Week 4-6 Flashcards
1
Q
Presenting Symptoms
A
- Weight loss
- Persistent pain
- Indigestion
- Difficulty swallowing
- Change in bowel and/or bladder habits
- Change is skin lesion (wart/mole)
- A sore that doesn’t heal
- Fatigue
- Unexplained fever
- Painless lump
- Unusual bleeding or discharge
2
Q
Constitutional Symptoms
A
- Fevers
- Weight loss
- Night sweats
- Fatigue
- Myalgias
- Anorexia (N/V)
3
Q
Patient Assessment
A
Past medical history (PMHx)
Family history (FHx)
Risk factors
Physical exam
Patient’s expectations
Beliefs/social/emotional /spiritual
Ongoing assessment
4
Q
Lab Testing
A
- CBC
- Liver & kidney function test
- Blood chemistry
- Urinalysis
- Fecal occult blood
- Tumour markers
5
Q
Imaging
A
- X-ray
- Fluoroscopy
- CT
- MRI
- PET scan
- US
- Nuclear medicine
6
Q
Biopsy
A
- Provides histological tissue analysis
- Suspicious area seen on imaging
7
Q
Fine Needle Aspiration (FNA)
A
- Fine needle/syringe
- Radiological guidance may be required
8
Q
Core Biopsy
A
- Larger sample
- Extracts core of tissue
9
Q
Surgical Biopsy
A
- Larger amount of tissue
- Incisional or excisional
10
Q
ECOG Performance Status
A
0 - no restriction
1 - light/sedentary work
2 - 50% able
3 - limited
4 - completely disabled
5 - dead
11
Q
Treatment Goals
A
- Cure - complete eradication
- Control - prolonged survival
- Relief of symptoms - palliation
12
Q
Primary Surgery
A
Local or wide excision
13
Q
Prophylactic Surgery
A
Risk reduction surgery
14
Q
Palliative Surgery
A
Relieve cancer complications & promote QOL
15
Q
Reconstructive Surgery
A
May follow curative surgery to improve function/obtain improved cosmetic effect
16
Q
Staging Surgery
A
- Lymph node assessment
- Sentinel node biopsy
17
Q
Systemic Drug Therapy MOA
A
- Causing lethal toxicity or apoptosis
- Attacking DNA, interfere with cell division or metabolism
- Target rapidly dividing cells – normal cells can be affected
18
Q
Neo-adjuvant Chemo
A
Treat/shrink cancer before surgery and/or radiation
19
Q
Adjuvant Chemo
A
After surgery/radiation
20
Q
Maintenance Chemo
A
Given in low doses to prolong remission
21
Q
Palliative Chemo
A
For symptoms to improve QOL not reduce cancer
22
Q
Antimetabolites
A
Interfere with synthesis of DNA in S phase
23
Q
Antitumour Antibiotics
A
Act at DNA level across cell cycle
24
Q
Alkylating Agents
A
- Act at DNA level across cell cycle
- Block DNA replication
25
Microtubule Inhibitors
Inhibit formation of mitotic spindle in M phase
26
Platinum Agents
- Act similarly to alkylating agents
- Block DNA replication across cell cycle
27
Radiation Uses
- Cure cancer
- Control disease – when tumour can’t be removed
- Neoadjuvant therapy – with or w/o chemo to shrink tumour prior to surgery
- Prophylaxis – prevent spread
- Palliative – relieve symptoms of metastatic disease
28
Topoisomerase Inhibitors
Inhibit DNA synthesis in S phase
29
Intrathecal Admin
Subarachnoid space into CSF vis lumbar puncture
30
Subc & IM Admin
- Tissue damage
- Biologicals via SC
31
Inta-Arterial Admin
High concentration to artery supplying tumour blood
32
Topical Admin
Skin cancers
33
Oral Admin
- Increased use
- Less complications
- Improved QOL
34
Radiation Delivery
- Most tissues sensitive to radiation
- External beam most common
- Internal (brachytherapy) high dose to localized areas
35
Radiation S/E
- Rapidly dividing cells more radiosensitive
- Toxicity localized to area of radiation
36
Radiation Fractions
- Allows time for normal cells to repair
- Catch cells at different times
- Palliative radiation an exception to small dosing
37
Radiation Dermatitis & Fibrosis
- Damage of healthy cells
- Develops in up to 95% of people getting radiation
- Can occur in any tissue
- 4-12 months after treatment
38
Normal Cells Damaged by Chemo
Hair follicles
Bone marrow – blood-forming cells – RBCs, WBCs, platelets
GI tract
Reproductive system
Others – heart, lungs, bladder, kidneys, CNS
39
Chemo Complications
