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Common Hlth: Final > Oncology & Breast Cancer > Flashcards

Oncology & Breast Cancer Flashcards

1
Q

Risk factors

A

Carcinogen exposure – predisposes a person to DNA destruction, leading to malignancy (i.e. Ionizing radiation, benzene, HPV, sunlight, tobacco)

Other: Environmental, hormonal and lifestyle factors, meds., immune status, nutritional status

Modifiable – Weight, smoking

Non-modifiable – Age, genetics (10%)

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2
Q

Characteristics of normal cells & CA cells

A

NORMAL CELLS:
1. Contact inhibition: Cells will stop growing when they come in contact with other cells

  1. Apoptosis: Programmed cell death
  2. Anchorage dependence: Cells anchor to neighboring or basement cells to remain viable
  3. Structural and functional characteristics

CA CELLS: Anaplasia (the loss of mature or specialized features)

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3
Q

CA types

A

Types of CA:
1. SOLID – i.e. Lung CA

  1. HEMATOLOGIC – Originate from hematopoietic cell lines (RBCs, WBCs, platelets) OR secondary immune organs (Lymph nodes, spleen)
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4
Q

Staging

A

Dependent on tumor size, burden of disease, and spread

Solid tumor staging:

  1. Tumor size (T)
  2. Number of lymph nodes (N)
  3. Presence of metastasis
Stages:
Stage 1 – no spread outside the organ
Stage 2 – invasion of deeper tissues and lymph node involvement
Stage 3 – locally invasive tumors
Stage 4 – metastasis

**All hematologic tumors are stage 4 at diagnosis

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5
Q

Clinical presentation

A 
3 types of symptoms:
1. CAUTION (>2 weeks)
C: Changes in bowel or bladder habits
A: Sore throat that doesn't heal
U: Unusual bleeding or discharge
T: Thickening or lump
I: Indigestion or difficulty swallowing
O: Obvious change in wart or mole
N: Nagging cough or hoarseness
  1. Constitutional – vague symptoms (i.e. Fatigue, unexplained weight loss, fever of unknown etiology, night sweats)
  2. Malignancy-specific – (1) BREAST CA: Breast mass/lump, axillary node enlargement, disproportionate breasts, and nipple discharge; (2) ESOPHAGEAL CA: Dysphagia and chest discomfort; (3) GASTRIC CA: Indigestion, loss of appetite, abdominal discomfort, and N/V/
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6
Q

Prevention

A

PRIMARY (reduce the probability of CA development by modifying risk factors):

  1. Risk factor modification – i.e. Smoking cessation
  2. Immunization – i.e. HPV is linked with head and neck CA
  3. Chemoprevention – i.e. Early stage hormonal cancers such as breast and prostate CA

SECONDARY (early CA detection and screening):

  1. Mammogram
  2. PAP smear test

TERTIARY (reducing complications and improving quality of life):
1. CA treatment

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7
Q

Diagnosing CA: LABORATORY TESTS

A

Types of laboratory tests:
1. Blood/serum, or tissue – used to validate malignancy (i.e. PSA is linked to prostate CA; presence is also indicative of inflammation)

  1. Track response – CBC (i.e. Monitor WBC count)
  2. Track tumor marker – i.e. CA-125 is linked to ovarian CA
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8
Q

Diagnosing CA: IMAGING

A

Radiological, sonographical, and other technology are used to detect mass/metastasis that are often undetectable by PE

**Useful in diagnosis and assessment of solid tumor masses (NOT in hematologic, except lymphomas)

Types of imaging:
1. Computerized Tomography (CT scan) – mass locations and vessel involvement

  1. Positron Emission Tomography (PET scan) – injection of radioactive material that accumulates in areas of increased metabolic activity (hot spots)
  2. Magnetic Resonance Imaging (MRI) – evaluates changes on brain, joint, and breast tissue
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9
Q

Diagnosing CA: BIOPSY

A

Types of biopsies:
1. Incisional (cut into mass) – danger in tracking malignant cells through healthy tissue

  1. Excisional (cut out mass) – clean margin cut
  2. Fine needle biopsy (if mass is close to surface) – less cells = difficult to analyze
  3. Bone marrow aspiration/biopsy – used for hematologic malignancies
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10
Q

Diagnosing CA: ENDOSCOPIC PROCEDURES

A

Visualize structures (i.e. Esophagus, lungs) and allow for tissue access and biopsy

