Neoplasia Flashcards
What is cancer?
Group of diseases characterized by uncontrolled and unregulated growth of cells
●Occurs in people of all ages
○ Majority of cases are diagnosed in those over age 55 becuase they have been more exposed to carcinogens throughout life and their immune system is worse
Both the incidence and mortality rate of cancer has been declining
○ Incidences of lung, colorectal (colon), breast and oral cancer have ↓
○ Other cancers have ↑ skin, kidney, and thyroid. The number tends to go up based on the years. now it’s 1.8 million.
- Higher in men than women
- Secondmostcommoncauseofdeath
in the United States after heart disease - Leadingcauseofdeathinpeople 40-79 years of age
What is cancer 2.0 continues.
> 16.9 million Americans are alive today who have a history of cancer
* Disease free
* In remission
* Under treatment
- 78% of all CA diagnosed at age 55 or older
- Incidence highest in individuals 60-69 yrs of age
- Most common type of CA: Skin Cancer
- Highest Mortality Rate: Lung CA
Check slide 4 and 6 watch lecture.
Cancer cells have a worse shape and go passed thier boundaries becoming bigger
Normal Cellular Differentiation
* Orderly process progressing from a state of immaturity to a state of maturity
* Stable and will not change
Orderly process progressing from a state of immaturity to a state of maturity
* Stable and will not change. Check slide 5
Pathophysiology of cancer cells irreversible cell growth?
Irreversible cell growth is when you have anaplasia; (the loss of the mature or specialized features of a cell) They become like zombies
- Loss of differentiation between cells
- Lack of normal cellular characteristics
and are nearly always malignant
Defect in Cellular Differentiation
Two types of genes that can be affected by mutation:
1 Proto-oncogenes are a group of genes that cause normal cells to become cancerous meaning oncogenes)
2 Tumor suppressor genes
Protooncogenes
Regulate normal cellular processes such as promoting growth
Genetic locks that keep cells functioning normally
Mutations that alter their expression can activate them to function as oncogenes (changed) form of a type of gene called a proto-oncogene) causing unrestrained growth
Tumor suppressor genes stop tumors;
Exist in normal cells and function to control cell growth (suppress growth)
May also play role in carcinogenesis
When these genes mutate, normal constraints on cell growth are removed so cancer cells appear.
Tumor Immunology
Surveillance Network in cells;
- Destroys cells before growing into detectable masses
- Tumor antigens assist in the recognition process
Carcinogenesis?
Carcinogens: substances or agents that damage genetic material
Carcinogenesis
External factors?
External Risk Factors
Chemicals such as nicotine, asbestos, sunlight
Radiation
Chronic Irritation: pollution, alcohol, acid reflux, cigarette smoking
Dietary Influences: red meat in excess, bbq, burned food, processed meat
Viral carcinogens.
Epstein Barr virus: Burkitt’s lymphoma
HIV: Kaposi sarcoma
Hepatitis B virus: Hepatocellular carcinoma
Human papillomavirus: squamous cell carcinoma
Internal Risk Factors Carcinogenesis meaning that are not external to the body
Immune Function
* Immunosuppressed = increased risk
-Surveillance Failure
-Genetic Predisposition
*Has influence on the efficiency of the carcinogenic process
Breast CA, Colorectal CA
slides 13 14 and 15 16 17 starting min 19 all covered on this slide no worries!
The initiation phase of cancer by carcinogens is stoppable by killing the infected cell That damages the DNA of the cell . If that cell is not killed and it multiplies it goes to a phase called promotion where it replicates itself. (Excess Fat, protein, calories are promotors) This can be reversible except with cigarettes because they have both the promoting factor and the initiating factor.
The progression stage is when you have evidence of cells having a cluster meaning. The size of a marble of cells is a billion cells.
Malignant tumor: more dangerous, it has metastasized meaning that it travels to another area.
Beginning tumor: does not metastasize, they are generally encapsulated. It can be deadly as well depending on size and location example impeding a vital vessel.
