Cancer Flashcards
Hypertrophy
– growth that causes tissue to increase in size by enlarging each cell.
Hyperplasia
growth that causes tissue to increase in size by increasing the number of cells.
Neoplasia
– any new or continued cell growth not needed for normal development or replacement of dead and
damaged tissues.
Cell growth
Most types of altered cell growth are benign, but nearly 1.5 million people in U.S. and Canada diagnosed with cancer each year (ACS, 2008).
longer life span
increase in exposure to carcinogens
Benign Tumors
ll
What are the steps in carcinogenesis?
Initiation – Step 1 in carcinogenesis. Exposure to carcinogen which penetrates cell, damage DNA, and change or mutate the cell. Irreversible, but only leads to cancer if cell division is not impaired.
Promotion – enhancement of growth of initiated cell. Normal hormones and body proteins, like insulin and estrogen, can cause altered cells to divide more frequently. Shortens the latency period.
Progression – increasing malignancy over time. To become a health problem, tumor must develop it’s own blood supply: TAF; less resemblance to original initiator, increasing malignancy.
Metastasis – breaks away from primary location and establishing remote colonies
True or false
80% of cancer come from external factors
True
Top four common sites of cancer
BBLL
- Brain
- Breast
- Lung
- Liver
How do you grade a tumor?
Initiation – Step 1 in carcinogenesis. Exposure to carcinogen which penetrates cell, damage DNA, and change or mutate the cell. Irreversible, but only leads to cancer if cell division is not impaired.
Promotion – enhancement of growth of initiated cell. Normal hormones and body proteins, like insulin and estrogen, can cause altered cells to divide more frequently. Shortens the latency period.
Progression – increasing malignancy over time. To become a health problem, tumor must develop it’s own blood supply: TAF; less resemblance to original initiator, increasing malignancy.
Metastasis – breaks away from primary location and establishing remote colonies
What are oncogenes?
Oncogenes are not abnormal genes – part of every cell’s make-up. Oncogenes are activated by External and
Personal factors.
External factors for cancer
External Factors – 80% of all cancers in North America
Chemical – 30% related to tobacco, single most preventable source. Tobacco is an initiator and a promoter.
Physical – Radiation, chronic irritation, and tissue trauma, scars. (frequent cell division increases risk for mutation)
Viral – when viruses infect body cells and break DNA strands, mutation may activate the oncogene or damage
suppressor cells. Oncoviruses are viruses known to cause cancer: EBV, HBV, HCV, HPV,
Cancer prevention
Avoidance of carcinogens
Skin cancer – sunscreen; avoid sun exposure
-Lung cancer – eliminate tobacco; environmental asbestos
-Modifying associated factors
-alcohol,
-Diet
-Multiple sex partners
-Removal of ‘at-risk’ tissues
-moles
-polyps
-breasts
Chemoprevention – drugs, chemicals, natural nutrients to disrupt cancer development
ASA, Celebrex – reduce risk of colon cancer
Vit D, Tamoxifen – reduce risk of breast cancer
Lycopene – prostate cancer
Vaccincation – Gardasil for HPV
Cancer Screening
Regular Screening does not reduce incidence but can reduce types of cancer death - mammography (over 40) clinical breast exam colonoscopy (50) PSA (50)
Features of early embryonic cells
Rapid and continuous cell division
Anaplasia
Large nuclear-to-cytoplasmic ratio
Pluropotency
Loose adherence
Migration
No contact inhibition
Normal chromosomes(23 pairs)
Day 8, commitment: oncogenes suppressed(off) or expressed (on) in
different cell typesFeatures of benign tumors
Continuous or inappropriate cell growth Specific morphology Small nuclear-to-cytoplasm ratio Specific differentiated functions Tight adherence No migration Orderly growth Normal chromosomes(23 pairs)
Features of cancer cells
-Rapid or continuous cell division
-Anaplasia
-Large nuclear-to-cytoplasmic ratio
-Specific functions lost
-Loose adherence
-Migration
-No contact inhibition
-Abnormal chromosomes (aneuploidy)
lost (23), or broken
Cancer development: initiation
Initiation – Step 1 in carcinogenesis. Exposure to carcinogen which penetrates cell, damage DNA, and change or mutate the cell. Irreversible, but only leads to cancer if cell division is not impaired.