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11
Q

Treatment

A

Based on: (1) Cell type, (2) Staging, and (3) Markers

GOALS:
1. Cure – disease-free for 5 yrs. (debatable)

  1. Remission (if not curable) – reduce tumor burden or prevent progression; disease-free as long as meds. are taken (i.e. Hematologic)
  2. Palliation – alleviation of the burdens of cancer; team-based approach with pt goals
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12
Q

Treatment types

A

Types of treatment – can be done with one modality or in combination of:

  1. Surgery
  2. Radiation
  3. Medical therapy

Treatment classification:
1. PRIMARY – the definitive (best) treatment in a multimodal therapy

  1. NEOADJUVANT – administration of therapeutic agents before a main treatment
  2. ADJUVANT – in addition to the primary or initial therapy to maximize its effectiveness (i.e. Breast CA)
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13
Q

Breast CA

A

Requires multimodal treatment (surgery, radiation, and medical therapy)

Example of breast CA therapy:
1. Primary: Surgery – removal of malignant tumor

  1. Neoadjuvant: Chemotherapy – medical therapy to reduce tumor prior to surgery
  2. Adjuvant: Radiation after surgery – decrease risk of recurrence
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14
Q

Surgery

A

Preferred, greatest probability of cure; primary modality for solid tumors

Goal: Total excision or tumor debunking (including rerouting of vessels and organs)

Nursing interventions:
1. Understand the pt’s goals, education deficits, treatment plans, and anticipated barriers to post-op recovery

  1. Include plan for: Monitoring infection, pain, nutrition, reconditioning (and ADLs), and psychological considerations
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15
Q

Radiation

A

Defined as a localized manner of delivering ionizing radiation to destroy DNA within malignant cells and induce cell death

Types of radiation:
1. EXTERNAL BEAM RADIATION

  1. INTERNAL RADIATION (BRACHYTHERAPY): Insertion of radioactive implants directly into the tissue
  2. SYSTEMIC RADIATION: Injecting radioactive substance or taking oral substance
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16
Q

Medical therapy

A

Antineoplastic agents:
1. CHEMOTHERAPY: Interferes with all dividing cells (It is either cell cycle specific OR cell cycle non-specific); Many routes – IV, intrathecal (spinal), topical, intra-arterial, intraperitoneal, oral

  1. TARGETED AGENTS: Precision medicine that targets proteins that control how CA cells grow, divide, and spread
  2. IMMUNOLOGIC AGENTS: Assist the immune system in detecting and destroying abnormal cells (Types: Non-specific immune simulation, T-cell transfer therapy, and immune checkpoint inhibitor)
  3. HORMONAL AGENTS: Slows or stops the growth of CAs that use hormones to grow (i.e. Breast, prostate CA)

Goals of medical therapy:

  1. Cure
  2. Control
  3. Palliation
  4. Minimize adverse affects
  5. Maximize cell kill
17
Q

Stem cell and bone marrow therapy

A

Used to replace bone marrow cells that have been destroyed by CA or by antineoplastic drugs

18
Q

Role of the nurse

A

Minimize adverse effects with radiation and antineoplastics – GI, hair loss, fatigue, anemia, infection

Supportive care – psychosocial care

19
Q

GI effects

A

Adverse effects due to damage to the lining of the stomach and intestines:
1. DIARRHEA – avoid fried foods and high fiber foods, limit dairy, and screen for C. diff and CMV (virus)

  1. CONSTIPATION – high fiber foods, be active, and drink plenty fluids
  2. N/V – non-irritating foods, small frequent meals, sit up after eating, ginger, PRN meds (i.e. Zofran), assess PMHX (i.e. Extreme N/ during pregnancy)
  3. ANOREXIA – meds.
  4. STOMATITIS – soft foods, avoid hot and spicy food, and “magic” mouthwash (infection prevention)
  5. FOOD TASTES BAD – rinse before eating, ginger ale
20
Q

Hair loss

A

Most disturbing adverse effect

Support via:

  1. Wigs
  2. Scarves
  3. Hair pieces
  4. DigniCap (cooling cap): minimizes hair loss during chemotherapy treatment
21
Q

Fatigue

A

Can lead to distress, interfere with ADLs, and decrease desire to care for oneself

Nursing interventions:
1. Treat the underlying cause (i.e. Anemia)

  1. Regular exercise, as tolerated – 150 min/week
  2. Conserve energy when possible
  3. Stress reduction techniques
  4. Adequate nutrition and sleep
22
Q

