The big Cancer lecture Flashcards

Question

Cancer screening test: Colorectal

Answer 1

* Starts at age 45 * Flexible sigmoidoscopy * Colonoscopy * highly sensitive guaiac-based fecal occult blood test (gFOBT) or highly sensitive fecal immunochemical test (FIT) * Multi-targeted stool DNA test (MT-sDNA) test

Answer 2

* Low Dose CT scan (LDCT) annually * current or former smokers (quit within past 15 years, ages 55-74, 30pack year or more) * Only for those who have been smoking within the past 15 years

Answer 3

* Digital rectal exam (DRE) and PSA (prostate-specific antigen) * Starts at age 50 While males, age 45 African-American males

Answer 4

* Diagnosis: cancer screening, symptoms or incidentally found * Extensive work up to determine presence and extent of cancer * History and Physical Exam * Symptoms? Abnormal exam? * Palpable/visible lymph nodes, tumors * Skin lesions, evidence of bleeding, DVT * Enlarged spleen, liver * Imaging—localized or metastatic? * Blood work * Biopsy

Answer 5

* Detects tumors, lymph nodes and metastases * Used to Stage the cancer * Typically multiple scans used * Mammogram * CT scans * MRI * Ultrasound * Bone scan * PET/CT scan

Answer 6

Cells only

Answer 7

Need tissue to tell tumor type and to confirm if malignant tissue

Answer 8

Larger chunk than the fine needle, includes a bone marrow biopsy

Answer 9

* Needle biopsy (Fine needle, Core needle) * Sentinal lymph node * Excisional

Answer 10

* Teach patient and family members about procedure and any pre-procedure instructions * NPO, restrict fluids, light breakfast * Hold blood thinners * Meds to hold or take and timing of each * Assist pt and family to manage anxiety * Provide teaching hand out to patient and family

Answer 11

* Administer pre-procedure medications after IV placed * Positioning of the client * Monitoring patient and providing any medications during procedure * Provide safe environment * Assist patient and family to manage anxiety * Post-procedure Instructions

Answer 12

Phone call for follow up with patient

Answer 13

T-tumor size and extent of local invasion, * Tx: Primary tumor cannot be assessed * T0 no evidence of primary tumor * Tis Carcinoma in stiu T1-T4 is increasing size or extent of primary tumor

Answer 14

Lymph node involvement * Nx: Cannot be assessed * N0 no regional lymph node metastasis N1-N3 increasing involvment of regional lymph nodes

Answer 15

metastases Mx: Cannot be assessed M0: no distant metastasis M1: distant metastasis

Answer 16

G1 Well differentiated –better prognosis G2 Moderately differentiated G3 Poorly differentiated G4 Undifferentiated —more aggressive Lower the grade the better

Answer 17

Cancer cells break off from the original tumor and travel through the blood and lymph to other parts of the body and grow

Answer 18

White blood cell cancer

Answer 19

Cancer of lymph cells

Answer 20

Cancer of the plasma cells

Answer 21

* Prevention * Cure * Control * Palliation

Answer 22

* Based on treatment goals for the specific tumor type, stage and grade * Based on the patient’s beliefs and goals * Maintenance of quality of life is very important to maintain as best possible! * Treatment options not finalized until staging is complete * Health care team, patient and caregivers need to have open communication, support and clear understanding of the goal and treatment plan, including during times of disease progression or complications from treatment * Guided by factors such as: age, childbearing desire, pregnancy, current state of health * Collaboration with other disciplines—Supportive/Palliative Care, Pain team, Dietitian, PT/OT, Psychiatry/Psychology, Social Work, Spiritual

Answer 23

* Surgery: Best chance at a cure * Chemotherapy * Radiation Therapy * Hematopoietic Stem Cell Transplantation (HSCT) * Immunotherapy * Hormonal Therapy * Targeted Therapy * Other

Answer 24

treatment given prior to surgery (Chemo/radiation)

Answer 25

treatment given after primary therapy such as after surgery

Answer 26

* If patient exhibits response to treatment (no progression/no recurrence) may be kept on therapy for extended period (months, years)

Answer 27

Complete removal of the tumor (debulking), localized lymph nodes and adjacent involved tissues

Answer 28

* full incision * if minimally invasive unsafe or may be converted from minimally invasive to open

Answer 29

* Laparoscopic, VATS (video-assisted thoracic surgery), Robotic * Lung, abdomen, pelvis (any GI, prostate, uterus, ovaries)

Answer 30

in certain circumstances, removing metastatic lesions for cure

Answer 31

used preop for breast cancer and melanoma

Answer 32

* removing local LNs which drain from tumor * Also called lymphadenectomy

Answer 33

* ERAS: Enhanced Recovery After Surgery * Collaborative guidelines * Education of perioperative process, procedure and pre-op prep * Instruct on NPO vs carb load w/juice up to 2 hours before procedure * Withhold blood thinners per guidelines * Administer pre-procedure testing medications and IV placement * Maintain proper monitoring and positioning of the client * Provide safe environment * Prevent general postoperative complications: infection, electrolyte imbalances, hemorrhage, ileus, embolisms, inadequate O2, shock * Prevent and treat pain, N/V, constipation, early ambulation * Provide teaching & resources to patient and family on drains, ostomies, wounds, implanted devices * Provide psychological support for coping, body image alterations (loss of body part, incisions) * Involve collaborative resources (social work, psychology, OT, PT, dietitian, prosthetics, speech, respiratory, case management

