Cancer Care Flashcards
Malignant Cancer Cells
- Have abnormal regulation of growth
- Continue to grow even at the expense of their host
- Grow by invasion
- Travel via lymph nodes and blood
Benign Cancer Cells
- Grow by expansion
- Slow or may halt
What is are the differences b/t Malignant and Cancer cells?
- Rate of growth
- Ability to metastasize/spread
- Destruction of tissue
- Ability to cause death
Metastasis
The capacity of a tumor to invade and spread from their original site to other organs in the body
What are the 2 most common mechanisms of metastasis?
lymphatic channels or blood vessels
What are the most common sites of metastasis?
bones, lungs, liver, and CNS
Angiogenesis
process by which a new blood supply is formed, creating an interface b/t the tumor and the vascular surface of the host
Lymphatic Spread
Tumor emboli enter the lymph channels by way of the interstitial fluid, which communicates w/ lymphatic circulation
-penetrate by infiltration
What happens after the tumor emboli enter lymphatic circulation?
They lodge in lymph nodes or pass b/t the lymphatic and venous circulation
Hematogenous Spread
Dissemination of malignant cells via the blood stream
What happens when malignant cells travel through the blood stream?
They attach to endothelium and attract fibrin and platelets to seal themselves from the immune system
-then enzymes are secreted that destroy surrounding body tissues allowing implantation
What viruses and bacteria are linked to cancer?
- Hep C = hepatocellular carcinoma
- Helicobacter pylori = gastric ulcers
- HPV = genital region, upper respiratory tract, or skin
Chemical agents and Cancer
- 1/3 cancer deaths are from tobacco use
- 4% daily alcohol consumption
- 30-40% oral cancers and 20-50% esophageal cancers are from daily alcohol consumption
- Chemicals in workplace = carcinogens/co-carcinogens
What are the most important modifiable determinants of cancer risk?
Obesity, diet, and levels of physical activity
What dietary substances appear to increase the risk of cancers?
fats, alcohol, salt-cured/smoked meats, and nitrate containing foods
Primary Prevention of Cancers
Focus on preventing or delating the onset of cancer
Secondary Prevention
Focuses on EARLY detection w/ the goal of identifying cancer in early stages before symptoms develop
Tertiary Prevention
Management of the disease and the prevention of progression to later stages
What is the process to diagnose cancer?
- Determine presence of tumor and its extent
- Identify possible spread
- Evaluate function of involved/uninvolved body system/organs
- Obtain tissues and cells for analysis
TNM System
T = extent of primary tumor
N = Lymph node involvement
M = metastasis
-Determines the size of the tumor and extent of the disease
Tumor Grading
Classifying tumor cells
-tumor assigned numeric value from I-IV
What does a grade 1 tumor mean?
Well differentiated, closely resemble the tissue of origin in structure and function
What does a grade 4 tumor mean?
Poorly differentiated as they do NOT clearly resemble the tissue of origin in structure or function
What are the 3 Management Goals?
- Cure- completely eradicate
- Control-prolong survival/prevent progression
- Palliation-relief of symptoms
What is the most important factor in determining eligibility for treatments?
Performance Status
Surgery
May be the primary method of treatment or it may be prophylactic, palliative, reconstructive, or diagnostic
Diagnostic Surgery
BIOPSY must be performed to obtain a tissue sample for analysis of cells suspected to be malignant
What are the 2 goals of surgery?
- Remove the entire tumor
- Remove as much as possible and any involved surrounding tissue
What are the 2 types of surgical approaches?
Local excision or Wide/radical excision
Local Excision
removal of the mass and a small margin of normal tissue that is easily accessible
Wide/Radical Excision
removal of the primary tumor, lymph nodes, involved structures, and surrounding tissues that may be high risk for tumor spread
Prophylactic Surgery
Removing nonvital tissues or organs that are likely to develop cancer
- offered selectively b/c long term physiological/psychological effects are not known
- Colectomy, mastectomy, oophorectomy
Palliative Surgery
Cure is NOT possible, the goals are to make the patient as comfortable as possible and improve their quality of life
-relieves complications: obstructions, hemorrhage, pain
Internal Radiation Risks
- Time = as the amount of time w/ the patient increases, the nurses exposure to radiation increases
- Shielding = use of a lead shield to buffer the exposure to radiation
- Distance = the closure you are, the greater the radiation exposure
What is the goal of Internal Radiation
Deliver safe, efficient care that meets the patients’ needs in the shortest amount of time -NO more than 30 minutes in 8 hour shift
External Radiation
Dependent on the depth of the tumor
-95% develop radiation dermatitis
What should a patient do for Radiation Dermatitis?
- Avoid creams/powders on treated area
- NO scrubbing
- Avoid constrictive clothing
- Avoid extreme temps
- Avoid itching
- Gently cleanse w/ lukewarm water and a mild non-deodorant soap
Chemotherapy
Antineoplastic agents are used in an attempt to destroy tumor cells by interfering w/ cellular functions, including replication
-repeated therapy needed over prolonged period to achieve regression
What is chemo used primarily to treat?
Systemic disease rather than localized lesions that are amendable to surgery or radiation
Chemo may be combined w/ what?
Surgery, radiation therapy, or both to reduce tumor size to destroy remaining tumor cells postop or to treat hematological malignancies
What do most people with cancer actually die from?
