Care of Patients w/ Specific Cancers Flashcards
How to identify skin cancer
skin self-exams monthly
ABCDE rule for skin cancer
- asymmetry
- border irregularity
- color changes
- diameter >6mm
- evolving in appearance
risk factors for skin cancer
- 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
explain skin cancer w/ darker skin
- less susceptible (more melanin serves as sunscreen)
- can still get skin cancer (most often palms of hands, soles of feet, and mucous membranes)
most common form of skin cancer
non-melanomas
characteristics of non-menalomas
- develop in epidermis and not melanocytes
- develop in sun exposed areas (face, neck, hands, arms)
precancerous lesions on skin that may go away w/ reduced sun exposure
actinic keratosis
most common and least deadly for of skin cancer (rare metastasize beyond skin)
basal cell carcinoma (BCC)
what do basal cell carcinomas look like
enlarging papule w/ pearly border, erosion, or ulcer
what does actinic keratosis look like
flat or elevated scaly papule
less common and highly aggressive form of skin cancer (potential for metastasis and death if not treated)
squamous cell carcinoma (SCC)
what does squamous cell carcinoma look like
scaly erythematous plaque, nodules, lesions, or ulcerations
what can lead to SCC around the mouth and lips
pipes, cigars, and cigarette smoking
describe malignant melanoma
- 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
epidemiology of malignant melanoma
- incidence and death much higher among caucasians
- genetic predisposition plus all other risk factors
most common sites for malignant melanoma
- males: back and chest
- females: back and legs
collaborative care for skin cancer
- 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)
describe laryngeal cancer
- occurs in the larynx
- most commonly squamous cell in origin
- more common in males 55-70
risk factors for laryngeal cancer
- 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)
clinical manifestations of laryngeal cancer
- 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
late signs of laryngeal cancer
- dysphagia
- dyspnea
- weight loss
diagnostic tests for laryngeal cancer
- indirect laryngoscopy
- biopsy
- CT/MRI
- PET scan (check for metastasis)
collaborative care for laryngeal cancer
- 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
post op care after total laryngectomy
- airway assessment and maintaining airway
- tracheostomy care and suctioning (secretion may be blood-tinged at first)
- tube (enteral) feedings
- alternative communication methods
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)
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
leading cause of cancer related deaths
lung cancer
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)
types of non-small cell lung cancer (NSCLC)
- squamous cell (slow growing)
- adenocarcinoma (moderate)
- large cell (rapid; highly metastatic)
most aggressive type of lung cancer
small cell lung cancer (SCLC) -> very rapid growing w/ worst prognosis;
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
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
characteristics of large cell carcinoma (lung cancer)
- least common
- grows in bronchi and peripherally
- highly metastatic (sx not usually option)
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
diagnostic tests for lung cancer
- Xray
- CT
- bronchoscopy (biopsy)
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
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
health promotion w/ lung cancer
avoid smoking (smoking cessation programs)
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
clinical manifestations for cervical cancer
- usually asymptomatic in early stages
- vaginal discharge (white/thick); possibly foul smelling
- bleeding after intercourse and between periods
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
diagnostic tests for cervical cancer
- pap smear
- colposcopy and biopsy
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
collaborative care for cervical cancer
- laser or cryotherapy
- conization
- radiation/chemo
- hysterectomy
most common GYN cancer
endometrial cancer
characteristics of endometrial cancer
- slow growing
- low mortality
- 95% survival rate if local at time of dx
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)
clinical manifestations of endometrial cancer
- abnormal uterine bleeding (after menopause)
- low back pain/ABD pain (late signs)
- signs of metastasis
screening for endometrial cancer
if HNPCC gene mutation -> yearly endometrial biopsy starting at age 35
