Lecture 11 - Cancer/Palliative Care Flashcards
What are some modifiable risk factors for cancer?
–> Tobacco
–> Excessive body weight
–> Lack of physical activity
–> Unhealthy eating habits
–> Alcohol consumption
–> Excessive exposure to the sun
What are the phases of cancer development?
Initiation, Promotion, progression
What occurs during the initiation phase of cancer? What are some known carcinogens?
A cell becomes altered and its proliferation and differentiation functions mutate
Carcinogens can be of:
Viral, chemical, radiation, genetic, and hormonal in nature
What occurs during the promotion phase of cancer development? Is it reversible?
Factors such as:
Obesity, tobacco + alcohol use, and dietary fat promote proliferation of the mutated cell.
This phase is reversible (as in it will not develop into cancer)
What occurs during the progression phase of cancer development?
There is an increased growth rate of the tumour, it invades surrounding tissue, and then metastasizes
Why might a bone scan be performed in breast cancer?
To detect metastases
What kind of imaging can be used to detect cancerous masses?
Ultrasound, MRI, CT
Biopsies after mass detected
What is the histological analysis of cancer classification?
Grading system
1 - Well differentiated
2 - Somewhat abnormal and moderately differentiated
3 - Cells look very abnormal, poorly differential
4 - Most abnormal and undifferentiated
How do we classify the extent of cancer disease progression?
Staging System
0 - In situ
1 - Tumour has not spread outside of organ of origin
2 - Tumour has spread into nearby tissue
3 - Has spread to nearby lymph nodes
4 - Metastasis
What is a portacath?
An implanted venous access device used to deliver IV chemotherapy
What is an oophorectomy?
Surgical removal of one of both ovaries
Why would be put a breast cancer pt on tamoxifen for the rest of their life?
Blocks the estrogen receptor to block further cancer development
What are the most common kinds of cancer by sex?
Men: Prostate, lungs, colon, rectum
Women: Breast, lung, colon, rectum
What are the CAUTION warning signs for cancer?
C - Change in bowel/bladder patterns
A - A sore throat that does not heal
U - Unusual bleeding/discharge
T - Thickening/lump
I - Indigestion of difficulty swallowing
O - Obvious changes in wart or mole
N - Nagging cough or hoarseness
A diagnostic plan for a cancer diagnosis consists of…
Health Hx, identification of risk factors, physical examination
Tissue for biopsy may be obtained through which methods?
–> Needle/Aspiration
–> Incisional procedures (portion of tumour)
–> Excisional procedures (entire mass is removed)
What laboratory tests can be done for diagnosis of cancer?
Alkaline phosphate blood levels
Calcitonin (elevated calcium)
Carcinoembryonic Antigen
Tumor Markers
What patient teaching should be done for someone receiving radiation therapy
–> Keep skin dry and do not apply any non-prescribed lotions
–> Avoid applications of heat or cold
–> Instruct client not to remove markings
–> Protect radiated area from direct sunlight
–> 2-3 L of fluid daily, high protein and calorie diet
Is the administration of chemotherapy drugs specialized?
Yes.
Takes specialized training of about 6 weeks
What PPE should be worn to administer chemotherapy?
Disposable gowns made of fabric with low permeability and with closed-front cuffs
Gloves that are powder free and labelled for use with chemotherapy drugs
–> Latex, nitrile, neoprene
What is extravasation with chemotherapeutic agents? What to do if it occurs?
When chemo drugs leak from cannula/BV into surrounding tissue
–> Causes cell death
Call provider immediately
What kinds of devices do we use to administer IV chemo to avoid extravasation?
Hickman, Broviac, portacath
What side effects should we monitor for when administering chemotherapy
Leukopenia (less than 4 x 10^9/L)
Neutropenia
Anemia
Thrombocytopenia
Alopecia
Anorexia
What nutritional recommendations should we make for someone with cancer?
High protein - repair and regenerate cells
High Cal - energy to minimize weight loss
Avoid unwashed produce, lightly cooked or raw fish and eggs, and unpasteurized dairy
What alterations in taste can occur in cancer patients?
Cancer treatment can make bitter foods taste increasingly bitter
What pain management therapies can be used for cancer patients?
NSAIDs, Opioids, Adjuvant pain medication
–> Long acting PO
Can also use relaxation and imagery
What is the latent phase of cancer? How long does it last?
The period of time between when a cell is first exposed to a carcinogen and when the tumor is clinically detected.
–> Lasts 1-40 years
Describe the process of a tumour metastasizing.
The tumour develops its own supply and segments of the primary tumour invade surrounding tissues.
Detached cells then invade lymph nodes and vascular vessels to travel to distant site - surviving tumour cells must create an environment conducive to growth and development.
What is a carcinoma?
Cancers that start in epithelial tissue
–> Breast, lung, bowel, prostate
What is a sarcoma?
Cancers of connective/supportive tissue
–> cartilage, fat, muscle, BVs
What is a lymphoma?
Cancers that develop in the glands or lymphatic system
At what age should females get regular breast cancer screening?
40+
At what age should people be regularly screened for cervical cancer?
starting at age 21-29 every 3 three years
–> Every 5 years after 65
How often should people be screened for colorectal cancer?
Yearly at 50+
At what age should people be screened regularly for prostate cancer?
Age 50+
–> Digital exam + PSA test
How often should people perform self examinations for testicular masses/cancer?
Monthly
What is brachytherapy?
Placement of radioactive implant into cancerous tissue
What is an example of unsealed internal radiation?
Use of radioactive iodine for thyroid cancer
What precautions should be taken for patients with both sealed and unsealed internal radiation? Which precautions are specific to sealed radioactive materials?
Both:
–> Pt in private room
–> Limit time with patient
–> Nurse wears dosimeter
Sealed specifically:
–> Pt wears radioactive badge
–> Lead-lined container kept in room
What is a Broviac device?
A central venous device used to administer chemotherapeutic drugs in children and teenagers.
What is a Hickman device?
A central venous catheter used to administer chemotherapy
What cells are involved in fighting cancerous cells?
Cytotoxic T Cells (Dominant Role)
NK cells
Macrophages
B Lymphocytes
What is the TNM classification system for cancer?
Standardized staging system
T - Tumour size
N - Lymph nodes
M - Metastasis
What chromosomes are the BRCA genes located on?
BRCA1 - 17
BRCA2 -11
BRCA genes are autosomal dominant
What is Paget’s disease (cancer)?
A rare breast malignancy - Persistent lesion of the nipple and areola with or without palpable mass
What is triple negative breast cancer?
Breast cancer that tests negative for all three receptors (estrogen, progesterone, HER2)
–> Chemo most effective
For how long after breast cancer treatment should the patient return for assessment?
Every 3-6 months for the first 5 years; Annually after
What are some risk factors for colorectal cancer?
Red and processed meat
Obesity
Physical Inactivity
Alcohol use
Long-term Smoking
Low intake of fruit and vegetables
What is the most common symptom of colorectal cancer?
Rectal bleeding
–> Often occult
Colorectal cancer screening should be performed how often for individuals between 50-74 years with no other risk factors?
Every two years
–> Screening for high risk patients should be done starting age 50.
How do clinical manifestations of lung cancer present?
Usually non-specific and appear late in the disease process.
–> Often extensive metastasis before symptoms become apparent
What are the most widely used tests for lung cancer?
Radiography, followed by CT.
How to intermediate stage prostate cancers present?
Similar to BPH
–> Dysuria, hesitancy, dribbling, frequency, hematuria, nocturia, retention, interruption of urinary stream