Answer 34

* Targets tissues and destroys cells using different types of ionizing radiation * Alters DNA of both malignant and healthy cells but only in the field radiation given * Like in chemotherapy, most actively dividing cells are affected (slow growing tumors are radio-resistant--some sarcomas) * Localized treatment—only destroying cells where radiation directed

Answer 35

* to cure or to control cancer * Neoadjuvant +/- chemotherapy * Prior to surgery to decrease size of tumor * Prophylactically to prevent recurrence (after primary tx such as breast surgery) * To control symptoms (spine, brain, bone, soft tissue) * Emergencies-spinal cord compression, bronchial obstruction, superior vena cava syndrome)

Answer 36

* 3D conformal radiation; multiple beams given at different angles * Dose given daily over several weeks in small “fractions” (6-8 weeks) * Allows healthy tissue to repair and allows better cell kill as cells go through the cell cycle and begin active division * **Patient is not radioactive**

Answer 37

* uses many angles to focus the radiation at one small target to deliver a high dose of radiation * fewer doses in larger fractions over short span of time (1-5 days) * **Patient is not radioactive**

Answer 38

* Radiation seeds placed within or next to the tumor within a body cavity or cavity (uterus, chest) * **Patient is radioactive** and will be given safety instructions * May be in hospital in a sealed room built for radiation (lead)

Answer 39

Fatigue (every site), Skin changes at site of radiation (every site), hair loss at site

Answer 40

* memory/concentration issues * N/V * headache

Answer 41

* mucositis * trouble swallowing (pain, dryness, tightening) * taste changes * hypothyroid

Answer 42

swelling, tender

Answer 43

* mucositis (esophagitis) and trouble swallowing (pain, scarring) * cough * dyspnea,

Answer 44

* N/V * diarrhea * urinary and bladder problems

Answer 45

* diarrhea * sexual problems * fertility problems * urinary and bladder

Answer 46

* Monitor skin for radiodermatitis: redness, blanching, sloughing, wet or dry desquamation, ulceration * Monitor oral cavity for mucositis, xerostomia (dry mouth), change in taste * Monitor for dysphagia * Monitor GI-N/V, anorexia, diarrhea * Monitor for bone marrow suppression (RT over iliac crests, sternum)-decreased WBC, neutrophils, RBCs, platelets; risk of infection and bleeding * Monitor for pneumonitis-dyspnea, cough

Answer 47

* Advise patient possible s/e dysgeusia (altered taste) * Advise to report any s/s of skin damage * Instruct that tattoo cannot be washed off * Avoiding sun or heat if skin is irritated * Avoid use of powders, ointments, lotions, deodorants, perfumes if skin is irritated * Cleanse skin gently using mild soap & water, pat dry * If mucositis occurs, avoid spicy, salty, acidic foods, temperature of food should not be hot

Answer 48

* Patient is radioactive * Precautions must be taken to not touch excretions * Place patient in private room with door closed * Place sign on door that says radiation in use * Wear dosimeter badge (records radiation exposure) * Limit visitors, must have 6ft of distance from patient * Pregnant, trying to conceive or 16yrs or younger are not permitted to enter room * Health Care Staff must wear lead apron while in patient’s room * Keep lead container in room

Answer 49

* Must call for assistance when using restroom * Explain rational for apron, visitation and distancing * Explain rational for remaining in specific position during treatment * Distance—at least 6 feet

Answer 50

* Administration of cytotoxic medications that damage a cell’s DNA & destroy rapidly dividing cells during different phases of the cell cycle (**Need proper PPE when handling**) * Chemo agents are classified based on mechanism of action in relation to the cell cycle (S, M or G phase) or independent of the cell cycle (cell cycle specific or non-specific) * Based on mechanism of action, will receive **combo** of agents to increase number of cells damaged/destroyed * Need multiple cycles to destroy cells; not all in a dividing phase of * cell cycle at same time; some may be in a non-dividing phase * **Treats systemic disease**—cancer that has spread (stage 4) or is suspected to have spread (microscopic disease) from primary site * Given as neoadjuvant, adjuvant or primary (i.e. **leukemia** or stage IV) * Goals: cure, control or palliate

Answer 51

* Dosage based on total **Body Surface Area** (BSA)takes into account age, gender, weight and height * Dose **modifications** for decreased renal function, liver function, age, comorbidities, prior toxic side effects (stomatitis, neutropenic fever/sepsis) * Some agents have a *lifetime maximum dose* due to risk of irreversible organ toxicity (Doxorubicin-cardiac toxicity)

Answer 52

* Leakage of chemo into tissue from vein * Can range from mild tissue irritation to severe dmg

Answer 53

* RN must be trained in mgmt of extravasation to give chemo * **Stop chemo if extravasation occurs** * Get extravasion kit with antidotes

Answer 54

Localized irritation but no perm dmg

Answer 55

* Vesicants-inflammation, tissue damage and can cause necrosis of skin, tendons, muscle, nerves and blood vessels * Could require skin graft

