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NSG 470 - Exam 3 > Cancer Lecture > Flashcards

Cancer Lecture Flashcards

1
Q

what is cancer?

A

group of disorders known as “malignancy”

abnormal cell proliferation –> mass (solid tumor) or invading hematologic system (liquid tumor)
- acquired thru genetic mutation, can destroy surrounding tissue, occurs anywhere

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2
Q

what is a benign tumor?

A

dont spead but can increase in size, presses on local structures (NOT cancerous/malignant)

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3
Q

what is carcinogenesis?

A

malignant transformation of normal cells –> cancer cells

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4
Q

what is dysplasia?

A

“precancerous with risk of becoming cancerous

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5
Q

most common cancers in males?

A
  1. prostate (29%)
  2. lung/bronchus (12%)
  3. urinary bladder (8%)
  4. melanoma
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6
Q

most common cancers in females?

A
  1. breast (31%)
  2. lung (13%)
  3. colon/rectum (8%)
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7
Q

cancer that causes most deaths?

A
  1. lung (male/female - 21%)
  2. prostate (11%)
  3. breast (female - 15%)
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8
Q

what are risk factors for developing cancer? (17)

A

**tobacco/smoking - leading cause of lung cancer
- diet/obesity/lack of physical activity - high fat/calorie/meats
- genetics
- occupational/environmental - asbestos, pesticides, formaldehydes, arsenic, soot, tar
- infectious agents - ebstein-barr, hep B, HPB, HIV
- age
- gender
- race
- sunlight
- immune function
- chronic irritation/tissue trauma
- alcohol
- sexual lifestyle
- socioeconomic
- geographic location
- hormones

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9
Q

CAUTION (major warning signs)

A

C - changes in bowel/bladder
A - a sore that doesn’t heal
U - unusual bleeding/discharge
T - thickening/lump
I - indigestion/difficulty swallowing
O - obvious change in wart/mole
N - nagging cough/hoarseness

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10
Q

signs/symptoms of cancer

A

General: night sweats, fever, weight loss, fatigue, weakness, cachexia

Neuro: unrelenting HA, vision changes, paresthesia, slurred speech, seizures

Pain: unrelenting/worsening

New lumps/bumps

Lung: new/worsening SOB, hemoptysis

GI: loss of appetite, B/V, abdominal distention

GU: enlarged prostate s/s (slow stream, diffic

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11
Q

signs/symptoms of cancer

A

General: night sweats, fever, weight loss, fatigue, weakness, cachexia

Neuro: unrelenting HA, vision changes, paresthesia, slurred speech, seizures

Pain: unrelenting/worsening

New lumps/bumps

Lung: new/worsening SOB, hemoptysis

GI: loss of appetite, B/V, abdominal distention

GU: enlarged prostate s/s (slow stream, difficulty, stream stops/starts

Heme: bruising/bleeding, new DVT/PE

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12
Q

what is the breast cancer screening?

A

mammogram (self breast exam)
starts age 40; earlier if high risk

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13
Q

cervical cancer screening

A

pap test, +/- HPV DNA
starts at 21

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14
Q

what is the colorectal cancer screening?

A

starts at 45
flexible sigmoidoscopy
colonoscopy
gFOBT or FIT
multi-targeted stool DNA test (MT-SDNA)

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15
Q

what is the lung cancer screening?

A

low dose CT scan annually
current/former smokers (quit within past 15 years, ages 55-74, 30 pack year or more)

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16
Q

what is the prostate cancer screening?

A

digital rectal exam (DRE) and PSA (prostate specific antigen)
starts at 50, age 45 for African American males

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17
Q

purpose of imaging studies?

A

detects tumor, lymph nodes, metastases
used for staging
typically multiple scans (mammogram, CT scan, MRI, ultrasound, bone scan, PET/CT scan

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18
Q

what is the purpose of a biopsy/types?

A

*tissue needed to tell tumor type/confirm if malignant

needle biopsy
fine needle aspirate (FNA): cells ONLY
core needle: “core” tissue; includes bone marrow biopsy

excisional: used for small accessible tumor (palpable lymph node)

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19
Q

what is the nurse role in pre-biopsy?

A

patient/family education on procedure
- NPO, restrict fluids, light breakfast
- hold blood thinners
- meds to hold/timing
- manage pt/family anxiety
- provide teaching hand outs

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20
Q

what is the nurse role day of the procedure? (biopsy)

A

admin pre-procedure meds
- positioning
- monitoring
- provide safe environment
- assist pt/fam anxiety
- post-procedure instructions

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21
Q

what is the nurse role in post procedure? (biopsy)

A

phone call follow up with pt

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22
Q

what are the stages of solid tumors?