Cancer development: promotion
Promotion – enhancement of growth of initiated cell. Normal hormones and body proteins, like insulin and estrogen, can cause altered cells to divide more frequently. Shortens the latency period.
Cancer development: Progression
Progression – increasing malignancy over time. To become a health problem, tumor must develop it’s own blood supply: TAF; less resemblance to original initiator, increasing malignancy.
Cancer development: Metastasis
Metastasis – breaks away from primary location and establishing remote colonies
Common sites of metastasis
- Breast
- Lung
- Colorectal
- Prostate
- Melanoma
- Brain cancer`
Grading
Grading – compares the cancer cell with the normal cell from which it arose. Classifies cellular aspects of the cancer. Some cancer cells are more malignant than others, vary in aggressiveness and sensitivity to treatment.
Ploidy
Ploidy – description of cancer cells by chromosome number and appearance. Aneuploidyincreases with the degree of malignancy
Staging
Staging – determines the exact location and degree of malignancy at diagnosis. Influences the selection of therapy. Clinical; Surgical; Pathologic.
T – Primary tumor: Tx, To, Tis, T1, T2, T3, T4
N – Regional lymph node involvement: Nx, No, N1, N2, N3,
M – Distant metastasis: Mx, Mo, M1
Mitotic index
Mitotic Index – percentage of cells actively dividing.
Malignant tumor (endings)
Carcinoma, blastoma, and sarcoma
Oncogenes
Oncogenes are not abnormal genes – part of every cell’s make-up. Oncogenes are activated by External and
Personal factors.
Regular Screening does not reduce incidence but can reduce types of cancer death
TRUE
- mammography
- clinical breast exam
- colonoscopy
- PSA
The client wishes to become pregnant but has a family member with cystic fibrosis. She asks about the need for genetic testing. How does the nurse respond?
Refers the client to a genetic counselor
Correct: The nurse is not expected to be the final source of definitive information on genetic issues. However, the nurse can help ensure that the client is appropriately referred to a genetic counselor
When teaching the client and family about genetic counseling, what information does the nurse include in the teaching plan?
Diagnostic genetic testing determines the risk for a specific disorder.
Correct: Diagnostic genetic testing determines whether the client has or does not have a mutation that increases the risk for a specific disorder.
The client with a family history of polycystic kidney disease, an autosomal dominant disorder, states to the nurse, “I would like to be genetically tested for the disease, but I don’t want my family to know the results.” How does the nurse respond?
Assures the client that confidentiality will be maintained
Correct: The results of a genetic test must remain confidential to the client. These results cannot be given to a family member, another health care provider, or an insurance carrier without the client’s permission.
What is the purpose of genetic testing?
Determines whether a mutation exists
Correct: Genetic testing can determine the risk of disease before symptoms develop.
A 23-year-old female client has a BRCA1 gene mutation, which heightens her risk for developing breast cancer. She says, “I do not want to cut off my breasts!” What is the nurse’s response?
“Let’s discuss some other options.”
Correct: Yearly mammography and ovarian ultrasound can detect cancer at an early stage, when it is more easily cured.
The daughter of the client diagnosed with bilateral breast cancer has been counseled about genetic testing. She has decided not to be tested, despite the client’s insistence. How does the nurse respond to the daughter’s decision
“It is your decision. You can always call if you change your mind.”
Correct: The final decision to have or not have genetic testing rests with the daughter. This is a tough decision, so it is good to allow her the opportunity to change her decision at some later time.
Which statement is true about the structure and forms of DNA?
Every time a cell divides, it must replicate its DNA.
Correct: DNA must reproduce itself (replicate) every time a cell divides (undergoes mitosis). For each new cell to have exactly the right quantity of DNA and genes, the DNA in the dividing cell must replicate exactly.
Which statement is true about the role of a gene in the synthesis of a specific protein?
A gene contains the code for a specific protein.
Correct: A gene is a specific segment(s) of DNA that contains the code (recipe) for a specific protein.
Which statement is consistent with an autosomal dominant pattern of inheritance for a specific trait or characteristic?
The genotype cannot be predicted from the phenotype.
Correct: This is a true statement.
The 36-year-old client with a suspicious mammogram tells the nurse that her mother died of bone cancer at the age of 40. In assessing the client for cancer risk, what question does the nurse ask next?
“Did your mother ever have any other type of cancer?”