Answer 56

implanted device used for long term administration of medications accessed via a Huber Needle(90○):

Answer 57

* Typically occur during infusion; can have delayed reaction * rash, urticaria, fever, hypotension, dyspnea, wheezing, throat tightness, syncope, cardiac arrest

Answer 58

* recognize signs and symptoms and react quickly * *turn off infusion* and give prescribed medications (steroids, benadryl, Epinephrine) * **Pre-medications given prior to meds that can cause HSR** to prevent further occurance

Answer 59

* Fatigue/Generalized Weakness-multifactorial * Bone Marrow—Myelosuppression/Immunosuppression * WBCs and neutrophils (neutropenia) * RBCs and platelets (anemia & thrombocytopenia) * Renal toxicity –hemorrhagic cystitis, tumor lysis syndrome * Cardiopulmonary-reduced ejection fraction (LVEF), pneumonitis * Epithelial cells lining GI tract * Nausea & Vomiting * Stomatitis * Mucositis * Diarrhea * Hair follicles and skin * Alopecia * Neurotoxicity * Peripheral Neuropathy * Cognitive impairment * Infertility—decreased sperm count, abnormal menses or early menopause

Answer 60

* Personal protection per Institute policies for handling and disposing of chemotherapy and bag/lines, spill kits readily available, * Monitor labs (CBC w/diff, CMP) and contact provider with any abnormalities * Monitor and document any side effects/toxicities * Monitor for signs of infection or bleeding * Assess integrity of port or line site, return of blood, resistance to flow, burning/pain with infusion; contact provider for any issues * Assess lungs, heart, abdomen, neurologic, peripheral (paresthesias or edema), skin * Teach pt/caregivers about specific chemotherapy and side effects, when to call provider * Teach pt/caregivers on taking anti-nausea meds initially around the clock to prevent for first 1-2 days after chemo, then as needed * Teach diet—small frequent meals, bland food, encourage pt to push fluids, encourage Boost, Ensure, Carnation Instant Breakfast if unable to eat * **Teach safe-handling of body fluids**

Answer 61

* Chemotherapy remains in the body for 3-7 days, depending upon the properties of the drug. Chemo is excreted in urine, stool, vomit, semen, and vaginal secretions during this time. * If urine, stool, or vomit come in contact with your hands or other body parts, wash the area immediately with soap and water. * Caretakers should wear latex gloves w/any contact of body fluids * Flush the toilet immediately. Flush toilet twice if any children or pets in contact with. Close the lid to prevent splashing, if splashing occurs on the seat, wipe with a disinfectant using gloves. * Double bag any soiled pads/diapers in a tied plastic or zip-lock bag and place in a tied trash bag. * Wash linens soiled with body fluids as soon as possible; separate from normal wash. Soiled linens should be washed a second time and can be washed with other linens for the second washing. Unsoiled linens can be washed in the usual manner.

Answer 62

* **Take temp daily & if chills, feel unwell; call for temperature >100.4/38.0** * Call for any s/s of infection * Avoid crowds, wear mask. * Avoid sick people * Frequent hand hygiene (pt and family) * Low microbial diet (avoid fresh fruits & veggies, fish, meats, eggs, paprika) (usually limited to leukemia pts) * No digging in soil, changing cat litter. * Do not consume beverages or food that have been left out for over an hour at room temp * Wash dishes with hot soapy water, wash cups daily * Wash toothbrush in dishwasher daily or rinse in bleach * Do not share toiletries *

Answer 63

* Neutropenic precautions * Monitor absolute neutrophil count * **Report ANC <1000** * **Report Temp >100.4 F /38.0 C)—1st sign of infection in a neutropenic patient** * Monitor skin & mucus membranes for fissures, breakdown, abscess * Obtain cultures prior to starting antibiotics * Administer growth factors (GCSF) to stimulate WBC production-Filgrastim

Answer 64

* Culture: * Urine * Blood * Two sets * Consider if patient has CVAD * Stool (C diff.) * Skin lesions, including viral * VAD site * Throat/nasopharynx

Answer 65

* Place patient in a private room * Have patient wear a mask outside of the room * Avoid live plants or fresh flowers, stagnant water & contaminated equipment (increases risk of infection) * No visitors permitted if they are ill * Frequent hand washing for health care personnel, patient and visitors * No invasive procedures unless otherwise specified * Keep all necessary equipment in patient’s room * Place on neutropenic precautions for absolute neutrophil count <1000

Answer 66

* Administer antiemetics prior to chemotherapy and several days after * Remove vomiting cues (odor) * Offer alternatives to reduce nausea (relaxation) * Administer appetite inducing medication as prescribed (Megestrol, Marinol) * Assess nutritional imbalances * Perform oral care prior to meals

Answer 67

* Frequent, small meals during the day * Low fat bland foods, soups * Avoid consuming fluids during meals but hydrate in between as much as possible * Consume cold foods to prevent nausea * High protein, high calorie dense foods; Boost, Ensure * Use plastic ware to avoid metallic taste * Keep food journal

Answer 68

* Depends on chemotherapy agent * Discuss effect on self image and provide psychological support * Teach that alopecia is temporary in most cases * Hair will grow in differently * Hair will begin to grow in after chemo completed * Hair loss can affect entire body

