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NURS 313R > Exam 4: Oncology/Lung Cancer/Colorectal Cancer/Liver Cancer/Pancreatic Cancer > Flashcards

Exam 4: Oncology/Lung Cancer/Colorectal Cancer/Liver Cancer/Pancreatic Cancer Flashcards

1
Q

Cancer

A

Uncontrolled and unregulated growth of cells caused by defective cell proliferation (growth) and defective cell differentiation.

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2
Q

Chemical carcinogens

A

Drugs that interact with DNA (alkylating drugs)

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3
Q

Radiation

A

UV light causing skin cancer

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4
Q

Radiation can lead to higher incidences of bone cancer for

A

Radiologists
Radiation chemists
X-ray

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5
Q

Viral carcinogens include

A

Hepatitis

AIDS

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6
Q

An immunosuppressed or weakened body increases the risk for

A

Cancer

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7
Q

Benign neoplasms

A
  • Normally differentiated.
  • Growth does not infiltrate other areas.
  • Does not metastasize.
  • Cells are fairly normal and similar to parent cells.
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8
Q

Malignant Neoplasms

A
  • poorly differentiated
  • EASILY INVADE AND METASTASIZE*
  • cells are abnormal and different than parent cells
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9
Q

Cancer: Grade I Cells

A

Mild dysplasia: differ slightly from normal cells

Low grade: well differentiated

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10
Q

Cancer: Grade II Cells

A

Moderate dysplasia: more abnormal cells

Intermediate grade: moderately differentiated

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11
Q

Cancer: Grade III Cells

A

Severe dysplasia: very abnormal

High grade: poorly differentiated

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12
Q

Cancer: Grade IV Cells

A

Anaplasia: Immature and primitive undifferentiated

High grade: cell of origin is difficult to determine

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13
Q

Cancer: Grade X Cells

A

Grade cannot be assessed.

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14
Q

Cancer Stages: Stage 0

A

Cancer in situ (only in epidermis, same cell growth, just multiplying fast (precancerous))

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15
Q

Cancer Stages: Stage 1

A

Tumor limited to tissue of origin

Localized tumor growth

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16
Q

Cancer Stages: Stage 2

A

Limited local spread

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17
Q

Cancer Stages: Stage 3

A

Extensive local and regional spread

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18
Q

Cancer Stages: Stage 4

A

Metastasis (spreads to different organ)

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19
Q

Tumor Size and Invasiveness Classification: T0

A

No evidence of primary tumor

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20
Q

Tumor Size and Invasiveness Classification: T1-4

A

Increase in tumor size and involvement

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21
Q

Spread to Lymph Nodes Classification: N0

A

No evidence of lymph nodes involved

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22
Q

Spread to Lymph Nodes Classification: N1-4

A

Increase in nodal involvement

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23
Q

Metastasis Classification: M0

A

No evidence of distant metastasis

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24
Q

Spread to Lymph Nodes Classification: M1-4

A

Increased metastatic involvement, including distant nodes

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25
Q

Prevention of Cancer

A
  • Smoking Cessation
  • Use sunscreen with sun protection factor of 15 or higher
  • Limit alcohol intake
  • Eating a balanced diet
  • Maintain normal body weight
  • Regular exercise (30 minutes or more 5x a week)
  • Adequate rest
  • Screenings
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26
Q

Warning signs of colorectal cancer

A

Changes in bowel or bladder habits

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27
Q

Warning signs for liver cancer include

A
  1. A sore that does not heal (d/t lack of prothrombin, clotting factors and vitamin K)
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28
Q

Warning signs for leukemia include

A

Unusual bleeding or discharge from any body orifice

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29
Q

Warning signs for breast cancer include

A

Thickening or a lump in the breast or elsewhere

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30
Q

Warning signs for GI cancer

A

Indigestion or difficulty swallowing

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31
Q

Warning signs for lung cancer include

A
  1. Indigestion or difficulty swallowing

2. Nagging cough or hoarseness

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32
Q

Warning signs for skin cancer include

A

Obvious changes in wart or mole

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33
Q

Diagnostic Studies for Cancer

A
  • cytology studies (sputum samples, bronchoscopy)
  • Tissue Biopsy
  • CXR
  • Lab Work
  • Liver Function Studies
  • Endoscopic Examination or Colonoscopy
  • Radiographic Studies: mammography, ultrasound, CT scan, MRI
  • Radioisotope scans: bone, lung, liver, rain
  • PET scan: indicates effects of therapy
  • Tumor Markers (CEA, AFP, PSA, CA-125)
  • Genetic Markers (BRCA1, BRCA2)
  • Molecular receptor status (estrogen and progesterone receptors)
  • Bone marrow examination
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34
Q

