Cancer Flashcards
1
Q
The number one non modifiable risk factor for cancer
A
Age
- Tends to affect the very young and 65 and older
2
Q
The number one preventable carcinogen
A
Tobacco
- Use of tobacco both initiates and promotes cancer
3
Q
How does cancer begin (cellular)
A
Begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA. Cell forms a clone and begins to proliferate - ignores growth regulating signals and changes the surrounding tissue. These abnormal cells infiltrate and gain access to lymph nodes and blood vessels, which travel to other areas of the body.
4
Q
Epidemiology of Cancer
A
- Tends to affects the very young and 65 and older
- Affects more men than women
- Increased incidence of those who work in industrialized sectors
5
Q
What is a primary tumor?
A
Original tumor site
6
Q
Parent Tissue
A
Cells identified from which it came from
7
Q
Metastasis
A
Primary tumors first extend into the surrounding tissues –> tumor cells secrete enzymes, causing pressure –> cause size increase –> forced cells to invade new territory
- Blood borne metastasis is most common cause of metastasis disease
8
Q
Three interacting factors influence cancer development
A
- Exposure to carcinogen
- Genetic predisposition
- Immune function
- These account for variation in cancer development from one person to another - even if exposed to the same hazard
9
Q
Viral Causes of Cancer
A
Difficult to evaluate due to their difficulty to isolate. Thought to incorporate themselves in the genetic structure of the cell
10
Q
Examples of Viral Causes of Cancer
A
- Epstein-Barr = primary liver cancer
- Hepatitis B = primary liver cancer
- HPV = cervical, vulvar, and other genital carcinomas
11
Q
Examples of Bacterial Causes of Cancer
A
Helicobacter pylori = gastric malignancy
12
Q
Can alcohol cause cancer?
A
Increases cancer risk of mouth, pharynx, larynx, esophagus, liver, colorectal, and breast
- No more than two drinks per day for men
- One beverage per day for women
13
Q
Etiology of Cancer: Hormonal Agents
A
- Breast, prostate, and uterus believed to rely on endogenous hormonal levels for growth
- OCPs and prolonged estrogen therapy associated with hepatocellular, endometrial, and breast cancer
- Menarche of < 12 years, delayed onset of menopause, etc. increase risk of cancer of breast
- Increased number of pregnancies associated with breast endometrial and ovarian
14
Q
Primary Prevention of Cancer
A
- Avoidance of known or potential carcinogens
- Modifying associated factors
- Removal of “at risk” tissues
- Chemoprevention
- Vaccination
15
Q
Chemoprevention
A
Used for primary prevention of cancer
- Using ASA and Celecoxib to decrease risk of colon cancer
- Vitamin D and Tamoxifen to decrease risk of breast cancer
- Lycopene to reduce risk of prostate cancer
16
Q
Secondary Prevention of Cancer
A
- Yearly mammogram for women > 40 years of age
- Clinical breast exam for women > 40 years of age every 3 years
- Colonoscopy at age 50 and then every 10 years
- Yearly fecal occult blood for adults of all ages
- Yearly prostate specific antigen (PSA) and digital rectal exam (DRE) for men older than 50
17
Q
Seven Warning Signs of Cancer
A
C = change in bowel/bladder habits A = a sore that doesn't heal U = unusual bleeding or discharge T = thickening or lump in breast/elsewhere I = indigestion or difficulty in swallowing O = obvious change in wart or mole N = nagging cough or hoarseness
18
Q
Three types of cancer staging
A
- Clinical
- Surgical
- Pathologic
19
Q
Clinical Staging
A
Assesses the patient’s clinical manifestations and evaluates clinical signs for tumor size and possible spread
20
Q
Surgical Staging
A
Assesses the patient’s clinical manifestations and evaluates clinical signs for tumor size and possible metastatic disease
21
Q
Pathologic Staging
A
Most Definitive Type in determining tumor size, number sites, and spread by pathologic examination of tissues obtained at surgery
22
Q
Duke’s Staging
A
Stages colon and rectal cancer
23
Q
Clark’s Staging
A
Stages skin cancer
24
Q
Three Forms of Cancer Treatment
A
- Surgery
- Radiation therapy
- Chemotherapy
25
Prophylactic Surgery
Removal of "at risk" tissue
| - removal of mole from a site where there is constant irritation
26
Diagnostic Surgery
Removal of part or all of a suspected lesion
| - provides proof of the presence of cancer
27
Curative Surgery
Removal of the entire neoplasm
| - Prostatectomy
28
Cytoreductive Surgery
Known as "cancer control"; removing part of the tumor and leaving a known amount of gross tumor
- known as "debulking"; reduces the number of cancer cells and increases the chances that other therapies can be successful
29
Palliative Surgery
Focus is to improve the quality of one's life - not focused on a cure
- Removal of tumor that is causing pain or causing obstruction
30
