Week 1 - Cancer Seminar Flashcards
why is early detection and prompt treatment important with cancer
= increased survival rates among patients with cancer
what is the difference between screening and diagnostics?
- screening = for someone who is asymptomatic but at high risk
- diagnostic = for someone who has symptoms
what are the 2 screening tests for breast cancer?
- mammogram
- breast self exam
what is the screening test for cervical cancer?
- pap smear
what are the 2 screening tests for colorectal cancer?
- colonoscopy
- stool tests
what is the screening test for prostate cancer?
- digital rectal exam
what is the screening test for testicular cancer?
- testicular self exam
what is the screening test for lung cancer
- low dose CT scan for high risk
what is a screening test for skin cancer
- skin cancer self exam
what is a general screening test for various cancers?
- blood tests
the nursing process begins with….
- assessment
what are the 3 things involved in assessment
- health history/interview
- physical exam
- diagnostic studies
what acronym is used when gathering information for history of the current illness?
OPQRSTU
list 10 risk factors for cancer we should ask about/ identify during the interview
- age
- smoking/tobacco
- alcohol intake
- sun exposure
- infectious agents
- genetic risk
- radiation
- carcinogens
- nutrition
- physical activity (
what are 3 things we should ask the patient about during the interview?
- past medical history
- family history
- lifestyle
what are the 7 cancer warning signs
- change in bowel or bladder habits
- sore that doesnt heal
- unusual bleeding or discharge
- thickening or a lump anywhere
- indigestion or difficulty swallowing
- obvious change in wart or mole
- nagging cough or hoarseness
what are the 4 aspects of a physical exam
- inspection
- palpation
- auscultation
- percussion
what should we look for during inspection
any abnormalities in the skin
- color (pallor, jaundice)
- bruising
- bleeding
- visible lesions or lumps
- asymmetry
what should we feel for during palpation
- feel for palpable masses in each body system
what specific places are good to palpate when assessing for cancer?
- breasts (breast cancer)
- lymph nodes (lymphomas)
- chest (lung cancer)
- abdomen
what are the 5 local signs of cancer
- visible lesions
- physical asymmetry
- palpable masses
- abnormal sounds
- pain
what are the 5 systemic signs of cancer
- cachexia
- bleeding
- anemia
- infections
- fever
list the 7 diagnostic categories
- cytology
- lab tests
- endoscopy
- radiological studies
- radioisotope scanning
- bone marrow aspiration
- biopsies
what is cytology? what is an example?
- examination of cells from the body under a microscope
ex. pap smear
what are 2 types of labratory tests used as diagnostic studies?
- CBC
- electrolytes
what type of markers can be found and used in lab tests?
- tumour markers
describe the use of tumour markers
- helpful, not definitive
- need another diagnostic test to confirm
what is an endoscopy?
- procedure which uses a camera to gather biopsies, take pictures, etc.
what is an example of an endoscopy?
- upper endoscopy through the mouth to see the upper GI tract
what are 2 examples of radiological studies?
- MRI
2. CT
what is the main difference between MRIs and CT scans?
- MRI = no radiation
- CT = uses radiation
what is a MRI
- imaging technique that uses magnets
- can be used to see size of tumour and mets
who would a MRI be good for? not good for?
- good for pregnant women
- not good for patients with pacemakers or any sort of metal
what is a CT
- imaging technique that uses xray imaging to create a 3D image
- can see tumour size & mets
what is an example of radioisotope scanning
- PET scan
how does a PET scan work
- an imaging technique that uses radiotracers
what is a PET scan specifically good for?
- determining how well a treatment is working
- shows how active a cancer is
what is bone marrow aspiration? what is a con to this procedure?
- procedure that takes a sample of your bone marrow for examination
- very painful
which diagnostic test is the most definitive means of diagnosing cancer?
- biopsy –> piece of tissue is surgically removed for histological examination
what are the 3 different types of a biopsy?
- needle
- incisional (only a sample of the lesion is removed)
- excisional (entire lesion removed)
why is grading and staging of a cancer so important?
- impacts our treatment
what comes after diagnosis?