A
  • based on imaging/pathology results
    T = tumor size, extent of local invasion
    N = lymph node involvement
    M = metastases

Stages:
o - carcinoma in situ (precancerous)
I - early stage
II
III
IV - metastatic

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23
Q

what is TNM staging?

A

T - extent of primary tumor
N - absence/presence + extent of regional lymph node metastasis
M - absence/presence of distant metastasis

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24
Q

what is primary tumor (T) staging?

A

Tx - primary tumor cant be assessed
T0 - no evidence of primary tumor
Tis - carcinoma in situ
T1, T2, T3, T4 - increasing size and/local extent of primary tumor

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25
Q

what is regional lymph node (N) staging?

A

Nx - regional lymph node cannot be assessed
N0 - no regional lymph node metastasis
N1, N2, N3 increasing involvement

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26
Q

what is distant metastasis staging (M)?

A

Mx - distant metastasis cant be assessed
M0 - no distant metastasis
M1 - distant metastasis

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27
Q

what is cancer grading and differentation?

A

G1 - well differentiated (better prognosis)
G2 - moderately differentiated
G3 - poorly differentiated
G4 - undifferentiated (more aggressive)

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28
Q

what is metastasis?

A

cancer cell breaks off from original tumor/travels to blood/lymph to grow in other parts of the body
**always named based on origination site

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29
Q

what is leukemia?

A

cancer of WBC

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30
Q

what is lymphoma?

A

cancer of lymph cells

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31
Q

what is multiple myeloma?

A

cancer of plasma cells

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32
Q

what are the goals of cancer therapy?

A

prevention, cure, control, palliation

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33
Q

what is the management of cancer?

A
  • based on pt’s beliefs/goals
    **MAINTAIN QUALITY OF LIFE
  • tx options not finalized until staging is complete
  • guided by age, pregnancy, current state of health
  • collaborate w/ other disciplines
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34
Q

what are the possible treatment modalities?

A

surgery
chemo
radiation
HSCT (stem cell)
immunotherapy
hormonal therapy
targeted therapy

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35
Q

treatment terms

A

neoadjuvant: tx given PRIOR to surgery
adjuvant: tx given AFTER primary therapy (ex. surgery)
maintenance: if pt is responsive to tx (no progression/recurrence) may be kept for extended periods

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36
Q

what are the different surgeries for cancer tx?

A

en bloc resection: complete removal of tumor, localized lymph nodes/adjacent involved tissue

open (full incision): if minimally invasive unsafe –> convert to open

minimally invasive: laparascopic, VATS (vide assisted thoracic surgery), robotic - lungs, abdomen, pelvis

metastectomy: removing metastatic lesions for cure

sentinel lymph node (SLN) mapping - used for preop breast cancer/melanoma

lymph node dissection (LND) - removing locan LNs which drain from tumor (lymphadenectomy)

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37
Q

what is the nurse’s role with surgery?

A

ERAS (enhanced recovery after surgery)
- safe environment
- hold blood thinners
- prev/tx pain, N/V, constipation, early ambulation
- teaching: drains, ostomies, wounds, implanted devices
- prev post op complications: infection, electrolyte imbalances, hemorrhage, ileus, embolism, O2, shock
- involve other disciplines (PT, OT, SW)

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38
Q

what is radiation therapy/how is it used?

A

targets tissues/destroys cells using ionizing radiation (alters DNA of maligant + healthy cells BUT ONLY IN FIELD RADIATION GIVEN)

  • most actively dividing cells affected
  • localized tx

used to:
- cure/control cancer
- prior to surgery to dec size
- to control symptoms
- prophylactically
- emergencies (SC compression, bronchial obstruction , SVC syndrome)

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39
Q

external beam radiation therapy (EBRT) types

A

traditional: multiple beams, several weeks of daily dosing, allows healthy tissue to repair + better cell kill

stereotactic body RT (SBRT) or RS: one small target but high dose, fewer doses but in larger fractions

**PT is NOT radioactive

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40
Q

internal radiation therapy (brachytherapy)

A

radioactive seeds placed within/next tumor (uterus or chest)
**PT IS RADIOACTIVE
may be placed in a sealed room

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41
Q

what are the common side effects of radiation?

