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
2
Q
what is a benign tumor?
A
dont spead but can increase in size, presses on local structures (NOT cancerous/malignant)
3
Q
what is carcinogenesis?
A
malignant transformation of normal cells –> cancer cells
4
Q
what is dysplasia?
A
“precancerous with risk of becoming cancerous
5
Q
most common cancers in males?
A
- prostate (29%)
- lung/bronchus (12%)
- urinary bladder (8%)
- melanoma
6
Q
most common cancers in females?
A
- breast (31%)
- lung (13%)
- colon/rectum (8%)
7
Q
cancer that causes most deaths?
A
- lung (male/female - 21%)
- prostate (11%)
- breast (female - 15%)
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
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
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
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
12
Q
what is the breast cancer screening?
A
mammogram (self breast exam)
starts age 40; earlier if high risk
13
Q
cervical cancer screening
A
pap test, +/- HPV DNA
starts at 21
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)
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)
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
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
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)
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
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
21
Q
what is the nurse role in post procedure? (biopsy)
A
phone call follow up with pt
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
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
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
25
what is regional lymph node (N) staging?
Nx - regional lymph node cannot be assessed
N0 - no regional lymph node metastasis
N1, N2, N3 increasing involvement
26
what is distant metastasis staging (M)?
Mx - distant metastasis cant be assessed
M0 - no distant metastasis
M1 - distant metastasis
27
what is cancer grading and differentation?
G1 - well differentiated (better prognosis)
G2 - moderately differentiated
G3 - poorly differentiated
G4 - undifferentiated (more aggressive)
28
what is metastasis?
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
29
what is leukemia?
cancer of WBC
30
what is lymphoma?
cancer of lymph cells
31
what is multiple myeloma?
cancer of plasma cells
32
what are the goals of cancer therapy?
prevention, cure, control, palliation
33
what is the management of cancer?
- 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
34
what are the possible treatment modalities?
surgery
chemo
radiation
HSCT (stem cell)
immunotherapy
hormonal therapy
targeted therapy
35
treatment terms
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
36
what are the different surgeries for cancer tx?
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)
37
what is the nurse's role with surgery?
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)
38
what is radiation therapy/how is it used?
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)
39
external beam radiation therapy (EBRT) types
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
40
internal radiation therapy (brachytherapy)
radioactive seeds placed within/next tumor (uterus or chest)
**PT IS RADIOACTIVE
may be placed in a sealed room
41
what are the common side effects of radiation?
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
42
what is the nurse role in EBRT?
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
43
what is the pt education for EBRT?
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
44
what is the pt education for brachytherapy?
**PT/BODILY FLUIDS ARE RADIOACTIVE
must call when using bathroom
explain apron, visitation, distancing
explain specific position during tx
distance - at least 6 ft
45
what is the nurse role for brachytherapy?
**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
46
what is chemotherapy?
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
47
what is extravasation?
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
48
what are the nursing interventions for extravasation?
must be trained
STOP CHEMO if occurs
get extravasation kit with antidotes
49
catheters used for cancer patients
mediport or port-a-cath: implanted device used for long term med admin (accessed through Huber needle - 90 deg.)
PICC line
50
hypersensitivity reactions
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
51
what are chemotherapy toxicity s/s?
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
what are nursing interventions/teaching for chemotherapy
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
how to safely handle chemo?
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
what is the nurse's role in immunosuppression/neutropenia?
**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
what is the pt edu in immunosuppression/neutropenia?
**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
neutropenia: fever mgmt
culture: urine + blood (2 sets, different sites), stool (C. diff), skin lesions, VAD, throat/nasopharynx
57
what are neutropenic precautions?
**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
nursing role/education for N/V, anorexia?
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
nursing role/education for alopecia?
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
what is mucositis?
inflammation in the mucous lining of the upper GI tract from the mouth to the stomach
61
what is stomatitis?
inflammation of tissues in the oral cavity, such as gums, tongue, roof of the mouth, lips and cheeks
62
what is esophagitis?
inflammation of esophagus usually from radiation therapy
63
med admin - oral effects
candidiasis - antifungal + mycostatin
pain - BMX solution 4x prior to meal/bedtime
64
what is the nursing intervention for thrombocytopenia?
monitor: petechiae, ecchymosis, bleeding, platelets
bleeding precautions
avoid IVs/injections if possible
transfuse for PLTS (>50K)
USE electric razors, soft toothbrush
65
what is the nursing intervention for anemia?
monitor: fatigue, pallor, dizziness, SOB, syncope, HGB
rest periods b/t activities
conserve energy
admin anti anemia (darbapoietin alpha)
transfuse PRBCs
66
nursing intervention for chemotherapy induced peripheral neuropathy?
