oncologic disorders Flashcards
biology of cancer
cancer does not response correctly to signals to regulate cell proliferation/cell death
cells should go from immature to mature
cells should not dedifferentiate
development of cancer
intiation
promotion
progression
initiation
phase of cancer
mutation occurs
causes:
genetic
enviornmental factors
usually our body stops it at this phase
promotion
phase of cancer
altered cell proliferates (grows)
may be accelerated (smoking, high fat diet)
latent period occurs
progression
phase of cancer
growth, invasion, and metastasis
tumor increase in size and forms blood vessels
tumor cells detach and invade other tissues (metastasis)
types of neoplasm (tumor)
benign:
*well differentiated tumor
*localized (do not metastasize)(encapsulated)
*recurrence unusual after excision
*usually harmless
malignant:
*rapid growth
*metastasis common
*recurrence common
classification of cancer
site
histology (grading)
extent of disease (staging)
clasification by site
carcinoma:
*skin/glands/mucous linings
sarcoma:
*connective tissue
*muscle
*bone, fat
lymphoma/leukemia:
*blood/bone marrow
histologic grading and staging of cancer
histologic grading:
*amount of dysplasia (difference from normal cell)
*1-4 (4 is worst)
staging based on spread:
*extent/spread of disease
*0:in situ (unlikely to spread)
*I,II,III: growing/ may be in lymph nodes
*IV: metastasis (spread to other areas)
main sites of metastasis
brain and cerebrospinal fluid:
*headaches
lung
liver:
*jaundice
Adrenals:
no symptoms
bone:
fracture without a fall
cancer preventions
primary
secondary
tertiary
primary prevention ***
p=prevent
dont have cancer yet
physical activity
diet recommendations
sunscreen
limit ETOH (2 drinks or less/day men and 1 for women)
HPV vaccination (cervical and neck cancer)
secondary prevention ***
early detection/screenings
middle of getting it or having
tertiary prevention ***
management of disease
attempts to slow progression
*tx
breast cancer screening ***
mammogram (gold standard)
clinical breast exam
self breast exam
colon cancer screening ***
colonoscopy
FIT test (fecal immunochemical testing)
*if positive then colonoscopy
multitarget stool DNA testing
*ex: cologuard
stool guiac
*from stool sample
prostate cancer screening ***
high incidence of false positive
PSA (blood test) is the only test
*prostate specific antigen
testicular cancer screening ***
age 20-40 y/o monthly self ecam
cervical cancer screening ***
PAP: age 21-29
HPV testing: age 30-65
lung cancer screening ***
low dose chest CT
pack years: #yrs smoked x packs/day
warning signs of cancer ***
CAUTION
C=change in bowel/bladder habits
A=a sore that does not heal
U=unusual bleeding/discharge
T=thickening or lump in breast or elsewhere
I=indigestion or difficulty swallowing
O=obvious change in wart/mole
Nagging cough or hoarseness
skin cancer
ABCDE
Asymmetry
Border
Color
Diameter
Evolution
cancer diagnosis ***
biopsy: collecting cells and looking under microscope
PET scan: shows places of high metabolic activity
*tells us we have spread or metastasis
invasive procedures: if you have to do surgery to get biopsy
cancer treatment goals ***
cure (eradicate)
control (slow progression)
pallitation (alleviate symptoms)
cancer treatment
main:
surgery
chemo
radiation
immunotherapy and target therapy
bone marrow transplant
surgery for cancer
cure: remove tumor
ex: thyroidectomy
palliative: help manage symptoms, alleviate pain
ex: feeding tube to maintain nutrition
chemotherapy
Types of tumors
Types of tx
What it does
mainstay for solid tumors and hematologic cancers
can use for cure or palliation
disrupts the cell cycle
systemic adverse effects
chemo administration ***
must be trained/certified
PO, IM, IV, topical
*IV most common (big risk of extravasation)
regional administration:
*intraperitoneal
*intrathecal (injected into subarachnoid space for CNS)
*intravesicular (into bladder via f/c)
effects of chemo on normal tissue
Acute
Delayed
Chromic
acute toxicity: during and after admin
*anaphylaxis, hypersensitivity, extravasation, N/V
delayed effects: numerous
*N/V, alopecia, rashes, bone marrow suppression, diarrhea/constipation
