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101 Cards in this Set

  • Front
  • Back
Cancer
a disease process whereby cells proliferare abnormally, ignoring growth regulating signals in the environment surrounding the cells
Epidemiology of Cancer
- most occurs at age 65 or older
- higher incidences in males vs females
Leading Causes of Cancer Deaths
men
- lung
- prostate
- colorectal

female
- lung
- breast
- colorectal
Pathophysiology of Cancer
cancer alterations within cell
abnormal cell division occurs
- cancer cells ignore limit regulatory signals
- have invasive characteristics
- metastasis occurs
Proliferative Patterns
Patterns of Cell Growth

Hyperplasia
cells within makes too many and increase
Proliferative Patterns
Patterns of Cell Growth

Metaplasia
metamorphosis - changing cells divide and take on different characteristics that are abnormal. they wont be like their normal parent cells, they divide abnormally
Proliferative Patterns
Patterns of Cell Growth

Dysplasia
bazaar cell growth. different in shape, size, and arrangement. not normal but doesn't mean it is cancerous
Proliferative Patterns
Patterns of Cell Growth

Anaplasia
lacking normal characteristics. entire structure of cell has changed. tend to be malignant
Proliferative Patterns
Patterns of Cell Growth

Neoplasia
have a mind of their own. very stubborn uncontrolled cell growth. malignant cells
Benign Cells
- non cancerous in nature
- does not have the ability to cause harm
- is slow growing
- dont usually metastasize
- doesn't usually destroy tissue
- will not cause death
Malignant Cells
- is cancerous
- has the ability to harm
- grow rapidly
- can metastasize
- can cause tissue damage
- can cause death
Characteristics of Malignant Cells
- alteration in cell membrane
- contains proteins
- tumor specific antigen
- nucleus are large and irregularly shaped; or more than one nucleus
- cell division occurs more frequently and rapidly
- chromosomal abnormalities- translocation- switching of DNA, deletions of chromosomes in cell
- anaerobic in nature. can live with little O2 supply
- cause mechanical pressure. press into surrounding tissues and hurt environment around it
Metastasis
spread of cancer cells from the primary tumor to distant sites

3 methods of metastasis:
- blood
- lymphatic system
- body organs
Angiogenesis
ability of body to make new blood vessels
- release growth factor and enzymes to make these vessels
- even though anaerobic in nature, will make blood vessels to feed cancer cells with more O2 and nutrient

stimulates body to make so they can continue to grow
Carcinogenesis
transformation of normal cells into malignant cells

is a 3 step process:
- initiation phase
- promotion phase
- progression phase
Carcinogenesis
Initiation Phase
carcinogenesis substance that alters genetic structure in DNA
Carcinogenesis
Promotion Phase
might develop but not happen with the first exposure, but with repeated exposures will come down with cancer (ex: sun exposure - skin cancer)
Carcinogenesis
Progression Phase
cell exhibits malignant behavior. different in size, shape, DNA structure with deletion
Cancer Etiology
Viruses and Bacteria - HPV if you have repeated exposure you will come down with cervical cancer

Physical Agents - sunlight, radiation exposure, tobacco use

Chemical Agents - tobacco, pesticides, asbestos, benzene (used on construction sites)

Genetic and Familial Factors - passed on generation to generation (breast cancer)

Dietary Factors - high fat diets - breast cancer, alcohol, smoked meats (nitrates - preservatives convert to carcinogens in body) Obestiy, bar b q foods that are burnt on the grill increase stomach cancer

Hormonal Agents
Role of Immune System
- to detect development of malignant cells and destroy them before cell growth becomes uncontrolled
- when immune system fails to ID and stop the growth of malignant cells, cancer will develop
Cancer Detection and Prevention
2 mechanisms
- primary
- secondary
Cancer Detection and Prevention
Primary
prevention
- avoid known carcinogens
- make lifestyle changes
- participate in cancer prevention programs
Cancer Detection and Prevention
Secondary
screening
- teach about screening methods. breast and testicular exams, pap smears, mammogram, PSA, rectal exams
Tumor Staging
TNM Staging

