Oncology Part 1 Flashcards
Sarcoma vs Carcinoma vs hematologic malignancy
Sarcoma originate in the connective tissue (bones, muscle, fat, tendon)
Carcinomas originate in the epithelial tissue (organ linings including skin)
HM originate in the blood or lymphatic cells
What’s the most common type of cancer?
Carcinoma - includes all type of skin cancer
What are the ways metastasis can occur?
Direct invasion, through blood, through lymphatic system
Worst co-carcingenic pair
Alcohol and tobacco
Low fiber is bad why
Fiber causes less motility and causes us to retain the carcinogens for longer (processed foods, preservatives, red meat and animal fat)
In what age is cancer most prevalent? What race?
> 60 d/t a more poor immune system, the longer you’ve been exposed to toxins such as tobacco, asbestos, diesel, exhaust)
(immunosuppressed also at high risk)
African Americans, then caucasian
Breast cancer familial gene
BRCA 1
Does getting chemo for another cancer increase the risk for another type of cancer?
YES
When is the best time to do a breast exam? What about after menopause?
Day 7-12 after the period is just about over
NEVER do prior because there is swelling then
If post menopausal - Pick a day of every month
How often should women get a breast exam?
Yearly if >40 years old
Every 3 years if age 20-39
At what age should women get a yearly mammogram
Starting at age 40
What do you tell a women prior to getting a mammogram? Why?
No lotion, powder, deodorant because it can be picked up as a Ca deposit, which usually indicates cancer
How often should women get a pap smear?
Every 3 years starting at age 21 if there are no problems
When should people get a colonoscopy?
Starting at age 50, and every 10 years if there haven’t been any problems
When should fecal occult blood be tested?
Start at age 50 and be done yearly, unless there have been problems or a family history of problems
How often should men have testicular exams? Are testicular tumors dangerous? Why?
Every year
Yes, because they grow very fast
How often should testicular self exams be done? What is the major age group for testicular CA?
Monthly
Age 15-36 - need to teach TSE early
When should men get a prostate exam?
> 50, yearly
CAUTION acronym for cancer
Change in bowel/bladder habits A sore that doesn't heal Unusual bleeding/discharge Thickening/lump Indigestion or difficulty swallowing Obvious change in wart/mole Nagging cough or hoarseness
Differences between
Anemia
Leukopenia
Thrombocytopenia
Anemia: Low RBC
Leukopenia: Low WBC
Thrombocytopenia: Low Platelets
All because cancer invades the bone marrow
Differences in risks
Anemia
Leukopenia
Thrombocytopenia
Anemia: Risk for hypoxia
Leukopenia: Risk for infection
Thrombocytopenia: Risk for bleeding (shaving, IM)
What does cachexia mean?
Extreme wasting and malnutrition, usually indicates close to death
What is the most common complaint of impending cancer?
FATIGUE especially if the cancer has spread and is d/t either anemia or growth of cancer
Exhaustion that doesn’t go away with sleep
Fever is a common sign in what kind of cancer?
Leukemia and lymphoma
Common sites for pain with CA
HA - brain cancer
Back - colon, ovaries, rectum
3 most common blood tests used to diagnose cancer
- Abnormal CBC & differential (# of different types of WBC - neutrophils are most concerning)
- Elevated liver enzymes - AST and ALT
- Tumor markers (biomarkers) - increased, substance or process that is indicative on cancer
Positive diagnostic studies
CXR, CT, MRI
PET scan
Imaging studies (such as bronchoscopy, endoscopy)
Biopsies
What do we need to thinking about with a patient having a bronchoscopy in terms of eating? What are we going to watch for afterwards?
NPO during and until gag reflex returns
Watch for RR depression, hoarseness, dysphagia, or SQ emphysema
What is SC emphysema
Crackles when touching skin indicating air trapped and airway perforation and air leaking into the tissue
Is RR depression normal after bronchoscopy?
