Neoplasia Flashcards
Irreversible (abnormal to ana is irreversible)
Anaplasia
- Loss of differentiation
- Lack normal cellular characteristics
and are nearly always malignant
Proto-oncogenes (proto locks) and ex.
Regulate normal cellular processes such as promoting growth (loss of liver tissue ex.)
Genetic locks that keep cells functioning normally
Tumor suppressor genes (suppress growth)
puts the brakes on cell growth
Exist in normal cells and fx to control cell growth (supress growth)
When genes mutate, normal constraints on cell growth removed
Refer to McCance 12-4, 12-5 for comparison of gene types
Surveillance Network (surveillance kills)
Surveillance Network
Destroys cells before grow into detectable masses
Tumor antigens assist in recognition process
External Risk Factors - (CCRD is external to the office) and ex.
Chemicals - formaldeyhde
Radiation - sunlight
Chronic Irritation - acid reflux, smoking
Dietary Influences - nitrates
internal factors (SIG is internal to me)
Immune Function
Immunosuppressed = increased risk
Surveillance Failure
Genetic Predisposition
Has influence on efficiency of carcinogenic process
Breast CA, Colorectal CA
Nutrition (how many fruits and veggies a day? :)
Nutrition
- Five servings of fruit and vegetables q day
- Limit red meats, processed high fat meats
- Whole grains
Physical Activity (physical for 120 minutes)
Physical Activity
- Engage in at least 150 minutes of moderate intensity or 75 min of vigorous intensity physical activity each week, or equivalent combination
- Children engage in 60 min moderate- vigorous activity each day with vigorous activity at least 3x week.
Regular screening and self examinations could increase 5 yr survival rate to…
82%
If all Ca dx at localized stage through regular screening, 5 yr survival rate could increase to 95%
7 warning signs of cancer (CAUTION) (bowel, throat, bleeding, lump, indigestion, mole. cough)
Change in bladder or bowel habits
A sore throat that does not heal
Unusual bleeding or discharge
Thickening or lump
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
diagnostic tests (diagnose my cyte, is it a genetic tumor or bone marrow?)
Cytology studies
Tumor Markers
Genetic Markers
Bone Marrow Exam
classification of cancer - Histologic (study tissue under a microscope) classification
Appearance of cells and degree of differentiation are evaluated to determine how closely cells resemble tissue of origin.
histological grade (how is history looking?)
Evaluation of appearance of cells and degree of differentiation
staging
TNM classification for a 4cm lung cancer with 3 involved lymph nodes and metastasis would be as follows:
T2N2M1(bone).
clinical staging (get situated in staging)
Stage O
Stage I
Stage II
Stage III
Stage IV
surgical therapy
Nursing Considerations
Same as perioperative specific care for organ dysfunction
Nutritional deficits
Risk for Infection
Psychosocial issues (important at Julia’s stage)
radiation therapy
May be used to cure or with other modalities, i.e. Surgery
radiation internal (aka brachytherapy)
Requires less dosage***
Implant place directly in tumor or in close proximity
Will emit radiation when implant in place
radiation safety - limit visiting time to what? And under what age?
Safety Precautions (ALARA: As low as reasonably achievable)
Principles of time, distance, shielding
Limit visitors to 30 min
No children under 16, pregnant women
radiation systemic affects - what areas of the body impacted? (radiation affects my bones, mucus, and skin)
Usually localized to region being irradiated
Affects rapidly proliferating cells
bone marrow
gastrointestinal mucosa
skin
radiation late effects (late radiation scars me and causes other cancers)
May be chronic
Fibrotic changes (thickening or scarring of the tissue)
Increased risk for other malignancies (ex. lymphoma)
radiation nursing considerations
Provide appropriate education
Monitor response to tx
Assure that radiation protection measures are followed
inspection of the skin
chemotherapy - (do not replicate chemo)
The use of various chemical agents that interfere with the replication and other normal functions of cancer cells.
Should result in malignant cell death and tumor shrinkage
chemo risk of (your mom is extravagant)
Risk of Extravasation (occurs with vesicant drugs)
Can cause blistering or tissue necrosis. monitor for signs of redness, necrosis, tenderness.
chemo systemic effects - affects which cells? (just rapid)
Affects cells with rapid growth rates
chemo nursing dx
Cardiac output, decreased
Nutrition, less than body requirements
Infection, risk for
Pain
Fatigue
Body Image, disturbed (hair loss)
chemo nursing interventions - what is the most common cause of death among cancer patients?
Infection: Most frequent cause of morbidity and death in CA pts.
Neutropenic (bones) precautions if indicated
Assess for signs of infection
May need WBC growth factors (i.e Neupogen)
chemo nursing interventions - bleeding
Bleeding (thrombocytopenia)
Soft bristle toothbrush
chemo nursing interventions - nutrition (hard candy, no oj, avoid what?)
Minimize effects of altered taste sensations (ex metallic taste)Ii.e. Hard candies
Mechanical soft, avoid citrus with stomatitis***
Anorexia - small frequent meals, liquid supplements
High calorie, high protein foods: examples? nuts, ensure, yogurt. try to avoid carbs.
chemo nursing interventions - pain (pain based on WHO? And long or short?)
