Unit 22 Altered Cell Proliferation: Solid Tumors Flashcards
What is considered a low ANC (absolute neutrophil count)?
What can this be an indication of?
ANC less than 500 is critical
Can be indication of the need to reduce chemo dosage or delay of next therapy
Describe colorectal cancer.
3rd most common cancer is US
Rare before age of 30
Early dx = great prognosis
Late dx = poor prognosis
What are general, lifestyle, and genetic risk factors for Colon Cancer?
General:
- Age
- DM2
- IBD
- Polyps
Lifestyle:
- Inactivity
- ETOH
- Tobacco
- Poor diet
Genetics:
- Family hx
- Inherited (HN gene, FAP gene- full of polyps, by age 40 most likely to develop cancer)
What are Colorectal Cancer manifestations?
Local:
- Changes in stool (blood, shape, frequency, “melena stool”
- Abdominal fullness
- Symptoms of obstruction (constipation, hard stools)
Systemic:
- Weight loss (tumor increases metabolism
- N/V
- Weakness
- Anemia (from bleeding, fatigue presents)
What are Colorectal Cancer Diagnostic Labs?
Stool for guiac/ occult blood
CBC - to check for anemia
LFT (liver function tests)
CEA (carcino embryonic antigen):
- Commonly used to monitor PT’s for effectiveness of Rx
- Level should be 0
- Indicates if there is cancer
- If tumor removed CEA level should drop
What are Colorectal Cancer Diagnostic Radiology procedures?
CT scan
Colonoscopy/sigmoidoscopy
Double contrast barium enema w/X-ray
What is the surgical collaborative management of Colorectal cancer?
How does the nurse prep the PT before these procedures?
After colectomy what should the nurse assess?
-Colon resection with or w/o colostomy
-R hemicolectomy (remove right portion of colon, small intestine to transverse colon)
-L hemicolectomy
(removed left portion of colon, transverse to sigmoid
-Total colectomy
-Abdomino-perineal resection
(assess for pain and bleeding post-procedure)
PT NPO
No food coloring or meat before
Go Lyte-ly (solution to clear bowels)
Bowel sounds
What is stomatitis?
Alteration in oral mucosa secondary to radiation, inflammation of the oral tissuesama
What is the medical collaborative management of Colorectal Cancer?
Chemotherapy:
- Antimetabolites (5-FU)
- Tumor profiling to treat w/ most effective Chemo
Biotherapy:
-Monoclonal antibodies (bevacizumab)
Radiation:
-Cyberknife
What is a sign of left sided colorectal cancer?
Narrow stools
What is the most common treatment for colorectal cancer?
Surgical resection
What is adjuvant care?
Give example.
Additional treatment
Ex: Chemo if lymph node involvement or metastasis
- 5-FU with leucovorin and oxaliplatin
- radiation before or after sx
What is the most common site of metastasis colorectal colon cancer?
Liver
What is the nursing colostomy care?
Assess stoma every 8 hrs, should be red/shiny
Cleanse skin and apply skin barrier
Record volume, color, and consistency of stool
Mild edema and bleeding are normal,
Moderate to severe edema and bleeding are not
Teach ostomy self-care
What can an increase in CEA (carcinoembryonic antigen) indicate?
Cancer has returned or metastasized
Describe the Prostate/Prostate Cancer.
- Prostate needs male hormones like testosterone to grow.
- Located under the bladder
Most prostate cancer is acquired
Most common occurring cancer in men
Second leading cause of death among men
What are Prostate Cancer Risk factors?
Advancing age
Family hx
Genetics (BRCA-2 gene)
Race/ethnicity
Lifestyle (poor diet, STD’s, smoking, etc)
What are prostate cancer manifestations?
Early: Asymptomatic
Later on:
- Signs and symptoms of bladder obstruction
- Loss of bladder control
- Hematuria or blood in semen
- Bone pain
- Difficulty obtaining erection
When should digital rectal exams be done?
Age 40 for men with several close relatives with prostate cancer or cancer at an early age.
Age 45 for men at high risk for all cancers.
Age 50 for all men who do not have major health problems.
What are the diagnostic test for Prostate Cancer?
What diagnoses?
Biopsy (diagnoses)
Digital rectal exam
PSA
Trans-rectal ultrasound
CT of pelvis
Bone scan for metastasis
What is the collaborative management for Prostate Cancer?
Watchful waiting (prostate cancer progresses slowly)
Drug therapy
Radiation (external/teletherapy or internal/brachytherapy)
Surgery (TURP)
What is the drug therapy for Prostate Cancer?
What does this drug do?
What are the adverse effects?
Hormone Modulator:
-leuprolide (lowers estrogen in women and testosterone in men)
Inhibits growth of hormone dependent tumors
Adverse effects:
- Mood changes
- Hot flashes
- Acne
- Impotence
- Decreased libido
After TURP (Transurethral resection of the prostate) sx, what should be done and why?
