Cancer Development Flashcards
Grading Malignant Tumors
Gx: not determined
G1: well differentiated, low grade, slow growing
G2: moderately differentiated, malignant characteristics
G3: poorly differentiated, tissue established, few normal characteristics
G4: poorly differentiated, no normal characteristics, difficult tissue origin
Staging of Cancer
(T) Primary Tumor: x- cannot be accessed 1-4- increasing size
(N) Regional Lymph Nodes: x- cannot be accessed 1-3- increasing involvement
(M) Distant Metastasis: cannot be accessed 1- distant metastasis
Breast metastasis
Bone
Brain
Lung
Liver
Lung metastasis
Brain Bone Liver Lymph Pancreas
Colorectal metastasis
Liver
Lymph
Prostate metastasis
Bone
Pelvis
Melanoma metastasis
GI
Lymph
Lung
Brain
Brain metastasis
CNS
External factors
Chemical carcinogenesis: tobacco 30%, alcohol
Physical: radiation and chronic irritation
Viral: oncoviruses
Dietary: decreased fiber, increased red meat
Immune fxn: immunosuppressed
Age: immune protection decreases and external exposure increases
Genetics: provide risk not diagnosis
Cancers associated with tobacco, virus, genetics
Tobacco: lung, oral cavity, pharynx, larynx, esophagus, pancreas, uterus, kidney, bladder, liver, stomach
Virus: Epstein Barr, hep b & c, HPV, lymphotropic 1 & 2
Dietary habits to decrease cancer risk
Decrease animal fat intake, avoid nitrites, decrease red meat, decrease alcohol, increase bran, increase cruciferous vegetable, increase vitamin A & C
Wash the fruits and veggies and salads
CAUTION
Changes in bowel and bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast tissue Indigestion or dysphagia Obvious change in wart or mole Nagging cough or hoarseness
Primary prevention
Use of strategies
Avoid carcinogens, modify associated factors, remove at risk tissue, chemoprevention, vaccination
Secondary prevention
Screening strategies Yearly mammogram for 40 and older Clinical breast exam yearly for 40 and older, every 3 years for 20-39 Colonoscopy at 50 then every 10 years Yearly fecal occult blood all ages Digital rectal exam for men 50 and older
Benign vs Malignant
Benign- harmless, doesn’t require intervention, doesn’t spread
Malignant- indicates cancer, serious and can lead to death without intervention
Pathophysiology of cancer cells
We’re once normal, underwent genetic mutations to no longer function normally
Hypertrophy vs Hyperplasia
Hypertrophy- increase in size by enlarging each cell
Hyperplasia- increase cell number
Cancer development
Other names = carcinogenesis and oncogenesis
Initiation- genes promoting cell division, irreversible
Promotion- enhanced growth by promoters such as insulin and estrogen
Progression- continue change of a cancer,more malignant over time
Metastasis- cancer cells move from primary location by breaking off and establishes remote colonies
Primary vs Secondary tumors
Primary- identified by the tissue from which it arose
Secondary- cancer cells move from primary location, additional tumors, still a cancer from altered tissue
Cancer classification
Grading- varies on malignancy
Ploidy- chromosome number and appearance
Staging- location and degree of metastasis at diagnosis
TNM- tumor, node, metastasis, anatomic extent of cancers
Solid vs hematologic
Solid- specific tissues, breast and lung
Hematologic- arise from blood cell forming tissues, leukemias and lymphomas
Which pathologic description of a clients to,or does the nurse interpret as being the most malignant or high grade cancer
Undifferentiated, mitotic index 50%, aneuploid
The nurse is caring for a patient who is concerned about developing cancer. The nurse recognizes that cancer occurs how frequently in people currently living in North America
1 in every 3
The nurse understands that normal cells and benign cells share which characteristics
No migration
Orderly growth
Tight adherence
Specific morphology
An example of a primary prevention strategy for reducing cancer is
Regular physical exercise
Related consequences of Cancer
Reduced immune and blood producing function- depends on CA & tx, decreases WBC & RBC causing infection and anemia
Altered GI structure and function- decreases absorption and elimination, increases metabolic rate, anorexia, increase protein and carbs
Motor and sensory deficits- compresses nerves, causes pain, “chemo brain”
Decreased respiratory function- disrupt oxygenation, death, hypoxia, pulmonary edema, dyspnea, poor gas exchange and tissue oxygenation
Surgery as Treatment
Oldest form of tax
Removal of diseased tissue
Prolong survival time and improve QOL
Types of surgery
Prophylaxis- removes at risk tissue
Diagnosis- removal of all or part of suspected lesion for exam and testing
Cure- remove all CA tissue
Control- remove part of tumor
Palliation- improve QOL, reduce pain
Reconstruction- increase fxn, appearance, or both
Radiation therapy
