Nurb test 4: cancer Flashcards
=tumor suppressor genes, mutated but not highly mutated, turns of the cells division , gets turned off when you have a mutated cell dividing uncontrollably turns off turns into an ___
proto-oncogenes
Turn intoOncogene
- permanent change (irreversible)in the cell’s structure=mutated, allows the growth doesn’t regulate, from single exposure
- proto-oncogenes
- oncogenes
Initiation
=tumor growth gene allows the cell to keep dividing, no turning it off
oncogene
- goes to proto-oncogenes to oncogenes increasing and keeps dividing
Prolonged exposure, speeds up cell division
Promotion
- no contact inhibition, keeps growing, goes where ever it wants to go
Grow out of control
Progression
three staged in development of cancer
initiation
promotion
progression
originate from skin, glands, mucous membranes linings of respiratory tract, GI tract, and GU tract.
Carcinoma
originate from connective tissue, muscle, bone, and fat.
Sarcomas
originate from the hematopoietic system or lymph nodes.
Lymphoma and Leukemia’s
- you don’t see any or very few cancer cells, most generally won’t see, rare
Grade X
- best to have, cells resemble parent cell, differentiated= stay in one part and look like regular cell, hasn’t mutated that much Ex: pancreatic cell
Grade I
- less differentiated= can tell it is of that parent cell but not exactly like that parent cell
Moderate differentiated
Grade II
- cells are reverting back to a fetal stage, becoming undifferentiated, means you can’t tell where they are coming from and what their parent cell is
Poorly differentiated
Grade III
- cells are undifferentiated in fetal appearance, can’t tell what the parent cell is
- When doing a biopsy it tells you lower the grade more probability to treat it, where it located from, better chance if lower grade
Grade IV
-insite to=tumor is encapsulated a lining around it, tumor cells are not getting out, can do a lumpectomy remove it/ best to have
Stage 0
- in that area, no movement Ex: breast cancer biopsy is just in that area
Stage I
- still in that area but beginning to branch out a little bit
Stage II
- branched out, going into the lymph system Ex: breast cancer to lymph system
Stage III
- metastasized to other area
Stage IV
tnm
t classification
tumor size
-degree of regional spread to the lymph nodes, involvement 0-4, rate by how many nodes they took out / number of nodes divided by 4 = n / can only take out 16, can range 4-16 nodes
N tnm classification
T rate it 1-4 T1= T2= T3= T4=
T
- 1-3
- 4-6
- 6-9
- more than 10 cm
Based on 8 nodes N0= N1= N2= N3= N4-
N
- no involvement
- 1-2
- 3-4
- 5-6
- greater than 6
M-metastasis-: 0-4 M0= M1= M2= M3= M4=
- no mets
- to one area or 1 organ, most generally it close to the original site Ex: breast to lung
- two different areas close to it
- two -three area, plus distance Ex: prostate mets to lung and to bone
- more than three organs
7 warning signs of cancer
change in bowl habits
- a sore that does not heal= needs to be looked at for melanoma
- uncontrolled bleeding out of any orfice
thickening or a lump in breast or elsewhere
- indigestion or difficulty in swallowing
-obvious change in a wart or a mole
- nagging cough or hoarseness
- Reduce exposure: sun unprotected= never
- Diet
- Exercise
- Rest
- Health Exams: mammograms, digital rectal gland= prostate, pap smear, inspecting skin
- Stress: decreases your immune system
Prevention and Early Detection of Cancer
: very important, see if it runs in the family, cancer in the past, lifestyle= smoking, alcohol, high fat diet, sleeping habits=recovery lack is related to stress, diet, occupation, past medical history, what meds they are on, and exercise.
Health history
dx
: whole exam not just the one for the complaint
Physical examination dx
where it originated from, undifferentiated or poorly,
Cancer Factors that determine the treatment modality is:
Cell type of cancer:
Cancer Factors that determine the treatment modality is:
- Cell type of cancer:
- location of the cancer
- size of the cancer
- extent of the disease
Ex: aorta=constriction
Size of the cancer or tumor
Location of the cancer:
how many areas has it metastasized to Ex: bone, liver, or brain how many areas seen / several areas in liver will be palliative
Extent of the disease:
-Treatment following primary treatment Ex: remove tumor now chemo
Adjuvant
-Treatment prior to surgery Ex: cancer tumor of lung is huge and wrapped around nerve and muscle in clavicle will use radiation to shrink then will go into to remove
Neoadjuvant
try to remove the tumor and surrounding tissues until you come to clean margins= cant visualize any cancer in that tissue Ex: 5 cm remove 7 cm bc clean margins
Surgery:
directed at one area within the body, now for micromets= 1 or 2 cells may have gone through the lymph nodes, 3 rounds of chemo also Ex: breast stage 2 best option
Radiation therapy:
- specific area within the body Ex: breast hormone treatment
- Biologic therapy
decreasing the size of the tumor, remove much of the tumor as they can without hurting the normal structures, then can do radiation to help shrink more, can never remove whole thing Ex: tumor engulfed around pancreas, can’t remove tumor, and need pancrease
Debulking:
cancer surgical therapy
: Make lead block before pt gets there and then shine light from the simulator will light up the area, area bigger than the tumor, make dots where they need to line up to get the exact area, usually within 2-3 weeks after surgery= enough time for body to recoup but not enough time for cells to start reproducing initial treatment can take up to two- three hours
Go in everyday Monday through Friday 36-42 treatments , go home every night / will have burns
Simulation
cancer radiation therapy
weight, eating, sleeping, feeling, examine skin for burns and blisters= certain lotion (Carie), can’t use any type bc metals in it
After 1st week will be so tired, over long bone wbc counts and hemoglobin will be down
Nurses always need to do assessment:
cancer radiation therapy
mild doesn’t penetrate through the skin
Alpha:
cancer radiation emission
strong, normal type used
Beta:
cancer radiation emission
: more forceful, strong, may not have to do 36 treatments , more burns with
Gamma
cancer radiation emission
will have, want to lay in bed all day long, could be depression= doesn’t mean have to be on meds/ tell them to eat good meals 6 snacks= skin break down, and walking program=release endorphins, blood circulating, feel good about self
Cancer Radiation Therapy- Nursing Management
1. Fatigue:
6 small meals a day= if bad skin break down, just don’t feel like eating, metal taste in mouth after 5th treatment ,
- don’t use silverware use plastic wear, - Oral care: good mouth care don’t use Listerine or strong mouth wash can breakdown membrane= baking soda and warm water/ suck on a lemon drop before eat will stimulate taste buds so they can taste there food - Eat favorite food
Anorexia:
nursing management cancer radiation
may have n/v bc stress, fatigue, and where it is/ use Zofran if nausea not if vomiting / drink enough fluids, eat small meals
Gastrointestinal:
cancer radiation nursing care
: due to radiation over long bones, where cells are made at, nurse monitor labs wbc too low will have to stop so they can come back up bc immune system problem, eating correctly
Bone Marrow Suppression