Oncology Flashcards
Cancer is the
mutation in the DNA of the cells
- genetics
- carcinogenic environmental
-sedentary lifestyle
What percentage of cancer is hereditary?
5-20
What are the good genes for the human body?
Proto-oncogene
Tumor suppressor gene
Proto-oncogene does what in the body
controls the growth of cells
Oncogene does what in the body?
uncontrolled cell growth
- mutated proto-oncogene
The tumor suppressor gene does what in the body?
slows down a cellular division
causes cell death
The mutated tumor suppressor gene does what in the human body?
uncontrolled cell growth
What are the “bad genes’ involved in cancer?
oncogene
mutated tumor suppressor gene
The differentiated cells show the
maturity or development of tumor cells
The more it resembles normal tissue the _________ it is to treat.
easier
Well-differentiated cells characteristics
resemble normal cells; mature
function more like a normal cell
grow at a slower rate
less aggressive
typically benign
Poorly differentiated cells characteristics
do not resemble normal cells
immature cells
lack of structure/function
aggressive
typically malignant
Every average person has what genes?
Proto-oncogene
Tumor suppressor gene
From the Biopsy, the pathologist determines
grade and differentiation
What differentiation is harder to treat?
poorly diff.
Benign
not cancer
- tumor cells grow only locally and can’t spread by invasion or metastasis
Malignant
cancerous
- invade neighboring tissues, enter blood vessels, and metastasize to different sites
Metastasize means
spread from the primary location
Characteristics of a Benign tumor
well differentiated
expands (encapsulated)
slow growth
NO METASTASIS
localized effects
no destruction unless blood flow impaired
What is the morbidity level of a benign tumor? unless?
minimum
unless location interferes with vital organs
Characteristics of malignant tumor
poorly differentiated cells
sends out projections to infiltrate and destroy
growth rate variable
YES METASTASIS
generalized effects (anemia, weakness, wt. loss)
extensive destruction
- excretes toxins and uses up blood supply
What is the morbidity of a malignant tumor? unless?
high
unless growth and spread can be controlled/halted
What tumor has the potential to metastasize?
malignant
If cancer has metastasized to another organ, is the cancer name changed or does it stay the same?
Ex) Starts out as Liver cancer, then spreads to the stomach
The name stays the same
still Liver cancer (primary)
How does cancer spread?
locally invasive
metastasis
Locally invasive cancer
“fingers” of cancer cells invade surrounding tissue
Metastasis
malignant cells travel through the blood/lymph system and invade other tissues or organs to form a secondary tumor
- find another similar organ to primary
What are the top 4 places for metastasis?
bone
lungs
liver
brain
If the primary is the breast, then it tends to go to the
lymph nodes first then the liver lungs or brain
Melanoma is very deadly because
by the time it appears
the body is completely exposed to the cancer
Which cancer is the most painful?
bone
Risk factors for cancer (most)
tobacco and smoking
Diet and obesity
sedentary lifestyle
occupation exposure
family hx
viruses
alcohol
socioeconomic status
pollution
UV radiation
drug and medical procedures
salt, additives, containments
What is the most common spot for breast cancer to form?
Lateral upper quadrant next to the armpit
If a patient works outside, then they should wear
sunscreen and protect skin due to the risk of occupational exposure
What is the hallmark cause of hereditary cancer syndrome?
family hx
Hereditary cancer syndrome can occur from what
cancer in 2 + relatives
cancer in family members younger than 50 y/o
the same type of cancer in multiple family members
rare type of cancer in 1 + family members
family with more than 1 type of cancer
If colon cancer runs in your family, when should you do a colonoscopy?
early because very hereditary
Viruses are difficult to
evaluate and isolate
Virus and generic structure of cells become
incorporated with each other
Initial viral infection to the development of cancer is
delayed after many years
viruses must act in conjunction with other factors in order to
develop into cancer
What virus is most common in causing cancer?
