Mesenchymal tissue
Leukemias
Blood forming cells
Lymphomas:
Lymph tissue
Myelomas:
Plasma cells
Risk factors for cancer
Age Race Genetic Exposure to chem. toabacco and alcohol Certain viruses and bacteria Diet- red meat high fat low fiber Sun/ radiation Sexual lifestyle Poverty, obesity, GERD Chronic disease.
Viruses
Hep. B/C- liver cancer Human T leukemia- lymphoma/ leukemia Epstein Barr- lymphoma HPV- cervical HIV- lymphoma/ Kaposi's sarcoma Helicobacter pylori- stomach cancer lymphoma
Tumor Node metastasis (TNM)
Used to stage cancer
Tumor (T) Tx unable to evaluate primary tumor T0 no evidence of primary tumor Tis- tumor in situ T1,2,3,4 size and extent of tumor
CAUTION: seven warning signs client should watch for
Change in bowel or bladder habits A sore that doesn't heal Unusual bleeding or discharge Thickening or lump in the Brest or elsewhere Indigestion or difficulty swallowing Obvious change in warts or moles Nagging cough or hoarseness
Soft bland foods
Mashed potatoes Scrambled eggs Cooked cereal Milk shakes Icecream Frozen yogurt Bananas Breakfast mixes
Anemia secondary to bone marrow suppression
Monitor: fatigue, pallor, SOB
Manage fatigue with rest periods and energy saving methods
Administer epoetin Alfa and ferrous sulfate.
Monitor Hgb and be prepared to admin. Blood.
Thrombocytopenia secondary to bone marrow suppression:
Monitor: petichae, ecchymosis, gums, nosebleeds, occult or frank blood in stool, urine, or vomitus.
Institute bleeding precautions (hold pressure for 10min)
Administer oprelvekin
Be prepared to admin. Platelets <30k
Client education thrombocytopenia
Electric razor Soft bristle toothbrush Avoid blowing nose vigorously Ensure dentures fit Avoid NSAIDS Prevent injury when ambulating Apply cold if injury does occur
Brachytherapy
- Internal radiation placed close to the target tissue (placement in body orifice)
- Delivered via IV such as radionuclide iodine which is absorbed by the thyroid.
Dosimeter film badge:
Records personal amount of radiation exposure.
Dysgeusia secondary to external radiation or teletherapy
Distorted sense of taste
Xerostomia secondary to radiation
Dry mouth and typically associated with mucositis as well.
Client education for radiation
- Nutrition: avoid spicy, salty, acidic, and hot foods.
- gently wash skin w/ mild soap and water drying with patting motions.
- Do not remove tattoo used to guide therapy
- wear soft clothing and avoid tight
- Do not expose skin to sun or heat source.
- inspect skin
Hormone therapy: gonadotropin releasing hormone agonists.
- Androgenic hormones are used to suppress estrogen dependent cancer
- estrogen in hormones are used to suppress testosterone dependent cancer.
Hormone therapy: Nursing actions
- Monitor cardiac, blood pressure, pulmonary edema
- male clients: decreased libido, erectile dysfunction and feminizing effects(gynecomastia, hot flashes, bone loss)
- client should increase Calcium & Vit D
- female: (chest/ facial hair, amenorrhea, decreased breast tissue)
Immunotherapy:
Biological Response modifiers BRM
Antibodies Cytokines: 2 primary cytokines: •interleukins- coordinate inflammatory and immune response (lymphocytes) •interferons- have an anti-tumor effect.
BRM Nursing Actions
Interleukins: monitor for influenza-like symptoms and edema.
Interferons: Altered LOC lethargy
Peripheral neuropathy
Orthostatic hypotension
– skin rashes are common (avoid sun & swimming)
Photodynamic therapy
Injection of photo sensitizing agent absorbed by all cells. After 1-3 days only remains in cancer cells. Exposed to specific wavelengths via endoscope. Destroyed or reduced. Used: non small cell lung cancer Esophageal cancer Small rumors close to body surface Avoid: sun for 6 weeks
Skin cancer type:
Squamous cell
Rough scaly lesion with central ulceration and crusting
•localized; may metastasize.
Skin cancer type: Basal cell (basal epidermis or nearby dermal cells)
Small waxy nodules w/ superficial blood vessels, well defined borders.
•erythema and ulceration
•invade local structures (nerve bone cartilage lymphatic and vascular tissue) rarely metastasize but high rate of recurrence.
Skin cancer type: Malignant melanoma (melanocytes)
New moles or change in existing mole
(Can occur in intestines or any other body structure with pigment cells)
•cracks ulcerations bleeding are possible
•teach client ABCDE system to evaluate moles.