A

general: fatigue, skin changes, hair loss @ site

sites of RT:
brain - memory/concentration issues, N/V, HA
head/neck: mucositis, dysphagia (pain, dry, tight), taste changes, hypothyroid
breast: swollen, tender
chest: mucositis (esophagus), dysphagia, cough, dyspnea
stomach/abdomen: N/V, diarrhea, urinary/bladder
pelvis/rectum: diarrhea, sexual/fertility problems, urinary/bladder

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42
Q

what is the nurse role in EBRT?

A

monitor skin or radiodermatitis: redness, blanching, sloughing, ulceration

monitor oral cavity: mucositis, xerostomia, change in taste

monitor for dysphagia, N/V, anorexia, diarrhea

bone marrow suppression: dec WBC, neutrophils, RBC, platelets, infection/bleeding

pneumonitis: dyspnea, cough

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43
Q

what is the pt education for EBRT?

A

S/E of dysgeusia (altered taste), skin damage, avoid sun, use of powders, deodorant, lotions in skin is irritated

mucositis: avoid spicy, salty, acidic, temp of food should NOT be spicy

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44
Q

what is the pt education for brachytherapy?

A

**PT/BODILY FLUIDS ARE RADIOACTIVE
must call when using bathroom
explain apron, visitation, distancing

explain specific position during tx
distance - at least 6 ft

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45
Q

what is the nurse role for brachytherapy?

A

**PT/BODILY FLUIDS ARE RADIOACTIVE
- place in private room with door closed
- dosimeter badge (records radiation exposure)
- limit visitors (6 ft)
- pregnant or 16 yrs or younger NOT permitted to enter
- keep lead container in room

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46
Q

what is chemotherapy?

A

goals: cure, control, palliate
*cytotoxic meds that damage cell’s DNA + destroys rapidly dividing cells

classified based on MOA in relation to cell cycle

tx systemic disease - cancer that has spread
given neoadjuvant, adjuvant or primate (leukemia or stage IV)

dosage based on TBA - dec for renal function, liver, age, comorbidities
some have a lifetime max dose due to irreversible organ toxicity (ex Doxurubicin - cardiac)

**wear proper PPE, dispose in YELLOW BINS
have a spill kit

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47
Q

what is extravasation?

A

leakage of chemo into tissue from vein
causes mild to severe damage

irritants - localized irritation
vesicants - inflammation, tissue damage, can cause necrosis

dactonomycin, daunorubicin, doxorubicin, nitrogen mustard, mitomycin, vinblastine, vincristine - GIVE THROUGH CENTRAL LINE

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48
Q

what are the nursing interventions for extravasation?

A

must be trained
STOP CHEMO if occurs
get extravasation kit with antidotes

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49
Q

catheters used for cancer patients

A

mediport or port-a-cath: implanted device used for long term med admin (accessed through Huber needle - 90 deg.)

PICC line

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50
Q

hypersensitivity reactions

A

typically occur during infusion
s/s: rash, urticaria, fever, hypotension, dyspnea, wheezing, throat tightness, syncope, cardiac arrest

nursing: recognize s/s, *turn off infusion**, give meds (steroids, epi, benadryl)

**pre meds given prior can cause HSR

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51
Q

what are chemotherapy toxicity s/s?

A

fatigue, generalized weakness
**bone marrow - immunosuppression
- dec WBC + neutrophils (neutropenia)
- dec RBC + PLTs (anemia, thrombocytopenia)
renal toxicity - hemorrhagic cystitis, tumor lysis syndrome
cardiopulmonary - reduced EF, pneumonitis
epithelial cells lining GI - N/V, stomatitis, mucositis, diarrhea
hair - alopecia
neurotoxicity - peripheral neuropathy, cognitive impairment
infertility - dec sperm count, abnorm menses/early menopause

52
Q

what are nursing interventions/teaching for chemotherapy

A

PPE
monitor: labs (CBC, CMP), infection/bleeding, SE or toxicities
assess: lung, heart, abdomen, skin, neuro, peripheral
teach: SE when to call provider, anti nausea meds, diet (small freq meals, bland foods, fluids)

**handling body fluids

53
Q

how to safely handle chemo?