HPV
Viruses cause ________ and why is it harmful for cancer pts***
long term inflammation
immunosuppressed people
HPV can cause what type of cancer
cervical
Hepatitis B and C can cause what type of cancer
Liver
Epstein-Barr (mono) can cause what type of cancer
Lymphoma
Human Herpes Virus 8 can cause what type of cancer
Kaposi’s sarcoma
HIV can cause what type of cancer
Lymphoma
Karposi’s sarcoma
Helicobacter pylori can cause what type of cancer?
stomach ulcers
lymphoma in the stomach lining
The vaccination of the HPV
should be encouraged to avoid HPV and warts on genitalia
Hormone Replacement Therapy
estrogen
progestin
How can a hysterectomy cause cancer?
not produce estrogen and progesterone with hormone replacement therapy which causes cancer
Can hormone replacement therapy cause cancer?
yes
What type of cancers do the risks outweigh the benefits?
Ovarian
breast
uterine
lung
brain
colon
Primary prevention
health promotion and illness prevention
- reduction in the incidence of cancer
What preventions are done in primary intervention
exercise
lifestyle change
dietary change
stress reduction
avoid carcinogens
Secondary prevention
screening
diagnosis and treatment of illness
What type of screening is done in secondary prevention?
self-breast and testicular exams
pap smear
mammogram
colonoscopy
What is the goal of secondary prevention?
halt the progress of cancer through early screening and diagnosis
Tertiary prevention
disease treatment and rehab
- restore health
The goal of tertiary prevention
prevent further deterioration
Chemoprevention
use of substances to lower risk of cancer
What are the different drugs used in chemoprevention?
Selective estrogen receptor modulators
- Tamoxifen and raloxifene
- selenium
Pathophysiology of Tamoxifen
binds estrogen and progesterone to prevent them from feeding the tumor
early menopause
Tamoxifen and Raloxifene**
reduced risk of breast cancer
binds estrogen and progesterone
used for up to 5 years
What is the 1st chemopreventative drug approved?
Tamoxifen
Selenium
reduced risk of prostate cancer
What is the goal of screening?
find cancer in the early stages
What are the different types of screenings?
physical exam
lab tests
imaging procedures
genetic testing
Beginning at what age should men and women get a colorectal screening?
45
How often should a fecal occult blood test be done for colorectal screening?
yearly
How often should a flexible sigmoidoscopy be done for colorectal screening?
every 5 years
How often should a colonoscopy be done for colorectal screening?
every 10 years
What cancer is considered very treatable when caught early but very deadly when caught late?
colon
Monthly Self Breast exams need to start after
20 years old
HCP Breast exams need to be done between what years
and every ___ years
40-44 and completed every 3 years
(However, Mrs.Duriex recommends one every year after 40)
Pap smear is looking for
abnormal cells of the cervix (mostly through sex)
At age 45-54, HCP exams and mammograms need to be done
yearly
At age 55, HCP and mammograms need to be done
every 2 years
Women at high risk for breast CA need to have what yearly
MRI and mammogram
Cervical cancer screening needs to be done when
type of test every
age 21 or within 3 yrs of initiating intercourse
- pap test every 2-3 years
If the patient has dysplasia noted, then pap tests are done
annually
At the age of 30, a pap test and HPV need to be done
5 years
every 3 years with only pap test
Cervical cancer screening is not necessary if all previous tests are negative after what age
60
If the petient has had a hysterectomy, should the woman continue a pap test related to vaginal or vulvar cancer?
yes
What are the 7 warning signs of cancer? CAUTION
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast/elsewhere
Indigestion or difficulty swallowing
Obvious change in a wart or mole
Nagging cough or hoarseness
Grading
pathologist compares the appearance of cancer cells to the normal surrounding cells
Staging
Oncologist classifying a malignancy by the extent of spread within the body
What does the pathologist do to cancer?
differentiation and grade
What does the oncologist do after the pathologist?