Answer 69

* Hair loss can begin 7 days after treatment starts * Cut hair short or shave prior to chemotherapy starting * Avoid damaging hair products (curling irons, perms, hair dye) * Consider wig, hats, scarves, turbans * Protect scalp from sun, heat and cold

Answer 70

inflammation in the mucous lining of the upper GI tract from the mouth to the stomach

Answer 71

inflammation of tissues in the oral cavity, such as gums, tongue, roof of the mouth, lips and cheeks

Answer 72

Antifungals (Clotrimazole(Mycelex Troche) and Mycostatin (Nystatin swish and swallow)

Answer 73

* BMX solution 4 times daily prior to meals and at bedtime (Benadryl/Maalox/Xylocaine Suspension) * Magic Mouthwash: several types; same as BMX with addition of antibiotic and anti-fungal

Answer 74

Monitor for fatigue, pallor, dizziness, SOB, syncope Provide rest periods between activities Conserve energy during activities (frequent sitting) Monitor Hemoglobin Administer anti-anemia meds (Darbepoietin alpha) Transfuse PRBCs (packed red blood cells) based on parameters

Answer 75

* Monitor for petechiae, ecchymosis, bleeding gums, nose bleeds, occult blood, hematuria, platelets * Place on bleeding precautions * Avoid IV’s & injections if possible * Transfuse for platelets < 10-2o (provider decision) * Transfuse prior to procedure to get platelets >50K * Electric razor, soft toothbrush

Answer 76

* Numbness and tingling, starts in toes and fingers * Can progress up hands/feet * Loss of motor function can occur * May require dose reduction of chemo * May improve some but usually a chronic issue

Answer 77

Can have fogginess or “chemo brain” Difficulty concentrating, short term memory, focusing

Answer 78

teach/monitor for decreased concentration, memory loss, decreased ability to learn

Answer 79

* Avoid excessive alcohol intake, recreational drug use, engage in memory/concentration activities, avoid high-risk activities

Answer 80

* monitor for numbness, tingling or loss of sensation in hands and feet * If severe, may not feel hot, cold or pressure * May have difficulty driving (foot pedals)

Answer 81

* Fall prevention, possible erectile dysfunction, inspect feet daily, do not drive if cannot feel pedals

Answer 82

* donor can be a family member or from National Bone Marrow Registry or Cord Blood Registry (HLA matched or unmatched donor) * Most common disease treated--leukemia

Answer 83

* patient’s own stem cells * Most common diseases treated--lymphoma and myeloma * Have to have healthy bone marrow

Answer 84

Infection, sepsis, bleeding, alopecia, N/V, mucositis, diarrhea, fluid and electrolyte imbalance, acute kidney injury (similar to chemo side effects but persist longer and more severe)

Answer 85

* Graft Vs Host Disease (GVHD)—donor cells see pt’s tissue as foreign and mount an immune response; pt given immunosuppression to prevent or minimize GVHD * Acute—1st 100 days * Chronic-after 100 days * Can involve—skin, liver, GI tract

Answer 86

* Stops growth of breast cancer cells that are estrogen dependent (ER+) * Used to treat and prevent ER+ breast cancer * Tamoxifen (oral), Raloxifene, Fulvestrant (IM), Toremifene * Complications: endometrial cancer, hypercalcemia, N/V, DVT/PE/Stroke, hot flashes, vaginal bleeding or discharge

Answer 87

* Stops growth of breast cancer cells by blocking estrogen production * Used to treat breast cancer in post-menopausal women; may be given to anyone after ER blocker failure * Anastrazole, Letrozole, Exemestane * Complications: muscle and joint pain, headache, nausea, vaginal bleeding, risk of osteoporosis, hot flashes, decreased blood flow to heart

Answer 88

Targets breast cancer cells, prevents cell growth, causes cell death Used to treat metastatic breast cancer Only effective against tumors that are **HER2 positive** Complications: flu-like symptoms 1st infusion, cardiac toxicity (tachycardia, heart failure, pulmonary HTN), hypersensitivity reaction (premedicate), N/V

Answer 89

monitor F/E, calcium, ECG baseline, osteoporosis instructions (weight bearing exercise, safety-falls), cholesterol (MI risk)

Answer 90

* used in multiple ways to get the immune system to work better against cancer cells * Vaccines: HPV—helps present cervical cancer

Answer 91

* Form of immunotherapy * block receptors on cells to allow the T-cells to remain “turned on” and find, kill tumor cells (normally there is a mechanism that “turns off” immune system when the job is done. * Side Effects: inflammation of normal tissue---gi tract, lung, heart, thyroid, pituitary, eyes, liver, pancreas, kidneys, skin * Treated with high dose steroids when serious

Answer 92

Nah not until C-diff is ruled out

Answer 93

* use agents to kill or prevent the spread of cancer cells by targeting a specific molecule on the cell * Used in many types of cancer, both solid tumor and blood tumors * Downside—cancer cells are smart and can figure out a way to grow—develop acquired resistance; eventually the drugs no longer work * Common side effects: skin, hair and nail changes, hand-foot syndrome, mucositis, HTN, hyperglycemia, hypothyroidism, N/V, diarrhea, fatigue, pancytopenia * Diarrhea should not be treated with medication (Lomotil or Imodium) until C. diff is ruled out!!

