Class 6 - Immune System And Cancer Flashcards
Modifiable risk factors
Smoking Obesity Lack of exercise Poor eating habits Sun exposure Heavy alcohol consumption Exposure to carcinogens
Prevalence
Total number of people who are living with a disease
The increased incidence of cancer with age could result from?
Age related changes that reduce the ability to resist disease or prolonged exposure to carcinogens.
Classifications systems for for cancer provide a standardized way to?
Communicate with the health care team Assist in determining the most effective treatment plan Evaluate treatment plan Determine prognosis Compare group statistics
There are 4 types of classification systems. What are they?
Anatomic site classification:
Identified by tissue of origin
Histological analysis classification:
Appearance of cells and the degree of differentiation
Poorly differentiated tumours have a worse prognosis
Clinical staging classifications: Stage 0- cancer in situ Stage 1- limited to tissue of origin Stage 2- limited local spread Stage 3- extensive local and regional spread Stage 4- metastasis
TNM classification:
T- Tumor size
N- spread to lymph nodes
M- metastasis
define cancer
characterized by uncontrolled and unregulated growth of cells.
define carcinoma in situ
cancer that has stayed in place where it began and has not spread to neighbouring tissue.
define carcinomas
a cancer arising in the epithelial tissue of the skin or of the lining of the internal organs.
define benign neoplasm
non cancerous forms of tissue proliferation such as skin moles or uterine fibroids. These do not become cancerous and mainly cause problems due to their space occupying nature.
define malignant neoplasm
this is cancer.
define chemotherapy
the treatment of disease by the use of chemical substances, especially the treatment of cancer by cytotoxins and other drugs.
define biopsy
involves histological examination by a pathologist of a pice of tissue.
define angiogenesis
process of the formation of blood vessels within the tumor itself.
define TAAs or tumor associated antigens
changes in the cancer cells surface as a result of malignant transformation.
define immunological surveillance
response of the immune system to antigens of the malignant cells.
define immunological escape
process by which cancer cells evade the immune system
define staging
classifying the extent and spread of the disease
define needle biopsy
cells and tissue fragments are obtained through a large-bore needle guided into the tissue
define incisional biopsy
performed with a scalpel or dermal punch is a common technique for obtaining a tissue sample
define excisional biopsy
removal of the entire tutor. Usually done a tutor less than 2cm in diameter, skin lesions, intestinal polyps and breast masses
define colony-stimulating factors
a family of glycoproteins produced by various cells. These cells stimulate production, maturation, regulation and activation of cells
define aneuploidy
condition in which the number of chromosomes in the nucleus of a cell is not an exact multiple of the monoploid number of a particular species. An extra or missing chromosome is a common cause of genetic disorders including human birth defects.
define autoimmune disease
when the body produces antibodies that attack its own tissues. Ex: psoriasis, lupuis
define opportunistic infections
an infection that takes advantage of a person with a weakened immune system.
What are some age-reated immune changes
- impaired function of T and B lymphocytes
- failure of lymphocytes to recognize abnormal cells
- decreased antibody function
- suppressed phagocytic immune response
(phagocytic = cells that ingest harmful foreign debris)
What are some age-related GI changes
- decreased gastric secretions and motility
- decreased phagocytosis by the liver’s Kupffer cells
- altered nutritional intake wih inadequate protein intake
What are some age-related urinary changes
- decreased kidney function and changes in lower urinary tract function
- altered GU tract flora (ex: higher pH is better for for bacteria growth)
What are some age-related pulmonary changes
- impaired cilliary action d/t exposure to smoke and environmental toxins
What are some age-related skin changes
- thinning of the skin
- loss of elasticity
- loss of adipose tissue
What are some age-related circulatory changes
- impaired microcirculation
circulation at the capillary level
What are some age-related neurological changes
- decreased sensation
- slowing of reflexes
Classification systems provide a standardized way to:
- communicate with health care team
- assist in determining the most effective treatment plan
- evaluate treatment plan
- determine prognosis
- compare groups statistically
What is anatomical site classification
- identified by tissue of origin, the area on the body it is located and the behaviour of the tumor (benign or malignant)
What is histological analysis classification
- appearance of cells and the degree of the differentiation are evaluated to determine how closely cells resemble tissue of origin
- poorly differentiated tumors have a worse prognosis than those closer in appearance to normal cells
What is clinical staging classification
Stage 0 = cancer in situ
Stage 1 = tumor limited to tissue of origin
Stage 2 = limited local spread
Stage 3 = extensive local and regional spread
Stage 4 = metastasis
What is TNM classification
- it is the anatomic extent of the disease based on three parameters:
1. T = tumor size and invasiveness
2. N = spread to lymph nodes
3. M - metastasis
Nursing roles related to cancer
- demonstrate discretion
- encourage healthy lifestyle choices
- educate patients about screening for cancer
- facilitate their efforts to obtain tests
When patient is experiencing anxiety the nurse should
- give clear explanations and repeat them if necessary
- give written information for reinforcement
- actively listen to clients concerns
Collaborative care includes:
- goals
- curative therapy (sx alone or periods of systemc therapy)
- control treatment
(initital course and maintenance therapy) - palliative goal (relief or control of symptoms and maintain quality of life)
Factors that determine the way a cancer is treated
- cell type
- location /size of tumor
- extent of disease
- physiological/psychological status
- express needs and desires
Surgical therapy is
removal of the tumor and a margin of the surrounding normal tissue may cure localized tumors, but is ineffective if the cancer has metastasized to other locations
Chemotherapy
- use of chemicals as systemic therapy for cancer
- goal is to reduce number of malignant cancer cells in the tumor
- most common for solid and hematological cancers
Handling chemotherapy agents
- can pose an occupational hazard
- drugs may absorb through the:
*skin
*inhaled during preparation or
when administered
*only properly trained personnel should
handle drugs
The effects of chemotherapy on normal tissue
- it cannot tell the difference between normal cells and cancer cells
- body’s response to cellular destruction (fatigue, anorexia, taste alterations)
Older adults and chemotherapy
- advanced age can affect the movement of and distribution of the cytotoxic drugs in the body
- this increases the risk of complications for (constipation, dehydration, malnutrition, infection)
Radiation therapy
- localized treament mode
- has a central role in the treatment of cancer
Effects of radiation therapy on the cells
- cellular damage can be lethal or sublethal
- normall tissues are usually able to recover
- cancer cells are more likely to be permanently damaged
- radiation therapy can be delivered externally or internally
Radiation therapy can be used in the fight against cancers as?