NO IT IS ABNORMAL
Slow RR just means decreased, but DEPRESSION indicates less than 12/min
The respiratory rate should always be ______ for NCLEX?
PERFECT! Or else something is wrong!!
When is the best time to get a sputum sample? Why?
Is this a sterile sample?
First thing in the morning because they have been accumulating
It is a sterile sample and we are using a sterile technique (aka don’t let their mouth tough the collecting device)
What should a patient do first before obtaining a sputum sample? Why?
Rinse mouth out with water
This decreases the bacteria count in the mouth because we want the sputum bacteria, not the mouth
Should they just go ahead and to a bronchoscopy to get the sputum?
NO - LEAST INVASIVE FIRST… and it’s more expensive that way
Can you get sputum from a trach?
Yes
What does a total laryngectomy remove?
Vocal cords, epiglottis, and thyroid cartilage - permanent stomal breathing forever
There are 2 tubes for fluid and air
What happens if a trach falls out?
First of all, never let go of the trach..
BUT if it does and there isn’t a sterile one there, put the dirty one back in because infection is better than death
Position of a post-op total laryngectomy
35-45 degree HOB elevated - Mid fowlers
NEVER high-fowlers
What kind of feedings will total laryngectomy patients have? Why?
NG to protect the suture line
S/S Carotid artery rupture
Innominate artery
Pulsating trach: EMERGENCY because the artery was nicked
When do we hyper oxygenate a sanctioned patient? With what technique? How long?
Before and after
Sterile
No longer than 10 seconds
When do you stop advancing the suction catheter?
When you meet resistance or the patient coughs
What nerve can the suction hit?
Vagus - STOP suction and give 100% oxygen
*they are not hypoxic, just have bradycardia
How does a humidified environment help a trach patient?
It warms the air and causes less secretions to develop
What devices to the total laryngectomy patients use
Blom Singer, electrolarynx
- They can smoke
How does TNM staging work?
T - size of tumor
N - lymph node involvement
M - Presence of metastasis
T1-4
N0-3
M0-1
Cancer grading
Compares the cancer cells to the parent cancer cell that they evolved from
1-4 (4 is most aggressive)
3 goals of cancer treatment
Cure, Control, Palliation
What is adjuvant therapy?
2 therapies used together (chemo and radiation)
What are neoadjuvant therapies?
Therapies that are time-specific, or one before the next (Ex: surgery THEN chemo)
What 3 things are treatment plans based on?
Recommended plans for the diagnosis
Grade of cancer
What the client wants
4 reasons for surgery
- Prevention (benign lesion)
- Diagnose (staging)
- Treatment (remove tumor)
- Reconstruction (Mastectomy - partial or total/radical)
Where is the most common site to use for mastectomy reconstruction?
Abdomen - will have an incision site there as well
What kind of drains will a mastectomy patient have?
Jackson Pratt or Hemovac
What to do you if a lymph node has been removed during a mastectomy?
LIMB ALERT ON THAT SIDE d/t risk of infection!
Wear gloves in the garden, no nail biting, no sunburn, caution with small cuts, NO types of constriction
What are good exercises to do when a lymph node is removed? Why?
Brush hair, squeeze a ball, wall climbing, flex and extend elbow
All promote new/collateral circulation
Where to check for bleeding after mastectomy?
Front and BACK! Because here may be pooling of blood in the back
Can mastectomy patients use their arm right away?
No…. they need the circulation but need to work up to it
Can surgery be palliative?
Yes to improve QAL
What is the #1 question after cancer surgery?
Did they get it all?
Successful surgery is based on what 3 things?
- Could it completely be removed?
- Did it already spread at the time of surgery?
- Could the surgeon get adequate margins? - amount of normal tissue needed to be removed around the tumor
Why would someone do chemo or radiation before surgery? What kind of therapy is this?
To shrink the size…. this is neoadjuvant therapy
