Oncologic Disorders Cancer Flashcards
CANCER
- Disease process that begins when a cell is transformed by genetic
mutation of cellular DNA. Cancer can involve any organ system. - Terms:
- Benign cells: not cancerous; may grow but unable to spread
- Malignant cancer: cells or processes that are characteristic of cancer
- Metastasis: Abnormal cells invade surrounding tissue and gain access to
lymph and blood vessels carrying them to other areas of the body - Strong familial factors
PRECISION MEDICINE DEVELOPMENT
- Possible due to recent development of biologic databases (e.g.,
human genome sequencing) - Technologic advances that can identify unique characteristics of
individual persons (e.g., genomics, cellular assay tests) - Computer-driven systems that can mine and analyze datasets
EPIDEMIOLOGY
- Approximately 600k persons lost to cancer annually
- Most occur in older adults
- Men slightly higher incidence (Black men highest)
- Lung, prostate, colorectal
- Women (again, Black women are at a slightly higher risk)
- Lung, breast, colorectal
MALIGNANT PROCESS
- Cell proliferation:
- Genetically altered cells clone and proliferate abnormally
- Evade normal intra/extracellular processes such as growth
regulating and immune system defenses - Abnormalities in cell signaling processes lead to cancer
development - Ultimately metastasis occurs
CHARACTERISTICS OF BENIGN AND MALIGNANT NEOPLASMS
- Cell characteristics
- Mode of growth
- Rate of growth
- Metastasis
- General effects
- Tissue destruction
- Ability to cause death
CHARACTERISTICS OF BENIGN AND
MALIGNANT NEOPLASMS (TABLE 12-1)
BENIGN
* Grows by expansion, no
infiltration of adjacent cells
* Slow growth
* No metastasis
* Localized effects
* Rare tissue damage
* Death rare
MALIGNANT
* Grows at periphery, invades
surrounding tissues
* Variable growth rate
* Uses blood and lymph channels
to invade other areas
* Generalized effects
* Frequent tissue damage
* Death
CARCINOGENESIS (MALIGNANT
TRANSFORMATION)
- Three-step process
- Initiation: apoptosis
- Carcinogens cause mutations in cellular DNA. Normal cell cycle
interrupted. - Promotion: initiated cells are prompted to grow and survive. tumor
suppressor gene - preneoplastic/benign lesions - Progression: proliferation and differentiation; angiogenesis
CARCINOGENIC AGENTS AND FACTORS
- Viruses
- HPV, HBV, EBV
- Bacteria
- H Pylori
Physical agents:
* Sunlight: cumulative exposure
* Radiation: x-ray, radon
* Chronic irritation
* Genetic, and familial factors
Diet, obesity, Red meat and alcohol
Chemical agents:
* Tobacco: combustible & smokeless
* Asbestos
* Many others
SYMPTOMS & WARNING SIGNS OF CANCER
- Change in bowel or bladder habits.
- A sore that does not heal.
- Unusual bleeding or discharge.
- Thickening or lump in the breast or elsewhere.
- Indigestion or difficulty in swallowing.
- Obvious change in a wart or mole.
- Nagging cough or hoarseness.
DIAGNOSIS OF CANCER
- Physical examination
- Imaging studies
- CT, MRI, ( w/wo contrast) Nuclear Scan, Bone Scan, PET Scan
- Laboratory tests of blood, urine, and other body fluids
- BRCA1 and BRCA2
- Exploratory/diagnostic procedures
- Pathologic analysis (biopsy)
Biopsy:
* Needle:
- Excisional:
- Incisional:
Biopsy:
* Needle: sample suspicious masses that are easily and safely
accessible
* Excisional: small, easily accessible tumors
* Incisional: tumor mass is too large to be removed
SURGICAL TREATMENT
- Prophylactic surgery
- Removal of non-vital tissues or organs that are at increased risk of
developing cancer - Palliative surgery
- Relieve symptoms, promote comfort, increase quality of life
- Reconstructive surgery
- s/p breast, head/neck, skin sx
RADIATION THERAPY
- Used with/without chemotherapy
- Localized therapy
- Damages DNA within the cancer cells
- More effective on tissues that are faster growing
- Bone marrow, lymphatic tissue, GI tract, gonads
- Less effective on slower growing tissues
- Muscle, nervous system, connective tissue
External Beam Radiation Therapy (EBRT)
- Stereotactic Body Radiotherapy (SBRT)
External Beam Radiation Therapy (EBRT)
* Delivers tightly targeted radiation beams directed from different
angles and different planes from outside the body.
