Cancer Flashcards
True or False: Cancer is more prevalent in men than women?
True
true or False: Colon cancer is the leading cause of cancer in both men and women.
False: Lung Cancer
True or false: Cancer is the leading cause of death in America
False: Heart Disease. Cancer is #2. However in people over the age of 85, cancer is #1
Protooncogenes
Normal cell genes that are important regulators of normal cell processes. They promote growth. Protooncogenes are the genetic lock that keeps the cell in its mature functioning state. This is unclocked by exposure to carcinogens or oncogenic viruses.
Tumor Suppressor genes
Suppress growth; regulate cell growth. Mutations that alter TSG can make them inactive, resulting in a loss of their suppressive action. (BRCA1 and BRCA2)
Oncogenes
Mutations that alter the expression of protooncogenes. Oncogenes are tumor inducing genes.
BRCA1 and BRCA2
Tumor suppressor genes that increase a persons risk for breast and ovarian cancer
APC gene
Tumor suppressor gene that increase risk for familial adematous polyposis, which is a precursor for colorectal, esophageal, liver, lung, and ovarian cancer.
Carcinoma
Cancer composed of epithelial cells. Cover or align tissues of the body. Arises from glandular epithelium. Ex: Skin and glands. Mucous membranes of the respiratory, GI and GU tract.
Sarcoma
Cancer of supporting tissue, cartilage, bone, muscle, fat.
Tumor angiogenesis
The process of the formation of blood vessels within the tumor itself.
Hematogenous metastisis
involves several steps begining with primary tumor cells penetrating blood vessels. These tumor cells then enter the circulation, travel through the body, and adhere to and penetrate small blood vessels of distant organs. Most tumor cells do not survive this process and are destroyed.
Main sites of metastisis
Brain and CSF, Lung, Liver, Adrenals, Bone
Solid tumors
Brain, head and neck, lung, esophagus, liver, pancrease, gallbladder, small intestine, colon, rectal, uterus, cervix, ovaries, breast, skin, bone.
Hematologic cancers
Lymph, leukemia (wbc), myeloma
Malignant cells
- Grow uncontrollably
- Do not exibit contact inhibition
- Poorly differentiated
- Do not stay with their cell types
- Have own blood supply
Stages of metastatic process
- Tumor growth
- Angiogenesis
- Entry into capillaries and lymph
- circulation to other organs
Factors related to carcinogenesis
- Genetic predisposition
- Chronic inflammation
- Environmental toxin exposure (radiation, tobacco, diet)
- Diet
- Regional geography
High fat and Low fiber diet equals
Increase cancer risk
Mediterranean Diet increases or decreases cancer risk?
Decreases
Lymphoma
Leukemia, hemopoetic
Cancer of lymph nodes or lymph tissue
Grade
Degree of malignancy by cells
Stage
Degree of spread
Blood studies for cancer
CBC: RBC and WBC
Tumor Markers: eg. PSA (Prostate surface antigen)
Cytology Exam
Brushing; PAP, Bronchial
Sent to lab
Types of Biopsies
Needle aspirate: Fine or Core needle Surgical excursion of tissue sample Frozen section vs. traditional pathology Identifies cell type and grade Sent to lab
Grade 1
Differs slightly from normal cells, well differeniated
Grade 2
More abnormal; moderately differentiated
Grade 3
Very abnormal, poorly differentiated
Grade 4
Undifferentiated, difficult to determine cell origin. Cells are immature and primitive.
Encapsulated Neoplasms
Usually benign; Rarely Malignant
Differentiated Neoplasms
Normally benign; Poorly malignant
Metastasis Neoplasms
Not benign; Capable of being malignant
Recurrence of Neoplasms
Rarely benign; Possibly malignant
Vascularity of Neoplasms
Benign: Slightly; Malignant: Moderate to marked
Mode of growth of Neoplasms
Benign: Expansive
Malignant: Infiltrative and expansive
Cell characteristics of Neoplasms
Benign: Fairly Normal, similar to parent cells
Malignant: cells abnormal, become more unlike parent cells
Stage 0
Cancer in situ or a neoplasm whose cells are localized and show no tendency to invade or metastasize to other tissues.
Stage 1
Tumor limited to the tissue of origin; localized tumor growth
Stage 2
limited local spread
Stage 3
Extensive local and regional spread
Stage 4
metastasis
TNM Classification system
T: Tumor size and invasiveness
N: Presence of absense of regional spread to lymph nodes
M: Metastasis to other tissues
TNM Only used with sold tumors.
Surgical staging
refers to the extent of the disease as determined by surgical ecision, exploration, and/or lympth node sampling.