Correct: Breast cancer is considered an autosomal dominant trait disorder and is caused by the BRCA1 and BRCA2 genes and autosomal dominant transmission. Bone cancer can be a complication of breast cancer because of metastasis.
What is the effect of gene mutation and amino acid sequencing on insulin and blood sugar control?
Ineffective insulin is produced.
Correct: If some of the amino acids are missing or are in the wrong position, the protein made would be different from real insulin and could not reduce blood glucose levels. The actual order of the amino acids is critical for the final function of any protein
In analyzing a three-generation pedigree for the client, which questions help determine the genetic implications of a health trait? Select all that apply.
Do affected or unaffected individuals have children affected by the trait? Correct
B. Is the trait expressed equally among male and female family members or is it expressed unequally? Correct
C. Is the trait present in every generation, or does it skip one or more generations?Correct
D. Is a pattern evident, or does the trait appear to be sporadic?
Which condition might require genetic counseling for the client?
Huntington disease
Correct: The gene for Huntington disease (HD) has an autosomal dominant pattern of transmission. Therefore, a person who has one HD allele is at risk for developing HD.
The nurse is teaching the client about genetic counseling. Which statement by the client indicates that the teaching has been effective?
“Just because I have the trait does not mean that I will get the disease.”
Correct: A genetic trait may be recessive or may be controlled, which means that the person may never contract the disorder.
Which activity related to genetic counseling best illustrates the role of the medical-surgical nurse?
Ensures that the client understands the consequences of having a genetic test performed
Correct: The nurse can emphasize to the client and family the importance of using genetic testing as a preventive measure and for early detection of diseases related to genetic defects.
The nurse is giving a group presentation on cancer prevention and recognition. Which statement by an older adult client indicates understanding of the nurse’s instructions?
“I need to report the pain going down my legs to my health care provider.”
Correct: Pain in the back of the legs could indicate prostate cancer in an older man.
The nurse is teaching the 47-year-old female client about recommended screening practices for breast cancer. Which statement by the client indicates understanding of the nurse’s instructions?
My mother and grandmother had breast cancer, so I am at risk.”
Correct: A strong family history of breast cancer indicates a risk for breast cancer.
A 72-year-old client recovering from lung cancer surgery asks the nurse to explain how she developed cancer when she has never smoked. Which factor may explain the possible cause?
Advancing age
Correct: Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases.
The nurse reviews the chart of the client admitted with a diagnosis of glioblastoma with a T1NXM0 classification. Which explanation does the nurse offer when the client asks what the terminology means?
“The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis.”
Correct: T1 means that the tumor is increasing in size to about 2 cm, and that no regional lymph nodes are present in the brain. M0 means that no distant metastasis has occurred.
The client has a diagnosis of lung cancer. To which areas does the nurse anticipate that this client’s tumor may metastasize? Select all that apply.
Brain, bone, liver and lymph nodes
The nurse manager in a long-term care facility is developing a plan for primary and secondary prevention of colorectal cancer. Which tasks associated with the screening plan will be delegated to nursing assistants within the facility?
Testing of stool specimens for occult blood
Correct: Testing of stool specimens for occult blood is done according to a standardized protocol and can be delegated to nursing assistants.
The nurse is conducting a community health education class on diet and cancer risk reduction. What should be included in the discussion?
Avoid beef and processed meats. Correct
C. Increase consumption of whole grains. Correct
D. Eat “colorful fruits and vegetables,” including greens
The nurse presents a cancer prevention program to teens. Which of the following will have the greatest impact in cancer prevention?
Do not smoke cigarettes.
Correct: Tobacco is the single most important source of preventable carcinogenesis.
The nurse is teaching a group of clients about cancers related to tobacco or tobacco smoke. Identify the common cancers related to tobacco use. Select all that apply.
lung cancer, cancer of the tongue, cancer of the larynx
The nurse suspects metastasis from left breast cancer to the thoracic spine when the client has which symptom?
A.
Back pain
Correct: Typical sites of breast cancer metastasis include bone, manifested by back pain, lung, liver, and brain.
The nurse explains to the client that which risk factor most likely contributed to his primary liver carcinoma?
Infection with hepatitis B virus
Correct: Hepatitis B and C are risk factors for primary liver cancer
The nurse is caring for an adult client with Down syndrome who reports fatigue and shortness of breath. Which type of cancer has been identified in clients with Down syndrome?
