Unit 20 Altered Cell Overview/Pain control Flashcards
Defnine Malignancy.
Abnormal regulation of growth
Describe the Proliferative Patterns, Benign and Malignant.
Benign:
- Well differentiated
- Encapsulated (stays where it is)
- Slow growth
- No metastasis
- Local effects
- No tissue destruction
Malignant:
- Undifferentiated “dysfunctional”
- Infiltrates
- Rapid growth
- Metastasis
- Systemic effects (anemia, cachexia, infections)
- Tissue Destruction
What is the most common cancers for men and women?
Men:
- Prostate
- Lung
Women:
- Breast
- Lung
What are characteristics of a cancer cell?
Undifferentiated (Dysfunctional):
-polymorphic and pleomorphic
Autonomous self sufficiency of growth signals:
- Resists apoptosis (resistant to “death”)
- Multiplies indefinitely (immortal)
Angiogenesis (grows on it’s own)
Metastasis (spreads):
-invades local tissue and instant tissue
What is Carcinogenesis? What is the process?
Process by which cancer arises.
Initiation:
-gene mutation from carcinogens (smoking, etc)
Promotion:
-repeated exposure (cell multiplication)
Progression:
- cancer developed at this point
- increase in malignancy, angiogenesis
What are the mechanisms of metastasis?
Lymphatic spread (most common) -travels next to circulatory system
Hematogenous spread
-tumor piece breaks off and travels/grows in capillaries
Angiogenesis
-own blood supply to jump to next organ , new blood vessels form from pre-existing ones
What is the Cell Cycle?
G0 = doing what it should be doing
G1 = Growth
S = DNA replicates (good time to kill a cancer cell)
G2 = prepare to divide / repairs
Mitosis = Mother cell becomes 2 daughter cells
What is proto oncogenes?
What are tumor suppressor genes?
ON switch for cellular growth
OFF switch for cellular growth
in cancer they do not shut off
What are examples of the following carcinogens:
- Viruses, bacteria
- Physical agents
- Chemical agents
- Genetic susceptibility
- Dietary factors
- Hormonal agents
- Immune system failure
Viruses, bacteria: HPV, HIV, HEP B
Physical agents: Sunlight, radiation, tobacco
Chemical agents: Nitrogen mustard
Genetic susceptibility: BRCA (breast cancer), down syndrome at risk for leukemia
Dietary factors: alcohol, etc
Hormonal agents: estrogen
Immune system failure: HIV
What is the primary prevention of cancer?
> To ensure it never develops:
-Education
- Vaccination
- Avoidance of known carcinogens
- Modifications of associated factors
> Removal of at risk tissue
What is secondary prevention for cancer?
Screening for early detection and Rx
Examples:
- Self exams
- Clinical exams
- Blood, urine, and stool tests, etc.
What is the new protocol for mammograms within the age ranges?
What is the new protocol for clinical self breast exams?
40-44 optional
45-54 anual
55+ once every two years
New protocol is to not do them (which is bologna sandwich)
Describe the testicular self-exam.
After a shower:
- Gently locate right testicle
- Roll between your thumb and fingers
- Repeat on left side
Contact MD if lump is found
What is the screening guidelines for early detection of prostate cancer by the ACS?
Age 50 men who at average risk and are expected to live at least 10 years or more:
- Have conversation
Age 45 for men at high risk:
- First degree relative dx’d with prostate cancer at early age (< 65)
- do testing
Age 40 for men at even higher risk:
- > one first degree relative who had prostate cancer at an early age,
- do testing
What are the screening guidelines for men and women for Colorectal Cancer?
Beginning at age 50, should follow one of the following examination schedules:
>Tests that find polyps and cancer
-Flexible sigmoidoscopy every 5 years
-Double-contrast barium enema every 5 years
-CT colonography every 5 years
-Colonoscopy every 10 years
> Tests that find mainly cancer
- Guaiac fecal occult blood test every year
- Fecal immunochemical test every year
- Stool DNA test every 3 years
What is the lung cancer screening protocol?
Who would be excluded?
Low dose CT scan for High Risk PT’s who:
- Are age 55-74 y.o, with no signs of symptoms of lung cancer
- Active or former smoker with a 30 pack hx
- Active smoker: should also be vigorously urged to enter smoking cessation program
- Former smoker: must have quit within the past 15 years
General excluded ppl:
- Life limiting co-morbid conditions.