Seven warning signs of cancer
CAUTION Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge from any body orifice Thickening or a lump in the breast or anywhere else Indigestion or difficulty in swallowing Obvious change in wart or mole Nagging cough or hoarseness
Prevention and early detection of cancer
Limit alcohol abuse Get regular physical activity Maintain a normal body weight Obtain regular colorectal screenings Avoid cigarette smoking and other tobacco use Get regular mammography and Pap test Use sunscreen SPF 15 or higher Practice health dietary habits. Decrease Fat and increase fruit and veggie consumption
Fine needle aspiration biopsy
accomplished witha small gauge needle that provides cells from the mass for cytologic exam
Large core biopsy
Cutting needles deliver actual peice of tissue that can be analyzed with the andvantage of preserving the histologic architecture of the tissue specimen
Excisional biopsy
Surgical removal of the entire lesion, lymph node, nodule, or mass
Goals for cancer treatment
Cure, Control, Palliative, Rehabilitation
Therapy used is determined by:
Tumor histology and staging outcomes. Patient physiological status, psychological status, and personal desires.
Treatment is usually multimodal use of:
Surgery, radiation, and/or chemotherapy.
Control of Cancer
The goal for many cancers that cannot be completely eradicated, but are responsive to anticancer therapies.
Palliation goal of cancer
The treatment goal when relief or control of symptoms and the maintenance of a satisfactory quality of life are the primary objectives.
Surgery from prevention
Removal of nonvital organs to prevent cancer
Surgery for cure and/or control of cancer
Removal of localized cancer tissue
Surgery for Palliative care
Relief of pain, obstruction, hemorrhage
Surgery for rehabilitation
Reconstructive surgery
Surgery for Supportive care
Insertion of therapeutic devices
Goal of Chemotherapy
to eliminate or reduce the number of malignant cells in the primary tumor and metastatic tumor sites.
Goals of Chemo
Cure: Burkitt’s lymphoma, Wilm’s tumor, Neuroblastoma, Acute lymphocytic leukemia, Hodgkin’s lymphoma, Testicular cancer
Control: Breast cancer, Non-Hodgkin’s lymphoma, Small cell lung cancer, ovarian cancer
Palliation: Relieve pain, Relieve obstruction, Improve sense of well being
Chemotherapy
Cytotoxic agents used to destroy cancer cells.
Systemic action
Impacts cell reproduction
Cell kill theory
Affects rapidly dividing cells (Cancer and normal)
Combo therapies
WOrks best when cells are dividing
Antimetabolites
Cell cycle specific chemotherapy drug Interfere with purine metabolism Interfere with pyridimine metabolism Interfere with folic acid metabolism Interfere with DNA synthesis Stops synthesis of cell protein Used fo GI cancers
Example of Antimetabolites
5 Flurouracil (5-FU)
Adverse effects of Antimetabolites
myelosuppression, n/v, diarrhea, stomatitis, alopecia, hyperpigmentation, rash, Nadir 10-14 days, recovery 21 days
Nadir
Period of time WBC lowest
Tends to be 7-14 days post chemo
More susceptible to bleeding and infection
Plant alkaloids
Cell cycle specific chemotherapy drug
Vincristine (periwinkle)
Prevents mitosis
Used for leukemia, lymphoma, neuroblastoma
Adverse effects of Plant alkaloids
Neurotoxicity, strong vesicant
Taxanes
Cell cycle specific chemotherapy drug
paclitaxel (Taxol) (pacific yew)
Second line treatment for ovarian and breast cancer
Adverse effects of Taxanes
n/v, alopecia, joint pain, myelosuppression, hypersensitivity
Cell cycle non-specific Chemotherapy drugs
More toxic
Acts on cells during proliferative and non-proliferative phases.
No differentiation from normal cells.
Alkalating agents
Cell cycle non-specific Chemotherapy drug
cyclophosphamide (Cytoxan) most common
Adverse effect: Severe myelosuppression, hemorrhagic cystitis, SIADH, cardiomyopathy, sterility, alopecia, n/v, anorexia
Nitrosureas - carmustine
Cell cycle non-specific Chemotherapy drug
Antibiotics - doxorubicins (Adriamycin)
Cell cycle non-specific Chemotherapy drugs
Adverse effects: n/v, myelosuppression, mucositis, alopecia, cardiotoxicity, strong vesicant.
Methods of administration of chemotherapy
Oral, Intramuscular, Intravenous, Intracavitary, Intrathecal, intraarterial, Perfusion, continuous infusion, Subcut, Topical
Chemotherapy agents on normal cells
Cannot distinguish between normal and cancerous cells.