- treatment
what are 6 different types of treatment for cancer
- surgery
- chemo
- radiation
- hormonal therapy
- targeted therapy
- hematopoietic drugs
what is combination therapy?
- treatment whereas the patient is taking two or more drugs
why do we use combination therapy for cancer?
- so the drugs hit different parts of the cell cycle
- avoid resistance
- protect normal cells & allow them time to repair
what is the difference between radiation & chemo?
- radiation = more localized & targeted, damage to cells is permanent (ex. hair wont grow back)
- chemo = more systemic, hair recovers
does damage to other cells still occur with radiaition?
- yes, radiation will damage cells around the tumour
what type of cancer do you want to use chemo vs radiation for?
- solid cancer = radiation
- dissemiated cancer = chemo
describe pain in relation to cancer treatment
- 50% of cancer patients experience pain while receiving treatment
what is a significant barrier to effective pain management?
- inadequate pain assessment
describe pain assessment related to cancer treatment
- vital signs & patient behavior do not provide enough data
- neither does a pain scale in isolation
- should ask many questions about their pain (OPQRSTU)
describe the effects of chemotherapy on the GI system (7)
- anorexia (no appetitie)
- NV
- stomatitis
- mucositis
- esophagitis
- diarrhea
- constipation
what is mucositis
- general term for inflammation of the mucus membranes
what is stomatitis
- oral form of mucositis
- inflammation of the mouth
what do we do to avoid NV with chemo
- anticipate the NV
= give antiemetics to prevent 1hr before treatment
describe subjective assessment of the GI system for a patient on chemo
- OPQRSTU
- diet history
- LBM & characteristics
- urine output, color
describe objective assessment of the GI system for a patient on chemo
- patient weight
- hydration status
- nutritional status
- inspect mouth & throat
- blood work
what are potential consequences of the side effects occuring in the GI system?
- infection
- malnutrition
- weight loss
- dehydration
describe hematological effects of chemotherapy (3)
- neutropenia
- thrombocytopenia
- anemia
what is neutropenia? what are risks asssociated with it
- condition associated with neutrophil count lower than 1-1.5
- severe neutropenia = lower than 0.5
- risk of infection & death from sepsis
what is thrombocytopenia? what are risks associated with it?
- condition associated with platelet count less than 10x10^9
- risk of bleeding & spontaneous hemorrhage
what is anemia
- deficiency in the number of RBC
which are killed from first to last order: RBC, WBC, platelets? how does this effect which conditions are most common regarding hematological effects of chemo?
- WBC then platelets then RBC
= neutropenia, then thrombocytopenia, then anemia
what is nadir? how long does it take to reach?
- the lowest WBC we are willing to accept while giving chemo
- usually 7-14 days to reach nadir
describe the assessment for hematological conditions when giving chemo
- frequent lab work (CBC, WBC, Hgb, platelets)
- look for signs of infection
- signs of bleeding
- vitals
what specific vitals should we consider when assesing hematological system
- temp (fever, espeically low grade fever = signs of infection)
- bp & HR (signs of sepsis)
what causes the hematological side effects of chemo>
- BMS
list the 3 main side effects of cancer treatment on the integumentary system
- alopecia
- extravasation
- radiation damage –> desquamation
describe alopecia during chemo vs radiation
- chemo = systemic
- radiation = only in treatment area
what is extravasation? is this a problem with chemo?
- when the IV is no longer going into the vein & leaking onto the tissue around
- very very bad with chemo
what do you do if someone who is receieving chemo complaing of pain in their hand
- stop the IV!!!
what is desquamation? what are the 2 types that occur with radiation
- condition where the radiation will start to cause erythema, scaling, and flaking of the skin
1. dry
2. wet
how long does it take for radiation damage to occur?