oncologist
Grading: GX
can not be assessed
Grading: G1
low grade
well differentiated, slow growing
Grading: G2
moderate grade
moderately differentiated, growing slightly faster
Grading: G3
high grade
poorly differentiated, growing faster
Grading: G4
high grade
undifferentiated, not distinct at all, very aggressive
Stage 1 CA
small cancer found in an organ where it originated
Stage 2 CA
larger cancer that may/may not have spread to the lymph nodes
Stage 3 CA
larger cancer also in the lymph nodes
Stage 4 CA
cancer has spread from the original site into other organs
PET scan
lights up inflammation in the body
TNM system of staging
T = size of primary tumor
N = # of lymph nodes involved
M = extent of metastasis
Staging Tumor Size
TX
the tumor can not be measured
Staging Tumor Size
T0
no primary tumor, can’t be found
Staging Tumor Size
Tis
the tumor is “in situ” (best case)
in 1st layer of the organ
Staging Tumor Size
T1
small or early stage
Staging Tumor Size
T2
confined to original area
Staging Tumor Size
T3
has spread to surrounding tissues
Staging Tumor Size
T4
large, advanced stage cancer
TNM classification reflects
depth of tumor infiltration
Staging: Number of Nodes
NX
Nearby nodes can’t be tested/evaluated
Staging: Number of Nodes
N0
lymph nodes are cancer free
Staging: Number of Nodes
N1
cancer cells have reached one node
Staging: Number of Nodes
N2
cancer spread to more than one node
Staging: Number of Nodes
N3
cancer in lymph nodes extensive/widespread
Staging: Extent of Metastasis
MX
UNKNOWN if cancer has spread
Staging: Extent of Metastasis
M0
no distant metastases were found
Staging: Extent of Metastasis
M1
cancer has spread to one or more distant parts of the body
In situ
still in the original layer
Localized
still in original organ
Regional
spread to nearby lymph nodes or organs
Distant
spread to distant body parts
Tumor markers
determine the effectiveness of tx
Tumor Marker CEA stands for
Carcinoembryonic Antigen
CEA tumor marker is related to
pancreas, GI (colon, lung, breast)
Normal: 0-2.5 in nonsmokers / less than 5 in smokers
When reviewing the chart for a patient with cervical cancer, the nurse notes that the cancer is staged as Tis, N0, M0. The nurse will teach the patient that
a. the cancer cells are well-differentiated.
b. it is difficult to determine the original site of cervical cancer.
c. further testing is needed to determine the spread of the cancer.
d. the cancer is localized to the cervix.
d. the cancer is localized to the cervix.
A 61-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg) tells the nurse that she has a glass of wine two or three times a week. The patient works for the post office and has a 5-mile mail-delivery route. This is her first contact with the healthcare system in 20 years. Which of these topics will the nurse plan to include in patient teaching about cancer? (Select all that apply.)
a. Alcohol use
b. Physical activity
c. Body weight
d. Colorectal screening
e. Tobacco use
f. Mammography
g. Pap testing
h. Sunscreen use
d. Colorectal screening
f. Mammography
g. Pap testing
h. Sunscreen use
Treatment of Cancer
surgery
radiation therapy
chemotherapy
What is the most frequent treatment method for cancer?
surgery
Surgery is used in conjunction with
chemotherapy or radiation
What is the ideal scenario for cancer when operating in surgery
localized and operative to remove the tumor
determine other conjunction treatments
What are the reasons for a cancer patient to have surgery
prevent
diagnose
stage
treat
If the tumor is benign why would they need surgery?
causes problems to other organs or systems
- by becoming too big
What are the different types of surgeries?
Diagnostic
Primary
Prophylactic
Palliative
Reconstructive
A biopsy is what type of surgery?
diagnostic
Mastectomy is what type of surgery?
Primary
Vasectomy is what type of surgery?
Prophylactic
Quality of life improvement is related to what type of surgery?
Pallative
Augmentation/plastic surgery is what type of surgery?
reconstructive
Tissue Biopsy encompasses these methods?