A

remains in body for 3-7 days (urine, semen, stool, vaginal secretions)
- if comes in contact –> wash with soap + water immediately
- caretakers: wear gloves
- flush toilet immediately, twice if children/pets (close lid)
- double bag any soiled pads/diapers
- wash linens w/ body fluids (ASAP) - wash 2x

54
Q

what is the nurse’s role in immunosuppression/neutropenia?

A

**report neutril count >1000
**report temp >=100.4 F or 38 C

monitor: skin/mucous membranes
admin GCSF to stim WBC production
obtain cultures PRIOR TO antibiotics

55
Q

what is the pt edu in immunosuppression/neutropenia?

A

**take temp daily
call for s/s of infection
avoid crowds, wear mask, sick people
freq. hand hygiene
low microbial diet: AVOID fresh fruit/veg, fish/meat
no digging in soil/changing litter
dont consume beverages/food that have been left out for over an hour
wash dishes + toothbrush daily

56
Q

neutropenia: fever mgmt

A

culture: urine + blood (2 sets, different sites), stool (C. diff), skin lesions, VAD, throat/nasopharynx

57
Q

what are neutropenic precautions?

A

**if pt ANC <1000

private room
wear mask outside of room
no live plants/flowers
freq hand wash
no visitors
no invasive procedures
keep necessary equipment in room

58
Q

nursing role/education for N/V, anorexia?

A

NR: admin antiemetics (days before), remove odors, offer alternatives (relax), admin appetite induce (Magestrol, Marinol), assess nutritional imbalances, perform oral care

education: freq, small meals, low fat + bland food (soups), cold foods, high protein + calorie dense foods, use plastic ware, food journal

59
Q

nursing role/education for alopecia?

A

NR: temporary, hair will grow back differently, can affect entire body

education: can begin 7 days after, avoid damaging hair, protect scalp from sun/heat/cold

60
Q

what is mucositis?

A

inflammation in the mucous lining of the upper GI tract from the mouth to the stomach

61
Q

what is stomatitis?

A

inflammation of tissues in the oral cavity, such as gums, tongue, roof of the mouth, lips and cheeks

62
Q

what is esophagitis?

A

inflammation of esophagus usually from radiation therapy

63
Q

med admin - oral effects

A

candidiasis - antifungal + mycostatin
pain - BMX solution 4x prior to meal/bedtime

64
Q

what is the nursing intervention for thrombocytopenia?

A

monitor: petechiae, ecchymosis, bleeding, platelets
bleeding precautions
avoid IVs/injections if possible
transfuse for PLTS (>50K)
USE electric razors, soft toothbrush

65
Q

what is the nursing intervention for anemia?

A

monitor: fatigue, pallor, dizziness, SOB, syncope, HGB
rest periods b/t activities
conserve energy
admin anti anemia (darbapoietin alpha)
transfuse PRBCs

66
Q

nursing intervention for chemotherapy induced peripheral neuropathy?

A

numbness/tingling, loss of motor function, may require dose reduction, chronic issue

NR: if severe may NOT feel hot/cold pressure, difficulty driving

education: fall prevention, possible erectile dysfunction, inspect feet daily, DONT drive if unable to feel

67
Q

hematopoietic Stem Cell Transplant (HTSC)

A

allogeneic: donor stem cells (tx - leukemia)

autologous: own stem cells (tx - lymphoma/myeloma), need healthy bone marrow

**long time for engraftment/growth of new cell –> prolonged neutropenia, thrombocytopenia, anemia

complications:
(BEFORE) infection, sepsis, bleeding, alopecia, electrolyte imbalance, acute kidney injury

(AFTER) graft v host, acute - 1st 100, chronic - after 100 days

68
Q

prostate cancer: hormone therapy

A

GOAL: block testosterone production

gonadotropic-releasing hormone AGONISTS
(Leuprolide, Zoladex, Goserelin)

androgen blockers (anti-androgen) - block testosterone @ receptor site (Bicalutamide, Flutamide, Nilutamide)

gonatotropin-releasing antagonists - **immediate suppression (Degarelix)

**SE: hot flashes, dec libido, erectile dysfunction, gynecomastia, dec bone density, muscle mass
NR: monitor lab (liver tox), teach safety precautions for falls, warn about SE

69
Q

breast cancer: hormone therapy

A

estrogen receptor blockers - stops growth of breast cancer cells that are estrogen dependent (Tamoxifen, Raloxifene, Toremifene)
complications: endometrial cancer, hypercalcemia, N/V, DVT/PE/Stroke, hot flashes

aromatase inhibitors - blocks estrogen production (post menopausal women) - (Anastrazole, Letrozole, Exemestane)
complications: muscle/joint pain, HA, nausea, vaginal bleeding, risk of osteoporosis, hot flashes, dec blood flow to heart

Monoclonal AB (Trastuzumab) - targets breast cancer cells, tx metastatic breast cancer
ONLY effective agent against tumors HER2 pos
complications: flu-like symptoms, cardiac tox (tachy, HF, pulmonary HTN)

NR: monitor F/E, calcium, ECG, osteoporosis precautions (safety, weight bearing exercises), cholesterol (MI risk)

70
Q

what is immunotherapy?