Anemia

A

Caused by: CA itself, antineoplastics and radiation, and decreased RBC production

Nursing interventions:
1. Treat the cause of anemia (if possible)

  1. Monitor RBC, H&H, and platelets
  2. Raise Hgb level to alleviate symptoms
  3. Meds. (i.e. Erythropoetin alpha)
23
Q

Infection

A

Fever (>38 Celsius or 100.4 Fahrenheit) – Reliable indicator, and often the only sign of infection

MEDICAL EMERGENCY – most common life-threatening complication

Interventions:
1. Monitor neutropenia; Minimal risk = 1,000-1,500 ANC, Moderate = 500-1,000, Severe <500 (wear mask)

  1. Hygiene and oral health; sterile utensils when eating
  2. Avoid large crowds; remain away from people with fevers or colds; flu shot
  3. Electric shaver instead of razor
  4. No fresh flowers or live plants indoor
  5. Do not clean litter box
24
Q

Psychosocial care

A

Individual:

  1. Situational demoralization
  2. Long-term depression
  3. Body image disturbance
  4. Depression in survivorship
  5. Spiritual distress

Family – Caregiver burden

Provide social networking

25
Q

End of life

A

PALLIATIVE CARE: Care for adults/children that focuses on relieving symptoms caused by serious illnesses like CA and improving the quality of life of pts and their families

26
Q

Breast CA

A

Can occur in the cells of:

  1. Lobules – milk-producing glands
  2. Ducts
  3. Stromal tissue – includes fatty and fibrous connective tissue (less common)

Incidence: 1 in 8 females in the U.S. will develop breast CA over the course of their lifetime

Risk factors: Female, ERT/PRT (especially post-menopause), >50 yrs. old, genetic (BRCA1 or BRCA 2 – 5-10%), FHX (CA), early menarche (<12 yrs. old), first pregnancy after 30, dense breast tissue, weight gain and obesity after menopause

Types:

  1. Ductal; in situ (non-invasive) – 20%
  2. Ductal carcinoma (invasive infiltrating) – 70-75%
  3. Lobular carcinoma (invasive) – 5-10%
27
Q

Breast CA: Clinical S/S

A

Clinical signs – Swelling of entire/part of breast, skin irritation/dimpling, nipple or breast pain, nipple turning inward, redness/scaliness/thickening of nipple or breast, discharge, lump in underarm area

Early signs – may not be detectable except via mammogram

28
Q

Breast CA: Diagnosis/Post diagnosis

A

Diagnosis – On PE, mammogram, breast MRI, biopsy

Post diagnosis – Axillary node dissection, tumor size, estrogen and progesterone receptor status, HER-2 receptor, DNA content (policy status) correlates with tumor aggression

29
Q

Breast CA: Staging

A

Breast CA stages:
Stage I: Tumor <2cm with no lymph node spread, and no distant metastasis

Stage II: Tumor may increase in size with possible spread to nearby lymph nodes, and no distant metastasis

Stage III: Tumor may increase in size with possible spread to lymph nodes, chest wall, or skin; no distant metastasis

Stage IV: Tumor of any size with direct extension to chest wall or skin and with distant metastasis

30
Q

Breast CA: Surgical options and other therapies

A

Surgical options:
1. BREAST CONSERVATION (local) – removal of tumor and sentinel lymph node biopsy

  1. MODIFYING RADICAL MASTECTOMY – removal of entire breast and of axillary lymph nodes

Other therapies:

  1. Radiation – prevent occurrence after surgery
  2. Chemotherapy – main treatment for women with hormone receptor negative CAs (HT is NOT helpful)
  3. Hormone therapy – antiestrogen used in estrogen receptor positive (HR+) CAs
  4. Targeted therapy – treat tumors that overexpress HER-2 gene (HER+)
31
Q

Breast CA: Nursing management

A

Post surgery:

  1. Prevent infection
  2. Lymphedema – semi-fowlers, rest arm, and no BP on affected side
  3. Pneumonia – monitor for PE

Radiation therapy – monitor for skin breakdown, pneumonitis

Psychosocial needs

Follow-up (lab work) – monitor serum HER2/neu test

Talk to family – caregiver burden

Connect to support services

32
Q

Breast CA: Basic assessments

A

Monitor for adverse effects related to radiation and antineoplastic meds. (i.e. Infection, VT, mobility, body image)

Collaborate – PT/OT for lymphedema, diet (chemo meal plan), support groups

Common Hlth: Final (14 decks)

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