Week 3; Cancer Care Flashcards
Malignant cells
BNORMAL, SERVE NO USEFUL FUNCTION, AND ARE
HARMFUL TO NORMAL BODY TISSUES. MALIGNANT TRANSFORMATION IS WHEN A NORMAL CELL CHANGES INTO A CANCER CELL.
CANCER REFERS TO
A GROUP OF COMPLEX DISEASES
WHOSE MANIFESTATIONS DEPEND ON THE AFFECTED
BODY SYSTEM AND THE TYPE OF CELLS INVOLVED.
Cancer cells often have these characteristics
1) ANAPLASIA – LOSS OF SPECIFIC APPEARANCE OF
THEIR PARENT CELLS, CANCER CELL BECOMES MORE
MALIGNANT, IT BECOMES SMALLER AND ROUNDED,
LOOK ALIKE UNDER A MICROSCOPE
2) LARGER NUCLEAR-CYTOPLASMIC RATIO - NUCLEUS
LARGER THAN NORMAL CELL
3) SPECIFIC FUNCTIONS LOST
4) LOOSE ADHERENCE – EASILY BREAK OFF FROM TUMOR
Migration of cancer cells
DO NOT BIND TIGHTLY TOGETHER, ALLOW HEM TO
SPREAD (METASTASIS). INVADE OTHER TISSUE CLOSE BY OR REMOTE FROM ORIGINAL SITE
Metasitasis
CELLS MUST PENETRATE BLOOD VESSELS TO SPREAD TO DISTANT ORGANS AND TISSUES. BLOODBORNE
METASTASIS IS THE MOST COMMON. CELLS ALSO TRAVEL THROUGH LYMPH TO INVADE OTHER TISSUES AND ORGANS. METASTASIS OCCURS WHEN CANCER CELLS MOVE FROM PRIMARY LOCATION BY BREAKING OFF FROM THE ORIGINAL GROUP AND ESTABLISHING IN REMOTE AREAS.
Breast cancer screening
SCREENING ANNUALLY AGE 45 OR EARLIER DEPENDING ON RISK. LIMITATIONS OF BREAST SELF-EXAM
s/s of breast cancer
BREAST LUMP OR THICKENING THAT FEELS DIFFERENT FROM THE SURROUNDING TISSUE, CHANGE IN THE SIZE, SHAPE OR APPEARANCE OF A BREAST, CHANGES TO THE SKIN OVER THE BREAST, SUCH AS DIMPLING, NEWLY INVERTED NIPPLE, PEELING, SCALING, CRUSTING OR FLAKING OF THE PIGMENTED AREA OF AREOLA OR BREAST SKIN, REDNESS OR PITTING OF THE SKIN OVER YOUR BREAST, LIKE THE SKIN OF AN ORANGE
PROSTATE AND TESTICULAR CANCER SCREENING
PSA TESTING, DIGITAL EXAM
PROSTATE AND TESTICULAR CANCER
ONE OF THE MOST COMMON TYPES OF CANCER. MANY PROSTATE CANCERS GROW SLOWLY AND ARE CONFINED TO THE PROSTATE GLAND, WHERE THEY
MAY NOT CAUSE SERIOUS HARM. SOME TYPES
GROW SLOWLY AND MAY NEED MINIMAL OR EVEN
NO TREATMENT, OTHER TYPES ARE AGGRESSIVE.
PROSTATE CANCER S/S
PROSTATE CANCER MAY CAUSE NO SIGNS OR SYMPTOMS IN ITS EARLY STAGES.
PROSTATE CANCER THAT’S MORE ADVANCED MAY CAUSE:
* TROUBLE URINATING
* DECREASED FORCE IN THE STREAM OF URINE
* BLOOD IN THE URINE
* BLOOD IN THE SEMEN
* BONE PAIN
* LOSING WEIGHT WITHOUT TRYING
* ERECTILE DYSFUNCTION
PANCREATIC CANCER DX
- BY SYMPTOM AND TESTING, NO SCREENING
- RADIOLOGY – CT, MRI, PET, ULTRASOUND
- BIOPSY
- CARCINOEMBRYONIC ANTIGEN (CEA) AND CA 19-9, ARE ELEVATED IN PEOPLE WITH PANCREATIC CANCER.
HOWEVER, BLOOD TESTS DON’T ALLOW FOR EARLY
DETECTION OF PANCREATIC CANCER, BECAUSE THESE
LEVELS MAY NOT RISE UNTIL PANCREATIC CANCER IS
ADVANCED, IF AT ALL.