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
hematopoietic Stem Cell Transplant (HTSC)
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
prostate cancer: hormone therapy
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
breast cancer: hormone therapy
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
what is immunotherapy?
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
what is targeted therapy?
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
targeted therapy: monoclonal antibodies
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
neuropathic pain
nerve damage
numb, tingling, shooting, burning, radiating
74
visceral/deep pain
in internal organs
difficulty to identify
deep, sharp
75
somatic pain
bone/connective tissue
localized sharp, dull, throbbing
76
pain mgmt
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
pain mgmt: non-opioids/NSAIDs
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
pain mgmt: opioids
morphine
fentanyl
hydromorphone
MODERATE TO SEVERE PAIN, BREAKTHROUGH, ADDICTIVE
79
pain mgmt: opioids
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
what is superior vena cava syndrome (SVC)?
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
what is SVC mgmt?
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
what is spinal cord compression?
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
how is spinal cord compression diagnosed?
MRI (gold standard)
- CT and bone scan
84
what are spinal cord compression nursing interventions?
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
hypercalcemia
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
how is hypercalcemia managed?
**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
what is tumor lysis syndrome?
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
tumor lysis syndrome diagnostics
K+ > 5.0
usually 24-48 hrs after tx
uric acid > 10 (hyperuricemia)
phosphate > 5 (hyperphosphatemia)
Ca2+ < 8.7 (hypocalcemia)
89
what are the s/s of tumor lysis syndrome?
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
what is the treatment of tumor lysis syndrome?
**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
other emergent situations
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
breast cancer
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
what are the breast cancer screening recs?
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
breast cancer risk factors
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
what are the s/s of breast cancer?
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
what will tumor sample be tested for?
ER (estrogen receptor), PR (progesterone receptor), and HER2 status (human epidermal growth factor receptor 2)
- tumor type/grade
- lymph nodes
97
what is a sentinel lymph node biopsy (SLNB)?
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
SLNB and LN dissection
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
what are the types of breast cancer?
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
what are the types of surgery for breast cancer?
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
breast cancer surgery nursing intervention/education
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
lymphedema mgmt
*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
chemotherapy for breast cancer
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
breast cancer: hormone therapy
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
breast cancer prevention
healthy diet
timely mammogram
healthy weight
exercise
limit alcohol
avoid hormone replacement therapy/environmental estrogen
breastfeed (1 yrs)
106
prostate cancer
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
prostate cancer: risk factors
>65
fam hx (BRCA1 or BRCA2)
unhealthy diet (high fat, complex carbs, low fiber)
obesity
rapid growth of prostate
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prostate cancer: s/s
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
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PSA
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
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prostate cancer diagnostics
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
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prostate cancer TNM staging
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.
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prostate cancer grade (Gleason scale)
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)
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prostate cancer: tx options
Watchful waiting/active surveillance
Surgery
Radiation therapy
Hormone therapy
Chemotherapy
Targeted therapy
Immunotherapy
Bisphosphonate therapy—bone metastases
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prostate cancer: surgery
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
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prostate cancer: radiation therapy
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.
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prostate cancer: additional therapies
chemotherapy (docetaxel)
biphosphate therapy (clodronate or zoledronate (Zometa), reduce bone disease when cancer has spread to the bone.)
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prostate cancer: tx side effects
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
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survivor
any person with a history of cancer, from the time of diagnosis through the remainder of their life.
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survivorship
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)
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survivorship care
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
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survivorship plan
History of Cancer treatment
Persistent Effects
Possible Late Effects
Signs and symptoms to report
Wellness Plan
Future Cancer Screening
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supportive/palliative care
- 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.
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palliative v. hospice similarities
goal of both: provide better QoL + symptom relief, special care teams
hospice often includes palliative care
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palliative v. hospice differences
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
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supportive care
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
