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NSB236 > Week 4: Cancer Care > Flashcards

Week 4: Cancer Care Flashcards

1
Q

What are common psychological issues in response to cancer?

A
  • Body image
  • Sexuality
  • Interpersonal problems
  • New relationships post diagnosis
  • Stress and adjustment reactions / severe emotional distress
  • Anxiety, depression, PTSD
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2
Q

What are common practical issues in response to cancer?

A
  • Cost
  • Reconstructive surgery
  • Lymphoedema
  • Travel and accommodation
  • Other support needs
  • Loss of income
  • Difficulties with business dealings
  • Legal issues related to advanced disease
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3
Q

What are common physical issues in response to cancer?

A
  • Nausea and Vomiting
  • Pain
  • Fatigue
  • Fertility
  • Lymphoedema
  • Disfigurement
  • Odour
  • Incontinence
  • Bowel dysfunction
  • Cognitive problems
  • Communication difficulties
  • Malnutrition
  • Respiratory symptoms
  • End of life concerns
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4
Q

What are the 1st possible clinical course of cancer?

A 
Suspicious symptoms 
Workup for cancer 
Diagnosis 
Primary treatment 
Adjuvant therapy 
Rehab
Disease free (no evidence)
Long-term survival / cure
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5
Q

What is the 2nd possible clinical course of cancer?

A 
Suspicious symptoms
Workup for cancer
Diagnosis
Adjuvant therapy
Rehab
Disease free (no evidence)
Recurrence or dissemination
Progressive disease
Palliative treatment
Terminal Illness
Death
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6
Q

What is the 3rd possible clinical course of cancer?

A 
Suspicious symptoms
Workup for cancer
Diagnosis
Adjuvant therapy
No rehabilitation possible
No disease free interval
Progressive disease
Palliative
Terminal illness
Death
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7
Q

What is the 4th possible clinical course of cancer?

A 
Suspicious symptoms
Workup for cancer
Diagnosis
No primary treatment possible
Palliative treatment
Terminal Illness
Death
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8
Q

What is the scope of the problem with cancer?

A

Cancer is a group of more than 200 disease characterized by unregulated growth of cells

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9
Q

In 2007 how many people were diagnosed with cancer in Australia?

A

108,368

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10
Q

How many of those diagnosed with cancer in 2007 were over the age of 60?

A

68%

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11
Q

Which groups are worse off ?

A

Indigenous
Those living in remote areas
Low socioeconomic status individuals

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12
Q

Cigarette smoking is estimated to have directly caused ___% new cases of cancer and __% deaths in 2005

A

11%

21%

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13
Q

Alcohol consumption is estimated to have directly causes __% of new cases of cancer and __% of deaths in 2005

A

3%

3.5%

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14
Q

Obesity is consistently associated with what cancers?

A

Adenocarcinoma of the oesophagus
Kidney Cancer
Colon Cancer (men)
Breast & endometrial cancer in post menopausal women.

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15
Q

T/F there is sufficient evidence associating obesity with prostate cancer

A

False

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16
Q

T/F preventative effects increase with increasing physical activity in terms of duration and intensity

A

True

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17
Q

About __% of all cancer is attributable to lifestyle or environmental factors and is thus potentially preventable

A

75%

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18
Q

What are examples of primary prevention of cancer?

A

Sun smart campaigns
Tobacco Control Programs
Healthy lifestyle programs

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19
Q

What are examples of secondary prevention of cancer?

A

Breast screening
Cervical screening
Bowel cancer screening

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20
Q

How is cancer characterized and how does it arise?

A

Cancer can arise from any cell of the body capable of evading regulatory controls.
Cancer is characterised by defective cellular proliferation (cell growth) and defective cellular differentiation (cell maturation).

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21
Q

What is the process of cancer development?

A

Initiation: chemical, radiation, viral, genetic
Promotion: dietary fat, obesity, smoking, alcohol, stress(?)
Progression: increased growth and invasiveness

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22
Q

What does the cell undergo throughout cancer?

