Exam 4: Oncology/Lung Cancer/Colorectal Cancer/Liver Cancer/Pancreatic Cancer Flashcards
Cancer
Uncontrolled and unregulated growth of cells caused by defective cell proliferation (growth) and defective cell differentiation.
Chemical carcinogens
Drugs that interact with DNA (alkylating drugs)
Radiation
UV light causing skin cancer
Radiation can lead to higher incidences of bone cancer for
Radiologists
Radiation chemists
X-ray
Viral carcinogens include
Hepatitis
AIDS
An immunosuppressed or weakened body increases the risk for
Cancer
Benign neoplasms
- Normally differentiated.
- Growth does not infiltrate other areas.
- Does not metastasize.
- Cells are fairly normal and similar to parent cells.
Malignant Neoplasms
- poorly differentiated
- EASILY INVADE AND METASTASIZE*
- cells are abnormal and different than parent cells
Cancer: Grade I Cells
Mild dysplasia: differ slightly from normal cells
Low grade: well differentiated
Cancer: Grade II Cells
Moderate dysplasia: more abnormal cells
Intermediate grade: moderately differentiated
Cancer: Grade III Cells
Severe dysplasia: very abnormal
High grade: poorly differentiated
Cancer: Grade IV Cells
Anaplasia: Immature and primitive undifferentiated
High grade: cell of origin is difficult to determine
Cancer: Grade X Cells
Grade cannot be assessed.
Cancer Stages: Stage 0
Cancer in situ (only in epidermis, same cell growth, just multiplying fast (precancerous))
Cancer Stages: Stage 1
Tumor limited to tissue of origin
Localized tumor growth
Cancer Stages: Stage 2
Limited local spread
Cancer Stages: Stage 3
Extensive local and regional spread
Cancer Stages: Stage 4
Metastasis (spreads to different organ)
Tumor Size and Invasiveness Classification: T0
No evidence of primary tumor
Tumor Size and Invasiveness Classification: T1-4
Increase in tumor size and involvement
Spread to Lymph Nodes Classification: N0
No evidence of lymph nodes involved
Spread to Lymph Nodes Classification: N1-4
Increase in nodal involvement
Metastasis Classification: M0
No evidence of distant metastasis
Spread to Lymph Nodes Classification: M1-4
Increased metastatic involvement, including distant nodes
Prevention of Cancer
- 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
Warning signs of colorectal cancer
Changes in bowel or bladder habits
Warning signs for liver cancer include
- A sore that does not heal (d/t lack of prothrombin, clotting factors and vitamin K)
Warning signs for leukemia include
Unusual bleeding or discharge from any body orifice
Warning signs for breast cancer include
Thickening or a lump in the breast or elsewhere
Warning signs for GI cancer
Indigestion or difficulty swallowing
Warning signs for lung cancer include
- Indigestion or difficulty swallowing
2. Nagging cough or hoarseness
Warning signs for skin cancer include
Obvious changes in wart or mole
Diagnostic Studies for Cancer
- 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
Lab Work: Cancer
- 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
Liver Function Studies: Cancer
AST, ALT, usually elevated in liver cancer
Goal for Cancer Treatment
Cure
Control
Palliative
Surgical Treatment for Cancer
Cytoreductive Procedure (Debulking) Neoadjuvant
Cytoreductive Procedure
Surgically removing as much tumor as possible prior to chemotherapy and radiation therapy
Neoadjuvant
Chemotherapy and radiation performed to help shrink tumor before surgery
Post op care after surgery for cancer includes
Splinting incision (have pillow and hold it where incision is, during deep breathing and coughing)
Chemotherapy Nursing Implications
- 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.
Radiation Therapy
Emission of energy destroys cancer cells.
Once a day, 5 days a week
Radiation Therapy: Nursing Implications
- 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
Radiation Therapy: Adverse Effect
Can lead to anemia (bone marrow suppression)
Neutropenic Precautions include
- Strict hand washing
- No sick visitors or personnel
- No plants or fresh fruit or vegetables
- Pure bottled water (no tap)
Biological Targeted Therapy
- Effective alone or with surgery, radiation and chemotherapy.
- Causes flu-like symptoms, increases fluid
Biologic Therapy
Agents that alter biologic response to tumor cells
Targeted Therapy
Targets and binds cell receptors important to tumor growth
Hematopoietic Stem Cell Transplantation
Allows high doses for treatment:
- Failing to respond to standard doses of chemotherapy or radiation.
