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Module 3 > Exam 4- Oncology/GI > Flashcards

Exam 4- Oncology/GI Flashcards

1
Q

Are proto-oncogene good or bad genes to have? and why?

A

Good- It control the growth of cells

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2
Q

Are oncogene good or bad genes to have? and why?

A

Bad- Mutated proto-oncogene which leads to uncontrolled cell growth

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3
Q

Are tumor suppressor genes good or bad genes to have and why?

A
  1. Good- slows down cellular division, cause cell death
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4
Q

Are mutated tumor suppressor genes good or bad and why?

A

Bad– leads to uncontrolled cell growth

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5
Q

Well differentiated cells resemble….. what?

A
  1. Normal cells
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6
Q

Well differentiated cells function like?

A

“more like normal cells”

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7
Q

What is a growth rate for a well differentiated cell?

A
  1. Grows at a slower rate
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8
Q

True or false: Well differentiated cells are typically benign?

A
  1. True
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9
Q

Poorly differentiated cells resemble…. what?

A
  1. Does not resemble normal cells
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10
Q

Which cells are mature cells and which are immature out of a well differentiate and poorly differentiated cell?

A
  1. Well differentiated = mature
  2. Poorly differentiated = immature
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11
Q

Poorly differentiated cells function likeeee…

A
  1. They lack structure (immature)/function and g
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12
Q

True or false: Poorly differentiated cells a less aggressive than well differentiated?

A

False- Poorly differentiated are more aggresive

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13
Q

True or false: Poorly differentiated cells are typically malignant?

A

True

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14
Q

What is a benign tumor?

A
  1. Benign (not cancer) tumor cells grown only locally and cannot spread by invasion or metastasis
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15
Q

What is a malignant tumor?

A
  1. Malignant (cancer) cells invade neighboring tissues, enter blood vessels, and metastasize to different sites
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16
Q

what is the mode & rate of growth of a benign tumor with well differentiated cells?

A
  1. Expands, usually encapsulated
  2. usually slow growth
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17
Q

What is the mode & rate of growth of a malignant tumor with undifferentiated cells?

A
  1. Sends out projections that infiltrate and destroy growth rate variable
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18
Q

Do benign tumors metastasize?

A

no- not typical

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19
Q

Can a malignant tumor metastasizes?

A
  1. Yes
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20
Q

With benign tumors what are the general effects?

A

Usually localized to the area

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21
Q

With malignant tumors what are the general effects?

A
  1. Generalized: anemia, weakness, weight loss
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22
Q

With benign tumors what kind of destruction do we expect?

A
  1. Usually non unless blood flow is impaired
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23
Q

With malignant tumors what kind of destruction do we expect to see?

A
  1. Often extensive; excretes toxins, uses up blood supply
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24
Q

What is the morbidity of a benign tumors?

A
  1. Minimal- unless location interferes with vital function
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25
Q

What is the morbidity of a malignant tumor?

A
  1. High- unless growth and spread controlled/halted
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26
Q

Review cancer prefixes

A
  1. Adeno- gland
  2. Chondro- cartilage
  3. Erythro- red blood cell
  4. hemangio- blood vessels
  5. hepato- liver
  6. lipo- fat
  7. lympho- lymphocyte
  8. melano- pigment cell
  9. myelo- bone marrow
  10. myo- muscle
  11. Osteo- bone
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27
Q

What are two ways that cancer speads?

A
  1. Locally invasive
  2. Metastasis
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28
Q

What does it mean if a cancer spreads locally invasive?

A
  1. “finger” of cancer cells invade surrounding tissues
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29
Q

What does it mean if a cancer metastasizes?

A
  1. Malignant cells travel through blood or lymph system & invade other tissues or organs to form secondary tumor
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30
Q

What are four common sites of mets?

A
  1. Brain
  2. Lung
  3. Liver
  4. Bone
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31
Q

What are some risk factors for cancer?

A
  1. Tobacco and smoking
  2. Diet and obesity
  3. Sedentary lifestyle
  4. Occupational exposure
  5. family history
  6. Viruses
  7. Perinatal factors/growth
  8. Alcohol
  9. Socioeconomic status
  10. Pollution
  11. UV radiation
  12. Drugs & medical procedures
  13. Salt, Food additives and contaminant
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32
Q

What do we need to know about family history as a risk factor of cancer?

A
  1. Hallmark of hereditary cancer syndrome
  2. Cancer in 2 or more relatives
  3. Cancer in family members < 50 years old
  4. Same type of cancer in multiple family members
  5. Rare type of cancer in 1 or more family members
  6. Family members with more than 1 type of cancer
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33
Q

What do we need to know about viruses as a risk factor of cancer?

A
  1. Difficult to evaluate and isolate
    2.May incorporate in the genetic structure of cells
  2. Delay of many years form initial viral infection to the development of cancer
  3. Must act in conjunction with other factors in order to develop into cancer
  4. Number of persons infected with viruses is more larger than those numbers who develop cancer
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34
Q

The HPV virus can cause what type of cancer?