T = # of tumors
N = # of nodes involved
M = metastasis to distant organs
Tumor Grading
- the classification of tumor cells
- has numeric value ranging from I - IV

I = well differentiated, closely resembles the tissue of origins. best one to have

IV = poorly differentiated tumors are very aggressive and are less responsive to treatment
Management of Cancer
- Cure
- Control: cant get rid of it but you want to control cell growth to prolong life
- Palliation: cant cure or control but give a better quality of life
Methods of Cancer Control
Surgery
- Biopsy
- Debulking
- Local Excision
- Wide or Radical Excision
- Salvage
- Prophylactic
- Palliative
- Reconstructive
Methods of Cancer Control
Surgery

Biopsy
fine needle aspirations
Methods of Cancer Control
Surgery

Debulking
remove as much as possible of the tumor
Methods of Cancer Control
Surgery

Local Excision
take out tumor when tumor is small (lumpectomy) and take out the margin around the lump
Methods of Cancer Control
Surgery

Wide or Radical Excision
invasive. mastectomy. take out tumor, tissue, lymph nodes, and adjacent structures because of nature of the disease
Methods of Cancer Control
Surgery

Salvage
tumor grows back in same spot, so you go back in and do salvage surgery. you take out as much as possible. usually 2nd exposure
Methods of Cancer Control
Surgery

Prophylactic
done not to get rid of cancer, because you dont have it but you do it to prevent it. getting mastectomy because your at high risk so you dont get it
Methods of Cancer Control
Surgery

Palliative
know you cant cure the patient but you can give a better quality of life. brain tumor metastasize to spinal cord (causes a lot of pain) so you take as much out to take away some pain and give better quality of life
Methods of Cancer Control
Surgery

Reconstructive
major body image disturbance
Cancer
Nursing Management
- age
- co-morbid conditions
- medical clearance
- DVT risk - bed rest or radiation therapy (intracavity radiations - abdomen type of radiation; internal source implanted into the body)
Cancer Treatments
Radiation Therapy
used for:
- cure
- control
- prophylactically
- palliative

- interrupt cells as they are dividing in the replication phase of DNA/RNA
- effects stage of mitosis (cells are dividing)
- effects them systemically - lymphatic system, bone marrow (myelosuppressed - not making enough WBC/RBC/Platelets) gonad cells (eggs/ sperm)
- alopecia (hair loss)
Types of Radiation
External Radiation
- radiation beam aim directly at the tumor. every day 4 to 6 weeks to target cells as they are dividing in different stages. mark the body so you know where to aim the beam
- radiation that is given via an external source
Types of Radiation
Internal Radiation aka Brachytherapy
implanting of seeds, beads or catheters into a body cavity

- prostate cancer - implant seed into prostate
- reproductive cancer (ovarian, vaginal, etc)

OR to remove as much of the tumor as possible and follow up with radiation. take an x ray of the area so you know where you are putting radiation source

isolation precautions - private room - roomate can get radiation if in room with patient
insert radiation source into pelvic area and put in something that looks like a tampon to hold canister in - in case you cough, sneeze or move you dont want ot dislodge radiation source. if dislodged and you touch it you can get burned. radiation wagon and prongs are always left in room in case it does fall out
Intracavitary Radiation
- maintain bed rest/ log roll patient
- head of bed no more than 30 degrees
- indwelling urinary catheter - dont want patient getting in and out of bed to go to the bathroom. and you dont want a distended bladder
- low residue diet
- antidiarrheals - want to constipate them so they dont have bowel movements while having treatment
Radiation Precautions
Targets all cells
- no pregnant and young visitors allowed
- no pregnant RN's caring for patient
- use of dosimeter badges - how much radiation exposure is in the room
- limiting visits to 30 minutes per shift - tell patient to make a list of everything they need so you dont have to keep coming in and out
- maintain 6 foot distance from radiation source
Radiation Side Effects
- alopecia: hair loss, once radiation is over it will regrow
- shedding of skin aka desquamation: dry skin, red area, almost like burn mark on skin
- GI tract: disrupts epithelial cells; stomatitis : xerostomia (dry mouth)
- bone marrow suppression: myelosuppression - not making enough WBC - at risk for infection, not making enough RBC - anemia and not making enough platelets - bleeding
- fatigue/ malaise
- anorexia: lesions in the mouth and they dont want to eat
Chemotherapy
- use of medications to kill tumor cells by interfering with cellular functions and reproduction. kills healthy and malignant cells. cant tell the difference- that is why they become myelosuppressed
- it is usually combined with other treatment modalities
- has numerous toxic effects
Cell Cycle
4 distinct phases:

