Cancer Flashcards
Cancer
A group of cells that has lost its control mechanisms and thus has unregulated growth
2nd cause of death after heart trouble
Can develop from any tissue in an organ forming a mass – tumor
Cancerous cells from the primary site can spread (metastasize) throughout the body
- Tumor invades and destroys adjacent tissue
Cancer cells need more glucose, oxygen
Spread through the lymphatics
Benign means it does not spread (in medicine means not cancerous)
Spreading
Initiation
Change in genetic material brought on spontaneously or by a carcinogen
Could be a virus
Promotion
Agents in the environment allow the cell that has undergone initiation to become cancerous.
Several factors – combination of susceptible cell (the cell that was mutated in the beginning) and a carcinogen
Spread
Invasion directly
Through the lymphatic system
Through the bloodstream
Types
blood and blood forming
- Leukemias, Lymphomas& multiple myelomas
- These cells remain separate and harm by crowding out normal blood cells in the bone marrow and blood stream
- Gradually replace the normal cells
Solid tumors
Carcinomas
- Epithelial cells that cover inside and outside of the body, produce hormones, make up glands – Adeno (produced in a place that produces fluids), basal (lower level of the epidermis), squamous (below the outer layer of the skin linings), transitional (lining of stretchy things. Like the bladder)
- Occur more in older folks
Sarcomas
- Mesodermal cells that form muscles and connective tissue
- Occur more in younger folks
Risk Factors
Family history- chromosomal defect passed down
Age- 77% diagnosed before the age of 55
Environment- anything that causes a lot of irritation (chronic), inflammation (chronic), chemicals (smoking), sun
Geography
Diet- obesity, smoke foods, high fat foods, nitrates
Viral infections- puts you at risk, HPV virus (cervical cancer), Hepatitis B, mono
Inflammatory diseases- chrones
Hormone- don’t cause cancer but support cancer, estrogen supports the formation of breast, uterine, ovarian cancer, testosterone supports _________
Defenses
Immune system
- Normally the body recognizes the tumor antigen as foreign and can contain or destroy it before it becomes established
- If the cells have reproduced rapidly and formed a mass the system may be unable to contain/destroy
- Antibodies are formed but may not be powerful enough to overcome in some cancers
- Might not have enough T cells
- Some antigens can be detected with blood tests – tumor markers: Used to screen, evaluate response to treatment
Symptoms
Some occur with almost all cancers and others are specific to the type of cancer and its location
- Growing in a large space- minimal S/S
- S/S due to growing into thus irritating and destroying tissue,
- putting pressure on tissue- feel s/s faster
- Producing toxins
- using nutrients normally available for normal tissue- may see unexplained weight loss because the food is nourishing the cancer cells
- While growing in primary site may have one set of S/S but different with Metz
- Pain – at 1st painless -> mild discomfort -> worsens with time and enlargement, Compression/erosion into nerves & other structures
- Bleeding – At 1st slight since CA cells are not well attached to each other and its vessels are fragile. With better organization, bleeding may be massive. Site of the CA determines the site of the bleeding
- Weight loss and fatigue – increase as the CA progresses
Appetite good at 1st -> body goes into ketosis which makes you not feel hungry, leading to anorexia and even nausea - Advanced stage tired and sleepy
- If anemic not only tired but SOB with exertion
- Swollen lymph nodes: As the lymph system tries to clear the CA, they swell. As they become affected they start to become immovable and possibly painful
- Depression: Related to the illness, fear of dying, loss of control. Perhaps related to the spread to the brain
- Respiratory symptoms: Due to blockage, pressure (tumor pressing on lungs or diaphram), bleeding , anemia (can make you SOB)
Complications – paraneoplastic syndrome (cancer everywhere)
Prevention
Primary Prevent: clean eating, no smoking, limited drinking, exercise
Secondary prevention: screening (mammogram, etc), health promotion
Diagnostics
Physical exams