Lab Work: Cancer

A
  • CBC, chemistry profile
  • WBC’s usually elevated
  • RBCs usually decreased (prothrombin, clotting factors, vitamin K impaired for liver cancer; GI bleeding for colorectal cancer)
  • Hb/Hct
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35
Q

Liver Function Studies: Cancer

A

AST, ALT, usually elevated in liver cancer

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36
Q

Goal for Cancer Treatment

A

Cure
Control
Palliative

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37
Q

Surgical Treatment for Cancer

A 
Cytoreductive Procedure (Debulking)
Neoadjuvant
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38
Q

Cytoreductive Procedure

A

Surgically removing as much tumor as possible prior to chemotherapy and radiation therapy

39
Q

Neoadjuvant

A

Chemotherapy and radiation performed to help shrink tumor before surgery

40
Q

Post op care after surgery for cancer includes

A

Splinting incision (have pillow and hold it where incision is, during deep breathing and coughing)

41
Q

Chemotherapy Nursing Implications

A
  • Only administered by properly trained personnel (oncology nurses)
  • Our role is to care for medication sites
  • Take care in handling body excretions first 48 hours, monitor and put in yellow containers.
42
Q

Radiation Therapy

A

Emission of energy destroys cancer cells.

Once a day, 5 days a week

43
Q

Radiation Therapy: Nursing Implications

A
  • Patient may wash themselves only with plain water and mild soap (no powders, lotions, scratching or scrubbing)
  • Limit visitors for 10-30 minutes and stay 6 feet away from patient
  • Bed rest is important
  • Neutropenic precautions
44
Q

Radiation Therapy: Adverse Effect

A

Can lead to anemia (bone marrow suppression)

45
Q

Neutropenic Precautions include

A
  • Strict hand washing
  • No sick visitors or personnel
  • No plants or fresh fruit or vegetables
  • Pure bottled water (no tap)
46
Q

Biological Targeted Therapy

A
  • Effective alone or with surgery, radiation and chemotherapy.
  • Causes flu-like symptoms, increases fluid
47
Q

Biologic Therapy

A

Agents that alter biologic response to tumor cells

48
Q

Targeted Therapy

A

Targets and binds cell receptors important to tumor growth

49
Q

Hematopoietic Stem Cell Transplantation

A

Allows high doses for treatment:

  1. Failing to respond to standard doses of chemotherapy or radiation.
  2. Develops resistance
50
Q

Common Side Effects of Chemotherapy and Radiation

A
  1. Bone Marrow Suppression
  2. Fatigue
  3. GI Disturbances: N/V/D, ulcers, anorexia, constipation
  4. Integumentary and Mucosal Reactions: Alopecia, May cause thickened secretions, May cause tissue breakdown and infiltration
  5. Pulmonary effects
  6. Reproductive dysfunction
51
Q

Chemotherapy and Radiation Side Effects: Bone Marrow Suppression

A
  • Neutropenia (decreased neutrophil count) -> risk for infection and sepsis
  • Thrombocytopenia (decreased platelet count) -> risk for hemorrhage and bleeding
  • Anemia (symptoms like fatigue and weakness)
52
Q

Chemotherapy and Radiation Side Effects: Fatigue is caused by

A
  • Accumulation of toxic substances in the body
  • Need for energy to repair and heal body damaged by treatment
  • Lack of sleep from chemotherapy drugs
53
Q

Lung Cancer: Pathophysiology

A

Inhaled carcinogens -> damage cell’s DNA -> abnormal cell growth -> malignancy that is uncontrolled

54
Q

What are possible causes of lung cancer?