G1 phase - not a lot going on. cells growing preparing themselves to divide

S phase - DNA is getting copied, synthesized

G2 phase - cells getting ready to divide

Mitosis phase - division of cells occurs. cell splits into 2 distinct cells (daughter cells)

G0 phase - cells are dormant, resting taking nap, getting energy to start over again

* chemo targets S phase (copied) and M phase (divides)
Classification of Chemotherapy Agents
can be cell cycle specific - effects in a specific phase of cell cycle. target maybe S or maybe M phase

can be non cell cycle specific - medication works in all phases
Types of Chemo Drugs
- alkylating agents
- antimetabolites
- mitotic inhibitors
Types of Chemo Drugs
Alkylating Agents
directly damage DNA and prevent cancer cell from reproducing/ dividing. non - cell specific (cisplatin) - works in all phases
Types of Chemo Drugs
Antimetabolites
cell cycle specific. interfere with DNA/RNA works best in S phase (5FU)
Types of Chemo Drugs
Mitotic Inhibitors
plant alcoloids derived from natural products. stop mitosis. prevents cells from dividing into daughter cells. M phase (vinchristine). cell cycle specific
Chemotherapy Administration Routes
- PO
- IV
- IM
- Sub-q
- Intrathecally - directly into spinal column; like epidural (mets to spine area)
- Intraarterially - (MD does only) melanoma to a limb. limb profusion
- Intracavity - catheters and administer chemo- usually in OR applied directly to tumor area
Chemotherapy Dosing
based on BMI (body mass index)

start low dose and gradually increase drug. if tolerated well they will build it up to a good tolerance level.

dosage adjustments to be made if:
- s/sx of myelosuppression

oncologic emergency - life threatening. stop chemo and wait to blood values recover. blood transfusions
Problems Associated with Chemotherapy
extravasations: leakage of a vesicant (chemo drugs, heavy duty antobiotics- vanco, vasopressors - dopamine or levo, IV dyes) medication from veins into the surrounding tissues (infiltrations - swelling, discomfort, warm to touch)
- tissue necrosis/ sloughing and ulceration. cell death immediately
- damage to underlying tendons, nerves and blood vessels

if extravasations is suspected, stop medication immediately

patient doesnt feel because they have peripheral neuropathy

LAW SUIT - must monitor IV that no infiltration occurs

STOP IV and take it out if extravasation occurs.
Checking To Make Sure You Are In A Vein
- tourniquet test. put tourniquet above, and the chamber should stop dripping (you are in the vein)

- press on vein above IV and it should stop dripping

- bring IV bag below level of heart, blood should back up and shows you are in a vein

- pull back on port to see if you get blood
Chemotherapy Antidotes
Na thiosulfate - given in multiple little injection around the area and it reverses effects of extravasations

DMSO - dimetholthysufoxide - cream apply 4 times a day for about 14 days
Cold Therapy

Heat Therapy
Cold - 20 minutes 4 times per day apply cold for 3 days. vasoconstrict area and keeps drug in that area. minimized effect (doxerumisin)

Heat - 20 minutes 4 times per day. apply heat for 3 days. minimized effect (vinchristine)

Explain to patient to watch and tell any discomfort to you
Problems with Extravasations
- compartment syndrome - increase pressure in an enclosed space. fluid in tissue compresses nerves and blood vessels and end up with muscle and nerve damage