- Metallic implants or devices in chest or back
- Requirement for home O2 supplementation
What are early cancer warning signs?
Think CAUTION:
C hanging bowel/bladder habits
A sore throat that doesn’t go away
U nusual bleeding
T hickening or lump
I ndigestion or difficulty swallowing
O bvious change in wart or mole
N agging cough or harseness
What are tumor makers for?
Give some examples.
Point to, but do not dx cancer
Examples:
- PSA (prostate specific antigen)
- AFP (alfa fetal protein) -think, why would adult secrete this?
- CEA (carcinoembryonic antigen)
- CA 125 (cancer antigen 125)
- b-HCG (beta- Human chrionic gonadotropin)
- Bence Jones proteins in urine
What are diagnostic tests that dx cancer?
Bone marrow biopsy
Endoscopic biopsy
Needle biopsy
Surgical biopsy
What confirms Cancers?
Biopsy
How is Cancer graded?
Grade 1: closely resembles normal tissue
Grade 2: Tissue still has well-formed glands, but they are larger and further apart
Grade 3: Glands are recognizable, but they are beginning to invade other tissues
Grade 4: Only a few recognizable glands, neoplastic clumps seen
Grade 5: No recognizable gland cells
How is Cancer staged?
T = primary tumor
N = Nodes
M = Metastasis
Describe the staging of cancer, Primary Tumor (T).
Tx- primary tumor cannot be assessed
T0- no evidence of primary tumor
Tis- carcinoma in situ (removed even though not metastasized
T1 to T4 - Increasing size and local extent of primary tumor
Describe the staging of cancer, Regional Lymph Nodes (N).
Nx -regional lymph node cannot be assessed
N0 - no regional lymph node metastasis
N1 to N3 - increasing involvement of regional lymph nodes
Describe the staging of cancer, Distant Metastasis (M).
Mx - Metastasis cannot be assessed
M0 - No distant metastasis
M1 - presence of distant metastasis
What does metastasis essentially mean?
Cancer spread to “distant” organs
What are radiology diagnostic tests used for cancer?
PET scan - ionized solution into vein, shows cancer
CT scan
Bone scan
Ultrasound
Xrays
What is the leading cause of cancer related death in men and women in the US?
What are the risk factors?
Lung cancer
- Tobacco smoke
- Secondhand smoke
- Smog
- Radon
- Genetics
What is the pathophysiology of Lung Cancer?
> 90% arise from the epithelium of bronchus
8 to 10 years to reach 1 cm (that’s why we CT)
Liver, brain, bone are most common sites of metastasis
What are the types of lung cancer?
> Small Cell or Oat Cell carcinoma
(rapid growing, worst one)
> Non-small Cell carcinoma
- squamous cell
- large cell
- adenocarcinoma
Post Bronchoscopy what should the nurse check for?
Return of gag reflex
What do the following tumor markers test for?
EGFR gene
ALK gene
EGFR - Non-small cell lung cancer
ALK - Non-small cell lung cancer
What are the ways to manage the potential side effects of opioids such as: Sedation Constipation N and V Itching Respiratory depression
Sedation: rest, put on fall risk
Constipation: ducosate sodium, increase fiber and fluids
N and V: take w/ food, oldonasterone
Itching: anti-histamine, calamine lotion
Respiratory depression: O2, stimulate breathing, naxolone
What do you not want to supplement oxycodone with and why?
Acetaminophen
4,000 mg a day limit. of acetaminophen
What is adjuvant medication refer to?
Enhances effectiveness of opioid analgesics
What are common side effects of the following adjuvant medications:
antidepressants
anticonvulsants
corticosteroids
antidepressants:
- nausea
- constipation
- insomnia
- increase weight gain
- decreased libido
anticonvulsants:
- dizziness
- drowiness
- rash
- bone marrow suppression
corticosteroids:
- immunosuppression
- Increased weight gain
- muscle weakness
- ecchymosis
- osteoporosis
What are causes of malnutrition in cancer PT’s?
The medications
Depressed moods
Changes in taste
GI disturbances
N and V
Diarrhea
Early satiated (fullness)
What is cancer cachexia?
Wasting syndrome characterized by weight loss, anorexia, asthenia (weakness), and anemia.
PT’s have weight loss that cannot be reversed with normal nutritional support
What are ways to improve nutrition in cancer PT’s?
Small amounts frequently
High calorie foods
Lean meats
Increased fruits and vegetables
Increased fluids
Multivitamins
Avoid smells that make PT sick
