Exam 4 - Cancer Flashcards
cancer is the ___ and ___ growth of cells
uncontrolled; unregulated
this results when normal cells mutate into abnormal, deviant cells that multiply and spread
cancer
study of cancer is called
oncology
3 potential patient goals r/t cancer
curative
control
pallative
curative care
no microscopic evidence of cancer in the body
remission
control care
treatment, retreatment
reduce s/sx
reduce burden of disease
increase quality of ife
palliative care
increase quality of life until death
frequent cancer locations in male
prostate
lung
colon/rectal
frequent cancer locations in females
breast
lung
colon/rectal
proliferation is ___ ___
cell growth
differentiation is the cycle of ___ ___
cell maturity
specialized cells are for what?
a specific area (GI, bone marrow, etc)
this is part of normal proliferation
what is contact inhibition
cells do not touch each other
benign growths are ___ where as malignancy will ___
encapsulated; spread
___ is a mass of new tissue that grows independently of its surrounding structures; no physiologic purpose
neoplasm (tumor)
what are the 2 neoplasm/tumor types
benign
malignant
benign neoplasm characteristics
localized, solid mass
well defined borders
easily removed
usually do not reoccur
slow growing
malignant neoplasm characteristics
grow, double aggressive
irregular shape
can reoccur
travel to form secondary tumor(s) (metastasis)
apoptosis is ___ ___
cell death
T or F. cancer cells are able to avoid death
true
what are the 2 major defects of cell mutation that result in cancer
defective cellular proliferation (growth) and differentiation (maturity)
grading the differentiation (maturity) of cancer
histological grading
increase in the number of density of normal cells
hyperplasia
adaptation of a cell d/t a stressor in the environment; normal for its type but has developed in an abnormal location; it is a protective manner and is reversible when stressor ceases
metaplasia
loss of DNA control over differentiation occurring in response to adverse condition
dysplasia
regression of a cell to an immature or undifferentiated cell type; not under DNA control
anaplasia
3 steps to cancer development
initiation
promotion
progression
initiation stage of cancer development
IRREVERSIBLE
mutation in cells genetic structure
avoids apoptosis
exposure to carcinogenic
DNA mutate
change and stays changed
examples of carcinogenics
chemical
radiation
viral/infections: HSV, mono, hepatitis, Epstein barre, HIV
genetics
tobacco
inherited mutation
hormones
immune conditions
mutations that occur from metabolism
promotion stage in cancer development
REVERSIBLE
can last 1-40 years
depends on level of exposure to carcinogens
progression stage of cancer development
NONREVERSIBLE
increased growth
cells not act as malignant cells
being to break off, travel, create own blood supply (mets)
body actively stops trying to kill the cell
how large must a mass be to be detectable
1cm = 1 billion cells
common site for mets
brain*
lung*
bone*
liver*
lymph nodes
*first sites affected
cancer risk factors
infections
genetics/heredity
age (80% occur after 55)
gender
socioeconomics (prevalent in lower)
stress (< 6-8 hours sleep/night)
diet: high fat, low fiber
occupation
tobacco (decrease risk if quit before middle age)
alcohol use
obesity (esp. BMI >30)
sun exposure
recreational drug use (marijuana worse than tobacco)
what are the 4 tumor associated antigens (TAAs)
cytotoxic t cells
NK (natural killer) cells
monocyte and macrophages
B lymphocytes
what is the role of TAAs
immune cells responsible for seeking and destroying cancer cells in the body
what are TAAs located
on the cell surface
CA -125 is produced by ___ cancer cells
ovarian
PSA is produced by ___ cancer cells
prostate
CEA is produced by ___ cancer
GI
AFP is produced by malignant ___ cells
liver
first choice testing for Dx cancer
MRI
PET scan looks for ___
mets
tumor classification is the ___ of the tumor
name
tumor classification is by ___ site
anatomic site
6 anatomic sites
carcinomas
sarcomas
adenocarcinoma
leukemias
lymphomas
multiple myeloma
where do carcinomas arise from?
ectoderm
endoderm
where do sarcomas arise from?
mesoderm
where do adenocarcinomas arise from?
grandular tissue
where does leukemias arise from?
blood-forming cells
where does lymphoma arise from?
lymph tissue
where does multiple myeloma arise from?
plasma cells, effects the bones
grading grades the ___ of the tumor
aggressiveness
How many tumor grades are there?
