Care of Patients w/ Specific Cancers Flashcards
1
Q
How to identify skin cancer
A
skin self-exams monthly
2
Q
ABCDE rule for skin cancer
A
- asymmetry
- border irregularity
- color changes
- diameter >6mm
- evolving in appearance
3
Q
risk factors for skin cancer
A
- fair skin type (blond or red hair; blue or green eyes)
- chronic sun exposure (leading cause)
- indoor tanning booths
- family Hx
- exposure to tar or arsenic
- living close to equator, outdoor occupations, or frequent outdoor activities
4
Q
explain skin cancer w/ darker skin
A
- less susceptible (more melanin serves as sunscreen)
- can still get skin cancer (most often palms of hands, soles of feet, and mucous membranes)
5
Q
most common form of skin cancer
A
non-melanomas
6
Q
characteristics of non-menalomas
A
- develop in epidermis and not melanocytes
- develop in sun exposed areas (face, neck, hands, arms)
7
Q
precancerous lesions on skin that may go away w/ reduced sun exposure
A
actinic keratosis
8
Q
most common and least deadly for of skin cancer (rare metastasize beyond skin)
A
basal cell carcinoma (BCC)
9
Q
what do basal cell carcinomas look like
A
enlarging papule w/ pearly border, erosion, or ulcer
10
Q
what does actinic keratosis look like
A
flat or elevated scaly papule
11
Q
less common and highly aggressive form of skin cancer (potential for metastasis and death if not treated)
A
squamous cell carcinoma (SCC)
12
Q
what does squamous cell carcinoma look like
A
scaly erythematous plaque, nodules, lesions, or ulcerations
13
Q
what can lead to SCC around the mouth and lips
A
pipes, cigars, and cigarette smoking
14
Q
describe malignant melanoma
A
- occur anywhere on skin (cutaneous melanoma) -> lesions often dark brown or black
- can also occur in eyes, GI tract, mucous membranes, or lymph nodes
- can metastasize to any organ
15
Q
epidemiology of malignant melanoma
A
- incidence and death much higher among caucasians
- genetic predisposition plus all other risk factors
16
Q
most common sites for malignant melanoma
A
- males: back and chest
- females: back and legs
17
Q
collaborative care for skin cancer
A
- biopsy (shows type and depth)
- treatment depends on site of tumor, stage of cancer, and patient’s age and health
- surgical excision
- chemo, biological, radiation therapy (if spread)
18
Q
describe laryngeal cancer
A
- occurs in the larynx
- most commonly squamous cell in origin
- more common in males 55-70
19
Q
risk factors for laryngeal cancer
A
- prolonged use of alcohol and tobacco (most common)
- vocal straining
- chronic laryngitis
- family Hx
- industrial exposure to carcinogens
- nutritional deficiencies
- HPV (common in men under 50)
20
Q
clinical manifestations of laryngeal cancer
A
- earliest sign -> hoarseness or change in vocal quality lasting > 2 weeks
- color changes of mouth/tongue
- sore throat, neck pain radiating to ear
- hemoptysis
- swelling or lump in neck
21
Q
late signs of laryngeal cancer
A
- dysphagia
- dyspnea
- weight loss
22
Q
diagnostic tests for laryngeal cancer
A
- indirect laryngoscopy
- biopsy
- CT/MRI
- PET scan (check for metastasis)
23
Q
collaborative care for laryngeal cancer
A
- chemo/radiation
- hemilaryngectomy
- supraglottic laryngectomy
- supracricoid laryngectomy
- total laryngectomy (will need permanent tracheostomy)
- radical or modified neck dissection (if lymphatic spread): all tissues removed and will need reconstruction
24
Q
post op care after total laryngectomy
A
- airway assessment and maintaining airway
- tracheostomy care and suctioning (secretion may be blood-tinged at first)
- tube (enteral) feedings
- alternative communication methods
25
alternative communication methods after total laryngectomy
- electrolarynx (external battery powered device)
- transesophageal puncture: voice prosthesis placed through creation of fistula between esophagus and trachea (block stoma w/ finger to speak)
26
how to care for tracheostomy
- have suctioning, replacement trach tube and ambu bag at bedside
- must stay secured
- sterile procedure when suctioning
- wear face shield and mask when suctioning
27