Leukemia
Correct: Leukemia is associated with Down syndrome and Turner syndrome.
The nurse includes which of the following in teaching regarding the warning signs of cancer?
Persistent constipation Correct
B. Scab present for 6 months
Axillary swelling
The nurse is assessing a client with lung cancer. Which symptom does the nurse anticipate finding?
Dyspnea
Correct: Dyspnea is a sign of lung cancer, as are cough, hoarseness, shortness of breath (SOB), bloody sputum, arm or chest pain, and dysphagia.
Which activity performed by the community health nurse best reflects primary prevention of cancer?
Teaching a class on cancer prevention
Correct: Primary prevention involves avoiding exposure to known causes of cancer; education assists clients with this strategy.
A 52-year-old client relates to the nurse that she has never had a mammogram because she is terrified that she will have cancer. Which response by the nurse is therapeutic?
“Finding a cancer in the early stages increases the chance for cure.”
Correct: Providing truthful information addresses the client’s concern.
Which information must the organ transplant nurse emphasize before each client is discharged?
Taking immune suppressant medications increases your risk for cancer and the need for screenings.
Correct: Use of immune suppressant medications to prevent organ rejection increases the risk for cancer.
The home health RN is caring for a client who has a history of a kidney transplant and takes cyclosporine (Sandimmune) and prednisone (Deltasone) to prevent rejection. Which assessment data would be most important to communicate to the transplant team?
D. A lump is palpable in the client’s axilla.
Correct: Clients taking immune suppressive drugs to prevent rejection are at increased risk for development of cancer; any lump should be reported to the physician.
A client who is scheduled to undergo radiation for prostate cancer is admitted to the hospital by the registered nurse. Which statement by the client is most important to communicate to the physician?
My legs are numb and weak.”
Correct: Numbness and weakness should be reported to the physician because paralysis caused by spinal cord compression can occur.
When the nurse is counseling a 60-year-old African-American male client with all of these risk factors for lung cancer, teaching should focus most on which risk factor?
Tobacco use
Correct: Although all of these are risk factors for lung cancer, the client’s tobacco use is the only factor that he can change.
The registered nurse is teaching a group of nursing students about malignant transformation. Which statement about the process of malignant transformation is true?
Insulin and estrogen enhance the division of an initiated cell during the promotion phase.
Correct: These promoters increase cell division.
The nurse receives report on a client with a glioblastoma. Recognizing that cancers are classified by their tissue of origin, the nurse begins to plan care for a client with which type of cancer?
Brain
Correct: The prefix “glio-“ is used when cancers of the brain are named.
Which of these does the nurse recognize as the goal of palliative surgery for the client with cancer?
Relief of symptoms or improved quality of life
Correct: The focus of palliative surgery is to improve quality of life during the survival time.
Which statement made by the client allows the nurse to recognize whether the client who is receiving brachytherapy for ovarian cancer understands the treatment plan?
“I will have a radioactive device in my body for a short time.”
Correct: Brachytherapy refers to short-term insertion of a radiation source.
Which potential side effects should be included in the teaching plan for a client undergoing radiation therapy for laryngeal cancer?
Fatigue, change in taste, changes in skin of the neck, difficulty swallowing
The client receiving chemotherapy will experience the lowest level of bone marrow activity and neutropenia during which period?
Nadir
Correct: The lowest point of bone marrow function is referred to as the nadir.
The nurse teaches the client that intraperitoneal chemotherapy will be delivered where?
Into the abdominal cavity
Correct: Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity.
The registered nurse is teaching a nursing student about the importance of observing for bone marrow suppression during chemotherapy. Select the person who displays bone marrow suppression.
Client with hemoglobin of 7.4 and hematocrit of 21.8
Correct: Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; this client has anemia demonstrated by low hemoglobin and hematocrit.
The registered nurse would correct the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance?
Student teaches the client that symptoms of neutropenia include fatigue and weakness.
Correct: Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected.
Which signs or symptoms should the nurse report immediately because they indicate thrombocytopenia secondary to cancer chemotherapy? Select all that apply.
Bruises, petechaie, epistaxis
Which intervention will be most helpful for the client with mucositis?
C. Providing oral care with a disposable mouth swab
Correct: Mouth swabs are soft and disposable and therefore clean.
A client who is undergoing chemotherapy for breast cancer reports problems with concentration and memory. Which intervention is indicated at this time?
