cancer disorders Flashcards
1
Q
skin cancer most effective strategy for prevention
A
of skin cancer is avoidance or reduction of skin exposure to sunlight.
- easiest to prevent
2
Q
skin cancer types
A
Squamous cell (epidermis)
- Rough, scaly lesion with central ulceration and crusting
Basal cell
- looks like flesh, smally waxy nodules, can grow central ulceration
Malignant melanoma
- vary in color, moles that changed, itchy, cracked, 6mm size, fatal, red/white/blue, irregular shape, not good borders
3
Q
skin cancer disease prevention
A
- Limit exposure to sunlight, especially between 1000 and 1500.
- Apply sunscreen when near reflective surfaces (sand, snow, water, concrete).
- Use sunblock that has an SPF of at least 15/20, with both UVA and UVB protection, even in winter months
- Avoid indoor tanning (tanning beds, booths, sunlamps).
4
Q
skin cancer ABCDE: A
A
Asymmetry: One side does not match the other
5
Q
skin cancer ABCDE: B
A
Borders: Ragged, notched, irregular, or blurred edges
6
Q
skin cancer ABCDE: C
A
Color: Lack of uniformity in pigmentation (shades of tan, brown, or black)
7
Q
skin cancer ABCDE: D
A
Diameter: Width greater than 6 mm, or about the size of a pencil eraser or a pea
8
Q
skin cancer ABCDE: E
A
Evolving: Or change in appearance (shape, size, color, height, texture) or condition (bleeding, itching)
9
Q
skin cancer therpautic procedures
A
- Chemotherapy
Topical chemotherapy with 5‑fluorouracil cream - Interferon therapy
- Vemurafenib is an oral medication used for targeted therapy to treat melanoma.
- Radiation: shrink tumor cells w radioactive waves, localized bc it is dangerous
- Cryosurgery
- Curettage (scrapes cancer) and electrodessication
- Excision
1) operate
2) chemo
10
Q
Leukemias are cancers of white blood cells
Leukemias are divided into:
A
acute lymphocytic leukemia (ALL)
acute myelogenous leukemia (AML)
chronic lymphocytic leukemia (CLL)
- increase bleeding, infection, increase wbc
11
Q
Leukemia and Lymphomas are diagnosed with
A
imaging, biopsies, and blood work
- A CBC will show abnormal white blood cells with Leukemia
12
Q
cause of Leukemias and Lymphomas
A
- The goal of treatment is to eliminate all leukemic cells.
- The exact cause of leukemia is not known.
- Overgrowth of leukemic cells prevents growth of platelets, erythrocytes, mature leukocytes.
- Lack of mature leukocytes leads to immunosuppression.
13
Q
leading cause of death among clients who have leukemia.
A
- infection
- Lack of platelets increases the client’s risk of bleeding.
- Patients often present with abnormal brusing!
14
Q
Lymphomas are cancers of
A
lymphocytes and lymph nodes.
- Can metastasize to almost any organ
15
Q
Hodgkin’s lymphoma (HL) cause
A
Possible causes include viral infections and exposure to chemical agents.
- teens, young adults 40&50s
16
Q
Non‑Hodgkin’s lymphoma (NHL) cause
A
Possible causes include gene damage, viral infections, autoimmune disease, and exposure to radiation or toxic chemicals.
- negative for reed sternburg
17
Q
Lymphoma: Expected Findings
A
- Most clients experience an enlarged lymph node in the neck
- WBC can show leukemia
- Hemoglobin, hematocrit, and platelets decreased, patient will have brusing
- Coagulation time is increased with acute leukemia: Monitor for bleeding.
18
Q
Hodgkin’s lymphoma: expected findings
A
presence of Reed-Sternberg cells (cancerous B-lymphocytes)
19
Q
Non‑Hodgkin’s lymphoma: expected findings
A
any other lymph node malignancy
20
Q
Lymphoma: Nursing Care
A
- Monitor for evidence of infection.
- Implement neutropenic precautions
- Frequent, thorough hand hygiene is a priority intervention.
- Place the client in a private room.
- Monitor WBC.
- lungs, no crackles, cough
- no uti, olguira
- skin for cuts, puss
21
Q
Leukemia and Lymphoma Treatment
A
Chemotherapy
Radiation
Bone Marrow Transplant
22
Q
Chemotherapy complications
A
- Pancytopenia: blood count decreased
- Thrombocytopenia: decreased platelets
- Hypoxemia: hemoglobin goes down, not enough 02 b/c decreased rbc, conserve energy, and 02 consumption, rest, no activity, eat diet high in carbs, proteins, rbc transfusion
23
Q
Prognosis of lung cancer is
A
poor because it is often diagnosed in an advanced stage, when metastasis has occurred.