leading cause of cancer related deaths
lung cancer
28
most important risk factor for lung cancer
- cigarette smoking (80-90%)
| - other causes: second hand smoke inhalation and other inhaled carcinogens (asbestos, radon, air pollution etc)
29
types of non-small cell lung cancer (NSCLC)
- squamous cell (slow growing)
- adenocarcinoma (moderate)
- large cell (rapid; highly metastatic)
30
most aggressive type of lung cancer
small cell lung cancer (SCLC) -> very rapid growing w/ worst prognosis;
31
characteristics of squamous cell lung cancer
- second most common
- grow in bronchial tubes
- earlier sxs due to bronchial obstruction
- centrally located and don't tend to metastasize
32
characteristics of adenocarcinoma (lung cancer)
- peripherally located
- don't see sx until widespread metastasis
- doesn't respond well to chemo
- not usually related to smoking
33
characteristics of large cell carcinoma (lung cancer)
- least common
- grows in bronchi and peripherally
- highly metastatic (sx not usually option)
34
clinical manifestations of lung cancer
- persistent cough w/ sputum (most common)
- SOB
- wheezing
- chest pain (due to pressure on diaphragm and mediastinum
- hemoptysis (due to tumor bleeding)
- other less common sxs: N/V, fatigue, and anorexia
35
diagnostic tests for lung cancer
- Xray
- CT
- bronchoscopy (biopsy)
36
screening guidelines for lung cancer
low dose CT if:
- current smoker or smoker who has quit in past 15 years and
- have at least 30 year pack hx and
- receive counseling to quit smoking if current and
- have been told by doctor about benefits, limits, and harms of screening and
- have facility where they can go for screening
37
collaborative care for patient w/ lung cancer
- surgery (not usually w/ large cell or small cell)
- chemo/radiation
- nutritional evaluation
- comfort and pain control
- adequate oxygenation of tissues
- realistic attitude toward tx and prognosis
38
health promotion w/ lung cancer
avoid smoking (smoking cessation programs)
39
risk factors for cervical cancer
- first full-term pregnancy at < age 17
- >3 full term pregnancies
- multiple sex partners
- HPV or chlamydia infection
- immunocompromised
- smoking
- family Hx
- low socioeconomic status
- obesity
- long term use of oral contraceptives
40
clinical manifestations for cervical cancer
- usually asymptomatic in early stages
- vaginal discharge (white/thick); possibly foul smelling
- bleeding after intercourse and between periods
41
screening guidelines for cervical cancer
- 21: Pap smear every 3 years
- 30-65: pap every 3 years or pap and HPV every 5 years
- >65: stop screening if no lesions last 20 years
- more often screenings if high risk or immunocompromised
42
diagnostic tests for cervical cancer
- pap smear
| - colposcopy and biopsy
43
prevention of cervical cancer
- latex condoms
- limiting number of sexual partners
- HPV vaccine (Gardasil 9): recommended ages 9-14 (2 doses) or 15-26 (3 doses)
- smoking cessation
44
collaborative care for cervical cancer
- laser or cryotherapy
- conization
- radiation/chemo
- hysterectomy
45
most common GYN cancer
endometrial cancer
46
characteristics of endometrial cancer
- slow growing
- low mortality
- 95% survival rate if local at time of dx
47
risk factors for endometrial cancer
- estrogen (when not counteracted by progesterone -> after menopause)
- increased age
- late menopause
- nulliparity
- obesity/smoking/DM
- HNPCC (genetic colon cancer)
48
clinical manifestations of endometrial cancer
- abnormal uterine bleeding (after menopause)
- low back pain/ABD pain (late signs)
- signs of metastasis
49
screening for endometrial cancer
if HNPCC gene mutation -> yearly endometrial biopsy starting at age 35
50
diagnostic tests for endometrial cancer
- US
| - endometrial biopsy
51
collaborative care for endometrial cancer
- total hysterectomy w/ bilateral salpingo-oophrectomy
- lymph node dissection
- radiation
- progesterone
- chemo (advanced or recurrent)
52
risk factors for ovarian cancer (most deadly of GYN cancers)
- personal or family Hx of ovarian, breast or colon cancer