Allow the client an opportunity to express her feelings.
Correct: Although no specific intervention for the side effect is known, therapeutic communication and listening may be helpful to the client.
Which client problem does the nurse set as the priority for the client experiencing chemotherapy-induced peripheral neuropathy?
Risk for Injury related to sensory and motor deficits
Correct: The highest priority is safety.
The nurse is caring for a client who is receiving rituximab (Rituxan) for treatment of lymphoma. It is essential for the nurse to observe for which side effect?
Allergy
Correct: Allergy is the most common side effect.
Which intervention will be most helpful in preventing disseminated intravascular coagulation (DIC)?
Using strict aseptic technique to prevent infection
Correct: Sepsis is a major cause of DIC, especially in the oncology client.
When caring for a client with suspected syndrome of inappropriate antidiuretic hormone secretions (SIADH), the nurse reviews the medical record to uncover which signs and symptoms consistent with this syndrome?
Hyponatremia, mental status change, weakness
The nurse anticipates administering which medication to treat hyperuricemia associated with tumor lysis syndrome (TLS)?
Allopurinol (Zyloprim)
Correct: Tumor lysis syndrome results in hyperuricemia, Allopurinol decreases uric acid production and is indicated in TLS.
When caring for a client with cachexia, the nurse expects to note which symptom?
Weight loss
Correct: Cachexia results in extreme body wasting and malnutrition. Severe weight loss is expected.
When caring for a client who has had a colostomy created as part of a regimen to treat colon cancer, which activities would help to support the client in accepting changes in appearance or function? Select all that apply.
B. Encourage the client to participate in changing the ostomy. Correct
D. Offer to have a person who is coping with a colostomy visit. Correct
E. Encourage the client and family members to express their feelings and concerns
The nurse has received in report that the client receiving chemotherapy has severe neutropenia. Which of the following does the nurse plan to implement? Select all that apply.
A. Assess for fever. Correct
C. Administer pegfilgrastim (Neulasta). Correct
D. Do not permit fresh flowers or plants in the room. Correct
F. Teach the client to omit raw fruits and vegetables from his diet.
Which of the following findings would alarm the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000/mm3?
Change in mental status Correct
Correct: A change in mental status could result from spontaneous bleeding; in this case, a cerebral hemorrhage may have developed.
Which teaching is most appropriate for a client with chemotherapy-induced neuropathy?
Consume a diet high in fiber.
Correct: A high-fiber diet will assist with constipation due to neuropathy.
The nurse is teaching a client who is receiving an anti-estrogen drug about the side effects she may encounter. Which of these should the nurse include in the discussion?
Breast tenderness, dvt
Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea?
Ondansetron (Zofran)
Correct: Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting.
A newly graduated RN has just finished a 6-week orientation to the oncology unit. Which of these clients would be most appropriate to assign to the new graduate?
A 45-year-old with pancytopenia who will require IV administration of erythropoietin (Procrit) Correct
Correct: A new nurse after a 6-week oncology orientation possesses the skills to care for clients with pancytopenia and with administration of medications to stimulate the bone marrow.
The RN working on an oncology unit has just received report on these clients. Which client should be assessed first?
A client with chemotherapy-induced neutropenia who has just been admitted with an elevated temperature Correct
Correct: Neutropenia poses high risk for life-threatening sepsis and septic shock, which develop and progress rapidly in immune suppressed people; the nurse should see this client first.
The outpatient client is receiving photodynamic therapy. Which environmental factor is a priority for the client to adjust for protection?
Reducing all direct and indirect sources of light Correct
Correct: Lighting of all types must be kept to a minimum. It can lead to burns of the skin and damage to the eyes because they are sensitive to light.
Which manifestation of an oncologic emergency requires the nurse to contact the health care provider immediately?
Edema of arms and hands Correct
Correct: Edema of the arms and hands indicates worsening compression of the superior vena cava consistent with superior vena cava syndrome. The compression must be relieved immediately, often with radiation therapy, because death can result without timely intervention.
A 53-year-old male patient is diagnosed 2 months ago with stage 2 lung cancer. He has a 38 pack year history of cigarette smoking, worked in a coal factory for the last 20 years, and his father died from lung cancer 5 years ago. What are his modifiable risk factors? (select all that apply)
- Smoking/Tobacco Use
3. Occupation Exposure to carcinogens
A 48-year-old woman female patient was recently diagnosed with breast cancer. She appears anxious and states “I am worried I am going to die, I should have gotten a mammogram sooner.” How should the nurse respond?