A
  1. Cervical cancer
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35
Q

The hepatitis B/Hepatitis c virus can cause what type of cancer?

A
  1. Liver cancer
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36
Q

The Epstein-Barr can cause what type of cancer?

A
  1. Lymphoma
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37
Q

The human herpes virus 8 can cause what type of cancer?

A
  1. Kaposi’s sarcoma
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38
Q

The HIV virus can cause what type of cancer?

A
  1. Lymphoma, kaposi’s sarcoma
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39
Q

The h-pylori virus can cause what type of cancers?

A
  1. Stomach ulcers, lymphoma in the stomach lining.
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40
Q

Hormone replacement therapy with estrogen and progestin showed to have an increase risk in developing what kinds of cancers?

A
  1. Ovarian
  2. Breast
  3. Uterine
  4. Lung
  5. Brain
  6. Colon
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41
Q

What is primary prevention?

A
  1. Health promotion & illness prevention
  2. Reduction of cancer mortality via reduction in the incidence of cancer
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42
Q

How is primary prevention accomplished?

A
  1. Avoiding the carcinogen
  2. Adequate & Proper nutrition
  3. Stress reduction
  4. Lifestyle changes
  5. Dietary changes
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43
Q

What is secondary prevention?

A
  1. Screening (self breast & testicular exams)
  2. Diagnosis & Treatment of illness
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44
Q

What is the goal of secondary prevention?

A
  1. Halt the progress of cancer through early screening & diagnosis.
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45
Q

What is tertiary prevention?

A
  1. Disease treatment and rehabilitation
  2. Health restoration
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46
Q

What is the goal of tertiary prevention?

A
  1. Prevent further deterioration
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47
Q

What is chemoprevention?

A
  1. The use of substances to lower risk of cancer
  2. Selective estrogen receptor modulator (SERMs)
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48
Q

What are two examples of selective estrogen receptor modulators (SERMs)

A
  1. Tamoxifen & raloxifene: reduce risk of breast cancer
  2. Selenium: reduced risk of prostate cancer
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49
Q

What is the goal of cancer screenings?

A

Goal: find cancer in the early stages
1. Look for cancer before symptoms appear

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50
Q

What types of screening can they do for cancer?

A
  1. Physical exam
  2. Lab tests
  3. Imaging procedures
  4. Genetic testing
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51
Q

What are the colorectal screening guidelines?

A
  1. Beginning at age 45, men & women should follow one of the examination schedules
    • Fecal occult blood test (FOBT): yearly
    • Flexible sigmoidoscopy: Every 5 years\
    • Colonoscopy: every 10 years
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52
Q

What are some breast cancer screenings guidelines

A
  1. 20+ monthly SBE
  2. 40-44: Breast exam by HCP every 3 years
  3. 45-54: HCP breast exam & mammo yearly
  4. 55- every two years
  5. Women at high risk for breast Ca: MRI/mammo yearly
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53
Q

What are the cervical cancer screening guidelines?

A
  1. Age 21 or within 3 years of initiating vaginal intercourse
    -pap test every 2-3 years
    • if dysplasia notes- pap test annually
  2. Age 30+
    • Pap test & HPV every 5 years or every 3yrs with pap test only
  3. 60+
    • not necessary if all previous test negative
  4. Hysterectomy
    • Continue pap test to r/o vaginal or vulvar cancer
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54
Q

What are the 7 warning signs of cancer? (remember C-a-u-t-i-o-n )

A
  1. C- change in bowel or bladder habits
    2.A- A sore that does not heal
  2. U- Unusual bleeding or discharge
  3. T- Thickening or lump in breast or some where else
  4. I- Indigestion or difficulty swallowing
  5. O- obvious change in wart or mole
  6. N- nagging cough or hoarseness
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55
Q

What is “grade” in terms of cancer?

A
  1. Pathologist compares the appearance of cancer cells to the normal surrounding cells
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56
Q

What is staging in terms of cancer?

A
  1. Classifying a malignancy by the extent of spread within the body
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57
Q

What are the different grades?

A
  1. GX
  2. G1
  3. G2
  4. G3
  5. G4
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58
Q

What is a GX grade?

A
  1. Can not be assessed
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59
Q

What is a G1 grade?

A
  1. (low grade): well differentiated, slow growing
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60
Q

What is a G2 grade?

A
  1. Moderate grade: Moderately differentiated growing slightly faster
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61
Q

What is a G3 grade?

A
  1. High grade: poorly differentiated, growing faster
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62
Q

What is a G4 grade?

A
  1. High Grade: undifferentiated, not distinct at all, very aggressive
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63
Q

What is a stage 1?

A
  1. Small cancer found only in organs where it originated
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64
Q

What is stage 2?