What if there is blood in the drainage bag?
Continuous bladder irrigation to prevent clots!
If there is blood in drainage bag turn up infusion rate
What are testicular cancer risk factors?
An undescended testicle
Family hx of testicular cancer
HIV infection
Caucasian
Age 15-40
High cure rate
What are the manifestations of testicular cancer?
- PAINLESS lump or swelling in either testicle
- Dull ache in the lower abdomen or the groin
- Sudden build-up of fluid in the scrotum
- Pain or discomfort in a testicle or in the scrotum
- Heaviness in scrotum
What are the assessments for testicular cancer?
Monthly testicular self-exams
Blood tests: AFP (alfa fetal protein), hCG
Ultrasound
Tissue biopsy
What is the treatment for testicular cancer?
Orchiectomy (testicle removal)
Chemo
Radiation
Banking sperm
How can skin cancer present in African Americans?
Black line in the middle of nails
What are risk factors for Skin Cancer?
A lighter natural skin color
Family hx
Hx of sunburns
Hx of indoor tanning
Exposure to sun through work and play
Skin that burns, freckles, reddens easily
Blue or green eyes
Blond or red hair
Large number of moles
What are the types of skin cancer?
Non-melanomas:
- Basal cell carcinoma (white and waxy)
- Squamous cell carcinoma (give 5-FU)
Malignant Melanoma
What are the warning signs of Melanoma? (ABCDEs)
A symmetry
B order irregularity
C olor
D iameter 1/4 inch
(should be no bigger than pencil eraser)
E volution
What is the diagnosis for skin cancer?
Shave biopsy
Punch biopsy
Incisional and Excisional
What is the treatment for Basal Cell and Squamous Cell?
What is the goal?
Goal: eradicate the tumor
Treatment/management:
- Surgical excision
- Mohs’ micrographic surgery
- Electrosurgery
- Cryosurgery
- Radiation therapy
Describe Malignant Melanoma.
What age range is most at risk?
What genes spontaneously mutates?
Neoplastic growth of melanocytes
Most lethal
Age 20-45 years
Widespread metastasis
Spontaneous mutation in B-RAF gene is responsible for about 50% of all cases
What is the treatment for Melanoma?
Surgical excision
Immunotherapy w/pembrolizumab
Combination chemotherapy
-isolated limp perfusion
Radiation therapy
What is Superior Vena Cava Syndrome?
Symptoms?
What is the treatment?
What is the nursing care?
SVC is partially blocked or compressed, usually by tumor.
Symptoms:
- Enlarged vessels above SVC
- Periorbital edema
- Hoarseness/cough
- Dysphagia
- Late stage - ICP
Tx: Shrink tumor w/chemo or radiation
Nursing care:
- HOB elevated
- No valsava maneuver
- Remove constrictive clothing and rings
- Avoid venipuncture in arms
Describe Spinal Cord Compression.
Symptoms?
Treatment?
Tumor presses against spine.
Symptoms:
- PAIN!
- Numbness
- Neuroloss
- Incontinence
Tx: Shrink tumor, steroids
What are symptoms of pericardial effusion/tamponade?
Why could this happen?
Chest tumor pressing up against heart
Symptoms:
- muffled/distant heart sounds
- narrow pulse pressure
What are the symptoms of Hypercalcemia?
What is the treatment?
What is the normal range?
What can it be a common complication of?
Hypercalcemia can be a common complication of most cancers.
Symptoms:
- Lethargy
- Polyuria
- Muscle weakness
Tx:
-Increase fluid intake ~3-4L/day
Normal Ca range 8.5-11
What is DIC?
What could cause this regarding cancer?
What is the tx?
- Disseminated Intravascular Coagulation
- Bleeding and clotting
Some leukemias, and chemotherapies can cause this
Tx: Fresh Frozen Plasma, Platelets, Underlying cause
What are the symptoms and treatment of SIADH?
What is the tx?
- Decreased serum Na+
- ALOA
Tx: Fluid restriction, possibly 3% NS
What is Tumor Lysis Syndrome?
What is the tx?
Complication during treatment of cancer, large amounts of tumor cells are killed off (lysed) at the same time by the treatment, releasing their contents into the bloodstream.
Intracellular cancer contents spill out which:
- Increase uric acid
- Increase phosphorus
- K+ > 5.5
- Can cause kidney failure
Tx: Increase fluids prior to chemo treatment
What are options to address Chemotherapy Induced Nausea and Vomiting (CINV)?
- Small frequent foods
- metoclopramide
- Avoid bad smells
- Suggest foods that the patient enjoys
- ondansetron
- Guided imagery
- Medical marijuana