Particularly effect rapidly proliferating normal cells such as: bone marrow, lining of GI, and integumentary system (Skin, hair, nails)
Radiation Therapy
Mechanism of action: ionizing radiation destroys cells ability to reproduce. Rapidly dividing cells are more vulnerable (Skin, hair, RBC’s, GI tract lining, cancer cells.
Chain of chemical events results in formation of oxygen-free radicals that interact with surrounding cells to destroy them.
Radiation
energy that is emitted from a source through space or some material. Delivery of high energy beams, when absorbed into the tissue, produces ionization of atomic particles. The energy in ionization acts to break the chemical bonds in DNA. The DNA is damaged, resulting in cell death.
External beam radiation
Outside source of radiation beam accelerator
Skin area is marked
Repeated doses 5 days/wk X several weeks depends on size, location and type of tumor
Complications of external beam radiation
Dry desquamation - Skin looks sunburned
Wet desquamation - occurs when the rate of cell sloughing is faster than the ability of the new epithelial cells to replace dead cells. Generally produces pain, drainage, and increased risk for infection
Fatigue
Brachytherapy Radiation or Internal radiation
Radiation that is delivered close to tumor or internally.
Seeds or Rods
Allows for direct deliver of radiation to the target with minimal exposure to surrounding healthy tissues.
Seeds or Rods
Placed into tumor or surrounding tumor area
Short term or permanently placed (eg Prostate seeds - left in and stop giving off radiation after weeks/months)
Liquid radiation
A liquid that is drunk. Systemic into circulation. (Unsealed)
Sealed radiation
Encased in nonradioactive covering - intracavity (Prostate)
Can be placed inracavity or interstitial but can contaminate if it comes in contact with skin. (eg. removable vaginal implant; emits small amount of radiation in the short term)
Unsealed radiation
Secretions are radioactive - circulate through the entire body.
EX: Thyroid - drink iodine. Emisis is radioactive.
Radiation Safety
Time, Distance, and shielding are vital to a ahealth care provider caring for a patient with a source of internal radiation.
Unsealed Radiation safety and patient centered teaching
Active for 2-3 days after receiving
Protection from body fluids: wears off after a few days
Drink extra fluids to flush out of body
Avoid sexual contact for 2-3 days
Limit contact with infants, children and pregnant women
Wash hands after using toilet
Double flush toilet
Use separate bathroom, towels, utensils
Don’t sleep/sit right next to person immediately after receiving.
Nursing management of a patient receiving radiation
Throrough assessment to ensure safety, quality care
Unsealed and Sealed Internal in Hospital:
- Private room and bath
-Diversional avtivities, communication
- Floor covering, disposable food trays
- Limit exposure
- Track caretakers/time spent
Antiestrogens - Tamoxifen
First line treatment for breast cancer in post-menopausal women.
May have menopausal symptoms: Hot flashes
Adrenocorticosteroids
May have palliative affects
Ex: Decrease inflammation, improve appetite, increase sense of well-being (prednisone, decadron)
Biotherapy
Interferon
Biologic modifiers
Monocolonal antibodies
Antibodies against specific antigens on cell surfaces
Eg: Herpicept for breast cancer; Avastin used in lung cancer
Clinical Trials
Phase 1: Testing volunteers with advanced disease with no other treatment options to determine safety, kinetics, and interactions
Phase 2: Based on phase 1 info. Also tests volunteers with advanced disease for refinement of dose range, kinetics, and effectiveness
Phase 3: If drug holds promise testing of drug on larger scale for efficacy. Last step before FDA application
Phase 4: Post market surveillance after FDA approval
Myelosuppression
Decreased RBC
Decreased WBC
Decreased Platelets
Neutropenic precautions and interventions for Absolute Neutrophil Count <1000 mm3
Avoid crowds
Stay away from sick people
Stay away from people who have had immunizations for smallpox and chicken pox
Protect skin against breakdown
Check rectal, oral, eyes, nose, genital, PICC line for redness
Notify if chills, sweating, loose stools, fever (low grade), mouth breakdown, abd pain, vaginal itching, discharge
Report temp of 100.4 or greater; considered onco emergency
Notify if cough, sore throat, UTI
Use good hand washing, oral cleaning, good rest, some activity, NO fresh cut flowers.
Thrombocytopenic precautions and interventions for platelets <20,000
Care with flossing Blow nose gently Avoid contact sports Drink increased fluids Avoid household injures Electric Razors Check joints for bleeding report dizziness; change in LOC Soft toothbrush Check for bleeding gums, bruising, h/a, black stools, petechae. Avoid aspirin, NSAIDS Patient at increased risk for hemorrhage. Recover 2-6 weeks after chemo. May give platelet transfusion.
