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51 Cards in this Set
- Front
- Back
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Oral Cancers
Premalignant Leukoplakia |
most common in adults, most often see in men
Slow developing changes in the oral mucousa Thick, white, firmly attached, slightly raised and sharply circumscribed patches (can not be removed by scraping) Small percentage become malignant after about 8 years Lesions on lips and tongue most likely to become malignant Causes Long term irritation to the oral membranes Poorly fitting dentures Chronic cheek chewing Broken teeth HIV infection Tobacco use |
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Oral Cancers
Premalignant Erythroplakia |
Red, velvety mucosal lesion on oral mucosa
More likely to become malignant Usually seen on the floor of the mouth, tongue, palate and mandibular mucosa |
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Oral Cancers
Malignant Tumors Squamous Cell Carcinoma |
Most common of the oral cancers
Usually found on lips, tongue, buccal mucosa, oropharynx Occurs because over many years cell changes take place in the oral cavity Early symptom is mucosal erythroplasia (lesions that are red, raised, and eroded) Risk factors Increasing age Tobacco Alcohol ingestion (combination with tobacco increases risk) Textile workers, plumbers, coal and metal workers Sun exposure Poor oral hygiene Poor dietary habits Human papillomavirus (HPV16) |
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Oral Cancers
Malignant Tumors Basal Cell Carcinoma |
Usually occurs on the lips
Asymptomatic, doesn’t usually spread Starts with a small scabbed area that does not heal and advances to an ulcerated area with a pearly border High risk factor is sun exposure Prevention Important Screening by dentist yearly Decrease sun exposure/wear SPF Stop tobacco use Decrease alcohol consumption |
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Oral Cancers
Malignant Tumors Basal Cell Carcinoma Clinical Manifestations |
Unusual lumps or thickened areas
Red or white patches Sore that does not heal Soreness, pain, burning sensation Trouble swallowing or chewing Pain may radiate to ear Enlarged lymph nodes |
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Oral Cancers
Malignant Tumors Basal Cell Carcinoma Diagnosis |
History/Physical exam
CT scan/MRI Biopsy-definitive Toluidine blue solution for high risk persons-may have false positive (if solution turns blue it indicates cancer) results with inflammation |
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Oral Cancers
Malignant Tumors Basal Cell Carcinoma Interventions |
Airway is the priority
Assess breath sounds, oxygen saturation levels, respiratory rate Clear secretions-cough, suction Semi-fowler’s/high fowler’s position Prevent aspiration May need a trach |
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Oral Cancers
Malignant Tumors Basal Cell Carcinoma Non-surgical Treatment |
Good oral care
Q 2 hours No commercial or harsh mouthwash (use warm saline or baking soda) Soft bristle toothbrush Lubricant to lips Soft, bland, non-acidic foods Radiation Goal-get rid of the tumor while preserving function and appearance May be given alone or with chemo or surgery Can be given externally or internally Chemotherapy May be given alone or with radiation or surgery May receive more than one chemo agent |
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Oral Cancers
Malignant Tumors Basal Cell Carcinoma Surgical treatments |
Type of surgery depends on the size, location of lesion, spread into the bone and lymph nodes
If small enough can be removed under a local anesthesia More extensive lesions may require a partial or total glossectomy (tongue removal) and partial mandibulectomy with radical neck dissection |
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Oral Cancers
Malignant Tumors Basal Cell Carcinoma Pre-op and Post-op care |
Preoperative care
Make sure patient understands what procedure is planned Possibility of trach, drains, IVs, ICU placement Changes with speech NPO Routine post op care-T, C, DB, out of bed Post operative care Airway, airway, airway Prevention of infection-good oral care, antibiotics, assessment Elevate HOB at least 30 degrees-prevents edema, prevents aspiration Pain control Nutrition-NPO with TPN/tube feedings, assess for trouble swallowing |
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Esophageal Cancer
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High mortality rate
Fast growing tumors Easily spread to lymph nodes/high rate of metastasize Tumor usually pretty advanced when discovered |
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Practice question:
On assessment of a patient, the nurse sees a red, velvety lesion on the floor of the patient’s mouth. What type of oral cavity tumor may this patient have? A. Leukoplakia B. Erythroplakia C. Squamous cell carcinoma D. Basal cell carcinoma |
B. Erythroplakia
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Esophageal cancer
Pathophysiology |
Usually come from the epithelium of the esophagus which allows the tumor to grow quickly and spread rapidly.