A
  1. Larger cancer that may/may not have spread to the lymph nodes
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65
Q

What is a stage 3?

A

1.Larger cancer also in the lymph nodes

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66
Q

What is stage 4

A

Cancer has spread from original site into other organs

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67
Q

TNM system of staging… what does T- N- M stand for?

A
  1. T= size of primary tumor
  2. N= Number of lymph nodes involved
  3. M= extent of metastasis
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68
Q

What is TX in tumor size?

A
  1. Tumor size can’t be measured
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69
Q

What is TO in tumor sizing?

A
  1. No primary tumor, or cant be found
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70
Q

What is “tis” in tumor sizing?

A
  1. Tumor is “in situ”
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71
Q

What is T1 in tumor sizing?

A

Small or early stage

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72
Q

What is T2 in tumor sizing?

A
  1. Confined to original area
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73
Q

What is T3 in tumor sizing?

A

1.Has spread t surrounding tissues

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74
Q

What is t4 in tumor sizing?

A
  1. Large, advanced stage cancer
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75
Q

True or false: TNM classification reflects the depth of tumor infiltration

A

True

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76
Q

NX is what in staging number of nodes?

A
  1. Nearby nodes can’t be tested/evaluated
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77
Q

N0 is what in staging number of nodes?

A
  1. Lymph nodes are cancer free
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78
Q

N1 is what in staging number of nodes?

A
  1. Cancer cells have reached one node
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79
Q

N2 is what in staging number of nodes?

A
  1. Cancer spread to more than one node
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80
Q

N3 is what in staging number of nodes?

A
  1. Cancer in lymph nodes extensive/widespread
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81
Q

MX is what in staging extent of mets?

A
  1. Unknown if cancer has spread
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82
Q

M0 is what in staging extent of mets?

A
  1. No distant mets were found
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83
Q

M1 Is what in staging extent of mets?

A
  1. Cancer has spread to one or more dsitant parts of the body
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84
Q

What does “In situ” mean?

A
  1. Still in the original tissue layer
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85
Q

What does localized mean in terms of staging?

A
  1. Still in original organ
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86
Q

What does regional mean in terms of staging?

A
  1. Spread to nearby lymph nodes or organs
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87
Q

What does distant mean in term of staging?

A
  1. Spread to distant body parts
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88
Q

What do we need to know about tumor markers?

A
  1. Molecules associated with cancer cells
  2. Found in blood, urine, tumor tissue
  3. Different markers found in different tumors
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89
Q

What are tumor markers used for?

A
  1. Screen
  2. Diagnose (in conjunction with other tests)
  3. Treat (determine if body responding to treatment)
  4. Determine prognosis
  5. Monitor for recurrence
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90
Q

What can Carcinoembryonic antigen CEA tell us?

A
  1. Associated with tumors & developing fetus
  2. Increased levels found in cancers of
    • colon, pancreas, gastric, lung, breast
  3. Increased levels found in certain conditions
    • Cirrhosis, IBD, Chronic lung disease, pancreatitis
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91
Q

What are normal levels of CEA?

A
  1. 0-2.5ng/mL in non-smoker
  2. <5.0 ng/ML in smoker
92
Q

What can Alfa-fetoprotein AFP tell us?

A
  1. Major component of fetal plasma
  2. Valuable as a screening tool
  3. Increased levels in hepatocellular carcinoma
  4. Increased found in certain conditions
    • Pregnancy, hepatitis, cirrhosis
93
Q

What is a normal range of AFP

94
Q

What can a Cancer Antigen 125 (CA-125) tell us?

A
  1. Monitor tx or recurrence
  2. Increased level found in cancers of
    • Ovary, lung, breast, colon, pancreas
  3. Increased levels found in certain condition
    • Pregnancy, menstruation, endometriosis
95
Q

What is a normal CA-125

96
Q

What can cancer antigen (CA-19-9) tell us?

A
  1. Not used for screening
  2. Increased levels found in colon & pancreatic cancer
  3. Increased levels found in certain conditions
    -gallstones, cirrhosis, pancreatitis, cholecystitis
97
Q

What are the risk factors of breast cancer?

A
  1. Gender
  2. Increasing age (40+)
  3. Early menarche/late menopause
  4. Family history
  5. High fat diet
  6. Obesity
98
Q

What are the symptoms of breast cancer?

A
  1. Painless and/or painful breast mass
  2. Nipple discharge
  3. Local edema
  4. Nipple retraction
  5. nipple crusting
99
Q

What is the primary prevention of breast CA?

A
  1. Wellness
  2. Smoking cessation
  3. Daily exercise
  4. Healthy diet
    -Low in saturated fat
    • High in fiber
100
Q

What is the secondary prevention of breast CA?

A
  1. Mammogram
    • beginning yearly after age 40
  2. Breast self exam (BSE)
    • after 20 years of age
    • perform after menstruation
    • Same time every month
101
Q

What are tertiary prevention for breast CA?