PANCREATIC CANCER S/S
JAUNDICE. AS PANCREATIC CANCER BLOCKS DUCT THAT RELEASES BILE INTO THE INTESTINE (COMMON BILE DUCT), DARK URINE, LIGHT COLORED STOOLS, AND ITCHING, ABDOMINAL PAIN (CAUSE A DULL ACHE
IN THE UPPER ABDOMEN), BACK PAIN, BLOATING, EARLY FULLNESS WITH MEALS, AN UNCOMFORTABLE
SWELLING IN THE ABDOMEN, NAUSEA/VOMITING
COLON CANCER
GUIDELINES GENERALLY RECOMMEND THAT COLON CANCER SCREENINGS BEGIN AROUND 50. YOUR DOCTOR MAY RECOMMEND MORE FREQUENT OR EARLIER SCREENING IF YOU HAVE OTHER RISK FACTORS, SUCH AS A FAMILY HISTORY OF THE DISEASE.
S/S OF COLON CANCER
A PERSISTENT CHANGE IN YOUR BOWEL HABITS, INCLUDING DIARRHEA OR CONSTIPATION OR A CHANGE IN THE CONSISTENCY OF YOUR STOOL, RECTAL BLEEDING OR BLOOD IN YOUR STOOL, PERSISTENT ABDOMINAL DISCOMFORT, SUCH AS CRAMPS, GAS OR
PAIN, FEELING THAT YOUR BOWEL DOESN’T EMPTY COMPLETELY, WEAKNESS OR FATIGUE, UNEXPLAINED WEIGHT LOSS
Common sites of metastasis for breast cancer
BONE, LUNG, LIVER, BRAIN
Common sites of metastasis for lung cancer
BRAIN, BONE, LIVER, LYMPH NODES, PANCREAS
Common sites of metastasis for colorectal cancer
LIVER, LYMPH NODES, ADJACENT STRUCTURES
Common sites of metastasis for prostate cancer
BONE (ESP. SPINE AND LEGS) and PELVIC NODES
Cancer impacts physical function
- IMPAIRED IMMUNITY AND CLOTTING
- ALTERED GI FUNCTION
- ALTERED PERIPHERAL NERVE FUNCTION
- MOTOR AND SENSORY DEFICITS
- CANCER PAIN
- ALTERED RESPIRATORY AND CARDIAC FUNCTION
Cancer management
- SURGERY
- RADIATION
- CHEMOTHERAPY
- IMMUNOTHERAPY
- PHOTODYNAMIC THERAPY
- HORMONAL THERAPY
Surgery r/t cancer
- OLDEST FORM OF CANCER TREATMENT
- PROPHYLAXIS
- DIAGNOSIS
- CURE
- CONTROL
- PALLIATION
- ASSESSING THERAPY EFFECTIVENESS
- RECONSTRUCTION
Radiation therapy
PURPOSE—DESTROY CANCER CELLS WITH MINIMAL
DAMAGING EFFECTS OF SURROUNDING NORMAL CELLS; MAINTAIN SAFE ENVIRONMENT
* LOCAL TREATMENT
* IONIZING RADIATION
* EXPOSURE—AMOUNT OF RADIATION DELIVERED
* RADIATION DOSE—AMOUNT OF RADIATION ABSORBED
PART OF THE MULTIDISCIPLINARY
TEAM - DOSIMETRIST
- USE TREATMENT PLANNING SOFTWARE TO HELP THE
RADIATION ONCOLOGIST DEVELOP A TREATMENT PLAN - CONTOURS ARE CREATED FOR NORMAL TISSUES, SUCH AS THE LUNGS OR LIVER AND FOR TUMOR STRUCTURES AND OTHER AREAS AT RISK FOR HARBORING CANCER CELLS.
- CALCULATE THE DOSE OF RADIATION THAT WILL BE
DELIVERED TO THESE CONTOURED STRUCTURES TO MAKE SURE THAT THE TUMOR GETS ENOUGH RADIATION TO DESTROY IT WHILE SPARES THE NORMAL TISSUES. - THERE ARE GENERALLY ACCEPTED GUIDELINES (DOSE
CONSTRAINTS) FOR THE AMOUNT OF RADIATION THAT A PARTICULAR ORGAN CAN TOLERATE.
Role of oncology nurse r/t radiation
- WORK WITH THE RADIATION TEAM TO CARE FOR
PATIENTS DURING THE COURSE OF TREATMENT. - HELP EVALUATE THE PATIENT BEFORE TREATMENT
BEGINS. - EDUCATE HE PATIENT ABOUT POTENTIAL SIDE EFFECTS AND THEIR MANAGEMENT.