Tumors are usually large and well established when found |
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Esophageal cancer
Causes |
Tobacco use-common
Alcohol intake-common Long term, untreated GERD High levels or nitrosamine/nitrates in food Diets lacking fresh fruits/vegetables Possible genetic influence with p53 gene |
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Esophageal cancer
Clinical Manifestations |
Dysphagia-common-persistent and progressive
Weight loss Odynophagia-(painful swallowing)-steady, dull, substernal pain that may radiate Problems with regurgitation, vomiting, foul breath, chronic hiccups are a sign of advanced disease Chronic cough Increased secretions hoarseness |
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Esophageal cancer
Diagnosis |
History-what risk factors does the patient have
Barium swallow-usually done first Biopsy via EGD CT scan/PET scan-show spread Esophageal ultrasound (EUS)-definitive |
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Esophageal cancer
Nutritional Therapy |
very important
Dietary consult Daily weights Position with HOB upright to eat/after Soft diet/thicken liquids Supplements Feeding tubes Protect from aspiration-may need swallowing training |
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Esophageal cancer
Non-surgical Interventions |
Chemotherapy
Usually given with radiation treatments 5FU and Cisplain-usual agents Radiation When give alone usually just palliative May be given with chemo Side effects of radiation Acute esophagitis Odynophagia (difficulty swallowing) Anorexia, nausea, vomiting Nutritional assessment important |
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Esophageal cancer
Photodynamic Therapy |
Pallitive treatment if surgery not an option
Photofrin (a drug) is given that goes to cancer cells, light from a fiberoptic source activates the med and destroys the cancer cells Esophageal Dilation Provides temporary but immediate relieve from dysphagia. May be repeated as needed Stents may be used to keep the esophagus open Recommended use of prophylactic antibiotics to decrease the risk of endocarditis |
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Esophageal cancer
Surgical Interventions |
Esophagectomy-removal of all or part of the esophagus
Esophagogastroctomy-removal of part of the esophagus and stomac Minimally invasive esophagectomy-done thru laparoscopy, can only be used if caught early |
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Esophageal cancer
pre-operative care |
Usually done electively so patient should be in optimum health
Stop smoking-improves pulmonary function Nutritional support-tube feedings F and E corrections Good oral hygiene T, C, DB instructions Colon cleansing if appropriate What to expect post op-ventilator, chest tubes, NG tube (will depend on the procedure done) Emotional/family support |
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Esophageal cancer
post-operative care |
Prevent pulmonary complications (highest priority)
Intubated/on ventilator T, C, DB Assess breath sounds Medicate for pain Elevate HOB Assess O2 sats Check chest tube functioning (if in place) Prevent cardiovascular complications Monitor for hypotension-adm IV fluids Assess for fluid overload Cardiac monitor-watch for atrial fibrillation |
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Esophageal cancer
Wound Care |
Assess for leakage at the anastomosis site
Will occur 2-10 days after the surgery S and S will be fever, fluid accumulation, signs of inflammation/shock Notify the MD is suspected Keep NPO |
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Esophageal cancer
NG tube care |
Monitor drainage for color and amount
Do not reposition-very important |
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Esophageal cancer
Nutrition |
Usually start via jejunostomy tube
Liquid diet advancing to solid food-need to be sure that there is no leakage at the surgical site-done with cine-esophagram study Should eat in an upright position Monitor swallowing efforts for aspiration Eat six small feedings instead of 3 large meals Ingest fluids separate from eating solids Vagotomy syndrome-diarrhea that occurs as a result of interruption of the vagal nerve during the surgical procedure. Manage with loperamide (Imodium) |
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Practice question:
What are non surgical treatment options for cancer of the esophagus? A. swallowing therapy B. Chemoradition C. Photodynamic therapy D. Endoscopic therapies |
A. swallowing therapy
B. Chemoradition C. Photodynamic therapy |
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Gastric Cancer
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Second leading cause of cancer death in world
5 year survival rate is low Cancer is usually advanced by the time of detection |
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Gastric Cancer
Pathophysiology |
Most gastric cancers are adenocarcinoma and will be either intestinal (contained) or diffuse (scattered).
Gastric cancers usually spread through the wall of the stomach into the lymphatic system |
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Gastric Cancer
Causes |
Presence of H. Pylori bacteria due to chronic inflammation
Increased risk with pernicous anemia, gastric polyps, chronic gastritis, achlorhydria (no hydrochloric acid) Increased risk with ingestion of certain foods (salt, nitrates) Smoking and increased alcohol use (controversial) Family history Previous gastric surgery (increased risk of developing gastritis) |
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Gastric Cancer
Prevention |
Get rid of H. pylori bacteria
Make sure gastritis heals No smoking Limit alcohol Consume well balanced diet Genetic counseling with family history |
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Gastric Cancer
Diagnosis |
History
H. pylori Food intake Family history Smoking/alcohol use Diagnostic Tests Low hemoglobin and hematocrit Stool positive for occult blood Elevated CEA, usually only seen in infants, in adults may indicate cancer Double contrast upper GI series-done first CT scan to stage the disease and see extent of spreading EGD (esophagogastroduodenoscopy)-definitive |
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Gastric Cancer
Clinical Manifestations |
Asymptomatic-early
Indigestion/abdominal discomfort-common Epigastric/back pain-common and early Weight loss Nausea and vomiting Weakness, fatigue, anemia Metastasis may show up as hepatomegaly (enlarged liver) or enlarged lymph nodes |
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Gastric Cancer
non-surgical management |
May or may not get chemo alone or with other therapy
Chemo agent more effective if given in combination of two chemo agents Radiation: limited |
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Gastric Cancer
Surgical Management |
Treatment of choice
Usually have total or subtotal gastrectomy with Billroth I (duodenum attached to stomach) or II (jejunum attached to stomach) Preoperative care-same as for any patient having abdominal surgery Post operative care Same as for other abdominal surgery T, C, DB-assess breath sounds Observe for bleeding/infection Nutritional support-feeding tube, TPN, dumping syndrome (small meals, don’t drink while eating, low to moderate carb diet, high protein diet) Emotional support |
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Gastric Cancer
Practice Question: Which statement about general principles of diet therapy for patients with dumping syndrome is true? A. Patients with dumping syndrome should have liquids between meals only. B. Patients with dumping syndrome should be encouraged to eat diet high in roughage C. Patients with dumping syndrome should eat a high carb diet. D. The diet for a patient with dumping syndrome must be low in fat and protein. |
