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NUSC 2P14 > Week 6: Cancer Care > Flashcards

Week 6: Cancer Care Flashcards

1
Q

Cancer Stats

A

-Cancer is a group of more than 200 diseases characterized by uncontrolled and unregulated growth of cells
-Occurs in people of all ages and ethnicities
-Lung cancer remains the leading cause of premature death from cancer
-Pancreatic cancer expected to be the 3rd leading cause of cancer death
-Female breast cancer death rates dropped 48% since 1986

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2
Q

Cancer Risk Factors

A

Modifiable risk factors, within the client’s control, include:
-Tobacco use
-Sun exposure
-Excessive body weight
-Lack of physical activity
-Unhealthy eating habits
-Alcohol consumption
*If these lifestyle factors were modified, the rates of cancers and other chronic diseases would be reduced

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3
Q

Defective Cellular Proliferation (growth)

A

-Mutated stem cells are viewed as the origin of cancer development
-Cell division is dysregulated and haphazard
-Proliferation of cancer cells is indiscriminate and continuous
-Cancer cells breach cellular boundaries and will grow on top of one another, and also on top of normal cells

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4
Q

Defective Cellular Differentiation

A

Normal genes important for regulating cellular processes can be affected by mutations:
-Proto-oncogenes: promote growth but can be activated to function as oncogenes (tumour-inducing genes)
-Tumour suppressor genes: suppress growth, but can be rendered inactive, which results in a loss of their tumour suppressor ability

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5
Q

Cancer Tumours

A

Tumours can be classified as benign or malignant
-Benign neoplasms are well-differentiated, and remain confined to its original location
-Malignant neoplasms are undifferentiated, and cells are able to invade and metastasize

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6
Q

Cancer Development

A

-Cancer development is an orderly process comprising several stages and occuring over a period of time

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7
Q

Three stages in the development of cancer

A

1.) Initiation
2.) Promotion
3.) Progression

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8
Q

Cancer Development- Initiation

A

-Mutation of cell’s genetic structure resulting from an inherited mutation
(error in DNA replication from exposure to carcinogen)
-Mutated cell has the potential to develop into close of neoplastic cells
(once initiated, mutation is irreversible, not all mutated cells form a tumour)
-Mutated cells become tumours only when they establish the ability to self-replicate and grow

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9
Q

Cancer Development- Promotion

A

-Characterized by the reversible proliferation of the altered cells
-An important distinction between initiation and promotion is the activity of promoters is reversible, which is a key concept in cancer prevention
-Dietary fat, obesity, smoking, alcohol consumption are promoters

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10
Q

Cancer Development- Latency Period

A

-Time between initiation and clinical evidence of cancer
-May range from 1 to 40 years
-Clinically evident = tumour must reach a critical mass
-1.0cm tumour contains 1 billion cancer cells (detectable by palpation)
-0.5cm tumour is the smallest that can be detected by MRI

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11
Q

Cancer Development- Progression

A

Characterized by:
-Increased growth rate of the tumour
-Increased invasiveness
-Spread of cancer to a distant site (metastasis)
Metastasis is a multistep process beginning with the rapid growth of the primary tumour
-Develops its own blood supply crucial to its own survival and growth
-Forms blood vessels within the tumour- tumour angiogenesis
-As the tumour grows, it begins to mechanically invade surrounding tissues, growing into areas of least resistance
-Cells detached from the primary tumour invade lymph nodes and vascular vessels to travel to distant sites
-Surviving tumour cells must create an environment conducive to growth and development

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12
Q

Cancer- Classification

A

Tumours can be classified by:
-Anatomical site
-Histological analysis
-Extent of disease
Classification systems provide a standardized way to:
-Communicate the cancer status of a patient to the health care team
-Assist in determining the most effective treatment plan
-Evaluate the treatment plan
-Help determine the prognosis
-Compare patients with similar conditions for statistical purposes

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13
Q

Cancer Classification- Anatomical Site

A

Identified by tissue of origin, site and behaviour
-Carcinomas
-Sarcomas
-Lymphomas and leukemias (originate in the bone marrow)

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14
Q

Cancer Classification- Histological Analysis

A

-Appearance of cells and degree of differentiation are evaluated
-Determines how closely cells resemble tissue of origin
-Four grades of abnormal cells

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15
Q

Grade I

A

Cells differ slightly from normal cells (mild dysplasia) and are well differentiated