- gene mutations - BRCA1 or 2 or HNPCC
- greater number of ovulatory cycles (nulliparity or early menarche and/or late menopause)
- HRT
- infertility drugs
- increase in age
- high fat diet
53
early clinical manifestations of ovarian cancer
vague
- ABD discomfort
- bloating
- gas
- indigestion
- loss of appetite
- urinary urgency or frequency
54
late clinical manifestations of ovarian cancer
- pain
- bowel and bladder dysfunction
- ascites
- menstrual irregularities
- weight loss or gain
- intestinal obstructions
55
diagnostic tests for ovarian cancer
- pelvic exam yearly
- US (ABD or transvaginal)
- CA-125
- exploratory laparotomy
56
screening and prophylaxis for ovarian cancer (high-risk pts)
- CA-125
- transvaginal US
- prophylactic oral contraceptive that contains estrogen and progestin
- salpingo-oophrectomy
57
collaborative care for ovarian cancer
- total hysterectomy w/ bilateral salpingo-oophrxectomy
- tumor debulking (palliative)
- radiation
- chemo (IV and intraperitoneal)
- second look (exploratory sx 6 months after chemo/radiation to check for recurrence)
58
risk factors for breast cancer
- family hx (1st degree relative)
- genetics (BRCA1 or 2)
- increasing age (>50)
- early menarche/late menopause
- nulliparity
- 1st pregnancy >30 y/o
- Hx of breast, colon, endometrial, or ovarian cancer
- obesity
- sedentary lifestyle
- ionizing radiation exposure
- alcohol > 1 drink/day
- HRT (estrogen/progesterone)
- oral contraceptives (younger women)
59
T/F: most women w/ breast cancer have no family hx or genetic mutation
True
60
characteristics of ductal and lobular carcinoma (breast cancer)
- non-invasive (in situ) -> can metastasize if not treated
| - main metastasis through axillary lymph nodes
61
characteristics of inflammatory breast cancer (IBC)
- uncommon cancer
- aggressive and rapid growing w/ high risk for metastasis (poor prognosis)
- redness, warmth, swelling
- orange peel skin
- breast mass may or may not be present
62
characteristics of Paget's disease
- nipple or areola lesion w/ or without breast mass
- itching, burning, nipple w/ discharge (bloody)
- good prognosis of confined to nipple
63
clinical manifestations of breast cancer
- palpable lump (hard, irregularly shaped, non- mobile, non-tender)
- abnormality in mammogram
- nipple discharge or inversion
- orange peel breast skin appearance (due to plugged lymphatics)
64
screening guidelines for breast cancer
- 40-44 have option to start screening w/ yearly mammogram
- 45-54 get mammogram yearly
- 55 and older can switch to every other year or continue yearly
- high risk: breast MRI and mammogram starting age 30
65
T/F: breast exams are not recommended anymore
True
66
diagnostic tests for breast cancer
- mammogram
- breast US or MRI
- biopsy (definitive test)
- sentinel (first node that would be hit by cancer) and/or axillary lymph node dissection
- estrogen and progesterone receptor (+ is slow growing and - is fast growing and frequently reoccur)
- HER-2, CA 15-3, CA 27-29
- metastatic workup
67
collaborative care for breast cancer
- surgery (main treatment)
| - radiation, chemo, hormonal therapy if estrogen receptor +, biologic and targeted therapy
68
types of surgery for breast cancer
- sentinel lymph node dissection (SLND)
- axillary lymph node dissection (ALND)
- lumpectomy
- modified radical mastectomy
- breast reconstruction (tissue expander; TRAM flap)
69
adverse effects of breast cancer surgical therapy
- lymphedema due to removal of lymph nodes (redness, edema, pressure)
- post mastectomy pain syndrome (neuropathic pain and symptoms)
70
treatment of lymphedema after breast cancer surgery
- compression stockings or sleeves
- elevation
- diuretics
- isometric exercises
71
treatment of post mastectomy pain syndrome
- gabapentin (Neurontin)
- NSAIDs
- lidocaine patches
72
nursing care after breast cancer surgical therapy
- restoring arm function (semi fowlers position w/ arm on pillow; exercises)
- post-op pain management, post-op drains, and S&S to report
- prosthesis after mastectomy
- psychosocial care (body image) and sexual issues