Anemia
Side effect of cancer treatment due to abnomal destruction of RBC
Nursing mamagement of Upper GI effects
Anti-emetic pre, during and post chemo Avoid favorite foods during chemo time Relaxation, hypnosis, guided imagery, meditation Small meals Avoid strong odors Drink fluids separate from solid foods Low fat foods Oral care
Anorexia recommendations
Fluids after food Eat with family/friends Meals on wheels Loose fitting clothes Ice cubes/mints/tart candies (if no open sores) to stimulate saliva Cool, clear fluids; avoid carbonations Increase protein Oral care
Refer individual for nutritional counceling as soon as ____% weight loss is noted or if the patient has the potential for protein and calorie malnutrition
5
Teach the patient to use nutritional supplements in place of milk while cooking or baking. Foods to which nutritional supplements can be easily added incude
scrambled eggs, pudding, custard, mashed potatoes, cereal, and cream sauces.
Superior Vena Cava Syndrome
Oncologic emergency
Results from the obstruction of the superior vena cava by a tumor or thrombosis
S&S: Facial edema, periorbital edema, distention of veins of the head, neck, and chest, headache and seizures.
Most common causes are lung cancer, non-hodgkins lymphoma, and metastatic breast cancer.
At increased risk if presence of a central venous catheter and previous radiation therapy to the mediastinum.
Spinal Cord compression
a neurologic emergency caused by a malignant tumor in the epidural space of the spinal cord. The most common cancers that cause this are breast, lung, prostate, GI, and renal tumors and melanomas.
S&S: Severe back pain, localized and persistant, accompanied by vertebral tenderness and aggrevated by the valsalva maneuver; motor weakness and dysfunction; sensory paresthesia and loss, and autonomic dysfunction. Change in bowel or bladder function.
Third Space Syndrome
Involves a shifting of fluid from the vascular space into the interstitial space that generally occurs secondary to extensive surgical procedures, biologic therapy, or septic shock.
Nursing Management of Mucositis
Moth care before and after meals
Seek order for topicals
Avoid commercial alcohol based mouthwashes
Monitor mouth for redness, white lesions, dry mouth, low grade fever, difficulty swallowing
Artificial saliva
Push non-carb fluids, sugarless gum, moisten all foods with butter, gravy, sauce; soft foods
Critical to monitor- may preclude a patient from receiving next chemo and/or radiation treatment
Chapstick
Alopecia
Side effect of some drugs
Begins in 2-3 weeks after 1st dose
New hair growth begins 4-6 weeks after last done
May lose eyebrows, lashes, other hair throughout the body
Hair may grow back with a different texture
Skin Reactions
Erythema, uticaria, hyperpigmentation, photosensitivity, radiation recall (with chemo, post RT)
Reproductive changes
Sterility, pre-Rx sperm banking, use of birth control
Body image changes
Hair loss, weight loss, mastectomy, limb loss, laryngectomy, urinary or fecal diversion or incontinence, erectile dysfunction, skin changes
Fatigue
Neuro-immune factors, not well understood
Pain
Goal: Maximize pain relief, minimize adverse effects. Not all cancer patients have pain
Coping
Fear, Loss, Change
Treatment of fatigue
Evidence of highest level supports benefit of exercise in management of fatigue during the following treatment for patients with breast cancer and solid tumors.
Likely to be effective: Screening for other causes, energy conservation and activity management, education, optimize sleep quality, relaxation, massage.
Hypercalemia - Oncologic Emergency
Occurs in metastatic disease of bone or multiple myeloma, or when the parathyroid hormone like substance is secreted by cancer cells.
High due to increased bone reabsorption of calcium
Tumor lysis syndrome
A metabolic complication characterized by rapid release of intracellular components in response to chemotherapy.
Labs show high K, Phosphate, Uric acid levels.
Sepsis
Indicator is a high temp
Nurses must be diligent in recognizing signs of infection
Disseminated intravascular coagulation
Abnormal clotting of small Blood Vessels
Syndrome of Inappropriate ADH secretion
Can be caused by drugs or tumor
Abnormal production of ADH
Increased sodium level and Increased fluid retention
Hospice
Symptom relief Treatment of client and family as a unit Multidisciplinary approach 24 hr/day, 7 day/wk services Focuses on end of life issues Bereavement Follow up
Hospice Symptom Management
Breathlessness Nausea Restlessness, Sleep deprivation Pain Fatigue, Weakness Depression
Palliative Care
“an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early detection and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”
A multidisciplinary approach to patient care