A
  1. Symptom control
    -lymphedema
  2. Rehabilitation
    -Reconstruction
102
Q

What is included in the assessment of breast CA

A
  1. Mass felt during BSE
  2. Mammogram
  3. A non-moveable mass-typically painless
  4. usually only one breast involved.
103
Q

When assessing the breast we are looking for what change in size, ocuntour, or texture of breast?

A
  1. Skin dimpling, puckering
  2. Nipple discharge, retraction
  3. Peau d’orange
104
Q

What are some late signs of breast CA?

A
  1. Pain
  2. Ulceration
  3. Cachexia
105
Q

How do we diagnosis breast CA?

A
  1. BSE
    2.Clinical exam
  2. Mammo
  3. Ultrasound
    -Consistency of breast mass– cyst or dense mass
  4. Biopsy
    -aspiration
    -incisional
    • excisional
      6.Axillary lumph node status
  5. Diagnostic tests
    -BRCA-1 or BRCA 2
    -HER-2
    -Estrogen and progesterone receptor -
106
Q

What are some surgical treatments for breast CA?

A
  1. Lumpectomy
  2. Simple mastectomy
  3. Radical or modified radical mastectomy
107
Q

What are some nonsurgical treatments for breast CA?

A
  1. Chemotherapy
  2. Radiation
  3. Hormonal manipulation
108
Q

What are some radiation treatments for breast ca?

A
  1. External (teletherapy)
    • Using radiation beams to affected area
  2. Internal (brachytherapy)
    • Radium implants
    • Pellets
      -Seeds
109
Q

What hormone therapy drug might be used in breast CA?

110
Q

True or false: breast ca can be treated with forms of chemotherapy?

111
Q

What does pre-operative care consist of for a breast ca patient?

A
  1. emotional support
  2. General preop teaching
  3. Specific training
112
Q

True or false: lymphedema is a complication of breast CA?

113
Q

What should we know about the lymphedema complication of breast CA?

A
  1. Lifelong potential complication
  2. Importance of follow up
114
Q

How can we prevent lymphedema?

A
  1. Elevation, ROM, ADL’s, protect
115
Q

What is the treatment for lymphedema?

A
  1. Intermittent compression sleeve, manual massage, elevation, diuretics
116
Q

What is are the functions of the skin?

A
  1. Protection
  2. Body temp regulation
  3. Psychosocial
  4. Sensation
  5. Vit D production
  6. Immunological
  7. Absorption
  8. Elimination
117
Q

What are skin assessment tools

A
  1. Eyes???
  2. Hands??
  3. Ears???
  4. History taking and data gathering
  5. Braden Scale
  6. Nutritional assessment tools
118
Q

What are key steps for skin assessment?

A
  1. Health history
  2. Inspection and palpation
  3. examination
  4. documentation
119
Q

What should our documentation include for skin assessments?

A
  1. Document exactly what is observed or palpated
  2. appearance
  3. Texture
  4. temp
  5. Turgor
  6. Color
  7. Moisture
  8. sensation
  9. vascularity
  10. leasions/rash
120
Q

What are 3 types of skin cancer?

A
  1. Melanoma
  2. Basal cell skin cancer
  3. Squamous cell skin cancer
121
Q

What are risk factors of skin cancer?

A
  1. Sunlight and UV radiation
    2.Severe and or/blistering sunburns
  2. Tanning (direct sunlight or tanning booths)
  3. Family history
  4. Fair (pale)skin that burns easily
  5. Medical conditions or medications
122
Q

What are s/s of skin cancer?

A
  1. Change in shape, color, size or feel of an existing mole
  2. Skin that is hard or lumpy
  3. The surface of the skin oozes or bleeds easily and does not heal
  4. Can be itchy, tender or painful
123
Q

Using ABCDE how can we recognize skin cancer?

A

A- look for Asymmetry in a mole
B- assess for an irregular border
C- is the color a mixture of different colors or has it changed recently?
D- Is the diameter > 6mm
E- Has there been an evolution in the mole size, shape, color?

124
Q

How is skin cancer diagnosed?

A
  1. Biopsy: shave, punch, incisional, excisional
  2. Labs and imaging:
    -CBC,BMP, LFT’s
    • Chest x-ray, CT, MRI, PET scan
  3. Sentinel node biopsy
125
Q

How is skin cancered staged?

A
  1. Size of growth
  2. How deeply embedded in the layers
  3. Whether it has metastasized
126
Q

Treatment of skin cancer depends on?

A
  1. Type and stage
  2. Size and location of tumor
  3. General health and medical history
127
Q

How is skin cancer often treated?

A
  1. Excision
  2. Surgery
  3. Chemotherapy
  4. Radiation
  5. Biologic therapy
128
Q

What is prevention and education for skin cancer?

