Oncology Nursing Flashcards
What is cancer?
Malignant neoplasms
More than 100 different types of cancers
Refers to diseases where abnormal cells divide without control + are able to invade other tissues
What are cancer cells derived from?
They are derived from normal cells that have undergone neoplastic transformation
This is an irreversible process leading to transformation of healthy cell to cancer cell
What are the two characteristics of cancer cells?
Uncontrolled proliferation + uncontrolled spread
What is the growth fraction of tumour cells
The ratio of the total number of cells to the number of dividing cells
So; the ↑ the growth fraction the more rapidly tumour mass ↑
What is doubling time of tumour cells?
The time taken for the tumour to double its volume
Average time for solid tumours being 2-3 months
When are tumours clinically detectable?
When they have doubled around 30 times
About 1 Cm in size + 1 gram in weight
What is the Gompertzian Tumour Growth Curve?
Describes the decrease in cell doubling time as tumour progression occurs
Useful in describing tumour response to treatments
what is metastasis?
Cancer cells invade lymph nodes + blood vessels near a tumour + spread to other parts of the body
Cancer cells have the capacity to intravasate and extravasated, or enter and leave the circulatory + lymphatic systems
Describe the metastatic cascade
Tumour initiation → progression of primary tumour → proliferation → cells detach + enter the bloodstream or lymphatic system → successfully evade immune system → invasion / intravasation → extravasation → angiogenesis → colony formation
What is clinical distress related to?
Disease status, treatment to.seance, symptom intensity and frequency, lifestyle effects of symptom intensity and frequency, quality of life,
Examples of psychosocial problems in cancer patients and family
Adjustment to illness and changes in care, feeling isolated from family, family conflict , decreased quality of life, decisions around advanced care directives, abuse/ neglect, coping difficulties (overwhelmed, irritable and angry, inability to cope with pain, fatigue and nausea), mental health issues, disturbances in body image, sexual problems
Treatments for psychosocial problems
Education materials, support and education groups, resource lists, community resources, relationship counselling, grief counselling
Patient counselling, psychotherapy, medication, community responses
Examples of practical problems
Transportation issues and parking costs, financial issues, school problems, food/ clothing problems
Treatments for practical problems
Education, support groups, counselling for patients and family
Describe supportive care
Facilitating a patient or family with the necessary services that they require to meet their physical, social, emotional, informational, psychological, spiritual and practical needs during the journey of a cancer patient
Risk factors that increase the likelihood of heightened emotional distress
Being very old or very young, being single, separated, widowed, female, having children younger than 21, past psychiatric treatment, having cognitive impairment
What is involved in screening + triage of a cancer patients + families journey
Adequate level of care for level of distress of family + pt
Referral to services required by pt
Education, peer support, counselling
What are the key principles of supportive care?
Person centred, system wide + team approach, developing + supporting the workforce to improve their ability to respond to the needs of cancer patients, focus on quality of care by providing evidence based protocols etc, population based planning to identify needs of population
Barriers to the delivery of psychosocial care
Do not have access to care (geographically), lack health insurance / coverage that includes mental Health Services, do not ask for help due to stigma, patient-provider miscommunication, inexperience, poor coordination of complex care
What are oncogenes?
The mutated form of proto-oncogenes, which are the normal growth promoting genes (growth factor, cell survival genes, cell cycle controlling genes)
They become oncogenes when inappropriately activated by mutations in themselves or other genes controlling them
When mutation occurs, the resulting oncogene causes excessive production of growth factors responsible for tumourorigenesis
What are some mediators of cell growth?
PDGF - platelet derived growth factor = one of the numerous proteins that regulate cell growth and division
EGF- epidermal growth factors = protein with 53 amino acid residues and 3 intramolecular disulphide bonds, plays role in cell growth and proliferation
TGF - transforming growth factor = role in tissue development, cell differentiation, embryonic development
VEGF - vascular endothelial growth factor = signal protein involved in angiogenesis
what are some tumour suppressor genes?
Function by encoding proteins that block growth promoting proteins, when function is lost uncontrolled growth occurs, so when mutation occurs in tumour suppressor gene, the cell loses its switch off and the cell growth continues with a cease, most common one is in the p53 gene
What are the staging systems of cancer diagnosis?
TNM
T- tumour = size and extent of primary tumour
N - nodes = number of nearby lymph nodes that contain cancer cells
M - metastasis = spread to other sites
Describe breast screen
Women aged over 40 (focus 50-69)