A
  1. 80-90% caused by smoking (carbon monoxide and nicotine) - interferes with normal cells development
  2. Second hand smoking
  3. Environmental and occupational exposure
  4. Genetics: African Americans - highest incidence
  5. Dietary factors
55
Q

Types of Lung Cancer

A
  1. Small Cell Lung Cancer

2. Non-Small Cell Lung Cancer

56
Q

Small Cell Lung Cancer

A

20%

  • Most malignant form
  • Very rapid growth rate
  • Metastasizes early via lymphatics and bloodstream
57
Q

Non-Small Cell Lung Cancer

A

80%

Includes adrenocarcinoma and large cell carcinoma

58
Q

Adrenocarcinoma

A

Moderate growth

Early metastasis

59
Q

Large cell carcinoma

A

Rapid growth

60
Q

Clinical Manifestations of Lung Cancer

A
  • Coughing (reported first)
  • Hemoptysis and blood tinged sputum (bleeding caused by malignancy)
  • Dyspnea or wheezing
  • Chest and shoulder pain (may be localized or unilateral)
  • Weakness, anorexia, weight loss, N/V
  • Unilateral paralysis of the diaphragm
  • Hoarseness, dysphagia (pressure on laryngeal nerve)
  • Head and neck edema
  • Fever
  • Palpable lymph nodes in neck or axillae
  • Pericardial effusion, cardiac tamponade, dysrhythmias
  • Pleural effusion
  • Symptoms of ectopic hormones
61
Q

Nursing Considerations: Goals for Lung Cancer Treatment

A
  • Effective breathing patterns
  • Adequate airway clearance
  • Adequate oxygenation of tissues
  • Minimal to no pain
  • Realistic attitude about treatment and prognosis
62
Q

Nursing considerations for Lung Cancer Patients

A
  • Encourage smoking cessation
  • Emotional support and pain management
  • Pneumenectomy (removal of entire long) or lobectomy (removal of one or more lobes)
63
Q

Pneumonectomy

A
  • May require chest tube to keep fluid in and prevent air from entering (not continuous suction, stays clamped)
  • Post op: splint incision
  • Encourage incentive spirometer use
64
Q

Causes of Colorectal Cancer

A
  • Diet
  • Lifestyle
  • Health Factors
65
Q

What kind of diet can lead to colorectal cancer?

A
  • High in red or processed meat (nitrites)

- Low in fruits and vegetables

66
Q

What kind of lifestyle leads to colorectal cancer?

A
  • Obesity
  • Physical inactivity
  • Alcohol
  • Long-term smoking
67
Q

What health factors leads to colorectal cancer?

A
  • Genetic conditions such as FAP (polyps)
  • History of IBD
  • Individual or family history of colorectal cancer
  • Colorectal polyps
  • Age, and more common in men
68
Q

Pathophysiology of Colorectal Cancer

A

Tumor grows -> penetrates muscularis mucosae -> reaches lymph nodes and circulation -> metastasis

69
Q

Clinical Manifestations of Colorectal Cancer

A
  • Iron-deficiency anemia
  • Rectal bleeding (most common)
  • Abdominal pain and tenderness
  • Change in bowel habits (alternating constipation and diarrhea)
  • Narrow, ribbon-like stool
  • Sensation of incomplete evacuation
  • Intestinal obstruction or perforation
70
Q

Early Symptoms of Colorectal Cancer

A

fatigue and weight loss (nonspecific)

71
Q

Advanced symptoms of Colorectal Cancer

A

abdominal tenderness
palpable abdominal mass
hepatomegaly
ascites

72
Q

Diagnostics for Colorectal Cancer

A
  • Digital Rectal Examination
  • Barium Enema
  • CT and MRI abdomen
  • Sigmoidoscopy & Colonoscopy (screening starts at 50 years old)
  • Testing for stool occult blood
  • Labs: CBC, liver functions tests, carcinoembryonic antigen
73
Q

Colonoscopy

A

Polyps can be removed during colonoscopy

74
Q

Bowel Prep for Colonoscopy and Sigmoidoscopy

A
  • Clear liquid diet 24-48 hours prior to procedure.
  • NPO after midnight.
  • Golytely or Miralax 2 L nigh before and 2 L morning of procedure.
  • Successful if stool is clear or yellowish liquid and indicates the colon is clean.
75
Q

