Cancer Flashcards
Define cancer?
- Group of more than 200 diseases
- Characterized by uncontrolled and unregulated growth of cells
- Occurs in people of all ages and ethnicities
What is the incidence and mortality rate in canada?
- incidence: 177,800
- mortality: 75,000
Three stages in cancer development?
- Initiation: Mutation of cell’s genetic structure due to inherited mutation or exposure to a chemical, radiation, or viral agent
- Promotion: Characterized by reversible proliferation of altered cells
- Progression: Increased growth rate of tumour, invasiveness, metastasis
Activities of promotion are reversible?
- Obesity
- Smoking
- Alcohol
- Dietary fat
Most frequent sites of metastasis?
lungs, brain, bone, liver, and adrenal glands.
to metastasize, cancer cells must enter circulation system
Modifiable risk factors?
excessive body weight
lack of physical activity
unhealthy eating habits
excessive exposure to the sun.
Non-midifiable risk factors?
genetics, gender
Two cellular dysfunctions of cancer cells?
- divide quickly and in a random matter
- Can survive after mutation and pass on damage to two or more daughter cells
- Surviving mutated cells have potential to become malignant.
Two types of genes that can be affected by mutation?
- Proto-oncogenes: Regulate normal cellular processes such as promoting growth
- Tumour suppressor genes: Suppress growth
Benign neoplasm characteristics?
non-cancerous
- Well differentiated
- Usually encapsulated
- Expansive mode of growth
- Characteristics similar to parent cell
- Metastasis is absent
- Rarely recur
Malignant neoplasm characteristics?
- May range from well differentiated to undifferentiated
- Able to metastasize
- Infiltrative and expansive growth
- Frequent recurrence
- Moderate to marked vascularity
- Rarely encapsulated
- Becomes less like parent cell
Factors that affect development of cancer?
- Genetic
- Chemical
- Environmental
- Radiation
- Carcinogens
- Viral or immunological
- From causes not yet identified
What happens when cancer metastasizes
- Metastasis process begins with rapid growth of primary tumour
- Cells can invade lymph nodes and vascular vessels to travel to distant sites
- Develops its own blood supply
- Critical for survival and growth of tumour
- Tumour angiogenesis is formation of blood vessels within tumour
- Certain segments of primary tumour can detach and invade surrounding tissues.
Immune response to cancer?
reject or destroy cancer cells.
What is the CA 125 test?
- used to test for amount of protein in cancer cell
- can be used to screen for ovarian cancer
Classification of cancer?
Tumours can be classified by:
- Anatomical site
- Histological analysis
- Grading severity
- Extent of disease
- Staging
Classification of cancer provides a standardized way to?
- Communicate with health care team
- Prepare and evaluate treatment plan
- Determine prognosis
- Compare groups statistically
Anatomical site classification?
Identified by tissue of origin
Sarcomas originate from?
Embryonal mesoderm (connective tissue, muscle, bone, and fat
Lymphomas and leukemias originate from?
Hematopoietic system
Carcinomas originate from?
- Embryonal ectoderm (skin, glands)
- Endoderm (mucous membrane of respiratory tract, GI and GU tracts)
Four grades of abnormal cells?
- Grade I: Cells differ slightly from normal cells and are well differentiated.
- Grade II: Cells are more abnormal and moderately differentiated.
- Grade III: Cells are very abnormal and poorly differentiated.
- Grade IV: Cells are immature and primitive and undifferentiated. Cell of origin is difficult to determine.
Clinical staging classifications of cancer?
0: Cancer in situ
1: Tumour limited to tissue of origin; localized tumour growth
2: Limited local spread
3: Extensive local and regional spread
4: Metastasis
TNM classification system?
based on three parameters:
- Tumour size and invasiveness (T)
- Spread to lymph nodes (N)
- Metastasis (M)
Lifestyle habits to reduce risks?
- Avoid or reduce exposure to known or suspected carcinogens. In ex:Cigarette smoke, excessive sun exposure
- Eat a balanced diet.
- Limit your diet in meat and fats.
- Exercise regularly.(30 min per day 5 times a week)
- Obtain adequate rest.
- Limit alcohol consumption.
- Follow recommendation for cancer screening guideline such as for prostate cancer of for breast cancer.
Decreased ability to sleep related to anxiety..
Nursing interventions?
should aim at assisting the patient to develop knowledge, motivation and skills to eliminate the limitation of SCA
- Give clear explanations, repeat if necessary
- Give reinforcement, teach relaxation techniques.
- Actively listen to patient’s concerns.
Diagnostic plan includes?
- Health history
- Identification of risk factors
- Physical examination
- Specific diagnostic studies
7 warning signs of cancer?
Use acronym: CAUTION.
- C: Change in bowel or bladder habits.
- A: a sore that does not heal.
- Unusual bleeding or discharge.
- Thickening or a lump in the breast or elsewhere.
- Indigestion or dysphagia.
- Obvious change in a wart or mole.
- Nagging cough or hoarseness.
Diagnostic studies?
depend on site of cancer.
- Many diagnostic exams possible:
- Biopsy
- cytology studies(cellular)
- hematology (blood) and other chemistry studies, -radiological studies(MRI, CT scan..)
