Oncology Flashcards
Hypertrophy
growth that causes tissue to increase in size by enlarging each cell (heart muscle cells)
Hyperplasia
growth that causes tissue to increase in size by increasing the number of cells ( skin, hair, bone marrow, …)
Neoplasia
any new or continued cell growth not needed for normal development or replacement of damaged tissue.
Benign tumor cells
- Continuous or inappropriate cell growth
- Specific morphologic features
- Small nuclear-to-cytoplasmic ratio
- Differentiated functions
- Tight adherence
- No migration
- Growth- Expansion
- Normal chromosomes(eupliod)
- Low mitotic index
Examples of benign tumor cells
uterine fibroid tumors; moles; skin tags; endometriosis; nasal polyps
Cancer cells
Rapid or continuous cell division • Anaplastic appearance • Large nuclear-to-cytoplasmic ratio • No differentiated function • Loose adherence • Migration • Growth –Invasion • Abnormal chromosomes (aneuploid) • High mitotic index
Metastasis: Malignant transformation
some normal cuboidal cells undergone malignant transformation and have divided - forming tumorous area within cuboidal epithelium
Metastasis: Tumor vascularization
cancer cells secrete tumor angiogenesis factor (TAF) stimulating the blood vessels to bud and form new channels that grow into the tumor
Metastasis: Blood vessel penetration
cancer cells broken off from main tumor - enzymes make holes in blood vessels - cancer cells enter - travel around the body
Metastasis: Arrest and invasion
cancer cells clump up in blood vessels walls and invade new tissue areas- new tumors will form. (if conditions are right).
Staging of cancer - TNM Classification
- Primary Tumor
- Regional Lymph Nodes
- Distant Metastasis
Grading of malignant tumors
Gx ( cannot be determined ), G1, G2, G3, G4
External factors ( environmental carcinogenesis)
- Chemical : tobacco…
- Physical : radiation, chronic irritation (tissue trauma)
- Viral : viruses infect body cells and break the DNA strands
Personal factors
- Immune function: cell mediated immunity - natural killer NK and T-cells . At risk: immunosuppressed, older than 60;
- Advancing age: most important risk factor for cancer;
- Genetics: testing foe cancer predisposition is available to confirm or rule out persons genetic risk.
Caution: Seven Warning Signs of Cancer
- Change in bowel or bladder habits
- A sore that doesn’t heal
- Unusual bleeding or discharge
- Thickening (lump) in the breast or elsewhere
- Indigestion or difficulty swallowing
- Obvious change in a wart or mole
- Nagging cough or hoarseness
Diagnostic Studies
- CBC
- Chemistry
- Protein tumor markers (PSA, CEA)
- X-ray/ MRI/ CT
- Ultrasound
- Biopsy
- Endoscopy/ Laparoscopy
Treatment & Management: Goal:
Prolong Survival Time or Improve Quality of Life
Treatment & Management:
Surgery o Radiation Therapy o Chemotherapy o Hormonal Manipulation o Immune Therapy o Photodynamic therapy o Biologic Response Modifiers (BMRs) o Targeted Therapy
Types of Surgery
- Diagnostic: removal of leison
- Prophylactic: removal at risk tissue
- Curative: removal all cancerous tissue
- Cytoreductive : part of cancerous tissue
- Palliative: improve quality of life
- Reconstructive/ Rehabilitative : increase of function
• Second-look
Radiation Therapy: purpose (local treatment)
destroy cancer cells with minimal exposure of the normal cells to the damaging action of radiation.
Radiation therapy:
Gamma rays (used most commonly); beta particles; alpha particles (not used in cancer treatment); Inverse square law.
Radiation delivery:
depends on the patients general health, and on the shape , size and location of the tumor.
Teletherapy
distant treatment ; radiation source is external to the patient - patient is not radioactive and is not a hazard to others.
Brachytherapy
short or close therapy; radiation source comes into direct, continuous contact with the tumor tissue for specific period of time; uses radioactive isotopes ( solid form or within body fluids( radioactive iodine)); patient is hazard to others.
Radioactive isotopes
eliminated in wastes products within 48 hrs (which are radioactive);
Side effects of radiation therapy
- skin changes and hair loss ( local)
- altered taste sensations and fatigue ( external radiation)
- tissue fibrosis and scaring
LDR and HDR
low dose radiation and high dose radiation
Radiation: priority nursing intervention
teaching patient about skin care
Chemotherapy (systemic)
used to cure and increase survival time ; has some selectivity for killing cancer cells over normal cells. ; damage DNA and interfere with cell division.
Normal cells affected by chemotherapy
cells that divide rapidly - skin, hair, intestinal tissue, spermatocytes, blood forming cells.
Chemotherapy : methods of delivery most common
PO and IV; assess for extravasation (infiltration of drug into tissue)- pain, infection, tissue loss.
Alkylating agents
cross link DNA - making two DNA strands bind together which prevent proper DNA and RNA synthesis; Side effects: Nausea, vomiting, alopecia , anemia, bone marrow suppression, cystitis .
Antitumor antibiotics
damage the cells of DNA; interrupt DNA or RNA synthesis ; side effects: alopecia, N&V, stomatitis, leukopenia, thrombocytopenia.
Antimiotic agents
interfere with formation of microtubules so cells cannot complete mitosis during cell division. cancer cell cannot divide or divides only once.
Antimetabolites
“counterfeit metabolites” fool cancer cells into using them; impair cell division. SE: bone marrow supression, stomatitis; N&V, alopecia, hepatic and renal dysfunction.