Purpose is to destroy CA cells with minimal damaging effects of surrounding normal cells
Local tx
Cure, control or palliate disease
Exposure vs Radiation dose
Exposure- Amount of radiation delivered
Radiation dose- Amount of radiation absorbed
Dose > Exposure
Teletherapy
Delivered from source outside of patient
Radiation
Brachytherapy
Short, close therapy
Isotopes
Dangerous to others
Private room, closed doors, lead apron, lead container
Do not have to take out, half life 2 weeks
Not absorbed or eliminated
Thyroid, ovarian,prostate
Side effects of Radiation
Acute and long term site specific changes Vary according to site Local skin changes and hair loss Altered taste sensation and fatigue Bone marrow suppression Tissue fibrosis and scarring Infection Avoid sun exposure during tx and 1 year after
Patient centered care
Provide accurate information Skin care- wash area daily, pat dry, use lotion, soft clothing, avoid exposure, avoid heat Don't remove temporary marking Avoid skin irritation Skin will become dry and break down Nutrition Care for xerostomia Teach about fractures Exercise and sleep
Chemotherapy
Treatment of CA with chemical agents
Used to cure and increase survival time
Adjunct therapy- surgery or radiation
Tumors with active growth are more sensitive
Normal cells that are affected most are ones that divide rapidly
Chemo drugs
All affect a part of cell division or reproduction
Using more than one can be more effective in killing CA cells, but side effects and damage to normal tissues increase
Routes: IV, intrathecal, intraventricular, intraperitoneal, topical, intravesicular, intraarterial, oral
Chemo tx issues
Dosage- based on total body surface, ht, wt
Scheduling- normal cells recover, not CA cells, every 3-4 weeks
Administration: extravasation- drug leaks into surrounding tissues
Vesicants- damage tissues on direct contact
Pain,infection, tissue loss
PREVENTION!!!
Chemo side effects
Anemia Neutropenia- decreased leukocytes, causes immunosuppression Thrombocytopenia- reduction in blood platelets N/V Alopecia Mucositis Skin changes Anxiety Altered bowel Change in cognitive function
Protection for side effects
Neutropenia- reduce infection risk
Thrombocytopenia- bleeding precautions
Chemo induced N/V- many CA drugs are emetogenic, occurs 1-2 days after, give antiemetic
Growth factors- Neupogen & Neulasta
Protection from side effects (cont)
Mucositis- sores in mouth, painful, interfere with eating, assess frequently, bone marrow suppression- risk bleeding
Alopecia- temporary, regrowth one month, avoid scalp injury, cope with body image change
Cognitive changes- decreases concentration, memory loss, difficult learning new info, “chemo brain”
Chemo induced peripheral neuropathy- no known interventions, loss of sensory or motor fxn, related to dosage, loss sensation in hands/feet, ortho hypoTN, erectile dysfunction, neuro pain, loss taste, constipation, long term- may be permanent
Biological Response Modifiers
Modifys pts biological responses to tumor cells
Can have direct anti tumor activity
Can interfere with cancer differentiation, transformation, metastasis
Can improve immune fxn and enhance the body’s ability to repair or replace cells damaged by CA tx
Photodynamic therapy
Selective destructive of cancer cells via by types of light
Used for non melanoma, skin CA, ocular tumors, GI tumors, and lunch CA in upper airways
May require one exposure or several days
Hormonal therapy
Prostate, breast, ovary
Changes usual hormone response
Decreasing hormone amounts can slow CA growth rates
Doesn’t cure
Side effects hormone therapy
Masculinity effects in women Femininity effects in men- gynecomastia Fluid retention Acne Hypercalcemia Liver dysfxn Venous thromboembolism
Sepsis
Risk for infection
Decreased WBC
impaired immune fxn
Pg 392
Disseminated intravascular coagulation
Clotting problem
Triggered by CA, viral or bacterial infections, gram - sepsis, life threatening, increased mortality, PREVENTION, anticoags, clotting factors
SIADH
Fluid overload
Low sodium
Pt safety, restore normal fluid balance, supportive care
Spinal cord compression
Pain Neuros Recognize and tx Corticosteroids decrease inflammation Radiation or surgery
Hypercalcemia
Bones dissolving
Superior vena cava syndrome
Pain
Life threatening
Result from blockage of venous return
Facial edema, erythema, death
Tumor lysis syndrome
End stage
Tissue damage
Kidney injury
Death
Which order should the nurse implement first
Feed clear liquid diet
Apply stockings
Admin D51/2NS
Obtain labs
C
What is the expected outcome related to hair loss undergoing chemo
Hair loss may be permanent
Viable txs exist
Hair regrowth begins 1 month after completion of chemo
New hair growth will likely be identical to previous hair
C
A patient receiving radiation for breast cancer is likely to experience which side effect
Fatigue
Mucositis
Hair loss
N/V
A