Hypersensitivity reactions and anaphylaxis
Tumour lysis syndrome
Sepsis
Pulmonary toxicity (e.g. pulmonary fibrosis with certain chemo drug classes)
Cardiomyopathy (anthracyclines)
Neurotoxicity
Ototoxicity (tinnitus and hearing loss with cisplatin)
Nephrotoxicity
Hepatotoxicity (with certain chemo drug classes)
Secondary cancers
Cognitive dysfunction
Extravasation
40
CINV
- Affects 70-80% of patients
- Typically associated with systemic chemo
41
CINV Management
- Depends of emetogenic potential of chemo drug
- Antiemetic prophylaxis when risk below 10%
42
Antiemetic Prophylaxis
- Corticosteroids
- Serotonin blockers
- Sedatives
- Antiemetics
- Used in combo prior to chem & given for first week after chemo - delayed nausea
43
CINV Non-Pharm
- Small frequent meals, bland foods, fluids, ginger
- Relaxation techniques
- Dietitian referral
44
Oral Mucositis
- Rapid turnover of epithelium lining oral cavity
- Entire GI tract susceptible - diarrhea
- Most chemo agents can cause
- Onset shortly after chemo - peak 7 days
- Interferes with eating, swallowing, speech
- Causes pain & discomfort
45
Non-Pharm Oral Mucositis
- 8-12 cups fluid daily
- Avoid spicy foods, smoking, alcohol
- Complete dental work prior to starting chemo
- Soft toothbrush
- Ice chips
46
Pharm Oral Mucositis
- Mouth rinses
- Topical lidocaine
- Avoid alcohol mouthwashes
47
Diarrhea
- Rule out other causes
- Detailed assessment
- Mild dietary changes - avoid milk, alcohol spices
- Increase clear fluid
- Loperamide/octreotide
48
Loperamide
- Decrease GI motility
- Slows transit time
49
Octreotide
- Decrease GI motility
- GI hormone secretion
50
Myelosuppression
- Bone marrow function depressed
- Causes by many chemo drugs
51
Neutropenia
- Absolute neutrophil count (ANC) less than 1.9 x 10^9/L
- Febrile neutropenia - oncological emergency
52
Peripheral Neuopathy
- Systemic chemotherapies damage nerves in extremities
- Sock & glove distribution
- Dose-dependent
53
Cancer Related Cognitive Impairment (CRCI)
- Deficits in attention, concertation, memory, processing speed
- Reported in patients treated for non CNS cancers
- Role of psychological response to cancer diagnosis
54
Alopecia
- 7-10 days post chemo
- Not all chemo agents cause hair loss
- Regrowth 1-3months after chemo finishes
- 6-12 months to grow back - different colour/texture possible
- Should return to normal over time
55
Secondary Cancers
- Some chemo agents associated with developing 2nd cancer
- Blood cancers most common
- Highest risk 5-10 years after treatment
- Second cancers now 15-20% of all cancers
56
Nociceptive Pain
- Direct activation of nociceptors
- Peripheral somatosensory nervous system
57
Neuropathic Pain
Occurs with abnormally functioning somatosensory nervous system
58
Disease Pathway Management Program
- Disease site approach to cancer care
- Looks across the entire cancer continuum for a specific disease site (vs. points of care
- Establishes priorities, plans services to improve cancer care in Ontario
- Evidence pathway maps developed with experts, advisory functions
- Best practice promoted
59
9 Cancer Groups (Disease sites)
Breast
CNS
GI
GU
Gynecologic
Hematologic
Thoracic
Skin
60
CIHC Framework
- Role classification
- Team functioning
- Interprofessional conflict resolution
- Collaborative leadership
61
Interdisciplinary Teamwork (ITW) Dimensions
Prompt access to care
Quality of patient-professional communication
Person-centred response
Continuity of care
Quality of the care environment
Results of care
62
Compassion Fatigue
- All healthcare workers at risk
- Accumulates over time
- Occupational stress and emotional demands exceed capacity to respond
63
Compassion Fatigue Outcomes
- Unable to nurture or empathize with person in their care
- Patient dissatisfaction
- Increased risks to patient safety
- Reduced productivity
- More sick days
- Increased staff turnover
- Negative impact on workplace culture/professional relationships