. You seem concerned about your diagnosis. What are your most concerned about?
Which of the following cancers is screening not an option?
c. Lung
A 40 yr old woman was just told she has stage 3 breast cancer. She begins crying and weeping. What is the nurses best response?
b. “I see that you are upset, tell me how you are feeling?”
Which cancers should be screened for starting at age 50, unless there is a family history?
c. Prostate and colorectal
Which statement from a patient post-op day 2 from bilateral mastectomy indicated the need for further teaching?
b. With hormone replacement therapy, my breast tissue can grow back
Which two cancers can greatly impair a women’s sexual identity?
a. Breast
c. Ovarian
What are the most prevalent nursing cared and intervention for patients with cancer? (select all the apply)
a. Education about diagnosis
b. Psychosocial support
d. Management of disease or therapeutic side effect
A 33 year sold female patient with a history of long-term oral contraceptive use, smoking, and a BMI of 27 has just been diagnosed with ovarian cancer. Her husband, mother, and father are in the room. The patient is visibly distraught and she states to the nurse, “I just can’t believe this is happening to me. I just don’t know what to do.” What is the most appropriate response the nurse can say?
c. You appear upset, can you tell me more about how you are feeling?
Which of the following cancers does not exhibit symptoms until late stages?
c. Ovarian
Which statement made by the patient with non-Hodgkin’s lymphoma indicates the need for further teaching by the nurse?
d. I feel great at this moment, by cancer must be in remission and I have been cured.
CANCER NOTES FROM THE BOARD
Cancers that have screenings: Prostate, colorectal, breast, testicular, skin, cervical, thyroid, oral
No screenings: ovarian, pancreatic, lung, brain, renal, non-hodgkins, leukemia, bladder
Self-screenings: breast, testicular, skin, oral
Nursing:
Emotional support, patient education, providing resources, pain management, spiritual needs, time to process, manage symptoms of treatment (nausea, dizziness, etc), discuss finances/referal needs,
What is initiation?
Initiation – Step 1 in carcinogenesis. Exposure to carcinogen which penetrates cell, damage DNA, and change or mutate the cell. Irreversible, but only leads to cancer if cell division is not impaired.
What is promotion?
Promotion – enhancement of growth of initiated cell. Normal hormones and body proteins, like insulin and estrogen, can cause altered cells to divide more frequently. Shortens the latency period.
What is progression?
Progression – increasing malignancy over time. To become a health problem, tumor must develop it’s own blood supply: TAF; less resemblance to original initiator, increasing malignancy.
What is metastasis?
Metastasis – breaks away from primary location and establishing remote colonies
True or false
Benign tumor grow by expansion whereas malignant tumors grow by invasion
True
True or false
A key feature of cancer cells is the loss of apoptosis. These cells have an infinite life span
True
Primary vs secondary prevention
Primary prevention of cancer involves avoiding exposure to known causes of cancer and secondary prevention involves screening for early detection
What is the most important nursing intervention for extravasition?
Prevention
Where do cancer spread?
Know where things spread i.e. lung cancer goes to the brain , colon cancer goes to the liver, prostate cancer goes to the bone, the bone, brain, lung and liver are the 4 main areas all cancer goes to
What are the steps of blood borne metastasis?
Malignant transformation, Tumor vascularization, blood vessel penetration, arrest and invasion
Which age group is most at risk for developing testicular cancer?
15-35
Cancers that you can screen for?
Cancers that have screenings: Prostate, colorectal, breast, testicular, skin, cervical, thyroid, oral
Cancers you can’t screen for?
No screenings: ovarian, pancreatic, lung, brain, renal, non-hodgkins, leukemia, bladder
Cancers with self screenings?
Self-screenings: breast, testicular, skin, oral
Which of the following cancers does not exhibit symptoms until late stages?