Palliative care is often the focus at the advanced stage (III, IV).
24
Q
Small cell lung cancer (SCLC) is
A
fast-growing and is consistently linked to a history of cigarette smoking.
25
Lung Cancer: Clinical Findings
- Orthopnea
- Chronic cough
- Chronic dyspnea
- Chest wall pain
- Fatigue, weight loss, or anorexia
- Fever
- Hoarseness
- Altered breath sounds (wheezing)
- Diminished or absent breath sounds
- Chest pain or tightness
- Muffled heart sounds
- Pleural friction rub
- Clubbing of fingers
- Increased work of breathing
- Decreased bone density
26
Lung Cancer: Nursing Care
- Determine the pack-year history for clients who smoke. Encourage cessation!
- Ask about exposure to secondhand smoke.
- Monitor for a cough that changes in pattern.
- Monitor nutritional status, weight loss, and anorexia.
- Promote adequate nutrition of infection.
- Maintain a patent airway and suction as needed.
- Position the client in Fowler’s position to maximize ventilation.
- Encourage the client to take rest periods as needed.
- Provide information for psychosocial support.
27
Lung Cancer: Treatment
- Chemotherapy
- Radiation
- Surgery
- Palliative Measures
- Thoracentesis to ease breathing
- Laser therapy and photodynamic therapy to open airways blocked by tumors.
- Pericardiocentesis or pericardial window to improve cardiac function
- bronchodilators/steroids: help with inflammation
28
Colorectal Cancer
- Cancer of the rectum or colon.
- Most are adenocarcinoma occurs in stages from 0 to IV.
- The most common location of CRC is the rectosigmoidal region.
- surgery very affective
29
CRC can metastasize to the
liver (most common site), lungs, brain, or bones.
- Spreading can occur as a result of peritoneal seeding (during surgical resection of tumor).
30
Colorectal Cancer: Risks
- More common in women; rectal cancer is more common in men.
- Adenomatous colon polyps
- African American descent
- Inflammatory bowel disease (ulcerative colitis, Crohn’s disease)
- High-fat, low-fiber diet
- Age older than 50 years
- Long-term smoking & Heavy alcohol consumption
- Infection exposure to Helicobacter pylori
- History of breast, ovarian, or endometrial cancer
31
Colorectal Cancer: Expected Findings
- Changes in stool consistency or shape
- Blood in stool (many times the only finding)
- Cramps and/or gas
- Palpable mass (elicited by provider only through abdominal palpation or digital rectal exam)
- Weight loss and fatigue
- Vomiting
- Abdominal fullness, distention or pain
- Abnormal bowel sounds indicative of obstruction (high-pitched tinkling bowel sounds)
- Fecal occult blood testing (FOBT) (over 50)
+ Test should be done EVERY YEAR (ANUALLY)
+ Two positive stools within 3 days
32
Colorectal Cancer: Diagnosing
Biopsy is definitive diagnosis
Endoscopy: colonoscopy (10y), sigmoidoscopy (5y)
- Visualization of polyps or lesions
- Recommend screening between ages 50 and 75
- Colonoscopy every 10 years
- Sigmoidoscopy every 5 years
Carcinoembryonic antigen (CEA) (send blood)
- Positive denotes malignancy
33
Colorectal Cancer: Procedures: Colectomy
- Involves the removal of a portion of the colon to excise the tumor.
- The remaining colon can be reconnected by (end-to-end) anastomosis or a colostomy or ileostomy can be created (temporary or permanent).
- Review care and assessment of Ostomies!
34
when is chemo and radiation given for colorectal cancer
stage 4
35
Pancreatic Cancer
Has a high mortality rate.
Five year survival rates are low
difficult to treat
painful
36
pancreatic s/s
Pain that radiates to the back and is more severe at night
Fatigue
Anorexia/ Weight loss
Puritus
Palpable abdominal mass, enlarged gallbladder and liver
Hepatomegaly
Jaundice (late finding)
Clay colored stools
Dark, frothy urine
Ascites
Pruritus (buildup of bile salt)
Early satiety or anorexia
37
Pancreatic Cancer: Nursing Care
Care usually focuses on palliation and not curative measures.