A

gets immune system to work better against cancer cells

vaccines: HPV (cervical cancer)
checkpoint inhibitors: block receptors on cells that allow T cells to remain “turned on”, finds and kills tumor cells
SE: inflammation
tx: high dose steroids

other: BCG, interferon, interleukin 2, T cell transfer therapy

71
Q

what is targeted therapy?

A

agents that kill/prev spread of cancer cells by targeting specific molecules

Cons: acquired resistance
common SE: skin/hair/nail changes, hand-foot syndrome, mucositis, HTN, hyperglycemia, hypothyroidism, N/V, diarrhea, fatigue

**Diarrhea should NOT be tx with meds until C. diff is ruled out

72
Q

targeted therapy: monoclonal antibodies

A

given IV
end in “ab”
SE: infusion reaction (pre medicate), rash, flu-like s/s, N/V, edema, hypo/hyper tension, tumor lysis syndrome (Rituximab), VTE (Bevacizumab)

NR: monitor labs, skin changes, rashes, vs, edema, teach sun protection

report: abnormal labs, vitals, bleeding, infection, dyspnea, new swell

73
Q

neuropathic pain

A

nerve damage
numb, tingling, shooting, burning, radiating

74
Q

visceral/deep pain

A

in internal organs
difficulty to identify
deep, sharp

75
Q

somatic pain

A

bone/connective tissue
localized sharp, dull, throbbing

76
Q

pain mgmt

A

Non-opioids/NSAIDS
opioids
antidepressants, anticonvulsants
corticosteroids
muscle relaxants
systemic local anesthetics
tens units
relaxation, imagery, distraction
heat/cold
massage, vibration, hypnosis, acupuncture, hypnosis
support groups

77
Q

pain mgmt: non-opioids/NSAIDs

A

APAP (acetaminophen)
ASA (acetylsalicylic acid)
ibuprofen
Celebrex (celecoxib)
ketorolac

MILD TO MODERATE PAIN

monitor: GI upset/bleed, bruising, bleeding, tinnitus, CV status

education: liver health, no more than 3-4g/day, take with food, dont crush/chew, watch for bleeding, drink fluids

78
Q

pain mgmt: opioids

A

morphine
fentanyl
hydromorphone

MODERATE TO SEVERE PAIN, BREAKTHROUGH, ADDICTIVE

79
Q

pain mgmt: opioids

A

morphine
fentanyl
hydromorphone

MODERATE TO SEVERE PAIN, BREAKTHROUGH, ADDICTIVE

monitor: constipation, urinary retention, orthostatic hypotension, N/V, sedation, respiratory depression

education: take stool softener/laxative, don’t consume alcohol, rise slowly from sitting position, make dietary changes to prevent constipation

**NAXOLENE ON STANDBY

80
Q

what is superior vena cava syndrome (SVC)?

A

compression/invasion of SVC by tumor, lymph nodes; causes obstruction of venous drainage from head, neck, arms, chest

complication: lack of O2 to brain, laryngeal swelling, bronchial obstruction/death

s/s: SOB, cough, hoarseness, chest pain, swelling of face/neck/chest/arms
signs: engorged veins of chest, neck, arms**

dx: physical exam/CT

81
Q

what is SVC mgmt?

A

radiation therapy - shrink tumor/lymph nodes, relieves symptoms
chemotherapy - if lymphoma/small cell lung cancer
anticoagulants - if thrombus

supportive care: *steroids, O2, diuretics
nursing: semi fowlers, avoid BP/venipuncture to upper extremities, monitor I/Os to avoid fluid overload

82
Q

what is spinal cord compression?