Ovarian
What are the most prevalent nursing cares and intervention for patients with cancer? (select all the apply)
a. Education about diagnosis
b. Psychosocial support
d. Management of disease or therapeutic side effect
Common sites of metastasis for breast
Bone ,lung, liver, brain
Common sites of metastasis for Lung
Brain, bone, liver, lymph nodes, pancreas
Common sites of metastasis for colorectal
Liver, lymph nodes, adjacent structures
Common sites of metastasis for prostate
Bone, pelvic nodes
Common sites of metastasis for melanoma
GI tract, lymph nodes, lung, brain
Common sites of metastasis for primary brain cancer
Central nervous system
Sarcoma
Sarcoma: found in the soft tissues
Carcinoma
Carcinoma: derived from epithelial tissue
Blastoma
Blastoma: originates from precursor cells
or blasts (immature or embryonic tissue)Hematologic cancer
Hematologic cancers- arise from blood cell forming tissues (leukemia, lymphomas)
Ploidy
– description of cancer cells by chromosome number and appearance.
Aneuploidy
Aneuploidy: increases with the degree of malignancy.
Grading tumors
T – Primary tumor: Tx, To, Tis, T1, T2, T3, T4
N – Regional lymph node involvement: Nx, No, N1, N2, N3,
M – Distant metastasis: Mx, Mo, M1
Adeno
Epithelial glands
Benign: Adenoma
Malignant: Adenocarcinoma
Chondro
Cartilage
Benign: Chondroma
Malignant: Chondrosarcoma
Glio
Glia cells (brain)
Benign: Glioma
Malignant: Glioblastoma
Hemangio
Benign:Hemangioma
Malignant: Hemangiosarcoma
Leiomyo
Smooth muscle
Benign: Leiomyoma
Malignant: Leiomyosarcoma
Lipo
Adipose tissue
Benign: Lipoma
Malignant: Liposarcoma
Melano
Pigmented skin
Benign: N/A
Malignant: Melanoma
Meningio
Meniges
Benign: Meningioma
Malignant: Meningioblastoma
Neuro
Nerve tissue
Benign: Neurofibroma
Malignant: Neuroblastoma
Osteo
Bone
Benign: Osteoma
Malignant: Osteosarcoma
Renal
Kidney
Benign: N/A
Malignant: Renal cell carcinoma
Rhabdo
Skeletal Muscle
Benign: Rhabdomyoma
Malignant: Rhabdomyosarcoma
Squamous
Skin
Benign: Pailloma
Malignant: Squamous cell carcinoma
What are the 3 main causes of oral cancer?
- Chewing tobacco
- Poor oral hygiene
- Alcohol
Grading
Grading
Gx: Can’t be determined
G1: Cells well differentiated
G2: Cells moderately differentiated
G3: Cells poorly differentiated
G4: Cells retain no normal cell
characteristic, difficult to determine
cell of originWhat percent of cancers are related to tobacco?
Chemical – 30% related to tobacco, single most preventable source. Tobacco is an initiator and a promoter.
What is the biggest risk for cancer?
Biggest risk for cancer: age over 60!!! ON TEST
-immune system decreases, reduced skin integrity, steroids or immunosuppressant’s effect immune system
True or false
Regular Screening does not reduce incidence but can reduce types of cancer death
True Regular Screening does not reduce incidence but can reduce types of cancer death - mammography -clinical breast exam -colonoscopy -PSA
Genetic screening for breast and colon cancer
Genetic screening create a 3-generation pedigree to more explore possibility of genetic risk
BRCA1 & BRCA2 – breast cancer
APC, MLH1, MSH2 – colon cancer
Oldest form of cancer treatment
First method to cure cancer
Surgery
Side effects of surgery
Surgical therapy
- disfigurement
- loss of function
- changes in body image
- change in lifestyle
Side effects of radiation
Radiation therapy
- **Local effects
- vary according to site (skin, hair, -fibrosis, scarring)
- may not be immediately apparent
- *Systemic effects
- altered taste
- fatigue
Side effects of chemotherapy
Chemotherapy
- alopecia
- nausea/vomiting
- mucositis
- bone marrow suppression
Radiation therapy for cancer
Tele vs brachy
- *Teletherapy – EBRT (distant)
- maintain markings
- proper positioning
- assess whether patient able to —assume and maintain positioning
**Brachytherapy (close)
-Unsealed sources
-suspended in fluid
-administered orally, IV, or instilled into body cavity
-concentrate in body tissues, –enter body fluids, eliminated in waste products
-Sealed sources(Chart 28-1)
implanted within or very near the tumor
-continuous low energy emission (LDR) requiring hospitalization
HDR administered outpatient, minutes or hours, daily or several times a week
excreta are not radioactive
Long term considerations for patient receiving radiation
- Photosensitivity.