- Risk factors examined (smoker, drinker, overweight)
- Screeners – not definitive
- Further testing necessary
CBC
- Electrolytes
- Liver function tests
- Cytology (biopsy of cells) Needle biopsy, take out the lump (excision), incision
- Chest x-rays
- Endoscopic tests
- Tumor markers in blood – test further
Staging
- Check for presence of a tumor, spread of a tumor, effects on organs
- Clinical
- Labs, x-rays, scans, biopsies and other procedures
- Pathological
- Excision of tumor and node exam – more precise
Staging
- Determines the size, location, and growth into near structures
- Helps determination of appropriate treatment and prognosis
***- Different types but most common is the TNM: Tumor- size, how deep into organ, Nodes, Metastasis
Group staging (another way but not as common as TNM)
***- Cancer staging # does not change , even if the condition does
TNM System
T – Primary tumor
- Size, how deep into the organ, has it grown into surrounding tissue
- TX – cannot be measured
- T0 – cannot be found
- Tis- cells growing on superficial layer (in situ)
- T1,T2,T3,T4 - size of tumor and/or the more spread to surrounding tissue (T4 is more aggressive than a T1)
- The higher the number the larger the tumor or the more it has spread, the less responsive to treatment
Nodes
- N refers to the number of nearby lymph nodes that have cancer
- NX –cancer in nearby nodes cannot be measured
- N0 – nodes to not contain cancer
- N1,N2,N3 describes the size, location and/or the number of node affected
- The higher the number the greater the spread
Metastasis
- M refers to whether the cancer has spread or not
- MX – Metastasis cannot be measured
- M0 – no distant cancer spread found
- M1 – cancer has spread to other parts of the body
Grouping:
Once these value have been achieved, they can be grouped into stages I-IV. Stage 0 is very early and Stage I is the next least advanced and has a good prognosis the higher the stage # the poorer the outlook
Stage 1: cells are slightly different, not differentiated
Stage 2: slight differentiated
Stage 3: Severe, undifferentiated
Stage 4: immature, primal, totally undifferentiated
Terms You May Hear
In situ
Abnormal cell are present but have not spread to other tissue
Localized
Cancer is limited to the starting place with no sign of spread
Regional
Cancer has spread to nearby nodes, tissue or organs
Distant
Cancer has spread to distant part of body
Unknown
There is not enough information to figure out the stage
Prevention/Treatment
Lifestyle changes
- Diet
- Exercise
- Avoidances
- Smoking
- Sun exposure
- All tobacco products
- Protective foods (fruits and veggies) and meds
- Limit alcohol but don’t have to cut it out completely
Surgery- can be preventative, diagnose, stage, treatment, curative if cancer is in one location, reconstructive, palliative (de-bulk the tumor that is pressing on vital organs), can implant portacaths, tunneled tubes for chemo
Radiation- destroys and or damages cancer cells, beams aimed directly on the tumor, pt. doesn’t feel them but can do damage to healthy tissue. Often have redness in skin, lose appetite, fatigue, diarrhea and nausea if on abdomen, can give radioactive drugs, capsules, brachial therapy, make sure that you are not pregnant when caring for this patient, need rest, skin care, eat healthy. Small frequent doses. Could end up with pathological fractures.
Chemo- goal to cure or control cancer, can be palliative by shrinking tumors before surgery, used for recurrent tumors, hematological stuff so it will go into the bone marrow. Look at overall health before administering chemo. SE: hair falls out, mouth breaks out, fatigue, hair loss, appetite change, n/v, nerve damage, forgetful, changed attitudes (chemo brain), hair different texture when it grown back in, fingernails may be dried out and brittle.
Immunotherapy- monochlomo, may break off a part of the cell, changing the mechanism of it. Looking at new vaccines. Developing onochologic viruses to infect and kill cancer cells. Stem cell transplants, hyperthermia
Combination
Alternative
Nursing Care:
Drinking water dilutes the cells when they explode within the body
Be supportive and comforting to the patient
Must manage your own discomfort
Listen to patient concerns
Explain therapy clearly- repeat it PRN – give written information