A

tumor compressing the spinal cord/nerve roots
- primary SC tumor (intramedullary)
- metastasis of paravertebral tissue/vertebrae (extramedullary) - most commonly from lung, breast, prostate, lymphoma

s/s: **PAIN that radiates in band like fashion (chest or abdomen), motor/sensory loss (weakness/numbing/tingling), bladder/bowel dysfunction, tenderness w/ percussion at tumor site

83
Q

how is spinal cord compression diagnosed?

A

MRI (gold standard)
- CT and bone scan

84
Q

what are spinal cord compression nursing interventions?

A

monitor for neuro changes (urinary/bowel incontinence/retention)

pain mgmt/assessments

ROM exercises

prev immobilility complications (pressure ulcer, skin breakdown, VTE, pneumonia)

intermittent straight cath education

psychosocial support

referrals for discharge

85
Q

hypercalcemia

A

more calcium released from bones that kidneys can excrete/bones reabsorb
- mostly: multiple myeloma, breast, lung, prostate
s/s:** severe muscle weakness, fatigue, confusion, N/V, constipation, dehydration, inc urination, arrthymias

dx: Calcium > 10.4 usually no s/s until 12+

86
Q

how is hypercalcemia managed?

A

**hydration/IV therapy w/ NS (may need diuretics for fluid retention)

**biphosphate therapy immediately (Zolendronic Avid - Zometa) IV over 15 mins
- adjust dose for renal function

calcitonin
tx underlying cause
long term: may need continuous biphosphate therapy, avoid (thiazide, diuretics, NSAIDs, Calcium supplements)

nursing: IV access, admin fluids (IV/oral), anti-emetics, stool softener/laxative, monitor blood work, F/E imbalances, neurological changes, mobilization/weight bearing exercises

87
Q

what is tumor lysis syndrome?

A

rapid cell lysis that results from treatment in tumor cells that rapidly grow (leukemia, lymphoma, small cell lung cancer)

release of intracellular products from cell lysis into circulation leads to rapid development of electrolyte abnormalities (hyperkalemia, hyperphos, hypocalcemia)

no treatment: **acute renal failure, multiple organ failure, cardiac arrhythmia + death

88
Q

tumor lysis syndrome diagnostics

A

K+ > 5.0

usually 24-48 hrs after tx
uric acid > 10 (hyperuricemia)
phosphate > 5 (hyperphosphatemia)
Ca2+ < 8.7 (hypocalcemia)

89
Q

what are the s/s of tumor lysis syndrome?

A

early signs: N/V, paresthesia, muscle weakness, syncope, lethargy, inc bowel sounds, diarrhea, htn, EKG changes, pain, fatigue
**earliest: hyperkalemia (6-72 hrs after tx)

late: syncope, anuria/acute renal failure, seizures, laryngospasm w/ stridor, tetany, arrythmia/cardiac arrest

90
Q

what is the treatment of tumor lysis syndrome?

A

**early detection, prevention in cancers (hematologic malignancies)
**oral allopurinol (24-48 hrs BEFORE chemo + after)
**aggressive hydration
- diuresis if inadequate urine output

NR: monitor s/s, risk factors, VS, F/E, I/O, cardiac status, education

91
Q

other emergent situations

A

brain metastates: inc ICP due to inc vol within cranial vault (tumor/swelling/hemorrhage)
tx: steroids!!, surgery, radiation
s/s: HA, N/V, vision changes, motor/sensory changes (weakness/paralysis)

sepsis: fever neutropenia, shock s/s

hemorrhage: thrombocytopenia, shock s/s

VTE/PE: malignancy –> hypercoagulable = clots

92
Q

breast cancer

A

affects men (rare)/women

second leading cause of cancer death in women (1st = lung)

triple neg cancer: aggressive, cells lack estrogen, progesterone + HER2 (normal gene for cell replication)

metastasis common to bone, lung, brain, liver

93
Q

what are the breast cancer screening recs?

A

monthly self breast exam + provider (yearly)
MRI/Ultrasound - high risk pt

average risk:
40 - 44: option to start
**45 - 54: should have it yearly
ages 55 & older: every 1-2 yrs based on choice

HIGH RISK: mammogram + MRI annually starting at 30
- BRCA1 or BRCA2 gene
- 1st degree relative w/ gene
- radiation to chest prior 30

94
Q

breast cancer risk factors

A

high genetic risk
hx of prior breast cancer/benign breast disease
dense breast
1st degree relative
prior radiation
early menarche
late menopause
nulliparity or 1st child after age 30
hormone therapy after menopause (estrogen only HRT)

95
Q

what are the s/s of breast cancer?

