TLO 103c Neoplastic Flashcards
Neoplastic
neoplasm?
Neoplasm:
any abnormal growth of new tissue, benign or malignant
Also called tumor
How does cancer spread, two ways?
Invasion:
cancer cells grow in an unrestricted disorderly way at site of origin
Metastasis:
cancer cells grow in other sites than that of which it originated
Malignant of cancer
Malignant of cancer
A group of >200 diseases characterized by uncontrolled and unregulated growth of cells
Characteristic of malignant neoplasm Poorly differentiated Capable of metastasis Possible reoccurrence Moderate to marked vascularity Infiltrative and expansive mode of growth
Benign characteristic, noncancerous
Usually encapsulated Normally differentiated No metastasis Rare reoccurrence Slight vascularity Expansive growth
Development of cancer
Development of cancer
Initiation:
mutation in cells genetic structure so that it can develop a clone
Promotion:
Reversible proliferation of the altered cells
Progression:
Increased growth rate of the tumor, increased invasiveness, increased metastasis
Carcinogens defined
Carcinogen:
Cancer causing agents capable of producing cellular alterations
Immune system
Immune system:
Role: recognition and destruction of tumor cells
Can distinguish normal from abnormal cells
- transplant organs can be recognized as foreign, rejection can occur
- because cancer cells develop from normal human cells that mutate, the response against cancer cells may not be sufficient to kill cells
Immune response to malignant cells:
Cytotoxic T cells: role in resisting tumor growth by killing tumor cells. Produce cytokines which stimulate T cells, natural killer cells, B cells and macrophages
Natural killer cells: directly lyse tumor cells
Macrophages: nonspecific lytic of tumor cells
B lymphocytes: produce antibodies that bind to tumor cells and kill them; detects in serum/saliva
Oncofetal Antigens, tumor markings
Oncofetal antigens: useful marker for cancers
Found on both the surfaces/inside of cancer cells and fetal cells
Cells shift to immature metabolic path associated with fetal period of life. Cell regains embryonic capability to differential into many different cell types
Carcinoembryonic (CEA): useful marker for cancers
Found on surface of cancer cells from the GI tract, fetal gut, liver, pancreas, normally disappears in last 3 months of fetal life.
Monitor therapy
Developmental of cancer in children
Alterations in normal DNA predispose the child to cancer or chromosomal abnormalities cause an inherited disposition
Failure of the immune system to distinguish between normal and abnormal cells
Inactivation of tumor suppressor genes
Oncofetal antigens tumor markers
Oncofetal antigens tumor markers
A-fetoprotein (AFP) is produced by malignant liver cells and fetal liver cells
AFP detection is of value in tumor detection and tumor progression
Elevated in testicular carcinoma, viral hepatitis and nonmalignant liver disorders
Diagnostic is primary cancer of the liver, hepatocellular
Produced with metastatic liver growth
Other oncofetal antigens:
CA 125: ovarian carcinoma
CA 19-9 pancreatic and gallbladder cancer
CA 15-3 and CA 27-29 breast cancer
Cancer classifications of tumors provide a standardized method
Classification of tumors provide a standardized method to:
Communicate the status of the cancer to health care team
Assist in determining the most effective treatment plan
Evaluate the treatment plan
Predict prognosis
Compare like groups for statistical purposes
Carcinogens
Chemical
Carcinogens
Chemical
Chemical: drugs that interact with DNA
Chemical:
Drugs: alkylating agents (Cytoxan): secondary leukemias are refractory to induction of remission with combination chemotherapy
Immunosuppressive agents: secondary leukemias has been observed in patients with transplant surgery or immunosuppressive drugs.
Carcinogens
Radiation
Carcinogens
Radiation
The dose of radiation that causes cancer is unknown
Debate surrounding the effects of low dose exposure over time
Leukemia, lymphoma, thyroid cancer and others increased in Hiroshima and Nagasaki after atomic bomb
More bone cancer in occupations as radiologists, radiation chemists and uranium miners.