Most tumors are capable of developing their circulatory pathways. It’s called angiogenesis. Once they do that they can invade other areas and develop a whole new system. If a cancer metastasizes from bone to brain it’s still gonna be called bone cancer.
Prevention of cancer Smoking?
Smoking Cessation
-The deadliest form of cancer can be prevented by smoking cessation
- Also attributed to other cancers like: Mouth, esophageal, bladder
Protection from cancer ?
Nutrition
- Five servings of fruit and vegetables q day
- Limit red meats, processed high fat meats
- Whole grains
Protection from cancer Nutrition?
Nutrition
- Five servings of fruit and vegetables q day
- Limit red meats, processed high-fat meats
- Whole grains
-The best is the Mediterranean diet. omega 3, olive oil
Prevention Alcohol?
Limit Alcohol Consumption
- No more than 2 drinks/day for men
- No more than 1 drink/ day for women
- Even a few drinks q week assoc with breast CA
Prevention sun?
Sun Protection
- Many of more than one million skin cancers could be prevented
- Avoid exposure during peak periods
- Wear protective clothing, hats
- Wear sun protection
- Inspect for new skin lesions when performing a skin assessment
Prevention exercise?
Physical Activity
- Engage in at least 150 minutes of moderate-intensity or 75 min of vigorous-intensity physical activity each week, or an equivalent combination
- Children engage in 60 min moderate-vigorous activity each day with vigorous activity at least 3x week. People used to walk to school now they don’t.
Prevention from cancer behavior?
Behavioral Modification
- Certain CA related to infectious exposures including Hep B, HIV, HPV, and others could be prevented through behavioral changes, vaccines
Prevention screening?
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%
Screening Guidelines?
Breast
Uterus/cervical
Colon/rectal
Lung Ca
Prostate/testicular
(Refer to link on Canvas)
Seven Warning Signs of Cancer? Caution
Caution Mnemonic Device!
-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
Tests?
Complete history
Physical Exam
Labs CBC
chest x-ray
Chest CT to detect size and location of the mass, as well as the enlargement of lymph nodes
PET(positron emission tomography) scan to look for lymph nodes and spread to other parts of the body
Brain MRI (magnetic resonance imaging)
Excisional Biopsy
chest x-ray?
YOu can see a tumor
Additional Diagnostic Tests
Mark with a needle and a bone is about to make an incision is an additional player in my team
Cytology studies
Tumor Markers to identify the origins of cancer to find the best way of treatment (anything present in or produced by cancer cells or other cells of the body in response to cancer )
Genetic Markers
Bone Marrow Exam
Types of Biopsies: Only definitive means of diagnosis
1. Needle Bx(biopsy)
2. Incisional Bx you take a part out to examine it
3. Excisional Bx you take the entire mass
FYI random: You want to remove the least amount of lymph nodes.
Classification of Cancer Histologic? The closer to? The farther?
Histologic (cells) classification:
-The appearance of cells and degree of differentiation are evaluated to determine how closely cells resemble tissue of origin.
-Poorly differentiated tumors have a worse prognosis than those closer in appearance to normal cells of origin
Histological Grading? Dys abnormal
Plasma (formation). remember that dysplasia has to do with a cell
Evaluation of the appearance of cells and degree of differentiation
-Grade I mild dysplasia
-Grade II moderate dysplasia
-Grade III severe dysplasia
-Grade IV anaplasia ( the worst) The higher the number the worse the prognosis.
Check slide 38 no need to learn
During surgery, once we have identified the tumor size is to use the TNM system.
T tumor
N nodes number
M metastasis
Staging example of case study
TNM classification for a 4cm lung cancer with 3 involved lymph nodes and metastasis would be as follows: T2N2M1(bone).
Clinical Staging?
Stage O - Carcinoma In Situ
Stage I - tumor limited to the tissue of origin
Stage II - limited local spread
Stage III - extensive local and regional spread
Stage IV - metastasis
The goal of Cancer Treatment?
