Oncology Flashcards
Tumor Staging- T
Tx- cannot be assessed
T0- No evidence of primary tumor
TiS Carcinoma in situ
T1-T4- increasing size or local extent of tumor
Tumor Staging- Lymph Nodes-N
Nx- Cannot be assessed
N0- No regional metastasis
N1-N3- Increasing involvement regional lymph nodes
Tumor Staging- Metastasis
Mx Distant metastasis cannot be assessed
M0- No distant metastasis
M1- Distant metastasis
Purpose of staging
Baseline
Determine tx option and prognosis
Intraperitoneal chemo
Abdominal/ovarian cancer
Higher doses provided
Intraarterial chemo
Liver only (From colon)
Delivered into hepatic artery. Very high doses chemo.
5 FU and FUDR (Combo)
By pump
Intrathecal
For mets to CNS. Tube to spinal fluid.
Cross brain blood barrier
Portacath benefits
0 dressing less heparin under skin -may move -may occlude
Most common s/e of chemo
N/v
- premedicate
- relaxation
- no spicy food
- avoid favorite foods
- anti-anxiety meds
Management of Diarrhea with chemp
^fiber food ^K+ foods ^fluid intake Immodium Call if >24 hr or stanky
Managing Mucositis
- Soft nylon tooth brush
- Lidocaine
- Bland, soft, cold foods
- Straw
- Dentist prior to chemo
- pain meds
- Maalox
AVOID
- Salty/sugar/acid/booze
- Whitening toothpaste, mouthwash
Cancer fatigue
- Not resolved with rest
- interferes with life
- encourage rest
- administer blood
- assess fluid/electrolyte
- assess meds
- assess nutrition
Myelosuppression
- decreased WBC, RBC, PLT
Neurtopenia Drug therapy
Neupogen, leukine
IV/SQ
WBC WNL
(4.5-11)
RBC WNL
(4.5-6)
Neutrophil count <500
Severe risk- rating 4
Neutrophil count 1500-2000
No risk, normal, Rating 0
Thromocytopenia measures
- No IM
- Caution with foley
- Monitor LOC- Intracranial bleed
- Report bleeding
Anemia
S/s
- low BP
- Orthostatic BP
- Tachycardisa
- Decreased sat
Give fluids/RBC
Oxygen
OOB with assist
Alopecia
Temporary with chemo
Permanent with radiation
Avoid hair dryers/straighteners
Top 3 cancers in men
Prostate
Lung
Colorectal
DEATHS
Lung
Prostate
Colorectal
Top 3 cancer women
Breast
Lung
Colorectal
DEATHS
Lung
Breast
Colorectal
S/s Breast ca
- Redness
- veins
- edema/pitting
- Nipple inversion
- discharge
Are Lymph nodes usually palpable?
Nope
High risk breast CA screening
Annual mammogram with MRI
Excisional lumpectomy
Entire mass, plus margin of skin
Incisional biopsy
Surgical- portion of mass
Ductal Carcinoma in situ
Non-invasive Milk ducts No metz no death Removal of CA without breast
Invasive
Infiltrating ductal (Common, ducts=pathway) Medullary Mucinous tubular inflammatory Paget's
Risk factors: Breast CA
- female
- age
- History CA
- Family history CA
- BRACA1 BRCA2
- Early menarche
- Late menopause
- No full term pregnancy
- Old first pregnancy
- hormone therapy
- radiation
- Obesity
- alcohol, high fat diet
Chemo Prevention
Tamoxifen, Evista
Estrogen blocker
Breast CA most likely to spread,,,
Bone, lung, liver, pluera, adreanal, skin, brain
Sentinel node
-The first node that receives drainage from primary tumor
Found by injecting dye or radioactive isotope into breast and watching for first node
Prevention of lymphedema
- avoid IV/injections/blood draws
- Avoid BP
- Only electric razor
- Do not lift more than 5lb
- insect/sun repellent
Sentinel lymph node biopsy management
Blue/green urine and stool
Radiation probably needed for how long?
5-6wks
Decreases recurrence
SE radiation
Erythema Edema Skin breakdown Rash Fatigue
Combo Chemo time
3-6 mo
70% of patients with lung ca have what at time of diagnosis?
Spread to regional lymph nodes
Small cell lung CA
Aggressive, quick, rapid spread
10-15%
Lower the stage, better the prognosis
Non-small cell CA
85-90%
Lower the stage, better teh prognosis
S/S lung CA
- CHRONIC COUGH*
- dyspnea
- Hemoptysis
- Chest/shoulder pain
- Anorexia
- weight loss
-Asymptomatic until late
Diagnostics Lung CA
CXR
CT
Bronchoscopy with biopsy
Fine needle aspiration
SE lung radiation
Esophagitis Pneumonitis Lung fibrosis Pericarditis Fatigue
Risk factors colorectal CA
- western culture
- age
- genetics
- IBD
- Smoke/drink/fattyfat
- High fat, high protein
Colorectal CA
-90% survival if caught early, but most not caught early
Low rate at late stages
Asymptomatic early stages
Screening colonoscopy
At age 50
- Blood testing every year
-Sigmoidoscopy q3yr
Colonoscopy q10yr
s/s Butt cancer
Most common- Change bowel habits
- blood or tarry stoools
- abd pain, constipation, distension
Tenesmus
-Gotta poop, can’t poop. No poop.
Post-op colorectal monitors
- abd assess
- bowel sounds
- distension
- Palpitation
- s/s infection
- Report stat
- –Rectal Bleeding
- –Abrupt change in abd pain
- –s/s shock
Atelectasis
Pneumonia
Stages Colorectal cancer
A- Mucosa B1- Into mucosa B2- Penetrating mucosa C1- Into muscle, nodes C2- Into muscle, nodes D- many spreads
