Cancer

Front 1

Benign neoplasm

Back 1

Well differentiated
Usually encapsulated (easily removed)
Expansive mode of growth
Characteristics similar to parent cell
Metastasis is absent
Rarely recur

Front 2

Malignant neoplasm

Back 2

May range from well differentiated to undifferentiated
Able to metastasize
Infiltrative and expansive growth
Frequent recurrence
Moderate to marked vascularity
Rarely encapsulated
Become less like parent

Front 3

Carcinomas originate from

Back 3

Embryonal ectoderm (skin, glands)
Endoderm (mucous membrane of respiratory tract, GI and GU tracts)

Front 4

Sarcomas originate from

Back 4

Embryonal mesoderm (connective tissue, muscle, bone, and fat)

Front 5

Lymphomas and leukemias originate from

Back 5

Hematopoietic system

Front 6

Breast Cancer

Back 6

By age 20 routine self breast exam
Age 20-39 breast exam by health professional every 3 years
Over 40 yearly mammogram and breast exam

Front 7

Colon/Rectal Cancer

Back 7

Over age 50 yearly fecal occult blood
Digital rectal exam and flex sigmoidoscopy every 5 years
Colonoscopy every 10 years

Front 8

Uterine Cancer

Back 8

Yearly pap smear for sexually active female or those over 18
At menopause high-risk patient should have endometrial tissue sample taken

Front 9

Prostrate Cancer

Back 9

At age 50 yearly digital rectal exam
At age 50 yearly PSA test

Front 10

7 Warning Signs of Cancer

Back 10

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

Front 11

Biopsy

Back 11

only definitive means of diagnosing cancer

Front 12

Chemotherapy

Back 12

Use of cytotoxic medications and chemicals to promote cell death
Goal is to reduce number of malignant cancer cells in tumor site(s)
Mainstay for most solid tumors and hematologic cancers

Front 13

ChemotherapyClassification of agents:
Cell cycle phase–nonspecific

Back 13

Alkylating agents (interfere with DNA replication)
Nitrosoureas-(interfere with DNA replication)
Platinum drugs-(bind to RNA and DNA)
Antitumor antibiotics (disrupt or inhibit DNA or RNA systhesis)
Corticosteroids –interfere with RNA Synthesis
Hormone therapy- interfere with RNA Synthesis

Front 14

ChemotherapyClassification of agents: specific

Back 14

Antimetabolites (interfere with metabolites or nucleic acids necessary for RNA and DNA synthesis)
Mitotic inhibitors-inhibit mitosis of cells
Topoisomerase inhibitors-inhibit enzyme which repairs DNA strands -

Front 15

Chemotherapy-Nursing ConsiderationsPreparation & Handling of Chemotherapeutic Agents

Back 15

May pose an occupational hazard
Drugs may be absorbed through
Skin
Inhalation during preparation, transportation, and administration
Only properly trained personnel should handle drugs
Double check when administering (like Heparin, insulin, and blood products you should always have 2 RN check the orders!!!!!!!!)

Front 16

ChemotherapyMethods of Administration

Back 16

Oral
IM
IV (most common route of administration)
Intracavitary (peritoneal cavity/plural cavity)
Intrathecal
Intraarterial (tumors blood supply)

Front 17

Drugs may be irritants or vesicants

Back 17

Damage intima of vein
Severe local tissue breakdown and necrosis

Front 18

Radiation Therapy

Back 18

Local treatment modality used to kill tumor, reduce the tumor size, relieve obstruction, or decrease pain
One of the oldest nonsurgical methods of cancer treatment
Up to 60% of all cancer patients will receive radiation therapy
Cellular damage may be lethal or sublethal

Front 19

Collaborative care: radiation

Back 19

Implantation or insertion of radioactive materials into or close to tumor
Minimal exposure to healthy tissue
Patient is emitting radioactivity
Limit amount of time near patients being treated this includes making sure family members limit their time as well
Organize care
Shielding should be used
Wear film badge to monitor exposure
Patients should understand needs for time and distance restrictions on health care providers

Front 20

Nursing Implications: CHEMO & RADIATION SIDE EFFECTS

Back 20

Bone marrow suppression (what labs should we pay attention to???????????????)
Fatigue and muscle weakness (think about nursing implications!!!!!!!!!!!)
GI disturbances (Nutrition implications!!!!!!!!!)
Nausea, vomiting, diarrhea, constipation
Integumentary and mucosal reactions (Nutrition and body image!!!!!!!!!)
Stomatitis, hair loss
Pulmonary effects
Pulmonary fibrosis & pneumonitis
Reproductive effects
Cardiac effects
Arrhythmias, CHF, Cardiac toxicity

Front 21

Bone marrow suppression

Back 21

Myelosuppression: Most common side effect of chemotherapy
Treatment-induced reductions in RBCs, Platelets, and WBCs can result in
Infection
Hemorrhage
Overwhelming fatigue
See Neutropenic Diet handout

Front 22

Fatigue

Back 22

Identifying when patient is feeling better may allow more activity
Rest before activity and after activity
Get assistance with activity
Maintain nutritional and hydration status
May continue after treatments

Front 23

Gastrointestinal (GI) effects

Back 23

Prophylactic administration of antiemetics
What mode of medication administration is the best????????
Assess for signs and symptoms of
Alkalosis, dehydration, electrolyte imbalances, and I&O
Nonirritating, low-fiber, high-calorie, high-protein diet (what labs should we look at here and why?)
Antidiarrheal, antimotility, and antispasmodic medications
Anorexia
Monitor carefully to avoid weight loss
Weigh twice weekly
Small, frequent, high-protein, high-calorie meals
Encourage nutritional supplements