Answer 94

* Usually given IV * End in “Ab” * Potential side effects: infusion reaction (pre-medicate), rash, flu-like symptoms, N/V, diarrhea, edema, fluid/electrolyte imbalance, hypotension/hypertension, pancytopenia, tumor lysis syndrome (Rituximab), VTE (Bevacizumab) * Nursing: monitor for infusion reaction, abnormal labs, skin changes, rashes, VS changes, edema. Teach patient on sun protection. * Report-any abnormal labs, vital signs, physical findings, bleeding, infection, dyspnea, new swelling

Answer 95

* Nerve damage * Numb, tingling, shooting, burning, radiating

Answer 96

* In internal organs * Difficult to identify * Deep, sharp

Answer 97

* Bone or connective tissue * Localized, sharp, dull, throbbing

Answer 98

* Non-Opioid/NSAIDS * Opioids * Antidepressants * Anticonvulsants * Corticosteroids * Muscle relaxants * Systemic Local Anesthetics * Sympatholytic * Topical * Tens Unit * Relaxation * Imagery * Distraction * Heat/Cold * Massage * Vibration * Acupuncture * Hypnosis * Support Group

Answer 99

APAP (acetaminophen) ASA (acetylsalicylic acid) Ibuprofen Celebrex (celecoxib) Ketorolac Mild –Moderate pain

Answer 100

* GI upset or bleed * Bruising, bleeding * Tinnitus * Cardiovascular status

Answer 101

* Take if liver is healthy * No more than 3-4g per day * Take with food * Do not crush or chew * Watch for s/s bleeding * Drink plenty of water

Answer 102

* Constipation * Urinary Retention * Orthostatic hypotension * N & V * Sedation * Respiratory depression

Answer 103

* Take stool softener or laxative as needed * Do not consume alcohol while taking med * Rise slowly from sitting position * Make dietary changes to prevent constipation

Answer 104

* Take stool softener or laxative as needed * Do not consume alcohol while taking med * Rise slowly from sitting position * Make dietary changes to prevent constipation

Answer 105

* Compression or invasion of the superior vena cava by tumor, lymph nodes or an intravascular thrombus (most common lung cancer and lymphoma) * Causes obstruction of venous drainage from the head, neck, arms and chest * If not diagnosed, can cause lack of oxygen to the brain, laryngeal swelling, bronchial obstruction and death * Symptoms: shortness of breath, cough, hoarseness, chest pain, swelling of face/neck/chest/arms * Signs: engorged veins of chest, neck arms * Diagnosed by: physical exam, CT scan

Answer 106

* Radiation therapy to shrink the tumor and/or lymph nodes which will relieve symptoms * Chemotherapy if lymphoma or small cell lung cancer—both immediately affected by chemo * Anticoagulants or thrombolytic therapy if thrombus (can be due to CV catheter-associated, compression of vena cava or intraluminal tumor thrombus) * Supportive Care: steroids, Oxygen, diuretics (if fluid overload) * Nursing Care: monitor and report symptoms of SVC syndrome, administer medications for treatment, elevation of head/upper body to facilitate drainage (semi-fowler), support to patient and family, avoid BP and venipuncture to upper extremity, have patient avoid restrictive clothing and jewelry, monitor I/Os to avoid fluid overload, monitor for radiation side effects, monitor for chemo side effects, teaching patient and family

Answer 107

* Tumor compressing the spinal cord and/or the nerve roots * Primary spinal cord tumor (intramedullary) * Metastasis of paravertebral tissue or vertebrae (extramedullary)—most commonly from lung, breast, prostate and lymphoma * Signs/Symptoms: Occur in dermatome(s) affected by tumor. * PAIN which radiates in a band-like fashion around chest or abdomen * motor and sensory loss (weakness or paralysis, numbness/tingling in dermatomes) * Bladder and bowel dysfunction: above S2 overflow incontinence; below S2 flaccid sphincter tone, bowel incontinence * Clinical Findings: Tenderness with percussion at site of tumor, abnormal reflexes, sensory and motor changes

Answer 108

* Monitor for neurological changes (urinary or bowel incontinence or retention) * Pain assessment and management * Range of Motion exercises * Prevent immobility complications (pressure ulcer, skin breakdown, VTE, pneumonia) * Intermittent straight catheterization; will need to teach patient/family * Psychosocial support * Referrals for discharge care

Answer 109

* MRI * CT * Bone Scan

Answer 110

* Radiation #1-emergent * Steroids-decrease swelling * Pain Management * Surgery-debulk the tumor * Chemo (small cell lung cancer or lymphoma)

Answer 111

* Potential life-threatening metabolic abnormality * Occurs from more calcium being released from bones than kidneys can excrete, or bones can reabsorb * Most commonly seen in multiple myeloma, breast, lung and prostate * Symptoms: severe muscle weakness, fatigue, confusion, N/V, constipation, dehydration, increased urination, arrhythmias * Diagnostics: Calcium level > 10.4 but usually no manifestations until 12+

Answer 112

* Identify and treat asap * Hydration!!! IV hydration with NS 0.9% (may also need diuretics (furosemide) if fluid retention) * Bisphosphonate therapy immediately * Zolendronic Acid (Zometa) IV over 15 minutes * Adjust dose for renal function! * Calcitonin 4-8 IU/kg subcutaneously or IM every 12 hours * Treat underlying cause * Long-term: May need continuous bisphosphonate therapy every 3 months. Stop/avoid medications that can increase calcium levels (thiazide diuretics, NSAIDs, Calcium supplements). Dietary calcium is okay. * Nursing: IV access. Administer fluids (IV and oral), anti-emetics, stool softeners/laxatives. Monitor blood work, F/E imbalances, neurologic changes, constipation/ileus. Teaching of diagnosis and treatments. Encourage mobilization/weight bearing exercises to limit bone resorption.