Shave
Punch
Incision
Excisional
Fine needle
Core needle
Shave Biopsy
top layers of the skin are shaved off with a small surgical blade
bandaid
Punch Biopsy
a small round piece of tissue about the size of a pencil eraser is removed using a sharp, hollow, circular instrument
down into the dermal cells
closed with sutures
Incisional Biopsy
a cut is made through the skin to remove a sample of abnormal tissue or part of a lump or suspicious area is too big
Fine Needle Biopsy
23-30g needle
aspirate and suction fluid out of the site
superficial tumor
least painful
Core Needle Biopsy
12g needle
liver, kidney and retract specimens
most painful
Surgery as a primary treatment includes these 3 curing methods
Debulking
Radical Excisions
Salvage Surgery
Primary/Curative Surgery
Debulking
remove as much of the tumor as possible
Radical means
take everything including muscle, sub Q, and skin
Primary/Curative Surgery
Radical Excisions
can be disfiguring and alter functioning
takes muscle, sub Q and skin is all taken
Primary/Curative Surgery
Salvage Surgery
extensive surgery to site at which previous therapies have failed
Radical Mastectomy
removal of the breast and associated lymph nodes near the armpit
Radical Neck Dissection
removal of jaw bone, tongue, lymph nodes, neck glands
Primary Treatment Surgery
Electrosurgery to skin
electrical current to destroy tumor cells
Primary Treatment Surgery
Cryosurgery to skin
liquid nitrogen to freeze tissue
Primary Treatment Surgery
Chemosurgery to skin
chemical applied to tissue
Primary Treatment Surgery
Laser surgery to skin
precise high-dose radiation therapy
Prophylactic Surgery
removal of non-vital tissues/organs that may develop cancer
Prophylactic Surgery considerations
family hx and genetic predisposition
presence/absence of symptoms
risks vs benefits
ability to detect cancers early
patient’s acceptance of post-op outcomes
Palliative Surgery
pain relief
not intended to treat or cure
goal high quality of life
“to alleviate without curing”
Reconstructive surgery
trying to repair injury or loss of function from curative or radical surgeries
- spacer until healed and tx is done then do plastic surgery (6 months to a year)
Care of surgical pt
incision care
prevent infection
manage pain
educate on drains, s/s of infection, and dietary intake to promote healing
Does the nurse take off the surgical dressing first?
no, the surgeon does
S/S of infection
redness, swelling, warmth
What food is eaten to promote healing?
Vitamin C
Protein
The radiation and Chemotherapy goal is to
eliminate cancerous cells
Radiation/Chemotherapy affects
rapidly proliferating cells (skin, GI, and hair)
- a wide range of symptoms
- death can result
- benefits outweigh the risks (mostly)
Is it the nurse’s job to encourage a patient to pursue chemotherapy?
no, patient’s choice if they want to pursue
Radiation Therapy does what to the body
energy to kill/shrink tumors
energy to eliminate CA cells
damages cell’s DNA
Healthy cells can be damaged
tx of choice for localized CA if inoperable
Lethal Tumor Dose
the amount required to eradicate 95% of the tumor and simultaneously salvage or spare normal tissue
Total radiation dosage is delivered over
weeks to allow healthy tissue to recover
Repeated radiation doses allow
the periphery of the tumor to reoxygenate and become more susceptible to radiation
Factors affecting dosage
radiosensitivity of tumor
normal tissue tolerance
the volume of tissue to be irradiated
The radiosensitivity of the tumor is dependent on
presence of oxygen
Normal tissue tolerance is the point which
normal tissues are irreparably damaged
The volume of tissue to irradiated determines the
total prescribed dose to be separated into several smaller doses
Treatments are usually given daily, ___ days per week for an average of ____ - ______ treatments
5;
25-30
Benefits of Radiation Therapy
used before surgery to shrink tumors
intra-operative
given before, during, or after chemo
palliative (shrink tumors, reduce pressure, pain, and other symptoms)
Radiation Toxicity
localized to the area of treatment
maybe higher if in conjunction with chemo
Generalized effects of Radiation Toxicity
Fatigue
N/V
Anemia
Thrombocytopenia
A hypoxic cell is ________ times harder to treat as it shrinks
2-3
How does a pt with Radiation Toxicity get anemia?
bone marrow suppression and decrease in RBCs
How does a pt with Radiation Toxicity get thrombocytopenia?
low platelet levels w/ low blood flow
External Radiation Therapy aka
Teletherapy
Internal Radiation Therapy aka
Brachytherapy
If a Cancer pt is getting radiation treatment, what assessments and education do we need to tell them?