Nursing Considerations for Colorectal Cancer

A
  • Decreasing risk of CRC (physical exercise, balanced diet, screenings)
  • Temporary or permanent colostomy
  • Proper bowel prep
  • Reduce colonic bacteria and chance of intra-operative and post-operative infection (meticulous care)
  • Emotional support and pain management
76
Q

Causes of Liver Cancer include

A
  • Chronic liver disease
  • Hepatitis B and C
  • Cirrhosis of the liver
  • Exposure to chemical and toxins
77
Q

Risk Factors for Liver Cancer

A
  • Cigarette smoking
  • Alcohol
  • Aflatoxin (poison produced by mold on crops such as corn and peanuts)
78
Q

Clinical Manifestations of Liver Cancer

A

Similar to Cirrhosis

  • Dull, epigastric or RUQ pain
  • Anorexia, weight loss, N/V
  • Loss of strength
  • Anorexia
  • Anemia -> risk for bleeding (prothrombin, clotting factors, vitamin k impaired)
  • Hepatomegaly
  • Jaundice -> pruritis
  • Ascites (increased abdominal girth)
  • Peripheral edema
79
Q

Complications of Liver Cancer include

A
  • Splenomegaly (blood backs up into spleen)
  • Portal vein thrombosis (blood stasis above liver)
  • Pulmonary emboli
80
Q

Nursing Considerations: Goals for Liver Cancer

A

Provide patient comfort and symptomatic management (similar to liver cirrhosis)

81
Q

Nursing Considerations for Liver Cancer

A
  • Treatment of Hep B&C
  • Decrease alcohol intake
  • Correct Fluid Retention
  • Jaundice and skin assessment
  • Pruritus Management
  • Transhepatic biliary tubes
  • Radiofrquency ablation
  • Chemoembolization
  • Systemic chemotherapy
  • Liver Transplant
82
Q

Transhepatic Biliary Tubes

A

-Allows decompression of obstructed extrahepatic bile ducts

83
Q

Transhepatic Biliary Tubes: Nursing Care

A
  • Observe for bile leakage at insertion site
  • Monitor for dark green mucous
  • Only flush with MD order
  • Cleansed daily with antiseptic
  • Do not aspirate (to avoid pulling out fecal matter)
  • Increased secretions after insertion indicate blockage
84
Q

Radio frequency ablation

A
  • Thin needle inserted into tumor and uses electrical energy to destroy tumors.
  • Done percutaneously, laparoscopically or through open incision.
85
Q

Radiofrequency ablation: Complications include

A

Infection
Bleeding
Dysrhythmias
Skin Burn

86
Q

Chemoembolization

A

Minimally invasive

Uses catheter to administer emboli agent and chemotherapy agents

87
Q

Alcohol injection

A

Insert liquid high concentration of alcohol, effective in small sized tumors..

88
Q

Pancreatic Cancer

A

Carcinomas of the head of the pancreas, the ampulla of Vater, the common bile duct and the duodenum

89
Q

Risk Factors for Pancreatic Cancer

A 
Chronic pancreatitis
DM
Age
Cigarette smoking
Diets high in fat
Exposure to chemicals (like gasoline)
90
Q

Clinical Manifestations of Pancreatic Cancer

A
  • Abdominal Pain (dull and aching): can radiate to back
  • Anorexia, rapid weight loss, N/V: eating aggravates symptoms (d/t lack of digestive enzymes form pancreas which leads to poor digestion and absorption)
  • Jaundice -> pruritus
  • Gray, pale, greasy stool (d/t lack of pancreatic juice going into the intestines for digestion)
91
Q

Nursing Considerations for Pancreatic Cancer

A
  • Similar care as pancreatitis
  • Emotional support and pain management
  • Adequate nutrition (supplemental feedings might be necessary)
  • Monitor for bleeding from body orifices and mucous membranes (decreased Vit K production)
  • Surgical removal of Pancreas
  • Radical Pancreaticodueodenectomy (Whipple Procedure)
92
Q

Whipple Procedure

A
  • Removal of head of pancreas, distal pancreas, gallbladder, part of duodenum and regional lymph nodes
  • Anastomosis of pancreatic duct, bile duct, and stomach to the jejunum
93
Q

Whipple Procedure: Complications include

A
  • decreased insulin production, may become insulin dependent

- common complication: pancreatic juices leaking, drainage system needed

NURS 313R (18 decks)

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