Answer 113

* Rapid cell lysis that occurs as a result of treatment in tumor cells that rapidly grow (leukemia, lymphoma, small cell lung cancer) * Release of intracellular products from cell lysis into circulation leads to rapid development of electrolyte abnormalities (hyperK+, hyperPhos and hypoCa+). * Without treatment, can lead to acute renal failure, multiple organ failure, cardiac arrhythmia and death

Answer 114

* Hyperkalemia >5.0mEq/liter (normal 3.5 – 5.0) * Hyperuricemia (uric acid above 10mg/dl 24-48 hours after treatment) * Hyperphosphatemia (serum phosphorus above 5 mg/dl) usually 24-48 hours after initiation of therapy * Hypocalcemia (calcium less than 8.7 mg/dl) occurs 24-48 hours after therapy) (normal 8.8 – 10.4)

Answer 115

* Nausea, vomiting, * paresthesias, * muscle weakness, * paralysis, * syncope, * lethargy, * muscle cramps, * increased bowel sounds and diarrhea, abdominal and/or flank pain, * fatigue, * mental status changes, * EKG changes, * elevated BP, * acidic urine pH

Answer 116

Syncope, Anuria/acute renal failure, seizures, laryngospasm with stridor, tetany, cardiac arrhythmias/cardiac arrest

Answer 117

1st abnormality is **hyperkalemia**, generally between 6-72 hours after therapy begins

Answer 118

* Early detection is critical!! * Prevention in cancers that are known to cause (hematologic malignancies) * Oral Allopurinol for 24-48 hours before chemotherapy * Aggressive hydration -start 24-48 hours before chemotherapy and continue after * Treat electrolyte abnormality * Diuresis if inadequate urine output * Nursing: monitor for signs and symptoms of tumor lysis syndrome in those at risk, monitor vital signs, F/E, I/O, cardiac status. Educate pt and family about potential risk, symptoms, treatments.

Answer 119

* Early identification: increased ICP due to increased volume within cranial vault (tumor, swelling, hemorrhage). * TX: steroids immediately, possible surgery, radiation Signs/Symptoms: * **HEADACHE** (persistent, early am, associated symptoms i.e. N/V) * N/V * Cranial nerve deficits: vision changes (diplopia, field cuts), slurred speech, facial droop, fixed or sluggish pupil response * Motor and/or sensory changes-weakness or paralysis, pronator drift, weak grip ## Footnote 1

Answer 120

* Can affect both men and women (rare in men) * Second leading cause of cancer death in women (first is lung cancer) * Triple Negative Cancer: aggressive, cells lack estrogen, progesterone & HER2 (normal gene for cell replication) * Metastasis most common to bone, lung, brain & liver

Answer 121

* Ages 40–44--have the option to start screening with a mammogram every year * Ages 45-54 --should have mammograms yearly * Ages 55 & older—every 1-2 years based on choice

Answer 122

Mammogram+MRI starting at age 30

Answer 123

Have BRCA1 or BRCA2 gene Have 1st degree relative with BRCA1 or 2 gene Radiation to the chest prior to age 30

Answer 124

* High genetic risk * Inherited mutations of BRCA1 and BRCA2 * History of prior breast cancer or benign breast disease * H/O atypical hyperplasia * Dense breasts * Age > 65 * African American and Puerto Rican descent * 1st degree relative with breast cancer * mother, sister, daughter, father, brother * Prior radiation to breast or chest * 10 yrs after * Highest risk when XRT during puberty when breasts developing * Early menarche * Late menopause * Nulliparity or 1st child after age 30 * Hormone therapy after menopause (esp. estrogen only HRT) * Testicular disorders * Excessive alcohol consumption * Smoking * Obesity * Use of oral contraceptives (unclear risk; being studied)

Answer 125

* A lump or thickening in or near the breast or in the axilla. * A change in the size or shape of the breast (asymmetry). * A dimple or puckering in the skin of the breast. * A nipple turned inward into the breast. * Fluid, other than breast milk, from the nipple, especially if it's bloody. * Scaly, red, or swollen skin on the breast, nipple, or areola. * Dimples in the breast that look like the skin of an orange, called peau d’orange.