- Develops resistance
Common Side Effects of Chemotherapy and Radiation
- Bone Marrow Suppression
- Fatigue
- GI Disturbances: N/V/D, ulcers, anorexia, constipation
- Integumentary and Mucosal Reactions: Alopecia, May cause thickened secretions, May cause tissue breakdown and infiltration
- Pulmonary effects
- Reproductive dysfunction
Chemotherapy and Radiation Side Effects: Bone Marrow Suppression
- Neutropenia (decreased neutrophil count) -> risk for infection and sepsis
- Thrombocytopenia (decreased platelet count) -> risk for hemorrhage and bleeding
- Anemia (symptoms like fatigue and weakness)
Chemotherapy and Radiation Side Effects: Fatigue is caused by
- Accumulation of toxic substances in the body
- Need for energy to repair and heal body damaged by treatment
- Lack of sleep from chemotherapy drugs
Lung Cancer: Pathophysiology
Inhaled carcinogens -> damage cell’s DNA -> abnormal cell growth -> malignancy that is uncontrolled
What are possible causes of lung cancer?
- 80-90% caused by smoking (carbon monoxide and nicotine) - interferes with normal cells development
- Second hand smoking
- Environmental and occupational exposure
- Genetics: African Americans - highest incidence
- Dietary factors
Types of Lung Cancer
- Small Cell Lung Cancer
2. Non-Small Cell Lung Cancer
Small Cell Lung Cancer
20%
- Most malignant form
- Very rapid growth rate
- Metastasizes early via lymphatics and bloodstream
Non-Small Cell Lung Cancer
80%
Includes adrenocarcinoma and large cell carcinoma
Adrenocarcinoma
Moderate growth
Early metastasis
Large cell carcinoma
Rapid growth
Clinical Manifestations of Lung Cancer
- 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
Nursing Considerations: Goals for Lung Cancer Treatment
- Effective breathing patterns
- Adequate airway clearance
- Adequate oxygenation of tissues
- Minimal to no pain
- Realistic attitude about treatment and prognosis
Nursing considerations for Lung Cancer Patients
- Encourage smoking cessation
- Emotional support and pain management
- Pneumenectomy (removal of entire long) or lobectomy (removal of one or more lobes)
Pneumonectomy
- 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
Causes of Colorectal Cancer
- Diet
- Lifestyle
- Health Factors
What kind of diet can lead to colorectal cancer?
- High in red or processed meat (nitrites)
- Low in fruits and vegetables
What kind of lifestyle leads to colorectal cancer?
- Obesity
- Physical inactivity
- Alcohol
- Long-term smoking
What health factors leads to colorectal cancer?
- Genetic conditions such as FAP (polyps)
- History of IBD
- Individual or family history of colorectal cancer
- Colorectal polyps
- Age, and more common in men
Pathophysiology of Colorectal Cancer
Tumor grows -> penetrates muscularis mucosae -> reaches lymph nodes and circulation -> metastasis
Clinical Manifestations of Colorectal Cancer
- 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
Early Symptoms of Colorectal Cancer
fatigue and weight loss (nonspecific)
Advanced symptoms of Colorectal Cancer
abdominal tenderness
palpable abdominal mass
hepatomegaly
ascites
Diagnostics for Colorectal Cancer
- 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
Colonoscopy
Polyps can be removed during colonoscopy
Bowel Prep for Colonoscopy and Sigmoidoscopy
- 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.
Nursing Considerations for Colorectal Cancer
- 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
Causes of Liver Cancer include
- Chronic liver disease
- Hepatitis B and C
- Cirrhosis of the liver
- Exposure to chemical and toxins
Risk Factors for Liver Cancer
- Cigarette smoking
- Alcohol
- Aflatoxin (poison produced by mold on crops such as corn and peanuts)
Clinical Manifestations of Liver Cancer
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
Complications of Liver Cancer include
- Splenomegaly (blood backs up into spleen)
- Portal vein thrombosis (blood stasis above liver)
- Pulmonary emboli
Nursing Considerations: Goals for Liver Cancer
Provide patient comfort and symptomatic management (similar to liver cirrhosis)
Nursing Considerations for Liver Cancer
- 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
Transhepatic Biliary Tubes
-Allows decompression of obstructed extrahepatic bile ducts
Transhepatic Biliary Tubes: Nursing Care
- 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
Radio frequency ablation
- Thin needle inserted into tumor and uses electrical energy to destroy tumors.
- Done percutaneously, laparoscopically or through open incision.
Radiofrequency ablation: Complications include
Infection
Bleeding
Dysrhythmias
Skin Burn
Chemoembolization
Minimally invasive
Uses catheter to administer emboli agent and chemotherapy agents
Alcohol injection
Insert liquid high concentration of alcohol, effective in small sized tumors..
Pancreatic Cancer
Carcinomas of the head of the pancreas, the ampulla of Vater, the common bile duct and the duodenum
Risk Factors for Pancreatic Cancer
Chronic pancreatitis DM Age Cigarette smoking Diets high in fat Exposure to chemicals (like gasoline)
Clinical Manifestations of Pancreatic Cancer
- 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)
Nursing Considerations for Pancreatic Cancer
- 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)
Whipple Procedure
- 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
Whipple Procedure: Complications include
- decreased insulin production, may become insulin dependent
- common complication: pancreatic juices leaking, drainage system needed