- NO BP, blood draws, or injections on affected arm
73
characteristics of kidney cancer
- arise from renal cortex or pelvis
- renal cell carcinoma (adenocarcinoma) is most common
- twice as common in males
- more common in ages 50-70
74
risk factors for kidney cancer
- smoking (major)
- family Hx
- obesity
- HTN
- asbestos and gasoline exposure
- cystic kidney w/ ESRD
75
clinical manifestations of kidney cancer
- no early sxs - many undiagnosed until cancer progressed
- painless hematuria
- flank pain
- palpable mass in flank or ABD
- weight loss, fever, HTN, anemia
- altered lab values (BUN/Cr)
76
diagnostic tests for kidney cancer
- CT, US, MRI
- angiography
- renal biopsy (lay flat 6 hours after and monitor for hemorrhage)
77
collaborative care for kidney cancer
- surgical treatment
- chemo/radiation
- biologic and targeted therapy
78
preventative measure for kidney cancer
- reduce modifiable risk factors
| - includes: smoking cessation, healthy weight, control BP, and reduce exposure to toxins
79
surgical treatment for kidney cancer
- partial or radical nephrectomy
| - ablation (use of cold/heat to remove tumor)
80
characteristics of bladder cancer
- transitional cell carcinoma of bladder is most common
- most common between 60-70
- 3x more common in men
81
risk factors for bladder cancer
- smoking
- exposure to dyes used in rubber
- Actos (DM med)
- previous radiation of pelvic area
- arsenic in water supply
- recurrent bladder renal calculi
- chronic UTIs or chronic Foley catheters
82
clinical manifestations of bladder cancer
- painless hematuria
- dysuria
- urinary urgency
- urinary frequency
83
diagnostic tests for bladder cancer
- urine cytology (neoplastic or atypical cells and bladder tumor antigen test)
- CT, US, MRI
- cystoscopy and biopsy
84
collaborative care for bladder cancer
- depends on stage
- surgery
- radiation/chemo
- intravesical therapy (chemo or BCG infusion directly into bladder)
85
surgical options for bladder cancer
- TURBT - transurethral resection of bladder tumor
- partial cystectomy
- radical cystectomy (bladder and surrounding reproductive organs) -> ileal conduit needed
86
characteristics of prostate cancer
- 2nd most common cancer in men
- androgen-dependent adenocarcinoma
- slow growing
87
risk factors of prostate cancer
- age (>50)
- ethnicity (AA) -> higher incidence, young age, and more aggressive
- family Hx
- diet high in fat, red meat and low in fruits/vegetables
88
clinical manifestations of prostate cancer
early: asymptomatic
| - late: BPH sxs w/ S&S of metastasis
89
screening for prostate cancer
- PSA and DRE
- age 50: men should talk to HCP about pros and cons of testing
- High risk: AA or have father or brother w/ prostate cancer before 65 (consider screening at 45)
90
diagnostic tests for prostate cancer
- PSA (not specific for cancer)
- PAP (prostatic acid phosphate)
- DRE
- Biopsy
- TRUS
- metastatic workup
91
collaborative care for prostate cancer
- active surveillance (watchful waiting)
- surgical therapy
- radiation
- chemo (if metastatic)
- hormonal therapy (block androgen hormones to decrease growth)
92
surgical therapy for prostate cancer
- radical prostatectomy -> causes incontinence and ED)
- nerve sparing procedure (only for cancer confined to prostate)
- cryotherapy
- orchiectomy (if metastatic; also done to reduce testosterone levels for hormone therapy -> chemical castration)
93
characteristics of testicular cancer
- rare but most common cancer in young males (15-44)
| - median age 33
94
risk factors for testicular cancer
- ethnicity (most common in caucasians)
- family Hx
- HIV
- undescended testes
- orchitis
- maternal exposure to exogenous estrogen
95
clinical manifestations for testicular cancer
- painless lump
- scrotal edema
- dull pain or heaviness
- signs of metastasis (advanced cancer)
96
screening for testicular cancer
monthly self exams especially if high risk
97
diagnostic tests for testicular cancer
- AFP
- LDH
- hCG
- testicular US
98
collaborative care for testicular cancer
- orchiectomy
- chemotherapy
- radiation
99
risk factors for colorectal cancer