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16
Q

Grade II

A

Cells are more abnormal (moderate dysplasia) and moderately differentiated

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17
Q

Grade III

A

Cells are very abnormal (severe dysplasia) and poorly differentiated

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18
Q

Grade IV

A

-Cells are immature and primitive and undifferentiated
-Cell of origin is difficult to determine

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19
Q

Cancer Classification- Extent of Disease

A

-Classifying the extent and spread of disease is termed staging
-Based on a description of the extent of the disease rather than on cell appearance
-The extent to which the disease has spread has ramifications for prognosis and determines the most effective treatment plan

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20
Q

Stage 0

A

-Carcinoma in situ
-Lesion of cancer cells without the invasion

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21
Q

Stage I

A

Tumour limited to tissue of origin; localized tumour growth

22
Q

Stage II

A

Limited local spread

23
Q

Stage III

A

Extensive local and regional spread

24
Q

Stage IV

A

Metastasis (aka mets)

25
Q

Cancer TNM Classification System

A

-Another staging classification of solid tumours
-Extent of the disease process of cancer based on three parameters:
Tumour size (T#)
Degree of spread to lymph nodes (N#)
Metastasis (M#)
-TNM staging cannot be applied to all malignancies
-The leukemias are not solid tumours and therefore cannot be staged by using these guidelines

26
Q

Cancer- Prevention and Detection

A

-Avoid or reduce exposure to carcinogens
-Eat a balanced diet
-Physical activity regularly (30 mins 5x/wk)
-Maintain a healthy weight
-Limit alcohol to 1-2 drinks/day
-Learn and practice self-examination
-Follow cancer screening guidelines for early detection
-Know the seven warning signs of cancer

27
Q

Seven Warning Signs

A

-Change in bowel or bladder habits
-A sore that does not heal
-Unusual bleeding or discharge from any body surface
-Thickening or a lump in the breast or elsewhere
-Indigestion or difficulty in swallowing
-Obvious change in a wart or mole
-Nagging cough or hoarseness

28
Q

Diagnosis of Cancer

A

-It is a stressful time for the client and family
-May undergo several days to weeks of diagnostic studies
-Fear of the unknown is more stressful than the actual diagnosis of cancer
During this time of high anxiety, the client needs:
-Repetition & reinforcement of information
-The opportunity to ask questions
-Clarification of the diagnostic workup
Client may experience fear and anxiety, the nurse should:
-Give clear and explanations tailored to the clients and family’s needs
-Be sensitive to the client’s ability to absorb the information
-Give written information for reinforcement: be mindful of literacy level and clear language

29
Q

Cancer Diagnostics

A

Biopsy is the definitive means of diagnosing cancer and involves histological examination of a piece of tissue by a pathologist
Tissue may be obtained by:
-Needle or aspiration: large bore needle into the tissue
-Incisional procedure: removes only a small part of the lump with a scalpel or dermal punch
-Excisional procedure: removes the entire tumour (small) or abnormal area where the margin is clear (lesions, polyps, breast lumps)

30
Q

Cancer- Diagnostics

A

-Health history: chief complaint, family hx
-Identification of risk factors
-Physical examination
-Specific diagnostic studies depend on site of cancer

31
Q

Cancer Treatment- Goals

A

Factors determining approach contingent on cancer type, location, size and stage

32
Q

Cancer Treatment- Goals (Cure)

A

-Treatment that eradicates the disease
-Induce permanent remission
-Must be cancer free 20 years to be considered cured

33
Q

Cancer Treatment- Goals (Control)

A

-When cancer cannot be completely eradicated but is responsive to cancer therapies
-Controlled by therapy for variably extended periods in a manner similar to other chronic illnesses, such as diabetes, chronic lung disease, and heart failure

34
Q

Cancer Treatment- Goals (Palliation)

A

-Relief or control of symptoms
-Optimization of quality of life

35
Q

Cancer Treatment Modalities

A

Four treatment modalities
-Surgery
-Radiation
-Chemotherapy
-Biological therapy

36
Q

Cancer Treatment- Surgery

A

Removal
-of the tumour and a margin of the surrounding normal tissue may cure localized cancers
-Ineffective if the cancer has metastasized to other locations
Debulking
-to reduce size, may be used if the tumour cannot be completely removed
-Usually accompanied by chemotherapy
Palliative
-To relieve pain or pressure
-Insertion of feeding tubes
-Colostomy
-Cystostomy

37
Q

Cancer Treatment- Chemotherapy

A

Use of chemicals to reduce the number of cancer cells present in the primary tumors and metastatic tumour sites
-Administered by multiple routes
-PO & CVADs most common (PICC line, central line)