A

Cells undergo a series of genetic mutations and/or alterations which result in their inability to respond normally to intracellular and/or extracellular signals that control proliferation, differentiation and ultimately death

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23
Q

What are 5 mechanisms / processes that the body utilizes ?

A
  1. Contact inhibition
  2. Apoptosis
  3. Immune response
  4. Proto-oncogenes regulate normal cell processes
  5. Tumour suppressor genes suppress growth
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24
Q

What can result from genetic alterations?

A

Genetic alterations can result from such factors as inherited gene mutations, chemical or radiation induced DNA damage, viruses or random errors during DNA synthesis

25
Q

What is metastasis?

A

It is the spread of cancer from initial or primary site to a distant site.

26
Q

What is the multistage process of cancer invasion?

A

Tumour angiogenesis
Mechanical invasions
Detaching and invading surrounding tissue and walls

27
Q

What are the 3 stages of cancer classification?

A

Anatomic site = tissue is identified by tissue of origin, anatomic sit, and behaviour of the tumour (carcinoma - tumours of skin and mucous membrane) (Sarcoma - tumours of connective tissue, bone) (Lymphoma/leukaemia - haematopoetic system)

Histologic analysis (grading)

Extent of disease (staging)

28
Q

What is the classification system for staging / grading the cancer?

A

Primary tumour (T) =

  • T0 no evidence of primary tumour
  • T1 carcinoma insitu
  • T2-T5 ascending degrees of increase in tumour size and involvement

Regional lymph nodes (N) =

  • N0 no evidence of disease in lymph nodes
  • N1-N4 ascending degrees of nodal involvement
  • NX regional lymph nodes unable to be assessed clinically

Distant Metastases =

  • M0 no evidence of distant metastases
  • M1-4 ascending degrees of metastatic involvement
29
Q

How is cancer diagnosed?

A
  • Cytology studies
  • Radiographic investigations (x-ray, mammogram, CT, MRI, PET, ultrasound, bone scan, isotope scans)
  • Endoscopy
  • Bone marrow aspiration
  • Surgery / biopsy
  • Blood studies (LFT, FBC)
  • Oncofetal antigens and other tumour markers
30
Q

What are the goals of cancer treatment?

A
  • Cure
  • Control
  • Palliate
31
Q

What are the options for cancer treatment?

A
  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Biotherapy and molecular targeted therapy
  • Haematopoetic stem cell transplantation
32
Q

What factors will influence treatment decisions?

A
  • Tumour factors
  • Treatment factors
  • Patient factors
33
Q

What is the basis for clinical trials?

A

They are designed with the intent of determining efficacy of new treatments

34
Q

What is the role of surgery in cancer?

A
  • Diagnosis and staging
  • Cur and / or control
  • Rehab
  • Supportive care
  • Palliation of symptoms
35
Q

What is the role of radiotherapy in cancer?

A
  • Radiation therapy is the use of ionising radiation to treat cancer
  • The absorption of irradiated energy in the tissues results in complex reactions affecting biochemical and molecular structures of the cells
  • Primary treatment for some cancer, adjuvant treatment for others
  • It’s used for cure, control or palliation of cancer
36
Q

What is adjuvant therapy?

A

Also known as add on therapy, it is therapy that is given in addition to the primary or initial therapy to maximise its effectiveness

37
Q

What equipment is used in radiotherapy?

A

Ionising radiation is formed using a linear accelerator.

Teletherapy (delivered externally from a distance)
Brachytherapy (administered internally close to the target)
Unsealed sources

38
Q

What are the principles of radiation safety?

A

As low as reasonable achievable principle.

  • Shielding
  • Time
  • Distance
39
Q

What are nursing considerations for radiotherapy?

A
  • Pt education and support

- Side effect management (early/late effects) = depends on treatment fields

40
Q

What are common side effects of radiation therapy?