- family Hx
- genetics (HNPCC) - 5-10%
- obesity and physical inactivity
- red meat and processed meat
- alcohol/smoking
- high fat/low fiber/low fruit and vegetable diet
- Hx of IBD
- 85% of all colorectal cancer arise from adenomatous polyps
100
clinical manifestations of colorectal cancer
- gradual onset (sxs usually present w/ cancer is advanced)
- iron-deficiency anemia
- ABD pain
- rectal bleeding
- change in bowel habits
- bowel obstruction or perforation
101
screening for colorectal cancer
- age 45-75 stool based test every year OR flex sig every 5 years OR colonoscopy every 10 years or CT colonography every 5 years
- people at increased risk might need to start screening before age 45 and be screening more often
- age 76-85 discuss w/ HCP
- >85 end screenings
102
diagnostic tests for colorectal cancer
- DRE
- colonoscopy
- fecal occult blood (stool guaiac) or fecal immunochemical test
- CEA
- CBC
- CT, MRI (r/o metastasis)
103
collaborative care for colorectal cancer
- colon resection and reanastamosis
- chemo/radiation
- targeted therapies
104
group of malignant disorders that affects blood, blood forming tissues of bone marrow, lymph, and spleen
leukemia
105
characteristics of leukemia
- affects all age groups - 9x more common in adults (especially over age 50)
- no single cause
106
potential risk factors of leukemia
chemo/radiation exposure or treatment
- viruses
- immunologic deficiencies
107
4 types of leukemia
- acute myelogenous (AML)
- acute lymphocytic (ALL)
- chronic myelogenous (CML)
- chronic lymphocytic (CLL)
108
characteristics of AML
- abrupt onset
- common in adults
- growth of immature leukocytes
109
characteristics of ALL
- abrupt (fever) on insidious onset
- most common in children
- growth of immature lymphocytes
110
characteristics of CML
- chronic stable phase -> acute aggressive phase
- chronic phase can last several years controlled w/ tx
- Philadelphia chromosome is diagnostic hallmark (90-95%)
111
characteristics of CLL
- most common in adults
| - may not need tx in very early stages
112
clinical manifestations of leukemia
- fatigue, anorexia, weight loss, dysphagia
- bleeding, ecchymosis, petechiae
- fever, infections, night sweats
- bone pain and oral lesions
- enlargement of liver, spleen and lymph nodes
- low, normal, or high WBCs
- low H&H, RBCs and platelets (pancytopenia)
113
diagnostic tests for leukemia
- CBC w/ peripheral smear
- bone marrow biopsy
- uric acid levels
- LDH
114
collaborative care for leukemia
- goal is remission
- chemo/radiation
- splenectomy
- hematopoeietic stem cell transplant (HSCT)
- blood and/or platelet transfusions
- antiinfectives
115
characteristics of Hodgkin lymphoma
- abnormal Reed-Sternberg cells in affected lymph nodes
- most frequent at 15-35 or >55 years
- 80% long term survival
116
risk factors for Hodgkin lymphoma
- EBV
- genetics
- occupational toxins
- HIV
117
clinical manifestations of Hodgkin lymphoma
- painless lymphadenopathy
- progress from one group of lymph nodes to another
- mediastinal mass
- splenomegaly
- ABD mass
- fever, weight loss, night sweats, and pruritus
118
diagnostic tests for Hodgkin lymphoma
- CBC w/ peripheral smear
| - lymph node bx and analysis -> Reed Sternberg cells
119
collaborative care for Hodgkin lymphoma
- main tx w/ radiation/chemo
- HSCT
- promote screening for secondary cancers
120
characteristics of Non-Hodgkin lymphoma
- diverse group of lymphomas (B cell is most common, T cell, and NK cell)
- cause is unknown
- usually over age 50
- survival rate is less than Hodgkin lymphoma
121
risk factors for Non-Hodgkin lymphoma
- family Hx
- chromosome translocations
- viral infections
- environmental agents/chemicals
- immunosuppression
122
clinical manifestations for Non-Hodgkin lymphoma
- localized or generalized painless lymphadenopathy (noncontiguous spread)
- lymph nodes enlarge over period of months to years
- fever, night sweats, weight loss
123
diagnostic tests for Non-Hodgkin lymphoma
- lymph node bx
| - CT and BM biopsy for staging
124
collaborative care for Non-Hodgkin lymphoma
chemo/radiation