**Breathing
*Nutrition
Skin
Pain
Brachytherapy procedure includes??????
needles inside the tissue to spare the dying tissue
Nursing Considerations for Brachytherapy
monitor the number of needles and don’t move
needle could puncture the bladder if moved
Brachytherapy Side effects
sealed/unsealed *implants
fatigue
anorexia
immunosuppression
other similar to external
If the pt has a sealed implant, then the body
does not give off radiation BUT pregnant women and small children should still avoid exposure to pt
- limit time to 60 mins a shift as a nurse and visitors
If the patient has an unsealed implant then the body
will give off radiation
body secretions may be contaminated
Isolation
What type of isolation will occur with a radiation implant?
Nurses and pts have less than 60 mins in the room per shift
Education for Temporary Brachytherapy
avoid close contact with others until tx is completed
no contact with pregnant women
bed rest to prevent dislodging radioactive source
maintain balanced diet, consider small, frequent meals
maintain fluid intake to ensure adequate hydration: 2-3 L/day
What is the key to flushing out radiation?
hydratation
In brachytherapy, If the needle comes out and is laying on the bed, what does the nurse do?*****
pick up chemotherapy gloves and long-handed forceps and place them in a lead-lined container
Side Effects of Radiation
fatigue
skin changes
alopecia
immunosuppression
radiation pneumonia
ulceration of oral mucous membranes
GI: N/V/D
symptoms increase as treatment progresses
Patient Education for Radiation Therapy (6)
wash the treated area with tepid water and a soft washcloth
use an electric razor only
DO NOT remove treatment markings on skin
no heat or cold packs
no products (lotion/deodorant) to the sites during tx
avoid wearing tight, starched, or stiff clothing over treatment area
If the patient has radiation therapy wash the affected area with
tepid water and a soft washcloth
T/F: You should wash off the teletherapy radiation marks everyday after treatment.
False, never wash off the markings
What type of tape is used for radiation therapy patients?
paper (apply outside the treatment area
no adhesive tape
Patients with radiation treatment need to protect their
skin with sunscreen (for up to a year after radiation stops)
if hair loss occurs, cover their head
Radiation therapy patients should eat
5-6 small meals/day
= fat/fiber/lactose
If a patient has diarrhea, they should be on what type of diet?
BRAT
Radiation therapy pts need
proper rest
diet
fluid intake for health and repairing normal tissues
Nursing Considerations for Brachytherapy
needle could puncture the bladder if moved
Chemotherapy (aka Poison)
use of anticancer drugs to eliminate cancer cells (combo)
- affects the entire body’s normal cells
- numerous side effects
- death may occur
Antineoplastic
meds used to treat cancer (systemic poison)
What is the number 1 cause of death during chemotherapy?
sepsis
bc they have no WBCs to fight due to bone marrow suppression
CHemotherapy goal
kill cancerous cells while preserving other, more healthy cells
- not always possible
- high % of pts die from treatment, not cancer
T/F: Chemotherapy has multiple cycles, administration, and body surface areas unique to every person.
True
Administration of Chemotherapy
excreted in body fluids up to
48 hours after treatment
Administration of Chemotherapy
usually requires
specialized ports
Administration of Chemotherapy
Monitor
lab values closely (WBCs, RBCs, H&H, Platelets)
=liver enzymes especially
= Steroid should check glucose
Administration of Chemotherapy
is given by a
chemo-certified RN only (2) to check drugs, pt, and orders
patency of port
set the pump together to ensure the rate is correct
Extravasation
causative leakage of meds into the tissue around it
causing death of tissue
What is a crucial step in Pt teaching guidelines for chemotherapy?