A
  1. limit sun exposure
  2. Stay away from sunlamps and tanning booths
    3.. Avoid outdoor activities during the hottest part of the day
  3. Wear long sleeves and long pants
  4. Wear a hat with wide brim
  5. use (SPF 30)
  6. Regularly check your skin for changes in moles
129
Q

What is lymphoma?

A
  1. Cancers of the immune system
130
Q

What does lymphoma primarily affect?

A
  1. Lymphatic system
131
Q

How is lymphoma classified?

A
  1. Degree of cell differentiation
  2. Ogrin of predominant malignant cell
132
Q

What are two broad categories or lymphoma?

A
  1. Hodgkin lymphoma
  2. Non-Hodgkin lymphoma
133
Q

Where can lymphoma originate in?

A
  1. Lymph nodes
  2. Spleen
  3. Thymus gland
  4. Tonsils
  5. Adenoids
  6. Adenoids
  7. Bone Marrow
  8. Digestive tract
134
Q

What is stage 1 of lymphoomas?

A
  1. Earliest stage; the lymphoma only involves a single lymph node group
135
Q

What is stage 2 of lymphomas?

A
  1. In several lymph nodes either above or below diaphragm
136
Q

What is stage 3 of lymphomas?

A
  1. In several lymph nodes both above and below diaphragm
137
Q

What is stage 4 of lymphomas?

A
  1. Widespread beyond lymph nodes and spleen; spread to 1 or more organs
138
Q

Hodgkin lymphoma develops from what abnormal b cell?

A
  1. Abnormal B cellls
139
Q

What should we know about Hodgkin lymphoma?

A
  1. Rare
  2. 5 Subtypes
  3. High cure rate
140
Q

What are the s/s of Hodgkin lymphoma?

A
  1. Firm, painless enlargement of 1+ lymph nodes
  2. Fatigue, weakness, night sweats, wt loss greater than or equal two 10%
141
Q

What two common age groups that are affected by Hodgkins lymphoma?

A
  1. 16-34 years old
  2. 55 and older
142
Q

What are the risk factors of Hodgkin lymphoma

A
  1. EBV
  2. HIV
  3. Weakened immune system
  4. Family history
143
Q

Non-Hodgkin’s lymphoma develops from what type of abnormal cells?

A
  1. Abnormal B or T cells
144
Q

How many subtypes are there of Non-Hodgkin lymphoma are there ?

145
Q

What age group in Non-Hodgkin lymphoma prevalent in

A
  1. 50-70 years old
146
Q

What are the risk factors of Non-Hodgkin lymphoma?

A
  1. Viral infections
  2. Autoimmune disease
  3. Infection with H.Pylori
  4. Exposure to chemicals
147
Q

What are s/s of Non-Hodgkins lymphoma?

A

Same as HL except NO reed-sternberg cells

  1. Firm, Painless enlargement of 1+ lymph nodes
  2. Fatigue, weakness, night sweats, wt loss more than or equal to 10%
  3. May have CNS involvement (neuropathy, H/A)
148
Q

What are 3 types of Non-Hodgkin lymphoma?

A
  1. Low grade or “indolent”
    -Slow growing, Lifelong disease
  2. Intermediate grade
    -Moderately aggressive
  3. High grade or “aggressive”
    • very aggressive, Poor prognosis
149
Q

What is the diagnostic testing that can be done for both HL and NHL?

A
  1. CBC
  2. CXR, CT Scans
  3. Lymph node biopsy:
    -Identify type of cell & pattern (B vs. T cells)
    -Reed-sternberg cells in HL only
  4. Bone marrow biospy
150
Q

What is treatment for NHL based upon?

A
  1. Type & Stage of disease, prior treatment, ability to tolerate therapy
151
Q

What are the options for NHL treatment?

A

1 Watchful watching (only NHL low grade stage)
2. Chemotherapy
3. Radiation therapy
-Combo radiation/chemo in later stages?
4. Stem cell transplantation

152
Q

How do manage fatigue with lymphoma?

A
  1. Balance activity with rest
153
Q

How do we manage nutrition with lymphoma?

A
  1. Monitor weight, fluids and food intake
154
Q

How do we manage the risk for infection with lymphoma?

A
  1. Myelosuppression
155
Q

How do we manage body image with lymphoma?

A
  1. Weight loss, alopecia, sterility
156
Q

How do we manage hopelessness with lymphoma?

A
  1. Support groups, ACS, Family Planning options
157
Q

What are some treatment options for lymphoma?

A
  1. Surgery
  2. Chemotherapy
  3. Photodynamic therapy
    -Use of drugs that become active when exposed to light
  4. Biological therapy
    -Monoclonal antibodies
    -Growth factors
    -Vaccines
  5. Radiation
158
Q

What are 3 treatment options for cancer?

A
  1. Surgery
  2. Radiation therapy
  3. Chemotherapy
159
Q

Surgery is often used in conjunction with chemotherapy or radiation for what 4 purposes?

