Cancer Part 1 Flashcards
Cancer Etiology and Genetic Risk
- Oncogene activation
— External Factors
— Chemical carcinogenesis – exposure to tobacco
— Physical carcinogenesis – exposure to radiation
— Viral carcinogenesis –exposure to oncoviruses
— Dietary factors – low fiber high fat (bad for you)
— Personal factors - immune function, advancing age, genetic risk
Risk Factors
External Factors
*Know what to teach
Responsible for 80% of cancer in North America
- Smoking (30% of cancer are related to tobacco use)
- Alcohol
- Radiation (uranium, UV lights) (avoid tanning beds)
- Viral (Epstein-Barr virus, hepatitis, HPV) Table 21-7 pg 366
- Diet (low fiber with a high intake of red meat, preservatives)
Genetic considerations for predisposition for cancer
See Chart 15 -1 Example of Ca influenced by genetics
- Genetic risk overall is small
- But people who have a genetic predisposition are at very HIGH risk for developing cancer.
- Genetic Testing available – expensive, not usually covered by ins. Do not diagnose, only provide risk info
Genetic considerations for predisposition for cancer
- Hallmarks of families with hereditary cancer syndrome include:
— Cancer in two or more first degree relatives
— Onset of cancer in family member younger than 50
— Same type of cancer in several family member
— Individual family members with more than one type of cancer
— Rare cancer in one or more family members.
*Cancer prevention and screening Chart 15-2 Health Promotion
Primary
- Avoidance of known or potential carcinogens
- Modification of associated factors (diet/ no smoking/ etc.)
- Removal of “at-risk” tissues (mole removal)
- Chemoprevention (chemo prior to diagnosis)
- Vaccination
Secondary
- Regular screening – eg. mammogram
- Genetic screening – eg. BRCA1
Tertiary Screening
- Treatment and prevention of *reoccurrence and secondary cancers
Question
*Is the following statement true or false?
Primary prevention involves detection and screening to
achieve early diagnosis and intervention.
FALSE – This is Secondary Prevention because 2nd is screening
The Nurse’s Role in Cancer Prevention and Screening
The 7 Danger Signs
C = Changes in bowel or bladder habits (not yeast infection)
A = A sore that does not heal
U = Unusual bleeding or discharge
T = Thickening or lump in the breast or elsewhere
I = Indigestion or difficulty swallowing
O = Obvious change in a wart or mole
N = Nagging cough or hoarseness
Name Dietary Habits to Reduce Cancer Risk
- Avoid excessive intake of animal fat and red meat
- Avoid nitrites (prepared lunch meats, sausage, bacon).
- Keep alcohol consumption to no more than 1 to 2 drinks per day.
- Eat more bran.
- Eat more cruciferous vegetables eg. broccoli, cauliflower, Brussels sprouts, and cabbage. Eat foods high in vitamin A (e.g., apricots, carrots, leafy green and yellow vegetables) and vitamin C (e.g., fresh fruits and vegetables, especially citrus fruits)
The nurse includes which factors in teaching regarding the typical warning signs of cancer? (Select all that apply)
- A. Persistent constipation
- B. Scab present for 6 months
- C. Curd like vaginal discharge
- D. Axillary swelling
- E. Headache
A, B, D
Cancer Classification
- Staging – Provides common language for accurate communication between healthcare providers. (4 stages)
- Grading – pathologic classification of tumor cell
- TNM (tumor, node, metastasis) Chart 15-3 pg. 334
Cancer Development
Step 1
- Initiation – loss of cellular regulation
Step 2
- Promotion – enhanced the growth
Step 3
- progression – continued change
Step 4
- Metastasis – Moves from primary location
Metastasis
- Metastasis occurs through a progression of steps:
- Extension into surrounding tissues
- Blood vessel penetration (most common cause of spread)
- Release of tumor cells
- Invasion of local areas
- Local seeding
- Bloodborne metastasis
- Lymphatic spread
Cell Growth & the Pathophysiology of Cancer
Hypertrophy- cells swell
Hyperplasia- cells multiply
Features of Normal Cells
- Limited cell division
- Apoptosis – programmed death of cells
- Specific morphology – same shape, size and look
- Small nuclear-to-cytoplasmic ratio
- Differentiated function
- Tight adherence
- Nonmigratory
- Contact inhibition – stops from over dividing
- Normal chromosomes – 23 pairs
Features of *Benign Tumor Cells
Features of Cancer Cells (Malignant)
- Rapid or continuous cell division
- Anaplasia – loss of look of parent cell
- Large nuclear-to-cytoplasmic ratio – large nucleus
- Specific functions lost
- Loose adherence
- Migration
- No contact inhibition
- Abnormal chromosomes
A 65-year-old client tells the nurse she does not have mammograms because there is no history of breast cancer in her family. What is the nurse’s best response?