- DURING THE COURSE OF RADIATION TREATMENTS, THE NURSE MAY EVALUATE THE PATIENT WEEKLY OR MORE FREQUENTLY TO ASSESS PROBLEMS AND CONCERNS.
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
Interprofessional collaborative care
- PROVIDE ACCURATE INFORMATION
- DO NOT REMOVE TEMPORARY INK MARKINGS
- AVOID SKIN IRRITATION
- FOLLOW POLICY FOR SKIN CARE PRODUCT USE
- NUTRITIONAL SUPPORT
- CARE FOR XEROSTOMIA
- TEACH ABOUT RISK FOR FRACTURES
- FOR BONE EXPOSED TO RADIATION
- EXERCISE AND SLEEP INTERVENTIONS FOR FATIGUE
Teaching points
- HAVING RADIATION THERAPY SLIGHTLY INCREASES THE RISK OF DEVELOPING A SECOND CANCER. BUT FOR
MANY PEOPLE, RADIATION THERAPY ELIMINATES THE EXISTING CANCER. THIS BENEFIT IS GREATER THAN THE
SMALL RISK THAT THE TREATMENT COULD CAUSE A NEW CANCER IN THE FUTURE. - DURING EXTERNAL-BEAM RADIATION THERAPY, THE PATIENT DOES NOT BECOME RADIOACTIVE. AND THE
RADIATION REMAINS IN THE TREATMENT ROOM. - HOWEVER, INTERNAL RADIATION THERAPY CAUSES THE PATIENT TO GIVE OFF RADIATION. AS A RESULT,
VISITORS SHOULD FOLLOW THESE SAFETY MEASURES: - DO NOT VISIT THE PATIENT IF YOU ARE PREGNANT OR YOUNGER THAN 18.
- STAY AT LEAST 6 FEET FROM THE PATIENT’S BED.
- LIMIT YOUR STAY TO 30 MINUTES OR LESS EACH DAY.
- PERMANENT IMPLANTS REMAIN RADIOACTIVE AFTER THE PATIENT LEAVES THE HOSPITAL. BECAUSE OF THIS,
FOR 2 MONTHS, THE PATIENT SHOULD NOT HAVE CLOSE OR MORE THAN 5 MINUTES OF CONTACT WITH
CHILDREN OR PREGNANT WOMEN. - SIMILARLY, PEOPLE WHO HAVE HAD SYSTEMIC RADIATION THERAPY SHOULD USE SAFETY PRECAUTIONS. FOR
THE FIRST FEW DAYS AFTER TREATMENT, TAKE THESE SAFETY MEASURES: - WASH YOUR HANDS THOROUGHLY AFTER USING THE TOILET.
- USE SEPARATE UTENSILS AND TOWELS.
- DRINK PLENTY OF FLUIDS TO FLUSH THE REMAINING RADIOACTIVE MATERIAL FROM THE BODY.
- AVOID SEXUAL CONTACT.
- TRY TO AVOID CONTACT WITH INFANTS, CHILDREN
CYTOTOXIC SYSTEMIC THERAPY
- TREATMENT OF CANCER WITH CHEMICAL AGENTS
- USED TO CURE AND INCREASE SURVIVAL TIME
- ADJUVANT THERAPY = CHEMOTHERAPY + SURGERY OR
RADIATION - CYTOTOXIC EFFECTS EXERTED ON HEALTHY CELLS AND
CANCER CELLS
Drug treatment issues
- DOSAGE
- SCHEDULING
- ADMINISTRATION
- EXTRAVASATION
- VESICANTS
- VESICANT VS IRRITANT - NOT THE SAME
What is a vesicant?
