Topic 6: Cancer Flashcards
cancer
Characterized by uncontrolled unregulated growth of cells
stage 0
cancer in situ
stage I
tumor limited to the tissue of origin; localized tumor growth
stage II
limited local spread
stage III
extensive local and regional spread
stage IV
metastasis
TNM
(primary) tumor, (regional lymph) nodes, (distant) metastases
T0
No evidence of primary tumor
Tis
Carcinoma in situ
T1-4
ascending degrees of increase in tumor size and involvement
Tx
Tumor cannot be measured or found
N0
No evidence of disease in lymph nodes
N1-4
ascending degrees of nodal involvement
Nx
regional lymph nodes unable to be assessed clinically
M0
no evidence of distant metastases
M1-4
ascending degrees of metastatic involvement, including distant nodes
Mx
cannot be determined
Side effects of Radiation Therapy
· Acute and long-term site-specific changes
· Vary according to site
· Local skin changes and hair loss
· Altered taste sensations
· Fatigue
· Bone marrow suppression
Prevention and Early Detection of Cancer
· Limit alcohol use
· Get regular physical exercise
· Maintain a normal body weight
· Have regular colorectal screenings
· Avoid smoking and tobacco
· Get regular mammography screening and Pap smears
· Obtain adequate, consistent periods of rest (at least 6-8 hours a night)
· Use sunscreen of 15 or higher
· Eliminate, reduce and cope with stress
· Eat balanced diet that includes vegetables, fruit, whole grain, and adequate amounts of FIBER
Heath Promotion and Maintenance
· Avoidance of known or potential carcinogens (use skin protection, don’t use tobacco)
· Modifying associated factors (decrease alcohol, high fiber diet, low fat)
· Removal of “at risk” tissues
· Chemoprevention
· Vaccination
· Cancer Screening Guidelines
Problems Caused by Chemo and Radiation Management: hyperuricemia
o Monitor uric acid levels
o Allopurinol may be given prophylactically
o Maintain fluid intake
Problems Caused by Chemo and Radiation Management: cardiotoxicity
o Monitor heart with ECG and EF
o Administer antidysrhythmics as ordered
Problems Caused by Chemo and Radiation Management: fatigue
o Assess for reversible causes of fatigue
o Reassure client that fatigue is a common side effect
o Encourage patient to rest when fatigued, pace activities according to energy levels
Problems Caused by Chemo and Radiation Management: anorexia
o Monitor weight
o Eat small frequent meals of high-protein, high-calorie foods
o Encourage patient to eat
Problems Caused by Chemo and Radiation Management: constipation
o Take stool softeners as needed
o Eat high fiber foods
o Increase fluid intake
o Increase activity IF TOLERATED
Problems Caused by Chemo and Radiation Management: diarrhea
o Antidiarrheal, low fiber, low residue diet
Problems Caused by Chemo and Radiation Management: N/V
o Encourage patient to eat and drink when not nauseated
o Prophylactic antiemetics
o Diversional activities
Problems Caused by Chemo and Radiation Management: stomatitis, mucositis, esophagitis
o Asses oral mucosa daily and teach patient to do this
o Encourage nutritional supplements if intake is decreasing
o Avoid spicy or acidic, and too hot or too cold foods
o Teach patient to choose moist, bland, softer foods
o Encourage patient to keep oral cavity clean and moist with oral rinse (saline or salt and soda solution)
o Discourage of irritants like alcohol and tobacco
Problems Caused by Chemo and Radiation Management: anemia, leukopenia, thrombocytopenia (due to bone marrow suppression)
o Monitor CBC levels
o Avoid large crowds and people with infections
o Observe for signs of bleeding
Problems Caused by Chemo and Radiation Management: Alopecia
o Suggest ways to cope with hair loss (hair pieces, scarves, wigs)
o Cut long hair before therapy
o Avoid excessive shampooing, brushing, curling, and drying of hair
Problems Caused by Chemo and Radiation Management: chemo induces skin changes
o Alert patient to potential skin changes
o Encourage to avoid sun exposure
o Symptomatic management (lotion, corticosteroid creams)
Problems Caused by Chemo and Radiation Management: radiation skin changes (dry to moist desquamation
o Lubricate the dry skin with a nonirritating lotion emollient (such as aloe vera)
o Wet reaction must be kept clean and protected from further damage.
o Wet desquamation of tissues generally produces pain, drainage, and increased risk of infection.