- Pain management is priority
- Advise client to ask for analgesics before the pain becomes severe.
- Monitor blood glucose and administer insulin as prescribed.
- A jejunostomy is placed to provide enteral feedings
- Provide nutritional support (enteral supplements, TPN). watch albumin and malnutrition
38
Liver Cancer
- Can originate in the liver or be a metastatic cancer that spreads from other organs to the liver
- Avoid excessive alcohol intake.
- Receive a hepatitis B vaccination.
- lung and pancreatic cancer can metasized this
39
risk factors for liver cancer
- Older age
- Cirrhosis
- Hemochromatosis (inability to breakdown iron)
- Male gender
- Tobacco use
- Mediterranean or Asian heritage (particularly Vietnamese)
- African American or Hispanic clients
40
liver cancer nursing care
- Observe for frank bleeding, decreased hemoglobin and hematocrit, altered coagulation findings.
- Administer blood products (packed red blood cells and fresh frozen plasma) Encourage the client to consume small, frequent meals that are high-calorie, moderate fat.
- Replace vitamins due to the inability of the liver to store them
- Restrict fluids for clients who have ascites.
- Instruct the client on the benefits of avoiding alcohol
- Measure abdominal girth daily (indicates increased ascites) over umbilicus, same place every time
41
liver cancer treatments
- Targeted therapy (sorafenib) (PO inhibitor): advanced, heart palpations, bleeding
Hepatic arterial infusion
- The direct infusion of chemotherapy via a catheter into the tumor.
- Instruct the client to watch for infection at the catheter site, hepatic toxicity (jaundice, liver function tests)
Tunneled abdominal drain
- Can be placed and used at home to remove excess ascetic fluid: no more than 1L at a time= shock
- Surgery
- Radiation: shrink, sensitive to it
42
Urinary Bladder Cancer
Bladder cancer is often described based on how far it invades the bladder wall.
43
Urinary Bladder Cancer risk
- Frequent contact with rubber, paint, or electric cable
- Inhalation of gas, fumes, or chemical compounds
- Tobacco use
- Male gender
- Chronic urinary tract inflammation
- Caucasian clients, male clients, and clients older than 55
44
urinary bladder cancer clinical findings
- Hematuria
- Dysuria, frequency, urgency
- Weight loss
- Anorexia
- Prepare the client for cystoscopy biopsy.
Bladder wash
- Presence of cancerous cells in saline “wash” solution (definitive diagnosis)
45
urinary bladder cancer treatment: systemic chemotherapy
Can be used alone or in combination with external beam radiation
46
urinary bladder cancer treatment: surgical interventions
Surface excision
Transurethral resection of bladder tumors
Partial cystectomy
Radical cystectomy
47
urinary bladder nursing actions
- Assist with management and client/family education related to urinary diversion.
- Provide adequate nutrition, priority after pain
- Monitor output from drains or catheters for expected color and amount.
- Notify the provider if urine is decreased or absent in a client who has an external pouch.
- Secure the client’s external drainage catheter.
- Notify the provider if it becomes dislodged or removed.
48
urinary bladder nursing actions: urine
- Instruct the client to self-catheterize and plan procedure at timed intervals since there is no sensation of bladder fullness
- Teach the client to monitor peristomal skin for redness, excoriation, or infection (ileal conduit, continent pouch). (meticulous skincare around device no urine leaking)
49
breast cancer: risk factors
- High genetic risk
- Inherited mutations of BRCA1 and BRCA2
- History of previous breast cancer
- Dense breast tissue
- Female gender
- Age over 65
- First-degree relative who has breast cancer
- Late menopause
- Childlessness or first pregnancy after age 30
- Excessive alcohol intake
- Cigarette smoking
- Exposure to low-level radiation
- Hormone replacement therapy
- Recent oral birth control use
- Obesity
- Early or prolonged use of oral contraceptives
- Early menarche
- metastasized to bone, brain, lung, liver
50
breast cancer: expected findings
- Breast change (appearance, texture, presence of lumps)
- Breast pain or soreness
- Skin changes
- Dimpling
- Breast tumors (usually small, irregularly shaped, firm, nontender, and nonmobile)
- Increased vascularity
- Nipple discharge
- Nipple retraction or ulceration
- Enlarged lymph nodes
51
Breast Cancer: Therapeutic Procedures
Ovarian ablation
Chemotherapy/radiation therapy
Surgical interventions
52
surgical intervention for breast cancer
- Lumpectomy (breast-conserving)
- Wide excision or partial mastectomy
- Total mastectomy
- Modified radical mastectomy (lymph nodes removed)
- Radical mastectomy (lymph nodes and muscle removed)
- Reconstructive surgery: body image
53
toremifene (tamoxifen and raloxifene) & docorubicin
- Used in high risk for breast cancer or who have advanced breast cancer
- used for 5 years
- Suppress the growth of remaining cancer cells post mastectomy or lumpectomy
********Will cause hot flashes********
- Clients are usually given a combination of several medications (cyclophosphamide, doxorubicin, and fluorouracil)
- Multiple doses of doxorubicin can cause cardiomyopathy
54
breast cancer Hormone therapy
- Most effective in cancer cells with estrogen or progesterone receptors.