chronic toxicities: damage to organs
*heart, liver, kidneys, lungs
hematologic effects of chemo
bone marrow suppression
*neutropenia (infection)
*thrombocytopenia (bleeding)
*anemia (bad perfusion/fatigue)
usually lowest 7-10 days after chemo
radiation therapy
External
Internal
high energy beams damage DNA -cell death
external beam: most common
* exposed to radiation from tx machine
internal radiation (aka brachytherapy)
*radioactive material goes into pt
*pt can emit radiation
*sealed source: stays where you put it (do not touch)
*unsealed: IV/oral radiation drug (bodily fluids are contaminated
radiation safety for internal radiation
-reduce time
-keep distant
-shielding (lead shields)
-caregivers should wear film badge (patch to turn colors if exposed to too much radiation)
-NO pregnant staff should care for these pts
fatigue
multifactorial
*anemia
*insomnia
*depression/anxiety
*dehydration
tx: balance rest/activity
GI effects to radiation and chemo
anorexia:
*nausea, stomatitis (inflammation of mouth), appetite suppressant
tx:monitor wt, small freq meals, topical analgesia for stomatitis
consitpation:
tx: stool softeners, high fiber, fluid intake, activity
Diarrhea: replace fluids
N/V: prophylactic tx before sessions
skin effects: alopecia
2-3 weeks after first tx
may or may not grow back
may grow back different
interventions:
support groups
avoid excessive shampooing
wigs, scarves
skin effects radiation
photosensitivity
*protect from sun 1 year
*soft clothing
skin reactions:
ranging from mild rash to second degree burn
*avoid extreme temps
*gentle soaps/detergent
other effects
neuro:
chemo brian
peripheral neuropathy
pulomnoary: pulmonitis
cardiac: dysrhythmias
reproductive: may lose fertility
*discuss preservation of ova/sperm
cancer pain management
undertreatment is common
inadequate assessment is Huge barrier
*VS/ nonverbal signs of pain are not reliable in chronic pain
*always believe pt
management:
Nsaids
Opioids
nerve blocks, epidural anesthesia
self care
coping strategies
family support
palliatige care/hospice
hematopoietic growth factors
colony stimulating factos
to stimulate plts, neutrophils or macrophages
ex:
filgrastim (neupogen)=stimulate WBC production
Oprelvekin (neumega)=stimulate plt production
epoeitin (procrit) stimulate RBC production
*most common (helps with fatigue)
biologic response modifiers
create environmet that is not conducive for cancer cells to grow (stimulating immune system)
attack cancer cells directly
(ex: monocolonal antibodies-attack specici antigens)
hematopoietic stem cell transplantation
high dose chemo to clear the bone marrow
*healthy stems then transplanted
autologous: pt own stem cells
syngeneic: identical twin
allogenic: from a donor
used to treat: leukemia, multiple myeloma, lymphoma
harvest procedures: 2 methods
bone marrow aspiration:
going to bleed and have pain
under local anesthesa
taken from iliac crest
higher risk
from peripheral blood
complications of treansplace of hematopoietic stem cells
graft vs host disease
pancytopenia until transplanted marrow begins to work (2-4 weeks)
*high risk of infection (will be in isolation)
spinal cord compression
cause:
cancer in epidural space or spinal cord
s/s:
-back pain, verebral tenderness
-motor weakness/sensory loss
-autonomic dysfunction (bowel/bladder)
*(looks like retention or incontinence)
management:
ER, radiation/surgery
superior vena cava syndrome
obstruction of superior vena cava by tumor
s/s:
facial/periorbital edema
distention of veins of head, neck, chest
HA, seizures
mediastinal mass on CXR
management:
ER
radiation at site
more sensitive chemo
hypercalcemia
metastatic disease of bone or multiple myeloma
*causes release ca from bone
s/s:
fatigue/weakness
hyporeflecia
cardiac dysrhythmias
kidney stones
management:
hydration (dilute it)
bisphosphates
diuretics
tumor lysis syndrome
rapid release of cellular contents
(tumor open up and the intracellular electrolytes get out)
hallmark signs:
hyperuricemia (gout)
hyperphosphatemia
hyperkalemia
hypocalcemia
watch for cardiac due to these
within 24-48 hours after starting chemo
management:
hydration
allopurinol (decreases uric acid)
electrolyte correction