- Fibrosis, stenosis, and scarring.
- Xerostomia (dry mouth).
- Bone is more vulnerable to fracture.
Types of chemotherapy drugs
Antimetabolites: “counterfeit” metabolites impairs cell division (Cytosar; Methotrexate)
Antitumor antibodies: damage cell’s DNA & interrupt DNA & RNA synthesis (Daunorbuicin, Doxorubicin; Idarubicin)
Antimitotic agents: interfere with microtubules so cells can’t complete mitosis (Vincristine; Paclitaxel [Taxol])
Alklating agents: cross link DNA, two DNA strands bind tightly together, inhibits cell division (Cisplatin, Lomustine [CCNU],Cytoxan)
Topoisomerase inhibitors: disrupts enzyme needed for DNA synthesis & cell division; nicks & straightens DNA & reattaches DNA causing DNA breakage (Captosar
Antimetabolites
Antimetabolites
- Trojan Horse
- 5-FU, Methotrexate
Antitumor Antibiotics
Antitumor Antibiotics
- Interrupt DNA and/or RNA synthesis
- adriamycin
- bleomycin
Antimitotics
Antimitotics
- Plant sources, interfere with microtubule formation, incomplete or no mitosis
- Taxol
- Vincristine
- Vinblastine
Alkylating Agents
Alkylating agents
- Crosslink and bind DNA strands together, inhibit synthesis
- Cisplatin
Toposiomerase Inhibtors
Topoisomerase inhibitors
- DNA breakage
- Etoposide
- Topotecan
True or false
Males and females taking estrogens or progestins are at increased risk for DVT
True
Cytokines
- *Cytokines
- Stimulate immune system to recognize cancer cells and take action to destroy them
Interleukins
- *Interleukins
- “charge up” immune system and enhance attacks on cancer cells by macrophages, NK cells
Interferons
**Interferons
-Cell proteins that protect noninfected cells from viral infection and replication
Heightened Immmune response!
DIC
Disseminated intravascular coagulation: Problem with blood clotting process caused by sepsis, release of thrombin or thromboplastin, or by blood transfusions
SIADH
SIADH is most commonly found in carcinoma of the lung (especially small cell lung cancer)
Water is reabsorbed to excess by the kidney and put into system circulation–hyponatremia ( Na+ 115-120 mEq/L) and fluid retention
Spinal cord compression
Tumor enters spinal cord; vertebra collapse
Back pain; neurologic problems; paralysis
**Collaborative care includes: Early recognition and treatment Palliative High-dose corticosteroids High-dose radiation Surgery External back or neck braces to reduce pressure in the spinal cord
CARDINAL SIGN IS BACK PAIN
If paralysis occurs it is usually permanent. Early recognition is essential!
True or false
Decreased mobility and dehydration worsen hypercalcemia
True
Decreased mobility and dehydration worsen hypercalcemia
Superior Vena Cava Syndrome
**Superior vena cava is compressed or obstructed by tumor growth.
**Condition can lead to a painful, life-threatening emergency.
**Signs include edema of face, tightness of shirt or blouse collar, edema of arms and hands, dyspnea, erythema upper body, and epistaxis
Death if compression not relieved
SVC syndrome care
Collaborative Care
- -High-dose radiation therapy - -Metal stent in the vena cava
Tumor Lysis Syndrome
Large number tumor cells rapidly destroyed, intracellular contents (K+, DNA purines) released into blood stream faster than the body can eliminate them.
Collaborative care includes: Prevention Hydration (3000 mL/day) Antiemetic regimen Drug therapy (Allopurinol; sodium polystyrene) Dialysis
Potassium and purines Hyperkalemia Severe cardiac dysfunction Purines Convert in the liver to uric acid and released into the blood, uric acid crystals precipitate in the kidneys, form sludge, block tubules, ARF
Tumor lysis syndrome
Prevention through hydration
Hydrate prior to treatment, during treatment, and for 3 days following treatment
Follow and antiemetic regimen to encourage oral intake
Bicarb tablets may prevent uric acid precipitation
**More aggressive treatment
Diuretics to increase urine flow through the kidneys; careful not to dehydrate
Allopurinol to excrete purines
True or false
Without intervention, cancer invasion of normal tissue leads to death
True