- CAUSE BLISTERING AND TISSUE DAMAGE WHEN LEAKAGE OUTSIDE THE VEIN
- CAN BE SEVERE LEADING TO NECROSIS
Vesicant intervention
- INTERVENTIONS – SOME HAVE ANTIDOTES (FOR CISPLATIN)
- D/C IMMEDIATELY, REMOVE FLUID FROM VEIN, APPLY COLD OR WARM DEPENDING ON DRUG AND MD ORDER, REMOVE PRESSURE, ELEVATE LIMB, MARK/CIRCLE AREA WITH PEN TO MONITOR IF GETTING LARGER
- PREVENTION IS A VASCULAR ACCESS DEVICE (PORT
Examples of vesicant drugs
CHEMO SUCH AS DOXORUBICIN, VINCRISTINE, DIGOXIN, HYDROXYZINE, PROMETHAZINE (IV NOT PREFERRED METHOD OF ADMINISTRATION)
Extravisation most important nursing intervention
Prevention
CARE FOR EXTRAVASATION
- INTERVENTIONS – SOME HAVE ANTIDOTES (FOR
CISPLATIN) - EARLY INTERVENTION AND ASSESSMENT IMPORTANT
- OBSERVE FOR C/O BURNING, SWELLING, BLISTERING,
DISCOLORATION - D/C IMMEDIATELY, REMOVE FLUID FROM VEIN (10 ML),
APPLY COLD OR WARM DEPENDING ON DRUG AND MD
ORDER, REMOVE PRESSURE, ELEVATE LIMB,
MARK/CIRCLE AREA WITH PEN TO MONITOR IF GETTING
LARGER - ASSESS FOR INFECTION OR PROGRESSION
- PREVENTION IS A VASCULAR ACCESS DEVICE (PORT)
Extravasation
The leakage of blood, lymph, or other fluid, such as an anticancer drug, from a blood vessel or tube into the tissue around it. It is also used to describe the movement of cells out of a blood vessel into tissue during inflammation or metastasis (the spread of cancer).
SIDE EFFECTS OF CHEMOTHERAPY
- INFECTION RISK
- BONE MARROW SUPPRESSION
- NEUTROPENIA
- ANEMIA, THROMBOCYTOPENIA RISK
- BONE MARROW SUPPRESSION
- IMPAIRED CLOTTING
- CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CINV)
- MUCOSITIS
- ALOPECIA
- COGNITIVE CHANGES
- CHEMOTHERAPY-INDUCED PERIPHERAL NEUROPATHY
(CIPN) - LOWERED IMMUNE SYSTEM, RISK FOR INFECTION
HORMONAL MANIPULATION
- CHANGING USUAL HORMONE RESPONSES
- SOME HORMONES MAKE HORMONE-SENSITIVE TUMORS
GROW MORE RAPIDLY - DECREASING THE HORMONE AMOUNTS TO HORMONE-
SENSITIVE TUMORS CAN SLOW CANCER GROWTH RATE - STEROIDS, STEROID ANALOGUES, ENZYME INHIBITORS
PHOTODYNAMIC THERAPY
- SELECTIVE DESTRUCTION OF CANCER CELLS VIA
CHEMICAL REACTION TRIGGERED BY TYPES OF LIGHT
SIDE EFFECTS OF HORMONE THERAPY
- MASCULINIZING EFFECTS IN WOMEN
- FEMINIZING EFFECTS IN MEN (GYNECOMASTIA)
- FLUID RETENTION
- ACNE
- HYPERCALCEMIA
- LIVER DYSFUNCTION
- VENOUS THROMBOEMBOLISM
ONCOLOGIC EMERGENCIES
- SEPSIS (SEPTICEMIA)
- INTRAVASCULAR COAGULATION
- SIADH – SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE, CAUSE INCREASED WATER RETENTION AND FLUID AND ELECTROLYTE IMBALANCE (HYPONATREMIA)
- SPINAL CORD COMPRESSION
- HYPERCALCEMIA- NUMBER OF REASONS BUT PRIMARILY METASTASIS OR BONE RESORPTION. RESORPTION OF BONE TISSUE OCCURS WHEN OSTEOCLASTS BREAK DOWN THE TISSUE IN BONES AND RELEASE CALCIUM FROM BONE TISSUE TO THE BLOOD.
- SUPERIOR VENA CAVA SYNDROME (SVC)
*TLS
*AKI
*DIC
TUMOR LYSIS SYNDROME -
HYPERKALEMIA, HYPERPHOSPHATEMIA, HYPOCALCEMIA, LACTIC ACIDOSIS, HYPERURICEMIA, AZOTEMIA, SIMILAR TO RHABDOMYOLYSIS
SVC SYNDROME
- CONGESTION OF BLOOD CAUSED BY COMPRESSION
- DEVELOPMENT OF COLLATERAL CIRCULATION
- CAN BE PAINFUL AND LIFE THREATENING
- EARLY SIGNS ARE EDEMA OF THE FACE
- AS COMPRESSION WORSENS, ENGORGEMENT
- COMPRESSION MUST BE RELIEVED
- FIBRINOLYTIC DRUG TO REDUCE CLOT, CHEMO OR RADIATION TO
REDUCE TUMOR - SURGERY FOR THIS IS RARE.
- STENT CAN BE PLACED IN THE VENA CAVA BY INTERVENTIONAL
RADIOLOGY