- Ovarian ablation: Luteinizing releasing hormone (LH-RH): leuprolide or goserelin
- Selective estrogen receptor modulators (SERMs)
Anastrozole
- It is taken by mouth.
- Common side effects include hot flashes, musculoskeletal pain, and nausea.
- early metapause state
55
ovarian cancer
- Epithelial tumors that grow on the surface of the ovaries
- Tumors grow quickly and are often bilateral.
- Metastases frequently occur before the primary ovarian malignancy is diagnosed.
- Leading cause of death from female reproductive cancers = poor prognosis
- The exact etiology of ovarian cancer is unknown.
56
Ovarian Cancer: Expected Findings
- Abdominal pain or swelling
- Abdominal discomfort (dyspepsia, indigestion, gas, distention)
- Abdominal mass
- Urinary frequency
- Unexpected weight loss
- Vaginal bleeding
- Urinary frequency or incontinence
57
ovarian cancer, chemotherapy and surgery
- Chemotherapy is always given for ovarian cancer, even if surgery was performed.
- Cisplatin and carboplatin are the most common chemotherapeutic medications used for ovarian cancer.
- Instruct the client to report findings of infection, including peritonitis.
- Monitor temperature, white blood cell (WBC) count, and absolute neutrophil count.
58
cervical cancer
- With proper screening, it can be detected early and treated with good results.
- Early cervical cancer is often undetected.
59
cervical cancer risk factors
- Infection with high-risk HPV types (strains 16 and 18), which is associated in 90% of cases
- Chronic cervical inflammation/infections
- Infection with HIV or other immunosuppressive disorder
- History of sexually transmitted infections
- Early sexual activity (before 18 years of age)
60
diagnostic procedures for cervical cancer
- Simultaneous PAP test and HPV testing improves the accuracy of the reading.
- An abnormal Pap requires additional testing= biopsy, hysterectomy: removal or cervic
s/s:
- pain before and after sex
- blood in urin e
- vaginal discharge/blood
61
Uterine/Endometrial Cancer risk factors
Most common gynecological cancer
- More common in older adult women
- Family history of endometrial or colorectal cancer
- Personal history of breast or ovarian cancer
- Diabetes
- Genetic mutation for HNPCC
- Obesity
- Use of tamoxifen to treat breast cancer
- Late menopause
62
Uterine/Endometrial Cancer EXPECTED FINDINGS
Irregular and/or postmenopausal bleeding
Low-back, abdominal, or low pelvic pain
63
Prostate Cancer
- Second most common type of cancer in men
- It is usually slow-growing: good survival rate
- Manifestations are often similar to those of benign prostatic hyperplasia.
64
diet for prostate cancer
diet low in animal fat and include omega-3 fatty acids (fish), fruits, and vegetables.
65
screenings for prostate cancer
- Discuss PSA screening with a provider after age 50
- Prostate specific antigen (PSA)
- Elevation (greater than 4 ng/mL) indicates possible prostate disease (not specific to carcinoma).
66
issues male will have with prostate cancer
urination
hesitancy
weak stream
urgency
issues incontinent @ night
infections
blood in urine
pain
weight decrease
residual urine
swollen lymph
67
prostate cancer hormone therapy
Leuprolide acetate, goserelin, triptorelin: luteinizing hormone-releasing hormone (LH-RH) agonists
and raditation
68
surgical intervention for prostate cancer
- Radical prostatectomy is the treatment of choice.
- Not likely to be beneficial if the cancer has spread to the lymph nodes, bones, or other organs.
- Involves the removal of the prostate gland, along with the seminal vesicles, the cuff at the bladder neck, and the regional lymph nodes.
- may need bladder irrigation don't until everything is clear