- within the first 24 h
what is the acronym for skin assessment
Color
Warmth
Circulation
Movement
list 2 side effects of cancer treatment on the genitourinary system
- nephrotoxicity (from chemo drugs going thru the kidney)
2. cystitis
what is cystitis
- inflammation of the bladder
describe assessment of the genitourinary system for a a patient receiving cancer treatment
assess kidney function:
- urine output & characteristics
- vitals (especially BP)
- signs of fluid overload (similar to signs of CHF)
- lab (BUN, creatine, potassium)
list 2 side effects of cancer treatment on the nervous system
- peripheral neuropathy (chemotherapy induced)
2. increased intracranial pressure
what is peripheral nueropathy
- numbess, tingling, pins & needles feeling in the peripheral system
describe the componenets of a neurological assessment
- LOC
- orientation
- cranial nerves
- reflexes
- sensation
- motor strength
list 2 side effects of cancer treatment on the respiratorty system
- pneumonitis
2. fibrosis
what is pneumonitis
- inflammation of the lung tissue
what specific chemo drug causes pneumonitis
- bleomycin
how long does it take for pneumonitis to occur
- 2-3 months after treatment
what is fibrosis? how long does it take for it occur?
- scarring & hardening of the lung tissue
- 6-12 months after treatment
describe respiratory assessment for a patient receving cancer treatment
- OPQRSTU
- inspect, palpate, and auscultate lungs
- cap refill
- skin color
- WOB
- vitals (RR, o2)
- pulmonary function tests
- ABGs
- chest x-ray, CT scan
how come it takes so much longer for respiratory effects to occur than GI effects for example
- these cells do not replicate as fast = less targeted by chemo = develops later
list 5 side effects on the cardio system from cancer treatment
- cardiotoxicity
- cardiomyopathy
- HF
- arrhythmias
- pericarditis/myocarditis
which chemo drug specifically has a impact on the cardio systen
- doxorubicin
describe cardio assessment for a patient receiving cancer treatment
- OPQRSTU
- inspect, palpate, auscultate the heart
- look at color, edema, cap refill
- pulses
- vitals
- EKG
- echocardiogram
list 2 oncologic emergencies
- superior vena cava syndrome
2. carotid artery rupture
what is superior vena cava syndrome? how can cancer cause this?
- syndrome where the superior vena cava is obstructed
- if a head or neck tumour gets large enough it can block it
list what type of symptoms you may see with superior vena cava syndrome
- increased intracranial pressure
- edema in eyes
- confusion
- headaches
- JVP distension
what is carotid artery rupture? what can this cause?
- radiation to the neck area causes erosion of the carotid artery
- this can cause hemorrhage
describe the difference between the characteristics of a normal lymph node, cancerous lymph node, adn infected lymph node
- normal = normal temp, not hard, movable, small, nontender
- cancerous = hard, fixated, nontender, large
- infected = warm, tender, enlarged
what is a lymphocyte
- type of WBC
describe the function of the spleen
- store healthy blood cells
- filters outs damaged blood cells, bacteria, and cell waste
what are lymph nodes
- small structures that work as filters for harmful substances
what is bone marrow
- this is where new blood cells are made
what are the tonsils
- collects of lymph tissue at the back of the throat
- they help make antibodies against germs that are breathed in or swallows
lymphoma is a ______ (descriptive word) cancer
- travelling cancer
why does weight loss occur with cancer/lymphoma?
- cachexia
- nutrient trapping
- decreased appetite
why does pallor occur with lymphoma
- anemia (due to BMS & increased destruction & decreased production of RBC)
why does bruising occur with cancer/lymphoma ?
- thrombocytopenia
why does fatigue occur with cancer/lymphoma
- nutritional deficit
- just the whole cancer process in general
why do night sweats occur with cancer (specifically lymphoma)?
- fever
- B symptoms
why do achy bones occur with lymphoma
- due to bone marrow infiltration
why does splenomegaly occur with lymphoma
- RBC are dying = increased demands on the spleen
why do swollen lympho nodes occur with lymphoma
- too many lymphocytes
the diagnostic test that involves taking several mult angle x-rays to form a 3D image is a _____
CT scan
what are the benefits of using a central line to administer chemo vs a regular IV? what are we trying to avoid?
- this will allow us to avoid extravasation
it is 7-14 days after treatment, you are most concerned about which 2 blood cells reaching their nadir?
- WBC
- platelets
what type of drug can we administer to help stimulate blood cell production
- hematopoietic drugs