Problems Caused by Chemo and Radiation Management: cognitive changes “chemo brain”
o Teach clients to use a daily planner, get enough rest, exercise brain (puzzles), focus on one thing
chemo PPE
· Eye protection
· Masks
· Double gloves (or “chemo” gloves)
· Gown
Teach 7 warning signs of cancer: CAUTION
· Change in bowel or bladder habits
· A sore that does not heal
· Unusual bleeding or discharge from any orifice
· Thickening or lump in the breast or elsewhere
· Indigestion or difficulty in swallowing
· Obvious change in a wart or mole
· Nagging cough or hoarseness
Radiation skin reaction teaching:
· Cleanse skin with mild soap, rinse thoroughly, pat dry
· Apply nonmedicated, nonperfumed lotions/creams to alleviate dry skin
· Rinse area with saline solution. Expose the area to air as much as possible
· Observe area DAILY for signs of infection
· Avoid weaking tight fitting clothes and harsh fabrics
· Avoid direct exposure to sun and excessive heat or cold
Avoid potential irritants (perfume, lotion, tape, dressings)
SE of radiation
o Acute and long-term site-specific changes
o Vary according to site
o Local skin changes and hair loss
o Altered taste sensations
o Fatigue
o Bone marrow suppression
leukemia
cancer of the blood
Chronic Myelogenous Leukemia (CML)
excess mature yet hypofuncitonal neutrophils
- both mature and immature granulocytes are present in large numbers in the marrow and blood
Chronic Lymphocytic Leukemia (CLL)
a form of leukemia characterized by extremely high levels of lymphocytes; most often found in middle-age adults
s/s of CML
· No symptoms in early disease
· Fatigue and weakness
· Fever
· Sternal tenderness
· Weight loss
· Joint & bone pain
· Massive splenomegaly
· Increase in sweating
s/s CLL
· Frequently no symptoms (detection often makes during exam of unrelated condition)
· Chronic fatigue
· Anorexia
· Splenomegaly and lymphadenopathy and hepatomegaly
· May progress to fever, night sweats, weight loss, and frequent infection
Leukostasis
o A high leukemic white count in the peripheral blood (more than 100,000 cells/µL) can causes blood to thicken and potentially block circulatory pathways, life threatening
diagnostic studies for leukemia
· Peripheral blood evaluation and bone marrow examination
Diagnostic Findings of CML
· Low RBC count
· Low Hgb, Hct
· High platelet count early, lower count later
· ↑ banded neutrophils and myeloblasts and often basophils, normal number of lymphocytes, and normal or low number of monocytes.
Diagnostic Findings of CLL
· Mild anemia and thrombocytopenia with disease progression
· Total WBC count >100,000/µL.
Increase in peripheral lymphocytes and lymphocytes in bone marrow
DIAGNOSTIC HALLMARK of CML
The Philadelphia chromosome
Treatment for leukemia
· Chemotherapy is the mainstay of the treatment
· Other medications: Corticosteroids
· Radiation therapy
· Leukostasis treatment
> Leukapheresis (proced. to reduce WBC ct)
> Hydroxyurea (med to reduce WBC ct, used in emergency leukostasis)
> To prevent thrombosis (clot w/in vessel)
Hydroxyurea SE
N/V/D, Constipation, Mucositis, flu-like symptoms, hair loss
Leukapheresis Procedure
· Step 1 - Blood will flow from the vein into the machine where it’s separated into different parts.
· Step 2 - A small portion of the immune, platelets, & RBCs will be removed.
· Step 3 - The rest of the cells are returned to your body.
Stages of Chemotherapy
Induction
Postinduction or postremission
Maintenance
Induction therapy
· attempt to bring about remission
o Aggressive, seeks to destroy leukemic cells
Patient may become critically ill because bone marrow
Postinduction or Postremission therapy
intensification therapy and consolidation therapy
Intensification therapy
high-dose therapy given right after induction therapy for several months
Consolidation therapy
started after remission is achieved; purpose is to eliminate remaining leukemic cells
Maintenance therapy
uses lower doses of the same drugs; goal is to keep the body free of leukemic cells
