Week 1 (exam 1) Flashcards
Disease process of cancer
Some type of carcinogen causes a cell to become abnormal. the initial genetically altered cell forms a clone and begins to proliferate abnormally, evading normal intracellular and extracellular growth-regulating processes
Viruses that can cause cancer (and what type they cause)
Hepatitis B (liver cancer)
HPV (cervical cancer)
Epstein Bar (Burkett lymphoma and nasopharyngeal cancer)
Mono
Bacteria that can cause cancer (and what kind they cause)
Helicobacter pylori (stomach cancer)
Salmonella (colon cancer)
Chlamydia trachomatis (ovarian and cervical cancer)
3 step of carcinogenesis
Initiation: carcinogens cause mutations in cellular DNA
Promotion: repeated exposure of carcinogen causes proliferation and expansion of initiated cells
Progression: the altered cells exhibit increasingly malignant behavior, they acquire the ability to stimulate angiogenesis
Malignant cell characteristics
cells bear very little resemblance to the surrounding tissue, they infiltrate surrounding tissue, rate of growth depends on the differentiation, the more anaplastic the tumor the faster it grows. These cells also cause generalized weakness and tissue damage.
Different ways that cancer cells spread
Lymphatic spread
Hematogenous spread
Angiogenesis
Invasion
Primary prevention
concerned with reducing cancer risk in healthy people
Secondary prevention
detection, screening to achieve early diagnosis, intervention
Tertiary prevention of cancer
monitoring for and preventing recurrence of the primary cancer as well as screening for the development of second malignancies in cancer survivors
How is cancer diagnosed
- blood work
- Imaging (ultrasound, CT, MRI)
- Biopsies
- tissue scraping
- surgical excision
- body fluids such as urine
- PET scan
steps to diagnosing cancer
(1) determine the presence and extent of cancer
(2) identify possible disease metastasis
(3) evaluate the function of involved and uninvolved body systems and organs
(4) obtain tissue and cells for analysis, including evaluation of tumor stage and grade.
Tumor staging and grading
this is done prior to treatment to provide a baseline for evaluating the outcomes of therapy
Staging and Grading definition
Staging describes the size of the tumor and Grading is the classification (how abnormal the cancer cells look compared to the normal tissue cells) of tumor cells
Grading is on a scale of 1-4 , the higher the grade the worse it is
TNM classification system
T- The extent of the primary tumor
N- The absence or presence and extent of regional lymph nodes metastasis
M- The absence or presence of distance metastasis
Disease process of cancer
Some type of carcinogen causes a cell to become abnormal. the initial genetically altered cell forms a clone and begins to proliferate abnormally, evading normal intracellular and extracellular growth-regulating processes
Viruses that can cause cancer (and what type they cause)
Hepatitis B (liver cancer)
HPV (cervical cancer)
Epstein Bar (Burkett lymphoma and nasopharyngeal cancer)
Mono
Bacteria that can cause cancer (and what kind they cause)
Helicobacter pylori (stomach cancer)
Salmonella (colon cancer)
Chlamydia trachomatis (ovarian and cervical cancer)
3 step of carcinogenesis
Initiation: carcinogens cause mutations in cellular DNA
Promotion: repeated exposure of carcinogen causes proliferation and expansion of initiated cells
Progression: the altered cells exhibit increasingly malignant behavior, they acquire the ability to stimulate angiogenesis
Malignant cell characteristics
cells bear very little resemblance to the surrounding tissue, they infiltrate surrounding tissue, rate of growth depends on the differentiation, the more anaplastic the tumor the faster it grows. These cells also cause generalized weakness and tissue damage.
