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Cancer Development Flashcards

1
Q

Grading Malignant Tumors

A

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

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2
Q

Staging of Cancer

A

(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

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3
Q

Breast metastasis

A

Bone
Brain
Lung
Liver

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4
Q

Lung metastasis

A 
Brain
Bone
Liver
Lymph
Pancreas
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5
Q

Colorectal metastasis

A

Liver

Lymph

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6
Q

Prostate metastasis

A

Bone

Pelvis

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7
Q

Melanoma metastasis

A

GI
Lymph
Lung
Brain

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8
Q

Brain metastasis

A

CNS

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9
Q

External factors

A

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

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10
Q

Cancers associated with tobacco, virus, genetics

A

Tobacco: lung, oral cavity, pharynx, larynx, esophagus, pancreas, uterus, kidney, bladder, liver, stomach
Virus: Epstein Barr, hep b & c, HPV, lymphotropic 1 & 2

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11
Q

Dietary habits to decrease cancer risk

A

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

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12
Q

CAUTION

A 
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
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13
Q

Primary prevention

A

Use of strategies

Avoid carcinogens, modify associated factors, remove at risk tissue, chemoprevention, vaccination

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14
Q

Secondary prevention

A 
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
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15
Q

Benign vs Malignant

A

Benign- harmless, doesn’t require intervention, doesn’t spread
Malignant- indicates cancer, serious and can lead to death without intervention

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16
Q

Pathophysiology of cancer cells

A

We’re once normal, underwent genetic mutations to no longer function normally

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17
Q

Hypertrophy vs Hyperplasia

A

Hypertrophy- increase in size by enlarging each cell

Hyperplasia- increase cell number

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18
Q

Cancer development

A

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

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19
Q

Primary vs Secondary tumors

A

Primary- identified by the tissue from which it arose

Secondary- cancer cells move from primary location, additional tumors, still a cancer from altered tissue

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20
Q

Cancer classification

A

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

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21
Q

Solid vs hematologic

A

Solid- specific tissues, breast and lung

Hematologic- arise from blood cell forming tissues, leukemias and lymphomas

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22
Q

Which pathologic description of a clients to,or does the nurse interpret as being the most malignant or high grade cancer

A

Undifferentiated, mitotic index 50%, aneuploid

23
Q

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

A

1 in every 3

24
Q

The nurse understands that normal cells and benign cells share which characteristics

A

No migration
Orderly growth
Tight adherence
Specific morphology

25
An example of a primary prevention strategy for reducing cancer is
Regular physical exercise
26
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
27
Surgery as Treatment
Oldest form of tax Removal of diseased tissue Prolong survival time and improve QOL
28
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
29
Radiation therapy
Purpose is to destroy CA cells with minimal damaging effects of surrounding normal cells Local tx Cure, control or palliate disease
30
Exposure vs Radiation dose
Exposure- Amount of radiation delivered Radiation dose- Amount of radiation absorbed Dose > Exposure
31
Teletherapy
Delivered from source outside of patient | Radiation
32
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
33
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 ```
34
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 ```
35
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
36
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
37
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!!!
38
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 ```
39
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
40
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
41
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
42
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
43
Hormonal therapy
Prostate, breast, ovary Changes usual hormone response Decreasing hormone amounts can slow CA growth rates Doesn't cure
44
Side effects hormone therapy
``` Masculinity effects in women Femininity effects in men- gynecomastia Fluid retention Acne Hypercalcemia Liver dysfxn Venous thromboembolism ```
45
Sepsis
Risk for infection Decreased WBC impaired immune fxn Pg 392
46
Disseminated intravascular coagulation
Clotting problem Triggered by CA, viral or bacterial infections, gram - sepsis, life threatening, increased mortality, PREVENTION, anticoags, clotting factors
47
SIADH
Fluid overload Low sodium Pt safety, restore normal fluid balance, supportive care
48
Spinal cord compression
``` Pain Neuros Recognize and tx Corticosteroids decrease inflammation Radiation or surgery ```
49
Hypercalcemia
Bones dissolving
50
Superior vena cava syndrome
Pain Life threatening Result from blockage of venous return Facial edema, erythema, death
51
Tumor lysis syndrome
End stage Tissue damage Kidney injury Death
52
Which order should the nurse implement first
Feed clear liquid diet Apply stockings Admin D51/2NS Obtain labs C
53
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
54
A patient receiving radiation for breast cancer is likely to experience which side effect
Fatigue Mucositis Hair loss N/V A

Med Surg (11 decks)

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