- the primary therapy
- as an adjuvant with another therapy
- as a prophylaxis
- for disease control
- palliative
Common side effects of radiation therapy
- fatigue
- anorexia
- pulmonary effects
- GI disturbances
- reproductive effects
Biological therapy
- effective alone or with surgery, radiation and/or chemotherapy
- biological therapies (agents alter biological response to tumor cells)
Targeted therapy
- targets and binds to cell receptors important to the tumors growth
Bone marrow and stem cell transplantation
- allows high doses for treatment to clients where tumors are:
*failing to respond to standard doses of
chemotherapy or radiation
*or have developed a resistance
Effects of bone marrow/stem cell transplantation
- has many risks including death
- highly toxic
- overall cure rates still low, but increasing
Gene therapy is
- transfer of genes from somewhere else into cells of a client in an effort to correct defective gene
- this approach is currently still in the investigative stages
The development of cancer has three stages what are they?
Stage 1 - Initiation
this is the mutation in the cells genetic structure from an error that occurs during DNA replication or after exposure to a carcinogen
Stage 2 - Promotion
this is the reversible proliferation of the altered cells.
**NOTE: an important distinction btw inititation and promotion is that the activity of the promotors is reversible. Promotors are, diet, obesity, smoking, alcohol consumption
Stage 3 - Progression
this is the increased growth rate of the tumoras well as the increased invasiveness and spread of the cancer (metastasis)
Histological grading is grade 1 through 4, what are they
Grade 1 - cells differ slightly from normal cells (mild dysplasia) and are well differentiated
Grade 2 - cells are more abnormal (moderate dysplasia) and moderately differentiated
Grade 3 - cells are very abnormal (severe dysplasia) and are poorly differentiated
Grade 4 - cells are immature and primitive (anaplasia) and undifferentiated; cell of origin is difficult to determine
Seven warning signs of cancer are
C A U T I O N
C = change in bowel or bladder habits
A = a sore that does not heal
U = unusual bleeding or discharge from any
body orifice
T = thickening or a lump in the breast or
elsewhere
I = indigestion or difficulty swallowing
O = obvious change in a wart or mole
N = nagging cough or hoarseness
diagnostic studies that could be used in cancer detection
- cytology
- hematology
- sigmoidoscopy/colonoscopy
- CXR
- biopsy
nursing management of cancer pain
- accept pain as patient reports it
- drug therapy includes: NSAIDS, opioids and
adjuvant analgesics - analgesics should be given around the clock with a breakthrough doses as needed.
- pain meds are given in a large enough dose to keep pain under control
- non pharmacological therapies include
(relaxation therapy and imagery)
What factors may determine how a client will cope with a diagnosis of cancer?
- ability to cope with stressful events
- availablility of significant other
- ability to express feelings and concerns
- age at the time of Dx
- extent of the disease
- disruption of body image
- presence of symptoms
- past experience with cancer
- attitude associated with cancer
nursing centered care for the patient would include
- being available for discussion with the patient and family, especially in difficult times
- actively assess patients needs for counselling or other services
- listen actively for fears and concerns
- provide essential information as the patient asks for it and be sensitive to information overload
- offer strategies for enhanced coping abilities
- establish a therapeutic relationship
- be “present” with the patient to offer comfort and assistance
- encourage normal ADLs
- consider spiritual aspects of care
- encourage patient to participate in their care.
Characteristics of cancer cells
- divide rapidly
- they are indiscriminate
- nucleus in cancer cells is larger than in normal cells
- cancer cells have no function
- they can break away from each other easily
- they grow by invasion
- they are contact inhibited (they keep dividing even when they hit a wall, they keep going)
- they can metastasis (move or migrate)