Primary prevention
concerned with reducing cancer risk in healthy people
Secondary prevention
detection, screening to achieve early diagnosis, intervention
Tertiary prevention of cancer
monitoring for and preventing recurrence of the primary cancer as well as screening for the development of second malignancies in cancer survivors
How is cancer diagnosed
- blood work
- Imaging (ultrasound, CT, MRI)
- Biopsies
- tissue scraping
- surgical excision
- body fluids such as urine
- PET scan
steps to diagnosing cancer
(1) determine the presence and extent of cancer
(2) identify possible disease metastasis
(3) evaluate the function of involved and uninvolved body systems and organs
(4) obtain tissue and cells for analysis, including evaluation of tumor stage and grade
Tumor staging and grading
this is done prior to treatment to provide a baseline for evaluating the outcomes of therapy
Staging and Grading definition
Staging describes the size of the tumor and Grading is the classification of tumor cells
Grading is on a scale of 1-4 , the higher the grade the worse it is
TNM classification system
T- The extent of the primary tumor
N- The absence or presence and extent of regional lymph nodes metastasis
M- The absence or presence of distance metastasis
Primary tumor (T)
Tx - Primary tumor can not be assessed
T0 - No evidence of primary tumor
T- Carcinoma in situ (in the place where it originally formed)
T1, T2, T3, T4 increasing size or local extent of the primary tumor
Regional Lymph Nodes (N)
Nx - Regional lymph nodes cannot be assessed
N0- No regional lymph node metastasis
N1, N2, N3 increasing involvement of regional lymph nodes
Distant Metastasis (M)
Mx - Distant metastasis cannot be assessed
M0- No distant metastasis
M1- Distant metastasis
Incisional biopsy is performed…
if the tumor mass is too large to be removed. in this case a wedge of tissue from the tumor is removed for analysis.
negative biopsies do not guarantee the absence of cancer
Needle biopsy is performed to…
sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney
these are most often performed on an out pt basis
Chemo effects on psychosocial/emotions
- brain fog
- depression
- anxiety/fear (anticipatory nausea)
- guilt
- shock/overwhelmed
- fear of the unknown
-hopelessness - new found dependency
Chemo effects on the hematologic system
- myelosupression
- neutropenia (increased risk of infection - they will need to go on neutropenic precautions)
- thrombocytopenia - increased risk of bleeding (eliminate fall risk, use soft bristle tooth brush, electric razor)
- anemia - fatigue, impaired O2 exchange
Chemo effects on the respiratory system
- dyspnea
- impaired perfusion
- inflammation
- decreased SpO2
- dry cough
- lung wheezes or crackles (pulmonary edema)
- chest pain
- pneumonia
- fatigue
- coughing up blood
Chemo effects on the Integumentary system
- sunlight sensitivity
- skin peeling or rash
- alopecia
- blisters
- skin thickens
radiation effects on the integumentary system
skin can be…
dry, peeling, red, itchy
sores may develop
may look sunburnt
swollen or puffy skin
Chemo effects on the GI system
- N/V
- diarrhea
- taste changes
- nutritional deficiencies
- fluid and electrolyte imbalances (due to vomiting and diarrhea)
- stomatitis
How to treat/improve the chemo effects on the GI system
- encourage small frequent meals
- give antiemetics
- oral care
- probiotics
- give fluids and electrolytes
Superior Vena Cava Syndrome
the obstruction of the SVC thus preventing blood flow
Signs and Symptoms of superior vena cava syndrome
- SOB
- nagging cough
- upper edema
- JVD
Causes of Superior Vena Cava Syndrome
- Lung cancer
- Bronchogenic carcinoma
- Lymphoma
Treatment of Superior Vena Cava syndrome
- stent placement
- anticoagulants
- chemo therapy
- endovascular therapy
- radiation therapy
basically get rid of tumor
What is tumor lysis syndrome?