A

lump or thickening near the breast or axilla
asymmetry
inward nipple
fluid other than breast milk (bloody)
scaly, red, or swollen skin or areola
dimple in breast that looks like orange (peau d’orange)

96
Q

what will tumor sample be tested for?

A

ER (estrogen receptor), PR (progesterone receptor), and HER2 status (human epidermal growth factor receptor 2)
- tumor type/grade
- lymph nodes

97
Q

what is a sentinel lymph node biopsy (SLNB)?

A

first LN to which cancer cells are most likely to drain to from a primary tumor

(+) = cancer is present, may have spread to nearby lymph nodes
radioactive substance injected to find “hottest” LN

  • used in breast cancer/melanoma
98
Q

SLNB and LN dissection

A

site of dissection: internal mammary or axillary lymph nodes

benefits: if neg, no further surgery
complications:
- lymphedema: if numerous removed (20-40), build up of fluid in tissue
- skin thickens, hard, red, tender
- infection risks
- may need PT for lymphedema

99
Q

what are the types of breast cancer?

A

ductal carcinoma in situ (DCIS) - abnorm cells in milk duct, (early stage/precancerous)
- infiltrates tissue –> invasive/infiltrating ductal carcinoma

lobular carcinoma in situ (LCIS) - abnorm cells in milk-producing glands, (early stage/precancerous)
- infiltrates tissue –> lobular carcinoma (both breasts)

adenocarcinoma - starts in breast tissue

triple neg breast cancer (ER neg, PR neg, HER2 neg) - more aggressive

inflammatory breast cancer - aggressive, breast appears inflamed, tender, swollen
- may not see in mammogram; only 1-5%

100
Q

what are the types of surgery for breast cancer?

A

lumpectomy - only lump removed, breast appears “normal”, may require post operative radiation, goal is breast preservation/cure

total mastectomy - entire breast + possibly SLNB removal of one/more LN, may require radiation/chemo/targeted tx

modified radical mastectomy - all axillary LN and breast removed, may require radiation/chemo/targeted tx

101
Q

breast cancer surgery nursing intervention/education

A

elevate HOB postop
lie on unaffected side, pillows on surgical side
surgical arm in sling
DONT give injections, BP or obtain blood from affected arm
emotional support
monitor drainage/surgery site
educate on prosthesis/bras

edu: supportive sleeve, some numbness is norm, perform arm exercises, never have affected arm dependent, non restrictive clothes

102
Q

lymphedema mgmt

A

*goal: minimize swelling/prevent infection

  • avoid sunburns, SPF
  • insect repellent
  • use lotion/creams
  • dont cut cuticles (push back instead)
  • wear protective gloves
  • wear a thimble (sewing)
  • careful when shaving
  • okay to use affected arm but only minimally
103
Q

chemotherapy for breast cancer

A

Adjuvant neoadjuvant chemo drugs

  • Anthracyclines, such as doxorubicin (Adriamycin), Taxanes, such as paclitaxel (Taxol) and docetaxel (Taxotere), Carboplatin (Paraplatin)

Chemo drugs for metastatic breast cancer -
Taxanes, Anthracyclines: Doxorubicin (Adriamycin)
- Platinum agents (Cisplatin, carboplatin)

**HER2 Regimens (chemo + Trastuzumab)
- for HER 2 + tumors

Triple Negative Disease (chemo + immunotherapy)
- (ER/PR negative, HER2 negative)

104
Q

breast cancer: hormone therapy

A

Tamoxifen - redue risk of recurrence
- taken daily for 5-10 yrs
- inc risk of developing endometrial cancer, DVT, PE

aromatase inhibitors - dec estrogen made in tissue (ovaries not making estrogen)
- nastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara)
- pills daily for 5-10 yrs

105
Q

breast cancer prevention

A

healthy diet
timely mammogram
healthy weight
exercise
limit alcohol
avoid hormone replacement therapy/environmental estrogen
breastfeed (1 yrs)

106
Q

prostate cancer

A

most common cancer dx in men
2nd leading cause of cancer death
slow growing
manifests sim to BPH
*black men from US + caribbean = highest rates

107
Q

prostate cancer: risk factors

A

> 65
fam hx (BRCA1 or BRCA2)
unhealthy diet (high fat, complex carbs, low fiber)
obesity
rapid growth of prostate