Biopsy involves histological examination by a pathologist of a piece of tissue.
The biopsy allow for a definitive diagnosis of cancer.
3 treatment goals with cancer?
- Cure: Healing, eradicating the disease. Inducing permanent remission.
- Control: When the cancer cannot be eradicted completly but the disease is responsive to treatment.
- Palliation: The objective is to relief or control the signs and symptoms of the patient. We try to optimize the quality of life using different methods.
The type of treatment is determined by factors such as?
cell type of cancer, the location and the size of the tumour and also the extent of the disease
Types of treatment options?
Surgery, radiation therapy. Chemotherapy and biological therapy.
goal: reduce number of cancer cells present in tumor
Surgery as treatment?
- tumour is localized and removed alone and or including a margin of the surronding normal tissue.
- This may cure localized cancer.
- Surgery is ineffective if the cancer has Metastasized.
Chemotherapy side effects?
use of a chemical agent (such as a drugs) to treat cancer.
Inflamed mucous membranes Nausea and vomiting Loss of appetite Changes in taste and smell Diarrhea Dehydration Constipation Fatigue Hair loss Weight gain
interventions: encourage pt to eat when not nauseated, administer antiemetics, high fibre diet, increase fluids
Radiation therapy side effects?
And interventions?
usage of energy (different type) to prevent the continous growth of the highly miotic cancer cells.
fatigue hair loss skin damage to affected area leukopenia diarrhea anorexia
interventions: encourage pt to eat when not nauseated, administer antiemetics, low fibre diet, increase fluids
Biological therapy side effects?
treatment that uses the body’s immune system to kill cancer cells
Fever and chills. Pain. Weakness. Nausea and vomiting. Diarrhea. Headaches. Difficulty breathing. Rashes.
Clinical case: Lung cancer
Mr. Pierre is a 67 Y.O. diagnosed with lung cancer.
He had a thoracotomy and a partial removal of a lobe(lower R lobe) and arrives on the unit with a chest tube, and a PCA device.
What is the goal of this Surgery?
He has a chest tube in place:Why and what assessment is required?
What post operative complication is he at risk and for each complication name one nursing intervention to prevent such complication:
- Risk of pneumonia: Interventions: To prevent: promote ambulation, give ATBX as prescribed, encourage spirometry exercise. DB and C. Intervention in collaboration with other members of the health team.
- May develop atelectasis(alveolar collapse):Interventions:promote DB and C, movement of secretion.
- May develop pneumothorax. Interventions:Ensure the patency of the chest tube, look for SS of pneumothorax.
- Risk of hemothorax. Interventions: Monitor the chest tube output.Check incision, monitor breathing.
Chest wall pain. Intervention: Monitor pain (use numeric scale or other ) and offer RX and follow up (breakthrough dose if needed). Teach and monitor if patient on PCA.
Risk of infection. Intervention: Monitor SS of infection, DB and C. Mobilization of patient ASAP and as per order.
Monitor CT drainage.
Risk of being SOB. Intervention: Ensure pain control follow up. CT patency, check for infection.
In order to reestablish negative pressure: Insertion of CT is needed.
Why does Mr. Pierre have a chest tube?: Because of the surgery negative pressure get destroyed. CT will reestablish negative pressure.
Why?:The thoracotomy is a surgical incision that the surgeon makes to open the chest wall (inside the lung). Its the surgical cut that breaks the negative pressure of the lungs.(like if you break a seal)
2 cellular dysfunctions?
cell proliferation: increase in cell number due to cell growth and division
cell differentiation: cell changes from one type to another
Define lung CA?
uncontrolled growth of abnormal cells that start off in one or both lungs; usually in the cells that line the air passages. The abnormal cells do not develop into healthy lung tissue, they divide rapidly and form tumors
Risk factors for lung CA?
smoking
second hand smoke
asbestos/carcinogen exposure
family Hx
Squamous cell carcinoma?
These cancers start in early versions of squamous cells, which are flat cells that line the inside of the airways in the lungs.
They are often linked to a history of smoking and tend to be found in the middle of the lungs, near a bronchus.
Types of non-small cell lung CA?
Squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma
Adenocarcinoma?
These cancers start in early versions of the cells that would normally secrete substances such as mucus.
Occurs mainly in current or former smokers, but it is also the most common type of lung cancer seen in non-smokers.
It is more common in women than in men, and it is more likely to occur in younger people than other types of lung cancer.
Large cell carcinoma?
can appear in any part of the lung. It tends to grow and spread quickly, which can make it harder to treat.
fast-growing cancer that is very similar to small cell lung cancer.
Small cell lung cancer?
It is very rare for someone who has never smoked to have small cell lung cancer.
SCLC often starts in the bronchi near the center of the chest, and it tends to spread widely through the body fairly early in the course of the disease.
Small cell lung CA VS non-small cell lung CA
SCLC usually starts near the center of the chest in the bronchi. It is a fast-growing form of cancer that tends to spread in its early stages. SCLC is rare in non-smokers, and tends to grow and spread much faster than NSCLC.
Non-small cell adenocarcinoma tends to form in the cells along the outer part of the lungs.