Hand washing is crucial
Chemotherapy will delay
healing
For 48-72 hrs following chemo the pts need to (7)
flush toilet twice
rinse toilets with bleach daily
caregiver should wear gloves if in contact with
- any body fluids
- contaminated laundry
avoid sex
- use 2 forms of birth control
Handling cytotoxic drugs
no safe exposure limit (PPE and 48 hrs of chemo)
routes of exposure (inhalation, absorption, indigestion)
follow agency guidelines for proper disposal
What PPE is needed to handle chemo drugs?
gloves
gowns
chemo hazard containers
Cytotoxic Drugs RISK OF EXPOSURE
Handling body fluids of pt within 48 hours of chemo
Always PPE
Accidental spills
Immunotherapy
boosts the immune system
creates an environment that is not conductive for CA cells to grow
attacks CA cells directly
Is immunotherapy toxic like chemotherapy?
no, it is less toxic then chemotherapy
Targeted Therapy
interferes with cancer growth
targets specific receptors important in tumor development
Side effects of Immunotherapy and targeted therapy
flu-like symptoms (HA, fever, chills, fatigue, extreme weakness, anorexia, and nausea)
tachycardia
orthostatic hypotension
neurologic deficits - confusion, memory loss, insomnia
bone marrow depression
Side effects of chemo
N/V from rapidly proliferated cells
alopecia
stomatitis*
pain
enteritis
diarrhea
anemia
fatigue
Side effects related to labs of Chemo
myelosuppression
pancytopenia**
leukopenia
neutropenia
thrombocytopenia
granulocytopenia
pancytopenia
decrease in all cells (red, white, platelets)
In a cancer patient, what assessment is needed frequently to prevent or catch stomatitis
Mouth assessment
bc of rapidly proliferating cells
Fatigue in cancer patients is mainly caused by
stress and mental devastation
debilitating
prolonged
health and quality of life (see a therapist)
Fatigue from cancer therapy is unrelated to _________ and unrelieved by __________
activity and unrelieved by rest
With fatigue what levels should be monitored?
thyroid
Emetogenic
nausea causing drugs
Nausea and Vomiting is directly ralated to what in cancer patients?
type of chemo administered
What is the key to helping pts on chemo with N/V?
prevention give antiemetic before s/s and treatment from pt occur
Acute N/V
occurs within 24 hours
Delayed N/V
occurs within 2-5 days
Anticipatory N/V
occurs before chemo
like a trigger of a sound/smell/taste
Ondansetron is a
antiemetic (5-HT₃ antagonist ↓ risk of CINV)
Ondansetron combined with a steroid (dexamethasone/Emend)
increase appetite
limited side effects with short-term use
use around the clock for 24-72 hours following treatment
With N/V, monitor for
dehydration (I&O)
Anorexia-Cachexia Syndrome
loss of skeletal muscle and fat
not starvation
unexplained rapid wt loss
altered smell and taste
halt cancer treatment
corticosteroids are effective
end result of cancer
Catabolic state
body tissue and muscle proteins used to support cancer cell growth
What kills more cancer pts than cancer itself?
Immunosuppression
- no fighting ability with cold
-stem cells
Immunosuppression does what to the body
decreased ability to fight infection
risk for infection increases when
- low WBCs and neutrophils
risk for anemia increases when
- low RBCs and H&H
risk for bleeding increases when
- decrease platelets
Immunosuppressed pts (Stem cell units) are given what meds
prophylactic
antifungals
antivirals
What labs need to constantly be checked with immunosuppressed pts?
WBCs
platelets
risk for infection increases when
- low WBCs and neutrophils
risk for anemia increases when
- low RBCs and H&H
risk for bleeding increases when
- decrease platelets
NADIR
the lowest point of blood cell count will get
each cell occurs at a different time
immune system compromised
NADIR WBCs and platelets
7 - 14 days
NADIR RBCs
several weeks
Treatments are designed around what
NADIR
Absolute Neutrophil count shows what if low
increased risk of infection
less than 100 = extremely high risk (stem cell)
What is the 1st sign of a patient going septic?
respirations increase
S/S of Sepsis
high respirations
fever 100.5 +
fatigue, body aches
chills, sweating
hypotension
tachycardia
lab values (WBCs high)
notify MD
Before giving an antibiotic, get
blood cultures
If a pt is going septic , what should you do?
notify MD
obtain chest x-ray
blood and urine cultures
?if requested, then antibiotics?