108
Q

prostate cancer: s/s

A

most found through early screening - DRE and PSA

later: problems urinating, slow, weak urinary system, blood in urine/semen, erectile dysfunction, pain in hip, back, chest, weakness/numbness in legs/feet, swelling/ fluid buildup, cachexia, fatigue

109
Q

PSA

A

prostate specific antigen - protein prod by cells in prostate gland –> bloodstream
1.0 - 1.5 **
PSA can rise but can have norm PSA + still have cancer
used to monitor response to cancer tx

110
Q

prostate cancer diagnostics

A

PSA blood test

DRE (Digital Rectal Exam) - inserts gloved hand into rectum to feel irregularities

transrectal ultrasound (TRUS) + biopsy

staging scans: *bone scan, CT scan, MRI, PET/CT scan

111
Q

prostate cancer TNM staging

A

Stage IV:The cancer spread beyond the prostate.
Stage IVA:The cancer spread to the regional lymph nodes.
Stage IVB:The cancer spread to distant lymph nodes, other parts of the body, or to the bones.

112
Q

prostate cancer grade (Gleason scale)

A

Gleason score of 6 or –> well-differentiated or low-grade. (slow growing)
Gleason score of 7 –> moderately-differentiated or intermediate-grade.
Gleason scores of 8 to 10 –> called poorly-differentiated or high-grade. (most aggressive; risk for metastases)

113
Q

prostate cancer: tx options

A

Watchful waiting/active surveillance
Surgery
Radiation therapy
Hormone therapy
Chemotherapy
Targeted therapy
Immunotherapy
Bisphosphonate therapy—bone metastases

114
Q

prostate cancer: surgery

A

Radical prostatectomy: remove the prostate, surrounding tissue, and seminal vesicles.

Radical laparoscopic prostatectomy: incisions (cuts) are made in the wall of the abdomen. A laparoscope is inserted through one opening to guide the surgery.

Robot-assisted laparoscopic radical prostatectomy: regular laparoscopic prostatectomy

115
Q

prostate cancer: radiation therapy

A

external radiation therapy

brachytherapy (internal)

SE: increased urge to urinate or frequency; problems with sexual function; diarrhea, rectal discomfort, or rectal bleeding; fatigue. Most go away after treatment.

116
Q

prostate cancer: additional therapies

A

chemotherapy (docetaxel)

biphosphate therapy (clodronate or zoledronate (Zometa), reduce bone disease when cancer has spread to the bone.)

117
Q

prostate cancer: tx side effects

A

surgery - impotence, incontinence of urine/bladder/stool

radiation - impotence and urinary problems (rectal bleeding)

hormone therapy - hot flashes, impaired sexual function, weakened bones, diarrhea, nausea, itching

118
Q

survivor

A

any person with a history of cancer, from the time of diagnosis through the remainder of their life.

119
Q

survivorship

A

Begins at diagnosis of cancer and lasts until end of life

includes: monitoring for/treating late effects of cancer/tx

physical/vocational rehab

psychosupport/counseling

smoking cessation

coordination of care (influenza, pneumovax, shingles, echo, bone density)

120
Q

survivorship care

A

Watching for Recurrence
Managing long-term side effects
Treatment summary / Survivorship Care Plan
- (coordination of care between specialist and PMD)
Healthy Living
Second Cancers
Sexuality / Infertility

121
Q

survivorship plan

A

History of Cancer treatment
Persistent Effects
Possible Late Effects
Signs and symptoms to report
Wellness Plan
Future Cancer Screening

122
Q

supportive/palliative care

A
  • tx patient as whole
    manages symptoms
    address patient’s beliefs, goals (how to meet goals)

Medical Orders for Life-Sustaining Treatment (MOLST) - CPR, DNR, respiratory support etc.

123
Q

palliative v. hospice similarities

A

goal of both: provide better QoL + symptom relief, special care teams

hospice often includes palliative care

124
Q

palliative v. hospice differences

A

when:
palliative - any stage
hospice - last phase of incurable illness

what other care can be given:
palliative - can be provided while receiving active tx
hospice - no active or curative tx

what care team does:
palliative: separate from medical team
hospice: coordinates majority of care

125
Q

supportive care

A

psychosocial
- differentiate normal grief v. depression
- assess pt needs for info + decision making control
- includes cultural, religious, spiritual, financial, social, coping, sexuality

caregiver support
- communicate with family, pt, care providers
- allow person to express concerns, honor advanced directives, respect the person’s need for privacy

NSG 470 - Exam 3 (7 decks)

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