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MedSurg > Lecture 11 - Cancer/Palliative Care > Flashcards

Lecture 11 - Cancer/Palliative Care Flashcards

1
Q

What are some modifiable risk factors for cancer?

A

–> Tobacco
–> Excessive body weight
–> Lack of physical activity
–> Unhealthy eating habits
–> Alcohol consumption
–> Excessive exposure to the sun

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2
Q

What are the phases of cancer development?

A

Initiation, Promotion, progression

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3
Q

What occurs during the initiation phase of cancer? What are some known carcinogens?

A

A cell becomes altered and its proliferation and differentiation functions mutate

Carcinogens can be of:
Viral, chemical, radiation, genetic, and hormonal in nature

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4
Q

What occurs during the promotion phase of cancer development? Is it reversible?

A

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)

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5
Q

What occurs during the progression phase of cancer development?

A

There is an increased growth rate of the tumour, it invades surrounding tissue, and then metastasizes

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6
Q

Why might a bone scan be performed in breast cancer?

A

To detect metastases

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7
Q

What kind of imaging can be used to detect cancerous masses?

A

Ultrasound, MRI, CT

Biopsies after mass detected

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8
Q

What is the histological analysis of cancer classification?

A

Grading system
1 - Well differentiated
2 - Somewhat abnormal and moderately differentiated
3 - Cells look very abnormal, poorly differential
4 - Most abnormal and undifferentiated

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9
Q

How do we classify the extent of cancer disease progression?

A

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

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10
Q

What is a portacath?

A

An implanted venous access device used to deliver IV chemotherapy

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11
Q

What is an oophorectomy?

A

Surgical removal of one of both ovaries

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12
Q

Why would be put a breast cancer pt on tamoxifen for the rest of their life?

A

Blocks the estrogen receptor to block further cancer development

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13
Q

What are the most common kinds of cancer by sex?

A

Men: Prostate, lungs, colon, rectum

Women: Breast, lung, colon, rectum

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14
Q

What are the CAUTION warning signs for cancer?

A

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

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15
Q

A diagnostic plan for a cancer diagnosis consists of…

A

Health Hx, identification of risk factors, physical examination

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16
Q

Tissue for biopsy may be obtained through which methods?

A

–> Needle/Aspiration
–> Incisional procedures (portion of tumour)
–> Excisional procedures (entire mass is removed)

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17
Q

What laboratory tests can be done for diagnosis of cancer?

A

Alkaline phosphate blood levels
Calcitonin (elevated calcium)
Carcinoembryonic Antigen
Tumor Markers

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18
Q

What patient teaching should be done for someone receiving radiation therapy

A

–> Keep skin dry and do not apply any non-prescribed lotions
–> Avoid applications of heat or cold
–> Instruct client to remove markings
–> Protect radiated area from direct sunlight
–> 2-3 L of fluid daily, high protein and calorie diet

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19
Q

Is the administration of chemotherapy drugs specialized?

A

Yes.
Takes specialized training of about 6 weeks

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20
Q

What PPE should be worn to administer chemotherapy?

A

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

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21
Q

What is extravasation with chemotherapeutic agents? What to do if it occurs?

A

When chemo drugs leak from cannula/BV into surrounding tissue
–> Causes cell death

Call provider immediately

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22
Q

What kinds of devices do we use to administer IV chemo to avoid extravasation?

A

Hickman, Broviac, portacath

23
Q

What side effects should we monitor for when administering chemotherapy

A

Leukopenia (less than 4 x 10^9/L)
Neutropenia
Anemia
Thrombocytopenia
Alopecia
Anorexia

24
Q

What nutritional recommendations should we make for someone with cancer?

A

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

25
Q

What alterations in taste can occur in cancer patients?

A

Cancer treatment can make bitter foods taste increasingly bitter

26
Q

What pain management therapies can be used for cancer patients?

A

NSAIDs, Opioids, Adjuvant pain medication
–> Long acting PO

Can also use relaxation and imagery

27
Q

What is the latent phase of cancer? How long does it last?

A

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

28
Q

Describe the process of a tumour metastasizing.

A

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.

29
Q

What is a carcinoma?

A

Cancers that start in epithelial tissue
–> Breast, lung, bowel, prostate

30
Q

What is a sarcoma?

A

Cancers of connective/supportive tissue
–> cartilage, fat, muscle, BVs

31
Q

What is a lymphoma?

A

Cancers that develop in the glands or lymphatic system

32
Q

At what age should females get regular breast cancer screening?

A

40+

33
Q

At what age should people be regularly screened for cervical cancer?

A

starting at age 21-29 every 3 three years
–> Every 5 years after 65

34
Q

How often should people be screened for colorectal cancer?

A

Yearly at 50+

35
Q

At what age should people be screened regularly for prostate cancer?

A

Age 50+
–> Digital exam + PSA test

36
Q

How often should people perform self examinations for testicular masses/cancer?

A

Monthly

37
Q

What is brachytherapy?

A

Placement of radioactive implant into cancerous tissue

38
Q

What is an example of unsealed internal radiation?

A

Use of radioactive iodine for thyroid cancer

39
Q

What precautions should be taken for patients with both sealed and unsealed internal radiation? Which precautions are specific to sealed radioactive materials?

A

Both:
–> Pt in private room
–> Limit time with patient
–> Nurse wears dosimeter

Sealed specifically:
–> Pt wears radioactive badge
–> Lead-lined container kept in room

40
Q

What is a Broviac device?

A

A central venous device used to administer chemotherapeutic drugs in children and teenagers.

41
Q

What is a Hickman device?

A

A central venous catheter used to administer chemotherapy

42
Q

What cells are involved in fighting cancerous cells?

A

Cytotoxic T Cells (Dominant Role)
NK cells
Macrophages
B Lymphocytes

43
Q

What is the TNM classification system for cancer?

A

Standardized staging system
T - Tumour size
N - Lymph nodes
M - Metastasis

44
Q

What chromosomes are the BRCA genes located on?

A

BRCA1 - 17
BRCA2 -11

BRCA genes are autosomal dominant

45
Q

What is Paget’s disease (cancer)?

A

A rare breast malignancy - Persistent lesion of the nipple and areola with or without palpable mass

46
Q

What is triple negative breast cancer?

A

Breast cancer that tests negative for all three receptors (estrogen, progesterone, HER2)
–> Chemo most effective

47
Q

For how long after breast cancer treatment should the patient return for assessment?

A

Every 3-6 months for the first 5 years; Annually after

48
Q

What are some risk factors for colorectal cancer?

A

Red and processed meat
Obesity
Physical Inactivity
Alcohol use
Long-term Smoking
Low intake of fruit and vegetables

49
Q

What is the most common symptom of colorectal cancer?

A

Rectal bleeding
–> Often occult

50
Q

Colorectal cancer screening should be performed how often for individuals between 50-74 years with no other risk factors?

A

Every two years
–> Screening for high risk patients should be done starting age 50.

51
Q

How do clinical manifestations of lung cancer present?

A

Usually non-specific and appear late in the disease process.
–> Often extensive metastasis before symptoms become apparent

52
Q

What are the most widely used tests for lung cancer?

A

Radiography, followed by CT.

53
Q

How to intermediate stage prostate cancers present?

A

Similar to BPH
–> Dysuria, hesitancy, dribbling, frequency, hematuria, nocturia, retention, interruption of urinary stream

MedSurg (14 decks)

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