A
  1. Prevent
  2. Diagnose
  3. Stage
  4. Treat
160
Q

True or false: Surgery is the most frequent treatment method

161
Q

What are types of surgery for cancer treatment?

A
  1. Diagnostic
  2. Primary
  3. Prophylactic
  4. Palliative
  5. Reconstructive
162
Q

Diagnostic surgery includes tissue biopsy… what are the 6 types of biopsies?

A
  1. shave
  2. Punch
  3. Incisional
  4. Excisional
  5. Fine needle
  6. Core needle
163
Q

What is debulking in terms of surgery for cancer treatment?

A
  1. Remove as much of tumor as possible
164
Q

What is radical excisions in terms of surgery for cancer treatment?

A
  1. Can be disfiguring and alter functioning
165
Q

What is salvage surgery in terms of surgery for cancer treatments?

A
  1. Extensive surgery to site at which previous therapies have failed
166
Q

What is electrosurgery?

A
  1. Electrical current to destroy tumor cells
167
Q

What is cryosurgery?

A
  1. Liquid nitrogen to freeze tissue
168
Q

What is chemosurgery?

A

Chemical applied to tissue

169
Q

What is laser surgery?

A
  1. Precise high dose radiation therapy
170
Q

What is prophylactic surgery?

A
  1. Removal of non-vital tissues/organs that may develop cancer
171
Q

What are some considerations for prophylactic surgery?

A
  1. Family hx and genetic predisposition
  2. Presence or absence of symptoms
  3. Risk vs. benefits
  4. Ability to detect cancers early
  5. Patient’s acceptance of post-op out come
172
Q

What is palliative surgery?

A
  1. Pain relief
  2. Not intended to treat or cure
  3. Goal is high quality of life
173
Q

What is reconstructive surgery?

A
  1. Plastic surgery
  2. Trying to repair injury or loss of function from curative or radical surgeries
  3. May take several procedures
174
Q

Care of a surgical cancer patient includes?

A
  1. Incision care
  2. Prevent infection
  3. Manage pain
  4. Educate on
    -Care of drains, s/s of infection, dietary intake to promote healing
175
Q

What is the goal of radiation and chemotherapy?

A
  1. Eliminate cancerous cells
176
Q

What should we know about radiation and chemotherapy (generalized)?

A
  1. Affects rapidly proliferating cells
  2. Can cause wide range of symptoms
  3. Death can result from symptoms
  4. Benefits out weigh risk… in most cases
177
Q

What do we need to know about radiation therapy?

A
  1. Energy to kill tumors
  2. Energy to shrink tumors
  3. Energy to eliminate cancer cells
  4. Damages cell’s DNA
  5. Healthy cells can also be damaged
  6. Treatment of choice for localized cancer
178
Q

What is a lethal tumor dose?

A
  1. Amount required to eradicate 95% of tumor and simultaneously salvage normal tissue
  2. Total is delivered over weeks to allow healthy tissue to recover
  3. Repeated doses also allow periphery of tumor to re-oxygenate and become susceptible to radiation
179
Q

What factors can affect dosage?

A
  1. Radiosensitivity of the tumor,
  2. Normal tissue tolerance
  3. Volume of tissue to be irradiated
180
Q

Why can radiosensitivity of the tumor affect the radiation dosage

A
  1. Dependent on the presence of oxygen.
181
Q

How can normal tissue tolerance affect radiation dosage?

A
  1. Point at which normal tissues are irreparably damaged.
182
Q

How can volume of tissue to be irradiated affect factors of radiation dosage?

A
  1. total prescribed dose usually diveded into several smaller doses
  2. Treatments are usually given daily, 5 days per week for an average of 25-30 treatments
183
Q

What are the benefits of radiation therapy?

A
  1. Used before surgery to shrink therapy
  2. Intra-operative radiation
  3. Given before, during or after chemo
  4. Palliative
    -Shrink tumors
    -Reduce pressure, pain & other symptoms
184
Q

What do we need to know about radiation toxicity

A
  1. localized to area of treatment
  2. May be higher if in conjunction w/chemo
185
Q

Generalized effects of radiation toxicity include

A
  1. Fatigue
  2. Anemia
  3. N/V
  4. Thrombocytopenia
186
Q

What should we know about sealed implants?
(brachytherapy)

A
  1. Body usually does not give off radiation BUT pregnant women & small children should avoid exposure to patient.
187
Q

What should we know about unsealed implants? (brachytherapy)

A
  1. Body will give off radiation
  2. body secretions may be contaminated
  3. Isolation
188
Q

What are the side effects of brachytherapy?

A
  1. Fatigue
  2. Anorexia
  3. Immunosuppression
  4. Other side effects similar to external radiation
189
Q

What are some client education for temporary brachytherapy?