Second Look Surgery
This is a "rediagnosis" surgery after the patient has went through some type of treatment, such as radiation or chemo
- most common type of surgery used with ovarian cancer
31
Reconstructive or Rehabilitative Surgery
Enhances appearance, function of area, or both
| - breast reconstruction after mastectomy
32
Types of Radiation Therapy
1. Teletherapy
| 2. Brachytherapy
33
Teletherapy
A "distant" type of treatment - radiation source is external to patient
- Because this source is external, the patient is not radioactive and is not a hazardous threat to others
34
Brachytherapy
Is a "close" or "short" therapy - the radiation source comes into direct and continuous contact with the tumor tissues for a specific amount of time
- It produces a high amount of radiation to the tumor with limited amount around surrounding tissue
- Patient emits radiation and is a hazard to others
35
Side Effects of Radiation Therapy
1. Skin changes and hair loss
2. Altered taste sensation
3. Fatigue
4. Tissue fibrosis and scarring
36
Nursing Considerations for Patient on Teletherapy
1. Wash the irritated area gently with either water or a mild soap and water as ordered
2. Use your hand rather than a washcloth to provide gentle care to skin
3. Rinse soap thoroughly and pat skin dry with a clean, soft towel
4. If there are ink and dye marks, be careful not to remove them, as this indicates the exact area where the beam of radiation is to be focused
5. No powders, ointments, lotions, or creams at the radiation site, unless prescribed
6. Wear soft clothing over the radiation site, avoid wearing belts, buckles, straps or any type of clothing that binds or rubs the skin at the site.
7. Avoid exposure of the area to the sun, avoid tense sunrays—plan outdoor activities early in the morning or late in the evening
8. Avoid heat exposure
37
Nursing Considerations for Patient on Brachytherapy
1. Assign private room with a private bathroom
2. Door of patient’s room needs a “Caution: Radioactive Material” sign
3. If portable lead shields are used, place between patient and door
4. Keep patient’s room door closed as much as possible
5. Wear a dosimeter film badge at all times during the patient’s care. While badge offers no protection, it does measure the exposure to radiation. Do not ever share badge—should only be used by who it is assigned to.
6. Wear lead apron while providing care. Apron should always be facing the source of radiation (never turn your back toward the patient)
7. Pregnant nurses should not be assigned to these patients. Pregnant women or those <16yrs of age should not visit.
8. Visiting hours should be limited to 30 minutes per day. Visitors should remain at least 6 feet away from the source.
9. Do not touch the source with bare hands. If source becomes dislodged, use long-handled forceps to retrieve it. Dispose the radioactive source in a lead container that is kept in the room.
10. Save all dressings and bed linens until after the radioactive source is removed. (Other equipment can be removed from the room at any time without special precautions and does not pose a hazard to other people)
38
How is dosage determined for chemotherapy?
Dosage is determined by the patient's total body surface area, previous response to chemo or radiation therapy, and function of major organ systems. When receiving chemo, weight needs to be done prior to administration
39
Extravasation
Antineoplastic chemo agents are additionally classified by their potential to damage soft tissue if they inadvertently leak from a vein (extravasation). If extravasation is suspected, the medication is stopped immediately, and dependent on the drug, an attempt is made to aspirate any remaining drug from the site through the existing needle.
40
Vesicants
These are agents that if deposited into the subcutaneous tissue, cause tissue necrosis and damage to the underlying tendons, nerves, and blood tissues. It may take weeks before damage is apparent. Damage can be so severe that area may require skin graft(s).
41
Chemotherapeutic Agents
1. Alkylating Agents
2. Antimetabolites
3. Antitumor Antibiotics
4. Antimitotics or Antimicrotubules
5. Topoisomerase Inhibitors
42
Alkylating Agents
1. Carboplatin
| 2. Cisplatin
43
When is Carboplatin used?
Selected areas of use:
1. Head/neck
2. Ovarian
3. Testicular
44
Adverse Effects of Carboplatin
1. Myelosuppression
2. N/V
3. Peripheral neuropathy
45
When is Cisplatin used?
Selected areas of use:
1. Bladder
2. Esophageal
3. Head/neck
4. Lung
5. Ovarian
46
Adverse Effects of Cisplatin
1. N/V
2. Renal toxicity
3. Myelosuppression
4. Neuropathy
5. Ototoxicity
47
Special Considerations for Cisplatin
Causes severe N/V - possibly pre medicate before administering
48
Antimetabolite Drugs
Methotrexate
49
When would methotrexate be used?