Health promotion (skin cancer)
Limit exposure 10-3pm Apply sunscreen near reflective surfaces Sunblock should be at least 15 SPF UVA UVB applied 30 min before and reapply every 2 hours. Wear protective clothing Avoid indoor tanning.
Risk factors for skin cancer
Immunosuppressive therapy Exposure over long periods Chronic inflammation burns or scars Fair complexion Several large or many small moles Hx of melanoma Higher elevation and closer to the equator Age over 50
ABCDE of suspicious lesions
- Asymmetry- one side does not match other
- Borders-ragged mother irregular or blurred.
- Color- lack of uniformity in pigment
- Diameter- width > 6mm(pencil eraser)
- Evolving- change in appearance or condition(shape size color height texture bleeding or itching.
Therapeutic procedure for skin cancer
Cryosurgery
Freeze and destroy isolated lesions
Applying liquid nitrogen -200 C
-skin will be edematous and require cleansing w/ peroxide along with topical anti microbial.
Therapeutic procedure skin cancer:
Topical Chemotherapy
5-fluorouracil cream for Tx: of actinic keratoses or widespread superficial basal cell carcinoma.
Therapeutic procedure skin cancer:
Interferon
Post op Tx: of stage 3 or greater melanoma
Provide relief from adverse effects and promote nutrition/fluids.
Leukemia:
Cancer of WBC, they are not functional and spread to bone marrow, liver, spleen, lymph nodes, testes and brain.
Categ. As acute or chronic along with type of WBC affected.
Leukemia risks
Prevents growth of other blood components(platelets, erythrocytes, mature leukocytes)
•leads to immunosuppression leading cause of death is infection
•increased risk of bleeding
ALL Acute lymphocytic leukemia
5 year survival rare for children 85%
< 50% adults
AML Acute myelogenous leukemia
Most common among adults
Prognosis poor
Chronic lymphocytic leukemia CLL
Most cases people over 60 and progresses slowly
CML chronic myelogenous leukemia
Most cases young adults less than 2 year survival rate from time of diagnosis.
Lymphomas- cancers of lymphocytes and lymph nodes. Can metastasize to almost any organ.
Hodgkin’s lymphoma- young adults (viral infection, exposure to chem.)
Non Hodgkin’s -most common >50
Gene damage, viral infections, autoimmune disease, exposure
Thyroid cancer:
Papillary carcinoma
Grows slowly and is most common form.
Thyroid cancer: Follicular carcinoma
Affects blood vessels, bone, lung tissues.
Thyroid cancer:
Medullary cancer
Often the result of an endocrine disorder that causes multiple tumors.
Thyroid cancer: Anaplastic carcinoma:
Replicates quickly invading area around tumor usually metastasizes before diagnosis.
Health promotion secondary to thyroid cancer
Wear thyroid guard to protect neck during upper body X-Ray
Avoid smoking
Risk factors thyroid cancer
Female gender
Diet low in iodine
Radiation
Older adult
Hyperplasia
Increase in # or density of normal cells in response to stress, increased metabolic demands, elevated levels of hormones.
Ex: myocardial cells, uterine cells
Reversible
Metaplasia:
Differentiation into cell types not normally found in that location.
Normal cell not in normal areas- protective response to adverse conditions. (Inflammation)
Reversible
Dysplasia
Loss of DNA control over differentiation
Abnormal variation in size shape and appearance along with arrangement
Ex: cervix in response to HPV.
Anaplasia:
Regression of cell to an immature or undifferentiated cell type. No longer under DNA control.
In response to overwhelming destructive conditions inside the cell. Associated with malignancies.
Not reversible.
Diagnostics for cancer
Biopsy Bone marrow aspiration CT CAT MRI PET X-Ray Scans ultrasound CBC Tumor markers Urinalysis Lumbar puncture Serum chem panel Red blood indices
Benign tumor characteristics
Localized growth Well-defined borders Encapsulated Contact inhibition Grow slowly Stable in size Easily removed Typically Don't recur
Characteristics of malignant cells
•Loss of regulation
•Loss of specialization
•Loss of contact inhibition
•Progressive acquisition of a cancerous phenotype- new gen. More deviant
•Irreversibility
•Altered cell structure
•Simplified metabolic activities- increased synthesis of substances needed for cell division
•Transplantability
•Promote own survival- create a CT framework and own blood supply(angiogenesis)
Divert nutrition via diffusion (<1mm) or from blood supply thereafter.
Metastasis:
- Intravasation
- Survival while in blood
- Extravasation
Invasion of cancer cells through basal membrane into blood or lymphatic vessel.
Tumor suppressor genes
Normally suppress oncogenes (promote cell proliferation)
Become inactive through deletion or mutation.