A
  1. Avoid close contact with others until treatment is completed
  2. No contact with pregnant women
  3. Bed rest to prevent dislodging radioactive source
  4. Maintain balanced diet, consider small, frequent meals
  5. Maintain fluid intake to ensure adequate hydration: 2-3 liters/day
190
Q

What are the side effects of radiation?

A
  1. Fatigue
  2. Skin changes
  3. Alopecia
  4. Immunosuppression
  5. Radiation pneumonia
  6. Ulceration of oral mucous membranes
  7. GI: N/V, Diarrhea
  8. Symptoms increase as treatment progresses
191
Q

Patient education for radiation therapy includes?

A
  1. Wash treated area only with tepid water & soft wash cloth
  2. No application of heart or cold packs.
  3. Use electric razor only
  4. Do not remove treatment markings on skin
  5. Do not use any products to the sites during treatment
  6. Avoid wearing tight fitting, starched, or stiff clothing over treatment area
  7. Do not use adhesive tape- use paper tape- apply outside treatment area
  8. Protect skin from sun exposure
  9. Get proper rest, diet, fluid intake for health and repair of normal tissues
    -eat 5-6 small meals/day
    -fat/fiber/lactose
    -BRAT diet for diarrhea
  10. If hair loss occurs protect hair
192
Q

What is chemotherapy?

A
  1. Use of anticancer drugs to eliminate cancer cells
    • More than 100 drugs available
    • Combination drugs frequently used
    • Affects the entire body (Cancerous and non-cancerous)
      -Side effects are numerous
      -Death may occur due to side effects
193
Q

What is the goal of chemotherapy?

A
  1. Is to kill cancerous cells while preserving other, more healthy cells
    • Not always possible
    • High percentage of oncology patients die from treatment- not the cancer
194
Q

How is chemotherapy administered?

A

In cycles- daily, weekly, monthly

195
Q

What forms of chemo therapy are available?

A
  1. Pill
  2. Injection
  3. IV
  4. Topical
  5. Directly into body cavity
196
Q

How is chemotherapy dosage calculated?

A

By body surface area

197
Q

What are some things we need to know about the administration of chemotherapy?

A
  1. Excreted in body fluids up to 48 hours after treatment
  2. Usually requires specialized ports
  3. Monitor lab values closely
    -WBC’s, RBC’s, H&H, Platelets, etc.
  4. Chemo certified RN only
198
Q

What are some patient teaching guidelines for chemotherapy?

A
  1. Handwashing– family members & visitors as well

For 48-72 hours following chemo
1. Flush toilets twice
2. Rince toilets with bleach once/day
3. Caregiver should wear gloves if in contact with
-any body fluids
-contaminated laundry
4. Avoid sexual activity
- Use 2 forms of birth control

199
Q

What are the guidelines for handling cytotoxic drugs?

A
  1. No safe exposure limit
  2. Risk of exposure
    -Handling body fluids of pt within 48 hours of chemo
    • Always wear PPE
      -Accidental spills
  3. Routes of exposure
    • Inhalation, absorption, ingestion
  4. Follow agency guidelines for proper disposal
200
Q

What should we know about immunotherapy?

A
  1. Boosts the immune system. Which creates an environment that is not conductive for cancer cells to grow
  2. Attacks cancer cells directly
201
Q

What is targeted therapy for cancer?

A
  1. Interferes with cancer growth. Targets specific receptors important in tumor development
202
Q

What are side effects of targeted therapy for cancer?

A
  1. Flu-like symptoms-headache, fever, chills, fatigue, extreme weakness, anorexia, and nausea
  2. Tachycardia
  3. Neurologic deficits- confusion, memory loss, insomnia
  4. Bone marrow depression
203
Q

What are side effects of chemo?

A
  1. N/V
  2. Alopecia
  3. Stomatitis
  4. Pain
  5. Enteritis
  6. Diarrhea
  7. Anemia
  8. Fatigue
  9. Myelosuppression
  10. Pancytopenia
  11. Leukopenia
  12. Neutropenia
  13. Thrombocytopenia
  14. Granulocytopenia
204
Q

What should we know about fatigue as a side effect of cancer treatment?

A
  1. Frequent side effect of cancer therapy
  2. Can be debilitating
  3. Unrelated to activity
  4. Unrelieved with rest
  5. Can be prolonged
  6. Can affect health and quaility of life
  7. Monitor thyroid levels
205
Q

What should we know about N/V as a side effect of cancer treatment?

A
  1. More commonly associated with chemo
    -Can affect patient receiving radiation
  2. Emetogenic- nausea causing drugs
  3. Directly related to type of chemo administered
  4. Prevention is the key
  5. Categories
    -Acute- occurs within 24 hours
    -Delayed- occurs within 2-5 days
    • Anticipatory - occurs before chemo
206
Q

What medications can be given for N/V and what should we keep in mind with treatment?