Occurs when tumor cells break apart and release contents into the blood stream causing and imbalance of electrolytes
Symptoms of tumor lysis syndrome
- decreased urine output
- increased HR
- confusion
- numbness
- tingling
Spinal Cord Compression
When pressure is applied to the spinal cord preventing nerves from working properly
Treatment of tumor Lysis syndrome
- Agressive IV hydration
- Uric acid management (allopurinol, rasburicase)
- Electrolyte management
- Dialysis (in severe cases)
Causes of spinal cord compression
- bone fragments
- tumors
- abscesses
cancers that can cause it - breast
- lung
- prostate
- lymphoma
Symptoms of spinal cord compression
- back and neck pain, that worsens when laying down
- bladder/bowl dysfunction
- local inflammation
- edema
- venous stasis
- impaired blood supply to nerve tissues
Treatment of Spinal cord compression
Doxorubicin
the most harmful chemo to the heart
Cardiotoxicity symptoms
- increased BP
- signs and symptoms of HF
- abnormal heart rhythms
- chest pain/pressure
- edema
- SOB
- dizziness
- QT prolongation
this will increase your risk of blood clots, MI, and CVAs
Treatment of Cardiotoxicity
- diuretics
- cardiac meds
Hypercalcemia is most often seen in
bone cancer and possibly in tumor lysis syndrome
it is important to know if this pt has heart failure
Hypercalcemia symptoms
- N/V
- bone pain
- weakness
- fatigue
Treatment of hypercalcemia
- give fluids to dilute Ca levels
careful not to overload pt with fluids especially if they have a hx of heart failure - Biophosphanates
- Calcitonin
External Bean Radiation Therapy
radiation delivered in small doses over several weeks, aims radiation, right at targeted area rather than the whole body
Brachytherapy
Internal radiation both low dose and high dose
Low dose
Typically with gynelogil cancers
- in patient
- providers need to be wearing protective equipment
- no pregnant visitors
- bed rest - log roll pts
- remains in place for 72 hours
- low fiber diet - we do not want them straining to have a BM
High Dose
Seen most often with prostate cancer
- hooked up to a bunch of rods
- takes 15 min
- Pt is not admitting any radiation after the 15 min
- side effects of radiation often are determined by where the radiation is delivered
anyone around radiation should wear dosimeter
Chemotherapy
agents used to destroy tumor cells by interfering with cellular function replication
either kills cell or kills the cell at a certain point in the cell cycle
Effects of chemo on the renal system
chemotherapy agents can cause renal dysfunction by damaging the blood vessels or filtering structures of the kidneys. Damage to the kindneys can also lead to SIADH.
nursing management in chemotherapy
assess…
- fluid and electrolyte status (serum levels, HR, I’s and O’s
- cognitive status
- for signs of bleeding
- IV site if chemo is being given through IV
modify risks for infection, such as
- neutropenic precautions
when starting chemo…
2 nurses check bag, dose, and hang chemo bag together
Hypersensitivity reactions with chemo
may occur within 5min to 6 hrs of infusion or may not occur until infusion is complete. Most hypersensitivity reaction come with repeated exposure to chemo
- life threatening
give medications before chemo administration such as steroids, antihistamines, Tylenol, or IV benadryl
types of stem cell transplantation
Allogeneic HSCT (AlloHSCT): From a donor other than the patient
Autologous: From the patient
Syngeneic: From an identical twin
Allogeneic HSCT (AlloHSCT) is primarily used for…
Diseases of the bone marrow and is dependent on if they are able to find a donor that is a match
Autologous HSCT (AuHSCT) is considered for…
Patients with disease of the bone marrow who do not have a suitable donor for AlloHSCT
Syngeneic transplants result in…
less incidence of GVHD and graft rejection; however, there is also less graft-versus-tumor effect to fight the malignancy. For this reason, even when an identical twin is available for marrow donation, another matched sibling or even an unrelated donor may be the most suitable donor to combat an aggressive malignancy
Graft-Versus-Host disease
Occurs when the donor lymphocytes initiate an immune response against the recipient’s tissues, such as skin, GI system, or liver
Cancer management (Infection)
Common sites of infection, such as the pharynx, skin, perianal area, urinary, and respiratory tracts, are assessed on a regular basis. The nurse also monitors laboratory studies to detect early changes in WBC counts and inititates neutropenic precautions as needed.
Cancer management (Septic Shock)
Cancer management (Bleeding hemorrhage)
fall precautions
Radiation
Used with or without chemo is used to decrease the size of the tumor so it can be surgically removed.
Hypersensitivity reactions symptoms
rash, urticaria, fever, hypotension, cardiac instability, dyspnea, wheezing, throat tightness, and syncope
Thrombocytopenia is defined as a platelet count of
less than 100,000/mm3