- A “Breast cancer is an inherited type of malignancy and your family history indicates a low risk for you.”
- B “Performing breast self-examination monthly at home is sufficient screening for someone with your family history.”
- C “Because your breasts are no longer as dense as they were when you were younger, your risk for breast cancer is now decreased.”
- D “Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age.”
D. breasts get denser with age
Consequences of Cancer
- Physical and Psychological functioning changes
- Destruction of normal tissue
- Impaired immune and blood-producing function
- Altered GI structure and function
- Motor and sensory deficits
- Decreased respiratory function
Cancer Treatments
- Surgery
- Radiation
- Chemotherapy
Surgery as Cancer Treatment
- Oldest form of cancer treatment used for:
- Cure – Removal of all Cancer
- Control – Removes partial (debulking)
- Palliation- improve quality of life eg, pain mngt.
- Prophylaxis- removes at risk tissue
- Diagnosis - biopsy
- Second-look surgery – after treatment
- Reconstruction or rehabilitation – enhance function and appearance
- Requires collaborative care
How does radiation affect patients?
Radiation Causes Ionizations of ATOMS
- which may affect MOLECULES
- which may affect CELLS
- which may affect TISSUES
- which may affect ORGANS
- which may affect THE WHOLE BODY
radiation is external & internal beam
- external:
— tattoo
Radiation Therapy for Cancer
- Purpose—to destroy cancer cells with minimal exposure of the normal cells to the damaging actions of radiation
- EBRT – (teletherapy) - outside the body
— External beam radiation therapy - Brachytherapy - inside the body
— Sealed Sources – Interstitial, Intracavity
— Unsealed Sources. Liquid via oral/injection/etc
— Pt emits radiation and can be hazardous
— Dosages in units called grays (Gy) - Radiation Safety:
- distance, time, shielding, use of film badge (dosimeter)
Side Effects of Radiation Therapy
- Vary according to the site
- Local skin changes and hair loss that will likely be permanent depending on the total absorbed dose
- Altered taste sensations - common
- Fatigue related to increased energy demands - common
- Inflammatory responses that cause tissue fibrosis and scarring
- Each patient’s experience is different
Brachytherapy: Sealed
Prostate Brachytherapy
*Care of the Patient with Sealed Implants of Radioactive Sources
- Assign the patient to a private room with a private bath.
- Place a “Caution: Radioactive Material” sign on the door of the patient’s room.
- If portable lead shields are used, place them between the patient and the door.
- Keep the door to the patient’s room closed as much as possible.
- Wear a dosimeter film badge at all times while caring for patients with radioactive implants.
- Wear a lead apron while providing care. Always keep the front of the apron facing the source of radiation (do not turn your back toward the patient).
- If you are attempting to conceive, do not perform direct patient care regardless of whether you are male or female.
- Pregnant nurses should not care for these patients; do not allow pregnant women or children younger than 16 years to visit.
- Limit each visitor to one-half hour per day. Be sure visitors stay at least 6 feet from the source.
- Never touch the radioactive source with bare hands. In the rare instance that it is dislodged, use a long -handled forceps to retrieve it. Deposit the radioactive source in the lead container kept in the patient’s room.
- Save all dressings and bed linens in the patient’s room until after the radioactive source is removed. After the source is removed, dispose of dressings and linens in the usual manner. Other equipment can be removed from the room at any time without special precautions and does not pose a hazard to other people.
Sides effects of Radiation Therapy
- Fatigue
- Malaise
- Anorexia May Be Secondary To Substances Released When Tumor Cells Are Destroyed.