Requires comprehensive assessment
Make appropriate referrals
Use WHO ladder
Preference for long acting, SR preparations
AVOID Injections
chemo nursing interventions cont - Stomatitis (don’t forget saline)
Avoid citrus
Saline rinses
Lidocaine swishes
Rapidly dividing cells of mucous membranes being destroyed
chemo biologic therapy (immune system is biology)
uses body’s own immune system.
Now established as a major category of cancer therapy
Focus is manipulation of immune system through use of naturally occurring biologic substances (cells, cell products) or genetically engineered agents that modify immune response
chemo biologic therapy - May affect host-tumor response in three ways: (biology is direct, to the immune system, and may mess with CA)
Direct antitumor effects
Restore, augment, or modulate host immune system mechanisms
Have other biologic effects, such as interfering with CA cells’ ability to metastasize or differentiate
types of chemo biotherapy - interferon (junkies change metabolism bc they’re nk)
interferon
- Alters cellular metabolism in normal & CA cells
- Inhibits function of several oncogenes
- Can activate NK cells
targeted therapy (tyrone targets clones, angie, and tease)
Tyrosine kinase inhibitors
Monoclonal antibodies
Angiogenesis inhibitors
Proteasome inhibitors
biologic therapy - Hematopoietic Growth Factors (biology is HeMan in a colony with ears)
Hematopoietic Growth Factors
Colony Stimulating Factors
Erythropoietin
should try and get which lymph node? (sentinal node is the best)
sentinal node - just this one because it can identify cancer and you want to get as few lymph nodes as possible d/t lymphodema
during surgery, primary staging is…(primary is TNT - and what it stands for)
TNMdetermine prognosis, treatment, and to report to registry for statistics
T - tumor size
N - lypmph nodes
M - matastesties
dry desquamation
red raw skin from radiation
vancomyicin is a
250 mL dilute, infusion rate is longer due to risk of exstravigation.
nursing interventions
fatigue
body image and self esteem
progressing through the grieving process
Targeted therapy
Targeted therapy
Aims at a cancer’s specific genes or proteins that contribute to cancer growth and survival
Biopsy can help determine whether a tumor has the specific target
biologic therapy - Toxic and Side Effects (think interferon and the flu - you used to know this)
Systemic immune and inflammatory response
Rash
Flu like symptoms (rakers - sever shivering - same with hep C)
Symptoms decrease over time
Tachycardia, orthostatic hypotension
biologic therapy - Nursing Considerations (biology is capillaries and craziness)
Teaching
Acetaminophen
Demerol - good for riggers
Observe for neurologic deficits
Assess for complications, such as capillary leak syndrome
Hematopoietic Stem Cell Transplantation (Review in Reading)
Harvest Procedures - draw out and seperate wbc
Preparation - remove blood and then return it
Complications - bleeding infection
Stem Cell
Cord Blood Stem Cells - unbelical cord
Oncologic Emergencies - (emergencies are shocking to my superior, and diuretic)
Septic Shock
Superior Vena Cava Syndrome
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Gerontologic Considerations - what about the dose?
More than 57% of cancers occur in persons over age 65
Chemotherapy - maybe a lower dose
Radiation Considerations
Surgery
Pain Management
Nutritional Considerations
Care of the Patient with Advanced Cancer
Focus on promoting comfort and improving quality of life
Pain management
Provide support for family and pt
Multidisciplinary approach
Bereavement counseling
Kubler-Ross: focuses on behavior & includes 5 stages (I DABDA in kubla)
Denial
Anger
Bargaining
Depression
Acceptance
Bowbly’s Phases of Mourning
Bowbly’s Phases of Mourning
Numbing
Yearning & Searching
Disorganization & despair
Reorganization
Worden’s Four Tasks of Mourning
Task I
Task II
Task III
Task IV
cancer 55 and older - why?
more exposure to carcinogens, more cell damage, more immune problems, more screening.
mortality rate declining with what cancers? (BLOC is declining)
lung, colrectal, breast and oral
reversible disorders with cell growth (MAHH, hypertrophy is reversible)
atrophy
hypertrophy
hyperplasia
metaplasia
failure of immune response in what groups? (think vulnerable)
children less than 2 yrs old
adults older than 60 yrs
organ transplants
AIDS
Carcinogens
Carcinogens: substances or agents that damage genetic material
viral carcinogens (HHHE is viral - think pap)
The are anko!
epstein-barr - burkitt’s lymphma
HIV - Kaposi sarcoma
Hep B - Hepatocellular carcinoma
Human pap - squamous cell carcinoma
promotion is reversible or not? (the promoter can be stopped)
reversible. if cell goes on to develop more cells.
cigs have both
initiating and promoting factors
progression
cluster of cells, evidence of disease. Irrereversible.
malignant v. benign
malignant travel and metastisize, benign - non cancer, rarely regrow.
prevention
Smoking Cessation
-The deadliest form of CA can be prevented by smoking cessation
- Also attributed to other Ca i.e. Mouth, esophageal, bladder
prevention - Behavioral Modification
Behavioral Modification
- Certain CA related to infectious exposures including Hep B, HIV, HPV and others could be prevented through behavioral changes, vaccines
when proto-oncogenes become mutated….
they alter their expression can activate them to function as oncogenes, causing unrestrained growth (cancer)
tumor suppressor genes may
May also play role in carcinogenesis
ex of tumor suppressor genes (please suppress the B52s and Braca)
P53 supressor gene - mutation could be a risk of colon cancer. Braca 1 or 2 - breast and ovarian cancer.