4
grade 1
cells slight different
mild dysplasia; LEAST malignant
grade 2
more abnormal
moderate dysplasia
grade 3
clearly abnormal
severe dysplasia
grade 4
anaplastic (immature) and undifferentiated
cell origin is difficult to determine
staging is the ___ within the body
spread
what is TNM of staging
T umor size, depth, surface spread
N odes involvement (present or absent)
M ets (present or absent)
staging ranges from __ to __
0-4
stage 0
carcinoma in-situ
early form
stage 1
localized
stage 2
early locally advanced
stage 3
late locally advanced
stage 4
mets
different tumor classifications
T0
T-IS
T1, T2, T3, T4
T0
no evidence of primary tumor
T-IS
tumor in-situ
T1, T2, T3, T4
progressive degrees of tumor size and involvement
different node classifications
N0
N1A, N2A
N1B, N2B, N3B
NX
N0
no abnormal regional nodes
N1A, N2A
regional nodes, no mets
N1B, N2B, N3B
regional lymph nodes
mets suspected
NX
regional nodes can not be assessed clinically
different mets classifications
M0
M1, M2, M3
M0
no evidence of distant mets
M1, M2, M3
mets involvement, including distant nodes
these are protein molecules detectable in serum or other bodily fluid
biochemical indicator of the presence of malignancy
tumor markers
4 examples of tumor markers
antigens
hormones
proteins
enzymes
2 types of radiation therapy
teletherapy (external)
brachytherapy/intracavity (internal)
when is radiation therapy most effective
when cells are rapidly growing
brachytherapy/internal radiation ALARA principle
As Low As Reasonably Acceptable
r/t time, distance, shielding
Brachytherapy visitor restrictions
no pregnancy women
no person under 18 y/o
limit visitation time (30 minutes/day)
keep distance (6 feet)
long term effects of radiation
PNA
pericardium damage
blood vessel damage
infertility
lymphoma
radiation education
evaluate skin daily
gentle soap (non-alcohol based)
only clean site with your hand
avoid sun exposure
no cosmetics
wear loose clothing
taste distortion (red meat may taste metallic)
mucositis
anorexia
do not wash markings off
do chemo drugs only kill bad cells?
No, they kill bad AND healthy cells
2 major chemotherapy categories
cell cycle phase - specific
cell cycle phase - nonspecific
what is nadir
when WBC are at their lowest
< 1000
T or F. Monitor uric acid levels with chemotherapy
True
Chemotherapeutic agent drug classes (5)
alkylating agents
antimetabolites
antitumor abx
miotic inhibitors
hormone and hormone antagonist
common S/E among chemotherapeutic agents
bone marrow depression
N/V/D
electrolyte issues
Alkylating agents can cause ___ impairment
renal
what kind of diet should those on alkylating agents eat?
low purine d/t increase in uric acid
examples of alkylating agents
Cytoxan (admin on empty stomach)
Cisplatin (1-2 L IVF before, after; ototoxicity)
Mustargen
Can chemo drugs be administered in peripheral lines?