* Involves several daily treatments (fractions) over a few days to a
few weeks.
* Stereotactic Body Radiotherapy (SBRT)
* Higher doses of radiation over shorter time
Brachytherapy
Brachytherapy
* Placement of radioactive sources within or immediately next to the
cancer site
* Intense, highly targeted
* Seeds, beads, ribbons placed in body cavities, interstitial tissues
NURSING CARE OF THE PATIENT
UNDERGOING RADIATION THERAPY
- Protecting caregivers during brachytherapy
- Private room
- Appropriate notices, dosimeter badges
- Pregnant staff members are not assigned
- Restrict visits by children or pregnant women
- Limiting visits to 30 minutes/day
- Maintain a 6-foot distance
CHEMOTHERAPY ADMINISTRATION
* Dosage
- BSA, weight, previous chemotherapy or radiation, function of
major organ systems - Extravasation via vesicants
- No peripheral veins of hand or wrist
- PIV only for short-term chemo
- Prolonged dosing requires central line
CHEMOTHERAPY ADMINISTRATION
* Hypersensitivity reactions (HSRs)
*
Unexpected, adverse drug reactions associated with mild or
progressively worsening signs and symptoms
* Repeated exposure increases the likelihood of a reaction
* Desensitization procedures may be possible
* Premedication
CHEMOTHERAPY TOXICITY
- Gastrointestinal
- Hematopoietic
- Renal
- Cardiopulmonary
- Reproductive
- Neurologic
- Cognitive
- Fatigue
NURSING MANAGEMENT IN CHEMOTHERAPY
- Assessing fluid, electrolyte status
- Assessing cognitive status
- Modifying risks for infection, bleeding
- Administering chemotherapy
- Preventing nausea and vomiting
- Managing fatigue
- Protecting caregivers
HEMATOPOIETIC STEM CELL TRANSPLANTATION
(HSCT)
- Used to treat several malignant and nonmalignant diseases
- malignant myeloma, acute leukemia, and non-Hodgkin lymphoma
- Types of HSCT
- Allogeneic – matched donor
- Myeloablative - high dose chemo w/ total body radiation
- Nonmyeloablative – less aggressive combination of chemotherapy
and/or radiation - Autologous – from patient
- Syngeneic – identical twin
GRAFT-VERSUS-HOST DISEASE (GVHD)
- Major cause of morbidity and mortality in the allogeneic
transplant population - Occurs when the donor lymphocytes initiate an immune
response against the recipient’s tissues (skin, gastrointestinal
tract, liver) during the beginning of engraftment - To prevent GVHD, patients receive immunosuppressant drugs
- May be acute (within first 100 days) or chronic (occurring after
100 days)
NURSING MANAGEMENT IN HSCT
- Implementing pre-transplantation care
- Providing care during treatment
- Close monitoring of VS
- Providing post-transplantation care
- Caring for recipients
- Caring for donors
- Hyperthermia
NURSING CARE OF PATIENTS WITH CANCER: SEE CHART 12-6
- Maintaining tissue integrity
- Stomatitis
- inflammatory process of the mouth
- Radiation-associated impairment of skin integrity
- radiation dermatitis
- Alopecia
- Often temporary unless radiation
- Malignant skin lesions
- foul-smelling lesions
Promoting nutrition - Nutritional impairment
- Anorexia
- Malabsorption
- Cancer-related anorexia-cachexia syndrome
- Relieving pain
- Decreasing fatigue
- Improving body self image