A
  1. Ondansetron
    -Can be combined with dexamethasone or emend
  2. Premedicate with antimetics before treatment
  3. Use combination medications around-the-clock for 24-72 hours following treatment
  4. Monitor dehydration
207
Q

What is anorexia-cachexia syndrome?

A
  1. Loss of skeletal muscle & Fat- not starvation
  2. Unexplained rapid weight loss
  3. Altered smell and taste

Catabolic state
1. Body tissue and muscle proteins used to support cancer cell growth
2. May halt cancer treatment
3. Corticosteroids proven effective

208
Q

What are some immunosuppression risk factors?

A
  1. Decreased ability to flight infection
  2. Risk for infection increases when
    • WBC decrease
    • Neutrophils decrease
  3. Risk for anemia increases when
    • Red blood cell decrease
      -Decreased H&H
  4. Risk for bleeding increases when
    -Decreased platelets
209
Q

What is NADIR?

A
  1. Blood cell count at lowest point
  2. Occurs at different times
  3. WBC’s and platelets day 7-14
  4. RBC’s may take several weeks
  5. Immune system compromised
  6. Treatments designed around NADIR
210
Q

What should we know about the levels of the absolute neutrophil count?

A

Calculation: (Total WBC) x [%neutrophils + % bands] divided by 100

  1. > 1500 = no increased risk of infection
  2. 1000-1500 = slight increased risk
  3. 500-999 = moderate increased risk
  4. 100-449 = high risk
  5. <100 = extremely high risk
211
Q

What are s/s of infection?

A
  1. Fever of 100.5 or higher
  2. Fatigue, body aches
  3. Chill, sweating
  4. Hypotension
  5. Tachycardia
  6. Lab Values
    -WBC
    • Neutrophil
  7. Notify MD
    • Obtain chest x-ray
    • Blood and urine cultures
212
Q

Neutropenia is caused by?

A
  1. Decreased production of WBC
  2. Increased destruction WBC
213
Q

What should we know about neutropenia?

A
  1. Abnormally low ANC
  2. No symptoms until onset of infection
  3. Monitor CVC with differential
  4. Treatment varies depending upon cause
214
Q

What are some neutropenic precautions?

A
  1. Wash hands frequently
  2. Low bacteria diet
  3. No fresh flowers, plants, pets
  4. Avoid crowds
  5. No visitors with infections
  6. No immunizations
215
Q

What is thrombocytopenia (decreased platelets) and what should we know about it?

A
  1. PLT promote coagulation, vascular integrity, vasoconstriction, adhesion
  2. Produced in bone marrow
    -live 7-9 days
  3. Reference values
    -150,000-400,000
  4. Critical values:
    • < 50,000 or > 1 million
216
Q

What is patient education on thrombocytopenia?

A
  1. Monitor stools/urine for bleeding
  2. Use electric razor only,
  3. APply ice to affected area if trauma occurs
  4. Avoid dental work or other invasive procedures
  5. Avoid aspirin and aspirin-containing products
  6. Soft toothbrush and no flossing
  7. No aspirin
217
Q

What is the nursing management of thrombocytopenia?

A
  1. Monitor platelet count
  2. Monitor stools and urine for occult blood
  3. Assess skin for ecchymosis, petechiae and trauma at least every shift
  4. Educate client about bleeding safety precautions
  5. Avoid IM injections and limit venipuncture
218
Q

What is chemo-brain?

A
  1. A “mental fog” caused by chemotherapy, radiation and some types of immunotherapy
219
Q

What are some nursing interventions: Encourage with chemo-brain to:

A
  1. Use a calendar or day planner
  2. Write down every
  3. Exercise the brain with crossword puzzles or other word or number games, jigsaw puzzles, play cards
  4. Get physical exercise as tolerated
  5. Ask for support (friends, family, support groups)
  6. If it persists, some of the same drugs to treat Alzheimer’s disease can be used
220
Q

What is ascites?

A
  1. Pathological accumulation of fluid within the abdominal cavity
221
Q

What cancers is ascites common with?

A
  1. Ovary
  2. Breast
  3. Colon
  4. Stomach
  5. Pancreas
  6. End-stage liver disease regardless of cause
222
Q

What are the symptoms of Ascities?

A
  1. Abdominal distention
    2.fullness
    3.early satiety
  2. Difficulty breathing
  3. Decreased mobility
  4. Edema
223
Q

How is Ascites diagnosed?

A
  1. Serum albumin/protein (CMP), a simultaneous diagnostic paracentesis checking ascitic fluid for WBC, Albumin, protein and cystology
224
Q

How is ascites managed?

A
  1. Low salt diet (reduces the associated water retention and helps reduce edema)
  2. Diuretic therapy (monitor BP)
  3. Paracentesis (usually palliative… fluid build up will return)
  4. May place pleurx to enable patient to drain at home
  5. Peritoneovenous shunts
225
Q

True or false: Ascites is a late sign & usually a poor prognosis. Comfort is key in cancer patients?

Module 3 (3 decks)

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