Selected areas of use:
1. Breast
2. Head/neck
3. Leukemia
4. Lymphoma
5. Osteosarcoma
50
Side Effects of Methotrexate
1. Mucositis
2. Diarrhea
3. N/V
4. Myelosuppression
51
Special Considerations for Methotrexate
High doses (>150-12,000mg/m2) require rescue with leucovorin and serum monitoring. May deplete metabolites (e.g. folic acid); may need B12 or folic acid supplement
52
Antitumor Antibiotics
1. Bleomycin
53
When would Bleomycin be used?
Selected areas of use:
1. Lymphoma
2. Testicular
54
Adverse Effects of Bleomycin
1. Pulmonary fibrosis
2. Pneumonitis
3. Dermal reactions (hyperpigmentation, rash, hyperkeratosis)
55
Special Considerations for Bleomycin
Special Considerations: causes pulmonary fibrosis—may start out as interstitial Pneumonitis and progress to pulmonary fibrosis. Usually in doses >450U—doses should not exceed 400U
56
Antimitotics/Antimicrotubules
1. Vincristine
57
When would Vincristine be used?
1. Leukemia
2. Lung
3. Lymphoma
4. Myeloma
5. Sarcoma
58
Adverse Effects of Vincristine
1. Peripheral neuropathy
2. Bone pain
3. Jaw pain
59
Special Considerations of Vincristine
Do not give intrathecally; results in death; administer steroid, H1-receptor antagonist (diphenhydramine)& H2-receptor antagonist (ranitidine, famotidine) to prevent anaphylaxis and hypersensitivity
60
Topoisomerase Inhibitors
1. Irinotecan
61
When would Irinotecan be used?
1. Colorectal
| 2. Lung
62
Adverse Effects of Irinotecan
1. Diarrhea
2. Myelosuppression
3. N/V
63
Special Considerations for Irinotecan
May cause acute cholinergic symptoms (sweating, flushing, diarrhea)
- treated with Atropine
64
Nursing Interventions for Stomatits/Mucositis
1. Mouth care
2. Soft tooth brush
3. Triple mix mouthwash
4. NO lemon glycerin swabs
5. Alcohol-free mouthwash
6. Avoid irritating foods
65
Nursing Interventions for Nausea/Vomiting/Anorexia
1. Adjust diet
2. Avoid strong odors
3. Frequent mouth care
4. Schedule antiemetics (ondansetron)
5. Encourage rest after meals in chair or HOB elevated
66
Foods to help with Diarrhea
1. Yogurt
2. Rice
3. Noodles
4. Cream of wheat
5. Skinned chicken or turkey
6. Lean beef
7. Fish
8. White bread
67
Meds for Diarrhea
1. Atropine
| 2. Diphenoxylate
68
Meds for Constipation
1. Docusate sodium
2. Polyethylene glycol
3. Magnesium citrate
69
Foods for Constipation
1. High fiber foods
2. Fruits
3. Whole grains
70
Nursing Interventions for Alopecia
1. Teach to prevent head injury to the scalp & cope with body image
2. Head covering to prevent sunburn
3. May need assistance in choosing a type of headcovering
4. Purchase wig prior to therapy and have stylist to mimic usual style
5. “Look Good, Feel Good Program” from ACS to offer ways to improve appearance
71
Nursing Interventions for Myelosuppression
1. Protect from infection
2. Assess at least q8h and PRN
3. Aseptic technique with any invasive procedure
4. Teach family reduction of risks in the home
5. Report any changes in skin, mucous membranes, or other health condition
6. Notify HCP of cough, dysuria, pain at venous access site, or any type of drainage.
7. Good hand washing technique
8. Does not have typical signs of infections—any elevation in temperature should be considered a sign of infection and should be reported to the health care provider immediately.
9. Teach at no time is the patient a hazard to other people—however, other people can be an infection hazard to the patient.