A
  • Fatigue
  • Skin reactions (pruritis, erythema, dry desquamation, moist desquamation)
  • Anorexia
  • Mucositis
  • Nausea
  • Diarrhoea
41
Q

What are 3 irritations that commonly occur from radiotherapy?

A

Mechanical irritation
Thermal irritation
Chemical irritation

42
Q

What are intervention strategies to avoid irritations

A 
Mechanical = avoid tight clothing, rubbing
Thermal = avoid extreme temperatures
Chemical = avoid topical application containing metal or alcohol bases

General care strategies

43
Q

T/F chemotherapy is a systemic treatment

44
Q

What is the history of cancer chemotherapy?

A

It originated as a biological weapon (derived from mustard gas).
It led to the development of a number of single agent drugs and combination therapies.
It is used as a primary treatment (e.g. leukaemia) or as adjuvant treatment to treat micrometastases

45
Q

What is cell cycle specific drugs?

A

most effective against cells that are rapidly dividing; given in divided doses or continuous infusion

46
Q

What is cell cycle non specific drugs?

A

effective against large slow growing tumours; given as a bolus dose

47
Q

What is the benefit of endocrine therapies?

A

effective against hormone receptor positive cancers

48
Q

What is combination chemotherapy?

A

Use of several drugs with different mechanisms of action, times of onset of action and recovery, side effects and onset of side effects

49
Q

What are the priority interventions for patients receiving chemotherapy?

A
  • Pt assessment and monitoring factors
  • Calculation of dose and drug check procedures
  • Routes of administration (principles of vascular access)
  • Pt education
  • Preventing, identification and management of extravasation
  • Side effect management
  • Safe handling procedures
50
Q

Regarding safe handling, how can exposure occur?

A
  • inhalation of drug aerosols or droplets
  • absorption through direct contact with skin
  • ingestion through contact with contaminated food, food containers
51
Q

What are certain procedures required for?

A

Preparing, administering, disposing, transporting, cleaning up spills, handling excretions

52
Q

What are common chemotherapy side effects?

A
  • Neutropaenia
  • Thrombocytopaenia
  • Anaemia
  • Toxicities = cardiotoxicity, nephrotoxicity, pulmonary toxicity
  • Menopausal symptoms
  • Increased bone loss
53
Q

What are nursing interventions for neutropaenia?

A

Potential for sepsis - septic shock is an oncological emergency
Nursing actions = prevention and management

54
Q

What are nursing interventions for thrombocytopaenia?

A

Potential for spontaneous bleeding.

Nursing actions = prevention and management

55
Q

What is biotherapy and molecular targeted therapies?

A

Agents derived from biological sources, or agents or approaches that affect the body’s biological responses:

  • interferons and interleukins
  • Haemopoeitic growth factors (e.g. erythropoietin, GCSF)
  • Experimental vaccines

“Targeted therapies” - preferentially attack molecular flaws e.g. loss of tumour suppression; metastatic potential; angiogenesis; resistance to apoptosis:

  • Monoclonal antibodies
  • Tyrosine kinase inhibitors
  • Gene therapy
56
Q

What are biotherapy side effects and nursing interventions for cytokins?

A

Patient education and support.

Fatigue, flue like symptoms (chills / fever), bone pain (haemopoeitic growth factors)

57
Q

What are nursing interventions and biotherapy side effects of interleukins?

A

Patient education and support

  • Cardiovascular
  • Pulmonary
  • GI
  • Renal
  • Haematologic
  • Flu like symptoms
  • Hepatic
  • Integumentary
  • Neurologic
  • Psychosocial
58
Q

What are nursing interventions for biotherapy and molecular targeted therapies side effects?

A

Monoclonal antibodies:

  • Infusion reactions and hypersensitivity reactions
  • Cardiotoxicity
  • Bone marrow suppression (less)
  • Fatigue

Tyrosine kinase inhibitors

  • Skin eruptions
  • Diarrhoea, nausea, vomiting
59
Q

What are examples of transplantation?

A
  • Autologous
  • Allogeneic
  • BMT & PBSCT

NSB236 (5 decks)

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