No, central lines only
What are the 5 steps to complete if a pts IV infiltrates
turn off pump
D/C IVF from cannula
aspirate remaining contents in cannula
administer antidote (kept at bedside)
call MD
antimetabolites are used to treat ___, ___, and ___ ___
leukemia
lymphomas
solid tumors
antimetabolites contraindications
major sx previous month
previous use of alkylating agents
hx of high-dose pelvic radiation
pre-existing bone marrow impairment
women in childbearing years
hepatic, renal impairement
what to monitor for with antimetabolites
renal, cerebral function
photo sensitivity
examples of antimetabolites
methotrexate
5-FU
Mercaptopurine
5-FU can lead to which kind of toxicity
cardiotoxicity (resembles MI, angina, cardiogenic shock)
how are antitumor antibiotics administered
slow IVP
DO NOT USE in AC, dorsum of hand or wrist
antitumor antibiotic examples
doxorubicin (Adriamycin)
bleomycin (Blenoxane)
mithramycin (Plicamycin)
doxorubicin (Adriamycin) considerations
monitor for cardiotoxicity
nadir 10-14 days after administration
radiation recall is common
Mitotic inhibitors/plant extracts inhibit ___ causing ___ ___
mitosis; cell death
mitotic inhibitors/plant extract examples
etoposide (N/V, hypotension, bone marrow depression)
taxol (angioedema)
vincristine (motor weakness, paraesthesia)
hormone and hormone antagonist can be used for which 2 reasons
stimulate appetite
reduce inflammation
what to monitor with hormones and hormone antagonsts
hyperglycemia
impaired healing
HTN
osteoporosis
hirsutism
meds are prednisone based; think prednisone s/sx
hormones and hormone antagonist examples
estrogens (diethylstillbestrol)
antiestrogens (Tamoxifen)
—hot flashes, hemorrhage
progestin (megestrol; leuprolide)
androgen (testosterone)
general S/E of chemotherapeutic agents
bone marrow suppression (immunosuppression, thrombocytopenia, anemia)
anorexia
N/V/D
stomatitis
xerostomia
alopecia
fatigue
organ toxicity
impaired reproductive ability or altered fetal development
nurse PPE for handling chemo IV meds
gloves
mask
gown
which technique is used to access CVADs
sterile
nursing considerations for chemotherapy pts
monitor CBC with diff, plts, BUN, LFT
VS
neutropenic precautions
immunosuppression education
avoid crowds, infected people and small children
hand hygiene
avoid undercooked meat, raw fruits + veggies
report s/sx of infection ASAP to HCP
avoid yard work
no live virus vaccines
nursing considerations for thrombocytopenia pts
monitor stools, urine for bleeding
electric razor
avoid ASA, ASA containing products
avoid IM injections
avoid contact sports
avoid dental work unless absolutely necessary
soft toothbrush; don’t floss
avoid alcohol based mouthwashes
thrombocytopenia education
apply ice to injured area, seek medical attention
inform HCP of chemo, radiation treatments
assess for ecchymosis, petechiae, trauma
no skid sole; closed toe shoes
avoid tripping hazards
be alert to spontaneous bleeds if plt < 20000
what do immunotherapy/biotherapy/target therapy drugs do
enhance the person immune responses
changes relationship with cancer, how it reacts
immunotherapy/biotherapy/target therapy S/E
flu like symptoms
HA
rash
N/V
purpose of colony stimulating factors
reduce risk of thrombocytopenia
rapidly reproduces WBC, RBC, plt
when is it acceptable to use erythropoiesis-stimulating agents (ESAs)
treating anemia specifically caused by chemotherapy
what are the 2 types of bone marrow/stem cell transplant
autologous (own bone marrow)
allogenic (donor bone marrow)
how is bone marrow/stem cell transplant infused
central line
bone marrow/stem cell transplant are most commonly used for which cancer?
leukemia
bone marrow/stem cell transplant puts pt at high risk for ___ and ___
infection; death
where is bone marrow/stem cells harvested from
iliac crest (most common)
umbilical cord
blood
a pt receiving a bone marrow/stem cell transplant will be on which kind of precautions and isolation?
P: neutropenic
I: reverse
when will levels begin to increase after a bone marrow/stem cell transplant?