More thyroid cancer in person who received radiation to the head/neck area
Ultraviolet radiation, more melanoma, squamous and basal cells cancers
Carcinogens
Viral
Carcinogens
Viral
person with AIDS have a high incidence of Kaposi sarcoma
Hepatitis B has been linked to hepatocellular carcinoma
Human papilloma virus induces lesions that are capable of progressing to cervical cancer
Cancer tumors are classified by anatomic site
Cancer tumors are classified by anatomic site
Identified by the tissue of origin:
Behavior of the tumor (benign or malignant):
Extent of disease (staging)
Clinical staging
Determined the anatomic extent of the malignant disease
Determines the treatment options
Stage 0: cancer is situ
Stage I: localized tumor growth with cells of tissue of origin
Stage II: limited local spread
Stage III: extensive local and regional spread
Stage IV: metastasis
Cancer early warning signs
CAUTION
Change in bowel or bladder A lesion that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing Obvious changes in wart or mole Nagging cough or persistent hoarseness
Cancer classification TNM
TNM classification system: determines the anatomic extent of disease and tumor involvement according to 3 parameters
T: Tumor, how many 1-4
N: lymph nodes, how many are positive 1-4
M: metastasis, how many areas spread to 1-4
Cardinal s/s of cancer in children Overt signs (obvious signs)
Overt signs: A mass Purpura (A rash of purple spots due to small blood vessels leaking blood into the skin, joints, intestines, or organs) Pallor Weight loss Whitish reflex in eye Vomiting in early morning Recurrent or persistent fever
Cardinal s/s of cancer in children
Covert (not openly acknowledged or displayed)
Covert: (not openly acknowledged or displayed)
Bone pain
HA
Persistent lymphadenopathy (inflammatory)
Change in balance, gait or personality
Fatigue, malaise
Diagnostic studies
Bone, liver, lung brain scan US CT MRI PET Mammography Chest x-ray Endoscopic exam, UGI, colonoscopy Cytology, Pap test Tissue biopsy CBC Liver function Tumor markers Genetic markers Bone marrow exam
Therapies for pediatric cancer
Chemo Radiation Surgery Hematopoietic stem cell transplant: allogenic (matched donor), autologous (child's own) Biologic response modifiers Steroid Complementary, alternative medicine
Chemo nursing inplications
The use of chemicals as a systemic treatment for cancer. Chemo therapy drugs non selectively kill rapidly dividing cells. Tumors can develop immunity to chemo agents
Chemo agents in addition to killing cancer cells
Affect bone marrow production
GI tract and the integumentary system
Radiation therapy nursing implications
Radiation therapy nursing implications
Causes damage to the cells and stops them replicating
In a developing child normal cells develop may not be complete
Radiation to the brain causes alteration in cognitive level
Bone growth is altered if radiation is delivered to the areas of growth potential
Chemo side effects
Chemo side effects: Bone marrow suppression Alopecia Malaise/fatigue Nausea Vomiting Anorexia Stomatitis (oral, rectal sores)
Radiation side effects
Radiation side effects: Skin reactions (burns, redness) Fatigue Bone marrow suppression Nausea Vomiting Anorexia Mucositis (oral sores)
Leukemia
Broad term for group of malignant disease of bone marrow and lymphatic system
Most common childhood cancer
Peak onset 2-6 years old
> in males and Caucasians
Lymphoid leukemia 80% survival rates
Acute nonlymphoid leukemia has 50% survival rate
Leukemia defined
Leukemia is an abnormal proliferation of immature white blood cells which compete with normal cells for space and nutrients
Bone marrow production is suppressed which results in low numbers of WBC, RBC and platelets
Leukemia clinical manifestations
Liver and spleen are most effected (vascular organs) Acute form: leukocyte count is low S/S: Anemia Neutropenia Thrombocytopenia
Leukemia diagnostic
H&P
Peripheral blood smear: contains immature forms of leukocytes, low blood count
Bone marrow aspirate/biopsy: flow cyometry of cells in bone marrow
Lumbar puncture to determine CNS involvement
Brain tumor signs
Infant may be irritable, lethargic, feed poorly, have increased head, bulging fontanels
Young child loss of developmental milestones
School age have declining academic performance, fatigue, personality changes, seizures
Older children: HA upon waking, vomiting
Consequences of bone marrow disfunction
Decrease RBC= anemia; neutropenia= infection
Decrease platelets= bleeding tendencies
What are the clinical manifestations related to bone marrow dysfunction?
Pallor, fatigue, fever, hemorrhage, fractures, pain
How are the liver, spleen and lymph glands effected?
Infiltration, enlargement, eventual fibrosis (scarring)
Manifestations: hepatomegaly, splenomegaly, lymphadenopathy
How does leukemia impact CNS?
Increased ICP, meningeal irritation
What are the manifestation of hypermetabolism caused by leukemia?
Cell deprivation of nutrients by invading cells lead to muscle wasting, weight loss, anorexia, fatigue
Brain tumor diagnostic
MRI CT EEG Lumbar puncture Biopsy
Osteosarcoma what is it
The most common primary bone lesion in children
Originates from the bone producing cells that invade the medullary canal of the bone, incidence is higher in the most rapidly growing bones in adolescence
Goals of therapy: remove tumor, prevent spread
Leukemia four phases?