-Cure if possible
-Control: many people live chronically for years with some cancers
-Palliation to give life quality and comfort when it has metastasized
Role of Surgery in Cancer Treatment?
-Prevention removal of some damaged organs to prevent cancer
-Diagnosis and treatment plan
-cure and control cancer cut it off completely
-palliation relief
-Rehab
and supportive care insertion of tubes etc
Surgical Therapy Nursing Considerations:
-Same as perioperative-specific care for organ dysfunction
-Nutritional deficits before she begins treatment
-Risk for Infection
-Psychosocial issues help the patient as much as possible
Radiation Therapy
May be used to cure or with other modalities, i.e. Surgery
External Radiation: Total dose may be delivered over several weeks to allow healthy tissue to repair. it’s going to damage healthy cells as well.
Radiation Therapy Internal Radiation.
Internal Radiation (aka brachytherapy)
-Requires less dosage
-Implant placed directly in the tumor or in close proximity
-Will emit radiation when implant is in place
-Commonly used in head, neck, and gynecologic tumors
Radiation Therapy continues safety Precautions
Safety Precautions(ALARA (Mnemonic): As low as reasonably achievable)
-Principles of time least amount of time needed, distance, shielding
-Limit visitors to 30 min to avoid getting radiation on them
-No children under 16, pregnant women
Radiation Therapy Systemic effects:
Usually localized to the region being irradiated
Affects rapidly proliferating cells
- bone marrow
- gastrointestinal mucosa
- skin
Dry Desquamation slide 51 side effect of radiation
-If that happens you make sure that the patient is not laying on that part
-use lotion but you have to be careful you want unscented lotions, mild sope, and water, aloe vera
Wet Desquamation slide 52
is worse. If this happens to the skin radiation needs to be stopped
Radiation Therapy late side effects there are 3
Late side Effects
-May be chronic and occur way after the radiation has been completed.
-Fibrotic changes (thickening or scarring of the tissue)
-Increased risk for other malignancies
Radiation Therapy Nursing Considerations:
Provide appropriate education
Monitor response to treatments
Assure that radiation protection measures are followed: Be careful with the children coz they can give her a disease because she is immunocompromised due to radiation.
Chemotherapy?
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
Goals of Chemotherapy
The same as radiation
Chemotherapy routes of administration ?
Access through:
Routes of Administration
Tablets po
central line in chest
Chemotherapy Risk of Extravasation ( The leakage of blood, lymph, or other fluid, such as an anticancer drug, from a blood vessel or tube into the tissue around it.)
Risk of Extravasation (occurs with vesicant (tending to cause blistering) drugs
Can cause blistering or tissue necrosis
Vancomycin is an example
Chemotherapy Safe Handling Considerations
Safe Handling Considerations (classified as hazardous drugs)
Chemotherapy systemic effects
Systemic Effects: They are more systemic than those by radiation.
Affects cells with rapid growth rates
i.e. Epithelium, bone marrow, hair follicles, sperm
Integumentary System: hair loss
GI: esophagitis, GI upset, nausea, vomiting
Hematopoietic System: the blood system. if it affects the bone marrow it affects anything that has to do with blood wbc rbc
Renal System: chemo is killing cells so they have to be excreted through the kidneys. so this puts an extra strain on them.
Cardiopulmonary System: High levels of circulating electrolytes ex calcium
Reproductive System: have a good form of birth control for at least 2 years after therapy and then have counseling with a doctor
Nursing Diagnoses chemo
Cardiac output, decreased
Nutrition, less than body requirements
Infection, risk for
Pain
Fatigue
Body Image, disturbed
Nursing Interventions chemo
-Infection: Most frequent cause of morbidity and death in CA pts.