Types of Biopsies: Only definitive means of dx (NIE biopsies)
- Needle Bx
2. Incisional Bx (portion of mass taken out)
3. Excisional Bx (remove entire mass and boarders)
Poorly differentiated tumors have a
worse prognosis than those closer in appearance to normal cells.
Stage O (zero situations)
Stage O - Carcinoma In Situ (hasn’t spread)
Stage I (one is the origin)
Stage I - tumor limited to tissue of origin
Stage II (limited 2 locals only)
Stage II - limited local spread
Stage III (mom)
Stage III - extensive local and regional spread
Stage IV
Stage IV - metastasis
External Radiation (I need a few weeks externally)
Total dose may be delivered over several weeks to allow healthy tissue to repair
where is internal radiation used? (HNG the P internally)
Commonly used in head, neck and gynecologic tumors, prostate
systemic effects - chemo - epithelium
Affects cells with rapid growth rates
i.e. Epithelium, bone marrow, hair follicles, sperm
Integumentary System (hair loss)
systemic effects - chemo
GI
GI (esophagitis, diarrhea, N/V)
systemic effects - chemo - Hematopoietic System
Hematopoietic System (bone marrow - WBC, RBC, bleeding)
systemic effects - chemo - renal
Renal System (dead cells can accumulate in kidneys)
Cardiopulmonary System
systemic effects - chemo - Reproductive System
birth control up to 2 years after therapy. have genetic counseling if you’re having kids
if neutrophils low and neutropenic low, what precautions?
put on neutropenic precautions - few visitors, no flowers, no plants, no raw fruits veggies, eggs. assess for signs of infection - low grade fever more dangerous for neutropenic person. private room.
chemo nursing interventions - BM
Stool softeners (to prevent straining)
chemo nursing interventions - bloodwork?
Assess CBC, platelet ct
chemo nursing interventions - injections?
AVOID IM, SQ injections
Tissue Integrity (especially with radiation, surgery)
chemo nursing interventions - ice or heat?
No ice or heat on radiation sites
Susceptible to breakdown, pressure ulcers
May require wound care
interferon approved for what types of cancer? (interferon for MCK jag)
- Approved for tx of Kaposi sarcoma (KS), Chronic myeloid leukemia (CML), Melanoma
Cancer cells can become resistant to what?
target therapies
(Biologic therapy) Hematopoetic growth factors - Colony stimulating factors - (the colony of white)
Stimulate production, maturation, regulation and activation of cells in hematologic system i.e. Neupogen (med that stimulates WBC count)
if you need Erythropoietin (this is biologic therapy), you can take what drug?
i.e. Epogen for tx of chemo-related anemia
biggest danger of biologic therapy?
***Capillary Leakage Syndrome - biggest danger - inflammation and leaking
oncologic emergencies - (THC_D for oncology)
Hypercalcemia
Tumor Lysis Syndrome- large number of cancer cells die within a short period, releasing their contents in to the blood
Disseminated Intravascular Coagulation (DIC)
Cardiac Tamponade Syndrome - fluid sac around your heart fills with blood or other fluid, putting pressure on your heart.
atrophy ex. (reversible)
atrophy (brain, muscle cells),
hypertrophy ex. (reversible)
hypertrophy (muscle cells, cardiac muscle)
hyperplasia ex. (reversible) (hyper amount of cells)
increase in # of cells, tissue regeneration, hormonal
metaplasia ex. (reversible) (replace GERD trude at the met)
metaplasia (replace one cell for another - chemical insult - GERD - collumnar for squamous cells)
dysplasia ex. (the abnormal are displaced) (reversible)
abnormal tissue. connection to cancer growth
histological grades (history grades for ana)
Grade I mild dysplasia
Grade II moderate dysplasia
Grade III severe dysplasia
Grade IV anaplasia -
markers used to identify
best form of treatment
early signs of radiation
desquimation, fatigue, esophagitis, cough, pain
s/s of capillary leakage syndrome (capillaries crackle and cause edema)
tachycardia, ortho hypo, crackles on lungs, edema - urgent action needed
main sites of matasties
brain, spinal fluid, lungs, adrenal, liver, bones
Superior Vena Cava Syndrome
group of symptoms that happen when something blocks or compresses your superior vena cava
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
condition in which the body makes too much antidiuretic hormone (ADH)
septic shock
A widespread infection causing organ failure and dangerously low blood pressure