Answer 126

* Fine Needle Aspirate (FNA) —cells only retrieved * Core Needle Biopsy—larger needle, more tissue * Sentinel Lymph Node Biopsy (SLNB)—assesses degree of LN involvement * Aids in staging the disease for treatment planning * Tumor sample will be tested for: * ER (Estrogen Receptor), PR (Progesterone Receptor) and HER2 status (human epidermal growth factor receptor 2) * Tumor type and grade * Lymph nodes + or – for cancer cells (if biopsied) * Information such as margins, invasiveness and other features not known until mass removed surgically

Answer 127

* A sentinel lymph node is the first lymph node to which cancer cells are most likely to drain to from a primary tumor. * Sentinel lymph node biopsy (SLNB)--a procedure in which the sentinel lymph node is identified, removed, and examined to determine whether cancer cells are present. * A positive SLNB result means the cancer is present in the SLN and may have spread to nearby lymph nodes (“regional LNs”) and possibly other organs. * A radioactive substance and/or blue dye injected near the tumor then using a special probe (measures the radioactivity) to find the “hottest” LN and/or seeing which lymph node the blue dye collects in first. This is the SLN. More than 1 LN may be removed if multiple blue or “hot”. * The lymph node is excised through a small incision and sent to pathology for evaluation (frozen section). If positive, more lymph nodes may be removed at same time as resection of the primary tumor. * Used in breast cancer and melanoma

Answer 128

If negative, the surgeon will not have to do a more extensive surgery which would lead to more risk for complications.

Answer 129

Lymphedema

Answer 130

* if numerous lymph nodes (20-40) are removed (dissected) during the procedure, the lymph system is disrupted, cannot flow properly and lymph fluid will collect in the area of the dissected nodes. This leads to a build up of fluid in the tissue and extremity. * Skin thickens, hard, red, tender * Increased risk of infection * The more lymph nodes removed the more extensive the lymphedema. * Depending on how extensive, will need to see a lymphedema specialist (Physical Therapy)

Answer 131

abnormal cells **in the milk duct** and have not invaded any tissue, early stage/pre-cancerous

Answer 132

abnormal cells in the milk-producing glands and have not invaded tissue, early stage/precancerous

Answer 133

starts in the breast tissue (not milk glands or ducts)

Answer 134

breast cancer is ER negative, PR negative and HER2 negative. more aggressive

Answer 135

aggressive, breast appears inflamed, tender, swollen May not be evident on mammogram—may not present as a lump Only accounts for 1-5%

Answer 136

* (removes lump only) or other breast sparing surgery * Only tumor removed with additional tissue around it (margin) + few nearby lymph nodes * Breast looks “normal” * May require post-operative radiation +/- chemotherapy, hormonal therapy or targeted drug * Goal is breast preservation and cure

Answer 137

entire breast and possibly SLNB with removal of one or more of the axillary lymph nodes May need radiation therapy, chemotherapy, hormone therapy, or targeted therapy

Answer 138

all axillary lymph nodes and breast removed May need radiation therapy, chemotherapy, hormone therapy, or targeted therapy

Answer 139

* Elevate HOB 30 degrees postop * Lie on unaffected side, support surgical side with pillows * Surgical arm to be placed in sling when ambulating * DO NOT give injections, take BP or obtain blood from affected arm/side (provider’s discretion) * Offer emotional support * Monitor, document surgical drains, site * Educate on prothesis and bras

Answer 140

* Elevate extremity on pillow, supported * Never have affected arm in dependent position (can use sling) * Perform arm exercises-ball squeeze, hand wall climb, elbow extension & flexion—should be continued for several weeks to regain ROM, minimize swelling * Wear non restricted clothing * Wear support sleeve in case of lymphedema (compression sleeve) * Some numbness, tingling, pain, is normal after surgery. * Provide information about support groups

Answer 141

WHY: Lymph system carries infection fighting cells and drains fluid/filters bacteria, viruses from the area. Removal of portion of the lymph system causes risk for infection and swelling with lymphatic fluid. Goal: minimize swelling and prevent infection. Be careful not to get sunburned. Use a sunblock with an SPF of at least 30. Reapply it often. Use insect repellent to avoid stings and bug bites. Use a lotion or cream daily to help protect the skin on your affected arm and hand. Don’t cut your cuticles on your affected hand. Instead, push them back gently with a cuticle stick. Wear protective gloves when doing yard work or gardening, washing dishes, or cleaning with harsh detergent or steel wool. Wear a thimble when you’re sewing. Be careful if you shave under your affected arm. Think about using an electric razor. If you get a cut while shaving, take care of it following the instructions below. Have health care providers use the unaffected arm for blood draws, injections intravenous lines, and blood pressures. It’s okay to use affected arm if necessary but should be done minimally. If both arms affected, provider to determine which arm safest to use.

Answer 142

(chemo + **Trastuzumab**)—for HER 2 + tumors

Answer 143

to reduce risk of recurrence in both breasts or distant recurrence. Taken daily for 5-10 years Can increase risk for developing endometrial cancer, DVT & PE

Answer 144

* decrease the amount of estrogen made in tissues other than the ovaries in post-menopausal people (ovaries have stopped making estrogen). * anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara) * All are pills taken daily by mouth x 5-10 years

Answer 145

Healthy diet-five each fruits and veggies daily Timely Mammogram Maintain a healthy weight Exercise Limit alcohol Avoid hormone replacement therapy & environmental estrogen Breast feed for 1 yr.