Most people do NOT die from their tumor, but they die from infection or bleeding
What happens every time a tumor is exposed to a chemotherapeutic agent?
A percentage of tumor cells are DESTROYED (20-99%)
Goal of Chemotherapy
Eradicate enough of the tumor so that the remaining tumor cells can be destroyed by the body’s immune system
What cells are the most sensitive to chemo?
Cells that are rapidly dividing within a tumor
How is the route of chemo chosen?
Depends on the type of agent, the required dose, and type, location, and extent of tumor being treated
What is the dosage of chemo based on?
Based primarily on the patient total body surface area, previous response to chemo or radiation therapy, function of major organ systems, and PS
Chemo must be verified by how many nurses?
2
Extravasation: Infusion Related Event
Vesicants deposited into the sub q tissue causing tissue ulceration and necrosis as well as damage to underlying tendons, nerves, and blood vessels
When should a central venous access be inserted for chemo?
If frequent antineoplastic vesicants is anticipated in a patient w/ poor veins, or if vesicant agent requires administration over more than 1 hour
What patients are at high risk for extravasation?
- those w/ small veins
- lymphedema
- obesity
- impaired level of consciousness
What can the nurse do to decrease the risk of extravasation?
- Avoid veins in the hands, wrist, and antecubital area
- Avoid small/fragile veins
- Use smallest cannula in largest vein
- Clear dressing
- Avoid butterfly needle
What should the nurse monitor for w/ extravasation?
- Absence of blood return from IV catheter
- Resistance to flow of IV fluid
- Leaking around insertion site
- Swelling, burning, pain, redness, blistering at IV site or in the upper arm, back, chest, or jaw
What should the nurse do when extravasation occurs?
- STOP medication immediately
- Aspirate ant residual drug from IV line
- Administer antidote if indicated
Chemotherapy induced nausea and vomiting
Common and feared side effect and may persist for 24-48 hours after administration
-may be prescribed antiemetics
Anticipatory Nausea and Vomiting
may be experienced after the first cycle and is caused by classical conditioning: triggered by odors, sights, thoughts
Myelosuppression
depression of the bone marrow function, resulting in decreased production of blood cells
-Decreases WBS, RBC, and platelets
What happens when there is a decrease in RBC, WBC, and platelets?
Increased risk of infection and bleeding
Leukopenia
decreased number of white blood cells
Anemia
Decreased number of red blood cells
Thrombocytopenia
Low platelet count
When would a patient be considered for a blood transfusion?
Hemoglobin level < 8
Chemo Side Effects on Reproductive System
Results in abnormal ovulation, early menopause, or sterility
Fatigue
Feeling of weariness, weakness, lack of energy, lack of motivation
- exacerbated by the stress of coping w/ cancer
- Encourage alternating periods of rest and activity
- Maintain as normal a life as possible
Normal WBC Count
4,500-10,500 cells/mm3
NADIR
lowest point WBC count will drop after medication
What are CRITICAL Values of WBC?
< 500
> 30,000
Nursing Interventions for Infection
- Report temp > 101 F
- Administer antibiotics after cultures
- Strict sepsis w/ IV lines, catheters, etc..
- Hand Hygiene
- Coughing/Deep breathing
- Minimize contact w/ other ill people
Stomatitis
inflammatory response of the oral tissues that is characterized by mild redness and edema or if severe by painful ulcerations, bleeding, and secondary infection
When would a patient develop stomatitis?
5-14 days after the patient receives chemo
Nursing Interventions for Stomatitis
- Use soft bristled tooth brushes and nonabrasive toothpaste
- Oral rinses after meals and at bedtime
- Avoid any alcohol
- Avoid food difficult to chew or hot/spicy
- Lubricate lips
- Topical anti-inflammatory/anesthetic agents
Alopecia
temporary or permanent thinning or complete loss of hair
When does hair loss typically occur?
2-3 weeks after initiation of treatment; regrowth may take 6 months
Nursing Interventions for Alopecia
- Scalp hypothermia
- Advice to use shampoos w/o detergents
- Avoid hair coloring, bleaching, perms, hot rollers, excessive, aggressive hair brushing
- Encourage wig selection prior to hair loss to match color and texture
- Supportive programs
Nutrition for Cancer Patients
- high calorie/high protein snacks and supplements
- cold foods
- Small, frequent meals
- Add extra calories to foods patients want to eat
- Appetite stimulants
Superior Vena Cava Syndrome
Compression or invasion of the superior vena cava by tumor, enlarged lymph, or intraluminal thrombus that obstructs circulation of the head, neck, arms, and thorax
Spinal Cord Compression
Occurs when a malignant disease or a pathologically collapsed vertebrae compresses or displaces the thecal sac that contains the spinal cord causing neurologic impairment
Hypercalcemia
Potentially life threatening metabolic abnormality resulting when the calcium released from the bones exceeds the amount that the kidneys have the ability to excrete or the bones can reabsorb
Pericardial Effusion
Accumulation of fluid in the pericardial space compressing the heart and thereby impedes expansion of the ventricles limiting cardiac filling
Disseminated Intravascular Coagulation (DIC)
Complex disorder of coagulation and fibrinolysis (destruction of clots) resulting in thrombosis and bleeding
Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH)
result of the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone
Tumor Lysis Syndrome (TLS)
Rapid release of intracellular contents as a result of radiation, or chemo induced cell destruction of large or rapidly growing cancers