Neutropenia
abnormally low absolute neutrophil count (can’t fight against)
most cancer pts
What are the symptoms of neutropenia?
none until infection occurs
Monitor with neutropenia with
CBC with differential
What are the causes of neutropenia
decreased production of WBC
increased destruction of WBCs
Neutropenic Precautions
wash hands frequently
low bacteria diet (no fresh fruits or veggies)
no fresh flowers, plants, pets
avoid crowds
no visitors with infections
no live vaccinations
Thrombocytopenia
decrease in platelets
Platelets (150,000 - 400,000) promote
coagulation, vascular integrity, vasoconstriction, adhesion
- produced in bone marrow (7-9 days)
Critical Values of Thrombocytopenia
less than 50,000 or more than 1 million
Transfusion of platelets below
10,000
Pt education on Thrombocytopenia
Monitor platelet count
Monitor stools/urine for bleeding
Use electric razor only
Apply ice to the affected area if trauma occurs
Avoid dental work or other invasive procedures
Avoid aspirin and aspirin-containing products
bleeding safety precautions
- soft toothbrush and no flossing
Assess skin for ecchymosis, petechiae and trauma at least every shift**
Avoid IM injections and limit venipunctures**
No aspirin
Pain in a cancer pt should be assessed
at every encounter (pain scale with scheduled and prn)
Pain relief measures, not analgesics
distraction
imagery
relaxation
touch therapy
Chemo-Brain
“mental fog” caused by chemotherapy, radiation, and some types of immunotherapy
If a pt is having chemo-brain, what nursing interventions should you encourage pts to
Use a calendar or day-planner
Write down everything
Exercise the brain with crossword puzzles or other word or number games, jigsaw puzzles, play cards
Get physical exercise as tolerated
Ask for support (friends, family, support groups)
If chemo-brain persists, what drugs can be used?
Alzheimer drugs
Ascites is a ______ sign of cancer itself, not side effect of treatment
late
Ascites
pathological accumulation of fluid within the abdominal cavity
- serum albumin/protein
Symptoms of Ascites
abdominal distension
fullness
early satiety
difficulty breathing
decreased mobility
edema
Management of Ascites
low salt diet - reduces water retention and edema)
diuretic therapy
paracentesis (palliative)
possible pleurx to enable pt to drain at home
perioneovenous shunts
T/F: Ascites is a late sign and usually a poor prognosis.
What is the key to ascites
True, comfort is the key
Risk Factors of Breast Cancer
Gender
Increasing age (40+)
Early menarche/late menopause
Family history
High-fat diet
Obesity
Can males get breast cancer?
yes
The younger the breast cancer diagnosis
the more aggressive it is (UNDER 40)
Symptoms of Breast CA
Painless breast mass
Painful breast mass
Nipple discharge
Local edema
Nipple retraction
Nipple crusting
Primary prevention for Breast CA
Wellness
Smoking Cessation
Daily exercise
Healthy diet
Low in saturated fat
High in Fiber
Secondary Prevention for Breast CA
Mammogram
Beginning yearly after 40yrs of age
Breast Self Exam (BSE) every month
>20 years of age
Perform after menstruation
Same time every month
Tertiary Prevention for Breast CA
Symptom control
- Lymphedema (SWELLING OF THE LYMPH NODES)
Rehabilitation
- Reconstruction
What are you looking for when you do a self-breast examination every month?
if anything has changed since last time (lump)
Assessment of Breast CA
= Any chnage in size, contour, or texture*
Mass felt during BSE
Mammogram
A non-moveable mass –typically painless
Usually, only one breast is involved
Skin dimpling, puckering
Nipple discharge, retraction
Peau d’orange = orange dimpling of the skin
Late signs of Breast CA
pain
ulceration
cachexia
Ultrasound is used to do what with dx breast CA
Consistency of breast masses
(cyst or dense mass?)