Induction therapy:
achieves complete remission or less than 5% leukemia cells in bone marrow
CNS prophylactic therapy:
prevents leukemia cells form invading CNS
Consolidation/intensification therapy:
eradiation prevents emergence of resistant leukemic clones
Maintenance therapy:
maintain remission phase
Osteosarcoma sites
Primary tumor sites are in the metaphysis adjacent to the epiphyseal plate of long bones
Other sites: tibia, humerus, pelvis, jaw, phalanges
Higher in lower extremities
Leukemia treatment
Hematopoietic stem cells transplant: success with ALL and AML. Capable of differentiating into specialized calls.
Donors: antigen matched related donors matched unrelated mismatched donors obtained from related or unrelated donors or umbilical cord blood
Transplant cons: Significant morbidity and mortality Graft vs host disease Overwhelming infection Severe organ damage
Prognosis: long term survival depend on the following initial WBC count Child's age at diagnosis Type of cell involved Gender of child Karyotype analysis
Osteosarcoma clinical findings
Pain, mass, limping, limited ROM, pathological fractures
Osteosarcoma treatment
Surgery: biopsy, limb salvage or amputation
Chemo
Radiation, used only in the palliative pain control in the advanced patient
Osteosarcoma nursing care
Depend on type of surgery Post-op; emotional support Prepare for alopecia Permanent prosthesis fitting 6-8 wk posts op Elavil for phantom leg pain Physical therapy Planning for return to school
Ewing’s sarcoma
Arises in the marrow spaces of the bone
Tumor originates in the shaft of long and trunk bones
Most common site: femur, tibia, fibula, humerus, ulna, vertebrae, scapula, ribs, pelvic and skull
2nd most common bone tumor seen in children
Ewing’s sarcoma treatment
Radiation, chemo
Amputation if radiation causes deformity, loss of function
Vincristine, actinomycin D, cyclophosphamide, ifosfamide, etoposide, doxorubicin
Prognosis:
new chemotherapy agents have increased 3 years survival to 80%
Ewing’s sarcoma nursing care
Psychological adjustment
Prepare pt and family for bone marrow aspiration, surgical biopsy, radiation
Skin care
Encourage loose fitting clothing
Protect site from sunlight/temperature changes
Physical therapy
Prepare for alopecia, N/V, peripheral neuropathy, possible cardiotoxic side effects
Wilm’s tumor what is it? diagnostic
Wilm's tumor or nephroblastoma (kidney cancer) One or both kidneys involved Diagnostic: H&P Ab swelling/mass Ab US Ab/chest CT Hematologic studies Urinalysis Determine kidney function on opposite side
Wilm’s tumor pre-op and post-op
Pre-op: Surgery in 24-48 hr of admit BP, hypertension due to excess in renin production Do not palpate ab, post sign above bed Radiation/chemo teaching
Post-op: Recover is rapid GI activity BP, urine output, signs of infection Pulmonary hygiene Protect kidney that is left
Hodgkin’s
A neoplastic disease that originates in the lymphoid system
Most common: asymptomatic enlarged cervical or supraclavicular lymphadenopathy
Hodgkin’s classified
A= asymptomatic B= 3 symptoms: Fever 100.4 or higher for 3 days Drenching night sweats Unexplained loss of body weight over 6 mo
Cough Ab discomfort Anorexia N/V Pruritus Fatigue Non painful lymph node enlargement
Hodgkin’s treatment
Radiation Chemo Splenectomy in some cases: Prophylactic antibiotics Immunizations against pneumococci and meningococci
Retinoblastoma
Can be unilateral or bilateral
Caused by mutation in gene
Hereditary retinoblastomas are transmitted as an autosomal dominate trait
Retinoblastoma diagnostic
Ophthalmologist exam under general anesthesia
US, CT
What is the most common signs of retinoblastoma?
White eye reflex
What is the 2nd most common sign of retinoblastoma
Strabismus
condition in which the eyes do not properly align with each other when looking at an object
What is another sign, often with glaucoma?
Red, painful eye
What is the late sign of retinoblastoma?
Blindness
Retinoblastoma nursing management
Pre and post op teaching
Post op care of eye/socket care
Preparing parents for post op facial appearance
Post op enucleation (removal of the eye that leaves the eye muscles and remaining orbital contents intact):
Facial features return to normal w/in 3 wk of prosthesis
Retinoblastoma prognosis
Survival rate 90% Long term concerns: decreased visual acuity facial disfiguration secondary tumor
Two forms of leukemia in children?
Two forms of leukemia in children?
Classified by the type of WBC affected
Acute lymphoid leukemia (ALL) **most common: Stem cell or blast cell Lymphatic Lymphocytic Lymphoblastic Lymphoblastoid
Acute nonlymphoid leukemia (ANLL): Granulocytic Myelocytic Monocytic Myelogenous Monoblastic Monomyeloblastic