- peripheral neuropathy - when infiltrates they dont feel it

your job is to assess IV site regularly on your shift
Systemic Chemotherapy Administration
Central Lines - break in skin integrity - risk for infections (red, discharge, pain to area) strict aseptic technique (goes directly into subclavian vein)

Mediports - 1 time procedure - goes under surface of skin (no blood return, turn head to the side and cough and you should have return). flush mediport with SASH method. single or double. double - one to draw blood and one for meds

S - saline
A - antibiotic/ chemo
S - saline
H - heparin
Adverse Effects of Chemotherapy
- Toxicity
- GI system
- Hematopoietic system
- Renal system
- Cardiovascular system
- Respiratory system
- Reproduction system
- Neurological system
Adverse Effects of Chemotherapy
GI System
- nausea, vomiting, diarrhea, anorexia due to stomatitis (very painful sore in the mouth and patient cant eat

Tx:
- antiemetics
- corticosteroids: opens appetite and makes you want to eat
- food preparation prior to chemo (smell may make nauseous)
- bland foods: avoid hot and spicy
- small frequent feedings

bleeding from gums: non alcohol based mouthwash, soft toothbrush

dentures: remove and inspect for sores

dry mouth: water, ice chips, hard candy
Adverse Effects of Chemotherapy
Hematopoietic System
myelosuppression: depression of bone marrow function
decreases in:
- WBC - infection
- RBC - anemia
- platelets - thrombocytopenia


Tx:
colony stimulating factors
- neupogen: stimulates bone marrow to make neutrophils
- epogen: decrease in erythropoeitin - stimulates production of RBC
- blood transfusions
- platelet transfusions: low platelet counts

if very suppressed chemo will have to be stopped temporarily and patient will have to be put on isolation and once patient recovers than chemo can start again
Adverse Effects of Chemotherapy
Renal System
renal toxicity - enters body and causes cell lysis. cell contents spills out into the blood stream

renal failure - monitor BUN, creatinine, hydration, electrolyte levels

electrolyte imbalances- high calcium, high potassium, phosphorous levels
Adverse Effects of Chemotherapy
Cardiovascular System
(adriamycin/ doxorubicin hydrohcloride)

- irreversible - cardiac toxicity/ structural damage
- decreased ejection fraction
- possible heart failure
- R vs L sided heart failure- R- peri orbital edema, JVD, dependent edema - sacrum, hand and feet. L - lung area, CHF, pulmonary edema, pulmonary congestion. drowning in own secretion. hear crackling, rhales
Adverse Effects of Chemotherapy
Respiratory System
(bleomycin/ blenoxane)

- pulmonary fibrosis - effects lung function
- scarring of lung tissue
- SOB
- cyanotic
- use of accessory muscles
- decreased lung function
Adverse Effects of Chemotherapy
Reproductive System
- targets egg cells and sperm cells
- early menopause
- sterility
- temporary or permanent azospermia
- harvest eggs or sperm prior - dont want to have a baby while taking chemo. dont know effects on fetus. use back up method of birth control
Adverse Effects of Chemotherapy
Neurological System
(vinchristine sulfate/ oncovin)

- peripheral neuropathies
- loss of deep tendon reflexes - risk for falls
- paralytic ileus - small intestine shut down. no motility. abdomen very distended, no bowel sounds
- hearing loss related to acoustic nerve damage - cranial nerve VIII
- fatigue (common symptom of chemo and radiation)
- anemia : weakness, SOB, pallor, activity intolerance
- decreased CO
- dehydration: from nausea and vomiting
Absolute Neutrophil Count (ANC)
total number of neutrophil you have available in your body to fight off infection
- a measure of the number of neutrophils present in the blood
- a type of WBC that fights against infection
- calculated from measurements of the total number of WBC usually based in the combined percentage of mature neutrophils
- the unit of ANC is cell per microlitre of blood