Answer 146

Most common cancer diagnosis in men 2nd leading cause of death in med (after lung cancer) Slow growing Manifestations similar to BPH Black men from the U.S. and Caribbean have highest rate around the globe

Answer 147

Over age 65 Family History-can run in families and men can have BRCA1 or BRCA2—risk for breast cancer and aggressive prostate cancer Unhealthy diet (high fat, complex carbs, low fiber) Obesity Rapid growth of the prostate

Answer 148

* Most prostate cancers are found early, through screening. * DRE (digital rectal exam) and PSA * Early prostate cancer usually causes no symptoms.

Answer 149

* Problems urinating, including a slow or weak urinary stream or the need to urinate more often, especially at night * Blood in the urine or semen * Trouble getting an erection (erectile dysfunction or ED) * Pain in the hips, back (spine), chest (ribs), or other areas from cancer that has spread to bones * Weakness or numbness in the legs or feet, or even loss of bladder or bowel control from cancer pressing on the spinal cord * Swelling or fluid buildup in the legs or feet (lymph node compression or involvement) * Unexplained weight loss * Fatigue

Answer 150

* PSA blood test—used for diagnosis and treatment to monitor response * DRE—Digital Rectal Exam--the doctor inserts a gloved, lubricated finger into the rectum and feels the surface of the prostate through the bowel wall for any irregularities. * Transrectal ultrasound: (TRUS) + Biopsy * Use the ultrasound for guidance and a biopsy tool to take very small slivers of prostate tissue.

Answer 151

Cancer has spread beyond the prostate

Answer 152

Cancer has spread to the regional lymph nodes

Answer 153

Cancer has spread to distant lymph nodes: other parts of the body or to the bones

Answer 154

Cancers with a Gleason score of 6 or less may be called well-differentiated or low-grade.(slow growing) Cancers with a Gleason score of 7 may be called moderately-differentiated or intermediate-grade. Cancers with Gleason scores of 8 to 10 may be called poorly-differentiated or high-grade. (most aggressive and risk for metastases)

Answer 155

* Watchful waiting/active surveillance * Surgery * Radiation therapy * Hormone therapy * Chemotherapy * Targeted therapy * Immunotherapy * Bisphosphonate therapy—bone metastases

Answer 156

Patients in good health whose tumor is in the prostate gland only may be treated with surgery to remove the tumor. The following types of surgery are used: Radical prostatectomy: A surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles. Radical laparoscopic prostatectomy: Several small incisions (cuts) are made in the wall of the abdomen. A laparoscope (a thin, tube-like instrument with a light and lens for viewing) is inserted through one opening to guide the surgery. Robot-assisted laparoscopic radical prostatectomy: Several small cuts are made in the wall of the abdomen, as in regular laparoscopic prostatectomy. The surgeon inserts an instrument with a camera through one of the openings and surgical instruments through the other openings using robotic arms.

Answer 157

uses a machine outside the body to send radiation toward the area of the body with cancer.

Answer 158

internal radiation therapy; radioactive soeds placed directly into the prostate. The seeds give off radiation just around the area where they are inserted and may be left for a short time (high-dose rate) or for a longer time (low-dose rate).

Answer 159

increased urge to urinate or frequency of urination; problems with sexual function; problems with bowel function, including diarrhea, rectal discomfort, or rectal bleeding; and fatigue. Most of these side effects usually go away after treatment.

Answer 160

Used for metastatic disease not responding to hormone therapy; it is not standard treatment for early-stage disease, but it has been shown to help patients live longer and slow the growth of cancer. Agents typically used are docetaxel (most commonly used in combination with steroids as the first treatment option)

Answer 161

Bisphosphonate drugs, such as clodronate or zoledronate (Zometa), reduce bone disease when cancer has spread to the bone.

Answer 162

Impotence Incontinence of urine from the bladder or stool from the rectum

Answer 163

impotence and urinary problems that may get worse with age Rectal bleeding

Answer 164

Hot flashes, impaired sexual function, loss of desire for sex, and weakened bones may occur in men treated with hormone therapy. Other side effects include diarrhea, nausea, and itching.

Answer 165

Begins at diagnosis of cancer and lasts until end of life Includes: monitoring for and treating late effects of cancer and prior treatments (hypothyroidism, lymphedema, pain management, enterostomal therapy, fertility physical and vocational rehab psychosocial support and counseling surveillance and screening for recurrent or new cancer (mammography, pap smear, colonoscopy, PSA) Smoking cessation coordination of care for patient with specialists (care of comorbidities, influenza vax, pneumovax, shingles vax, bone density, echocardiogram)

Answer 166

Palliative care can be offered and provided at any stage of a serious illness. Hospice care is offered and provided for patients during their last phase of an incurable illness or near the end of life, such as for some people with advanced or metastatic cancer.

Answer 167

Palliative care can be provided while the patient is getting active treatment. In other words, it can be given at the same time as chemo, radiation, or immunotherapy for cancer. Hospice care is provided when there is no active or curative treatment being given for the serious illness. "Treatment" during hospice care means only managing symptoms and side effects.

Answer 168

A palliative care team is separate from the medical care team that's giving and managing treatment for the illness, but communicates with the medical care team. A hospice care team coordinates the majority of care for a patient, and communicates with the patient's medical care team.