- Early Effects Tend To Be Temporary And Most Often Subside Within 6 Months Of The Cessation Of Treatment.
- Late Effects (Approximately 6 Months To Years After Treatment)
Nursing Care of Patients Undergoing Radiation Therapy
- Teach accurate objective facts to help patient cope
- Do not remove markings.
- Administer skin care
- Do not use lotions or ointments unless prescribed by oncology department
- See Nursing Care Plan on page 359
Nursing Care of Patients Undergoing Radiation Therapy
- Avoid direct exposure of the skin to the sun.
- Care for xerostomia (dry mouth)
- Bone exposed to radiation is more vulnerable to fracture.
- Soft/ loss clothing over affected area
The client receiving brachytherapy with implanted radioactive “seeds” for prostate cancer asks the nurse when these seeds will be removed. What is the nurse’s best response?
- A “The half-life of radiation in these seeds is so short that it is not necessary to remove them.”
- B “They will be removed only if their presence is painful or leads to an enlarged prostate gland.”
- C “When we know for certain that all cancerous cells have been killed, the seeds will be removed.”
- D “The seeds are small enough to be absorbed by your body and excreted in the urine or stool.”
A
Chemotherapy
- Treating cancer with chemical agents
- Major role in cancer therapy
- Used to cure and increase survival time
- Some selectivity for killing cancer cells over normal cells
- Normal cells most affected—the skin, hair, intestinal tissues, spermatocytes, and blood-forming cells
NADIR
how low a drug will make wbc fall after chemo
Treatment Issues
- Based on cancer sensitivity
- Drug dosage based on size of patient / Nadir
- Drug schedule regular basis timed to kill cancer cells and minimize damage
- Education is critical to maintain schedule and outcomes
- Nadir - lowest point of white blood cell depression after therapy that has toxic effects on the bone marrow
- Drug administration:
— Extravasation
— Vesicants
Administration of Chemo
- Admin. by RN who is certified in the knowledge and established competencies
- Prevention and management of extravasation are essential
- Should never be given in peripheral veins involving the hand or wrist
- May be short duration in the forearm
- Frequent or prolonged admin should be Central Lines, implanted venous access devices, or peripherally inserted central catheters (PICCs)
Side Effects of Chemotherapy
everything basically:
- Hypersensitivity Reactions
- Bone Marrow Suppression Anemia, neutropenia, thrombocytopenia
- Alopecia or hair loss
- Nausea and vomiting
- Mucositis in the entire GI tract
- Skin changes
- Anxiety, sleep disturbance
- Altered bowel elimination
- Changes in cognitive function
- Peripheral Neuropathy
- Any increase in temp is reported
ABSOLUTE NEUTROPHIL COUNT(ANC) CALCULATION
- ANC equals the Total WBC count multiplied by the total percentage of neutrophils (segs plus bands).
- Absolute neutrophil count
— (ANC) of 1000-1800:
—- Most patients will be given chemotherapy in this range.
—- Risk of infection is considered low. - Mild neutropenia
— Absolute neutrophil count (ANC) of 500-1000:
—- Carries with it a moderate risk of infection - less than 500:
— Severe neutropenia- high risk of infection.
— Remember that a reduced WBC is known as leukopenia. - think nadir
Administration of Chemotherapy
- Routes of administration – IV PO Intrathecal (spine) etc
— Increased risk for fluid and electrolyte imbalances
— Risk for infection
— Risk for bleeding
— Protection of caregivers - Better to have an implanted port or central line
- IV and Oral are the 2 most common routes
- When giving Oral Medications REMEMBER to wear PPE
- These oral Medications can be absorbed through the skin
- Myth: Oral drugs are less toxic than IV
- When giving IV make sure to monitor for signs of extravasation
— Assess site for swelling, coolness, numbness and tingling
— Use of central lines is highly recommended
— Coordinate with oncologist and pharmacist for antidote
Chemotherapy Patient-Centered Nursing Care
Delegation to UAP:
- Teach importance protecting neutropenic pt. from infection
- Stress ways cross-contamination occurs - Ensure UAP understands neutropenic patient
- Stress aspects of personal hygiene cannot be deferred
- Teach importance of mouth care and washing of the axillary and perianal regions at least every 12 hours.