Normal ANC = 15,000 or above
1000 - 1500 = mild risk of infection
Below 1000 = moderate risk of infection
500 = severe risk of infection
Neutropenic Precautions
reverse isolation precaution
- private room
- mask and gloves when in contact
- no sick visitors allowed/ nurses
- can only eat cooked foods - fruit, salads, sushi has microorganism in them
- no fresh flowers - harbors microorganism
- maintain asepsis as needed - medi port, central lines
NADIR
- is the lowest ANC after chemo or radiation treatment
- circulating amount of total cells are depleted

high risk of bleeding, anemia, infection, a lot of myelosuppression

usually about 10 days after treatment. doesnt happen right away.
stop chemo temporary if very low
Bone Marrow Transplant
- reserved for patients with sever myelosuppression
- for patients with solid tumors
- for patients with leukemia's and lymphomas

3 sources
- allogenic - receive bone marrow transplant from a donor. external source. someone else was a match
- autologous - harvest your own stem cells prior to chemo/ radiation
- syngeneic - getting from an identical twin - perfect match
Bone Marrow Transplant
Nursing Care
-early detection of infection
- daily temps - PO
- no rectal temps
- bleeding from various sites (urine and stool samples to check for bleeding)
- stool softeners - dont want them to be constipated
anemia, fatigue, dizziness, SOB, difficulty breathing, skin color, light headed
Hyperthermia
above 106.7 degrees
- aka thermal therapy/ heat therapy
- whirl pool bath, parafin,US or microwave therapy
- use to destroy tumor in human cancers
- cancer cells are more susceptible to be destroyed by heat
- can be used in conjunction with chemotherapy
- can be regional or whole body
Hyperthermia Side Effects
- burns: 1st, 2nd and 3rd degree; tissue damage
- hypotension - heat brings down BP
- nausea and vomiting and electrolyte disturbance

Radiation burns - do not apply powder, cream, lotion, or make up. you want area to breathe. only take antibiotic cream - silvadene. dont cover it leave it open to air
Chemotherapy Nursing Assessment
- bleeding: platelet count below 40,000, dont floss teeth because can bleed from gums, use soft tooth brush; below 20,000, bone marrow transplant, 100,000, assess signs and symptoms of bleeding
- infection: decreased WBC. monitor vital signs, send out urine samples, lung assessment - pneumonia
- alopecia: get a wig and remind them the hair will come back after the chemo stops
- nutrition:
- anorexia
- cachexia: wasting away more than 10% weight loss
- anosmia: loss of sense of smell and taste
- malabsorption

GI - no harsh material- use lidocaine around lesions so patient will eat and wont be in so much pain
Chemotherapy Nursing Interventions
anorexia
- small frequent feedings
- vitamin replacement
- antiemetics - standing order
- good oral hygiene
- use of corticosteroids (magase and marinol)
- G tube/ TPN
Pain
is what the patient says it is. assess for intensity

- an unpleasant sensory and emotional experience resulting from actual or potential tissue damage
- considered your 5th vital sign
- types of pain
- acute - specific injury
- chronic - there all the time; constant

pain is a lot different. some patients see it as punishment as to they did something wrong
Cancer Related Pain
may be acute or chronic
- related to bony infiltration with tumor cells
- nerve compression
- surgery or radiation (burns)
WHO
3 steps ladder approach to treat pain
- mild pain
- moderate pain
- severe pain
WHO
Mild Pain
- non narcotic meds (advil and tylenol)
- adjuvant drugs- chemo makes nausea, so you give an antiemetic. if anxious they might need ativan or xanax
WHO
Moderate Pain
- weak narcotic meds - codeine, percocet, percodan
- adjuvant drugs
WHO
Severe Pain
- strong narcotics - morphine pump, phentynol patch, morphine lollipops
- adjuvant drugs
- non narcotics
Pain Characteristics
- intensity: pain scale 1 to 10
- timing: when does pain occur; movement dressing change
- location: localized to one area or radiate
- quality: sharp, stabbing, annoying
- aggravating or alleviating factors: what brings it on or takes it away
Treatment of Cancer Pain
- surgery, chemo, radiation
- drugs, nerve blocks, physical therapy, and non traditional techniques such as relaxation, hynosis, or distraction, guided imagery
- prescription drugs (opioids, codeine, morphine, and fentanyl)
- non prescription drugs (aspirin, acetaminophen, and ibruprofen
Administration Routes of Pain Treatment
- parenteral
- GI
- transdermal - patch
- transmucosal - nose
- epidural - epidural space
- intraspinal - into spinal canal
Break Through Pain
- a severe flare of pain that occurs even though a person may be taking pain medicine regularly for their persistent pain
- called breakthrough pain because it is pain that breaks through a regular pain med schedule
- as a rule: it comes on quickly, last a long time (hour) and feels much like persistent pain except that it is more severe or intense