38
Q

Cancer Treatment- Chemotherapy

A

Important to know the specific guidelines for administration of chemotherapeutic drugs
-These drugs may also pose occupational hazard for health care providers
-Many chemo drugs are irritants that cause severe local tissue breakdown and necrosis when accidentally infiltrated into the skin

39
Q

Cancer Treatment- Chemotherapy

A

Regional administration- delivery of the drug directly to the tumour site
-Higher concentrations of the drug can be delivered to the tumour with reduced systemic toxicity

40
Q

Cancer Treatment- Chemotherapy

A

Chemo cannot selectively distinguish between normal cells and cancer cells
-Adverse and toxic effects results from the destruction of normal cells, especially those that proliferate rapidly, such as the cells of the bone marrow, the GI lining, and the integumentary system
-The body’s response to the products of cellular destruction in the circulation may cause fatigue, anorexia, and taste alterations
Adverse Effects:
-Acute (vomiting, allergic reactions, dysrhythmias)
-Delayed (mucositis, alopecia, bone marrow suppression)
-Chronic (damage to organs such as the heart, liver, kidneys, and lungs)

41
Q

Cancer Treatment- Radiation

A

The emission and distribution of energy through space or a material medium
-Cancer cells less able to repair damage
-Repetitive, divided doses of radiation are delivered to a tumour, so damage to malignant cells is maximized
-Cellular death = irreversible loss of proliferative capacity

42
Q

Radiation Types/Delivery

A

External: source comes from a machine that aims radiation at cancer site
Internal: source of radiation is put inside the body- patient is radioactive

43
Q

Radiation Adverse Effects

A

-Fatigue affects at least 80% of cancer patients, weeks 3-4
-GI tract mucosa is sensitive to radiation therapy and alters gastric secretion- N&V, diarrhea - dehydration & alkalosis
-Skin reactions- erythema & desquamation

44
Q

Cancer Treatment- Biologics

A

-Treatment involving the use of biological agents such as interferons, interleukins, and monoclonal antibodies, and growth factors to modify the relationship between the host and the tumour
-Bone marrow transplantation allows for the safe use of very high doses of chemo or radiation to patients whose tumours are resistant or unresponsive to standard doses
GOAL = CURE

45
Q

Nursing Priorities

A

When caring for patients with cancer, the nurse should know the goals of the treatment plan to communicate with and support patients
A nursing care plan focus for treatment:
-The patients understanding of therapy goals, treatment schedules, and possible side effects of therapy
-Physical and psychological preparation for therapy
-Physical and psychological comfort
-Compliance

46
Q

Cancer- Pain Management

A

Pain relief is a basic human right
-Cancer pain is commonly undertreated
-Inadequate pain assessment, significant barrier
-Patients report must be accepted
-Common drugs: NSAIDs, Opioids
-Meds should be administered on time and around the clock, as well as for breakthrough pain
-Fear of addiction is not warranted

47
Q

Common Opioids & Side Effects

A

Codeine
Hydrocodone
Oxycodone
Oxycontin
Percocet (with acetaminophen)
Morphine (MS contin)
Hydromorphone (Dilaudid)
Fentanyl (Duragesic)- transdermal
Side Effects:
-Drowsiness
-Constipation
-Nausea and vomiting
-Dry mouth
-Itchy skin
-Difficulty urinating
-Lowered breathing rate

48
Q

Pain Management Routes

A

Oral & Parenteral (SC, IM) to start
Epidural Analgesia
-Catheter into the epidural space
-Intermittent bolus or continuous infusion
-Stable consistent pain relief
-Highly potent –> receptors in the spinal cord

49
Q

Patient-Controlled Analgesia

A

PCA
-Infusion system that allows the pt to self-administer a dose of opioid through a pump when needed (IV, SC, epidural)
-Can be continuous infusion and/or bolus
-Pre set dose and rate
-Patient presses a button to manage breakthrough pain
-Requires a lot of patient teaching

50
Q

Cancer- Psychosocial

A

Psychosocial care is an important aspect of cancer care
-Dx may precipitate a crisis in the lives of the pt & their family, and repercussions may affect all aspects of their lives
-Includes services & strategies to help cancer pts & their families cope with the cancer experience
-An optimal quality of life must be maintained after the dx of cancer
-Wellspring Niagara – FREE support

NUSC 2P14 (7 decks)

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