-Neutropenic precautions if indicated: visitors need to check in. etc… because they can’t fight infection. no raw foods, no raw eggs, etc.,
-Assess for signs of infection
-May need WBC growth factors (i.e Neupogen)
-Bleeding (thrombocytopenia) and to prevent it you need to:
-Soft bristle toothbrush
-Stool softeners
-Assess CBC, platelet ct
-AVOID IM, SQ injections
Tissue Integrity (especially with radiation, and surgery)
-No ice or heat on radiation sites
-Susceptible to breakdown, pressure ulcers
-May require wound care
Nutrition:
Minimize effects of altered taste sensations i.e. Hard candies can be helpful. If someone has stomach problems avoid citrus coz of its acidity ex as in stomatitis or a sore in mouth.
Mechanical soft, avoid citrus with stomatitis
Anorexia - small frequent meals, liquid supplements
High calorie, high protein foods: examples?
drinks with carbs, peanut butter, and yogurt.
Nursing Interventions chemo for pain?
Pain
Requires comprehensive assessment
Make appropriate referrals
Use WHO ladder
Preference for long-acting, SR  (Sustained release )to stay under the influence longer. preparations
AVOID Injections
Stomatitis which are ulcers in the mouth and all the way down the gi tract (mucosa) etc…
Avoid citrus
Saline rinses
Lidocaine swishes
Rapidly dividing cells of mucous membranes being destroyed
Fatigue
Body Image and Self Esteem
Progressing through the grieving process
Biologic Therapy 3 effects ?
-Now established as a major category of cancer therapy
-Focus is the manipulation of immune system through use of naturally occurring biologic substances (cells, cell products) or genetically engineered agents that modify immune response
May affect host-tumor response in 3 ways:
1-Direct antitumor effects
2-Restore, augment, or modulate host immune system mechanisms
3-Have other biologic effects, such as interfering with CA cells ability to metastasize or differentiate
Types of Biotherapy interferon (protein) usually in response to the entry of a virus,
Interferon:
- Alters cellular metabolism in normal & CA cells
- Inhibits function of several oncogenes
- Can activate NK cells
- Approved for tx treatment corpus sarcoma of KS, CML, chronic Mylogenis lumkimia and Melanoma
Personalized Cancer Medicine 2 things
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 ( a weakness: to hit it right there)
Targeted Therapy types?
Targeted therapies include:
-Tyrosine kinase inhibitors
-Monoclonal antibodies
-Angiogenesis inhibitors (when they create their bv)
-Proteasome inhibitors
Cancer cells can become resistant
Biologic Therapy Hematopoietic Growth Factors
Hematopoietic Growth Factors(hormone-like substances that help bone marrow make new blood cells)
1-Colony Stimulating Factors
- Stimulate production, maturation, regulation and activation of cells in hematologic system i.e. Neupogen (help make wbc)
2-Erythropoietin (hormone secreted by the kidneys that increases the rate of production of red blood cells )i.e. Epogen for tx of chemo-related anemia
Biologic Therapy Toxic and Side Effects 6 of them
Toxic and Side Effects
1-Systemic immune and inflammatory response
Rash
Flu-like symptoms
Symptoms decrease over time
Tachycardia, orthostatic hypotension
6- Capillary Leakage Syndrome
Biologic Therapy Nursing Considerations
Nursing Considerations
1-Teaching
Acetaminophen for pain
Demerol for pain (dolor)
Observe for neurologic deficits
5-Assess for complications, such as capillary leak syndrome
Hematopoietic Stem Cell Transplantation (Review in Reading) An immature cell that can develop into all types of blood cells, including white blood cells, red blood cells, and platelets.
Harvest Procedures
Preparation
Complications
Stem Cell
Cord Blood Stem Cells
Gerontologic Considerations
More than 57% of cancers occur in persons over age 65
Chemotherapy
Radiation Considerations
Surgery
Pain Management
Nutritional Considerations
Discharge Planning
Home has become preferred environment
Requires multidisciplinary approach
Make appropriate referrals
Stages of Loss and Grief
Kubler-Ross: focuses on behavior & includes 5 stages
Denial
Anger
Bargaining
Depression
Acceptance
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
Categories of people prone to cancer
children under 2
older than 60
failure of immune responses
Aid’s
Proto-oncogene: original form or template
Oncogene : once it has mutated