Front 24

Skin reactions

Back 24

Dry intact skin should be lubricated with nonirritating lotion or solution that contains no metal, alcohol, perfume, or additives
Wet reaction must be kept clean and protected from further damage
Prevent infection
Facilitate wound healing
Protect irritated skin
Avoid temperature extremes
Avoid constricting garments, harsh chemicals, and deodorants
Protect skin from sun exposure
Help patients deal with hair loss

Front 25

Oral, oropharynx, and esophageal reactions

Back 25

Teach patients to examine oral cavity and maintain oral care routine
Dental work should be performed before initiation of radiation or Chemo
Pain relief is key!!!!!!!!
Saliva substitutes or drink water frequently
Soft, nonirritating, high-protein, high-calorie foods
Avoid extreme temperatures, alcohol, and tobacco

Front 26

Pulmonary effects

Back 26

May be progressive and irreversible (i.e. pulmonary fibrosis)
Treatment
Bronchodilators
Expectorants/cough suppressants
Bed rest
Oxygen

Front 27

Cardiovascular effects

Back 27

Patients with preexisting coronary artery disease are more vulnerable
Radiation-induced heart disease is more likely in patients given high doses of radiation and doxorubicin
Herceptin is cardiotoxic

Front 28

Reproductive effects

Back 28

Inform patient on expected sexual side effects
Use appropriate shielding
Encourage discussions of issues related to sexuality
Refer to counseling if needed
At risk for secondary cancers

Front 29

Coping

Back 29

Assist in planning
Transportation, nutrition, emotional support
Teach symptom management to maintain quality of life
Offer community resources

Front 30

Oncologic Emergencies

Back 30

Life-threatening
Occur due to disease or treatment
Emergencies can be
Obstructive
Metabolic
Infiltrative

Front 31

Obstructive emergencies:
Superior vena cava syndrome

Back 31

Obstruction of vena cava by tumor or thrombosis

Front 32

obstructive emergencies:
Spinal cord compression

Back 32

Tumor in epidural space of spinal cord; signs include:

Third space syndrome
signs of hypovolemia

Front 33

third space syndrome

Back 33

Shifting of fluid from vascular space to interstitial space

Front 34

hypovolemia

Back 34

including hypotension, tachycardia, low central venous pressure, and ↓ urine output

Front 35

Metabolic emergencies caused by production of ectopic hormones

Back 35

Syndrome of inappropriate antidiuretic hormone (ADH) secretion
Hypercalcemia
Tumor lysis syndrome
Septic shock
Disseminated intravascular coagulation (DIC)

Front 36

Infiltrative emergencies

Back 36

Cardiac tamponade
Carotid artery rupture

Front 37

Cardiac Tamponade

Back 37

Fluid accumulation in pericardial sac, constriction of pericardium by tumor, or pericarditis

Front 38

Carotid Artery Rupture

Back 38

Invasion of artery wall (seen in head and neck cancers)

Front 39

Management of Cancer Pain

Back 39

Patient report should always be believed and accepted as primary source for pain assessment data
Drug therapy should be used to control pain
Fear of addiction is unwarranted
Nonpharmacologic interventions including relaxation therapy and imagery can be effectively used

Front 40

CancerPsychologic Support

Back 40

Emphasis placed on maintaining optimal quality of life
Support patient and family
Common fears
Disfigurement, emaciation
Dependency
Disruption of relationships
Pain
Financial depletion
Abandonment
Death

Front 41

CancerGerontologic Considerations

Back 41

Clinical manifestations may be mistaken for age-related changes
More vulnerable to complications of cancer and cancer therapy
Functional status should be considered when selecting a treatment plan
Survival rates have steadily increased over last 30 years
Goal is to maintain an optimal quality of life

Front 42

When planning a community education program related to prevention of the cancer with the highest death rates in both women and men, the nurse will stress the importance of

Back 42

1. screening with colonoscopy.
2. smoking cessation.
3. use of sunscreen and protection from ultraviolet light.
4. regular examination of reproductive organs.

Front 43

To help prevent the debilitating cycle of fatigue-depression-fatigue that can occur in patients with cancer, an appropriate nursing intervention is to

Back 43

1. prevent the development of depression by informing the patient to expect fatigue during cancer treatment.
2. teach the patient to ignore the fatigue in order to maintain normal daily activities.
3. have the patient rest after any major energy expenditure.
4. encourage the patient to implement a daily walking program.

Front 44

. After 3 weeks of radiation therapy, a patient has lost 10 pounds and does not eat well because of mucositis. An appropriate nursing diagnosis for the patient is

Back 44

1. risk for infection related to poor nutrition.
2. ineffective therapeutic regimen management related to refusal to eat.
3. imbalanced nutrition: less than body requirements related to oral inflammation and ulceration.
4. ineffective health maintenance related to lack of knowledge of nutritional requirements during radiation therapy.

Front 45

A client undergoing radiation therapy has a severely depressed white blood cell count. A priority nursing intervention would include which of the following?

Back 45

1. Place client in a private room and maintain strict aseptic technique with all procedures
2. Encourage client to include fresh fruits and vegetables in the diet
3. educate client to avoid shaving with a razor
4. encourage frequent visitors to reduce client’s feelings of isolation