Plant alkaloids
block cellular division; derived from natural plants; SE: leukopenia, allergic reaction, alopecia, N&V, constipation, diarrhea.
Anemia
decreased level of circulating RBC;
Assess: respiratory status: SOB; weakness, fatigue, dizziness, pale skin color, TX: epoetin alfa (Procrit);
Anemia : Teaching
- Get Rest/ Stand slowly to prevent dizziness when changing positions
- Limit activities
- Eat a well-balanced diet
Neutropenia
decrease number of circulating WBC; At risk for infection: fungal, bacterial, viral;
Neutropenia: Teaching
- Washing your hands with soap and water and carry sanitizer for
times when you can’t
• Stay away from people who are sick
• Stay away from crowds
• Be careful around animals, do not clean litter boxes, pick up dog
waste etc…
• Do not get a flu shot or other vaccine b/c it may contain a live virus
• Wash raw foods & vegetables before eating them
• Don’t eat raw or undercooked fish, seafood, meat, chicken or eggs
Thrombocytopenia
decreased number of circulating platelets; Risk for excessive bleeding when platelet count is less than 50000; less than 20000 - at risk for spontaneous uncontrolled bleeding ; Avoid injury !!!
Thrombocytopenia: Do
- Brush your teeth with a soft toothbrush
o Men- use an electric shaver, not a razor
o Blow your nose gently
o Be careful when using scissors, knives or other sharp objects
o Wear shoes all the time, even in the house
Thrombocytopenia: Don’t
- Use dental floor or toothpicks
o Play sports or participate in other activities which you could
get hurt
o Use tampons, enemas, suppositories or rectal
thermometers
Nausea/Vomiting/ Appetite Changes
- Eat small meals & snacks (5-6), instead of 3 large meals
o Eat bland, not spicy foods, salty and/or acidic foods
o Provide anti-emetics before, during and after treatment
o Set a daily schedule for eating your meals and snacks
Mucositis/Stomatitis/Xerostomia
- Visit dentist at least 2 weeks before starting Chemotherapy
• Check your mouth and tongue daily
• Keep your mouth moist
o Clean your mouth, teeth , gums & tongue
o Be careful what you eat when your mouth is sore
o Stay away from things that can hurt, scrape or burn your mouth
Assess: sores, fissures, blisters, redness, tissue swelling, dry mouth, white patches.
Rinse mouth half peroxide half NS twice a day ( don’t use commercial mouthwash)
Alopecia
Before Hair Loss
• If you plan to buy a wig, do so before you lose your hair
• Be gentle when you wash your hair
• Do not use items that can hurt your scalp
• Curling irons/ Brush rollers or curlers
• Hair Dyes/ Perms to relax hair
o After Hair Loss
• Protect your Scalp
• Sleep on satin pillow case (less friction)
• Talk about your feelings
Alopecia: priority
teach how to prevent injury to the scalp; coping with body image change
Peripheral neuropathy
Loss of sensory or motor function of peripheral nerves
Presentation: Tingling, Burning, Weakness, Numbness in Hands or Feet
o Priority: Injury Prevention
Assess:
• Balance
• Trouble Picking up Objects
• Shaking/ Trembling
Cancer Prevention: Primary
use of strategies to PREVENT the actual occurrence of cancer (most effective when there is known cause for cancer type)
Cancer prevention: Secondary
use of SCREENING strategies to detect cancer early, at a time when cure or control is more likely.
Oncologic Emergencies
- Sepsis or septicemia + DIC (disseminated intravascular coagulation)
- SIADN : syndrome of inappropriate antidiuretic hormone
- Spinal cord compression
- Hypercalcemia
- Superior Vena Cava Syndrome SVC
- Tumor Lysis Syndrome
DIC
problem with blood clotting ; Clots block blood vessels and decrease blood flow to major organs and result in pain, strokelike manifestations, dyspnea, oliguria, bowel necrosis - TX: anticoagulants.
Bleeding from many sites - clotting factors are given - Hemorrhage is the primary problem.
SIADH
Water is reabsorbed - hyponatremia, , weakness, fatigue, fluid retention, muscle cramps, confusion, seizures, coma, death.
TX: fluid restriction, sodium intake + drug therapy; immediate cancer therapy. Safety - prevent fluid overload - pulmonary edema - heart failure.
Spinal cord compression
damage occur either when a tumor directly enters the spinal cord or when vertabre collapse from tumor degradation of the bone. Back pain (paralysis) , muscle weakness, numbness, tingling, unsteady gait. TX: Palliative
SVC
occurs when SVC is compressed or obstructed by tumor growth or by formation of clots in vessel . Blockage of blood flow in the venous system of the head , neck, upper trunk.
S/s: edema of face, tightness of the shirt collar (Stokes sign); TX: high dose radiation therapy to provide temporary relief
Tumor Lysis Syndrome (positive sign - cancer treatment is effective)
large number of tumor cells are destroyed rapidly - intracellular content ( K + purines) released into bloodstream faster than body can eliminate them .
s/s: hyperkalemia - severe cardiac dysfunction ;
purines - liver - uric acid - hyperuricemia - block tubules - ARF . TX: Hydration 3000-5000 ml of water day before, day of, 3 days after treatment.
Cachexia
extreme body wasting and malnutrition
Melanoma
most dangerous type of skin cancer
“Debulking” surgery
cytoreductive surgery or cancer control; removing part of the tumor and leaving a known amount of gross tumor; alone cannot result in a cure.