Anorexia- cachexia syndrome
Wasted appearance due to rapid weight loss, emancipation, malnutrition, and loss of energy.
Neoplastic cells divert nutrition to their own use and glucose metabolism is altered causing increased serum glucose that suppresses appetite. Tumor also secreted substances that alter smell and taste and cause early satiety. Catabolism of body’s tissue and muscle proteins. Normally state of starvation reduces metabolic rate, but not in cancer because of malignant cells.
GI cancer decreases absorption
What is only diagnostic that reveals type of cell and structural difference from Parent tissue?
Microscopic histologic examination
Biopsy (PAP smear)
Sputum
Focused interview
- Hx of disease S/S led to seeking care
- other diseases
- current physical or psych. Problems
- understanding
- expectations
- functional limitations
- effect on lifestyle
- reliable support system
- coping strategies
Nursing diagnosis for cancer
Anxiety Disturbed body image Anticipatory grieving Risk for infection Risk for injury Imbalanced nutrition< than require. Impaired tissue integrity
Goals:
Client will maintain weight within normal range based on height and body type
Client will remain hydrated evidenced by skin turgor and mucous membranes.
Client and family will vocalize feeling and seek support from others
Client with list potential side effects of chosen therapies and strategies for minimizing symptoms.
Cancer screening guidelines
Colorectal cancer
Fecal occult blood test annually beginning at age 50
Flexible sigmoidoscopy at age 50 Q5Y
Colonoscopy- Q10Y
Double contrast barium enema- Q5Y
Cancer screening guidelines
Breast cancer
Monthly self breast exam at age 20 in shower just after period.
Clinical breast exam Q3Y 20-40, annually >40
Mammogram annually age 40
Cancer screening guidelines
Cervical and uterine
PAP Q3Y beg. W/ vag. Intercourse or age 21
After age 30 may perform less freq.
PAP may be stopped at age 70
PAP smear may be stopped following hysterectomy.
Cancer screening guidelines
Prostate cancer
PSA and digital rectal exam Beg. Age 50 and for younger men at high risk.
Health counseling and cancer checkup-
Exam for cancer of thyroid, testicles, ovaries, Lymph node, oral region, and skin Q3Y over age 20 and annually over age 40.
When to call nurse or physician
When to call 911
Oral temp >101.5 Severe headache Significant increase in pain at usual site or pain at new site not relieved by meds Difficulty breathing New bleeding Confusion,irritability, restlessness. W/D decreased activity level crying Deep sadness or desire to end life Changes in body function Changes in eating patterns Appearance of edema 911: difficulty breathing cyanosis unconscious or convulsion Unmanageable behavior
Normal range lab values
Protein: 6-8 g/dL Albumin: 3.5-5 g/dL Hgb: 13.5-18 g/dL Hct: 40-54% BUN: 5-25 mg/dL Creat: 0.5-1.5 mg/dL
Radical mastectomy
Removal of entire affected breast underlying chest muscles and lymph nodes under the arms.
Simple mastectomy:
Removal of the complete breast only
Segmental mastectomy
Removal of the tumor and surrounding margin of breast tissue.
Modified radical mastectomy:
Removal of breast tissue and lymph nodes under the arm leaving chest muscle intact.
Sentinel node biopsy:
Radioactive substance or dye is injected into region of tumor the dye is carried to the first (sentinel) lymph node to receive lymph from the tumor and most likely to contain cancer cells.
Lumpectomy
Excision of primary tumor adjacent breast tissue followed by radiation therapy.
Breast cancer diagnosis
Anxiety Decisional conflict Grief Risk for infection Risk for injury Disturbed body image over loss of breast.
Breast assess:
Family HX personal Hx Breast changes Nipple discharge Use of hormone replacement therapy Menstrual Hx Pregnancies Alcohol Physical activity Diet
Small cell carcinoma (oat cell)
20-25% of all lung cancers
Central lesion with hilar mass
SIADH, Cushing syndrome, thrombophlebitis.
>40% of clients have distant metastasis at time of presentation.
Adenocarcinoma
20-40% of all lung cancers
Peripheral mass involving bronchi w/ few local symptoms. Hypertrophic pulmonary osteoarthropathy
Early metastasis to central nervous system, skeletal and adrenal gland.
Squamous cell carcinoma
30-32% of all lung cancers
Central lesion located in large bronchi
S/S: cough, dyspnea, atelectasis, wheezing. Hypercelcemia.
(Local invasion)
Large cell carcinoma:
10-15% of all lung cancers
Peripheral lesion larger than associated adenocarcinoma and tends to cavitate; gynecomastia, thrombophlebitis.
Early metastasis