2-4 weeks
explain graft vs. host complication r/t bone marrow/stem cell transplant
donated cells attack the host
what is the desired effect/graft vs. tumor r/t bone marrow/stem cell transplant
donated cells attack the tumor
when is a dietary referral needed?
noted weight loss of 5%
what is the primary cause of death r/t chemotherapy
infection
s/sx of poor nutrition
withdrawn/fatigued
over/under weight
pasty/dry/scaly skin
bruising
brittle hair
red/spongy gums
dark red/swollen tongue
stooped posture
easily distracted
metabolic oncologic emergencies
SIADH
hyperkalemia
tumor lysis syndrome
septic shock
DIC
does SIADH cause:
fluid retention/hyponatremia OR fluid deficit/hypernatremia
fluid RETENTION
HYPOnatremia
SIADH treatment
treat the cancer
fluid restriction
salt tables, lasix
3% NS (hypertonic solution)
monitor closely
hypercalcemia is r/t ___ ___
bone mets
often a complications of breast cancer
hypercalcemia treatment
treat cancer
hydrate: 3-4L daily
diuretics
biophosphonates (-ronate)
stool softeners
what is tumor lysis syndrome
when cells are killed, they burst releasing all the intracellular contents into the bloodstream
aka tissue distruction
tumor lysis syndrome shows the chemo/radiation is ___
working!
rapid tumor lysis syndrome can lead to ___ failure
renal
tumor lysis syndrome s/sx
elevated phosphate, K, uric acid
low calcium
renal failure
24-48 hr after treatment (lasts 5-7 days)
weakness, muscle cramps
N/V/D
tumor lysis syndrome treatment
prevent renal failure
prevent severe F/E imbalances
prophylactic meds with chemo
catch early
HYDRATION + Allopurinol
K treated with insulin + glucose
DIC s/sx
low plt
prolonged PT, PTT
elevated d-dimer
pallor
petechia, purapura, bleeding
DIC nursing priorities
support airway
O2
circulation
DIC treatment
O2
volume replacement
blood products: plt, FFP
DIC is associated with which 2 cancers
lung cancer, lymphoma
what is superior vena cava syndrome
compression of the vena cava by a tumor, enlarged lymph node, obstructed circulation
s/sx of superior vena cava syndrome
excess fluid in the chest, neck, face
superior vena cava syndrome treatment
immediate radiation to reduce the size of the obstruction
s/sx of spinal cord compression
intense, localized, persistent back pain
motor weakness + dysfunction
change in bowel, bladder habits
paresthesia
where is a tumor located r/t spinal cord compression
epidural space
diagnostic test for Dx spinal cord compression
MRI
spinal cord compression treatment
pain meds
corticosteroids
radiation/chemo
laminectomy
anorexia-cachexia syndrome
cancer diverts nutrition to itself while causing changes that decrease appetite
SEVERE muscle wasting; nausea, pain, elevated glucose
sunscreen should be at least SPF ___
15
good dietary habits for cancer prevention
low fat, high veggie
limit sugar, red meat, nitrates, and processed food
CAUTIONUF r/t warning signs of cancer
C hange in bowel/bladder
A sore that doesn’t heal
U nsual bleeding, discharge
T hickening, lump
I ndigestion, difficulty swallowing
O bvious change in wart/mole
N agging cough, hoarseness
U nexplained weight gain, loss
F eeling tired, weak
PAP smear recommendations for:
21-29
30-65
65+
21-29: q3 years
30-65: q5 years + HPV
65+: no testing if have been normal, cont x20 years if abnormal
mammograms for women 45-54
annually + monthly SBE
when should men and women have a FOB
q3 years starting at 50 y/o
when should men and women begin colonoscopies
50; q5-10 years
When should African American men with a hx of prostate cancer begin getting exams
45 y/o
when should men begin getting prostate exams
70 y/o
what are Kubler-Ross’ 5 stages of grieving
denial
anger
bargaining
depression
acceptance
active listening techniques
maintain eye contact
lean foward
sit eye level
living will vs. POA
LW: pt has their preferences outlined
POA: pt appoints someone to make medical decisions on their behalf
expected physiologic changes r/t impending death
weakness, fatigue
social isolation
increased sleepiness > unresponsiveness
increase HR, RR, low BP > irregular pulse, respirations, BP
impaired secretion removal
decreased UOP
incontinence > oliguria, anuria
skin is warm or cool > pallor, mottling
pain