determine blood flow to that area
Aspiration Biopsy
fine needle aspiration (FNA), a small amount of breast tissue or fluid is removed from a suspicious area with a thin, hollow needle and checked for cancer cells
Incisional Biopsy
removes only part of the abnormal area
Excisional Biopsy
removes the entire tumor or abnormal area
50% of breast cancer occurs in what quadrant
lateral upper
The diagnostic tests (BRCA1-2, HER-2, Estrogen and Progesterone receptors) show what
types of breast cancer (known as the triple)
Triple negative means
good
Triple positive means
bad
Easier to treat what type of cancer
Hormones
surgical Tx for Breast CA
Lumpectomy
Simple Mastectomy
Radical or Modified Radical Mastectomy
NONsurgical Tx for Breast CA
Chemotherapy
Radiation (Teletherapy anf Brachytherapy via radium implants, pellets, and seeds)
Hormonal manipulation - Tamoxifen
Simple Mastectomy means
removal of just breast tissue
Modified Radical Mastectomy means
removal of all cancerous and leave a few lymph nodes
Radical Mastectomy means
breast and lymph node removal
Brachytherapy preserves
skin tissue
Nurse Pre-Operative Care
Emotional support - look good feel good room
General preop teaching
Specific training
Lymphedema of the arm Complications
Lifelong potential complication
Prevention
- Elevation, ROM, ADLs, protect
Treatment
- Intermittent compression sleeve, manual massage, elevation, diuretics
Importance of follow up
Functions of the skin
Protection
Body temperature regulation
Psychosocial
Sensation
Vitamin D production
Immunological
Absorption
Elimination
What is the most important thing for helping the skin?
Sunscreen
Skin Assessment Tools
Perfect time when giving them a bath
Eyes
Hands
Ears
History taking and data gathering
Braden Scale
Nutritional assessment tools
Key Steps for Skin Assessments
Health history*
Inspection and palpation
Examination (head to toe, light, Braden scale, variables)
Documentation
Skin CA is a _____ person disease
young
Document exactly what is
observed or palpated
- appearance, texture, temp, turgor, color, moisture, sensation, vascularity, lesions/rashes
Are these documentations correct and accurate skin assessments?
“Skin is pink, warm, dry, and elastic; no petechiae, lesions or excoriation; multiple moles of small size and regular border and surface.”
“Red, macular rash generalized over trunk and thighs; semi-confluent lesions measure 1 to 2 cm; abrupt onset.”
Yes both are
Which skin cancer is the most deadly and has several different dark colors?
melanoma
Which cancer is more common in farmers, takes years to grow, and becomes deadly?
Basal cell carcinoma
Which skin cancer looks scaly?
Squamous cell carcinoma
Risk factors of Skin CA
Sunlight and UV radiation
Severe and/or blistering sunburns
Tanning (direct sunlight or tanning booths)
Family history
Fair (pale) skin that burns easily
Medical conditions or medications
What meds can cause you to be more sensitive to the sunlight?
antibiotics
corticosteroids
What meds can cause you to be more sensitive to the sunlight?
antibiotics
corticosteroids
How do you recognize skin cancer?
ABCDE assessment
- change, hard/lumpy, oozes/bleeds/does not heal/itchy/tender/painful
ABCDE assessment
A – Look for asymmetry in a mole
B – Assess for an irregular border
C – Is the color a mixture of different colors or has it changed recently?
D – Is the diameter >6mm
E – Has there been an evolution in the mole size, shape, color?
Dx and Staging of Breast Cancer
Biopsy
labs/imaging
sentinel node biopsy
staging (size, deep of layers, metastasis)
Treatment depends on
Type and stage
Size and location of tumor
General health and medical history
Treatment types of Skin CA
Excision
Surgery
Chemotherapy
Radiation
Biologic Therapy (IMMUNOTHERAPY)
Prevention and Education of Skin CA
Limit sun exposure
Stay away from sunlamps and tanning booths
Avoid outdoor activities during the hottest part of the day
Wear long sleeves and long pants
Wear a hat with a wide brim
Use sunscreen (SPF 30)
Regularly check your skin for changes in moles
What port is used for cancer patients and can only be accessed with what?
Port a Cath
Huber needle