A. Patients with dumping syndrome should have liquids between meals only.
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Colorectal Cancer
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Colon and rectal cancer-very common
Often metastasis to liver Can be screened for |
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Colorectal Cancer
Pathophysiology |
Adenocarcinomas are the most common (tumors that develop from the glandular epithelial tissue of the colon)
They usually develop slowly over many years Initially start in the mucosa and takes a long time to spread through the layers of the stomach to get into the lymphatic system |
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Colorectal Cancer
Risk Factors |
Occurs more commonly in families
Age-most occur after 50 years of age Presence of adenomatous polyps Consumption of foods that decrease bowel transit time Co-morbity of inflammatory bowel disease |
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Colorectal Cancer
Prevention |
Balance diet
NSAIDs (aspirin)-decreases risk of colon cancer Exercise MVI (multi vitamins) Female Hormone Therapy-Oral contraceptives Regular screening-very important-to include FOBT (fecal occult blood testing) |
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Colorectal Cancer
Diagnosis |
Ask routine history questions plus:
Change in bowel habits-very common Blood in stool Feeling of fatigue Recent weight loss Complaints of abdominal fullness and pain |
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Colorectal Cancer
Diagnosis |
Ask routine history questions plus:
Change in bowel habits-very common Blood in stool Feeling of fatigue Recent weight loss Complaints of abdominal fullness and pain FOBT (fecal occult blood test) Decreased hemoglobin and hematocrit Elevated CEA Barium enema CT scan/liver scan Colonoscopy-definitive method |
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Colorectal Cancers
Clinical Manifestations |
Change in bowel habits/stool-common
Anemia - common Rectal bleeding-hematochezia - common c/o gas pains, cramping Constipation/straining to have BM Narrowing of the stool May see abdominal mass Hypoactive or absent bowel sounds Steatorrhea – fat in the stool |
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Colorectal Cancer
Non-surgical treatment |
Radiation
May be done pre op or post op May be done for palliative therapy Rectal cancer almost always includes radiation therapy Chemotherapy Drug of choice is 5FU with or without leucovorin New drug-oxaliplatin (Eloxatin) may be added Bevacizumab (Avastin)-new antiangiogensis med which decreases blood supply to tumor Cetuximab (Erbitux)-slows cell growth |
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Colorectal Cancer
Surgical Interventions |
Depends on location of tumor and extent of disease
Colon resection Colectomy Colostomy Abdominal perineal resection – removal of sigmoid colon, rectum and anus Preoperative care Same as for all abdominal surgeries May consult ET nurse (ostomy nurse) Bowel prep Educate patient about what to expect postop Postoperative care NG tube care Ostomy/wound management Routine care for abdominal surgery |
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Practice question:
Colonoscopy with biopsy is the definitive test for the diagnosis of CRC? TRUE FALSE |
TRUE
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Malabsorption Syndrome
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Inability of the gut to absorb nutrients due to problems with the intestinal mucosa
Depending on where in the intestines the problem occurs will depend on which nutrients are not being absorbed Occurs commonly after gastric surgery |
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Malabsorption Syndrome
Clinical Manifestations |
Diarrhea-common
Steatorrhea-common Weight loss Bloating/excessive gas Decreased libido Easily bruised Anemia Bone pain edema |
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Malabsorption Syndrome
Diagnosis |
Lab values depends on the nutrient being lost
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Malabsorption Syndrome
Intervention |
Supplements for the lost nutrients
Avoid things that cause malabsportion to get worse |
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Malabsorption Syndrome
Constipation is a classic symptom of malabsorption TRUE FALSE |
FALSE
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Malabsorption Syndrome
The Schilling test measures urinary excretion of vitamin B12 for dxg of pernicious anemia and a variety of other malabsorption syndromes. TRUE FALSE |
TRUE
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