prior to procedures give additional medication to avoid additional pain. sudden, acute, intense pain
Instrument for Assessing Pain
- pain intensity scale
- faces pain scale

body language shows a lot, restless, grabbing on to things, increased HR, increased RR, diaphoresis, anxious, sleep disturbances, depressed

wounds take a longer time to heal
Oncologic Emergencies
- superior vena cava syndrome
- spinal cord compression
- hyperkalemia
- pericardial effusion
- disseminated intravascular coagulation (DIC)
- syndrome of inappropriate secretion of ADH
Ovarian Cancer
- causes more deaths than any other cancer of the female reproductive system
- often difficult to detect
- usually later in life, after age 50 but you can get prior

if had breast cancer are now at a higher risk of developing ovarian cancer
Ovarian Cancer Epidemiology
- risk increases with age
- high risk of breast cancer, if + for ovarian cancer and visa versa
- risk factors
- high fat diet
- mumps before 1st period
Ovarian Cancer Risk Factors
- nummiparity - no kids
- infertility
- family history
Ovarian Cancer Decreased Risk Factors
- use of oral contraceptives
- multi parity
- breast feeding
Ovarian Cancer Pathophysiology
3 types
- germ cell tumor
- stromal cell tumor
- epithelial tumors
Ovarian Cancer Signs and Symptoms
- vague and non specific
- palpable ovary in post menopausal women
- bloating sensation/ flatulence
- abdominal swelling/ pain/ ascites
- pelvic pressure/mass
- backache/ leg pain
- urinary urgency
- indigestion
Ovarian Cancer DX
detection
- pelvic exam
- transvaginal ultrasound
- laparotomy
- CA - 125 marker/ antigen. carcinoma embryonic antigen
- biopsy

easy for metastasis to occur. piece breaks off and lodges into cavity
Ovarian Cancer DX Findings
benign - non proliferation or invasion. mass that stays in ovaries

borderline - proliferation but no invasion. not cancerous but left alone could turn into cancer

malignant - invasion
Ovarian Cancer Staging
stage 1 - limited to ovary
stage 2 - spread
stage 3 -
stage 4 - metastasis
Ovarian Cancer Management
surgery - Total Abdominal Hysterectomy with bilateral Salpingo Oopherectomy (TAHBSO). take out uterus, cervix, fallopian tubes, ovary

Omentectomy - inner lining of pelvic cavity

chemotherapy - taxol, doxirubison, cisplatin

radiation

liposomal therapy - intracavity delivery of chemo over a short period of time

many people will have relapse that it why they take everything out to prevent it
Ovarian Cancer Nursing Management
- control pain post op
- manage drainage tubes
- administer meds: diuretics
- assist with paracentesis for ascites

risk for DVT, pulmonary emboli, infection and bleeding
Cervical Cancer
gone down over the years from early detection
- a cancer of the female reproductive tract
- 3rd most common female reproductive cancer 35 - 45
- is the easiest gynecological cancer to prevent through screening
Cervical Cancer
Squamous Cell Cancer
resembles cells inside of the mouth
Cervical Cancer
Glandular Cell Cancer
secretes a lot of mucus ( like inside of nasal passages) - inside of cervix
Cervical Cancer Causes
HPV - human papilloma virus (chronic exposure)
- sexually transmitted
Different types of HPV
- low risk types can cause warts
- high risk types can cause pre cancer and cancer of the cervix
- early intercourse before 14 or 15
- early childbearing
- multiple sex partners
- smoking