72
Nursing Interventions for Thrombocytopenia
1. Avoid IM injections and venipunctures
2. Avoid frequent flossing, soft bristled tooth brush, do not use water pick, be sure dentures fit properly and do not rub,
3. Use electric shaver instead of razor
4. No nose blowing, do not insert any objects in the nose
5. Avoid any trauma to rectal tissues—no enemas, no rectal temps
6. Measure the abdominal girth daily
73
Patients at Risk for Anaphylaxis
1. Lymphomas that are being treated with Bleomycin
2. Acure lymphoblastic leukemia (ALL) treated with L-asparaginase
3. Crainospinal tumors treated with tenoposide
74
Treatment of Anaphylaxis
1. Stop drug
2. Maintain IV with NS
3. Maintain patent airway
4. Administer O2
5. Administer Epinephrine SC or IM in early stages, IV if unconscious or hypotensive
75
S/Sx of Hypercalcemia
1. Anorexia
2. N/V
3. Constipation
4. Renal insufficiency
5. EKG changes
6. Muscle fatigue
7. Bone pain
8. Weakness
76
Hypercalcemia Treatment
1. Includes vigorous IV hydration (5-8L) of NS per day
2. Diuretics
3. Glucocorticoids
4. Calcitonin
5. Diphosphonate
6. Mithramycin
7. Dialysis (if life threatening)
77
SIADH
- Water is reabsorbed by the kidney and put into systemic circulation
- Causes hyponatremia and fluid retention
- Cancer is the most common cause
78
Nursing Care of SIADH
- Fluid restriction (only allowed 1L/day)
- Increase sodium intake and drug therapy.
- Demeclocycline –PO antibiotic that works in resistance of ADH
79
Superior Vena Cava Syndrome
SVC is compressed or obstructed by tumor growth or formation of clots in the vessel.
* Life threatening EMERGENCY
80
S/Sx of Superior Vena Cava Syndrome
1. Edema of the face, especially around the eyes
| 2. Tightness of the shirt or blouse collar (Stoke's sign)
81
S/Sx of Worsening Superior Vena Cava Syndrome
1. Edema in the arms and hands
2. Dyspnea
3. Erythema of the upper body
4. Epistaxis
82
Late S/Sx of Superior Vena Cava Syndrome
1. Hemorrhage
2. Cyanosis
3. Mental status change
4. Decrease cardiac output
5. Hypotension
6. Death (if compression is not relieved)
83
Treatment for Superior Vena Cava Syndorme
1. High dose radiation therapy (temporary relief)
2. Surgery (rarely done)
3. Metal stent in the vena cava (relieve swelling)
84
Tumor Lysis Syndrome
- Large numbers of tumor cells are destroyed rapidly.
| - TLS is a positive sign that cancer treatment is effective. If untreated, can lead to death
85
S/Sx of Tumor Lysis Syndrome
1. Hyperkalemia
2. Cardiac arrhythmias
3. Hyperuricemia
4. Acute renal failure
86
Nursing Care for TLS
1. Hydration!
2. Alkaline Fluids (Sodium Bicarb) to prevent uric acid preciptation
3. Antiemetics
4. Diuretics (Furosemide)
5. Allopurinol, rasburicase (to decrease uric acid levels)
6. Polystyrene Sulfonate (po or enema)
7. IV glucose and insulin
8. Dialysis
87
Nursing Care for Pain
1. Assist with rest and sleep.
2. Benzodiazepines, and/or antidepressants may improve the effect of analgesics. It is best to give meds on a schedule.
3. IV bolus of a narcotic may be used
4. PCA pump
5. Oral sustained release analgesic
6. Pain Patches
7. PO routes must be a higher dose to equal IM or IV dose. It is considered a 1:3 ratio for the equivalence of IV/PO dosage.
88
Morphine
Multiple routes of administration. Available in immediate and controlled release
89
Morphine Dosages
```
Parental = 10
PO = 30
```
90
Codeine
IM has unpredictable absorption and tons of side effects, used PO for mild to moderate pain; usually compounded with nonopioid (like tylenol #3)
91
Codeine Dosages
```
Parental = 130
PO = 200
```
92
Hydromorphone
Useful alternative to morphine. Has shorter duration than morphine. Available in high-potency formulation useful for SC infusion
93
Hydromorphone Dosages
```
Parental = 1.5
PO = 7.5
```
94
Levorphanol
Longer acting than morphine
95
Levorphanol
```
Parental = 2
PO = 4
```
96
Meperidine
No longer preferred as first-line therapy for management d/t by-product is normederidine, which has side effects of irritability, crabbiness, and seziures. Also not recommended in elderly patients with impaired renal function. continuous IV infusion is not recommended
97
Meperidine Dosages
```
Parental = 75
PO = 300
```
98
Methadone
Longer acting morphine when given repeatedly. Long half-life—can lead to delayed toxicity from accumulation within 3-5 days. Start PO dosing on PRN schedule
99
Methadone Dosages
```
Parental = 10
PO = 20
```
100
Oxycodone
Used for moderate pain when combined with a nonopioid (Percocet, Tylox); can be used like PO morphine for severe pain
101
Oxycodone Dosages
```
Parental = N/A
PO = 20
```
102
Oxymorphone
Used for moderate to severe pain; No PO form
103
Oxymorphone Dosages
```
Parental = 1
Rectal = 10
```
